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HomeMy WebLinkAbout03-0827PETITION FOR GRANT OF LETTERS Estate of Gladys R. Shumberger also known as Ronald R. Shumberger and Donald W. Shumberger Petitioner(s), who is/are 18 years of age or older, apply)les) for: (COMPLETE "A" OR "B" BELOW:) , Deceased Social Security No 178165323 named in the Last Will of the A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ors r~ Decedent, dated 11/19/1973 and codicil(s) dated State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a,, d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 1900 Market Street, Camp Hill, PA 17011 (list street, number and municipality) Decedent, then 91 years of age, died September 29 2003 at Manor Care, Camp Hill, PA (Location) Decedent at death owned property with estimated values as follows: (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 ........................................................................................ $ Total ..................................................................................................................... $ 14,000.00 14,000.00 Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence Ronald R. Shumberger 1202 Apple Dr., Mechanicsburg, PA 17055 Donald W. Shumberger 23 Lancaster Blvd., Mechanicsburg, PA 17055 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and 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 Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this 13th day of Donna M. Otto,'ls~ 'Depu~ /~ DECREE OF REGISTER Estate of Gladys R. ShumbCrgCr also known as Deceased No 21-2003-827 Social Security No: 178165323 Date of Death: 9/29/2003 AND NOW, October 13th, 2003 in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary D of Administration. ((c.ta., d.b.n.c.t; pendente lite; durante absentia; durante minoriate) are hereby granted to Ronald R. Shumberger and Donald W. Shumberger in the above estate and that the instrument(s), if any, dated November 19, 2003 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... $ 50.00 Short Certificates(s) ...{.3.) ...... $ 9.00 DO~ ~t~ ~. w~)~t to ,~ls t (~p~ty Renunciation .......................... $ Extra Pages( i ) ............... $ 3.00 I.T.R ....................................... $ Signature JCPFee ................................. $ 10.00 Attorney: R. Mark Thomas Inventory ................................ $ I.D. No: 41301 Other ...................................... $ Address: 101 S. Market St. Mechanicsburg PA 17055 TOTAL ............................. $ 7~:nO Attorney will pick up letters Telephone: 717-796-2100 DATE FILED: Tuesday Morning 10-14-03 REGISTER OF WILLS OF C~berland COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (eag) being duly qualified according to law, depose(s) and say(s) that / present and saw, the testat__., sign the same and that / signed as a witness at the request of testat___ in h__ presence and (in the p~/sence of each other) (in the presence of the other subscribing witness(es)). / Sworn to or affirmed and subscribed before me this day of Re~ster (Name) (Address) (Name) (Address) 21-2003-827 REGISTER OF WILLS OF Cumberland COUNTY OATH OF NON-SUBSCRIBING WITNESS Ronald R.ShL~berqer and Donald W. Shumberger (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that We are familiar with the signature of Gladys R. Shumberger , codicil testat rix of ~x~ Yo~ the (will) presented herewith and codicil that We believe~:the signature on the ~ )is in the handwriting of Gladys R. Shumberger to the best of Our knowledge and belief. Sworn to or affirmed and subscribed before ~'J4~'c~ ~ . (~~ .12~ me this 13th day of (NamO ~a M. Otto, 1st ~ty (NamO [ (Address) 21-2003-827 LAST WILL AND TESTAMENT OF GLADYS R. SHUMBERGER I, GLADYS R. SHUMBERGER, of the Borough of Me- chanicsburg, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Tes- tament, hereby revoking and making void all former Wills by me at any time heretofore made. I direct the payment of all my just debts and fune- ral expenses as soon as conveniently may be after my decease. e Ail the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath unto my beloved husband, Clarence W. Shumberger, to his own use and benefit absolutely. e In the event, however, that my said husband should predecease me, or should die at about the same time as I do, such as in a disaster common to both of us, I give, devise and bequeath my said Estate to my sons, Ronald R. Shumberger and Donald W. Shumberger, in equal shares. e In the event, however, that both of my sons, Ronald R. Shumberger and Donald W. Shumberger, should predecease me, I give, devise and bequeath my Estate to my grandchildren, in equal shares. If any of them is a minor at the time of my decease, and needs a Guardian for his or her share in my Estate, I appoint the Dauphin Deposit Trust Company to be such Guardian. Se LASTLY, I nominate, constitute and appoint my hus- band, Clarence W. Shumberger, to be the Executor of this, my Last Will and Testament. If he should predecease me, or for any other reason be unable to act as such Executor, I appoint my sons, Ronald R. Shumberger and Donald W. Shumber- ger, to be the Executors in his place and stead. I further direct that they shall not be required to file bond or other security in the office of the Register of Wills for the pur- pose of acting as such Executors. IN WITNESS WHEREOF, I have hereunto?~set my hand and seal this /~ ~day of November, A. D. 1973. Signed, sealed, published and declared by the above- named GLADYS R. SHUMBERGER, as and for her Last Will and Tes- tament, in the presence of us who have hereunto subscribed our names at her request as witnesses thereto, in the presence of the said Testatrix and of each other. LAST WILL AND TESTA~4ENT OF GLADYS R. SHUMBERGER CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Date of Death: 9/29/2003 SSN: 178165323 Date Letters Granted: To the Register: Name of Decedent: Shumberger, Gladys R. Estate No. 21-03-0827 File No. 2003-00827 Will or Administration No. I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 10/13/2003 Name Ronald R. Shumberger Donald W. Shumberger Address 1203 Apple Drive Mechanicsburg PA 123 Lancaster Blvd. Mechanicsburg PA 17055 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Capacity: Personal Representative X Counsel for Personal Representative Signature Name (Please type or print) R. Mark Thomas, Esq. Address 101 S. Mar~t Street Mechanicsburg -, T~phone NO 717-796-2100 PA 17055 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Gladys R. Shumberger Date of Death: 9/29/2003 Will No. 2003-0827 Admin. No. 21 03 0827 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes__ No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: 3/04 R. Mark Thomas Name (Please type or print) 101 S Market St , Mechanicsburg, Address PA 17055 (717) 796-2100 Tel. No. Capacity: Personal Representative x Counsel for personal representative (MAH:rmf/AM3) !EV 150(} EX (6 00) ~:~k COMMONWEALTH (~F ~,~,~?~ ~ PENNSYLVANIA .¢'~.~',~,,~L:~"~'~ DEPT. 280601 ~HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER .~..1__ -- CLO_ __ 827 CouNrY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z Shumberger, Gladys R. I 78 - 65 -5323 ~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE f,.) 09/29/2003 07/17/1912 REGISTER OF WILLS I.LI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRS]-, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ,,, [] 1. Original Return [~]4. Limited Estate E6.Decedent Died Testate (Attach copy of Will) F- Z UJ Z O 0~ O 8. 9. 10. 11. 12. 13. 14. X E~9. Litigation Proceeds Received []2. Supplemental Return E~4a. Future Interest Compromise (date of dealh after 12 12-821 [~7. Decedent Maintained a Living Trust (Attach copy of 'trust) E~10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ] 3. Remainder Return (date otdeath prior to 12d3-82) E~]5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [~11. Election to tax under Sec. 9113(A)(Attach Sch O) THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INpORMATiON SHOULD BE DIRECTED TO:; NAME R. Mark Thomas: FIRM NAME (IfApplicable) Esq. TELEPHONE NUMBER 717-796-21OO 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Padnership or Sole-Proprietorship (3) 4. Morlgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [~] Separate Billing Requested Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total 6ross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Bebts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11) COMPLETE MAILING ADDRESS 101 S. Market St. Mechanicsburg, 7,092.09 1,289.00 407.00 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) PA 17055 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 5, 3 9 5. 5 0 x .12 (8) 7,092.09 (11) 1,696.59 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate x .15 19. Tax Due (12) 5,395.50 (13) (14) (15) (16) 242.80 (17) (18) (19) Decedent's Complete Address: STREETADDRESS 1900 Market St. CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty ISTATE PA Iz~P 17055 (1) 242.80 Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5, If Line 1 + Line 3 is grealer than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 242.80 242.80 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did deceden{ make a transfer and: Yes No a. retain the use or income of the properly transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year o[ death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and Io tire best of my knowledge and belial, it is Irue, correct and complete. Declaration oi' preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT, J,~RE OF P, ERS, ON RESPOI'JS, IBLE FOF),-¢ILING RETURN f'~ DATE ADDRESS 1202 Apple Dr., Mechanicsburg, PA 17055 / 123 Lan~ast~ Rl v~ M~H~~ .... ~,, SIGNATU ~-P ER OI N REPRESENTATIVE ADDRESS 101 s. Market St., Mechanicsburci~A 1 7055 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For da~es of death on or after January 1, 1995, lhe tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [~2 P.S. §9116 (a) (1.1) (ii)]. The s~atute does not exemp__t a transfer to a surviving spouse from tax, and the slatutory requirements for disclosure of assels and l'iling a tax return are still applicable even if the surviving spouse is lhe only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on lhe net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The lax rale imposed on the net value of transfers to or for lhe use of the decedent's lineal beneficiaries is 4.5%, except as noled in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has al least one parent in common with lhe decedent whelher by blood or adoption. COMMONWEALTH OF PENNS~ LVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Shumberger, Gladys R. 21-03-827 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A.Ronald Shumberger Son 1202 Apple Drive Mechanicsburg, PA 17055 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number, Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S tNTERES 1J' ~.. 10/75 M&T Bank 14,184.17 50 7,092.09 Checking Acct. #78384745 TOTAL (Also enter on line 6. Recapitulation) $ 7,092.09 (If more space is needed, insed additional sheets of the same size) SCHEDULE H FUNERAL EXPENSES & ADMINISTEATIVE COSTS DOMMONWEALTII OF PENNSYLVANIA INItERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Shumberger, Gladys R. 21-03-827 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 5. 6. 7. FUNERAL EXPENSES: Myers Funeral Home First Church of God, Pastor Baxter Main St., Mechancisburg, PA ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Repmsenlalive (s) Social Security Number(s) / EIN Number DJ Personal Represenlalive(s) Streel Address City State Year(s) Commission Paid: AltorneyFees R. Mark Thomas, Esq. Family Exemption: (if decedent's address is not lhe same as claimant's, atlach explanalion) Claimant Zip Street Address City Relalionship of Claimanl Io Decedent Probale Fees Accountant's Fees Tax Return Preparer's Fees Slate __ Zip TOTAL (Also enter on line 9, Recapilulalion) (If more space is needed, insed addilional sheets of Ihe same size) 331.00 300.00 60.00 345.00 87.00 166.00 $ 1289.00 IIE¥'151) EX f I1° 861. ~ CO~OIIWEAI. iii OF PEIIItSyIYAtlIA INIIERIIANCE IAX REIUAI~I RE$1DEttl DECED~FII ESTATE OF Shumberger, Gladys R. SCttEDULE I DEBTS OF DECEDENT, MORTGAGE LIABLITIES AND LIENS FILE NUMBER 21 -03-827 IFEM NUMBEF DESCRIPIION Neighborcare (Mail-in pharmaceuticals) Mobile X-Ray Imaging TOFAL (Also enler on line I0, RecapIlulallon) AMOUNT 217.24 190.35 $ 4.07.59 (If mo,e space is needed i,,se,I addilional si,eels of sa,ne size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shumberger~ Gladys R. NUMBER 1I. SCHEDULE J ' BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal dislributions) Ronald R. Shumberger 1202 Apple Dr. Mechanicsburg, PA 17055 Donald W. Shumberger 123 Lancaster Blvd. Mechanicsburg, PA 17055 FILE NUMBER 21 -03-~ RELATIONSHIP TO DECEDENT Son Do Not List Truslee(s) Son ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE~ NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 50% 50% 27 TOTAL OF PART il- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insed additional'sheels of lhe same size) AMOUNT OR SHARE OF ESTATE 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET (717) 766-3421 Myers Funeral Home, Inc. Boyd L. Myers Jr., Supervisor 37 East Main Street Mechanicsburg, Pennsylvania 17055 A standard of excellence in Central Pennsylvania since 1910 Fax (717) 795-7291 Tuesday, October 14, 2003 Mr. Ronald R. Shumberger 1202 Apple Drive Mechanicsburg, Pa. 17055 Dear Mr. Shumberger, Thank you for selecting our funeral home to provide services for your family during your bereavement. I hope that you found our services to be of the highest standards and that they met your needs and those of your family and friends. The following is a summary of the service charges as previously explained and provided in written form on the services for: Gladys R. Shumber.qer SUMMARY OF EXPENSES TOTAL OF SERVICE RENDERED $9,367.00 LESS: Credits granted 1,865.32 LESS: Total Payments 7,501.68 PLUS: Items ordered later 331.50 CURRENT BALANCE $331.50 Credits Granted: $125.32 Adjustment $1,740.0 Package Price Discount PLUS: Items ordered later Patriot 176.50 Organist 100.00 Flowers 55.00 Interest at the rate of 1.5 % per month ( 18 % per annum) will be added to balance after 30 days. If there are any questions or concerns that remain unanswered, please call me. Sincerely, 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 003889 THOMAS R MARK 101 SOUTH MARKET STREET MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 1 78-1 6-5323 FILE NUMBER: 2103-0827 DECEDENT NAME: SHUMBERGER GLADYS R DATE OF PAYMENT: 05/03/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/29/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $242.80 TOTAL AMOUNT PAID: $242.80 REMARKS: SEAL CHECK//2212 INITIALS: JA RECEIVED BY' GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX R MARK THOMAS ESQ 101S MARKET ST HECHANICSBURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN REV-I~7 EX AFP (01-05) 06-21-2004 SHUMBERGER 09-29-2003 21 03-0827 CUMBERLAND 101 Amount Remitted ] GLADYS R MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA I7013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -.~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SHUMBERGER GLADYS R FILE NO. 21 03-0827 ACN 10I DATE 06-21-2004 TAX RETURN NAS: (X} ACCEPTED AS FILED C } CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate CSchedule A} 2. Stocks and Bonds CSchedule B) (23 $. Closely Held Stock/Partnership Interest CScheduZe C) 4. Mortgages/Notes Receivable (Schedule D} 5. Cash/Bank Deposits/Hlsc. Personal Property CSchedule E) 6. Jointly Owned Property CSchedule F} 7. Transfers CSchedule G} C7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses CScheduIe H} 10. Debts/Mortgage Liabilities/Liens CSchedule I) CIO} 1[. Total Deductions 12. Net Value of Tax Return .00 .00 .00 .00 .00 7r092.09 .00 1,289. C8} O0 4O7 .00 (11} C12} 13. 14. NOTE: ASSESSMENT OF TAX.. 15. Amount of Line 14 at Spousal rate CIS}, 16. Amount of Line 14 taxable at Lineal/Class A rate CI6) 17. Amount of Line 14 at Sibling rate C17) 18. Amount of L/ne 1~ taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 7,092.09 5,395.50 Charitabie/Governmenta! Bequests; Non-elected 9113 Trusts CSchedule J) C13) Net Value of Estate SubSect to Tax C14) If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and ref/ect flgures that include the total of ,ALL returns assessed to date. PAYMENT DATE 05-03-2004 RECEIPT NUMBER CD003889 DISCOUNT C+) INTEREST/PEN PAID C-) .00 5, .00 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 5,395.50 19 will 242.80 .00 .00 .00 ¢ IF TOTAL DUE IS LESS THAN ¢1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ¢CR}, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.} TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE AMOUNT PAID 242.80 X O0 = .00 x 0~§ 242.80 x 12~ = .00 x 1.~ = . oo c~)= 242.80 RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT= REFUND OBJECTIONS= ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side. --Make check or money order payable to: RBGIST~-I~ OF NXLLS) AGBNT 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" CREV-I$1$). Applications are available at the Office of the Register of Mills, any of the 25 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-S&2-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-~47-$020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax Cincluding discount or interest) as sho~n on this Notice must object within sixty (&O) days of receipt of this Notice --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to= PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone C717) 787-&505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. If any tax due Ks paid within three CS) calendar months after the decedent's death, a five percent CSX) discount of the tax paid is allowed. The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable tn 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 Ks charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before JanuarY 1, 1982 bear interest at the rate of six CEX) percent per 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 1982 through 2004 are= Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor ~'~ 20% .000548 ~T8-8-1991 11% .000s01 1985 1EX .000458 1992 9x .000247 1984 11X .000501 1995-1994 7X .000192 1985 15X .000S5~ 1995-1998 9X .000247 198& lOX .000274 1999 7~ .000192 1987 lOX .00027~ 2000 7X .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID Daily Year Rate Factor 2001 9X .0002~7' 2002 &X .000164 2005 S~ .000157 2004 4~ .000110 X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent wi1! reflect an interest calculation to fifteen C15) days beyond the date of the assessment. If payment Ks made after the interest computation date shown on the Notice, additional interest must be calculated.