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HomeMy WebLinkAbout03-0535COMMONWEALTH 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 002757 LOEW HAROLD R III 1120 WENRICH STREET HARRISBURG, PA 17112 ........ fold ESTATE INFORMATION: SSN: 204-20-8688 FILE NUMBER: 2103-0535 DECEDENT NAME: LOEW GEORGINE K DATE OF PAYMENT: 07/01/2003 POSTMARK DATE: 06/30/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/01/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,985.90 TOTAL AMOUNT PAID: $3,985.90 REMARKS: HAROLD RLOEWIII SEAL CHECK# 1358 INITIALS: VZ RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE CARLISLE PA 17013-3387 ~~ COMMONWEALTH Of PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1 500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER COUNTY CODE YEAR NUMBER r~l. Odginal Retum E~]4. Limited Estate [~6. Decedent Died Testate (Attach copy of Will) E~]9. Litigation Proceeds Received ---] 2. Supplemental Return --"] 4a. Future Interest Compromise (dale of dealh after 12-12-82) ---]7. Decedent Maintained a Living Trust (A~ch copy of Trust) D10. Spousal Poverty Credit (date of dealh behveer~ 12-31.91 and 1-1-95) '--]3. Remainder Return (date of death prior to t2-13-82) [-"~ 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes ~-"] 11. Election to tax under Sec. 9113(A) (AItach Sch O) NAME MARTIN C. NAUGLE, CPA FIRM NAME (l[Applicable) WALBORN, NAUGLE, SHAMBACH ASSOCIATES TELEPHONE NUMBER (717) 236-7912 1714 NORTH SECOND ST HARRISBURG, PA 17102 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) 12,209.57 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) E~] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 80,966.13 (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 9. Funeral Expenses &Administrative Costs (Schedule H) (9) 4,600.14 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) 12. Net Value of Estate (Line 8 minus Line 11) (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) 93,175.70 4,600.14 88,575.56 88,575.56 BEE 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 .0 (15) 16. Amount of Line 14 taxable at lineal rate 88,575.56_ x .0 45 (16) 17. Amount of Line 14 taxable at sibling rate x ,12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 3,985.90 3,985.90 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER LOEW, GEORGINE K. 204-20-8688 DATE OF DEATH (MM-DM-YEAR) DATE OF BIRTH (MM-DM-YEAR THIS RETURN MUST BE FILED IN DUPLICATE WITH THE O7/01/02 02/29/28 REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Decedent's Complete Address: STREET ADDRESS 12 HUMMEL AVE C~TYcAMP HILL I STATEpA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3. InterestJPenalty if applicable Total Credits (A + B + C ) (2) 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. Check box on Page 1 Line 20 to request a refund (4) 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. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT J ZIP17011 3,985.90 3,985.90 43.68 4,029.58 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the 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. SIGiNATURE OF PERSON RESP~ FOR B.~ RETURN 1120 WENRICH ST HAE~RISBURG, PA 17112 SIGN/~'~/i_~L.~E~,,AOF RER ~R OT~'~R~ tj~RETHAN R RESENTATIVE ADDRESS' -' v~ ' ~7 ~ /DATE /.2 -! 1714 NORTH SECOND ST HARRISBURG, PA 17102 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 (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 doe~ nol 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 twenly-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. LAST WILL AND TESTAMENT I, GEORGINE K. LOEW, of Cumberland County, pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all other Wills and Codicils at any time heretofore made by me. ~ I direct that all of my just debts and funeral. expenses be paid for as soon as practicable after my decease, as part of the administration of my estate, from'the funds in my -~ residuary estate. ~T~ I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death, whether or not with respect ' 'to property passin~ under this Will, shall be Paid out of the funds in my residu~ary estate. ~ All the rest, residue and remainder of my estate, of. whatever kind and wheresoever situate, I give tomy three children, Harold R. LoeW, III, Jennie Carswell, and Linda. Frymire, to share' eqUally. ~ I direct that my Executor or his successorB or assigns, shall not be reqUired to enter bond or security'in any jurisdiction in which he or she may act, but ifa bond is reqUired notwithstanding this direction, I direct that a surety bond shall not be reqUired. 1 ~ I hereby nominate, constitute and appoint my son Harold R. Loew, III, as my Executor. IN WITNESS WHEREOF, I have set my hand and seal to ~his my Last Will and Testament, which consist, s of two (2)pages, to each of which I have affixed my signature this 9 day of "C, eo:~fne K. Loew SIGNED, sEALED, PUBLISHED AND DECLARED by the above named testator, as and for her will, in the presence of us, who, at her request, in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses in station thereof. W~tnesS ~ Witness 2 COMMO~TH OF PENNSYLVANIA: COUNTY OF DAUPHIN: I, GEORGINE K. LOEW, having beenduly qualified according to law, acknowledge that I signed the foregoing instrument as my Last Will and Testament, and that I signed it as my free and volUntary act for the purposes therein expressed. 'G~OR~-±~E K. LOEW We, having been duly qualified according to law, depose and say that we were present and saw GEORGINE K. LOEW sign the foregoing instrument as her Last Will a_nd Testament; that she signed it as her free and voluntary act for the p~rposes therein expressed; that each of us in her sight and hearing and at her request signed the Last Will and Testament as witnesses; and that to the best of our knowledge she was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Subscribed, sworn to or affirmed and acknowledged' before me by the above named testator and by the Witness .? .t_ ..':3 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY REV-1508 EX+ (6-98) ~ COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GEORGINE K. LOEW FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH M & T BANK - CHECKING ACCOUNT # 2670049879 PENNSYLVANIA CENTRAL FCU SHARE ACCOUNT # 13329-016 PERSONAL PROPERTY TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2543.83 9165.74 500.00 12,209.57 2670049879 CLASSIC CHECKING O0 00q320M NM 017 JUN.20-JUL.19,,2002 1 OF 1 GEORGINE K LOEW HAROLD LOEW III Y27 W PERRY ST ENOLA PA 17025 qq6BO .... SOUTH' 16TH' STREET:'OFFZCE ACCOUNT SUMMARY 2~S43.83 0 O. O0 0 0. O0 0 O. O0 0. O0 2~S43.85 ACCOUNT ACTIVITY DATE TRANSACT[ON DESCRIPTION: 06-20- 02 BEGZ~ZNG BALANCE ~2~S.8~ ENDZNG BALANCE ~2~3.83 BUY A HOME WITH LITTLE HONEY DOWN WITH M&T'S FHA MORTGAGE. IF YOU'RE INTERESTED ZNBUYING A FIRST HOME OR A LARGER HOHE, AND DON'T HAVE MUCH CASH ON HAND, M&T CAN HELP. M&T'S FHA MORTGAGE OFFERS A VARIETY OF FLEXIBLE FINANCING FEATURES WHICH HELP )lAKE BUYING A HOME EASY AND AFFORDABLE. WITH AN FHA NORTGAGE FRON M&T, YOU CAN MOVE INTO YOUR NEW HOME WITH AS LITTLE AS 2.2SX DOWN. AND SELLERS CAN EVEN HELP PAY YOUR CLOSING COSTS. TO FZND OUT MORE CALL M&T MORTGAGE TODAY, OR VISIT US ONLINE AT WWW.MANDTMORTGAGE.COM. M&T 1S AN EQUAL HOUSING LENDER. ABOUT LOANS MARKED WiTH AN # STATEMENT OF ACCOUNT WRITE TO: Ii i iiii iiiiiiiJ PENNSYLV^. ^ CE.TRAL FCU iiiii!i~iiiii HARRZSBURG PA 1'7111-2810 GEORGZNE K LOEN &/OR HAROLD R LOEN 327 N PERRY ST ENOLA PA 17025-2537 I,,,111,,,111 ..... I'l'l,l,,,I,l,IRl,,,ll,l,,,I,,I,II,,,ll,l,,I TO REPORT ERRORS OR MAKE INQUIRIES AEOUT "ELECTRONIC FUNDS TRANSFERS" MARKED EFT, ATM, H~K, OR TEL. WRITE TO THE ADO~q[$S AT LEFT OR CALL: 71'7/564-4661 1250016P 3870. 13329-016 S;S.N. SECURED 1 07~5~2 07d 0:02 07il 2~2 · 07!16~02 07i31.02 O?OSO2 0705.02 o?il o.~2 07110~02 07il 0~2 07il 1.02 07i12.02 07il 2.02 07il 2~02 07il 2~02 07il 6.~2 07i16.02 07i31.02 SHARE DRAFT 146 TRANSFER SHARE DRAFT 143 SHARE DRAFT 146 TRANSFER DEPOSZT SHARE DRAFT 147 SHARE DRAFT 149 SHARE DRAFT 148 TRANSFER SHARE DRAFT 144 TRANSFER TRANSFER : PRE~ZDUS BALANC~ 7595~0 ,1527~6- 6067~4 TRANSFER '~' ~ ' '600~0- 5467~4 TRANSFER .... i' ~ ....... 2361~9- 3106~5 TRANSFER..,, , .,~ J~-~.,; - ;~ ..,.~.'~500- 3031~5 !,.., i NEN BALANCiE 3031.05 076 SHARE DRAFT ACC ; PRE~ZOUS BALANC~ 1570~4 ': '3098~0- 1527~6- 1527~6 :00 100~0- 100~0.:0- 500.00- 60O.00- 600~0 .00 1094~0 1094~0 484~5- 629~5 . , 1293~0- 663~5- . . . 1697~4- 2361~9- 2361E9 ~0 ?s.0o- 75~o- 75.00 .00 NEN BALANCiE .00 ....... DRAFT LZSTZNG * ZNDZCATES A SKZiP ZN D~AFT NUMBERS ....... ~¢¢~,r,m. 143 100.00 : -144;,' 75';~0'~ , , !~, 145-::~:,..~098.00 148 500.00 147 ...... 464.415'" "~ ~ 148~ 'i1897;g4 149 1293.30 $115.09 REGULAR DZVZDENDS : 1ST MORTGAGES AVAILABLE: COMPETjlTIVE RATES & FEES, PRE-APPROVALS/RATE LOCK OPT!ON. i HOME !EQUITY LOANS AS LOW AS 5.'95%. CURRENTLY NO Hi.E. A~PLICATIONi FEE : + '-H ,-{- ,4- --I- ~ + <> + '0' I -)6 CD ["- O', CD · · ~ , · · See Reverse Side For Important Information REV-1510 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GEORGINE K. LOEW SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through on the ITEM DESCRIPTION OF PROPERTY INCLUDETHENAMEOFTHETRANSFEREE, THEtRRELATIONSHiPTODECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. GIFT OF CASH - HAROLD R LOEW, III, SON 1/25/2002. 6000.00 100% 3000.00 3000.( 2 GIFTS OF CASH - LINDA FRYMIER, DAUGHTER FROM 38449.00 100% 3000.00 35499.( JULY 10, 2001 TO JANUARY 10, 2002. 3 GIFTS OF CASH - JENNIE CARSWELL, DAUGHTER FROM 23000.00 100% 3000.00 20000.C AUGUST 16, 2001 TO FEBRUARY 20, 2002. 4 422.871 SHS AMERICAN WATER WORKS-COMMON 18762.79 100% 18762.7 STOCK, TRANSFERED TO JOINT OWNERSHIP WITH HAROLD R. LOEW, III, SON ON 9/25/2001. 5 107 SHS JOHN HANCOCK FINANCIAL SERVICES, INC.- 3704.34 100% 3704.3 COMMON STOCK, TRANSFERED TO JOINT OWNERSHIP WITH HAROLD R. LOEW, III, SON ON AUGUST 6, 2001. TOTAL (Also enter on line 7 Recapitulation) $ 80,966.13 O D0 9 ~,4 insert additional sheets of the same size) EO_UlSERVE' Post Office Box 4301 O, Providence, RI 02940-3010 www. EquiServe cam HAROLD R LOEW III ( GEOR~INE K LOEW JT TEN 112C WENRIC~ STREET HARRISBURG PA 17112-1862 STATEMENT OF HOLDINGS .................. ~.o_rqD~.ny Name i2i0-i0~- ACc.~o.~nt . ~l~,k~¢..D~scription Record Date Balance Reinvested Record Date Payment Date $ Dividend Rate )ate Transaction Description $ Service $ Net Amount Invested $ Price Per Share Transaction Shares $ Tax Basis Total Shares Held Fee Per Share b..y Agent '~" ~AL,~',;CE FORWARd, ~ 4c2.B7i0 OPT EASH AND RE[NVEST~ENT OF DIVIDENDS HA~E BEEN SUSPENDED. FOE INTERNET ACCESS. LOGON TO HTI'P://GATE4AY.EQUISERVE.(;OM USING ISSUE ID# 12101]. ACCT#. S~# AND PASSWORD OF: 4?719795. Current Value Year-To-Date Income Summary Market Price Market Value ~ Total Gross Dividends/ $ Total Additional Capital Gains Reinvested Income $ Total Taxable Income $ Total Tax Withheld ' 4~. 370 18.762.78 s~-~u,,u,. S-O1/O10200Z FI 11126102 SHARE BALANCE AS OF: ~ INVESTMENT INFORMATION Shares Hetd By You Shares Hold By The Agent Total Shares I $ Gross Dividend Reinvestment $ Tax Withheld (if any) $ Net Dividend Reinvestment 4-'2. 8710 422. 8710 [ I Year-To-Date Activity EQ_LIISERVE' Innovative Leadership in Shareholder Services. December 17, 2002 HAROLD R LOEW III & GEORGINE K LOEW JT TEN 1120 WENRICH ST HARRISBURG PA 17112 1862 JOHN HANCOCK FINANCIAL SERVICES INC HAROLD R LOEW III & GEORGINE K LOEW JT TEN Acc_o_I.J~T _N[41~__~B____ER: 129_0-4__!1~3-8016 Dear Mr. Loew: Thank you for your inquiry regarding the share balance of the above referenced account. We appreciate the opportunity to be of service to you. On July 1, 2002, account number 4113-8016 held 107 shares. On that date, the closing price was $34.62 per share. Should you have any questions, please call us toll free at 1-800-333-9231 or write to us at EquiServe, P.O. Box 43015, Providence, RI, 02940-3015. Our telephone representatives are available Monday through Friday between the hours of 9 a.m. to 5 p.m. Eastern Time. For certain routine information, you may call us 24 hours a day, 7 days a week and access our teleservicing system. If you have intemet access, you may also obtain additional information on products and services by visiting our website at www.equiserve.com, Reference Number: 01067515 $incerely~, }£ /? / t/. , / :C~e~ Vei~a~/t~ L~perat~on Specialist REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 'ESTATE OF GEORGINE K. LOEW SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule ITEM NUMBER DESCRIPTION 2 3 4 5. 6. 7. FUNERAL EXPENSES: SULLIVAN FUNERAL HOME, ENOLA - FUNERAL EXPENSES BILL ATTACHED. CLERYMAN ORGANIST FOOD AND REFRESHMENTS ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip Attorney Fees Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation) Claimant Street Address city Relationship of Claimantto Decedent Probate Fees Accountant's Fees Tax Retum Preparer's Fees State Zip TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 3158.00 100.00 75.00 67.14 1,200.00 $ 4,600.14 '5]' ~. Enola Drive - EnoZa ~ Pa 17025 ~ 732-5400 "' STA~~ OF ~~ ~ODS ~ S~CES SE~D ~es ~e o~y for ~o~ t~ ~ you s~d or ~ ~e req~ed. ~ we ~e re.ed by ~w or b a ~e~ or ~o a;:~t~r~ ~ll~~!' I~ ~ ~,~ ~ ~g, yo~a~ha~e.to pay f~r ~b~g, You do. nat ~ve w pay for ~r ,- 8w~.~cctcr~auono~e~ae v~ ffwecn~edfor~b~ we~ . ~oraeSe~lceof ~~ ~ ~.. ' ~, __ ~y~ow. N~e Address ~ ' ' City State A. C~GE. FOR SER~CE$ 1. PROFESSIONAL SERVICES Embalming ....................... Other preparation of body Flower car or floral disposition Local... . .. . Lead car/clergy car Local.. ... . Car for pallbearers Local ........................... Out of town transportagon ...... ;.. SUB-TOTAL OF PROFESSIONAL SERVICES ........ 2. FACILITIES AND SERVICES Use of facilities and services for viewing (Visitation/Wake) ......... $ . Use of facilities and services for funeral ceremony ............ Use of facilities and services for Memorial Service ............... $. Use of equipment and services for graveside service ............. $. Other use of facilities SUB-TOTAL OF FACILITIES/EQUIPMENT ........... A2 $..'"--~ 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral' Hon~e~ Local ................. . .......... Hearse (Casket Coach) Local ........................... Limousine Loc ........................... Other clothing $ Cremation urn ................... (Description) OTHER $ $ $ TOTAL MERCHANDISE SELECTED ................. B $ C. SPECIAL CHARGES: Forwarding of remains to (Funeral Home) $-'~ Receiving of remains from / · (Funeral Home) $ -'['--'- Immediate Burial ................. $ _L__- Direct Cremation ................. $$._~ SUB-TOTAL OF SPECIAL CHARGES ...... D, CASH ADVANCED Opening Grave ............... Cemetery Equipment .... Lot and Deed .................... $_ Newspaper Notices--Local ......... $ ~-~,,(~ Newspaper Notices--Out-of. town .... $_ Telephone & Telegrams ........... $ . Airfare ........................ .z $ Clergy/Mass Offering ............. Pallbearers ...................... ~' Certified Copies of the Death Certlficate/,~, ................... Police Escort ................. $__ ~1° .wers/~'(O .... ~'.('~.Y .... vault Service Charge ......... ' ..... $ _$ $ SUB-TOTAL OF ADVANCES ....................... D dg3~ SUB-TOTAL, OE AUTOMOTIVE £QUIPMEI~KF ........ A3 ST~S ~'} We charge you for our services in obtalrdng: TOTAL OF PROFESSIONAL SERVICES, (specify cash advances that are marked, up) FACILITIES A_ND AUTOMOTIVE B. CHARGE FOR MERCHANDISE SELECTED: Casket .......................... $ (Description) ~. ~rt~ Other Receptacle ................. $ (Description) Outer burial container ...~ ~,,. ~ ] ~ (Description) .. ~ Acknowledgement cards ........... $ ~ Register book(s) .................. ~ Memory folders .................. Prayer cards ..................... $,. ,,~. Temporary grave marker ........... $ ~m=~.. Burial clothing ................... ~ SUMMARY OF CHARGES A, Professional Services, Facilities and Equipment, and Automotive Equipment ...................... $~?/,~0 B. Merchandise ..................... $ ..--,~ C, Special Charges $ ~ TOTAL OF ALL SECTIONS ...... ~ .............. "- PAID AT TIME OF oR PRIOR TO ~CL'~hL~I~_~'~ ~ ~'~'~ BALANCE DUB .................................. $... REASON FOR EMBALMING If any law, cemetery, or crematory requirements have required the purchase of any of the items listed above the law or requirement is explained below. I agree that I have examined the tema of goods and services selected above and found them to be correct and according to the arrangements I have requested I aclmowled e receipt of a copy of this Statement of Funeral Goods and Services Selected, I represent that I have sufficient funds available for payment of the cash price for the and services selected. I also agree to make payment of $ within _ days. I agree to be jointly :nd severally ~abk with anyone else who signs below. A late charge of ~ per month amotultlng to. pet year will be applied to the unpaid balance beginning da s from the date of this agreement I will also pay to the Funeral Director all reasonable cost~ aid b the ' -- Y Those costs may include attorneys' fees court costs and other costs An- additional ' p y . Fu~..eral Du'ector to collect amounts I owe under this a cut be considerejl part of this agreement a~'d the cost tbe--~t ....... ~-'~ y. _ ~servlces or mercnanoise ordered or reouested after th- (Seal) ' '~ '~]' :/'. ~'/¢.-~ ,,.X_ ........ rcnecteu on ttl~ nnal bill or statement ........... ap-~%cment wm (Purcb .r) 7 '/' 6 L (Seal) (Purchaser) ~ A'~I II~4~UM.,,,~,w © Pennsylvania Funeral Oircctor~ A~$oc~ation ~'r/Liceffse~qqlheral Director) form - 600 Revised 4/94 WmT~ Funeral DU¢¢tor ~ YELLOW Funeral Dire:tot PINK Customer NFl P. AMF TA SUBTOTAL **DISCOUNT ADd TOTAL~ TAX TOTAL "1' 65.99" $3.30 82.69 0.00 62.69 *CHECK*. ID ******.5813 CHANGE DUE DUE==> 82.69 62, ..69 THANK YOU'AND HAVE'A' SHURF][NE DAY!!! 7/3/02 ALICE lO: lC:28 AM REV-1515 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GEORGINE K. LOEW SCHEDULE J BENEFICIARIES FILE NUMBER NUMBER ! NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] LINDA FRYMIER 327 WEST PERRY ST ENOLA, PA 17025-2537 JENNIE CARSWELL 32 SOUTH ENOLA DR ENOLA, PA 17025-2537 HAROLD R. LOEW, III 1120 WENRICH ST. HARRISBURG, PA 17112-1862 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) DAUGHTER DAUGHTER SON ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 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 $ (If more space is needed, insert additional sheets of the same size) AMOUNT OR SHARE OF ESTATE ONE-THIRD ONE-THIRD ONE-THIRD BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX DTVZSZON DEPT. 180601 HARRTSBURG, PA 17118-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX MARTIN C NAUGLE NALBORN ETAL 1714 N 2ND ST HBG PA 171~ DATE 08-11-2005 ESTATE OF LOEN DATE OF DEATH 07-01-2002 .~FZLE NUMBER 21 05-0555 T~i'~:I~COUNTY CUHBERLAND ACN 101 Amount Remitted RE¥-I;~? EX AFP (01-05) GEORGINE K HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE M'~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLONANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF LOEN GEORGZNE K FILE NO. 21 05-0535 ACN 101 DATE 08-11-200~ TAX RETURN gAS: (X ~ ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSF APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) q. Hortgages/Notes Receivable (Schedule D) (q) $. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) ($) 6. Jointly O~ned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) B. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Costs/Nisc. Expenses (Schedule H) (9) 10. Debts/Nortgage Liabilities/Liens (Schedule I) (10) 11. Tote1 Deductions 12. Nat Value of Tax Return 15. lq. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) Net Value of Estate Subject to Tax 12z209.57 .00 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper portion .00 of this form ~ith your tax payment. 80~966.15 (B) 4,600.14 NOTE: 9:5,175.70 TAX CREDITS: PAYHFNT DATE 06-:50-2005 RECEIPI NUHBER CD00~757 DISCOUNT (+) INTEREST/PEN PAID (-) .0O BALANCE OF UNPAID INTEREST/PENALTY AS OF 07-01-2005 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATZON OF ADDITIONAL INTEREST. reflect flgures that include the total of ALL returns assessed to date. AHOUNT PAID 3,985.90 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ASSESSMENT OF TAX: 15. Amoun* of Line 1~ at Spouse1 rate (15). . O0 X O0 = 16. Amount of L/ne 1~ taxable at Lineal/Class A rate (16) 88,575.56 X 045 = 17. Amount of Line lq et Sibllng rata (17) . O0 X 1~ = 18. Amount of Line 1~ taxable at Collateral/Class B rata (18) . O0 X 15 = 19. Principal Tax Due (19)= .00 3,985.90 .00 .00 3,985.90 5,985.90 .00 49.15 49.15 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REi)UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" [CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) If an assessment gas issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will .00 (ll) ~.&00.14 (12) 88,575.56 (13) . O0 (lq) 88,575.56 RESERVATZON: Estates of decadents dying on or before December 1Z, 1981 -- 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 Coaaonmealth hereby expressly reserves the right to appraise and assess transfer [nheritance Taxes at the lawful CIass B (collateral) rate on any such future interest. PURPOSE OF NOT/CE: PAYMENT: REFUND £CR): OBJECTIONS: ADNZN- ISTRATZVE CORRECT/ONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 21q0 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 aith your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF NXLLS, AGENT A refund of a tax credit, which ems not requested on the Tax Return, say be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Office of tho Register of Hills; any of the 2~ Revenue District Offices, or by calling tho special Z4-hour answering service for forms ordering: 1-800-561-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, alloeanca; or disallowance cf deductions, or assessment cf 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. 281011, Harrisburg; PA 17128-1011, 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 Raviea Unit, Dept. 180601, Harrisburg; PA 17118-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid eithin three (~) calendar months after the decedent's death, a five percent (5Z) discount cf the tax paid is allowed. The 1SZ 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 saaa 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 (93 months and one (1) day from the date of death; to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .O0016q. All taxes ~hich 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 far 1982 through ZO0~ ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Yea~r Rate Factor 1982 ZOZ .000548 1987 91 .000247 1999 71 .000192 1983 161 .000438 1988-1991 11X .000301 ZOO0 81 .000119 1984 111 .OOO~O1 1991 91 .000247 2001 91 .000247 1985 131 .000356 1993-1994 71 .O0019Z ZOOZ 61 .000164 1986 lOZ .000174 1995-1998 9Z .O00Zq7 2003 52 .000137 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPAI'D X NUNBER OF DAYS DEL/NQUENT X DAI:LY TNTEREST 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. 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 003834 LOEW HAROLD R III 1120 WENRICH STREET HARRISBURG, PA 17112 ........ fold · ESTATE INFORMATION: SSN: 204-20-8688 FILE NUMBER: 2103-0535 DECEDENT NAME: LOEW GEORGINE K DATE OF PAYMENT: 04/1 6/2004 POSTMARK DATE: 04/1 5/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/01/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~49.15 REMARKS: ...... SEAL CHECK# 1501 TOTAL AMOUNT PAID: $49.15 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF ZNDZVZDUAL TAXES TNHERTTANCE TAX D'rVTSTON DEPT. :~80601 HARRTSBURG,, PA 171Z8-0601 HARTZN C NAUGLE WALBORN ETAL 171~ N ZND ST PA 17102 COHHONWEAI.:TH,` OF, PENNSYLVANTA BEPARTH~ ~ 'i': ~F ~ REVENUE; ' NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT,, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTTONS0~ND ~E~iS~EN~,: fF: ]T~X BATE , ESTATE OF ',*~, !. BATE OF BEATH F'rLE NUHBER COUNTY ACN 08-11-Z005 LOEW 07-01-Z002 21 05-0555 CUHBERLAND 101 RE¥-1~,~7 EX AFP (01-051 GEORGINE HAKE CHECK PAYABLE ANB RENZT PAYHENT TO: REGZSTER OF WILLS CUHBERLAND CO COURT HOUSE CARLZSLE, PA 17013 CUT ALONG THZS LZNE ~" RETAZN LOWER PORTZON FOR YOUR RECORBS *-~ ........ . ........ ~ ~-- -- ~ ~-- ~ ~ ~ ~ ~-- ~ -- ~ ~ ~ ~ ~ -- ~-- ~ ~ ~ ~ ~-- -- -- ~ -- ~ ~ ~ ~ ~. ~ ................ ~WALBORN NAUGLE SHAMBACH ASSOCIATES CERTIFIED PUBLIC ACCOUNTANTS 1714 NORTH SECOND STREET HARRISBURG, PENNSYLVANIA ! 7102 9 [ ~dV VO. REGISTER OF WILLS CUMBERLAND COUNTY COURT CARLISLE PA 17013 HOUSE i z...r.~ t 3+3323. o2 I,,,lll,,,lll,,,,,,ih,lh,,lh,,IJ,,,1,1,,! BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVTSIOH DEPT. 280601 HARRISBURG,, PA 171Z8-0601 CONHONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT RE¥-16D? EX AFP (al-03) HARTIN C NAUGLE WALBORN ETAL 1714 N ZND ST HBG PA 17102 DATE 06-01-2004 ESTATE OF LOEW DATE OF DEATH 07-01-Z002 FILE NUNBER 21 05-05:35 COUNTY CUHBERLAHD ACN 101 Amoun~ RemL**md GEORGIHE K HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701:3 NOTE: To insure proper credi~ ~:o your account, submi~ ~he upper portion of ~his form wi~:h your ~:ax payment. CUT ALONG THIS LINE ~ RETA'rN LOWER PORTION FOR YOUR RECORDS -~ REV-1607 EX AFP (01-03) ##~ INHERITANCE TAX STATENENT OF ACCOUNT ~ ESTATE OF LOEW GEORGINE K FILE NO. 21 0:3-05:35 ACN 101 DATE 06-01-2004 THIS STATENENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NANED ESTATE. SNONN 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 ASSESSHENT OR RECORD ADJUSTNENT: 08-11-200:3 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): :3,985.90 PAYHENT RECEIPT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID (-) ANOUNT PAID .00 06-:30-200:3 04-15-2004 CD002757 CD0058:34 49.15- :3,985.90 49.15 TOTAL TAX CREDIT :3,985.90 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE IS LESS THAN $1, NO PAYNENT ZS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PAYMENT: Detach the top portion of this Notice and submit mith your payment made payable to the name and address printed an the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH 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-1513). Applications arm available at the Office of the Register of Hills, any of tho 25 Revenue District Offices or from the Department's Zq-hour ansaoring service for fores ordering: 1-800-36Z-ZOSO~ services for taxpayers aith special hearing and / or speaking needs: 1-&OO-qqT-3OZO (TT only). REPLY TO: questions regarding errors contained on this notice should be addressed to: PA Department of Revenue) Bureau of Individua! Taxes, ATTN: Post Assessment Review Unit, Dept. ZS0601) Harrisburg, PA 171ZB-O601) phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (Sg) discount of the tax paid is allowed. PENALTY: 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. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and Dna (1) day from the date of death, to the data of payment. Taxes which became delinquent before January l) 198Z bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on 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 1982 through ZOO4 are: Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor Year Rate X98Z ZOZ .00054B 1988-1991 X1Z .00030! 2001 9Z 1985 16Z .0D0438 199Z 9Z .000Z47 ZOOZ 6~ 1984 1lZ .000301 1993-1994 7Z .O0019Z 2005 5Z 1985 152 .000336 1995-1998 92 .000247 ZOO4 4Z 1986 iOZ .O00Z?4 1999 7Z .00019Z 1987 9Z .000Z47 ZOO0 8Z .000Z19 Daily Factor .000247 .000164 .000137 .000110 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELINI;IUENT X DATLY I'NTEREST 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 bo calculated.