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HomeMy WebLinkAbout03-0974COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF ZND/V/DUAL TAXES DEPT. 180601 HARRISBURG, PA 17118-0601 REV-15¢i5 EX AFP CDg-O0) ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE F]:LE NO. ?! ACM DATE 10-02-2005 JAMES T HAAS 515 COLONY RD CAMP HILL PA 17011 TYPE OF ACCOUNT ;.ST. OF THERESE K HAAS [] SAVINGS S.S. NO. q09-71-8988 [] CHECKING DATE OF DEATH 07-08-200:5 [] TRUST COUNTY CUMBERLAND [] CERTTF. REHTT PAYHENT AND FORHS TO: REGISTER OF b/ILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 PNC BANK has provided the Department with the information listed below which has been used in calculating tho potential tax due. Their records indicate that et the death of the above decadent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction frcm the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance mith tho Inheritance Tax Laws of the Commonamalth o; Pennsylvania. Duest~ons may be answered by calling (717) 787-83Z7. COMPLETE PART ! BELOb/ x # # SEE REVERSE SZDE FOR FZLZNG AND PAYMENT ZNSTRUCTZONS Account No. 51~0025552 Date 0~-01-1970 Established Account Balance 8,786.75 Percent Taxable X 16.6 6 7 Amount: Sub.~ect to Tax ~1 ~,EI6~' .~'9 Tax Rate X .15 Potential Tax Due 219.67 To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments are made within three (3) months of the decodent's date of death, you may deduct · 5X discount of the tax due. Any inheritance tax due will become delinquent nine [9) months after the date of death. PART TAXPAYER RESPONSE A. N Tho above information and tax duo is correct. u 1. You may choose to remit payment to the Register of Nills with two copies cf this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to tho Register of  CHECK ~ Nills and an official assessment will bm issued by the PA Department of Revenue. ONE BLOCK s. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decmdent's representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART [] and/or PART [] below. If you indicate a different tax re*e, plea;a state your relationship to decedent: /-//~/- ~$A~) RETURN -COMPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS PART TAX L/NE 1. Data EstablishagJ 3. Percen~ Taxable 5. Deb~s and 6. Amoun~ Taxable 7. Tax Rate 8. Tax Due PART DATE PAID DEBTS AND DEDUCT:iONS CLA]:MED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on L/ne $ of Tax Computer/on) Under penalties of perjury, ! declare the* the facts I have reported above ere true, correct end coaplata/f ~--~ ~//t"° the bast of my ~,nowladge and belief. HOME (~/~) SIGNATURE TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND NZLL RESULT ZN AN OFFICIAL TAX ASSESSNENT aith applicable interest based on information subaltted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the decedent's name was added as a matter of convenience. ~. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death ara fully taxable as transfers. S. Accounts established jointly between husband and wife acre than one year prior to death are nat taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit thee with your check for the amount of tax to the Register of Niils of the county indicated. The PA Department of Revenue will lssue an offlcial assessment (Fora REV-15~B EX) upon receipt of the return fram the Register of Hills. Z. BLOCK B - If the asset specified on this notice has been or mill be reported and tax paid with the Pennsylvania /nheritance Tax Return filed by the dacadant's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of individual Taxes, Dapt 280601, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If tho notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts Z and according to the instructions below. Sign two copies and submit thee with your check for the amount of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART 2 - TAX CONPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/ii/BI: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $5,000 par transferee regardless of the value of the account or the number of accounts held. If a double asterisk (Ne) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by tho financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUNBER OF X 100 = PERCENT TAXABLE JOINT ORNERS SURVIVING JOINT O#NERS Example: A joint asset registered in tho name of the decedent and tee other persons. I DIVIDED BY 5 (JOINT OHNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR} B.The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE O#NERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .SO X 100 SOZ (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (Line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line S) from the amount subject to tax (line ~). 7. Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse [ Lineal [ Sibling Collateral 07/01/9q ~o 12/$1/9q 01/01/95 ~o 06/30/00 OX 6Z 07/01/00 ~o presen~ OX q.BZ~ 12Z eThe tax rate imposed on the net value of transfers from a deceased child t~enty-ane years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0X. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class af heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally ara responsible for payment, ar the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed oust be itemized fully in Part 5. If additional space is needed, use plain paper S 1/2" x 11". Proof of payment nay be requested by the PA Department of Revenue. CONNONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF XNDZVZDUAL TAXES DEPT. 180601 HARRISBURG, PA 17128-0601 REV-1S,~$ EX AFP C09-no) ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE FZLE NO. Z1 ACN 03135542 DATE 10-02-2003 JAMES T HAAS 515 COLONY RD CAMP HILL PA 17011 TYPE OF ACCOUNT EST. OF THERESE K HAAS [] SAVINGS S.S. NO. 409-72-8988 [] CHECKZNG DATE OF DEATH 07-08-2005 [] TRUST COUNTY CUMBERLAND [] CERTZF. REMIT PAYMENT AND FORMS TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided tho Department aith fha infornatlon listed baloa which has been used in caIculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. Zf you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance Hith tho Xnheritanca Tax LaHs of tho CoaaonHeaXth o; ~enn~y)~,mnJm_ ~mstJons may be answarad bv caXling (717) 787-BSZ7. CONPLETE PART I BELOH # # ~ SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS Account No. 5140158957 Date 07-01-1976 Established Account BaXance 17,4 6 0.0 4 Percent TaxabXe X 16. 667 Amount Subject to Tax 2,910.06 Tax Rate X .15 Potent/aX Tax Due 436.51 To insure proper credit to your account, tho (Z) copies of this notice lust accompany your payment to the Register of WilXs. Hake check payable to: '"Register of HiXXs, Agent". NOTE: If tax payments ara made within throe (5) months of the dacedant's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax duo Hill become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX A. ~ The above inforeation and tax due is correct. 1. You may choose to remit payment to the Register of Nails 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 Ragistar of NilXs and an official assessment wilX be issued by the PA Dapartesnt of Revenue. B. [] The above asset has been or wilX be reported and tax paid ~ith tho PsnnsyXvania Xnharitanca Tax return to be filed by the decedent's representative. ~Tha above inforlation is incorrect and/or debts and deductions were paid by you. C. You must coapXata PART ~ and/or PART ~ bslow. If you ~nd[cate a different tax ra~ please sta~e your relationship ~o decedent: /- //~'~'c)Z ~,-~'~ RETURN - CONPUTATZON OF TAX ON JOiNT/TRUST ACCOUNTS [. Date Established 2. Account Balance $. Percent Taxable R. Amount Subject $. Debts and Deductions 6. Amount Taxable 7. Tax Rate a. To× Bus PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AHOUNT PAXD TOTAL (Enter on LLne $ of Tax Computer/on) $ Under peneXttes of perjury, Z declare that the facts X have reported abov,e are true, correct and complete// /-~ ~ z~~° ~he bBs~ of my knowXedge and bel/ef. HOHE (~/~) ~ / ~~ ~~~~ .ORK ( ) ~ T~ SIGNATURE TELEPHONE NUHBER DATE GENERAL ~NFORHAT~ON 1. FAILURE TO RESPOND #ILL RESULT ZN AN OFF/C/AL TAX ASSESSHENT .ith applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decadant's date of death. ~. A joint account is taxable even though the dacadent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prier to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than Dna year prior to death ara not taxable. 6. Accounts held by a decedent "in trust far" another or others are taxable fully. REPORTING [NSTRUCT[ONS- PART I - TAXPAYER RESPONSE 1. BLOCK A - If the information end computation in the notice are correct and deductions ara not being claimed, place an "X" in block "A" of Part I of tho "Taxpayer Response" section. Sign tee copies and submit them with your check for the amount of tax to tho Register of Nills of the county indicated. Tho PA Department of Revenue w111 issue an official assessment (Form REV-1S4S EX) upon receipt of the return from the Register of Hills. Z. BLOCK B - If the asset specified on this notice has been or wilL be reported and tax paid with the PennsyLvania Tnheritance Tax Return filed by the decadant's representative, place an "X" in block "B" of Part i of tho "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dapt Z80601, Harrisburg, PA 171Z8-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, chock block "C" and complete Parts 2 and 5 according to the instructions below. Sign two copies and submit thom with your chock for the amount of tax payable to the Register of Mills of tho county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-la48 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART Z - TAX COHPUTATTON LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/aZ: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $5,000 par transferee regardless of the value of tho account or the number of accounts hold. If a double asterisk (wx) appears before your first naaa in tho address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter tho to,al balance of tho account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as folloas: A. The percent taxable for joint assets established more than one year prior to the decedent's death: I DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 = PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT ONNERS Example: A joint asset registered in tho name of the decedent and two other parsons. I DIVIDED BY 5 (JOINT ONNERS) DIVIDED DY Z (SURVIVORS) = .167 X 100 = 16.7X (TAXABLE FOR EACH SURVIVOR) B.Tho percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but hold in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by tho decedent. i DIVIDED BY Z (SURVIVORS) = .SO X 100 = SOX (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (Line 5). 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (1ina 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal ] Sibling Collateral I 07/01/9q ~o 12/$1/9~ 01/01/95 ~o 06/$0/00 OX 6X 07/01/00 ~o presen~ 0Z ~.$Z~ 12Z aThe tax rate imposed on the net value of transfers free 8 dec teenty-one years age younger at death to or far the use of a natural parent, an adoptive parent, or a stepparent of the child is OZ. The lineal class of heirs includes grandparents, parents, children, and linaaZ descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes ell children of the natural parents and their descendents, whether ar not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLATMED DEDUCT]:ONS - PART :5 - DEBTS AND DEDUCTIONS CLAZMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid tho debts after death of tho decedent and can furnish proof of payment. C. Debts being claimed must ba itemized fully in Part 5. If additional space is needed, usa plain paper S l/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. COHMONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 RE¥-1~¢5 EX AFP Cgg-O0) ZNFORHATZON NOTICE AND TAXPAYER RESPONSE ACN 03135538 DATE 10-02-2005 JAMES T HAAS 513 COLONY RD CAMP HILL PA 17011 TYPE OF ACCOUNT EST. OF THERESE K HAAS [] SAV/NGS S.S. NO. qOg-TZ-8988 [] CHECKING DATE OF DEATH 07-08-2003 [] TRUST COUNTY CUMBERLAND [] CERTIF. REHTT PAYHENT AND FORNS TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLTSLE, PA 17013 PNC BANK has provided the Department with the information listed bales ehich has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form end return it to the above address. This account is taxable in accordance with the Inheritance Tax Lams of the Commonwealth of Pennsylvania. Questinns may be answered bv calling (7173 787-83Z7. COMPLETE PART !BELON ~ # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 51qOOZ55qq Date 05-01-197q Established Account Balance 1 ?, q 11 . 9 q Percent Taxable X 16.6 6 7 Amount SubSect to Tax :7,068.70 Tax Rate X .15 Potential Tax Due 310.3] To insure proper credit to your account, tho (Z) copies of this notice must accompany your payment to the Register of #ilXs. Make check payable to: "Register of NilXs, Agent". NOTE: If tax payments ere made within three (3) months of the decadent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquant nine (9) months after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY A. ~ The above information and tax due is correct. u 1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain a discount or avoid interest, or you amy check box "A" and return this notice to the Register of Nills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return B. to be filed by the decedent's representative. []The above information is incorrect and/or debts and deductions were paid by you. C. You must complete PART []and/or PART []below. PART xf you ~nd~cato a different, tax rato.~ p]~easoatate your  relationship ~o decedent: /-/ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LTNE 2. Accoun~ Balance 2 /~. ~// ~ ~ 3. Percen~ Taxable 3 X / /~, ~ ~ q. Amoun~ Sub~ec~ ~o Tax q ~ ~.~ ~ / ~. Debts and Deductions S - 6. Amoun~ Taxable 6 ~ ~, ~ ~ 7. Tax Rm~e 7 X ~ 0~ 8. Tax Due 8 ~, ~ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION ~':: AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) $ Under penaXties of perjury~ T decXare that the facts T have reported above are true, correct and complete to the best of lay knowledge and beXief. HOME (~/'~) ~/~/~ ~/~-~ E TELEPHONE NUMBER DATE GENERAL INFORNATION 1. FA/LURE TO RESPOND #ILL RESULT ZN AN OFF/CZAL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes deIinquent nine months after the dacadent's date of death. 5. A joint account is taxable even though the decadant's name Nas added as a .attar of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death ara fully taxable as transfers. 5. Accounts established jointly bet~aen husband and wife more than one year prior to death ara not taxable. 6. Accounts held by a decedent "in trust for" another or others ara taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions ara not being claimed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and sub. it thee with your check for the amount of tax to the Register of Hills of the county indicated. The PA Depart.ant of Revenue will issue an official assess.ant (Form REV-1548 EX) upon receipt of the return from the Register of t~ills. Z. BLOCK B - If the asset specified on this notice has been or will ba reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the dec.dent's representative, place an "X" in block "B" of Part I of the "Taxpayer Respansa" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Tax.s, Dapt ZBg601, Harrisburg, PA 17LZ8-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and ceapleta Parts Z and according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-1548 EX) upon receipt of the return from the Register of Rills. TAX RETURN - PART Z - TAX CONPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/1Z/BZ: Accounts which the decedent put in joint names within one (1) year of death ara taxable fully as transfers. However, there is an exclusion not to exceed $5,000 par transferee regardless of the value of the account or the number of accounts held. If a double asterisk (wx) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 5. The percent of tho account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decadant's death: I DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 = PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT O#NERS Ex.apl.: A joint asset registered in the name of the decadent and two other parsons. 1 DIVIDED BY 3 (JOINT ORNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the dec.dent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE O#NERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within cna year of death by the decedent. I DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50Z (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (Line 2) by the percent taxable (Line S. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (Line 6) is determined by subtracting the debts and deductions (Line S) from the amount subject to tax (line 7. Enter the appropriate tax rata (Line 7) as determined below. De~e of Dea*h Spouse Lineal I Sibling Collateral 07/01/9~ ~o 12/$1/9~ 01/01/95 to 06/30/00 OX 6X 07/01/00 ~o presen~ -The tax rata imposed on the nat value of transfers from a deceased y-uF.e years age younger at death to or for the use of a natural parent, an adoptive parent, or a stapparent of the child is 07.. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or net they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and stap-descendants. "SiblLngs" ara defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of hairs includes all other beneficiaries. CLAIHED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLATHED Allowable debts and deductions ara determined as follows: A. You legally ara responsible far payment, er the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part $. If additional space is need.d, usa plain paper 8 1/Z" x 11". Proof of payment may be requested by the PA Department o~ Revenue. 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 003275 HAAS JAMES T DUPLICATE CMR 480 BOX 1948 APO AE 09128 ........ fold ACN ASSESSMENT CONTROL NUMBER AMOUNT 03135542 $130.95 ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 21 03-0974 DECEDENT NAME: HAAS THERESE K DATE OF PAYMENT: 11/24/2003 POSTMARK DATE: 11/17/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2003 REMARKS: TOTAL AMOUNT PAID: $130.95 SEAL CHECK# 8623 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: HAAS JAMES T CMR 480 BOX 1948 APO AE 09128 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DUPLICATE NO. REV-1162 EX(11-96) CD 003276 ........ fold ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 2103-0974 DECEDENT NAME: HAAS THERESE K DATE OF PAYMENT: 11/24/2003 POSTMARK DATE: 11/17/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 03135540 $65.90 REMARKS: TOTAL AMOUNT PAID: $65.90 SEAL CHECK# 8625 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS 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 003277 HAAS JAMES T DUPLICATE CMR 480 BOX 1948 APO AE 09128 ........ fo;d ACN ASSESSMENT CONTROL NUMBER AMOUNT 03135538 $93.09 ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 2103-0974 DECEDENT NAME: HAAS THERESE K DATE OF PAYMENT: 11/24/2003 POSTMARK DATE: 11/17/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2003 REMARKS: TOTAL AMOUNT PAID: $93.09 SEAL CHECK# 8624 INITIALS: AC RECEIVED BY.' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS 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 003277 HAAS JAMES T CMR 480 BOX 1948 ........ fold ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 2103-0974 DECEDENT NAME: HAAS THERESE K DATE OF PAYMENT: 11/24/2003 POSTMARK DATE: 11/17/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 03135538 ~93.09 REMARKS: TOTAL AMOUNT PAID: 993.09 SEAL CHECK# 8624 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS 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 003276 HAAS JAMES T CMR 480 BOX 1948 ........ fold ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 2103-0974 DECEDENT NAME: HAAS THERESE K DATE OF PAYMENT: 11/24/2003 POSTMARK DATE: 11/17~2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 03135540 $65.90 REMARKS: TOTAL AMOUNT PAID: $65.90 SEAL CHECK# 8625 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2806O1 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD O03275 HAAS JAMES T CMR 480 BOX 1948 ........ fold ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 2103-0974 DECEDENT NAME: HAAS THERESE K DATE OF PAYMENT: 11/24/2003 POSTMARK DATE: 11/17/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 03135542 $130.95 REMARKS. TOTAL AMOUNT PAID' $130.95 SEAL CHECK# 8623 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS U S. POSTRGE CRMP HILL.PR DEC 23.' 03 RHOUNT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 :CEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003380 HAAS BRYAN R 513 COLONY ROAD CAMP HILL, PA 17011 ....... fold ESTATE INFORMATION: SSN: 000-00-0000 :ILE NUMBER: 2103-0974 ~ECEDENT NAME: HAAS THERESE K DATE OF PAYMENT: 12/26/2003 ~OSTMARK DATE: 1 2~23~2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 13155539 ~93.09 TOTAL AMOUNT PAID: 593.09 REMARKS' BRYAN R HAAS SEAL CHECK//2651 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 :CEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003381 HAAS BRYAN R 513 COLONY ROAD CAMP HILL, PA 17011 ........ fold ESTATE iNFORMATION: SSN: 000-00-0000 :ILE NUMBER: 2103-0974 DECEDENT NAME: HAAS THERESE K --------- DATE OF PAYMENT: 1 2/26/2003 '~OSTMARK DATE: 1 2/23/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 03135541 I $65.90 TOTAL AMOUNT PAID' ~65.90 ,REMARKS' BRYAN R HAAS CHECK# 2652 SEAL INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171 ?.8-0601 ECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 003778 HAAS JAMES T CMR 480 BOX 1948 ........ fold ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 2103-0974 DECEDENT NAME: HAAS THERESE K .------- DATE OF PAYMENT: 04/06/2004 ~OSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND ~ DATE OF DEATH: 07/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $9,000.00 TOTAL AMOUNT PAID: $9,000.00 REMARKS: CHECK# 2694 INITIALS: JA RECEIVED BY: .... SEAL REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COL. JAMES T. HAAS GEMMA HAAS CMR 480 BOX 1948 APO,AE 09128 MARY C^$$ATT US^37 MARY CASSATT US^37 COHNONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF XNDZVIDUAL TAXES DEPT. 180601 HARRXSBURO, PA 17128-0601 RE¥-IS~IS EX AFP ZNFORMATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 21-~- ~f//~ ACN 03135539 DATE 10-02-2003 BRYAN R HAAS 513 COLONY RD CAHP HILL PA 170,I1 TYPE OF ACCOUNT EST. OF THERESE K HAAS [] SAVINGS S.S. NO. 409-72-8988 [] CHECKING DATE OF DEATH 07-08-2003 [] TRUST COUNTY CUNBERLAND [] CERTTF, REMIT PAYHENT AND FORHS TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE· PA 17013 PNC BANK has provided the Department Nith the information listed baloN ahich has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you Nero a joint owner/beneficiary of this account. If you feel this information is incorrect, pIeasa obtain written correction from the financial institution, attach a copy to this ~orm end return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Comaonaealth of Pennsylvania. Questions may be answered by calling (7177 767-6317. CONPLETE PART I BELOH# # N SEE REVERSE SIDE FOR FXLZNG AND PAYNENT INSTRUCTIONS Account No. 5140025544 Data 05- 01-1974 To insure proper credit to your account, two Established (Z) copies of this notice must accompany your Account Balance 12 · 411.94 payment to the Register of Hills. Nake check payable to: "Register of Hills, Agent". Percent TaxabXa X 16.667 Amount Subject to Tax 2· 068.70 NOTE: Xf tax payments ara made within three ($) months of the dacedant's date of death, Tax Rata X . ~ you may de~ot a SZ discount of the ~x due. Any inheri~nce ~x due ~iXX become dmXinqumnt Po~en~ZmX Tax Due ~[0. ~ nine (9) months after the date of death. PART TAXPAYER RESPONSE A. [] The above information end tax due is correct. 1. YOU may choose to remit payeent to the Register of Hills with two copies of this notice to obtain ECHECK ONE BLOCK ONLY PART TAX LXNE a discount or avoid interest, or you may check box "A" and return this notice to the Register of Mills and an official assessaent ~ili ba issued by the PA Departaent of Revenue. B. ~Tha above asset has been or ail1 be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by tho decadent's representative. C. ~ The above information is incorrect and/or debts and deductions wera paid by you. You oust complete PART [] and/er PART []below. If you indicate a different tax rata, please state your relationship to decadent: /.~A~L [~O/u~ RETURN -CONPUTATZON OF TAX ON JOINT/TRUST ACCOUNTS 1. Data Established 3. Percent Taxable ~. Amount Subject to Tax $, Debts and Deductions 6. Amount Taxable 7. Tax Rate ~. Ta~ Du. PART DEBTS AND DEDUCTZONS CLAZH;;I PAYEE DESCRIPTION ANOUNT PATD TOTAL (Enter on Line $ of Tax Ce~utation) Under penalties of perjury, Z declare that the facts Z have reported above are true· correct and ~mpXata to the best of ay knowXadga and battmf. HONE ( ~17 ) ~~S [~GNATU R~~E .ORK ('717 T TELEPHONE NUHSER OENERAL INFORMATION 1. FAILURE TO RESPOND NZLL RESULT ZN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacedant's date of death. 3. A joint account is taxable even though the decedent's name ems added as a matter of convenience. 4. Accounts (including those held bat, aaa husband and wife) which the decedent put in joint names within one year prior to death ara fully taxable as transfers. 5. Accounts established jointly bateaan husband and wife more than one year prior to death ara not taxabIa. 6. Accounts held by a decedent "in trust for" another or ethers ara taxable fully. REPORTIN6 INSTRUCTIONS - PART ! - TAXPAYER RESPONSE 1. BLOCK A - If tho information and computation in the notice ara correct and deductions ara not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign twa copies and submit them with your check for the amount of tax to the Register of Mills of tho county indicated. Tho PA Department of Revenue will issue an official assessment (Form REV-IS48 EX) upon receipt of tho return from the Register of Nills. Z. BLOCK B - Zf tho asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedant's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dapt Z80601, Harrisburg, PA 171Z8-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions era being claimed, check block "C" and complete Parts Z and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Farm REV-1548 EX) upon receipt of the return frae the Register of Mills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter the date tho account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/az: Accounts which tho decadent put in joint names aithin one (1) year of death ara taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of tho account or the number of accounts hold. If a double asterisk (ma) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the total baIance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as fullows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT ONMERS Example: A joint asset registered in the name of the decadent and two other parsons. I DIVIDED BY 3 (JOINT ONNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within Dna year of the decadant's death or accounts owned by the decadent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEFICIARIES Example: Joint account registered in tho name of the decedent and two other persons and established within Dna year of death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (!~n?,~) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. De~e of Death Spouse Lineal, I Sibling Colle{i~al 07/01/9q ~o 12/$1/9q 01/01/95 ~o 06/30/00 OX 6X 07/01/00 ~o presen~ 0Z q.SZa , ..... younger at eTha tax rate imposed on th~ death to or for the usa of a natural parent, an adoptive parent, or e stapparant of the child is OZ. The lineal class of hairs includes grandparents, parents, children, and lineaL descendants. "Children" includes nature1 children whathmr or not they have bean adapted by othsrs, adopted children and step children. "kineal descendants" includes elL chiLdren of the natural parents and their descendents, whether or not they have bean adopted by others, adopted descendants and their descendants and stap-descendants. "Siblings" ara defined as individuals who have at laastona'p~rant in cocoon with the decadent, whether by blood er adoption. The "Collateral" class of hairs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions ara determined as follows: %~ A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insuff~ .~ , to pay the deductible itaes. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must ba itemized fully in Part 3. If additional space is needed, usa plain paper 8 l/Z" x II". Proof of payment may ba requested by the PA Department of Revenue. CONNONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA I?IZB-060! RE¥-lSlll5 EX AFP COg-DO) BRYAN R HAAS 515 COLONY RD CAMP HILL PA 17011. ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE FZLE NO. 2!-~Z~- ~y ACN 031355ql BATE 10-02-2005 TYPE OF ACCOUNT EST. OF THERESE K HAAS [] SAVTN$S S.S. NO. q09-72-8988 [] CHECKING DATE OF DEATH 07-08-Z005 [] TRUST COUNTY CUMBERLAND [] CERTZF. REHZT PAYHENT AND FORHS TO: REGISTER OF ~/ILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided the Department with the information listad baloa mhich has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint o-nar/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coemonaealth of Pmnnsylvani~. Questions amy bg answered by calling (717) 787-85Z7. COMPLETE PART 1BELO# # # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 51q0025552 Date 0~-01-1970 To insure proper credit to your account, tad Established (2) copies of this notice must accompany your Account Balance 8,786.75 payment to the Register of gills. Naa check payable to: "Register of gills, Agent". Percent Taxable X 16. 667 Amount Subject to Tax [, ~6~. ~9 NOTE: If tax payments are made aithin three ($) months of ~e decedent's date o~ dea~, Tax Ra~e X . [~ you amy de,ct a SZ discount of ~e ~x due. Any JnherJ~nce tax due .JZZ b~oee delinquent PoVertY,aZ Tax Due 219.67 nine (9) eon~s after the ~ta of --mm PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LINE A. O 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 a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will bo issued by the PA Department of Revenue. B. []Tho above asset has been or will be reported and tax paid aith tho Pennsylvania Inheritance Tax return to bo filed by the decodent's representative. C. ~The above information is incorrect and/or debts and deductions aero paid by you. You must complete PART [] and/or PART [] bale#. Zf you indicate a diffaren~ tax rate,_~Zease state your relationship to decedent: Lj RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS l. Date Established 2. Accoun~ Balance 2 7 7 q. Amoun~ Sub,oct to Tax q /L/6~. ~ y 5. Debts and Deductions S 6. Aeoun~ Taxable 6 7. Tax Rate 7 ~ ~ ~ s. Tax Due ~ ~5;, ~ PART DATE PAID BEETS AND DEDUCTIONS CLAZM;q PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) $ Under penalties of porjury~ T declare that tho facts T have reported above are ~r~; correc~ ~d complete ~o ~he bes~ of my knowledge ~d belief. ~ ~ ~ HOME (~,~) ~0EE ~x~aY'~ N TELEPHONE NUMBER DATE GENERAL INFORMATION . FAILURE TO RESPOND #ILL RESULT ZN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decodent's date of death. 5. A joint account is taxable even though the docedant's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. S. Accounts established jointIy bet14ean husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS PART I - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice ara correct and deductions are not being claimed, place an "X" in block "A" of Part I of tho "Taxpayer Response" section. Sign two capias and submit thaa with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-1548 EX) upon receipt of the return from the Register of #ills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the dacedent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept lBO601, Harrisburg, PA ZTIZB-060! in the envelope provided. $. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and 3 according tD the instructions below. Sign two copies and submit thee with your check for the aeount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of tho return from tho Register of Wills. TAX RETURN - PART 2 TAX COMPUTATION LINE 1. Enter the date tho account originally was established or titled in the manner existing at data of death. NOTE: For a decedent dying after 1Z/II/aZ: Accounts which the decedent put in joint names within one (l) year of death era taxable fully as transfers. However, there is on exclusion not to exceed $3,000 per transferee regardless of the value of the account or tho number of accounts hold. If a doubIo asterisk (~) appears before your first name in the address portion of this notice, tho $3,000 exclusion already has been deducted from tho account balance as reported by tho financial institution. Z. Enter tho tote! baIanco of the account including interest accrued to the date of death. 3. Tho percent of the account that is taxable for each survivor is determined as follows: A. Tho percent taxable for joint assets established aero than one year prior to the decedent's death: I DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUHBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of tho decedent and two other parsons. I DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.?Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decodent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUHBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by tho decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X 100 = 5OZ (TAXABLE FOR EACH SURV/VOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by tho percent taxable (line 3). S. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 63 is determined by subtracting the debts and deductions (line 5) fram the amount subject to tax (line 4). 7. Enter the appropriate tax rate (Iine 7) as etormined below. Date of Death Spouse Lineal , Sibling Collateral 07/01/94 to 12/$1/94 IX 6X 1EX 1SI 01/01/95 to 06/30/00 0X 6X ~EX 07/01/00 to present OX 4.$X~, ~ ,12X ...... ~ ..-t .... · m .... ;~ ~r~a a deceased child ~enty-one years lounger at ~The tax rata imposed on ' death to or for tho uso of a natural parent, an adoptive parent, or a stepparent of the child is OZ. The lineal class of heirs includes grandparents, parents, children, and 11neaI descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children.' "Lit~eal descendents" includes all children of the natura! parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at [east one ~aront ~n common ~[th the decedent, ~hether by blood or adoptton. The "Collateral" class o; heirs includes ali other bena;ic[artes. CLA~HED DEDUCT/OHS - PART ~ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by m personal representative is insuffi ~ to pay the deductible items, ~ B. You ac~ally paid the debts after dea~ of the decedent and can furnish proof of payment. C. Debts beJng claimed must be itemized fully Jn Part 5. [f additional space is needed, use pla[n paper 8 l/Z" x 11". Proof of payment may be requested by ~e PA Department of Revenue. COHRONREALTH OF PENNSYLVANIA DEPARTRENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171Z8-0601 REV-IS~$ EX AFP ~09-aO) BRYAN R HAAS 513 COLONY RD CAMP HILL PA 17011 ZNFORMATZON NOTZCE AND TAXPAYER RESPONSE I FZLE NO. ACN 031355~3 DATE 10-02-2003 TYPE OF ACCOUNT EST. OF THERESE K HAAS [] SAVXNGS S.S. NO. q09-72-8988 [] CHECKZNG DATE OF DEATH 07-08-2003 [] TRUST COUNTY CUMBERLAND [] CERTTF. REH:]:T PAYHENT AND FORHS TO: REGISTER OF gILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PHC BANK has provided the Department with the information listed bale, which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you care a joint owner/beneficiary of this account. Zf you feel this information is incorrect, please obtain Nrittan correction frae the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coeeoneaalth of Pennsylvania. Questions may ba answered by calling (717) 787-85Z7. COMPLETE PART !BELON ~ # ~ SEE REVERSE SIDE FOR FILING AND PAYMENT ZNSTRU¢¥ZONS Account No. 51q0158937 Date 07-01-1976 To insure proper credit to Your account, two Established (z) copies of this notice Bust accompany your Account BaZanco 17,~60. O~ payment to the Register of Hills. Rake check payable to: "Register of Rills, Agent". Percent Taxable X 16. 667 Amount Subject to Tax 2 · 910.06 NOTE: Zf tax Payments ara made within three (3) months of the decedant's date of death, Tax Rata X .15 you may deduct e 5Z discount of the tax due. Potent/al Tax Due q36,51 Any inheritance tax due will become delinquent nine (9) ion*L- after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LZNE A. []The above information and tax due is correct. Z. You may choose to remit payment to the Register of Rills with two copies of this notice to obtain a discount or avoid interest, or you may check box -A" and return this notice to tho Register of Rills and an official assessment will be issued by the PA Department of Revenue. B. []The above asse~ has been or will bo reported and tax paid with the Pennsylvania [nheritance Tax return to be filed by the decadant's representative. C. ~The above information is incorrect and/or debts and deductions ware paid by you. You must complete PART ~-~and/or PART J~-]below. If you indLcate a different tax rate,plee~e state your relationship to decadent: LJne~C, ~;04J_} RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Estab/tshed :1 2. Account Balance 2 3. Percent Taxeb/e q. Amount Subject to Tax $. Debts and Deductions 6. Amount Taxable 7. Tax Rata 8. Tax Due PART DATE! PATD Z~/~, o~ 6 s___L~o, ?~ DE~TS AND DEDUCTIONS CLAZPrq PAYEE DESCRIPTION AMOUNT PAID TOTA~on L/ne $ of Tax Computation) $ Under Penalt~Las of P~rSury, Z declare that the facts Z have reported above are true· correct and complete to the best of ay kno. ledga and bellef. TAXPAYc~ S~GNATURE 3 D~C · TELEPHONE NUH~ER ~ GENERAL INFORMATION 1. FAILURE TO RESPOND N/LL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacadant's data of death. $. A joint account is taxable avan though the decadent's name was added as e matter of convenience. 4. Accounts (including those held be[aeon husband and aifa) which the decedent put in joint names within cna year prior to death ara fully taxable as transfers. S. Accounts established jointly bet#aaa husband and wi~e more than one year prior to death ara not taxable. 6. Accounts held by a decedent "in trust for" another or others ara taxable ~ully. REPORTING INSTRUCT[OHS - PART I - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions ara not being claimed, place an in block "A" of Part ! of the "Taxpayer Response" section. Sign tee copies and submit thee with your check for the amount of tax to the Rag[star of Wills of the county indicated. The PA Department of Revenue wi1! issue an official assessment (Fora REV-lSq8 EX) upon race[pt of the return free the Rag[star of Wills. Z. BLOCK B - If the asset specified on this notice has been or will ba reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the dacadent's representative, place an "X" in block "D" of Part I of the "Taxpayer Response" sac[ion. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dap[ 280601, Harrisburg, PA 171ZB-0601 in the envelope provided. S. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and according to the instructions beloa. Sign two copies and submit them mith your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-15q8 EX) upon receipt of the return from the Register of Wills· TAX RETURN - PART 2 TAX COMPUTATION LINE 1. Enter the date the account originally ams established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/Il/aZ: Accounts ahich the decedent put in joint names within cna (1) year of death ara taxable fully as transfers. However, there is an exclusion not to exceed $3,000 par transferee regardless of the value of the account or the number of accounts held. If a double asterisk (aa) appears before your first name in the address portion of this no[ica, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decadant's death: I DIVIBEO BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X lO0 = PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED DY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the decadant's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): i DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXADLE ONHERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50Z (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is da[ermined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 5. · 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (lin~.5) from the amount subject to tax (line line 7) as la[ermined below. De~e of Death Spouse Lineal Sibling Collateral 07/01/9q ~co 12/$1/9q SX 6X lJ~X 15X 01/01/95 ~o 06/$0/00 OX 6X 15X i 07/01/00 ~o prosen~ OX lounger at 7. Enter the epproF The tax rate iepos death to or ~or the usa of a natural parent, an adoptive parent, or a stapparant of the The l[nea! class of hairs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children aha[her or not they have been adopted by others, adopted children and step children. ,"Lineal descendents" includes all children of the natural parents and their descendents, whether or nat they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in 'common with the decedent, whether by blood or adoption. The "Collateral" class of hairs includes al1 other beneficiaries. CLAIMED DEDUCT[OHS - PART $ - DEIiTS AND DEDUCT[OHS CLAIMED AI1owabXe debts and deductions ara determined as folloas: A. You legally ara responsible for payment, or the estate subject to administration by a personal representative is insuffi '.cv~"~' to pay the deductible items. B. You actually paid the debts after death of the decedent and can ~urnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, usa plain paper B 1/2" x 11". Proof '04 -6 p ':? ' Z 0 .-/2 S~ MAR 2004 CAMP HILL, PA PA Department of Revenue Bureau of Individual Taxes Inheritance Tax Division ATTN: Claudia Maffei Department 280601 Harrisburg, PA 17128-0601 REFERENCE: Estate ofTHERESE K. HAAS (409-72-8988) SUBJECT: (a) Request for Extension 1. As co-executors for the Estate ofTherese K. Haas and per subject (a) above; we respectfully request a 180 day extension for payment of inheritance taxes for Therese K. Haas (409-72-8988). 2. Therese K. Haas passed away on 08 JULY 2003. 3. Per the enclosed orders, I, Bryan R. Haas, have been on active duty outside the Commonwealth of Pennsylvania for the period 22 JUNE 03 until 03 DECEMBER 03. 4. Respectfully request your cooperation in this matter. 5. Point of contact for this action is Bryan R. Haas, 513 Colony Rd., Camp Hill, PA 17011-2010 (717) 761-0405. ~. HAAS 513 Colony Rd. Camp Hill, PA 17011-2010 JAMES T.HAAS 513 Colony Rd. Camp Hill, PA 17011-2010 DEPARTMENT OF THE ARMY U.S. TOTAL ARMY PERSONNEL COMMAND 9700 PAGE AVENUE ST. LOUIS, MO 63132-5200 TAPC-PD%-B ORDERS: A-06-393003 16 JUN 03 '04. /~?R-6 P3:,iO BRYAN R HAAS 513 COLON~ ROAD CAMp HILL, PA 17011 214-54-4494 LTC AR YOU ARE ORDERED TO ACTIVE DUTY UNDER PROVISION OF SECTION 12301(d), TITLE 10 UNITED STATES CODE FOR THE PERIOD SHOWN PLUS THE TIME NECESSARY TO TRAVEL. YOU WILL PROCEED FROM YOUR HOME OR CURRENT LOCATION IN TIME TO REPORT FOR DUTY ON THE DATE SHOWN BELOW. UPON COMPLETION OF THIS DUTY, UNLESS SOONER RELEASED, YOU WILL RETUP.N TO YOUR HOME AND UPON ARRIVAL, BE RELEASED FROM ACTIVE DUTY. REPORT TO: CRC, BLDG 4713 CUSSETTA RD, FT BENNING GA 31905 FOR SRP/FURTHER DUTY JSFOC, MACDILL AFB FL REPORTING DATE: RPT NLT 1600 HRS. 030622 PERIOD OF ACTIVE DUTY: 29 DAYS (END DATE: 030720), INCLUDES ACCUMULATED LEAVE PURPOSE: CO-TTAD SUPPORT OPERATION ENDURING FREEDOM (JFSOC JS03 072-00 INFO OPS OFCR) ASSIGNED TO: USAR CONTROL GROUP (IMA), 1 RESERVE WAY, ST LOUIS MO 63132-5200 ADDITIONAL INSTRUCTIONS: EARLY REPORTING IS NOT AUTHORIZED. SOLDIER WILL BE ORDERED TO TTAD To PERFORM SPECIAL WORK IN CURRENT RESERVE GRADE UNDER THE PROVISIONS OF'10 USC 12314. ATTACHED TO: HQ JSFOC FOR ADMIN TO INCLUDE UCMJ. YOU WILL RETUR~ TO THE PLACE OF INITIAL ENTRY ON AD FOR OUTPROCESSING/REFRAD. SURE PAY IS MANDATORY. BRING THE APPROPRIATE DOCUMENTATION TO AUTHORIZE SURE PAY TO THE BANK (SFl199). PER DIE~ AUTH IAW JFTR. THIS IS AN UNACCOMPANIED TOUR. MOVEM~/TT OF HHG AND DEPENDENTS NOT AUTH. BRING COPIES OF MARRIAGE CERT, DIVORCE~ECREE, BIRTH CERT OF NATURAL CHILDREN OR DOCUMENTATION OF DEPENDENCY/CHILD SPT, FAMILY CARE P~AN, WILLS, POWERS OF ATTORNEY & OTHER DOCUMENTS AFFECTING PAY STATUS. OFFICER WILL BE EXCLUDED FROM THE ACTIVE ARMY END STRENGTH IAW 10 USC 115 AND WILL NOT BE P ,L~,CED ON THE ACTIVE DUTY LIST (ADL) UP 10 USC641(1} (D) AND 620(A). ID CARD AND TAGS REQUIRED TO BE O~ PERSON WHILE ON GOVERNMEITT ORDERS. PANOGRAPHIC DENTAL X-RAYS OR SF 603 AND HIV SCREEN REQUIRED IF NOT CURRENT. PAY STATUS REPORTED IN DJMS-RC A24 TRANSACTION MUST BE 0 (ALPHA CHARACTER). POV AUTH AS MORE ADVANTAGEOUS TO THE ~OVT. NON TEMPORARy STORAGE OF HHG IS AUTH. SUBMIT TVL CLAIM TO DFAS-IN/CONTIGENCY TVL, DEPT 3900, 8899 E $6TH St, INDIANAPOLIS IN 46249- 3900. FAX 317/510-4351/3966; DSN: 699. ~OYT QTRS/MESS WILL BE USED IF AVAILABLE WHEN TVL IS TO,MIL INSTALL, OR YOU MUST OBTAIN STMT OF NON-AVAILABILITY. HIV TEST RQD W/I 48 HRS OF RPT FOR DUTY. RESULTS MUST BE FORWARDED TO AR-PERSCOM ATTN: ARPC-ZSG-H W/I 29 DAYS OR YOUR ORDERS WILL TERMINATE. DD FORM 214 SEND TO: CDR, AR-PERSCOM, ATTN: ARPC-PSV-E, i RESERVE WAY, ST LOUIS MO 63132-5200. YOU & YOUR DEPNS, AS YOUR AGENTS, AUTH PX/COM/THEATER & MED CARE DURING THE PERIOD COVERED BY THIS ORDER. 'SECURITY CLEARANCE: TS-SCI. FOR ARMY USE AUTH: 10 USC 12301(d) AND 12314 ACCT CLAS: 2132010.0000 01-1100 PiW1C00 11'*/12'* 01FFGU VFRE F3203 5570 S99999 AND TRAVEL/PER DIEM CHARGE'TO: 2132020.0000 01-1100 P135198 21'*/22'*/25,* VFRE F3203 5570 S99999 MDC: N/A HOR: SAME AS SNL COMP: USAR PPN: N/A PMOS: 12B SEX: M DOR: 20000611 PEBD: 19800614 FORMAT: 162 FOR THE COMMANDER: RODGER L SHUTTLEWORTH * PERSCOM * CW5 * .OFFICIAL * DEPARTMENT OF THE ARMY u.s, t ^RMY PERSOm,rEL COMMAND .:~.. 9700 PAGE AVENUE 'ST. LOUIS, MO 63132-5200 TAPC-PDZ-B '04 ORDERS A-06-393003A01 BRYAN R HAAS ,.~ 51-3 COLONY ROAD CAMP HILL PA 17011 P3 26 JUN 03 214-54-4494 LTC AR FOLLOWING ORDER IS AMENDED AS INDICATED: SO MUCH OF: FORMAT 162, ORDERS A-06-393003 THIS CEN"I~R DATED 16 JUN 03. PERTAINING TO: ABOVE NAMED INDIVIDUAL AS READS: PERIOD OF ACTIVE DUTY: 29 DAYS (END DATE: 030720), INCLUDES ACCUMULATED LEAVE HOW CHANGED: IATR: PERIOD OF ACTIVE DUTY: 179 DAYS (END DATE: 031217), INCLUDES ACCUMULATED LEAVE IATA: ADDITIONAL INSTRUCTIONS.'--TDY IN EXCESS OF 139 DAYS AUTH AS MISSION ESSENTIAL BY EXIGENCIES OF THE ARMY LAW JlZ'rR CHAP 7, PAR G, PARA U71504e. FOR ARMY USE: ACCT CLAS: 2142010.0000 01-1100 P1W1C00 11'*/12'* 01FFGU VFRE F3203 5570 S99999 AND TRAVEL/PER DIEM CHARGE TO: 2142020.0000 01-1100 P135198 21'**/22'*/25'* VFRE F3203 5570 S99999 *FY04 FUNDS SUBJECT TO AVAILABILITY AUTHORITY: VOCG FORMAT: 700 FOR THE COMMANDER: * PERSCOM * * OFFICIAL * ***************** RODGER L SHUTFLEWORTH CW5 CHIEF, RC SPT SVCS DIV DISTRIBUTION: A3 pLUs ARPC-OPC-R (1) CRC BLDG 4713, CUSSETrA RD, Fr BENNING, GA 31905 (1) DEPARTMENT OF THE ARMY U.S. A~eY HUMAN RESOURCES COMMAND c:~ . 1 RESERVE WAY : '~ST. LOUIS, MO 63132-5200 AHRC-PDZ-B ORDERS A-06-393003A01 '04 fi?i~-6 P2:~0 25 NOV 03 BRYAN R HAAS 513 COLONY ROAD CAMP HILL PA 17011 214-54-4494 LTC AR FOLLOWING ORDER IS AMENDED AS INDICATED: SO MUCH OF: FORMAT 162, ORDERS A:06-393003 THIS CENTER DATED 16 JUN 03, AS AMENDED BY ORDERS A-06-393003A01 DATED 26 JUN 03, IS FURTHER AMENDED. PERTAINING TO: ABOVE NAMED INDIVIDUAL AS READS: PERIOD OF ACTIVE DUTY: 179 DAYS (END DATE: 031217), INCLUDES ACCUMULATED LEAVE HOW CHANGED: IATR: PERIOD OF ACTIVE DUTY: 165 DAYS (END DATE: 031203), INCLUDES ACCUMULATED LEAVE. ALrI~ORITY: VOCG FORMAT: 700 FOR THE COMMANDER: * AHRC * * OFFICIAL * ******:~a********* RODGER L SHWI'I~EWORTH CW5 CHIEF, RC SPT SVCS DIV DISTRIBUTION: A3 PLUS ARPC-OPC-R (1) CRC BLDG 4713, CUSSETTA RD, FT BENNING, GA 31905 (1) DEPARTMENT OF THE ARMY U.S. AIMVlY HUMAN RESOURCES COMMAND r'~.~'7: 1 RESERVE WAY "-ST. LOUIS, MO 63132-5200 AHRC-PDZ-B ORDERS A-06-393003A01 '04 ~PR-6 ?.., .,. 25 NOV 03 BRYAN R HAAS 513 COLONY ROAD CAMP HILL PA 17011 214-54-4494 LTC AR FOLLOWING ORDER IS AMENDED AS INDICATED: SO MUCH OF: FORMAT 162, ORDERS A~06-393003 THIS CENTER DATED 16 JUN 03, AS AMENDED BY ORDERS A-06-393003A01 DATED 26 JUN 03, IS FURTHER AMENDED. PERTAINING TO: ABOVE NAMED INDIVIDUAL AS READS: PERIOD OF ACTIVE DLYFY: 179 DAYS (END DATE: 031217), INCLUDES ACCUMULATED LEAVE HOW CHANGED: IATR: PERIOD OF ACTIVE DUTY: 165 DAYS (END DATE: 031203), INCLUDES ACCUMULATED LEAVE AUTHORITY: VOCG FORMAT: 700 FOR THE COMMANDER: **************** * * AHRC * * OFFICIAL * ******:{~********* RODGER L SHUTTLEWORTH CW5 CHIEF, RC SPT SVCS DIV DISTRIBUTION: A3 PLUS ARPC~OPC-R (1) CRC BLDG 4713, CUSSETTA RD, FT BENNING, GA 31905 (1) April' 14, 2004 Bryan Haas 513 Colony Rd. CampHill ,PA 17011-2010 COMMONVVEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES [~PARTMENT 280601 HARRI~'URG, PA 17128-0601 Telephone (717) 787-3930 FAX (717) 772-0412 Dear Sir/Madam: Re: Estate of Therese Haas File Number 2103-0974 This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 10/08/04. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. Sincerely~__"- __ · J ~/~' ~ . Claudia Maffei, 8up~M~ Document Processing Unit Inheritance Tax Division April 14, 2004 Bryan Haas 513 Colony Rd. CampHill ,PA 17011-2010 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF iNDIVIDUAL TAXES ~PARTMENT 280601 HARRISBURG, PA 17128-0601 Telephone (717) 787-3930 FAX (717) 772-0412 Dear Sir/Madam: Re: Estate of Therese Haas File Number 2103-0974 This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 10/08/04. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. Sincerely, Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division 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. CD REV-1162 EX(11-96) O04023 HAAS BRYAN R 513 COLONY ROAD CAMP HILL, PA 17011 fold ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 2103-0974 DECEDENT NAME: HAAS THERESE K DATE OF PAYMENT: 06/08/2004 POSTMARK DATE: 06/08/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $533.54 REMARKS: BRYAN HAAS TOTAL AMOUNT PAID: $533.54 SEAL CHECK# 2721 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ky to the rderof ~,~rlST~i~ OV~II/-~, 4q£~T [ $ ~.~ O. PNCBA PNC Bank, N.k 0~) C~al PA For,, tqot~ -r.q x...r ~~~ m:D:l ~ ~ ~ 2 ? 58,_' 5 ~hO ~5~q:~?,, 272~. j~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER -O L 0 0 COUNTY CODE ¥ F..AR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I-- THERESE K. HAAS 409-72-8988 Z t't DATE OF DEATH (MMA:)D-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE IJJ 07/08/2003 05/20/1932 REGISTER OF WILLS IZJ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER r~l. odgieal Retum [~4. Umited Estate ~---~ 6. Decedent Died Testate (~:~ D9. Litigation Proceeds Received NAME BRYAN R. HAAS FIRM NAME TELEPHONE NUMBER (717) 761-0405 [~2. Supplemental Retum ~--~ 4a. Futura Interest Compromise (dale ddea~h a~er 12-12-82) ~17. Decedent Maintained a Living Trust {Attach ~opy of Trust) [~3. Remainder Return (~ate of ~.ath p~to 12-13-82) [-'~ 5. Federal Estate Tax Retom Required ~ 8. Total Number of Safe Deposit Boxes [~10. Spousal Poverty Credit (dat~ d ~ath ~et~, 12-31-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A) (Ar, a~ s~ o) 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Pmbata Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Adminisffative 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 {Une 8 minus Line 11) COMPLETE MAILING ADDRESS 513 COLONY RD. CAMP HILL, PA 17011-2010 13,000.00 163,205.28 45,063.21 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE 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 (B) 9,500.00 OFF~CIAL USE ONLY I 221,268.49 (11) 9,500.00 (12) 211,766.49 (13) (14) 211,766.49 x .0_ (15) 211,766.49 x .0 _45 (16) 9,529.58 .......................... x .12 (17) x .15 (18) (19) 9,529.58 Decedent's Complete Address: STREET ADDRESS 513 COLONY RD. CITY CAMP HILL I STATEpA J ZIP17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount 9,000.00 3. Interest/Penalty if applicable Total Credits (A * B + C ) D. Interest E. Penalty Total InterestJPenalty ( D + E ) 4. 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (1) (2) (3) (4) (5) (5A) (5[~) 9,529.58 9,000.00 529.58 3.96 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 533.54 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the properly transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Unde~ penalties of perjury, I declare Ihat I have examined this return, including accui~q~i,ying ~.~ules and statemenls, and to the best of my ~e and belief, it is line, correct and complete. Dedaa~,on of preparer other than the pemonal representaave is based on all information of whicfl preparer has any knowledge. DATE SIGI~TURE OF PERSON RESPONSIBLE FOR FILING RE~URN 513 COLONY RD. CAMP HILL, PA 17011-2010 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS For dates of death on or alter July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rata imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 RS. §9116(1.2) [72 RS. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ (6-98) ,~ -~- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER THERESE K. HAAS Z. I - 0 ] - 0 ~ 7~ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 2002 HONDA ACCORD 1HGCG665X2A141946 MISC. HOUSEHOLD PROPERTY TOTAL (Also enter on line 5, Recapitulation) $ VALUE AT DATE Of DEATH 12000.00 1000.00 13,000.00 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98~ '~' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF THERESE K. HAAS SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21-02 - 097q If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. BRYAN, R. HAAS JAMES T. HAAS 513 COLONYRD. CAMP HILL, PA 17011-2010 513 COLONY RD. CAMP HILL, PA 17011-2010 SON SON JOINTLY-OWNED PROPERTY L~:~ ,eK DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SiMiLAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST UECEDENT'S INTEREST t. A/~BB 1991 FIDELITY 2AU-350842 57813.54 33 19078.4( 2. 1991 STRONG 026-2600139161 36504.01 33 12046.3~ 3. A/B 1991 STEARNS 208-1975 66513.11 33 21949.3~ 4. A/B 1991 ALGER 800000630 34142.34 33 11266.97 5. A/B 1991 MEMBER'S FIRST FCU 16614-00 10081.86 33 3327.01 6. A/B 1991 MEMBER'S FIRST FCU 16614-04 4000.95 33 1320.31 7. A/B 1991 MEMBER'S FIRST FCU 16614-05 20096.48 33 6631.8,~ 8. A/B 1991 MEMBER'S FIRST FCU 16614-11 7616.26 33 2513.3( 9. A/B 1991 EATON VANCE 0001648252 154295.77 33 50917.6(: 10. A/B 1991 NEW CUMBERLAND FCU 067576 4085.53 33 1348.22 11. A/B 1991 AMERICAN CENTURY 022-00340868 20549.22 33 6781.24 12. A 1991 US SAVINGS BONDS (SEE AFl'ACHED) 7167.58 50 3583.7~c 13. B 1991 US SAVINGS BONDS (SEE ATTACHED) 7672.44 50 3836.22 WACHOVIA 044-283778 14. NB 1996 Stroud Township PA Sewer 863450BG6R 9072.50 33 2993.92 15. A/B 1997 Southeast Delco School District 841350GM7R 9945.20 33 3281.91 16. NB 1998 McKeesport PA Area School 581408GCgR 9310.00 33 3072.3(:] 17. A/B 1998 PA State Financial Niquippa 709151CN2R 9730.00 33 3210.90 18. A/B 1999 PA General Obligation 709140CS4R 8810.00 33 2907.30 19. A/B 2000 Washington County PA 938589D~q R ' 9510.00 33 3138.30 TOTAL (Nso enter on line 6, Recapitulation) $ 163,205.28 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 'z.I- o$- 09'7'9 This schedule must be completed and fled if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET i~ yes. DESCRIPTION OF PROPERTY ITEM INCLUDETHENAMEOFTHETRANSFEREE. THEIRRELATIONSHIPTODECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TR,'~ISFER. ATrACHACOPYOFTHEOEEDFORREALESTATE. VALUE OFASSET INTEREST (IFAPPUCABLE) VALUE 1. ALGER 500161708 43455.76 100 43455.'/ 2. MEMBER's FIRST FCU 4121449998166149 158.03 100 158.C 3. METROPOLITAN LIFE 3FO25075573A 1449.42 100 1449.4 TOTAL (Also enter on line 7 Recapitulation) $ 45,063.21 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99)~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF THERESE K. HAAS SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ITEM NUMBER 5. 6. 7. Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERALEXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Sodal Securily Number(s)/EIN Number of Personal Representative(s) Street Address City Year(s) Commission Paid: Attomey Fees · State Zip Family Exemption: (ff decedent's address is not the same as claimant's, attach explanation) Claimant BRYAN R. HAAs Street Address 513 coLONy RD. city CAMP HILL Relationship of Claimant to Decedent SON Probate Fees Accountant's Fees Tax Return Preparer's Fees State PA .Zip AIRLINE/TRAVEL EXPENSES BRYAN R. HAAS (TAMPA, FL to CAMP HILL and return) JAMES T. HAAS (GERMANY to CAMP HILL, PA and return) 17011 AMOUNT 3,500.00 1,000.00 5,000.00 9,500.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insad additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF THERESE K. HAAS FILE NUMBER 21-03-0974 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and tmnsfem under BRYAN R. HAAS 513 COLONY RD. CAMP HILL, PA 17011-2010 Sec. 9116 (a) (1.2)] JAMES T. HAAS 513 COLONY RD. CAMP HILL, PA 17011-2010 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) .con AMOUNTORSHARE OF ESTATE 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE BfSTRtBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of lhe same size) VALUE AS OF 08 JULY 2003 US SAVINGS BONDS K97115342 K97115343 K97115344 K97115345 K97115346 K97115347 K97115348 K97115349 K97115350 K97115351 K97115352 K97115353 K97115354 K97115355 K97115356 K97115357 K97115358 K97115359 K97115360 K97115361 M43804692 M43804693 M43804694 M43804695 M43804696 M43804697 M43804698 M43804699 M43804700 Date Made Joint Thcrese K. Haas Bryan R. Haas 1991 409-72-8988 214-54-4494 Date of Death Value of Asset % of Decd's Interest $114.90 $113.16 $113.16 $113.16 $109.71 $109.71 $109,71 $109.71 $107.94 $107.94 $107.94 $107.55 $107.55 $107.55 $107.55 $105.45 $105.45 $105.45 $105.45 $105.45 $1351.20 $1351.20 $1351.20 $1351.20 $1351.20 $1351.20 $1351.20 $1351.20 $1351.20 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 5O 50 50 50 50 50 50 50 50 50 50 50 TOTAL Date of Death Value of Decedent's Interest $57.45 $56.58 $56.58 $56.58 $54.85 $54.85 $54.85 $54.85 $53.97 $53.97 $53.97 $53.77 $53.77 $53.77 $53.77 $52.72 $52.72 $52.72 $52.72 $52.72 $675.60 $675.60 $675.60 $675.60 $675.60 $675.60 $675.60 $675.60 $675.60 $7167.58 VALUE AS OF 08 JULY 2003 US SAVINGS BONDS K97115366 K97115367 K97115368 K97115369 K97115370 K97115371 K97115372 K97115373 K97115374 K97115375 K97115376 K97115377 K97115378 K97115379 K97115380 K97115381 K97115382 M43804701 M43804702 M43804703 M43804704 M43804705 M43804706 M43804707 M43804708 M43804709 M43804709 Date Made Joint Therese K. Haas James T. Haas 1991 409-72-8988 129-38-2609 Date of Death Value of Asset % of Decd's Interest $113.16 $113.16 $109.71 $109.71 $109.71 $107.94 $107.94 $107.94 $107.55 $107.55 $107.55 $105.45 $105.45 $105.45 $105.45 $105.45 $105.45 $1351.20 $1351.20 $1351.20 $1351.20 $1351.20 $1351.20 $1351.20 $1351.20 $1351.20 $1351.20 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 5O 50 50 50 50 50 50 50 50 50 50 50 TOTAL Date of Death Value of Decedent's Interest $56.58 $56.58 $54.58 $54.58 $54.58 $53.97 $53.97 $53.97 $53.77 $53.77 $53.77 $52.72 $52.72 $52.72 $52.72 $52.72 $52.72 $675.60 $675.60 $675.60 $675.60 $675.60 $675.60 $675.60 $675.60 $675.60 $675.60 $7672.44 BuREAu OF TNDTVTOUAL TAXES TNHERTTAY~:E TAX DZVTSTON ~:PT. ~80601 HA~q~'gRURG, PA 171Z8-0601 BRYAN R HAAS 515 COLONY RD CAHP HILL PA 17011 COHHONNEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTTCE OF TNHERTTANCE TAX APPRATSEMENT, ALLONANCE OR D/SALLONANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FZLE NUHBER COUNTY ACN 07-Z6-ZOOq HAAS 07-08-2005 11 05-097q CUHBERLAND 101 Amoun'~ Rem i'~:t:ed REV-16q? EX /~FP (01-05) THERESE K HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGZSTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LZNE ~ RETA/N LONER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOT/CE OF /NHERZTANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF HAAS THERESE K FZLE NO. 21 05-097~ ACN 101 DATE 07-26-200~ TAX RETURN NAS: ( ) ACCEPTED AS FZLED (X) CHANGED SEE ATTACHED NOTICE RESERVATZON CONCERNING FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: 0RTGI'NAL RETURN 1. Real Es~a~a (Schedule A) (1) 2. S~:ocks and Bonds (Schedule B) (2) :5. Closely Held S~ock/Per~narship Zn~eres~ (Schedule C) q. Mortgages/No'cas Receivable (Schedule D) (q) $. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) 6. Jointly O~ned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~el Asse~s APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expensas/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Dab,s/Mortgage Liabili~ies/Liens (Schedule T) (10) 11. To~:el Deduc~:ions O0 O0 O0 O0 15~000 O0 165~205.Z8 ~5~063.Z1 (B) 9,500.00 12. 1S. 1~,. NOTE: ASSESSHENT OF TAX: 15. Amoun'l: of Line lq a~ Spousal ra~:e 16. Amoun~ of Line lq ~axable a~ Lineal/Class A ra4:e 17. Aaoun~ of L/ne lq a~ Sibling re4:e 18. Amoun~ of Line lq ~axabla a~ Collateral/Class B re~e =al Tax Due Ne~ Value of Tax Ra~urn ~ Charitable/governmental Bequests; Non-elected 911:5 Trusts (Schedule J~ ':!' Ne'l: Value of Es~a~e Subjec~ ~o Tax ~,~::~:! NOTE: To insure proper cradi~ ~o your account, submi~ ~he upper portion of ~his fore wi~h your ~ax payment. 221,268.q9 .O0 .6oo.oo (la~ ~.,768.~9 '~ © .00 Z~ an assess.ant was issued previously, llnes 14, 15 and~r 16, ,.~7, 18:and 19 wlll re~lect ~lgures that lnclude the total o~: ALL returns as~SSed ~date"7 '.:: 0 = <~- .00 ~,529.5~ .00 .00 (16) 211,768~i, X O4~i: (17) .00 x 1~'i = (18) .00 x 15 = RECEZPT NUMBER CD00~778 CDOOq02~ 19. Princi TAX CREDZTS PAYMENT DATE O~SCOUNT (+) ZNTEREST/PEN PAZD (-) .00 :5.55- AMOUNT PAZD 9,000.00 533.5q TOTAL TAX CREDZT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE (19)= 9,529.58 9,529.99 .qlCR .00 .~ICR ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORM FOR ZNSTRUCTZONS.) 0q-06-Z00q 06-08-Z00q ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after tho expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfil! the requirements of Section ZlqO of tho Inheritance and Estate Tax Act, Act 13 of ZOO0. (72 P.S. Section 91qO), Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-151~). Applications ara available at the Office of the Register of Hills, any of the Z$ Revenue District Offices, or by calling the special Iq-hour answering service for fares ordering: 1-800-36Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-qq7-3OgO (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZalOgl, Harrisburg, PA 17lIB-leI1, OR --election to have the matter determined at audit of the account of the personal representative) OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Oept. 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-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SI) 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, 198Z bear interest at the rate of six (SI) percent par annum calculated at a daiIy rate of .OOOZSq. Ali taxes which became delinquent on and after January 1, 1982 witZ 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 ars: Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor Year Rate 1982 ZOX .O00Sq8 ~"~)"~'~ - 1991 IIZ .000301 ~ 9X 1983 16Z . O00qS8 1992 92 . 0002q7 ZOOZ 67. 198~ llZ . OO0301 X99~- 199q 77. . O0019Z 2003 5Z 1985 137. .000356 1995-1998 92 . O00Z~,7 ZOOq ~X 1986 lOZ . 000276 1999 7Z . O00xgz ~987 lOZ . O0027~ ZOO0 7Z . O00xgz --Interest is calculated as fo~o~s: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR BaiXy Factor ,O00Z~7 .OOOlSq .000157 .O00110 --Any Notice issued after the tax becomes daIinquent 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.  INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT, 28O6O1 HARRISBURG~ PA 17128-0601 :ILE NUMBER DECEDEN~FS NAME Therese K Haas 2103-0974 ACH REVIEWED BY Sandra J Eslinger 101 ITEM EXPLANATION OF CHANGES SCHEDULE NO. The value of the estate has been adjusted as the result of the correction of an error in arithmetic. Row Page 1 BUREAU OF TNDZVZDUAL TAXES TNHERZTANCE TAX DTVTSTON DEPT. Z80601 HARRTSBURGj PA 171ZB-0601 BRYAN R HAAS 515 COLONY RD CAHP HILL PA 17011 COMMONWEALTH OF PENNSYLVANTA DEPARTMENT OF REVENUE NOTICE OF /NHBRZTANCE TAX APPRAXSEI{ENT, ALLOWANCE OR D'rSALLONANCE OF DEDUCTIONS,, AND ASSESSI{ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-19-200~ ESTATE OF HAAS THERESE K DATE OF DEATH 07-08-2003 FTLE NUMBER 21 05-097~ COUNTY CUMBERLAND SSN/DC ~09-7Z-8988 ACN 031355~1 Amoun'l: Remi'H:ed r HAKE CHECK PAYABLE AND RENZT PAYNENT TO.' REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 REV-I~$ EX AFP (01-OS) CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-19-Z00~ ESTATE OF HAAS THERESE K DATE OF DEATH 07-08-2003 COUNTY CUHBERLAND FILE NO. 21 03-097~ S.S/D.C. NO. ~09-72-8988 ~(:.~ AC.N... ::~:31355~1 TAX RETURN WAS: (X) ACCEPTED AS FI:LED ( ) CHANGED JOZNT OR TRUST ASSET ZNFORHATZON~:~ '":::~ ~ r~*. ~ :::~ F~NANCZAL ~NSTZTUTZON: PNC BANK ACCOUNT NO.~ 51~555Z'~ ":::~'~ TYPE OF ACCOUNT.' ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) T/HE CE~.FZCA~ DATE ESTABLISHED 0~-01-1970 Account Balance 8,786.75 Percent Taxable X 0.166 Amount Subject to Tax 1,~6~.~9 Debts and Deductions - .00 TaxabZe Amount 1,~6~.~9 Tax Rate X .~5 Tax Due 65.90 TAX CREDTTS: 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 HONEY ORDER PAYABLE TO: "REGISTER OF WILLS, ASENT.** PAYHENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 1Z-23-ZO03 CD003381 .00 65.90 TOTAL TAX CREDIT I I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 65.90 IF PA/D AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. .00 .00 .00 PURPOSE OF NOTICE: PAYNENT: REFUND OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill tha requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (TI P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on tho reverse sida. -- Hake check or money order payable to: REGISTER OF gILLS, AGENT. A refund of a tax credit, ehich was not requested on tha tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications era available at the Office of the Register of Nills, any of the Z3 Revenue District Offices or by calling the special Z4-hour ansaering service for fores ordering: 1-800-36Z-ZO50; services for taxpayers with spacial hearing and or speaking needs: 1-BOO-447-30ZO (TT only). Any party ]n interest not setisfiad with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown an this Notice may object wlthin sixty (60) days of receipt of this Notice by: --aritten protest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 17128-10Z1, OR --electing to have the matter determined at the audit of tha account of the personal representative, OR --appeal to the Orphans' Court Factual errors discoverad on this assessment should bo addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Rasident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid mithin three (3) calendar months after the decadent's death, a five percent (5Z) discount of the tax paid is allowed. Tha 15Z tax amnesty non-participation penalty is computed on the total af the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnasty period. This non-participation penalty is appealable in tha 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 chargad baginning aith first day of dalinquancy, or nine (9) months and one (1) day free the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes ahich became delinquent on or after January 1, 198Z will bear interest at a rate which w111 vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicabZe interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198--'~ ZOZ .000548 198--8-1991 Z1Z .000301 ZOO1 92 .000247 1983 16Z .000438 1992 9Z .000247 ZOO2 6Z .000Z19 1984 11Z .000301 1993-1994 7Z .000192 2003 5Z .000137 1985 132 .000356 1995-1998 92 .000247 2004 42 .000110 1986 lOZ .000274 1999 7Z .00019Z 1987 9Z .000Z47 ZOO0 8Z .000219 --Interest is calculated as follows: XNTEREST = BALANCE OF TAX UNPATD X NUNBBR OF DAYS DELZNQUBNT X DAXLY ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen [1S) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additionaI interest must be caicuIated. BUREAU OF ZNDTVZDUAL TAXES TNHER/TANC£ TAX DTVTSZON DEPT. Z80601 HARRISBURG.. PA 171ZS-O6nl BRYAN R HAAS 513 COLONY RD CAHP HILL PA 17011 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTXCE OF INHERITANCE TAX APPRAXSEHENT, ALLOMANCE OR DXSALLONANCE OF DEDUCTTONS, AND ASSESSHENT OF TAX ON JOTNTLY HELD OR TRUST ASSETS DATE 07-19-Z00q ESTATE OF HAAS DATE OF DEATH 07-08-2003 FILE NUHBER 21 03-097q COUNTY CUMBERLAND SSN/DC ~ 09 - 72-8988 ACN 031355~3 Amoun~ Remi~c*~ed REV-15q8 EX AFP (01-03) THERESE K HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUHBERLAND 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 APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-19-200~ ESTATE OF HAAS THERESE K DATE OF DEATH 07-08-2003 COUNTY CUMBERLAND FILE NO. 21 03-097q. S.S/D.C. NO. q09-72-8988 ~(,: AC~ .T,::D3135S~3 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET ZNFORHATZON~ .... ~ ~"~.. ~::::~ FINANCIAL INSTITUTION: PHC BANK ACCOUNT NO.~} TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIHE CE~.F/CA~~.~?~;<"~ DATE ESTABLISHED 07-01-1976 Account Balance 17,~60.0~ Percent Taxable X 0.166 Amount Subject to Tax 2,910.06 Debts and Deduct/ons - .00 Taxable Amount 2,910.06 Tax Rate X .~5 Tax Due 130.95 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 (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 1Z-23-2003 CD003379 .00 130.95 TOTAL TAX CREDIT J BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ZF TOTAL DUE TS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDTT" (CR), YOU NAY DE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTXONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S. Section 91~0). 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 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-IS133. Applicatlons are available at the Office of the Register of Nills, any of the Z3 Revenue District Offices or by calling the special Zq-hour answering service for fores ordering: 1-800-36Z-ZO50; services for taxpayers with special hearing and or speaking needs: 1-BOO-~q7-30ZO (TT only). Any party in interest not satisfied with the appraisement, allowance, or disalloeance of deductions or assessment of tax (including discount or interest) as sheen 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. Z810Z1, 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 Individua! Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page S of the booklet 'Instructions for Inheritance Tax Return for a Resident Decedent" (REV-la01) for 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 (SI) discount of the tax paid is allowed. The 15X tax amnesty non-participation penalty is computed on the toter 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. lnterest 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 (6X) percent per annum caZcuZated at a daily rate of .00016~. AZ! taxes which became deZinquent on or after January 1, 1982 will bear interest at a rate which wilZ vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200q are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .0005q8 1988-1991 llZ .000301 Z001 9Z .0002q7 1983 16Z .00O~3B 1992 9Z .OOOZ~7 ZOOZ 6Z .OOOZ19 198~ XIZ .000301 1993-199q 7Z .00019Z 2003 5Z .000137 1985 13Z .000356 1995-1998 9Z .O00Z~7 ZOOq q2 .000110 1986 lOX .O00Z7~ 1999 72 .O0019E 1987 9Z .O00Z~7 ZOO0 8Z .000Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUI~BER OF' DAYS DELTNI;IUENT X DAILY XNTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill 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 ZNDTVIDUAL TAXES TNHERTTANCE TAX DIVTSTON DEPT, Z80601 HARRTSBURG, PA 17118-0601 BRYAN R HAAS 513 COLONY RD CAHP HILL PA 17011 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF ZNHER/TANCE TAX APPRAISEHENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-19-2004 ESTATE OF HAAS DATE OF DEATH 07-08-2003 FZLE NUHBER COUNTY SSN/DC ACN I 21 03-0974 CUHBERLAND 409-72-8988 03155539 Amoun'l: Rem i'l:'l:ed RE¥-I~8 EX AFP (01-05) THERESE K HAKE CHECK PAYABLE AND RENIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE REV-1548 EX AFP (01-03) RETAIN LOHER PORTION FOR YOUR RECORDS *'~ NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOHANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS DATE 07-19-2004 ESTATE OF HAAS THERESE K DATE OF DEATH 07-08-2003 COUNTY CUHBERLAND FILE NO. 21 03-0974 S.S/D.C. NO. 409-72-8988 ACN 03135559 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORNATZON FINANCIAL INSTITUTION: PNC BANK TYPE OF ACCOUNT: DATE ESTABLISHED ACCOUNT NO. ¢ ) SAVINGS (~ CHECKING ( ) TRUST ( ) 05-01-1974 Account Balance 12,411.94 Percen~ Taxable X 0.166 Amoun~ Sub~ec~ ~o Tax 2,068.70 Debts and Deduc~/ons .00 Taxable Amoun~ 2,068.70 Tax Ra~e X .45 Tax Due 93.09 5140025544 TIHE CER~I~ICAT~ NOTE: TAX CREDZTS: PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID 12-23-2003 CD003380 .00 95.09 TO I URE P PER TO YOU~CCOUNT-, SUB~i~:THE UPPE~ ~ORTI~ OF ~ NOTICE WIT~UR T~ PAY~J TO THE RECUR O~ILLS A~ THE A~OVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO: "RE~ISTER OF WILLS, A~ENT." TOTAL TAX CREDZT 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 $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. 95.09 .00 .00 .00 PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. A refund of e tax creditt 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 Z3 Revenue District Offices or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-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, 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 thls Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-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 Taxes, ATTN: Post Assessment Review Unit, DEPT. 260601, Harrisburg, PA 171Z8-0601 Phone (717) 787-650S. Sac 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 (5) calendar months after the decedent's death, a five percent 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 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, 198Z bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, igBZ will bear interest at a rate which will vary free 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 Rate Factor 19B'~ ' 20Z .000548 1988-1991 XXZ .000301 200'-~ 9Z .000247 1983 16Z .000438 199Z 9Z .000247 ZOOZ 6Z .000Z19 1964 llZ .DO0301 1993-1994 72 .000192 2003 SZ .000137 1985 13Z .000356 1995-1996 9X .000Z47 ZOO4 4Z .000110 1986 lOX .000274 1999 7Z .OO019Z 1987 9Z .000Z47 ZOO0 8Z .000Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAZLY 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 INDIVTDUAL TAXES TNHERTTANCE TAX DIVTSTON DEPT. 280601 HARRTSBURG, PA 17128-0601 CONHONWEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTICE OF INHER/TANCE TAX APPRAISENENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-ZS~8 EX &FP (01-03) JAHES T HAAS 513 COLONY RD CAHP HILL PA 17011 DATE 09-06-2004 ESTATE OF HAAS DATE OF DEATH 07-08-2003 FILE NUHBER Z1 03-0974 COUNTY SSN/DC ACN THERESE CUHBERLAND 409-72-8988 HAKE CHECK PAYAB~ AND ~XT PAYHENT TO: REGISTER OF N:ZLLS ~ CUHBERLAND C0 COURT°~OUSE.. CARLISLE, PA:" 17013*'-~ K CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRAISEHENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOZNTLY HELD OR TRUST ASSETS DATE 09-06-2004 ESTATE OF HAAS THERESE K DATE OF DEATH 07-08-2003 COUNTY CUHBERLAND FILE NO. 21 03-097~ S.S/D.C. NO. ~09-72-8988 ACN TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED 03135538 JOINT OR TRUST ASSET XNFORNATZON FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 51~002554~ TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ¢ ) TRUST ( ) TINE CERTIFICATE DATE ESTABLISHED 05-01-1974 Account Balance 12,411.94 Percent Taxable X 0.166 Amount Subject to Tax 2,068.70 Debts and Deduct/ons - .00 Taxable Amount 2,068.70 Tax Rate X .45 Tax Due 93.10 TAX CREDTTS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYHENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO: **REGISTER OF WILLS, AGENT.** PAYHENT RECEIPT DISCOUNT C+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAZD (-) 11-17-2003 CD003277 .00 93.09 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 93.09 .01 .00 .01 ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATZON OF ADDITIONAL ZNTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: PAYMENT: REFUND (CA): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (7Z P.S. Section 9160). Detach the top portion of this Notice and submit with your payment to the Register of Hills 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 tho tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at the Office of the Register of Wills, any of tho 23 Revenue District Offices or by calling the special Iq-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and or speaking needs: 1-800-647-30Z0 (TT only). Any party in interest not satisfied mith 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 tho PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of tho 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. ZB0601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page S of the boaktot "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid eithin three (3) calendar months after the decedant's death, a five percent (5Z) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on tho toter of the tax and interest assassad, 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 tho 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 cna (1) day from the date of dmath, to the date of payment. Taxes which became dmlinquent before January 1, 198Z bear interest at tho rate of six ¢6X3 percent par annum calculated at a daily rata of .000166. Ali taxes which became delinquent on or after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2006 arm: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .000568 198'-~B-1991 llZ .000301 ZO0'-~ 9Z .000Z67 1983 16Z .000638 1992 92 .000267 Z002 6Z .OOOZX9 1986 llZ .000301 1993-1996 72 .O00lgz 2003 SZ .000137 1985 132 .000356 1995-1998 92 .000267 ZOO6 62 .O00110 1986 lOX .000Z76 1999 72 .O0019Z 1987 9Z .000267 ZOOO aZ ,OOOZ19 --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 will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 CONHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT. ALLONANCE OR DZSALLOHANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS RE¥-1548 EX AFP JAHES T HAAS 515 COLONY RD CAHP HILL PA 17011 DATE 09-06-200~ ESTATE OF HAAS THERESE DATE OF DEATH 07-08-2005 FILE NUMBER Z1 05-097~ COUNTY CUHBERLAND SSN/DC ~0.,8T~2-8988 ACN O$~b~..~O c::5 ?:~ Amo~ ::~Romi~ed I'I HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND C~ COURTHOUSE::.: CARLISLE, PA'~i717015.. ~::'". CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-15~8 EX AFP NOTICE OF INHERITANCE TAX APPRAISEHENT~ ALLONANCE OR DZSALLONANCE OF DEDUCTZONS~ AND ASSESSHENT OF TAX ON ,JOINTLY HELD OR TRUST ASSETS DATE 09-06-Z00~ ESTATE OF HAAS THERESE K DATE OF DEATH 07-08-2005 COUNTY CUHBERLAND FILE NO. 21 03-097~ S.S/D.C. NO. ~09-72-8988 ACN 031555~0 TAX RETURN WAS: eX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 51~0025552 TYPE OF ACCOUNT: ¢ ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 0R-01-1970 Account Balance 8,786.75 Percen~ Taxable X 0.166 Amoun~ Sub~ec~ ~o Tax 1,~6~.~9 Debts and Deduc~/ons - .00 Taxable Amoun~ 1,~6~.~9 Tax Ra~e ~ .~5 Tax Due 65.9~ TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE gITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. HAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AMOUNT PAID 11-17-Z00~ CD005276 .00 65.90 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 RE{~UZRED. ZF TOTAL DUE IS REFLECTED AS A "CREDIT" { CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) 65.90 .0~ .00 .0~ PURPOSE OF NOT~CE~ To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S. Section 91qO). PAYMENT: Detach the top portian of this Notice and submit with your payment to the Register of ~ills printed on the reverse side. -- Make check or money order payable to: REGISTER OF MILLS, AGENT. REFUND (CR): A refund of a tax creditj which was not requested on the tax return, may be requested by completing an "Application far Refund of Pennsylvania Inheritance and Estate Tax" (REV-iS15). Applications ara available at the Office of the Register of Wills, any of the Z5 Revenue District Officas or by calling the special Iq-hour answering service for forms ordering: 1-800-56Z-ZO50; services for taxpayers with special hearing and or speaking needs: 1-800-~q7-5020 (TT only). ODJECTIONS: 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 Notica by: --written protest to the PA Department of Revenua, Board of Appeals, Dapt. ZBIOZ1, Harrisburg, PA 17liB-lOll, OR --electing to have the matter determined at the audit of the account of the parsonal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Ravenue, Bureau of Individual Texas, ATTN: Post Assessment Review Unit, DEPT. leO601, Harrisburg, PA 171ge-060l Phone (717) 787-650S. See page S of the booklet "Instructions for Inheritance Tax Raturn for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's deathj a five percent discount of the tax paid is allowed. The lSZ tax amnesty non-participation penalty is computed on the total of the tax and interest assassed~ and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation panaZty is appealable in the same manner and in the the same time period as you would appeal tha tax and interest that has been assessed as indicated on this notica. Interest is charged beginning with first day of dalinquancy, or nine (9) months and one (1) day from the date of daath~ to the date of payment. Taxes whlch became delinquent before January 1, 19AZ bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on or after January l, 198Z will bear interest at a rate ehich 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 200q are: Interest Daily Interest Daily Interest Dally Year Rate Factor Year Rate Factor Year Rate Factor 19B'-'~ ZOZ ,0005fi8 198'~8-1991 11Z .000501 ZO0"-~ 9Z .OOOZ~7 1985 16g .000q58 199Z 9Z .O00Zq7 ZOOZ 6Z .000Z19 198q llZ .000501 1995-199q 72 .00019Z ZOO3 5Z .000157 1985 132 .000556 1995-199B 9Z .O00Zq7 ZOOq ~Z .000110 1986 lOX .O00Z7q 1999 72 .O0019Z 1987 92 .O00Z~7 ZOO0 aZ .O00ZZ9 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPAXD X NUNBER OF DAYS DEL/NQUENT X DAXLY :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 bm calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT, Z80601 HARRISBURG, PA 171Z8-0601 CONHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOHANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-Z$~$ EX AFP [01-05) JAMES T HAAS 515 COLONY RD CAHP HILL DATE 09-06-200~ ESTATE OF HAAS DATE OF DEATH 07-08-2005 FILE NUHBER 21 05-097~ COUNTY CUHBERLAND SSN/DC ~09-72-8988 ACH 05,1~2 THERESE PA 17011 !~ HAKE CHECK PAYABLE AND RERIT PAYHENT TO: REGISTER OF HILLS CUHBERLAND cO COURT HOUSE CARLISLE, PA 17013 ~ CUT ALONG THIS LINE ~ RETAIN LO~ER PORTION FOR YOUR RECORDS REV-15~8 EX AFP NOTICE OF INHERITANCE TAX APPRAZSEHENT~ ALLONANCE OR DISALLOWANCE OF DEDUCTZONS~ AND ASSESSHENT OF TAX ON dOINTLY HELD OR TRUST ASSETS DATE 09-06-200~ ESTATE OF HAAS THERESE K DATE OF DEATH 07-08-2005 COUNTY CUHBERLAND FILE NO. 21 05-097~ S.S/D.C. NO. ~09-72-8988 ACN 051555~2 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED dOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 51~0158957 TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIHE CERTIFICATE DATE ESTABLISHED 07-01-1976 Accoun~ Balance 17,~60.04 Percen~ Taxable X 0.166 Amoun~ Sub~ec~ ~o Tax Z,910.06 Debts and Deduc~/ons - .00 Taxable Amoun~ 2,910.06 Tax Ra~e X .~5 Tax Due 150.96 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. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF MILLS, AGENT." PAYHENT DATE 11-17-2005 RECEIPT NUHBER CD005275 DISCOUNT (+) INTEREST/PEN PAID C-) .00 AHOUNT PAID 150.95 130.95 .01 .00 .01 TOTAL TAX CREDIT BALANCE OF TAX DUEI 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 NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PURPOSE OF ROTICE: PAYNENT: REFUND (CR): OBJECT/ONE: ADNIN- ISTRATXVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To ~ulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF 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-1315). Applications are available at the Office of the Register of #ills, any of the Z5 Revenue District Offices or by calling the special Z4-hour answering service for forms ordering: 1-BO0-56Z-ZOSD~ 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, allowance, or disallomance of deductions ar assessment of tax (including discount or interest) as shown on this Notice amy object within sixty (60) days of receipt of this Natice by: --written protest ta the PA Department of Revenue, Board of Appeals, Dept. ZSlOZ1, Harrisburg, PA 17iZB-laZl, 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 Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-iS01) for 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 (SI) discount of the tax paid is allomed. 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 tho 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, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 196Z through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rata Factor Year Rate Factor Year Rate Factor 198'---~ ' ZOZ .000548 198~-1991 llZ .000501 2001 9Z .000Z~7 1982 ZBZ ,000458 1992 9Z .000Z47 ZOOZ 6Z .OOOZZ9 1984 112 .000301 1993-1994 7X .O0019Z 2003 5X .000137 1985 15Z .000556 1995-1998 92 .000247 2004 4Z .000110 1986 lOZ .000Z74 1999 7Z .O0019Z 1987 92 .000247 ZOO0 8Z .O00Z19 --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 wi11 reflect an interest calculation to fifteen (15) days beyond the data of the assessment. If payment is made after the interest computation date shown on the Rotice, additional interest must be calculated.