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HomeMy WebLinkAbout03-0354 PETITION also known as Social SecuriLv No. FOR PROBATE and GRANT OF LETTERS 21-03-354 No. To: Deceased. Register of Wills for the County of CUMBERLAND Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), xxho is/are 18 years of age or older an the e~ecu! in the last wilt of the above decedent, dated and codicil(s) dated A,(--,-,~c" . · in the named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in /~'~0 ~ {< /~m ,.w County,~ennsylvania, with last family or prindpal residence at (list streel, number and muncipality) De~d~l, then ~ ~&~ years of age, died ~~ // , 19 Except as follo~,s, deceden~n;t~a~y, was not divorced and did not have a child born or adopte~ 9fter execution of the will offered for probate; was not the victim of a killing and was never adjudicated ~ncompetent: Decendent 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 $ situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters theron. (testamentary; administratio~c.l.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ COUNTY OF CUMBERLAND ; ~S 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 represen- tative(s) of ~he above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 22nd day of ~z~[zAPRIL ~ ' -5,,gg)j.~,~_.~ ~ kegiste/r IN{}. 21-03-354 Estate Of ETHEl. P BELTZ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW APRIL 23 ~I92__Q.QO_, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated September 30, 1982 described therein be admitted to probate and filed of record as the last will of ETHEL P BELTZ -; and Letters TESTAMENTARY are hereby granted to CHARLES BELTZ and EVELYN B SHEARER FEES Probate, Letters, Etc .......... $ 115.00 Short Certificates( ) .......... $ 12.00.. 9.00 x-pages Renunciation ................ $ JCP $ 10.00 TOTAL , $ 146.00 Filed ....A?.R.I.L...2.3.,...20.0.3. ............... A'FrORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE I05.81)5 RFV 9/86 This is to certify that the information here given is correctly copied f~om an original certificate of death duly filed with me as I,ocal Registrar. The original certificate will be forwarded t~ the State Vital Records Office for permanent fiiing. WARHIHG: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9132794 No. l.ocal Registrar Date H105.143 Re~ 2J87 PERMANENT ETHEL PEARL BELTZ Franklin Housewife 120 S. Prince Street Shippensburq, PA 17257 James Albert Reed Charles E. Beltz COMMONWEALTH OF PENNSYLVANIA - OEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH STATE FILE NUMBER I t /-05/06/1906 I~ ...... .ll~ [~,~ ~ I~ ~ L. Chambersburg Cha~ersbur Ho 'ie~l ~-~-;~a=.~--"' --' .... ,. g sp .... I,- ' .... J,o. Aite ~ ~ I ~1 ~ ~'~"~' · CTU~L ,t,. s~,. Pennsylvania ~} ,~.c~7 Cumber lahd -'-~-~? ,td.~ ~ ~ ~ Shippensbur~ ~,. Zora Adaline Gabler j~ms~,~ ~. 13996 Lur~an Road, Newburg, PA 17240 ~',b. 04/17/2003 ~,e. Otterbein Cemetery ~"' I Franklin County, ~~.~ j J J~dLurgan Twp., PA ~ ~- 22b. 012984-L ~-l~anger-Rricker F.H., PO Box 336, S~';.,:~.q~3rg PA 17257 ~ ~A~OUE.C~: ' ', J ~ ~ I~"' I--' ~ ~- ~1 I I I i~. D "~,- ~1 I I~ D ~ I ~ D ~1 ~ ~ ~ I~ ~ ~ .... ~. I~ ..J~. J~ - LAST WILL AND TESTAMENT OF ETHEL P. BELTZ I, ETHEL P. BELTZ, of the Borough of Shippensburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils thereto heretofore made by me. FIRST I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as may be done. In the event I am not the owner of a cemetery lot at the time of my death, I direct my Executors to purchase such lot with a contract for perpetual care and to improve the lot and have erected thereon a suitable monument and marker, using therefor funds from my estate in such amount as they in their sole discretion shall deem advisable. SECOND I give, devise and bequeath all my property, whether real or personal, tangible or intangible, together with all insurance policies thereon, in as nearly equal shares as possible, unto such of my children as shall survive me by thirty (30) days, per stirpes. THIRD I hereby direct that all inheritance, estate or transfer taxes imposed upon my estate, whether passing under this my Last Will and Testament or other- wise, b~ paid out of my estate. -1- FOURTH Any and all payments of any sum or sums, whether in cash or in kind and whether for principal or income, payable to the beneficiaries or any of them shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment and pledge and free from control by the creditors of such beneficiary. Ail shares of principal and income herein given shall be free from anticipation, assignment, pledge or obligation of any beneficiary and shall not be subject to any execution or attachment. FIFTH I nominate, constitute and appoint my son, Charles Belt~ and my daughter, Evelyn B. Shearer, or the survivor, Co-exeCutors of this my Last Will and Test- ament. I hereby relieve my Executors from the necessity of posting security in connection with their duties as such in any jurisdiction in which they may be called upon to act, insofar as I am able by laW to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of two (2)typewritten pages, the first one (I) of which bears my signature in the margin for the purpose of identification, this 30th day of SePtember, ~952. Ethel P. Beltz Testatrix SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testatrix, Ethel P. Beltz, as and for her Last Will and Testament in the presence of us who at her request and in her sight and presence and in the sight and presence of each other have hereunto subscribed our names as witnesses: -2- COMMONWEALTH OF PENNSYLVANIA : : ss COUNTY OF CUMBERLAND : I, Ethel P. Beltz, the Testatrix whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; that I signed it as my free and voluntary act for the purpose therein expressed. Sworn or affirmed to and acknowledged before me by Ethel P. Beltz, the Testatrix, the 30th day of September, 1982. Ethel P. Beltz Notary Publi6 My Commission Expires 20/29/84 -3- COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, ~ora~ /~/. /~'~'~r.5 , , SS and . Jo~¢~c ~. Cco~ , the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Ethel P. Beltz, Testatrix, sign and execute the instrument as her Last Will and Testament, that she signed it willingly and that she executed as her free act and voluntary act for the purposes therein expressed, that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at the time eighteen or more years of age and under no constraint or undue influence. Sworn to and subscribed before me by and J~ ~, C~e~ witnesses, this 30th day of September, 1982. NStary Public My Co~nission Expires: 10/29/84 -4- FOREST N. MYERS ATTORNEY-AT-LAW P. O. Box 695 SHIPPENSBURG, PENNSYLVANIA 17257 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. ZBOBO! HARRISBURG, PA 171Z8-0601 REV-161~5 EX AFP C09-DO) ZNFORNATZON NOTZCE AND TAXPAYER RESPONSE '04 FEB 27 P3:15 EVELYN H SHEARER 1:5996 LURGAN RD NEWBURG PA 17240 L~:~.i~- _ ~i~©dF+~ FILE NO. 21 03-055q ACN 04102426 DATE 01-Z7-ZOOq TYPE OF ACCOUNT E~.;~F ETHEL P BELTZ [] SAVZNGS 9:'~'.~ NO. 205-09-8917 [] CHECKING DAT~ OF D~ATH 0~-11-200~ ~ TRUST COUNTY CUHBERLAND ~ CERTZF. REHZT PAYHENT AND FORHS TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA I70I~ CITIZENS BANK OF PA hms provided the Department wlth 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 ~ere 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 ;ora and return it to the above address. This account is taxable in accordance aith the Inheritance Tax La~s of the Coaaonaealth COMPLETE PART 1 ~ELOW ~ ~ # SEE REVERSE SIDE FOR FILING AND PAYMENT ZNSTRUCTZONS Account No. 610079Z889 Data 05-29-1980 Es*ablishad Account Balance 4,080 . 05 Percent Taxable X 50.000 Amount Subject to Tax Z, 040 . O~ Tax Ra~e X .15 Potential Tax Duo ,~06. O0 To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Hills. Hake chock payable to: "Register of Mills, Agent". NOTE: If tax payments are eade within three (3) months of tho decedent's date of death, you cay deduct a 5Z discount of the tax due. Any inheritance tax due #ill become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LINE A. D The above inforeation and tax due ~s correct. 1. You may choose to remit payment to the Register of Nills ~ith t~o copies of this notice to obtain a discount or avoid interest, or you amy check box "A" and return this notice to the Register of Wills and an official assessment ail! be issued by the PA Department of Revenue. B. ~ The above asset has been or Hill be reported and tax paid a[th the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. D Tho above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~-~and/or PART [~---lbeZoa. If you indicate a d~ff®rant tax rata, please sta~e your raZat~onsh~p to decadent: RETURN -CONPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Data Established I 2. Account Balance 2 3. Percent Taxable $ ~ ~. Amount Subject to Tax ~ S. Dab~s and Deductions 5 - 6. Amount Taxable 6 7. Tax Rata 7 ~ 8. Tax Due 8 PART DATE PAID PAYEE I DEBTS AND DEDUCTIONS CLAZNED DESCRIPTION AHOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of par jury, Z declare that ~he facts I have reported above ara true, correct and coapla~=e '1:o fha bast of ay kno~ladge and belief. HOHE (~'/~' WORK ( ) ~,~~ TAXPAYER SIGNATURE TELEPHONE NUMBER REGISTER OF WILLS CUMBERLAND COUNTY COURT HOUSE CARLISLE, PA. 17013 '04 FEB27 P3:15 The prior tax payment erroneously listed in part 3 was for a savings account in the name of Ethel P. Beltz deceased 04-11-2003. The file number for that account was 2103-0354. That proceeding was paid and receipted 05-23-2003. I have listed the paymem of this joim checking account for the amount of $306.00. The total for line 5 should read $ 306.00. I have enclosed a check for $ 306.00 Thank you for your kind consideration. Evelyn M. Shearer (Executor) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Date of Death: To the Register: I certify that notice of (beneficial interest) 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 Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Signature Address /,__~..9~ ~;~. d Telephone (?/~ j~_~ Capacity: r'" Personal Representative ~.Counsel for personal representative REV.487 EX+ (5-88) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 ENTRY INTO SAFE DEPOSIT BOX TO REMOVE A WILL OR CEMETERY DEED J Date af Entry J Month Day I Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS. ~ DECEDENT'S NAME (Last, First, Middle) M SOCIAL SECURITY NUMBER ~.~ DATE OF DEATH rd DECEDE.T ~ NAME AND ADDRESS OF PERSON REQUESTING THE OPENIN~ OF THE SAFE DEPOSIT N~me Street Address . J NAME AND AD~RESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX I Name of Finan~l Institution ~ Strut Address ~ity State Zip Code ~ NUMBER OF SAFE DEPOSIT BOX ~ ~ TITLE OR NAME(S) UN~ER~HICH BOX IS R~RED ~ WAS THERE A WILL IN THE BOX? ~YES ~NO Ifye, a. Date of will, ~' Moth / Day Y~r b. Name and address of personal mpm~ntatlve(s), if ~med in the will: Name Street Address City State Zip Code Street Address City State Zip Code '' c. Name and address of a~orney, if any: Street ~ddress Ci~ State Zip Code Name Street Address City State Zip Code I ce~ify under penalty of perju~ that the above ~cord is cerre~ and c~mplete to the best of my knowledge and belief. Print 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 002606 BELTZ CHARLES 13996 LURGAN ROAD NEWBURG, PA 17240 ........ fold ESTATE INFORMATION: SSN: 205-09-8917 FILE NUMBER: 2103-0354 DECEDENT NAME: BELTZ ETHEL P DATE OF PAYMENT: 05/23/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/1 1/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $2,387.50 REMARKS: CHARLES BELTZ TOTAL AMOUNT PAID: $2,387.50 SEAL CHECK//O992 INITIALS: VZ RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS ~,EV-1500 EX (6-00)  COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT /7_ USE ONLY FILE NUMBER oz o o,.35_'-}__ COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) 2 DATE OF DEATH"(MM-DD-YEAR) DATE OF BIRTH (MM-DB-YEAR) ,,~.o~-;///. ~ (I~APPLICABLE) ~URVIVING SPOUSE'S NAME (~ST, FIRST, AN~IDDL~IN~TI~L) I.- Z ILl Z o gU o (.3 SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIALSECURITYNUMBER ~1. Original Return E~4. Limited Estate ~.d~. Decedent Died Testate (Attach copy ef Will) E~9. Litigation Proceeds Received [~2. Supplemental Return --] 4a. Future Interest Compromise (date of death after 12-12-82) [--'~ 7. Decedent Maintained a Living Trust (Attach cop~, of Trust) ---]10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ---]3. Remainder Return (date of death prior to 12-13-82) ~'~5. Federal Estate Tax Return Required j.__ 8. Total Number of Safe Beposit Boxes r--] 11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME ~,/ / FIRM NAME (IfApplicakle) TELEPHONE NUMBER " ~ q~ 7 - ~ ~ - ~o ~ COMPLETE IdAILING ADDRESS 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Padnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Properly (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 14. 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) OFFICIAL USE ONLY (11) (12) (13) (14) ,Cf ,O/_,.~ d~-,.~---~'~ ~:"~' / 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) x 0 (15) 16. Amount of Line14 taxable at lineal rate '"'~¢'~¢'~'- ~ ,¢-Jk-~'~-- ~'/-/' 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) Decedent's Complete Address: ISTREETADDRESS ./~.-~) ,..,~-'¢~_+A ,'~t' '/¢"(~ ,~'_'f,¢_ Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount STATE Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) aC / Make Check Payable to: REGISTER OF WILLS, AGENT Total Interest/Penalty ( D + E ) PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] c. retain a reversionary interest; or .......................................................................................................................... [] d. receive the promise for life of either payments, benefits or care? ...................................................................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 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 to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. BATE SIGNATURE OF PERSOI~ RESPONSI.BLE FOR FILING RETURN - . SIGNATURE OF PREPARER OTHER THAN,~RESENTATIVE L_./"' / D~E ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii) The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive paren or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as a individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owmed with the right of survivorsh ~ must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH ETHEL P. BELTZ INVENTORY OF POSSESSIONS as of April 11, 2003 WILL NO. -2.Q_Q.3.:.0.,~5.~ PA NO. 21 - 03 - 0354 The following is a list of the Ethel P. Beltz personal accunts upon the date of her decease at the Chambersburg Hospital at 8:45 P.M. Citizens Bank 153 W. Orange St.- Shippensburg, PA 17257 AccountNo. 0060299E901988 0215 0060299E901988 0214 0060299E901988 0213 0060299E901988 0212 0060299E901988 0211 Total---0060 299E901988 0216 Date Amount 4/21/03 $10,047.05 4/21/03 $ 6,151.50 4/21/03 $ 5,823.74 4/21/03 $10,210.45 4/21/03 $ 5,010.00 4/21/03 All First Bank - Walnut Bottom Road- Shippensburg, PA. 17257 Account No. 87005700174294 87008100343721 Total---0060 299E901988 0019 Date Amount 4/23/03 $ 4,362.07 4/23/03 $10,010.83 4/23/03 $37,242.74 $14,372.90 Refund of prepaid residency for the month of April Orrstown Personal Care Inc. 5/10/03 Total---0060 299E9019880019 $1,440.00 $1,440.00 Total accounts in the estate of Ethel P. Beltz (April 11,2003) Charles Beltz Executor Date Evelyn B. Shearer $53, 055.64 Executrix Date CITIZENS BANK Transaction Date Amount l)escriptinn Account Number Customer Receipt Please be sure to enter this transaction in your records. 0060 2~E90i~88 0216 04/211200.5 11:31 Ct< DEP-CA(P[{I) F 00606200.5~861 $.51,242.74 SEE REVERSE FOR CREDITING OF DEPOSITS AND PAYMENTS CITIZENS BANK Transaction Date Amnunt Description Account Numbe,, Customer Receipt Please be sure to enter this transaction in your records. OObO 29~/EgOIgBB 0019 04/2,3/2003 11: 50 CK-CK(PHI) F 0060 b2003388bl $14,372.90 SEE REVERSE FOR CREDITING OF DEPOSITS AND PAYMENTS CITIZENS BANK Transaction Date Description Account Number Amount Customer Receipt Please be sure to enter this %60 299E900954 0218 05/12/2003 09:4b Ct<-CK(PHI) F 0060 6200.5388bI $1,440.00 SEE REVERSE FOR CREDITING OF DEPOSITS AND PAYMENTS EV-1511EX + (1~97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER 5. 6. 7. DESCRIPTION FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) cAo¥,-'/~ ..~ ~/~ Social Security Number(s) / EIN Number of Personal Representative(s) / ~ ~ ~ ~.~ - StreetAddress /. ~ ~' ~'~'~ ,~ ~)0~"? ~ ~0/ City ,/"[/(~cC) ~ "~:~7' State P ~ Zip Year(s) Commission Paid: Attorney Fees ~) Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant / ~' PJ4 0 Street Address City Relationship of Claimant to Decedent Probate Fees ~ State __ Zip Accountant's Fees. Tax Return Preparer's Fees .--- TOTAL (Also enter on line 9, Recapitulation) AMOUNT (If more space is needed, insert additional sheets of the same size) REVA512 EX + (1-9F). ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Include unreimbursed medical expenses. ITEM NUMBER 1, SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS DESCRIPTION FILE NUMBER TOTAL (Also enter on line 10, Recapitulation) $ AMOUNT (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER ! II 1. SCHEDULE J GENER¢IARIES Sec. 9116 (a) (1.2)] TOTAL OF PART I! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE ! B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS / NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under ETHEL P. BELTZ ESTATE DECEASED APRIL 11, 2003 EXECUTOR CHARLES E. BELTZ EXECUTRIX EVELYN B. SHEARER WILL NO. 2003 - 009;54 PA. NO. ITEM ACTIVITY 1. Death certificate filed at the Citizens Bank of Shippensburg, PA. 2. Certificates of Deposit and savings accounts placed into an Ethel P. Beltz Estate Fund at the Citizens Bank 3. Requested that Orrstown Personal Care make any refund of moneys to the Ethel P. Beltz Estate Fund. 4. Filed the Ethel P. Beltz Last Will and Testament in the Courthouse Carlisle Cumberland County PA. for Probate. 5. Requested four (4) Letters Testamentary (short form) and paid for them. 6. Charles Beltz and Evelyn B. Shearer duly sworn as Executors of the Ethel P. Beltz Estate. 7. Prepared the notification of decease of Ethel P. Beltz to the beneficiaries of the Ethel P. Beltz Estate. Rule 5.6(a) 8. Prepared the Legal Notice to creditors and debtors of the Ethel P. Beltz Estate to be published in the local newspaper (s) for three consecutive weeks. 9. Received (4) Letters Testamentary (short form) from he Registry of Wills. 10. Placed the required Legal Notice in the Newspaper(s) for all debtors and creditors of the Ethel P. Beltz Estate. 11. Closed the savings account of Ethel P. Beltz at the All First Bank. A check for the amount of fourteen thousand three hundred seventy two dollars and ninety cents ($14,372.90) was issued in the name of the Ethel P. Beltz Estate Fund Letters Testamentary was given to the Citizens Bank of Shippensburg PA. and the check from All First placed into the Ethel P. Beltz Estate Fund. Received a copy of the Ethel P. Beltz burial expenses paid for by a Revocable Burial Fund C.D. Delivered the Notification of Beneficiary Forms for Evelyn B. Shearer, Charles Beltz, Delores Smith and Janet Whisler for signature(s). Rule 5.6(a) 12. 13 14. 21 - 03- 03;54 DATE 4/21/03 4/21/03 4/21/03 4/22/03 4/22/03 4/22/03 4/22/03 4/22/O3 4/22/03 4/22/03 4/23/03 4/23/03 4/23/03 4/24/03 15. Filed the completed Notice to Beneficiaries (Rule 5.6) in the Orphans Court at Carlisle PA. 16. Legal Notice to creditors and debtors of the Ethel P. Beltz Estate was printed in the local paper. 17. Phone call to Thomas Shambaugh, IRS Agent, to schedule a review of Ethel P. Beltz's security deposit box at the Citizens Bank of Shippensburg, PA. The review is scheduled for Thursday, M ay 1, 2003 at 11;00 A. M. 18. Met with Mr. Thomas Shambaugh, IRS Agent, at the Citizens Bank of Shippensburg, PA. to review the contents of the Ethel P. Beltz security deposit box. Mr. Shambaugh listed two CD accounts that had had matured and had been reissued. 1. CDNo. A51111 ($10,000) Maturity Date 08/18/91; CD No. 4100077368 ($5010.00) Maturity date 04/21/87; 19. The second Executors Legal Notice was published in the local paper(s). 20. Paid Choice Critical Car~ (Medical Bill) from the Ethel P. Beltz Estate Fund 21. Notified Elaine Swartz at Orrstown Personal Care Inc. that a refund of of money was due for Ethel. P. Beltz's April residency. 22. Receipt of refund check from Orrstown Personal Care Inc. 23. Refund check for $1,440.00 placed into the Ethel P. Beltz Estate fund at the Citizens Bank, Shippensburg, PA. 17257. 24. Prepared the form: REV-1500 (Inheritance Tax Return) to be filed in duplicate in the Orphans Court of Cumberland County. 25. Friday, May 23,2003: filed the REV-1500 (Inheritance Tax Return) in the Orphans Court of Cumberland County. Paid the lineal inheritance tax of .045%. Two thousand three hundred eighty seven dollars and fifty cents ($2,387.50) 26. By agreement of the beneficiaries, a partial disbursement of twelve thousand dollars ( $12, 000 ) each was issued. 27. The rest of the Ethel P. Beltz Estate Fund and the accrued interest will be disbursed in equal amounts to the beneficiaries in two (2) months. July 25, 2003 Status report (Rule 6.12) will be filed July 25, 2003 28. 4/25/03 4/25/03 4/28/03 5/01/03 5/02/03 5/07/03 5/08/03 5/10/03 5/12/03 5/13/03 5/23/03 5/23/03 BUREAU OF ZNDZVZDUAL TAXES TNHERTTANCE TAX DTVTSTOH DEPT. Z80601 HARRTSBURG, PA 17128-0601 CONHONHEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLOgANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX CHARLES BELTZ !3996 LURGAN RD NENBURG ~(;~' .? DATE 07-07-2003 ~" ~ ~ ESTATE OF BELTZ DATE OF DEATH 04-11-Z003 FZLE NUMBER 21 03-0354 '03 JUL -7 P4:16COUNTY CUMBERLAND ACM 101 Amoun'~ Remi'l:'l:ad REV-iS*iT EX AFP COZ-OS) ETHEL p HAKE CHECK PAYABLE AND RENZT PAYMENT TO: REGZSTER OF NZLLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THZS LZNE ~'~ RETAZN LO#ER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF BELTZ ETHEL P FZLE NO. 21 03-0354 ACN 101 DATE 07-07-2003 TAX RE~JRN gAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVER$~ APPRAZSED VALUE OF RETURN BASED ON: ORTSTNAL RETURN 1. Real Es~a~a (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) $. Closely Held Sg:ock/Par~cnership Zn~aras~ (Schedule C) ($) ~. Norg:gagas/No~cas ReceivabZe (ScheduZe D) (~) $. Cash/Bank Daposi~cs/Misc. Personal Propar~y (Schedule E) (5) 6. Jointly O~ned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) .00 8. To'l:aZ Assa~s (8) APPROVED DEDUCTZONS AND EXENPTZONS: 9. Funeral Expanses/Ada. Costs/Misc. Expanses (Schedule H) (9) . O0 10. Debts/Mortgage Liabili~1es/Liens (Schedule z) (10) .00 11. To~a! Deductions (11) 12. Ne~ Value of Tax Ra~urn (12) 1:5. Charitable/governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (1:5) lq. Na~ Value of Es~a~e Sub.iec~ ~o Tax (lq) NOTE: ASSESSMENT OF TAX: 15. Amoun~ of Line 1~ a~ Spousal ra~e 16. Aeoun~ of Line lq ~axable a~ Lineal/Class A ra~e 17. Aeoun~ of Line 1~ a~ Sibling re~e 18. A,oun~ of Line lq taxable a~ Collateral/Class B ra~a 19. Princi}al Tax Due TAX CREDZTS: PAYMENT REC~ZPT DZ$COUNT (+) DATE NUMBER ZNTEREST/PEN PA/D (-) 05-23-2003 CD002606 119.38 53~055.6q .00 Zf an assessment ,as issued previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. .00 NOTE: To insure proper .00 credt~ ~o your account, .00 s~mi~ ~he upper portion .00 of ~his form wi~h your ~ax payment. 53,055.6q TOTAL TAX CREDZT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. 2,387.50 2,506.88 I 119.38CR I ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUZRED. ZF TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF TMZS FORM FOR INSTRUCTZONS.) AMOUNT PAZD 53,055.64 .00 53,055.64 18 and 19 will (15) .00 x O0 = .00 (16) 53,055.64 x 045 = 2,387.50 (17) . O0 X 12 = . O0 (18) .00 x 15 = .00 (19)= 2,387.50 RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DXSCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 19BZ -- if any future interest in the estate is transferred in possession ar 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 et the lawful Class B (collateral) rate on any such future interest. To ~ulfi11 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 #ills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLSj 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 Iff-hour answering service for fores ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-q47-30ZO iTT only). Any party in interest not satisfied with the appraisement, allowance, ar disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 2810Z1, Harrisburg, PA 171ZB-lOZ1, 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. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedsnt's death, a five percent (SX) 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 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, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ehich 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 which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through Z005 ara: Interest Daily Interest Daily Interest Daily Rate Factor Year Rate Factor Year Rate Factor Year 1982 207. .000548 1987 9;( .0002q7 1999 77. .000192 1983 167. .000q38 1988-1991 117. .000301 ZOO0 87. .O00ZX9 1984 117. .000301 199Z 9Z .000Z47 ZOO1 97- .000247 1985 152 .000556 1993-1994 77- .00019Z 2002 67- .000164 1986 107. .000274 1995-1998 97. .000247 Z005 57. .000157 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. STATUS REPORT UNDER RULE 6.12 NameofDecedent: ,~"~ L/"~i~ / '~. ,~.-~ . Date of Death: /~,or") t/ // .,tr~ Y / , WillNo.: ~.g?~,~S- ag~',~',p-ff Admin. No.: B/-O~Y~o~6'q 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: 1. State whether administration of the estate is complete: Yes [] No [-"l 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 [-1 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 [~ No I-"] Co Date: ~/~, ~y_~ o~v_~ Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. S~l~gnature Name Capacity: Telephone No. [~ersonal Representative F"] Counsel for personal representative ETHEL P. BELTZ ESTATE DECEASED APRIL 11, 2003 EXECUTOR CHARLES BELTZ EXECUTRIX EVELYN B. SHEARER WILL NO. 2003-00354 PA. NO. 21 - 03 - 0354 (1) The Last Will and Testament of Ethel P. Beltz requested that all taxes and creditors be paid from her estate. The remainder of the estate to be divided among the four (4) beneficiaries of her Will. (2) The Last Will and Testament of Ethel Pearl Beltz, deceased, is completed. (3) A formal account of closure has been filed with the Clerk of the Orphans' Court at Carlisle, PA. (STATUS REPORT RULE 6.12) (4) Each beneficiary has received a record of the Representative's activities filed with the Clerk of the Orphans' Court, Carlisle, PA. (5) The distribution of the Ethel P. Beltz Estate to the beneficiaries is completed. (6) All required accounts, joinders and releases have been filed with the Clerk of the Orphans' Court at Carlisle, PA. (7) Funeral expenses were paid by a revocable burial trust established for that purpose. (8) All expenses for Ethel P. Beltz's personal care, hospitalization and physicians care have been paid by Medicare, Blue Shield Plan B or from the estate. (9) Services of the Executor, Executrix and the Representative of the Ethel P. Beltz Will has been rendered without charge to the Estate. (10) Copies of this report will be given to each beneficiary. Charles Beltz; Executor -Represen 'ta~e Evelyn B. Shearer Executrix [ Date BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX Dzv*rszoN DEPT. Z60601 HARRTSBURG, PA 171P'8-0601 CHARLES ~ELTZ 13996 LURGAN RD NENBURG PA 17Z~0 CONHON#EALTH OF PENNSYLVANIA BEPARTNENT OF REVENUE INHERITANCE TAX STATEt4ENT OF ACCOUNT BATE 08-18-2003 ESTATE OF BELTZ BATE OF BEATH 0~-11-2003 FILE NUNBER 21 03-035~ ' .-:~OOUNTY CUNBERLAND ACN 101 Amoun'l: REV-16B? EX AFP ETHEL p HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF I/ILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper por~/on of ~his for. frith your ~ax payment. CUT ALONG THIS L'rNE ~'* RETAIN LO#ER PORTION FOR YOUR RECORBS REV-1607 EX AFP (01-03) ##~ 'rNHER'rTANCE TAX STATENENT OF ACCOUNT ESTATE OF BELTZ ETHEL P F'rLE NO. 21 03-035q ACN 101 BATE 08-18-2005 THTS STATENENT TS PROVTDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN TN THE NANED ESTATE. SI'IOgN BELON 1S A SUNNARY OF THE PR/NC/PAL TAX DUE, APPLICATION OF ALL PAYNENTS, THE CURRENT BALANCE, AND, ZF APPL/CABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 07-07-2003 PRINCIPAL TAX DUE: PAYHENTS (TAX CREDITS): PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) 2,587.50 05-25-2003 08-01-2003 6 119.38 .00 ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF TH/S FORN FOR ZNSTRUCT/ONS. ) AHOUNT PAID 2,387.50 TOTAL TAX CREBZT 2,387.50 BALANCE OF TAX BUE .00 INTEREST AND PEN. .00 TOTAL BUE .00 119.38- PAYMENT: Detach the top portion of this Notice and submit aith your payment made payable to tho name and address printed on the reverse side. -- If RES[DENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMON#EALTH OF PENNSYLVANIA. REFUND (CA): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Applicat[on for Refund of Pennsy[vania Inheritance end Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Nills, any of the ZS Revenue District Offices or from the Department's Z4-hour answering service for forms ordering: 1-800-$GZ-ZOSO~ services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg) PA 17128-060[, phone (7[7) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the dacedent'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 nat paid before January 18, 1996, the first day after tho end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day frae the date of death, to the date of payment. Taxes ahich became delinquent before January 1, 1982 bear interest at tho rate of six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent an 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 tho PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .0005~8 1987 92 .000247 1999 7Z .000192 1983 16Z .000~8 1988-1991 llZ .000301 2000 BZ .OOOZ19 1984 112 .000~01 1992 92 .000247 ZOO1 9Z .000247 1985 132 .000356 1993-1994 72 .000192 2002 62 .000164 1986 102 .000274 1995-1998 92 .000247 ZOO3 5Z .000137 --Interest is catculatad as folloas: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent .ill reflect an interest calculation to fifteen (IS) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additionat interest must be calcutatad. COMMONWEALTH OF PENNSYLVANIA .OEPARTMENT 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 003612 SHEARER EVELYN B 120 S PRINCE STREET SHIPPENSBURG, PA 17257 ........ fold ESTATE INFORMATION: SSN: 205-09-8917 FILE NUMBER: 21 03-0354 DECEDENT I"(.Z~ME: BELTZ ETHEL P DATE OF PAYMENT: 02/27/2004 POSTMARK DATE: 02/25/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/11/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 041O2426 $306.00 REMARKS: TOTAL AMOUNT PAID: $306.00 SEAL CHECK//6432 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~-~822 6 4 3 2 EVELYN M. SHEARER 09-90 313 PH. 717-532-2958 ~~~z~ 120 S. PRINCE ST, ' ' SHIPPENSBURG, PA 17257 DA3 E.14~ EX (3-99) Attention: PA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG PA 17128-0601 h-llh.h.lh,hlhlhlh.illl,lh...lhh,i Commonwealth of Pennsylvania Del~artment of Revenue Bureau of Individual Taxes Dept 280601 Harrisburg PA 17128-0601 DI~OP AUTHORIZATION 2E-8~ I~IL£D AT READING MS GLENDA FARNER REGISTER OF WILLS CUMBERLAND CO COURTHOUSE 1 COURTHOUSE SQ CARLISLE PA 17013 i,,,llh,,llh,,,,,lh,lh,,Ih,,Ihlh.,,,lllh,,,,,illl BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG,, PA 171Z8-0601 EVELYN H SHEARER 13996 LURGAN RD NEWBURG PA 172q0 CONHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLO#ANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS FILE NUMBER COUNTY SSN/DC ACN REV-1648 EX AFP C01-05) DATE 05-03-2004 ESTATE OF BELTZ ETHEL DATE OF DEATH 04-11-2003 21 03-0354 CUHBERLAND 205-09-8917 04102426 Amount Remitted I HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-03-2004 ESTATE OF BELTZ ETHEL P DATE OF DEATH 04-11-Z003 COUNTY CUMBERLAND FILE NO. 21 03-055q S.S/D.C. NO. 205-09-8917 ~._~ A¢~ ;~ 0q102426 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED ¢: JOINT OR TRUST ASSET INFORHATION FINANCIAL INSTITUTION: CITIZENS BANK OF PA ACCOUNT NO. TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIHE CERTIFICATe-: DATE ESTABLISHED 03-29-1980 ~ 6100~)Z889 Account Balance 4,080.05 Percen~ Taxable X 0.500 Amount Sub~ec~ ~o Tax Z,040.03 Debts and Deductions - .00 Taxable Amount 2,040.05 Tax Ra~e Tax Due 91.80 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYHENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT DATE 02-25-2004 RECEIPT NUMBER CD003612 DISCOUNT (+) :NTEREST/PEN PAID (-) .45- AMOUNT PAID 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 TS 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. ) 305.55 Z13.75CR .00 213.75CR 306.00 PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (71 P.S. Section 91qO). Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF NILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Hills) any of the Z3 Revenue District Offices or by calling the special Z~-hour answering service for forms ordering: 1-800-361-2050; services for taxpayers with special hearing and or speaking needs: 1-800-~47-3010 (TT only). Any party in interest nat satisfied mith the appraisement, allowance, or disalloaance of deductions or assessment of tax (including discount or interest) as sheen on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue) Board of Appeals, Dept. zeioz1, Harrisburg, PA 17128-1011) OR --electing to have the matter determined at the audit of tho account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. Z80601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sas 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 aithin three (5) calendar months after the decedant's death, a five percent (SI) discount of the tax paid is allowed. 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. This non-participation penalty is appealable in the seem manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1) 1981 bear interest at the rate of six (6Z) percent per annum celcuZatad at a daily rate eT .00016q. Ali taxes which became delinquent on or after January 1, 19Bi will bear interest at a rate .hich mill vary from calendar year to calendar year mith that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198'--~ 20X .goose8 198--8-1991 111 .000301 ZOO~ 91 .000247 1983 161 .000q$8 1991 91 .000247 2002 61 .O00Z19 1984 1XZ .OO0$OX X993-199q 71 .O00leZ 2003 SZ .000137 1985 132 .000356 1995-1998 9Z .0002~7 ZO0~ qZ .gOOIXO 1986 1gl .OOOZ7q 1999 72 .000192 1987 9Z .OOOZq7 ZOO0 8Z .O00Z19 --Interest is caXcuXated as foXXo~s: ZNTEREST= BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY ZIqTEREST 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 sho~n on the Notice, additional interest must be calculated. BUREAU OF ZNDZVZDUAL TAXES INHERITANCE TAX DI'VTSTON DEPT, 180601 HARRTSBURG, PA 17118-0601 CONNONllEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF ACCOUNT REV-I$07 EX &FP (01-OS) EVELYN M SHEARER 13996 LURGAN RD NENBURG PA 172qO DATE 05-2q-200~ ESTATE OF BELTZ DATE OF DEATH 0~-11-Z005 FILE NUHBER 11 COUNTY CUMBERLAND ACN 0~101q26 Amoun~ Remi'l:'l:ed ETHEL HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF MILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credA~ ~o your account, submi~ ~he upper por~cAon of ~his fora wi~h your ~ax payment. CUT ALONG THzS LZNE ~ RETAZN LOllER PORTZON FOR YOUR RECORDS -~ REV-1607 EX AFP (01-03) ~# ZNHER'rTANCE TAX STATEHENT OF ACCOUNT ~ ESTATE OF BELTZ ETHEL P FZLE NO. 21 03-035q ACN OqlO:;'q26 DATE 05-2~-200q THTS STATEMENT ZS PROVZDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAHED ESTATE. SHO#N BELOI./ ZSA SUNHARY OF THE PRZNCZPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED ZNTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 0~-Z6-200~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... 91.80 PAYMENTS PAYMENT DATE OZ-Z5-ZO0~ 05-06-200q (TAX CREDITS): DISCOUNT (+) [NTEREST/PEN PAID C-) RECEIPT NUMBER CD003612 REFUND IF PAZD AFTER THZS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL ZNTEREST. ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REQUZRED. ZF TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR), .q5- .00 AMOUNT PATD 306.00 213.75- TOTAL TAX CREDZT 91.80 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THIS FORH FOR ZNSTRUCTZONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGTSTER OF N/LLS) AGENT. -- Tf NON-RES/DENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANTA. REFUND (CA): 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 ara available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or from the Department's Z4-hour answering service for forms ordering: 1-BOO-36Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-BOO-447-30ZO (TT only). REPLY TO: Questions regarding errors contained an this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. lB0601, Harrisburg, PA 171ZB-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the dmcedent's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January l, 19BI will bear interest at a rate which mill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor Year Rate 1982 ZOZ .000548 1988-1991 1XZ ,go0301 ZOOl 9Z 1983 162 .000438 1992 92 .000247 ZOOZ 62 198q 112 .000301 1993-1994 72 .O0019Z 2003 5X 1985 13X .000356 1995-1998 92 .000247 2004 42 1986 102 .000274 1999 72 .O0019Z 1987 9Z .000Z47 ZOO0 BZ .O00Z19 Daily Factor .000247 .000164 .000137 .O00XlO --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD X NUIJBER OF DAYS DELXNQUBNT X DATLy TNTEREST FACTOR --Any Notice issued attar the tax becomes delinquent will reflect an interest calculation to fifteen (1S) 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.