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Home My WebLink About02-0089 PETITION FOR PROBATE and GRANT OF LETTERS ~tate of f~h~i VO, 6teen also known as TO: ' Resister of ?ills fo, r thq County of Cu~-~anal Social Security No. ] ~3 q- Oq - ~cbD~ased' Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age_or older an the execut r'; g in the last will of the above decedent, dated ~ ne. 2.2. and codicil(s) dated ~ in the named , 19~.~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~ ~ rv~ [~-e v- ~ ci v~al ..... County, Pennsylvania with h ~_w _ last ~amtll{ or gnncLo,al l'eside, alce at ~ ..... ,,~-~.-,m (list street, number and muncipality) at~.e~e~,.d~n~at~en t2- years of age, died.. [~eceiv~er ~ ,1~ Za~ot Except as follows, decedent did not marry, was not divorced and'did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: N/~ Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Penasylvania situated as follows: WHEREFORE, petitioner(s) respectfully irequ,est(s) the ,probate of the last will and codicil(s) presented herewith and the grant of letters. T theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) -nO ._~ OATH OF PERSONAL REPRF~ENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF C-.~v~i~ev [a~x~ } ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decec!ent petitioner(s) will well arid truly administer the estate~according to law. Sworn to or affirmed and subscribed _ befor/gzme this_ ~_'~/ _T?:- ~ day of [ ~ ,egisler~L 1"-7 - Estate of· {~ache\ ~. '6~een ,, Dece~md DECREE OF PROBATE AND GRANT OF L~ AND NOW j~tJA~,¥ 3~. :.:."' the reverse 'Side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated described therein be admitted to probate and f'Hed of record as the last will of and Letters T~'~'Jr~ vv~e are hereby sranted to .~_~ 7_zz~ne. ['Y%, ,1~. 2~)2., in ~onsideration of the petition on FEES Probate, ' Letters, Etc ..........$. 2On. 0O Short Certificates( ~)'. .........$ ~, ~ Renunciation ................ $ x pages (3~, 9.00 TOTAL $. 22~ · 00 Filed . JANUARY.. 25,. 2Q 0 ? ............... CALLED ATTORNEY ON 1-25-02 ATTORNEY (Sup. Ct. I.D. No.) ADDI~--~S PHONE ( 7_ 776g) his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be. forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Local Registrar P 7714702 DEC 8 2o01 No. Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH · ~' -- -- . · , 2001 I ~ h~ I ~0 ~ I~ ~ / ~ ' I Ha~ Wil~n Dec. 10, 2001 17241 Memorial Carlisle, PA 219 N. Hanover St. Carlisle PA 17013 0 LAST WI~W. ANDTESTAMENT 21-02-89 OF RACHEL W. GREEN I, RACHEL W. GREEN, a resident of and domiciled at 50 Stoneledge Road, Newville, West Pennsboro Township, Cumberland County, Pennsylvania, being of sound mind and disposing intent, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils at anytime heretofore made by me. ITEM I I order and direct my Executrix, hereinafter named, to pay all of my debts, and expenses involved or connected with the administration of my estate as soon after my death as is reasonably practicable. However, my Executrix need not accelerate and pay those unmatured obligations which, in her opinion, might be proper and more advantageous to retain or renew and pay as they become due and payable. ITEM II I have purchased a prearranged funeral (Guardian Plan) with Hoffman-Roth Funeral Home, Inc. or its successor with burial in Westminster Cemetery, Carlisle, Pennsylvania. Any additional expenses incurred shall be paid out of my estate. I~III I have three children: MARCIA L. LIEBL, Kutztown, PA., JUDITH D. HEJMANOWSKI, Camp Hill, PA. and SUZANNEM. N~HN, Newville, PA. It is my desire, and my children are in agreement, that the family home located at 44 West I Street, Carlisle, PA. be kept in the family as long as it is economically feasible to do so. When they agree that it is no longer economically feasible to keep the home, then it is to be sold at public or devises) wherever situate and whether acquired before or after execution of this Will, and after the items of personal property listed in the Directive attached to this Will have been distributed, in equal shares to such of my children who survive me for a period of thirty (30) days, provided that if a child does not survive me, the share such child would have received shall be divided equally among her surviving siblings. I hereby nominate, constitute and appoint as Executrix of this my Last Will and Testament my daughter, SU~ M. ~O~, and direct that she shall serve without requirement of bond or surety. By way of illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to executors generally, my Executrix is specifically authorized to and empowered with respect to any property, real or personal, at any time held under any provision of this my Will, to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convey, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, to make distributions in cash or in kind or partly in each without regard to the income tax basis of such asset, and in general to exercise all of the powers in the management of my Estate which any individual could exercise in the management of similar property owned in her own right, upon such terms and conditions as to my Executrix may deem best, and to execute and deliver any and all instruments and to ITEM VI My Executrix shall be entitled to reasonable compensation for services rendered in administering and distributing the assets of my estate and to reimbursement for expenses. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this ~dayJ°f ~<~ , 19~/W~.~GRE~ ,~~~ SIGNED, SEALED, PUBLISHED and DECLARED by the above Testatrix as and for her Last Will, in the presence of us, who thereupon at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. Witness Addre s s Witness Addre s s STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND : SS : We, RACHEL W. GREEN, DEBRA PETERS and PATRICIA R. BROWN the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of each witness' knowledge and belief the Testatrix was at that time eighteen years of age or older· of sound mind and under no undue/~onstraint or i~fluence. / // JTes%~atrlx ~t - Witness Witness Subscribed, sworn to and acknowledged before me by RAC~L W. GREEN, the Testatrix and subscribed and sworn to before me by DEBRA PETERS and PATRICIA R. BROWN · witnesses, this 22nd day of June , 1993. Nota~Publ~'c/ NOTA'RIAL ~SEAL SHELLY SEXTON, NO_TARY PUBLIC CARLISLE BORO, ClI~ERLAND COUNTY MY COMMISSION 'EXPIRES OCT 51, 1994 Membel' PennsylVeaia, ~Uen cf' Net,~ri# Z COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIV~DUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-11 62 EX(11-96) CD 000879 MICHAEL R RUNDLE ESQUIRE 454 SHED ROAD NEWVILLE, PA 17241 ........ fold ESTATE INFORMATION: SSN: 189-09-4631 FILE NUMBER: 2102-0089 DECEDENT NAME: GREEN RACHEL W DATE OF PAYMENT: 02/21/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/06/2001 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4,500.00 TOTAL AMOUNT PAID' $4,500.00 REMARKS: SUZANNEM MOHN C/O MICHAEL R RUNDLE ESQUIRE SEAL CHECK#4 INITIALS: JA RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS Name of Decedent: Date of Death: Will No. To the Register: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) O 2. - (90~t~ Admin. No. I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) ~f t..he Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on [ ¥~ 3: ~..~2- ' Name Address ~vxo,,,,cco, L. L,',eloi ,500 ~$o l 7otl Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: 7_002.- I Signature Address Telephone Capacity: __ Personal Representative Counsel for personal representative COMMONWEN. TH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. HARRISBURG, PA 17128-0~01 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I OFFICIAL USE ONLY FILE NUMBER 21 02 00089 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECUR,'~' NUMBER Green, Rachel W 189-09-463 l ~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DO-YEAR) THIS RETUI~I MUST BE FILED ,. DUPUCATE WITH THE ,,q 12/06/200] 09/20/1919 REGISTER OF WILLS ¢3 IF APPUCABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER N/A, -- --~ 1. Original Return [] 4. Limited Estate [] 6. Decedent Died Testate (Attach copy of win) [] 9. Litigation Proceeds Received [] 2. Supplemental Return ] 48. Future Interest ComprOmise (date o! death after 12-12-82) [] 7. Decedent Maintained a Living Trust (Atlach copy o~ Trust) [] 10. Spousal Poverly Credit (date of death between ] 3. Remainder Return (date of death prior to 12-13-82) [] 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) 12-~11-91 an(;I 1-1-95) .~ , ~w , ,,, ~, -,, ,, ,.~ .~ THIS SECTION MUST BE COMPLETED. ALL;CORRESPONDENCE AND CONF DENTIA~,TAX INFORMATION SHO'~LD BE DIRECTED TO'--;, ',., ~,~'~,: ',lAME Michael R. Rundle :IRM NAME (Il applicabIe) FELEPHONE NUMBER (717) 249-3274 COMPLETE MAlUNG ADDRESS 62 South Yin Oak I~i~ Boiling Springs, PA :::! 7007 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-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) None None None None 96,445.15 None None 1,687.58 1,818.52 12. Net Value of Estate (Line 8 minus Line 11) (8) OFFICIAL USE ONLY (11) 96,445.15 3,506.10 92,939.05 92,939.05 (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x ,00 (15) or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate x .045 (16) 17.Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .1 5 (18) 19. Tax Due (19) 92,939.05 4,182.26 4,182.26 Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 64)0) Decedent's Complete Address: STREET ADDRESS Thornwald Home 442 Walnut Bottom Road CITY STATE PA ZIP 17013 Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty 4,500.00 209.11 (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) 4. If 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (3) (4) (5) (5Al (5B) 4,182.26 4,709.11 0.00 526.85 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or inceme 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 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. SIGNATI~ OF PERSON RESPONSIBLE FOR FILIN~RETURN ADDRESS DATE Suza~ M. Morn ('--~.//c~.p~ ~/ 454 Shed Road ~~,2~/~//,.. ~ Newville, PA 17241 "/- $ I- 0 Z_ ADDRESS DATE SIGI~URE OF PREPARER OTHER ~J~N R~RESENTAi~IVE MiChael R. Rundle, Esfluirl~ ' "x '~ ADDRESS 62 South Pin Oak Drive Boiling Springs, PA 17007 DATE 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 (al (1.1) (il]. 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 (al (1.1) (ii)]. The statute does not exemDt 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 (al (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 (al (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 (al (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. COMMONtNEALllfl OF pENNSYLVANIA INHERITANCE TAX RETURN RESIDI~IT DECEDENT* ESTATE OF Green, Rachel W SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-02-00089 Include the proceeds of litigation and the date the proceeds were received by the estat_e. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 2 3 4 5 6 7 8 9 10 11 DESCRIPTION Check, Bankers Life Insurance Co. Check, Bankers Life Insurance Co. Check, Bankers Life Insurance Co. :~ Check, Bankers Life Insurance Co. Check, Prudential Life Insurance Co. Check, Blue Cross/Blue Shield Refund check, Internal Revenue Service Members 1st Federal Credit Union, Savings Account No. 14539-00 - 3,582.71 Accrued interest - .82 Members 1st Federal Credit Union, Savings Account No. 14539-05 - 79,602.14 Accrued interest - 26.93 Members 1st Federal Credit Union, Checking Account No. 14539-11 Debt due decedent from William and Suzanne Mohn TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE DEATH 1,550.00 1,500.00 11.54 11.54 426.60 3.52 2,025.00 3,583.53 79,629.07 704.35 7,000.00 96,445.15 SCHEDULE H FUNF_RAL EXPENSES & .aDMINISTRATIVE COSTS COMMONWEAL~'I OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Green, Rachel W 21 - 02 - 00089 Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT ITEM NUMBER FUNERAL EXPENSES: Hoffman-Roth Funeral Home - Funeral Services Mabel Lebo - Refreshments following service ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Michael R. Rundle, Esquire Family Exemption: {If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Register of Wills - Letters Testamentary Zip Accountant's Fees Tax Return Preparer's Fees H & R Block Other Administrative Costs Register of Wills, Short Certificates Register of Wills - filing Inheritance Tax return Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 452.50 62.00 750.00 214.00 155.00 6.00 15.00 33.08 1,687.58 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Green, Rachel W Sdledu~H FILE NUMBER 21 02-00089 Notary Fees Members 1st Federal Credit Union - Service Fees 10.00 23.08 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Green, Rachel W SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 - 02 - 00089 Include unreimbursed medical expenses. ITEM NUMBER 2 3 4 DESCRIPTION Checks issued by decedent prior to death but presented for payment on checking account (Schedule E, Item 10) after death. Brian Robertson, DDM, Bill Pharmerica, Prescription Bills Thomwald Nursing Home, Final Bill TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 95.00 15.00 374.73 1,333.79 1,818.52 RE~-'1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Green, Rachel W 21 - 02 - 00089 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE I~n N~t I let L TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Suzanne M. Mohn Daughter one-third 454 Shed Road Newville, PA 17241 2 Marcia L. Liebl Daughter one-third 500 Walbert Road Kutztown, PA 19530 3 Judith D. Lewis Daughter one-third 1868 Holly Drive Camp Hill, PA 17011 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II, NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTVTSZON DEPT. ZBO60Z HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RE¥-16~17 EX kFP (01-02) !:' DATE 09-16-2002 ESTATE OF GREEN DATE OF DEATH 12-06-2001 FILE NUMBER 21 02-0089 "i'. ~ i:" COUNTY CUMBERLAND MICHAEL R RUNDLE ACN 101 62 S PIN OAK DR t Amount Remitted BOILING SPGS PA 17007 RACHEL MAKE CHECK PAYABLE AND REMIT PAYMENT TO= REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~,~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOTICE OF /NHERITANCE TAX APPRA/SEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GREEN RACHEL W FILE NO. 21 02-0089 ACM 101 DATE 09-16-2002 TAX RETURN NAS: { X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE IN]~EST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 Z. Stocks end Bonds (Schedule B) (2) .00 5. Closely Held Stock/Partnership /nterest (Schedule C) ($) .00 q. Mortgages/Notes Receivable (Schedule D) (q) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($) 96~qq5.15 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 (a) 96,qq5.15 8. Tote1 Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 1,687.58 9. Funeral Expenses/Ada. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 1;818.52 11. Total Deductions (11) 3.50~.10 12. Net Value of Tax Return (12) 92,959.05 .00 15. Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) lq. Net Value of Estate Sub~ect to Tax (lq) 92,959.05 NOTE= If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX= O0 x O0 .00 15. Amount of L/ne lq at Spouse1 rate (15) ' = 16. Amount of L/ne lq taxable at L/neal/Class A rate (l&) 92,959.05 X Oq5 = q,18Z.Z6 17. Amount of L/nm lq et S/bl~ng rate (17) .00 X ~2 = .00 18. Amount of L/ne lq taxable at Collateral/Class B rate (18) .00 X 15 = .00 (19)= q,18Z.26 19. Pr/ncipel Tax Due TAX CREDITS= PAYMENT ' RECE/PT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-21-2002 CD000879 209.11 q,500.O0 ¥OYAL TAX CREDIT I q,709.1! BALANCE OF TAX DUE 526.85CR INTEREST AND PEN. .00 TOTAL DUE 526.85CR a IF PA~D AFTER DATE ~NDICATED~ SEE REVERSE ( ZF TOTAL DUE ~S LESS THAN $1, NO PAYMENT ~S REQUIRED. FOR CALCULATION OF ADDITIONAL ~NTEREST. ~F TOTAL DUE 1S REFLECTED AS A 'CREDIT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S~DE OF TH~S FORM FOR 1NSTRUCTZONS.) NOTE: To /nsure proper credit to your account, submit the upper port/on of th/s fora w~th your tax payment. RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CA): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 19SI -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for Years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such futura interest. To fulfill the requirements of Section 21¢0 of the Inheritance and Estate Tax Act, Act Z3 of 2000. (72 P.S. Section Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, ahich was not requested on tho Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special lC-hour answering service for fores ordering: 1-800-362-2050~ services for taxpayers with special hearing and / or speaking needs: 1-800-¢¢7-$0Z0 iTT 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. ZSIOZ1, Harrisburg, PA 17IlS-lOll, 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 ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviae Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. Sea page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid withln three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is a11oaed. The 15Z tax amnesty nan-participation penalty is computed on tho total of the tax end interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and gna (1) day from the date of death, to the date of payment. Taxes which became delinquent before January Z, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016¢. All taxes which became delinquent on and 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 198Z through ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 207. .0005¢8 1992 9Z 1983 I6Z .000638 1995-199¢ 77. 198¢ 117. .000301 1995-1998 9Z 1985 137. .000356 1999 77. 1986 IOZ · O0027~, ZOO0 87. 1987 9Z .000Z¢7 2001 9Z 1988-1991 117. .000301 2002 6Z --Interest is calculated as fei'lows: I'NTEREST = BALANCE OF TAX UNPAI'D .0002¢7 .000192 .000247 .D00192 .000219 .OOOZq? .OOO16q X NUNBER OF DAYS DELINQUENT X DATLy INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRTSDURG,, PA 17128-0601 COHHONWEALTH OF PENNSYLVAN/A DEPARTHENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-llO7 EX AFP (61-0~) HICHAEL R RUNDLE 62 S PIN OAK DR BOILING SPGS PA 17007 DATE 10-15-2002 ESTATE OF GREEN DATE OF DEATH 12-06-2001 F'rLE NUHBER 21 02-0089 COUNTY CUHBERLAND ACN l 01 f Amount Remitted RACHEL HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credi~ ~o your account, subeit ~he upper pore:ion of this fore wASh your tax payment. CUT ALONG TH'rS L'rNE ~ RETA'rN LOWER PORT'rON FOR YOUR RECORDS REV-1607 EX AFP (01-02) #~# 'rNHERZTANCE TAX STATENENT OF ACCOUNT ESTATE OF GREEN RACHEL W FILE NO. 21 02-0089 ACN 101 DATE 10-15-2002 THIS STATENENT TS PROV/DED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACN IN THE NANED ESTATE. SHONN BELON ZSA SUNNARY OF THE PRINCIPAL TAX DUE, APPL/CATZON OF ALL PAYNENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 09-09-Z002 PRINCIPAL TAX DUE= ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 4,182.26 PAYHENT DATE 02-21-2002 09-24-2002 RECEIPT NUHBER DISCOUNT ¢+) INTEREST/PEN PAID (-) CD000879 REFUND 209.11 .00 AHOUNT PAID 4,500.00 526.85- TOTAL TAX CREDIT BALANCE OF TAX DUE 4,182.26 .00 INTEREST AND PEN. .00 TOTAL DUE .00 ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE 1S 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. ) 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 RESIDENT DECEDENT make check or money order payable to: REGISTER OF NZLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or coney order payable to: COHHONWEALTH OF PENNSYLVANIA. REFUND (CR): 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-IS13). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices or from the Department's Zq-hour enamoring service for forms ordering: 1-800-362-Z050; services for taxpayers aith special hearing and / or speaking needs: 1-800-447-5010 (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 Reviea Unit, Dept. 180601, Harrisburg, PA 17118-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (SZ) discount of the tax paid is allowed. PENALTY: The 151 tax amnesty non-participation penalty [s computed on the total of the tax and interest assessed, and not paid before January IB, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, ar 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 (61) percent per annum calculated at a daily rate of .O001&4. All taxes which became delinquent on and after January 1, 1982 will bear interest et 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 ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1981 ZOZ .000548 1991 91 .000247 1983 161 .000438 1993-1994 71 .000192 1984 111 .O003Ol 1995-1998 91 .000247 1985 131 .000356 1999 71 .OOOlqZ 1986 ZOZ .OOOZ74 ZOO0 81 .000119 1987 91 .000Z47 2001 91 .000247 1988-1991 llZ .000301 ZOOZ 6Z .000164 --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD X NUXBER OF DAYS DELZNQUENT X DALLY ZNTEREST 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. STATUS REPORT UNDER RULE 6.12 Date of Death: will No. Zoo~- OOO~q Admin. NO. pursuant to Rule 6.12 of the Supreme Court orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate~ 1. State whether administration of the estate is complete: Yes × No 2. If the answer is No, state when the personal representative reamonably b~lieves that the administration will be complete~ 3. If the answer to No. i is Yes, state the following~ a. Did the personal representative account with the Court? Yes ._ No × . file a final b. The separate Orphans' Court No. (if any) for the personal representative's account is: c.. Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, Joinders and approvals of formal or informal accounts may be filed with the Cerk of the OrphaNs' Court and may be attached to this report. Signature Name (please type or print) Address Tel. NO. Capacity: .. Personal Representative Counsel for personal representative (MAM:rmf/AM3)