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HomeMy WebLinkAbout04-0232PETITION FOR PROBATE and GRANT OF LETTERS Estate of' ~r'~c~.? 3( ,~/~Z )c7 No. also known as d To: , Deceased. Social Security No. j c! ~ _ ( ~ Q _ . 3 i ~7 ~ Od- Register of Wills for the County of Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execuU't % in the last will of the above decedent, dated ,~7:/t/ ~l and in the codicil(s) dated named ,19 'Zff (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~ rm ~ e_r [c~ ~c_J. County, Pennsylvania, with h ~_ v- last family or princ,~.al residence at /+ q Oq D~ I )~ r~:. ,-, l< -'~oa eL_ (list street, number and muncipality) Decendent, then, .~ q years of age, died })Q(,~-¢' ~'~ ~3 2~o~ ~ ,~1~ Except as follows, decedent did not marry, was not di4orced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: tNc ,,~ e 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 $ - 0 - situated as follows: WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters. theron. request(s) the probate of the last will and codicil(s) (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEAI~TH OF PENNSYLVANIA COUNTY OF ~c, xx'~ ~-\°-c~ , f 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 the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or af'r~ned and subscribed before me this M~ . day of DECREE OF PROBATE AND GRANT OF LETTERS , Deceased AND NOW ~%~ C'~L~ q C~0ON '1~ , 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 ~ ~ J~ ~ 6- tQ I , I~"/~ described therein_~.be admitted to probate and filed-~f recor~ as-the llst will of and Letters '-]-'E ~f~'¢ ~ ~ ~t D are hereby granted to __ ~_~'~x~.~ ~ ~ '~~ ) L2. FEES Probate, Letters, Etc .......... $ Short Certificates( ) .......... $ ~n ~.'~:cc~ · tO TOTAL $ ~-~,. Filed .~.' .~...'. 9..q- ......................... ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE e codicil ~ ' (ach) a subscribing witness~e will presented herewith, (e~ac~.! being duly qualified acco~ng to law, dep°s~,a~,d say(s) that ~. '% present an~, the testat ,"~.th.e same and th% _ %gned as a witness at the request of testate, i~L~ presence a"~dx(in the presence of each other)~the presence of the °ther subscribing wiTess!es)~ % ~ Sworn to or affirmed and subscribe'lM2efore % me this -~ ___ _ day of '% (Name) , .o'3. ~i!~? 19. ~ :' ~ i~i' ~ (Address) Register (Name) ': ...... (Address) REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS 31- 0'4 -,~. (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that (one of the testat~ of that ~r~ / to the best of w ~/~ knowledge and belief. Sworn to or affirmed and subscribed before me this ~ day of familiar with the signature of ,J~'ci r~ ~C ~/~ g/? , codicil subscribing witnesses to) the will presented herewith and codicil believes the signature on the will is in the handwriting of (Name) (Name) (Address) his 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. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (.. ,. Jean Stricker minzig h. Finale I' 199 -- ~.:'~ 31~ J,. hrc~ 3, 2004 · I I i It Ir. It I ' ~ I~- I~. N- ' ' bt ,,~gove~ent ~ ~-- ~,~, t,,~., ,,~ secretary 4707 Delbrook Road ,t Mechanicsburg, PA 17050 i I I o~c~.,.s PA ,,,.Df ~ ,,,,,~,,,,~ Hampden .... ,r..~ CLraberland "'"~? ,,~O .~'~ Edward C. Stricker Susan Hetrick I,,. Esther Kyle ,~,. 470~lbro~ R~a~~icsburg, PA 17050 ~op s Cemetery I Harrisburg, PA la~c. J2~d. ~ ~ 0 rch 6, 2004 i ~u~~~~,~,~. I;%~%~4~4-L J~%r~c~u%.~%e, Inc., 3125 Walnut St., ~.PA I L- j ~,. '515roll (I~2/)T~P ~ ~ ~ .~ ~-,~-, ~ , LAST WILL AND TESTAMENT OF JEAN S. EINZIG I, JEAN S. EINZIG, of Lower Paxton Township, Dauphin 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 heretofore made by me. FIRST I direct that my body be buried no later than the calendar day following the day of my death and if it be legally permissible I direct that my body be subject to no embalming or similar procedures. In no case shall there be a public viewing of my body, and my funeral shall be private, for my family only. I direct the payment of my debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment, owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using there- for funds from my estate, in such amount as he shall consider necessary and desirable, and I authorize my personal repre- sentative to cause title to or ownership of such lot so pur- chased to be vested in such person as my personal representative shall designate. Further, in this connection, I authori ~_'~i~y pe~rsonal~ representative to expend funds from my estate, in such as my personal representative shall consider necessary desirable, for the purchase, erection and inscription o~. a suitable marker for my grave. ...~ - 1 - SECOND I give, devise, and bequeath all property, real, personal, or mixed, owned by me at my death, together with all insurance policies thereon, unto my husband, FREDERICK A. EINZIG, if he survives me by thirty (30) days, for his use, retention, and disposition as he may desire. THIRD If my husband, FREDERICK A. EINZIG, should fail to survive me by thirty (30) days, I direct that my personal repre- sentative convert all my property, real, personal, and mixed, to cash and distribute the proceeds equally among my three (3) children: SUSAN J. HETRICK, MEGAN L. ABBOTT, and JILL A. LILES. If any of these three children should predecease me, I direct that any share which would have gone to her had she been living be distributed among her lineal descendants per stirpes. FOURTH I direct that any and all Inheritance, Estate, and Transfer Taxes imposed upon my estate passing under my will or otherwise, shall be paid out of my estate. FIFTH In addition to the powers conferred by law, I auth- orize my personal representative in his or her absolute discretion: (a) To compromise claims without court approval, and without the consent of any beneficiary. (b) To join with my husband, FREDERICK A. EINZIG, or his personal representative in the filing of any income tax re- turns for any year for which I have not filed such return prior - 2 - to my death, and to consent to the treatment of any gifts made by him as being made one-half (1/2) by me for gift tax purposes notwithstanding the fact that any such action may result in additional liability for my estate. Any income or gift taxes due on such returns and any deficiencies, interest, penalties, or refunds thereon, shall be allocated between my estate and my said husband or his estate, or all to any of them, in such manner as my personal representative and my said husband or his personal representative may agree. SIXTH I nominate, constitute, and appoint my husband, FREDERICK A. EINZIG, Executor of this my last will and testa- ment. In the event of the renunciation, death, resignation, or inability to act for any reason whatsoever of my said husband, I nominate, constitute, and appoint my daughter, SUSAN J. HETRICK, Executrix of this my last will and testament. I hereby relieve my personal representative from the necessity of posting security in connection with his duties as such in any jurisdiction in which he may be called upon to act insofar as I am able to do so by law. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my last will and testament, consisting of three (3) typewritten pages, the first two (2) of which bear my signature in the margin for the purpose of identification this ~/~ day of / ' 1975 - 3 - Signed, sealed, published and declared by the above named Testatrix, JEAN S. EINZIG, as and for her last will and testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~~/ Address - 4 - CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Jean S. Einzig Date of Death: March 3, 2004 Will No. 04-00232 Admin. No. To the Register: I certify that notice of beneficial interest required by Rule 5.7(a) of the Orphans' Court Rules was served on or mailed to the following Beneficiaries of the above-captioned estate on March 10, 2004. Name: Megan L. Abbott Jill A. Liles Susan E. Hetrick Address: 1884 Richmond Avenue, Bethlehem, PA 18018 32 Sallianne Drive, Halifax, PA 17032 4707 Delbrook Road, Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except N/A Date: May 25, 2004 J. Stephen Feinour, Esquire Nauman, Smith, Shissler & Hall, LLP Supreme Court I.D. No. 24580 200 N. 3ra Street, 18th Floor P. O. Box 840 Harrisburg PA 17108-0840 Capacity: Personal Representative X Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPAR'~,~ENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICAL USE ONLY Z ILl Z DECEDENTS NAME (LAST, FIRST. AND MIDDLE INITIAL) Einzig Jean DATE OF DEAl3-{ (MM-DO-YEAR) DATE OF BIRTH (MM-DD-YEAR) 3/3/2004 1/3/1920 IF APPLICABLE) SURVIVING SPOUSE~ NAME (LAST, FIRST, AND MIDDLE INITIAL) 00232 ] 1. Original Ratum 1~]2. Supplemental Retum NUMBER FILE NUMBER 21 -- 04 SOCIAL SECURITY NUMBER S 199-07-3176 THIS RETU~ MUET BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [~] 3. Remainder Ratum (date of death pdor to 12-13-82) --]4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [~ 5. Federal Estate Tax Ratum Required ~ 6. Decedent Died Testate (Attach copy of 'A~II) ~ 7, Decedent Maintained a Living Trust (Attach copy of Trust) 0__ 8. Total Number of Safe Deposit Boxes [~ 9, Litigation Proceeds Recei,.~d [~] 10. Spousal Povedy Credit (d.,e of death b ...... 12-31-el ..~ 1-1-S~) [] I 1, Election to tax under Sec. 9113(A)(Attach Sch Oi THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS P. O. Box 840 J. Stephen Feinour, Esquire FIRM NAME (If Appli~ble) Nauman, Smith, Shissler & Hall, LLP Harrisburg, PA 17108-0840 $0.0 ~_~.) $50,460.0~ 8o. 80.4 859,024.~ OFFICIAL USE ONLY ! (5) $109,484.74 $0.00 $7,611.45 $6,348.00 $13,959.45 $95,525.29 80.00 (11) (12) ~LEPHONE NUMBER 717-236-3010 (13) $95,525.29 1. Reel Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sofe-Propriatorship (3) 4. Mortgages & Nofes Receivoble (Schedule D) (4) 5, Cash. Bank Deposits & Misc~laneeus Personal Property (Schedule E) (5) 6. Jointly Owr~ed Propelty (Schedule F) (5) [~ Separate Billing Requested 7,Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G o,- L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Scheduie l) (10) 11. Total DeducBons (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 13. Charitable and Governmental Bequests/Sec 9113 Trusts f~ which an election to tax has nat been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9116 (a)( 1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at coitateral rate 19. Tax Due $0.00 $4,298.64 $o.oo 80.00 $4,298.64 (14) 80. 00 x.0 0 (15) 895,525.29 x.0 45 (16) 80. 00 x.12 (17) 80. O0 x.15 (18) (19) > > BE SURE TO ANSWER ALL QuEsTiONS ON REVERSE SIDE AND RECHECK MATH < < 3W4f1451000 Dec,dent's Complete Address: Messiah Village, 100 Mount Allen Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A Spousal Poverty Credit B. Prior Payments C. Discount $0.00 $4f373.00 $218.65 3. Interest/Penalty if applicable D. Interest $0.00 E. Penalty $0.00 (1) Total Credits (A + B + C) (2) Total Interest/PenaEy (D + E) (3) $4,298.64 $4,591.65 $0.o0 $293.01 $o.0o 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) Enter the interest on the tax due. (SA) $0.00 B. Enter the total of Line 5 + 5A. Tnis is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (5B). $0.00 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 edher 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 $CH~nU~ E G AND FILE T AS PART OF THE RETURN SlC~A'rI.~E OF PERSON RESPONSIBLE FOR FILING RE33JRN Susan E. Hetrick 4707 Delbrook Road J. Stephen Feinour, Esquire P. O. Box 840 Me~h~ic sburg, PA 17050 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the nat value of transfers to or for the use of the surviving spouse is 3% [72 P.S § 9916 (a} (1 ,f) (i)]. For dates of death on o after January 1, 1995, the tax rate imposed on the net vatue of transfers to or for the use of the surd~ing spouse is 0% [72 P.S. § 9116 (a) (1.1) (ii)J The statute does not exempt a transfer to a surviving spouse from tax, and the statutory ragui~ments for disclosure of assats and filing a tax return are still applicable even if the surviving spouse is the only beneficiary, For dates of death on or after July 1,2000: The tax rate im posed on t he net value of transfers from a deceased child t¥~enty-o~e years of age or y~unger at death to or for the use of a natural parent, an ad opti,~ parent, or a steppamnt of the child is 0% [72 P.S. § 9116(a)(1.2)]. The tax rate imposed on the nat vstue of transfers to or for the use of the decedent's lineal benefidabes 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 nat vsfue 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 v,~th the decedent, whather by blood or adoption 3W4646 1.000 COMMONWEALTH OF PENNSYLVANIA INHERrTANCE T~X RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Jean S Einzig 00232 All property jointly-owned with right of survivorship must be disclosed on Schedule F. I'I~M VALUE AT DATE NUMBER DESCRIFq]ON OF DEATH FRMA Bond held by Jean S. Einzig Revocable Trust with Waypoint Bank, Acct. #20001101029 CUSIP= 31359MES8 $50,460.05 TOTAL (Also enter on line 2, Recapitulation) 3w4696 ~ ooo (If more space is needed, insert additional sheets of the same size) COMMONWEAL~t OF PENNSYLVANIA INHBRITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Jean S Einzi~ 00232 Include the proceeds of litigation and the date the proceeds w~re received by the estate. All property JolntJy.~wned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTrON OF DEATH 7 8 9 10 11 Checking Account with Wa~r~oint Bank, Acct. #200007928 Checking Account with Weypoint Bank, Acct. #100630284 Checking Account with WayLooint Bank, Acct. #203003007 Final retirement benefits due from PA State Employees' Retirement System Lehigh Cooperative close-Out Proceeds from MetLife life insurance policy, policy #560121528M Miscellaneous payment from MetLife Miscellaneous personal items Pre-Paid funeral contract with Hetrick Funeral Home Retirement Account with Way~oint Bank, Acct. #123004434 SEI Prime Money Market held by Jean S. Einsig Revocable Trust with Waypoint Bank, Acct. #20001101029 CUSIP= 78392630P $960.78 $6,928.65 $4,343.69 $72.28 $51.22 $3,038.21 $11.50 $100.00 $4,093.00 $2,349.70 $37,075.66 TOTAL (Also enter on line 5, Recapitulation) $ $ 5 9,0 2 4.6 9 3W46AD 1 Do0 (If more space is needed, insed additional sheets of the same size) REV-1511 EX + (12-99) COMMONW~_AL'~'I OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEE~NT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Jean S Einzig 00232 Deb~ ofdecedentmustbe mpodedonSchedulel. NUMBER DESCRIPTION AMOUNT A. 1. 2 5. 6. 3. FUNERAL EXPENSES: Brachendorf Memorials Hetrick Funeral Home ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State __ Zip_ Year(s) Commission Paid: Attorney Fees Family Exemption: (if decedent's address is not the same as claimant's, attach explanetion) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Publishing of Estate Notice H&R Block Preparation of 2003 tax return Total from continuation pages $295.00 $4,712.52 $2,000.00 $46.00 $75.00 $234.00 $248.93 TOTAL (Also enter on line 9, Recapitulation) $ $7,611.4 r, 3W46AG 1 000 (If more space is needed, inse~t additional sheets of the same size) Schedule H part 2 (Page 2) Estate of= Jean S Einzig Item NO. Description Amount 4 Susan E. Hetrick, Executrix Reimbursement of expenses incurred in administration of Estate The Patriot-News Co. Publication of Estate Notice $76.66 $172.27 Total (Carr~ forward to main schedule) $248.93 REV-1512 EX+ (6-98) COMMCNWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN F~SI DENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Jean S E1nzig 00232 Include unreimbursed medical expenses. VALUE AT DATE NUMBER DESCRIPTION OF DEATH Internists of Central PA Messiah Village Paul D. Dalbey, DPM $60.36 $6,248.00 $39.64 TOTAL (Also enter on line 10, Recapitulation) $ $6,348. SW46AH 1000 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMOr-NVBALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Jean S Einzig 00232 NUMBER NAME AND ADDRESS OF PERSON(~ ~CEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright s~usel distri~tions, and transfer under Sec. 9116 (a) (1.2)] Megan L. Abbott 1884 Richmond Avenue Bethlehem, PA 18018 33.333333% Residue= $31,841.76 Susan E. Hetrick 4?0? Delhrook Road Mechanicsburg, PA 17050 RELATIONSHIP TO DECEDENT DO Not List Trustee(s) Daughter AMOUNTORSHARE $31,841.76 33.333333% Residue= $31,8%1.76 Daughter $31,841.76 Total from continuation pages $31,841.76 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 B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART Il - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 3W46AI 1.000 (If more space is needed, insert additional sheets of the same size) Schedule J part i (Page 2) Estate of= Jean S Einzig Item No. Description Relation Jill A. Liles 32 Sallianne Drive Halifax, PA 17032 33.333333% Residue= $31,841.76 Daughter $31,841.76 Total (Carr~ forward to main schedule) $31,841.76 Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Jean S. Einzig also known as No. 21-04-00232 Date of Death: March 3, 2004 Deceased Social Security No.: 199-07-3176 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situzte and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory am true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa.C.S. {}4904 relating to unsworn falsification to authorities. Name of Attorney: J. Stephen Feinour, Esquire LD. No.: 84906 Address: 200 N. 3rd Street, 18th Floor P. O. Box 840 Han-isburg PA 17108-0840 Personal Representative: Susan E. Hetrick, Executrix Dated: July 22, 2004 Telephone: (717) 236-3010 Description FNMA Bond Checking accounts with Waypoint Bank (3) Retirement Benefit Lehigh Cooperative Met-Life Pa)anent Misc. Personal Items Retirement Account with Waypoint Bank SEI Money Market Account Life Insurance Proceeds $50,460.05 $12,233.12 $72.28 $51.22 $11.50 $100.00 o C: $2,349.70 er ~,' $37,~)"75.66 ~ : , 21 (Attach Additional Sheets if necessary) Total: $105,391.74 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARR/SBURG, PA 17128-0601 J STEPHEN ~][TNOUR ~SO NAUHAN ETA~ PO BOX 8qO~ HBG ? "~ 17108 CUT ALONG THIS LINE COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX DATE 09-27-200q ESTATE OF EINZIG DATE OF DEATH O$-O$-ZOOq FILE NUNBER 210~-OZSZ COUNTY CUHBERLAND ACN 101 Amoun'~ Re.i~:'ked REV-15~? EX AFP [01-~$) JEAN S HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF EINZTG JEAN S FILE NO. 21 Oq-OZ3Z ACN 101 DATE 09-Z7-200~ TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (l) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held S~ock/Partnership Zn~eres~ (Schedule C) ($) q. Nortgages/No~es Receivable (Schedule D) 5. Cash/Bank Deposi~s/Nisc. Personal Proper~y (Schedule E) ($) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G} (7) 8. Total Assets APPROVED DEDUCTIONS AND EXENPTIONS: 9. Funeral Expenses/Ada. Costs/Nisc. Expenses (Schedule H) (9). 10. Deb~s/Nortgage Liabilities/Liens (Schedule I) (10) 11. To,al Deductions 12. Nat Value of Tax Re~urn 0O 50~60.05 O0 O0 59;02q.69 O0 O0 (8) 7,611.~5 NOTE: To insure proper credit to your account, subei~ ~he upper portion of ~his fore wi~h your ~ax payment. 15. 1~. NOTE: ASSESSNENT OF TAX: 15. Aeoun~: of Line 1~ a~ Spousal rata 16. Amount of Line 1~ ~axable a~ Lineal/Class A rata 17. Amount of Line lq at Sibling ra~e 18. Amount of Line lq taxable at Colle~ceral/Class B ra*e ~al Tax Due 19. Princi TAX CREDITS PAYMENT DATE 05-28-200~ 109,q8q.7q 6.5q8.00 (11) 13.959.q5 (12) 95,525.29 Charitable/Governmental Beques)cs; Non-elected 9115 Trusts (Schedule J) (15) . O0 Ne~ Value of Estate Sub~ect to Tax (lq) 95,525.29 If an assessment was issued previously, 11nas 1~, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. RECEIPT NUMBER CD005990 DISCOUNT INTEREST/PEN PAID (-) 21q.95 (151 .00 X O0 : .00 (161 95,525.29 X Oq5 = q,Z98.6q (17). . O0 x 12 = . O0 (la), .00 x 15 : .00 (l~)= q,Z98.6q AHOUNT PAID q,$75.00 q,587.95 Z89.Z9CR .00 Z89.Z9CR TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ( IF TOTAL DUE TS LESS THAN $1, NO PAYMENT ZS REQUIRED. IF TOTAL DUE ~S REFLECTED AS A 'CRED/T' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) IF PA/D AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. RESERVATION: Estates of decedents dying on or before December 12, lgBZ -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Comeonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the taaful Class B (collateral) rate on any such future interest. PURPOSE OF NOT[CE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the top portion of this Not[ce and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, ahich was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania [nheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-B00-362-2050; services for taxpayers with special hearing and ! or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance 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: --aritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-ISOI) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent"s death~ a five percent (5Z) discount of the tax paid is alIowad. 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 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 (l) 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 (6Z) percent per annum calculated at a daily rate of .000164. All taxes ehich became delinquent on and after January 1, 1982 will bear interest at · 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 Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 202 .000548 ~J~'~-1991 XlX .000301 ~ 9Z .000247 1983 16X .000438 1992 92 .000247 2002 62 .000164 1984 llZ .000301 1993-1994 72 .000192 2003 52 .000137 19B5 13Z .000356 1995-1998 92 .000247 2004 42 .000110 1986 10Z .000274 1999 7Z .000192 1987 10Z .000274 ZOO0 72 .000192 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINgUBNT X DATL¥ 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 Name of Decedent: Jean S. Einzig Date of Death: March 3, 2004 Will No.: 21-04-0232 Admin. 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 X No. 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: __ 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: interest? Co Did the personal representative state an account informally to the parties in Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal O ~ ' accounts may be filed with the clerk of the rphans Court apda,may b~attached to th~s report. Date: Decemb er 8, 2004 /-"~-~(~~L~'- ( Ctepl~en Feinour, Esquire "--~Nauman, Smith, Shissler & Hall, LLP P. O. Box 840 200 N. 3ra Street, 18th Floor Harrisburg PA 17108-0840 Capacity: ~ Personal Representative X Counsel for Personal Representative IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: : ESTATE OF JEAN S. EINZIG : Deceased : NO. 21-04-00232 RECEIPT AND REI,EASE KNOW ALL MEN BY THESE PRESENTS that I, SUSAN E. HETRICK, hereby acknowledge that I have received of and from Susan E. Hetrick, Executrix of the Estate of Jean S. Einzig, deceased, the sum of Eleven Thousand One Hundred Seven Dollars and 17/100 ($11,107.17) as the final distribution of my distributive share of the residuary estate of the Decedent as an heir under the THIRD paragraph of the Last Will and Testament of Jean S. Einzig, deceased, in accordance with said Will dated July 21, 1975. AND I agree to refund to the said Estate any amount which may be necessary in the future to discharge any future liabilities to creditors which may arise, in particular but not limited to, any Federal fiduciary or personal income tax liability, Pennsylvania inheritance, fiduciary or personal income tax liability, or reports filed which have not been accepted by the Internal Revenue Service or the Pennsylvania Department of Revenue, respectively. AND, THEREFORE, I do by these presents remise, release, quitclaim, and forever discharge the said Executrix as Fiduciary, as well as her successors and assigns, of and from any and all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any other act, matter, cause or thing whatsoever relating to the distribution which I have had, now have, or might in the future have. IN WITNESS WHEREOF, I have hereunto set my hand and seal this e~////~ day of · /"/~/;7.5~[,°''' ., 2004. WITNE S S: Susan E. Hetrick Notaflal Seal Chrisline L. Swariz, Notary Public Lower Paxton Twp., Dauphin County ~ Con~ission Expires Mar. 31, 2007 Metal)er, Pennsylvania Association Of Notades IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: : ESTATE OF JEAN S. EINZIG : Deceased : NO. 21-04-00232 RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS that I, MEGAN L. ABBOTT, hereby acknowledge that I have received of and from Susan E. Hetrick, Executrix of the Estate of Jean S. Einzig, deceased, the sum of Eleven Thousand One Hundred Seven Dollars and 20/100 ($11,107.20) as the final distribution of my distributive share of the residuary estate of the Decedent as an heir under the THIRD paragraph of the Last Will and Testament of Jean S. Einzig, deceased, in accordance with said Will dated July 21, 1975. AND I agree to refund to the said Estate any amount which may be necessary in the future to discharge any future liabilities to creditors which may arise, in particular but not limited to, any Federal fiduciary or personal income tax liability, Pennsylvania inheritance, fiduciary or personal income tax liability, or reports filed which have not been accepted by the Internal Revenue Service or the Pennsylvania Depa~-tment of Revenue, respectively. AND, THEREFORE, I do by these presents remise, release, quitclaim, and forever discharge the said Executrix as Fiduciary, as well as her successors and assigns, of and from any and all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any other act, matter, cause or thing whatsoever relating to the distribution which I have had, now have, or might in the future have. IN WITNESS WHEREOF, I have hereunto set my hand and seal this fi.c[ day of ~ ~ ~ ,2004. WITNE S S: Notarial Seal Melonie A. Stone, Notary Public City of Bethlehem, Northampton County My Commission Expires Mar. 7, 2006 Member, Pennsylvania Association of Notaries Me al~egai~. A~~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: ESTATE OF JEAN S. EINZIG Deceased : NO. 21-04-00232 : RECEIPT AND REI,EASE KNOW ALL MEN BY THESE PRESENTS that I, JILL A. LILES, hereby acknowledge that I have received of and fi.om Susan E. Hetrick, Executrix of the Estate of Jean S. Einzig, deceased, the sum of Eleven Thousand One Hundred Seven Dollars and 20/100 ($11,107.20) as the final distribution of my distributive share of the residuary estate of the Decedent as an heir under the THIRD paragraph o£ the Last Will and Testament of Jean S. Einzig, deceased, in accordance with said Will dated July 21, 1975. AND I agree to refund to the said Estate any amount which may be necessa~ in the future to discharge any ~ture liabilities to creditors which may arise, in particular but not limited to, any Federal fiduciary or personal income tax liability, Pennsylvania inheritance, fiduciary or personal income tax liability~ or reports ~led which have not been accepted by the Internal Revenue Service or the Pennsylvania Department of Revenue, respectively. AND, THEREFORE, I do by these presents remise, release, quitclaim, and forever discharge the said Executrix as Fiduciary, as well as her successors and assigns, of and fi.om any and all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any other act, matter, cause or thing whatsoever relating to the distribution which I have had, now have, or might in the furore have. IN WITNESS WHEREOF, I have hereunto set my hand and seal this &{Id day of : ~.~)F'('~:~¥~., 2004. Jill ~[Liles Notar~ Seal Tomieaon L~ylon, Nola~ Public Cily Of Harrisburg, Dauphin Counly My Commission Expires June 24, 2006 Member, Pennsylvania Ass~cial~:m Of Nolaries BUREAU OF INDIVIDUAL TAXES /NHERTTANCE TAX DTVTSZON DEPT. Z80601 HARRISBURG., PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE 'TAX STATEHENT OF ACCOUNT R£V-1607 EX AFP C01-0S) J STEPHEN FEINOUR ESQ NAUMAN ETAL PO BOX 840 HBG PA 17108 DATE 11-01-2004 ESTATE OF EINZIG DATE OF DEATH 05-05-2004 FILE NUMBER 21 04-0252 COUNTY CUt~EI~.LAND ACN 10~% ~ JEAN Amou~ Remi~:~ced HAKE CHECK PAYABLE AND RF~IZT PAYMENT TO: REGISTER OF WILLS ~!: CUMBERLAND CO COURT..HOUSE CARLISLE, PA 17015~:~ NOTE: To insure proper credi~ ~o your account, submA~ ~he upper portion of ~his form frith your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~ ESTATE OF EINZIG JEAN S FILE NO. 21 04-0252 ACN 101 DATE 11-01-2004 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELO# IS A SUHHARY OF THE PRINCIPAL TAX DUE., APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND.. IF APPLICABLE., A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 09-20-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 4,298.64 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 05-28-2004 10-15-2004 CD005990 REFUND 214.95 .00 289.29- IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CRED'rT 4,298.64 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. 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 NTLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANTA. 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" (RE¥-I~13). Applications are available at the Office of the Register of Nills, any of the Z3 Revenue District Offices or from the Department's ZB-hour answering service for fores ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-667-30Z0 (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. 28060l, Harrisburg, PA lTlZB-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Z) discount of the tax paid is allowed. PENALTY: The lSZ 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 frae the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000166. All taxes which became delinquent on and after January l, 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 Z006 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year__ Rate Factor 1982 ZOZ .O0056B 1988-199! 112 .000301 ZOO1 9X .O00267 1983 16~ .000638 199Z 92 .000247 ZOO2 6Z .000164 1986 llX .000301 1993-1996 72 .000192 ZOO3 5Z .000137 1985 13X .000356 1995-1998 9Z .O00Zq7 ZOO6 qg .000110 1986 lOX .000Z76 1999 7Z .00019Z 1987 9Z .O00Z~7 ZOO0 8Z .OOOZX9 --Interest is calculated as follows: 'rNTEREST = BALANCE OF TAX UNPATD X NUMBER OF DAYS DEL'rN~UENT X DA/L¥ /NTEREST 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. NOT~G-f- OF INHERITANCE TAX Pennsylvania ~_ ' BUREAU OF INDIVIDUAL TAXES ~ APPRAISEM'EN-T^' ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE ~; INHERITANCE TAX DIVISION OF DEDU.C.T~"ONS AND ASSESSMENT OF TAX REY-1547 EX AFP (12-10) PO BOX 280601 HARRISBURG PA 17128-0601 ` DATE 05-16-2011 ESTATE OF WOOLUMS JEPTHA B ~_ ~ DATE OF DEATH 02-29-2004 FILE NUMBER 21 04-0235 C.: COUNTY CUMBERLAND ROBERT G FREY ACN 101 5 S HANOVER ST APPEAL DATE: 07-15-2011 CARLISLE PA 17013 (See reverse side under Objections) Amount Remitted C MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~) RETAIN LOWER PORTION FOR YOUR RECORDS !-- ------------------------------------------------------------------------------------------- REV-1547 EX AFP C12-10~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: WOOLUMS JEPTHA BFILE N0.:21 04-0235 ACN: 101 DATE: 05-16-2011 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1. Real Estate (Schedule A) (1) 5,550.00 NOTE: To ensure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3 )• 00 submit the upper portion of this form with your 4. Mortgages/Notes Receivable (Schedule D) C4) •00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5} .00 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 5,550.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (q) 2,5 78.0 0 10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) DO 11. Total Deductions (11) 2,578.00 12. Net Value of Tax Return (12) 2,972.00 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 1,143,344.00 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) .00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 1 .143.344.00 x 045 = 51,450.48 17. Amount of Line 14 at Sibling rate C17) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 - .0 0 19. Principal Tax Due (19)= 51,450.48 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 05-25-2004 (0003975 2,572.52 49,122.00 03-15-2005 REFUND .00 3;~1.10- 03-02-2011 (0014068 45.15- 183.09 TOTAL TAX PAYMENT 51,461.36 BALANCE OF TAX DUE 10.88CR INTEREST AND PEN. .00 TOTAL DUE 10.88CR + IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. „~.