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Home My WebLink About04-23-10 (2) 15056Q41114 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~f ~~' 9 PO BOX 280801 N ~ / ~ O Hamabu PA 17128-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 077-18-3648 Decedent's Last Name 02042010 07251923 Suffix Decedent's First Name MI AUSTIN BETTY M (If Applicable) Erltsr 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 Retum Q 2. Supplemental Return ~ 3. Remainder Retum (date of death prior to 12-13-82) 0 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required death after 12-12-82) 8. Decedent Diad Testate ~ 7. Decadent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Wilq (Attach Copy of Trust) 0 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date or death Q 11. Election to tax under Sec. 9113(A) between 12-31-g1 and 1-1-85) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number DONNA M. MULLIN, CPA N ,:a 717-761 0 0 ~ Firm Name (If Applicable) NLY REGIST ~ I,L LS U 1 i ~ i C ' ~ ` 1 ~ ~- ~ BOYER & RITTER, CPAS rn tv -} -' ; First line of address °'- ~ - `f w ~ ~ ~-'-' ~ -`-' 211 HOUSE AVENUE j Second line of address ~ N " ?ri D ~ ~ C W City or Post Office CAMP HILL State ZIP Code PA 17011 Correspondent's e-mail address: DMULLIN®CPABR . COM n r pena o pequry, are at ave exam Is return, in u ng accompany ng s u an statements, an to e t o my now ge an le , is true, correct and corn late. Dedaretion of re rer other ih Isonal re resentatNe is based on all inionnatbn o(which rer has an know e. SIGNATURE OF I SO SPON~DI~ ~ ~ ~ pAT~ r ~'3 /~ 3011 LAKE GEORGE WAY, PUTNAM STATION, NY 12861 SIGNATURE OF PREPARER OTHER J,tiAl~(,jjEPRESENTATIVE„ „ BOYER & RITTER, CPAS, 211 HOUSE AVE., CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY 15056041114 Side 1 15056041114 J J 15056042115 REV-1500 EX Decedent's Social Security Number oecedent'sName: BETTY M AUSTIN 077-18-3648 RECAPITULATION 1. Real estate (Schedule A) ............................... . ........... 1. NONE 2. Stocks end Bonds (Schedule B) ...................................... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages 8 Notes Receivable (Schedule D) ........................... . 4. NONE 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ....... . 5. NONE 6. Jointly Owned Property (Schedule F) ~]Separete Billing Requested ........ 6. 7 3 8 5 4 . 0 0 7. Inter-Vivoa Transfers 8 Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ........ 7 141694.00 8. Total Gross Assets (total Lines 1-7) .................................. 8. 215 5 4 8 . 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) ................... 9. 3 0 5 4 . 0 0 10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) ............... 10. 4 314.0 O 11. Total Deductions (total Lines 9 8 10) .............................. . .. 11. 7 3 6 8 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................ . 12. 2 0 818 0 . 0 O 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which . en election to tax has not been made (Schedule J) ...................... • 13. 0 . 0 0 14 Net Value Subject to Tax (Line 12 minus Line 13) . ........... 14. 2 0 8 18 O . O O TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 O (a)(1.2) X .0 ~ 15. . 16. Amount of Line 14 taxable at linealratex.0 45 208180.00 16. 9368.00 17. Amount of Line 14 taxable at sibling rate X • 12 17. 0 . 0 0 18. Amount of Line 14 taxable 0 0 0 at collateral rate X . 15 18. . 19. TAX DUE ....................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 9368.00 15056042115 15056042115 J REV-1500 Ex Page 3 077'16-3648 D d Cs Com lets Address• file Number ece en p DECEDENTS SOCIAL SECURITY NUMBER DECEDENTS NAME BETTY M AUSTIN 077-18-3648 STREET ADDRESS MOORE CIRCLE CITY STATE ZIP CARLISLE PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments (~) 9368.00 C. Discount 488.40 Total Credits (A + B + C) (2) 488.40 3. InteresVPenalty if applicable D. Interest E. Penalty Total InteresVPenalty (D + E) (3) 0.00 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8899.60 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 8889.60 Make Check Payable to: REGISTER OF WILLS, AGENT ~~~~,i~;,.. .. ~~ 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 : ................ ^ Q c. retain a reversionary interest; or ...................................................... ^ ^X d. receive the promise for life of either payments, benefds or care? ............................. ^ 0 2. If death occurred after December 12, 7982, did decedent transfer property within one year of death ^ ^ without receiving adequate consideration? ................................................. X 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? .. ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................... 0 ^ 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 (D) percent [72 P.S. §9116 (a) (1.1) (ii)J. The statute does not exemot 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. §9118(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. §9118(a)(1)J. 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 t~mmon with the decedent, whether by blood or adoption. REV-1509 EX+(01-1D) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY OF: FILE NUMBER: BETTY MAE AUSTIN If an asset became jolnUy owned within one year of the decedent's date of death, it must bs reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. RICHARD C. AUSTIN e. C. IOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST CITIZEN'S BANK SAVINGS ACCOUNT # 6140-272416 8 429 50 00% 215 3 1. A. 8!25/00 , . , CITTIZEN'S BANK CHECKING ACCOUNT # 6100652610 416 9 50 00% 4 708 2. A 8/7/00 , . , CITIZEN'S BANK CERTIFICATE OF DEPOSIT # 6240- 4q 125 50 00% 22 063 3. A 72/8/03 409818 , . , CITIZEN'S BANK CERTIFICATE OF DEPOSIT # 6249- 8 501 50 00% 4 251 4. A 1zn108 182336 , . , CITIZEN'S BANK CERTIFICATE OF DEPOSIT # 6240- 31 026 50 00% 15 513 5. A 11/29/03 410115 , . , VERIZON COMMON STOCK, 124 SHARES ~ 28.83/SH 575 3 50 00% 1 788 6. A 12/31/93 , . , JPMORGAN CHASE & CO COMMON STOCK, 1,011 40 632 00% 50 316 20 7. A 12!31/93 SHARES Q 40.19/SH , . , 6 SHARES -WORTHLESS COMMON IDEARC INC 8. A 12/31!93 , . 0 50.00% 0 US SAVINGS BONDS, HH SERIES, 4 ~ $1,000/BOND 9 A 4,000 50.00% 2,000 0 0 0 0 0 0 0 1 LAKE GEORGE WAY, PUTNAM STATION, NY 12861 TOTAL (Also enter on Line 6, Recapitulation) I = 73.854 .00 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (OB-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER BETTY MAE AUSTIN Thla schedule must be completed end filed H the answer to any of questions 1 lhrouyh 4 on page three of the REV-1500 is yea. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.ATTACHACOPVOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION or~FnicAeu~ TAXABLE VALUE 1. RIVERSOURCE LIFE INSURANCE COMPANY, ANNUITY CONTRACT 2,419 100.00% 2,419 #9920-5865917, RICHARD AUSTIN, BENEFICIARY 0 2. CUMBERLAND CROSSINGS RETIREMENT CENTER, REFUND 139,275 100.00% 139,275 OPTION PAYMENT TO BENEFICIARY, RICHARD AUSTIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on Line 7 Recapitulation) SI 141 694 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX + (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER BETTY MAE AUSTIN Decedent's debb must be reported on Schedule I. A. FUNERAL EXPENSES: 1. EWING BROTHERS -CREMATION, DEATH CERTIFICATES 2. S&S MEMORIALS -STONE ENGRAVING 3. TOWN OF HEMPSTEAD -GRAVE OPENING B. 1 2. 3. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: Attorney Fees: Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation.) r:IAlmAfl} State ZIP Street Address 4. 5. 6. 7. 8. 9. City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Ratum Preparor Fees: IBERLAND CROSSINGS -ROOM CHARGE TO DECEDENT'S REPRESENTATIVE DIMMER -PREPARATION OF INCOME TAX RETURNS OF DECEDENT iISTER OF WILLS -FILING FEE INHERITANCE TAX RETURN 1,884 380 175 0 0 0 0 400 150 80 15 TOTAL (Also enter on Line S If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-09) Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8 LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER BETTY MAE AUSTIN Report deWe Incurred by the decedent prior to death that remained unpaid at the date of death, includlrrg unrelmbureed medkal expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CENTURY LINK -UTILITY BILL 25 2. DR. DARRYL K. GUISTWITE, DO. -MEDICAL BILL 40 3. CUMBERLAND CROSSING -ROOM FEE 50 4. MET-ED -UTILITY BILL 48 5. CONTINUING CARE RX -PHARMACY BILL 38 6. DR. DARRYL K. GUISTWITE, DO. -MEDICAL BILL 236 7. CUMBERLAND CROSSING -NURSING HOME FEES 2,189 8. CONTINUING CARE RX -PHARMACY BILL ~ 9. CARLISLE HMA PHY MGMT -MEDICAL BILL 19 10. CUMBERLAND CROSSINGS EMS -AMBULANCE TRANSPORT 39 11. PINNER 8 ASSOCIATES -MEDICAL 8 12. CUMBERLAND CROSSINGS -FEES 58 13. CUMBERLAND CROSSINGS -FINAL NURSING HOME FEES 1,488 TOTAL (Also enter on Line 10, Recapkulation) I : 4,314 If more apace is needed, insert etltlitional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: BETTY MAE AUSTIN RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY Do Not List Trustss(s) OF ESTATE TAXABLE DISTRIBUTIONS [InGude outright spousal distributions and transfers under Sec. 9118 (a) (1.2).] RICHARD C. AUSTIN 1' 3011 LAKE GEORGE WAY, PUTNAM STATION, NY 12861 SON 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN A80VE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, S If more space is needed, use additional sheets of paper of the same size. PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 Po Box zeocal TAXPAYER RESPONSE ACN 10116254 HARRI38UR6 PA 17128-8601 DATE 03-17-2010 RICHARD AUSTIN 3011 LAKE GEORGE WAY PUTNAM STATION NY 12861-2801 EST. OF BETTY M AUSTIN SSN 077-18-3648 DATE OF DEATH 02-04-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. CITZENS BANK OF PA provided the Department with the infonation 6plew, which has Gaon used in ealeulatinp the potential tax due. Records indicate the! at the Math of the above-prod decedent, You wars a ioint owner/bonaficfary of this account. If you feel the information is incorrect, please obtain written eorroet ion from the financial lnstitution, attach • copy to this fore and return it to tM above address. This account is taxsbl• in accordance with tM Inheritance Tare laws of,the Corenwplth of Pennsylvania. Please call 1717) 787-8327 with euastiens. COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 614 0-27241 6 Dato 08-25-2000 70 ensure proper credit to the account. two Eatablishod eoples of this notiep must aeeomparo psympnt to the Register of Wills. Make chock Account Balene• 6, 428. (r5 paysbl• to ^Rpeistpr of Wills, Aepnt^. Pareont Taxablo X 50.000 NOTEa If tax payments ve rdp within thru Amount Subioet to Tax g 3,214.33 months of the decedent's date of death, TeX Rmt• X .045 deduct a 5 vercpnt discount on the tax dw. Aro Inheritance Tax dw will become delinewnt Potential Tax Duo ~ 144.64 nine months after the data of death. RT P TAXPAYER R PON E A 1 A. ~ The above infonation and tax duo is correct. Remit payment to the Resister of Wills with two eopias of this notiep to obtain a discount er avoid interest, or cheek box ^A" and return this notiep to the Resister of CHECK Wills and an official assssament will b• issued by the PA Department pf Ravanue. C ONE ~ BLOCK B. ~ Thp above asset has boon or will be reported end tme paid with the Ppnnsylvanla Inhpritsnep Tax return ONL Y to by filed by the estate representat ivp. C. ~ Ths above info ~a ion is ineorr ct and/or tlabts and deductions were paid. Cmplpt• PART L'J and/or PART 3~ halve. PART If indicating s different tmx rate, please state 2^ relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Eatablishod 1 2. Account Balonea 2 ~ 3. Porcont Taxablo 3 X 4. Amount Subioct to Tax 4 $ 5. Dobts and Deductions 5 6. Amount Taxablo 6 $ 7. Tax Rat• 7 X 8. Tax Due ~ 8 $ PART DEBTS AND DEDUCTIONS CLAIMED O DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of periury, I declare that the facts I have reported abovo are true, eorroet and complete to the best of my knowledge and boiiof. HOME C ) WORK C ) TAXPAYER SIGNATURE TELEPNONE NUMBER DATE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE euREAU of INDIVIDUAL TAXES AND FILE NO. 21 Po cox zaa6ol TAXPAYER RESPONSE ACN 10116253 lMRRISpuR6 PA 17128-0601 DATE 03-17-2010 imvasati a ,wr ua•ao RICHARD AUSTIN 3011 LAKE GEORGE WAY PUTNAM STATION NY 12861-2801 EST. OF BETTY M AUSTIN SSN 077-18-3648 DATE OF DEATH 02-04-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TD: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. CIT2ENS BANK OF PA provided the Department with the lnfonation below, which has bean used 1n ealeulatinp the potential taz due. Records indieaN that at the death of the above-named decedent, you wan a 3oint owner/baoafielary of this account. If you foal the infonation Ss lneorreetr please obtain written correction from the financial institution, attach a copy to this fora snd return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Coaonwealth of Pennaylvanla. Please call C717) 787-6327 with questions. COMPLETE PART 1 BELOW 1~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6100652610 Account Balmnee Percent Taxable Amount Subject to Tax Tax Rata Potential Tax Du• Dat• 08-07-2000 Established $ 9,415.50 X 50.000 $ 4,707.75 X .04b g 211.85 PART a CHECK C ONE BLOCK ONLY PART TAX To ensure proper credit to the account, two copies of this notice must aeeamparo payment to the Register of Wills. Make cheek payable to ^Rapiaier of Wills. Agent^. NDTEa If tax payments en meda within throe months of the decedent •s date of death, deduct a 5 percent discount on the tax due. Aro Inheritance Tax due will become delinquent nine months after the date of death. A. ~ The abora information and tax due is correct. Remit pdaent to the Rapistar of Wills with two copies of this notice to obtsin a discount or Braid interest, or chock box ^A^ and return this notice to the Rapistar of Wills and an official assessment will ba issued by the PA Department of Rarenua. 8. ~ Tha above asset has been or will be reported and tax paid with the Pennaylrenia Inharitanea Tax return Lo be filed by the estate representative. C. ~ The above into ion ia. incorr ct and/or debts end deductions were paid. Complete PART r 2 and/or PART 3~ bplw. If Sndleatine a difforont tax rata, ploas• stato relationship to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE I. Dato Estsblishod 2. Account Balane• 3. Percent Taxable 4. Amount Subieet to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Dua 1 2 $ 3 X 4 5 6 ~ 7 X e ~ PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID 70TAL CEntor on Lino 5 of Tax ComputatlonJ 4 Under penalties of perjury, I doclaro that the foots I have reported above era true, correct and complete to the best of my knorledpe and belief. HOME C ) WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE BUREAU OF INDIVIDUAL TAXES Po Box zeocol FMRRISBUR6 PA 17126-0601 ecvasas a arv cee-x~ PENNSYLVANIA INHERITANCE INFORMATION NOTICE AND TAXPAYER RESPONSE T FILE N0. 21 ACN 10116255 DATE 03-17-2010 RICHARD AUSTIN 3011 LAKE GEORGE WAY PUTNAM STATION NY 12861-2801 EST. OF BETTY M AUSTIN SSN 077-18-3648 DATE OF DEATH 02-04-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CNECKIN6 TRUST ® CERTIF. CITZENS HANK OF PA provided the Dapartaent with the intonation below, which has bean used in ealculatinp the potential tax due. Records indicate that at the death of the above-owed decedent, you ware a joint wnar/beneficiary of this account. If you foal the intonation is Sneorraet, plassa obtain written correction frw the financial institution. attach a copy to this fora and return 1t to the sbove address. This account is taxable in aeeordsnu with. the Inheritance Tax .laws of the Cowenwulth of Pannsylvanle. Plesse cell C717) 787-BB27 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 624 0-4098 18 Dat• 12-08 -2D03 To ensure prooar credit to the account, two Established copies of this notiea oust aecwparo aayaent to the Rapistar of Wills. Make chock Account Balance 44 ~ 124 . 55 Payable to "Rapistar of Wills, Apent^. Percent Taxable X 50. 000 NOTE. If to payunta era ude within throe Anount Subject to Tax ~` 22, D62. 28 aonths of the decedent's date of death. Tax Rat• X . 045 deduct a 5 percent discount on the tax duo. Arp~ Inharitanca Tax duo will become delinquent Potential Tax Duo $ 992. 80 nine aonths after the data of death. PART A. ~ The above infonstion and tax duo is correct. Resit pairunt to the Re03star of Wills with two eooies of this notice to obtain CHECK a discount or avoid interest, or cheek box ^A^ and return this notiea to the Rapistar of C ONE ~ Wills and an off ieiel assesaaent will be iasuad by the PA Departaent of Ravanue. BLOCK B. ~ Tha above asset has boon or will be reported end tax paid with the Pennsylvania Inharitanca Tax return ONLY to ba filed by the estate roprosentative. C. ~ Tha above info a ion is inearr et and/or debts and deductions wore paid. Complete PART ~ and/or PART 3~ below. PART If indieatinp a different tax rata, please state relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balsnc• 2 ~ 3. Poreent Taxable 3 X 4. Anount SubOact to Tax 4 5. Dobts and Deductions 5 6. Anount Taxable 6 7. Tax Rate 7 X 8. Tax Dua 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED 3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID PENNSYLVANIA INHERITANCE T INFORMATION NOTICE 6URFAU OF INDIVIDUAL TAXES AN D PD HOX 280601 TAXPAYER RESPONSE w-RRISeuRS PA Inge-osol isv-,sa a erP ua-en FILE N0. 21 ACN 10116257 DATE 03-17-2010 RICHARD AUSTIN 3011 LAKE GEORGE WAY PUTNAM STATION NY 12861-2801 EST. OF BETTY M AUSTIN SSN 077-18-3648 DATE OF DEATH 02-04-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST ® CERTIF. CITZENS BANK OF PA vrovided the Department with the infonatlon below, which has been used in calculetino the potential tax duo. Records indicate that at the death of the sbove-naed decedent, you were s ioint owner/beneficiary of this eecount. If you fool the information is incorrect, please obtsln written corroction frog the financial institution, attach a copy to this fen and return it to the above address, This account is taxpble in aeeordsnee with tM InheriLnca Tax laws of the CoMOnwealth of Pennsylvania. Please call (717) 787-1327 with questions. COMPLETE PART 1 BELOW • SEE REVERSE SIDE FOR FILING AN~;_~lIYhEHj_;INSTRUCTIONS Account No. 6249-182336 Dat• 12-D7-2006 To ensure proper credit to the account, two Established topics of this notieo must acewparo Account Halanc• 22 payemt to the Reeister• of Wills. Naka cheek 8 501 ~ . payable to ^Reoister of W111s, Aoent". Perunt Taxable X 50.000 Amount Sub~aet to NOTE: If tax payments are ude within throe Tax $ 4 250 61 • , . months of the deceeent s dsta of death, Tax Rata X .045 deduct a 5 percent discount on tM tax due. Potential Tax Des Aro Inhe ritsnee Tax duo will become delinquent ~` 191.28 nine aonths after the date of death. P r TAXPAYER RESPONSE ~ 1 A. ~ The above fnformstfon end tax due is eorroct. Resit payment to the Register of Wills with two copies of this notieo to obtain CHECK a discount or avoid interest, or chock box "A" end return this notieo to the Register of Wills end an official assessment will be issued by the PA Department of Revenue. C ONE ~ BLOCK B. ~ Tha above asset has bean or will be reported and tax paid with the Pennsylvania Inheritsnee Tax return ONLY to be filed by tM estab roprosantative. C. ~ Tha above info a ion is ineorr ct and/or debts and deductions ware paid. Com let• PART ~2 and/or PART 3~ b l o e ow. PART If indlcatiny a different tax rate, please state relationship to docodant: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 t 5. Debts and Deductions 5 6. Amount Taxable 6 ~ 7. Tax Rate 7 X 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the foots I have reported above era true, correct and complete to the bast of wy knowledp• and belief. HOME C ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE T INFORMATION NOTICE auREAU OF INDIVIDUAL TAxES AND Po amc zsosol TAXPAYER RESPONSE IMRRISaURC PA 17128-0601 ~tv-isa [x err na-m, FILE N0. 21 ACN 10116256 DATE 03-17-2010 TYPE OF ACCOUNT EST. OF BETTY M AUSTIN SSN 077-18-3648 DATE OF DEATH 02-04-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: RICHARD AUSTIN REGISTER OF WILLS 3011 LAKE GEORGE WAY 1 COURTHOUSE SpUARE PUTNAM STATION NY 12861-2801 CARLISLE PA 17013 SAVINGS CHECKING TRUST ® CERTIF. CITZENS BANK OF PA provided the dvartmant with the infonation below, which has boon used fn ealeulstin0 the potential tax due. Records indicate thst at the death of the above-nrad decedent, you ware a joint avnar/beneficiary of this account. If you foal the information Ss incorrect, please obtefn written correction frog the financial inatitutionr attach a copy to this ion and return it to the ebova address. This eeeount is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pmnrilvsnia. Plnse call Q17) 787-/327 with aueations. COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6240-410115 Dat• 11-29-2003 To insure proper endit to the account, two Established copies of this notiea oust aeeo~Paro payment to the Raaistar of Wills. Make check Account Balane• ~ 31, 026.16 priabU to "Register of Wills, Aaent^. Poreont Taxablo X 50.000 15 513.08 NOTES If tax Pavaents aro made within thra• Amount Subjaot to TaX $ ~ months of the decedent's dst• of death, Tax Rato X .045 deduct a 5 Poreont discount on the tax due. 698..09 Aro Inheritanw Tax due will beewe delinquent Potential Tax Dua ~ nine months after the data of death. Par TAXPAYER RESPONSE 1 A. ~ Tha ebova infonation and tax due is correct. Remit pavmen! to the Rapistor of Wills with tro eopias of this notiea to obtain CHECK a diaeount or avoid interest, or ehack box "A" and return this notice to the Rapistor of C ONE ~ Wills and an official assasa.ent rill be issued by the PA Department of Ravanua. BLOCK B. ~ Tha ebova asset has boon or will be reported and tax paid rith the Pannrilvania Inheritance Tax return ONLY to be filed by th• estate rapresentatlva. C. ~ Tha ebova into a ion is ineorr et and/or debts and detluctions we ra Paid. Coaplat• PART ~2 and/or PART ~ below. PART If indicating a different tax rate, please stela relationship to decadent: TAX RETURN - COMPUTATION OF TAX ON JDINT/TRUST ACCOUNTS LINE 1. Data Established 1 2. Account Balance 2 ~ 3. Poreont Taxable 3 X 4. Amount Sub~aet to Taz 4 5. Debts and Deductions 5 6. Amount Taxablo 6 $ 7. Tax Rat• 7 X 8. Tax Duo 6 $ PART DEBTS AND DEDUCTIONS CLAIMED 0 Under penalties of perjury, I declare that th• facts I have reported above aro true, eorroet and complete to th• best of my knowledp• and belief. HOME C ) WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE DATE PAID PAYEE DESCRIPTION AMOUNT PAID V7: Historical Prices for Verizon (;ommunicatians Inc. Cam -Yahoo! Finance Page 1 of 2 Now User? Sign Up Sign In Help Mako YI My Homepage Yahao! Mail YAHOO-~ FINANCE .... .... ,~. x~arch i Web Search Dow ~ 0.23% Nasdaq ~' 0.15% HOME INVESTING NEWS & OPINION PERSONAL FINANCE MY PORTFOLIOS TECH TICKER GET QUOTES rlpanc:et ;ienrch Thu. Apr 22, ZOIp, ?:54PM IShY - U.S. Markets closo In 1br Bruins Verizon Communications Inc. IVZ~ At 2:38PM EDT: 29.21 ~ 0.36 (1.18°~) p,uwsrerra,-aE ~ .., ;:: SC0~7'itdE' ;~! Inten t . $rJaQlnlt~ woe n!p ~t Historical Prices SET DATE RANGE Start Date: Feb 4 End Date: Feb 4 PRICES Date Feb 4, 2010 Get PdO~ Last October, I gave Get Historical Prkes for: 00 ADVERTISEMENT ~~•Daily BREAKING NEWS 2010 Eg. )an 1, zoto ;:;M r°„y 100 Trades 2010 .:. DNiaefxls Only 9 2 Win s my readers 100 stocks that had the best Frst ~ hrevwus !Next ! L.n!zt chance of doubling. Since then, 24 have Open High Low Close Volume AdI more than doubled. Close' 28.98 29.04 28.62 28.63 28,973,800 28.19 ` Close price adJusted for dividends and splits. Ftrsl I Previous I Next ~ Last '~"' Download to Spreadsheet High 529.04 ~~~v 52a.~2 Avg $28.83 D(:7D value = 528.83 X 124 5hs _ $3575 ;w, 4. r` f~ Mika Turner ~f Tar,erQurtrotan %;c+artisement My average return is +63.7ai6 while 92 aut of the 100 stocks are up. Not bad for a free service, Get my next pick here (;opyrighl (i: 20tU Vahno! Inc. AU nghls reserved. privacy Pdiny ~ About Our Ads ~ Terms al Service - CopydptrUlP POYCy • Send Feodt~ack Quotas dslaynd. oxwrpt wfurre indk:aftrri o(hnrwiso Dufay tunas are i5 mmc for NASDAQ. NYSE and Anxz See also delay Umas Iw Odter exchanpea Qwlr•.n aril odrar udormatmo supplied lri uxrenenttent providers idantdr(id wt the Vahtw~ f-manCO paMar Papa QuWOS era rrpdaieA at,tgnatwalty. but wdl bs http://f nance.yahoo.com/q/hp?s=VZ&a=01 &b=4&e=2010&d=01 &e=4&1=2010&g=d 4/22/2010 JYM: Historical Prices for JP Morgan Chase & Co. Common St -Yahoo! Finance Page 1 of 2 New User9 Sign Up Slgn In Help Make Y! My Homepage Yahoo! Mail '~~,Hae~!e FINANCE '.. , seA~cn " ~ ,~ ", ~ W] Web Search Dow 1 0.229b Nesdeq 1f' 0.37a/o HOME INVESTING NEWS 8 OPINION PERSONA!. FINANCE MY PORTFOLIOS TECH TICKER ~~ ~ GET QUOTES finance 7eRrrh lhu. Apr 72, 7.Otq, ?.55i~'RA El)f - U.S. Markots closo in thr Smina JPMorgan Chase & Co. (JPM) At 2:3sPM EDT: 44.77' ~ 0.68 (1.2894) „~..; .. , _ "TRANSFER ~ AMERRRA06 {''.»y..,„ a• FEa:S ~ Interr olvnnr ~ r.. TltAOI s .~711#VI:SIEQ;. Historical Prices Get Hlatoriwl Prices for: L ~, SET DATE RANGE ADVERTI9EMEN7 .;.pa;ly BREAKING Start Date: Feb 2 2010 2olD n 1~ ' _' W~kb NEW5 End Date: Feb 2 2010 ':'Monthly 100 Trades • : • Dividends Only 92 Wins Get Prices Last October, I gave my readers 100 stocks that First i Fhevrous ! Nr;xt ! Last had the best PrucES chance of doubling. Date Open High Low Close Volume Cl~e' Feb 2, 2010 39.80 40.68 39.70 40.55 45,968,500 40.50 Iw. Close prke adjusted for dividends and spUts. ~~' First ! f~revious i Next i Last ''~ Pown)oad.to. Spread..&hRpt Mlk. wwTurner $TREETjgVTIN7R11Y High $40.58 r..~yart+fem.nr Low $39.70 since then, z4 Avg $40.19 have doubled. DC7D Value = My average return is $40.19 X 1,011 Shs +63.7wo while = $40,532 92 out of the 100 stocks are up. Not bad for d re service, Get my next pick here Copynrjhl ~ 2(NU Yahoo' inr, all npMx rCServed. Privacy Pdicy • About Our Ads • Terms d Servke • CopyrlphVlP Ppllcy • 5en4 Feedback Queles delayed, ezcapl where mdrealed atharwise. D.IRy aurae are 'i5 rrnnx for NASDAQ NYSE: and Arne.a 5oe alsa duk+y unvta ra oNer exdwnpes Quoloa ane olhar urtwrrrauon aupnlied W irWeptmdam provniers Wonhfied on Iho Yahoos Finantxi panner page Quufoa me u(xialed aulomaucally. Iwt vnR bu http://finance.yahoo,com/q/hp?s=JPM&a=01 &b=2&c=2010&d=01 &e=2&f=2010&g=d 4/22/2010 IATt: 1•iistorical Arices for II)I"iARC INC -Yahoo! hinance Page 1 of 2 New User? Sign Up Slgn In Help Make Yl My Homepage Yahoo! Mail ~,A-~30C~~® F 1 N A N C E ~ search, _M.~ ..-.~ ,.~ _.~,..»M v_~,~_.A,..~MY»~ , Web Search Dow 1~D.23aPo Nasdaq ? 0.15Wo HOME INVESTING NEWS 8 OPINION PERSONAL FINANCE MY PORTFOLIOS TECH TICKER GETQVOTES r,nanc:r: ,Search Thu Tur. 7.?.LOl(i 2.'.iiiPFJ, IiJ! • U.S. Markets closo in 1hr4minr, IDEARC INC (IAR) on roov ~~: 0.16 0.00 X0.00%1 ' TRANSFER ~+, AMEIIITRr110E '~ ~ ? ~ i~ES ` Inter ~•;~°>` :.,: J Historical Prices Get Historical Prkes for: GO SET DATE RANGE ADVERTISEMENT •i• Daily Stsrt Date: Feb 2 2010 E9' )a" t' - zoto ~ - • Weekly End Date: Feb 2 2010 ~ . ~ Monthly _: Dividends Only Get Prices Historical quote data la unavailable for the specified date range. C:opynghl :+~ zOtO yahoo! hrC fill nphh r,~snrvHd. Privacy Pdicy ~ Alloul Our Ada - Terma or Servltt - fiOPyfi9hVIP Policy • SeeQFeetlbaok 4uotes delayed t>rwepl whern ,ndicafrd olhrlnv,sa Delay t,rnrn a,e i'i m,ns lur NA5DA(J N~Sf: and Amax SNU olsn delay 4rnus for other excMnpas Uuotw and ptlmr rnformuUOn Sup{wett by :ndepandam provrdr)rs Wanlilied on Iha Yahoor fmanrxe peAner peas DUOMS ura irpdaled autumaUCafy. Uut wal by http://finance.yahoo.com/q/hp?s=IAR&a=01&b=2&c=2010&d=01&e=2&f 2010&g=d 4/22/2010 November 14, 2001 Ms. Betty Austin 2 Moore Circle Carlisle, PA 17013 Dear Ms. Betty Austin: We have been reviewing the records for each cottage at Cumberland Crossings Retirement Center and are updating any modifications or changes made to these cottages. The modifications, when meeting the specified threshold, are as follows: A. Greater than $ 250 B. A fixed item (excludes furniture) C. Any construction modifications to the original floor plan The coaesponding monetary amounts will be added to your entrance fee and become part of your refund option when you leave our community. The following are the particulars for your cottage: ' Refund Option 90% Entrance Fee $ 154,750.00 Modifications $ 0.00 Total eligible for refund $154,750.00 If you have any questions or concerns regarding the above mentioned update, please contact me at your earliest convenience. Thank you. Sincerely, Jeffrey Goodling ~ ~ ~ ~ , Chief Financial Officer