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Home My WebLink About04-0443 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003903 WAGNER KATHLEEN 3885 LAUER LN DOVER, PA 17315 ACN ASSESSMENT AMOUNT CONTROL NUMBER __nn__ fold ---------- -------- 03135532 I $63.62 ESTATE INFORMATION: SSN: 203-10-8037 I FILE NUMBER: 2104-0443 I DECEDENT NAME: NOEL RUSH R I DATE OF PAYMENT: 05/05/2004 I POSTMARK DATE: 05/04/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 07/04/2003 I I TOTAL AMOUNT PAID: $63.62 REMARKS: CHECK# 6614 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA '* at/- 443 DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 BUREAU OF INDIVIDUAL TAXES AND DEPT. Z80601 TAXPAYER RESPONSE ACN 03135532 HARRISBURG, PA 171Z8-0601 DATE 10-02-2003 REV-1543 EX AFP 109-001 Fh;,_ TYPE OF ACCOUNT \---' EST. OF RUSH R NOEL D SAVINGS S.S. NO. 203-10-8037 IX] CHECKING DATE OF DEATH 07-04-2003 D TRUST '04 [/If\Y -5 cqt11!1ll7 CUMBERLAND D CERTIF. RE"IT PAY"ENT AND FOR"S TO: KATHLEEN WAGNER REGISTER OF WILLS 3885 LAUER LN ~.I ;;". CUMBERLAND CO COURT HOUSE DOVER PA 17315 C\:r:,., CARLISLE, PA 17013 PNC BANK has provided the Depart.ent with the inforBation listed below which has baen used in calculating the potential tax due. Thair records indicate that at the death of the above decedent, you were a joint owner/benaficiary of this account. If you feel this inforBation is incorrect, please obtain written correction fro. the financial institution, attach a copy to this forB and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COBmonwealth (If Per",'Sy.lvan;aw D"....tlnn'" ..ay b.. an'!wer..d by calling (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5003762599 Date 04-20-2001 To insure proper credit to your account, two Established (Z) copies of this notice .ust acco.pany your Account Balance 3,974.60 pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax 1,987.30 NOTE: If tax paYBents are Bade within three (3) Bonths of the decedent's date of death, Tax Rate X .045 you Bay deduct a 5% discount of the tax due. Potential Tax Due 89.43 Any inheritance tax due will becoBe delinquent nine (9) Bonths after the date of death. PART TAXPAYER RESPONSE [!]liii!iill~~.li!iil!iij_iiiil~~I!iii!"lii!ii~liii!.!iii.~I~~I!i!ii!.iiiil.I_!i!i..~ii.iii!.~I!lli_~.iiiii~ A. [] The above infor.ation and tax due is correct. 1. You Bay choose to reBit paYBent to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of [ ONE ] Wills and an official asseSSBent will be issued by the PA Departaent of Revenue. BLOCK B. [] The abova asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's representative. C. ~ above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your ~ relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS lINE 1. Date Established 1 2. Account Balllllce 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 19 9'7. 3 c 5. Debts and Deductions 5 -Sf),1-.1/ 6. Amount Taxable 6 It.f09. /9 7. Tax Rate 7 X 8. Tax Due 8 (p~. C:, 1-~ PART DEBTS AND DEDUCTIONS CLAIMED ~ DATE PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on line 5 of Tax Computation) $ r perjury, I declare that the facts I heve reported above are true, correct and my knowledge and belief. HOME ( '7/-1 ) 2-12. -7(;,3 ~ WORK ( ) TELEPHONE NUMBER GENERAL INFORMATION 1. FAILURE TO RESPOND WIll RESULT IN AN OFFICIAL TAX ASSESS"ENT with applicable interest based on inforlll,tion subaitted by the financial institution. Z. Inheritance tax becomes delinquent nine aonths after the decedent's date of death. 3. A joint account is taxable even though the decedent's na.e was added as a .atter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the inforaation and computation in the notice are correct and deductions are not being claiaed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and subait them with your check for the aaount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept Z80601, Harrisburg, PA 171Z8-0601 in the envelope provided. 3. BLOCK C - If the notice infor.ation is incorrect and/or deductions are being claimed, check block "C" and co.plete Parts Z and 3 according to the instructions below. Sign two copies and sub.it them with your check for the aaount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessaent (Form REV-1548 EX) upon receipt of the return froa the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the .anner existing at date of death. NOTE: For a decedent dying after lZ/IZl8Z: Accounts which the decedent put in joint naaes within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (MM) appears before your first naae in the address portion of this notice, the $3,000 exclusion already has been deducted fro. the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER DF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Exa.ple: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7% (TAXABLE FDR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50% (TAXABLE FDR EACH SURVIVDR) 4. The aaount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deter.ined below. Date of Death Spouse lineal Sibling Collateral 07/01/94 to 12/31/94 37- 67- 157- 157- 01/01/95 to 06/30/00 07- 67- 157- 157- 07/01/00 to present 07- 4.57-. 127- 157- MThe tax rate l.posed 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%. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in comaon with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payaent, or the estate subject to ad.inistration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being claiaed aust be iteaized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" xli". Proof of payaent may be requested by the PA Department of Revenue. ~I",Q~etcR;"~Nl1"Q~",It~~~NU.E,..".nl$l1ltl(lll1iiQFf;f~I:LJ]R"C.At:Li,)r:F:U$",IU.ItEAU.i,Q~"iii""""""""","i'..ii,ii""i"""i"""""",..,i ~ _~=c := TX" ~,E=)i ;1__ -'2_'= ;~::0"; 0 V Track Your Expenses -'A'.; ~. ir':;'J~! ~,jl~:at!')~ 1Vler!lcC'! Olc":"il Be =~itE:'"':z:'~-r:::r' Chc;fltles =)00 - Ciolhlrg :....Orr!~ Utili!!';;::' BAL -:.= Oependenr Care 'nsuri1nr:~ Onler FOR"8 !TEM AMOUNT . . - -- . __BALANCE ----.- , . ~_.... ,; . --- DEPOSIT Call to Reorder FOR'D 1-800-204-2244 Memo -~---~_.~_.- NOT NEGOTIABLE CHECK HERE IF TAX DEDUCTIBLE ITEM 0 v Track Your Expenses, 64 J. (1 r- = AutoiTravei = Education .J MedicaliOenta; 9 = BUSiness = Entertainment = Savings r, , -= Charities .-=: Food --= Taxes = Clothing = Home ~~ Utilities BAL. c-':'~ ~ Dependent Care ~-: Insurance ~ Other FOR'O ITEM - / UI - _--AMOUNT I -...- ~ 'SI BALANCE = -~:-: - -- :;;:: -. DEPOSIT L: p C~I to Reorde( FOR'D .~t~00-204-2244 .~~ Memo --~---- ~--~----- NOT NEGOTIABLE CHECK HcHc: if= lAX DEuUCTJ8i_E iTEr'.l1 D v Track Your Expenses" ~~ I.. J~ ~'. == AutGlra'ie: Education Medical/Oenia.; C Bu"-;,<ess Entertalnmenr == Savings :=0--, i,:!S _ Food = Taxes -= C" = Home =.: Utilliies BAL. ~'[)e: 'lent Care Insurance ~-= OthAr FOA'O ITEM AMOUNT BALANCE --.." DEPOSIT Call to Rec,der FORD 1-800-204-2244 Mem8______ NOT NEGOTIABLE \)'- /-'-"'-'''"'.~-..' I ;. -- ... .- I _ . .-= ~...--::: ~-:: ...-;:: .-:;: 'd ..- j'l-J :: . ... .-:: ~ :f .- (t' (~, . .....::: ~.~ ~ 0' ~_ CC' -~ : ~'~ ~ ;~ u..J 'I C, ..' \- U- d; (\):r .4., ,0 ,,~ (_') ~ ',-~ /, ':J ~( ~ t. '. ',J,," I' ..,_ ~. -...:. ;, /'''' ....., '""'" -:= Ii ....c__.,v \ I ..J "^ . .., II , ....& 0 ,., .., '-::::\" - .... '\ '.- .- '~ J "-...J 0 ::::::: \...:J C- ....: .~- .q- U rn J c , (/'I --,... ~ 1'/'1 ~ C........ i'n . (\ - . , ~ ~. <. \.,:j I J. ! ~ ...5.1._ .,../ \ - ~ 'HI . j ~" ~ lU 1"" ~ u1'~ .,,,/ I ,'fo{> ~ ..:3 .... e ~ ~ ~ <:t " ~ J;,~ c) ,'.1 \-:T.- ;::, 5; cJ _'._ a: . )c: ~ ~ lU I") "2 -7 f" \1 <.... --- ~ "J ~ ,~ ~ ,~~ ~ ,~ \lJ ,\ J - ''l ~ ::t ~ 4! l- . -:> ,,-<::t, \Y: V .Y C-<-. ^ -- f',... !--\ J PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of KU.Sf-l K. NaEL No. -2J-oL.f - 443 also known as 1( R. NOE-L To: Register of Wills for the Deceased. County of (b/hber/.4ND in the Social Security No. :2..0.3 - r () - R'O:S 7 COillmonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, applieS for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in <:!-I.< In st=d aND County. pen~vania, will> h IS last family or principal residence at /5..:3 ~ . v,qu-.t:J/'J,A,j ,rT~/a ~rt /702.r (list street, number and municipality) z..oO:.s Decendent, then ~ / years of age, died ~ V , +9__, at MIl. j ~YJ //"'''1- fIr,,so /-fA ( . I r . Decendent at death owned property with estimated values as folllows: '::J/. (j c> (If domiciled in Pa.) All personal property $ v {p . (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: ~~ ,/ ~ No E L S'r ao/<z""- .4- ::--; ~- ; .. .., .C::> ? = --" .C::> THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administI1ltion in the appropriate form to the undersigned. f'-l .j~." ----......--....'......--...... ......" . -.- .(::>. SToO i A;:7~ t\. ~ \ ~~ ( "'~ '" .... ~'" c: -00 c';:: tU '.c 30:: "'<0-. 30 Oi c: Ol) ;;) OATH OF PERSONAL REPRESENTATIVE COMMONW,L TH OF PENNSYLVANIA } ss COUNTY OF ilm~oJ\ \llx"\ ~ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~ subscribed f I{ J ~ ff ,-.. '" day of - Q) l1J._ ~ ;::S ..... Register rt tV c: bO ti5 No. 2.1 - 04 - L{ LJ3 Estate OiliL~~ K ~oe..\ ~~~~~.~~\ , Deceased . GRANT OF LETTERS OF ADMINISTRATION AND NOW ~ \l\.. J.c::x.y..\ W_, in consideration of the petition on the reverse side hereof, tlsfactory p~ havmg been presented before me, IT IS DECREED that ~\(' V""'\. h Not'.. \ is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to \\c~ , ~) ~~_ in the estate of ......~"'-_ '--i<......... ~!} \( ok' .'L-~ ~-X'~ ~-"'... ~ Register of Wills'" or- ~ ' FEES Letters of Administration . 0 0 o. $1.i:) 0 00 Short Certificates( \ ) . . . . . . . . .. $ -:3. ex:::> ATTORNEY (Sup. Ct. 1.0. No.) Renunciation ................ $ ~p $10.00 ADDRESS oJOTAL - $ Filed 6 .-. )~~............. A.D. 19_ PHONE "", This is to certifY that the information here given is correctly copied from an original certificate of death dul~ filed with me as Local Regisuar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 a -.:t.:-L.-.--' ""f/1!/ .......,'(' 0-;::' , q , /' ~kt.-cLt:; Local Registrar r- p 9267781 JUL 0 7' 2003 No. Dare Cj C 'T; g..; "F' -;? SO; -< '3 Aey, 2187 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECOROS -' CERTIFICATE OF DEATH ~ STATE FilE NUMBER NAME OF DECEDENT (FlrSl. Mldclle. Las) SEX SOCIAL SECURITY NUMBER ....~ ~ I. f<-(,{5H No2"'L 2.Male 2,203 - 10 - AGE (LaS! BW1hday) UNDER 1 YEAR UNDER 1 DAY 8IR'THPL.ACE ICoty ow:t PlACE OF DEATH ICI1ecll, aNy one ManlN . D.ya Hours. Minut.. Sla&e Of FCte.gn Counlry) HOSPITA~' I . . Dlhe, 8 1vrs i i Inpalten' (Specify) 0 . COUNTY OF OERH FACilITY NAME (II nolln!.1'tuIlOn. gIve S(reet and number) RACE . Amenc.n Indian, Slack. Whtt.. etc. ISi>e<<lYI . .... CUmber land II. White DECEOENT'S USUAL OCCUPIO'ION MAAlTAL SWUS . ...,.... SURVIVING SPOUSE (~~~~:o~uc::~~ N""'Di~":~~~d. IItWila.gtVemaldenname. Electrician '2, 12. ... Married II.Helen Covatto . '70.SIo.. PA D" 17c.DO _.__in East Pennsboro 'l'w!>. lWp, 153 East Dauphin street =:':'" ... Enola, PA 17025 '1b.Cou CUmberland lownoh;p? ._ FATHER'S NAME (Fitst, MIOdIe. LaaI) ". Samuel Kenned Noel INFORMANT.S.....E (T ,pelPrinI) 200. Kathleen R. Wa METHOD OF DISPOSITION DATE OF DISPOSITION . 8urial 5iI Cromaticn 0 AemoYol "om slo.. 0 ("onlh. Do,. -I OIhor(Si>e<<lYl-- 0 21~uly 8, 2003 17011 PEASONACTINQASSUCH LICENSE NUMIlER 17025 LICENSE NUMBER 2211. 22c. WAS CASE REFERRED TO MEDICAL EXAMINERlCORONER? ,...../' r- ' Yeo 0 No~ 24. ~ ' _hi. H. 21. 27. PART I: Ene., It... diM..... iniurles 01 c::ompUcalions which ca death. 00 not enter the mode 01 dying, I Approximate PART II: 0Ihet tfgniftcanI c:onditiona conuibuIing to deeth, but: Lilt only one cause on each line. . ~ : inllItYaI bMwMn noI ruuIIing in 1M undeftV'ng ceuM giwn in PART I. '....EDlATE CAUSE IF""" . ~ -e..) P J1 M ~ -Fe. '-'..,.- end...... OlSNSII or condIIton I 188Uling 111 eleafll---+ .. I c>DUE 10 lOA AS A CllNSEQU~NCE Of), _0" ("" bLJ~~ LV-~ : I J'fJE:;::::JXONSf.~ c:J! : . n I .. DUE 10 (OA AS A CONSEQuENCE Of), : WEAE AUTOPSY FINOtNGS MANNER OF DEATH DATE Of INJURV TIME OF INJURY INJURY JIJ WORK? oeSCRJee HOW INJURY OCCURRED. AIAllA8lE PRtOR 10 (Monrh. Day. Year) ~~~~ OF CAUse Nalural ",kt" HomICide 0 Accident 0 Pending Lnvesligalion 0 No Yes 0 No 0 Suicide 0 Could noI be determined 0 2". 211b, 29. CERTIFIER ,Check aniy one) .CER1IFYlNG PHYStClAN (phySICI&O Cflrll'Y1n9 cause 01 death when anomer phySIC.an has pronounced dealh ana complele<J Item 23) To lhebealot my know'-dge, deelhoceurrecl due 10 Ihe cauH(l) and manner...tated. ........ ............,......,............,.......... .PRONOUNCING AND CERTifYING PHYSICIAN (PhYSICian both j)l'OflO\.lncll'lg death and certifYing to cause 01 death) .- 0 '3> To the ~t 01 my knowlltdge, death occ:urrH ..the lime, date, and piKe, and due '0 lhe cau..(.} and manner.. staled.. "..........",..... .MEDICAL EXAMINER/CORONER ~:~~::::I:.::::.~~.j~~~I~~ ,..~a:~ ~~~~~.~~~t,i~~: ~~ ~.~ ~~i.n.i~~: ~~~~~ ~~~~~~ ~~ ~~~ ~I~~..~~t~: ~~~. ~I~~~: ~~~.~~~ ~~ ~~~ ~~~~~~~).~~~ 0 31a. ~/~/I/I .. cumberland County - Register of wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 08/02/2004 NOEL HELEN R 153 E DAUPHIN ST ENOLA, PA 17025 RE: Estate of NOEL RUSH R File Number: 2004-00443 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 08/25/2004 Your prompt attention to this matter will be appreciated. Thank You, ;:;:~~ GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court cc: File Counsel Judge 21-61- tfL/J CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Ru..S'/-I 7? NOEL Date of Death: 11l/lo3 Will No. Admin. No. 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 FJ/2./ I 0 If : ~ Address /./AII-lLEEN' R.. W,4.1J~ an ~ ::0 ::f:t' :lJ(\l Fi<.ArJ K..LIN R. W A-G-N&e- :j ~;:" (\.1 (1 fC, () rr t~~ ~,; m ~ f::' G1 t'} ..:' WAYNF- f<.. Not:L {'~,' N .... '~._'" .,""' -,,' /-kLfSN (') a 1<... I\JdE.L "',) ~ Iii Q J.: ~ );. ;:, U1 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: 'if/~I/O<l Signature Name {...f-.4. o. -, re. ~ Address 153 C. l>~~ ~ ;00- 17(J~..r Telephone (1/1 732- - 0& 3'1 Capacity: ,/' Personal Representative _Counsel for personal representative r COMMONWEALTH OF PENNSYLVANIA '* BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 NOTICE OF INHERITANCE TAX HARRIS8URG, PA 171Z8-0601 APPRAISEKENTS ALLOHANCE OR DISALLOHANCE OF DEDUCTION , AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP [01-03) DATE 08-30-2004 ESTATE OF NOEL RUSH R DATE OF DEATH 07-04-2003 FILE NUMBER 21 04-0443 COUNTY CU~~LAND KATHLEEN WAGNER SSN/DC 20~~()-808_j 3885 LAUER LN ACN I '.~~f1''::t~::1 DOVER PA 17315 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS -0 CUMBERLAND CQ.., COURT rtOUSE CARLISLE, PA)'::' 17013 ~ CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...... iifv=is4-i-E3f-AFFi-foi-:oij------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-30-2004 ESTATE OF NOEL RUSH R DATE OF DEATH 07-04-2003 COUNTY CUMBERLAND FILE NO. 21 04-0443 S.S/D.C. NO. 203-10-8037 ACN 03135532 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 5003762599 TYPE OF ACCOUNT: ( ) SAVINGS ()() CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 04-20-2001 Account Balance 3,974.60 NOTE: TO INSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 1,987.30 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 1,987.30 REGISTER OF WILLS AT THE Tax Rate X .45 ABOVE ADDRESS. MAKE CHECK Tax Due 89.43 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-04-2004 CD003903 .00 63.62 INTEREST IS CHARGED THROUGH 09-07-2004 TOTAL TAX CREDIT 63.62 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 25.81 REVERSE SIDE OF THIS FORM INTEREST AND PEN. .66 TOTAL DUE 26.47 iii IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. iii ') y,,- ( IF TOTAL DUE IS lESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section Zl40 of the Inheritance and Estate Tax Act, Act Z3 of ZOOO. (n P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your pay.ent to the Register of Wills printed on the reverse side. -- Make check or money order payabla to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, .ay 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 Wills, any of the Z3 Revenue District Offices or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and or speaking needs: 1-800-447-30ZO (TT only). OBJECTIONS: Any party in interest not satisfied with the appraise.ent, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Depart.ent of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171Z8-1OZ1, OR --elacting to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovared 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 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar .onths after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% 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 ti.e period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) .onths and one (1) day fro. the date of death, to the date of pay.en!. Taxes which became delinquent before January 1, 198Z bear interast at tha rate of six (6%) percent per annum calculated at a dailY rate of .000164. All taxes which became delinquent on or after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z "'2iiZ"" .000548 rn8-1991 ~ :Diiii3ol Ziiiii -W- . iiiiii2'47 1983 16% .000438 199Z 9% .000Z47 ZOOZ 6% .000Z19 1984 ll% .000301 1993-1994 n .00019Z Z003 5% .000137 1985 13% .000356 1995-1998 9% .000Z47 Z004 4% .ooollo 1986 10% .000Z74 1999 n .00019Z 1987 9% .000Z47 ZOOO 8% .000Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER 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 assassment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA - BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 r "'1NHE1UTANCE TAX HARRISBURG, PA 171Z8-0601 RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS REV-1604 EX AFP 101-031 DATE 10-21-2004 ESTATE OF NOEL RUSH R DATE OF DEATH 07-04-2003 FILE NUMBER 21 04-0443 COUNTY CUMBERLAND SSNI'DC 203-10-8037 KATHLEEN WAGNER ACN 03135532 3885 LAUER LN I Amount Remitted I DOVER PA 17315 ~ ' . . MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE 1.::-...1 CARLISLE, PA 17013 ..-- P~_~_~~P_~~_I_~!~__~~_______~____~_~!~~~_~~~~~_~~~!_I_~~_~~~_~~~~__~~P~~~~______~____________________ REV-1604EXAFP (1)>'1-03);-:: .. INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS .. DATE 10-21-2004 ESTATE OF NOEL RUSH R DATE OF DEATH 07-04-2003 COUNTY CUMBERLAND FILE NO. 21 04-0443 S.S/D.C. NO. 203-10-8037 ACN 03135532 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 5003762599 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 04-20-2001 Account Balance 3,974.60 NOTE: TO INSURE PROPER CREDIT TO YOUR Percent Taxable X 0.500 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax 1,987.30 OF THIS NOTICE WITH YOUR TAX Debts and Deductions - 578.11 PAYMENT TO THE REGISTER OF WILLS Taxable Amount 1,409.19 AT THE ADDRESS SHOWN ABOVE. Tax Rate X .45 MAKE CHECK OR MONEY ORDER PAYABLE Tax Due 63.42 TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-04-2004 CD003903 .20- 63.62 TOTAL TAX CREDIT 63.42 BALANCE OF TAX DUE .00 INTEREST AND PEN. .01 TOTAL DUE n1 IE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS lESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) . ):,.. ~ PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the na.e and address printed on the raverse side. __ Make check or .oney order payable to: REGISTER OF WIllS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313l. Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Offices or from the Department's Z4-hour answering service for forms ordering: 1-8oo-36Z-Zo5o; services for taxpayers with special hearing and / or speaking needs: 1-8oo-447-3oZo (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-o601, Phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax aanesty non-participation penalty is co.puted 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 data of death to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6%) percent per annua calculated at a dailY rate of .000164. All taxes which beca.e delinquent on and after January 1, 198Z will bear interest at a rate which will vary fro. calendar year to calendar year with that rate announced by the PA Departaent of Revenue. The applicable interest rates for 198Z through Z003 are: Interest Daily Interest Daily Interest Daily ~ Rate ~ ~ ~ ~ Year ~ ~ 198Z ZO% .000548 1987 9% .000Z47 1999 n .00019Z 1983 16% .000438 1988-1991 ll% .000301 ZOOO 8% .000Z19 1984 ll% .000301 199Z 9% .000Z47 Zool 9% .000Z47 1985 13% .000356 1993-1994 n .00019Z ZOOZ 6% .000164 1986 10% .000Z74 1995-1998 9% .000Z47 Z003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER 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 assessaent. If payment is made after the interest co.putation date shown on the Notice, additional interest .ust be calculated. r REV-1470 EX (6-88) '* "'-, . INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER Noel, Rush R 21 04-0443 REVIEWED BY ACN Steven James 03135532 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The funeral expenses have been allowed against the value of the above referenced ACN. - ' . -'.- ; ~ ROW Paqe 1 \..oUllLJ..IC::J.. J..CU1U \.-UUllL.. Y .Ke~.L::;L:.er UI:' Wl..L..LS One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 6/06/2005 NOEL HELEN R 153 E DAUPHIN ST ENOLA, PA 17025 RE: Estate of NOEL RUSH R File Number: 2004-00443 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 7/04/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~J~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge cA Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 N_ofD_d." KUsA.. R --;jo-U . D'..D~_ ~ t~ . Estate No.: ),,/- _ 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 94 No 0 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. I is Yes, state the follOwing: a. Did th~ perso~resentative :file a :final account with the Court? Yes U No ~ b, The separate Orphans' Court No, (if any) for the personal representative's account is: c. Did the pers;~epresentative state an account infOrmally to the parties in interest? Ye~ No 0 c. Copies of receipts, releases,joinders and approval offarmal or informal accounts may be :filed with the Clerk of the Orphans' Court and may be attached to this report - ~- >, -0, ~>H.l.... ~,~ Si ture JI A--r-t. I" D ~ IA J fL.&r. ~ Name 3~f{>G...th (L.. Dq~ 0t f7)(J" Address 7( 7 - '2-12. - I L-J ( Telephone No. Capacity: f5. Personal Representative o Counsel for personal representative C~ .__J REV-1500 Ex (os-D5) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 15056051047 Suffix OFFICIAL USE ONLY County Code Year File Number Decedent's First Name MI Suffix Spouse's First Name ~ s N ~® ~ iJ ~2~z~o~3 ~" 8 7 o T~~~~~ RfG15TER OIF FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Retum O 3. Remainder Return (date of death O 4. Limited Estate O 4a. Future Interest Compromise (date of prior to 12-13-82) O 5. Federal Estate Tax Return Required O 6. Decedent Died Testate O death after 12-12-82) 7. Decedent Maintained a Llvin Trust 9 (Attach Copy of Will) (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes O 9. Litigation Proceeds Received O 10. Spousal Povert Credit d y ( ate of death b O 11. Election to tax under Sec 9113(A) etween 12-31-91 and 1-1-95) . (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INF Name ORMATION SHOULD BE DIRECTED T0: E S E rJ N a E t Daytime Telephone Number ~ ~ ~~~ ? f 7 ~ 3 z 3 9 Finn Name (If Applicable) LS'll NLY ~ `' a First line of address W ~ ~ ,~ ; 5 3 ~ A a P -~ f r~ s ~ C/~ ~ ~ r-r. Second line of address ~, ~ cP, . pQ -- ~ 3 _ ~, :;- ~~ .. e City w Post Office a p c. ~~ ~ State ZIP Code DATE FILEO Q1 E rI o ~ A h l 7 0 ~ Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, InGuding 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 infomration of which preparer has any knowledge_ SIGNATURE of PER9AN rtcaonue~ni~ ~.,., .-.....,. ___ F, DAtlP~in~ SIGNATURE , ,.~rr~ncrt V I TICK i ngrv REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 J ~n1o CA ~R- 17o aS-' 15056052048 ~ - REV-1500 EX Decedent's Name: RECAPITULATION 1. Real estate (Schedule A) ........................................... .. 1. 2. Stocks and Bonds (Schedule B) ..................................... 2. . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. ) 4. Mortgages & Notes Receivable (Schedule D) ........................... 4. I . . 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ..... 5. i .. . 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property O Separate Billing Requested..... ... 7. (Schedule G) 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. .. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ....... . ... 10. 11. Total Deduettons (total Lines 9 & 10) ................................ ... 11. 12. Net Value of Estate (Line S minus Line 11) ........................... 12. o .. . 13. Charitable and Governmental BequestslSec 9113 Trusts for which j 13 an election to tax has not been made (Schedule J) ..................... . ... 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 (a)(1.2) X .0_ 16. Amount of Line 14 taxable 16 at lineal rate X .0 17. Amount of Line 14 taxable 17 at sibling rate X .12 18. Amount of Line 14 taxable 113 at collateral rate X .15 19. TAX DUE ......................................................... 19. Decedent's Social Security Number O 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056052048 15056052048 REV-1500 EX Page 3 ~ ~~ Decedent's Complete Address: File Number DECEDENT'S NAME ~uS h ~No EL STREETADDRESS ----- ----- --__ _! s3 ~_~ Doh ~~i S+ - ~i'7a ~Q ~ STATE~~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments (i) A. Spousal Poverty Credit __ B. Prior Payments -- --- C. Discount -- - 3. InteresUPenalty if applicable Total Credits (A + B + C) (2) D. Interest - E. Penalty -- - - --- -- - 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.~I InteresUPenalty (D + E) (3) Pill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) A. Enter the interest on the tax due. (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) ~ J Make Check Payable to: REGISTER OF WILLS, AGENT ZIP ~.70 Z s -- -._ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a tran f s er and. a. retain the use or income of the property transferred : Yes No ................................................................................... 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 pa ments b fit ....... ,~ y , ene s 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 A t ...... ^ ccoun , annuity, or other non-probate properly 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. O W ~ ~ ~ ¢ a c +~N 0 N C'JOY F- G p_.+~oN7 Vo aN~._~ ~o Vl J W¢ o ~ r LL O i ~'i i i M of M1 ~~~ ~ o, ~~ ° ~$II i ~~ Yi M M ~' I _~ ~ (~ M (~ O ~ ~ to , ~ ~: = ~ o~c ~ o - ~: ~__~ ^_~ ~ o ~ ~ ~, `~ ~:,~ v ~ ~., ~ aA w w ~ rsa ~ o N rte', VVV000 O . 1~ ~ ~ ~. A ~ ~~ ~ '..., ~. _. ..~. +~.. .~; 1~ f'~! ~~ NOTICE OF INHERITANCE TAX p~I1n~y ~~n~t~ BUREAU OF INDIVIDUA j,~~ ~, ~3fMENT, ALL~k~tCE OR DISALLOWANCE DEPARTMENT OF REVENUE INNEttITANCE TAX DIVISIO~` ~''~ ~`'~ DEDUCTIONS AHD ASSESSMENT OF TAX REV-1547 EX AFP C12-o9) PO dOX 250601 ~ ~ ~" •"'~ ~ ~ ~i,~~a r~~..~~v ~..+~ ~~ 1,~ t HARRISEURG PA 17124-0601 ~~,~~ ~~ ~ ~ ~~ ~~y ~~ DATE 06-08-2010 ESTATE OF NOEL RUSH R DATE OF DEATH 07-04-2003 ~.~ ~~ FILE NUMBER 21 04 - 0443 ~~~~ ~'~~ COUNTY CUMBERLAND HELEN NOE!~'~~~...~~~~ ~~., ~A, ACN 101 153 E DAUPHIN ST APPEAL DATE: 08-07-2010 E NOLA PA 17 0 25 (See reverse side under Objections) Amount Remitted ~- MAKE CHECK PAYABLE AND REMIT PAYMENT TOs REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1541 EX AFP ''C12-09) NOTICE OF INHERITANCE TAX APPRAIS~lIENT, ALLOYlANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: NQEL RUSH RFILE N0 .:21 04-0443 ACNs 101 DATE: 06-08-2010 TAX RETURN WAS: CX) ACCEPTE D AS FILED C ) CHANGED APPRAISED YALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate'CSchedule A) C1) •d ~ NOTE:. To ensure proper 2. Stocks and Bonds (Schedule B) C2) .0 0 credit to your account, 0 0 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule . C) C3) of this form with your 4. Mortgages/Notes Receivable (Schedule D) C4) •~ 0 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) •d~ 6. Jointly Owned Property (Schedule F) C6) •~ 0 7. Transfers CS'chedule G) C7) •fl 0 8. Total Aasets C8) .00 APPROV ED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expelnses/Adm. Coats/Misc. Expenses (Schedule H) Cg) 6.000.00 10. Debts/Mortgaige Liabilities/Liens (Schedule I) C10) ._0 0 I1. Total Deductions C11) 6,000.00 12. Net Value of Tax Return C12) 6, Q00 . 00 - 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) _ _~0 ~ 14. Net Value of Estate Subject to Tax C14) ,~, 6,400.00- NOTE: If an asssss~ent was issued previously, reflect ~iyures that include the total ASSESSMENT OF TAB: 15. Amount of Lihe 14 at Spousal rate lb. Amount of Lihe 14 taxable at Lineal/Class A rata 17. Amount of Lime 14 at Sibling rats lines 14, 15 and/or 16, 17, 1a and 19 will of ALL returns assessed to date. 18. Amount of Lime 14 taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: C15) • 00 X C16) _ DO X C1~) _ On x C18) • 00 x 00 ~ .00 045 : . 00 12 ~ .00 15 •00 C19)= • 00 PAYM NT DATE ' RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX PAYM-ENT •00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU NAY SE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~.,,~ M