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Home My WebLink About02-0715COMMONWEALTH OF PENNSYLVANIA DEPARTMENT DF REVENUE INFORMATION N OT I C E BUREAU OF INDIVIDUAL TAXES FILE N0. 21 -~~ ` 7~t~ DEPT. 280601 AND ACN 02132306 HARRISBURG, PA 17129-0601 TAX PAYER R E S P O N S E DATE 07-12-2002 REY-1545 E% ~FP (09-RO) TYPE OF ACCOUNT EST. OF H R GROVE ^ snviNGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST -~ COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 17324. CARLISLE, PA 17013 PNC 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 Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001037034 Date 04-1 Established 2-1994 To insure proper credit to your account, two (2) copies of this notice must accompany your Account Balance 5, 042 .87 Payment to the Register of Wills. Make check payable to: ''Register of Wills, Agent••. Percent Taxable X S .333 Amount Subject to Tax 420 .22 NOTE: If tax payments are made within three (3) months of the decedent's date of death Tax Rate x .045 , You may deduct a 5% discount of the tax due. Potential Tax Due 1 8 .9 1 Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE :~~.err::~e3~~::~w~...~~e~~~....~~~..~._ ~.~~~~ ~:..~.~.............~~.:w.y~~..~ .. :_:,. -~:__:;~~_::.~_~:::~:1::~u~.;:.:..:.....~.~::::::::::::- :::::: .:::........: A. ^ 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 CHECK a discount or avoid interest, or ycu may check box '•A^ and return this notice to the Register of 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK 0 N LY g, ^ 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. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART If you indicate a different tax rate lease stet P e Your ~;;=€€~i:€t;€;:i€~~;::::::-:::::~~-++.::-::.:::::°~ ::::::::::::::::-::~::::-:::::::::,::::::::::<.:.:.:::: :;:;~:~: a:::~::s~::::::::::::~~ ~~s s .. °:~;i ~ ~~ i€.°°°:°:°:°:''° ~ ' ~ relationshi P to decedent: :.:.:.:::::::::::::::~::::::::::::,::::::: :. s t V . ..~;::: ~ ~:::3 ;i;€ i€[€[ ~i;;~~ss sst:ss:as~ ~ aFtts::~;:;~ ::::::::::::.::...................................... .... TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions b. Amount Taxable 7. Tax Rate 8. Tax Due PART DATE PAID PAYEE DESCRIPTION eMnnur Pern Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete t the best of ny knowledge and belief. HOME C ~'~~ ) 7 f 8 ~~~~~~ T PAYER IGNA l1RE WORKco (^,)p ~~ )...,.-^~z .. ~/~ ~ ~ 7- _ ~ Do2 GENERAL iNFOKMAIlON FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based an information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife mare than one year prior to death are not taxable. Accounts held by a decedent "in trust for^ another ar others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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. 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. BLOCK C - If the notice information is incorrect and/or 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 (Farm REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: Far 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 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (~*) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 8Y 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 8Y 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 DIVIDED 8Y TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate Cline 7) as determined below. ^The tax rate lnposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or far 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 ar not they have been adapted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether ar not they have been adopted by others, adapted 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. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% b% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% 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 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES I N F ORMATI O N N O T I C E FILE NO 21 -~~- 7~~ AND . DEPT. 28D601 HARRISBURG, PA 17128-D6D1 TAXPAYER R E S P O N S E ACN 02132291 DATE 07-12-2002 REV-1543 EM AFP (09-00) TYPE OF ACCOUNT EST. OF H R GROVE ^ saviNGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST COUNTY CUMBERLAND X^ CERTIF. `s; i - , REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 1734 CARLISLE, PA 17013 PNC 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 Pennsylvania. Questions say be answered by calling (717) 787-8327.. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 210001037027 Date 03-24-1994 To insure proper credit to your account, two Established (2) copies of this notice must accompany your Account Balance 5, 055 .70 Payment to the Register of Wills. Make check payable to: ^Register of Wills, Agent^. Percent Taxable X 8.333 4 2 1 .2 9 NOTE: If tax payments are made within three Amount Subject to Tax (37 months of the decedent's date of death, Tax Rate X .045 You may deduct a 5% discount of the tax due. 1 8.9 6 Any inheritance tax due will became delinquent Potential Tax Due nine (97 months after the date of death. PART TAXPAYER RESPONSE ..."I`~kIF....~.~Sii: ::::: A. ^ The above information and tax due is correct. 1. You nay choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or ycu may check box "A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK ~ g, ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PA RT If you indicate a different tax ::.:......:::-:::::.:.:.,. rate, please state Your :::::::::::.:::::::::~~:::::::::: relationshsP to decedent: ::.::::.:::.::::::::~:::::::~::~:: ,.,...,.;.;.,.:::::::::::;-::::~::~~:::::;::::::::::;:;::-:::.::::::::-::::::::::-....::::::::::::::::::: ::......; ...:::... ;; :::::::: ..:,, :.::: • _:::::::::::::::::: - : .., ~::::::~::::::::~::~::~::~::~:::;:;:;:~::;:;:;:::::::::::::::::::::::::::~::~::;::::: TAX RETURN - COMPUTATION OF i€€~ :~ : t:=.:.i~ iii~i=€i=s`•€;t'i; TAX ON JOINT~TRUST ACCOUNTS ,;:: ~ :::::::::.::::::::: .#~A~i::: ~ ~ ....... ii€~ i~ ~i':i€s~ ~ €'s;€~ i€iiisii~~ i`:•'i':iis~ ~ ~i~s~ i i?~ `:''iti ~~~;iii;~ €~ i€is~ iii: ::::::::::::::::~:::~::::::::::::::::::::::::::::::~:::::::::::::::::::::::::::::::::~:::~::~;:::;~;~:::;::::: ......................................................................... TINE 1. - D ate Es table shetl 1 ~€ €; nt Balance 2 ::~ ; 3 . Perce nt Taxable 3 € is;isi';;;':?iiii ~~~ ~ ~ X • ~ i~ ~ _ ':iii ~=iiEiEi':s€€ii;€~ €~ ~ siiiiiis~ isiiiiii= .::::::::::::::::~ €:~ ;:;:;:~ €:~ ;:;:; • • ~ ••••~~~~~ 4. Anoun t Sub ' ect to T ax 4 J z':iii~ ii€=` ~ iiE~ `':"~iiE~ '!~~~ ii ~':':~ a~ iii=ii= ~~ ~!~ ~ ~ ~`?i'~iii~~ ~~~~:` 5. Debts and Deductions 5 - :~, : . . ,,, ... ,., ,., ,. 6. Ano unt T axable , : :: _::: :~ : ::::::::: ,:,:;;::. ~:::::€si~i ` ```: :::::::::::::::::::::::::::::::::~~::::::::::::::::::::::::::::::::::~:::::::::::::::::::::::::::::::::::::::::::::::::: ~ si€ i ':i€si€~ €==i;i`i€i?i~_;i :~ €:~ €:~ €:::~:s:::::: ;;:: ~::::;s::::s::~ ::::s::s:;:::<s: 7. Tax Rate 7 .... ...:::.:.:.:.:.:.:::.:.:.: X .:.:.:::.:::.:::.:.:.:.:.:::.:.:.:.:.:.:.:.::.:.:.:.:.:.:::::::::::::~;:;:;:::;:;:~€:~;:€:~€:~::s:::::: ~:::.::::.~:. ...: .. .. x Due 8 ~~ :::~::::;;:~>:~>:::: ~:~:;~:::•:~:~: PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE P AID PAYEE DESCRIPTION AMOl1NT PnTn Under penalties of perjury, I declare that the facts I have reporct~ed above are true, correct and coeplete t the best of my knowledge and belief. HOME C gd~ ) ~~g-~j~`~'y~f WORK ( p ) ,. bf 2 TA AYER SIGN URE TELEPHON NUMBER GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife more than one year prior to death are not taxable. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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 than 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 EXl upon receipt of the return from the Register of Wills. 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. BLOCK C - If the notice information is incorrect and/or deductions era 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 the date the account originally was established or titled in the manner existing at date of death. NDTE: 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 53,OD0 per transferee regardless of the value of the account ar the number of accounts held. If a double asterisk (*~) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued tc the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established mare 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 (JDINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR) B. The percent taxable far 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 X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death b~ the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax Cline 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. ^The tax rate imposed an the net value of transfers from a deceased child twenty-one years of age ar 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. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% A. You legally are responsible for payment, or the estate subject tc 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 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE ~ ~ BUREAU OF INDIVIDUAL TAXES FILE NO. 21--~~- 7 DEPT. 280601 AND ACN 02132294 HARRISBURG, PA 171ze-obol TAX PAYER R E S P O N S E DATE 07-12-2002 REV-1543 E% ~FV (V9-007 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST t' = - •`~ COUNTY CUMBERLAND XQ CERTIF. REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WILLS 203 FR05T RD CUMBERLAND CO COURT HOUSE GARDNERS PA 173'24 CARLISLE, PA 17013 PNC 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 Pennsylvania. Questions nay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ * ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001036938 Date 11-10-1989 To insure proper credit to your account, two Established C2) copies of this notice must accompany your Account Balance 28 Payment to the Register of Wills. Make check 5 044 , . payable to: ^Register of Wills, Agent^. Percent Taxable X 8.333 Amount Subject to 3 4 NOTE: If tax payments era made within three TeX 4 2 0 . [3) months of the decedent's date of death, Tax Rate x .045 you may deduct a 5% discount of the tax due. Potential Tax Due 9 2 Any inheritance tax due will became delinquent 1 8 . nine (9) months after the date of death. PART TAXPAYER RESPONSE ........................:::::::::::::...... ...................................................................... .....4~::~'~~.....:~'.~~~...... A. ^ 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 CHECK a discount or avoid interest, or you may check box ^A^ and return this notice to the Register of C 0 N E ~ Wills and an official assessment will 6e issued by the PA Oeparteent of Revenue. B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed 6y the decedent's representative. C. ^ The above information is incorrect and/or dehts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART Y ndicate a different tax rate, please state your ~~~~=-~~~~~~- ~=~°~~ li ~;iiiii€s~ ~ ~~i~S ~~ i€iii t ~ i~l"T€ , _:;: ;: €'i':( :.: ~-€~ ~ i€: `:i€s";`.€~ ~ i?i €i€::;~ : . 2 rela ionship to decedent: ;;~€~~~~€°?:-:::;;;; ~:::::-:_::_,:::::~:-::::::-::::::-::::::::-:::::::::-::::- ::::::::::::::.::.:~::~::::::~:::: €=1?'~ .. ~`#~12 ~ . pis ~ ::~...::... . AX RETURN COMPUTATI ON OF TAX ::: ::::::::::: ~:~:::::: ON JOINT~TRUST ACCOUNTS ~:`7~1~::~::~ :........ :;::_~:,=:::::::::~::~::::::~::~::::::~;:;:;:;:;:::;:;:,:::::::::-:::::::::::::,:::::~::::::::::::::::::: ..:......:................:.::::::.::.:....:.:.:.:::.::::-::.:.:.:.,.;.:.:.,.,.,:-::: t.INE 1 Date Establishe d Z ' ' 2. Acc ount Balance 2 ::~::~:; :si::~::<:::__::::;i'.i€i`i ........:.........: . ......:.:.::-:.:. ~ ::~ :::::.::...:................. ::::::s:::::::: :::: : : i:i:i:€:€~:~:~: =__`:i nisi€:':~:_:'ii;iiii€i':i€i€i':i~si':ii!iiiici€i€~~=€ iii issii°':i€'iiiii :.:.,.;.,.,.,.,.,.,.,...,.,.;.,.:.::-:.....,.,.,.,.,.;.,.::::::-:::::::::::::::::::::::::::::::::::: ...... ....................:.........:.....:.:.:.:...:::::::::, :::::::::::~ :::,:,:::,:,:::::; ;:~,::.::,.,.: 3 . Percen t Taxable 3 X : ~ : ::::::: ~:: ii~~ iii;: ~~;;~ ~ i ~ ~':i':i': ~:~::~ :::::::~:~ :....... ~::::::::::-:::::: ~:::::::::::::::::::::~ ::::::::: ~:::~ : ~:: ~:::::::::::: ~:::::::::::::::::::::~ ...,.,.,.:.:.:.:.: ~ii[f€€;~~~ €'__"i~i~si€s ~ ~~i°;;€€€ ~ ~ ~ ~':si?i?isi~ii ~€s;;;~ ;; .....::::::::::.::.:.:::::::::-:.:.,.:.,.;.,.,.,.,.,.,...:.,.,.,.,.:.,.;.;.,.,.:.:.:.:_::_:::,_: 4. unt Su . Aeo b ect to Tax 7 4 5. De bts and Deducti ons 5 6. Ano unt Taxable 6 .......... ~ ~~ °•°°~~~~~~~~•• 7. Tax Rate 7 X :~::~::::::::::::- :::::::::::::::::::: .::.,. ::::::~::::::::::::::::::::::::::::::::::::::::::::::~:::::::::::::::::::::::~::::::::::::::::::::~:::::::::::::::::::::~: 8. Tax Due 8 ::-::::-::::::::::- :::::::: ::::::::~ :::::::::::~ : ~ ::::::::::::::: ::::::::::::::.:.:.:::..::.:.::::.:::::::::::::::::.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:...:.:.:.:.:.:: ::::: ~:::::::::::::::::::::::::::::::::::::::~ ::~ ::~ ::~ ::~ ::~ ::ss::::::::::::::::;:_ ;;::;:~s::s::~ ::~ ::~ : PART DEBTS AND DEDUCTIONS CLAIMED _ ::::s: s 0 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, rc/oGrrect and co3nplete to the best of ny knowledge and belief. HOME C ~Q~ ) 795f''~~,~7'! X AYER SIGN TORE WTELEPHONE~NUMBE~~ ~~/~ nn F x GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior tc death are fully taxable as transfers. Accounts established jointly between husband and wife mare than one year prior to death are net taxable. Accounts held by a decedent ^in trust for^ another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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. BLOCK 8 - 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 tc the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/ar 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 (Farm REV-1548 EXl upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: Far 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 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (*~) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable far each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior tc the decedent's death: 1 DIVIDED BY TDTAL 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 awned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL HUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax Cline 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 67 is determined by subtracting the debts and deductions (line 57 from the amount subject to tax (line 4l. Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. 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 ^Callateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible far 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 11^. Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE I N F ORMATI O N N O T I C E DEPTAU280601DIVIDUAL TAXES AND FILE N0. 21 '~~ - 7 HARRISBURG, PA 171zs-o6o1 TAXPAYER RESPONSE ACN 02132297 DATE 07-12-2002 REV-1543 E% AFV (09-007 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST ~" ~ ~ - ` t~ COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: H R GROVE III REGISTER OF WILLS 203 FROST RD r- CUMBERLAND CO COURT HOUSE GARDNERS PA `1 324 CARLISLE, PA 17013 PNC 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 farm and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. 9uestions may be answered by calling (717) 787-$327.. COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31000212813 Date 01-16-1996 To insure proper credit to ycur account, twc Established C2) copies of this notice must accompany your ACCOUnt Balance 5, 014.04 Payment to the Register of Wills. Make check payable to: ^Register of Wills, Agent". Percent Taxable X 8.333 NOTE: If tax payments are made within three Amount Subject to Tex 417.82 [3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 5% discount of the tax due. 1 8.8 O Any inheritance tax due will become delinquent Potential Tax Due nine (9) months after the date of death. PART TAXPAYER RESPONSE A. ^ 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 CHECK a discount or avoid interest, or you may check box ^A^ and return this notice to the Register of O N Wills and an official assessment will be issued by the PA Department of Revenue. [ B L 0 CK ~ B. ^ The above asset has been or will be re orted and tax p paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid 6y You. You must complete PART 2^ and/or PART 3^ below. PART If you indicate a different tax rate, please state your a relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS `~~'~!; .....................:..... LINE 1. Date Established 1 ........................... 2. Account Balance 2 ~'•: 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 j~s!j 5. Debts and Deductions 5 - 6. Amount Taxable 6 ~'s 7. Tax Rate 7 X 8. Tax Due 8 ~~ ~~ f .:.:.:.:::.:::::::::::::::: PART DEBTS AND DEDUCTIONS CLAIMED 0 Under penalties of perjury, I declare that the facts I have reported above are true, correct and c replete to the best of ny knowledge and belief. HOME ( 0 ) WORK ( b ) 7 L TAXPAYER SIG ATURE TELEPHONE Nl1MRFR ~ e ~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID VtNtKAL 1NtUKMAIlUN FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife mare than one year prior to death are not taxable. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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 then 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 (Porn REV-1548 EX) upon receipt of the return from the Register of Wills. 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. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit then 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 (Porn REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE L. Enter the date the account originally was established or titled in the Wanner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint naves within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (*x) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established mare than one year prior to the decedent's death: 1 DIVIDED BV 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 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decadent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance Cline 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7l as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^The tax rate imposed on the mat 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 descendants. ^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 adapted by others, adopted descendents and their descendants and step-descendants. "Sibling s^ era 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. 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 11^. Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA BUREAUMOFTINOIVIOUALETAXES INFORMA AND NOTICE FILE NO. 21-~~` 7~br DEPT. 280601 ACN 02132300 HARRISSl1RG, Pa 171za-obol TAX PAYER R E S PON S E DATE 07-12-2002 REV-1543 E% ~FP (09-09) TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST ~''~~ - - COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 1324 CARLISLE, PA 17013 PNC 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 farm and return it to the ahove address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 318000084260 Date 04-22-1997 To insure proper credit to your account, two Established (2) copies of this notice must accompany your Account Balance 5, 057.14 payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 8.333 Amount Subject to Tax 421 .41 NOTE: If tax payments are made within three (3) months of the decedent's date of death, Tax Rate x . 045 you may deduct a 5% discount of the tax due. 1 8.9 6 Any inheritance tax due will become delinquent Potential Tax DUe nine (9) months after the date of death. PART TAXPAYER RESPONSE .... A. ^ The above information and tax due is correct. 1. You nay choose to remit payment to the Register of Wi11s with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A° and return this notice to tha Register of Wills and an official assessment will be issued 6y the PA Department of Revenue. ONE ~ B L 0 CK g. ^ The ahove asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y tc be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your relationship to decedent: TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ........................... LINE 1. Date Established 1 ........................... 2. Account Balance 2 3. Percent Taxable 3 X ''? 4. Amount Subject to Tax 4 `Ss 5. Debts and Deductions 5 - 6. Amount Taxable 6 7. Tax Rate 7 X ~~ s~sEl~' 8. Tax Due 8 ~~ is~i[ PART .:.:.:.::.:.:.:.:.:.:.:: : DEBTS AND DEDUCTIONS CLAIMED Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete t the best of ny knowledge and belief. HOME C~yl,~ ) ?~/~ --Cl~r~y WORK ( ) - T PAYER S GNA RE TELEPHONE NUM ER n DATE PAID PAYEE DESCRIPTION AMOUNT PAID GtNEKAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based an information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife more than one year prior to death are not taxable. Accounts held by a decedent "in trust for^ another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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. 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" secticn. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Oept 280601, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check black "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 the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within ono (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (x*l appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted fron the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 BV 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 far another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amcunt subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable Cline 37. Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, ar 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 ar adoption. The "Collateral^ class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible far 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 11^. Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INFORMATION NOTICE FILE NO. 21-0~- ,'/~ AND DEPT. 280661 T P Y ACN 02132303 HARRISBURG, PA 171z6-ob61 AX A ER R E S PO N S E DATE 07-12-2002 REV-1545 E% ~FP (09-00) TYPE OF ACCOUNT EST. OF H R GROVE ^ sAViNGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ reusr 'I_i,_ , _ .. - ,; _' COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 1732.4 CARLISLE, PA 17013 PNC 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 Pennsylvania. Questions may be answered by calling (7171 787-8327. COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31400084640 Date 04-22-1997 To insure proper credit to your account, twc Established (2l copies of this notice must accompany your Account Balance 5, 047.14 Payment to the Register of Wills. Make check payable to: "Register of Wills, Agent^. Percent Taxable x 8.333 NOTE: If tax payments are made within three Amount Subject to Tax 420.58 (3) months of the decedent's date of death, TaX Rate X .045 You may deduct a 5% discount of the tax due. 1 8.9 3 Any inheritance tax due will become delinquent Potential Tax Due nine (97 months after the date of death. PART TAXPAYER RESPONSE A. ^ 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 CHECK a discount or avoid interest, or you may check hox "A^ and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C ONE B L 0 CK B. ^ Tha above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART If ou . n Y nt tax rate, please state your ~ ~:-,:-,, .......................... ~':~ ............................................. ~~~ :: _; :.: ":i~i`:i ~ ~:; .;ii€"s ~i[i iii':€~ i€_ ~~ ~ .sii 2 relationship to decedent: ~s:::~~:::~~:;::_:::::::-::~ :::::~::_:::;-:;-,,,,, :::..::::.:.::::::::~::;:_:::€::~:::::::~:::::;::-:.::; ;,::;:~:;:;: ........................... TAX RETUR - N COMPUTATION OF TAX ON JOINT~TRUST ACCOUNTS ~=;;~~'~'':~''s~ ~`A~;- :.:...:.:.. =~~'''~i~~~~~~s~~~~~i~~~~€'s~is~i~i=€~'€ .:.:.:.:.:...:.........:...:.....:.::::::::-::_:.::.:.,.:.,.,.,.:.:.:.:.:.:...,:-,.,.,.,.:.:.,.:_::_:::::::-:.: LINE 1. Date Established 1 °` 2. Account Balance 2 :::::::::::::::>.::::::::::::::::::::::::....::,::::::::::::::::::::...:::: :::~::~:::~::~:::~ :::;:~:::~::~::~::~::~ •::st:s:~:;::::~::~::~:::::.::::::~ ::~::~::: 3. Percent T x a able 3 X : ~.:~;::~ ::::::::: ~::;:.,::::::~:: •:::::::~ :::::: ::.::::::::~::~:::~;::•:•::::;::~:::~::~::~::•:r::;:,:;:.:.::~::~::~::~;~:r:•:;:;:.:•::•::~: ::::::::-::::::::::::::::::::::~:::::::~::~:::.,.,:.:::::::::::.::::::::::::::::::: 4. Amount Sub 'ec t to Tax J 4 5. D ebts and Dedu ctions 5 - :~ 6. Amount Taxab le 6 ~?~ ~ €~ € ~ [Piss ~ a ~ ~~€~€~~€~~ €~€~€~_ €~€~~€ ~~€€~€~ €€ ~ ~~€~~€€ 7. Tax Rate 7 X :::::::~::~::~>:~::::;::::::~::::::::::•:::::,::.:::~::~::~::~>: ::::::.::.:::::::::.:::. .:..::....:::::::::: ~: ::::::.::::.:. 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of ny knowledge and belief. HOME C ~~{ ) 7/ ~~ ~,S'~Jr WORK (~ ) ~- --h ~4 AX AYER SIGN TORE TELEPHON NUMBER '~ GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife more than one year prior to death are not taxable. Accounts held by a decedent "in trust for^ another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in black "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. 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. BLOCK C - If the notice informaticn is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z 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 the date the account originally was established ar titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1l year of death are taxable fully as transfers. However, there is an exclusion not to exceed S3,OD0 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (**) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable far 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 BV TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT 7AXABLE 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 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 1D0 = SD% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined 6y multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable Cline 6) is determined by subtracting the debts and deductions (line 5l from the amount subject to tax (line 4). Enter the appropriate tax rate [line 7l as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is D%. 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, adapted 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. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. Yau legally are responsible for payment, ar 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 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21-~~ 7~~ BUREAU OF INDIVIDUAL TAXES A N D DEPT. 280601 HARRISBURG, PA 171zs-obol TAX PAYER R E S PO N S E ACN 02132279 DATE 07-12-2002 REV-1545 EX ~FP (09-007 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST _~;-:; _ - ,-. ~~,COUNTY CUMBERLAND Q CERTIF. REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 173~+~ _ CARLISLE, PA 17013 +. PNC 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 Pennsylvania. questions may be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * * ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001036937 Date 11-10-1989 Ta insure proper credit to your account, two Established [2) copies of this notice must accompany your Account Balance 28 Payment to the Register of Wills. Make check 5 044 " , . payable to: Register of Wills, Agent". Percent Taxable X 8.333 Amount Subject to 34 NOTE: If tax payments era made within three Tax 420 . (3l months of the decedent's date of death, Tax Rate X . 045 You may deduct a 5% discount of the tax due. Potential Tax DUe Any inheritance tax due will become delinquent 18 92 . nine (9l months after the date of death. PART TAXPAYER RESPONSE A. ^ The above information and tax due is correct. 1. You nay choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box ^A^ and return this notice to the Register of C 0 N E ~ Wills and an official assessment will 6e issued by the PA Department of Revenue. B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to 6e filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by ycu. You must complete PART 2^ and/or PART 3^ below. PART If ou ind " c y i ate a different tax rate, please state your = = 'i~ fig ~i~i`€?s;~s;si!i€ ~s~ i ~ :::::~ : ~ :~ ::::::::::::::::::::::::~ :::::::::-:::::::::::::,::::::::::::::::::.....::::::::::::::-:::: ~: ; :::;: ;: ~ ;i;€;€; ; .: ~~:~ iii : ? 2 ^ relatsonshi t P o deceden t . :::::::::::::::::::::::::::::::::::::::::: i?iis:: ~::::;si ~ ~ ~ i~ iii i~' _ :::::::::::::::.:::.::.:.:.:.:.:.:.:.:.:.:.:.::::::~::::::::::::::::::::-::::::::~:::,~:.....:.,. €::::::::::::-::::-::::- :::::::::::::-::-:::~ : ,~::,.,:,.,.:::-:.,.::::;- :ss::::s::::s: : €€~ €;;;~ ~ s`~s's ;i~~~ss~~iiii~~ii~ i~~ ~ iisiii iE TAX RET - URN COMPUT ATION OF ~ TAX ON JOINT T RUST ACCOUNTS LINE 1. Date Estab " lsshed 1 ~': ~`=ii as [ ~r ~~ ?!€>°~~ ~ ~ ~~ ~ ~? ~s€=~€[z'~~ ~ ~ ~ ~; ~ ~ ~~ ~€ 2. Account Ba a 1 nce 2 €:~:;;;:;:;:;:~;:-:::::_;;:°;::~~ ••••••~~~ ~:~::::::::::::~::~::~;::°=:~::::;::::s:~~::::::::~::::~::~::::~:::;:~:::;:::;:::_::~:€:~;:_€~::: 3. Percent T axable 3 X ::::::::.:::::::::::::::::::::: ~:::: ::::::::::::::..::::::-::::::::: :::::::::::::::::~::::~ s:::::::::::::::::::::::::~ s:~ ::::::::::::::::~::~ :::::~ ::::::~ ::~::_ ::::::::: :::~:::::::::::::::-:::::::::::::::::::::::::::::-::-:::::~::::::~:::::::::::::::::.,.,.,.,.,.,.,.,.,.,.,.,.,.:.;., 4. Ano unt Sub "act to Tax 7 4 5. Debts and Deductio ns 5 6. Amount Taxable 6 ~[; : 7. e Tax Rat , ::::~;:~:~;:~::;:: :::..::~::~::~::~ : ::::->:::~::~::::~:.:::::::~::~::~::~::~:::::::~:•~>:~::~::::::~::::~:::•>;:>::~:;~;:.: :::::::::::::;:~::~::~::~: s::: ~::::~ ::::~::~:::~::::::~:::::;•::~::~::~:::::::s:::::z::::::::::: 8. Tax Due 8 ~iiii' €=i ~ ~ isisi~i=`'€~€'i€'i€€s€ ;s€'€ ~~'€`€€ s ~ ~ ~€ <' ~'~~i'ii ~€€ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are truge,,c/orrect and c plate to the best of my knowledge and belief. HOME ~~~~ ) ?9~- !s~^~ WORK C ) _L _ TA PAYER SIGNA U E TELEPHONE NUMB 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 hetween 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 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 (Farm REV-1548 EX) upon receipt of the return from the Register of Wills. 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. BLOCK C - If the notice information is incorrect and/or 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 EXl upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 53,OD0 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (*x) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account halance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 = 16.7% (TAXABLE FOR EACH SURVIVOR) 8. 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) Ctrust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 160 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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) The amount subject tc tax Cline 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6l is determined by subtracting the debts and deductions (line 5) from the amount subject to tax Cline 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. 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 ar 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. 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 tc 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 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH DF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU DF INDIVIDUAL TAXES INFORMATION NOTICE FILE N0. 21 O - ~' "T ~ ~ AND ~ DEPT. 280601 HARRISBURG, PA 171z6-abol TAX PAYER R E S PO N S E ACN 02132304 DATE 07-12-2002 REV-1545 E% AFP (09-007 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST -~, , COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 17324,; CARLISLE, PA 17013 PNC 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 fore and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS account No. 31400084640 Date 04-22-1997 To insure proper credit to your account, two Established (2) copies of this notice must accompany your Account Balance 5, 047 .14 Payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 8.333 Amount Subject to Tax 420.58 NDTE: If tax payments are made within three C3) months of the decedent's date of death, Tax Rate X . 045 You may deduct a 5% discount of the tax due. Any inheritance tax duo will become delinquent Potential Tax Due 18.93 nine (9) months after the date of death. PART TAXPAYER RESPONSE °° .................................................................................................................... 3~..0~..~1'N~.fik....~1`~....... A. ^ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wilts with two copies of this notice to obtain CHECK 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. C ONE B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If ou indicate a PART y dsfferent tax rate, please state your :::::~ ::::::::::::::: ::::::::::::::::::::::: ::::::::::::::::::::::::::-:.:.:::::::::::::::::::::::::::::::::::::::::::::::::-::::::::::-,::.,........:: :::::::::: relatsonshs P to deceden t ::::::::::::::::::::::: :::::::~ :::::::::::::: :::::::.:::~:::::::::::::::::::::::::_-,..,:...........:...............:.........................................:. ::::::.-:............ .................. .. ..... TAX RETURN - COMPUTATION LINE 1. Date Estab"lisped 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and conpl to the be of ny knowledge and belief. HOME ('7l'~ ) ~-j 3' E, ~ ~~ AX AYER IGNATURE WTELEPHONE NUMBER `DATE a~,~ 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 tc 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 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. 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, Oept 280601, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1l year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of the account ar the number of accounts held. If a double asterisk (a*) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the acccunt balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 = 16.7% (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death ar accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 47 is determined by multiplying the account balance Cline 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable Cline 6l is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^The tax rate lmposetl 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. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally era 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 11^. Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE NO. 21 ~;,1 ~ ~J DEPT. 28D601 ACN 02132307 HARRISBURG, PA 1712s-obol TAX PAYER R E S P O N S E DATE 07-12-2002 REV-1545 E% ~FP c09-RR~ TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST COUNTY CUMBERLAND X^ CERTIF. ;i__ . ~ REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 1724 CARLISLE, PA 17013 PNC 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 Pennsylvania. questions may be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001037034 Date 04-12-1994 To insure proper credit to your account, two Established (27 copies of this notice must accompany your Account Balance 5, 042.87 Payment to the Register of Wills. Make check payable to: ^Register of Nills, Agent^. Percent Taxable x 8.333 Amount Subject to Tax 420.22 NDTE: If tax payments are made within three (3) months of the decedent's date of death, Tax Rate X .045 you nay deduct a 5% discount of the tax due. 1 8.9 1 Any inheritance tax due will become delinquent Potential Tax DUe nine [9) months after the date of death. PART TAXPAYER RESPONSE 1 :::::_ :::-::- :::::::::::::::-:_:::::::_::~ ::::::::-:::::-::-::::::::-::::-:::~ ~ :::::_::::::-::::::::-::::-:::-::::.::_:_::_::::::_:::::....................................................................................................................................................... ... ~..~~€i~~iii~~~`i~'1~~~!1: ;.. ;: , .. '€ ° ~ ~~: ~ ~°~:. ...... ; :sus ~ :::: :~:; : :: :~:: : , :::: ::::: A. ^ The above information and tax due is correct. ' 1. Vou may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box ^A^ and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. [ B L 0 CK ~ B Th b t h b i . ^ e a ove asse as een or w ll be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART If ou Indic :::::::::::- ::::.:::::::: Y ate a different tax rate, please state your ~_~_~~=~~~~°~~~°_~_° :::::-::::::::::::-::::::~:::;~:::;::::::::-:::-:-::: ~:~:::::::::::::::.....:::,::::::::-:::: ° ..:;~;• :::~ :::::::::.::::::::::::: 2 elationshiP to decedent. :::::::::::::::::::::::::::::......~: ::-......::,::,::.::::;.:.:::::.,.,.:::::_:::::=~: : : :: :,:~:: :: ::::-~::: : : : _ [~' i's':ii~ii~= # ~ ~ ! # ~ :: ::::: ~: ~: : i€i~~~~iEi~~iE~il!FG1m.; ..:i€;€t€€; TAX R - ETURN COMPUTATION OF ::::::~ ::::;:a:~ ::::::::::::~ : €~€:....:...- ~~;_~ TAX ON JOINT/TRUST ACCOUNTS :;,;J~#~~::;;;~ __ _ :::~ ~ ::::::::::: ::::::::::::: ~:::::::::::::::::::::::::::::: ~ ~:::::::::::::::::::::::::~ :::::~ ::~ :: ~~ i~~°~~€;~~~~~~~€~~€,~_;_~;~€~;; :::::::::::.::::.:.:.:.:.:.:::::::.:.::.::.:.:.:.:.::::::::: LINE 1. Date Esta blished 1 2. Account Ba lance 2 €i€i€s ~i~ iiiiii~ ~ ~ iz':s': ::~::~~::~::~:.• ::~::~:: ~:; ;:;:;:;:~ ::.:::::: ... ...... ..,. s~ ~ iii€;i i€si€i€i;i€i'i; ~:'•iiiiiiii i€s~ ~€i~ sis~ i€~ i€ i€~ i€i~i€;a;€:i<~i~iii€~ ~ ~ ii's;;i;;i ::~:::~:~~ :::::::::::::::::::::~::::::~::~::~::~ ::: ~ ::;:;:;:;:;:;:;:;:;:;:~::~:::_::::::::::::::::_:~:::::~: ............. ............................:::..:::::::::::.:...:...:...:::::::::..:... 3. Percent Taxable 3 ::.:.:.:.:::.:::::.:.:.:.:::::::.:: X ::::::::::.:::::.:::::::,::::::::::::::::::::::::::::::::::-:::=:::::,:,.,.,.:.,:,:,:,:,:;:,:,:;:,:;:.:;:;:;.; 4. Amount Sub" ect to T ax J 4 :::::. 5 . Debts and De ductions 5 ::::~: ~:: _:::::-::::::, ::::. :::. :::......::::::, :::::::,:,:;:;:,.,.;.,.;.,.,. ~ ;:,:,:,:,:,:,:,.,:;:,:,:, :, :::,:,:,:::,:,:;:;:,:;:,:;-,:,,:::::: 6 . Amount Taxab €i€i'i E i` ~siii'".i€i;i€"=_' it s€iii€s~ ~ ~ =iii ~ i~€ i€iii€€i€i[€€ : iii€i€~ ~ ~ ii i~~ i~i':sissi'€;;d i~ i':'s':si€i€ 7 . Tax Rate 7 X ..... ~'~ ~'~' `"`' 8 . Tax Due 8 s ~~ ='':~ =s~ ::::::::::::::.:.:: :::::::::::::::: ~::~: ::. 's'iEilSii~ iiiiii'::`i`:i ~i'iiii`ifEi= ~ ~~ ; ~~Isi[iEiEsiEsi's`:['='~;ttiifiEiEiEs ~°?~ ;~I~~ is : :: ~ _:::::::;:::;:::::::;::::::;:;:;:;:; ~:;:::::~ ;:;:;:;:;:;:;:;:; _:~ ;:: ~ : €:::::::;:;:; :,:: ,:::: PART RESTS AND DEDUCTIONS CLAIMED DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and compl a to the best f ny knowledge and belief . HOME C ~7/'~ ) Z 3 ,~ E ~ f~' ~. /~ ~ WORK ( ) . ~~; ._ AX AYER SIGNATUR TELEPHONE NUMBER DATE GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife more than one year prior to death are not taxable. Accounts held by a decedent ^in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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. 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 260601, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or 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 the data the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint Hanes within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk C**) appears before your first name in the address portion of this notice, the 53,000 exclusicn already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 8Y 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 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and twc other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X lOD = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2l by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable [line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4l. Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or far the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. fhe lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children^ includes natural children whether ar 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 Hat 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. 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 11". Procf of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 ©,1 ~ ~~ BUREAU OF INDIVIDUAL TAXES AN D DEPT. 280601 ACN 02132289 HARRISBURG, PA 171z6-obol TAXPAYER RESPONSE DATE 07-12-2002 REV-1543 E% RFP tV9-VV~ TYPE OF ACCOUNT EST . OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST ~ - . COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 1{7824 CARLISLE, PA 17013 PNC 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 fore and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. questions may be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001D37033 Date 04-14-1994 Established Account Balance 5,041.47 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''. Percent Taxable X 8.333 Amount Subject to Tax 420.11 NOTE: If tax payments are made within three (3l months of the decedent's date of death, Tax Rate X . 045 You may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 18.9D nine (97 months after the date of death. PART TAXPAYER RESPONSE ........................._.._......................................................................................:.............................................................._.........................._....................__ _ _...._...._................. ......... k.~.. ''i'~.~i A. ^ The above information and tax due is correct. 1. You nay choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box ^A^ and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK ~ B. ^ The above asset has been or will he reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You oust complete PART ~ and/or PART ~ below. PART y i dicate a dsfferent tax rate, please state your ;;;~; ~~;~_;~;;_; ~~; ; -• -.; :::..:: ~~ ::_ -• :::: :: .::::::::::::,:::77RR:: ::: ;;:~';~;--,,;1 ~ ::::::::::::::::::~ ::::~ a;~.~}:.1;~ ~ii:~sPI;~ :i:ii iisi ii71!ffs relationship to decedent: ~ ~ --•-----•::::..~::. TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reporrt~ed above are true, correct and complete to the best of ny knowledge and belief. HOME C / I`7 ) ~ SK E Z ~~ ~/ ~~ WORK ( ) '~ ~ Z~-~, Z AXPAYER SIGNATU E TELEPHONE NUMBER DATE GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife more than one year prior to death are not taxable. Accounts held by a decedent •'in trust for^ another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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 amcunt of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment CForm REV-1548 EX) upon receipt of the return from the Register of Wills. 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. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check black "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 the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1l year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (**) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 tc the decedent's death: 1 DIVIDED 8Y TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT DWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT DWNERS) DIVIDED 8Y 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 DIVIDED 8Y TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE DWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and twc other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X lOD = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax Cline 4). Enter the appropriate tax rate (line 77 as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^The tax rate imposed on the net value of transfers from a deceased child twenty-ono years of age or younger at death to or for the use of a natural parent, an adoptive parent, ar 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, adapted descendents and their descendants and step-descendants. ^Siblings^ are defined as individuals who have at least one parent in common with the decedent, whether 6y blood or adopticn. The ^Collateral•• class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deducticns are determined as follows: A. You legally are responsible for payment, or the estate subject to administraticn 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 11'•. Procf of payment may be requested by the PA Department of Revenue. CDMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES I N F O RMAT I O N N O T I C E FILE N0. 21 ~;~ ,fir AND DEPT. 280601 TAXPAYER RESPONSE ACN 021 32292 HARRISBURG, PA 171z8-abol DATE 07- 12-2002 REV-1543 E% ~FP [09-DD) TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST . ; .:- ,COUNTY CUMBERLAND X^ CERTIF. ~ _- _ - REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 17324,_... CARLISLE, PA 17013 PNC 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 Pennsylvania. questions nay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 210001037027 Date 03-24-1994 To insure proper credit to your account, two Established (2) copies of this notice must accompany your Account Balance 5, 055.70 Payment to the Register of Wills. Make check payable to: ^Register of Wills, Agent^. Percent Taxable x 8.333 NOTE: If tax payments are made within three Amount Subject to Tax 421 .29 (3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 5% discount of the tax due. Any inheritance tax due will 6econe delinquent Potential TeX Due 18.96 nine C9) months after the date of death. PART TAXPAYER RESPONSE ::::.i*d:M~a:~te~lt•::~M!#~:°:~:11#!~t-~!#~fk°°:Y~tM!a # :;:#itl+~i~1#:?!M:::~:!M1t~:~:~:dat~::hl~+:~t#a:M~1tt~::~:!h~ikir.•:•:::~iF~~+~~+iu}M:: ll~ie~t~ ~r :iD*i~i:!t::::#i~rMMli~*~:~: A. ^ 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 CHECK 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. C 0 N E ~ BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by yeu. You must complete PART ^ and/or PART ^ below. PART If you indices e a differen ax ra e, please state your ~~~~~~~ ~ ~~~ ~ 2 relationship to decedent: .. ................ ~~~ TAX RETURN COMPUTATION OF T X A ON JOINT TRUST ACCOUNTS ~ ,,;::,:.:,iiiii;~ ;~~;° ~ i~~ ~~;;~~~~€i~ii;i;€~~;~= ~!~~ :,:. LINE 1. Date Established 1 ~€ l[[9'a 2. Account Balance 2 :::::::::::::::::.::::::::::::::~:~~~::::::::::::::~::::::::::::::::::::::::::::::::::::::::::::::~::~:::::::::::::::~:::::::::::::::::::::::::::::::::::: 3. Percent Taxable X 3 4. A mount Subject to Tax 4 J 5. _ Debt s and Deductions 5 ~ €'~ ~~ €~ €sij~~~ ~~ €~ €~°~ i'€ _i ~ €~~~~ €~~ €~ €~ Vii; ~°s€`~ €€€€~ s 6. Amount x Ta able 6 7. Tax Rate X 7 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are truep, correct and conpl a to the bes of ny knowledge and belief. HOME C 7 ~ ) ~ ~c~ L ~ p 6 WORK ( ) ~j ' l 6r1 Z A ER SIGNA RE TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based an information submitted by the financial institution. 2. Inheritance tax bectlnes 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 era fully taxable as transfers. 5. Accounts established jointly between husband and wife mare 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 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 then 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 CForm REV-1548 EX) upon receipt of the return from the Register of Wills. BLDCK 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 288601, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (**) appears before your first name in the address portion of this notice, the 53,088 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established Wore than one year prior to the decedent`s death: 1 DIVIDED BY TDTAL 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 CJOINT 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 DIVIDED BV TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other parsons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% = me cox race ampaseo on me net value of transfers tram a tleceasetl child twenty-one years of age or younger at death to tlr 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, adapted 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 ar adoption. Tha ^Collateral" class of heirs includes all other beneficiaries. 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. 8. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being clamed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES FILE NO. 21 p~1, ~ i,5- DEPT. 280601 AND ACN 02132295 HARRISBURG, PA 17128-obol TAX PAYER R E S PO N S E DATE 07-12-2002 REV-1545 E% AFP (09-007 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST ., , ._COUNTY CUMBERLAND ~ CERTIF. :_.`_ : REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 17324': CARLISLE, PA 17013 PNC 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 Pennsylvania. questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * * ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001036938 Date 11-10-1989 To insure proper credit to your account, two Established (2) copies of this notice must accompany your Account Balance 5, 044.28 Payment to the Register of Wills. Make check payable tc: ^Register of Wills, Agent^. Percent Taxable X 8.333 NOTE: If tax payments are made within three Amount Subject to Tax 420.34 (3) months of the decedent's date of death, Tax Rate x . 045 You may deduct a 5% discount of the tax due. 1 8.9 2 Any inheritance tax due will become delinquent Potential Tax Due nine (9) months after the date of death. PART TAXPAYER RESPONSE ~~~il ~: A. ^ Tha above information and tax due is correct. 1. You may choose to remit payment to the Register of Mills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box ^A^ and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK ~ B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. C. ^ The above information is incorrect and/ar debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If ou indicate a different t .:::::::::::::::::.::::::::::::-::.:::-:::::::::::::::::::::::::::;::::::::-::::::::::::::::::::::;:;::::::-....::::::::::::::::::::: PART y ax rate, please state your _°_°~ ~~°~~~°~_°~ ~::~:: #}!!~ . ~~ ~` its=sf~Ti .:~ €< '; ::;ii ~ :.: '~.s;i€; relationshsp to decedent: .:::.:.::::::. ;; __.:::: .::::::::::::::.:~:.~: ~ ~::. TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate S. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 ~ x 8 -- PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT Path Under penalties of perjury, I declare that the facts I have reported above are true, correct and conpl to the b t of ny knowledge and beiief . HOME C ~~/ 7 ) Z ~ {~ ~ .1 ~~~ s.,%i, WORK ( ) .~ _ 2C . (~ L- TAXPA ER SIGMA URE TELEPHONE NUMBER DATE GtNtKAL 1NFOKMAIlUN FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife more than one year prior to death are not taxable. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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 EXl upon receipt of the return from the Register of Wills. BLDCK B - If the asset specified an 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. BLOCK C - If the notice information is incorrect and/or 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 tc the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EXl upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 net to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (a*) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 160 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BV 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR) The percent taxable far assets created within one year of the decedent's death ar accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .SD X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable Cline 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. 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 descendants" includes all children of the natural parents and their descendents, whether ar not they have been adapted 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 ar adoption. The ^Collataral" class of heirs includes all other beneficiaries. 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 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE N0. 21 BUREAU OF INDIVIDUAL TAXES AND G ~' ~ ~ S DEPT. 280601 ACN 02132298 HARRISBURG, PA 171zs-obol TAXPAYER RESPONSE DATE 07-12-2002 REV-1545 EX AFP <09-00] TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST _ COUNTY CUMBERLAND X^ CERTIF. i i ~ , REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 17324, CARLISLE, PA 17013 PNC 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 Pennsylvania. Questions may be answered 6y calling (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31000212813 Date 01-16-1996 To insure proper credit to your account, two Established C2) copies of this notice must accompany your Payment to the Register of Wills. Make check Account Balance 5, 014 .04 payable to: ^Register of Wills, Agent^. Percent Taxable X 8 .333 Amount Subject to Tax 417 82 NOTE: If tax payments are made within three ' . (3) months of the decedent s date of death, Tax Rate X . 045 You may deduct a 5% discount of the tax due. Potential Tax Due 18 80 Any inheritance tax due will become delinquent • nine (9) months after the date of death. PART TAXPAYER RESPONSE '~:~'.~'~k:rl'~:'~~~}.'.::~'~'~~::~~'.L`~~::~il"~?~?? F~:'Y~..~A€~:["Fk ..:Y`fi€..:A-1# 1!~~'~~I'~9:M`.~~..:..'•~I!~k~F.. .iLL`:C~7L~#R~~i"1k:i~`.~lil~$'+~:~:l~!#~? !+!~#T~::~:~:iilL!W.h!~!i#l~~~c A. ^ 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 CHECK a discount or avoid interest, or you may check box ^A" and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK B. ^ The above asset has been or will 6e reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART Y indica te a different tax rate, please state your ~c si~ S~~ ~iii~ ~'=~~ ~ relationsh- i P 2 to decedent: V ~ ~ ii; ;iiss~ € ........................ ~.........~..s. ~ ~...~.~....r.,........................,~:..__...... TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and comp a to the b t of ny knowledge and belief. ~~~~ HOME (~7s7 ) Z 5~ ~6 ~ ,~'"G WORK ( ) `7 - 2 ~ °w-Z TAX AYER SIGNA URE TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based an information submitted by the financial institution. 2. Inheritance tax beccaes 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 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. 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 6y 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-D601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or deductions era 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 Nills 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: Far 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 53,000 per transferee regardless of the value of the account or the number of accounts held. If a dcuble asterisk (**) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 300 = 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 FDR 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 X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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) The amcunt subject to tax (line 4) is determined by multiplying the account balance Cline 2) by the percent taxable Cline 3). Enter the total of the debts and deductions listed in Part 3. The anaunt taxable (line 6) is determined by subtracting the debts and deductions Cline 5) from the amount subject tc tax (line 4) Enter the appropriate tax rate (line 77 as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^ me tax rate lmposea on the net value of transfers from a deceased child twenty-one years of age or younger at death to ar far the use of a natural parent, an adoptive parent, or a stepparent of the child is D%. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether ar not they have been adapted 6y others, adapted 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 6y 61ocd or adoption. The "Collateral^ class of heirs includes all other beneficiaries. 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 11". Proof of payment may be requested 6y the PA Department of Revenue. COMMONNEALTH DF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU DF INDIVIDUAL TAXES DEPT. 2806D1 HARRISBURG, PA 17IZS-abol REY-1543 Ex AFP (P9-PO) I N F O RMAT I O N N O T I C E AND TAXPAYER R E S P O N S E FILE ACN DATE ~~ N0. 21-~- 021322$0 07-12-2002 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S . S . NO . 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST ' ,: - . COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WI LLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 17324;'.. CARLISLE, PA 17013 PNC 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 Pennsylvania. Questions may 6e answered by calling (7177 787-8327. COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001036937 Date 11-10-1989 To insure proper credit to your account, two Established C2) copies of this notice must accompany your Account Balance 5, 044.28 Payment to the Register of Wills. Make check payable tc: ^Register of Wills, Agent^. Percent Taxable x 8.333 Amount Subject to Tax 420.34 NOTE: If tax payments are made within three (3) months of the decedent's date of death, Tax Rate x .045 You may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent POtentlal TEiX DUe 18 • 92 nine (9) months after the date of death. PART TAXPAYER RESPONSE 1 ::::::::-::-::-:::::::-::::::- :.::::::..::::::::::::::-: ,:::-::::::::-::::-::::::::::::::::::::::::::::: -:::.:.:.:.:.:.,.,.,.,.:.:.:.:.,.,.:.:.:.:.:.:.:.:.:.:.:.:.:.:...:............................................................................................................................................................................................................... ~1~1 "~' A. ^ The above information and tax due is correct. 1. You may choose to remit payeent to the Register of Wills with twc copies of this notice to obtain CHECK a discount or avoid interest, or you may check box ^A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK ~ B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART y e a daffierent tax rate, please state your ~ ::::::::::::.:::::::::.::: €ii~ ~ ~ ~ :~~ €s~ iii s~GAI~i~;s~~~=~~ ° =:;.:. .:; a relatsonshiP to decedent. .............................~.~::::::~:~~~:~:~a:_~::_~;.:::::.~;:,~::::.::y,,~:y: ~1:u.:::::::::::::::::::: TAX RETURN - COMPUTATION LINE 1. uate Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate S. Tax Due PART a DATE PAID PAYEE DESCRIPTION AMOUNT PAID U der penalties of perjury, I declare that the facts I have reported above are true, correct and conpl to t~e best o ny knowledge and belief. HOME C'`7 /'~ ) AX YER I$ GNATUR WTELEPHONE NUMBER DATE`iZ 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 pricy 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 BLDCK 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. 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, Oept 280601, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check black "C^ and complete Parts 2 and 3 according tc the instructions below. Sign two copies and submit them with your check far 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1l year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk C^*) appears before your first name in the address portion of this notice, the 53,OD0 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 = 16.7% (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 far another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED 8Y 2 (SURVIVDRSI = .50 K 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable Cline 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax Cline 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate Imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. (he 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 net 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 ~r adoption. The "Collateral^ class of heirs includes all other beneficiaries. 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 tc 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 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOT I C E / BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 -Oo~- 7' DEPT. 280601 ACN 02132268 HARRISBURG, PA 17128-06D1 TAX PAYER R E S PO N S E DATE 07-12-2002 REV-1543 EX RFP (09-00) WILLIAM K GROVE 203 FROST RD GARDNERS PA 17324.~~ TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST ,COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC 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 Pennsylvania. questions may be answered by calling [717) 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001037050 Date 08-30-1994 To insure proper credit to your account, two Established C2) copies of this notice must accompany your Account Balance 5, 039.30 Payment to the Register of Wills. Make check payable to: ^Register of Wills, Agent". Percent Taxable X 8.333 4 1 9 .9 2 NOTE: If tax payments are made within three Amount Subject to Tax (37 months of the decedent's date of death, Tax Rate x .045 You may deduct a 5% discount of the tax duo. 1 8.9 0 Any inheritance tax due will become delinquent Potential Tax Due nine (9) months after the date of death. PART TAXPAYER RESPONSE A. ^ 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 CHECK a discount or avoid interest, or you may check box ^A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK ~ 8. ^ Tha above asset has been or will 6e reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed 6y the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ^ and/or PART ^ below. If ou indite ~i€i€€€~~~€~::;:;:€sii~:~€€::::::::,:- .::..:::::::::::::::::::::::::::::..:::::.::::::-::-:,:~::,:-:::::::::.....::~::~::::::::::: PART y to a different tax rate, please state your ::##:: :::::::::::::::::::::a:::: relationshi to d :::::::...:.........................................................:.....................................:.:.:.:.....:,~::: TAX RETURN - COMPUTATION LThE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINTiTRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Un r penalties of perjury, I declare that the facts I have reported above are true, correct and cou/ple to t\he, be t of my knowledge and belief. HOME C ~/7 ) ~S ~ ~ 7 ,~' l /! %~~ ~c WORK ( ) 7' Z~ -C Z AX AY R SIGNA RE TELEPHONE NUMBER DATE GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based an information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife Wore than one year prior to death are not taxable. Accounts held by a decedent ^in trust for^ another ar others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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 (Farm REV-1548 EX) upon receipt of the return from the Register of Wills. 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. BLOCK C - If the notice information is incorrect and/or deductions era being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit then 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 (Porn REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 mat to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (~*) appears before your first name in the address portion of this notice, the 53,000 exclusicn already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 TDTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT DWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVDRS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR) 8. Tha percent taxable for assets created within one Year of the decedent's death or accounts awned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE DWNERS OR TRUST BENEFICIARIES Example: faint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 37. Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate Cline 7) as determined below. *The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. 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. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% 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 procf 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 11". 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 EY-1543 EM aFP (Y9-00) INFORMATION NOTICE AND TAX PAYER R E S PO N S E ~~ FILE NO. 21-d~- 7 ACN 02132271 DATE 07-12-2002 TYPE OF ACCOUNT EST . OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST `; .:~ COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 17$24 CARLISLE, PA 17013 PNC BANK has provided the Department with the information listed below which has bean 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 Pennsylvania. 9uestions may be answered by calling (717] 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31200132328 Date 07-07-1998 To insure proper credit to your account, two Established (2] copies of this notice must accompany your ACCOUnt Balance 5, 025.75 Payment to the Register of Wills. Make check payable to: "Register of Wills, Agent^. Percent Taxable X 8.333 NOTE: If tax payments are made within three Amount Subject to Tax 418.80 (3) months of the decedent's date of death, Tax Rate x .045 You may deduct a 5% discount of the tax due. 1 8.8 5 Any inheritance tax due will become delinquent Potential Tax Due nine (9] months after the date of death. PART TAXPAYER RESPONSE ......................................................................................................................................................................................................................................................... ~;;~::::I~~~iiii~~~~...... A. ^ 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 CHECK a discount or avoid interest, ar you may check box ^A^ and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK 8. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART Y s d3cate a different tax rate, please state your i€i€~ iii.::. ;: °. ~ ~ €€i .: ~-'? : ~~ ~ €i; ~ =i`~i'si~i i'si'siEs ~ i` ;s ° .:': ..................................................................... 31 y p ...........................:.::.:.:.::.:.:.:.:.:.:.:::::::::::::: .................. relationshi to decedent: '`````~~~~~~~~~` TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7-_ X 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Un er penalties of perjury, I declare that the facts I have reported above are true, correct and conpl to`t~he bes of ny knowledge and belief . HOME C '7/ 7) Z S ~ E 1 ~'E /~ WORK C ) `7 -Z ~ -~ `L TA AYER SIGNA RE TELEPHONE NUMBER DATE VtNtKAL 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 becones 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 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 then 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 (Fora REV-1548 EX) upon receipt of the return from the Register of Wills. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance lax 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, Oept 280601, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check black "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check far 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 EXl upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk C*~) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 (JDINT 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 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax Cline 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date ofi Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adaptive 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 adapted 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. 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 procf 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 11^. Proof of payment may be requested by the PA Department of Revenue. COMMONNEALTH OF PENNSYLVANIA DEPARTMENT DF REVENUE BUREAU OF INDIVIDUAL TAXES INFORMATION NOTICE FILE NO. 21- ~ ~ 7 !~ AND DEPT. 280601 HARRISBURG, PA 171z8-obol TAXPAYER R E S P O N S E ACN 02132274 DATE 07-12-2002 REV-1545 E% ~FP (09-007 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST j; - ;; COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 173~Q4 CARLISLE, PA 17013 PNC 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 fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31200118978 Date 02-06-1998 To insure proper credit to your account, two Established (2) copies of this notice must accompany your ACCOUnt Balance 5, 026 .48 Payment to the Register of Wills. Make check payable to: "Register of Wills, Agent^. Percent Taxable x 8.333 4 1 8.8 6 NOTE: If tax payments are made within three Amount Subject to TBX (3) months of the decedent's date of death, Tax Rata X . 045 you may deduct a 5% discount of the tax due. Potential Tax Due 18.85 Any inheritance tax due will became delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE :... :°€; A. ^ The above information and tax due is correct. 1. You nay choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box ^A^ and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. I f ou Indic €~ i~€i€t;€_ €€~~ z~f~i :.::...::.::.:::::::::::-::::::::::::::::-:::::::::::::: ~:::-::::: ~:: ~::::::::::.:.:.::::~ :::;,::: ~::::::: PART y ate a dsfferent tax rate, please state your ~!~! ~-- ~- ~y is's"'~ ;i~i'.`~~~~il~~tri~[ilsifsfs i ~ ~~ . ~° . ~ ~~ iii relationshi to ::::::.::.....:.....................................:...................:.::-:::::::::::::.,.,.,.,.,.;.,.,...,.,.,.,.,.,....::. P decedent . ........................ ...... . TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART DATE PAID PAYEE DESCRIPTION AMOUNT PAID U der penalties of perjury, I declare that the facts I have reported above are true, correct and coop a to the bes of ny knowledge and belief. HOME ('~17 ) '2 S $' E7 7~b • ~L~~ WORK ( ) - Z(7 --Q Z TAXPA ER SIGNATU E TELEPHONE NUMBER DATE 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 jcint 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 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. 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 black "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. BLOCK C - If the notice information is incorrect and/or 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 53,000 per transferee regardless of the value of the account or the number of accounts held. 1f a double asterisk (w~) appears before your first name in the address portion of this notice, the S3,000 exclusion already has keen deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 tc 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 = 16.7% (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts awned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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) The amount subject tc tax (line 4l is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4l Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed on the net value of transfers Pram a deceased child twenty-one years of age or younger at death to or far 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 net 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 whc have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral^ class of heirs includes all other beneficiaries. 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 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH DF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, Pa 17128-obol REV-1545 E% AFP (09-007 INFORMATION NOTICE AND TAX PAYER R E S PO N S E FILE ACN DATE d~ - ~'~ S N0. 21' 02132277 07-12-2002 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST '-~-' - -- '.-='COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WI LLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 17324 CARLISLE, PA 17013 PNC 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 decadent, 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 fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31600072307 Date 01-18-1997 To insure proper credit to your account, two Established (2l copies of this notice must accompany your Account Balance 5, 027.81 Payment to the Register of Wills. Make check payable to: ^Register of Wills, Agent". Percent Taxable X 8.333 Amount Subject to TaX 418.97 NOTE: If tax payments are made within three [3) months of the decedent's date of death, Tax Rate x . 045 you may deduct a 5% discount of the tax due. 1 8.8 5 Any inheritance tax due will became delinquent Potential Tax Due nine (9) months after the date of death. PART TAXPAYER RESPONSE A. ^ 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 CHECK a discount or avoid interest, or you nay check box "A^ and return this notice to the Register of Wills and an official assessment will 6e issued by the PA Department of Revenue. ONE ~ BLOCK B. ^ The above asset has been ar will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART Y u lndacate a dsfferent tax rate, please state your :# ~ ~ #i ~y z':isiisi€si€siiss€i;':siii~i~?i:i~~~s!i;~1?Ilssii~~~~~ •` ~ ~~€ relationshsP to decedent. . ::~:;~::::~::~~;:~::~ _::::::::;~:::::::- ....:::::::::::~ :~ ::~ :,::;:::::~:::~:::~ :~:::,:,:::,.~,.,.:::::::::::::::::::::: X RETURN - COMPUTATION OF TAX ON JOINT~TRUST ACCOUNTS ;~`~~I .:..:.....:.:.......:.::::::::::.....:...:.:...:.:.............:...:::.:.:.:.....:.:.:...:.:.:...:...:...:.:.:.:.:.:...:...:.........:.:.: LINE 1. - Date Established 1 :. _ ~::::•:• ::.:.::::::::~;::::::;:::<<:::::~:;~;:~::~::....:::::::::~; :. _,,;.;;::., .:, : ....:........:........:...............::::::.:.:.:.:.:.:.:.:.:.:::::...s:::,:,:,:,:,~:,:,:;;:;:;:;:;:::;:,:.:,:,:,:.::~ :: 2. Account Bala nce 2 ;~ •.~:::,::::::::•:~:::::::::~::~::~:• :::::::::..:.~~.~:;;:,:,:;:...:::::::: •.:::,:,:,:...:::::.~:::: ,., .......................................:.....:.....:...........................:.....:.........................:.:.:.:.:......................... 3. Percent Tax able 3 X ::::~, ;;!_'__;:' ~siiiiii€i€~~~~~ ~€s~;iiiiiiii€i?i!_i~i€i€~_~:€as3+aii'=_"iiii€iisi€si€i€it'€='~iii~"sisiis€€i€€ ~~ ! :;~ ~.. •:€:;:;:;:~ ::::::::::::::::::::::~ ~;:;.,:; ~:;:;:::::;:::;;;:;:;:::; :~ €:;:;:;:::::::;:_:; ~:::~ €:~ :;:;:;:;:;:;:::;:::;:;:::_: ; 4. Amount Sub "ect to Tax 4 7 5. Debts and Deduct' sons 5 6. Amount Taxable 6 7. Tax Rate 7 __ X 8. Tax Due 8 Und r penalties of perjury, I declare that the facts I have reported above are true, correct and couple to the best o y knowledge and belief . HOME C 7 ~ ? ) ~ S K b ~ S~ 6 .,~,.-~,i ~~. WORK ( ) ~ ••26 --~;~~ YER SIGNATURE TELEPHONE NUMBER DATE PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information subwitted 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. Acccunts established jointly between husband and wife mare than one year prior to death are not taxable. 6. Accounts held by a decedent ^in trust for^ another ar others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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 far the amount of tax to the Register of Wills of the county indicated. The PA Bepartment of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. BLOCK B - If the asset specified an this notice has been ar will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X^ in black "B^ of Part 1 of the "Taxpayer Response^ section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Oept 280601, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit then 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 the date the acccunt originally was established or titled in the manner existing at date of death. NDTE: 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 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (~~) appears before your first name in the address portion of this notice, the 53,000 exclusion already has keen deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 8Y 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 ar accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 300 = PERCENT TAXABLE OWNERS DR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and twc 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) The amcunt subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable Cline 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 47. Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. 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 ar not they have been adapted 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 decadent, whether by blood or adoption. The "Collateral^ class of heirs includes all other beneficiaries. 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 11". 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 171zs-abol REV-1545 EX ~FP (09-007 INFORMATION NOTICE AN D TAXPAYER R E S PO N S E FILE ACN DATE N0. 21-dam'' ~~~ 02132283 07-12-2002 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ rRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WI LLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 17324-. CARLISLE, PA 17013 PNC 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 Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31100023533 Date 01-05-1996 To insure proper credit to your account, two Established (2l copies of this notice must accompany your Payment to the Register of Wills. Make check ACCOUnt Balance 5, 027 .22 payable to: "Register of Wills, Agent". Percent Taxable X 8 .333 NOTE: If tax payments are made within three Anount Subject to Tax 418 .92 (3l months of the decedent's date of death, Tax Rate X . 045 you nay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 18 .85 nine [9) months after the data of death. PART TAXPAYER RESPONSE :~:::~~:'tl::l~~€~~1~~t#kh:::::~#M'#::i::: :1i~~~Ni? 'IE~(ii:~i~t~....f~~*!t~!E>~i'~.Abe d~~.~~tr~f~t"::::~~~~?N€:ice:€4!t~iit~~~t~#!€€ A. ^ 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 CHECK a discount or avoid interest, or you may check box "A^ and return this notice to the Register of C 0 N E ~ Wills and an official assessment will 6e issued by the PA Department of Revenue. B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/ar PART 3^ below. PART If ou indicate a different tax rate lease state our y , P Y =__€i iiiiiiiiiiii~iii€i€i€ ::°:::-:-::-:::::::-::~:::~;:::::~::°:;-::: -: ~:;:-,:::: ~°°isiits€:~:::: €[;:::_::;:::: ifi€F~i€i~i~~[iiiiisi~~i€iii€_i €_ii€;i~ ° 2 relationshi to decedent: P . . sssssi~i~f'~:X!fig~iRL(il?G~13~iSs~~i"' i74G~!?/ Vi~~i~f~~i~i~ss TAX - ~ RETURN COMPUTATION OF TAX ON JOINT TRUST ACCOUNTS L1NE 1. Date Established 1 ~~ •: ~~~~ ::: 2. Account Balance 2 3. Percent Taxab e X 1 3 4. Anount Sub"ect to Tax 4 J 5. Debts and Deductions 5 6. Anount Taxable 6 7. Tax Rate 7 X 8. x Ta Due 8 PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Un er penalties of perjury, I declare that the fiacts I have reported above are true, correct and c~~le to the best f ny knowledge and belief. HOME C ~~~ ) 7S ~ ~ ~- 8 6 ~rll/L ~Cf/~ _ WORK ( ) ~.~E..~~~ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on informaticn 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 pricy 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 ar others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE BLDCK 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. BLOCK 8 - If the asset specified on this notice has been ar 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. BLOCK C - If the notice information is incorrect and/or 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 (Farm REV-1548 EX) upon receipt of the return from the Register of Nills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (~*) appears before your first Wane in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 1D0 = 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 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 160 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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 K lOD = 50% (TAXABLE FOR EACH SURVIVOR] The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable Cline 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5l from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7l as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^ina tax rata lmposec on the not value of transfers tram a tlecease0 ch11tl 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%. (he lineal class of heirs includes grandparents, parents, children, and lineal descendants. ^Children" includes natural children ohether or not they have bean adopted by others, adapted children and step children. ^Lineal descendents^ includes all children of the iatural parents and their descendents, whether ar 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 ~r adoption. The ^Collateral" class of heirs includes all other beneficiaries. 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 11". 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 INFORMATION NOTICE FILE N0. 21-Dc~' ~~`S AND ACN 02132286 TAXPAYER RESPONSE DATE 07-12-2002 REV-1543 EX RFP (09-VO) TYPE OF ACCOUNT EST. OF H IR GROVE ^ savlNGs S . S . NO . 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST COUNTY CUMBERLAND 0 CERTIF. `- REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 1732;4 CARLISLE, PA 17013 PNC BANK has provided the Oepartnent with the infornatien 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 infornation is incorrect, please obtain written correction fron the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Connonwealth of Pennsylvania. Questions nay 6e answered 6y calling C717) 787-8327. COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Under penalties of perjury, I declare that the facts I have reported above are true, correct and couple to the best f ny knowledge and belief. HOME C .7~~ ) ZS ~ G 2 ~E' ~~v+-ti ~~ WORK ( ) ~-z6~-~~ AXP YER SIGNAT E TELEPHONE NUMBER DATE litNtKAL 1NrUKMAIlUN FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife more than one year prior to death are not taxable. Accounts held by a decedent "in trust for^ another ar others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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. BLOCK B - If the asset specified on this notice has been ar 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. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit then 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 L. Enter the date the account originally was established ar titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1l year of death are taxable fully as transfers. However, there is an exclusion not to exceed S3,D00 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk Cx*) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 1D0 = 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 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the Wane of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax Cline 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable Cline 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate Cline 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. the lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children^ includes natural children whether or not they have been adapted 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. 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. 8. 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 11". Proof of payment may be requested by the PA Department of Revenue. COMMDNWEALTH DF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE /`,j~ FILE N0. 21-L~?- 7 BUREAU OF INDIVIDUAL TAXES AND DEPT. 280601 TAX PAYER R E S PO N S E ACN 02132285 HARRISBURG, PA 171za-abol DATE 07-12-2002 REY-1545 E% AFP (09-007 TYPE OF ACCOUNT EST . OF H R GROVE ^ SAVINGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST : - - -.,COUNTY CUMBERLAND X^ CERTIF. l.iL 1 REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WILLS 203 FROST RD _ CUMBERLAND CO COURT HOUSE GARDNERS PA 17324- CARLISLE, PA 17013 PNC 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 Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001035967 Date 06-15-1994 To insure proper credit to Your account, two Established (2) copies of this notice must accompany your Payment to the Register of Wills. Make check Account Balance 5, 008 .22 payable to: "Register of Wills, Agent". Percent Taxable X 8 .333 Amount Subject to Tax 417 33 NOTE: If tax payments are made within three ' . (3) months of the decedent s date of death, Tax Rate x .045 you nay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 18 .78 nine (9) months after the date of death. PART TAXPAYER RESPONSE ^ i*A.?tms#~~R~€~;~+irrs~;€~#itelb~s€n~;:~+i'~_#; ;i1~~~1#~ 4~~;~;;dm#;;,!t~"ahth?~t;;; _~A#r:: :ltl~~~+a~:f~~: ri.ie~it~is:::~>!tatk*~ ~:iits.~!tl~a::~: A. ^ The above information and tax due is correct. 1. You nay choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK 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. C 0 N E ~ BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/ar debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART If ou indicate a different tax rate lease state our y , P Y ::::::- :.::::::::::::::::::::::::: ~~is ::-,.,.,.,.,.,.,.,.,.,.,...,.,..::::.::::...,.,.::::::-:::::::::::::::::::::~:::::::::-....:::::•:::::•::•:::: ii~i~~`':`R'A"=i':LA':f':f~A?!~_T::s':~~i~ ~`.~ ::[i relatsonshsp to deceden t. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ ~~~~~~~~~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TAX RE TURN - CO PU A 0 M T TI N OF TAX ~ ON JOINT TRUST ACCOUNTS ~-,_,,::::::;~ `~~~ ....:.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . °~~~~~~~€~~€~~€~€~~~;~~;s€~€°~~~~~~~; :........:.:.:.:.:.:.:.:.:.:...::::.:.::::::::::::-:.:.:.:.:.:.:.,.:.,.:.:.,.,.,.,.:.;.,.,.,.:.:.:.:.,.,.:.,.,.: LINE 1. Date Established 1 .;. 2. Account Balance 2 :s:s[:::::: ~::; a::: ~•~ "" '~~~ '~ 3. Percent Taxable 3 X :::: :~ :::::::::: :::::::::::::::::::.:c:::::::::::,:~ :::::::::::::::::::::::::::::::::::::::::::::-::::- ~:::::~ ::::::::::::::::::::::: ~:: ~:::: ~::::::::::::::::::::::::::::::: :::::~::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~::::~::~::::~::~::~:•~:::::::;:~:~::~::~::~:: 4. Amount Sub.7ect to Tax 4 ; .::::::::::::::::::::s:::::::::s::::•:~:__~~:::,:,:,:,:,.,.,:,.,:,.,. ~:::::.:::.. 5. Debts and Deductions 5 - .......:::....:::::.:_.,.:.....;...::::: •::::::::::::::::::::: ~.~ ~.:: ~~::: 6. Amount Taxable 6 .:.::.:.:.::::::::::::::: .: :::::.~::::::::::::::::::.:::.:;:...:;,:, 7. Tax Rate 7---X ;:~::~:•:;~:•;. ~::::;:::::;:~:€:~. 8. Tax Due 8 ....................: ::.:_.~::::::::::::.::..:;,:.:,:,:,:;.:.:•.:::. PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above arte~ true,'/correct and co lets to the best of ny knowledge and belief . HOME C ~Q ~ ) 7J d ~ ~1.~7"J~ WORK C p ) TAXPAYER S GNAT RE TELEPHONE NUMBER GENERAL INFORMATION 1. FAILURE TD 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 mare than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust far" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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. BLOCK B - If the asset specified an this notice has been ar 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. BLOCK C - If the notice informaticn is incorrect and/or 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (**) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable far joint assets established more than one year prior to the decedent's death: 1 OIVIOEO 8Y 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 8Y 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 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE DWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED 8Y 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2l by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *Ihe tax rate Imposed an 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, ar 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. 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 he itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Prcof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRI58URG, PA 17128-6601 REV-1545 E% AFP (09-00) INFORMATION NOTICE AND TAXPAYER R E S PO N S E FILE ACN DATE N0. 21-pA.2- 7~S 02132282 07-12-2002 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S . S . NO . 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST '(>>~ __ - ,~ .~ COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WI LLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 17324 '_, CARLISLE, PA 17013 PNC 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 Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * ~ * 5EE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31100023533 Date 01-05-1996 To insure proper credit to your account, two Established C2) copies of this notice must accompany your ACCOUnt Balance 5, 027.22 Payment to the Register of Wills. Make check payable to: ^Register of Wills, Agent^. Percent Taxable X S .333 Amount Subject to TaX 418.92 NOTE: If tax payments are made within three C3) months of the decedent's date of death, Tax Rate x .045 You may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 18.85 nine (9l months after tha date of death. PART TAXPAYER RESPONSE A. ^ The above information and tax due is correct. 1. You nay choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART 3^ below. If ou indicate ;;~~€!~;i;i€~~€~:~::~ :::.:.::::::::::::::::::::::::::::::::::::::::::::-:~:::::::::::::::::-:.......::::::::::::::::::::: PART y a dsfferent tax rate, please state your ~!~! ~ ~••• ##`~ : :::-s::.:::::~ :: :: Si~ii`:i€~ ~i€ii'~':'i~'sii~ii~si€isiI":i~~~~ii~l?{sii=i':E `:i=i~€? ~~. relatsonshiP to decedent. .....................................:::~:~:.~ ::~.~__~.:..::::,;;_;~;;LL;:;:;~::~~~:~,.::;::,:u:::::::::::::::::::: TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of ny knowledge and belief . HOME C ~D ~ ) "7 `[ ~ - jS'!~~ WORK (~f1~1 ) `7SZ ^~6i9 '~j~ T CP YER IGNA~FURE TELEPHONE NUMBER A GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior tc death are fully taxable as transfers. Accounts established jointly between husband and wife more than one year prior to death are not taxable. Accounts held by a decedent ^in trust for^ another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in Klock "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 Pram the Register of Wills. BLOCK B - If the asset specified an 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 28D601, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or 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 far 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 EXl upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at data of death. NOTE: 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 53,OD0 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (*~) appears before your first Hama in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established Wore 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 JDINT OWNERS Example: A joint asset registered in the Wane of the decedent and two other persons. 1 DIVIDED BY 3 (JDINT 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 far another individual(s) (trust beneficiaries): 1 DIVIDED BY T07AL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS DR TRUST BENEFICIARIES 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) The amount subject to tax Cline 4l is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 47. Enter the appropriate tax rate (line 7) as determined below. Date ofi Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed an 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 adapted 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 ^Collataral" class of heirs includes all other beneficiaries. 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 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE ~ FILE NO. 21 -C~a-' ~ BUREAU OF INDIVIDUAL TAXES AND DEPT. 280601 TAXPAYER RESPONSE ACN 02132276 HARRISBURG, PA 171za-obol DATE 07-12-2002 REV-1543 E% RFP [09-DO) TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST °~~ __. ;; COUNTY CUMBERLAND CERTIF. REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WILLS 203 FROST RD ti. CUMBERLAND CO COURT HOUSE GARDNERS PA 173'x4.- CARLISLE, PA 17013 PNC 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, ycu 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 Pennsylvania. questions may be answered by calling (7171 787-8327. COMPLETE PART 1 BELOW ~ ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31600072307 Date 01-18-1997 To insure proper credit to your account, two Established (2) copies of this notice must accompany your Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of ny knowledge and belief . HOME C 0 6 ~ ) 7 ~~ - ~.S ~/ „~ WORK ( gp y) 7 SZ -~ 6/~ ~ ~ L TA A ER SIGNATI~ TELEPHONE NUMBER AT GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife more than one year prior to death are not taxable. Accounts held by a decedent ^in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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 (Farm REV-1548 EX) upon receipt of the return from the Register of Wills. 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. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check black "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 the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1l year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (~~) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established mare 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 CJOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FDR EACH SURVIVOR) B. The percent taxable far assets created within one year of the decedent's death ar accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 160 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED 8Y 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 27 by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5l from the amount subject to tax Cline 4). Enter the appropriate tax rate Cline 7l as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed an the net value of transfers from a deceased child twenty-one years of age ar 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. 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 B 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH DF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU DF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1545 E% RFP (09-007 INFORMATION NOTICE A N D TAXPAYER R E S PO N S E FILE ACN DATE N0. 21-0` 7~~ 02132273 07-12-2002 TYPE OF ACCOUNT EST. OF H R GROVE ^ savlNGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST ~,`•_' _ ,` CpUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WI LLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 17324: CARLISLE, PA 17013 PNC 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 faro and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. 9uestions nay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31200118978 Date 02-06-1998 To insure proper credit to your account, two Established C2:1 copies of this notice oust accompany your Account Balance 5, 026 .48 Payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 8.333 NOTE: If tax payments are made within three Amount Subject to TBX 418.86 (3:1 months of the decedent's date of death, Tax Rate X .045 You nay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax DUe ~ 18.85 nine (9) months after the date of death. PART TAXPAYER RESPONSE ::::~~.~r~::lx,l~~~~::~~1€ ~M~;1~1~~~~~~~~~!:::~....~:!t~:!~a~:,:,:::a~e~~ ~>;~~~~~ ~t~~~r,~~~ _;. A. ^ 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 ahtain CHECK a discount or avoid interest, or you may check box ^A^ and return this notice to the Register of C 0 N E ~ Nills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART If ou indicate a different tax rate lease state our y , P y :::::::::::::::::::::::::-::-:::::::::::-::::::::::::,::::::::::::::::;::::,:-:.::::::::::-:::::::,:--::-:::......::::-::::-:::::: ~{~~!!tt!!~~ *} ##~~i~~ . . . . . . . . ~' ~' s~RIS:T €ii~~iiis~~ ~7?~s ~ ~ iii is iii{ ii `~ ~ '° ~k 2 relationship to decedent. ::::::::::::::: . . . . . . . :: r , . ~ . ..... ... s::a;::::::::~:~ :::::...:.::::-::::::::-::::.::::::::: ~::~::::-:::~:<,.,.;.,.::-::::::..,::: TAX RETURN COMPUTATION OF TAX 0 N JOINT TRUST ACCOUNTS LINE 1. Date Established 1 . ..::: ~~ 2. Accou nt Balance 2 3. Percen T x X t a able 3 4. Amount Sub"ect to Tax 4 5. Debts and Deductions 5 6. A o n unt Taxable 6 7. Tax Rate 7 -~ 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and co pieta to the best of ny knowledge and belief. HOME C ~ ) 7 " ~.~ WORK C ~ ) TA P YER SIGNAT TELEPHONE NUMBER AT GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based do 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 td death are not taxable. 6. Accounts held by a decedent ^in trust for" another dr 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 era net 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 df 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 8 - 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 black "B" df Part 1 of the ^Taxpayer Response" section. Sign one copy and return td the PA Department of Revenue, Bureau df Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check black "C^ and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check far the amount of tax payable to the Register of Wills of the county indicated. The PA Department df 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one C1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed S3,000 per transferee regardless of the value df the account dr the number of accounts held. If a double asterisk (x*) appears before your first name in the address portion of this notice, the 53,000 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 df 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 Wane df 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) 8. The percent taxable for assets created within one year df 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 X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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 Cline 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. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%^ 12% 15% amine tax rate Imposed on the net value of transfers from a deceased child twenty-one years of age dr younger at death to or far the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. The lineal class df heirs includes grandparents, parents, children, and lineal descendents. "Children^ includes natural children whether or not they have been adopted by others, adapted 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, adapted descendants and their descendants and step-descendants. "Siblings^ are defined as individuals who have at least one parent in common with the decadent, whether by blood or adoption. The "Collataral^ class of heirs includes all other beneficiaries. 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 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE 7 Ja~ J BUREAU OF INDIVIDUAL TAXES FILE N0. 21~'d AND DEPT. 280601 HARRISBURG, PA 171zs-obol TAXPAYER RESPONSE ACN 02132270 DATE 07-12-2002 REY-1543 E% AFP (09-00) TYPE OF ACCOUNT EST . OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ 7RUSr • .. 4~OUNTY CUMBERLAND X^ CERTIF. ~_ '' REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA 173 2+.; CARLISLE, PA 17013 PNC 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 Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No 31200132328 Date 07-07-1998 . To insure proper credit to your account, two Established (2:1 copies of this notice must accompany your Payment to the Register of Wills. Make check Account Balance r~ ~ 02r, 7r, payable to: ^Register of Wills, Agent^. Percent Taxable X 8 .333 Amount Subject to Tax 418 80 NOTE: If tax payments are made within three . (3) months of the decedent's date of death, Tax Rate X . 045 You may deduct a 5% discount of the tax due. Potential Tax Due 18 85 Any inheritance tax due will become delinquent . nine (9] months after the date of death. PART TAXPAYER RESPONSE ::::: t*l~:!ta: tmb#t~:~>!tls:~::~f#t~#i!f#a~~::aE+i[a:~#~>: ~: a~+~~i#~:!M:::;::4#t::t::dat~:eff~#+:reshh i# t~ iie :a'~'va_+~1.#~#iwrt~ ~ iib'~w;~#tws ~#a;~ ;+iFl,i~iil!~:.<ira*i:Tw~why:~+~:~::~: A. ^ 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 CHECK a discount or avoid interest, or you may check box ^A" and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Oepartsent of Revenue. B L 0 CK 8. ^ The above asset has been ar will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. If PART ou indica y te a different tax rate, please state your iiiii':=i':i€si€~~~[~~_~~ ::::::.:.:.:...:.::::::::::::~:::::::;:;:;:::;:::::::::;:;::::::::,::,::i;i'i€ii~"::::: , i€~ iz€isi~~^GA~iiii~S~~~~`l€L~ ~ ;i €€ €; relationship to decedent: ~ ::::r: ~.~~.~.: TAX RETURN - COMPUTATION SINE i. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS i 2 3. X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported abov/e~ ar~ie true, correct and c npl to to the best of ny knowledge and belief . HOME C ~~ ~ ) [ ~O ' /jam` ~J`~ j ` G WORK ( 0 ) Z- 6 -~~i~~~ T XPAYER SIGNAT RE TELEPH NE NUMBER AT VtNtRAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based an 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 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. 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. BLOCK C - If the notice information is incorrect and/or 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: Far 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 mat to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk C^*) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported 6y the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established mare 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 SURVIVIND 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 1D0 = 16.7% (TAXABLE FOR EACH SURVIVOR) 8. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decadent but held in trust far another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE DWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death 6y the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4l is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions Cline 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or far the use of a natural parent, an adaptive parent, or a stepparent of the child is D%. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or mat 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 mat 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. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible far 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 11^. 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-abol REV-1543 E% IIFP [09-00) INFORMATION N OT I C E AND TAX PAYER R E S PO N S E FILE ACN DATE NO. 21-0,7- 7'1.S 02132267 07-12-2002 TYPE OF ACCOUNT EST . OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST ~~ -' ~ - ' ~'CO~J~iTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WI LLS 203 FR05T RD CUMBERLAND CO COURT HOUSE GARDNERS PA 17324 ~~ CARLISLE, PA 17013 PNC BANK has provided the Department with the information listed below which has bean 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 farm and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. questions nay be answered by calling (7171 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001037050 Date 08-3 0-1994 To insure proper credit tc your account, two Established (2l copies of this notice oust accompany your Payment to the Register of Wills. Make check Account Balance 5, 039 .30 payable to: ^Register of Nills, Agent•'. Percent Taxable X 8 .333 NOTE: If tax payments are made within three A3nount Subject to Tax 419 .92 (3l months of the decedent's date of death, Tax Rate x . 045 you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 18 .90 nine (9l months after the date of death. PART TAXPAYER RESPONSE _::~A<!t~i€~~~.....~t~::::foil~#Y;:::~#!t~::t::~ :::~~~€d~~i!#€~A~....f~k't~l'Ai;~=~tAc~~~~t~~~M€~€~~~#t~i~!t~;Ai~1*!~~~1= A. ^ 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 CHECK 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. C 0 N E ~ B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return D N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You oust complete PART 2^ and/or PART 3^ below. PART If ou indicate a different tax rate lease state our y , P Y :::- ::::::::::::::::::::::::::::::::::::::,::,::::::;:-:,:.::::::::::::;::::::::-::~:::,:-:,~:: ,:s;s:::.:::::::::~::::::~::: :::~;:::::.:~::::::~ :::::::::::::::::::• 2 relatsonshsP to decedent. ...:~ ,.; :;::~€::;:::::::s:::~:::-~;:::~:;:::::,.::::;-::-::-::::::::-::::-:= ::::::::...::~::::::::~::::::;::::;:;::°_:€:: .:.:.:.:.:.:.:::::::::::::::: ... : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TAX RE TURN - COMPUTA IO / T N OF TAX ON JOINT TRUST ACCOUNTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ s€€;~~ ::.:::::::::::::::~::;~:;:;:;:;:;:;:;:::;:::;,;:;:;:;:;:;:;:;:;:;:;:;:;~:;:::_:;,;:~~;:~~:~:;:;:;:~:~~:~~: __#?#~~ __:. LINE 1. Date Established 1 ~~~'••``' 2. Account Balance 2 ;;~,' 3. Percent Taxa le X b 3 ':~~ ~ €?_€~ €~ €~ €~ €`~€€ ~ €~ €€~ €s € Vii':°€~~~i~ €~€~ ~~ €~ ~ €si 4. o Ae unt Subject to Tax 4 7 P's':isS':'~ ~ ~E~ ~ ~ '''~ `:~ [':'': ~~~~ ~ ~ ~ iii €i ~ ~~ ~j'''' ~'~ ~ ~ ~~ ~~ ':~' 5. Debts and Deductions 5 6. A3nount Taxable 6 :::::::~:..:.:.: ,: _•>:•>::as€:;=::~;~:::~::~;:~::~::~::~::~:;::~::;::•:;::~~~:€~:<~: 7. Tax Rate 7 X ~ ::::::::::..... :::~:::~:::::•~::s::::::::::::::~::::~::~::~::~::::~;:~.;~:::~:::::•~::: 8. Tax Due 8 !~ ~ iii €~~ ~€ ~ s~ ~ ~ ~i_~ €~~~ €~ '~ €`~ iii PART DEBTS AND DEDUCTIONS CLAIMED S^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, 'c/orrect and c eplete o the best of my knowledge and belief. HOME C ) - ~S Y-~ WORK ( p ) -- 6l 7 ~. TA P YER IGN T RE TELEPHONE NUMBER AT 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 ar others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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. BLOCK B - If the asset specified an 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. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check black "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check far 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: Far 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 S3,D00 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (**) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 = 16.7% (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 DIVIDED BY TOTAL NUMBER OF SURVIVING JOIN7 X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decadent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable Cline 3l. Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate Cline 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%~ 12% 15% ^ n~u ~dx roes impvseo vn me net value or vansters trom a deceased chlld twenty-one years of age or younger at death to ar 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 net 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. 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 11". Proof of payment may be requested by the PA Department of Revenue. CDMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE /S FILE NO. 21-Oo~- 7' BUREAU DF INDIVIDUAL TAXES AND DEPT. 28D601 TAXPAYER RESPONSE ACN 02132288 HARRISBURG, PA 171za-obDl DATE D7-12-2002 REV-1543 E% ~FP (09-OV) TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST t,? ., +~ COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: H R GROVE II REGISTER OF WILLS 203 FROST RD - CUMBERLAND CO COURT HOUSE GARDNERS PA 17~Y4; CARLISLE, PA 17013 PNC 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 tc the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling [717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001037033 Date 04-1 4-1994 To insure proper credit to your account, two Established (2) copies of this notice must accompany your Payment to the Register of Wills. Make check Account Balance 5, 041 .47 payable to: ^Register of Wills, Agent^. Percent Taxable X 8 .333 NOTE: If tax payments are made within three Amount Subject to Tax 420 .11 (3) months of the decedent's date of death, Tax Rate x . 045 you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 18 • 90 i n ne (9) months after the date of death. PART TAXPAYER RESPONSE ,:.:; ~~.r~: ~.~~e ~t~__~R~~u~:. ,~t~t~ l_,., . ~~~~~:: t~..,A~~:~M~~ ~~:;~:~r~A.rr::;:A~~~:ct~x~}e!:::~;:~~~~:~:~~: ~r~::~~~+:!r~~e~::~ A. ^ The above informaticn 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 CHECK 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. C 0 N E ~ B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART If you indicate a different tax rate, please state your relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 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 DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported abovre~ are true, correct and c eplete to the best of ny knowledge and belief . HOME C ~~' ~ ) / pQ " ~.5 ~J`' WORK ( ) S2 T P E SIGN T RE TELEPHONE NUMBER AT 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 tc 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 era taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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. BLDCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance lax 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. BLOCK C - If the notice information is incorrect and/or 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 Registefr of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Farm REV-1548 EXl upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 53,OOD per transferee regardless of the value of the account or the number of accounts held. If a double asterisk [*~) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable far 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 = 16.7% (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 DIVIDED BY T07AL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FDR EACH SURVIVOR) The amount subject to tax Cline 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. Tha amount taxable Cline 6) is determined by subtracting the debts and deductions (line 5) from the amount subject tc tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed an the net value of transfers from a deceased child twenty-ono 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 descendants. "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, adapted descendents and their descendants and step-descendants. ^Si6lings" 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. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible far payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. 8. 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/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2806D1 HARRISBURG, PA 171z6-D6o1 REV-1543 EX RFV (09-00) INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE N0. 21 ~ ~.~. - `1 ~ J 4 02132301 07-12-2002 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST "- ~ - ' ~ COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: WILLIAM K GROVE REGISTER OF WI LLS 203 FROST RD ` CUMBERLAND CO COURT HOUSE GARDNERS PA 17324 '•'~. CARLISLE, PA 17013 PNC 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 farm and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (7171 787-8327. COMPLETE PART 1 BELOW ~ * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 318000084260 Date 04-22-1997 Established Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due 5,057.14 X 8.333 421.41 x .045 18.96 To insure proper credit tc your account, two (27 copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent^. NO'iE: If tax payments are made within three C37 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. PART TAXPAYER RESPONSE A. ^ 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 CHECK a discount or avoid interest, or you nay check box ^A^ and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK B. ^ The above asset has been or will he reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART If ou 'c ' sndi ate a different y tax rate, Please state Your :;:;:::~ ::::::::::::::::::ss:~:::: ::::::::::::::::::::::::::::::::::~:: ~ iis?~ ii;i'ii~ ii i€~ i? € :::::::::~::::::::::::~::::::::::;;:,,.:::::.:.,.::::::-,::::,::::::::::~;:::::::::::;,:~::::~: i~ :.......:::.::: :::::::::...:::::. ::.-::~s::::::::::::: - ~ ~~~~iii ~~i€s 17i€; €ii €i€si i€iAAi ~ 2 - _ relatsonshi to P deceden t: _s[ ~_~i€~i€~ii~i::::;:= ::::::::::::::::::~: ~~::~::::::::;;::~::::::~ ::::::::::..::~::~:~::~:;:::<,~:::-::::::.................. ....::: _ TAX RE TU - RN COMPUTATION 0 F ~ TAX ON JOIN T TRUST ACCO LINTS LYNE 1. Date Established 1 2. Account Balance 2 :~ ;; _;'::_ ~ ;:,.,:s[:? ;<t:;<[:[: :.:.:.:::::.:::...•.:::~~~_;:;::;: t:::[:t<[;::::s::::~ ::~ ::~ [__ it=.::~ ;:ist1~ ti: ~~ ::~ :~ :~ :~ [astss ~i•it9:iS:it€=_':~ ti[i[€s[€:~[€=~ ;:::;:;:;:;:;:;:;:;:;:;~:::;:;:;:;:;:;:;:::;:,:;:;:::;:;:;:;~:;:;:;:;:;:;,~::;:;:;:;:::::::::::::;:;:;:;:; 3. Percent Taxable 3 X :::::::::.:::~::..:.;...,.,.,.,.,. .:.:.,, :,:::~, ::-:.,.,.,.,.,.,.,.,.,.,.,.;.,.,.;.,...,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.;...,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.:.,.: ::: :: ,:: 4. Ano unt Sub 'ect to Tax J 4 5. Debts and Deductions 5 6. Amount x Ta able 6 7. Tax Rate 7 X 8. Tax Due 8 :::::..:::::: .. . _~ :::::.:::::::::::::::::::;•:s:;:::;:::::~::~::~::::;~;:;:;:;:::::~::::::~::a::: ........................ ... PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and conpl a to the b t of ny knowledge and belief . HOME C 7 ~7 ) 7 ~ ~~ l ,y L~ -~~~. WORK ( ) 7-2G X AYER SIGNA LIRE TELEPHDNE NUMBER DATE VtNtRAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based an 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 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. 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 2806D1, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check black "C^ and complete Parts Z 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 Nills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decadent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,DOD per transferee regardless of the value of the account or the number of accounts held. If a double asterisk C^*) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 = 16.7% (TAXABLE FOR EACH SURVIVOR) 8. The percent taxable far assets created within one year of the decedent's death or accounts owned by the decedent but held in trust far another individual(s) (trust heneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X lOD = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is D%. 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 ar 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. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. Vou 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 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA ,J DEPARTMENT OF REVENUE N BUREAU OF INDIVIDUAL TAXES DEPT. 288601 HARRISBURG, PA 17128-8681 FILE N0. 21 w(>a-?~Jr ACN 02132266 DATE 07-12-2002 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST - COUNTY CUMBERLAND ~ CERTIF. ~.` REMIT PAYMENT AND FORMS T0: ROBERTA D GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS RQ 17324 CARLISLE, PA 17013 INFORMATION NOTICE AND TAXPAYER RESPONSE REV-1543 E% ~FP (09-OR) PNC 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 farm and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (7171 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001037050 Date 08-3 0-1994 To insure Proper credit to your account, two Established (2) copies of this notice must accompany your Payment to the Register of Wills. Make check ACCOUnt Balance 5, 039 .30 payable tc: "Register of Wills, Agent^. Percent Taxable X 8 .333 NOTE: If tax payments are made within three Amount Subject to Tax 419 .92 (3] months of the decedent's data of death, Tax Rate X , 00 you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax DUB .00 nine (9l months after the date of death. PART TAXPAYER RESPONSE ::,:::~>~:h'.~::~~#i€~ €t*~€€~#!1#:~ i~#!f'issi:::::::1dl~~~1#€'M€i€st!1uai1#....~*~'~!tla.!titt.......'t~~t.:.:. dl~~~''~~#i~"~i!€~~lk~~#k'~;;~?!t'i~SE~€€~';M!E#~~ TAX RETURN - COMPUTATION i.iNE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due A. ^ The above information and tax due is correct. 1. Yau may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of Mills and an official assessment will he issued by the PA Department of Revenue. C 0 N E ~ B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY tc be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/ar PART 3^ below. If PART ou indicate a different tax rate lease state our y , P y ::::::- ::::::::::::::::::::::::::::::::::::::-::-::;:_:::::::;:_::::::~::~::~:::;-::::-:_:.,.::,.,.,:`::,::::s:<:~~.:.:.:.,::: ~ iii: iii ~~~i~~ii~it~Llss~l?Ii~s'€~si ' s relationshi P to decedent: : ....................... •:i'!'.i~~ ~:~:#sf?i'.;i°sii~i~i'.'~tYi?'.~SSytiii'.+SS?3ti~~t!tferiM" OF TAX ON JOINT/TRUST ACCOUNTS i 2 3 X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of ny knowledge and belief. HOME C /~~ ) ~ SQL ~ ~ L ` , ) il,~ d~ l ~. ~ G' J`.:.~-'Lc*-~J--c ~,~ ~ WORK ( ) ~r 'i' ~ ,'~L TAXPAYER SIGNATU~~I TELEPHONE NUMBER 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 these held between hushand 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 hushand and wife more than one year prior to death are mat taxable. 6. Accounts held by a decedent ^in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE BLOCK A - If the information and computation in the notice are correct and deductions are mat 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. BLDCK 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. BLOCK C - If the notice information is incorrect and/er 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 amcunt 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1l year of death are taxable fully as transfers. However, there is an exclusion not tc exceed 53,OD0 per transferee regardless of the value of the account ar the number of accounts held. If a double asterisk (**) appears before your first name in the address portion of this notice, the 53,OD0 exclusion already has bean deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable far joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER DF DIVIDED 8Y TDTAL 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 1D0 = 16.7% (TAXABLE FOR EACH SURVIVDR) B. The percent taxable far assets created within one year of the decedent's death or accounts awned by the decedent but held in trust far another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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 lD0 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4l is determined by multiplying the account balance Cline 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amcunt taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 47. Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. 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 decadent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. 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 11". Proof of payment may be requested by the PA Department of Revenue. /COMMDNMEALTH DF PENNSYLVANIA ~~ DEPARTMENT DF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2806D1 HARRISBURG, PA 17128-0601 INFORMATION NOTICE AND TAXPAYER RESPONSE REV-1543 EK AFP (09-RO) j~_ ~~- /v FILE N0. 21-Ua -7l,rj ACN 02132269 DATE 07-12-2002 ROBERTA D GROVE 203 FROST RD GARDNERS PA 17324 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC 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 ycu 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 Pennsylvania. questions nay he answered by calling [717) 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31200132328 Date 07-07-1998 To insure proper credit to your account, two Established (2) copies of this notice must accompany your Account Balance 5,025.75 payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 8.333 NOTE: If tax payments are made within three Amount Subject to TeX 418.80 (3) months of the decedent's date of death, Tax Rate X , QQ ycu nay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential T9X Due • 00 nine (97 months after the date of death. PART TAXPAYER RESPONSE ::::.~A•:rte:tati#t~::~'hrei:::~f#tsit~>:~thba:~t;:~:~i:i~~~i#::~t!:>::tt~t:~::~Lat ~s~*~+:hk~:t!•~k#:::.~~.~I~ir.::::~l;L~+s~A.#~rrrk::S6s~ii~ IwUE :t*M~:::;wtis~+h~?~~;;:° A. ^ 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 CHECK a discount or avoid interest, or you may check box."A^ and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART Y t a different tax rate, please state your iii: i€?~ ~ ;€siiii~ iii i` . ~ ~~ .: •~: ::::isiisi iiiisi i€~ '= ~ ..:i relationshi to decade t: ::::::::::::.:::~:::::::::::::::::~:::~:::::::::-:::::::::::::::::::::::...::........::...::...:.........::..::..::.:.::.......... ?~'; ~si~ iiiii€si€~}i€s~G~~:i:~GR7:#:[. ° -a ~€ . '~~: ~~ . ~ '~~ ':': ~iii'iii TAX RE TUR - N COMPUTATION OF T AX ON JOINT TRUST ACCOUNTS :::- ..:......:::::::::~::~::~::_::~:::::;::~::::::::::~::~~:~::~::~::~~~;;;:~:::~:::::~:::;::~::~::~::~;:~_;:_>~:;;::::::::: !A~° ::::::::::::::::::::::::::::::::::::~::::~:::::::::::;:;:;:;:;:::;:::::~::::::::::::,:_::_::::;:;:::;:::;:;:;:; LINE 1. Date Established 1 2. Account Balance 2 :~ 3. Percent Taxable 3 X :~s::::~::::::::..- :...........:..:.:.:.:.:.:.:::::::::::::::::::...:.:::.:.:.:.:.:.::::::::::~:::~::::::::,:,:,:,:,:,:,:,:,:::,:,:,:: 4. A o n unt Sub "act to T x a 4 J 5. Deb s t and Deductions 5 6. Amo unt Taxable 6 ~l~ ~ ~~~ ~ iii !! _i6?~~~~_'~~ ~ ~ s~ ~ ~~?~ r ~ ~~s~~fsss~ ~~~ ~ ~' 7. Tax Rat e X 7 8. Tax D ue 8 ......_~~[`~':`~iyyfj~ {6}[~ ~€[€~ ~ ~ ~~ €i ~_ _['~+~~ €~ ~==s ~"~''sss~~ iii Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete /to the best of ny/ kno~,wrledge and belief. HOME C ~~ s~) ) C.f ;S~ L; )J ~ 1 `{ =;fl)B~'L~Lc~i~ %~:; . ~.f'../~~=1.~.:~,-~_ WORK ( ) ~ ~ °~ TA PA ER SIGNATURE TELEPHONE NUMBER AT PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID VtNtKAL 1NFURMATiON 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. Acccunts (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. b. Accounts held by a decedent "in trust for^ another ar others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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. 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 6y 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. BLOCK C - If the notice information is incorrect and/or 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 tc the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Farm REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 53,D00 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (~*) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the data of death. 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 = 16.7% (TAXABLE FOR EACH SURVIVOR) The percent taxable for assets created within one year of the decedent's death ar accounts owned 6y the decedent but held in trust for another individual(s) Ctrust beneficiaries): 1 DIVIDED BY TDTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable Cline 6) is determined by subtracting the debts and deductions (line 5l from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7l as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^The tax rate Imposed on the not 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. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible far 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 11". Proof of payment may be requested by the PA Department of Revenue. DNMDNWEALTH OF PENNSYLVANIA / ` V`~ /~~ DEPARTMENT OF REVENUE INFORMATION NOTICE FILE N0. 21 ~Vi2-?!$ r~ BUREAU OF INDIVIDUAL TAXES ~~ DEPT. 280661 AND ACN 02132272 ` HARRISBURG, PA nlzs-obol TAXPAYER R E S P O N S E DATE 07-12-2002 REV-1543 E% RFP [R9-DO> TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST - COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: ROBERTA D GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PA `;a 7324 CARLISLE, PA 17013 PNC BANK has provided the Department with the infornation 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 infornation 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 Connonwealth of Pennsylvania. questions may be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31200118978 Date 02-06-1998 To insure proper credit to your account, two Established C21 copies of this notice oust accompany your Account Balance 5, 026 .48 Payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 8.333 NDTE: If tax payments are made within three Amount Subject to Tax 418.86 (3:l months of the decedent's date of death, Tax Rate X , QQ you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential TaX DUB • 00 nine (9) months after the date of death. PART TAXPAYER RESPONSE ?~~::::~:'€~::::1#~f;:::~~I:~::~:~~~i'1'~tai~did~€#~~.~,":~A~:::~:;'I'~!',.14:::::~4~'i..+~`'i.~i~~:::;s~~~.~i~I~!'1*~t; A. ^ The above information and tax due is correct. 1. You nay choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A^ and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to ba filed by the decedent's representative. C. ^ The above infornation is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If ou indicate a different tax rate lease state our ~~~i~?€;~€~~€€€~=€€;€~€€€ :::::::::::::-::::::-::,::::::::::;::::::::::::::,,~::::::::~,~::~€€~:::~::;€:_:,:::: PART y , P y ~ ~€°~sOCAIr'L~~€~~~IIr~~ ss~=;:. ~;~? relationshi to decedent: ~~iE~€==~[€~€i~ii€~i~€iss:°s<~;:;~€:_:==?;s;::~:~~==~~s€;s€;~::=~:s::::::.::~s ::::::::::::: 2 p :::::::::::::::::::::::::::.::::::: .. ..... .... ............................. :::s€:;:;:;:~ii~ i~Ll"fiR4MR`1::f:~T:~s347[~eRi ~' ~'~ is T N CO PUTATIO 0 TAX ON TAX RE UR M N F JOINT TRUST ACCOUN S T E`~' ~~ ~~€~€ ~~€ ~`€~~ € ~~€i~ _ €~~~€~_ ~~~€~ ~i~ ~ iii ~i~~ ~~= INE 1. D 's L ate Establs hed 1 2. Account Balance 2 . P c X 3 er ent Taxable 3 `:i':iiiii°'ii[i~ ~~~~ ':' ~ ~':'' ~!''~ !~ ~ ' ~'~ f'sfiffi~ ~ ~ ~~ Vii; ~!~ ~ €i?€~ ~_ ~s 4. Amount Sub"ect to Tax 4 7 ?~ `~~s`~~~~~'_~'''='~''z~ ~ ~~~~~ jib ~~atj~~~!~~~ ~ ? ~ ~~ ~~~ ~_ 5. Debts and Deductions 5 6. A o n unt Taxable 6 7. Tax Rate X 7 `ii'i``°~~~~'~~~~''[`'~`~'~ ~'~''`~ ~ ~ ~ ~ iii I~ ':as~j' ~''~~ '``~ ''~' 8. Tax Due 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of ny know~dge and belief. HOME C 7 i~~ ) ~ ~ ,,)~ ~~$, ~ / .,~- . ! - ~:~r~~_ ~--t~J~,r~':~c ~ ~. ~ ~ ~CL__~ ~%«:• WORK C ) ,,,~. TA PAY R SIGNATURE TELEPHONE NUMBER -1)4Te` GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based an 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 thcugh 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 era not taxable. 6. Accounts held by a decedent ^in trust for^ another or others era taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in black ^A^ of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax tc the Rag is ter 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. BLDCK B - If the asset specified on this notice has been or will ba reported and tax paid with the Pennsylvania Inheritance lax Return filed by the decedent's representative, place an ^X" in block ••B^ of Part 1 of the ^Taxpayer Response" section. Sign on copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or 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 TAX RETURN - PART 2 - TAX COMPUTATION 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 53,000 per transferee regardless of the value of the account ar the number of accounts held. If a double asterisk C~~) appears before your first name in the address portion of this notice, the S3, 000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 tc the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF JOINT OWNERS X 100 = PERCENT TAXABLE Exam le: A SURVIVING JOINT OWNERS P 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 DIVIDED BY T07AL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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) _ .SO X 100 = 50% (TAXABLE FOR EACH SURVIVOR) Tha amount subject to tax (line 4) is determined by multiplying the account balance (line 27 by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions Cline 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present The tax rate mposed on the 0% net vwli~° ^c +.-~^ 4.5%* ~r..__ ,__ _ 12% _ . 15% death to or for the use of a natural " ""' ° veceasea cnltd twenty-one years of ago or younger at parent, an adoptive parent, or a stepparent of the child is 0%. he lineal class of heirs includes grandparents, parents, children, and lineal descendants. ^Childran^ includes natural children bather or not they have been adapted by others, adopted children and step children. ^Lineal descendents" includes all children of the atural parents and their descendents, whether or not they have been adopted by others, adapted descendants and their descendants nd step-descendants. ^Siblings^ are defined as individuals who have at least one parent in common with the decedent, whether by blood r adoption. The ^Collateral^ class of hairs includes all other beneficiaries. 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. 8. 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 11". 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 INFORMATION NOTICE AND TAXPAYER RESPONSE REV-1543 E% ~FP (09-OD) i ~ - ~'C1 _i'0 FILE N0. 21 -()oZ~Z/~ ACN 02132275 DATE 07-12-2002 TYPE OF ACCOUNT EST. OF H R GROVE ^ savlNGs S.S. N0. 178-16-5175 ^ CHECKING ~:, DATE OF DEATH 05-12-2002 ^ TRUST .;,. ~ ~ `~ ~ COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: ROBERTA D GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS P~:i17324 CARLISLE, PA 17013 PNC 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 Pennsylvania. Questions may be answered by calling [717) 787-8327. COMPLETE PART I BELOW * ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3160D072307 Date 01-18-1997 To insure proper credit to your account, twc Established (2) copies of this notice must accompany your Account Balance 5, 027.81 Payment to the Register of Nills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 8.333 NOTE: If tax payments are made within three Amount Subject to Tax 418.97 (3) months of the decedent's date of death, Tax Rate X , QQ you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential TaX Due • 00 nine (9) months after the date of death. PART TAXPAYER RESPONSE s~>~t~i~#i:::::'!r~ ::::~~~~YEf::::~#~t~::#:,:::iQ~~€~::at!,:~:~:t~~::::~A#....i*1'#a~!t~i_.....1t>tir:._. A#i~l~?t!~::::~t>i~~~ :s:i:€:'!t~ ::~i~1!;'~i A. ^ The above information and tax due is correct. 1. You ^ay choose to remit paywent 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 CHECK C 0 N E ~ Wills and an official assesswent will be issued by the PA Departwent of Revenue. B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. C. ^ The above inforwation is incorrect and/or debts and deductions were paid by you. You roust complete PART 2^ and/or PART 3^ below. PART If you indicate a different tax rate, please state your ~~~~~~~~ ~ ~~{~ 2 ^ relationship to decedent: ......... .... ..... ~#y' :s:~=_~:;: ~: iii. iii iii":~iiiii~EiG~PG::~Gl?{~s~~~ 14LG1?I~ ~isi~ '__"~~~[ TAX RETURN COMPUTATION OF TAX ON JOINT TRUST ACCOUNTS ...1~~1` ~~ i ~~ Vii!=':._~ i!~ ~ ~~~ `~ ~~ ~~ '€~~ '€i'~i~~i~ €~ €i€~ ~ +€~~ € <€~~ €~ € LINE 1. Oate Established 1 s~~t' `f€t[{€EtfE€fzE€~ ~ 3~ `~ €€~ ~ iii ~ ~ ~ ~ _ '~ ~ ' 'E` 2. Account Balance 2 s 3. Percent Taxable 3__X 4. Amount Sub"ect to Tax 4 7 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED H^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of ny knowledge and belief. ~ , r A ~ r~ ~ HOME C ')J ) ) ~1,~ 13 '[ ,G'#~- ,-% . -~~ _~~-~C~7,,~-'~- -= WORK ( ) ~~~~ TAXPAYER STAXPAYER S GNA~TELEPHONE NUMBERNUMBER ~1)/4TE litNtRAL 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 BLDCK 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. BLOCK 8 - 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. BLOCK C - If the notice information is incorrect and/or 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one C1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (**) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted fron the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable far each survivor is determined as follows: A. The percent taxable far joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BV 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) 8. The percent taxable for assets created within one year of the decedent's death ar accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED 8Y TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE DWNERS OR TRUST BENEFICIARIES 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 8Y 2 (SURVIVORS) _ .50 X lOD = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance Cline 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 57 from the amount subject to tax (line 4) Enter the appropriate tax rate (line 7] as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^ine tax rate inposea an the net value of transfers trom a tleceased chlld twenty-one years of age or younger at death to or for the use of a natural parent, an adaptive parent, or a stepparent of the child is 0%. fhe lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children^ includes natural children +hether or not they have been adopted by others, adopted children and step children. ^Lineal descendents" includes all children of the iatural parents and their descendents, whether ar not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Sibling s^ are defined as individuals who have at least one parent in common with the decedent, whether 6y blood ~r adoption. The "Collateral^ class of heirs includes all other beneficiaries. 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 11". Proof of payment may be requested 6y the PA Department of Revenue. COMMDNNEALTH OF PENNSYLVANIA DEPARTMENT DF REVENUE \ BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 INFORMATION NOTICE AND TAXPAYER RESPONSE REV-1545 EX ~fP (09-DO) y-~a ~a FILE N0. 21 -~~ 7/S ACN 02132278 DATE 07-12-2002 i :- _ ROBERTA D GROVE 203 FROST RD GARDNERS PA i]{7-324 TYPE OF ACCOUNT EST. OF H R GROVE ^ savlNGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC 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 Pennsylvania. questions nay be answered 6y calling (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001036937 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due Date 11-10-1989 Established 5,044.28 x 8.333 420.34 X .00 .00 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, AgenY'. 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. PART TAXPAYER RESPONSE A. ^ The above information and tax due is correct. 1. Vou ^ay choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or You may check box ^A" and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L D CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your ;;;;;;;;;; ;~;; ~~~~~~~~ ~ ~~~ 2 ^ relationship to decedent: :::::;:~::~::~::.... ..1t...l~~!i~~::..: ~:::.. ii€`s`X!fiXL~"~~Ll?/:it:iitiiF€i1?i~fi TAX RETURN COMPUTATION OF TAX ON JOINT TRUST ACCOUNTS ?~~~~ LYNE i. Date Established i - 2. Account Balance 2 :::::::::::::::::::.:::::::::::::::::::::::::::~::::::::::::::::::::::::::::::::::::~::::::::::::::~::::::::::::::::::::::::::::::::::::::::::::::~:::::::: 3. Percent Taxable 3 X 4. Amount Sub' c e t to Tax 4 7 5. Debts and Deductions 5 - '""""""" """""""'i'd" 6 . Amount Taxable 6 ~~ ~'~ "' ° ` `' "~` ~ `~ 7. Tax R t X a e 7 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and comp,,l~ete to the best of ny kn~ow.ledge and belief. HOME ( ~!'~ ) ~/ s L '~ .yj L y _~~f'~-+~-~..t~h~,.i~ -_ ~ %~ .~JC~-'~' _ WORK ( ) '~ 9~/.~~ - TAXPA ER SIGNATURE TELEPHONE NUMBER A~ TE VtNtKAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information subnitted 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 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 Raspanse^ 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. 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. BLOCK C - If the notice information is incorrect and/or 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decadent 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 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk C~~) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 = 16.7% (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 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax Cline 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 37. Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions Cline 5l from the amount subject to tax (line 4l. Enter the appropriate tax rate (line 77 as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^The tax rata Imposed on the net value of transfers from a deceased child twenty-one years of age ar younger at death to or for the use of a natural parent, an adaptive 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 bean 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. 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 11^. Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE U OF INDIVIDUAL TAXES INFORMATION N OT I C E FILE N0. 21 ~(J,Z--~~$ BUREA DEPT. 250601 AND ACN 02132281 (\~', e~~ HARRISBURG, PA I7IZS-o6ol 1~" TAXPAYER RE SPONSE DATE 07-12-2002 REV-1545 E% SFP (09-00) u J ~ TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST {- -; COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: ROBERTA D GROVE REGISTER OF WI LLS 203 FROST RD CUMBERLAND CO COURT HDUSE GARDNERS PA ];x,324 CARLISLE, PA 17013 PNC BANK has provided the Department aith 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 Pennsylvania. questions may be answered by calling (717J 787-8327. COMPLETE PART 1 BELOW * * ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31100023533 Date 01-05-1996 Established Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due 5,027.22 x 8.333 418.92 x .00 .00 To insure proper credit tc your account, two (2l copies of this notice must accompany your payment to the Register of Wills. Make check payable to: ^Register of Wills, Agent^. NOTE: If tax payments are made within three (37 months of the decedent's date of death, you may deduct a 5% disccunt of the tax due. Any inheritance tax due will become delinquent nine [9) months after the date of death. PART TAXPAYER RESPONSE A. ^ 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 CHECK a discount or avoid interest, or you may check box ^A" and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to he filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ^ and/or PART ~ below. PART If you indicate a different tax rate, please state your ~~~~~~~ ~~~ relationship to decedent: .:.: s :: ::~::~::~::~:: : : .: ...... : :.....::. :: : :: . ..:: : :. . : ::: ::.::.......:..::~~~: ~ :::;~: : 2 - ~ :~:: : : z:s:~::~ ::~i~ .~ # ~ ! ; # Y ~ ,, i :: :: . . . : :::::::::::~ ~ l~~'~Mis=~~i~iiiP.GG!?~ V iEiEs~ i~s~ ~` TAX - RETURN COMPUTATION OF ~ TAX ON JOINT TRUS C T A COUNTS LINE 1. Date Established 1 : :: :: ..:.:.:. ~ -~ .:: 2. Account anc Bal e 2 3. Percent Taxa ble 3 X 4. Amount Sub"ect to Tax 4 7 5. Debts a nd Deductions 5 6. Amount Taxab 7. Tax Rate X 8. Tax Due 8 ::::::, . _,..." ::::::::::::::::: :: s ::;::::::::: ~:::~: ~:~::~::::::::::,:,:,:,:.:.:::::;;::::;:.:::;:;:;:;:; ~:;:;:::;:,:,:,:,:.:,:,:,:;:,: PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. .~ i~ ~ HOME ( ' ~ ) ~.. ) 3 z `/ r-~ Se'~:~--~+-~ ~-.'-,? ~~~.~,,7 7 ~:c_S: ____-, WORK ( ) ~~1 ~. ~_ TAXPAYER S GNATU E TELEPHONE NUMBER 'T ATE 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 taxahle 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 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. BLDCK 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. BLOCK C - If the notice information is incorrect and/or 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 (Porn REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (*~) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established mare 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 8Y 3 CJOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 1DD = 16.7% (TAXABLE FOR EACH SURVIVDR) B. The percent taxahle 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 X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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 BV 2 (SURVIVORS) _ .50 X 100 = SD% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5l from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%^ 12% 15% *Ihe tax rate Imposed an 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 D%. 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, adapted 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. 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 tc 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 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE _~~, BUREAU OF INDIVIDUAL TAXES ~1 DEPT. 280601 4 HARRISBURG, PA 17128-D601 INFORMATION NOTICE AND TAXPAYER RESPONSE REV-1545 E% ,FP f09-00) ~ ~~_ ~~;- ~c~ FILE N0. 21 -'va"7~5 ACN 02132284 DATE 07-12-2002 ,> ROBERTA D GROVE 203 FROST RD GARDNERS PA 17324 ', ' °, TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUS7 COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the Department with the infornation 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 infornation is incorrect, please obtain written correction from the financial institution, attach a copy to this fern and return it tc the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Connonwealth of Pennsylvania. questions nay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001035967 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due u TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due Date 06-15-1994 Established 5,008.22 x 8.333 417.33 x .00 .00 OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 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^. NOTE: If tax payments are Wade within three C3) months of the decedent's data of death, you nay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine C9) months after the date of death. PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of ny knowledge and belief. ~ o / . ~ HOME ('~/`~' ) ( .,: ~_. I.~ ~1. _~ _ y r--~-'`.R-~~t.t%~ ~~ _> ~i~~--'~~!~~~ - WORK ( ) ~~~~,/~v.~. 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 ar others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in black ^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 [Farm REV-1548 EX) upon receipt of the return from the Register of Wills. 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. BLOCK C - If the notice information is incorrect and/or 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: Far a decedent dying after 12/12/82: Accounts which the decedent put in joint Hanes within one (1) year of death are taxable fully as transfers. However, there is an exclusion mat to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (~~) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 8Y TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JDINT 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 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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) The amount subject to tax (line 4) is determined by multiplying the account balance Cline 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 67 is determined by subtracting the debts and deductions Cline 5) from the amount subject to tax (line 4). Enter the appropriate tax rate Cline 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *ihe tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death tc or for the use of a natural parent, an adoptive parent, or a stepparent of the child is D%. the lineal class of heirs includes grandparents, parents, children, and lineal descendants. ^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. 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 11". Proof of payment may be requested by the PA Department of Revenue. f~{ t! COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE I N FO RMAT I O N NOT I C E BUREAU OF INDIVIDUAL TAXES AN D DEPT. 280601 HARRISBURG, PA 17128-0601 TAX PAYER R E S PO N S E il-~~~C~ FILE N0. 21 ~a -~~~ ACN 02132287 DATE 07-12-2002 REV-1545 E% ~FP (R9-RR] ~~ ROBERTA D GROVE 203 FROST Rp, GARDNERS PA 17324 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC 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 fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. questions nay be answered by calling (7171 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001037033 Date 04-14-1994 To insure proper credit to your account, two Established (2) copies of this notice must accompany your Payment to the Register of Wills. Make check Account Balance 5, 041 .47 payable to: ^Register of Nills, Agent^. Percent Taxable X 8.333 ND'fE: If tax payments are made within three Amount Subject to Tax 420.11 C3) months of the decedent's date of death, Tax Rate X , QQ you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax DUe .00 nine (9) months after the date of death. PART TAXPAYER RESPONSE 1 ^ : :::::..................................................................................................................... :: .................................................................................................................................. ...................._.....................................................................................................................................::::: ism[!1;~::~11y~'i:+b'#R::t~~'r`~.(:*a'u':t~i#!f'~! _ ~~~A`t~€'M 'F11~__€di(~__~fik''~!~!~#i 'M'A#C..i~''~'`i~'~.'''ti~#nt''tii''.Yk~:~`Mi:A~i~'f!?~:~li#:~'(!'lit'r!:~:ti's~F(.~l!iM#S A. ^ The above information and tax due is correct. 1. You say choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK 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. C 0 N E ~ B L 0 CK 8. ^ The above asset has been ar will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART If you indicate a different tax rate, please state your ~' ~~~ ~' ~~~~~' ~~'~ ~~ `'~-"'`"`°'" ,` '"~ z~ii i= ~s':€_ ~S€~ [€~ iisiiiiili~S1r€i€ii;iii~i€`Si€i:i ~~~ ~ ' :: 2 - - relatsonshl to deceden p t: . . i[iissiii~ii~ii"si~iii':€;;i':i~;==€~t,;:~~=;i;<;:~;:~;:iii`'':s;:~'_~=nisi:::-:::::::-::::~::::~~::~:: ~ i~~ iii €~ i' i ~;~~ ~ °~ : - :::. ~ ::::::: ..::::::..:. - =i~ ii€~ ~ ii i€ TAX RE TURN COMPUTATION OF TA X ON JOINT TRUST ACCOUNTS `~~~~ s ! ~;!€`=~ ~ ~ ~ ~ ~ ~:~ iii€€sEi~ ii'.='. ~!~ ~€~ ~ ~ ~i€? LINE 1. Date Established 1 t; 2. Account Balance 2 3. Percent Taxable 3 X iii ~ ~~ ~='=~~ ~~~ ~~ i~i~ ~€€~ €~€~€s€`!€€~~ ~~ €~€~ €~~i~€€ 4. Amount Sub"ect to Tax J 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 P r DEBTS AND DEDUCTIONS CLAIMED ~ 3 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have repor~tted above are true, correct and complete to the best of ny knowledge and belief. HOME C / ~`~' ) ~/ ~ (~ /~ ?y 1 y ~,; ~i-~z ~, _~ ~ ~~ ; r- ..~ ~~ WORK ( ) J ~"D' TE .~_. TAXP ER SIGNATURE TELEPHONE NUMBER A GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife more than one year prior to death are not taxable. Accounts held by a decedent "in trust for^ another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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. BLDCK 8 - If the asset specified an 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. BLDCK C - If the notice information is incorrect and/ar 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 COMPUTATIDN LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decadent dying after 12/12/82: Accounts which the decedent put in joint names within one C1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,OD0 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (**) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 JDINT 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 far 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 X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions Cline 5) from the amount subject to tax Cline 4l Enter the appropriate tax rate (line 77 as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^ine tax race 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, adapted 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. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible far 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 11". Proof of payment may be requested by the PA Department of Revenue. 4 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D DEPT. 280601 HARRISBURG, PA 171zB-obol TAXPAYER R E S PO N S E REV-1545 EX RFP (09-00) FILE N0. 21 .-~.Z '7 ~~ ACN 02132293 DATE 07-12-2002 r.-: ~~ .. ROBERTA D GROVE 203 FROST RD GARDNERS PA,17324 TYPE OF ACCOUNT EST. OF H R GRDUE ^ SAVINGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ rRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC 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 acccunt. 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 Pennsylvania. Questions may be answered by calling (7171 787-8227. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001036938 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due Date 11-10-1989 Established 5,044.28 x 8.333 420.34 X .00 .00 To insure proper credit tc your account, two [2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Nills, Agent^. 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. PART TAXPAYER RESPONSE ... ... ...... ~ . A. ^ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Nills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box ^A^ and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK g. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART If you indicate a different tax rate, please state your ~~~`~~~~ 1~~~~~`~~lr lIS`€ ~~I1.~ :.:. ~ 2 relationshi to deceden t: .............. s=SS;iii;5ii~;i~i ::~ :z ~aa~ ::::::::::::: .:::::~ ::;:; ~~~~~~~~~~~~~ ~~~ '~'` .. !i~,i~ :~r: . ~*Yyyy~! rye . iitt . ~~YYl, iRL~"~:;F:~PI:if:isiE~iEiEiYIX+~ ~~~5ii~i~;_ :;:;:;:;:;:;:;:;:;:;:;:;:;:;:~ ;:: ~:::::::::::::::~ : ~:::::::::::::::::::::::::::::::::::::::~ ::: ~::~ ::~ ::~ :::::: TAX R E - TURN COMPUTATION OF TAX • ON JOINT TRUST ACCOUNTS :::-...:,~::::-::::::::::~:::::: `Ali'siis~:::~;~:; ::~::~::~::~::~::~::_;::;:~::~::~~::::::::::::~::~::~:;~~:;~ ::::::::::::::::~ ::::::~::~::~;::<: :_:::::~ ::::.:.:..:...::_:::::::;:;:;:;~:;:;:;:;:;:;:::;:::::;:::;:::;:;:::;:;:;:;:;:;:;:;:;:;:~~;:; LINE 1. Date Established 1 " 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Sub"ect t o Tax 4 5. Debts and ed D uctions 5 6. Amount Taxable 6 _ 7. Tax Rate X 7 8. Tax Due 8 _ss ~~~~~~~!~~~€'=~~€i ~€€€~~~~~iii:€'€~~~€~~~€ PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of ny knowledge and belief. HOME C ~ ~ ) " ~. ~ ~ "2. ~`~-t,~lt ~i~.__, ~ ~ ~ . ~- ~- WORK C ) - '^ 1 TAXPAI'ER SIGNATURE TELEPHONE NUMBER AT f 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 tc 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 far^ another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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 far the amount of tax tc 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. BLOCK 8 - 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 on copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-D601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check black "C" and complete Parts 2 and 3 according to the instructicns below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the ccunty 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 TAX RETURN - PART 2 - TAX COMPUTATION I. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 S3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (*~) appears before your first name in the address portion of this notice, the 53,000 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 JDIN7 OWNERS X 100 = PERCENT TAXABLE Example: A joint asset registered in the name of theVdecedentland twoRother persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 1D0 = 16.7% (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts awned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DI VIDEO BY TOTAL NUMBER OF SURVIVING JOINT X I00 = PERCEN7 7AXABLE OWNERS OR TRUST BENEFICIARIES 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) The amount subject to tax Cline 4l is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax Cline 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present *The tax rate Imposed on the 0% net value of tran 4.5%* sfers fr.,^ ~ ae......_ 12% _~ _ 15% seam to or for the use of a natural --~~ - --""'"°° ""'° `°°"`y-une years or age or younger at parent, an adoptive parent, or a stepparent of the child is D%. he lineal class of heirs includes grandparents, parents, children, and lineal descendents. ^Children" includes natural children hether or not they have been adopted by others, adopted children and step children. ^Lineal descendents" includes all children of the atural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants id step-descendants. ^Siblings^ are defined as individuals who have at least one parent in common with the decadent, whether by blood r adoption. The ^Collateral^ class of heirs includes all other beneficiaries. 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 claimetl must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/Z" x 11^. Proof of Payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA () DEPARTMENT OF REVENUE , \ p REAU OF INDIVIDUAL TAXES INFORMATION NOTICE FILE NO. 21 --1~,2-~~~ 1 j " BU AN D , DEPr. zsabol Pa nlza-o6al HARRISBURG TAXPAYER R E S PO N S E ACN 02132296 , Y I e\,i REV-1545 EX AFP (09-00 ) DATE 07-12-2002 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS - S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: ROBERTA D GROVE REGISTER OF WI LLS 203 FROST RD CUMBERLAND CD COURT HOUSE GARDNERS PA 17324 CARLISLE, PA 17013 PNC 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 Pennsylvania. questions nay be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31000212813 Date 01-16-1996 To insure proper credit to your account, two Established (2:) copies of this notice must accompany Your Account Balance 5, 014.04 Payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 8.333 Amount Subject to TaX 417.82 NOTE: If tax payments are made within three [3) months of the decedent's date of death, Tax Rate X , 00 You may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential TeX Due . 00 nine (9) months after the date of death. PART TAXPAYER RESPONSE ....:~AMt~~~~~ ~f~€€~t~~~~ it!~l°#€~€~€~ft~sB~M;~:~ ;:T#(€:a~ _;~r~!~r~~;. ?!f;A?)G ~s€8~#1~~# 1`€=€~~~~ti;;,;?`1'li#~~€€€€ Hf#'7` ~~~i€ A. ^ The above information and tax due is correct. 1. Yau 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 nay check box "A" and return this notice to the Register of CHECK Wills and an official assessment will be issued by the PA Department of Revenue. C 0 N E ~ BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART if you - dicate a different tax rate lease state our In , P Y t€;s€€t~€€~€~~:::::-::-:::- ::::::..:..:.:::::..:::::::::::::::::::::::::::#..:::#.::~::::.:::::!~;;!~;::: ; isi;ssii~i~~i~iiii~isi[aJl1X,~i€i€si€i€€i€i€€i relationshi 2 to decedent: ................................................................................................................................. ::::::~ ::::::::::::::::::~:::::::::~:::::::~:_:~::::::::_:::::::::::::::::::::~::::~::: ~:-::::::::::::::::::::::::::...................... :::::::::::::::::::::::::::::a!ili:: _:"xi~te:isFi:l:'r~~!~Y:Je!:::::L.V!!i:iiiii:4l!e!ii-i(di-iiif~iii TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART S^ OF TAX ON JOINT/TRUST ACCOUNTS l 2 3 X 4 5 6 7 X 8 DEBTS AND DEDUCTIONS CLAIMED Under penalties of perjury, I declare that the facts I have reported above afire true, correct and complete to the best of ny knowledge and belief . HOME C '~ ~7 ) y ,} ~' // `~y kf17~~~^i.'~c -~ ,1G..~~*7o~i-:e WORK ( ) ~ ~~_- TA PA R SIGNATURE ' TELEPHONE NUMBER DATE PAID PAYEE DESCRIPTION AMOUNT PAID GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information suhmitted by the financial institution. Inheritance tax becoees delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a natter of convenience. 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. Accounts established jointly between husband and wife more than one year prior to death are not taxable. Accounts held by a decedent "in trust for" another ^r others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE BLOCK A - If the informatien 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 then 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. 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 17126-06D1 in the envelope provided. BLOCK C - If the notice information is incorrect and/or 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 CForm REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/62: 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 53,00D per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (*x) appears before your first name in the address portion of this notice, the 53,OOD exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 T07AL 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 CJOINT OWNERS) DIVIDED BY Z (SURVIVORS) _ .167 X 100 = 1b.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 decadent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Jeint 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) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 37. Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6l is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4) Enter the appropriate tax rate (line 7l as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% eon ~a~n ampusea un me nei vague or Uansrer5 rrom a aeceasea Chlld twenty-one years of age ar 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. 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 11". Proof of payment may be requested by the PA Department of Revenue. j COMMONWEALTH OF PENNSYLVANIA J DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO.2I-Ua^~~5 ti BUREAU OF INDIVIDUAL TAXES AN D ~ DEPT. 280601 ACN 02132299 w HARRISBURG, Pa 1nzB-obol TAXPAYER RESPONSE DATE 07-12-2002 '~ REV-1545 E% ~FP (09-00) TYPE OF ACCOUNT EST. OF H R GROUE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST `~ COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: ROBERTA D GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS ~A,17324 CARLISLE, PA 17013 PNC 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 ware a joint owner/beneficiary of this account. If you feel this infornation 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 Pennsylvania. questions may be answered by calling (7171 787-8327. COMPLETE PART 1 BELOW * ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 318000084260 Date 04-22-1997 To insure proper credit to your acccunt, twc Established C2) copies of this notice oust accompany your Account Balance 5, 057.14 Payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable x 8.333 NOTE: If tax payments are made within three Amount Subject to TaX 421 .41 (3:1 months of the decedent's date of death, Tax Rate X , QQ You may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due • 00 nine [9) months after the date of death. PART TAXPAYER RESPONSE A. ^ The above information and tax due is correct. 1. You nay chocse to remit payment tc the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A^ and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 CK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above infornation is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your ~~~~C~~ ~ ~1NL~ ^ ~~ relationship to decedent: .......... ............................................................................................................................................................ . . . . . . . . . . .. .. . . . . .. . . .. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TAX RETURN - COMPUTATION OF TAX ON JOINT TRUST ACCOUNTS ~~#~~}~:. __ ..... LINE 1. Date Established 1 !'~~_ ~~°~~~~~~~~~~~ ~ ~ ~ ~ ~ iii ~a~~~ ~~ ~~~~ ~ ~~~'"~' ~'' 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 7 5. Debts and Deductions 5 6. Amount Taxab e 1 6 7. Tax Rate 7 X 8. Tax Due 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties ofi perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowle~+dge and belief . HOME ( " / ) ~/ ~ /.,~ .~J~ /?-~'.[-~C~c r:~~~~ I~1L? . ~-~[--~L i~%>=~ W.s WORK ( ) ~ » .7 TAXPA ER SIGNATURE TELEPHONE NUMBER A utNtKAL iNFOKMATION 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 tc death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are net taxable. 6. Accounts held by a decedent ^in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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. 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. BLOCK C - If the notice information is incorrect and/or 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (^*) appears before your first name in the address portion of this notice, the S3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 BV 3 (JOINT OWNERS) DIVIDED BY 2 [SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR) 8. 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 X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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) The amount subject to tax (line 4l is determined by multiplying the account balance (line 2) by the percent taxable Cline 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% *The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. (he lineal class of heirs includes grandparents, parents, children, and lineal descendents. ^Children" includes natural children Whether or mat they have bean adopted by others, adopted children and step children. "Lineal descendents" includes all children of the iatural parents and their descendents, whether ar 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 ~r adoption. The "Collateral^ class of heirs includes all other beneficiaries. 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 11^. Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 ~U~^~/rj BUREAU OF INDIVIDUAL TAXES AN D n DEPT. 280601 ACN 02132302 ~~/ HARRISBURG, PA 171z6-obol TAXPAYER R E S PO N S E DATE 07-12-2002 REV-1545 EX AFP (09-00) ROBERTA D GROVE 203 FROST RD GARDNERS PA, 17324 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAViNGs S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ TRUST COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC 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 Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ * ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31400084640 Date 04-22-1997 Tc insure proper credit to your account, two Established C21 copies of this notice must accompany your Payment to the Register of Wills. Make check Account Balance 5, 047 .14 payable to: "Register of Wills, Agent^. Percent Taxable X S .333 NOTE: If tax payments era made within three Anount Subject to TeX 420 .58 (3) months of the decedent's date of death, TaX Rate X , Q Q You may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due .00 nine (9] months after the date of death. PART TAXPAYER RESPONSE A. ^ The above information and tax due is correct. 1. You may choose to remit payment tc the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice tc the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C 0 N E ~ B L 0 CK B. ^ Tha above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to 6e filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. If PART ou indicate a different tax rate lease state our Y ~ P Y :.:.:.............«,.,.,,,.,.,:,.,...:,:::::::.,.,.,.,::::~::~:::,:::~::::::_:::::::~:::::~~:::-: ::::::::::::::::::.:.:.:::: relationshi P to decedent: ................._..._~~ a~~?ri~~'tii?a::~~~vr~ ;::ham ~a:s~5~~~~'vs= ~'~. TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Anount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS I 2 3 X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID ~. - ~..'" ~/C.c`-z-~ WORK ( ) ~~~i /~/~ =~ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of ny knowledge and belief. unMF r '7 ~•7 ~ ~, o c r) r i ., GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife more than one year prior to death are not taxable. Accounts held by a decedent ^in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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 (Farm REV-1548 EX) upon receipt of the return from the Register of Wills. 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. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and 3 according td 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 Pram the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: 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 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (*x) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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 = 16.7% (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 DIVIDED BY T07AL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death 6y the decedent. 1 DIVIDED 8Y 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable [line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^~nn pax ra ~e amposeo vn me net value or vansters trom a deceased ch11d twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, ar 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 6y 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 ^Cdllateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowahle debts and deductions are determined as follows: A. Ydu legally are responsible far 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 he itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. 1 COMMONWEALTH OF PENNSYLVANIA 1~,J1 DEPARTMENT OF REVENUE INFORMATION NOTICE FILE N0. 21 -U~~ t rj r~ BUREAU OF INOIVIOUAL TAXES AN D DEPT. 28U601 ACN 02132305 HARRISBURG, PA 171z8-o6o1 TAX PAYER R E S P O N S E DATE 07-12-2002 REY-1543 EX RFP (09-001 TYPE OF ACCOUNT EST. OF H R GROVE ^ SAVINGS S.S. N0. 178-16-5175 ^ CHECKING DATE OF DEATH 05-12-2002 ^ rRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: ROBERTA D GROVE REGISTER OF WILLS 203 FROST RD CUMBERLAND CO COURT HOUSE GARDNERS PAk'~7324 CARLISLE, PA 17013 PNC 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 Pennsylvania. questions may be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW ~ ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001037034 Date 04-12-1994 To insure proper credit to your account, two Established (23 copies of this notice must accompany your Payment to the Register of Wills. Make check Account Balance 5, 042.87 payable to: "Register of Wills, Agent". Percent Taxable X 8.333 NOTE: If tax payments are made within three Anount Subject to Tax 420.22 (3) months of the decedent's date of death, Tax Rate X , 00 you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due .00 nine C97 months after the date of death. PART TAXPAYER RESPONSE ^ ::::::~A:rte:~tmbi;~::~!f~lr~:~:lb#!~#if~_~€r~#~tt_#_ iz~~€~€~ i~ta_~~xi=~~:!~~!~~i,; ~~~ Ai~"~~Mi4"itM:°i~~!#l~If~ ;"t~hh! r(#n~i+ht~iis;::: A. ^ 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 CHECK 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 6e issued by the PA Department of Revenue. C 0 N E ~ B L 0 CK B. ^ The above asset has been or will 6e reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ Tha above information is incorrect and/or debts and deductions were paid 6y you. You must complete PART 2^ and/or PART 3^ below. PART Ifi ou indicate a different tax rate lease state our y , P y €~~~~~~ s€°_~€€€:::::,°:,,;-:::::::::~ =__°::,:::=:,,;:;=:':::':: ie#°€;€ii':::::::i€°°°i:::;:::::°i; €si€;~~ i€iisi€~ its iii~~ iii€~ ii~CAz i':~si~i'~~litiisi = ~ ;€ ;< :_ ' 2 'o to decedent: . : . ~::::::::::::~:::~:::~~ ~ :::::::::::::~::::~::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ~ €[~ ~ iii iii iiP~ itii'~iiisi~~!'~l~~~ ~s~~~~ ~ iii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TAX / RETURN COMPUTATION OF TAX ON JOINT TRUST ACCOUNTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ° :,;:,'s~ €~ tsii'sis'si;l€€iiiiiiiiii~ iii iiziii ~~~ i€€ €~ ~ ~ sip ~iiii~iii'siii ~ii~~ iii iii ~ iis`i=€iiiii i~i~si':i~?iii'i ;;;:!#~~;;;;;;;;~ LINE 1. Date Established 1 :. ::::. :<:: ::::: 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Sub"ect to Tax 4 J 5. Debts and Deductions 5 - 6. Anount Taxable 6 ::::::.- :...::::............:.::::..:::.:::.::::::.:::::::::.:: -. ,: err r: : : ~ ~ _ ~ ~ ~ ~ ~ ~~ ~ ~ ~ ~ ~ ~ . 7. Tax Rate 7 X : .::::::: [:~:;~•~:•: .:;: ~: : [ : : : t _[ >[•[ : [ : [ : ~:~;::~:: _ :::• ......................._......._.............................. € 8. Tax Due 8 :::::::::::::::::•~::::::,:::::.:.::::.::.:.:.:.:.:.:.:.:.::::::. PART ^3 DEBTS AND DEDUCTIONS CLAIMED Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of ny knowledge and belief. ~'~ HOME C )/7 ) Y_, [ ~).;; L y i~ lS-ty ~~>-~z.~fcz~ ~a-y-•' WORK ( ) ~!i 7' TAXP ER SIGNATURE TELEPHONE NUMBER~17ATE -- DATE PAID PAYEE DESCRIPTION AMOUNT PAID GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becoses delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. 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. Accounts established jointly between husband and wife mare than one year prior to death are not taxable. Accounts held by a decedent ^in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 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. 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 ana copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block ^C^ and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit then 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. En tar the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint Hanes within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,OD0 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (*~) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established mare 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 = 16.7% (TAXABLE FOR EACH SURVIVOR) B. The percent taxable far 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 X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED 8Y 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined 6y subtracting the debts and deductions Cline 5) frow the amount subject to tax Cline 4). Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ^~ne tax race lmposea on the nec value of iranst8rs tram a deceased ch11d 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 adapted 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. "Si6lings^ 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. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. Yau legally are responsible for payment, ar 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 11^. 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 1 7 1 2 8-0601 RECEIVED FROM: GROVE WILLIAM K 203 FROST RD GARDNERS, PA 17324 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssrv: i ~s-~ s-5175 FILE NUMBER: 2102-0715 DECEDENT NAME: GROVE H R DATE OF PAYMENT: 08/08/2002 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 05/12/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 02132280 ~ S 18.92 02132268 ~ S 18.90 02132271 ~ S 18.85 02132274 ~ S 18.85 02132277 ~ S 18.85 02132283 ~ S 18.85 02132286 ~ S 18.78 TOTAL AMOUNT PAID: REMARKS: WILLIAM K GROVE CHECK#1004 SEAL INITIALS: AC RECEIVED BY: MARY C. LEWIS S 132.00 REGISTER OF WILLS REV-1162 EXI11-96) N0. CD 001497 REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 001498 GROVE WILLIAM K 203 FROST RD GARDNERS, PA 17324 told ESTATE INFORMATION: SSN: ~ ~s-~ 6-5175 FILE NUMBER: 2102-0715 DECEDENT NAME: GROVE H R DATE OF PAYMENT: 08/08/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 05/12/2002 REMARKS: WILLIAM K GROVE CHECK#1003 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 02132301 ~ 518.96 02132298 ~ $18.80 02132295 ~ 518.92 02132292 ~ 518.96 02132289 ~ 518.90 02132307 ~ 518.91 02132304 ~ 518.93 TOTAL AMOUNT PAID: INITIALS: JA RECEIVED BY: MARY C. LEWIS REV-1162 EX111-96) 5132.38 REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 001499 GROVE WILLIAM K 203 FROST RD GARDNERS, PA 17324 fold ESTATE INFORMATION: ssN: i7s-16-5175 FILE NUMBER: 2102-0715 DECEDENT NAME: GROVE H R DATE OF PAYMENT: 08/08/2002 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 05/ 1 2/2002 REMARKS: WILLIAM K GROVE CHECK#1002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 02132279 ~ 518.92 02132303 ~ 518.93 02132300 ~ 518.96 02132297 ~ 518.80 02132294 ~ 518.92 02132291 ~ 518.96 02132306 ~ 518.91 TOTAL AMOUNT PAID: 5132.40 INITIALS: AC SEAL RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: GROVE WILLIAM K 203 FROST RD GARDNERS, PA 17324 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSty: t7s-t6-5t75 FILE NUMBER: 2102-0715 DECEDENT NAME: GROVE H R DATE OF PAYMENT: 08f08/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 05/12/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 02132285 ~ 518.78 02132282 ~ 518.85 02132276 ~ 518.85 02132273 ~ 518.85 02132270 ~ 518.85 02132267 ~ 518.90 02132288 ~ 518.90 TOTAL AMOUNT PAID: REMARKS: WILLIAM K GROVE CHECK# 1001 SEAL INITIALS: AC RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REV-1162EX111-961 NO. CD 001500 5131.98 REGISTER OF WILLS ./ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 ROBERTA D GROVE 203 FROST RD GARDNERS PA 17324 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 E% AFP (01-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 ACN 02132266 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISt_E, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132266 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION ^ FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001037050 TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 08-30-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,039.30 NOTE: X 0.083 419.92 .00 419.92 X .00 .00 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS RE4UIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS. AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-600-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may ob]ect 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 17126-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REY-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) 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 or 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 20Y. .000548 1992 9% .000247 1983 16Y. .000438 1993-1994 7i .000192 1984 11Y. .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10Y. .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 lli .000301 2002 6i .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 C15) 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIYISION DEPT. 280601 HARRISBURG, PA 17128-0601 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 REV-1548 IX RFP (01 -02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 j, COUNTY CUMBERLAND H R GROVE II SSN/DC 178-16-5175 203 FROST RD ACN 02132267 Amount Remitted GARDNERS PA. 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT TD: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132267 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION ^ FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001037050 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST ( ~ TIME CERTIFICATE DATE ESTABLISHED 08-30-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS 5,039.30 NOTE: X 0.083 419.92 .00 419.92 X .45 18.90 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001500 .95 18.90 TOTAL TAX CREDIT 19.85 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS RE4UIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 'URPOSE OF VOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the toD Portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. 2E FUND (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" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answerina service far forms ordering: 1-600-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). )BJECTIONS: 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 may object within sixty C60) 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court 4DMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5Y.) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) 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 (6i) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 7% .000192 1984 11Y. .000301 1995-1998 9% .000247 1985 13Y. .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9Y. .000247 2001 9% .000247 1988-1991 11Y. .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1548 IX AFP (OI-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND S5N/DC 178-16-5175 ACN 02132268 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 WILLIAM K GROVE 203 FROST RD GARDNERS PA 17324 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132268 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION r FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001037050 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST ( ~ TIME CERTIFICATE DATE ESTABLISHED 08-30-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT ALLONANCE OR DISALLOiIANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS 5,039.30 X 0.083 419.92 .00 419.92 X .45 18.90 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001497 .95 18.90 TOTAL TAX CREDIT 19.85 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDIT IONAL INTEREST. C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 'URPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). 'AYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. 2E FUND CCR): 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" CREY-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). 1BJECTIONS: 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 may object within sixty C60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 261021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court 40MIN- ISTRATIYE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13Y. .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .OOD164 --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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 ROBERTA D GROVE 203 FROST RD GARDNERS PA 17324 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISE![ENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-1548 D( AFP (OI-OI) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 ACN 02132269 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132269 TAX RETURN WAS: CX} ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31200132328 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST CX) TIME CERTIFICATE DATE ESTABLISHED 07-07-1998 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,025.75 X 0.083 418.80 .00 418.80 X .00 .00 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDIT IONAL INTEREST. C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND <CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REY-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 CTT onlv). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may obiect 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (57.) discount of the tax paid is allowed. PENALTY: The 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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, ar nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six Chi) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 20Y. .000548 1992 9% .000247 1983 16Y .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9Y. .000247 1985 13% .000356 1999 7% .000192 1986 10Y. .000274 2000 8% .000219 1967 9Y. .000247 2001 9Y. .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU![BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OP INHERITANCE TAX APPRAISEMENT ALLORANCE OR DISALLOHANCE OF DEDUCTION, AND ASSESS![ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS NEY-1548 D( AFP (01-027 DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 H R GROVE II ACN 02132270 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132270 TAX RETURN WAS: CX~ ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31200132328 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 07-07-1998 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,025.75 X 0.083 418.80 .00 418.80 X .45 18.85 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001500 .94 18.85 TOTAL TAX CREDIT 19.79 BALANCE OF TAX DUE .94CR INTEREST AND PEN. .00 TOTAL DUE .94CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN 81, 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. ) PUKPUSt Uh NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Anv 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 may object within sixty C60) 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent <5%) discount of the tax paid is allowed. PENALTY: The 15Y, tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time Deriod as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) 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 (6Y.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 16Y. .000438 1993-1994 7% .000192 1984 11Y. .000301 1995-1998 9% .000247 1985 13Y. .000356 1999 7% .000192 1986 10Y. .000274 2000 8% .000219 1987 9% .000247 2001 9Y. .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. COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INNERITANCE TAX HARRISBURG, PA I7IZa-o6ol APPRAISEKENT ALLONANCE OR DISALLORANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-3548 E% AFP CO1 -02) DATE 10-07-2002 ESTATE OF GROVE H DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND ' SSN/DC 178-16-5175 WILLIAM K GROVE ACN 02132271 203 FROST RD Amount Remitted GARDNERS PA 1.7324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE DEDUCTIONS, AND ASSES ESTATE OF GROVE H RETAIN LOWER PORTION FOR YOUR RECORDS -"~ TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF SMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND R FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132271 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31200132328 TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 07-07-1998 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,025.75 NOTE: X 0.083 418.80 .00 418.80 X .45 - 18.85 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001497 .94 18.85 C TOTAL TAX CREDIT 19.74 BALANCE OF TAX DUE .94CR INTEREST AND PEN. .00 TOTAL DUE .94CR IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REYERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent C5%) 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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (91 months and one C1) 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 or after January 1, 1982 will bear interest at a rate which will vary from calendar near 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 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1966 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. COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 171za-ocol APPRAISElIENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-1548 IX AFP (OI-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 ROBERTA D GROVE ACN 02132272 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE DEDUCTIONS, AND ASSES ESTATE OF GROVE H RETAIN LOWER PORTION FOR YOUR. RECORDS ~ TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF SMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132272 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31200118978 TYPE OF ACCOUNT: C ) SAVINGS ( ) CHECKING C ) TRUST CX) TIME CERTIFICATE DATE ESTABLISHED 02-06-1998 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,026.48 X 0.083 418.86 .00 418.86 X .00 _ .00 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .0D INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE 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. ) NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2D50; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may ob]ect 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent C5%) 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. This non-participation penalty is appealable in the same manner and in the the same tine period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10Y. .000274 2000 Si .000219 1987 9% .000247 2001 9% .000247 1968-1991 11Y. .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 260601 HARRISBURG, PA 17128-0601. H R GROVE II 203 FROST RD GARDNERS PA ,17324 ^ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT ALLOf1ANCE OR DISALLOKANCE OF DEDUCTION, AND ASSESS![ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX RFP (OI-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 - COUNTY CUMBERLAND SSN/DC 178-16-5175 ACN 02132273 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS '~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132273 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31200118978 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 02-06-1998 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,026.48 NOTE: X 0.083 418.86 .00 418.86 X .45 18.85 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 08-08-2002 CD001500 .94 18.85 TOTAL TAX CREDIT 19.79 BALANCE OF TAX DUE .94CR INTEREST AND PEN. .00 TOTAL DUE .94CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDIT IONAL INTEREST. ~ ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 CTT only). 08JECTIONS: 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 may ob]ect 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5Y.) 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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine 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 C6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 1962 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 10Y. .000274 2000 8% .000219 1987 9Y. .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. COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAxES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17126-0601 APPRAISEMENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESS![ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (01.02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 WILLIAM K GROVE ACN 02132274 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ---------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE DEDUCTIONS, AND ASSES ESTATE OF GROVE H RETAIN LOWER PORTION FOR YOUR RECORDS -r TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF SMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132274 TAX RETURN WAS: CX~ ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31200118978 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 02-06-1998 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,026.48 ~ 0.083 418.86 .00 418.86 X .45 18.85 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001497 .94 18.85 C TOTAL TAX CREDIT 19.79 BALANCE OF TAX DUE .94CR INTEREST AND PEN. .00 TOTAL DUE .94CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIREB. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF 40TICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS. AGENT. REFUND CCR): 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" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may obiect 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg. PA 17128-0601 Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REY-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent C5Y.) discount of the tax paid is allowed. PENALTY: The 15Y tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine 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 C6Y.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar near 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 9Y. .000247 1983 16% .000438 1993-1994 7% .000192 1984 11Y. .000301 1995-1998 9% .000247 1985 13% .000356 1999 7Y. .000192 1986 10Y. .000274 2000 8% .000219 1987 9% .000247 2001 9i .000247 1968-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 ROBERTA D GROVE 203 FROST RD GARDNERS PA 17324 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX AFP (01 -02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 ACN 02132275 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132275 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31600072307 TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING ( ) TRUST (X1 TIME CERTIFICATE DATE ESTABLISHED 01-18-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,027.81 NOTE: X 0.083 418.97 .00 418.97 X .00 .00 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDIT IONAL 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. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may ob]ect 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIYE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If anv tax due is paid within three C3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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% .000546 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 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 H R GROVE II 203 FROST RD GARDNERS PA _17324 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLORANCE OR DISALLORANCE OF DEDUCTION, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 E% RFP CO1-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 ACN 02132276 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132276 TAX RETURN WAS: (X) ACCEPTED AS FILED C )CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31600072307 TYPE OF ACCOUNT: C ) SAVINGS ( ) CHECKING C ) TRUST ( ~ TIME CERTIFICATE DATE ESTABLISHED 01-18-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,027.81 NOTE: X 0.083 418.97 .00 418.97 X .45 18.85 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001500 .94 18.85 TOTAL TAX CREDIT 19.79 BALANCE OF TAX DUE .94CR INTEREST AND PEN. .00 TOTAL DUE .94CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDIT IONAL INTEREST. ^ C IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Y.) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the taz and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine C9) months and one C1) 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 or 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 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 I1% .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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT ALLOiIANCE OR DISALLORANCE OF DEDUCTION, AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX AFP (01-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 WILLIAM K GROVE ACN 02132277 203 FROST RD Amount Remitted GARDNERS PA 17324 C MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE DEDUCTIONS, AND ASSES ESTATE OF GROVE H RETAIN LOWER PORTION FOR YOUR RECORDS ~ TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF SMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132277 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 316D0072307 TYPE OF ACCOUNT: C ) SAVINGS C 7 CHECKING C ) TRUST CX) TIME CERTIFICATE DATE ESTABLISHED 01-18-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,027.81 X 0.083 __ 418.97 .00 418.97 X .45 18.85 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001497 .94 18.85 TOTAL TAX CREDIT 19.74 BALANCE OF TAX DUE .44CR INTEREST AND PEN. .00 TOTAL DUE .94CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN 61, 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. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): 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 by calling the special 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 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone C717) 767-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 16, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Y.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 9Y. .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13Y. .000356 1999 7% .000192 1986 10% .000274 2000 B% .000219 1987 9Y. .000247 2001 9% .000247 1988-1991 11Y. .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 ROBERTA D GROVE 203 FROST RD GARDNERS PA T7324 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEliENT ALLORANCE OR DISALLORANCE OF DEDUCTION, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-1548 IX AFP (01 -02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 ACN 02132278 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-•2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132278 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ^ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ C 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. ) FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001036937 TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 11-10-1989 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,044.28 NOTE: X 0.083 420.34 .00 420.34 X .00 .00 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "ADplication 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 by calling the special 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 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 17126-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg. PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REY-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) 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 or 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 1962 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000436 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 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 C15) 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 BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA l~lza-osol NOTICE OF INHERITANCE TAX APPRAISENENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX RFP C01-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND H R GROVE II SSN/DC 178-16-5175 ACN 02132279 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132279 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001036937 TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING C ) TRUST ( ~ TIME CERTIFICATE DATE ESTABLISHED 11-10-1989 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,044.28 X 0.083 420.34 .00 420.34 ~ .45 18.92 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 08-08-2002 CD001499 .95 18.92 TOTAL TAX CREDIT 19.87 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDIT IONAL INTEREST. C IF TOTAL DUE IS LESS THAN 81, 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. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND ICR): 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 by calling the special 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). OBJECTIONS: Any party in interest not satisfied with the appraisement. allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may ob]ect within sixty C60) days of receipt of this Notice bv: --written protest to the PA Department of Revenue, Board of Appeals. Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent C5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six I6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 20Y. .000546 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11Y. .000301 1995-1998 9% .000247 1985 13Y. .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9i .000247 1986-1991 11% .000301 2002 6i .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15> 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 260601 HARRISBURG, PA 17126-0601 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 REV-1548 IX RFP (01 -02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND WILLIAM K GROVE SSN/DC 178-16-5175 203 FROST RD ACN 02132280 Amount Remitted GARDNERS PA x_7324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132280 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001036937 TYPE OF ACCOUNT: C ) SAVINGS C ~ CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 11-10-1989 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT ALLONANCE OR DISALLORANCE OF DEDUCTION, AND ASSESSt[ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS 5,044.28 NOTE: X 0.083 420.34 .00 420.34 X .45 18.92 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001497 .95 18.92 TOTAL TAX CREDIT 19.87 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDIT IONAL INTEREST. ~ C 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. ) ruKrust ur NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 17126-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREY-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1962 bear interest at the rate of six (6Y.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 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 11Y. .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUfIBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 260601 HARRISBURG, PA 17128-0601 ROBERTA D GROVE 203 FROST RD GARDNERS PA 17324 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT ALLONANCE OR DISALLONANCE OF DEDQCTION~, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-1548 IX AFP CO1-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND ' SSN/DC 178-16-5175 ACN 02132281 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1 ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132281 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31100023533 TYPE OF ACCOUNT: C ) SAVINGS ( ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 01-05-1996 Account Balance 5,027.22 NOTE: TO INSURE PROPER CREDIT TO Percent Taxable X 0.083 YOUR ACCOUNT, SUBMIT THE Amount Sub]ect to Tax 418.92 UPPER PORTION OF THIS NOTICE Debts and Deductions - •00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 418.92 REGISTER OF WILLS AT THE Tax Rate X .00 ABOVE ADDRESS. MAKE CHECK Tax Due •00 OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND., SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): 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" CREY-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-600-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty C60) 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3> calendar months after the decedent's death, a five percent C5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty Period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of siz (6Y.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 7% .000192 1964 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 11Y. .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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLORANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX AFP COI-027 DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND - ~` SSN/DC 178-16-5175 H R GROVE II ACN 02132282 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132282 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31100023533 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING ( ) TRUST C ~ TI:ME CERTIFICATE DATE ESTABLISHED 01-05-1996 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,027.22 X 0.083 418.92 .00 418.92 X .45 18.85 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001500 .94 18.85 TOTAL TAX CREDIT 19.79 BALANCE OF TAX DUE .94CR INTEREST AND PEN. .00 TOTAL DUE .94CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( IF TOTAL DUE IS LESS THAN S1> NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate lax" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Anv 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 may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Oept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIYE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent C5%) 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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) 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 or 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 1962 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1962 20% .000546 1992 9% ,000247 1983 16% .000438 1993-1994 7% ,000192 1984 11% .000302 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 follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-0601 APPRAISEl1ENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-1548 EX RFP (OI-02) DATE 10-07-2002 ESTATE OF GROVE H DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 WILLIAM K GROVE ACN 02132283 203 FROST RD Amount Remitted GARDNERS PA .17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE DEDUCTIONS, AND ASSES ESTATE OF GROVE H RETAIN LOWER PORTION FOR YOUR RECORDS 1 TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF SMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND R FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132283 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31100023533 TYPE OF ACCOUNT: C ) SAVINGS ( ) CHECKING ( ) TRUST CX) TIME CERTIFICATE DATE ESTABLISHED 01-05-1996 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,027.22 NOTE: X 0.083 418.92 .00 418.92 X .45 18.85 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 DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001497 .94 18.85 TOTAL TAX CREDIT 19.79 BALANCE OF TAX DUE .94CR INTEREST AND PEN. .00 TOTAL DUE .94CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 81, 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. ) ruxru~e ur NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): 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" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may ob]ect 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17126-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REY-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent I5%) 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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent Der annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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% .000546 1992 9Y. .000247 1983 16Y. .000438 1993-1994 7Y. .000192 1984 11Y. .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 follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSES5NENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX AFP (01-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 ~~ COUNTY CUMBERLAND SSN/DC 178-16-5175 ROBERTA D GROVE pCN 02132284 203 FROST RD Amount Remitted GARDNERS PA_17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE LO-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12••2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132284 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001035967 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING ( ) TRUST CX7 TIME CERTIFICATE DATE ESTABLISHED 06-15-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,008.22 NOTE: X 0.083 417.33 .00 417.33 X .00 .00 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT ~+) INTEREST/PEN PAID C-) AMOUNT PAID ^ TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .D0 INTEREST AND PEN. .00 TOTAL DUE .0D IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN &1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313}. Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-D6D1 Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REY-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed, PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 16, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine C9) months and one C1) tlay 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 C6 ;) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 Oaily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16Y, ,000438 1993-1994 79' .000192 }984 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 6Y. .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. 1f payment is made after the interest computation date shown on the Notice, additional interest must 6e calculated. COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INNERITANCE TAX DIYISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 111zB-o6o1 APPRAISEMENT ALLOf1ANCE OR DISALLORANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY MELD OR TRUST ASSETS REV-1548 IX APP (01 -02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 H R GROVE II ACN 02132285 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------- -- - ------------------------ REV-1548 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S /D.C. N0. 178-16-5175 ACN 02132285 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001035967 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 06-15-1994 Account Balance 5,008.22 NOTE: TO INSURE PROPER CREDIT TO Percent Taxable X 0.083 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 417.33 UPPER PORTION OF THIS NOTICE Debts and Deductions - •00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 417.33 REGISTER OF WILLS AT THE Tax Rate X •45 ABOVE ADDRESS. MAKE CHECK Tax Due 18.78 OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT t+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001500 .94 18.78 ^ TOTAL TAX CREDIT 19.72 BALANCE OF TAX DUE .94CR INTEREST AND PEN. .00 TOTAL DUE .94CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ C IF TOTAL DUE IS LESS THAN S1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): 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" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount ar interest) as shown on this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) 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 C6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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% .000436 1993-1994 7% .000192 1984 11% ,000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10Y. .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11Y. .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUIiBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT ALLOfiANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX AFP CO1-01) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 ....COUNTY CUMBERLAND ' ~~ '`SSN/DC 178-16-5175 WILLIAM K GROVE ACN 02132286 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX DN JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 0213228b TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 21001035967 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 06-15-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,008.22 NOTE: X 0.083 417.33 .00 417.33 X .45 18.78 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 TD: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001497 .94 18.78 TOTAL TAX CREDIT 19.72 BALANCE OF TAX DUE .94CR INTEREST AND PEN. .00 TOTAL DUE .94CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS RE4UIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Applicatio for Refund of Pennsylvania Inheritance and Estate lax" CREY-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service far forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Anv 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 may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, p7TN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" <REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 hear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164, All taxes which became delinquent on or 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 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 follows: INTEREST = BALANCE OF TAX UNPAID X NU![BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) 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 BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-0601 APPRAISENENT ALLORANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP f01-02) DATE 10-07-2002 ESTATE OF GROVE H DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 ;; COUNTY CUMBERLAND - SSN/DC 178-16-5175 ROBERTA D GROVE ACN 02132287 203 FROST RD Amount Remitted GARDNERS PA 17324.. MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ---------------------------------- REV-1548 EX AFP CO1-02~ NOTICE OF INHERITANCE DEDUCTIONS, AND ASSES: ESTATE OF GROVE H RETAIN LOWER PORTION FOR YOUR RECORDS ~ TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF SMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND R FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132287 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JDINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001037033 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 04-14-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,041.47 NOTE: X 0.083 _ 420.11 .00 420.11 X .00 .00 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN 61, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): 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" CREY-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-600-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Anv 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 may obaect within sixty 160) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 261021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRA7IYE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions far Inheritance Tax Return for a Resident Decedent" (REY-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (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 I8, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six C6%) percent Der annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 1963 16% .000438 1993-1994 7'. .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10Y. .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1986-1991 11Y. .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU![BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 H R GROVE II 203 FROST RD GARDNERS PA 1724 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT ALLORANCE OR DISALLORANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRU5T ASSETS REV-1548 E% RFP COI -02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 ACN 02132288 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132288 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001037033 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST CX) TIME CERTIFICATE DATE ESTABLISHED 04-14-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,041.47 NOTE: X 0.083 420.11 .00 420.11 X .45 18.90 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT ~+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001500 .95 18.90 TOTAL TAX CREDIT 14.85 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .0D TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS RE4UIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF JOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act. Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Resister of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): 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" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60J 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit. DEPT. 280601, Harrisburg, PA 17128-0601 Phone {717> 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5 :) discount of the tax paid is allowed. PENALTY: The 155; tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine 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 Chi) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar near 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 16Y. .000438 1993-1994 75: .000192 1984 11% .000301 1995-1998 9% .000247 1985 135: .000356 1999 7: .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 95: .000247 1988-1991 115: .000301 2002 65; .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Anv 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIYISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLONANCE OR DISALLOifANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRU5T ASSETS REV-1548 p! AFP CO1-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 • COUNTY CUMBERLAND ` SSN/DC 178-16-5175 WILLIAM K GROVE ACN 02132289 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132289 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 21001037033 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST CX7 TIME CERTIFICATE DATE ESTABLISHED 04-14-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Taz Due TAX CREDITS: 5,041.47 NOTE: X 0.083 420.11 .00 420.11 ~ .45 18.90 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 08-08-2002 CD001498 .95 18.90 TOTAL TAX CREDIT 19.85 BALANCE OF TAX DUE .45CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" {REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices ar by calling the special 24-hour answering service for forms ordering: 1-600-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 17126-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent C5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not Paid before January 18, 1996, the first day after the end of the tax amnesty Period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine 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 C6Y.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1962 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 1962 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20Y. .000548 1992 9Y. .000247 1983 16Y. .000438 1993-1994 7Y. .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 lli .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU![BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG. PA 17128-0601 ROBERTA D GROVE 203 FROST RD GARDNERS PA 17324 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT ALLONANCE OR DISALLORANCE OF DEDUCTION, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 D( AFP (01-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 ACN 02132290 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132290 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 210001037027 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 03-24-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,055.70 X 0.083 421.29 .00 421.29 X .00 .00 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .DO INTEREST AND PEN. .00 TOTAL DUE .00 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" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Applicatio: 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 by calling the special 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). OBJECTIONS: Anv party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of taz (including discount or interest) as shown on this Notice may object within sixty C60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Oept. 281021, Harrisburg, PA 17126-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent C5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation Penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six C6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 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 follows: INTEREST = BALANCE OF TAX UNPAID X NU![BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If Dayment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU Of INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLONANCE OR DISALLORANCE OF DEDUCTION, AND ASSESS}[ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX ~FP CO1-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 ,~; COUNTY CUMBERLAND ' SSN/DC 178-16-5175 H R GROVE II ACN 02132291 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS "~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132291 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 210001037027 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST CX) TIME CERTIFICATE DATE ESTABLISHED 03-24-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,055.70 NOTE: X 0.083 421.29 .00 421.29 X .45 18.96 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 DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001499 .95 18.96 TOTAL TAX CREDIT 19.41 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .DO TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE 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. ) NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may obiect within sixty f60) 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280401, Harrisburg, PA 17128-0601 Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REY-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation Penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six C6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1482 will bear interest at a rate which will vary from calendar year to calendar near 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% .000546 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 1968-1991 11% .000301 2002 6Y. .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 C15) 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT ALLOFANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX AFP (01 -02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND ' SSN/DC 178-16-5175 WILLIAM K GROVE ACN 02132292 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE DEDUCTIONS, AND ASSES ESTATE OF GROVE H RETAIN LOWER PORTION FOR YOUR RECORDS ~ TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF SMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132292 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 210001037027 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 03-24-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,055.70 X 0.083 421.29 .00 421.29 X .45 _ 18.96 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001498 .95 18.96 TOTAL TAX CREDIT 19.91 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN 81, 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. ) ^ NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): 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 lax" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount ar interest) as shown on this Notice may obiect within sixty C60) 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1962 bear interest at the rate of six C6Y.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 7Y. .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 follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days 6evond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 ROBERTA D GROVE 203 FROST RD GARDNERS PA 17~i24 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEKENT ALLONANCE OR DISALLORANCE OF DEDUCTION, AND ASSESSHENT Of TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX AFP (01-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 ACN 02132293 ~- Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ---------------------------------- REV-1548 EX AFP CO1-02~ NOTICE OF INHERITANCE DEDUCTIONS, AND ASSES ESTATE OF GROVE H RETAIN LOWER PORTION FOR YOUR RECORDS ~ TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF SMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132293 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001036938 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST (X1 TIME CERTIFICATE DATE ESTABLISHED 11-10-1989 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,044.28 X 0.083 420.34 .00 420.34 X .00 .00 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-~ AMOUNT PAID C TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) V07ICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may obiect within sixty C60) 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 --electing to have the matter determined at the audit of the account of the personal representative, 0 R --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 260601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is Paid within three (3) calendar months after the decedent's death, a five percent (5Y,) 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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine C9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1962 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1962 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 9Y, .000247 1983 16% .000438 1993-1994 7% .000192 1964 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10Y. .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 NUNBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 H R GROVE II 203 FROST RD GARDNERS PA 17324 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX AFP (01-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 ACN 02132294 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1 ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP f01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132294 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 2100103b938 TYPE OF ACCOUNT: C ) SAVINGS ( ) CHECKING ( ) TRUST (X1 TIME CERTIFICATE DATE ESTABLISHED 11-10-1989 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,044.28 X 0.083 420.34 .00 420.34 X .45 18.92 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001499 .95 18.92 TOTAL TAX CREDIT 19.87 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) F'UKPUSt Uh NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 CTT only). 08JECTIONS: 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 may 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 17126-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, DR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone <717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If anv 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 15i tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 16, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six C6%> percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1962 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% .000546 1992 9Y. .000247 1963 16% .000438 1993-1994 7Y. .000192 1984 11% .000301 1995-1998 9Y, .000247 1985 13Y .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1986-1991 11Y. .000301 2002 6i .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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 WILLIAM K GROVE 203 FROST RD GARDNERS PA, 17324 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISElIENT ALLORANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1546 IX AFP (OI-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-1b-5175 ACN 02132295 ~- Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ---------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE DEDUCTIONS, AND ASSES' ESTATE OF GROVE H RETAIN LOWER PORTION FOR YOUR RECORDS ~ TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF SMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-1b-5175 ACN 02132295 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 2100103b938 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST CX) TIME CERTIFICATE DATE ESTABLISHED 11-10-1989 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,044.28 NOTE: ~ 0_.083 _ 420.34 .00 420.34 X .45 18.92 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 TD: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-OS-2002 CD001498 .95 18.92 TOTAL TAX CREDIT 19.87 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE 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. ) VOTICE: 7o fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices ar by calling the special 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 CT7 only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty C60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17126-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tau and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine C9) months and one C1) 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 siz C6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 20Y. .000548 1492 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 B% .000219 1987 9% .000247 2001 9% .000247 1968-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLORANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX AFP CD1-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 ' COUNTY CUMBERLAND SSN/DC 178-16-5175 ROBERTA D GROVE ACN 02132296 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1 ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132296 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31000212813 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST CX7 TIME CERTIFICATE DATE ESTABLISHED 01-16-1996 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,014.04 NOTE: X 0.083 417.82 .00 417.82 J~ . 0 0 .00 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN &1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND.. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) N07ICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REY-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement. allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown an this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-D601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5Y.) discount of the tax paid is allowed. PENALTY: The 15Y, tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tine period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) 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 or after January 1, 1962 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 20Y. .000548 1992 9Y. .000247 1983 16Y. .000438 1993-1994 7% .OD0192 1984 11% .000301 1995-1998 9% .000247 1985 13Y. .000356 1999 7% .000192 1986 10Y. .000274 2000 8% .000219 1987 9% .000247 2001 9Y. .000247 1988-1991 11% .000301 2002 6%- .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA I7I2a-o6ol APPRAISENENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESS![ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-1548 IX AFP (OI-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 >COUNTY CUMBERLAND SSN/DC 178-16-5175 H R GROVE II ACN 02132297 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ---------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE DEDUCTIONS, AND ASSES' ESTATE OF GROVE H RETAIN LOWER PORTION FOR YOUR RECORDS ~ TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF SMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132297 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31000212813 TYPE OF ACCOUNT: { ) SAVINGS ( ) CHECKING C ) TRUST ( ~ TIME CERTIFICATE DATE ESTABLISHED 01-16-1996 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,014.04 X 0.083 417.82 .00 417.82 X .45 18.80 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 08-08-2002 CD001499 .94 18.80 TOTAL TAX CREDIT 14.74 BALANCE OF TAX DUE .94CR INTEREST AND PEN. .DO TOTAL DUE .94CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( IF TOTAL DUE IS LESS THAN 81, 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. ) NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. t72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): 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 by calling the special 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 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of taz (including discount or interest) as shown on this Notice may object within sixty C60) days of receipt of this Notice bv: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17126-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, DR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) 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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1> day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six C6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 7% ,000192 1984 11% ,000301 1995-1996 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 follows: INTEREST = BALANCE OF TAX UNPAID X NU![BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 REY-1548 IX AFP (01-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 °~ COUNTY CUMBERLAND WILLIAM K GROVE SSN/DC 178-16-5175 203 FROST RD ACN r~- 02132298 Amount Remitted GARDNERS PA 1732.4 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132298 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31000212813 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 01-16-1996 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT ALLONANCE OR DISALLORANCE OF DEDUCTION, AND ASSESS![ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS 5,014.04 X 0.083 417.82 .00 417.82 X .45 18.80 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001498 .94 18.80 TOTAL TAX CREDIT 19.74 BALANCE OF TAX DUE .94CR INTEREST AND PEN. .00 TOTAL DUE .94CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( IF TOTAL DUE IS LESS THAN 81, 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. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): 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 by calling the special 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). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty C60) 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601. Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent's (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent C5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine 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 (6Y.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 20Y. .000548 1992 9% .000247 1983 16Y. .000438 1993-1994 7% .000192 1964 11% .000301 1995-1998 9% .000247 1965 13% .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9Y. .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 C15) 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 REV•3548 IX AFP (01-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND ROBERTA D GROVE ~ SSN/DC 178-16-5175 203 FROST RD ACN 02132299 Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 COUNTY CUMBERLAND FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 ACN 02132299 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 318000084260 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING ( ) TRUST ( ~ TIME CERTIFICATE DATE ESTABLISHED 04-22-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT ALLOMANCE OR DISALLOiiANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS 5,057.14 X 0.083 421.41 .00 421.41 X .00 .00 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDIT IONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREY-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes. ATTN: Past Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed an the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10% .000274 2000 B% .000219 1987 9% .000247 2001 9% .000247 1968-1991 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 ~, H R GROVE II 203 FROST RD GARDNERS PA 173.24 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSE5SHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-IS4B IX ~FP CO1-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 ~~ ; COUNTY CUMBERLAND SSN/DC 178-16-5175 ACN 02132300 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132300 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION ^ FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 318000084260 TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 04-22-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,057.14 X 0.083 421.41 .00 421.41 X .45 18.96 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001499 .95 18.96 TOTAL TAX CREDIT 19.91 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar near with that rate announced by the PA Department of Revenue. The applicable interest rates for 1962 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000436 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13Y. .000356 1999 7% .000192 1986 10Y. .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 NUIiBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 REV-1548 IX 11FP (01 -02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND WILLIAM K GROVE SSN/DC 178-16-5175 ACN 02132301 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132301 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 318000084260 TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 04-22-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS 5,057.14 )( 0.083 421.41 .00 421.41 X .45 18.96 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001498 .95 18.96 TOTAL TAX CREDIT 19.91 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ C 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. ) ~uxrust ur 40TICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). °AYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). DBJECTIONS: 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 may ob]ect 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court 4DMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three <3) calendar months after the decedent's death, a five percent (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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Y.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 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 11Y. .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLORANCE OR DISALLONANCE OF DEDUCTION, AND ASSESS![ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-1548 IX RFP (01 -02] DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 >COUNTY CUMBERLAND ROBERTA D GROVE ASSN/DC 178-16-5175 ACN 02132302 203 FROST RD GARDNERS PA 17324 ~ Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132302 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31400084640 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 04-22-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,047.14 X 0.083 420.58 .00 420.58 X .00 .00 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID ^ TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ C IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ru:cru~t ur NOTICE: Ta fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and subnit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty C60) 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 --electing to have the matter determined at the audit of the account of the personal representative. OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg. PA 17128-0601 Phone C717) 767-6505. See page 5 of the booklet "Instructions far Inheritance Tax Return far a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine C9) months and one C1) 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 I6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 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 1968-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 REV-1548 IX ~FP CO1-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND I; H R GROVE II ~ SSN/DC 178-16-5175 ACN 02132303 203 FROST RD Amount Remitted GARDNERS PA-17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132303 TAX RETURN WAS: CX) ACCEPTED AS FILED { ~ CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31400084640 TYPE OF ACCOUNT: C ) SAVINGS ( ) CHECKING ( ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 04-22-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS 5,047.14 X 0.083 420.58 .00 420.58 X .45 18.93 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-~ AMOUNT PAID 08-08-2002 CD001499 .95 18.93 TOTAL TAX CREDIT 19.88 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THLS DATE, SEE REVERSE FOR CALCULATION OF ADDIT IONAL INTEREST. ~ C IF TOTAL DUE IS LESS THAN 51, 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. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): 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 by calling the special 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). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may obiect 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) 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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) 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 annun calculated at a daily rate of .000164. All taxes which became delinquent on or 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 20Y. .000548 1992 9Y. .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9Y. .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 follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17126-0601 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS "~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 REV-1548 E% 11FP (01-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 _ FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 WILLIAM K GROVE ACN 02132304 203 FROST RD Amount Remitted GARDNERS PA 1;7324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132304 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31400084640 TYPE OF ACCOUNT: C ) SAVINGS ( ) CHECKING C ) TRUST ( ~ TIME CERTIFICATE DATE ESTABLISHED 04-22-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS 5,047.14 X 0.083 420.58 .00 420.58 X .45 18.93 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001498 .95 18.93 TOTAL TAX CREDIT 19.88 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ^ ( IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REgUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court 4DMIN- ISTRATIYE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17126-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due 15 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 16, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine <9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 1962 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 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 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 260601 HARRISBURG, PA 17128-0601 ROBERTA D GROVE 203 FROST RD GARDNERS PA, 17324 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISE![ENT ALLONANCE OR DISALLORANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 E% AFP CO1-02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 ACN 02132305 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1 ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12••2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132305 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION ^ FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001037034 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 04-12-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,042.87 X 0.083 420.22 .00 420.22 X .00 .00 NOTES 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-~ AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDIT IONAL INTEREST. ~ C IF TOTAL DUE IS LESS THAN 81, 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. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-600-447-3020 (TT onlv). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Y.) discount of the tax paid is allowed. PENALTY: The 15Y. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six C6Y.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on ar 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 20i .000546 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 9Y. .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 C15) 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISE![ENT ALLONANCE OR DISALLORANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 IX AFP (01 -02) DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 ` COUNTY CUMBERLAND SSN/DC 178-16-5175 H R GROVE II ACN 02132306 203 FROST RD Amount Remitted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132306 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001037034 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST CX) TIME CERTIFICATE DATE ESTABLISHED 04-12-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,042.87 X 0.083 420.22 .00 420.22 X .45 18.91 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-08-2002 CD001499 .95 18.91 TOTAL TAX CREDIT 19.86 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDIT IDNAL INTEREST. ( IF TOTAL DUE IS LESS THAN fil, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-600-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) far an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six C6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 20Y. .000546 1992 9% .000247 1983 16% .000436 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7Y. .000192 1986 10% .000274 2000 8% .000219 1987 9Y. .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP CO1-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-07-2002 REV-1548 IX AFP (01-027 DATE 10-07-2002 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE NUMBER 21 02-0715 COUNTY CUMBERLAND SSN/DC 178-16-5175 WILLIAM K GROVE ACN 02132307 203 FROST RD Amount Remitted GARDNERS PA 17,:324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF GROVE H R DATE OF DEATH 05-12-2002 FILE N0. 21 02-0715 S.S/D.C. N0. 178-16-5175 COUNTY CUMBERLAND ACN 02132307 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION ^ FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 21001037034 TYPE OF ACCOUNT: C ) SAVINGS C 7 CHECKING ( ) TRUST ( ~ TIME CERTIFICATE DATE ESTABLISHED 04-12-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS 5,042.87 X 0.083 420.22 _ .00 420.22 X .45 18.91 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 08-08-2002 CD001498 .95 18.91 TOTAL TAX CREDIT 19.86 BALANCE OF TAX DUE .95CR INTEREST AND PEN. .00 TOTAL DUE .95CR IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDIT IONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): 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" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may ob]ect 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 17126-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5Y.) discount of the tax paid is allowed. PENALTY: The 15Y, tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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% .000546 1992 9% .000247 1983 16% .000438 1993-1994 7Y. .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 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 C15) 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.