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HomeMy WebLinkAbout02-1182PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of ~L-c:.~~-t- ~-'`u~ Lc=tr~ ~'-~ No. 21-~a- IIAZ also known as__7_`c~c< tiiGt ~-~t.f~n~,~F~ To: Deceased. Social Security No. 19 3 '- ~•~ - ~~ 7 X 7 Register of Wills for the County of CUMBERLAND in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl. ~ ; for letters of administration on the estate of (d.b.n.; pendente life; durance absentia; durance minoritate) the above decedent. Decendent was domiciled at death in L rr~ h-e, r' ~ u r. ~~ County, Pennsylvania, with h c~ ~~ last family or principal residence at `v'I f5~ ~r: l~ (list street, num rand municipality) Decendent, then ~_ years of age, died ~ ~ ~ v' 3 19~L__, at_ .~IeSS~~a E~ ~ li~.i~~ Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ ,~~~~ (If not domiciled in Pa.) Personal property in County $ , ~ Value of real estate in Pennsylvania $ ;~ - situated as follows: - Petitioner after a proper search ha ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name i ` ' c{ ~ r Relationship -~1- Residence ~ ~~Y ~~ a THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the' appropriate form to the undersigned. v c o ~. ~~ x~ ~ o c '~ ~ '~ ~a v ~. ~ o c eq cn ~~ 1 ~ ~,~~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) .that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or af~iF t d and subscribed be-fore J^tCCM II X day of J t ~cj L,~v, ~..CX.~:.,~~~~~~ Register No. ~ 1-01- 118 Estate of IDA MAE LEMSKE AKA IDA MAE HOFFMAN ~ Deceased GRANT OF LETTERS OF ADMINISTRATION .. a~ a AND NOW DECEMBER 31 , 2002 ~y , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that V T f K T A RAT R is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration I FTTFRS (1F anMr~~TRAT1'R are hereby granted to 11 T f K T A ~iA I R -- in the estate-of IDA MAE LEMIKE AKA IDA MAE HOFFMAN '~~1~tr.~y,~~'~~_~ Register of Wilis ~ ,~ ~~\ FEES 1$.00 Letters of Administration ..... $ Short Certificates( ) .. • . • • • • • • $ ~ ~~ Renunciation • • • • • • • ' ' ' C n ~ ~ $~ ~6 TOTAL $ 31_,~~ Filed .1,7-31.-.?002........ A.D. 19_ - maic~~d to admin 12-31-2002 ATTORNEY (Sup. Ct. LD. No.) ADDRESS PHONE CERTIFICATION OF NOTICE UNDER Pa. O.C. Rule 5.6(a) ~GIS,~'ER OF WII,LS C,~m r Q nd couivTY, PENNSYLVt1NIA Name of Decedent: ~d a M a -e ~e, r~ ~C e.~ Date of Death: ,~ ~~ u 3 . ~ QQ 1 File Number: ;~ L~C7 ~ -- ~ f f g ~ Date Letters Granted: To the Register: I certify that Notice of Estate Administration required by Pa. O.C. Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to die following beneficiaries of the above-captioned estate on Name: Address: - ` L C ~j ,~ ~ rU Cl i ~ `~~ ~t ~~ ~ ~a rX~ ~ r I ~~ ~l ~~ S~o~r ~ ~7aly (If more space is needed, attach separate sheet. ) Notice has now been given to all persons entitled thereto under Pa. O.C. Rule 5.6(a) except: t.~._ ate ,~ Imo/ l °~ ~ o~ d / ~r r--> ~,• ~, !l) Signature c fPersan Filing this Form ~~ _~... ~"~... - ~~ "~~ ., ~ ~ ~1 ~ Capacity: Personal Representative ^ Counsel , t, ` ~a ,~ ~ ~.~+._. '~' ~ ;' LtJ Name of Person Filing this Form I w ; ~ „~ K o... ~--? Q ~_ _ ~a ~- ~.t~oac~ lcc n G~ J r I ~ t ~ ° ~:a-~ ~ _ "~ ~ ~ ":_ ~ ~' Address ~ ~ p~ ~ ~ o ,~~5 j~ 7~ 7 - 3~ -~a~ g Telephone Form RW-08 rev 10.13.06 150561D101 REV-1500 Extol-la, ~ OFFICIAL U5E ONLY PA Department of Revenue Pen~Ytvania Cou Code Year File Number Bureau of Individual Taxes OEwnnrErn QF NErEl1UE PO Box 280601 INHERITANCE TAX RETURN Harrisburg, PA lyi2$-o6oi RESIDENT DECEDENT ~! Uv~ - f Ig ~ -_ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ~ 93 - is -87 8 ~ d ~ /a 3 199 ~ d~ ~ig l 193 Decedent's Last Name Suffix Decedent's First Name MI L~~, k~ ~~ rs ~ .~dr-~ M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Retum p 3. Remainder Retum (dais of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~~G~i ~ ~a-~ ~i~- ~3a-ya g First line of address ~~~ ~1/ooc~ l a h C~ J r ~~ e~ Second line of address City or Post Office State ZIP Code ~~llsbvr PA ~~o/~ Correspondent's e-mail address: V ,b Cj / r' ~ ~/ f' ~' ~ 2017 , ~ e~ REGISTER O f WILLS USE ~LY .- ~ '::~- r-- N r - _. ~ . ~~-: . " ~ ~ [7 ~ _ FLED _ under penalties of perjury, I declare that I have examined this r+etum, including accompanying schedules and statemergs, and to the best of my lva~wledge and belief it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge, SIGNATURE OF PERSON RESPONSIB~FOR FILING RETURN DATE ADDRESS ~o r~ J ~ ll ~4 ~ o/ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE AUUFZt55 PLEASE USE ORIGINAL FORM ONLY _,. !~ '.. ,. ~ ` ..} r:.~ t ..: -_ ._~ ,.::_ .j _.~_~ ~~-; ~:..r:.1 r~ ~ t. F.~ Side 1 1505610101 1505610101 J 1505610105 REV 1500 EX Decedents Social Security Number Decedent's Name: ~ll Ll l ~I G ~, ~ m k~ ~~~ ~~ '" 8 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. ~ ~ J ~ 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. ~ a S - ~ a 9. Funeral Expenses and Administrative Costs (Schedule H} ................... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 12. Net Value of Estate (Line $ minus Line 11) .............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ~ a ~ ~ ~ ~/ TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES o 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0- 15. 16. Amount of Line 14 taxable at lineal rate X .0 ~ 16 ~ ~ ~ / 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610105 1505610105 REV-1500 EX Page 3 Decedent's Complete Address: Flle Number ~ ~ o a _ ~ ~ 8 ~- DECEDENTS NAME .Zola Maw.. ~e I'~') ~ STREETADDRESS __1~/1-~_s_l~___ ll ~ ~l Q cf--ems - -- / b D ---~ ~_----~~y - ~ l ---- ----------- ------ -- - CITY STATE -------~- ZIP-------- ------ l ~I.~ - ~.s~ h ~~ ~ 7 ~~ss- J Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 4. tf Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. Total Credits (A + B) (2) (3} ~ 1.9-3 (4} 5. tf Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ ~, ~ /~ 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. ff death occurred after Dec. 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement acxount, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ~ ^ tF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. Far dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [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 21 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 percent [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 percent, 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 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~ Pennsylvania SCHEDULE G DEPARTMENT aF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER I/ This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-150Q is yes. ITEM DESCRIPTION OF PROPERTY NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD`S EXCLUSION TAXABLE THE DA E OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE . VALUE OF ASSET INTEREST IF APR~ICABL VALUE 1. T ( 1 ~ ~r l~ ~~~~~ ~ e m c.~-{`~ -r~ o n ~oc ~ \ 2~ ~ J3 `~ ~ (o aS . ~ . . S TOTAL (Also enter on Line 7, Recapitulation) ~ ~ 0.00 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF: '' JJ FILE NUMBER: .-~c~c~ /~'~ a -e ~e rm K ~ ~ f o ~ - 1 I g ~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. 1/ic`ki~ .~~ air ~ '-~a'~ Woor~~and 1~. r~v~~ ~~ h-~r C~~S. ~S ~~ Ilsbur P~ ~7 alq II 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II - ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ ~ If more space is needed, use additional sheets of paper of the same size. ~~~,~r~/ ~~ ~lcj~~ ~~, ~: ///f_,~ ~~--fit--Z.~c.k.~ ,, ~ ,~~ / /f R .. L.../ ~~{, ~ ~ -~..-- ~ ~~ - ~ ~ r .- ,~ ~, C~~ ~' F ~ ~,~ ~1-[.-~`~'L. ~ ~~ ~~-~ -~-~~, ~ . 1~ `~ I CL-, J ~ D /l~~ ~J ~;~ ~ ~/~~ ~+a~ l~la~f t~~ . ~~Ilsbur . (~a -~ ~70~9 Proceeds From Broker and Barter Exchange Transactions YEAR: 20012 OMB Na. 1.545-Oi15 FORM 1099-B' 'PAW1 t4t16;11ifk ~ tb rll~li~ II(t St:Gt~{lltYtlAt~.1l: - W ._._ --- -- - 2301 10 j 74432 10 2 Prudential Financial. Inc. ~ " t~'~. C~ATi: t)!= ~.LE ; > t;lltTtiS PRinI:FC~.~ fhnfl STl)f'KS, CTi; ~ B~':RTf:ftihlG 4. FEDERAL INCOME TAX WITHHELD 5. fiESCRIP]tt1N ----'--- OL`25~02 I 625.68 RECIPIENTS PIAA~E, STREETADDRESS (IIICLUDING APL N0.}, CITY, STATE, AND ZIP CODE 1430626 1001-48741 IDA M HOFFMAN C!O VICKI BAIR 1 JESSICA LN DILLSBURG PA 17019 187.70 COPY B -For Recipient KEEP FOR YOUR RECOR ~iii~niiiii~~iiM~i~ THIS IS Ih1PORTAFITTAX INFORMAT10F1 APID IS BEING FURNISHED TO THE INIERNAL REVENUE SERVICE. IF YOU ARE REQUIRED TO FILE A RETURN, A NEGLIGENCE PEFIALIY OR OTHER SAF1C11Of I MAY BE It•APOSED ON YOU IF THIS IF•ICOME IS TAXABLE AP1D THE IRS DEIERP.IR~lES THAT IT IIAS PIOT BEEN REPORTED. Prudential :5 Demutualization Proceeds C:CCNJFITPIUi+tE;Et{ (Qf'~ItOPIAI:j } fiECIPI€MI'~ IGf1TT1f1CATIgFI~Nt1MfiEl~ 1001-=18741 rertn:~ rtheir., rta~Lt+,it -UtWUIICi~Oi/tt t•11)f~4pffi Prudential Financial. Inc. 22-3703799 a~roR Ttf, o r EquiServe Trust Company, N.A. 1-800-243-1701 O l /'25/02 Reference Number: 1001-=18741 Retain for Your 2002 Tax Records We're pleased to inform you that Prudential has completed its conversion from a mutual company to a stock company. As part of our conversion, we are issuing cash payments to eli~,ible owners of the. company. This includes anyone who owned an eligible policy or annuity contract as of December 15, 2000. Your check is below. 's (loos nol affect ,y°our insurance pulicy~ or aimuity in any wa~~. 1 our payment is a benefit of holding an eligible, policy or contract. It does not replace your policy or contract, or change your benefits, cash values, eligibility for policy dividends or guarantees. You do not have to give anythin~~ up to receive your payment. How y(>'ur pa~•mcnt was (lets-cnllne(1. Co-npauy actuaries and eternal advisors developed a plan far dividing the value of Prud~Titial au~ong its owners. Factors such as the type of life, annuity or health policy or contract you owned, the face value, and how lone you o~~•neci it di:tertTUned your compensation. Your paynTent ~~•as first calculated as a number of stock shares. These shares were then converted to an equivalent value in cash. Compensation for all of your policies eligible for cash payment is included in this check. SEE BACK FC)R MORE DETAILS. Iio~~~~nant• slTtal•es.~•ou were euthle(t -1'rice.l~e~~ stl~u~r. ..,.~ Your c~~><sh p<<yltneni to b1SCCI ptl ~4•out• policies qz' ronti~lcts ~` cc~e brl'c•k;(or• nu»•~ cletcr'ils """ 2.0000 $28.44 ~ 625.68 Questions? Call 1-800-243-1701 weekdays from 8:00 a.m. to 7:00 p.;n. (ET). (Telecommunications Device for the Deaf, 1-800-619-2837.) 1430fi26 L C C L .TN ~~ INSTRUCTIONS FOR RECIPIENT Brokers and barter exchanges must report proceeds from transactions to the Internal. Revenue Service. This form is used to report these proceeds. Box 1a. Slzc>ws thy: trade date of the transaction. For aggregate rel~~>rtirzg, -~~~ entry wi11 be present. Box tb. For hrt~ker tran~:actions, may show the CUSIP (Committee o-~ I~nifc~rn~ Security [clcntific~ztion Procedures) number of th+~ item z~ept~rt!°cl. Box ~. ,Slzcz~~~s the l~rzzceccls from transactions involving stocks, b~~-zcls. <~ttzer ~ieht ohli~~ations, conznzoditius, or forw~u•d contracts. L~~~s~~s ~~n l~c-rw~ar~l contracts .-rc sho~~~n in parentheses. This box zl~~e, n~~t int~l~-ele pre~cceel5 from re~~ulat~:d futures contrz-cts. The hre~i.~~r ulu~t inelicatc Lvh~ther ~~rczss proceeds or ~~ross proceeds 1e,ss c~~~nzrnis~:i~-nti ~u~cl t~l>tie~-z l~re~nziun~s ~~~ere reported to IRS. l:.eport this ,.-nun-nt c~-z Sc~~ctla~la~ I~ (1{czr-~~ 1041)?, C<-pit~il Caains and Losses. Box 3. Shows the fair market value of any trade credits or scrip credited to your ~-ccount for exchanges or propc;rty or services as well as cash received through a barter excha-z~~~. Report bartering income in the proper part of Forrn 100. S~.e Pc-b 52~. Taxable and Non T~-xabl~; Income, for inforrrrzlion on hc>~~ to report this income. Box 4. Shows bacla-p witl~zolding. Gcncr4-Ily, a payer must backup withl~zukl ~-t ~- :~O`:<< rate if you did not furnish your taxpayer icl~;ntificatiun ntuz7her t~~ tizc payer. Sit Form V6~-9, Request for Taxpayer Identitic~-tic~n Number and Certification, for information on backr-p withhca(clizz{.~. Includt: this amuiuit ~~ia ynur iax~corne tax return as ta;~ tiviti~helcl. Box 5. Shc~~~~ti <- hriel~ d~:4c~ription of the item or service for which the pruceecls ~~r Iru-tc:ri-zg iz~co-n~; is being repented. For regulated futures cr-ntr4tct~ ~-ncl h~u~tii~ard co-itracts, "l~F~" or other appropri~-tc clescriptiE~-- ~--ay be shown. RETAIN THIS INFORMATION FOR YOUR RECORDS. 1(ey steps to Prudentiai's conversation to a stock company. L~ecerriber 1 ~, 2000 Prudential s Board of Directors c-nanimously adopted a pltlrz to reorganize Prudential and istiue stack. i 1~Iny -June 2007 A mailing was sent so that eligible policyholders could vote on the plan. Jazly~ 17 - 18, 2001 A public hearing was held to discuss the plan. Jul}~ 31, 2001 The plan ~ti~as approved by policyholders. ~ 1~~Iore than four mzllion pohcyhold~;rs I ve?te~l, overwhelmin;v~ly zn favor. i I ~c~ob~Y 15, 2001 Tllc plan ivas ~-l~proved by the i~iew i Iersey insurance ~on~nissioner. t i Tirs.t ~?u~rter 2002 Following an initial public offering (IPC~}, compensation zs distz-ibuted to i eligible policyholders. flow your cash payment vvas determined, ~oml~~.-~y ~tctuarics .-n~l e~te-7~a1 advisczr~ deti'elaped a plan for dividi-i~T the ~~~-luc cffi~ }'ruclcntial ~-nz<~n~; its o~ti~-zcrs. Based on factors such as the type c>f pe~lic~~ or cc-ntract you o~~n, its face value, a~ how lcang yuu -zti~~nc~l it. yeti ~ti~erti: allocated ~- ~;pecific number o. stock 5h~-rt~. 'phis payment reflects the allocation of additional shares for lx~licti~holders not recei~~ing stock ~-s their form of payment. To determine your cash paynzcnt, the number of shares z-llocated to ytat- ~~a~ --zultipliccl guy thy: share l~riee of the stock. The share price is b~-seel o-z the market p--ice of Pruel~ntial Financial, Inc. stocll ~~~he-- it g~~~-s first sold ~to the pztblic through an initial public ofl~erin~~ ~II'(~). Four payn-ent may hz-ve been revised upward by ~-p to ltl pence-~~ to reflect appreci<-tion of the stock during the first 2t~ tr~-clin~~ pit-~ti ~~~llt`~~i~i~1~~ tlzc. IPC. Information about taxes, This cash payment is considered 2002 taxable income by the IRS. Please consult your tax advisor for mare information. ~uestions~ ~'ali 1-HI)1i-243-1701 ~~~eekdays fro-n 8:00 a.--1. to 7:00 p.m. (ET). p'or hearin~~ impaired, call 1-~t)i)-619-237. Pa O.C. Rule 6.1xr2 STrATUS REPORT REGISTER OF WII,LS OF Lt YYI 0~ ~ ! Q'V11~ COUNTY, PENNSYLVANIA Name of Decedent: ~~ Q / yl a'e- l-e -'n 1~ -~ Date of Death: 3 ~ ~ ~ ~ L- File Number: ~ ©~ a -' ~ (< g ~ Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to complefiion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete :.................... ~ Yes ®No 2. If the answer is No, state when the personal representative 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 b. The separate Orphans' Court No. (if any) for the personal representative's account is: ~No c. Did the personal representative state an account ., informally to the parties in interest? ............................... Yes ~No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date_ j r r~ a Sr a s I o CJ c " tt7 , ~~ ._. c ~ ~_ ,~, F-- , -- ~ .-~ ~ ~, -!. ~.1 _ - N C~ - -- w ~% -. ! a e tZ , ~ t.: ~ tr .. t~__ o o d N Form RW-10 rev 10.13.06 ~~ Cam-- ~A ..~,~ Signature ofPerson Filing this Fwm Capacity: Personal Representative ^Counsel Vi ~~ i ~9 Name of Person Filing this Form ~a~- (,~ boo ~J11 cv„~~~ ,~ r ~ v ~e Address ~IISb-~ra ~ PA- ~~olq Telephone BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX ACA~l3~ME1!~Tji'~~A~.I~bWANCE OR DISALLOWANCE OF' DE~UDTI:QNE~, AND ASSESSMENT OF TAX X010 ~~Y 21 ~~ I~~ i 2 CLE~~ E~!r aaPH~,~~~~ c~~ -~,- VICKI A BAIR `~~. CUB "`~~=~= _. ;,~ -~, ~'~ ; A. 424 WOODLAND DRIVE DILLSBURG PA 17019 Pennsylvania ~ DEPARTMENT OF REVENUE REV-1547 EX AFP C12-09) DATE 05-17-2010 ESTATE OF LEMKE IDA M DATE OF DEATH 07-03-1991 FILE NUMBER 21 02-1182 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 07-16-2010 (See reverse side under Objections ) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG-THIS LINE ---_ ~-- R_ETA_IN LOWER POR_TION_ FOR YOUR RECORDS ~ REV-1547 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: LEMKE IDA MFILE N0.:21 02-1182 ACN: 101 _ _______________ OR DATE: 05-17-2010 TAX RETURN WAS: C ) ACCEPTED AS FILED C )() CHANGED SEE ATTACHED NOTICE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) C1) .0 0 NOTE: To ensure proper 2. Stocks and Bonds (Schedule B) (2) .0 0 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) C3) .0 0 submit the upper portion of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) •0 0 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) .0 0 6. Jointly Owned Property (Schedule F) (6) .0 0 7. Transfers (Schedule G) C7) 625.68 8. Total Assets (8) 625.68 APPROV ED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) .0 0 10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) .0 0 11. Total Deductions C11) .0 0 12. Net Value of Tax Return C12) 625.68 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .0 0 14. Net Value of Estate Subject to Tax C14) 625.68 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 (15) .00 X 06 -= .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 6 .68 x 0 6' = 3 7.54 17. Amount of Line 14 at Sibling rate C17) .0 0 X 0 0 ~ .0 0 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 0 X 15 - .0 0 19. Principal Tax Due C19)= 37.54 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 06-01-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 37.54 INTEREST AND PEN. 24.32 TOTAL DUE 61.86 * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS~1~ REV-1470 EX (01-10) r • ~ ~ enns Lvan~a p y DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 DECEDENTS NAME INHERITANCE TAX EXPLANATION OF CHANGES FILE NUMBER Ida M. Lemke 2102-1182 REVIEWED BY ACN Sheila Megonnell 101 ITEM SCHEDULE NO, EXPLANATION OF CHANGES ~ Taxable at 6%. The tax rate change for lineal heirs is effective for dates of death on or after 07-01-2000. Row Page 1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOIVIOUAL TAXES DEPT. 280801 HARRISBURG, PA 17128-0801 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 013391 BAIR VICKI 424 WOODLAND DRIVE DILLSBURG, PA 17019 -------- fold ESTATE INFORMATION: SSN: 193-12-8797 FILE NUMBER: 2102-1 1 82 DECEDENT NAME: LEMKE IDA MAE DATE OF PAYMENT: 09/21/2010 POSTMARK DATE: 05/05/2010 COUNTY: CUMBERLAND DATE OF DEATH: 07/03/ 1 991 REMARKS: AMNESTY SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 533.60 REV-1162 EXI11-961 TOTAL AMOUNT PAID: INITIALS: WZ RECEIVED BY 533.60 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Pennsylvania DEPARTMENT OFREVENUE DEY-1151 DOLE%EC (15-11) September 2, 2010 To the Register of Wills of the County of CUMBERLAND RE: INHERITANCE TAX CREDIT MEMO Estate of: File Number: Decedent's SS#: ACN Number: Payment Amount Postmark Date: IDA LEMKE 2102-1182 193-12-8787 101 $ 33.60 05/05/2010 13 3~J( -l ;i,;, ~r.FLi t_ Vii'%lf~ Vi- ~~~31Jit~ . , 4^.~li I ~ 2oio s€~ 2 ~ AM 10~ 5S CLERK OF CUMBPERLNANSI? OAR pq An Amnesty payment on the above-referenced inheritance tax liability has been received and transferred to the inheritance tax fund. Please issue an official inheritance tax receipt for the Tax Amnesty payment and postmark date above. Make the payment date on the receipt the date the receipt is prepared by your office. Also, type "AMNESTY" in the remarks area of the receipt. Mail the receipt to: Name: VICKI BAIR Street: 424 WOODLAND DRIVE City/State2lP: DILLSBURG PA 17019 The department's copy of the Official Receipt should be mailed using the postage paid Inheritance Tax bulk mail envelope (E-136) within five (5) business days after receiving this credit memo. Attach an "AMNESTY" cover sheet to the front of the receipt, or if multiple amnesty receipts are being submitted, attach the cover sheet to the top of the group. The amnesty cover sheet will help expedite the processing of the receipt when arrives in the Inheritance Tax Division. Please keep the amnesty receipts sorted and bound separately from the other Inheritance Tax documents when placing them in the bulk envelope. On your next Register of Wills Monthly Report, REV-714, include the payment amount in the monthly inheritance tax collections reported on Line 5, and claim a credit on Line 7. Your monthly inheritance tax collections, less the credit for this payment, should equal the Total Amount Deposited on Line 12. Your efforts in expediting the issuance and mailing of the Department of Revenue's copy of the tax amnesty payment receipt is greatly appreciated. Thank you for your timely attention to this matter. If you have any questions, please call 717-787-7031. Individual Taxes I PO Box 280603 I Harrisburg, PA 17128-0603 1717.787.7031 I vaww.revenue.state.Da.us ~ 1 - ~ _ - - ~ Pennsylvania ~~ ~ DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES -~--• IN'H;ERITANCE TAX r _ REV-1607 EX AFP C12-09) INHERITANCE TAX DIVISION ~ TAT E M E N T O F A C C O U N T PO BOX 280601 HARRISBURG PA 17128-0601 'e;' i f; iy I~ F j~ ~ -- i^) r' m J t ~ 1 ! I ~~ a' i±~.~~~ ~ ~~'' DATE 10-04-2010 ,;, , - ,~ ~ - - ~ _ VICKI A BAIR 424 WOODLAND DRIVE DILLSBURG PA 17019 ESTATE OF LEMKE IDA M DATE OF DEATH 07-03-1991 FILE NUMBER 21 02-1182 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~'- RETAIN LOWER PORTION FOR YOUR RECORDS ~ ~~~~~~~~~r~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~^ REV-1607 EX AFP C12-09) *** INHERITANCE TAX STATEMENT OF ACCOUNT **~ ESTATE OF:LEMKE IDA M FILE NO.: 21 02-1182 ACN: 101 DATE: 10-04-2010 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-13-2010 PRINCIPAL TAX DUE: 37.54 PAYMENTS CTAX CREDITS): PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 05-05-2010 CD013391 .00 33.60 INTEREST IS CHARGED THROUGH 10-19-2010 TOTAL TAX PAYMENT 33.60 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM.* BALANCE OF TAX DUE 3.94 INTEREST AND PEN. 24.29 TOTAL DUE 28.23 * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280801 HARRISBURG, PA 17128-0801 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-961 NO. CD 013588 BAIR VICKI A 1 JESSICA LANE DILLSBURG, PA 17019 °°---- fold ESTATE INFORMATION: ssN: 1ss-12-s~s~ FILE NUMBER: 2102-1 1 82 DECEDENT NAME: LEMKE IDA MAE DATE OF PAYMENT: 11/03/2010 POSTMARK DATE: 1 1 /02/2010 COUNTY: CUMBERLAND DATE OF DEATH: 07/03/ 1 991 REMARKS: VICKI BAIR ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $28.23 TOTAL AMOUNT PAID: $28.23 CHECK# 2156 INITIALS: WZ SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS LJ A4 w n -V T ~^ Z o .~i /A W ~ ~Y ¢ a ..~ o ~z~ b Q ti a W O rc a F Z x~ a° ~~ V W a V LL O r w ~ ~. W W 2 ~ Z W H ~ Q H y ^-~ u-3 -_ C_i ~-~ u~- ~ ~...- 1 G~ ~ u r u7 ~~ C,_' ~O O ~.. v p~ o ~ r N N ~ ry p ti z ~ ~ o d °z°mo~°c 7 ti N m a«.xH ~Wmp( m~°a~ O H Z Q W D = H t a w O .a N O ('~ ~ „'~ O~ OD Z Y ~ 0 o a .r „ E C~ N .y N J Z V' W M N W ~ a O Y 0 0 pq a+ ~ W i E ~ J o W f~ .-i ~ O ~ ~ ~ ~--~ J O N V N ~ 2 t 4 ~ K W W Y 4. 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MA ~4 ;:'~+ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17126-0601 RECEIVED FROM: BAfR VICKI A 1 JESSICA LANE DILLSBURG, PA 17019 fob PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: ~ 93-~ 2-8787 FILE NUMBER: 2102-1 182 DECEDENT NAME: LEMKE IDA MAE DATE OF PAYMENT: 1 1 / 17/2010 POSTMARK DATE: 1 1 / 16/2010 COUNTY: CUMBERLAND DATE OF DEATH: 07/03/ 1991 TOTAL AMOUNT REMARKS: CHECK# 2160 INITIALS: SAP SEAL RECEIVED BY: REV-1162 EX111-96) NO. Cf~ I 'I III ACN ASSESSMENT CONTROL NUMBER '~ 013658 MOUNT 101 ~ 524.32 ~ ~ 'AID: III I GLENDA EARNER ST 524.32 ASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~n ~C ~~ ~s °r O 'Z 1 K N r M ~. m 1 ~oz°tl =c ~o ..°~~m croZSZS ,} 4~7 eC7~ d 1~ '9em~1 H N H > .. -~ ,,,, rt~c~ ~Z r 7c ~ b VJ E ~ ~ ° •, Ivor O m < „~„ C O a "'' 70 d a ~ c c~DD ~ is r Z py -1 d ~o a x d tv N A p M~ ~~ ', ~ m~~ Z ~.,. -;, 'O ` ' ~ "C r t •~~ ~~ N -~1 0 y~~ r ~ z= yam ~o a~ > c~ 'n d m d vi m ~.. m ~ zz m n~i > m H °> zz D'~mn rr ~zom =dn zn°_ -. cm m~„~m ~cv~~ m ~~ ~t~~ ~y1 ,~ ~o s ~~m~w ~; ~~ ~~x m ox ~° > rr ee r s ~ cow • ~ y-is amTbe a' ">oc~~mton ~Cn gr' ~ 1r s ~ 3 ~ n1 m ~ m V1 ~ W O O 7t r r ,p r ~ m N W m V v c r~ ~ ~ z a w m z O;i o N ° o ~ o~ RI `Q' ~,,, "~ m N n O~ .• D V ~ N v -i ~. ~° Q~\_ r a ~- o H ~ d ~ ~ m~' D ~m~ -1 ^~ m e a ~. ~ ~ c ~ O m 3 M M- f/1 W W W N •` \ t~ v i C 4 i ~~ A1r V rM. r r .,. ~ ~ L~ ~~ C.? C..7 ~G U3 :~ ;. ... ~ ~- ` tJ ~ C ~ p= 3 Q~J- ~;; ~• LSJ ~ C ~. Z ~, o N COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES 1~1a~4J~ ~f" DEPT.28060> "'r' li~ t~ HARRISBURG, PA 1 7 1 28-0601 ~.fi « - ... PENNSYLVANIA RECEIVED FROM: ~~`~ ~~~,}~ ~,~ IAI,~iF~iITANCE AND ESTATE TAX II""i~'11 LL~~ ~pFFICIAL RECEIPT " ~ :K~~ GF I. ..~ I BAIR VICKI A 1 JESSICA LANE DILLSBURG, PA 17019 -------- fold ESTATE INFORMATION: SSN: 193-12-8787 FILE NUMBER: 2102-1 182 DECEDENT NAME: LEM KE I DA MAE DATE OF PAYMENT: 1 1 / 1 7/2010 POSTMARK DATE: 1 1 / 16/2 10 COUNTY: CUMBERLAND DATE OF DEATH: 07/03/ 1991 REMARKS: 101 ~ $24.32 REV-1162 EX~11-96) NO. CD 013658 ACN ASSESSMENT AMOUNT CONTROL NUMBER TOTAL AMOUNT PAID: 524.32 CHECK# 2160 INITIALS: SAP SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER ..~ »,~ ra a... ttl tIT+ ., Q~ a tJ ~ ~ ~ k.l y +~ ~{ p p~~ M'! '~ .*~ "' .., py ~ ~y ' V t ,.. ~ ~ y J .r. C '.p~ ~ ~ N ~ g y ~ y y~ \J ~ ~ "~ L ° rl .,~.,. ~ ~ r }~ ~ ~ + i~.n i ' i i .. p y G7 y y ~ I ~ W ~Ll• ~.., ~ ~} p g , A' d y ~ f iry ~ ry --9 8" -~ ~!#1 ~~~ ~ ~~~ ~~~ ~ ~ ®ir ~ ~ ~~ x~ ~ ~ ~ ~ tea ~'i ++ ~ ~ ~ ~..,. ~ [ ~ uu r .. ..r: ~~ ~~~ ;'."~ r.: i~ ~n • r~ '~. ~~i "~ " :. r ~"~~ . ~~ rY ~~.~ `.,; ?~ `ei ..i.` f~ ~..t. •3 ~.3 ,.a. •: ~: `# '~ +~ ~, ~~ ~ ~ ,~ t` :~ ,_ ~. ~~ ~~~ ~~. (c ~ g "s x ~; ' k: 3 d f; A ~m ~; ssvi~-lsZ» vsn BUREAU OF INDIVIDUAL TAXES ~ ~ ~ ~~ INHERITANCE TAX INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT PO BOX 280601 - HARRISBURG PA 17128-0601 ~ ~- ~~ '` L. 1, 1 4,f t `. ~.r L J ~ t~l~i 4. ~ L~ a.t ~',r ,^ r~ ti,L~~~~ ~, ~. VICKI A BA "`~ ~ ,'- 424 WOODLAND DRIVE DILLSBURG PA 17019 pennsylvania : ~ , DEPARTMENT OF REVENUE REV-1607 EX AFP (12-09) ~ ~~ ~~~~~ DATE 11-15-2010 ESTATE OF LEMKE IDA M DATE OF DEATH 07-03-1991 FILE NUMBER 21 02-1182 COUNTY CUMBERLAND ACN 101 Amount Remitted -~ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP C12-09~ *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF:LEMKE IDA M FILE N0.:21 02-1182 ACN: 101 DATE: 11-15-2010 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-13-2010 PRINCIPAL TAX DUE: 37.54 PAYMENTS CTAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-~ 05-05-2010 CD013391 .00 33.60 11-02-2010 CD013588 24.29- 28.23 BALANCE OF UNPAID INTEREST/PENALTY AS OF 11-03-2010 TOTAL TAX PAYMENT ~ 37.54 BALANCE OF TAX DUET .00 INTEREST AND PEN. ~ 24.32 TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. 24.32 tf.~l `~` BUREAU OF INDIVIDUAL T~~~,f~~1 (~~~}~~ INHERITANCE TAX INHERITANCE TAX DIVISION AT E M E N T O F AC C O U N T PO BOX 280601 ~~~~~~ ~ ' ~~~ ''.~~~ HARRISBURG PA 17128-0601 ' `w'~~`j ~ ~~ "_ ` ~~~`~"~J ~'i~~~~~~27 P 1~ ~3 ~~~~~ ~~ ~RP~~'~ ~t~~1RT V I C K I A BA I ~~~~~~s.;~~ (~ PA, 424 WOODLAND DRIVE DILLSBURG PA 17019 ~ r,~. , ~~ pennsylvan~a ~ ~ T DEPARTMENT OF REVENUE REV-1607 EX AFP C12-10) DATE 12-20-2010 ESTATE OF LEMKE IDA M DATE OF DEATH 07-03-1991 FILE NUMBER 21 02-1182 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS ~ _ _ _ _ _ REV X1607 SEX AFP C 12 10 ~ ~~w~~ * * * INHERITANCE TAX STATEMENT~OF ACCOUNT ~~* * * ~ ~ ~~~~~ ~~~~~~ ~~~ ESTATE OF:LEMKE IDA M FILE NO.: 21 02-1182 ACN: 101 DATE: 12-20-2010 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-13-2010 PRINCIPAL TAX DUE: 37.54 PAYMENTS tTAX CREDITS): PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 05-05-2D10 CD013391 .00 33.60 11-02-2010 CD013588 24.29- 28.23 11-16-2010 CD013658 24.32- 24.32 TOTAL TAX PAYMENT 37.54 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR?, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~~