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Home My WebLink About04-0112 REV-'500 EXl6-001 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 ;::lFFiCIAL ~JS:::: Or~i_Y W I- lI::$CI) u"lI: wl1.U ::coo u,,-J l1.111 l1. c( FILE NUMBER .2 .L - .ll L{ COUNTY CODE YEAR INHERITANCE TAX RETURN RESIDENT DECEDENT -1-L.J-__ NUMBER I- Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Kurtz, Margaret M. DATE OF DEATH (MM-DD-YEAR) 07 -06-2003 SOCIAL SECURITY NUMBER 211 - 24 - 5464 DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH T REGISTER OF WILLS SOCIAL SECURITY NUMBER 1 0-15-1912 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) none lliJ 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of wall D 9. Litigation Proceeds Received D 2. Supplemental Return o 4a. Future Interest Compromise (dale of death after 12-12-821 D 7. Decedent Maintained a Living Trust (Attach copy of Trusl) D 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-951 D 3. Remainder Return (dale of dealh priorto 12-13-82) D 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sell ( I- Z W Q Z o l1. CI) W " " o u COMPLETE MAILING ADDRESS Samuel L. Andes FIRM NAME (If Applicable) 525 North 12th Street Lemoyne, PA 17043 TELEPHONE NUMBER (717) 761-5361 z o ~ ...J ::) l- ii: ct o W 0::: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (1) (2) (3) (4) (5) 1,010.55 (6) 2,009.19 267,957.76 (7) 270,977:50 (8) (9) 15,499.10 (10) 701.51 OFFICIAL USE ONLY 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (11) 16,200.61 (12) 254,776.89 (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::) a.. ::i o o >< ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15) x.O_ (16) 11,464.96 x .12 (17) x .15 (18) (19) 11,464.96 16. Amount of Line 14 taxable at lineal rate 254,776.89 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 . <;'i . ....:... . .:!'.f';,\\'t";~~EI';$UR!;:ifr<>~N~Welt~r4~x:ll.ll;~'tit)"'~jOl\I';~E~~8~1o-i;fANb~t:H~Cf$;""~tH~/;~~\. CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 'becedEmt's Complete Address: STREET ADDRESS 1317 Mallard Road CITY Camp Hill I STATE PA I ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 11,464.96 Total Credits (A + B + C ) (2) 0.00 3. InteresVPenalty if applicable D. Interest E. Penalty TolallnteresVPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 11 ,464.96 Make Check Payable to: REGISTER OF WILLS, AGENT 2!;I'rili~\~l{J$~~1s7~~~~tJi[~~~~~~~Wjn_~~~~~~~~~_~A~~~~~];1li7~i~~~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... D b. retain the right to designate who shall use the property transferred or its income; ............................................ D c. retain a reversionary interest; or.......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D 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? ........................................................................................................................ D No ~ fl] !iI ~ ~ D ~ 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 pe~UlY. 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 ?#UC4 F-jJ~ ADDRESS 1317 Mallard Road, Camp Hill, PA 17011 SIGNATUREOFP~~~ ADDRESS ~ 525 North 12th Street, Lemoyne, PA 17043 DATE I 1'1 /t:'(" DATE 4~\oA)~ 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. 99116 (a) (1.1) (i)J. 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. 99116 (a) (1.1) (ii)J. The statute does not exemot 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, 99116(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. 99116(1.2) [72 P.S. 99116(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)J. 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. REV.,soaEX. ('.97) '*' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Margaret M. Kurtz FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of sUNivorship must be disclosed on Schedule F ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Checking Account No. 30038483 with Waypoint Sank (see statement attached). $760.55 2. Miscellaneous items of clothing and other personal effects $250.00 TOTAL (Also enteron line 5, Recapitulation) $ 1,010.55 (If more space is needed, insert additional sheets of the same size) ~l WayJ:tqi[lJ LOOK FOR US. WE'LL GET YOU THERE. 11/17/2003 SAMUEL LANDES 525 N TWELFTH ST PO BOX 168 LEMOYNE P A 17043 The information which you requested on the account(s) of MARGARET M KURTZ (Social Security Number 211-24-5464) is/are as follows: Account Number Class of Account Date Opened Principal Balance Accrued Interest 30000174785 CERTIFICATE 020900 197000.00 188.90 197188.90 Balance at Date of Death Account Ownership OWN/BNF Name of Joint RONALD F Owner, if any PETERS "rnT T~"'T'T':'t: Date Ownership 020900 Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, ifany Date Ownership Was Established Additional Information Requested 300008262 CHECKING 081386 4018.34 .04 4018.38 JTO RONALD F PETERS 081386 30038483 CHECKING 120898 760.55 760.55 SOLE 120898 7100028193 CERTIFICATE 042202 30000.00 20,67 30020.67 OWNIBNF RONALD F PETERS BNF 042202 ERIN WATTS SENIOR SERVICES REP. P.O. Box 1711. HARRISBURG, PENNSYlVANIA 17105-1711 Toll Free 1-866-WAYPOINT (1-866-929-7646) . IN YORK AREA 717/815-4500 . www.waypointbank.com REV. 1509 EX . (1-91) '* SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Margaret M. Kurtz FILE NUMBER If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S} NAME ADDRESS RELATIONSHIP TO DECEDE A. Ronald F. Peters 1317 Mallard Road, Camp Hill, PA 17011 son B. c. JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEAn ITEM FOR JOINT MADE Include name of financial insUtution and bank account number or similar idenUfying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed for joinUy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEF 1. A. 8/13/86 Checking Account No. 300008262 with $4,018.38 50% $2,009.19 Waypoint Bank (see statement attached) TOTAL (Also enter on line 6, Recapitulation) $ 2,009.19 (If more space is needed, insert additional sheets of the same size) , REV.1510EX..(1.97) SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF M t M K rtz argare . u FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSfEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. OA TE OF OEA TH DECO'S EXCLUSION TAXABLE VAll ATTACH A COPV OF THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST IIF APPliCABlE) NUMBER 1. Certificate of Deposit No. 30000174785 with 197,188.90 100% none 197,188.90 Waypoint Bank 2. Certificate of Deposit No. 7100028193 with $30,020.67 100% none 30,020.67 Waypoint Bank See statement from Waypoint Bank attached. These assets are included as entirely owned by the decedent because they were held by her son, Ronald F. Peters, as trustee for her benefit during her lifetime. 3. Regular share savings account with $33,743.80 100% none $33,743.80 Pennsylvania State Employees Credit Union 4. Seven Certificates of Deposit with Pennsylvania $7,004.39 100% none $7,004.39 State Employees Credit Union See statement attached to confirm value of these acounts. They are included as being the property of the decedent entirely because they were held in trust by the decedent's son, Ronald F. Peters, as trustee for her benefit during her lifetime. TOTAL (Also enter on line 7, Recapitulation) $ 267,957.76 (If more space is needed, insert additional sheets of the same size) ~l WayJ:tqi[lJ LOOK FOR US. WE'LL GET YOU THERE. 11/17/2003 SAMUEL LANDES 525 N TWELFTH ST PO BOX 168 LEMOYNE P A 17043 The information which you requested on the account(s) of MARGARET M KURTZ (Social Security Number 211-24-5464) is/are as follows: Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership OWN/BNF Name of Joint RONALD F Owner, if any PETERS rrOT TC"TT:"T:' Date Ownership 020900 Was Established 30000174785 CERTIFICATE 020900 197000.00 188.90 197188.90 300008262 CHECKING 081386 4018.34 .04 4018.38 JTO RONALD F PETERS 081386 Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name ofJoint Owner, if any Date Ownership Was Established Additional Information Requested 30038483 CHECKING 120898 760.55 760.55 SOLE 120898 7100028193 CERTIFICATE 042202 30000.00 20.67 30020.67 OWN/BNF RONALD F PETERS BNF 042202 ~ ERIN WATTS SENIOR SERVICES REP. P.O. Box 1711, HARRISBURG, PENNSYlVANIA 17105-1711 Toll Free I-B66-WAYPOINT (1-866-929-7646) . IN YORK AREA 717/815-4500 . www.waypointbank.com PSEClt; the financial link TM September 17, 2003 Account # 1203325084 SAMUEL LANDES 525 NORTH TWELFTH ST PO BOX 168 LEMOYNE, P A 17043 Dear MR ANDES: The following is the status of RONALD F PETERS's prefix account with PSECU as of the date of death of Margaret M Kurtz on July 6, 2003. Joint Owner's Name Date Established IN TRUST FOR MARGARET M KURTZ 04.30.1999 Share(s) Regular Shares (Sl) 3 Month Certificate (62) 3 Month Certificate (63) 3 Month Certificate (64) 3 Month Certificate (65) 3 Month Certificate (67) 3 Month Certificate (68) 36 Month Certificate (S69) Balance $33,740.33 500.00 500.00 500.00 500.00 500.00 500.00 4,000.00 Accrued Dividend $3.47 0.10 0.10 0.10 0.04 0.10 0.10 3.85 The dividend earned from January 1, 2003 through the date of death was $363.69. We do not have safe deposit boxes for our members. If you have any questions, please call 234-8484 in Harrisburg or our toll- free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. Sincerely, , . ~ ,. , '/"/ ..... /. . i ! rL.. jLk.....(....~.lj. ~-l-(-.....I Meacie Fairfat Member Service Representative Finance Support Unit PENNSYLVANIA STATE EMPLOYEES CREDIT UNION Main Address: 1 Credit Union Place. Harrisburg, PA 17110-2990 - (717) 234-8484. (800) 237-7328 Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013. (717) 777-2100 (TOO) . (800) 472-1967 (TOO) Web Address: www.psecu.com Savings federally Insured up to $100,000 by the National Credit Union Administration. REV-1511 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Margaret M. Kurtz FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Kreamer Funeral Home $6,975.10 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees Samuel L. Andes $5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Ronald F. Peters Street Address 1317 Mallard Road City Camp Hill $3,500.00 State PA Zip 17011 Relationship of Claimant to Decedent son 4. Probate Fees 5. Accountant's Fees 6. Tax Return Pre parer's Fees 7. Kreamer Funeral Home (additional death certificates) $24.00 TOTAL (Also enter on line 9, Recapitulation) $ 15,499.10 (If more space is needed, insert additional sheets of the same size) REV-15ft EX . {1-91j SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Margaret M. Kurtz FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. East Pennsboro Township (trash collection) $20.00 2. West Shore EMS (ambulance transportation) $468.86 3. Camp Hill Fire Company (ambulance service) $24.04 4. Holy Spirit Hospital (medical tests) $38.92 5. Dr. Kadiz (medical services) $35.84 6. Susquehanna Internal Medicine (medical services) $70.94 7. Central Pa. Hemotology (medical services) $8.48 8. Brookie Pharmacy (medications) $34.43 TOTAL (Also enter on line 10, Recapitulation) $ 701.51 (If more space is needed, insert additional sheets of the same size) ~ . . REV.1SiJ Ex'. (1.97) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Margaret M. Kurtz FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Ronald F. Peters 1317 Mallard Road son 100% Camp Hill, PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEEl II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. none 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II . ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003532 DUPLICA TE ANDES SAMUEL L, ESQ. 525 NORTH 12TH STREET LEMOYNE, PA 17043 -------- fold ESTATE INFORMATION: SSN: 211-24-5464 FILE NUMBER: 2104-0112 DECEDENT NAME: KURTZ MARGARET M DATE OF PAYMENT: 02/05/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/06/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $11,464.96 I I I I I I I I TOTAL AMOUNT PAID: $11,464.96 REMARKS: CHECK# 1336 SEAL INITIALS: JA RECEIVED BY: r" ~ REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS 'v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (01-03) F:8C\.); R'''c' ",--."-, , DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-22-2004 KURTZ 07-06-2003 21 04-0112 CUMBERLAND 101 MARGARET M SAMUEL LANDES 525 N 12TH ST LEMOYNE .04 MAR 1 9 All :42 PA ~ittf43 Clllni');: .' I "-"v-_,- Amount Remi tted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KURTZ MARGARET M FILE NO. 21 04-0112 ACN 101 DATE 03-22-2004 TAX RETURN WAS: ( ) ACCEPTED AS FILED x) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) .00 NOTE: To insure proper .00 credit to your account, . DO submit the upper portion . DO of this form with your 1,010.55 tax payment. 2,009.19 267,957.76 (8) 270,977.50 Jointly Owned Property (Schedule F) (1) (2) (3) (4) (5) (6) (7) 2. Stocks and Bonds (Schedule B) 3. 4. 5. 6. 7. 8. Closely Held Stock/Partnership Interest (Schedule C) Mortgages/Notes Receivable (Schedule D) Cash/Bank Deposits/Misc. Personal Property (Schedule E) Transfers (Schedule G) Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. 10. 11. 12. 13. 14. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) Debts/Mortgage Liabilities/Liens (Schedule I) Total Deductions Net Value of Tax Return (9) (10) 13,009.65 701.51 (11) (12) (13) (14) 13.711 16 257,266.34 .00 257,266.34 Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subject to Tax NOTE: If an assess.ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of !hh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS. (15) .00 X DO .00 (16) 257,266.34 X 045 = 11 ,576. 98 (17) .00 X 12 .00 (18) .00 X 15 .00 (19)= 11,576.98 . PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-05-2004 CD003532 .00 11,464.96 PAYMENT MUST BE MADE BY 04-06-2004*. TOTAL TAX CREDIT 11,464.96 BALANCE OF TAX DUE 112.02 INTEREST AND PEN. .00 TOTAL DUE 112.02 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1470 EX (6-66) INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER KURTZ, MARGARET M REVIEWED BY ACN 2104-0112 101 Kathryn Harbilas ITEM SCHEDULE NO. H B-3 EXPLANATION OF CHANGES Reduced to $1,010.55. Family exemption can only be claimed against assets subject to will or intestacy. ROW Page 1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ANDES SAMUEL L 525 N 12TH ST LEMOYNE, PA 17043 -------- fold r .~ C, . ESTATE INFORMATION: SSN: 211-24.5464 FILE NUMBER: 2104-0112 DECEDENT NAME: KURTZ MARGARET M DATE OF PAYMENT: 04/16/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/06/2003 NO. CD 003836 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $112.02 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: -}I CHECK# 1371 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS ~., $112.02 GLENDA FARNER STRASBAUGH REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REV-1U7 EX AFP (01-05> SAMUEl LANDES 525 N 12TH ST LEMOYNE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-01-2004 KURTZ 07-06-2003 21 04-0112 CUMBERLAND 101 MARGARET M Allount Rellitted PA 17043 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV: i6o7'-Ex-AFP--foY--oiY------...--iNirE'RiYANcE--TAX--STAYEME-NT-cfF'-AcCOlitff--.-..--------------------- ESTATE OF KURTZ MARGARET M FILE NO.21 04-0112 ACN 101 DATE 06-01-2004 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-22-2004 P R I NC I PAL TAX DU E : ........................................................................................................................................................................................................................... 11,576.98 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-05-2004 CD003532 .00 11,464.96 04-16-2004 CD003836 .00 112.02 \ . ',-j .' TOTAL TAX CREDIT 11 ,576.98 I (I .,tnr, ...J ,_ ,. .. BALANCE OF TAX DUE .00 INTEREST AND PEN. .12 1lI IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .12 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) (?..v.... PAYMENT: Detach the top portion of this Notice and submit with your peyment made payable to the name and address printed on 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-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (57.) discount of the tax paid is allowed. PENALTY: The 157. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (I) day from the date of death, to the date of payment. Taxes which became delinquent before January I, 1982 bear interest at the rate of six (67.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January I, 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 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 207. .000548 1988-1991 117. .000301 2001 97. .000247 1983 167. .000438 1992 97. .000247 2002 67. .000164 1984 117. .000301 1993-1994 77- .000192 2003 57. .000137 1985 137. .000356 1995-1998 97. .000247 2004 47. .000110 1986 107. .000274 1999 77- .000192 1987 97. .000247 2000 87. .000219 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) 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.