Loading...
HomeMy WebLinkAbout04-0250PETITION FOR PROBATE & GRANT OF LETTERS Estate of DOROTHY J. BOWERS also known as Social Security No. 174-05-2574 , decease~ No. 21-04- ,=,z~) To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The Petition of the undersigned respectfully represents that: Your Petitioners, who is 18 years of age or older and the Executrix named in the Last Will of the above decedent dated Auqust 13, 2003 , and codicils dated none . The Executor named none died Renunciations for none attached hereto. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 1000 West South Street Carlisle Borouqh Decedent, then 100 years of age, died Re.qional Medical Center, Carlisle, Pennsylvania January 10 ,2004, at Carlisle Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the Will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in PA (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania, situated as follows: $79,000.00 $ WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented herewith and the grant of letters testamentary thereon. Signature(s) and Residence(s) of Petitioner(s): ghirle¥ I. Hel{shmar{ ' '"" 398 CenteWille Road Newville, PA 17241 717-776-5280 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA : : COUNTY OF CUMBERLAND : SS The Petitioner(s) above named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that as personal representative of the above deceder.~t, petiticner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before meMarchthis/~,2.7-//, 2004. day of Shirle . Heishman ~'~?.~ (/~., Ro~gister No. 21-04-~2~ Estate of DOROTHY J. BOWERS, deceased. DECREE OF PROBATE & GRANT OF LETTERS AND NOW, March /'.-~-' ,2004, in consideration of the Petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated Auqust 13, 2003 described therein be admitted to probate and filed of record as the Last Will of Dorothy J. Bowers ; and Letters Testamentary are hereby granted to Shirley I. Heishman FEES Probate, Letters, Etc ........ $ 200.00 Short Certificates(-1- ) .... $ 3.00 Renunciation(s) ........... $.__ JCP .................... $10.00 Other Will Paqes (-2-) .... $ 6.00 TOTAL: .... $ 219.00 Filed .,,~c~/-/.. z' ,~,,..~--~.~'. ..... IRWIN & M.c,J~NIGHT Roqer)~. I, rw~n, Esquire (06282) ATTO N~__~' (Sup. Ct. I.D. No.) 60 West Pomfret St., Carlisle, PA 17013 ADDRESS 717-249-2353 PHONE LAST WILL AND TESTAMENT I, DOROTHY J. BOWERS, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my Executrix to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my Executrix to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I devise and bequeath all of my estate of every nature and wherever situate to SHIRLEY I. HEISHMAN. 4. I nominate and appoint SHIRLEY I. HEISHMAN to be the Executrix of this my Last Will and Testament; she is to serve as such without bond. Should she die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint ROGER B. IRWIN as substitute Executor, also to serve as such without bond, with the same powers as are given herein to my Executrix. IN WITNESS WHEREOF, I have hereunto set my hand and seal this August, 2003. __ day of Signed, sealed, published and declared by DOROTHY J. BOWERS, the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. 2 A CKNO WLEDGMENT AND AFFIDAVIT WE, DOROTHY J. BOWERS, KAMELA S. CORNMAN and SHARON L. SCHWALM, the Testatrix and wimesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament, that she had signed willingly, that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. - SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by DOROTHY J. BOWERS, the Testatrix herein, and subscribed and sworn to before me by KAMELA S. CORNMAN and SHARON L. SCHWALM, witnesses, this ,3 ~ day of August, 2003. Public Notarial Seal r B. Irwin, Notz_,'y Public ] Carli~lo Bom, Cumberland County [ My Comml,~ion ~xpims Oct. 3. 2004 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Estate No.: Dorothy J. Bowers January_ 10, 2004 21-04-250 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on March 24, 2004 . Name Shirley I. Heishman Address 398 Centerville Road, Newville, PA 17241 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: none . 03/24/04 Signature~~~ r~. ~ IR~KNIGHT Name Roger B. Irwin, Esquire Address60 West Pomfret Street Carlisle, PA 17013 Telephone (717) 249-2353 Capacity: X __ Personal Representative __ Counsel for Personal Representative REV- 1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. Z80601 HARRISBURG, PA 17128-0601 REV-1500 D E C E D E N T cAPB HpRL EpIO cRAC KoTK ES co,[ S T INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME(LAST, FIRST,AND MIDDLE INITIAL) Bowers Dorothy J DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 01/10/2004 12/21/1903 (IF APPLICABLE) SURV V NG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER 21-04-0250 COUNTYCODE YEAR NUMBER SOCIAL SECURITY NUMBER 174-05-2574 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 1. Original Return L~ 2. Supplemental Return }~ 4. Limited Estate 4a. Future Interest Compromise (date of death after 1Z- 1Z-8Z) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) ]--] 9. Litigation ProceedsReceived [] 10. Spousal PovertyCredlt ~ (date of death between 1Z-31-91 and 1-1-95) (d,ate of death 3. Remainder Return pnor to 12-13-8Z) 6. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME Roger B. Irwin Esq. FIRM NAME (If Applicable) IRWIN & McKNIGHT TELEPHONE NUMBER 717/249-2353 COMPLETEMAILINGADDRESS 60 West Pomfret Street West Pomfret Professional Bldg. Carlisle, PA 17013 T A X R E C A P I T U L A T I O N C O M T I 0 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) --J Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (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, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 13. 14. None N°ne None None 84,988.09 None None 9,424.00 3,462.41 OFFICIAL IL~ ONLY r :2 (6) 84,988.09 (11) 12,886.41 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13). made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (14) (12) 72,101.68 72,101.68 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) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 0.00 X .0 0 (15) 0.00 X .0 45 (16) 0.00 X .12 (17) 72,101.68 X .15 (18) (19) 0.00 0.00 0.00 10,815.25 10,815.25 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00) REV- 1508 EX + {1-97) COMMONWEALTH OFPENNSYLVANIA INHERITANCETAXRETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Dorothy J Bowers SS# 174-05-2574 01/10/2004 21-04-0250 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 2 VALUE AT DATE DESCRIPTION OF DEATH Manufacturers Traders and Trust Company - Checking Account 36,109.51 16799631 Manufacturers and Traders Trust Company - Checking Account 950221704 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 48,878.58 84,988.09 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-1511 EX+ (1-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF Dorothy J Bowers SS# 174-05-2574 01/10/2004 FILE NUMBER 21- 04- 0250 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1 Hoffman-Roth Funeral Home 1 2 3 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney's Fees IRWIN & McKNIGHT 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 Register of Wills Tax Return Preparer's Fees OtherAdministrativeCosts Cumberland Law Journal - Estate Notice Publication Register of Wills - Filing Fee The Sentinel Legal Advertising TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) 4,010.00 5,000.00 219.00 75.00 25.00 95.00 $ 9,424.00 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy J Bowers SS~/ SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS 174- 05- 2574 01/10/2004 FILE NUMBER 21 - 04- 0250 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 O'brien, Baric & Scherer Legal Fees PHARMERICA - Pharmacy Sarah A. Todd Memorial Home 1,000.00 449.01 2,013.40 TOTAL (Also enter on line 10, Recapitulation) $ 3,462.41 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX * (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy J Bowers SS# 174-05~2574 SCHEDULE J BENEFICIARIES 01/10/2004 FILENUMBER 21-04-0250 NUMBER I. II. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers u~er S~. 91 l~a)(1.Z)] Shirley I Heishman 398 Centerville Road Newville, PA 17241 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Niece AMOUNT OR SHARE OF ESTATE Remainder TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0 o 00 (If more space is needed, insert additional sheets of the same size) Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE LAST WILL AND TESTAMENT I, DOROTHY J. BOWERS, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my Executrix to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my Executrix to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I devise and bequeath all of my estate of every nature and wherever situate to SHIRLEY I. HEISHMAN. 4. I nominate and appoint SHIRLEY I. HEISHMAN to be the Executrix of this my Last Will and Testament; she is to serve as such without bond. Should she die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint ROGER B. IRWIN as substitute Executor, also to serve as such without bond, with the same powers as are given herein to my Executrix. IN WITNESS WHEREOF, I have hereunto set my hand and seal this August, 2003. __ day of (SEAL) Signed, sealed, published and declared by DOROTHY J. BOWERS, the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. A CKNO WLEDGMENT AND AFFIDAVIT WE, DOROTHY J. BOWERS, KAMELA S. CORNMAN and SHARON L. SCHWALM, the Testatrix and wimesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament, that she had signed willingly, that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a wimess and that to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. OW RS '- KAMELA S. CORNMAN SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by DOROTHY J. BOWERS, the Testatrix herein, and subscribed and sworn to before me by KAMELA S. CORNMAN and SHARON L. SCHWALM, witnesses, this ~ ~ day of August, 2003. "Notary Public ~[.--~/ Notarial Seal ] Roger B, Irwin, Notary Public ! Carllale Bom. Cumberland County My Commisaioa Bxgire, a Oct 3 2004 I'age2 k;state of: Dorothy d. Bowers' ,9ocial ,¥e.~iritw 17,/-05-2574 Date of Death: danuarp I0, 2004 Type of Account Account Number ( )wnerd~ip (Name6' Openi.g Dc~e Bal~tce on Dale qf l~ath Accnted Inl~vl 7btul ~D lnler~'l I'uM to Date of D~th C"hecldng Account 9511221704 Dorot~. d .lulie N Renninger, I'OA John K Zimmermatn POd 12/29/(10 $,18.868.34 $ I0.2,I $48,8 78. 58 Please be advised there was no safe deposit box found for the above decedent, For further account irlfomlation, closures and/or reinburse~lellt o~ funds ploaso call the High Street, Carlisle Office # 7'17-2a0-6703. Sincerely, Nmcy Clagett Records Management M&TBank 4~; Mitchcll Rmul. Mill.qhom, t,lli 19%6 Mail Cml~ DI!-Mlt-12 Irwin & McKnight Attorneys At Law West Pomfret Professional Building 60 West Pomfret Strcct Carlislc, PA 17013-3222 Phonc {8~{) 5u2-4349 Fax (3(r2193a-2955 March 16, 2004 Estate Of Dorothy.l. Bowers Social Security: ! 74-05-2574 Date o[?)eath: .lan..uary I0, 2004 Dc,,~ Mr. Roger B.lrwin: Per your inquiry dated March deposit with [his bank thc following: I. 7~p¢ of Account ~ccou~t Number Owncer. vJtip (Namc~ oj~ (.)[x:ning Dale Balance: on Daft, tf D¢:ath /Iccrue:d lnlerest Total I I, 2004. please be advised that at thc time of death, thc above-named decedent hud on (-'&.:,'ling Accounl 16799631 Dorothy.l Bom:rs 08128/64 $36109,51 $ O. flO $36,/09.51 E'd 9£IEgE~EOE[ SI3 ~£E:II 90 9I ~eN Inventory of the real and personal estate of DOROTHY J. BOWERS deceased 1. Manufacturers Traders and Trust Company - Checking Account #16799631 .... 2. Manufacturers Traders and Trust Company - Checking Account #950221704 . . TOTAL .................. 36,109 48,878 84,988 51 58 O9 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Shirley_ I. Heishman being duly sworn according to law, deposes and says that she is the Executrix of the Estate of Dorothy J. Bowers late of t_he__ B_prough of_ Carlisle , Cumberland County, Pa., deceased and that the w~fhln is an inventory made by Shirley I. Heishman , the said Executrix of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposlfe each item of the Inventory represent it's fair value as of the date of decedent's death. Sworn this and subscribed before me, day of March, 2004 Notarial ~1 Roger B. Irwin, Noaa3, Public Carlisle Bom, Cumberland Count~ My Commission Expires Oct. 3, 2004 398 Centerville Road Newville, PA 17241 Address Date of Death 10 01 2004 Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed wifhln thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. , O COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003729 IRWIN ROGER B ESQ 60 W POMFRET ST CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 174-05-2574 FILE NUMBER: 2104-0250 DECEDENT NAME: BOWERS DOROTHY J DATE OF PAYMENT: 03/29/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01 / 10/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $10,274.49 RiEMARKS: SEAL ROGER IRWIN ESQ CHECK//021035 TOTAL AMOUNT PAID' $10,274.49 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS STATUS REPORT UNDER RULE 6.12 Name of Decedent: DOROTHY J. BOWERS Date of Death: JANUARY 10, 2004 No. 21-04-0250 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: X Yes ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? ~ Yes X No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? X Yes No Date: 05/24/2004 Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphan's Court and may be attached to this report. Signature IRWIN & ~IeI~IGHT Roger B. Irwin, Esquire Name (please type or print) 60 West Pomfret Street Address Carlisle, PA 17013 City, State, Zip (717) 249-2353 Telephone Number Capacity: X Personal Representative Counsel for Personal Representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX D/VTSTON DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX RE¥-1~47 EX AFP (01-55) ~:.: DATE 05-17-2004 ESTATE OF BOWERS DATE OF DEATH 01-10-2004 FILE NUMBER 21 04-0250 ROGER B IRWIN ESQ '04 l"ii:~'i' i4 ?~ '~ COUNTY CUMBERLAND ACN 101 IRWIN & HCKNIGHT I Amoun~ RecLined 60 W POHFRET ST ~, CARLISLE PA 1~i~ DOROTHY J MAKE CHECK PAYABLE AND REHTT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~'~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF ZNHERTTANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BOWERS DOROTHY J FTLE NO. 21 04-0250 ACN 101 DATE 05-17-2004 TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) 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) $. CloseZy Held Stock/Partnership /nterest (Schedule C) ($) ~. Hortgages/Notes Reca/vable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly O~ned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expanses/Ada. Costs/Hisc. Expanses (Schedule H) (9) 10. Dabts/Hortgaga Liabilities/Liens (Schedule 1) (10) 11. Total Deductions 12. Net Value of Tax Return 988.09 .00 .00 NOTE: To Lnsure proper .00 credit to your account, .00 submit the upper portion .00 of th~s fora w~th your tax payment. .00 (B) 9,424.00 15. 1~. NOTE: ASSESSMENT OF TAX: 1.6. Amount of L/ne lq at Spousal rata 16. Amount of Line 1~ taxable at Lineal/Class A rata 17. Amount of Line 1~, at Sibling rata 18. Amount of Line 1~+ taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYflENT RECETp1 DZSCOUNT DATE NUHBER INTEREST/PEN pATD (-) 0~;-29-2004 CD005729 540.76 84,988.09 (12) 72,1 O1.68 CharLtable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (1:5) . O0 Nat Value of Estate Subject to Tax (lq) 72,101.68 Zf an assessment ,as issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. (1.6) .00 x O0 = .00 (16) .00 x 045 = .00 (17) .00 x 12 = .00 (18) 72,101.68 x 15 = 10,815.25 (19)= 10,815.25 :IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AMOUNT PAID 10,274.49 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 10,815.25 .00 .00 .00 ( IF TOTAL DUE ZS LESS THAN Gl, NO PAYMENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR}: OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or far years, the Commonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To ~u[fill the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act Z$ of 2000. (71 P.S. Section 91q0). 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 NZLLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Office of the Register of Nills, any of the 2S Revenue District Offices, or by calling the special Z~-hour answering service for fores ordering: 1-800-362-2050; services for taxpayers aith special hearing and / or speaking needs: 1-BO0-qqT-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disalloaanca of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Oaparteent of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-102l, OR --election to have the matter daters[ned at audit of the account of the persona[ 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. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sam page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decadent's death, a five percent (SZ) 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 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 l, 1982 bear interest at the rate of six (6X) percent par annum calculated at a daily rate of .00016q. AIl taxes which became delinquent on and after January 1, lgBz mill 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 ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rata Factor ~ 20X .0005q8' 1988-1991 llZ .000301 2001 91 .0002¢7 1985 162 .000q38 1992 92 .0002~7 2002 61 .00016~ 198q 111 .000301 1993-1994 7Z .OOO19Z 2005 5Z ,000157 1985 13Z .000356 1995-1998 9Z .000247 ZOO~ qZ .000110 1986 102 .00027~ 1999 7Z .000192 1987 lOX .00027~ ZOO0 7Z .00019Z --Interest is calculated as folloas: TNTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAI'LY XNTEREST 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 sheen on the Notice, additional interest must be calculated.