HomeMy WebLinkAbout02-0086~0 EX * (6.00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER21 02 ~?MB~R~
COUNTY CODE YEAR
l ~CEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
I REFFNER, KENNETH H.
~D,~[TE~)~EATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
06/21/2001 [11/17/1911
i~F-~,~-C~URVIVING SPOUSE'S NAME (LA~,, ~ ~L)
SOCIAL SECURITY NUMBER
179-05-6631
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[] 1. Original Return [] 2. Supplemental Retum [] 3. Remainder Return (date of death pdor to 12-13-82)
uJ
~ .~ [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death
after 12-12-82) [] 5. Federal Estate Tax Return Required
-,-E.o ~, [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes
a.aa of Will) copy of Trust) --
< ! [] 9. Litigation Proceeds Received I-I 10. Spousal Poverty Credit (date of death between [] 11.Election to tax under Sec. 9113(A) (Attach Sch O)
~' 12-31-91 and 1-1-95)
l .... ..... ~:::::~::':''::*:ti'~ ~" : ~ I ~*~ ~ ~,! ~;
NAME COMPLETE MAILING ADDRESS
Ivo V. Otto, III, Esquire
~, Martson Deardorff Williams & Otto
~-ELEPHONE NUMBER
717/243-3341
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
I-I Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
10 East High Street
Carlisle, PA 17013
Nor~e
No~,e.
11,209.7,$~,
Non~
None
7,661.99
53,108.14
(8)
11,209.75
60,770.13
insolvent
(11)
(12)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not
been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
x .00 (15)
z
o 16. Amount of Line 14 taxable at lineal rate x .045 (16)
~ 17. Amount of Line 14 taxable at sibling rate x .12 (17)
O
~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due
(19)
20. D ............
Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
ISTREET ADDRESS 1000 West South Street
CITY Carlisle
STATE PA iZlP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page I Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
III¸
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
0.00
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ............................... : ............................................. [] []
b. retain the right to designate who shall use the property transferred or its income; ................................ [] []
c. retain a reversionary interest; or ............................................................................................................ [] []
d. receive the promise for life of either payments, benefits or care? .......................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ................................................................................................................ [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ...... [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE
0.00
0.00
0.00
IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, 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
SIGNATURE OF PERSO~ESPONSIBLE
R~ REPRESENTATIVE
ADDRESS
ADDRESS
ADDRESS
One Wexford Court
Carlisle, PA 17013
102 South Ridge Road
Boiling Springs, PA 17007
DATE
DATE
10 East Hi[h Street /~/d
Carlisle, PA 17013 /
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116
1.2) [72 P.S. §9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
REFINER, KENNETH H. 21 - 02 -
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
2
3
4
5
DESCRIPTION
M&T Bank, Checking Account #2674023342
Orrstown Bank, burial account
Conseco Senior Health Insurance Co., refund of premium
Social Security Administration, benefit correction
PSERS, June pension
VALUE AT DATE
OF DEATH
3,165.46
7,516.97
351.92
19.00
156.40
TOTAL (Also enter on Line 5, Recapitulation) 11,209.75
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
REFFNER, KENNETH H.
SCtF=IXJLE H
RJNERAL EXPENSES &
~TNE COSTS
FILE NUMBER
21 - 02 -
Debts of decedent must be reported on Schedule I.
ITEM
DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
Ronan Funeral Home, Carlisle, PA
Carlisle Memorial Service, Carlisle
Luncheon, Memorial Service
Flowers, funeral service
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Sarah J. Otto Patricia Derr
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address One Wexford Court
City Carlisle State PA Zip 17013
Year(s) Commission paid
Attorney's Fees Martson Deardorff Williams & Otto (estimated)
Family Exemption: (If decedenrs 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
Register of Wills, filing fee, inheritance tax return
6,112.00
95.00
175.00
149.99
560.00
560.00
10.00
TOTAL (Also enter on line 9, Recapitulation) 7,661.99
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
REFFNER, KENNETH H. 21 - 02 -
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
15.79
Three Springs Family Practice, account payable
Commonwealth of Pennsylvania, Department of Public Welfare
TOTAL (Also enter on Line 10, Recapitulation)
53,092.35
53,108.14
ACCOUNT NO. ACCOUNT TYPE
267~.023'4Q2 CLASSIC CHECK [NG
O0 20q~O~M M 02!
STATEMENT PERIOD PAGE
JUN.Og-JUL.09,2001 ! OF
KENNETH H REFFNER
102 S RIDSE RD
BOIL[NO SPR$S PA 17007-970!
BOILTNG SPRING~,
ACCOUNT SUNMARY
DE~ & ] ~ ~ ] OTHER I CUERE~ I
OTHER ~D[T2~ ~ I ~ ~ CHE~S PAID ~ S~TRACT[~ ~ ~ INTEREST pD
I
~1 9~.eo I 21 7~2.o3 I o I o.oo I o.oo I
:BALANCE
4,069.$6
ACCOUNT ACTIVITY
' POSTXNG ~ DEF~)S:ZTSjZmER~T CHECKS 8 OTHER DAILY :
DATE TRANSACTTON DESCR/PTION : : g: OTHER ADDITIONS SUBTRACTTONS: BALANCE
06-09-01 BEGINNING BALANCE $$,876.49
06-14-0! CHECK HUHDER 0q14 $0.00 $~846.49
06-15-03 CHECK NUHBER 0~15 681.03
06-29-0.* PA TREASURY DEPT ANNUITANT 1~6.40 : *- 3,321.86
07-03-0] us TREASURY 303 SOC SEC -- /~=L~*~.~,~ i/t~/~ 748.00 q,069.86
ENDING BALANCE S4,069.86
413 06-1~-01 681.03 ~14 06-14-01 30.00
FULL-TIME AND PART-TINE ENPLOYNENT OPPORTUNITIES ARE AVAILABLE IN CusTONER SERVICE, SALES, AND
OPERATIOHAL AREAs OF THE DANK. FOIl INHEDT.~TE CONSIDERATION. PLEASE APPLY ON OUR WEBSITE AT
HHH.HANDTBANK.COM OR PICK-UP AN APPLICATION AT ANY LOCAL BRANCH OFFICE.
ACCOUNT NO. ACCOUNT TYPE
267~025:5~2 CLASSIC CHECKING
STATENENT PERIOD PAGE
JUL.10-AUG.09~2001 1 OF 1
oo 0 04:503H NM 017
12752
KENNETH H REFFNER
102 S RIDGE RD
BOILING SPRGS PA 17007-9701
bOILIN(; SPRINGS
ACCOUNT SUMHARY
I BEGINN:ZNG , DE~]:TS & ,
BALANCE !~ i OTHER AODIT/ONS i i CHECKSPAID | $~_~TRACTI~ ]:NTEREST PD
q,O&9.86 I 11 19.00 I O I 0.00 I 2 I q,oea.ee 0.00 I
END:]C~
: BALANCE
0.00
ACCOUNT ACTIVITY
POST:D~G : : : Fi-:-- "D~;~T-S~:]:~tTERF. ST CHECKS& OTHER : DA]:LY
DATE TRANSACTION DESCRZPTZ~ I OTHER ADDZTZ~S~ :: SUBTRACT/~: BALANCE
07-10-01 BEGZ~Z~ BALA~E $~,069.86
07-16-0] US TREA~RY 303 SOC SEC 19.00 ,/ q,088.86
07-~7-0~ REVERSE DZRECT DEPOSZT 748.00 ~,~0.86
07-2~-0~ CLOSEST ~0.86 0.00
E~Z~ BALA~E $0. O0
NEED LTFE INSURANCE COVERAGE, BUT DON'T WANT TO SPEND A FORTUNE? NgT INSURANCE SERVICES, A DIVISION OF
NgT BANK:. NATZONAL ASSOCIATION CAN HELP." #E HAVE ACCESS TO OVER A DOZEN LIFE /NSURANCE COtIPANI*ES ~
HANY DIFFERENT LIFE INSURANCE PRODUCTS TO HELP FIT YOUR NEEDS. DON'T #AZT TO PROTECT THE ONES YOU LOVE
FROfl FINANCIAL TRAGEDY. VZSZT ANY NgT BANK BRANCH OR CALL US AT 1-800-:5.60-928.6. INSURANCE PRODUCTS ~
ARE NOT FDIC-INSURED ~ HAVE RO BANK GUARANTEE ~ HAY LOSE VALUE. INSURANCE PRODUCTS ARE OBLIGATIONS OF
THE INSURANCE COHPANZES THAT ISSUE THE POLTCIES.
RONAN FUNERAL HOME
255 York Road
Carlisle, PA 17013 NO. I~
Phone (717) 258-9863
Dollars
Amount~md ~ $ [
Discount ~ ~e~ - _- ~ vA ~.efit
By
B~lanceDue ~ ~ ~ - ~Lifeln~umnce
PATRICIA DEN
102 S RIDGE RD
BOILING SPRINGS PA
17007
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
October 02, 2001
Re: KENNETH REFFN-ER
CIS #: 600148285
Co/Rec: 21/0087011
Date of Birth: 11/17/1911
SSN: 1'/9-05-6631
Dear Ms. Den:
Please be advised that the Department of Public Welfare is attempting to
recover the monetary value of any and all eligible assets in the subject
estate. Although the amount in the estate may be considerably less than that
which is owed to the Department, our claim is against the estate, no one
else. Your responsibilities, as the primary next of
kin/administrator/executor, is to advise the Department of any assets in the
estate and to insure that the remaining money, after all funeral and
administrative costs are deducted, is sent to the Department.
The Department of Public Welfare maintains a claim in the amount of
$53,092.35 against the above-mentioned estate. This claim is for restitution
of medical assistance granted on behalf of the decedent for which the Probate
Estate is now responsible to reimburse the Department according to Act 49, 62
P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June
30, 1995. Enclosed is the Department's itemized statement of claim.
A portion of this medical expense, namely $18,223.02, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $34,869.33, is
to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise when payment may be
expected. If the estate accounting is complete, please provide a copy. If
the estate contains real estate, please provide copies of the deed, the
latest tax assessment and a current appraisal, if available.
Enclosure
Sincerely,
Carol J. Zellers
TPL Program Investigator
717-772-6266
717-772-6553 FAX
LAW OFFICES
/ILLIAM F. MARt$ON, P. C.
LAST WILL AND TESTAMENT
I, KENNETH H. REFFNER, of South MiddIeton Township, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish
and declare this to be my Last Will and Testament, hereby revoking any and all former
Wills or Codicils by me made.
I.
I direct that all my just debts, funeral expenses, testamentary expenses and all
inheritance taxes shall be paid from my residuary estate as soon as practicable after
my decease and as part of the administration of my estate.
2.
After the payment of all my just debts, funeral and testamentary expenses, I
give, devise and bequeath all the rest, residue and remainder of my estate, both rea!
and personal property, unto my wife, JESSIE L. REFFNER, absolutely, and I hereby
appoint my said wife as Executrix of my estate.
3.
In the event my said wife shall predecease or fail to survive me, then I give,
devise and bequeath all of my estate, both real and personal property, in the following
manner:
a. I give to each of my grandchildren and great-grandchildren who shall be
living at the time of my death the sum of Two Thousand Dollars ($2,000.00). At the
present time this class of legatees is comprised of DENNIS OTTO, KEVIN OTTO, LISA
DERR, and DOREEN DERR, grandchildren, and ANDREW OTTO, great-grandson. I
direct that this sum shall be paid to any additional great-grandchildren who shall be
living at the time of my death, even though unascertained at this time, and that said
-1-
sums shall be paid to the parents of said legatees, to be held for the legatee, in the
event any shall be minors at the time of my death.
I further direct that in the event my death shall occur as a common disaster with
my wife, JESSIE L. REFFNER, then this legacy shall be a total of Two Thousand
Dollars ($2,000.00) including any share or legacy coming from the estate of my said
wife.
b. All the rest, residue and remainder of my estate, I give, devise and
bequeath unto my daughters, SARAH JANE OTTO and PATRICIA ANN DERR, and I
hereby appoint my said daughters as Executrices under the provisions of this paragraph
of my Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this /)~ day
,1982.
/~enfist~ffn~/...~· ~.
(SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testator,
as and for his Last Will and Testament, in the presence of us, who at his request, have
hereunto subscribed our names as witnesses thereto, in the presence of said Testator
and of each other.
-2-
LAW OFFICES
/ILL/AM F. MARTSON, p. C.
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
I, Kenneth H. Reffner, Testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I signed it
willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or af.flr ed to and a_ckn(~edged before me b Kenn~ee~H Re
~ Y . ffner,
Testator, this /7 -dav of .,.~.{f~.,~ , 198~ ~ the
~~otary'Pu~lic '
COMMONWEALTH OF PENNSYLVANIA )
COUNTY ~UMBERLAND )
the witnesses whose names ~e si~ed to the attached or foregoing instrument, being
duly qu~ified according to law, do dep~e and say that we were present and saw the
Testator sign and execute the instrument as his Last Will; that the Testator signed
willingly and that the Testator executed it as his free and volunta~ act for the
purposes therein expressed; that each of us, in the hearing and sight of the Testator,
signed the Will ~ witnesses; and that to the best of our knowledge the Testator was at
that time 18 or more years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed to and subscribed before me this /~ ~ day of
Notary Public
~D~ S. E~ENRODE ~TARY
-3-
BUREAU OF ZNDZVZDUAL TAXES
/NHERTTANCE TAX D/VIS/ON
DEPT. 180601
HARRISBURG, PA 17128-0601
ZVO V OTTO 11! ESQ
MARTSON ETAL
10 E HIGH ST
CARLISLE
CONNON#EALTH OF PENNSYLVAN'rA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT:, ALLO#ANCE OR DISALLOtfANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
F~ _ DATE ~
~, i ESTATE OF
DATE OF DEATH
FILE NUMDER
ACN
PA 1701S-118~Ul~b~
05-11-2002
REFFNER
06-21-2001
21 02-0086
CUMBERLAND
101
Amount Rami'l'tad
REV-16¢? EX AFP (01-0~)
KENNETH H
MAKE CHECK PAYABLE AND REM'rT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLTSLE, PA 17015
CUT ALONG TH'rS LINE ~ RETAIN LOWER PORTZON FOR YOUR RECORDS -~
REV-15&7 EX AFP (01-02) NOTZCE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF REFFNER KENNETH HF'rLE NO. 21 02-0086 ACN 101 DATE 03-11-2002
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVAT'rON CONCERN'rNG FUTURE TNTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Es~a~a (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) ($)
q. Mortgages/Notes Race/vable (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jo/ntly O~nad Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ada. Costs/M/sc. Expanses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)
11. Total Deduct/ons
12. Net Value of Tax Return
11/209.75
.00
.00 NOTE: To /nsura proper
.00 cred/t to your account,
.00 subalt the upper portlon
.00 of th/s fora w/th your
tax payment.
.00
(8)
7,661.99
13.
lq.
NOTE:
ASSESSMENT OF TAX:
15. Amount of L/ne Zq at Spouse1 rata
16. Amount of L/ne Zq taxable at L/heal/Class A rata
17. Amount of L/ne lq at S/bl/ng rata
18. Amount of L/ne lq taxable at Collateral/Class B rata
19. Pr/nc/pal Tax Due
tAX CREDITS:
PAYMENT RECETpT OT$COUNT I+)
DATE NUMBER INTEREST/PEN PA/D (-)
53~108. lq
(11)
(12)
Charitable/governmental Bequests; Non-a/acted 911:5 Trusts (Schedule J) (15)
Nat Value of Estate Subject to Tax (lq)
Zf an assessment was issued previously, lines la, 15 end/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
11,209.75
ZF PAID AFTER DATE ZNDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL ZNTEREST.
60.770.1~
q9,560.38-
.00
q9,560.38-
18 and 19 will
(15) .00 x O0 = .00
(16) .00 x 015: .00
(17) .00 x 12 = .00
('~8) .00 x 15 = .00
(19)= . O0
AMOUNT PAID
TOTAL TAX CREDZT
BALANCE OF TAX DUEI
ZNTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR)~ YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTZONS.)
RESERVATION:
Estates of decadents dying on or before December 1Z, 1982 -- if any futura interest in the estate is transferred
in possession or enjoyment to Class 8 (collateral) beneficiaries cf the decedent after the expiration of any estate for
life or far years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawfu! Class B (collateral) rate on any such futura interest.
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z~ of ZOO0. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side.
--Make check or money order payable to: REGISTER OF MILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, say be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-131S). Applications ara available at the Office
of the Register of Rills, any of the Z~ Revenue District Offices, or by calling the special 24-hour
answering service for fores ordering: 1-800-362-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-4q7-3020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, 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. Sss 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 dacedent's death, a five percent (52) discount of
the tax paid is allowed.
The 152 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 sams manner and in the the same time period as you would appeal the tax and interest
that has been assessed es indicated on this notice.
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 1, 1982 bear interest at the rate of
six (62) percent per annum calculated at e daily rate of .000164. All taxes ehJch became delinquent on and after
January 1, 1982 will bear interest at a rate which ail! vary from calendar year to calendar year with that rate
announced by the PA Departaent of Revenue. The applicable interest rates for 1982 through 2002 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 20Z .000548 1992 92 .O00Z~7
1983 I6Z .000438 1993-199~ 72 .OOOI9Z
1984 IlZ .000301 1995-1998 92 .000247
1985 132 .000356 1999 72 .000192
1986 XOZ .00027~ 2000 82 .000219
1987 92 .000247 2001 92 .000247
1988-1991 llZ .000301 2002 62 .000164
--Interest is calculated as follows:
ZNTEREST= BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becoees delinquent ail1 reflect an interest calculation to fifteen (15) days
beyond the date cf the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest oust be calculated.