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Home My WebLink About03-0657Register of Wills of c~.u~ County, Pennsylvania PETITION FOR GRANT OF LE'I'I'ERS EMItter KAREN E. DeMARTYN No.~;~/-D,.~- ~.-~),....~-7 .... ., Deceased Social Secudty No. 208-42-4813 A, Probate and Gent of Lair·rs Taslamenlary and aver Itel Petitioner(s) Is/·· Ih· exeaut___._named ~n Ih· I~st W of me D~ dated .nd codicil(s) d.t.d Gx(~)t II folowl, Dleedl,n! dM not many. was not cllK)rced, ·nd cid not hev.· child bom or adopted after execulton of the documents M/Ired ~ p~ebllt: wel not Ih· ~ of · killing and wes never adjudicated Incompetent: El. Grant of Letters of Ariel·lair·lion_ Potitiofleffs) after · proper search hes/hev~ ·scertalfled that De·ecrm left no Will a~d w·s sur~vecl!~b¥ the following spouse (if any) and ----------.- Relationship daughter Katrina j. Comer :) ttach m~llana/sheem I necessary. DIDIKIInt WIS domlcil/d Bt al·nih in ._..__._.._. Residence ] 311 Second Street,__ ~Summ. e.~dale, 17093 Cum~berlan4 ~~'~"'... 3~ Second Street. (l~f l~ ~m~ ~ m~'p~,~ ~ - · ~nt,~n 51 . ye~ofage,~ July 30 . 2~03 311 Second S~reqt~ S~erdale~ PA (Location) $ I000.00 $ $ P~ W ~e Pen~ ~ Am~)dat~n 1991 W~k~re. PMilloner(s) respectfully, reqUesl(s) Ih· probate of the leal Will and Codicil(s) presented with this Petition end ~e grant of leltem in t~e appropriate forro !o Ih· undersigned: ~Winston ~r~v:. Me_c_h.a~i_c~burg,' ~A 17~55 PA Oath of Personal Representative Commenw#llh of Pennsylvania .:~ c~ ~ ~ ~, ~ ...~ ~. ~ of :-~ ~ ~ PM~loner(s) a~ve-named ~ear(s) or affix(s) that the statements In l~ foregol~ Per,IOn:are tree a~ ~n~ to the best of the knowledge and belief of Petitioner(s) and that. as Personal ~resemat~e(s) of the D~, Peti~oner(s) ~11 well a~ truly ad~~e emate a~rding to law. , belore me this 8th day of Deceased No. ,-~/- 05- Estate of K~a'~.~ ~.. DS~TY~ Social Security No: 208-42-4813 ~ Date of Death: 7/30/03 AND NOW, August I~l' ~-.OO~ ._ ,XI~ 2003 , In consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~1 Testamentaryl[~ Of Administration ,,,.,,..,.:~.~.,~. am hereby granted to Katrina J. Comer In the above estate and that the Instrument(s) dated N/A described In the Petition be admilted to probate and filed of record as the last Will of Decedent. FEES Letter~ ..................... $ II~,c~ Shod Certificate(e) ....$ J2~. oo Renunciation ............ $ /Vndavits ( ) ............. $ Extra Pages ( ) ......... $ Codicil ...................... $ JCPFee ................... S /O.oD Inventory .................. $ O~her ....................... $ Attorney: R. Scott Cramer I.D. No: 22810 Address: P, 0, Box :[59 Duncannon, PA 17020 Telephone: (717) 834-5700 TOTAL ............. $/~ -. Fefl~lRW. IPageS of 2 105,805 REV 9/86 This 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. Fee for this certificate, $2.00 P 9505202 No. Local Registrar AU0 0 4 2003 Date .~5.144 Rev. 1/91 184 Karen UNDER 1 YEAR Days 51 Cumberland Conrai 1 ,~Railroad 311 Second St RES,~NCE Summerdale, Pa I°~°~''~' HER'S NAME (First. M cid,. Las0 Guy Lininger J MOTHER'S NAME (First. M~lde. Malden Surname) I". Maroaret Schar~ Katty J Comer ' 1~.127 Winston Dr~ Mech~ Pa 17055 = ~m =_,.~ .~._~,.B I~%T~,~V ~,~m~ ~(~ Dl,,,Aug 4, 2003 ,,=East Hbg Crematory .. bg, Pa B :N'~E ~ ~E L~ ~~ ~TI~ AS Such ,L~EN'E NUMBER ' ~¢.e..~ O~y~i~ ~ , · . - 011 897-L J~Sulllvan F.H. 1 __.~"~'~b~'".Ol''h~ I ' ure~''ath~r~mt~et~'~ea~pl .... ''' lUCENSENUMBER ~ 5 N. Eno~_..~.[Enola,Pa ~. ¢= ~ 123~. LM ~ ~ eKh ~. .J~xi~ e m~ATE ~e (F~ , ~Em(~C~E~E,CE~: ; Mitral Valve Defect ~.,~ ~. ae~o~e Cardiac Repair '~ PHY~ {~ ~ ~ d ~th ~ ~ ~Y~ b~ ~ ~ ~d ~.. ~ II~ ~3 .................. COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (Coroner) ST~E FILE NUMBER I SEX .SOCIAL SECURITY NUMBER IDATE OF D~ATH (Mo~, Day. Yea~) E DeMartyn ,. Female 3. 208-42-481 3 J, July 30, 2003 Slale c~ F~a~n Country) HOSPITAL: OTHER: I (Month, Day, Year) J ~RTHPLACE (Cily and i PLACE O~ DEATH (C.~eck ~y o,e _ ~ee ~uclkm$ o, amc, s~e) ~ Mi"'""'~Dec. 2,1951l,' Hbg, Pa ,.nt[] EP~O..,~,ntl--I ~:~1-'1 ~1-1 East Pennsboro I,d 311 2nd Street IWASD~OEDENTO~HISPAN~COR~IN? ' I''~'~"'"~ B~ .... 1,. White I ~ ~ ~ E*m,.~/~ I ~ ~--,~. W~. I,,. I.. "( ) U~k "'"~5+) ,,. Divorced ...~.,. Pennsylvania~ -,.~ Ye,,~. East Pennsboro ,..~.~ Cumberland '~,~ ~.~ 17d.~ ~ ~ ~m~ ~ I l: ~Y AT WOflK? DESCfllBE HOW INJURY OCCURRED. SIGNATURE AND T L \ Coroner {,,d. August 1, 2003 ~7),me~P.m Michael L. Norris, Coroner 6375 Basehore Road, Suite #i Mechanicsburg, Pa. 17050 REV-1500 EX + (6-00) I,LI ~oo Z Z X I- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAl REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DeMARTYN KAREN E. DATE OF DEATH (MM-DD-Year) 07/30/2003 DATE OF BIRTH (MM-DD-Year) 12/02/1951 OFFICIAL USE ONLY 7 FILE NUMBER 2 1 -0 3 0 6 5 COUNTYCODE YEAR ~ ~ NUMBER SOCIAL SECURITY NUMBER 2 0 8-4 2-4 8 1 3 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER r~l. Original Return E~]4. Limited Estate [~6. Decedent Died Testate (Attach copyof Will) E~9. Litigation Proceeds Received [] 2. Supplemental Return [~ 4a. Future Interest Compromise (dateofdeath after 12-12-82} [~7. Decedent Maintained a Living Trust (Attach copy of Trust) ] 10. Spousal Poverty Credit (date of death be~een 12-31-91 and 1-1-95) ; TH IS SECTION MUS~; BE ~M~ A L.E COrrESPONDENCE AB NAME FIRM NAME (If Applicable) TELEPHONE NUMB~ ] 3. Remainder Return (date of death priorto 12-13-82) E~5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [~11. Election to tax under Sec. 9113(A) (Attach S~h O) ~ ~N~iDEN~IA~ TA~ i~OR~!O~ SHOULD COMPLETE MAILING ADDRESS 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) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) OFFICIAL USE ONLY 62;886.O6 8,104.83 (11) 6,005.63 (12) 70,990.89 6,005.63 64,985.26 (13) (14) 64,985.26 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19, Tax Due 20. x .0 (15) 64,985.26 x .04.5 (16) x .12 (17) x .15 (18) (19) 2,924.34 2,924.34 Decedent's Complete Address: '1 STREET^DDRESS 311 SECOND STREET i C~T¥ SUMMERDALE ISTATE PA ziP 17093 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 146.22 Interest/Penalty if applicable D. Interest E. Penalty (1) No Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 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 + SA. This is the BALANCE DUE. (SD) Make Check Payable to: REGISTER OF WILLS, AGENT 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; ........................................................................... [] 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? ....................................................................................................... [] 2,924.34 146.22 2,778.12 2,778.12 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 thatJ~ave examined this return, including accompanying schedu es and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the, j;~rsonal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERzSO...~S/PONSIBLE FOR FILI~:rf~T.,Ig'R]~I¢, / DATE ADDRESS /127 WINSTON DRIVE/,/-- - / MECHANICSBURG PA 17055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE 10/29/03 ADDRESS 3528 BRISBAN STREET HARRISBURG PA 17111 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV 1508 EX +(f 97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER DeMARTYN KAREN ~. 21 03 0657 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 401(k) Plan with Massachusetts Mutual Certificate of Deposit at Waypoint Bank Miscellaneous personal property 8 shares of Norfolk Southern common stock @ 18.88 per share TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUEAT DATE OF DEATH 2,664.98 59,570.04 500.00 151.04 62,886.06 R~-1509 EX +(1 97)~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER DeMARTYN KARt~N I~. 21 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. 03 0657 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Katrina J. Comer 127 Winston Drive daughter Mechanicsburg, PA 17055 B JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT ,JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERE.c 1. A. 05~94 Certificate of Deposit at Waypoint Bank 16,209.66 50. 8,104.8~ TOTAL (Also enter on line 6, Recapitulation) $ 8,104.83 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF DeMARTYN KARI~N ~. Debts of decedent must be reported on Schedule I. FILE NUMBER 21 03 ITEM NUMBER 5. 6, 7, DESCRIPTION FUNERAL EXPENSES: Sullivan Funeral Home Gingrich Memorials Food after funeral ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) WAIVE D Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees Scott Cramer, Esquire; Charles E. Petrie, Esquire Family Exemption: (if decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address City Relationship of Claimant to Decedent Probate Fees Accountant's Fees State Zip Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) 0657 AMOUNT 2,108.60 1,213.60 500.00 1,980.00 203.43 $ 6,005.63 REV-1513 EX +(1-97} ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEJ BENEFICIARIES ESTATE OF DeMARTYN NUMBER II. 1. KARI~N ~. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Katrina J. Comer 127 Winston Drive Mechanicsburg, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LIND FILE NUMBER 21 03 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) daughter 15 THROUGH 17, AS APPROPRIATE 0657 AMOUNT OR SHARE OF ESTATE 100% of estate , 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 Il - 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) REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of DeMARTYN KAREN E. also known as Deceased No. 21 03 0657 Date of Death 07/30/2003 Social Security No. 208424813 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe verify that the statements made in this inventory are true and correct. INVe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: I.D. No.: CHARLES E. PETRIE 29029 Person~al~tive: ,.y// Address: 3528 BRISBAN STREET Dated 10/29/2003 HARRISBURG PA 17111 Telephone: (717) 561-1939 Description 401(k) Plan with Massachusetts Mutual Certificate of Deposit at Waypoint Bank Miscellaneous personal property 8 shares of Norfolk Southern common stock @ 18.88 per share (Attach Additional Sheets if necessary) Value 2,664.98 59,570.04 500.00 151.04 Total 62,886.06 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 NAME OF DECEDENT: KAREN E. DeMARTYN DATE OF DEATH: July 30, 2003 WILL NO: ESTATE NO: 2003-00657 Pursuant to Rule 6.12 of the Supreme Court Orphan's 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 X_ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) c. Did the personal representative state an account informally to the parties in interest? Yes No DATE: October 29, 2003 d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and ::/nay be attached to this report. SIGNATURE CHARLES E. PETRIE NAME (PLEASE TYPE OR PRINT) 3528 Brisban Street Harrisburg, PA 17111 ADDRESS (717) 561-1939 TELEPHONE NO. CAPACITY: __ Personal Representative X Counsel for Personal Representative CERTIFICATE OF NOTICE UNDER RULE NAME OF DECEDENT: KAREN E. DeMARTYN DATE OF DEATH: July 30, 2003 WILL NO.: ~ ADMIN NO.: 2003-00657 TO THE REGISTER: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on October 23, 2003. NAME ADDRESS Katrina J. Comer 127 Winston Drive, Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE DATE: 10 / 29 / 2003 ~__ff~~~__ SIGNATURE NAME CHARLES E. PETRIE ADDRESS 3528 Brisban Street Harrisburg, PA 17111 TELEPHONE (717) 561-1939 CAPACITY: X Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 28O6O1 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD OO3185 COMER CHARLES E ESQUIRE 3528 BRISBAN STREET HARRISBURG, PA 17111 ........ fold ESTATE INFORMATION: SSN: 208-42-4813 FILE NUMBER: 2103-0657 DECEDENT NAME: DEMARTYN KAREN E DATE OF PAYMENT: 10/30/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/30/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $2,778.12 TOTAL AMOUNT PAID: $2,778.12 REMARKS: LATRINA DASCH COMER-TAX PAYMT 10/31/03-CHARLES E PETRIE ESQ SEAL CHECK# 104 INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS CDHHONREALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 180601 HARRISBURG, PA 1711B-0601 REV-1S~5 EX AFP (Dg-O0) ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 21 03-0657 ACN 031q567q DATE 11-28-2005 DAVID ! THOMPSON $11N 2ND ST SUMMERDALE pA'17095 TYPE OF ACCOUNT EST. OF KAREN DEMARTYN [] SAVINGS S.S. NO. Z08-qZ-~815 [] CHECKING DATE OF DEATH 07-$0-2005 [] TRUST COUNTY CUMBERLAND [] CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 HAYPOZNT BANK has provided the Department with the information listed below which has been used in calcutating tha potential tax due. Their records indicate that at tha death of tha above decedent, you Nora a joint ownar/benaficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance eith the [nharitanca Tax Laws of the Commoneaalth oF Pennsylvania. Questions ee~ be answered by calling (717) 787-8317. COMPLETE PART I BELOW # # ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 90001~077 Date 0R-09-1990 Established Account Balance 1,~8q.21 Percent Taxable X 50.000 Amount Subject to Tax 7~Z.11 Tax Rate X .15 Potential Tax Due 111.52 To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of #ills. Hake check payabla to: "Register of Nills, Agent". NOTE: If tax payments are made within three ($) months of the dacedent's date of death, you may deduct a 51 discount of the tax due. Any inheritance tax due will bacoma delinquent nina (9) months after tha date of death. PART TAXPAYER RESPONSE A. ~ 1. You may choose to remit payment to the Ragistar of Rills aith two copies of this notice to obtain CHECK ONE BLOCK ONLY Tha above information and tax due is correct. a discount or avoid interest, or you may check box "A" and return this notica to the Register of Nills and an official assessment Hill be issued by the PA Department of Revenue. B. [] The above asset has been or will ba reported and tax paid with the Pennsylvania TnherJtanca Tax return to be filed by the dacadent's representative. C. [] The above information is incorrect and/or debts and deductions ware paid by you. You must complete PART [] and/or PART [] balom. PART If you indicate a different tax rate, please state your [] reiet[onship to decadent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established I 2. Account Balance 2 $. Percent Taxable 3 X ~. Amount Subject to Tax ~ S. Debts and Deductions $ - 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAZNE~) PAYEE DESCRTPTZON AMOUNT PATD TOTAL (Enter on Line $ of Tax Computation) Under penalties_of perjury, T declare that the facts I have rep~lr~tedabove ara ~Lrue,/g~or. rac~and WORK ~ ) ~ ~ t ~ TA~YE~ ~GNA~E TELEPHONE~NUH~E~ DATE GENERAL ZNFORHATZON 1. FAZLURE TO RESPOND #ZLL RESULT ZN AN OFFZCZAL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTZNG ZNSTRUCTZONS - PART ! - TAXPAYER RESPONSE 1. BLOCK A - [f the information and computation in the notice are correct and deductions ara not being claimed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign twa copies and submit thee with your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-154B EX) upon receipt of the return from the Register of t/ills. Z. BLOCK B - Zf the asset specified on this notice has been or will be reported and tax paid aith the Pennsylvania [nharitance Tax Return fi[ed by the decedent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Tndividual Taxes, Dept ZBO601, Harrisburg, PA 171ZB-0601 in the envelope provided. :5. BLOCK C - Tf the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and according to the instructions belom. Sign two copies and submit them mith your check far the amount of tax payable to the Register of t/ills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of t/ills. TAX RETURN - PART 2 - TAX CONPUTATZON L/NE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/ZZ/BZ: Accounts which the decadent put in joint names within one ii) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $$,000 par transferee regardless of the vaIue of the account or the number of accounts held. If a double asterisk (Ex) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as fallows: A. The percent taxable for joint assets established more than one year prior to the decedant's death: I D/VTDED BY TOTAL NUHBER OF DTVlDED BY TOTAL NUt/BER OF X 100 = PERCENT TAXABLE JOTNT Ot/NERS SURVTVTNG JOINT OHNERS Example: A joint asset registered in the name of the decedent and two other persons. ! DTVTDED BY 3 (JOTNT Ot/NERS) DTyTDED BY Z (SURVTVORS) = .167 X 100 = 16.77. (TAXABLE FOR EACH SURVTVOR) B.The percent taxable for assets created mithin one year of the decedent's death or accounts owned by the decedent but held in trust far another individual(s) (trust beneficiaries): 1 DTVTDED BY TOTAL NUt/BER OF SURVTVTNG JOTNT X 100 = PERCEt/T TAXABLE Ot/NERS OR TRUST BENEFTCTARTES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. X DXVXDED BY Z (SURVZVORS) = .50 X lO0 SOZ (TAXABLE FOR EACH SURVTVOR) The amount subject to tax (Xine 4) is determined by multiplying the account balance (line Z) by the percent taxabXe (line 5. Enter the total of the debts and deductions listed Jn Part $. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined below. Date of Death I Spouse Lineal Sibl/ng Collateral 07/01/9q ~o 12/31/9q SZ 6X 01/01/95 ~o 06/30/00 OX 6X 07/01/00 ~o present OX q.BZx 12X younger at aThe tax rate imposed on the nat value of transfers rom ; death to or for the use of a natural parent, an adoptive arent, or a stepparent of the child is OZ. The lineal cIass of heirs includes grandparents, parents, children, and lineal descendents. "Children" incLudes natural children whether or not they have been adopted by others, adopted children and stap children. "'Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes aL1 other beneficiaries. CLATMED DEDUCTTONS - PART 5 - DEBTS AND DEDUCTTONS CLATMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part $. If additional space is needed, usa plain paper 8 l/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. ~ ~~S ~ ~~ a~ ~ '" ~''''''ii'~''~'''~ ...... i~i'~i~" '~ i,~i~ .... ~' ~ i~!iiiiiii!i::iiiii COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OFINDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003359 CRAMER R SCOTT ESQ P O BOX 159 DUNCANNON, PA 17020 ........ fold ESTATE INFORMATION: SSN: 208-42-4813 FILE NUMBER: 21 03-0657 DECEDENT NAME: DEMARTYN KAREN E DATE OF PAYMENT: 12/22/2003 POSTMARK DATE: 12/19/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/30/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $111.32 REMARKS: TOTAL AMOUNT PAID: $111.32 SEAL CHECK# 533 INITIALS: AC RECEIVED BY' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-Z$115 EX AFP cgg-o0) DAVID I THOMPSON $11N 2ND ST : PO BOX 9q ~ SUMMERDALE PA'~17095 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 03-0657 ACN 031q5675 DATE 11-28-2003 TYPE OF ACCOUNT EST. OF KAREN DEMARTYN [] SAVINGS S.S. NO. ZOB-qZ-q815 [] CHECKING DATP. OF DF. ATN 07-$0-Z005 [] TRUST COUNTY CUMBERLAND [] CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 #AYPOINT BANK has provided the Department Nith the information listed beloa uhich has been used in calculating the potential tax duo. Their records indicate that at the death of the above decadent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain ~rittan correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance ~ith the Inheritance Tax Lams of the Commonwealth of Pennsylvania. Questions may be ans~arad by calling (717) 787-8527. COMPLETE PART I BELON # x x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 903000503 Date 05-16-1995 Establ 1shed Account Balance 8,65 0 . 13 Percent Taxable X 50.0 0 0 Amount: Subject to Tax ~')3~5.07 Tax Rate X .15 Potential Tax Due 6q8.76 To insure proper credit to your account) tho (Z) copies of this notice must accompany your payment to the Register of Mills. Make check payable to: "Register of Hills, Agent". NOTE: If tax payments ara made ~ithin three ($) months of the dacadant's date of death, you may deduct a 5g discount of the tax due. Any inheritance tax due ~il1 become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. ~.~The above information and tax due is correct. YOU lay choose to ralit paylent to the Register of Nills .ith tea copies of this notice to obtain a discount or avoid interest, or you lay check box "i" and return this notice to the Register of l-- CHECK --I Nins end an official assessment ~eill be issued by the PA Department of Revenue. ONE BLOCK J s. [] The above asset has been or Nil1 be reported and tax paid Nith the Pennsylvania Inheritance Tax return ONLY to be filed by the dacadent's representative. C. [] The above information is incorrect and/or debts and deductions aero paid by you, You must complete PART [] and/or PART [] balm1. If you indicate a different tax rate) please state your relationship to decadent: PART TAX LINE RETURN - COMPUTATION 1. Date Established OF TAX ON dOZNT/TRUST ACCOUNTS 1, 2. Account Balance ~. Percent Taxable q. Amount SubSact to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART DATE PAID DEBTS AND DEDUCTIONS CLAZMEn PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line S of Tax Computation) __Under panal_t~es of perSury, I declare that the facts I have reported above ore. true, .codFect and 0 X~YER SIGNATURE TELEPHONE NUMBER 6ENERAL ZNFORHATZON 1. FAILURE TO RESPOND NZLL RESULT ~N AN OFFiCiAL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. 2, Inheritance tax becomes delinquent nine months after the decedant's date of death. 5. A joint account is taxable even though the decedant's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) ~hich the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly bett~een husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING iNSTRUCTiONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions ara not being claimed, place an "X" Jn block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them ,ith your check for the amount of tax to the Register of #ills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-IS48 EX) upon receipt of the return from the Register of Nills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decadent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept leo601, Harrisburg, PA ITIZB-060I in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions ara being cLaimed, check block "C" and compLete Parts Z and 3 according to the instructions below. Sign two copies and submit thee with your check for the amount of tax payabLe to the Register of Nills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-IS4& EX) upon receipt of the return from the Register of Nills. TAX RETURN - PART 2 - TAX CONPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/Il/el: Accounts which the decedent put in joint names within one (1) year af death are taxable fully as transfers. Ho~aver, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (em) appears before your first name in the address portion of this notice, the $3,000 exclusion already has bean deducted free the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: i DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 = PERCENT TAXABLE JOINT O#NERS SURVIVING JOINT ONNERS Example: A joint asset registered in the name of the decedent and t~o other persons. I DIVIDED BY 5 (JOINT ONNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created wlthln one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): i DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE O#NERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. I DIVIDED BY 2 (SURVIVORS) = .50 X 100 = 5DZ (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is detaralned by multiplying the account balance (line Z) by the percent taxable (line 5). 5. Enter the total of the debts and deductions listed in Part 3. 6. The aaount taxable (line 6) is detarained by subtracting the debts and deductions (line S) froa the aaount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. .~ Date of Death [ Spouse ! Lineal Sibling Collateral 07/01/9~ to 12/31/9~ 3Z 6Z 15Z 15Z 01/01/95 to 06/30/00 OX 6Z 07/01/00 to present OX ~.$Z~ mThe tax rate imposed on th~ net value of tra younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OZ. The lineal class of heirs includes grandparents, parents, children, end lineal descendents. "Children" includes natural children whether er not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common t~ith the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLATHED DEDUCTTONS - PART $ - DEBTS AND DEDUCTTONS CLATHED AllowabLe debts and deductions are determined as foLlows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible itees. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being ¢laimed must be itemized fully in Part 3. If additional space is needed, use plain paper B l/Z" x 11". Proof of payment Bay be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003358 CRAMER R SCOTT ESQ P O BOX 159 DUNCANNON, PA 17020 ........ fold ESTATE INFORMATION: SSN: 208-42-4813 FILE NUMBER: 21 03-0657 DECEDENT NAME: DEMARTYN KAREN E DATE OF PAYMENT: 12/22/2003 POSTMARK DATE: 12/19/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/30/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $648.76 REMARKS: TOTAL AMOUNT PAID: $648.76 SEAL CHECK# 534 INITIALS: AC RECEIVED BY' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS CONHON#EALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17ZZ8-0601 REV-I;43 EX AFP ZNFORHATZON NOTICE AND TAXPAYER RESPONSE FILE NO. 21 05-0657 ACN 05145675 DATE 11-28-2005 DAVID I THOHPSON: 511N 2ND ST SUHNERDALE PA 17095 TYPE OF ACCOUNT EST. OF KAREN DEHARTYN I~-ISAVZNO$ S.S. NO. ZO8-4Z-4815 I---ICHECKZNG DATE OF DEATH 07-50-2005 [~]TRUST COUNTY CUNBERLAND I---]CERTZF. REHZT PAYHENT AND FORHS TO: REGISTER OF HILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 NAYPOZNT BANK has provided tho Department ,ith the information 11stad beloa ehich has been used in calculating the potential tax due. Their records indicate that at tho death of the above decedent, you were a joint owner/beneficiary of this account. Tf you feel this information is incorrect, please obtain erittan correction free the financial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance with the Tnheritance Tax Laos of the Coaeonwealth of PmnnsyZvan]e. Questions may be ansaered by calling (717) 787-85Z7. CONPLETE PART 1 BELON # ~ ~ SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS Account No. 950005977 Data 04-09-1990 Established Account Balance 25,177.15 Percent Taxable X 50.000 Amount Subject to Tax 1Z,565.57 Tax Rate X .15 Potential Tax Due 1,884.54 To lnsura proper credit to your account, two (Z) copies of this notice must accompany your payment to tho Register of Nills. Hake check payable to: "Register of gills, Agent". NOTE: If tax payments are made within three (3) months of tho decadant's date of death, you may deduct a SZ discount of the tax due. Any inheritance tax dug will bacoea delinquent nine (9) months after tho date of death. PART TAXPAYER RESPONSE A. ~ The above information and tax due is correct. 1. You may choose to remit payment to tho Register of Hills with two copies of this notice to obtain a discount or avoid interest, or you say check box "A" and return this notice to the Register of E CHECK ~] Nllls and an officlal assessment will be issued by the PA Department Of Revenue. ONE BLOCK J B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY ta be filed by the dacedant's representative. C. [] The above information is incorrect and/or debts and deductions ware paid by you. You eust complete PART [] and/or PART [] below. PART If you ~nd[cate a different tax rate, please state your relationship ~o decedent: TAX RETURN - COHPUTATZON OF TAX ON JOINT/TRUST ACCOUNTS LINE ~. Date Established 2. Account Balance $. Percent TaxabZe q. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rata 8. Tax Due PART DATE PAID DEBTS AND DEDUCTIONS CLAZHED PAYEE DESCRIPTION AHOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under panal~J~es of perjury. ! declare that the plat,//t/°~ th~/~e/st// of my kno,l,dg, and b, li,f. fa;ts! hav.HONEr.port.d ~AXPAYE~SZG~TURE TELEPHONE NUHBE, C~'e c t and 'DATE SENERAL INFORMATION 1. FAILURE TO RESPOND NILL RESULT IN AN OFFICIAL TAX ASSESSNENT with applicable interest based on information submitted by the financlal institution. 2. Inheritance tax becomes daIinquent nine months after the dacedent's date of death. $. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and aife) ahich the decedent put in joint names aithin one year prior to death are fully taxable as transfers. S. Accounts established jointly between husband and eifs moro than one year prior to death ara not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART [ - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an in block "A" of Part ! of the "Taxpayer Response" section. Sign two copies and submit them aith your check for the amount of tax to the Register of Mills of the county indicated. The PA Department of Revenue mill issue an official assessment (Form REV-LS4B EX) upon receipt of the return from the Rag[star of NilIs. Zo BLOCK B - If the asset specified on this no[ica has been or will ba reported and tax paid aith the Pennsylvania Inheritance Tax Return filed by the dacedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign cna copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dap[ zao6Ol, Harrisburg, PA 171Za-g601 in the envelope provided. $. BLOCK C - If the not[ce information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts Z and S according to the instructions below. Sign tee copies and submit them with your check for the amount of tax payable to tho Rag[star of NiLLs of the countY indicated. The PA Department of Revenue will issue an official assessment (Form REV-lS48 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART ? - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after II/II/BI: Accounts which the decedent put in joint names within one (1) year of death ara taxable fuZZy as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (xe) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as raparted by the financial institution. Enter tho to[mi balance of the account including interest accrued to the date of death. $. The percent of the account that is taxable for each survivor is da[ermined as fallows: A. The percent taxable for joint assets established more than one year prior to the decedant's death: I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X lO0 = PERCENT TAXABLE JOINT O#NERS SURVIVING JOINT OHNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT ORNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the decadent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): i DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = .SO X lO0 = ROI (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined below. De~e of Death Spouse Lineal ] Sibling Collateral 07/01/9q ~o 12/31/9q 3X 6X 15Z 15Z 01/01/95 to 06/30/00 OX 6Z 07/01/00 ~o presen~ OX xTha tax rate imposed on the nat value of transfers from a G~s :Y younger et death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OZ. The Lineal class of heirs includes grandparents, parents, children, and Linea! descendents. "Children" includes natural children ~hether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined es individuals who have at least cna parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can ~urnish proof of payment. C. Debts being claimed must be itemized fully in Part 5. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. 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 003357 CRAMER R SCOTT ESQ P O BOX 159 DUNCANNON, PA 17020 ........ fold ESTATE INFORMATION: SSN: 208-42-4813 FILE NUMBER: 2103-0657 DECEDENT NAME: DEMARTYN KAREN E DATE OF PAYMENT: 12/22/2003 POSTMARK DATE: 12/19/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/30/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,884.54 REMARKS: TOTAL AMOUNT PAID: $1,884.54 SEAL CHECK# 535 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS ~v]IUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT[CE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX R~V-1547 EX AFP DATE 12-22-2005 ESTATE OF DEMARTYN KAREN E DATE OF DEATH 07-50-2005 FILE NUMBER 21 05-0657 '~ .~ :COUNTY CUMBERLAND CHARLES E PETRIE ACN 101 $528 BRISBAN ST Amount Remitted HBG PA 17111 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS REV-1547 EX AFP C01-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF DEMARTYN KAREN E FILE NO. 21 05-0657 ACN 101 DATE 12-22-2005 TAX RETURN NAS: ( X} ACCEPTED AS FILED C ~ CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate CSchedule A) 2. Stocks and Bonds CSchedule B3 C2) $. Closely Held Stock/Partnership Interest CSchedule C3 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Sank Deposits/Misc. Personal Property (Schedule 6. Jointly Owned Property CSchedule F) 7. Transfers CSchedule G) C7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/M/sc. Expenses CSchedule H) 10. Debts/Mortgage Liabilities/Liens CSchedule I) CIO) 11. Total Deductions 12. Net Value of Tax Return 15. 14. Charitable/Governmental Bequests; Non-elected 9115 Trusts CSchedule J~ Net Value of Estate Subject to Tax 62~886.06 8t104.85 .00 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper portion .00 of this form with your tax payment. C8] 6,005.65 70,990.89 .00 ti2:) 64,985.26 .00 64,985.26 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: 15. Amount of Line 14 at Spousal rate C15} 16. Amount of Line 14 taxable at Lineal/Class A rate C16) 17. Amount of Line 14 at Sibling rate C17} [8. Amount of Line 14 taxable at Collateral/Class B rate C18) 19. Principal Tax Due .00 x O0 = .00 64,985.26 x 045= 2,924.54 .00 x 12 = .00 .00 x 15 = .00 c~9~= 2,924.5~ RECEIPT I DISCOUNT C+~ NUMBER I INTEREST/PEN PAID (-) CD005185 146.22 TAX CREDITS PAYMENT DATE 10-50-2005 AMOUNT PAID 2,778.12 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 2,924.54 .00 ( IF TOTAL DUE IS LESS THAN 91, NO PAYMENT IS REQUIRED. .00 .00 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CA}, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.} RESERVATION= PURPOSE OF NOTICE: PAYMENT= REFUND (CR): OBJECTIONS= ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class 8 (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 8 (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S. Section 9140). 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= EEGZS~"~ OF NZL[G, A~r~ 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-ISZSI. ApPlications are available at the Office of the Register of NilZs, any of the 25 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: ]-800-562-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-5020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must obSect within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. 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 within three (SI calendar months after the decedent's death, a five percent (SX) discount of the tax paid is allowed. The 15X 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 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 Daily Interest Daily Interest Daily Year Rate Factor Y ea.~r Rate Factor Year Rate Factor m 1982 20Y. .000548 1987 9Y. .000247 I999 7Y. .000192 1983 16Y. .000458 1988-1991 11X .000501 2000 8Y. .000219 1984 llY. .000501 1992 9~ .000247 2001 9X .000247 1985 ISY. .000556 1995-1994 7Y. .000192 2002 6~ .000164 1986 IOY. .000274 1995-1998 9Y. .000247 2003 5Y. .000157 --Interest is calculated as follows: /NTEREST = BALANCE OF TAX UNPAZD X NUHBER 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. Interest is charged beginning with first day of delinquencY, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six C&X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 wil! 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 2005 are: BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRTSBURG, PA 17128-0601 COMHONWEALTH OF PENNSYLVAN/A DEPARTHENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-I&07 EX AFP (01-03) CHARLES E PETRIE $528 BRISBAN ST HBG PA 17111 DATE 01-Z6-Z00q ESTATE OF DEMARTYN DATE OF DEATH 07-$0-2005 FILE NUMBER 21 0:5-0657 COUNTY CUMBERLAND ACN 101 f Amoun~c Remi'l:'l:ed KAREN E HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his fore wi~h your ~ax payment. CUT ALONG THIS LINE ~ RETA*rN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~a ZNHERZTANCE TAX STATEMENT OF ACCOUNT aa~ ESTATE OF DEMARTYN KAREN E FZLE NO. 21 05-0657 ACN 101 DATE 01-26-ZO0q THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHONN BELON 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: 1Z-22-2005 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 2,9Zq.$q PAYMENT DATE 10-$0-200~ 12-19-2005 12-19-Z005 12-19-2005 RECEIPT NUMBER CD005185 CD005557 CD003558 CD005359 DISCOUNT C+) INTEREST/PEN PAID (-) lq6.Z2 .00 .00 .00 IF PAID AFTER THIS DATE, SEE REVERSE SIDE 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), AMOUNT PAID 2,778.12 1,88q.Eq 6q8.76 111.$2 TOTAL TAX CREDIT 5,568.96 BALANCE OF TAX DUE Z,6qq.6ZCR INTEREST AND PEN. .00 TOTAL DUE 2,6qq.6ZCR YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- Zf RESIDENT DECEDENT make check or money order payable to: REG/STER OF HILLS, AGENT. -- Zf NON-RESIDENT DECEDENT make check or money order payable to: COHHONNEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit) ehich aaa not requested on the Tax Return) amy ba 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 13 Revenue District Offices or free the Department's Z4-hour ensaaring service for fores ordering: 1-800-362-Z050; services for taxpayers aJth special hearing and / or speaking needs: 1-800-q47-3020 (TT REPLY TO: guestions regarding errars contained on this notice should be addressed to: PA Department of Revenue) Bureau of Individual Taxes) ATTM: Post Assessment Reviee Unit, Dept. ZB06gl, Harrisburg) PA 17118-0601, phone (717) 787-6505. DZSCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Z) discount of the tax paid is aiZoaed. PENALTY: The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and nat paid before January 18) 1996, the first day after the and of the tax amnesty period. INTEREST: Interest is charged beginning eith first day of delinquency, or nine (9) months and one (1) day from the date of death) to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (61) percent par annum calculated at a daily rate of .000164. All taxes Nhich became delinquent on end after January l, 1982 mill bear interest at a rate ehich will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The appIicabIa interest rates far 198Z through 2003 are: Interest Daily Interest Daily Interest Daily Rate Factor Year Rate Factor Year Rate Factor 1981 ZOZ .000548 1987 91 .000147 1999 71 .000191 1983 161 .000438 1988-1991 111 .000301 ZOO0 81 .000Z19 1984 111 .000301 1991 91 .0002~7 2001 91 .000Z~7 1985 13Z .000356 1993-199~ 71 .000191 ZOOZ 61 .00016~ 1986 101 .O00ZTq 1995-1998 91 .000Z47 Z003 SZ .000137 --Interest is calculated as follows: :INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY 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. Zf payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF ZNDTVZDUAL TAXES TNHERTTANCE TAX D'[VI'S'rON DEPT. Z80601 HARRISBURG., PA 171Z8-0601 DAVID I THOMPSON 311N 2ND ST PO BOX 9q SUMHERDALE CONMONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHER/TANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS Regi~:t '04 q::~DATE O$-08-ZOOq ESTATE OF DEMARTYN DATE OF DEATH 07-30-2003 FILE NUMBER Z! 03-0657 CUMBERLAND 208-~2-~813 031~5675 REV-i~8 EX AFP COX-OS) KAREN E ,,C~UNTY P3 :~SSN-DC ACN Amoun'l: R~,m'i 't'lcmd HAKE CHECK PAYABLE AND REMXT PAYMENT TO: RE6TSTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THXS LINE ~-* RETAIN LOHER PORTION FOR YOUR RECORDS ~ REV-154B EX AFP (01-03) NOTICE OF XNHERXTANCE TAX APPRAISEMENT, ALLOHANCE OR DXSALLOHANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-08-Z00~ ESTATE OF DEMARTYN KAMEN E DATE OF DEATH 07-30-2003 COUNTY CUMBERLAND FILE NO. 21 03-0657 S.S/D.C. NO. ZO8-qZ-~813 ACN 051q5675 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: HAYPOINT BANK ACCOUNT NO. 903000505 TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING C ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-16-1995 Accoun~ BaZance 8,650.13 Percen~ TaxabZe X 0.500 Amoun~ Subjec~ ~o Tax q,325.07 Debts and Deductions - .00 Taxable Amoun~ ~,325.07 Tax Ra~e ~ .15 Tax Due 6~8.76 NOTE= TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE HITH YOUR TAX PAYHENT TO THE REGISTER OF HILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO= ffREGISTER OF HILLS, AGENT.ff TAX CRED'rTS: PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) PAYMENT MUST BE MADE BY 05-01-ZOOq~. TOTAL TAX CREDZT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ~F PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADD/TIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" { CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) .00 6q8.76 .O0 6q8.76 BUREAU OF INDIVIDUAL TAXES /NHERZTAHCE TAX DZVXS/nN DEPT. 280601 HARRISBURG, PA 171Z8-0601 DAVID I THOMPSON $11N ZND ST SUMMERDALE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF /NHERXTANCE TAX APPRAXSEHENT, ALLO#ANCE OR DXSALLO#ANCE OF DEDUCTTONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS R~d,'- ~ C:~ - , ! DATE 05-08-2004 ~,,e~ :~,~ : : i!S ESTATE OF DEMARTYN KAREN DATE OF DEATH 07-$0-Z005 FILE NUMBER 21 05-0657 '04 H~R-5 P3'A~COUNTY CUMBERLAND '~ SSN/DC 208-42-4815 ACN 0~145674 PA 17~[i~ ~ ~ I Amoun~ Rmm/~md HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 REV-1648 EX AFP (01-03) CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-156B EX AFP (01-03} NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS BATE 03-08-2004 ESTATE OF DEMARTYN KAREN E DATE OF DEATH 07-$0-2005 COUNTY CUMBERLAND FILE NO. 21 05-0657 S.S/D.C. NO. 208-42-4815 ACN TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED 05145674 JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: NAYPOINT BANK ACCOUNT NO. 900014077 TYPE OF ACCOUNT= ( ) SAVINGS ¢ ~ CHECKING ( ) TRUST ¢ ) TIME CERTIFICATE DATE ESTABLISHED 04-09-1990 Accoun~ Balance 1,484.21 Percen~ Taxable X 0.500 Amoun~ Sub~ec~ ~o Tax 742.11 Debts and Deduc~/ons - .00 Taxable Amoun~ 742.11 Tax Ra~e X .15 Tax Due 111.$2 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-19-2005 CD005559 .00 111.$2 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE XF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADD/TZONAL INTEREST. ZF TOTAL DUE 1S LESS THAN $1, NO PAYHENT 1S REQUIRED. ZF TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORH FOR INSTRUCT/OHS. ) 111 .$2 .00 .00 .00 BUREAU OF ZNDZI/ZDUAL TAXES TNHERZTANCE TAX DTVZSTON DEPT. Z80601 HARRXSBURG, PA 171Z8-0601 DAVID I THOMPSON $11N ZND ST SUNHERDALE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLORANCE OR DZSALLOHANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE O$-08-ZOOR ESTATE OF DEMARTYN DATE OF DEATH 07-$0-2005 FILE NUHBER Z1 05-0657 COUNTY CUHBERLAND -5 P3:43SSN/~C 208-~2-~815 ACN 051~5675 Amoun~ Rmm/~ed REV-I~8 EX AFP COl-OS) KAREN E MAKE CHECK PAYABLE AND RENXT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THTS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAXSEHENT, ALLOWANCE OR DXSALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON dOXNTLY HELD OR TRUST ASSETS DATE 03-08-200~ ESTATE OF DEHARTYN KAREN E DATE OF DEATH 07-$0-2003 COUNTY CUHBERLAND FILE NO. 21 03-0657 S.S/D.C. NO. ZO8-~Z-4813 ACN TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED 031~5673 JOINT OR TRUST ASSET XNFORHATZON FINANCIAL INSTITUTION: WAYPOINT BANK ACCOUNT NO. 930003977 TYPE OF ACCOUNT: (~ SAVINGS ¢ ) CHECKING ( ) TRUST ( ) TIHE CERTIFICATE DATE ESTABLISHED 0~-09-1990 Account Balance Percent Taxable X 0.500 Amount Subject to Tax 12,565.57 Debts and Deductions .00 Taxable Amount 12,563.57 Tax Rate X .15 Tax Due 1,884.5~ TAX CREDITS: 25,127.13 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT.** PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-19-2003 CD003357 .00 1,88~.5~ TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DTVZS/ON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 CHARLES E PETRIE 5528 BRISBAN ST HBG COHHONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT Re.,.~ ,.~ q* 'i:: ~ .... DATE 03-01-Z00~ ~ ~:: ........ ESTATE OF DEHARTYN DATE OF DEATH 07-30-2003 'OZ~ ,F~R -5 r~ '~, .FILE NUHBER 21 0S-0657 ..... "4COUNTY CUHBERLAND ACN 101 Amoun~ Remi~ed REV-1607 EX AFP KAREN E HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUH]iERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit: ~o your account, submi~ ~:he upper portion of ~:his form wJ~h your ~:ax payment:. CUT ALONG THIS LINE ~" RETAIN LONER PORTION FOR YOUR RECORDS ~ ESTATE OF DEHARTYN KAREN E FILE NO.Z! 03-0657 ACN 101 DATE 03-01-Z00~ THIS STATEHENT IS PROV/DED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAHED ESTATE. SHO#N BELO# TS A SUNNARY OF THE PR/NC/PAL TAX DUE, APpLTCATTON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, TF APPL/CABLE, A PROJECTED INTEREST FTGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 12-22-2003 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): Z,gZ~.3~ PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 10-30-Z003 12-19-2003 O2-Z5-Z00R CD003185 CD003358 REFUND 1~6.22 .00 .00 2,778.12 6~8.76 6~8.76- ZF PA/D AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDZT/ONAL [NTEREST. ( ZF TOTAL DUE 1S LESS THAN $1, NO PAYHENT 1S REQUIRED. ZF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORH FOR /NSTRUCTTONS. ) BUREAU OF ZND/VZDUAL TAXES THHER/TAHCE TAX D/VTSTON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (01-03) DAVID I THOMPSON 311 N 2ND ST SUMMERDALE PA 6~£0~ $ DATE 05-08-2004 ESTATE OF DEMARTYN DATE OF DEATH 07-$0-2005 FILE NUMBER 21 05-0657 COUNTY CUMBERLAND ACN 03145674 f Amoun~ Remi~ed KAREN E MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To /nsure proper credi~ ~:o your account~ submi~ ~che upper pore/on of ~ch~s fore wi~:h your ~ax payment. CUT ALONG THIS L'rNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-lb07 EX AFP [01-03) ~N INHERITANCE TAX STATEMENT OF ACCOUNT N~ ESTATE OF DEMARTYN KAREN E FILE NO. 21 05-0657 ACN 05145674 DATE 05-08-Z004 TH/S STATEMENT TS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACH TN THE NAMED ESTATE. SHONN BELO# ZSA SUMMARY OF THE PRINCIPAL TAX DUEt APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE; AND, ZF APPLICABLE, APROJECTED /NTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-08-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... 111.52 PAYNENTS (TAX CREDITS): PAYMENT DATE 12-19-Z005 RECEIPT NUMBER CD005559 DISCOUNT (+) INTEREST/PEN PAID (-) .00 ZF PAID AFTER THIS DATEr SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1~ NO pAYHENT ZS RE~U/RED. AMOUNT PAID 111.52 TOTAL TAX CREDIT 111.52 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ZF TOTAL DUE 1S REFLECTED AS A "CREDIT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PAYMENT: 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 WILLS, AGENT. -- If NON-RES/DENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CE): 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-1315). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the DepartMent's Z4-hour answering service for fores ordering: [-800-36Z-ZOSO~ services for taxpayers with speoJal hearing and / or speaking needs: 1-800-4qT-30ZO (TT 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. Za06Ol, Harrisburg, PA 171Z8-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent ESI) discount of the tax paid is allowed. PENALTY: The [SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, [996, 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 (l) day from the date of death, to the date of payment. Taxes which became delinquent before January I, 198Z bear interest at the rate of six (BI) percent per annum calculated at a daily rate of .000164. Al! taxes which became delinquent on and after January 1, 198Z wi[! 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 ZOO4 are: Interest Daily Interest Dally Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 log .O00Sq8 1988-[991 llX .OOO3O! ZOO1 9Z .OOOZ~7 1983 IBZ .000438 1992 9Z .000Z47 2002 6Z .00016~ 1984 iII ,000301 1993-1994 7Z .000192 2003 5Z .000137 1985 13Z .000356 1995-1998 9Z .000Z47 2004 OX .000110 1986 lOX .000Z74 1999 ?g .O0019Z 1987 9Z .O00Zq7 ZOO0 8Z .000219 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. Zf payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF ZMDZVIDUAL TAXES iNHERITANCE TAX DIVISION DEPT. Z8060! HARRTSBURG, PA 171Z8-0601 COMMONWEALTH OF pENNSYLVANIA DEPARTMENT OF REVENUE ZNHER/TANCE TAX STATEMENT OF ACCOUNT '04 B~R 12 P1:46 DAVID I THOMPSON 311N ZND ST SUMMERDALE PA 1~-~98: '': REV-lAG7 EX ~FP (01-05) ESTATE OF DATE OF DEATH F'rLE NUMBER COUNTY 03-08-ZOOq DEMARTYN 07-30-2003 21 03-0657 CUMBERLAND 031q5673 KAREN E Ac. MAKE CHECK PAYABLE AND REMTT pAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payment. TAZN LONER PORTZON FOR YOUR RECORDS '"~ CUT ALON6_?~I~-~-/-~---:?---I~- .... ~;G~-~-~fi~-f~"~T~-~[k~'~f'~-~-~'~5~T ~-~a ESTATE OF DEHARTYN KAREN E FILE N0.21 0~-0657 ACN 0~1q567~ DATE O$-08-ZOOq THZS STATEMENT 1S PROVIDED TO ADVZSE OF THE ~RR~T~ ~ THE STATED ACH ZH THE NAHED ESTATE. SHOHN BELOH IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLZCATZON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, ~ECTED ZNTEREST FZGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-08-ZOOq PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... pAYMENTS (TAX CREDITS): PAYMENT DATE 12-19-2003 NUMBER CD003557 DISCOUNT C+) INTEREST/PEN PAID (-) .00 AMOUNT PAID 1,88q.5fi TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THZS DATE~ SEE REVERSE S/DE FOR CALCULATION OF ADDZT/ONAL INTEREST. ( IF TOTAL DUE 1S LESS THAN $1, NO pAYMENT 1S REgU/RED. IF TOTAL DUE 1S REFLECTED AS A .'CREDZT" YOU MAY BE DUE A REFUND. SEE REVERSE SZDE OF TH/S FORM FOR ZNSTRUCTZONS- ) 1,88q.5~ 1,88q.5q .00 .00 .00 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 #ILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order Payable to: COHHON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested an the Tax Return, amy be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" the Office of the Register of Hills, any of the Z3 Revenue District (REV-1315). Applications are available at Offices or frei the Department's Z4-hour answering service for fares ordering: 1-800-$62-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-$020 (TT only). REPLY TO: Questions regard]no errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Past Assessment Review Unit, Dept. 280601, Harrisburg, PA 1712D-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 (52) discount of the tax Paid is allowed. PENALTY: The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, end not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest DaiIy Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rats Factor 1982 ZOZ .000548 1988-1991 112 .000501 ZOO1 92 .000247 1983 162 .000438 1992 92 .000247 ~OOZ 62 .000164 1984 112 .000301 1993-1994 72 .000192 Z003 52 .000137 1985 15Z .000356 1995-1998 92 .000247 2004 42 .OD0110 1986 lOZ .000274 1999 72 .000192 1987 92 .000247 ZOO0 82 .000219 Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of Payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (62) Percent per annum calculated at a daily rate af .000164. Ail taxes which became delinquent on and after January l, 1982 will bear interest at a rats 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 Z004 are: --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 (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. Oath of Personal Representative CommonwlMth of Penneylvanl~ ': County of _ .~ fllo~r e a~ve-named swear(s) or affix(s) that the statements in t~e: foregoi~ PetiU~n:are tree .~'~tto the ~st of tho knowledge and belief of Pehtioner(s)and that, as personal ~rese.atlve(s)of the O~, PetiUoner(s) ~11 well a~ truly ad~~e e~ate a~rding to law. ~fom ~ t~s ~ day of , August , :_~ 20~3 ~tate of_ ~'g~ g- DS~Y~ ~al Se~ty No: ~0~-42-4s~ 3 ~ Date of Death: 7/30/03 AND NOW, Au~st Il, ZOO~ -- ,,, ~ ~003 , In mnsl~ratlon el the Petit~n on the reverse side hereon, satisfa~ory proot having been presented before me, ff IS DECREED that Le~em ~ Testa~ma~O ~ Administration . are homey grained to Katrina J. Comer in the above estate and that the Instrument(s) dated N/A described In tho Petition bo admitted to probate and filed of record as the last Will of Decedent. · e.em ..................... Shod Certificate(s) .... $ J2... oo Renunciation ............ $ Afffda~s ( ) ............. $ Extra Pages ( ) ......... $ Codicil ...................... $. JCP Foe ................... $_ i0. o c~ Inventory .................. $ Other ....................... TOTAL ............. $ Ilmeled Iw ltl P~ h AIIOdl'dOfl 1991 Attorney: R. Scott Cramer I.D. No: 22810 Address: P.O. Box 159 Duncannon, PA 17020 Telephone: (717) 834-5700 BUREAU OF ZNDTVTDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMHONNEALTH OF PENNSYLVAN'rA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-I&07 EX AFP (02-05) '04 APR 14 A 9 ''*~.,.-,1 DAVID I THOMPSON $11 N 2ND ST PO BOX 9~ SUMHERDALE PA DATE 03-Z9-ZOOq ESTATE OF DEHARTYN DATE OF DEATH 07-$0-2005 F/LE NUHBER 21 05-0657 COUNTY CUMBERLAND ACN 051q5675 I Amoun~ RemL~ed KAREN E HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper cred/t to your account, subm/t the upper port/on of this fora with your tax payment. CUT ALONG THIS L'rNE ~ RETA'rN LONER PORT'rON FOR YOUR RECORDS *~ REV-1607 EX AFP (01-03) ### 'rNHER'rTANCE TAX STATEMENT OF ACCOUNT ~.- ESTATE OF DEMARTYN KAREN E FILE NO. 21 03-0657 ACN 031~5675 DATE 03-29-200~ THIS STATEMENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACM TN THE NAMED ESTATE. SHOWN BELO# 1S A SUMMARY OF THE pRTNCTpAL TAX DUE, APPLTCATTON OF ALL PAYMENTS, THE CURRENT BALANCE:. AND,, TF APPLTCABLE, A PROJECTED 'rNTEREST FTgURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-08-Z00~ PRINCIPAL TAX DUE= ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 6q8.76 PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-19-2003 CD003358 .00 6q8.76 ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. { ZF TOTAL DUE ZS LESS THAN $1., NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), TOTAL TAX CREDIT 6q8.76 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORM FOR TNSTRUCTZONS. } PAYNENT: Detach the top portion of this Notice and submit aith 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 HILLS, AGENT. -- Zf NON-RESIDENT DECEDENT make check or money order payable to: COHNONNEALTH 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-1315). Applications ara available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or from the Department's Z4-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers aith special hearing and / or speaking needs: 1-800-447-30Z0 (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. 280601, Harrisburg, PA 171Z8-0601, phone (717) 787-6505. DIS~OUNT: If any tax due is paid within three (3) calendar months after the dacedant's death, a five percent (SI) discount of the tax paid is a11oaad. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. INTEREST: Interest is charged beginning with first day cf delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ahich became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculatmd at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 ail1 bear interest at a rate which ail1 vary from calendar year ta calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z 20Z .000548 1988-1991 11Z .000301 ZOOZ 9Z .000Z47 1983 16Z .000438 199Z 9Z .000247 ZOOZ 6Z .000164 1984 X1Z .OaO$O1 1993-1994 7Z .OOO19Z 2003 5Z .000137 1985 13Z .000356 1995-1998 9Z .000247 ZOO4 4Z .000110 1966 IOZ .000274 1999 7Z .O0019Z 1987 9Z .000247 2000 8Z .O00ZX9 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (151 days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DTVI*SZON DEPT. 280601 HARRISBURG) PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT REV-1Ge7 EX &FP CHARLES E PETRIE 5528 BRISBAN ST HBG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN PA 05-29-2004 DEMARTYN 07-$0-2005 21 05-0657 CUMBERLAND 101 Aloun~ RelnJ. J:~ed KAREN E HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To /nsure proper credL~ ~o your account, sub. i~ ~he upper portion of ~his fore wi~h your ~ax peylen~. CUT ALONG THIS LINE ~'~ RETAIN LOWER PORTTON FOR YOUR RECORDS ~,~ REV-1607 EX AFP (01-03) ### ZNHERZTANCE TAX STATEHENT OF ACCOUNT ~ ESTATE OF DEMARTYN KAREN E FZLE NO. 21 0:5-0657 ACN 101 DATE 05-29-2004 THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHONN BELO# ZSA SUNHARY OF THE PRINCIPAL TAX DUE, APPLZCATZON OF ALL PAYHENTS., THE CURRENT BALANCE., AND, ZF APPLICABLE*' A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTHENT: 1Z-ZZ-Z00$ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 2,924.$4 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-30-2005 CD005185 146.22 2,778.12 ZF PAID AFTER THIS DATE*' SEE REVERSE S/DE FOR CALCULATION OF ADDITIONAL ZNTEREST. ZF TOTAL DUE ZS LESS THAN $1.' NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" TOTAL TAX CRED'rT BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THZS FORH FOR ZNSTRUCTZONS. PAYMENT: 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 #ILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order peyabla to: COMMON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an #Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at tha Office of the Register of Hills, any of the 22 Revenue District Offices or from the Department's Z4-hour answering service for forms ordering: 1-800-36Z-ZOSO; services for taxpayers with spacia! hearing and / ar speaking needs: 1-SOO-qqT-3OZO (TT on[y). REPLY TO: questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Dureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. IS0601, Harrisburg, PA IT1ZS-06Ol, phone (717) 787-6S05. DISCOUNT: If any tax due is paid within thraa (3) calendar months after the decmdent's death, a five percent (SI) discount of the tax paid is aIlowed. PENALTY: Tha 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid balers January 18, 1996, tha first day after the end of the tax amnesty period. INTEREST: Intarast is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which bacame delinquent before January l, I982 boar interest at the rate of six (6Z) parcent per annum caIculated at a daily rate of .OOO16q. Al! taxes which became delinquent on and after January I, I982 will boar intarest at a rate which wii! vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. Tha applicabIa interest rates for 1982 through 200q are: Interest Daily Interest Daily Interest Yaar Rate Factor Year Ratm Factor Year Rate 198Z ZOZ .0005q8 1988-1991 llZ °000301 2001 9Z 1982 16Z .000438 199Z 9Z .O00Zq7 200Z 6Z 1985 132 .000356 1995-1998 9Z .O00Zq7 ZOOq 4Z 1986 lOX .O0027~ 1999 72 .00019Z 1987 92 .000Z47 ZOO0 82 .000219 Daily Factor .0002q7 .000164 .000137 .O00lXO --Interest is calculatad as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after fha tax becomes delinquent will reflect an interest calculation to fiftaan [153 days beyond the date of fha assassmant. If payment is made after fha intarest computation date shown on the Notice, additional interest must bm calculated. COHHONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF iNDiViDUAL TAXES DEPT. Z8060! HARRISBURG, PA Z?lZS-060! REV-1;4S EX &FP c09-O0) ZNFORHATZON NOTICE AND TAXPAYER RESPONSE FILE NO. ZI 05-0657 ACN 0q00IZ$$ DATE 06-02-Z00q DAVTD I THOHPSON JR 311 2ND ST ~"' SUMMERDALE PA 17095 TYPE OF ACCOUNT EST. OF KAREN E DEMARTYN [] SAVTNSS S.S. NO. 208-~Z-~815 [] CHECKTHG , .DA~_ OF DEATH 07-50-2005 [] TRUST "COUNTy CUMBERLAND [] CERTIF. REHTT PAYHENT AND FORHS TO: RE6ISTER OF WILLS. CUMBERLAND CO COURT HOUSE CARLISLE· PA 17015 511 2ND ST·SUHHERDALE·PA 17095 has provlded the Department with the information listed below whlch has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. guestions amy be answered by calling (717) 787-83Z7. COMPLETE PART I BELOW # # ~ SEE REVERSE SXDE FOR FXLXNG AN~ PAYMENT INSTRUCTIONS Account No. 07-19-Z000 Account Balance 57 · 285. O0 Percent Taxable X 100.00 Amount Subject to Tax 57, Z85.00 Tax Rate X .15 Potential Tax Due 8,592.75 TAX#O9122995017 Date Established To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of Rills. Hake check payable to: "Register of #ills, Agent". NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY heabove information and tax due correct. · You may choose to remit payment to the Register of Hills with two copies of this notice to obtain a discount or avoid interest, er you may check box "A' end return this notice to the Register of gills and an official assessment wile be issued by the PA Department of Revenue· B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. O The above information is incorrect and/or debts and deductions were paid by you. You must complete PART []and/or PART [ below. PART X* you ~ndicate a different tax rate, please state your relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOiNT/TRUST ACCOUNTS L~NE ~. ~e+e Established 1 2. Account Balance 2 3. Percent Taxable $ ~ q. Amount Subject to Tax q $. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, Z declare that the facts Z have reported above are true· correct end /~coeplete :~o th~ best ,of my knowledge and belief. HOME TELEPHONE NUMBER DATE GENERAL [NFORHAT[ON 1. FAILURE TO RESPOND #/LL RESULT IN AN OFFICIAL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedant's date of death. 5. A joint account is taxable even though the dscedant's name was added as a matter of convenience. 4. Accounts [including those held between husband and wife) which the decedent put in joint names within Dna year prior to death ara fully taxable as transfers. 5. Accounts established jointly be[aeon husband and wife more than one year prior to death are nat taxable. 6. Accounts held by a decedent "in trust for" another or others era taxable fully. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - If the information end computation in the no[ica ara correct and deductions are not being claimed, place ~n in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-1548 EX) upon receipt of the return from the Register of Hills. Z. BLOCK B - If the asset specified on this no[ica has been or aiL1 ba reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the dmcadant's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" sac[ion. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept Z80601, Harrisburg, PA 171ZB-060! in the envelope provided. 5. BLOCK C - If the no[ica information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of HilLs of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-1548 EX) upon receipt of the return from the Register of Hills. TAX RETURN -'PART Z - TAX COHPUTAT[ON LINE 1. Enter thm date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after II/II/aZ: Accounts ahich the decedent put in joint names uithin one (1) year of death ara taxable fully es transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (xx) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the tote1 balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as foilous: A. The percent taxable for joint assets established more than Dna year prior to the decadsnt's death: 1 DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUHBER OF X 100 = PERCENT TAXABLE JOINT O#NERS SURVIVING JOINT ONNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 5 [JOINT ONNERS) DIVIDED DY Z [SURVIVORS) = .167 X lO0 = 16,7Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created Nithin one year of the dacedent's death or accounts oenad by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUHBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ONNERS DR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established ~ithin Dna year of death by the decedent. I DIVIDED DY* Z [SURVIVORS) = .SD X 100 = 50X [TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line S. Enter the total of the debts and deductions tisted in Part 3. &. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line ?) as determined below. Da~e of Death Spouse ,_ L/nee1 S/bl/ng Collateral 07/01/9q ~o 12/$1/9q SX 6X 15X 15X 01/01/95 '~o 06/50/00 OX 6X 07/01/00 ~o prosen~ OZ 4.5X~ 12X .~_ __. younger at xThe tax rate ilposad c death to or for the use of natural parent, an adoptive Parent, or a stapparent of the child is OZ. The lineal class of hairs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children end step children. "Lineal descendents" includes all children of the natural parents end their descendents, whether or not they have been adopted by others, adopted descendents and their descendants end step-descendants. "Siblings" ara defined as individuals aha have at toast Dna parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes a11 other beneficiaries. CLA[HED DEDUCT[OHS - PART $ DEBTS AND DEDUCTIONS CLA[HED AIlo~abIa debts and deductions ara determined as folloes: A. You legally ara responsible ~or payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 5. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of payment may be re~..a~ted by the PA Department of Revenue. GENERAL INFORMATION 1. FAZLURE TO RESPOND #ILL RESULT ZN AN OFFICIAL TAX ASSESSMENT aith applicable interest based on information submitted by the financial institution. Z. Inheritance tax bmcomas delinquent nine months after tho decedent's data of death. $. A joint account is taxable even though tho decedont's name was added as a matter of convenience. ¢o Accounts (including those hold bataman husband and eifo) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART ! - TAXPAYER RESPONSE 1. BLOCK A - If tho information and computation in the notice are correct and deductions are not being claimed) p[aca'an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign tad copies and submit them aith your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-IRC8 EX) upon receipt of tho return free the Register of Hills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the docadant's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes) Dept ZOO601, Harrisburg, PA 171Z8-0601 in tho envelope provided. 5. BLOCK C - If the notice information is incorrect and/er deductions are being claimed, check block "C" and complete Parts Z and according to the instructions below. Sign two copies and submit thai with your check for the amount of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-15¢8 EX) upon receipt of the return from the Register of HilZs. TAX RETURN -PART Z - TAX COMPUTATION LINE 1. Enter tho date the account originally was established or titled in the manner existing mt date of death. NOTE: For a decedent dying after 1Z/1Z/8Z: Accounts ehich the decedent put in joint names within one (1) year of death are taxable fulty as transfers. However, there is an exclusion not to exceed $3)000 par transferee regardless of the value of the account or the number of accounts held. If a double asterisk (xx) appears before your first name in the address portion of this notice) the $3)000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter tho tote! balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as folLows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: ! DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X lO0 PERCENT TAXABLE JOINT OHNERS SURVIVING JOINT D#NERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OHNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.TZ (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of tho decedent's death or accounts oanad by tho decedent but held in trust for another individual(s) (trust beneficiaries): ! DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X lO0 = PERCENT TAXABLE ONNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by thm decedent. I DIVIDED BY . Z (SURVIVORS) = .50 K 100 = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line q) is determined by multiplying the account balance (line Z) by the percent t~xable (1ina 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined baleD. Date of Death Spouse Lineal Sibling Collateral 0710119~ to 1215119~ 01/01/95 to 06/$0/00 OZ 6Z 07/01/00 to present OZ ~.$Zx 12Z 15Z aThe tax rate imposed on tho nmt value of transfers from a deceased child twenty-one years of ago or younger at death to or for tho usa of a natural parent) an adoptive parent, or a stapparent of the child is The lineal class of heirs includes grandparents) parents) children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others) adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adapted by others) adopted descendents and their descendants and stop-descar,dants. "Siblings" ara defined as individuals who have at least one parent in common eith the decedent, whether by blood or adoption. The "Collateral" class of heirs includes al! other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTTONS CLAIMED Allowable debts and deductions are determined ms follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items, B. You actually pald the debts after death of the decedent and can Turnlsh proof of payment. ~ C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, usa plain paper 8 l/Z" x 11". Proof of payment may ba requested by the PA Department of Revenue. E-143 EX (399) · / Zip Code Attention: T/C 340 PA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG PA 17128-0601 h.llh,d,,,Ih,hlh,hlh,,,Ihdh.,,,Ihh,II DEX$5 (9-93) ~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE Dear Register of Wills:j Enclosed you will find: ~check(s) [-]documents(s) which were received by the Department of Revenue in error. These may be processed according to normal procedures. REMINDER: The POST MARK DATE on envelope attar:heal Official Receipt. '~ ~ .~0 ,, '!: '. Thank you. to any checks enclosed must appear on your Sincerely, John Murphy, Chief Inheritance Tax Division 7s7- 2o' Commonwealth of Pennsylvania Department of Revenue Bureau of Individual Taxes Dept 280601 Harrisburg PA 17128-0601 MS GLENDA FARNER REGISTER OF WILLS CUMBERLAND CO COURTHOUSE 1 COURTHOUSE SQ CARLISLE PA 17013 I,,,lll,,,lli,,,,,,ii,,li,,,li,,,ll,li,,,,,,lill.,,,,lilh,,I 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 0041 O3 CRAMER R SCOTT ESQ P O BOX 159 DUNCANNON, PA 17020 ........ fold ESTATE INFORMATION: SSN: 208-42-4813 :ILE NUMBER: 2103-0657 DECEDENT NAME: DEMARTYN KAREN E DATE OF PAYMENT: 06/30/2004 POSTMARK DATE: 06/1 9/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/30/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04001233 $8,592.75 REMARKS: TOTAL AMOUNT PAID' $8,592.75 SEAL CHECK# 593 INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVIS/ON DEPT. Z80601 HARRISBURG, PA 171Z8-0601 DAVID I THOMPSON JR 511ZND ST SUMMERDALE PA 17093 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE "INHI~RITANCE TAX RECORD ADdUSTMENT dOZNTLY HELD OR TRUST ASSETS DATE 08-16-200~ ESTATE OF DEMARTYN KAREN DATE OF DEATH 07-50-2005 F'rLE NUMBER 21 03-0657 COUNTY CUHBERLAND SSN/DC 2 oA-:A2- ~ 815 ACM 0 ~25:5 c~ ~i ?, ~ ' HAKE CHECK PAYABEE AND I~/BMZT PA¥:HENT TO.' REGISTER OF WILLS "~ , CUMBERLAND CO COURT'-~OUSE '' CARLISLE, PA..., 17 01:~ .-':. !.'::' . ~ REV-1604 EX AFP (01-D$) CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS REV-1604 EX AFP (01-03) ~ XNHERZTANCE TAX RECORD ADJUSTMENT JOXNTLY HELD OR TRUST ASSETS DATE 08-16-200~ ESTATE OF DEMARTYN KAREN E DATE OF DEATH 07-30-2005 COUNTY CUHBERLAND FILE NO. 21 05-0657 S.S/D.C. NO. 208-~2-~815 ACM 0~0012~3 ADJUSTMENT BASED ON: ADHINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: 311 2ND ST,SUHMERDALE,PA 1709~CCOUNT NO. TAX#O9122995017 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 07-19-2000 Accoun~ Balance Percen~ Taxable X Amoun~ Sub~ec~ ~o Tax Debts and Deduc~Aons - Taxable Amoun~ Tax Ra*e X Tax Due TAX CRED'rTS: 57,285.00 NOTE: 1.000 57;285.00 .00 57,285.00 .15 8,592.75 TO XNSURE PROPER CREDXT TO YOUR ACCOUNT, SUBNXT THE UPPER PORTXON OF THXS NOTXCE NXTH YOUR TAX PAYMENT TO THE REGXSTER OF NXLLS AT THE ADDRESS SHONN ABOVE. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGZSTER OF MILLS, AGENT." PAYHENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 06-19-200~ 08-15-200~ CDO0~iO$ WRITEOFF .00 .00 8,592.75 ~7.26 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE IF PAID AFTER THXS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. XF TOTAL DUE IS LESS THAN $1; HO PAYHENT XS REQUIRED. XF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR); YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) 8,592.75 .00 .00 ,00 PAYMENT: Detach the top portion of this Notice and submit aith your payment made payable to the name and address printed an the reverse side. -- Hake check or money order payable to: REGTSTER OF NTLLS, AGENT. REFUND (CR): A refund of a tax credit, ahich ams 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 Nills, any of the Z5 Revenue District Offices or from the Department's Z~-hour answering service for forms ordering: 1-800-362-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-~7-3020 (TT only). REPLY TO: guestions 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 (52) discount of the tax paid is allowed. PENALTY: The 15X 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 (1) day from the date of death to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (62) percent per annum calculated at 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 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 207. .0005~,8 1987 97. .0002~,7 1999 77. .000192 1983 167. .000~,38 1988-1991 117. .000301 Z000 87. .000219 19B~ 117. .000301 1992 97. .0002~7 2001 92 .0002~,7 1985 132 .000356 1993-199~, 72 .000192 ZOOZ 62 .00016~+ 1986 102 .00027~, 1995-1998 92 .0002~7 2003 52 .000137 --/nterest is calculated as folloas: TNTEREST = BALANCE OF TAX UNPATD X NUHBER OF DAYS DEL'rNQUBNT X DATLy TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent ~ill reflect an interest calculation to fifteen (15) days beyond the date of the assessment, If payment is made after the interest computation date shoen on the Notice, additional interest must be calculated. REV-1470 EX (6-88) INI':IERIT,~NCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBUR(3~ PA 17128-0601 DECEDENT'S NAME FILE NUMBER Karen Demartyn 2103-0057 REVIEWED BY ACN Emerson Luciano 04001233 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The above referenced ACN has been adjusted to reflect a zero balance per our Telephone call of August 13, 2004 Pa.qe 1 BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX DTVZSZON DEPT. Z80601 HARRTSBUR(;, PA 171Z8-0601 CONNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-I[07 EX AFP (01-03) DAVID Z THOHPSON JR $11ZND ST SUHNERDALE PA 17095 *DA~E 08-02-?004 ESTATE~ OF DEHARTYN DATE OF DEATH 07-30-200:5 FILE NUH]~ER 21 0:5-0657 0 Y PARC. Z ' CUH.ERLAUD040012:5:5 KAREN E Amoun'l: Rem i'l:'l:ed HAKE CHECK PAYABLE AND REN'rT PAYHENT TO: REGISTER OF NZLLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 NOTE: To /nsure proper credi~ ~o your account, submi~ ~he upper portion of ~his for. wi~h your ~ax payment. CUT ALONG THIS L'rNE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~ ZNHER'rTANCE TAX STATEHENT OF ACCOUNT ~ ESTATE OF DEHARTYN KAREN E F/LE NO. 21 05-0657 ACN 040012:5:5 DATE 08-02-2004 THIS STATEHENT IS PROVIDED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACN IN THE NANED ESTATE. SHO#N BELO# IS A SUNNARY OF THE PRINCTpAL TAX DUE, APPLICAT/ON OF ALL PAYNENTS, THE CURRENT BALANCE:. AND, IF APPLICABLE, A PRO.JECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 07-26-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 8,592.75 PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHgER INTEREST/PEN PAID (-) 06-19-2004 CD00410:5 .00 8,592.75 ~ALANCE OF UNPAZD ZNTEREST/PENALTY AS OF IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE IS LESS THAN $1, NO PAYNENT 1S REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), 06-20-2004 TOTAL TAX CRED'rT 8,592.75 · ALANCE OF TAX DUE .00 INTEREST AND PEN. 47.26 TOTAL DUE 47.26 YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR ZNSTRUCTTONS. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 DAVID I THOMPSON JR $11 2ND ST SUMMERDALE PA 17095 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLONANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-26-200q ESTATE OF DEMARTYN KAREN DATE OF DEATH 07-30-Z003 FILE NUMBER 21 03-0657 COUNTY CUMBERLAND SSN/DC 208-q2-q813 ACN OfiOO1233 Amoun~ Remi~ed HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-26-200q ESTATE OF DEHARTYN KAREN E DATE OF DEATH 07-30-2003 COUNTY CUMBERLAND FILE NO. 21 03-0657 S.S/D.C. NO. ZO8-qZ-q813 ACN 0q001233 TAX RETURN WAS: eX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: 311 2ND ST,SUMMERDALE,PA 17093 ACCOUNT NO. TAX#09122995017 TYPE OF ACCOUNT: DATE ESTABLISHED ( ) SAVINGS ( ) CHECKING ( ) TRUST C ) TIME CERTIFICATE 07-19-2000 Account Balance 57,285.00 Percent Taxable X 1.000 Amount Subject to Tax 57,285.00 Debts and Deduct/ons - .00 Taxable Amount 57,285.00 Tax Rate X .15 Tax Due 8,592.75 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) NOTE: TO ~URE~OPER~OIT TO YOL~'~'CCOUNT, S~'t~ THE UPF~R~ii~PoRT~DN OFf,IS NOTICE WI~ YOUR ~AX PA~.~T TO THE REGC~STER O~WILL~A~ THE AB~"ADDRESS .... ~E CHECK OR ~Y O~ER P~Y~LE TO: "R~TER ~ WILlY'AGENT." INTEREST IS CHARGED THROUGH 08-03-200q AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) .00 8,592.75 89.79 8,682.5q PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMLN- ISTRATIYE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act ZS of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit eith your payment to the Register of HiLls printed on the reverse side. -- Nake check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "'Application for Refund of PennsyZvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Office of the Register of Nills, any of the Z$ Revenue District Offices or by calling the special Z4-hour answering service for fores ordering: 1-EOO-36Z-ZO50; services for taxpayers with special hearing and or speaking needs: l-EO0-fi47-30ZO (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice amy object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --eLecting to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See 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 within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The lSZ 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 same manner and in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary free 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 198~ gO[ .000548 198'~8-1991 1IX .000301 2009 9Z .000247 1983 162 .000438 1992 92 .000247 ZOOZ 6Z .000219 1984 112 .000301 1993-1994 7Z .O00Z9Z 2003 SZ .000137 1985 13Z .000356 1995-1998 9Z .000Z47 gOOfi 4Z .000110 1986 ZOZ .000274 1999 7Z .00019Z 1987 9Z .000247 ZOOO 8Z .OOOZ19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUIIBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional lnterest must be calculated. BUREAU OF THOTVZDUAL TAXES ZHHERITAHCE TAX I)TVl:SlrOH DEPT. Z80601 HARRTSBURG., PA 17128-0601 COMNONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT RE¥-16D? EX AFP (01-05) DAVID I THOMPSON ~ SEP 15 A8:24 $~! 2ND ST SUMMERDALE PA DATE 08-16-Z00q ESTATE OF DEMARTYN DATE OF DEATH 07-$0-Z005 FILE NUMBER Z1 03-0657 COUNTY CUMBERLAND ACN OqOO1233 Amoun* Remi~ed KAREN E MAKE CMECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To /nsure proper credi~ ~o your account:, submit: ~he upper potation of ~his form wi~:h your ~:ex payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORT'rON FOR YOUR RECORDS *~ REV-1607 EX AFP (01-03) ESTATE OF DEMARTYN #xm INHERITANCE TAX STATEMENT OF ACCOUNT ~-a KAREN E FILE N0.21 03-0657 ACN 0q001233 DATE 08-16-200q THIS STATEMENT 1S PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACH ZN THE NAMED ESTATE. SHONN BELO# IS A SUMMARY OF THE PR/NCZPAL TAX DUE, APPLKCATZON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, KF APPLKCABLE, A PROJECTED KNTEREST FKGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-13-ZOOfi PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYNENTS CTAX CREDITS): 8,592.75 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) .00 06-19-200q 08-13-200fi COOOql03 WRITEOFF .00 KF PAKD AFTER THKS DATE, SEE REVERSE SKDE FOR CALCULATKON OF ADDKTKONAL KNTEREST. ( KF TOTAL DUE KS LESS THAN $1, NO PAYMENT ZS RE~UKRED. KF TOTAL DUE KS REFLECTED AS A "CREDKT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SKDE OF THKS FORH FOR KNSTRUCTKONS. ) 8,592.75 q7.26 TOTAL TAX CREDIT 8,592.75 BALANCE OF TAX DUE .0§ INTEREST AND PEN. .00 TOTAL DUE .00