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HomeMy WebLinkAbout04-0344 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: WASHBURN LEO E 917 APPLE DRIVE MECHANICSBURG, PA 17055 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 003797 ........ fold ESTATE INFORMATION: ~ SSN: 193-28-4784 FILE NUMBER: 2 104- 0344 DECEDENT NAME: WASHBURN THELMA M - DATE OF PAYMENT: 04/12/2004 POSTMARK DATE: 00/00/0000 ---- COUNTY: CUMBERLAND -~ DATE OF DEATH: 01/13/2004 REMARKS: ACN ASSESSMENT CONTROL NUMBER AMOUNT TOTAL AMOUNT PAID: 101 I $1,042.24 I I I $1,042.24 SEAL CHECK//5979 INITIALS: dA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS JOHN E. SLIKE ROBERT C. SAIDIS GEOFFREY S. SHUFF JAMES D. FLOWER, JR. CAROL J. LINDSAY MATTHEW J. ESHELMAN KIRK S. SOHONAGE THOMAS E. FLOWER LINDSAY GINGRICH MACLAY JACLYN SMITH LAW OFFICES SAIDIS, SHUFF, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET CAMP HILL, PENNSYLVANIA 17~ TELEPHONE: (717) 737-3405- FACSIMILE: (71~9~¢2~7 EMAIL: attomey@ssfl-law.com '04 '12 .. ': i: OF COUNSEL 'i :: ALBERT H. MASLAND April9,2004 CARLISLE OFFICE: ~2']~WEST HIGH STREET "*CARLISLE, PA 17013 TELEPHONE: (717)243-6222 FACSIMILE: (717)243-6486 REPLY TO CAMP HILL Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Re: The Estate of Thelma M. Washburn Dear Ladies: Enclosed please find a check representing payment on account of Inheritance Taxes due with regard to the above estate. A return for joint assets only will be filed. Therefore, the estate has not been probated. Also enclosed is an Estate Information Sheet so that a file number may be assigned. Please issue a receipt for payment at your earliest convenience. Very truly yours, SMD-IS, SHUFF, FLOWER & LINDSAY /Sllelby L. ~:gl/ g, Estate earalegal /sly Enclosures cc: Leo Washburn 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 003862 WASHBURN LEO E 917 APPLE DRIVE MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 193-28-4784 FILE NUMBER: 2104-0344 DECEDENT NAME: WASHBURN THELMA M DATE OF PAYMENT: 04/23/2004 POSTMARK DATE: 04/23/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/13/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $2.89 REMARKS: TOTAL AMOUNT PAID' $2.89 SEAL CHECK# 5982 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS SAIDIS SHUFF, FLOWER & LINDSAY ATTORNEYS -AT-LAW 2109 Market Street Camp Hill, PA 17011 TO: REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE CARLISLE PA 17013 REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY COUNTY CODE YI~AR NUMBER D E C E D E N T cAPB HpRL EpIO CRAC roTK " ES cg R E C A P I T U L A T I O N C O M T I 0 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Washburn Thelma M.~ 193-28-4784 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS ~ Mus'r BE ri. ED IN ~ OIE/~B~/~)04 08/06/1911 REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER : 1. Original Return 2. Supplemental Return ~1 3, Remainder Return (p%a 4. Limited Estate 4a. ~ r~z~ S. f ~Et Compromise (date of death after 12-12- 2)8~.~ Federal Estate Tax Return 8. Decedent Died Testate __ 7. Beqeb'~lt Maintained a Living Trust 8. Total Number of Safe Depo (Attach copy of Will) (~=~.~=upy of Trust) [~]9. Litigation Proceeds Received r---110. Spousal Poverly Credit I~1 11. Election to tax under Ses. 9 ~8{~)f death between 12-31-91 and 1-1-95) (Attach Sch O) NAME Robert C. Saidis FIRM NAME (If Applicable) Saidis, Shuff, Flower & Lindsay TELEPHONE NUMBER 717/737- 3405 COMPLETE MAILING ADDRESS 2109 Market Street Camp Hill, PA 17011 1Real Estate (Schedule A) (1) 2Stocks and Bonds (Schedule B) (2) 3Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4Mortgages & Notes Receivable (Schedule D) (4) 5Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 8Jointly Owned Property (Schedule F) (6) [~eparate Billing Requested 7Jnter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8.Total Gross Assets (total Lines 1-7) 9Funeral Expenses & Administrative Costs (Schedule H) (9) l(13ebts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11Total Deductions (total Lines 9 & 10) l~et Value of Estate (Line 8 minus Line 11) None None 32,482.40 l~6ne 7,689.60 348.80 13Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) l~et Value Subject to Tax (Line 12 minus Line 13) OFFICIAL USE ONLY 'T_~ (8) 32,482.40 (11) 8,038.40 (12) 24,444. O0 (13) (14) 24,444. O0 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 150,mount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) X 160,mount of Line 14 taxable at lineal rate 24,444.00 X 17Amount of Line 14 taxable at sibling rate X 180,mount of Line 14 taxable at collateral rate X 191'ax Due .12 .15 .0 0 .0 45 (15) 0.00 (16) 1,099.98 (17) 0.00 (18) 0.00 (19) 1,099.98 ~l~J~ Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 917 Apple Drive CITY Mechanicsbur~ STATE IPA ZIP 17050 Tax Payments and Credits: 1.1'ax Due (Page 1 Line 19) ZCredits/Payments A. Spousal Poverty Credit B. Prior Payments Co Discount 1,042.24 54.85 (1) 1,099.98 Total Credits ( A + B + C ) (z) 1,097.09 3Jnterest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 0.00 4~f Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT, Check box on Page 1 Line 20 to request a refund (4) O. O0 5Jf Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2.89 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (5B) 2.89 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1Did decedent make a transfer and: Yes No ;. retain the use or income of the property transferred; ......................... ~ ~ · retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or .................................... d. receive the promise for life of either payments, benefits or care? ................... ~if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ [~ ~ 3Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. r~ ~] 4Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ r-~ ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and bdief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Le O E . Washburn -- ~ 917 Apple Drive SIGNATUREOFPREPARER~AN~PRESENTATIVE. ~ Saidis, Shuff, Flower & Lindsay ~~ 2109 Market Street ./ -- ;- ............................. . For dates of death on or a~er July 1, 1~4 and before Janua~ 1, 1995, the ~ rate im~s~ on the net value of transfers to or for the use of the su~iving spuse is 3% ~2 P.S. 9116 (a) (1.1) (i)]. For dates of death on or a~er Janua~ 1, 1~5, the ~ rate impsd on the net value of transfers to or for the use of ~e sullying spuse is 0% [72 P.S. 9116 (a) {1.1) (ii)]. ~e s~tute does not exempt a transfer to a su~iving s~use from t~, and the statuto~ r~uirements for disclosure of assets and filing a ~x return are still applicable even if the sullying s~use is the only beneficial. For dates of death on or aEer July 1, 2000: ~e ~x rate impsd on the net value of transfers from a d~eased child ~en~-one years of age or younger at dea~ 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 impsd on the net value of transfers to or for the use of the d~edent's lineal beneficiaries is 4.5%, except as notd in 72 P.S. 9116(1.2) [72 P.S. 9116(a)0)]. The tax rate im~s~ on the net value of transfers to or for ~e use of the d~ent's siblings is 12% [72 P.S. 911~(a)(1.3)]. A sibling is define, under S~tion 9102, as an individual who has at least one parent in common with the dec~ent, whether by blood or adoption. Copy~ght (c) 2000 fo~ so.are only The Lackner Group, Inc. Fo~ ~EV- ~ ~ ~X (Rev. 6-00) REV-1509 EX + (1-97) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thelma M. Washburn SS~/ 193-28-4784 01/13/2004 If an asset was made joint within one year of the decedent's date of death, R must be reported on Schedule G. FILE NUMBER SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Leo E. Washburn son Bo C° 917 Apple Drive Mechanicsburg,PA 17050 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOIN3 MADE Include name ~ financi~ in~itution and b~l DATE OF DEATH DECD'S VALUE OF account number or similar identi~ing numbe~ NUMBER TENANT JOINT A~achde~forjointl~held malestme. VALUE OF ASSET INTEREST DECEDENTS INTERE~ 1 A 11/06/98 Investment acct. with American Express Financial Advisors, consisting of: 7350.564 sh. mutual fund at 4.90 per share 36,044.45 50.00% 18,022.22 16631.57 Market Strategy Investment acct. at 1.00 16,631.57 50.00% 8,315.79 cash account 0.16 50.00% 0.08 2 A 08/01/99 AmeriChoice FCU, share act. 1,571.46 50.00% 785.73 07/01/02 AmeriChoice FCU,draft acct. 10,589.38 50.00% 5,294.69 08/01/99 AmeriChoice FCU, chk. act. 127.77 50.00% 63.89 TOTAL(Alsoenteronline6, R~apitulmion) $ 32,482.40 ~T (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) · REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thelma M. Washburn SS~/ SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 193-28-4784 01/13/2004 FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. Bo 5. 6. 7. :UNERALEXPENSES: Hennessey's Funeral Home flowers Funeral meal, Thompson Methodist Church Rev. Kenneth Bitler Susquehanna Monuments ~,DMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: A~orney's Fees Saidis, Shuff, Flower & Lindsay Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Filing fee for tax return TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. AMOUNT 6,455.00 169.60 400.00 75.00 75.00 500.00 15.00 $ 7,689.60 Form REV-1511 EX (Rev. 1-97) REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thelma M. Washburn SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SS# 193-28-4784 01/13/2004 FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 Dr. Hartzell Hospital telephone charges United Health Services, Inc., medical costs TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) 27.00 21.80 300.00 $ 348.80 Copyright (c) 1996 form software only CPSystems, Inc, Form REV-1512 EX (Rev. 1-97) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thelma M. Washburn SS# NUMBER I1. SCHEDULE J BENEFICIARIES 193-28-4784 01/13/2004 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY [AXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfem under Sec. 9116(a)(1,2)] Leo E. Washburn 917 Apple Dr. Mechanicsburg, PA 17050 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) S on FILE NUMBER AMOUNT OR SHARE OF ESTATE jr. owner of investment act. ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 181 AS APPROPRIATE1 ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0 . 00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV- 1513 EX (Rev. 9-00) 15:]7 71744!4808 /~H~CF'}C;~N -w'- ) cc : ,~, Brendan M De~aney 031021'2004 10 11 AM Subject' David R I yon/Fi~tdAAtHIAEFA~AM[X PLEASF READ L)O NO] DELETE - DAT[ O~- DEATH VALUES FOR -'IHELMA WASHBURN 17992514 a 001 IDS LIFE INSURANC[ COMPANY AMERICAN FXPRF:SS FUNDS AMERICAN EXPRESS CERTIFICATE COMPANY AMERICAN EXPRESS BROKERAGE 7'0100 AXP Financial Center Minneapolis, MN 615474 March 2. 2004 DAVID RAYMOND LYON S'IE 201 5006 E TRINDLE RI) MECHANICSBIJRG. PA I'~050-365 Dear DAVID RAYMOND L. YON: Thank you for yom- recent inquiry, regarding THELMA M WASHBURN's account.q, These are the values of the accounts as of 01/13f2004 .... ,,--' ;~ .......... Mutual Funds Account Number Total Value 02 t 38062944 0 0O2 $0 16 0.160 02248062944 7 00~ $36044.45 7350564 Certificates Asset Value Per Shar¢~ ~ ~ }/5 ~ ~ ~6301~35706 7 00~ $1~3~ ,~? // ~ ~ Thc chic of death values provided are Ib~ estate tax pmposc.q and am nol a va/ua to be paid. Accmmts may be subject lO ma~kei fluctuation as governed by c. cl~ product, ['least: note lhat thc values indicaled for any Life Insurance pmducl(s) rct'lcct fhe gloss death benefit al dale ufdeath, noi lhe cash value We aplm:c~atc the opporlnnity Iobc of service to vms Brcnd,'m Dclancy Death Scttlemenls Processing Teton '10100 AXP Financial Ccnte~ Please c~nlacl ns if you have any questions. 04,,'14/2004 Building Relat,;onships For Life April 8, 2004 Saidis, $1mft; Flower & I.indsay 2109 Market Camp ttfll, PA 1701 Allcntion: Shelby 1,. Ymgling RI':' t':statc of Thclma M W;lshbun~ Account ~31115 The accounts are as fidlo~s: Aeeolmt Type Date Opened DOD Balance Dividend thru Apr~ 2004 gavii~gs01 08 1999 $ 1,571.46 $ 2.19 Savings 02 07-2002 $10,589.38 $ 16.98 Checking 13 08 1990 $ 127.77 $ 0.00 The above accounts arc all ]oint w~th l.e.o Washbt',rli. The deceased, does no~ have a safe deposit box or any loans wifl~ the As of ApriI t, 2004, thc above referenced accounh; }mvc been closed. Please call me at (717) 591- 1275 if you need fiuther assistance. Sincerely, ( Beth M. Yowlers } toad Tdlm JOHN E. SLIKE ROBERT C. SAIDIS GEOFFREY S. SHUFF JAMES D. FLOWER, JR. CAROL J. LINDSAY MATTHEW J. ESHELMAN KIRK S. SOHONAGE THOMAS E. FLOWER LINDSAY GINGRICH MACLAY JACLYN SMITH LAW OFFICES SAIDIS, SHUFF, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 TELEPHONE: (717) 737-3405 - FACSIMILE: (717) 737-3407 EMAIL: attomey@ssfl-law.com April 22, 2004 OF COUNSEL ALBERT H. MASLAND CARLISLE OFFICE: 26 WEST HIGH STREET CARLISLE, PA 17013 TELEPHONE: (717)243-6222 FACSIMILE: (717)243-6486 REPLY TO CAMP HILL Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Re: The Estate of Thelma M. Washburn SS #193-28-4784 Date of Death: January 13, 2004 Dear Ladies: Enclosed please find an original and two copies of an inheritance tax return for the above estate, along with a check for the filing fee and for the balance of taxes due. A prior payment was made on account of taxes and an Estate Information Sheet was provided at that time. Therefore, a file number should have been assigned to this estate. Please return a time-stamped copy of the return in the envelope provided. Very truly yours, SAIDItS, SHUFF, FLOWER & LINDSAY Shelby L. (fin ing, Estate Paralegal /sly Enclosures BUREAU OF TNDTVTDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOT/CE OF /NHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCT/OHS AND ASSESSHENT OF TAX REV-154? EX AFP [gl-0S) ROBERT C SAIDIS SAIDIS ETAL 2109 MARKET ST CAHP HILL PA 17011 DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN 06-1q-ZOOq NASHBURN 01-15-200q 21 O~-03~q CUMBERLAND 101 Amouni Rem'i ~iad THELHA M HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF MILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS *-~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF NASHBURN THELHA HFZLE NO. 21 O~-O$~q ACN 101 DATE 06-1~-200~ TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. CZosely HeZd Stock/Partnership Interest (Schedule C) (3) q. Mortgages/Notes Receivable (Schedule D) (q) $. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7), 8. Total Assets O0 O0 O0 O0 O0 $2/~8Z ~0 O0 (8) NOTE: To insure proper credit to your account, subm/t ~ha upper port/on of th/s form w/ih your ~ax payment. i2,R8Z.~O APPROVED DEDUCTIONS AND EXEHPTZONS: 7,689.60 9. Funeral Expenses/Adm. Costs/Nisc. Expenses (Schedule H) (9) 10. Debts/Nortgage Liabilities/Liens (Schedule Z) (10) ~q8.80 11. Total Deductions (11) 12. Net Value of Tax Return (12) 13. Char/table/governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) lq. Nmi Value of Es~a~e Subject to Tax (1~) Z~,~.O0 .00 ZR,~q~.O0 NOTE: Z~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Aeouni of L/ne lq at Spousal rate (15) 16. Amouni of L/ne 1~ taxable at Lineal/Class A ra~a (16) 17. Amount of L/ne 1~ at Sibl/ng rate (17) 18. Amount of L/ne lq taxable at Collaleral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: PAYH~NT R~C~IPT DATE NUMBER Oq-12-ZOOq CD00~797 0~-25-200~ CD00~62 t DTSCOUNT (+J INTEREST/PEN pA'rD (-) 5q.85 · ~.-?";~' ':' O0 · O0 x O0 = . O0 2q,qqq. O0 x OqS= 1,099.98 . O0 x 1Z = .00 .00 x 15 = . O0 (19)= 1,099.98 AHOUNT PAID 1,0qZ.Zq 2.89 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 1,099.98 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A -CRED'rT' (CR), YOU NAY BE D~I~__-~, A REFUND. SEE REVERSE STDE OF TH/S FOR. FOR TNSTRUCT/ONS.),,~ ' RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decadents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for life or for years, the Coaaoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laafol Class B (collatmral) rate on any such future interest. To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (TZ P.S. Section 91~0). Detach the top portion of this Notice and submit aith your payment to the Register of Mills printed an the reverse side. --Hake check or money order payable to: REGISTER OF NILLS, AGENT A refund of a tax credit, ahich was not requested on the Tax Return, amy be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS15). Applications are available at the Office of the Register of Wills, any of the Z$ Revenue District Offices, or by calling the special Z4-haur answering service for forms ordering: 1-BOO-56Z-ZOSO; services for taxpayers eith special hearing and / or speaking needs: 1-800-447-$0Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disalloeanca 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. Z810Z1, Harrisburg, PA 171ZB-10Z1, 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 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. Sea 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 (S) calendar months after the dacedant's death, a five percent (BX) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquencY, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (SI) percent par annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after January 1, 1982 mill bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. Tho applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .000548 ~)~'8-1991 llZ .000501 ~ 9Z .OOOZq7 1985 16Z .000458 199Z 9X .000Z47 ZOOZ 6Z .00016~ 1984 llZ .OO05Ol 1995-1994 7Z .000192 2005 5Z .000157 1985 15Z .000556 1995-1998 9Z .000247 2004 CZ .000110 1986 IOZ .000274 1999 7Z .00019Z 1987 IOZ .000274 ZOO0 7Z .00019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUIIBER 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.