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HomeMy WebLinkAbout04-0086COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURg, PA 171ZB-0601 RE¥-'15li3 EX AFP cDg-oD) INFORMATION NOTICE AND TAXPAYER RESPONSE FZLE NO. 21 C)~ ~ ACN O$1q8qlq DATE 12-29-2005 GEORGE E MATTHIAS 511 ELLEN RD CAMP HILL PA 17011 TYPE OF ACCOUNT EST. OF DORA S MATTHIAS [] SAVINaS S.S. NO. 196-Z6-5q68 [] CHECKING DATE OF DEATH 08-Z5-2005 [] TRUST COUNTY CUMBER LAND [] CERTTF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coamonaealth COMPLETE PART ! BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8886712002 Data Oq-Oq-199q Established Accoun.t Balance 2,550.60 Percen.t Taxable X 50.000 Amoun.t Subjec.t .to Tax 1,265.$0 Tax Re.tm X .0~5 Po.ten.tim1 Tax Due 56.9q To insure proper credit to your account, two (Z) copies cf this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". NOTE: Zf tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5Z discount cf the tax due. Any inheritance tax due will become delinquent nine (9) months after the data of death. PART TAXPAYER RESPONSE A. a above information and tax due is correct. You amy choose to remit payment 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 assessment will be issued by the PA Department of Revenue. BLOCK~ B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Tnharitancs Tax return ONLY to be filed by the decsdent's representative. C. [] The above information is incorrect and/or debts and deductions wore paid by you. You must complete PART [] and/or PART [] below. PART Tf you indica.te a diffaran.t .tax ra.te~ pZease s.ta.ta your rele.tionship to deceden.t: TAX RETURN - COMPUTATION OF TAX ON JO]:NT/TRUST ACCOUNTS LINE 1. Data Established I 2. Accoun.t Balance ~ $. Percen.t TexabZe $ ~ q. Aaoun.t Subjac.t ~o Tax q 5. Dab.ts and Deduc.tions 5. 6. Aaoun.t Taxable 6 7. Tax Ra~e 7 ~ 8. Tax Due 8. PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (En.ter on Line 5 of Tax Coapu.ta.tion) Under panal~:ies of perjury, Z declare .tha.t .the fac.ts I have repot.ted above ara .true, correc.t and coaple.te~. 'to .the bes.t of ay kno.ledga and belief. HONE ( WORK TAXPAYER SII~NATURE TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FA/LURE TO RESPOND N/LL RESULT ZN AN OFF/CZAL TAX ASSESSHENT eith applicable lntarest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the decedent's name ams added as a matter of convenience. 4. Accounts (including those held bet#eon husband and wife) which the decedent put in joint names eithin one year prior to death are fully taxable as transfers. 5. Accounts established jointly beteeen husband and eife 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. REPORT[NC INSTRUCTIONS - PART ! - TAXPAYER RESPONSE BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount tax to the Register of Hills of the county indicated. The PA Department of Revenue aill issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of #ills. E. BLOCK B - Zf the asset specified on this notice has been or ail1 be reported and tax paid eith the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part I 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. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and compZete Parts 2 and according to the instructions below. Sign two copies and submit them eith your check for the amount of tax payable to the Register of Mills of the county indicated. The PA Department of Revenue will issue an officiaZ assessment (Form REV-Z548 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. ROTE: For a decedent dying after 12/12/62: Accounts ehich the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an excIusion not to exceed .$5,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (Mx) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from 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: I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT ORNERS SURVIVING JOINT OHNERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 5 (JOINT OHNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the dacedent's death or accounts coned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUHBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE O~/NERS 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. I DIVIDED BY 2 (SURVIVORS) = .50 X lO0 - 507. (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined below. Da~e of Death I Spouse Lineal Sibling I Collateral 07/01/9fi ~o 12/$1/94 01/01/95 ~o 06/$0/00 OX 6X 15X 15X 07/01/00 ~o presen~ OX 4.5X~ 12Z 15Z eThe tax rate imposed on the net value of transfers from a deceased chlld twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OZ. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children ahether or net they have been adopted by others, adopted children end step children. "Lineal descendents" includes ail children of the natural parents end their descendents, ehether or not they have been adopted by others, adopted descendents and their descendants end step-descendants. "Siblings" ere defined as individuals who have at least one parent in common aith the decedent, whether by blood or adoption. The "Collateral" class of heirs includes ell other beneficiaries. CLAIHED DEDUCTIONS PART 5 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as folloas: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 5. If additional space is needed, use plain paper B l/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF ZNDIV/DUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 REV-i$¢3 EX AFP (09-00) INFORMATION NOTICE AND TAXPAYER RESPONSE FILENO. 22 6H ACN 031~8~15 DATE 12-29-2003 GEORGE E MATTHIAS III 511 ELLEN RD CAMP HILL PA 17~11 TYPE OF ACCOUNT EST. OF DORA S HATTHIAS [] SAVINGS S.S. NO. 196-Z6-5q68 [] CHECKING DATE OF DEATH 08-25-2003 [] TRUST COUNTY CUMBERLAND [] CERTTF. REHZT PAYMENT AND FORHS TO: REGISTER OF gILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at tho death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain aritten correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Lams of the Commonwealth Q; Pennsylvania. Qu=stion= aayba ~n;w~rad b~ calXia9 (717) 787 3327. COMPLETE PART I BELOW # # x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31qOOZ13962 Date 07-07-2001 Established Account Balance 18,686.07 Percent Taxable X 50.000 Amount Sub~ec~ to Tax 9,3q3.0~ Tax Rate X .Oq5 Potential Tax Due ~20.~q To insure proper credit to your account, two (2) copies of this notice must accompany your payment to tho Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments ara made within three ($) months of the decedent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LINE A. ~h~lThe above information and tax due is correct. · You amy choose to tacit payment to the Register of Wills with two copies af this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. S. N The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax to be filed by the decadent's representative. C. D The above information is incorrect and/or debts and deductions ware paid by you. You must coeplete PART [] and/or PART []below. Zf you indicate a different tax rate, please state your relationship to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Established I 2. Account Balance 2 3. Percent Taxable $ ~ ~. Amount SubSect to Tax ~ 5. Debts end Deductions E - 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) $ Under penalties of perSury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge end belief. HOME (?/-~) ~*'/~,.~ TAXPAYE~SZGNATURE ' TELEPHONE NUHBER GENERAL INFORHATION 1. FA/LURE TO RESPOND #ILL RESULT IN AN OFF/C/AL TAX ASSESSHENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. $. A joint account is taxable even though the decedent's name was added as a matter of convenience. q. Accounts (including those held boteoan husband end 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 I - TAXPAYER RESPONSE BLOCK A - Tf tho information and computation in the notice are correct and deductions are not being claimed, place an in block "A" of Part 1 of the "Taxpayer Response" section. Sign tmo copies and submit them eith your check for the amount of tax to the Register of Nills of the county indicated. The PA Department of Revenue ail! issue an official assessment (Fora REV-15q8 EX) upon receipt of the return fram the Register of Hills. 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 I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dapt ZB0601, Harrisburg, PA 171ZB-O60i in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of NilLs of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-lSd8 EX) upon receipt of the return free the Register of Nills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally ems established or titled in the manner existing at date of death. NOTE: For a decedent dying after [Z/12/82: Accounts ~hJch the decedent put Jn ~aJnt names ~thJn one [1) year of death are taxable fully as transfers. Ho~ever~ there Js an exclusion not to exceed $~,000 per transferee regardless of the value of the account or the number of accounts held. Zfa double asterisk (~*) appears before your first name Jn the address portion of this notice, the S5,000 exclusion already has been deducted from the account balance as ~aported by the financial institution. Z. Enter ~e total balance of the account includ~ng interest accrued to the date of death. 5. The percent of the account that is taxable far each survivor Js determined as follo~s: A. The percent taxable for joint assets established ;ore ~an one year prior to the decedent's death: I DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUHBER OF X 100 PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT OWNERS Example: A 5oJnt asset registered Jn ~e name of the decedent and t~o o~er persons. I DIVIDED BY 5 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7X (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for ms,ts created ~JthJn one year of the decedent's death or accounts o~ned by the decedent but held in trust for ano~er individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUHBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEFZC1ARZES Example: Joint account registered Jn the name of the decedent and t~o other persons and established ~JthJn one year of death by ~e decedent. 1 DIVIDED BY Z (SURVIVORS} = .50 X 100 = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line q) is determined by multiplying the account balance (line Z) by the percent taxable (line ~). 5. Enter ~e total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from ~e amount subject to tax (line ~). 7. Enter the appropriate tax rate (line 7) as determined below. Da~e of Death Spouse I Lineal Sibling Collateral 07/01/9q ~o 12/$1/9q 01/01/95 ~o 06/50/00 OX 6Z 15Z 07/01/00 ~o presen~ OX q.SZ~ 12X wThe 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 stapparent of the child is OZ. Tho lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children ahether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the nature! 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 common with the decedent, whether by blood or adoption. The "Collateral" class of hairs includes a11 other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You Xegally are responsible for payment, or tho estate subject to administration 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 payment. C. Debts being claimed must be itemized fulty in Part 5. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: GREEN MARY E 1180 KING EDWARD WAY HARRISONBURG, VA 22801 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 003526 ........ fold ESTATE INFORMATION: SSN: 196-26-5468 FILE NUMBER: 21 04-0086 DECEDENT NAME: MATTHIAS DORA S DATE OF PAYMENT: 02/04/2004 POSTMARK DATE: 02/03/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/25/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 03148414 $56.94 iREMARKS: RECEIVED OF GEORGEMATTHIAS CHECK# 1888 INITIALS: TOTAL AMOUNT PAID: JA $56.94 SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003527 GREEN MARY E 1180 KING EDWARD WAY HARRISONBURG, VA 22801 ........ fold .ESTATE INFORMATION: SSN: 196-26-5468 FILE NUMBER: 2104-0086 DECEDENT NAME: MATTHIAS DORA S DATE OF PAYMENT: 02/04/2004 POSTMARK DATE: 02/03/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/25/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 03148413 $420.44 REMARKS: TOTAL AMOUNT PAID' RECEIVED OF GEORGE MATTHIAS $420.44 SEAL CHECK# 1889 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMNONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF /NDIV/DUAL TAXES DEPT. ZS0601 HARRISBURG, PA 17128-0601 RE¥-ISd$ EX AFP C09-Og) MARY / E~REEN 511 EL, L"EN RJ~ CAMPt/fllLL/,,~ PA 17011 Mary Green ZNFORHATZON NOTICE AND TAXPAYER RESPONSE ACM O$1q8qll DATE 12-29-2005 l 180 King Edward Way Harrisonburg, VA 22801 TYPE OF ACCOUNT EST. OF DORA S MATTHZAS [] SAVINGS S.S. NO. 196-26-5q68 [] CHECKING DATE OF DEATH 08-25-2005 [] TRUST COUNTY CUMBERLAND []CERTZF. REHZT PAYHENT AND FORHS TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided the Deportment with the information listed below which has been used in calculating the potential tax due. Their records indicate that at tho death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain ~rJtten correct~on ~rom the ~nancial ~nstJtut~on~ attach a copy to this ~orm and return it to ~e above address. This account Js taxable Jn accordance N1th the Inheritance Tax Laws of the Commonwealth of Pennsylvania. guestJ, o~ m~y be answered by calling (717) 797-B327. COMPLETE PART 1 BELON ~ a ~ SEE REVERSE SIDE FOR FZLZNG AND PAYMENT ZNSTRUCTZONS Account No. 51500215905 Data 07-07-2001 Established Account Balance 18,686.07 Percent Taxable X 5 0.0 0 0 Amount Subject to Tax 9,5~5. O~ Tax Rate X . 15 Potential Tax Due 1 ,q01. q6 PART TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of #ills. Make check payabZe to: "Register of Mills, Agent". NOTE: If tax payments are made within three (3) months of tho decedent's date of death, you amy deduct a 5Z discount of tho ~x due. Any inheritance tax due will become delinquent nine (9) months after the date of death. CHECK ONE BLOCK ONLY PART TAX LiNE A. O The above information and tax due is correct. 1. You amy choose to remit payment to the Register of Mills with two copies of this notice to obtain a discount or ovoid interest, or you amy check box "A" and return this notice to the Register of Mills and an official assessment will be issued by the PA Department of Revenue. B. []The above asset has been or will be reported and tax paid with the Pennsylvania inheritance Tax return to be filed by the decedent's representative. C. [] Tho above information is incorrect and/or debts and deductions were paid by you. You must complete PART [~and/or PART [-~-'~below. if you ,nd,cat. , d,ff.r.nt ~l[,~.ra_te~ ~e~s. st,t. your relationsh/p to decadent:V/VCL~/'I~l-_.~f9%_ _ RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Da~e Es~abZlshed 2 (~ ~ 0'--~"" ~2.~0 / ~. Account Balance 2 ! ~: (,~ff~ ~, 0 ~ 3. Percen~ Taxable 3 ~ ~0 , O~ q. Amoun~ Subjec~ ~o Tax q q/ ;~ ~ ~ 5. Debts and Deductions 5 - 7. Tax ea*e 7 X . ~ PART DATE PAID DEIITS AND DEDUCTIONS CLAZNEn PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on L/ne $ of Tax Computation) Under penalties of perjury, Z declare that the facts Z have reported above_era colnpXete to the bast o_f ay knol~,l, edge and boX,Sol. HOME (~yO) ~P'~)/ TAXPAYER SIGNAT41RE -' /- TELEPHONE NUMBER correct and/ / GENERAL INFORMATION 1. FAILURE TO RESPOND HILL RESULT IN AN OFFICIAL TAX ASSESSHENT eith applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the docedent's dote of death. 5. A joint account is taxable even though the decedent's name was added as a matter 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 fuI1y taxable as transfers. S. 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 far" another ar others are taxable ~ully. REPORTING INSTRUCTIONS PART ! - TAXPAYER RESPONSE I. BLOCK A - If the information and coeputatlsn in the notice are correct and daductlans are not being claimed, place an in block "A" of Part 1 of the "Taxpayer Response" section. Sign tmo copies and submit them with your check for the amount of tax to the Register of Rills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-15~8 EX) upon receipt of the return from the Register of Nills. Z. DLOCK B - If the asset specified on this notice has bean or will be reported and tax paid with tho Pennsylvania Inheritance Tax Return filed by the decadent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to tho PA Department of Revenue, Bureau of Individua! Taxes, Dept ZB060I, Harrisburg, PA I7LZB-060i in the envelope provided. $. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Rills of the county indicated. The PA Department of Revenue #iii issue an official ossessmont (Form REV-ISq8 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART Z TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/BI: Accounts which the decedent put in joint names within one (1) year of death are taxable fully es transfers. Hooever, there is an exclusion not to exceed $5,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (xx) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted free the account balance as reported by the financial institution. Enter the total balance of tho account including interest accrued to the date of death. $. The percent of the account that is taxable far each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedmnt's death: I DIVIDED DY TOTAL NUHBER OF DIVIDED BY TOTAL NURBER OF X 100 = PERCENT TAXABLE JOINT ORNERS SURVIVING JOINT ORR(RS Example: A joint asset registered in the name of the decedent and tad other persons. I DIVIDED BY 3 (JOINT ORR(RS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of tho decedont's death ar accounts owned by the decadent but held in trust for another individual(s) (trust beneficiaries): ! DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ONNERS 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 = 507. (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line 33. 5. Enter the total of the debts and deductions listed in Part S. 6. Tho amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) free the amount subject to tax (line ~). 7. Enter the appropriate tax rate (line 7) as determined below. Dais of Death Spouse [ Lineal Sibling Collateral 07/01/94 iD 12/$1/94 $Z 6Z 01/01/95 to 06/t0/00 OZ 61 lEI 151 07/01/00 iD present OX aThe tax rate imposed on the net value of t from a younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OX. The Iineal 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. "SibIings" are defined as individuaIs mhd have et Least one parent in common aith the decedent, ahether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 5 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as h. You legaZly are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid ~e debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part payment may be requested by ~e PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003604 MATTHIAS JOHN R 12656 COCONUT CREEK COURT FORT MYERS, FL 33908 ........ fold ESTATE INFORMATION: SSN: 1 96-26-5468 FILE NUMBER: 2104-0086 DECEDENT NAME: MATTHIAS DORA S DATE OF PAYMENT: 02/26/2004 POSTMARK DATE: 02/23/2004 COUNTY: CUM BERLAN D DATE OF DEATH: 08/25/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 03148412 $420.44 REMARKS: JOHN RMATTHIAS CHECK//420.44 SEAL TOTAL AMOUNT PAID: $420.44 INITIALS: MW RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURg, PA 171Z&-0601 JOHN ~ R. ~ATTHI:~ lZ656'::~OCON~ CREEK~T FORT MYERS ,,~ ,.'~ REV-IS45 EX AFP INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 C)L~-~ ACN O$1qaqlz DATE 12-29-2003 EST. OF DORA S MATTHIAS S.S. NO. 196-Z6-5q68 DATE OF DEATH 08-Z5-2003 COUNTY CUHBERLAND TYPE OF ACCOUNT [] SAVINGS [] CHECKTNG [] TRUST [] CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK 'i'JC"] has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint OCher/beneficiary of this account. If you feel this information is incorrect, please obtain Hritten correction free the financial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance Hith the Inheritance Tax LaHs of the CoaaonHealth n~ oepnsyJuanJa. Questqons ~y bq ensHered by cel!~ng (7]7) 7a7-~3~7 COMPLETE PART 1DELON # # ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Accoun~ No. 31800Z1269q Da~a 07-07-Z001 Established Accoun'l: Balance 18,686.07 Percen~ Taxable X 5 0.0 0 0 Aeoun~ Sub:jec~ ~o Tax 9,3~3. Oq Tax Ra*a X .15 Po~an~Lal Tax Due I ,,f-tOA . ~6 To insure proper credit to your account~ tho (2) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments are made within three (5) months of the decsdant's date of death, you may deduct a SZ discount of the tax due. Any inheritance tax due Hill become dulinquent nine [9) months after the date of death. PART TAXPAYER RESPONSE A. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills Hith tho copies of this notice to obtain -- CHECK a discount or avoid interast~ or you may check box  ~ #ills and an official assessment Hill be issued by the PA Department of Revenue. ONE BLOCKJ s. ~ The above asset has been or Hill be reported and tax paid Hith the Pennsylvania Inheritance Tax return ONLY ..-- to.~ filed by the decedent's representative. C. ,~ The above information is incorrect and/or debts and deductions Here paid by you. ~-%kYou must complete PART ~ and/or PART ~ below. [f yOU indicate a differen~ *ax ra~ please A~a~e your rela~/onsh~p ~o deceden~: ~0~ RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Establ/sheo 1 2. Accoun~ Balance 2 3. Percen~ Taxable 3 fi. Aaoun~ Subjec* 5. Deb*s and Deductions 5 - 6. Amoun~ Taxable 6 7. Tax Ra~e 7 8. Tax Due 8 PART TAX LINE PART DATE PAID DEBTS AND DEDUCTTONS CLA]:MED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) Under panel,/es of perjury, I declare ~haJ: ~he fac~s I have reported above are ~rue, corrac~ and co.pla*e to...~he best of ey k.o.ladga and belief. HONE TAXPAYE~S[GNATURE TELEPHONE NUMBER DATE GENERAL ~NFORMATION 1. FAILURE TO RESPOND HILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the dacedent's name was added as a matter of convenience. 4. Accounts (including these held between husband and #ifa) which the decedent put in joint names within one year prior to death are fully taxable as transfers. S. Accounts established jointly between husband and wife more than one year prior to death are net taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORT[NG [NSTRUCTIONS- PART I TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of flills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Tnheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department cf Revenue, Bureau of Individual Taxes, Dept Z80601, Harrisburg, PA 17128-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue w111 issue an official assessment (Fora REV-15fiB EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/BI: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $5,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (*w) appears before your first name in the address portion of this notice, the $5,00n exclusion already has been deducted from 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. 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 dacedent's death: 1 DIVIDED BY TOTAL NUHBER OF DTVIDEO DY TOTAL NUHBER OF X 100 = PERCENT TAXABLE JOINT OHNERS SURVIVING JOTNT OHNERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 5 (JOINT OHNERS) DIVIDED BY Z (SURVIVORS) = .167 X lO0 = 16.7Z (TAXABLE FOR 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): I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 PERCENT TAXABLE O#NERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year af death by the decedent. 1 DIVIDED DY Z (SURVIVORS) = .SO X 100 = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter the total of the debts and deductions listed in Part 5. 6. The a~ount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 73 as determined belcH. Da{e of Dea{h I Spouse Lineal S/bling Cella{era1 07/01/9~ ~o 12/$1/9q 3X 6X 01/01/95 ~o 06/30/00 OX 6X 07/01/00 ~o presen~ OZ ~.5X~ wTha tax rate imposed on the net value of transfers from a deceased years younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OZ. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have bean 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 common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes ail other beneficiaries. CLAIMED DEDUCTIONS - PART 5 - DE]iTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally ara responsible for payment, or the estate subject to administration 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 payment. C. Debts being cia[mad must bm itemized fully in Part 5. If additional space is needed, usa plain paper 8 I/Z" x 11". Proo~ o; payment may be requested by the PA Oepar~ent of Revenue. CONNONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG) PA 171ZB-0601 REV-lSd5 EX AFP (Dg-O0: ZNFORNATZON NOTICE AND TAXPAYER RESPONSE ACN 05148412 DATE 12-29-2005 TYPE OF ACCOUNT c'.~ .~. ~_<~ EST. OF DORA S HATTHIAS [] SAVINGS ~'!~ ~' o"~c~ S.S. NO. 196-Z6-5468 [] CHECKING :~,...: DATE OF DEATH 08-Z5-ZO0:5 [] TRUST ~ "~ ~ COUNTY CUHBERLAND [] CERTIF. ~L~ REHZT PAYNENT AND FORNS TO: JOHN ~ NATTH~S REGISTER OF WILLS 1Z656 COCO~HJT CREE~ CT CUNBERLAND C0 COURT HOUSE FORT!NYERS '~ $$908 CARLISLE, PA ~70~$ PNC BANK has provided the Department with the information listed below which has been used in calculating thc potential tax due. Their records indicate that at the death of the above decedent, you mare a joint oNnar/bana~iciary o~ this account. Zf you ~eal this information is incorrect, please obtain NrJttan correction from the financial institution~ attach a copy to this ~orm and return it to the above address. This account is taxable in accordance Nith the Inheritance Tax Laos o9 the Comaonaaalth CONPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS Account No. $1800212694 Date 07-07-2001 Established Accoun~ Balance 18,686.07 Percen~ Taxable X 5 0.0 0 0 Aeoun~ Sub~ec~ ~o Tax 9,~4~.04 Tax Ra~e X .15 Pot:ant:ia1 Tax Due 1, q01. ~6 PART TAXPAYER RESPONSE To insure proper credit to your account, tam (Z) copies of this notice must accompany your payment to the Register of Nills. Hake check payable to: "Rag[star of Nills, Agent". NOTE: I~ tax payments are made within three ($) months o~ the decedent's date o~ death) you may deduct a 5Z discount mT the tax due. Any inheritance tax due mill become delinquent nine (9) Months a~tar the date of death. ...................................... '"" ..................... ::::":: ................................ :!,!,!:!~!~!~!~!;!;!~!;~;~'~!~!~!~= =~,~,~,~,~q!,a!i~i~H,!,!=!~i~i~i~i~i~i~!ii~i~i~iii~i~i~i~i~i~i:~; ~;~;;;~;~;;;i;i~i~i~ilili~ E 'J'J~!~!~!~!~i~!;~i~i;i;i:J'. !!!~!~!~!~! A. ~ The above information and tax due correct. 1. You may choose to remit payment to the Register of Hills with too copies of this notlca to obtain CHECK ONE BLOCK ONLY PART TAX LINE a discount or ovoid interest, or you say check box "A" and return this notice to the Register o; Hills and an official assassmant mill be issued by the PA Department o~ Revenue. B. ~ The above asset has been or mill be reported and tax paid oith the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. ~ The above in;oraation is incorrect and/or debts and deductions ~ore paid by you. You must complete PART ~ and/or PART ~ beloa. If you indicate a differen~ ~ex ra~e~ please s~a~e your relationship ~o decedent: ~(~t~ RETURN - CONPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date EstebZzshed 2. Account Balance $. Percen~ Taxable ¢. Aeoun* Subject to 5. Debts and Deductions 6. Aeoun~ TaxabZe ~. tax .ate 8. Tax Due PART DATE PAID DEBTS AND DEDUCTIONS CLAZNE~ PAYEE DESCRIPTION ANOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury, I declare ~ha~ ~he feces I have reported above are ~rue, correc~ and complaCenCe ~he bes~_~.of~ and belief. WoRKHONE (( ~f )) dt"~ ~/-'~-~(- TAXPAYER ,~GNATURE TELEPHONE NUNBER DATE GENERAL INFORHATZON 1. FA/LURE TO RESPOND WILL RESULT ZN AN OFFICIAL TAX ASSESSNENT .ith opplicoble interest hosed on informotion submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. $. A joint account is taxable even though the decedent's name ems added as a matter of convenience. ~. Accounts (incLuding those held betHeen husband and Hire) Hhich the decedent put in joint names Hithin one year prior to death are fully taxable as transfers. S. Accounts established jointly betHeen husband and Hire 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 I - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice ere correct and deductions are not being claimed, place an in block "A" of Part 1 of the "Taxpayer Response" section. Sign tho copies and submit them Hith your check for the amount of tax to the Register of Rills of the county indicated. The PA Oepartment of Revenue Hill issue an official assessment (Form REV-lSd8 EX) upon receipt of the return from the Register of HiLls. Z. BLOCK B - If the asset specified on this notice has been or Hi(! be reported and tax paid Hith 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 Oepartment of Revenue, Bureau of Individual Taxes, Oept Z80601, Harrisburg, PA 171ZB-0601 in the envelope provided. $. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and according to the instructions beloH. Sign tee copies and submit them Hith your check for the amount of tax payable to the Register of fliils of the county indicated. The PA Department of Revenue Hill issue an official assessment (Fora REV-ISq8 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART Z TAX COHPUTATION LTNE 1. Enter the date the account originally Has established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/1Z/BZ: Accounts Hhich the decedent put in joint names eithin one (1) year of death ara taxable fully as transfers. HoHevmr, there is an exclusion not to exceed $5,000 per transferee regardless of the value of tho account or the number of accounts held. If a double asterisk (xx) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of tho account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as folloHs: A. The percent taxable for joint assets established more than one year prior to the decedent's death: I DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 = PERCENT TAXABLE JOINT OHNERS SURVIVING JOINT ONNERS Example: A joint asset registered in the name of the decedent and tho other persons. I DIVIDED BY 5 (JOINT O#NERS) DIVIDED BY Z (SURVIVORS) = .167 X 1oD = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created mithin one year of the decedent's death or accounts oHned by the decedent but held in trust for another individual(s) (trust beneficiaries): I BIVTBED BY TOTAL NUNBER OF SURVIVING JOINT X lO0 = PERCENT TAXABLE OflNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and tho other persons and established eithin one year of death by the decedent. 1 DIVINED BY Z (SURVIVORS) = .SO X lO0 = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line ~) is determined by aultipJying the account balance (line Z) by the percent taxable (line 5. Enter the tote1 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 ~). 7. Enter the appropriate tax rate (line 7) as determined beloe. Da~e of Death Spouse Lineal Sibling Collateral 07/01/9~ ~o 12/$1/9~ SZ 6X 01/01/95 ~o 06/30/00 OX 6X 07/01/00 ~o presen~ OZ HThe tax rata imposed on the net value ansfers a younger at death to or for the usa of a natural parent, an adoptive parent, or a stepparent of the child is OX. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children Hhether or not they have bean adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, ehether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined os individuals Hho have at least one parent in common Hith the decedent, Hhether by blood or adoption. The "Collateral" class of heirs includes eL1 other beneficiaries. CLAIHED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIHED A11oHable debts and deductions are determined as folloHs: A. You Xegally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You ac~ally paid the debts a~ter death of the decedent and can furnish proof of payment. C. Debts being cla~med must be ~tem~zed ~ully ~n Part 5. [~ additional space Js needed, use plain paper 8 l/Z" x 11". Proo~ o; payment may be requested by the PA Depar~ent of Revenue. BUREAU OF TNDTVIDUAL TAXES INHERTTANCE TAX DTVIS[OH DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 GEORGE 511 ELLEN RD CAMP HILL COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF TNflERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS Recorc~ =:~:,:: ~,;~D.~TE o5-o8-20o~ R '.'j:-~' ;-,t 'i,.E~TATE OF MATTHIAS e'~:~: ~TE OF DEATH FILE NUMBER E MATTHIAS III PA 17011 Clerr~ , .... j-'~ ACH 21 0q-0086 CUMBERLAND 196-Z6-Eq68 031~8~13 Amount Rem J,'~t~md DORA S HAKE CHECK PAYABLE AND REMIT PAYNENT TO: REGISTER OF WILLS CUMBERLAHD CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS REV-15q8 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRA/SEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-08-Z00~ ESTATE OF MATTHIAS DORA S DATE OF DEATH 08-25-2003 COUNTY CUMBERLAND FILE NO. 21 0~-0086 S.S/D.C. NO. 196-26-5q68 ACN 03168~13 TAX RETURN WAS: (X) ACCEPTED AS FILED ¢ ) CHANGED dOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 31~00213962 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 07-07-2001 Accoun~ Balance 18,686.07 Percen~ Taxable X 0.500 Amoun~ Sub~ec~ ~o Tax Debts and Deduc~Aons - .00 Taxable Amoun~ Tax Ra~e ~ .~5 Tax Due ~ZO.qq NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) ~AYMENT MUST BE MADE BY 05-Z6-ZOOq~. AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDTTIONAL INTEREST. ~ IF TOTAL DUE IS LESS THAN $1, NO PAYMENT TS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) .00 fiZO.qfi .00 qZO.qq PURPOSE OF NOTICE= To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (71 P.S. Section 9140). PAYHENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF NILES, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available at the Office of the Register of Hills, any of the 25 Revenue District Offices or by calling the special Z4-hour ansaering service for forms ordering: 1-800-561-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-$020 (TT onZy). Any party in interest not satisfied with the appraisement, 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 Department of Revenue, Board of Appeals, Dept. 281011, Harrisburg, PA 17118-I021, OR --electing to have the matter determined at the 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. 180601, Harrisburg, PA 17118-0601 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 adminlstrativaly correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is a11oaed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day free the date of death, to the date of payment. Taxes ,hich became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164. All taxes mhich became deIinquent on or after January 1, 1981 wilZ 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 1981 through 2003 are: Interest Daily Interest Daily Interest Daily Yea.~r Rate Factor Yea.~r Rate Factor Year Rate Factor 1982 20Y. .000548 1987 9Z .000147 1999 7X .000192 1983 161 .000458 1988-1991 111 .000501 ZOO0 81 .000Z19 1984 111 .000501 1991 91 .000247 2001 91 .0002~7 1985 131 .000356 1993-1994 71 .000191 2002 61 .000164 1986 IOZ .00027~ 1995-1998 91 .000147 ZOO3 51 .000157 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUI~BBR OF DAYS DBLTNI~UENT X DAZEY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. ~,. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-i;O? EX AFP C01-D$) '04 H~R 12 GEORGE E MATTHIAS III 511 ELLEN RD CAMP HILL PA DATE ESTATE OF DATE OF DEATH FILE NUMBER :41~OUNTY ACH 05-08-Z00~ MATTHIAS 08-25-2005 21 0~-0086 CUMBERLAND 05148415 DORA S Amoun~ Rem i'l:'l:ed MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submit: ~:he upper portion of ~his form wi~:h your ~:ax payment. CUT ALONG TH'rS L'rNE ~ RETA'rN LOWER PORT'rON FOR YOUR RECORDS ~.~ REV-1607 EX AFP (01-03) #-# ZNHER?TANCE TAX STATEMENT OF ACCOUNT ESTATE OF MATTHIAS DORA S F'rLE NO. 21 04-0086 ACN 05148415 DATE 05-08-2004 THTS STATEHENT IS PROVTDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHNARY OF THE PRTNCZPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-08-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 420.44 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 02-05-Z004 CDOOS527 .00 420.44 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 420.44 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- Zf RESIDENT DECEDENT make check or money order payable to: REGISTER OF #ILLS~ AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMON#EALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by complmting an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications arm available at the Office of the Register of Hills, any of the Z5 Revenue District Offices or from the Department's g4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-q47-3gZO (TT only]. REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg) PA 171ZB-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three ($) calendar months after the dmcedent's death, a five percent (SZ) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and nat paid before January 18, 1996, the first day after the and of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from thm date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (SI) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through gO0~ ara: Interest Daily lnterest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .O00Sq8 1988-1991 1XZ .000301 ZOO1 9Z .OOOZ47 1983 162 .000438 199Z 9X .O00Z~7 ZOOZ 6X .OOOlSq 198q llZ .000301 1993-199~ 72 .OOOlDg 2003 5Z .000137 1985 132 .000356 1995-1998 92 .OOOZq7 2004 qZ .000110 1986 IOZ .O00Z7~ 1999 7Z .OOOlDZ 1987 9Z .O00Zq7 ZOO0 8Z .OOOZZ9 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUIIBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (lS) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES THHERZTANCE TAX DTVZSZON DEPT. 28060! HARRISBURG, PA 17128-0601 GEORGE E HATTHIAS 511 ELLEN RD CAHP HILL COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLONANCE OR DISALLORANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (DI-OS) Recc:'ded-C[~;:~ ~ ~j~T, E o8-oz-zoo4 ~;~r -: ~t~i~STATE OF HATTHIAS DORA "-~ ..... ~ATE OF DEATH 08-25-Z005 FILE NUNDER 21 04-0086 COUNTY CUHBERLAND '04 JUL 30 ~ls~s-A~,Dc 196-26-5468 ACN 05148414 Amoun~ R~m~ed HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-15~8 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON .JOINTLY HELD OR TRUST ASSETS DATE 08-02-2004 ESTATE OF HATTHIAS DORA S DATE OF DEATH 08-25-2005 COUNTY CUHBERLAND FILE NO. 21 04-0086 S.S/D.C. NO. 196-26-5468 ACN 05148414 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOZNT OR TRUST ASSET ZNFORHATZON FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 8886712002 TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ( ) TRUST ( ) TIHE CERTIFICATE DATE ESTABLISHED 04-04-1994 Accoun~ Balance Percen~ Taxable X 0.500 Amoun~ SubSect ~o Tax 1,265.$0 Debts and Deduc~Aons - .00 Taxable Amoun~ 1,265.$0 Tax Ra~e ~ .45 Tax Due 56.94 TAX CREDTTS: 2,550.60 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS NOTICE NITH YOUR TAX PAYHENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF HILLS, AGENT." PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUNBER INTEREST/PEN PAID (-) 02-05-2004 CD003526 .00 56.94 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUTRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. 56.94 .00 .00 .00 PURPOSE OF NOTICE: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act ES of ZOO0. (72 P.S. Sectlen 91q0). PAYMENT: Detach the top portion of this Notice and submit eith your payment to the Register of Nills printed on the reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. REFUND (CA): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: A refund of a tax credit, mhich ems not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Nills, any of the Z3 Revenue District Offices or by calling the special Iq-hour ansaering service for fores ordering: 1-800-36Z-2050; services for taxpayers aith special hearing and or speaking needs: 1-800-~q7-3020 (TT only). Any party in interest not satisfied ~ith the appraisement, allowance, or disalloeance of deductions or assessment of tax (including discount or interest) as sho~n on this Notice may object ~ithin sixty (60) days of receipt of this Notice by: --~ritten protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171Z8-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Ravia~ Unit, DEPT. Z&0601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively carrectabZa errors. If any tax due is paid aithin three (3) caZandar months after the decadsnt's death, a five percent (5X) discount of the tax paid is allowed. The ZSX 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 tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning eith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ~hich became delinquent before January 1, 198Z bear interest at the rate of six (6g) percent per annum calculated at a daiZy rate of .00016~. All taxes which became delinquent on or after January 1, 1982 mill bear interest at a rate ehich wile vary from caZendar year to calendar year aith that rata announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOq are: [nterast Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198~ ZOZ .OOOSq8 198~-1991 XXZ .000501 ZO0--~ 92 .0002~7 1983 16Z .000~36 1992 9Z .000247 2002 6Z .000219 1984 11Z .000301 1993-1994 7Z .00019Z 2003 5Z .000157 1985 132 .000~56 1995-1998 9Z .000247 ZOOq 42 .000110 1986 102 .000E74 1999 72 .00019Z 1987 9Z .O00Zq7 ZOO0 8Z .000Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUIJBER OF DAYS DELINQUENT X DATL¥ INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days beyond the date of the assessment. If payment is made after the interest computation date sho~n on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES TNHERITANCE TAX DZVTSION DEPT. ZBO601 HARRISBURG, PA 171ZB-0601 MARY E GREEN 1180 KING EDNARD NAY HARRISONBUR$ VA 22801 (j.L~'~ CONNONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX AppRAISEHENT. ALLOHANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSREHT OF TAX ON JOINTLY HELD OR TRUST ASSETS Re orc d C ic,? .... 08-oz-z004 i'-~:~: .... : " .... DATE OF DEATH 08-Z5-ZO03 FILE NUMBER COUNTY '04 JUL 30 ACN 21 04-0086 CUMBERLAND 196-26-5468 05148411 Amoun~ Remi'l:'~ed REV-1S¢8 EX AFP COl-OS) DORA HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE RETAIN LOHER PORTION FOR YOUR RECORDS REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOHANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-02-20J_~_~ ESTATE OF MATTHIAS DORA S DATE OF DEATH 08-25-2003 COUNTY CUMBERLAND FILE NO. Z1 04-0086 S.S/D.C. NO. 196-Z6-5468 ACN 0~148411 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR YRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. ~1300215905 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TINE CERTIFICATE DATE ESTABLISHED 07-07-2001 Accoun~ Balance 18,686.07 PePcen~ Taxable X 0.500 Amoun~ Sub~ec~ ~o Tax .00 Debts and Deductions - '- Taxable Amoun~ 9,343.04 Tax Ra~e ~ 420.44 Tax Due NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE NITH YOUR TAX PAYMENT TO THE REGISTER OF HILLS AT THE ABOVE ADDRESS. MAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF HILLS, AGENT." TAX CREDITS: PAYMENT DATE RECEIPT NUMBER AMOUNT PAID DISCOUNT (+) INTEREST/PEN PAID (-) .00 420.44 3.56 424.00 INTEREST IS CHARGED THROUGH 08-10-2004 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT I BALANCE OF TAX DUEI INTEREST AND PEN. / TOTAL DUE / IF PAID AFTER THIS DATE~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section ZlqO of the Xnheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 91q0). PAYMENT: REFUND (CR) OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Make check er money order payable to: REGISTER OF #ILLS) AGENT. : A refund of a tax credit) which was not requested on the tax return) may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-]$13). Applications are available at tho Office of the Register of Nills) any of the 23 Revenue District Offices or by calling the special Iq-hour answering service for fores ordering: 1-800-361-2050; services for taxpayers with special hearing and or speaking needs: 1-800-qq7-3020 (TT only). Any party in interest not satisfied with the appraisement, alloeance) or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may abject within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue) Board of Appeals) Dept. 281021) Harrisburg) PA 17128-1011, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered an this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit) DEPT. 180601, Harrisburg, PA 17128-0601 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. If any tax due is paid within three (3) calendar months after the decedent's death) a five percent (51) discount of the tax paid is allaeed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18) 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) Months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016q. All taxes which became delinquent on or after January l, 1982 will bear interest at a rate ehich ail! vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200q are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 2OZ .goose8 198'~-1991 11X .OO03OZ ZOO'~ 91 .OOOZq7 1983 161 .000~38 1992 91 .0002~7 2001 61 .O00Z19 198q 111 .000501 1993-199~ 71 .000191 2003 51 .000137 1985 15Z .000356 1995-1998 92 .000147 gOO~ ~Z .000110 1986 ZOZ .OOO27q 1999 7Z .000192 1987 9Z .0002q7 2000 8Z .000219 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE SUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 004255 GREEN MARY E 1180 KING EDWARD WAY HARRISONBURG, VA 22801 ...... fold ESTATE INFORMATION: SSN: 196-26-5468 :ILl: NUMBER: 2104-0086 DECEDENT NAME: MATTHIAS DORA S DATE OF PAYMENT: 08/11/2004 POSTMARK DATE: 08/07/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/25/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 03148411 $424.00 TOTAL AMOUNT PAID: $424.00 REMARKS: CHECK# 1415 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF ZNDZVZDUAL TAXES HARRISOHDURG COMHONWEALTH OF PENHSYLVANIA DEPARTHENT OF REVEHUE &p~RAISE~_~I_~ A~.. ,=S~Sl~qT OF TAX ON .;v-~ e~ ~ ;e~-e~ DATE 08-02-200~ ESTATE OF MATTHIAS DORA S DATE OF DEATH 08-ZS-ZO05 FZLE NUH~ER 21 04-0086 CUMBERLAND COUNTY 196-26-5q68 SSN/DC 05148~11 ACH ~ MAKE CHECK pAYAbLE AND REH~T pAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 peter Id. Ma~/ M. C~ee~ 1180 I<)ng Edward Way Ha~iso~l~urg, VA 22801 BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTVTSTON PO BOX 280601 HARRTSBURG, PA 17128-0601 JOHN R MATTHIAS 12656 COCONUT CREEK CT FORT MYERS ~'~35908, ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT/CE OF ZNHERZTANCB TAX APPRAISEHENT. ALLO#ANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-29-200q ESTATE OF MATTHIAS DATE OF DEATH 08-25-2005 FILE NUMBER Z! 0q-0086 COUNTY CUMBERLAND SSN/DC 196-26-5~68 ACN 051~8~12 Amoun~ Remi~ed REV-1548 EX AFP DORA S MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ m m m m m m m mmmmmmmmmmmmmmmmmmmmmmm .mm.mmmmmmmmmmmmmmmm m...mm mm mm mm mm mmm mm..mmm..mmmmmmmm mmmmmmmm.mm mm m m m mm. mm m. m m m m m REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOZNTLY HELD OR TRUST ASSETS DATE 11-29-200~ ESTATE OF MATTHIAS DORA S DATE OF DEATH 08-25-2005 COUNTY CUMBERLAND FILE NO. 21 0q-0086 S.S/D.C. NO. 196-26-5~68 ACN TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED 051~8~12 JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. $180021269R TYPE OF ACCOUNT: ¢ ) SAVINGS ( ) CHECKING ( ) TRUST ¢ ~ TIME CERTIFICATE DATE ESTABLISHED 07-07-2001 Accoun~ Balance Percen~ Taxable X 0.500 Amoun~ Subjec~ ~o Tax 9,343.0~ Debts and Deductions - .00 Taxable Amoun~ 9,3~$.0~ Tax Ra~e X .15 Tax Due 1,~Ol.q6 TAX CREDITS: 18,686.07 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYHENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) OZ-Z3-ZOOq COOO360q .00 qZO.qq INTEREST IS CHARGED THROUGH 1Z-07-ZOOq TOTAL TAX CREDIT AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE REVERSE SIDE OF THIS FORM INTEREST AND PEN. TOTAL DUE ~ ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REI~UIRED. IF TOTAL DUE IS REFLECTED AS A 'CREDIT- (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~ q20.qq 981.02 21.15 1,002.17 PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z~ of ZOO0. (TZ P.S. Section 9140). Detach the tap portion of this Notice and submit ~ith your payment to tho Register of Hills printed an the reverse side. -- Hake check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, ~hich Has not requested on the Tax Return, amy be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available online at ~ww.ravenua.stata.Da.us, any Register of Hills or Revenue District Office, or from the Department's Z4-hour ansaaring service for forms orders: 1-800-362-Z050; services for taxpayers mith special hearing and/or speaking needs: L-800-447-30ZO (TT only). Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shoan on this Notice may object ~ithin 60 days of the data of receipt of this notice by filing one of the following: A) Protest to the PA Oepartment of Revenue, Board of Appeals. You may object by filing a protest online at ~a.boardofappeals.stata.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirlation number and processed date from the Board of AppeaLs aebsite. You may also send a ~ritten protest to PA Department of Revenue, 8oard of Appeals P.O. Box Z810Z1, Harrisburg, PA 171Z8-1021. Petitions may not be foxed. B) Election to have the matter determined at the audit of tho account of the personal representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in .riting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment ReviaN Unit, P.a. Box Z80601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-LS01) for an explanation of administratively correctable errors. If any tax due is paid uithin three (3) calendar months after the decedent's death, a five percent (SZ) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you uould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning ~ith first day of delinquency, or nine (9) months and one fi) day from the date of death, to the date of payment. Taxes ahich became delinquent before January 1, 198Z bear interest at the rate of six (SZ) percent per annum calculated at a daily rate of .000164. Ail taxes ~hich became delinquent on or after January 1, 198Z ~ill bear interest at a rate Nhich ail1 vary from caIendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2004 are: Interest Daily Interest Daily Interest Daily Year Rata Factor Year Rate Factor Year Rata Factor 198Z ' ZOZ '.000548 198'--~6-1991 11Z .000301 ZO0"~ 9Z .000Z47 1983 16X .00043B 199Z 9Z .000Z47 ZOOZ 6X .000164 1984 11Z .000301 1993-1994 7Z .00019Z ZOO3 5Z .000137 1985 lSZ .000356 1995-1998 9Z .000Z47 2004 4Z .000110 1986 lOZ .000274 1999 7Z .OOOleZ 1987 9Z .000247 ZOO0 8Z .000Z19 --Interest is calculated as follaas: INTEREST = BALANCE OF TAX UNPA'rD X NUtIBER OF DAYS DELXNQUENT X DAXLY XNTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is eade after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-Z60? EX &FP C01-05) MARY E GREEN 1180 KING EDWARD WAY HARRISONBURG VA 22801 DATE 09-Z7-200q ESTATE OF NATTHIAS DATE OF DEATH 08-25-2005 FILE NUMBER 21 0q-0086 COUNTY CUHBERLAND ACN 051~8~11 Amoun'l: Rem J.'l:'l:ed DORA S MAKE CHECK PAYABLE AND RENIT PAYNENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his form wi~h your ~ax paymsn~c. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~ *rNHER'rTANCE TAX STATENENT OF ACCOUNT ESTATE OF MATTHIAS DORA S F'rLE NO. 21 0~-0086 ACN 051~8qll DATE 09-27-200~ THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHO#N BELO# IS A SUMHARY OF THE pR'rNCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, TF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 08-0Z-200~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS PAYHENT DATE 08-07-200~ (TAX CREDITS): RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) CDOOq255 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), AMOUNT PAID qZq. O0 TOTAL TAX CREDIT q20.58 BALANCE OF TAX DUE .lqCR ZNTEREST AND PEN. .00 TOTAL DUE .lqCR YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. JOHN R MATTHIAS 12656 COCONUT CREEK CT INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE ESTATE OF DATE OF DEATH FILE NO. COUNTY SSN/DC ACN '* REV.ll04 EX AFP (03-87) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 03-28-2005 MATTHIAS DORA S 08-25-2003 21 04-0086 CUMBERLAND 196-26-5468 03148412 FORT MYERS FL 33908 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE c> RETAIN LOWER PORTION FOR YOUR RECORDS ~ --FiE\i:160~-Ej(~Ffi(Ci3:97)------------------------------------------------------------------------------------------------------------------- .. INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS .. ESTATE OF MATTHIAS DORA S DATE OF DEATH 08-25-2003 DATE 03-28-2005 COUNTY CUMBERLAND FILE NO. 2104-0086 SS/DC NO. 196-26-5468 ACN 03148412 ADJUSTMENT BASED ON : PROTEST BOARD DECISION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 31800212694 TYPE OF ACCOUNT: (0) SAVINGS (0) CHECKING (0) TRUST (~) TIME CERTIFICATE DATE ESTABLISHED 07-07-2001 X 18,686.07 .500 9.343.04 0.00 9.343.04 .45 420.44 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBMIT THE UPPER PORTION OF THIS NQT-:lCE WITH YOUR TAXfPAYMENT iohHE REGISTER OF Wftl~AT THE~: ABOVE ADDRESS. MA1<iE CHEtK OR MONEY ORDERPA.Yf'BL~:!O: "REGISTER OF WILLS;I\GENT." Account Balance Percent Taxable Amount Subiect to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due X TAX CREDITS: PAYMENT DATE 02-23-2004 ....'rC,:~\ RECEIPT NUMBER CD003604 DISCOUNT (+) INTEREST/PEN PAID (- 0.00 AMOUNT PAID 420.44 C,) C', TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 420.44 0.00 0.00 0.00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. * (IF TOTAL DUB IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUB IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) c... ~ ' BUREAU OF INDIVIDU4i.<TAXES INHERITANCE TAX DIYISION ' PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-1607 EX AFP (03-05) : 33 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-04-2005 MATTHIAS 08-25-2003 21 04-0086 CUMBERLAND 03148411 DORA S MARY E GREEN 1180 KING EDWARD WAY HARRISONBURG VA 22801 Allount R_itted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF MATTHIAS DORA S FILE NO. 21 04-0086 ACN 03148411 DATE 04-04-2005 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: 07-26-2004 PRINCIPAL TAX DUE: 420.44 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-10-2004 CD004255 3.56- 424.00 TOTAL TAX CREDIT 420.44 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE~ SEE REVERSE TOTAL DUE .00 . SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $l~ NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~ YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) Qs,-<-