Loading...
HomeMy WebLinkAbout03-0990ALLEN E. HENCH LAW OFFICES 220 MARKET STREET ... (CORt~ER OF MARKEF AND SECOND ~ ONE-HALF STREET) NEWPORT, PENNSYLVANIA 17074 (717} 567-3 ! 39 FAX NUMBER (717) 567-3130 Email: attorney@pa.net November 26, 2003 Cumberland County Register of Wills 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Frances L. Martz Dear Sirs: I enclose a death certificate for Francis L. Martz. We will be filing an Inheritance Tax Return shortly. A check toward the liability will be sent under a separate cover letter November 26, 2003. If you have any questions, please do not hesitate to give me a call. AEH:bsz Enclosure 11-26-03 The Rev. and Mrs. George C. Martz 20 East Main Street P.O. Box 358 New Bloomfield, PA 17068-0358 E-mail: gcmpcm(,~-'~p a.n et Phone: (717) 582-2141 November 26, 2003 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Dear Register: c>~l '~ O DO ,- ~ ~ 6 Enclosed you will find my check in the mount of $ 621.78 for the PA Estate Tax liability for the estate of France L. Martz. She died on August 29, 2003. According to our understanding the amount included should meet all of the tax liability for her estate. My mother resided at Thomwald Home, 442 Walnut Bottom Road, Carlisle, PA for about two and one-half years. Thomwald Home was her permanent address, although the address on her check is different. She had a supply of checks with here old address on them Since her account has been in both of our names for years, we will use the checks until we need to reorder them of.' The completed tax form will follow in a separate mailing. It will be t~om the law office Mr. Allen E. Hench Attorney at Law 224 Market Street Newport, PA 17074 Phone: 567-3139 Thank you for caring for this matter at your earliest convenience. Sincerely, The Rev. George C. Martz Executor for Frances L. Martz Estate The Rev. & Mrs. George C. Martz 20 East Main Street P.O. Box 358 New Bloomfield, PA 17068-0358 1 Courthouse'Square Carlisle, PA 17013 I,,,lll,.llh,,,,,ll,,ll,,,Ih,,Ihhl,,,,hll,h,l,l,,.ll COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 28O601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003294 MARTZ GEORGE C 20 EAST MAIN STREET NEW BLOOMFIELD, PA 17068-0358 ........ fold ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 2103-0990 DECEDENT NAME: MARTZ FRANCES L DATE OF PAYMENT: 12/01/2003 POSTMARK DATE: 11/28/2003 COUNTY: CUMBERLAND DATE OF DEATH: 08/29/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $621.78 REMARKS: GEORGE C MARTZ TOTAL AMOUNT PAID: $621.78 SEAL CHECK#6788 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS ARNING: ITIS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA DE!PARTMENT OF HEAl TH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT. NO. T 5480750 September 4, 2003 Date of Issue of This Certification NameofDecedent Frances L. Martz First Middle Last Sex Female Social Security No. 160-16-1830 Date of Death Date of Birth March 9, 1916 Birthplace Gettysburg, PA Place of Death Carlisle Reg. Med. Center Cumberland Carlisle 8-29-2003 Pennsylvania Facility Name County City Borough or Township Race White Occupation Homemaker Armed Forces? (Yes or No) No Decedent's Marital Status Widow Mailing Address 442 Walnut Bottom Road Carlisle Number Stree( Cily or Town Informant George C. Martz Funeral Director James Fo Nickel Name and Address of Funeral Establishment Nickel Funeral Home, Loysville, PA, 17047 PA 17013 State Part I: , Interval Between Immediate Cause , , Onset and Death (a) ASHD ' Unknown (b) (c) , (d) , Part I1: Other Significant Conditions Manner of Death Natural Accident Suicide Homicide Pending Investigation Could not be Determined Describe how injury occurred: Name and Title of Certfier George P. Branscum Jr. M.D. Address 850 Walnut Bottom Rd., Carlisle, PA 17013 (M.D., D.C., Coroner, M.E.) This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. .,, , .¢ ~- '~"00' ~6'~d~ Registrar o Vital Records District NO, S_eptember 4, 2003 01 Barnett St., New Bloomfio_]R_ Da 17068  COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENTS NAME (LAST, FIRST, AND MIODLE INITIAL) Frances L. DATE OF DEATH (MM-DD-Year) 08/29/2003 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DATE OF BIRTH (MM-DD-Year) 03/09/1916 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 1. Original Return r-j4. Limited Estate r~6. Decedent Died Testate (Attach copy of W~,) F--J 9. Litigation Proceeds Received 2. Supplemental Return r~4a. Future Interest Compromise (d~ ofbeath a~.r 12.12.82) L~7. Decedent Maintained a Living Trust (Z=ach copy of Tr~st) J'~10. Spousal Poverty Credit (date of bea~ between 12-31-91 and 1-1-95) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE Al NAME -- Allen E. Hench FIRM NAME (If Applicable) Allen E. Hench Law Office TELEPHONE NUMBER 567-3139 OFFICIN. USE ONLY FILE NUMBER 21 -03 0990 NUMBER SOCIAL SECURITY NUMBER 1 6 0-1 6-1 8 3 0 THIS RETURN MUST BE FILED IN [XJPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER r'-] 3. Remainder Return (d~ of death pdor to 12-13-82) ~-'] 5. Federal Estate Tax Retum Required __ 8. Total Number of Safe Deposit Boxes Oll. Election to tax under Sec. 9113(A) (A~ch Sch O) ) CONF~RMATION SHOU ~I.~D BE DIRECTED TO: COMPLETE MAILING ADDRESS Allen E. Hench Law Office 220 Market Street PA 17074 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) r"-] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) ? -':'.~'era'. Expenses & Administrative Costs (Schedule H) (9) ~0. De,ts :t Decedent, Mcrtgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line $ minus Line 11) 13. Charitab!e and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been mace S,:hedu!e J) 223.15 23,373.06~ 0.00 OFFICIAL USE ONLY (8) 23,596.21 8,500.40 587.4R (11) 9,087.88 14,508.33 (12) (13) 14 Net 'Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 14 508.33 *, 5. Amo,.nt of Line !4 taxabie at the spousal tax rate, or ~ransfers under Sec. 9116 (a)(1.2) 16, Amcunt cf Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 14~508.33 X ,0,, (15) x .04.5 (16) x .12 (17) x .15 (18) . (19) BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH 652.87 652.87 << Decedent's Complete Address: STREEI ADgRESS 442 Walnut Bottom Road C~TY Carlisle I STATE PA aP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2 Credits/Payments (1) A. Spousal Poverty Credit B. Prior Payments 621.78 C. Discount 31.09 Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. 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) 5. 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) 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 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, 652.87 652.87 O.OC O.OC 3 GNATURE.OF PERSON RESPONSIBLE FOE, FILING ADDRESS 20 E~st Main Street New BIg¢~n f~e'J'd S :.~NATURE OF PREPA,~I~H~,/~ . ~:DRESS 2,2/"Market Street Newport ~ ~er 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 flue, correct and complete. 2~,,;laration of preparer other than the persona representative is based on all information of which preparer has any knowledge. DATE 11/26/03 PA 17068 DATE 11/26/03 PA 17074 F :r 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% IT: P.S. §9118 (a) (1.1) (i)]. F :r dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. ; :r dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. LAST WILL AND TESTAMENT OF FRANCES L. MARTZ I, Frances L. Martz, resident of Springettsbury Township, York County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking, annulling and making void any and all Wills and Codicils by me at any time heretofore made. ITEM ONE: I direct that all of my just debts and funeral expenses shall be paid from the assets of my estate as soon as practicable after my decease. ITEM TWO: I give and bequeath the sum of Five Thousand ($5,000.00) Dollars to my grandson, G. Calvin Martz, Jr. ITEM THREE: I give and bequeath the sum of Five Thousand ($5,000.00) Dollars to my granddaughter, p. Christine Martz. ITEM FOUR: I give and bequeath the sum of Five Thousand ($5,0©©.00) Dollars to my granddaughter, Victoria C. Velez. ITEM FIVE: I give and bequeath the sum of Three Thousand ~$3,©©0.00) Dollars to St. Stephens U.C.C. Church, 1569 West Market FR~uNCES L. MARTZ ~J Street, York,.Pennsylvania. ITEM SIX: Ail the rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and wheresoever situate that I may own or have the right to dispose of at the time of my death, I give, devise and bequeath unto my son, George C. Martz, to be his absolutely. ITEM SEVEN: In the event my son, George C. Martz, should predecease me or fail to survive me by fifteen (15) days or should we die by common disaster so that it is impossible to determine which of us survived the other, then and in that event, I give, devise and bequeath all the rest, residue and remainder of my estate to my daughter-in-law, Phyllis C. Martz. ITEM EIGHT: In the event my son, George C. Martz, and my daughter- in-law, Phyllis C. Martz, should predecease me or fail to survive me by fifteen (15) days or should we die by common disaster so that it is impossible to determine which of us survived the other, then and in that event, I give, devise and bequeath all the rest, residue and remainder of my estate to my grandchildren, G. Calvin Martz, Jr., P. Christine Hartz, an~ ¥ic~oria C. Velez. ITEM NINE: I direct that all State Inheritance and Succession Taxes on property passing under this my Will, be paid out of the FRANCES L. MARTZ principal of my general estate to the same effect as if said taxes were expenses' of administration, and all legacies, devises and other gifts of principal and income made by this, my Will, or by any Codicil hereto, shall be free and clear thereof. In the absolute discretion of my Executor and Executors, whichever the case may be, she may pay such taxes immediately or postpone the payment of taxes on future or remainder interests until the time possession thereof accrues to the beneficiary. ITEM TEN: For the payment of my debts and settlement of my estate, I give my Executor or Executors, whichever the case may be, full power and authority to sell any and all of my real estate, at either public or private sale without order of the Court and to give good and sufficient deed and title therefor, the same as I could do if living and to do any and all things necessary for the complete administration of my estate. ITEM ELEVEN: I nominate, constitute and appoint my son, George C. Martz, to be the Executor of this my Last Will. In the event my said son~ George C. Martz, is unable or unwilling to serve as Executor of this my Last Will and Testament, then and in that event, I nominate, constitute and appoint my daughter-in-law, Phyllis C. Martz, to be the Executrix of this my Last Will and Testament. FRANCES L. MARTZ ~ d IN WITNESS WHEREOF, I have hereunto set my hand and seal this ay of '~ , 1994. FRANCES L. MARTZ ~ (SEAL) The preceding instrument consisting of this and three typewritten pages identified by the signature of the Testatrix was on the date thereof signed, published and declared by Frances L. Martz, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us wh6, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. 4 COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK We, Frances L. Martz, , the Testatrix , and and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare this instrument to be her Last Will and that she has signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of their knowledge, the Testator was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Witness Witness Sworn and subscribed to before me this ~day of /'~%4~ ~ L.~ 1994 ~ (,,~ k...-'l ~' ~..~ ',-.' . ~,_. Notary Public My Commission Expires: vds/1DAN NOTARIAL SEAL MELINDAA. SHOUCK, NOTARY pU~,LIC YORK, YORK COUNTY, PA MY COMMISSION EXPIRES NOV, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Martz. France8 L. Include the proceeds of litigation and the date the oroceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Refund from Orthopedic Institute of Pennsylvania 26.8(~ Refund from Capital Blue Cross Refund from Thornwald Home Refund from Sprint 156.54 35.7c. 3.9( TOTAL (Also enter on line 5, Recapitulation) $ 223.1 .~ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Martz. Frances ~,, 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. George C. Martz Son 20 East Main Street New Bloomfield, PA 17068 JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION Of PROPERTY % OF DATE OF DEATH ITEM FOR JOINT ~ MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S iNTERE ~. A. 2/20/97 M&T Bank CD #3103913656848, $6,857.14 plus accrued 6,862.84 50. 3,431.4: interest of $5.70. See attached letter of Charlene Warrington, dated November 12, 2003. A. 3/1/69 M&T Bank Checking account #72948114. See attached 38,855.52 50. 19,427.7, letter of Charlene Warrington, dated November 12, 2003. A. 6/17/81 M&T Bank Savings account #15004208371605. 1,027.75 50. 513.8. $1,027.50 plus accrued interest of $0.25. See attached letter of Charlene Warrington, dated November 12, 2003. TOTAL (Also enter on line 6, Recapitulation) $ 23~373.0~ (If more space is needed, insert additional sheets of the same size) November 12, 2003 Allen E. Hench Law Offices Attorney At Law 220 Market Street Newport, PA 17074 499 Mitchell Street, Millsboro, DE 19966 RE: Estate of Frances L. Martz Date of Death: AuEust 29, 2003 Social Security Number: 160-16-1830 Dear Mr. Hench: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the followin§ accounts. 1. Account Type ........................... Certificate of Deposit Account Number. ...................... 3103913656848 } Owners/dp (Names oJ) .............. Frances L. Martz, George C. Martz Opening Date ........................... 02/20/97 (account closed 09/30/03) Year to Date Interest ................. $115.48 l~__?ance on Date of Deatlt ......... $6,857.14 Accrued Interest $ 5.70 Total ...................................... $6,862.84 Account Type ........................... Checking Account Account Number ....................... 72948114 Ownersh/p (Names oj') .............. Frances L. Martz, George C. Martz OpeningDate ........................... 03/01/69 Year to Date Interest .................. $0.00 l~lo_,n~e~ . On Date of Deat~ ......... $38,855.52 Accrued Interest ............ $ -0.00 Total ...................................... $38,855.52 · Page 2 November 12, 2003 Account 7~pe ........................... Savings Account Account Number ....................... 15004208371605 Ownership (Names oj') .............. Frances L. Martz, George C. Martz Opening Date ........................... 06/17/81 (account closed 09 / 30/03) Year to Date Interest ................. $3.32 Balance on Date of Death. ......... $1,027.50 Accrued Interest ~ 0.25 Total. ...................................... $1,027.75 For any additional questions on the above accounts, please contact our branch at: 425 Loucks Road, York, PA, 17404- Phone (717) 848-6265 Sincerely, Charlene Warrington, Associate I (302) 934-2722 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Martz. Frances L. Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 2, 3. 4. 5. FUNERAL EXPENSES: 9/18, check #6775 Nickel Funeral Home 9/25, check #6778 Gerri Short, organist 9/25, check #6779 St. Stephens U.C.C. Church 9/25, check #6780 Reverend Scofield Obituary ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s) / EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees Allen E. Hench Law Office Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address City Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Prepare~'s Fees Filing and other Register of Wills fees Miscellaneous and final probate State Zip TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) 6,284.2C 100.OC 200.0C 100.0C 281.2C 1,150.0C 35.0C 350.0( 8,500.4£ REV-1512 EX +(1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES~ & LIENS ESTATE OF FILE NUMBER Martz. Frances L. Include unreimbursed medical expenses. ITEM NUUBER DESCRIPTION AMOUNT 1. 9/14, check #6774 West Shore EMS 110.0( 9/2,1check #6777 Pharmerica 9/26, check #6781 Mobile Optometry Check written prior to death but cashed aft:: Miscellaneous TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) 69.2~ 17.0( 41.2~ 350.0( 587.4~: COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Martz. Fr ~nc~ I., NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outdght spousal distributions) 1, George C. Martz 20 East Main Street New Bloomfield, PA 17068 SCHEDULE J BENEFICIARIES FILE NUMBER RELATIONSHIP TO DECEDENT Do Not LL~t_ Son AMOUNT OR SHARE OF ESTATE All (as co-owner) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - 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) BUREAU OF 'rNDZVTDUAL TAXES 'rNHER'rTANCE TAX DTv'rSTON DEPT. Z80601 HARRTSBURG,, PA 17128-0601 COMNONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-I&D7 EX AFP (01-05) ALLEN E HENCH ALLEN E HENCH LAN OFC ZZO MARKET ST NENPORT PA 1707q DATE 04-05-2004 ESTATE OF MARTZ DATE OF DEATH 08-29-Z005 FILE NUMBER Z1 05-0990 COUNTY CUMBERLAND ACN 101 Amoun'k Remi*l:*l:ed FRANCES L HAKE CHECK PAYABLE AND RENZT PAYNENT TO= REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his form wi~h your ~mx payment. CUT ALONG TH'rS L'rNE ~-* RETA'rN LONER PORT'rON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) M~ 'rNHER'rTANCE TAX STATEMENT OF ACCOUNT ESTATE OF MARTZ FRANCES L F'rLE NO. 21 05-0990 ACN 101 DATE 04-05-2004 THIS STATENENT 'rs PROV'rDED TO ADV'rSE OF THE CURRENT STATUS OF THE STATED ACN 'rN THE NANED ESTATE. SHOHN BELON TS A SUNNARY OF THE PR'rNC'rPAL TAX DUE, APPL'rCAT'rON OF ALL PAYNENTS, THE CURRENT BALANCE, AND, 'rF APPL'rCABLE, A PROJECTED 'rNTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-08-2004 PRINCIPAL TAX DUE: .......................................................................................................................................................................................................................... 652.87 PAYMENTS PAYMENT DATE 11-28-2005 05-ZZ-2004 (TAX CREDITS): DISCOUNT (+) INTEREST/PEN PAID (-) RECEIPT NUMBER CDOO3294 REFUND 32.64 .00 ZF PAID AFTER THIS DATE, SEE REVERSE SZDE FOR CALCULATION OF ADDITIONAL INTEREST. { ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT 'rS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" {CR), AMOUNT P/AiD 621.78 . 1.55- TOTAL TAX CREDIT YOU NAY BE DUE A REFUND. SEE REVERSE S'rDE OF TH'rS FORN FOR 'rNSTRUCT'rONS. 652.87 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 PAYMENT: Detach the top portion of this Notice and submit aith your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA. REFUND (CR]: A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or from the Department's Iq-hour answering service for forms ordering: 1-800-36Z-Z050~ services for taxpayers with special hearing and / or speaking needs: 1-BO0-qqT-$OgO (TT only). REPLY TO: Questions regarding errors contained on this notice should ba addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, Dept. Z80601, Harrisburg, PA 171ZD-OBO1j phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (5) calendar months after the decedant's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: Thm 1SI tax amnesty nan-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 eith first day of delinquency, or nine (9) months and one [1] day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .00016q. All taxes ahich became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 19BI 20Z .000548 1988-1991 llg .000301 ZOO1 9Z .000Z¢7 1963 16Z .000458 199Z 9Z .000247 2002 6Z .000164 1984 112 .00030! 1993-1994 7Z .O0019Z 2003 5Z .000137 1985 132 .000556 1995-1998 92 .000247 ZOO4 42 .000110 1986 lOX .000Z74 1999 7Z .00019Z 1987 9Z .000247 ZOO0 DX .OOOZ19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINI;IUENT X DA]~L¥ INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF ZNDZVZDUAL TAXES I'NHERI'TANCE TAX DTV]'SI'ON DEPT. 280601 HARRISBURG, PA 1712&-0601 CONNONNEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOHANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RE¥-ISq7 EX AFP (01-05) ALLEN E HENCH ALLEN E HENCH LAg OFC 220 NARKET ST HENPORT ~! : ~,'~i;5 ESTATE OF DATE OF DEATH FILE NUHBER 'C}~ MAR -5 P3:42 COUNTY ACH O$-08-ZOOq HARTZ 08-29-2005 21 05-0990 CUHBERLAND 101 Amount RemL'l:tad FRANCES L HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGTSTER OF NTLLS CUHBERLAND CO COURT HOUSE CARLI'SLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF HARTZ FRANCES L FILE NO. 21 05-0990 ACN 101 DATE 05-08-200q TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estate (Schedule A) (1) 2. Stocks and Bonds (Schedu/a B) (2) $. Closely Held Stock/PartnershAp Interest (Schedule C) ($) q. Mortgages/Notes RaceAvable (Schedule D) (q) 5. Cash/Bank Deposits/MAsc. Personal Property (Schedule E) (S) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (ScheduZa G) (7) B. Tote1 Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule H) (9) 10. Debts/Mortgage LiabilAtias/LAens (Schedule Z) (10) 11. Total Deductions 12. Nat Value of Tax Return 225.15 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper portAon .00 of this form with your tax payment. 25~$75.06 .00 (8) 8,500.~0 587.~8 15. lq. NOTE: ASSESSMENT OF TAX: 15. Amount of LAne lq at Spousal rate 16. Amount of LAne lq taxable at Lineal/Class A rate 17. Amount of LAne lq at SiblAng rata 18. Amount of LAne lq taxable at Collateral/Class B rata 19. PrAncipal Tax Due tAX CREDITS: PAYMENT RECEIPT DZSCOUNT DATE NUMBER INTEREST/PEN PAID (- 11-28-2005 CDOO$Z9q $Z.6q 25,596.21 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (15) .00 x O0 = .00 (16) lq,508.$3 X Off5 = 652.87 (17) . O0 x 12 = . O0 (lB) .00 x 15 = .00 (19)= 652.87 AMOUNT PAID 621.78 reflect f/gures that include the total of ALL returns assessed to date. TOTAL TAX CREDIT I I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 1.55CR .00 1.55CR ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REgUZRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Charitable/governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) . O0 Net Value of Estate Sub~ect to Tax (1~) 1~,508.~ Zf an assessment ~as lssued previously, lines 14, 15 and/or 16, 17, 18 and 19 ~ill (11) 9 .I]87.88 (1;) lq,508.$~ RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decadents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class S (collateral) beneficiaries of tho decedent after the expiration of any estate for life or far years, the Commonmealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at tho 1aclu1 Class S (collateral) rate on any such futura interest. To ~ulfill tho requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of 2000. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit mith your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF #ILLS, AGENT A refund of a tax credit, which ams not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at tho Office of the Register of #ills, any of tho 15 Revenue District Offices, or by calling the special Z4-hour ansmering service for ferns ordering: 1-800-56Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-50Z0 (TT only). Any party in interest not satisfied aith the appraisement, allowance, or disalloaanca of deductions, or assessment of tax (including discount or interest) as sheen on this Notice must object within sixty (60) days of receipt of this Notice by: --erittan protest to the PA Department of Revenue, Board of Appeals, Dept. 281011, Harrisburg, PA 17118-1021, 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 bo addressed in ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Raviae Unit, Oept. Z80601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax dug is paid eithin three (5) calendar months after tho dacadent's death, a five percent (mX) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning eith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ahich became delinquent before January 1, 198Z bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164. All taxes ahich became delinquent on and after January 1, 1982 ail1 bear interest at a rate ahich ail1 vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2005 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Yea.~r Rate Factor 198Z lOX . 000548 1987 97. . O00Z47 1999 7Z .OOOlgZ 1983 16Z .000458 1988-1991 1IX .000501 2000 8Z .O00Z19 1984 Ill .000301 199Z 9Z .000247 Z001 9Z .000147 1985 157. .000356 1995-1994 7Z .000192 ZOO2 67. .00016~ 1986 iOZ . O00Z7q 1995-1996 9Z .000Z47 2003 5Z .000157 --Interest is calculatad as folloas: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELZNI~UENT 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 bm calculated.