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Home My WebLink About04-0386CONNONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. IS0601 HARRISBURG, PA 171ZS-0601 REV-1543 EX &FP (09-00) ROSE H BARNES 2141 DOUGLAS DR CARLISLE PA 1701~!; ZNPORHATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 21 ACN 04115514 DATE 04-09-2004 ;EST. OF ROSE N JEPPESEN S.S. NO. 541-24-1041 DATE OF DEATH 01-17-2004 COUNTY CUNBERLAND TYPE OF ACCOUNT [] SAVINGS [] CHECKING ['~ TRUST [] CERTIF. RENIT PAYNENT AND FORNS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLTSLE, PA 17015 #AYPOINT BANK has provided the Department with the information listed below which has bean 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 form and return it to tho above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. guastions may ba ansHered hy ceiling (717) 787-8~Z7. COHPLETE PART ! BELOW ~ x x SEE REVERSE SIDE FOR FILING AND PAYHENT INSTRUCTIONS PART Account No. 100575463 Date 05-15-2005 Established Account Balance 4,270.28 Percent Taxable X 100.00 Amount Subject to Tax 4,270.28 Tax Rate X .15 Potential Tax Due 640.54 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of Wills. Naka check payable to: "Register of Wills, Agent". NOTE: If tax payments ara made within three (~) months of the decadent's date of death, you nay deduct a 5Z discount of tho tax due. Any inheritance tax due will become delinquent nine (9) months after the dale of death. CHECK ONE BLOCK ONLY PART TAX LINE A. ~ The above [~i..tion and tax due is correct. 1. You may choose to remit payment to the Register of Nills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Hills and an official assessment will be issued by the PA Department of Revenue. B. ~ Tho above asset has been or will ba reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. ~The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~and/or PART ~f you ~nd~cata a different tax rate~ please state your relationship to decedent: RETURN - CONPUTATZON OF TAX ON JOINT/TRUST ACCOUNTS l. Data Established I 2. Account Balance 2 $. Percent Taxable $ ~ q. Amount Subject to Tax ~... $. Debts and Deductions S - 6. Amount Taxable 6 7. Tax Rata 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAINE11 PAYEE DESCRIPTION ANOUNT PAID TOTAL (Enter on Line S of Tax Computation) $ Under penalties of perjury, Z declare that the facts I have reported above are true, correct and rumple to the bast of m, kno,ladga and bal.i, af. HONE ( T~PAYER SIGNATURE TELEPHONE NUMBER GENERAL ~NFORMAT~ON 1. FA/LURE TO RESPOND NILL RESULT /N AN OFF/C/AL TAX ASSESSHENT .ithapplicableinterestbasedoninforaetion submitted by ~e financial institution. Z. Inheritance tax becomes delinquent nine mon~s after ~a decedant's date of death. 3. A joint account is taxable oven though ~e decedant's name was added as a eat[er of convenience. 4. Accounts (including those held be~ean hu~and and ails) ahich the decadent put in joint names eithin one year prior to dea~ are fuLly taxable as transfers. 5. Accounts established jointly between hu~and and wife more ~an 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 I - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in ~a notice are correct and deductions are not being claimed, place an in block "A" of Part 1 of ~e "Taxpayer Re~onsa" section. Sign two copies and submit thee with your check for ~e amount of tax to the Register of Nills of the county indicated. The PA Department of Revenue will issue an official asses~ant (Form REV-154B EX) upon receipt of the return from the Register of Wills. Z. BLOCK D - If the asset specified on this notice has been or will be reported and tax paid eith the Pennsylvania Inheritance Tax Return filed by ~e dmcedent'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 Z80601, Harrisburg, PA 171ZB-0601 in the envelope provided. $. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and according to the instructions below. Sign two copies and submit thee aith your check for ~e amount of tax payable to the Register of Wills 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 Wills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter ~e date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/l~BZ: Accounts which the decedent put in joint names eithin one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $5,000 par transferee regardless of the value of the account or ~e number of accounts held. If a double asterisk (iN) appears before your first name in the address portion of ~is notice, the $3,000 exclusion already has been deducted from ~e account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is da[ermined as A. The percent ~xabla for joint assets established more than one year prior to the decedent's death: I DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUHBER OF X 100 = PERCENT TAXABLE JOINT ONNERS SURV/VIHG JOINT ONNERS Example: A joint asset registered in the name of ~e decedent and two other persons. I DIVIDED DY 3 (JOINT OHNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.?X (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of ~e decedent's death or accounts owned by ~'e decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED DY TOTAL NUHBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OHNERS OR TRUST BENEFICIARIES Example: Joint account registered in ~e name of the decedent and two other persons and established within one year of death by the decedent. I DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50Z (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 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 (1ina 7) as da[ermined bales. 01/01/95 ~o 06/$0/00 OX 6X 15X 07/01/00 ~o presen~ OX q.SXx 12X LThe tax rate imposed on the net value of transfers from a dmcea~d child twenty-one years of age or younger at death to or for the usa of a natural parent, an adoptive parent, or a stepparent 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 o~ers, adopted children end step children. "Lineal descendents" includes all children of the natural parents and ~eir descendents, whether or not ~ey 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 aith the decedent, ~hether by blood or adoption. The "Collateral" class of heirs includes ail other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DE~TS AND DEDUCTIONS CLAIMED Allocable debts and deductions ara determined as A. You Iegally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actualIy paid the debts after death of the decedent and can ~rnish 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 requested by ~e PA Oepar~ent 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 0O3856 BARNES ROSE M 2141 DOUGLAS DR CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 541-24-1041 FILE NUMBER: 21 04-0386 DECEDENT NAME: JEPPESEN ROSE M DATE OF PAYMENT: 04/22/2004 POSTMARK DATE: 04/21/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/17/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04115514 $640.54 REMARKS' CHECK# 8155 SEAL TOTAL AMOUNT PAID: 9640.54 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Rose M. Barnes 2141 Douglas Dr Car/is/e, PA 17013 CHRISTMAS CONNONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171Z8-0601 REV-15~5 EX AFP cog-00) INFORMATION NOTZCE AND TAXPAYER RESPONSE ACH 0~116529 DATE Oq-Z1-200q ROSE N BARNES 21ql DOUGLAS DR CARLISLE PA 17015 TYPE OF ACCOUNT t'*; ' '-" EST OF~ ROSE M JEPPESEN [] SAVINGS tee! S.S. NO. 5~1-2q-10~1 [] CHECK'rNG DATE OF DEATH 01-17-200~ [] TRUST '0[04 i T3 T'Z 7CUHBERLAHD [] CERTIF. REMTT PAYHENT AND FORMS TO: REGISTER OF Idl'LLS CUMBERLAND CO COURT HOUSE CARLTSLE, PA 17015 MEMBERS 1ST FCU has provided the Department alth the information listed below mhlch 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. Zf you feel this information is incorrect, please obtain mrittan correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 767-85ZT. COMPLETE PART 1 BELON # ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 115115-00 Date, 02-09-1990 Established Account Balance 7, $96.92 Percen'l' T=,xable X 5 0.0 0 0 Amount SubSect to Tax 3,698. fi6 Tax Rate X . 0~5 Po~:antial Tax Due 166. q$ To insure proper credit to your account, tNo (Z) copies of this notice must accompany your payment to the Register of Hills. Make check payable to: "Register of Mills, Agent". NOTE: Zf tax payments ara made within three (3) months of the dacedent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due wil! become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. ~ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Nills with tuo copies of this notice to obtain CHECK a discount or avoid interest, or you may check box 'A" and return this notice to the Register of E ONE] #ills and an offlcial assess.ent .ill be issued by the PA Depart.ant of Revenue. BLOCK B. [] The above asset has been or ~ill be reported and tax paid mith the Pennsylvania inheritance Tax return ONLY to be filed by the decedent's representative. C. [] The above inforlation is incorrect and/or debts and deductions ~ere paid by you. YOU must complete PART [] and/or PART [] below. PART l'f you indicate a different tax rate, please state your iiiii!i!i!iii!iiiiiiiiiiiiiiiii~~ ~ii~iiii~i~ii TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS I~ ~ ~~ PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) $ Under penalties of perjury, Z decZare that the facts Z have reported above are true, correct end complete to the bast of my knowledge and belief. .~*--~ ,.. HONE (?/?) ~*~/7/~'- //~'~ TAXPAYER- SIGNATURE TELEPHONE NUMBER DATE SENERAL INFORHATION 1. FAILURE TO RESPOND NZLL RESULT ZN AN OFFZCZAL TAX ASSESSNENT .ith applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent'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 wife) which the decedent put in joint names within one year prior to death ara 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 I TAXPAYER RESPONSE 1. BLOCK A - Zf the information and computation in tho notice are correct and deductions are not being claimed, place an "X" in block "A" of Fart 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1Sq8 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - Tf the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania inheritance Tax Return filed by the decedent's representat~ve~ place an "X" Jn block "B" o~ Part I o~ the "Taxpayer Response" section. S[gn one copy and return to the PA Department o~ Ravenue~ ~ureau of [nd[vJdual Taxes~ Dept 180601~ Harr[sburg~ PA 17118-0601 [n the envelope provided. 5. ~LOCK C - [~ the not[ce information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and 5 according to the instructions belo~. S~gn t~o copies and submit them w[~ your check ~or ~e amount o~ tax payable to the Register of Hills o~ the county indicated. The PA Department o~ Revenue ~[11 issue an of~[cJal assessment (For= REV-15~8 EX) upon receipt o~ the return ~roa the Register o~ Hills. TAX RETURN - PART 2 - TAX COHPUTATZON LZNE 1. Enter ~a date the account originally ~as established or titled in the manner existing at date o~ death. NOTE: For a decedent dying a~ter 1Z/lZ/eZ: Accounts ~h~ch the decedent put [n joint names ~[th[n one (1) year o~ death are taxable ~ully as transfers. HoNever~ there Js an exclusion not to exceed $5~000 per transferee regardless o~ the value o~ the account or the number o~ accounts held. 1~ a double asterisk (xx) appears before your ~irst name Jn the address portion o~ this not[ce~ the $5,000 exclusion already has been deducted ~rom the account balance as reported by the ~[nancJal JnstJ~tJon. 2. Enter the total balance o~ the account ~nclud[ng ~nterest accrued to the date o~ death. The percent o~ the account that is taxable ~or each survivor is determined as ~ollows: A. The percent taxable ~or joint assets established more than one year prior to the decedent's death: i D~V[DED BY TOTAL NUHBER OF D[VZDED BY TOTAL NUHBER OF X 100 = PERCENT TAXASLE JOZNT OWNERS SURVZV[NG JOINT OWNERS Example: A joint asset registered in the name o~ the decedent and t~o o~er persons. I DZV[DED BY ~ (JOINT ONNERS) DZV[DED BY Z (SURVIVORS) = .167 X 100 = 16.71 (TAXASLE FOR EACH SURVIVOR) B.The percent taxable ~or assets created ~Jth[n one year o~ the decedent's death or accounts o~ned by the decedent but held in trust ~or ano~er individual(s) (trust bene~cJarles): I D~VZDED BY TOTAL NUNBER OF SURVIV[NG JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEFZC[ARZES Example: Joint account registered in the name o~ the decedent and two other persons and establ[~ed ~Jth[n one year o~ death by the decedent. I DZVZDED BY Z (SURV~VORS) = .50 X 100 = 501 (TAXABLE FOR EACH SURVIVOR) The amount sub,act to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line 5). 5. Enter the to~l of the debts and deductlons listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) ~roa the amount subject to tax (line ~). 7. Enter the appropriate tax rate (line 7) as determined below. I Da*e of Death I Spouse Lineal / Sibling Cella*era1 07/01/9~ ~o 12/51/9q~ SZ 6Z J 15~ 15Z 01/01/95 ~o 06/30/00 O~ 6~ 15~ 15~ 07/01/00 ~o presen~ O~ ~.6~ 12~ 15~ xThe tax rate ~mposed on the net value o~ transfers ~ro. a decca ed child t~enty-on, years of age or younger at death to or ~or ~e use of a natural parent, an adoptive parent, or a stepparent o~ the child ~s 0~. The lineal class o~ heirs ~ncludes grandparents, parents, children, and 11neal descendents. "Children" includes na~ral children ~hother or not they have been adopted by o~ers~ adopted children and step children. "L~neal descendents" includes all children o~ the na~ral parents and ~eir descendents, ~hether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. 'Siblings' are defined as 1nd~v~duals ~ho have at least one parent Jn common ~Jth the decedent, ~hether by blood or adoption. The "Collateral" class of he,rs includes all other benefJc~ar~es. CLAIHED DEDUCTZONS - PART ~ - DEBTS AND DEDUCTZONS CLAZHED Allo~able debts and deductlons are determined as follo~s: A. You legally ~re responsible ~or payment, or the es~te subject to administration by a personal representative Js ~nsuf~JcJent to pay the deductible items. B. You actually paid the debts after death o~ the decedent and can ~urnJsh proo~ of payment. C. Debts being cla~med must be ~tem~zed fully 1n Part ~. ~ add~tlonal space is needed, use plain paper 8 1/Z' x 11'. Proo~ o~ payment may be requested by the PA Depar~ent 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 003929 BARNES ROSE M 2141 DOUGLAS DR CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 541-24-1041 FILE NUMBER: 2104-0386 DECEDENT NAME: JEPPESEN ROSE M DATE OF PAYMENT: 05/11/2004 POSTMARK DATE: 05/1 0/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/1 7/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04116529 $166.43 REMARKS: TOTAL AMOUNT PAID: 66.43 SEAL CHECK# 8170 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ROSE h. ]3~NES 2141 DOUGi,AS DRIVE CARl, ISLE PA i7013-1024 ~.~ },4AY x ,' .~IIIS iiEGiStER OF WILLS CUMBE~ND co CAP%ZSLE PA 17013 COMNONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. ZB0601 HARRISBURG, PA 171Z8-0601 REV-15q3 EX AFP (09-00) INFORMATION NOTICE AND TAXPAYER RESPONSE F'rLE NO. 21 ~ ~. ACN 0q116550 DATE 0q-21-200q 'O4 ROSE M BARNES Zlql DOUGLAS DR CARLISLE PA 17015 TYPE OF ACCOUNT EST. OF ROSE M JEPPESEN [] SAVINGS S.S. NO. ' 5q1-Zq-10ql [] CHECKING DATE OF DEATH 01-17-200q [] TRUST /,I/&I~OSX~ITY[~ .., CUMBERLAND [] CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLTSLE· PA 17015 MEMBERS 1ST FCU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were e joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laos of the Commonwealth of Pennsylvania. Questions may be ansuered by calling (717) 787-8527. COMPLETE PART I BELOW a ~ a SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Accoun1: No. 113115-11 De1:e 02-09-1990 E-1:=,bli.$hed Accoun1: Balance 6 · 59 0.55 Percen1: Taxable X 50. 000 Amoun1: Sub~mc'l: t:o Tex 5 · 19.-5.18 Tax Re1:e X , Oq5 Poi:rani:ia1 Tax Due lq$.78 To insure proper credit to your account, too (g) copies of this notice must accompany your payment to the Register of Hills. Make check payable to: "Register of Hills, Agent". NOTE: If tax payments are made within three (3) months of the decedant's date of death, you lay deduct a 5Z discount of the tax duo. Any inheritance tax due Nil1 become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain CHECK ONE BLOCK ONLY PART TAX LINE PART 1. Da1:e Established z. Accoun1: B.~an. 3. Pmrcan1: Taxable 3 5. Debts and Oe~otions 6. Amount Taxable 6 8. Tax Due 8 ///' ~7 a discount or avoid interest, or you may check box "A' and return this notice to the Register of Wills and an official assessment ~ill be issued by the PA Department of Revenue. B. ~ The above asset has been or ~ill be reported and tax paid aith the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. ~The above information is incorrect and/or debts and deductions ~ere paid by you. You must complete PART ~ end/or PART ~ below. If you indica1:e a differen1: 1:ax tel:e· please s1:a1:e your reZa1:ionsh[p 1:o decmden1:: ~)~.~?~ T~ RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS , DEBTS AND DEDUCTIONS CLATME~ DATE PATD PAYEE DESCRIPTION AMOUNT PAID ~',/,../ TOTAL (En1:er on Line $ of Tax Compu1:a1:ion) Under peneZ1:ims of perjury· Z declare 1:ha1: 1:ha fec1:s I have rmpor1:ed above ere 1:rum· corrmc1: and UORK ( 71 ? ) ,,q.~ 5"- q 703 'TAXPAYER SIGNATURE TELEPHONE NUMBER DATE GENERAL INFORHATION 1. FAILURE TO RESPOND HILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacedent's date of death. 3. A joint account is taxable even though the decadent'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 ere fully taxable as transfers. S. 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. REPORT[NG INSTRUCTIONS - PART i - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice ara correct and deductions ara not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-154B EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will ba reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedant's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign Dna copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept Za060I, Harrisburg, PA 17128-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts Z end 3 according to the instructions below. Sign two copies and so_bait them with your check for the amount of tax payab~la to the Remister of Wills of the county indicated. The PA Department of Raven~ will"issue a asses'se~t (Form~'~V-15~8 EX) upon receipt ~f tee return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account oriRineLly was established or titled in the manner existing et date of death. NOTE: For e decadent dying after 1Z/1Z/BZ: Accounts ahich the decedent put in joint names within Dna (1) year of death ara taxable fully 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 bald. If e double asterisk (~w) appears before your first name in the address portion of this notice, the $3,000 exclusion already hms bean deducted free the account balance es reported by the financial institution. Z. Enter the tote1 balance of the account including interest accrued to the date of death. $. The percent of the account that is tmxable for each survivor is determined as fallows: A. The percent taxable for joint assets established aero than one year prior to the decedent's death: I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the naea of the decedent and two other persons. I DIVIDED BY 3 (JOINT OWNERS) 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 nome of the decedent and two other persons and established within one year of death by the decadent. ! DIVIDED BY Z (SURVIVORS) = .SO X 100 50X (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (Line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line 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 4). 7. Enter the appropriate tax rate (1ina 73 as determined below. Da~e of _ne~_'l:h Spouse Lineal Siblir.g Collateral 07/01/9q ~o 12/$1/9q SX 6X 15X 01/01/95 ~o 06/30/00 OX 6X 07/01/00 ~o present OX q.SX~ 12X ...... , .... younger at ~The tax rate imposed on th~ death to or for the use of a natural parent, an adoptive parent, or a stepparant of the child is OZ. The lineal class of heirs includes grandparents, parents, children, and lineaI descendents. "Children" includes natural children whether or not they have bean adopted by others, adopted children and 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 and step-descendants. "Siblings" are defined es individuals who have at least Dna parent in common with the decedent, ehathar by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 5 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions ara determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a ~ersonal representative is insufficient to pay the deductible items. S. 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 3. If additional space is needed, usa plain paper B 1/2" x LI". 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 003928 BARNES ROSE M 2141 DOUGLAS DR CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 541-24-1041 FILE NUMBER: 2104-0386 DECEDENT NAME: JEPPESEN ROSE M DATE OF PAYMENT: 05/11/2004 POSTMARK DATE: 05/1 0/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01 / 17/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04116530 $111.47 REMARKS: TOTAL AMOUNT PAID: $111.47 SEAL CHECK# 8168 INITIALS' JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS I{OSE M. BARN~ 2141 DOUGLAS DRIVE CARLISLE PA 17013-1024 REGISTER O~''W~LL~ ldUMB~~ CO ¢OU~T HOUSE CARLISLE PA 17013 COHNON#EALTH OF PENNSYLVANIA DEPARTMENT DF REVENUE BUREAU OF IHDIVIDUAI TAXES DEPT. ZBO601 HARRISBURG, PA 171Z8-0601 ZNFORHATZON NOTICE AND TAXPAYER RESPONSE FILE NO. 21 O~ ~ ACH 0q116551 DATE Oq-21-200q ROSE H BARNES 21~1 DOUGLAS DR ~' CARLISLE PA 17015 .., TYPE OF ACCOUNT EST. OF ROSE Ft JEPPESEN [] SAVINGS S.S. NO. 5~1-2~-10ql [] CHECKING DATE OF DEATH 01-17-200~ [] TRUST COUNTY CUMBERLAND [] CERTIF. REMIT PAYMENT AND FERNS TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701S MEMBERS 1ST FCU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you eere a joint Donor/beneficiary 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 with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8527. COMPLETE FART 1 BELOH x x x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 11SllS-05 Date 05-20-1995 Established Account Balance 39,539.36 Percent Taxable X 50.000 Amount Subject to Tax 19,769.68 Tax Rata X .0~5 Potential Tax Due 889.6~ To insure proper credit to your account, two (Z) copies of this notice oust accompany your payment to the Register of Wills. Hake check payable to: "Register of Wills, Agent". NOTE: If tax payments are made within three (3) months of the dacedant's date of death, you amy 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 A. ~ The above information and tax due is correct. 1. You may choose to remit payment to tho Register of Hills eith tho copies of this notice to obtain CHECK e discount or avoid interest, or you amy check box "A" and return this notice to the Register of [ONE] #ills and an official assessment Hill be issued by the PA Department of Revenueo BLOCK a. [] The above asset has been or Hill be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's representative. C. [] The above information is incorract and/or debts and deductions were paid by you, You must complete PART [] and/or PART [] beloH. PART I'f you indicate a different tax rate, please state your []~ relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Estebizsllea l. 2. Account Balance 2 3. Percent Taxable 3 ~ q. Amount Subject to Tax ~ 5. Debts and Deduct/one 5 6. Amount Taxable 6. 7. Tax Rate 7 X 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line Jl of Tax Computation) Under penalties of perjury, ! declare that the facts I have reported above ere true/ correct end =omp.l~;~e to th~/~st of my kno. ledg. and bezier. HONEc7/7 ) age- 9~ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE ' GENERAL INFORMATION 1. FAILURE TO RESPOND #ILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. g. Lnheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. q. 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 REPORTING INSTRUCTIONS - PART ! - TAXPAYER RESPONSE 1. BLOCK A - Tf the information and computation in the notice are correct and deductions are not being claimed, place an 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 NJlls of the county indicated. The PA napartment of Revenue will issue an official assessment (Fora REV-1SqB EX) upon receipt of the return from the Register of Nills. Z. BLOCK B - [f the asset specified on this notice has been or will ba reported and tax paid with the Pennsylvania TnherJtanca Tax Return fiLed 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 Individual Taxes, Dept LB0601, Harrisburg, PA 171ZB-0601 in the enve[ope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions arm being claimed, check block "C" and complete Parts Z and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to tho Register of Nills of the countY indicated. The PA Department of Revenue wJII issue an official assessment (Form REV-lSqB EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART 2 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 12/1Z/BI: Accounts which the decedent put in joint names within one (1) year of death are taxable fully 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. Lf a double asterisk (ma) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than cna year prior to the decedant's death: I DLVLDED BY TOTAL NUMBER OF DiViDED BY TOTAL NUMBER OF X lO0 = PERCENT TAXABLE JOTNT OHNERS SURV[VZNG JOLNT ONNERS Example: A joint asset registered in the name of the decedent and two other parsons. I DTVIDED BY 3 (JOLNT ONNERS) DLVIOEO BY Z (SURVIVORS) = .167 X lO0 = L6.7Z (TAXABLE FOR EACH SURVTVOR) B.The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): [BIV[DED BY TOTAL NUMBER OF SURVL¥[NG JOINT X 100 = PERCENT TAXABLE OHNERS OR TRUST BENEFiCiARIES ExampLe: Joint account registered in the name of the decedent and two other persons and established within cna year of death by the decedent. i DZVIDED BY Z (SURV'[VORS) = .SO X 100 = 5OZ (TAXABLE FOR EACH SURVLVOR) The amount subject to tax (line q) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions ]isLed tn Part 3. 6. The amount taxable (Zinc 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (Line 7. Enter the appropriate tax rate (Line 7) as determined below. De~e ;~f Death Spouse Lineal I Sibling Collateral 07/01/9q ~o 12/31/9q 3X 6X 01/01/95 ~o 06/50/00 OX 6Z 15X 15X 07/01/00 ~o proson~ OX 4.$X~ 12Z -The tax rate imposed on the net value of transfers from a deceased t~anty-one y.ars age younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent 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 bean adopted by others, adopted children and step children. "Lineal descendants" 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 el1 other beneficiaries. CLAIMED DEDUCTIONS PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legaLly are rasper Bible for payment, or the estate subject to administration by a personal representattve is Jnsu{;icJent to pay the deductible items. B. You ao~aIIy paid the debts a~ter death o~ the decedent and can ~rnJsh proof of payment. C. Oebts being cIa~med must be itemized fully in Part ~. If additional space ~s needed~ use plain paper payment may be requested by ~e 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 003927 BARNES ROSE M 2141 DOUGLAS DR CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 541-24-1041 FILE NUMBER: 2104-0386 DECEDENT NAME: JEPPESEN ROSE M DATE OF PAYMENT: 05/11/2004 POSTMARK DATE: 05/1 0/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/17/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04116531 $889.64 TOTAL AMOUNT PAID: $889.64 REMARKS. SEAL CHECK# 8169 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ROSE M. BARNES 2141 DOUGLAS DRIVE CARLISLE PA 17013-1024 REGISTER OF WILLS CAR~~A~ 7 ~~ HOUSE BUREAU OF TNDIVTDUAL TAXES INHER/TANCE TAX DTVIS[ON DEPTo Z80601 HARR[SBURG, PA 171Z5-0601 ROSE M BARNES 21ql DOUGLAS DR CARLISLE PA COHNONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-15~i8 EX AFP (01-03) DATE 05-$1-200q ESTATE OF JEPPESEN ROSE DATE OF DEATH 01-17-Z00~ FILE NUHBER 21 0~-0586 ~i~¥ 2~ ~'}'R~ COUNTY CUHBERLAND ~-~ ..... SSN/DC 5ql-Zq-lOql ACN 0~11551q HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE RETAIN LONER PORTION FOR YOUR RECORDS REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOHANCE OR DZSALLOHANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-$1-200~ ESTATE OF JEPPESEN ROSE M DATE OF DEATH 01-17-200~ COUNTY CUHBERLAND FILE NO. 21 0q-0386 S.S/D.C. NO. 5q1-2~-10~1 ACN 0~11551q TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: HAYPOINT BANK ACCOUNT NO. 100575~65 TYPE OF ACCOUNT: C ) SAVINGS C ~ CHECKING ( ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 05-15-2005 Accoun~ Balance ~,Z70.Z8 Percen~ Taxable X 1.000 Amoun~ Subjec~ ~o Tax q,ZTO.Z8 Debts and Deductions - .00 Taxable Amoun~ ~,ZTO.Z8 Tax Ra~e X .15 Tax Due 6q0.5~ NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE HITH YOUR TAX PAYMENT TO THE REGISTER OF HILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF HILLS, AGENT." TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID PAYMENT MUST BE MADE BY 10-18-200q~. 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 IS LESS THAN $1~ NO PAYMENT 1S REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ~ CR), YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF THZS FORM FOR INSTRUCTIONS. ) .00 6qO.5q .00 6qO.5q PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 11~0 of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (71 P.S. Section 91qO). Detach the tap portion of this Notice and submit with your payment to the Register of NilIs printed on the reverse side, -- Make 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 Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Nills, any of tho Z3 Revenue District Offices or by calling the special Iq-hour answering service for forms ordering: 1-800-361-ZOS0~ services for taxpayers ~ith special hearing and or speaking needs: 1-800-qq7-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as sho~n on this Notice may object within sixty (60) days of receipt of this Notice by: --aritten protest to the PA Department of Revenue, Board of Appeals, Dept. 181011, Harrisburg, PA 17118-1011, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to tho 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 [7128-0601 Phone (717) 787-6S05. Sea page 5 of the book[et "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 discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, er nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on or after January 1, 1981 ~111 bear interest at a rate which will vary from calendar year to calendar year with that rata announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200q are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor --Year Rate Factor 198'~ ZOZ .O005q8 198"~-1991 1IX .000301 Z001 9Z .O00Zq7 1983 161 .000~38 1991 92 .0002~7 2002 62 .OOOZ19 198q 112 .000301 1993-1994 71 .000191 2003 52 .000137 1985 132 .000356 1995-1998 9Z .0002q7 200~ qX .000110 1986 lOX .000174 1999 7Z .000191 1987 9Z .O00Zq7 ZOO0 8Z .000119 --Interest is caXcuXated as faXlows: XNTEREST= BALANCE OF TAX UNPAZD X NUI{BBR OF DAYS DELZNQUENT X DATLy ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Not[ce, additional interest must be calculated. BUREAU OF ZHDIVZDUAL TAXES INHERITANCE TAX DIVISION DEPT. ZB0601 HARRISBURG, PA 171Z8-0601 '04 ROSE M BARNES 2141 DOUGLAS DR CARLISLE PA:~70!$ COHNONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOT/CE OF INHERITANCE TAX APPRAISBHENT, ALLOHANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS JUi~ -7 REV-I~8 EX AFP (01-05) DATE 05-$1-2004 ESTATE OF JEPPESEN ROSE DATE OF DEATH 01-17-2004 FILE NUNBER 21 04-0586 COUNTY CUMBERLAND SSN/DC 541-24-1041 ACN 04115514 Amoun~ Remi~ed' HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 M CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .Ros~ M. Barn~s 1141 Douglas Dr ........ Carlisle, PA 17013 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. CD REV-1162 EX(11-96) OO4O 1 6 BARNES ROSE M 2141 DOUGLAS DR CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 541-24-1041 FILE NUMBER: 2104-0386 DECEDENT NAME: JEPPESEN ROSE M DATE OF PAYMENT: 06/07/2004 POSTMARK DATE: 06/05/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01 /17/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04115514 $640.54 TOTAL AMOUNT PAID: $640.54 REMARKS: SEAL CHECK#1226 INITIALS: JA RECEIVED BY' GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS I am sending the $32.31 requested. But please look at the attachment. I had717.96 in bills that paid. BUREAU OF TNDZVZDUAL TAXES ZNHERTTANCE TAX DTVI'SI'ON DEPT. 280601 HARRTSBURg, PA 171Z8-060! COMHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEI'IENT OF ACCOUNT REV-i&D7 EX &FP ROSE M BARNES 2141 DOUGLAS DR CARLXSLE PA 17015 BATE 07-12-2004 ESTATE OF JEPPESEN BATE OF DEATH §1-17-2004 FILE NUMBER 21 04-0586 COUNTY CUMBERLAND ACN 04115514 Amoun~ Rem*i ~ed ROSE M MAKE CHECK PAYABLE AND RENZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account:, submit: ~he upper portion of ~h:~s fore w'~'l:h your tax payment. CUT ALONG THZS LINE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS *~ REV-1607 EX AFP (01-03) ##~ INHERZTANCE TAX STATEMENT OF ACCOUNT ESTATE OF JEPPESEN ROSE M F'rLE ND. Z1 04-0386 ACN 04115514 DATE 07-12-2004 TH/S STATEMENT TS PROVTDED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACM TN THE NAMED ESTATE. SHONN BELO# TS A SUMMARY OF THE PR/NC/PAL TAX DUE, APPLZCATTON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, 'rF APPLTCABLE, A PROJECTED TNTEREST FTGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-$1-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 640.54 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 04-21-2004 06-05-2004 CD005856 CD004016 .00 .00 ZF PAID AFTER THIS DATE, SEE REVERSE SZDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR /NSTRUCT/ONS. ) TOTAL TAX CREDIT 1,281.08 BALANCE OF TAX DUE 640.54CR INTEREST AND PEN. .00 TOTAL DUE 640.54CR BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DTVISION DEPT. Z8060! HARRISBURG, PA 17128-0601 COMHONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLOHANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-30-2004 ESTATE OF JEPPESEN DATE OF DEATH 01-17-Z004 FILE NUHBER Z1 04-0386 COUNTY CUMBERLAND SSN/DC 541-24-1041 ACN REV-l~48 EX AFP C01-03] ROSE M ROSE N BARNES 2141 DOUGLAS DR Amou~emL~ HAKE CHECK PAYAB~:~ AND R~'HIT PAYHENT TO: REGISTER OF ~iLLS CUMBERLAND cO~::cou~ CARLISLE, PA-~ i7015 CUT ALONG THZS LINE ~ RETAZN LO~ER PORTZON FOR YOUR RECORDS REV-15~8 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT~ ALLOHANCE OR DISALLOHANCE OF DEDUCTZONS~ AND ASSESSNENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS DATE 08-~0-200~ ESTATE OF JEPPESEN ROSE M DATE OF DEATH 01-17-Z004 COUNTY CUMBERLAND FILE NO. 21 04-0386 S.S/D.C. NO. 541-24-1041 ACN TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION 04116530 FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 113113-11 TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 02-09-1990 Account Balance Percent Taxable X 0.500 Amount Subject to Tax 3,195.18 Debts and Deductions - .00 Taxable Amount 3,195.18 Tax Rate Tax Due 143.78 TAX CREDTTS: 6,390.35 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 MONEY ORDER PAYABLE TO: "REGISTER OF HILLS, ASENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-10-2004 CD003928 .00 111.47 PAYHENT HUST BE HADE BY 10-18-Z004~. 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 TS LESS THAN $1, NO PAYHENT IS RE{iUIRED. IF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) 111.47 32.31 .00 32.31 PURPOSE OF NOTICE~ PAYNENT: REFUND OBJECTIONS: ADNIN- ISTRATZVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Hake 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 Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Nills, any of the Z3 Revenue District Offices or by calling the special lq-hour answering service for forms ordering: 1-600-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-4~7-30Z0 (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 may object within sixty (60) days of receipt of this Notice by: --Nritten 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 RevieN Unit, DEPT. Z80601, Harrisburg, PA 171Z8-060! Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. if any tax due is paid within three (3) calendar manths after the decedent's death, a five percent (5Z) discount of the tax paid is allowed. 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 end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes Nhich became delinquent before January l, 198Z bear interest at the rate of six (BI) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198'-'~ lOX .000548 198'~B-1991 1XZ .000301 ZOO~ 9Z .'OOOZ~7 1983 162 .000438 1992 92 .000247 200Z 6Z .O00ZI9 1984 11Z .000301 1993-1994 7Z .00019Z 2003 5Z .000137 1985 13Z .000356 1995-1998 9Z .000Z47 2004 4Z .000110 1986 IOZ .000Z74 1999 7Z .O0019Z 1987 9Z .0002~7 2000 BZ .OOOZ19 --Interest is calculated es 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. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES ROSE M BARNES 21ql DOUGLAS DR CARLISLE COMNONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRA/SSNSNT ALLONANCE OR DISALLOWANCE OF DEDUCTION~, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS ,~ ESTATE OF DATE OF DEATH FILE NUNBER COUNTY '~ ~EP -7 Fq2 :Zl~SSN/DC ACN 08-$0-200q JEPPESEN 01-17-200~ 21 0~-0386 CUMBERLAND 5~1-2~-10ql 0~116530 Amoun~ ROSE M MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ ............. REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-30-200q ESTATE OF JEPPESEN ROSE M DATE OF DEATH 01-17-200q COUNTY CUMBERLAND FILE NO. 21 0q-0386 S.S/D.C. NO. 5~l-2q-10ql ACN 0q116530 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TIME CERTIFTCATE DATE ESTABLISHED 02-09-1990 Accoun~ Balance 6,390.35 Percent TaxabZe X 0.500 Amoun~ Sub~ec~ to Tax $,195.18 Debts and Deductions .00 Taxable Amoun~ 3,195.18 Tax Ra~e ~ .q5 Tax Due lq3.78 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: ffREGISTER OF WILLS, AGENT? TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-10-200q CDO03928 ,00 111.q7 PAYMENT MUST BE MADE BY lO-18-ZOOq~. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE a IF pAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( IF TOTAL DUE TS LESS THAN $1, NO PAYMENT IS RE~UIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 111.q7 32.31 .00 $2.31 PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADMZN- ZSTRATZUE CORRECTIONS: DISCOUNT: PENALTY: ZNTER£ST: Factual errors discovered on t~Js assessment should be addressed in Nrlt[ng to: PA Department of Revenue, Rureau af Individual Taxes, ATTN: Past Assessment Review Unit, I~PT. E&0601, Harrisburg, PA 171E8-0601 INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR ROSE M BARNES 2141 DOUGLAS DR iNFORMATiON NOTICE AND TAXPAYER RESPONSE FZLE NO. Z~ .......... DATE D4-Zi~ZO04 EST. OF ROSE N JEPPESEN S.S. NO. 541-2q-1041 DATE OF DEATH 01-17-2004 COb'~¥ CUMBERLAND TYPE OF ACCOUNI' GS' []CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER. OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE PA 17015 _ ] /~_ CARLISLE, PA 17013~ · '~ ~/'¢,/ / /'' ~ ~0~ P~ ~ ~ ~ ~E~ REV~R~ SZ~ ~OR F~ZN~ AN~ ~AYHENT ~NSTRU~T~ON~ Percen~ Taxable X 5 0 . 0 0 0 PART TAXPAYER RESPONSE PART If you indicate a differen{ {ax ra{e~ please s~a*e ~our ] relationship ~o decedent: ~ ~ TAX RETURN - COMPUTATZON OF TAX ON dOINT/TRUST ACCOUNTS LINE 1. Date Established 2, Accuun~ Balance 2 $. Percen~ Taxable ~ X q. Amoun~ Sub~ec~ ~o Tax q ~. Debts and Deductions S - 6, Amoun~ Taxable 6 7. Tax Ra(e 7 ~ B. Tax Due 8 PART DATE PAID PAYEE DESCRIPTION / TOTAL (Eh%er on Line 5 of Tax CompuSa(ion) $ AMDUNT PAID Under penal%iRs of perjur~ I declare %ha% ~he fac%$ I have reported above are %rue, correc~ and. complete %0 ~hm bee% of my knowledge and belief. HOME C1/~ ) R~-//3D ~AXPAYEE ~T~ATII~C TF~ FPNDNE NUMBER ~ATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OFINOIVIDUAL TAXES DEPT28060~ HARRISBURG, PA 17128-0E01 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004347 BARNES ROSE M 2141 DOUGLAS DR CARLISLE, PA 17013 ........ f01d ESTATE INFORMATION: SSN: 541-24-1041 FILE NUMBER: 2104-0386 DECEDENT NAME: JEPPESEN ROSE M DATE OF PAYMENT: 09/07/2004 POSTMARK DATE: 09/04/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/17/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04116530 $32.31 TOTAL AMOUNT PAID: $32.31 REMARKS: 'SEAL CHECK//8216 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 2141 Dou~s Dr. · BUREAU OF TNDTVTDUAL TAXES INHERTTANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-060! ROSE M BARNES Z1~1 DOUGLAS DR CARLISLE PA 17013 COMMONMEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE ESTATE OF DATE OF DEATH FZLE NUMBER COUNTY SSN/DC ACN 10-21-200~ JEPPESEN 01-17-Z00~ 21 0~-0386 CUMBERLAND 5~1-2~-10~1 0~116530 Amoun~ Remi'~'l:ed RE¥-16DI~ EX AFP C01-05) ROSE MAKE CHECK PAYABLE AND RENZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 M CUT ALONG THZS LINE RETAIN LONER PORTION FOR YOUR RECORDS REV-1604 EX AFP (01-03) ## ZNHERZTANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE 10-Z1-200~ ESTATE OF JEPPESEN ROSE M DATE OF DEATH 01-17-Z00~ COUNTY CUMBERLAND FILE NO. 21 0~-0386 S.S/D.C. NO. 5~1-2~-10~1 ACN 0~116530 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION dOZNT OR TRUST ASSET ZNFORHATZON FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 113113-11 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 02-09-1990 Account Balance Percent Taxable X. Amount Subject to Tax Debts and Deductions - Taxable Amount Tax Rate ~ Tax Due TAX CREDITS: 6,390.35 NOTE: 0.500 3,195.18 717.96 2,~77.22 .~5 111.~7 TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHZT THE UPPER PORTZON OF THIS NOTICE NZTH YOUR TAX PAYMENT TO THE REGISTER OF HILLS AT THE ADDRESS SHONN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: 'REGZSTER OF NZLLS, AGENT." PAYMENT DATE 05-10-Z00~ 09-O~-ZO0~ RECEIPT NUMBER ~Doo3928 ~D00~3~7 DISCOUNT C+) INTEREST/PEN PAID (-) .00 .00 AMOUNT PAID 111.~7 32.31 TOTAL TAX CREDZT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE 1~3.78 3Z.31CR .00 3Z.31CR ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL /NTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR ZNSTRUCT/ONS.) 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. -- Make check or money order payable to: REGISTER OF N/LLS, AGENT. 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 are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or fram the Department's Z4-hour answering service for forms ordering: 1-800-36Z-lOS0; services for taxpayers with 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, ATTM: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17126-0601, Phone (717) 787-6505. DISCOUNT: If any tax due is paid wlthin three (3) calendar months after the decedant's death, a five percent (SI) discount of the tax paid is aXlowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 16, 1996, the first day after the and of tho 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 l, 19BI bear interest at tho rate of six (SI) percent par annum calculated at a daily rate of .000164. ALl taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through Z003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Yaa__r Rate Factor 198Z ZOZ .00050,8 1987 9Z .000247 1999 7Z .00019Z 1983 16Z .000438 1988-1991 112 .000301 ZOO0 82 .000219 1980, iIZ .000301 199Z 9Z .000247 ZOO1 9Z . O00Z47 1985 13Z .000356 1993-1994 77. .00019Z ZOOZ 6Z .000164 1986 I0Z . DOOZ74 1995-199B 9Z .00020,7 ZOO3 5Z .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUtIBER 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. Xf payment is made after the interest computation date shown on the Notice, additionaI interest must bm calculated. REV-1470 EX (6-88) ,~~ INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG~ PA 17128-0601 DECEDENT'S NAME FILE NUMBER Rose M Jeppesen 2104-0386 REVIEWED BY ACN Department of Revenue 04116530 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Debts and deductions you submitted have been approved and applied against the above mentioned ACN. ROW Pa.qe 1 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DTVTSTON DEPT. 280601 HARRISBURG, PA 171Z8-0601 ROSE M BARNES Zlql DOUGLAS DR CARLISLE PA 17013 CONMONgEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTZCE OF /NHER/TANCE TAX APPRATSEHENT, ALLONANCE OR DISALLO#ANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 06-14-2004 ESTATE OF JEPPESEN DATE OF DEATH 01-17-2004 FILE NUMBER COUNTY SSN/DC ACN 21 04-0586 CUHBERLAND 541-24-1041 04116551 Amount Rmmitted REV-I;~8 EX AFP (01-03) ROSE HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THXS LXNE ~ RETAXN LO#ER PORTION FOR YOUR RECORDS ~ REV-X548 EX AFP (01-03) NOTXCE OF XNHERXTANCE TAX APPRAXSEMENT, ALLOHANCE OR DXSALLOgANCE OF DEDUCTXONS, AND ASSESSMENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS DATE 06-14-2004 ESTATE OF JEPPESEN ROSE M DATE OF DEATH 01-17-2004 COUNTY CUMBERLAND FILE NO. 21 04-0386 S.S/D.C. NO. 541-24-1041 ACN 04116531 TAX RETURN HAS: IX) ACCEPTED AS FILED ( ) CHANGED dOZNT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 113113-05 TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING C ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 03-20-1993 Account Balance Percent Taxable X 0.500 Amount Subject to Tax 19,769.68 Debts and Deductions - .00 Taxable Amount 19,769.68 Tax Rate X .45 Tax Due 889.64 39,539.36 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE HITH YOUR TAX PAYMENT TO THE REGISTER OF HILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF HILLS, AGENT." TAX CREDITS: · . PAYHENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 05-10-2004 CDOO3~,Z7~ ~: ~ ~-.~ .",,,, .00 889.64 ZF PAID AFTER THIS DATE, SEE REVERSE 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), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE 889.64 .00 .00 .00 PURPOSE OF ROTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (72 P.S. Section PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF HZLLS, AGENT. REFUND (CR): A refund of a tax credit, Hhich ems nat requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (RE¥-IBi3). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or by calling the special Z4-hour ansaering service for forms ordering: 1-500-362-20501 services for taxpayers Hith special hearing and or speaking needs: 1-800-4q?-SOZO (TT only). OBJECTIONS: Any party in interest not satisfied Hith the appraisement, alloHance, or disalloHance of deductions ar assessment of tax (including discount or interest) as shoHn on this Notice may object aithin sixty (60) days of receipt of this Notice by: --aritten protest to the PA Department of Revenue, Board of Appeals, Dept. ZSlOZ1, Harrisburg, PA 171ZS-lOZ1, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADNZN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Factual errors discovered on this assessment should be addressed in ~riting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviea Unit, DEPT. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid Hithin three (5) calendar months after the decedent's death, a five percent (BZ) discount of the tax paid is a11o~ed. The 15Z tax amnesty non-participation penaIty is computed on the totaI of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in tho the same time period as you advid appeal the tax and interest that has bean assessed as indicated on this notice. Interest is charged beginning Hith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes Hhich became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes Hhich became delinquent on or after January 1, 1982 .ill bear interest at a rate ahich Hill vary from calendar year to calendar year eith that rate announced by tho PA Department of Revenue. The applicable interest rotes for 1982 through 2004 ara: Interest Daily Interest Daily Interest Dally Year Rate Factor Year Rate Factor Year Rate Factor 198''"~ ZOZ .000548 19B'~8-1991 XZZ .000301 200--~ 92 .000Z47 1983 16Z .00043B 199Z 9Z .000Z47 ZOOZ 62 .000Z19 1984 112 .000501 1993-1994 72 .OOO19Z 2005 52 .000137 1985 132 .000356 1995-1998 92 .000247 2004 42 .000110 1986 ZOZ .000274 1999 72 .OO019Z 1987 9Z .000Z47 ZOO0 8Z .OOOZi9 --Interest is calculated as folloas: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DATLY 'rNTEREST FACTOR --Any Notice issued after the tax becomes delinquent Hill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sho~n on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES ZHHER/TAHCE TAX DTVTSTOH DEPT. Z80601 HARRTSBURG,, PA 171Z8-0601 ROSE M BARNES 2161 DOUGLAS DR CARLISLE PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT. ALLONANCE OR DISALLONANCE OF DEDUCTION~, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS RE¥-1648 EX AFP CD1-0S) DATE 06-16-2006 ESTATE OF JEPPESEN ROSE DATE OF DEATH 01-17-2006 FILE NUMBER 21 06-0586 COUNTY CUMBERLAND SSN/DC 561-26-1061 ACN 06116529 Amount MAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 M 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 ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 06-16-2006 ESTATE OF JEPPESEN ROSE M DATE OF DEATH 01-17-2006 COUNTY CUMBERLAND FILE NO. 21 06-0386 S.S/D.C. NO. 561-26-1061 ACN 06116529 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET ZNFORMATZON FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 113113-00 TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ( ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 02-09-1990 Account Balance 7,$96.92 Percent Taxable X 0.500 Amount Subject to Tax 3,698.66 Debts and DeductAons - .00 Taxable Amount 3,698.66 Tax Rate X .65 Tax Due 166.63 TAX CREDZTS: '~ ' 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. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-10-2006 CDOOF$9.29~ "I ~'~ ...... ~ .00 166.63 TOTAL TAX CREDIT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE 166.65 .00 .00 .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THZS FORH FOR INSTRUCTIONS. ) PURPOSE OF NOTICE= PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Make check or money order payable to: REGISTER OF RILLS, AGENT. A refund of a tax credit, ehich was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" {REV-1313). Applications ara available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or by calling the special Z4-hour answering service for forms ordering: 1-800-362-Z050; services far taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty [60) days of receipt of this Notice by: --written pretest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021; OR --electing to have the matter determined at the audit of the account of the personal representative; OR --appeal to the Orphans' Court Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue) Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three ($) calendar months after the decedent's death, a five percent (523 discount of the tax paid is atlowed. 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 end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the data of death, to the date of payment. Taxes which became delinquent before January 1, 19BI bear interest at tho rate of six (6Z) percent par annum calculated at a daily rate of .000164. Al1 taxes which became delinquent on or after January 1, 1982 wiZ1 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 ZOOq are: Interest Daily Interest emily Interest Bally Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .000548 198'~8-1991 112 .000301 200[ 9Z .000247 1983 I6Z .00043B 1992 9Z .000247 2002 6X .000219 1984 112 .000301 1993-1994 72 .000192 2003 52 .000137 1985 13Z .000356 1995-1998 92 .000247 2004 42 .000110 1986 102 .000274 1999 7Z .000192 1957 9Z .000247 ZOO0 8Z .000219 --Interest is caIculatad as follows: INTEREST = BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELINQUENT X DAi[LY :INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice; additional interest must be calculated. BUREAU OF ZNDTVZDUAL TAXES ZNHERTTANCE TAX D]'VTSTON DEPT. Z80601 HARRISBURG:, PA 171Z8-0601 COHNONNEALTH OF PENNSYLVAN'rA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF ACCOUNT REV-I[07 EX &FP [01-05) ROSE H BARNE~O~-i i~}~'/ -~ ,'! ~ :23 21~1 DOUGLAS DR CARLISLE f~PA 1701:3 DATE 10-25-200~ ESTATE OF JEPPESEN DATE OF DEATH 01-17-200~ FILE NUNBER 21 0~-0:386 COUNTY CUHBERLAND ACN 0~1165:30 Aeoun~ Reei'l:'~ed ROSE H HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701:3 NOTE: To insure proper credi~ ~o your account, subei~ ~he upper portion of ~his fore wi~h your ~ax payeen~. CUT ALONG TH'rS L'rNE ~ RETA'rN LONER PORT'rON FOR YOUR RECORDS *~ REV-1607 EX AFP (01-03) .-# INHERITANCE TAX STATENENT OF ACCOUNT ESTATE OF JEPPESEN ROSE H FILE NO. 21 0~-0:386 ACN 0~1165:30 DATE 10-25-Z00~ TH'rS STATEHENT TS PROV/DED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NANED ESTATE. SHONN BELO# TS A SUNHARY OF THE PR/NCIPAL TAX DUE, APPLICAT/ON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPL/CABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHEHT OR RECORD ADJUSTHENT: 10-Z0-200~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 111.~7 PAYHENT RECEIPT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID (-) AHOUNT PAID CD00:3928 .00 05-10-200R 09-O~-ZO0~ CD00~:3~7 .00 111.~7 :32.:31 ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADD/T/ONAL INTEREST. ( ZF TOTAL DUE 1S LESS THAN $1, NO PAYNENT IS REQUIRED. ZF TOTAL DUE IS REFLECTED AS A "CRED/T" (CR), TOTAL TAX CREDIT 1~:3.78 BALANCE OF TAX DUE $2.31CR INTEREST AND PEN. .00 TOTAL DUE :32.:31CR YOU NAY BE DUE A REFUND. SEE REVERSE S'rDE OF TH'rS FORH FOR TNSTRUCTTONS. ) 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: REGTSTER OF NILLS, AGENT. -- If NON-RES[DENT DECEDENT make check or money order payable to: COMMONNEALTN OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania inheritance and Estate Tax" (REV-1513). Applications ara available at the Office of the Register of Nills, any of the Z3 Revenue District Offices or from the Department's Zq-hour answering service for forms ordering: 1-800-56Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-qq7-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should ba addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z8060[, Harrisburg) PA 17[Z8-060[, phone (7[7) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months attar the decedent's death, a five percent (SZ) 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, 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 l, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through gOOq are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year 1982 20Z .OOOSq8 19&8-1991 llZ .OD0301 2001 1983 16Z .000~38 1992 92 .000247 ZOO2 198q IIX .000301 1993-1994 7Z .000192 2003 1965 I3Z .000356 199S-1998 9Z .O00Z~7 200q 1986 lOX .O00Z7q 1999 72 .000192 1987 9Z .000247 2000 8Z .O00Zl9 Interest Daily Rate Factor 9Z .000247 6Z .000164 52 .0001~7 qZ .O001lO --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUtiBER OF DAYS DELTNQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (153 days beyond the date of the assessment. If payment is made after the interest computation data shown on the Notice, additional interest must be calculated. BUREAU OF 'rNDTVTDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z8060! HARRISBURG,, PA 171Z8-0601 COHHONNEALTH OF PENNSYLVAN'rA DEPARTHENT OF REVENUE ZNHER'rTANCE TAX STATEHENT OF ACCOUNT RE¥-Z6D7 EX AFP ROSE H BARNES /lq1 DOUGLAS DR CARLISLE PA 17015 DATE 06-01-200q ESTATE OF JEPPESEN DATE OF DEATH 01-17-200~ FZLE NUHBER 21 0~-0586 COUNTY CUHBERLAND ACN 0~11551~ Amoun~ Rem'~. ~:'l'ed ROSE H HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit: ~o your account, submi* *he upper por~:ion of ~hls fore wl~h your ~:ex payeen~:, CUT ALONG TH'rS LZNE ~.~ RETA'rN LONER PORTZON FOR YOUR RECORDS ~ REV-1607 EX AFP ¢01-03) ~#~ 'rNHERZTANCE TAX STATENENT OF ACCOUNT ~ ESTATE OF JEPPESEN ROSE H F*rLE NO. 21 0q-0586 ACN 0~11551q DATE 06-01-200~ THTS STATENENT 'rs PROV/DED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NANED ESTATE. SNO#N BELO# 'rS A SUNNARY OF THE PR/NC/PAL TAX DUE., APPL/CATTON OF ALL PAYNENTS, THE CURRENT BALANCE, AND., ZF APPL/CABLE, A PROJECTED 'rNTEREST FTGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 05-$1-Z00~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYNENTS (TAX CREDITS): 6q0.5~ PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID Oq-Zl-ZOOfi CD005856 .00 6qO.Sq 'rF PA/D AFTER TH/S DATE, SEE REVERSE S/DE FOR CALCULATZON OF ADD/T/ONAL /NTEREST. /F TOTAL DUE /S LESS THAN $1, NO PAYNENT IS REQUIRED. IF TOTAL DUE KS REFLECTED AS A 'CREDIT' YOU NAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORN FOR /NSTRUCT/ONS. ) TOTAL TAX CREDZT 6qO.Sq BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 PAYMENT: Detach the top portion of this Notice and submit Nith your payment mede payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA. REFUND (CA): A refund of a tax credit, Nhich Nas not requested on the Tax Return, amy 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 23 Revenue District Offices or from the Department's Iq-hour ansmaring service for fores ordering: 1-BOO-36Z-ZOSO; services for taxpayers Nith special hearing and / or speaking needs: 1-BO0-qq7-3OZO (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue) Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB060Z, Harrisburg) PA I71Z8-0601, phone (717) 787-6505. DZSCOUNT: If any tax due is paid within throe (3) calendar months after the decadent's death, a five percent (SI) discount of the tax paid is allowed. 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 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 deIinquent before January 1) 198Z bear interest at the rate of six (6g) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 19aZ Nil1 bear interest at a rate which Nil1 vary from calendar year to calendar year Nith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200q are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .OOOSqB 1988-1991 llZ .OO0301 ZOO1 9Z .O00Zq7 1983 16g .O00q38 1992 9Z ,000Z47 ZOOZ 6Z .00016q 1984 112 .000301 1993-1994 7Z .000192 2003 5Z .000137 1985 132 .000356 1995-1998 92 .000Z47 2004 42 .000110 1986 ZOZ .000274 1999 7Z .00019Z 1987 9Z .000247 ZOO0 8Z .000219 --Interest is calculated as folloNs: INTEREST = BALANCE OF TAX UNPAID X NUIIBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent Nill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF ZNDZVTDUAL TAXES INHERITANCE TAX DTVTSTON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 COHHONNEALTH OF PENNSYLVAN'rA DEPARTHENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-I~B7 EX AFP C01-03) ROSE H BARNES Zlql DOUGLAS DR CARLISLE PA 17013 DATE 09-07-200q ESTATE OF JEPPESEN DATE OF DEATH 01-17-200~ FZLE NUHBER 21 0~-0386 COUNTY CUHBERLAND ACN 0q11551fi I Amoun'l: Rem'i 'l:'l:ed ROSE M HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF HILLS CUMBERLAND C0 COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credi~ ~o your account, subei~ ~he upper potation of ~:his form wi~h your ~ax payment. CUT ALONG THZS L'rNE ~ RETA'rN LONER PORT'rON FOR YOUR RECORDS REV-1607 EX AFP (01-03) ~ ZNHERZTANCE TAX STATEHENT OF ACCOUNT ESTATE OF JEPPESEN ROSE M FZLE NO. 21 0q-0386 ACN 0~11551~ DATE 09-07-200~ THIS STATEHENT IS PROVIDED TO ADVZSE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHO#N BELON ZSA SUMMARY OF THE PRZNCZPAL TAX DUE, APpLTCATZON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, TF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-31-200~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 6q0.5~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT DATE NUMBER :NTEREST/PEN PAID (-) 0~-21-200~ 06-05-Z00~ 08-17-200q CD003856 CDO0~O16 REFUND .00 .00 .00 ZF PAID AFTER THZS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDZTZONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" 6~o. ~q 6~0 .Sq- TOTAL TAX CREDIT 6¢0.5~ BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE SZDE OF THIS FORH FOR ZNSTRUCTZONS. BUREAU OF INOI)/J,OUI\I.,TAXft\ir,('r .. INHERITANCE TAX r.:~~@~ '~n U:-~;\,X Ct PO BOX 281)60} r'!'~",_ :',,", ',' , HARRISBURG~ PA 17~(d~i,_. ,,_, LS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REV-IU7 EX .FP [o9-n~l Zn'" "'Ill po"'''9 GUJ ...1j':,\\ i rTi..): oj DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-20-2004 JEPPESEN 01-17-2004 21 04-0386 CUMBERLAND 04116530 A,1IIOUnt Remlti:ed ROSE M C\ r-' ...Ci-I(, O-C" ".....-. ri" ,<'- ROSE (' li~i~"~':~A~flES'. 2141 CM;UGLAS DR 0 CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper cr8dit to your account~ submit the upper portion of this form with your tax pay..nt. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...... nv:r&lI".~!/".AW.rBr-.lJ'!'.......ii.."fAFIW'fmer"fA!/""4tlYrJlM.b'l!'.Aei!'lJDFH....................... ... ESTATE OF JEPPESEN ROSE M FILE NO. 21 04-0386 ACN 04116530 DATE 12-20-2004 THIS STATEHENT IS PROVIOEO TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHEO ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, ANO, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 10-20-2004 PRINCIPAL TAX DUE:, ~,.,.,N'.".""'."".'.'...'.'N".,"''''''''.'.,.,.'.'....II'''.'.'M"".,.. 111.47 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-10-2004 CD003928 .00 111.47 09-04-2004 CD004347 .00 '" 32.31 12-06-2004 REFUND .00 32.31- TOTAL TAX CREDIT 111. 47 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAlO AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SlOE FOR CALCULATION OF AODITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRl, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. 1 '5.~ .....