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N ~ ~ N ~ cn .n ~ ~ cn C~ ~ U ~- ~ U x ~ a x NOTICE OF INHERITANCE TAX Pennsylvania ~ BUREAU OF INDIVIDUAL TAXES APPRAISEMEN~, .,A~. 0„~4NCE OR,rDISALLOWANCE INHERITANCE TAX DIVISION DEPARTMENT OF REVENUE Po eox 2ao6o1 OF DEDUCT#~{ON~3~~ j~,~t~1~ ~~~~$J~iENT OF TAX HARRISBURG PA 17128-0601 i~` « "-~ REV-1547 EX AFP (12-09) ~ , ~~~~ ~~~ ~`'~ ~ 1+~Y~ IOF KEESEMAN 10 M ILDRED S DATE OF DEATH 01-10-2009 ,~rr ~ ~''ILE NUMBER 21 09-0064 H ANTHONY ADAMS t~~~~~`~ TY CUMBERLAND 49 W ORANGE ST STE 3 `~~`~~~~ ~ 101 ' APPEAL DATE: 06-18-2010 S H I P P E N S B U R G P A 17 2 5 7 (See reverse side under Objections ) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 CUT ALONG THIS LINE _ ~ -"R_ETA_IN LOWER POR_TION_ FOR YOUR REC_O_R_D_S___~____ REV-1547 EX AFP (12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT --------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENTAOFOTAXCE OR ESTATE OF: KEESEMAN MILDRED SFILE N0.:21 09-0064 ACN: 101 DATE: 04-19-2010 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) C1) •Q 0 NOTE: To ensure proper 2. Stocks and Bonds (Schedule B) C2) .0 0 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) submit the u C3) .Q Q Peer portion 4. Mortgages/Notes Receivable (Schedule D) of this form with your C4) • 00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 16, 033.63 6. Jointly Owned Property (Schedule F) C6) .00 7. Transfers (Schedule G) C7) .00 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: ~$) 16,033 63 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9)- 8 6 0 0 10. Debts/Mortgage Liabilities/Liens (Schedule I) clo) 4,323.39 11. Total Deductions 12• Net Value of Tax Return C11) 5, 186.39 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C12) 10,8 4 7.2 4 14. Net Value of Estate Subject to Tax C13) .0 0 (14) 10,847 24 NOTE: If an assessment was issued previously, reflect figures that include the total of1ALL returns assessed~to d 18 and 19 will ASSESSMENT OF TAX: ate. 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate C16) 'Q 0 X 0 0 = .0 0 17. Amount of Line 14 at Sibling rate ~~ X 045 = .00 C17) oo x 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) 10,847.24 15 19. Principal Tax Due X = 1 , 627.09 TAX CREDITS: _ C19)= 1 , 627.09 PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID 11-05-2009 CD011957 .00 1,627.09 BALANCE OF UNPAID INTEREST/PENALTY AS OF 11-06-2009 TOTAL TAX PAYMENT * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 1,627.09 BALANCE OF TAX DUE .00 INTEREST AND PEN. 5.80 TOTAL DUE 5.80 IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if anv future interest in the estate is transferred in possession or en~ovment to Class B (collateral) beneficiaries of the decedent after the expiration of anv estate for life or for nears, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with Your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OFWILLS,AGENT. 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 (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available online at www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service for forms orders: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance or disallowance of deductions or assessment of tax Cincludin9 discount or interest) as shown on this Notice may ob]ect within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at www boardofappeals.state.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 confirmation number and processed date from the Board of Appeals website. You may also send a written protest to: PA Department of Revenue, Board of Appeals, P.O. Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed. B) Election to have the matter determined at the audit of the account of the personal representative. ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: 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, P.O. Box 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 4 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as You would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine C9) months and one C1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six C6%) 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 near to calendar Year with that rate announced by the PA Department of Revenue. Rates for nears 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501), the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Dept. of Revenue web site www.revenue.state.pa.us. The applicable interest rates for years 2000 through 2010 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 8% .000219 2001 9% .000247 2002 6% .000164 2003 5% .000137 2004 4% .D00110 20D5 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 --Ann Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) 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 BUREAU 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 012703 ADAMS H ANTHONY 49 WEST ORANGE STREET SUITE 3 SHIPPENSBURG, PA 17257 -------- fold ESTATE INFORMATION: SSN: 185-01-0338 FILE NUMBER: 2109-0064 DECEDENT NAME: KEESEMAN MILDRED S DATE OF PAYMENT: 05/04/2010 POSTMARK DATE: 05/03/2010 COUNTY: CUMBERLAND DATE OF DEATH: 01 / 10/2009 REMARKS: CHECK# 13449 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $5.80 I TOTAL AMOUNT PAID: INITIALS: JN $5.80 SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS