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HomeMy WebLinkAbout04-0289BUREAU 0~ INDIVIDUAL TAXES INHERXl%NCE TAX DX¥ISXON DEPT. Z80601 HARRISBURG, PA 171Z8-060! COMMONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAXSBHBNT ALLONANCE OR DXSALLO#ANCE OF DBDUCTZON~ AND ASSESSRENT OF TAX ON JOINTLY ~ELD OR TRUST ASSETS Recorded Office nf ' ~-t'r :DATE Reg;st~r of ]~ISESTATE OF '04 ItAR 12 DORIS E KOHR 101 MOUNTAIN LN ENOLA PA 1. 7025 03-15-200~ KOHR DATE OF DEATH IO-Z6-ZO05 PILE NUMBER ~2/-~ - ~? Pi COUNTY CUHBERLAND SSN/DC 161-52-~171 ACN 0~10175~ GORDON N Amoun't Rem/*~ted MAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA I?0~5 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~M REV-15~8 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAXSEHENT, ALLOICANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-15-200~ ESTATE OF KOHR GORDON W DATE OF DEATH 10-26-2005 COUNTY CUMBERLAND FILE NO S.S/D.C. NO. 161-~Z-~171 ACN 0~10175~ TAX RETURN WAS* (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. $1~000285~9 TYPE OF ACCOUNT ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE~ESTABLISHED 0~-05-Z005 Account Balance Percent Taxable Amoun~ Sub~ec~ ~o Tax Debts and Deductions Taxable Amoun~ Tax Ra~e Tax Due .00 NOTE. 0 500 .00 - .00 O0 15 .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 TO: "REGXSTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE) SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( ~F TOTAL DUE ZS LESS THAN $1; NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT'! CR)) YOU MAY BE DUE A REFUND SEE REVERSE S/DE OF THIS FORM FOR INSTRUCTIONS. ) .00 .00 00 00 BUREAU OF INDZV/UUAL TAXES COMHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTXCB OF XNSSRZTANCE TAX APPRAZSEHENT ALLONANCE OR DZSALLONANC£ OF DEDUCTXON~, AND ASSESSHENT OF TAX ON _ ~ JOXNTLY~I~LD OR TRUST ASSETS Register WtPs · 04 I' I P, 12 P 1 DORIS E KOHR ,_ 101 MOUNTAIN LN (~t,,~- ENOLA PA 1~025~ . CATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN O$-lS-ZOOq KOHR 10-26~2005 161-S2-q171 0q101756 Amoun~ RemZ~ed GORDON W MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE I~~ RETAIN LOWER PORTION FOR YOUR RECORDS ""~ REV-15~8 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-15-200q ESTATE OF KOHR GORDON W DATE OF DEATH 10-26-2005 COUNTY CUMBERLAND FILE NO S S/D C NO. 161-$2-q171 ACN 0~101756 TAX RETURN WAS. (X) ACCEPTED AS FILED ( ) CHANGED dOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION. PNC BANK ACCOUNT NO $1500028qSfi TYPE OF ACCOUNT: C ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE,ESTABLISHED Oq-OS-ZO0$ Account Balance Perce~t Taxable ~ 0.500 Amount Subject to Tax O0 Debts and Deductions .00 Taxable Amount .00 Tax Rate X 15 Tax Due .00 O0 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 TO. "REGISTER OF WILLS, AGENT TAX CREDZTS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) XF PA/D AFTER THIS DATE, SEE REVERSE FOR CALCULAT[ON OF ADDITIONAL INTEREST XF TOTAL DUE 1S LESS THAN $1, NO PAYMENT ZS RE~U/RED XF TOTAL DUE XS REFLECTED AS A *'CREDIT" (CA), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 BUREAU OF INDIVIDUAL TAXES DORIS E KOHR 101 MOUNTAIN LN ENOLA PA 17025 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISSNENT ALLONABCE OR DISALLONANCS OF DEDUCTION~, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS Records. d* O[flccD'~TE 03-15- 2004 Register or WiESTATE OF KONR --'D~,TE OF DEATH 10-26-Z003 FILE NUMBER COUNTY '04 PIAR 12 ?.~g~c ACN CUMBERLAND 161-$2-4171 04101738 Amoun~ Remi*~'~ed 60RDON W HAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701S CUT ALONG THZS LINE ll~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-1548 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-15-2004 ESTATE OF KOHR GORDON W DATE OF DEATH 10-26-2003 COUNTY CUMBERLAND FILE NO S S/D.C. NO. 161-3Z-4171 ACM 04101738 TAX RETURN WAS' (X) ACCEPTED AS FILED ( ) CHANGED dOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION PHC BANK ACCOUNT NO. 31600028484 TYPE OF ACCOUNT. ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TINE CERTIFICATE DATE ESTABLISHED 04-03-Z003 Account Balance Percent Taxable X 0.500 Amount SubSect to Tax .00 Debts and Deductions .00 Taxable Amount .00 Tax Rate X .15 Tax Due 00 TAX CREDZTS: O0 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 HAKE CHECK OR HONEY ORDER PAYABLE TO. "REGISTER OF WILLS, AGENT ' PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT I BALANCE OF TAX DUE] INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITZONAL INTEREST ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 00 00 0O .00 BUREAU OF INDIVIDUAL TAXES COMHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTXCE OF XNHERXTANCE TAX APPRAISENENT. ALLOBANCE OR DXSALLORANCH OF DEDUCTXON$. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS Recorded Off;ce ~TE 03-IS-Zoo~ Register of ¥?tlIESTATE OF KOHR '04 H/~R 12 DORIS E KOHR 101 MOUNTAIN LN ENOLA PA 17025 DATE OF DEATH 10-26-2003 ,COUNTY PIS~t~/DC 161-3Z-q171 ACN 0~1017~0 Amoun~ Remi~ed b GORDON W MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~'~ RETAIN LONER PORTION FOR YOUR RECORDS '"~ ....REV£1548 EX AFP (0I~03) ............... ' ...................................................... '-'" ............ NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS~ AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-15-200~ ESTATE OF KOHR GORDON W DATE OF DEATH 10-26-2003 COUNTY CUMBERLAND FILE NO S.S/D C NO 161-32-~171 ACN 0~1017~0 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION PNC BANK ACCOUNT NO. 31~000285~6 TYPE OF ACCOUNT ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 0~-03-2003 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due O0 NOTE 0.500 O0 O0 .00 .15 .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 HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER TH[S DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. · ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS .00 .00 .00 .00 CONNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-D601 REV-15iiS EX AFP (09-00) CONNIE L KOHR 99 MOUNTAIN LN ENOLA '04 PA 17025 ZNFORMATZONAND NOTTCE FILE NO. 21 OH -~,~ TAXPAYER RESPONSE ACN 0q101755 DATE 01-25-2004 TYPE OF ACCOUNT ]~ST ' OF GORDON W KOHR [] SAVINGS S.S. NO. 161-$2-4171 [] CHECKING DATE OF DEATH 10-26-2005 [] TRUST APR CUMBERLAND [] CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 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 Goner/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 uith the Inheritance Tax Lams of tho Coamoneaalth of Pennsylvania. Questions may be answered by calling (717) 787-85Z7. COMPLETE FART 1 BELOW x # x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 51400028549 Date 04-03-Z005 Established Account Balance .00 Percent Taxable X 50.000 Amount Subject to Tax .00 Tax Rate X .00 Potential Tax Due .00 To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of #ills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments ara made within three (3) months of the decedent's date of death, you may deduct a SZ 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 Hills with tea copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to tho Register of  ONE ~ Hills and an official assessment ~ill be issued by the PA Department of Revenue. BLOCKJ B. [] The above asset has been or alii be reported and tax paid ~ith the Pennsylvania Inheritance Tax return ONLY 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 ~x_ratp,.please state your [~] relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 2. Account Balance 2 $. Percent Taxable $ K --~-- q. Amount Subject to Tax 5. Debts and Deductions ~ - 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts I have reported above ere true, correct and complete to the best of my knowledge and belief. DATE' ' TAXPAYER S]6NATURE TELEPHONE NUMBER ~~ CONHONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF ZNDZ¥ZDUAL TAXES DEPT. 280601 HARRISBURG, PA 171ZB-0601 REV-I~5 EX AFP ZNFORHATZON AND TAXPAYER RESPONSE ACN 0q101757 DATE 01-Z$-ZOOq CONNIE L KOHR 99 NOUNTAZN LN ENOLA TYPE OF ACCOUNT ~'~:;Y,-, EST. OF GORDON N KOHR [] SAV:]:NGS c~ ~: ' S:S. NO. 161-~Z-~171 [] CHECKING DATE OF DEATH 10-26-2005 [] TRUST .cCOURTY~ ~ CUMBERLAND [] CERTIF. REHZT PAYHENT AND FORHS TO: REGISTER OF HILLS PA 17025 C. gi': CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 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 mere a joint other/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy ta this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Cosmonlsalth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 ~ELON ~ ~ ~ SEE REVERSE SIDE FOR FZLZNG AND PAYMENT ZNSTRUCTZONS Accoun~ No. $1500028~8~ Data 0~-0~-2005 Established Accoun~ Balance .00 Parcen~ Taxable X 50.000 Aaoun~ SubSec~ ~o Tax .00 Tax Ra*e X .00 Potential Tax Due .00 To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: [f tax payments ars made within three (3) months of the decedent's date of death, you say deduct a SZ discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LINE A. D The above information and tax due is correct. 1. You amy choose to remit payment to the Register of Hills 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 Hills and an official assessment will be issued by the PA Department of Revenue. B. [] The above asset has been or will be reported and tax paid tith the Pennsylvania Inheritance Tax return to bm filed by the decedent's representative. C. ~The above information is incorrect and/or debts and deductions were paid by you. You lust complete PART ~ and/or PART ~ below. If you indicate a differen~ ~ax r~a~e, please s~a~e your relationship ~o decedent: ~,~¥[%Xk~/~. RETURN - COMPUTATION OF TAX ON JO[NT/TRUST ACCOUNTS 1. Da~e Established 1 2. Accoun~ Balance $. Percent Taxable fi. A.oun* Sub5ec* ~o Tax 5. Debts and Deductions 6. Amoun~ Taxable 7. Tax Ra~e 7 8. Tax Due 8. PART DATE PAID DEIlTS AND DEDUCTIONS CLAZMED PAYEE DESCRIPTION AMOUNT PAID ¥OYAL (Enter on Line $ of Tax Compulation) Under penalties of perSury, Z declare that ~ha fac~s ! have reported above ara ~rue, correc~ and coeple*e to *ha bas* of my knowledge and belief. HOME TAXPAYER SIGNATURE- TELEPHONE NUMBER ~y~ DATE' COMHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF iNDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1712B-0601 REV-1;4S EX L~FP (09-OD) ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 21 ACN 04101759 DATE 01-25-200q CONNIE L KOHR 99 HOUNTAIN LN ENOLA R~!~;~: EST'~ OF GORDON N KOHR i'~,i, S.S. NO. 161-$2-4171 DATE OF DEATH 10-26-2005 COUNTY CUMBERLAND '04 ~PR 15 F'~2:55 PA 17025 TYPE OF ACCOUNT []SAVZNGS []CHECKING ~TRUST ~CERTZF. REHZT PAYHENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PHC BANK has provided the Department eith the information listed balo~ 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 ~ora and return it to the above address. This account is taxable in accordance Bith the Inheritance Tax La~s of the Coaaon~ealth of Pennsylvania. Questions may be ansBered by calling (717) 787-8527. COMPLETE PART 1 BELOW # ~ ~ SEE REVERSE SIDE FOR FZLZNG AND PAYMENT INSTRUCTIONS Accoun~ No. $1600028484 Da~a 04-05-2005 Established Accoun~ Balance .00 Parcan~ Taxable X 50.000 Aeoun~ Subjac~ ~o Tax .00 Tax Ra~e X .00 Po~an~al Tax Due .00 To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of gills. Make check payable to: "Register of #ills, Agent". NOTE: If tax payments are made aithin three (~) months of the decedent's data of death, you may deduct a 5X discount of the tax due. Any inheritance tax duo ~ill become delinquent nine (9) months after the date o~ death. PART TAX LINE PART TAXPAYER RESPONSE A. ~ The above information and tax duo is correct. 1. You may choose to remit payment to tho Register of giLLs aJth tad 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 - ONE ~ #ills and an official assessaent ail! be issued by the PA Department of Revenue. BLOCK J B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be fiZed by the decedent's representative. C. ~The above information is incorrect and/ar debts and deductions were paid by you. I 'You Bust complete PART ~ and/or PART ~ below. If you ind{©a~e a diffaren~ ~,-~a~a~ please rIla~[onship ~o decedent: ~'~t~_~Z_~ your RETURN - CONPUTATZON OF TAX ON JOINT/TRUST ACCOUNTS ~. Da~e Established 2. Accoun~ Balance $. Percan~ Taxable q. Amoun~ SubSec~ ~o Tax 5. Oab~s and Deductions 6. Amoun~ TIxabla 6 7. Tax Ra~e 7 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCT'rONS CLAZMED PAYEE DESCRIPTION AHOUNT PAID TOTAL (Enter on L/ne $ of Tax Computation) Under portal,JaB of perjury, Z declare ~ha~ ~he facts T have reported above ara ~rue, correc~ and comple*e *o *he bee* of ay kno. ledge end belief. HONE (~ ~ )'~-- tAXPAYER SIGNATURE TELEPHONE NUMBER CONHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 17128-0601 REV-~di$ EX AFP (79,-00) 'O4 INFORMATION NOTICE AND TAXPAYER RESPONSE FZLE N0. Zl ACN OqlO17ql DATE 01-23-Z00q EST.' OF GORDON W KOHR S.S. NO. 161-52-~171~ D~ :~,~ DEATH IO-Z6-ZO05 COUNTY CUMBERLAND CONNIE L KOHR L:~, 99 MOUNTAIN LN ~t~l~; : ENOLA PA 170Z5 TYPE OF ACCOUNT i--I SAVINGS [~CHECKING [--]TRUST [~]CERTIF. REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 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 ~orm and return it to the above address. This account is taxable in accordance with tho Inheritance Tax Laws of the Commonwealth of PannsylvanJa. Questions may be answered by calling (717) 787-85Z7. COMPLETE PART 1 BELOW # ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. $lqOOO285q6 Date 0q-05-2005 Established Account Balance .00 Percent Taxable X 50.000 Amount Subject ~o Tax .00 Tax Rate X .00 Potentia! Tax Due .00 To insure proper credit to your account, two (g) 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 [5) months of the decadant's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due ell1 become delinquent nine (93 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 Ragister of Wills with two capias of this notice to obtain CHECK e discount ar avoid interest, or you may check box "A" and return this notice to the Register of E ONE~ Hills and an official assessment will be issuad by the pA Department of Revenue. BLOCK B. [] The above asset has been or will ba reported and tax paid with tha Pennsylvania Inheritance Tax return ONLY to be filed by the dacadant's representative. C. ~The above information is incorrect and/or debts and deductions aarp paid by you. ' ~You must complete PART [] and/or PART [] baloe. PART If you indicate a different tax ~ate, p_lease state TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established I 2. Account Balance 2 $. Percent Taxable $ ~ ~'O-- q. Amount Subject to Tax q $. Debts and Deductions $ - 6. Amount Taxable 6 7. Tax Rate 7 ~ ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Ltne$ of Tax Computation) $ Under peneltles of perjury, I declare that the facts I have reported above are true, corr~ct and complete to the best of my know].,edge end ~ 00) TAXPAYER SIGNATURE TELEPHONE NUMBER ~ ~ OATE BUREAU OF INDIVIDUAL TAXES /NHERITANCE TAX DIVTS~ON DEPT. Z80601 HARR/SBURG, PA 17128-0601 CONNIE L KOHR 99 MOUNTAIN LN ENOLA *O4 PA 170~ ~ COMMONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLORANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF' TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-08-2004 ESTATE OF KOHR DATE OF DEATH 10-26-2005 FILE NUMBER Z1 04-0289 COUNTY CUMBERLAND '~ .... ~'~ '?SSN/DC 161-$2-4171 ['~Uv -9 ~ *~CN 04101741 Amoun~c Rem J.'l:'l:ed GORDON HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-08-2004 ESTATE OF KOHR GORDON H DATE OF DEATH 10-Z6-ZO03 COUNTY CUMBERLAND FILE NO. 21 04-0289 S.S/D.C. NO. 161-32-4171 ACN 04101741 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PHC BANK ACCOUNT NO. 31400028546 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 04-03-2003 Account Balance .00 Percent Taxable X 0.500 Amount Subject to Tax .00 Debts and Deduc~/ons - .00 Taxable Amoun~ .00 Tax Ra~e X .00 Tax Due .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE HITH YOUR TAX PAYMENT TO THE REGISTER OF HILLS AT THE ABOVE ADDRESS. HAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF HILLS, AGENT." TAX CRED'rTS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID ¢-) TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" { CR}, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. .0O .00 .00 .00 PURPOSE OF NOTICE: PAYNEHT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: ZNTEREST: To fulfill the requirements of Section Zl~O of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (72 P.S. Section Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Hills, any of the Z$ Revenue District Offices or by calling the special Z~-hour ansaaring service for forms ordering: 1-800-36Z-ZO50; services for taxpayers aith special hearing and or speaking needs: 1-800-~7-30Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Oapt. ZBlOZ1, Harrisburg, PA 171lB-lOll, OR --eXacting to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. Z80601, Harrisburg, PA 171Z8-060! Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-15013 for an explanation of administratively correctable errors. If any tax duo is paid within three (3) calendar months after the decedent's death, a five percent (SZ) discount of the tax paid is alloaed. The lex tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January lB, 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 appea! the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of ALI taxes ehich became delinquent on or after January 1, 1982 mill bear interest at a rate which a111 vary fram calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOq are: Interest Daily Interest Daily Intarast Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z 'ZOZ .OOOSq8 198'~-1991 IIX .000301 ZO0~ 9Z .O00Z~7 1983 16Z .000fi38 199Z 9Z .0002q7 ZOOZ 6Z .O00Z19 198q 11Z .000301 1993-199fi 7Z .OO019Z 2003 5Z .000157 1985 13Z .000356 1995-1998 92 .OOOZq7 200~ qZ .000110 1986 IOZ .O00ZTfi 1999 72 .00019Z 1987 92 .OOOZ~7 ZOO0 8Z .000Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent uill reflect an interest calculation to fifteen (15) days beyond tho data of the assessment. If payment ls made after the interest computation date shown on the Notice, additional lntarest must be calculated. BUREAU OF ZNDZVZDUAL TAXES INHERTTANCE TAX DIVISTON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 CONNIE L KOHR 99 MOUNTAIN LN ENOLA *04 PAL17025 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLO#ANCE OR DISALLOWANCE OF DEDUCTION~, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-08-200q ESTATE OF KOHR DATE OF DEATH 10-26-2005 FILE NUMBER 21 0q-0289 COUNTY CUMBERLAND SSN/DC 161-52-q171 ACN 0q101757 Amoun~ Remi~md REV-iS48 EX AFP COl-OS) GORDON W MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LXNE ~* RETAIN LOWER PORTION FOR YOUR RECORDS *~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-08-200q ESTATE OF KOHR GORDON W DATE OF DEATH 10-26-2005 COUNTY CUMBERLAND FILE NO. Z1 0q-0289 S.S/D.C. NO. 161-52-q171 ACN 0q101757 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 51500028q8q TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 0q-05-2005 Account Balance .00 Percent Taxable X 0.500 Amount Subject to Tax .00 Debts and Deductions .00 Taxable Amount .00 Tax Rate X .00 Tax Due .00 TAX CREDITS: 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 TO: **REGISTER OF WILLS, AGENT.** PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE XF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A *'CREDZT**(CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. .00 .00 .00 .00 PURPOSE OF NOTICE: To fulfill the requirements of Section Il60 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S. Section 9140). PAYHENT: Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. REFUND (CA): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-~6Z-ZOSO; services for taxpayers with special hearing and or speaking needs: 1-800-447-5020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 171ZB-lOZ1, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxas~ ATTN: Post Assessment Review Unit, DEPT. Z80601, Harrisburg, PA 171Z8-060! Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three ($) calendar months after the decedent's death, a five percent discount of the tax paid is allowed. The 1SI 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 is charged beginning with first day of delinquency~ or nine (9) months and one (1) day from the data of death, to the date of payment. Taxes which became delinquent before January 1~ 1982 bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .000164. All taxes which became deIinquent on er after January 1, 1982 wi11 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 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198~ 20Z .000548 198---~-1991 112 .000301 2009 9Z .000247 1985 16Z .000458 199Z 9Z .000247 ZOO2 62 .O00Zl9 1984 11Z .000301 1993-1994 7Z .O00lgZ 2003 5Z .000137 1985 13Z .000356 1995-1998 9X .000247 ZOO4 4Z .000110 1986 lOZ .000274 1999 72 .OOO19Z 1987 9Z .000247 2000 8Z .OOOZ/9 --Interest is calculated as folloes: 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 TNHERTTANCE TAX DZYTSTON DEPT. Z80601 HARR/SBURG,, PA 171Z8-0601 COHMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF XNHERZTANCE TAX APPRAXSENENT. ALLOWANCE OR DXSALLONANCE OF DEDUCTXONS, AND ASSESSHENT OF TAX ON JOXNTLY HELD OR TRUST ASSETS CONNIE L KOHR 99 MOUNTAIN LN ENOLA PA Z7025~: .. REV-Z6~i8 EX AFP COl-OS) DATE ll-08-ZOOq ESTATE OF KOHR GORDON DATE OF DEATH IO-Z6-ZO0$ FILE NUMBER 21 0q-0289 COUNTY CUMBERLAND ACN 0~10~755 Amoun~ Remi~ed HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-08-200q ESTATE OF KOHR GORDON W DATE OF DEATH 10-26-2005 COUNTY CUMBERLAND FILE NO. 210q-OZ89 S.S/D.C. NO. 161-$2-q171 ACN 0q101755 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. $lqOOOZ85q9 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST C~ TIME CERTIFICATE DATE ESTABLISHED 0q-05-200~ Account Balance Percent Taxable X 0.500 Amount SubSect to Tax .00 Debts and Deductions - .00 Taxable Amount .00 Tax Rate X .00 Tax Due .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 TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID ¢-) TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. .00 .00 .00 .00 PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DZSCOUNT: PENALTY: INTEREST: To Fulfill the requirements oF Section 1140 of the Inheritance and Estate Tax Act~ Act Z$ of ZOO0. (72 P.S, Section 9140). Detach the tap portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Make check or money order payable to: REGISTER OF NILLS, AGENT. 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-13133. Applications are available at the OFfice oF the Register oF Hills, any of the Z3 Revenue District OFfices or by calling the special 24-hour answering service For Forms ordering: 1-800-562-2050; services For taxpayers with special hearing and or speaking needs: 1-800-447-5010 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment oF tax (including discount or interest) as shown on this Notice 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 17118-1021, OR --electing to have the matter determined at the audit oF the account oF the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau oF Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. Z80601, Harrisburg, PA 17118-060! Phone (717) 787-6505. Sea 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 tax due is paid within three ($) calendar months aFter the decedent's death, a five percent (SZ) discount oF the tax paid is allowed. The 15Z 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 and oF the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning 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 (61) percent per annum calculated at a daily rate oF .000164. All taxes which became delinquent on or aFter January 1, [982 wi[! bear interest at a rate which mill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. Tho applicable interest rates For 1982 through 2004 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .000548 198~-1991 lIZ .O003Ol ZOO1 91 .000247 1983 16X .000436 1991 92 .000247 2002 6Z .000219 1984 llZ .000301 1993-1994 72 .000192 2003 5Z .000137 1965 13Z .000356 1995-1998 91 .000247 2004 42 .000110 1986 lOX .000274 1999 72 .000192 1987 9Z .000247 2000 82 .000219 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DATL¥ 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 calculatad. BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DZVTSTON DEPT. Z&0601 HARRXSBURG, PA 17128-D601 CONNIE L KOHR '0~ 99 HOUNTAIN LN ENOLA pA 17025 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTZCE OF INHERITANCE TAX APPRAISEHENT. ALLOWANCE OR DXSALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-08-200~ ESTATE OF KOHR DATE OF DEATH 10-26-2005 FILE NUHBER 21 0~-0289 COUNTY CUHBERLAND SSN/DC 161-$2-~171 ACN 0~101759 Amount Remitted REV-15~8 EX AFP GORDON HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF gILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~.~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-1548 EX AFP NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON dOINTLY HELD OR TRUST ASSETS DATE 11-08-200~ ESTATE OF KOHR GORDON W DATE OF DEATH 10-26-2005 COUNTY CUHBERLAND FILE NO. 21 0~-0289 S.S/D.C. NO. 161-~2-~171 ACN TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED dOINT OR TRUST ASSET INFORHATXON 0~101759 FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. $1600028~8~ TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ¢ ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 0~-05-2005 Account Balance Percent Taxable X 0.500 Amount Subject to Tax .00 Debts and Deductions .00 Taxable Amount .00 Tax Rate X .00 Tax Due .00 TAX CREDZTS: .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 TO: "REGISTER OF WILLS, AGENT." PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL ZNTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. .00 .00 .00 .00 PURPOSE OF NOTICE: PAYHENT: REFUND (CA): OBJECTIONS: ADH/N- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (TZ P.S. Section 91qO). 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 HILLS) AGENT. 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-15153. Applications are available at the Office of the Register of Hills, any of the 25 Revenue District Offices or by calling the special Z4-hour answering service for forms ordering: 1-&OO-362-Z050; services for taxpayers with special hearing and or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied with the appraisement, allomance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object mithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 181011, Harrisburg, PA 17118-1011, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factua! errors discovered on this assessment should be addressed in writing to: PA Oeparteant of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. Z80601, Harrisburg, PA 171Z8-0601 Phone (7171 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. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (mX) discount of the tax paid is allowed. The 15Z 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 is charged beginning mith 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, 198Z bear interest at the rata of six (6Z) percent per annum calculatad at a daily rate of .000164. All taxes which became delinquent on or after January 1, 198Z wi1! 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 198Z through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198'~ ZOZ .000548 1988-1991 111 .000301 ZO0'--'~ 91 .000147 1985 161 .000458 1991 91 .000147 ZOOZ 61 .000219 1984 112 .000301 1995-199~ 72 .000191 1005 51 .0001S7 1985 131 .000556 1995-1998 92 .000247 2004 42 .000110 1986 102 .000274 1999 7Z .000192 1987 92 .000147 ZOO0 82 .000219 --Interest is calcutated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (151 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.