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Home My WebLink About00-074715056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Coun Code Year File Number Bureau of Individual Taxes ry Po Box 2aosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 00 0747 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 3~,3'i~~ ~~ s° 181-34-4874 08/27/2000 ~s/~ 1 /1 a2r 0~~ Decedent's Last Name Suffix Decedent's First Name MI Bloser Mrs Mary p (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~~: 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST B E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Diane M. Dils, Esquire (717) 233-873 ~; Firm Name (If Applicable) ~ -, .. C.: REGISTER~F~LLS USE ~LY r - Dils & Dils Law Office ;~ p -, _zc~ r-- First line of address _ ~ ~~" r'~ ,.., - -ri ,t-' 1400 North Second Street ~~:f,--~~--; , ~ _, ; - ~ Second line of address ~. ~ C "" 7;J First Floor Front v -~ City or Post Office DATE FILED ~ ............ Harrisburg '~A „ ,~~ Correspondent's a-mail address: dIdIIS@VerIZOn.net PLEASE Side 1 15056051058 15056051058 Creek Valley Road, Harrisburg, PA 1711~d 'Z Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of oreoarer other than the oersnnal renraaantativo is haccri nn ~u ~.,r„~..,~f~..,, ..a ,.,~,~..~ .............. ~.,.., __.. ~.__...,_~__ ,~~r ~, -~, J~+~rs} ~- ~~,~~. Pennsylvania BUREAU OF INDIVIDUAL TAXES -~~ ~ I N~IE~I TANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION '- f 1 ~~ Po Box 280601 ` '- ° ~' ~'T~TE~M`E'NT OF ACCOUNT REV-1607 EX AFP clz-o9~ HARRISBURG PA 17128-0601 ~~L~i"t~ ~(" O ~ 1Ftfi ~} }~T DIANE M DILS ESQ C,=i.,4~`v~',~~;?~._~4,i~'r 4~.E,,,~.. P~. DILS B DILS LW OFCS 1400 N 2ND ST 1ST FL HARRISBURG PA 17102 DATE ESTATE OF DATE OF DEA FILE NUMBER COUNTY ACN 04-12-2010 BLOSER MARY p TH 08-27-2000 21 00-0747 CUMBERLAND 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-1607 EX AFP C12-09~ **~ INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF:BLOSER MARY P FILE NO.: 21 00-0747 ACN: 101 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMAR,YTOF H E P INCI~ AFL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-16-2010 PRINCIPAL TAX DUE: 17,000.84 PAYMENTS CTAX CREDITS: PAYMENT DATE RECEIPT DISCOUNT C+) NUMBER INTEREST/PEN PAID C-~ 11-22-2000 AA451488 578.95 03-05-2002 CD000918 08-04-2009 CD011575 .00 03-19-2010 CD012503 320.83- 122.22_ AMOUNT PAID 11,000.00 5,207.58 535.14 122.22 TOTAL TAX PAYMENT 17,000.84 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE ' I 00 * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~1 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 payment is for a resident decedent, make check or money order payable to: Register of Wills, Agent If payment is for a non-resident decedent, make check or money order payable to: Commonwealth of Pennsylvania Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from department's web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 CTT only). REPLY TO: Questions regarding errors should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call C717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 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 months and one day from the date of death, to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan. 1, 1982, will bear interest at a rate which varies from Year to Year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet CREV-1501), the Pennsylvania Non-resident Instruction Booklet CREV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 20D0 through 2010 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~,_ .~. 200D 8% .000219 2001 9% .000247 2002 6% .000164 2003 5% .000137 2004 4% .000110 2005 5% .000137 2006 7% .000192 2007 8% .000219 2008 7% .000192 2009 5% .000137 2010 4% .000110 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Anv notice issued after the tax becomes delinquent will reflect an interest calculation to 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. 15056052059 REV-1500 EX Decedent's Social Security Number Mary P Bloser 181-34-4874 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 8 Notes Receivable (Schedule D) .......................... ... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 6. Jointly Owned Property (Schedule F) `Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ;: . Separate Billing Requested..... ... 7. 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 Deductions (total Lines 9 ~ 10) ................................ ... 11. 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APP ~ ~ ~~~~ LICABLE RATES _ d ~~ ~ ~~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 200.00 16. Amount of Line 14 taxable at lineal rate x .0 45 16. 17. Amount of Line 14 taxable at sibling rate X .12 17, 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE .........................................................19 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 200.00 11, 892.07 11,892.07 535.14 535!t1 ~~ 5,3~ / y 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 00 '0747 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Mary P Bloser 181-34-4874 STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total InterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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) 535.14 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 535.14 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? .................................................................................................................. ...... ^ Q~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [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. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ (6-9g) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Mary Patricia Bloser Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-ownad with ~i~ti, „r e,,..,:,,,....~:_ _.._. ~_ ,._ _, _ . FILE NUMBER 2100-0747 REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Patricia Bloser ITEM NUMBER A FUNERAL EXPENSES: ~. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 2100-0747 Debts of decedent must be reported on Schedule I. DESCRIPTION AM e. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Donald Paul Bloser, Jr. Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees Diane M. Dils, Esquire 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant s Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9 Recapitulation) I $ (It more space is needed, Insert additional sheets of the same size) 200.00 200.00 REV'-1513 EX+-(11-U8) ~~ ~ s Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Mary Patricia Bloser FILE NUMBER 2100-0747 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Do Not List Trustee(s) OF ESTATE Sec. 9116 (a) (1.2).] 1. Donald Paul Bloser, Jr., 2260 Fishing Creek Valley Road, Son 25% Harrisburg, PA 17112 2 Irene Marie Musser P.O Box 827 , . Daughter 25% Opelika, AL 36803-0827 3 Richard Leon Bloser, 3248 Greenmore Court Son 25% Colorado Springs, Colorado 80920 4 Patricia Ann Liddick, 1645 Pisgah Road Daughter 25% Landisburg, PA 17040 II 1. 1 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF RE'J-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 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. $ ~~ ~ ~~ ATTORNEYS AT LAW ARTHUR K. DILS DIANE M. DILS 1400 NORTH SECOND STREET (FIRST FLOOR FRONT) HARRISBURG, PENNSYLVANIA 17102 PHONE: (717) 233-8743 FAX: (717)233-2567 August 13, 2009 Register of Wills of Cumberland County Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of Mary P. Bloser Dear Sir or Madam: Enclosed herewith is an original and two (2) copies of an Supplemental Inheritance Tax Return to be filed in your office along with a check made payable to you in the amount of $535.14 representing the additional Inheritance Tax owed in this matter. Also enclosed is aself-addressed, stamped envelope to send me a copy of the clocked-in Return after filing of the same. We had previously sent these documents to your office on August 4, 2009, (see attached) however they were then somehow forwarded from your office to the PA Department of Revenue. I apologize for any delay this error may have caused our office. Thank you for your assistance in this matter. Very truly yours, Diane M. Dils c_a C c-, O `` `~ ~ ~, '_!wTC7 -.J'r~ rn -'C;r ~. ~' Ty - .11 .~~. :~' N G3 DMD/dmh Enclosures ~~~~~ ~~~pennsylvania DEPARTMENT OF REVENUE August 11, 2009 Dear Sirs: ~! ~ ; i~__ ~4~ ~~ ~~ ~,~~ Enclosed please find aREV-1500 that was sent to this office in error. The return must be filed in duplicate and taxes paid to the Register of Will's Office of the county the decedent was a resident. Please contact the Inheritance Tax Division at 717-787-8327 with any questions. Sincerely, Inheritance Tax Division Bureau of Individual Taxes Pennsylvania Department of Revenue Enclosure(s) ~7 C ..Q .- ~ ~ ~. m - ~~ , .r~ 1 ,\ l~_ -~ ~ ' N G7 _..._ . _ . Department of Revenue ~ PO Box 280601 ~ Harrisburg, PA 17128 ~ 717.787.8327 ~ www.revenue.state.pa.us _ ~. ., ,. ; ~ I~ v:. f ,. . ,.,- t;< ~~ ~r'. n ~ ~ Y., .~~..+ L ~j U ~ o ~ ~ ~, ~ ~ o U a '-' 3 -~~¢ o ~ ~a L ~, o ~ a~ ~ ~ ~ ~ U ~ o ~ ~ ~ ~,000U y' N +--~ ~ O 'O ~ C ~ ~ ~ Q V] p G-. s. -- ~ Li. ~ Lz, ~ O ~ oz o~ ~~~ <~ ~: r ' 1`# // ~ ~^ d /~i'~ ~ ~s~~ s~ «,_.,. ~ ~ ~~~- . f~ ~ i J~ ~ 4 y t J1~~~4/I J i^ ~_ d ~~ ~~~I a ~ ,# ~~~ ~ t ,~ ..~ ,~Y i, i' t /. ~ ~ ~ 3 ,~ ,. ~{ ~ ; ~ { ~ ~E~ ~~~( ~{ R S E ~ ~ i~ f7 ~ ~ ~f ~. ~`°~ _ _~v, .~ ~ ~ 1 ~r .~. ~r ~. ~ r t j g{g _«,. ~ ! `} ~. o v s .~ L ~ ~ o a~ (~ U ~ O ~ ~ M ~ ~ O '_ O ~ ~ 3 U p c,.. ~ s Q ~ «S ~ O, ~ >, ~ O N ~ ~ .O (~ `n b4 ~ ~ ~ ~;, ~ U U O U ~, N N O ' ~ ~ ~ ~ ~ ~ N p G. r- f~ ~ fs, ~ ^ Z L ~ O p ~ r rJO [~.,~~ ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BLOSER DONALD PAUL JR 2260 FISHING CREEK VALLEY ROAD HARRISBURG, PA 17112 fold ESTATE INFORMATION: ssN: i ss-34-4874 FILE NUMBER: 2100-0747 DECEDENT NAME: BLOSER PATRICIA DATE OF PAYMENT: 08/06/2009 POSTMARK DATE: 08/04/2009 couNTY: CUMBERLAND DATE OF DEATH: 08/27/2000 REV-1162 EX111-961 NO. CD 01 1575 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 5535.14 TOTAL AMOUNT PAID: REMARKS: RECEIPT MAILED TO ATTY CHECK# 4865 SEAL INITIALS: JN RECEIVED BY: 5535.14 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~~ ~ ~~ ATTORNEYS AT LAW 1400 NORTH SECOND STREET (FIRST FLOOR FRONT) HARRISBURG, PENNSYLVANIA 17102 ARTHUR K. DILS PHONE: (717) 233-8743 DIANE M. DILS FAX: (717) 233-2567 August 4, 2009 .~ Register of Wills of Cumberland County ~ o ~_ - - Cumberland County Courthouse '' -'~-'. c.? ~~ - One Courthouse Square ~ ~ `-_~~ ~ -~; , Carlisle, PA 17013 ~' ~ -~ ~ ~ -~ _ .C;-„ -:r= _ . ~, w ~~ RE: Estate of Mary P. Bloser =n _~ ..... Dear Sir or Madam: Enclosed herewith is an original and two (2) copies of an Supplemental Inheritance Tax Return to be filed in your office along with a check made payable to you in the amount of $535.14 representing the additional Inheritance Tax owed in this matter. Also enclosed is aself-addressed, stamped envelope to send me a copy of the clocked-in Return after filing of the same. Thank you for your assistance in this matter. DMD/dmh Enclosures COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NL TAXES AXD V S r't"~,-~~nr~ ~ ~1H~RITANCE TAX ~ '~•°tJ L°s..;-~ t ~'~-~~ ENT OF ACCOUNT INHERITANCE T DI I I ~ ~,~ Po Box zao6ol }~~ ~ r r , '; ' t HARRISBURG PA 17128-0601 , '"'' - ~ ~~~-~-'~' i 2009 SEP 18 r'M f2.4 7 C~E~~ QF QRFHA+V'S C~JI)RT DIANE M RUPICH ESq~',U~R~,~! ~",,R,~~ (~(~ PA DILS ~ RUPICH 1017 N FRONT ST HBG PA 17102 REV-1607 EX AFP (12-08) DATE 09-08-2009 ESTATE OF BLOSER MARY P DATE OF DEATH 08-27-2000 FILE NUMBER 21 00-0747 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ --------------------------------------------------------------------------- REV-1607 EX AFP C12-08) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF BLOSER MARY P FILE N0. 21 00-0747 ACN 101 DATE 09-08-2009 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-19-2002 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 11-22-2000 AA451488 578.95 11,000.00 03-05-2002 CD000918 314.42- 5,207.58 08-04-2009 CD011575 .00 535.14 ~ IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. 16,465.70 TOTAL TAX CREDIT 17,007.25 BALANCE OF TAX DUE 541.55CR INTEREST AND PEN. .00 TOTAL DUE 541.55CR C IF TOTAL DUE IS LESS THAN S1, ND PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) s~ 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 012503 BLOSER DONALD PAUL JR 2260 FISHING CREEK VALLEY ROAD HARRISBURG, PA 17112 fold ESTATE INFORMATION: SSN: 186-34-4874 FILE NUMBER: 2100-0747 DECEDENT NAME: BLOSER PATRICIA DATE OF PAYMENT: 03/22/2010 POSTMARK DATE: 03/19/2010 couNTY: CUMBERLAND DATE OF DEATH: 08/27/2000 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $122.22 TOTAL AMOUNT PAID: 8122,22 REMARKS: CHECK# 4981 INITIALS: SAP SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 CLERK D IANE M D I L S ESQ Q~~'~' (~~~' DILS 8~ DILS LW OFCS:. Cl1N{$E~~...~ID ~~ ~A 1400 N 2ND ST 1ST FL HARRISBURG PA 17102 DATE 02-23-2010 ESTATE OF BLOSER MARY P DATE OF DEATH 08-27-2000 FILE NUMBER 21 00-0747 COUNTY CUMBERLAND ACN 101. APPEAL DATE: 04-24-2010 (See reverse side under Objections) Anount ReB:itted~ ~.2~-- MAKE CHECK PAYABL AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 Pennsylvania ~ DEPARTMENT OF REVENUE REY-1547 EX AFP (12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE ,-•OF~-~E~UC~-T;-O,i~LS ..qND ASSESSMENT OF TAX _ ,_ '~!i ,~~ i ,'i -- - ~ i w ~_ 2a~a~AR 22 Ph! is 20 CUT ALONG THIS LINE ~! RETAIN LOWER PORTION FOR,YOUR RECORDS ~ ______________ REV-1547 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: BLOSER MARY PFILE N0.:21 00-0747 ACN: 101 DATE: 02-23-2010 TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1 Real Estate (Schedule A) (1) .00 NOTE: To ensure proper . (2) .00 credit to your account, 2. Stocks and Bonds (Schedule B) submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C L3) .00 of this form with your 4. Mortgages/Notes Receivable (Schedule D) C4) .00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 12,092.07 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 t c8) 12,092.07 8. Total Asse s APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (g) 200.00 10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) .00 C11) 200.00 11. Total Deductions 11,892.07 12. Net Value of Tax Return (12) 00 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) . (14) 377,796.45 14. Net Value of Estate Subject to Tax NOTE: If an assess:~ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the Total of ALL returns assas3ed to date . ASSESSMENT OF TAX: 00 = 00 .00 15. Amount of Line 14 at Spousal rate (15) . X 16. Amount of Line 14 taxable at Lineal/Class A rate (16) X77 .796 _ 45 x 045 = 17, 000.84 17. Amount of Line 14 at Sibling rate (17) .00 X 12 ° .00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) .00 X 15 = .00 C19)O 17, 000.84 19. Principal Tax Due TAX CREDITS: PAYMENT Ktcnari ~+~~~~^~ .rte AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 11-22-2000 AA451488 578.95 11,000.00 03-05-2002 CD000918 .00 5,207.58 08-04-2009 CD011575 320.83- 535.14 BALANCE OF UNPAID INTEREST/PENALTY AS OF 08-05-2009 TOTAL TAX PAYMENT 17,000.84 BALANCE OF TAX DIE .00 INTEREST AND PEN. 122.22 TOTAL DUE 122.22 * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR). YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~1 It111~1`i 1111~11ilitt 111111 tt111111tfi1t 114fi~11111t1~1411 ill 1! 1 1 ll t{l` 11 1]1t 66 1 £~OLI. `dd `als!I~e~ aoi.}}p slllM ~o ~a}s!6a~ a~enbS asnoy~no~ I. asnou~no~ ~uno~ pual~agwn~ ~~ ..~~ Gn~~,~~wn~ 1~n0~ SrNbHd~10 ~u ~1~31~ 3~Jtl1S1,Od~Si~ -.OLL~ D~~Z~6~1~0 ~M n~0 a ~ Z ~ I Wd ZZ ~~N QIOl i 11~, in ~ ,~ . - rorGr muron~hsuuad `6-rn9s~'~ h~uno~ urydnrod ~O ~,rno~ ,s',rroy`C,ro ay~~o J~.~ puro s~JiM ~° aa~~Ba2L ~.aphuS ~~ ro~pub: BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX %IPP,-RAZ~¢FE#~~r- Ae,~LOWANCE OR DISALLOWANCE O'F D'FUUCT~I'O1~ AND ASSESSMENT OF TAX '~` {. !,fit,. li`Vf4 -~ „~~• C,-t ~ i'~ fi DIANE M DILS ESQ n~ ' ' ,,}i DILS 8~ DILS LW OFCS 1400 N 2ND ST 1ST FL HARRISBURG PA 17102 ~ ~~.-_. pennsylvarna ~ ~ T DEPARTMENT OF REVENUE REV-1547 EX AFP (12-09) DATE 02-23-2010 ESTATE OF BLOSER MARY P DATE OF DEATH 08-27-2000 FILE NUMBER 21 00-0747 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 04-24-2010 (See reverse side under Objections) Amount Remitted 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 F--' ------------------------------------------------------------------------------------------- REV-1547 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: BLOSER MARY PFILE N0.:21 00-0747 ACN: 101 DATE: 02-23-2010 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1. Real Estate (Schedule A) (1) .00 2. Stocks and Bonds (Schedule B) (2) .00 3. Closely Held Stock/Partnership Interest (Schedule C) C3) .00 4. Mortgages/Notes Receivable (Schedule D) (4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 12, 092.07 6. ,lointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. 8. Total Assets (8) 12, 092.07 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 200.00 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 200.00 (12) 11,892.07 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 f Estate Subject to Tax t V l (14) 377,796.45 ue o a 14. Ne 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) 377.796.45 X 045 = 17,000.84 17. Amount of Line 14 at Sibling rate (17) .DO X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) .00 X 15 = .00 19. Principal Tax Due (19)= 17,000.84 TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-22-2000 AA451488 578.95 11,000.00 03-05-2002 CD000918 .00 5,207.58 08-04-2009 CD011575 320.83- 535.14 BALANCE OF UNPAID INTEREST/PENALTY AS OF 08-05-2009 TOTAL TAX PAYMENT 17,000.84 BALANCE OF TAX DUE .00 INTEREST AND PEN. 122.22 TOTAL DUE 122.22 * IF PAID AFTER DATE INDICATEDr 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.