The URL can be used to link to this page

Home My WebLink About04-0276CONHONNEALTH OF PENNSYLVANIA DEPARTN£NT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1E~3 EX &FP (09-00) ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE ACH 0q106790 DATE 02-2q-200q ALICE L HERTZLER 11 STONE HEAD RD EST.' OF HAROLD HERTZLER S.S2 NO. 20q-50-68RZ DATE OF DEATH 12-Z8-ZOOZ TYPE OF ACCOUNT [] SAVINGS [] CHECKING [] TRUST C ~U~?~? CUMBERLAND [] CERTZF. 22 REMIT PAYMENT AND FORMS TO: REGISTER OF gILLS -,, ~, CUMBERLAND CO COURT HOUSE DILLSBURG PA 17019-Z08~;i CARLISLE, PA 17015 PNC BANK has provided the Department mith the information listed belom mhich has been used in calcutating the potential tax due. Their records indicate that at the death of the above decedent, you mere a joint omnsr/beneficlary of this account, zf you faa1 this information is incorrect, please obtain mritten correction free the ~inancial institution, attach a copy to this form and return it to the obeys address. This account is taxable in accordance eith the Inheritance Tax Lams of the Coamonmealth of Pennsylvania. Questions may be answered by calling (717) 787-B:527. COMPLETE PART ! ]IELOW ~ ~ ~ SEE REVERSE SIDE FOR FZLZNG AND PAYMENT ZNSTRUCTZONS Account No. 5070080587 Data 01-01-1960 Established Accoun'l: Balance 27,0~9.86 Percan~ Taxable X 5 0.0 0 0 AIoun~ Sub.iact: ~o Tax 15,52q.95 Tax Ra~e X .0~5 Po%mn%ia1 Tax Due 608.62 To insure proper credit to your account~ (Z) copies of this notice must accompany your payment to the Register of #ills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments are made mithin three ($) months of the decadent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due mill become delinquent nine (9) months after the date of death. PART TAX LINE PART TAXPAYER RESPONSE A. O The above information and tax due is correct, 1. You may choose to reait payment to the Register of Hills .ith tho copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice ts the Register of ~ Hills and an official assessIent will bi issued by the PA Departaent of Revenue. ONE BLOCKJ B. [] The above asset has been or miI! be reported and tax paid mith the Pennsylvania [nheritance Tax return ONLY to be fiZed by the decedent's representative. C. ~%.~he above information is incorrect and/or debts and deductions mere paid by you. ?ou IUSt coIplets PART I~ and/or PART ~ below. relationship ~o decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Established 1 2. Accoun~ Balance 2 ~7.0~ $. Percen~ Taxable $ X ~0.0 o0 q. kaoun~ Subjac~ ~0 Tax q t ~-~q.~'-~ 6. Debts and Deductions 5 - 6. Aeoun~ Taxable 6 7. Tax Ra~a 7 X 8. Tax Due 8 PART DATE PAID ~1,~ io~ DEI~TS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION I TOTAL (Enter on L/ne 5 of Tax Compu%a%ton) $ ~77~, ~ ~ AMOUNT PAID Under penaltles of perSury, Z declare that the facts Z have reported above are true, correc~ and comple~:e to the bes~ of ay knowledge and belief. HOME (Ti 7 ) TAXPAYER S[GNATURE TELEPHONE NUHSER DATE CONHONHEALTH OF FENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRXSBURG, PA 1712B-GBOZ REV-15qS EX AFP C09-00) ZNFORHATZON NOTICE AND TAXPAYER RESPONSE ACN 0q106289 DATE O2-Zq-ZO0~ ~0.,i~i.;. ~ EST. OF HAROLD HERTZLER ' S.S. NO. 20~-$0-68~2 DATE OF DEATH 12-28-2002 '0~ MAR 22 P2:24 COUNTY CUNBERLAND ALICE L HERTZLER ZZ STONE HEAD RD '{:~ ~ DILLSBURG PA 171~!~;i;:.: TYPE OF ACCOUNT [~SAV/NGS [--]CHECKZNO r--]TRUST ~']CERTIF. REHIT PAYNENT AND FORHS TO: REGISTER OF HILLS CUNSERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided the Department aith the information listed beloa ahich has been used in calculating tho potential tax due. Their records indicate that at the death of the above decedent, you mere a joint oaner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution~ attach a copy to this fora and return it to the above address. This account is taxable in accordance Nith the Inheritance Tax la~s of the Coamonaaalth of Pennsylvania. Questions may bo ensnared by cal]ing (717) 787-8~27. CONPLETE PART 1 BELON ~ # ~ SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS Accoun~ No. 21001010950 De~e 09-17-1989 Es*ablished Accoun~ Balance 1~, 8~2.05 Percen~ Taxable X 5 0.0 0 0 Aeouni: Subjec* ~o Tax 7, q16.05 Tax Ra~e X .0~5 Po~en~ial Tax Due ~.72 To insure proper credit to your account, tho (Z) copies of this notice must accompany your payment to tho Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments are made aithin three ($) months of the dacadant's date of death, you may deduct a 5Z discount of the tax duo. Any inheritance tax due ail1 become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. ~The above information and tax due is correct. Y-"'l. You may choose to re, it payment to the Register of Hills Nith tad copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A' and return this notice to the Register of ONE '~ HilLs and an official assessment .ill be issued by the PA Department of Revenue. BLOCK J B. [] The above asset has been or ~i11 be reported and tax paid ~ith the Pennsylvania Inheritance Tax return ONLY to bo filed by the decedont's representative. C. [] The above information is incorrect and/or debts and deductions aero paid by you. You must complete PART [] and/or PART [] beloa. PART If you ~ndice~e a differen~ ~ax ra~e, please s~a~e your relationship ~o decedent: TAX RETURN - CONPUTAT~ON OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Da~e Established I 2. Accoun~ Balance 2. $. Percen~ Taxable $ ~ ~. A.oun~ Subjec~ ~o Tax ~ 5. Debts and Deductions $ - 6. Aeoun~ Taxable 6 7. Tax Ra~e 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAINED PAYEE DESCRIPTION AHOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, ! declare ~ha~ ~he fec~s ! have reported above ara ~rue, correc~ and comple*e~,~;~._~'~o ~'*h~be~*'°f~~-'~aY kno. l(ed~g.e and~ belief. NoRKHONE c¢i~1T >)H3~- ck~-/ 3)~4/4, TAXPAYER SIGNATURE TELEPHONE NUNBER DATE COMr~,NWEALTH OF PENNSYLVANIA ?' DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: HERTZLER ALICE L 11 STONE HEAD RD DILLSBURG, PA 17019~2084 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003707 ........ fold r" ESTATE INFORMATION: SSN: 204-30-6842 FILE NUMBER: 2104-0276 DECEDENT NAME: HERTZLER HAROLD DATE OF PAYMENT: 03/22/2004 POSTMARK DATE: 03/20/2004 COUNTY: CUMBERLAND DATE OF DEATH: 12/28/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04106289 I 8333.72 I REMARKS: SEAL CHECK//6392 TOTAL AMOUNT PAID: 8333.72 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA D~ARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: HERTZLER ALICE L 11 STONE HEAD RD DILLSBURG, PA 17019-2084 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003706 ........ fold ESTATE INFORMATION: SSN: 204-30-6842 -"JLE NUMBER: 2104-0276 'DECEDENT NAME: HERTZLER HAROLD DATE OF PAYMENT: 03/22/2004 POSTMARK DATE: 03/20/2004 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/28/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 041 06290 $21 3.58 TOTAL AMOUNT PAID: $213.58 CONHONHEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-D601 REV-16~5 EX AFP (Bg-DD) ZNFORMATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 21 Oq '~'~ ACN 04110614 DATE 05-22-2004 ALICE L HERTZLER 11STONEHEAD RD DILLSBURG PA 17019-9714 TYPE OF ACCOUNT '%~!~'$?. Or HAROLD L "ERTZLER DSA~NSS ,-'-.,~:S:S. NO. ~ 204-$0-6842 ['~CHECKZNG DATE OF DEATH 12-28-2002 [] TRUST ~T_~ CUNBERLAND DCERTZF. '04 c ~i! :08 RE.IT P^Y. ENT AND FOR.S TO: REGISTER OF WILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 NAYPO/NT BANK has provided the Department with the information listed below Nhich has been used in calculating the potantial tax due. Their records indicata that at the death of the above decedent, you ~are a ~oint Goner/beneficiary of this account. If you feel this information is incorrect, please obtain ~rittan correction from the financial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance .ith the Inheritance Tax Laws o~ the Commonwealth of Pennsylvania. Questions may ba answered by calling (717) 787-8527. CONPLETE PART 1 BELOW # # ~ SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS Accoun~ No. 100258955 Oa~e 01-51-2002 Established Accoun~ Balance 500.00 Percen~ Taxable X 100.00 Anoun~ Subjec~ ~o Tax 500.00 Tax Ra~e X .15 Po~en~ial Tax Due 75.00 To insure proper credit to your account, tho (2) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Nills, Agent". NOTE: If tax payments are made aithin three (5) months of the decedent's date of death, you may deduct a SZ discount of the tax due. Any inheritance tax due .]11 become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE ECHECK ONE BLOCK ONLY A. ~Tha above inforwation and tax due is correct. 1. You nay choose to remit payment to the Register of Hills with tee copies of this notice to obtain a discount or avoid interest, or you nay check box "A" and return this notice to the Register of Hills and an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or mill be reported and tax paid eith the Pennsylvania Inheritance Tax return to be filed by the decedentVs representative. ~The above information is incorrect and/or debts and deductions were paid by C. you. ~' 'You must complete PART ~'~'] and/or PARI ~-] bela~. PART If you indicate a diffaren~ ~ax ra~e, please s~a~e your relationship :ko deceden:k: TAX RETURN - COHPUTATZON OF TAX ON JOINT/TRUST ACCOUNTS 1. Da:ke Es:kablishad 2. Accoun:k Balance 2 $. Percen:k Taxable ~. Aeoun:k Sub5ec:k :ko Tax 5. Dab:ks and Deduc:kions 5 - 6. Aaoun:k Taxable 6 ~'5~)~ E~) 7. Tax Re:ko 7 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAINED PAYEE DESCRIPTION ANOUNT PAID TOTAL (En:ker on Line ~ of Tax Conpu:ka:kion) $ Under penal:kiss of perjury~ T declare :kha:k :kha fac:ks I have rapor:ked above ara :krue, corrac:k and comple:ke :ko :kbs bes:k of my knowledge and belief. HONE ( ~(7 ) ~ ' ~°?~-~ .o. , , TAXPAYER'S/GNATURE TELEPHONE HUH~ER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND HILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based on information submitted by tho financial institution. Z. Inheritance tax becomes delinquent nine months after the decadent's dote of death. 3. A joint account is taxable even though the decedant's name ams added as a matter of convenience. q. Accounts (including those held batsman husband and wife) ehich the decedent put in joint noses within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death ara not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING [NSTRUCT/ONS - 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 1 of the "Taxpayer Response" section. Sign two copies and submit thee eith your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue ell1 issue an official assessment (Fore REV-1Sq8 EX) upon receipt of the return from the Register of Mills. Z. BLOCK B - [f the 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 I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Tndividual Taxes, Oept Z80601, Harrisburg, PA 171ZB-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts g 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 Mills of the county indicated. The PA Department of Revenue will issue an official assessment (Fore REV-la48 EX) upon receipt of the return {roe th; Register af Mills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/aZ: Accounts which the decedent put in joint names eithin one il) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. Tf a double asterisk (ax) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted free the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date cf death. The percent of the account that ts 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 D[VTDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT ONNERS SURVIVING JO[NT ONNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVTDED BY 3 (JOTNT DNNERS) DTVIDED BY Z (SURVIVORS) = .167 X lO0 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the dacadant's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVTDED BY TOTAL NUMBER OF SURVTVING 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 the decedent. I DZVTDED BY Z (SURVTVORS) = .50 X 100 = 5OZ (TAXABLE FOR EACH SURVIVOR3 4. The amount subject to tax (line 4) 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 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter tho appropriate tax rate (1ina 7) as determined below. Da~:e of Death Spouse Lineal ' Sibling ' Collar:era1 07/01/gq ~o 12/$1/9q 01/01/95 '~o 06/30/00 OX 6X 07/01/00 ~o presen~ OX q.SZ~ mThe tax rate imposed on th~ net value of transfers free a younger at death to or for the usa 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 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 nat they have been adopted by others, adopted descendents and their descendants and step-descendants. "SibLings" are defined as individuals who have at [east one parent in common with the decedent, whether by blood or adoption. The "Collaterat" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED AllowabIe debts and deductions are determined as follows: A. You legally ara responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can ~urnish proof af payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of payment cay be requested by tho PA Department of 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. CD REV-1162 EX(11-96) 003776 HERTZLER ALICE L 11 STONE HEAD RD DILLSBURG, PA 17019-2084 ........ fold ESTATE INFORMATION: SSN: 204-30-6842 FILE NUMBER: 21 04-0276 DECEDENT NAME: HERTZLER HAROLD DATE OF PAYMENT: 04/06/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/28/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04110614 $37.50 REMARKS: TOTAL AMOUNT PAID: $37.50 ..... SEAL CHECK# 6395 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COHNONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. ZB0601 HARRISBURG, PA 17128-0601 REV-1S4$ EX ZNFORHATZON NOTICE AND TAXPAYER RESPONSE I FZLE NO. 11 ACN 0q110615 DATE O$-ZZ-ZOOq ALICE L HERTZLER 11STONEHEAD RD DILLSBURG PA 17019-971q ~:,: TYPE OF ACCOUNT EsT. OF H'~ROLD L HERTZLER []SAVINGS S.S. NO.- 204-50-68~2 []CHECKTNG DATE OF DEATH 12-28-2002 [] TRUST AP~:O-U~T~!I :08 CUMBERLAND [] CERTIF. REHTT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE . - CARLISLE~ PA I70I$ #AYPOZNT BANK has provided the Department alth the information listed belou ahich has been used in calculating tho potential tax due. Their records indicate that at the death of the above decedent, you ~ere a joint oaner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the ;inancial institution, attach a copy to this ~orm and return it to the above address. This account is taxable in accordance ~ith the Inheritance Tax La~s of the Comaon~ealth of Pennsylvania. guestions may be ansasrsd by calling (717} 787-85Z7. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYHENT ZNSTRUCT[ONS Accoun~ No. 710002~267 Da~o 01-$1-2002 Established Accoun4: Balance f48,805, q7 Porcon~ Taxable X 100.00 Amoun~ Sub~oc~ ~o Tax ~8;805 . q7 Tax Ra~o X .15 Po~on~iaL Tax Duo 7 ,JZO. 82 To insure proper credit to your account, too (2) copies of this notice must accompany your payment to the Register of #ills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments are made within three ($) months of the decedent's date of death, you may deduct a 5g discount of the tax due. Any inheritance tax due mill become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY A. ~-~ The above information and tax due is correct. i i 1. You may choose to remit payment to the Register of Hills ~ith tmo 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 Hills and an official assessment mill be issued by the PA Department of Revenue. B. ~ The above asset has been or ~ill be reported and tax paid ~ith the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. ~The above information is incorrect and/or debts and deductions uers paid by you. ~% You must complete PART F~ and/or PART r~-'~ balou. PART If you indicate a diffaran~ ~ax ra~o, please s~a~o your relationship to docoden~: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LTNE 1. Da~o Established 1 2. Accoun~ Balance 2 $. Percen~ Taxable $ ~ ~. Amoun~ Subjoc~ ~o Tax 4 5. Dobbs and Doduc~ions S - 6. Amoun~ Taxable 6 7. Tax Ra~o 7 ~ 8. Tax Duo 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) $ Under penalties of porSury, I declare ~ha~ ~ho facts I have reported above ere ~rue~ corroc~ and complete ~o the bea~: Of my knowle~e and belief. HOME C TAXPAYER SI6NATURE TELEPHONE NUMBER DATE ' GENERAL INFORMATION 1. FAILURE TO RESPOND #ILL RESULT IN AN OFFICIAL TAX ASSESSMENT wlth applicable lntarsst based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the dacedent's date of death. $. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death ara not taxable. 6. Accounts held by a decedent "in trust for" another or others ara taxable fully. REPORTING [NSTRUCTIONS- 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 1 of the "Taxpayer Response" section. Sign two copies and submit them wlth your check for the amount of tax to the Register of Nills of the county indicated. The PA Department of Revenue eilI issue an official assessment (Fore REV-154D 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 Inheritance Tax Return filed by the decedent'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 Z80601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/er deductions are being claimed, check block "C" and complete Parts Z and 3 according to the instructions below. Sign tee copies and submit thee eith your check for the amount of tax payable to the Register of Rills of the county indicated. The PA Department of Revenue will issue an official assessment (Fore REV-la48 EX) upon receipt of the return from the Register of RiLls. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1g/1z/Dg: Accounts which the decedent put in joint names within Dna (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 the account or the number of accounts held. If a double asterisk (xx) 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. Z. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X lO0 = PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT ONNERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 3 (JOINT ONNERS) 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): I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ORNERS DR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death bV the decadent. I DIVIDED BY Z {SURVIVORS) = .50 X 100 = 507. (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 3). 5. Enter the totaI 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 (1ina 4). 7. Enter the appropriate tax rate (line 7) as determined below. i I Date of Death Spouse Ltnaal Sibling Collateral 07/01/9q to 12/$1/9q SZ 6X 15Z 15Z 01/01/95 to 06/30/00 OX 6Z 07/01/00 ~o presan~ OX eThe tax rate imposed on the net value of transfers from a deceased teenty-one years age younger at death to or for the use of a natural parent, an adoptive parent~ or a stepparant of the child is OZ. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children ehether 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~ ahathar by blood or adoption. The "Collateral~ class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, ar the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must ba itemized fully in Part 5. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003777 HERTZLER ALICE L 11 STONE HEAD RD DILLSBURG, PA 17019-2084 fold ESTATE INFORMATION: SSN: 204-30-6842 FILE NUMBER: 2104-0276 DECEDENT NAME: HERTZLER HAROLD DATE OF PAYMENT: 04/06/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/28/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04110615 $3,660.40 REMARKS: ...... SEAL TOTAL AMOUNT PAID' $3,660.40 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Alice L. Hertzler 11 Stone Head Rd. Dillsburg, PA 17019-9714 BUREAU OF TNDZVTDUAL TAXES INHERTTANCE TAX DTVTSION DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 ALICE L HERTZLER 11 STONE HEAD RD DZLLSBURG PA 17019 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF ZNHERZTANCE TAX APPRAISENENT, ALLONANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-I;~i8 EX AFP (01-05) FILE NUHBER COUNTY SSN/DC ACN DATE 05-05-200q ESTATE OF HERTZLER HAROLD DATE OF DEATH 12-28-2002 ~:..~/-~,~'- ~ ~ CUHBERLAND 20q-$O-68q2 0~106289 Amount Remitted I HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRATSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-05-200~ ESTATE OF HERTZLER HAROLD DATE OF DEATH 12-28-2002 COUNTY CUHBERLAND FILE NO. S.S/D.C. NO. 20~-$0-68q2 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORNATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. ZlO(k~O~ 10950 TYPE OF ACCOUNT: DATE ESTABLISHED ( ) SAVINGS ( ) CHECKING ( ) TRUST ()0 TIME CERTIFICATE; 09-17-1989 .. Account Balance Percent Taxable Amount Subject to Tax Debts and DeductAons Taxable Amount Tax Rate Tax Due 1~,85Z.05 NOTE: TAX CREDITS: X 0.500 7,~16.05 - .00 7,~16.05 X .~5 $$$.72 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: ffREGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 05-11-200q AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM 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 PAYNENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. .00 333.72 9.1q $qZ.86 PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To ~ulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (72 P.S. Section 91qO). Detach the top portion of this Notice and submit aith your payment to the Register of NiZls 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 ba requested by completing an "Application for Refund of Pennsylvania [nharitance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of #ills, any of the g3 Revenue District Offices or by calling the special gq-hour answering service for forms ordering: 1-SgO-36Z-Z050; services for taxpayers ~ith special hearing and or speaking needs: 1-800-qq7-3020 (TT only). Any party in interest not satisfied ~ith the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice nay object ~ithin sixty (60) days of receipt of this Notice by: --~rittan protest to the PA Department cf Revenue, Board of Appeals, Dept. ZSIOZ1, Harrisburg, PA 171ZS-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. Z80601, Harrisburg, PA 17128-0601 Phone (7173 787-6505. Sam 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 .ithin three (3) calendar months after the dacadent's death, a five percent discount of the tax paid is allo~ed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .00016q. All taxes which became delinquent on or after January l, [982 wil! bear interest at a rate which ~iIl vary calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The applicable interest rates for 198g through gOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOX .O00Sq8 198-~8-1991 [1Z .000301 ZO0~'~ 9X .O00Zq7 1983 162 .000q38 1992 92 .OOOZq7 ZOOZ 62 .000219 1984 IZX .000301 1993-199q 7X .000192 2003 5X .000137 1985 13Z .000386 1998-1998 9Z .O00Zq7 ZOOq q~ .000110 1986 lOX .OOOgTq 1999 7~ .O00ZOZ 1987 9Z .O00Zq7 ZOO0 8Z .000Z19 --Interest is calculated es follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after tho interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES TNHERZTAHCE TAX DXVZSZON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAXSEHENT. ALLO#ANCE OR DXSALLONANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-I;4* EX AFP (01-05) ALICE L HERTZLE 11 STONE HEAD RD DILLSBURG P~. 17019-208q DATE 05-$1-200q ESTATE OF HERTZLER HAROLD DATE OF DEATH 12-28-200Z FILE NUHBER Z1 0~-0Z76 COUNTY CUHBERLAND SSN/DC 20R-$0-68~2 ACM ORlOGZgO Amoun~ Remi~ed HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~'- RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DXSALLONANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-$1-200q ESTATE OF HERTZLER HAROLD DATE OF DEATH 12-28-2002 COUNTY CUHBERLAND FILE NO. 21 0~-0276 S.S/D.C. NO. 20~-$0-68~2 ACM 0~106290 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET XNFORHATXON FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 5070080587 TYPE OF ACCOUNT: ( ) SAVINGS C~ CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 01-01-1960 Account Balance 27,0q9.86 Percent Taxable X 0.500 Amount Subject to Tax 15,52q.95 Debts and Deduct/ons - .00 Taxable Amount 15,52q.95 Tax Rate X .q5 Tax Due 608.62 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYHENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: **REGISTER OF WILLS, AGENT.** PAYMENT DATE O$-ZO-ZOOq RECEIPT NUMBER CD005706 DISCOUNT C+) INTEREST/PEN PAID (-) .00 AMOUNT PAID 213.58 INTEREST TS CHARGED THROUGH 06-08-ZOOq TOTAL TAX CREDIT AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE REVERSE SIDE OF THIS FORM 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 PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT*' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THTS FORH FOR /NSTRUCTZONS. ) 215.58 395.0q 16.67 q11.71 PURPOSE OF ROTZCE: 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 23 of 2000. [72 P.S. Section 9140}. Detach the top portion of this Notice and submit aith your payment to the Register of #111s printed on the reverse side. -- Make check or money order payable to: REGISTER OF RILLS, AGENT. A refund of a tax credit, which mas not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Hills, any of the 23 Revenue District Offices or by calling the special Z4-hour answering service far forms ordering: 1-800-362-Z050; services for taxpayers with special hearing and or speaking needs: 1-B00-447-$020 (TT only). Any party in interest not satisfied mith the appraisement, a11oaanca, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court 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. 2B0601, Harrisburg, PA 17128-0601 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 dacedent's death, a five percent (SI) discount of the tax paid is allowed. The ISZ 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 tiaa period as you wouZd appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. A11 taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which wiZl vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198'"~ 202 .OOOS4B 198'"~-1991 11Z .O0030X 2001 92 .000247 1983 162 .000438 1992 92 .000247 2002 62 .000219 1984 llZ .000301 1993-1994 72 .000192 2003 52 .000137 1985 13Z .000~56 199S-1998 9Z .000247 2004 4Z .000110 1986 102 .000274 1999 7Z .000192 1987 9Z .000247 2000 82 .000219 --Interest is calculated es follows: INTEREST = BALANCE OF TAX UNPATD X NUI~BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DTYTSTON DEPT. 280601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-I&O7 EX AFP c01-05) ALICE L HERTZLER 11 STONE HEAD RD DILLSBURG PA 17019 DATE 05-24-200q ESTATE OF HERTZLER DATE OF DEATH 12-28-2002 FILE NUMBER 21 0~-0276 :'~-~COUNTY CUMBERLAND ACN 04106289 Amoun~ Remi'~'l'ed HAROLD HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credi~ *o your account:, submi* *he upper portion of ~:hXs fore w:i~:h your *ax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORT'rON FOR YOUR RECORDS -~ REV-1607 EX AFP (01-03) ~ INHERITANCE TAX STATEMENT OF ACCOUNT ESTATE OF HERTZLER HAROLD FILE NO. 21 04-0276 ACN 0~106289 DATE 05-2~-200~ THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHOWN BELO# ZSA SUNHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-03-Z00~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 333.72 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 03-20-200~ CD003707 .00 333.72 BALANCE OF UNPAID INTEREST/PENALTY AS OF 05-Z1-200~ IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REQUIRED. ZF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 333.72 ~ALANCE OF TAX DUE .00 INTEREST AND PEN. 7.~$ TOTAL DUE 7.23 YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- IF RESIDENT DECEDENT make check or money order payable to: REG:ISTER OF N:ILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVAN:IA. REFUND ECR): 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-Z513). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or from the Department's Iq-hour answering service for forms ordering: 1-aoo-36Z-ZO50; services for taxpayers with special hearing and / or speaking needs: 1-ao0-q~7-30ZO (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes) ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601, phone C7173 787-650S. DISCOUNT: 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. PENALTY: 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. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became deIinquant before January l, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016q. All taxes which became delinquent on and 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 198Z through gOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 19BI ZOg .0005q8 1988-1991 llg .OOO30l 2001 9Z .OOOZq7 1983 16Z .O00q36 199Z 9X .O00Zq7 ZOOZ 6Z .00016q 1984 X1Z .00030! 1993-1994 7Z .00019Z 2003 5g .000137 1985 132 .000356 1995-1998 92 .000Z47 2004 qZ .000110 1986 IOZ .O00ZTq 1999 7Z .000192 1987 9X .000Z47 2000 82 .000Z19 --Interest is calculated as follows: :iNTEREST = BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELTNQUENT X DAZLY ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (153 days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 004404 HERTZLER ALICE L 11 STONE HEAD RD DILLSBURG, PA 17019-2084 fold ESTATE INFORMATION: SSN: 204~30-6842 FILE NUMBER: 2104-0276 DECEDENT NAME: HERTZLER HAROLD DATE OF PAYMENT: POSTMARK DATE: 09/20/2004 09/17/2004 COUNTY: CUMBERLAND DATE OF DEATH: 12/28/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04106290 $416.31 R~EMARKS: CHECK# 6477 SEAL TOTAL AMOUNT PAID: 9416.31 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PLEASE RETURN THIS PORTION WITH YOUR THE REGISTER OF WILLS LISTED BELOW ESTATE OF HERTZLER HAROLD FILE NO/SSN 21 0~-0276 COUNTY CUNBERLAND DATE OF ASSESSHENT 05-2q-200~ ACN 0q106290 PAYMENT TO :~"<R~GISTER OF WILLS ~CUHBERLAIID CO COURT HOUSE CARLISLE,, PA 17015 '04 ~EP 20 p) :~7 Alice L. Hertzler l I Stone Head Rd. Dillsburg, PA 17019-9714 BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTVTSTON PO BOX 280601 HARRISBURG, PA 17128-0601 ALICE L HERTZLER 11STONEHEAD RD DILLSBURG CONNONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS PA 17019-971q DATE 11-15-200q ESTATE OF HERTZLER DATE OF DEATH 12-28-2002 FILE NUHBER 21 0~-0276 COUNTY CUHBERLAND SSN/DC 20~-$0-68~2 ACN 0Rl10615 Amoun~ Rem~ed REV-I$¢8 EX AFP (09-0~) HAROLD HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LONER 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 11-15-200q ESTATE OF HERTZLER HAROLD DATE OF DEATH 1Z-Z8-ZOOZ COUNTY CUHBERLAND FILE NO. 21 0~-0276 S.S/D.C. NO. 20R-SO-68R2 ACN 0Rl10615 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORNATION FINANCIAL INSTITUTION: NAYPOINT BANK ACCOUNT NO. 710002qZ67 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 01-$1-2002 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: ~8,805.~7 X 1.000 ~8,805.~7 - .00 q8,805.~7 X .~5 2,196.25 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 ?:~EuCME~/EPRT DISCOUNT (+) AMOUNT PAID DATE . _ INTEREST/PEN PAID C-) Oq-O6-200q S1.72- 5,660.q0 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. ) 5,608.68 1,q12.q$CR .00 1,q12.q$CR PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To ~ulfill the requirements of Section 21qO of the Inheritance and Estate Tax Act, Act Z3 of 2000. (72 P.S. Section 91qO). 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 HILLS, AGENT. A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available online at awN.revenue.state.pm.us, any Register of Hills or Revenue District Office) or from the Department's 2q-hour answering service for forms orders: 1-800-36Z-2050; services for taxpayers aith special hearing and/or speaking needs: 1-800-~q7-3020 (TT only). Any party in interest not satisfied with the appraismant, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing one of the folloeing: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at eww.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to bo valid, you must receive a confirmation number and processed date from the Board of Appeals website. You may also send a written protest to PA Department of Revenue, Board of Appeals P.O. Box ZBiOZ1, Harrisburg, PA 171LB-lOLl. Petitions may not be foxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) 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, P.O. Box 280601, Harrisburg, PA 1712B-0601 Phone (717) 787-6S05. 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 (5Z) 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 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, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016q. 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 19BI through 200~ are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198~ ZOZ .O00Sq8 198~8-1991 112 .O0030I ZO0'----~ 9Z .0002q7 1983 162 .000~38 1992 92 .0002fi7 ZOO2 62 .00016~ 198~ 112 .000301 1993-199q 72 .000192 2003 52 .000137 1985 132 .000356 1995-1998 9Z .O00Zq7 ZO0~ qZ .000110 1986 lOX .O00Z7q 1999 72 .000192 1987 92 .O00Zq7 2000 8Z .O00Zl9 --Interest is calculated as follows: /NTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 ALICE L HERTZLER 11STONEHEAD RD DILLSBURG CONMONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLONANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS PA L7019-971q DATE 12-15-200q ESTATE OF HERTZLER HAROLD DATE OF DEATH 12-28-2002 FILE NUMBER 21 0q-0276 COUNTY CUMBERLAND SSN/DC 20q-50-68qZ ACN 0qll061q Amoun~ Remi~ed I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~'- RETAIN LOHER PORTION FOR YOUR RECORDS ~ m m m m m m m mmmmmmmmmmmmmm m mmmmm mmm m mmmmmmmmm~mmmmmm .mmNmmmm m mmmmmmm m mmmmmmmmmm mmmmmmmmmmm mmmmmmmmmmmmmmmm Nm N mm m m m mN m REV-X548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOHANCE OR DZSALLOHANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 12-15-Z00~ ESTATE OF HERTZLER HAROLD DATE OF DEATH 12-28-2002 COUNTY CUMBERLAND FILE NO. 21 0q-0276 S.S/D.C. NO. ZOq-50-68qZ ACN OqllO61q TAX RETURN WAS: eX) ACCEPTED AS FILED ¢ ) CHANGED dOXNT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: HAYPOINT BANK ACCOUNT NO. 100258955 TYPE OF ACCOUNT: C ) SAVINGS (~ CHECKING ( ) TRUST ¢ ) TIME CERTIFICATE DATE ESTABLISHED 01-01-1960 Account Balance Percent Taxable X 0.500 Amount Subject to Tax 250.00 Debts and Deductions - .00 Taxable Amount 250.00 Tax Rate X .q5 Tax Due 11.25 TAX CREDTTS: 500.00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE HITH YOUR TAX PAYMENT TO THE REGISTER OF HILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: '*REGISTER OF HILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID Oq-OG-2OOq CD005776 .26- 57.50 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( TF TOTAL DUE TS LESS THAN $1, NO PAYMENT IS REQUIRED. TF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THTS FORM FOR INSTRUCTIONS. ) 57.Iq 25.99CR .00 25.99CR PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 21q0 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (TI P.S. Section 91qO). Detach the top portion of this Notice and submit mith your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available online at Nwa.revenue.stats.Da.us, any Register eT Wills or Revenue District Office, or from the Department's Iq-hour answering service for fores orders: 1-800-SSI-Z050; services for taxpayers eith special hearing and/or speaking needs: 1-800-qq7-30ZO (TT Any party in interest not satisfied eith the appraisaent, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice amy object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at ~we.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals wsbsita. You may also send a ~ritten protest to PA Department of Revenue, Board of Appeals P.O. Box Z81021, Harrisburg, PA 17IlS-lOll. Petitions may not be foxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) 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 Reviae Unit, P.O. Box Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-650S. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid eithin three (3) calendar months after the decedent's death, a five percent (SI) 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 tiaa period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning ~ith first day of delinquency, or nine (9) months and Dna (1) day free the date of death, to the date of payment. Taxes ehich became delinquent before January 1, 198Z bear interest st the rate of six (6Z) percent per annum caLculated at a daily rate of .00016q. All taxes which became delinquent on or after January 1, 198Z alii bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198"~ 20Z .O00Sq8 1988-1991 llZ .O003Ol ZOOX 9Z .O00Zq7 1983 16Z .000~38 X99Z 9Z .O00Zq7 ZOOZ 6Z .00016q 198q llZ .000301 1995-199q 7Z .00019Z 2003 5Z .0001~7 1985 13Z .000556 1995-1998 9Z .OOOZq7 ZO0~ qZ .000110 1986 lOZ .O00Z7q 1999 72 .00019Z 1987 92 .O00Z~7 ZOO0 8Z .000219 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NURBER OF DAYS DELINQUENT X DAILY INTEREST 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 sheen on the Notice, additional interest must be calculated. BUREAU OF TNDTVZDUAL TAXES INHERITANCE TAX nIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 COHHONNEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT REV-160? EX AFP (09-0~) ALICE L HERTZLER 11 STONE HEAD RD DILLSBURG PA 17019-208q DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN 11-08-200q HERTZLER HAROLD 12-28-2002 CUH~ERLAN~ 0~i:b6290 HAKE CHECK PAYABLE AND REHTT PAYNENT TO: REGISTER OF HILLS ::~;~ CUHBERLAND CO COURT ~flOUSE CARLISLE, PA 17013 NOTE: To insure proper credi~c ~co your account, submi~ ~he upper portion of ~his fore wi~h your ~ax paymen~c. CUT ALONG THIS LINE ~ RETA'rN LONER PORT'rON FOR YOUR RECORDS ~ ESTATE OF HERTZLER HAROLD F'rLE NO. 21 0~-0276 ACN 0~106290 DATE 11-08-200~ THTS STATEHENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NANED ESTATE. SHO#N BELON TS A SUNNARY OF THE pRTNCZPAL TAX DUE, APpLTCATTON OF ALL PAYNENTS, THE CURRENT BALANCE, AND, TF APPL/CABLE, A PROJECTED TNTEREST FTGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 10-ZO-ZOOq PRINCIPAL TAX DUE: .................................................................................... PAYHENTS (TAX CREDITS): 213.58 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-20-ZOOq 09-17-200q CD005706 CDOOqqOq .00 q.65- 215.58 q16.$1 ZF PA~D AFTER TH/S DATE, SEE REVERSE S/DE FOR CALCULAT/ON OF ADDZT/ONAL /NTEREST. ( ZF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQU/RED. IF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR), TOTAL TAX CREDIT 625.26 BALANCE OF TAX DUE q11.68CR ZNTEREST AND PEN. .00 TOTAL DUE qll.68CR YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORM FOR ZNSTRUCTTONS. ) PAYNENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RE$1DENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMNONNEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, mhich mas not requested on the Tax Return, may be requested by completing an 'Application for Refund of Pennsylvania Inheritance end Estate Tax" (REV-1313). Applications ara available online at aaa.revenue.state.pm.us, any Register of Nills or Revenue District Office, or from the Department's Zq-hour ensnaring service for forms orders: 1-800-36Z-ZOS0; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3010 (TT only3. REPLY TO: DISCOUNT: PENALTY: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, P.O. Box ZB0601, Harrisburg, PA 17118-0601) phone (717) 787-6505. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the tats1 of the tax and interest assessed~ and not paid before January 18, 1996, the first day after the and of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 1981 bear interest at the rate of six ¢62) percent per annum calculated at a daily rate of .00016q. All taxes which became delinquent on and after January 1, 1981 wilI bear interest at a rate which wiII vary from caIendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19az through 1004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1981 ZOZ .OOOSq8 1988-1991 11X .000301 ZOO1 91 .O00Zq7 1983 16Z ,000fi38 1991 9Z .000Z47 2002 62 .O0016fi 1984 112 .000301 1993-199~ 7X .O0019Z 2003 5Z .000137 1955 132 .000356 1995-1996 9Z .OOOZq7 2004 q2 .000110 1986 102 ,000274 1999 72 .000192 1987 9Z .000147 ZOOO 82 .000119 --Interest is calculated as follo~s: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINI~UENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill 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 Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVAN'rA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAX~F~ ~FE~,"E C~ ZNHERZTANCE TAX ~NHER[TANCE TAX DZVZS~ON :-[~0*~''''h ~ .... '~"l ATEHENT OF ACCOUNT po sox z~o6oz HARRISBURC~ PA 17128-0601 REV-160? EX AFP (09-04) DEC 29 AHg:13 CLERK OF ORPHAN'S COURT 11 STONEHEAD RD DILLSBURG PA 17019-971~ DATE 1Z-20-200~ ESTATE OF HERTZLER DATE OF DEATH 12-28-2002 FILE NUMBER 21 0~-0276 COUNTY CUHBERLAND ACN 0~11061~ I Aeoun~ Remi~ed HAROLD HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, sub. i~ ~:he upper por~:ion of :~his form .i~h your ~cax payment. CUT ALONG THIS L'rNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ESTATE OF HERTZLER HAROLD FILE NO. Z1 OR-OZ76 ACN 0~11061~ DATE 12-20-Z00~ THIS STATEHENT 'rs PROV'rDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOtfN BELON 'rS A SUHNARY OF THE PRINCIPAL TAX DUE, APPL'rCAT'rON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 12-15-200~ PRINCIPAL TAX DUE= ........................................................................ PAYHENTS (TAX CREDITS): 11.25 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-)' AMOUNT PAID 0~-06-Z00~ CD005776 .26- 11.51 'rF PA'rD AFTER TH'rS DATE, SEE REVERSE S'rDE FOR CALCULATION OF ADD'rT'rONAL 'rNTEREST. ( 'rF TOTAL DUE 'rS LESS THAN $1, NO PAYHENT IS REgU'rRED. 'rF TOTAL DUE 'rS REFLECTED AS A 'CRED'rT' (CR), TOTAL TAX CRED'rT 11.25 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE S'rDE OF TH'rS FORM FOR 'rNSTRUCT'rONS. ) COHMONtiEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL T~nr~.~ !,'~m*'-~r- f%~ INHERITANCE TAX INHERITANCE TAX DIVISION ~l~l~,; ~,..,;~'~i~V~ ~-e~A~e~ae~m~ OF ACCOUNT PO BOX 280601 ~/H/CflC~/ HARRISBURG~ PA 171Z~-0601 L.~_i; ,~h REV-160? EX AFP DEC 29 AH 9:!3 CLERK OF ORPHAN'S COURT ALICE L ~HE~bE~!,~,, ~ ~,;~, p~ D[LLS~URG PA 17019-208q DATE 12-20-200~ ESTATE OF HERTZLER DATE OF DEATH 12-28-Z002 FILE NUHBER 21 0~-0276 COUNTY CUMBERLAND ACN 0~106290 Amoun'l: Remi'lci:ed HAROLD HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit: ~o your account, submi* ~he upper pore/on of ~chis form ~ith your ~ex payment. CUT ALONG THZS LZNE I1~ RETAZN LOWER PORTION FOR YOUR RECORDS ~ ESTATE OF HERTZLER HAROLD FILE ND. Z1 0q-0276 ACN 0q106290 DATE 1Z-Z0-200q TH/S STATEMENT 1S PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHOIfN BELO# ZSA SUMMARY OF THE PRINCIPAL TAX DUE, APPLZCATTON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLTCABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-Z0-Z00~ PRINCIPAL TAX DUE:. PAYMENTS (TAX CREDITS): Z15.58 PAYMENT DATE 05-20-200fi 09-17-Z00fi RECEIPT NUMBER ~'"'~'CD005706 CDOOqqOq DISCOUNT (+) INTEREST/PEN PAID C-) .00 q.65- AMOUNT PAID 215.58 q.65 ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL /NTEREST. ( ZF TOTAL DUE IS LESS THAN $1~ NO PAYMENT 1S REQUIRED. ZF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 213.58 .00 · ALANCE OF TAX DUE INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) COMHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUALT~0fi~S ~.~ ~rr~,~r ZNHERZTANCE TAX TNHER'rTANCE TAX DTVTSI'ON [~Lr~ U;i'--!L~'~ O~ STATEHENT OF ACCOUNT PO BOX Z80601 RE¥-Z&g? EX AFP (09-04) DEC 29 AH 9:13 CLERK OF , ~ it COURT STONE H DILLSBURG PA 17019 DATE 1Z-ZO-2OOq ESTATE OF HERTZLER DATE OF DEATH 12-28-2002 FILE NUMBER 210q-OZ76 COUNTY CUMBERLAND ACN 0q106289 Amoun~ Remi~ed HAROLD HAKE CHECK PAYABLE AND RENZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To ~nsure proper credi~ ~o your account, submi~c ~che upper portion of ~his fore w~th your ~ax payeen~. CUT ALONG TH'rS L'rNE I~ RETA'rN LONER PORTZON FOR YOUR RECORDS ~ ESTATE OF HERTZLER HAROLD FZLE NO. 21 0q-0276 ACN 0q106289 DATE 12-20-200q THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHONN BELON TS A SUMMARY OF THE PRINCIPAL TAX DUE, APpLTCATTON OF ALL PAYMENTS,, THE CURRENT BALANCE, AND., IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-0~-200q PRINCIPAL TAX DUE: ............................................................................ PAYMENTS CTAX CREDITS): 333.72 PAYMENT OATE 03-20-Z00q Oq-O6-200q RECEIPT NUMBER "~' CD003707 CD003776 DISCOUNT (+) INTEREST/PEN PAID (-) .00 7.23- AMOUNT PAID 333.72 7.23 ZF PAID AFTER THIS DATE, SEE REVERSE SZDE FOR CALCULATION OF ADDITIONAL ZNTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 333.72 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORM FOR INSTRUCTIONS. ) COHNONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF TNDTVTDUAL T~(~[¥~ ~T~-~,~_ (~m ZNHERZTANCE TAX ZN,£,ZTA,C£ TAX ,ZVZS~O, ~-~J~ ~..L~L~ ~*F~ ~STATENENT OF ACCOUNT PO BOX Z80601 HARRISBURG, PA 17128-0601 ~ '~,'- ~ OO OEC 29 AH 9:13 CLERK OF ORPHAN'S COURT 11 STONEHEAD RD DILLS]tURG PA 17019-9714 DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN 12-20-2004 HERTZLER 12-28-2002 21 04-0276 CUNBERLAND 04110615 Amoun'l: Rem1 t'l:ed REV-I607 EX AFp (09-Od) HAROLD HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUH]IERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submit: ~he upper por~Aon of ~:his form wi~:h your ~ax payment. CUT ALONG TH'rS L'rNE ~ RETA*rN LONER PORTION FOR YOUR RECORDS -~1 ESTATE OF HERTZLER HAROLD FILE NO. 21 04-0276 ACN 04110615 DATE 12-20-2004 THIS STATENENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHOWN BELO# ZSA SUNHARY OF THE PRZNCZPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 11-16-2004 PRINCIPAL TAX DUE:. PAYHENTS (TAX CREDITS): 1,098.12 PAYHENT DATE 04-06-2004 04-06-2004 09-17-Z004 1Z-14-ZO04 RECEIPT NUHBER ~CD005777 CD005776 CD004404 REFUND ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATZON OF ADDITIONAL ZNTEREST. [ ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" DISCOUNT (+) INTEREST/PEN PAID (-) 25.86- .00 .00 .00 AHOUNT PAID 3,660.40 18.76 411.68 Z,966.86- TOTAL TAX CREDIT 1,098.12 .00 BALANCE OF TAX DUI ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR TNSTRUCTZONS. ) BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTVTSTON DEPT. Z80601 HARRISBURG, PA 171Z&-060! COMHONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX RECORD ADJUSTHENT JOINTLY HELD OR TRUST ASSETS ALICE L HERT R 11STONEHEAD RD DILLSBURG PA 17019-9714 REV-lOOli EX AFP COl-OS) DATE 11-17-2004 ESTATE OF HERTZLER HAROLD DATE OF DEATH 12-28-2002 FILE NUMBER 21 04-0276 COUNTY CUMBERLAND SSN/DC 204-$0-6842 ACN 04110615 Amoun~ Rem/~ed HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOHER PORTION FOR YOUR RECORDS ~ REV-1604 EX AFP (01'03) ~ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE 11-17-2004 ESTATE OF HERTZLER HAROLD DATE OF DEATH 12-28-Z002 COUNTY CUMBERLAND FILE NO. 21 04-0276 S.S/D.C. NO. 204-50-6842 ACH 04110615 ADJUSTMENT BASED ON: ADHINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: HAYPOINT BANK ACCOUNT NO. 7100024267 TYPE OF ACCOUNT: ( ) SAVZNGS ( ) CHECKING ( ) TRUST (X) TINE CERTIFICATE DATE ESTABLISHED 01-01-1960 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deduct/ons Taxable Amount Tax Rate X. Tax Due TAX CREDITS: 48,805.47 NOTE: 0.500 24,402.74 .00 24,402.74 .45 1,098.12 TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHZT THE UPPER PORTION OF THIS NOTICE HZTH YOUR TAX PAYHENT TO THE REGISTER OF HILLS AT THE ADDRESS SHOHN ABOVE. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF HILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AHOUNT PAID 04-06-2004 CD005777 25.86- 5,660.40 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE ZF PA/D AFTER THIS DATE, SEE REVERSE FOR CALCULATTON OF ADD/TZONAL TNTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR)., YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THTS FORM FOR ZNSTRUCTTONS.) 5,654.54 2,556.42CR .00 2,556.42CR REV-1470 EX (8-88) COMMONWEALTH OF PENNSYLVANIA EXPLANATION DEPARTMENT OF REVENUE BU.~U OF ~.D*WOU^L TAXES OF CHANGES PO Box 280601 HARRISBURG, PA 17128-0601 DECEDEN'FS NAME HAROLD L HERTZLER FILE NUMBER REVIEWED BY 2104~9276 Department of Revenue/Robin Graft ACN 04110615 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Accounts established within one (1) year prior to death are fully taxable at 100 percent. Changed tax rate from 15 percent to 4.5 percent since a daughter is a lineal beneficiary. ROW Page 1