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HomeMy WebLinkAbout02-0057PETITION FOR PROBATE and GRANT OF LETTERS Estate of Lottie .D. Cornman. ;i No. Social Securi'ty, No. .173-38-722'5 Deceased.. The petition of the undersigned respectfully represents that: Your petitioner(s), Who is/are 18 Years of age or older an the execut... in the last will of the above decedent, dated and 21-02~57 To: ' · Register of Wills for the County of O.tmk~rland Commonwealth of Pennsylvania in the codicil(s) dated rix named March 26 ,19 97 (state relevant ciffiumstances, e.g. renunciation, death of executor, etc.) Decendent' was domiciled at death in Cumberland County, Pennsylvania, with h last family· or principal residence at Green Ridge Villaqe ' 210 Big Sprinq Avenue, Newille, PA 17241' ' (list street, number and muncipality) Decendent, th~n :'- g~.~. years of age, died March 1 9 ,hl3}I 2001 at _.C~r~en Rid~e-.Vi.r~ge: 210 Big Spring Avenue, Newiile, PA 172~'1 ' Except as'follows, deced~6n't' di~not marry, was' not divorced and did not have a child born or adopted after execution '~"~ ' of the will offered. :tot probate; Was no~ the victim of a killing and was never adjudicated incompetent: Decendent at death owny,.~ pt'.d~pc~y with estimated values as follows: (If domiciled in Pa.) - //.'~'ll personal property (If not domiciled in~/t · ',~'"- ~' ~ · $ . . . . :)., . .-Personal property ~n Pennsylvania $ (If not domiciledrin Pa.} '~" Personal property in County $ Value of real estate·in Pennsylvania $. situated as follows: None 76.40 WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters_ theron. ' request(s) the probate of the last will and codicil(s) testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) 21 38 Pine~;~o~ · Newville~ PA 17241 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA · 3. COUNTY, ,,O,Fm~,,,,, CUMBERLAND f SS . ': . The peri~tj~¢r(:;, dbJ-~:i~$.~ed swear(s)or affirm(s)that the statements in the foregoin etitiofi ar true alid,corY~ct to "the'besffo~the knowled-e and bol;oc ~r ~,:.: ............ g P~ e Sworn to' or affirme~ 'amd~ subscribed ~/~ ~~ before~e this 15th day of ( ' -- ~ No. · 2i-02-57 Estate of' Lottie D. Co~ ' · , Deceased DECREE OF PROBATE AND GRANT OF LETTERS ~l~ 2002, in consideration of. the petition on AND NOW JANUARY 17 -- the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated March 26, 1997 described therein be admitted to probate and filed of record as the last will Of. Lottie D. Cornman and Letters. Testamentary' ~, are hereby' granted to Glenda K. Miley FEES Probate, Letters, Etc .......... $ 18.00 Short Certificates(~ ) .. ......... $ 9.00 ~-pages lZ.00 enunciation ................ $ JCP . $ 5 .~00 TOTAL $..44.00 Filed .. JANUARY ' 17.t,h, . 2.0.(]2 Lindsay Dare'B~ird #72083 ' ATTORNEY iSup. Et. I.D..No.) 37 South Hanover Street Carlisle, PAADDRESS 717-243-5732 17013 ..... PHONE ¥cl "oo pu~peqtunO. z£: £ d t ' zo. ,-2 105.805 REV 9/86 COM,MONWEAkItI~OI~ NNS.Y LVANIA DEPAR I MENI; ~UNOER IYFo~R ~:;UNO~R t O/*.Y~,,j ~I~-~)F:BIrlItl OlECEOENT:S EDUCA1]ON - LAST WILL AND TESTAMENT OF LOTTIE D. CORNMAN KNOW Al3. MF.N BY THESE PRESENTS, that I, Lottie D. Cornman, of Cumberland County, Pennsylvania, being ~in good health and of sound and disposing memory, do hereby make, declare, and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me. FIRST: I direct that all my just debts and expenses of my last Hiness and funeral expenses shah be paid by my Executor, hereinafter named, from my estate as soon after my decease as shah be found convenient. SECOND: (a) I give, devige, and bequeath all of my estate, whether real, personal or mixed, of any nature whatsoever and wherever situated, including any lapsed or void legacy, 'to my daughter, Glenda K. Miley, if she survives me by thirty (30) days. (b) If my daughter, Glenda K. Miley, predeceases me or is not living on the thirty- first day after my death, then I give my estate to my two grandaughters, Jennifer Miley, fifty (50) percent, and Melissa Miley, fifty (50) percent; each of the two grandaughters to share and share alike. THIRD: I hereby nominate, constitute, and appoint my daughter, Glenda K. Miley, as Executrix of this my Last Will and Testament. If my Executrix fails to serve, or for any reason falls to continue to serve, I then appoint Lindsay Dare Baird, 37 S. Hanover Street, Carlisle, Pennsylvania, to serve as Executrix. FOURTH: I direct that my Executrix, or her successor, shah not be required to furnish any bond or other security for the faithful performance of her duties, notwith- standing any provisions of law to the contrary. FIFTH: My Executrix shall have, in addition to the powers and authority conferred upon her by law, the following additional powers and authority: 1. To sell at public or private sale, exChange, lease, mortgage, or pledge any property, real or personal, constituting a portion of this estate, at any time, and upon such terms and conditions as. she shall deem wise. 2. To invest any money at any time in such bonds, stocks, notes, real estate, mortgages, life insurance, annuities, or other securities, or such property, real or personal, as she shall deem wise, without being limited by any statute or rule of law regarding investments by the Executrix. 3. To retain, without incurring any liability, as investments, any property owned by me at the time of my death, as long as she deems it wise, and even though such property is not the kind of property she would purchase as an investment, and even though to retain such property might violate sound diversification principles. 4. To cause any security or other property which may at any time constitute a portion of my estate to be issued, held, or registered in her own name, or in the name of a nominee, or in such form that title will pass by delivery. $. To consent to the reorganization, consolidation, readiustment of the financial structure, or sale of the assets of any corporation or other organization, the securities of which constitute a portion of my estate, and to take any action with reference to such securities which, in the opinion of my Executrix, is necessary to obtain the benefit of any such reorganization, consolidation, readiustment or sale; to exercise any conversion privilege or subscription right given to her as the owner of any securities constituting a portion of my estate; to accept and hold as a portion of my estate securities resulting from any reorganization, consolidation, readiustment, sale, conversion, or subscription. 6. To pay all costs, taxes, charges and expenses in connection with the administra- tion of my estate. 7. To determine what is "Income" and what is "Principal" hereunder, and her decision thereon shall be Final; and to purchase' securities at a premium or discount, and to apply or charge said premium or discount against income or principal as she may determine. 8. To transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon, or otherwise dispose of any property at any time held by her, at public or private sale, or otherwise. 9. To borrow money from any person, firm or corporation, for the purpose of protecting and preserving or improving my estate or .to execute promissory notes or other obligations for amounts so borrowed. I 0. To employ legal counsel, accountants, brokers, investment advisors, custodians, managers, and other agents and employees and to pay them reasonable compensation out 2 of my estate or out of any fund held hereunder to which said compensation is attribut- able. 11. To do all other acts in her iudgment necessary or desirable for the proper and advantageous management, investment, and distribution of my estate. SIXTH: I direct that all transfer and inheritance taxes, state or federal, assessed because of my death, whether the funds, property, or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate just as if they were my debts and none of those taxes shall be charged against any beneficiary; that my Executrix pay, or provide for payment, of all such taxes at such time or times and in such manner as my Executrix deems best. SEVENTH: AH questions as to the validity of this, my Last Will, or the administra- tion of the Will shall be governed by the laws of the Commonwealth of Pennsylvania. EIGHTH: If my daughter Glenda K. Miley and I shall die simultaneously or under circumstances which make it difficult to determine which of us died first, I direct that I shall be determined to have predeceased my daughter and I direct further that the provisions of this Will shall be construed upon that assumption irrespective of any provisions of law establishing a contrary presumption or requiring survivorship for a fixed period as a condition of taking property by inheritance. NINTH: Should my daughter Glenda K. Miley, and the issue of my daughter all fail to survive me, then I give, devise, and bequeath all the rest, residue, and remainder of my estate of whatsoever nature and wheresoever situate to Don Ridgley of 70 Mt. Rock Road, Lot 107, Shippensburg, Pennsylvania 17257. IN WITNESS WHEREOF, I, Lottie D. Cornman, the Testatrix to this, my Last Will and Testament, typewritten on three (3) sheets of paper which I have identified in the margin of each page by my signature, hereunto set my hand and seal this ~ ~T#day of Iv"l,~-~ , 1997. Lottie D. Cornman The preceding instrument consisting of three typewritten pages, each identified by the signature of the Testatrix, Lottie D. Cornman, was on this day and date signed, published, and declared by her, the Testatrix therein named, as and for her Last Will, in the presence of us, who at her request, in her presence, and in the presence of each other have subscribed our names as wimesses. COMMONWEALTH OF PENNSYLVANIA ) ) COUNTY OF CUMBERLAND ) SS: I, Lottie D. Cornman, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will on the .~ day of NAO~- , 1997; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein ~expressed. Lottie D. Cornman Sworn or affirmed to and acknowledged before me, by Lottie D. Cornman, the Testatrix, this ~ day of ~'3~c.~, 1997. Notary Public NOTARIAL SEAl.. NIVEN J. BAIRD. Notary Publ~ South Middleton Twp.. Curr, t)erland CO My Commission Ex~ires Nov. 2. 1998 4 COMMONWEALTH OF PENNSYLVANIA ) ) COUNTY OF CUMBERLAND ) SS: We, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Lottie D. Cornman sign and execute the instrument as a codicil to her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of Lottie D. Cornman signed the codicil as witnesses; and that, to the'best of our knowledge, Lottie D. Cornman was at the time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by the above-named witnesses, this ~cday of ~'~g~c~ , 1997. Notary Public NOTARIAL SEAL NIVEN J. BAIRD. Notary Pubt~: South Middtelon Twp.. Cun'~berlan(J Co !___~ Corn ~'~ ss o ~ Expires Nov. 2. 1998 5 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: _<-~. F_A-~..~ ~. Date of Death: 3 /,'q~ (~/O / / Will No. 21-02-57 Admin. No. 2002-00057 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 03-1 9-01 : Name Address Glenda K. Miley 21 38 pine Road, Newville, PA 1 7241 Notice has now been given to all persons entitled thereto under Ru~l~a) except None Date: April 24, 2002 'Signat~~.~l/~/'~ !/') Name~ Lindsay Dare'Baird, Esquire Address 37 South Hanover Street Carlisle, ~A Telephone (71~ 243-5732 Capacity: __ Personal Representative 17013 X Counsel for personal representative STATUS REPORT UNDER RULE 6.12 Name of Decedent: Lottie D. Cornman Date of Death: 03-1 9-01 Will No. 21-02-57 Admin. No. 2002-00057 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes x No__ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the C'~urt? Yes__ No X b. The separate Orphans' Court 'No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, .releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. _ Date: g'nature ~-- Lindsa¥ Dare Baird f Esquire Name (Please type or print) 37 South Hanover Street, Carlisle, PA Address 1717 ) 243-5732 Tel. No. Capacity: __Personal Representative (MAH:rmf/AM3) X __Counsel for personal representative 17013 Cumberlan~ ~66h~'=.~i~r Of Wills Hanover and High'Street Carlisle, PA i70i~ Phone:(717) 240-6345 Date: 2/07/2003 MILEY GLENDA K 2138 PINE ROAD NEWVILLE, PA 17241 RE: Estate of CORNMAN LOTTIE D File Number: 2002-00057 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 3/19/2003 Your prompt attention to this matter will be appreciated. Thank You. ~..erely, ' DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: ~/File Counsel Judge COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER ~-/- o ~-- COUNI~ CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ..... .~... /.orlr)r.. D /75 z , - DATE OF DEATH (MM-OD-YEAR) DATE OF BIRTH (MM-OD-YEAR) - . 7. o / 0 Io (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) X THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIALSECURITYNUMBER i~--'1 1. Original Return [~14. Limited Estate E~6. Decedent Died Testate (Attach copy of will) [~9. Litigation Proceeds Received I---] 2. Supplemental Return r-1 4a. Future Interest Compromise (date of death after 12-12-,32) [~7. Decedent Maintained a Living Trust (A~ch copy afTn~st) ~--I 10. Spousal Poverty Credit (date of death between 12-31--~1 and 1-1-~) r-i. Remainder Return (date of death pdor to 12-13~32) [] 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes i-~ 11. Election to tax under Sec. 9113(A) (Attad~ Sch O) FIRM NAME (IfApplicable) TELEPHONE NUMBER '~/~ - ~ ?& - ~-. Z t COMPLETE MAILING ADDRESS 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Uortgage~.& Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Properly (5) (Schedule E) 6. Jointly OWned Property (Schedule F) (6) [] separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Propert7 (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Lien~ (Sche.d.ule,I). (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. c) OFFICIAL USE ONLY L Z ('DO ~O (11) (12) (13) Charitable and Governmental Bequests/Sec 9113 Trusts for whichan election to tax has not been made (Schedule J) 14. Net Value Subject to Tax:(Line 12 minus Line 13).: (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15) 16. Amount of Line 14 taxable at lineal rate x .0 __ (16) 17. Amount of Line 14 taxable at sibling rate -' x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) Decedent's Complete Address: STREET ADDRESS ~.*O ~'"/,~2 .~ ~O~-.- ~ ~ ISTATE IZIP Tax Payments and Credits: 1.. Tax Due (P.age 1 Line'19) "'_., 2. Credits/Paymehts A. Spousal Poverty Credit B. Pdor Payments C. Discount 3. Interest/Penalty if applicable B. Interest E. Penalty .,:.Tota[ Credits ( A + B + C ) · Total Interest/Penalty ( D + E ) (3) If Line 2 is' greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. ' Check box on Page 1 Line 20 to request a refund (4) (2) , 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. . . . . (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE: 'q (5B) "' ",, Make Check PaYab/e to: REGISTER OF.WILL$,.AGENT . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS' :-"~1. Did de~.d.ent make a'tr~nsfer and: Yes No a. retair~ t~e use or income of the property tran§ferred;.i ................................................................... ..................... [] b. retain the right to designate who shall use the property transferred or its inCOme; ......................... i.~ ................ [] c. retain a reversionary interest; or ........................................................................................................ :.....; ........... [] d. receiyb the promise for life of either pa.yrfi?ts~benefits or care? ...................................................... ., ............... [] .. 2. If death occurred after December 1'2, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] 3. Did de~d?nt own an "in trust for* or payable upon death bank account or security at his or her death? .............. [] ' 4. Did decedi~nt own an Individual Retirement Account, annuity, or other non-probate property'which contains a benefidary ~lesignation?'' ' IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.. R,/OFPERSON RESPONSIBLE FOR FILING RETURN DATE y ' A~DRESS~ ..... _ [~ ' / / / SlGN~ARE~ ~~~ ~ ~,~,~DATE,/~/O ~ ' AB ~E CS - For dates of dea~ on or after July 1, 19~ and before Janua~ 1, 1995, the ~x rate imposed on ~e net value of transfers to or for ~e use of ~e suMving spouse is 3% [72 RS. {9116 (a) (1.1)(i)]. For dates of dea~ on or after Janua~ 1, 1995, the tax rate imposed on the net value of ~ansbm to or for the use of the su~iving spouse is 0% ~2 RS. {9116 (a) (1.1) (ii)]. The s~tute does not exempt a ~ansfer to a suwiving spouse from ~x, and the s~tuto~ requirements for disclosure of asse~ and filing a ~x return are still appli~ble even if · e suwiving spouse is ~e only benefida~. For dates of dea~ on or after July 1, 2000: The ~x rate imposed on ~e net value of ~ansfem from a deceased child ~en~ne yearn of age or younger at death to or for-the use of a natural parent, an adoptive parent, or a stepparent of the ~ild is 0% ~2 RS. {9116(a)(1.2)]. ~e ~x rote imposed on ~e net value of ~ansfem to or for the use of the de.dent's lineal beneficiaries is 4.5%, except as noted in 72 RS. {9116(1.2) [72 FS. {9116(a)(1)]. The ~x rate imposed on the net value of transbm to or for the use of the decedent's siblings is 12% [72 RS. {9116(a)(1.3)]. A sibling is define, under Section 9102, as an individual who has at least one parent in ~mmon with the de.dent, whether by blood or adop~on. '%-v.~ ~. ¢-9~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER include the proceeds of lilJgaUon and the date the proceeds were received by the estate. All property jointly, owned with the right of sumivorshi ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 5, Recapitulation) must be disclosed on Schedule F. VALUE AT DATE OF' DEATH (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DebtsofdecedentmustberepoRedonSchedulel. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 5. 6. 7. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State ~ Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) BUREAU OF ZNDZVTDUAL TAXES INHERTTANCE TAX DZVISTON DEPT. 180601 HARRISBURG, PA 17128-0601 GLENDA K MILEY 2158 PINE RD NEWVILLE COMMONNEALTH OF P'ENNSYLVANTA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLOHANCE OF DEDUCTIONS AND ASSESSMENT OF TAX Recoroaci ~--~ ~r ' ~'~ ~f DATE R~C~i$~',~T' C[ u\:[u~., ,o ESTATE OF DATE OF DEATH FILE NUMBER '03 JULll gS:0~OUNTY ACN ~,O., PA 07-21-2005 CORNMAN 05-19-2001 21 02-0057 CUMBERLAND 101 Amount Remitted REV-IS47 EX &FP (gl-OS) LOTTIE O MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGTSTER OF NTLLS. CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-15q7 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX . ESTATE OF CORNMAN LOTTIE D FILE NO. 21 02-0057 ACN 101 DATE 07-21-2003 TAX RETURN gAS: '(X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnersh/p Interest (Schedule C) ($) q. Mortgages/Notes Rece/vabZe (Schedule D) (q) 5. Cash/Bank Depos/ts/M/sc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTZONS: 9. Funeral Expenses/Adm. Costs/M/sc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10) 11. Total Deductions 12. Net Value of Tax Return Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) Net Value of Estate Sub~ect to Tax .00 .00 .00 .00 76 .q0 .00 .00 (8) 76.q0 .00 N~TE: To insure proper credit to your account, suba/t the upper port/on of th/s fora w/th your tax payment. 76 .q0 (11) 76.~0 (12) .00 (15) .00 (lq) .00 NOTE: Z~: an assessment ~as issued previously, 11nas lq, 15 and/or 16, 17, 18 and 19 ~ill reflect figures that include the total of ALL returns assessed to date. ASSESSNENT OF TAX: 15. Amount of L/ne lq at Spousal rate 16. Amount of L/ne lq tpxable at Lineal/Class A rate 17. Amount of L/ne lq at S/bl~ng rate 18. Amount of Line lq taxable at Collateral/Class B rate 19. Pr/nc/pal Tax Due TAX CREDITS: PAYMENT ' RECE/P1 ' DISCOUNT DATE NUMBER INTEREST/PEN PAID (-) (1~) .00 X O0 = .00 (15) . O0 X "Oq5 = . O0 (17) .00 X 12 = ..00 (18), .00 x 15 = .00 (19)= . O0 AMOUNT PAID ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1~ NO PAYMENT 1S REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR)~ YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.). RESERVATION: Estates of decedents dying on or before PURPOSE OF NOTICE: December lz~ 198Z -- if ~y futura' interest in the estatais transferred' .in possessianor enjoyment to Class B (collateral) beneficiaries of the.decddent:after the expiration of any estate'for life or for years, the Cammonmmalth hereby expressly reserves .the right to appraise and assess transfer Inheritance Taxes' at the laeful Class B (collateral} rate on any such future interest. * To fulfill the requirements of Section Zl~O .of the ~nhe~tan~e and EstataTax Act, A¢~ 23 of 2000. (TI P.S. Section Detach the top portion of this Notice and submit mith your payment to the Register of ~ills printed on the reverse Side. --Make check or money order payable to: REGISTER, OF ~ZLLS~ AGENT , .' A refund of a tax credit) mhich mas not'requested on the Tax Return, may be requested by completing an "Application' for Refund'of Pen~sYlvan!a Inheritance and. Estate Tax" (REV-1313). Applications are availabl'e at the Office of the Register of Nills, any of the Z~ Revenue District Offices,. or by calling tbs..special Z~-hour answering service for 'forms ordering: 1-800-56Z-ZOSO~ services for taxpayers with special hearing' and /'or speaking needs: 1-800-~7~30Z0 (TT onl~). ~. Any party in interest not'satisfied with the appraisement, allowance, or disalloaanc~ of deduction~, or assessment· of tax (including,discount or interest) as sho~n on this Notice must object mithin, sixty (60)' days of receipt of PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: ZN~:EREST ~ ',' this Notice by: .--mrittsn prate'st to the PA Department of Revenue) Board of Appeals, Dept. ZalOZ1) Harrisburg, PA171Za-lOZ1) : OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to tho O~phans' Court. '*. ~ ,, Factual errors discovered on thi%assessment should be addressed in ~riting to: PA DeParta~nt of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviem Unit~ Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 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. *. If any't~x due iS paid aithin threm'(~) calendar mohths ~fter the deCedant's daat~,'a five percent (SI) discount of the, tax paid is allamed. 'The 15Z tax amnesty non:participation penalty is computed on the .total of the t~x mhd interest'assessed, and not. paid before January 18) 1996, the first day mfta~ the eq~ of tho tax amnesty period. This non-participation penalty is appealable in the same manner and in the the sams time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is.c~argedbeglnnlng ~ith flrst day of dellnquency,.or nine (9) months and one (1) day from the date af death, to the date Of payment,' Taxes which became delinquent before January' 1, 19~2 bear 'lntarest at the rate'of six (6Z~ percent per annum calcplated..pt a daily rate of .00016~. All taxes mhich becamd delinquent on and after . January 1,.19aZ'mill bear interest at a rate mhich ail1 vary fram calendar year to calendar year mith that rate announced by the PA Department afRavenue. 'The applicable i~tere'st*ratms, for 198Z through ZOO3 are: Interest Daily Year Rate Factor 1999 7Z .00019Z ZOOO *-: *BI .... .OOOZ19 ZOO1 9Z .O00Z~7 ZOOZ 6Z .00016~ ZOO3 SZ .0001~7 Interest Daily Interest Daily Year Rate Factor Year Rate Factor 198Z I20Z .0005~8' 1987, 9Z : . O00Zq7 1983 16Z .... .000~38~ '* 1988-1991 -llZ :' .000301:* 198~ 11Z .000301 199Z 9Z .0002~7 1985 15Z .000356 1993-199~ 72 .00019Z 1986 ,IOZ .OOOZ7~ 1995-1998 9Z .0002~7 --Interest is calculated as follows: ~NTEREsT = ~ALANCE OF, 1'AX, I~"PAI'D X NUtIBER OF DAYS DELINI~EN? X DAILY I:NTEREST F~CTsR --~ny Notice issued'after'tho tax becomes delinquent will reflect an interest calculation to fifteen [15) days beyond the dat~ of the assess~'~nt. If payment is made after the interest computation date shown on the Notice) additional interest must be ~a!c~lated.