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HomeMy WebLinkAbout02-0640 /?- '/6----'l' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 OFFICIAL USE ONLY REV -1500 INHERITANCE FILE NUMBER TAX RETURN RESIDENT DECEDENT 21-02-0640 w <t ~t:CI) u"'''' wo.u IOO u"'~ a.'" a. <t COUNTY COOE YEAR rI NUMBER I- 2: W o W (,) W o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Bowser, Jr., Harland E DATE OF DEATH (MM-OO-YY) 6/25/2002 (IF APPLICABLE) SURVIVING SPOUSE'S NAME Bowser, Lorie L SOCIAL SECURITY NUMBER 175-66-3279 THIS MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-OO-YY) 12/31/1968 ,... z w o z o a. U) w '" '" o u 1. Original Return 0 2. Supplemental Return 4. Limited Estate 0 4a. Future interest Compromise 6. Decedent Died Testate 0 7. Decedent had Living Trust o 3. Remainder Return o 5. Fed. Est. Tax Return Req'd 0_ 8. Total number of SDB's 9. l~g'tion Prooeeds Reed 10. Spousal Poverty Cred~ 11. Eleotlon to tax wi Seo. 9113(A) .....N...... i!:fllc~l*~WlRiroilti~T..;l$tlpt.iOOlijfI~DI:K:.:]I.itt~~~ ............: itdlb'tN@@@i@ NAME. COMPLETE MAILING ADDRESS. Patricia R. Brown FIRM NAME. TELEPHONE NUMBER 717 -249-3024 Patricia R. Brown, Esq. 10 W. Pomfret St. Carlisle, PA 17013 ,. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3.Closely Held COlJlOfation, Partnership or Sole-Prop. 4. Mortgages & Noles Reoeivahle (Schedule 0) ~ash' Bank Deposfts & Misc. Personal Prop~ 6. Jointly OWned Property (Schedule F) Separate Billing Requested 7. Inter-Vivos Transfers & Misc. Non-Propate Prop. 8. Total Gross Assets (Iotalllnes 1-7) 9. Funeral Expenses & Administration Costs (Sch H) 10. Debts of Decedent, Mortgage liabilities, & Liens 11 . Total Deductions (total lines 9& 1 0) 12. Net Value of Estate (line 8 minus line 11) 13. Charilahle and Governmenlal Bequests/Seo 9113 Trusts for which an election to tax has not been made (13) 14. Net Value Subject 10 Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amnt of Line 14 taxable at the spousal rate, or lransfers under Soo.9116(.)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxabte at collateral rate 19. Tax Due 20 CHECK HERE If YOU ARE REQUESTING A.REFUND OF AN OVERPAYMENT II 'llimi)lliiiW@MI1i)ii~_:I!ifllR~~~m$j$JWaOO./ll~$.I!;f~~ft_"'..". ~-, C"" 2: o i= ~ ::l l- ii: <( u W 0:: (1) (2) (3) (4) (5) (6) $O.orr $0.00' .'OFFIC $0.00 $500.00 $0.00 ..... ex; (7) (9) (10) (8) $6,679.83 $548.70 $500.00 (11) (12) $7,228.53 ($6,728.53) z o S :::J a. ::; o o )( ~ ..0_ x,045 x'12 x.15 (15) (16) (17) (18) (19) $0 $0 $0 . USE ONLY "J -~ $0.00 $0.00 $0.00 $0.00 $0.00 ':'::':""U@@dfittnmlUWWJWi -0 ecedent's Comolete Address: (STREET ADDRESS 245 Pine Grove Road CITY STATE ZIP Gardners PA 17324 Tax Payments and Credits: 1. Tax Due 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discounts ilj Total Credits (A+B+q (2) 3. Interest/Penalty if applicable O. Interest E. Penalty 4 TotallnterestlPentalty (O+E) If Line 2 is greClter than line 1 "* Une 3, enter the d(ffel"enOO ThiS is tt'\e OVERPAYMENT. Check box on Page 1 Line 20 10 request a refund (3) (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax dUe. (5) (5A) (5B) $0.00 $0.00 $0.00 $0.00 a. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT m~mrnt~~~fMnmmr%nwt:m%mmmmm~mm%t;%%tl%1tTKMW~.rt.~~~.K~.wwnn.~.f.~.t.fMKt%tmmK%t:%1~%X~lltt~%~DtNHW%1%t~mWWW~WrM:rWW#%Wim~~~~t%W~ 2. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN 'X' IN THE APPROPRIATE BLOCKS Did decedent make a transfer and' yes o o -0 o o -CJ -CJ a. retain the use Of income of the property transferred- b. J(;l",in the right to designate who shan use the property transerred or Its income c. retain a reversionary interest: or d. retain the promise tor lite of either payments or care? If death occurred after December 12, 19a2, did decedent transfer property within one _'Iear of death without receivmg adequate consideration? 3 4. Did decedent 0YIl1 an ''In truSt to(' Of payable upon death bank account or secunty athls Dr Mf death) Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefICiary disigoation? no I!:J I!:J ~ I!:J I!:J K:J .~ IF THe ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Declaration of preoarer other than the pe~ooal reor~ntative is ba$ed on all information of which oreDarel ha$ anv KoOW\edae SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete ADDRESS DATE SIGNAnJRE OF PREPARER OTHER THAN REPRESENTATIVE '.-U-c,' '>f' ~ ,~, ".....-..- ADDRESS 10 West Pomfret Street, Carlisle, PA 17013 DATE '7- 7 - 2003 For date-sot death on or after July 1, 1004 and before January 1, 1995, the lax rate imposed on the net value ottransfers 10 or for the use of the- sUfViYing spoUSE' is 3% [72P,S, Sec_ 9116(a)(1.1)(1}] For dates of death on or after Januaxy 1. 1995, the tax fate imlJO~Qf\the net value cl tliln'<ifers to 01 tOI 'l'ne use of the su-rvM-ng spouse is O'ro 172 P.S_ St:!c_ 9116(a}(1,1)(1i)1 The statute does not exempt a transfer to a sUfVMng spouse- from tax, and the- Statl.itory requirements for disclosure of assets and filing a tal{ return are still applicable even if lt1e surliving spouse is the- onlybeneficiaf'j For dates of death on or after Jyly 1, 2000 The tax rate imposed on the net value Of transrers from a deseased child twenty-one years of age or younger at death to or for the use of a naNr.i1 parent, an adoptive pan;nt. or a stepparent of the child is 0% [72 PS_ Sec, 9116(a.}(1.2)] The tax rate imposed on the nel value of transfers to or for the use of the decedenfs lineal beneficiaries is 4,5%, e~cept as noted in 72 PS_ See 9116(1,2) [72 P_S_ Sec9116(a)(1) Ttletax r..tll'jmpQ5~ Qn ttl", nfrl:v...IIJ'iloftriln~l'itQ QflQrth'! 4.j~'" ofth"'''''ilc;edltnf~~i;llin9$ i'i 1~ [72 PS Sfoc911Q:(a)(1~] A $,lQling i..l;i~jned, under$'il-ction ilI102~ illcO-'.In individual who has at least one parent in common with the de<::ed:ent, whether by blood or adoption. SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY ESTATE OF FILE NUMBER Harland E.Bowser,Jr. (All property jointly-o\\oTled with Right of Survivorship must be disclosed on Schedule F) ITEM DESCRIPTION NUMBER 21-Q2-D640 VALUE AT DATE OF DEATH I FOR INFORMATIONAL PURPOSES: Decedent's father, Harland E. Bowser, Sr., of 1722 Baltimore Street, Dillsburg, PAl 70 19 is in possession of decedent's motorcycle and several guns To date, after repeated requests, Mr. Bowser, Sr. has refused to return the motorcycle and guns to the Executrix (and surviving spouse) of the estate, Lorie L. Yost Bowser. 2 OM Truck (1985) r $500.00 TOTAL <ilio online 5, R=pitu1ahon) $500.00 SCHEDULE H FUNERAL EXPENSES. ADMINISTRATIVE COST~ AND MISCELLANEOUSEXPENSES ESTATE OF FILE NUMBER Harland E. Bowser, Jr. (All propt.'I1y joint1y~owned with Right of Survivorship must be disclosed on Schedule F) 21 ~02-0640 c. ITEM DESCRIPTION AMOUNT NUMBER Funeral Expenses: I Cocklin Funeral Home $5,486.20 2 Open/Close of grave $500.00 Administrative Costs: I Personal Representive Commissions Social Security Number of Personal Representative: 2 Attorney fees to Patricia R. Brm\1l $500.00 3 Family Exemption Claimant Relationship: Address of Cjaimanl at decedent's death: Street: , - City: Slale & Zip 4 . Probate Fees to Register of Wills $33.00 Miscellaneous Expenses: I The Sentinel $77.63 2 The Cumberland Law Journal $75.00 3 P A State Police - copy of accident report $8.00 4 5 6 7 8 9 10 II 12 13 14 15 16 17 TOTAL (also on line 9, Recapitulation) $6.679.83 A. B SCHEDULE I DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUMBER HarlandE. Bow5el.Jr. 21 "02-0640 ITEM NUMBER DESCRIPTION AMOUNT Supportarrearages.due Aclm;ns'mtrix (CourtjJf Common Pleas of Cumberland County Docket No: 00190 S 2002) $548.70 ,- TOTAL (also on line 10, Recapitulation) $548.70 SCHEDULE J BENEFJClARIES ESTATE OF FILE NUMBER ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER OF ESTATE I Lorie L. Yost Bowser wife 100% 245 Pine Grove Road Gardners. PA 17324 HarlandE. Bowser. Jr. -21-02-1)640 ,- ITEM NAME AND ADDRESS OF BENEFICIARY NUMBER AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: TOTAL CHARIT ABLE A..~D GOVERNMENTAL BEQUESTS (also ~nter on line 13, Recapitulation) $0 Name of Decedent: Date of Death: Will No. _STATUS REPORT UNDER RULE 6.12 Harland E. Bowser~"~ & June 25, 2002 21-02-0640 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes. X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X Filed Family Settlement b. The separate Orphans' Court No. (if any) for the personal representative is: Co Did the personal representative state an account informally to the parties in interest? do Yes X No Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ,2004 Patricia R. Brown, Esq. 10 West Pomfret Street Carlisle, PA 17013 Phone: 717-249-3024 Capacity: Counsel for personal representatives PETITION FOR GRANT OF LETTERS OF ADMINISTRATION fr'':;:, Estate of Bgwser Jr., Harland E. also known as Howie Bowser No. 21-02- uU.O To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania DeceasE/" Social Security Nn.'.-l'15 -( flj!- v?') '7 l12B The petition of the undersigned respectfully represents that: Your petition (s), who is/are 18 years of age or older, appl ies c PIZ0> (d.h.n.; pen knle litc; dur;:lnle absentia; durante Jllin(l~i!:l[eJ the above decedent. for letters of administration on the estate of Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 245 Pine Grove Road, Gardners PA. Oist street., number, Twp. or Bora.) Die kinson Twp. Decedent, then 33 years of age, died _ June 25 ,X9<: 2002 at Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: Petitioner__ after a proper search ha_ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship Residence Lorie L. Yost Bowser Wife 245 Pine Grove Rd, G Ch e 1 s ey D. Bowser Dau<<hter same DFllton L. Bowser Son same , - ardners PA 17324 THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. l?i 0 .t ((00~ e'l;, w ( ~ ~ oj -g.g <'$'::: ~~ "~ " 0 ~ ., Vi ll-lS.cr OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF C.IIMRF.RI.AND } 55 The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. 1 /, (/--;<i(j-Lz fJ ""'- Register l~ II ~1(rJ-t ~wjJQr:.. ( j ~ , '1l' ~ ;:l - .. ;, <is ( '- Sworn to or before me this JULY' affirmed and subscribed 1 6th day of No. 2.1.02. lo"lO Estate of HARLAND E. BOWSER, JR. , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW JULY 16,2002 W 200?inconsiderationofthepetitionon the reverse side hereof, satisfactory. proof having been presented before me, IT IS DECREED that Lorle L. Yost tlowser is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to Lorie L. Yost Bowser in the estate of Harland E. Bowser. trg-- FEES Letters of Administration $ Short Certificates( ).,.".,... $ Renunciation ,....,.......... $ jcp $ TOTAL _ $ Filed . J: ! ?,-,~~02.. .. , ..' A.D. 25.00 3.00 Patricia R. Brown 27474 AlTORNEY (Sup, Ct. LD, No.) 10 W. Pomfret St, Carlisle ADDRESS 717-249-3024 PA 17013 5.00 33.00 19_ called atty 7-16-2002 PHONE rrp~T " -~ ~~- This is to certify that the information here given is correcdy copied from an original ce~tificate of death du~~ tlledwith me as Local Registrar. The original certificate will be fOlwarded to the State Vital Records OffIce for permanent hllllg. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certiflcate, $2.00 !!""fflflfN///,.-",.-" \1111\11~"'\\" OF PE~'---___ ",.;ji.~.:f""", ~ -~ .. ~- i'~~- ~\ ,~I . ..~ \":P~ !~I .. __ 1;2:~ ~f~I~. ..' .'/:...... /~f '" a > ..,-.. /-......I~ \.~, ,,~-..,l ~_~ _A~l -----:ftMENT ~\ ~':-:"" """""/Nff/flll'lllll ~aAA'~ l'ocal Regi ~A.J - JUL 02 1002 P 8502466 Date No. HI0!l.IQ~.._m1 COMMONWE~LTH OF PENNSYLVANIA. DEPAR,.MEN" Of HEALTH. VI,.AL RECORDS CERTIFICATE OF DEATH' .........CIFO!;~OEtI'\"\l'Q.._...-. Harland loOEiUoIlIi<I>tIr,j lIND'EA1'rV.'l - """ -~~ 8OXtAI.8I:CIJAl'tYIlIJl4l!A OonOf'~(Monf1.o.-,.~ ~. June 25, 2002 l. Male So 175 - 66 - "".JlCl! DeAIlip,oolo _-__~_ """'" ~O ~O E. Jr. 3279 ~""- _ofF<>t"",,~ UtIDEA' 0,.- -1- ~XJStre 7 Okarche, OK HAI<ollill""'--.......C;'O_O(IOj~ 33 ~~~ =. H Juniata County ~8U8UAl0CC\JPlllnCll0l KINDOf' ';~~'t,:"~""1 ." Truck Driver 11~. Transportation ~HrS"""l..lHG,I,l)()AliS8~~_Z;pCOClfl \Jhite ,. ~-IWUl."",- --.-. -- Married Lorie 'Washlngton 1Wp. S~SPOUSf: "'_.:;.0__ ;,.. Yost ,~. York ~ - ~.. ~ "..0::.....~=0I loICtl1liIl'S_IFnl.-,_"""*"ol Janie D. Hayward AOOI'lI!I$(9hoI. ._. 1722 Baltimore Pike, Dillsbur OF ._01 ~ ._- , PA 17019 _..n..00d0 ~ 1722 Baltimore Pike ,.. Dillsburg, PA 17019 !'<IIlltER'S_f'o1l.._."-' '.. Harland E. Bowser, Sr. I'fl'OIlt,I.I.HS_(f~ MI'. Harland E. Bowset", Sr., IlE. 3OO.ChestI1Jt St. Dillsblr PA 17019 \.lC9I8lM\lIoleEPl OonflG/olEo iM<>nI\Oay,-, ~ o . , l _ ~[J _""",_0 ~DOIM<~ ." llsbIrg (;egete-ry-Golf Coorse 'Rd. N.o.M~AHO OFI'IO.CllJT"I' Dillsburg, PA 17019 1, 2002 L/CliNSENUMBEA FD-012975-L SlIIYlCl!l.JCeISUOfIpfI'\ ~~ ~::,~,-"._h"""""'''''''_,cIO''.,,"_'''''''' ~ TIME Of"DEmI olCl'tP'AOi'lOU EO DliAojlol<wOl>. 0.-" ~ . {,,'I5' M -:s; if; "{.bd 17. I'MT I, EroooI...._....-..oomplIco___""'_.Do""'_...._oI~........cotdIooO..'"""""""........_.._~. ~...._~_..... ......c.o.seltEI'liAAlEo MliDICAI.ExAAlINE ~18 ~D ,==- ;-.....- i "",,""K, 0Ih00r.....-__...............1o_,b<A ""'~...""'~_ifo'O'I...,.,..,.TI [' "'f TllolEOFINJ\>>lY WI!....MffOI1'S1.o1ND1NGS .........~ro -~- ~~ MANNEflOf'DEArn Of:8Cfllllli:NCMrIN.AJ!lYOCCUFlAEtl lIaWlHf - o o o !;l o - .-- eo.iI<l_bo_ - ~O ~Ij/f - 8. o I'\.AC!Of'IOoWI'IY.Aj --- *. - ~~O<iy- .~~~~_oI___~....~_on</"""""'"'*'_Z3l ~...._oI.,.,..........___IO.........)____. ~ o . ~ j .~AN(I~~~_~_on</<Oo'IfyIngIo_"~ ~"'"_oI""'............,__..__._._..-.__..""'--tol......___...... ~"'-"'- Onltoo_lIf...-....uor-....-.ln"'l'....n.....,__..IIIOI_._._p1_._"".,..IIIO-..J_ ...-..-..............,........................,.............,...,....................................,... ., ~o, /7xs- .19j ;:( ctJ ;L, M. j CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Date of Death: HARLAND E. BOWSER, JR. JUNE 25, 2002 Name of Decedent: Will No. Admin. No. 21-02-0640 To the Reg is ter : I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the;above-captioned estate on Name Address Lorie L. Yost Bowser 245 Pine Grove Road. Gardn"rs PA 17324 Dalton L. Bowser 245 Pine Grove Road. Gardn"rs PA 17324 Chelsey D. Bowser 245 Pine Grove Road, Gardners PA 17324 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except N/A Da te : 1 /0 3 /0 2- I I '{]I~ '-K ~ Signature Name Patricia R. Brown Address 10 West Pomfret Street Carlisle PA 17013 Telephone (717) 249-3024 Capacity: Personal Representative x Counsel for personal representative \. /?- 76- ;1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 January 3, 2003 Telephone (717) 787-3930 FAX (717) 772-0412 Patricia R.Brown, Esq. 10 West Pomfret St. Carlisle, Pa.17013 Re: Estate of Harland E. Bower Jr. File Number 2102-0640 Dear Ms Brown: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before September 25,2003. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. Sincerely, . . <~?l? . .... f . :/' //J/Jp' /.,,~'! .."'.' -- I", Jeffrey Hollenbush, Supervisor Document Processing Unit Inheritance Tax Division 1"')-'7$- <J ~ BUREAU OF INDIVIDUAL INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 TAXES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX PATRICIA R BROWN lOW POMFRET ST CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUIITY ACN 09-22-2003 BOWSER JR 06-25-2002 21 02-0640 CUMBERLAND 101 *' REV-1541 EX AFP (Ol-O~) HARLAND E PA 17013 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO CDURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BOWSER JR HARLAND E FILE NO. 21 02-0640 ACN 101 DATE 09-22-2003 TAX RETURN WAS: (X> ACCEPTED AS FILED CHANGED If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of alh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) .00 .00 .00 .00 500.00 .00 .00 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 6,679.83 548.70 (9) ClO) 11. 12. 13. 14. Total Deductions Net Value of Tax Return Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subject to Tax NOTE: 16. Amount of Line 14 17. Amount of Line 14 14 Cl5) .00 X 00 (16) .00 X 045 = Cl7) .00 X 12 Cl8) .00 X 15 (19)= 18. Amount of Line taxable at Lineal/Class A rate at Sibling rate taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS. NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. (8) 500.00 (11) Cl2) (13) (14) 7.??R J;~ 6,728.53- .00 6,728.53- .00 .00 .00 .00 .00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE 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), 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 any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class 8 (collateral) rate on any such future interest. PURPOSE OF NOTICE; To fulfill the require~ents of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9l40). PAYMENT: Detach the top portion of this Notice and subMit with your p8ywent to the Register of Wills printed on the reverse side. --Make check or ~oney order payable to; REGISTER OF MILLS.. AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, lIIay be requested by co.pleting an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24~hour answering service for forms ordering: 1-800~362~2050; services for taxpayers with special hearing and I or speaking needs: 1~800-447.3020 CTT only}. OBJECTIONS; 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 must object 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 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR ~~appeal to the Orphans' Court. ADHIN~ 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, Dept. 280601, Harrisburg, PA 1712B-0601 Phone (717l 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. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5X) discount of the tax paid is allowed. PENALTY; The 15X tax amnesty non.participation penalty is computed on the total of the tax and interest assessed, and not paid before January IB, 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 (9) 1I0nths and one (I) day from the date of death, to the date of payment. Taxes which became delinquent before January 1. 19B2 bear interest at the rate of six (&X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January I, 19B2 will bear interest at a rate which will vary frolll calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19B2 through 2003 arB: Interest Daily Interest Daily Interest ~ ~ Year Rate Factor Year ~ Daily Factor ~ 19B2 20X .000548 1987 '" .000247 1999 7% .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 '" .000247 2001 '" .000247 1985 13% .000356 1993~1994 7% .000192 2002 6% .000164 19B6 10% .000274 1995~1998 9% .000247 2003 5% .000137 --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 .ust be calculated. f ~ FAMILY SETTLEMENT AND FINAL RELEASE IN ESTATE OF HARLAND E. BOWSER, JR. c-; (File No. 21-02-0640) ~ " ~__ KNOW ALL MEN BY THESE PRESENTS, that ~ ~-` WHEREAS, Harland E. Bowser, Jr., late of Gardners, Cumberland County, Penlvania, deceased, died intestate on June 25, 2002; WHEREAS, letters of administration on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Pennsylvania, to Lorie L. Yost Bowser, Adminstratrix, hereinafter called personal representative; WHEREAS, the said personal representative has gathered the probate assets of the estate of the said decedent and the said assets consist of only personal property; to a total value of $500.00, as set forth in Exhibit A, which is a statement of account of the said personal representative, and which is attached hereto and made a part hereof, and marked Exhibit A; WHEREAS, the debts and deductions amount to $7,228.53, leaving no balance for distribution, also asset forth in the statement of the said personal representative, which is attached hereto and marked Exhibit A; WHEREAS, the following is a list of all known unpaid creditors, said creditors having been informed by letter of the insolvency of the estate, and the amount of their claims, which will not be paid due to said insolvency: Name Amount Court of Common Pleas of Cumberland County (support arrears) $ 548.70 NOW, THEREFORE, KNOW YE, that I, Lorie L. Yost Bowser, being the wife of the said decedent, and being that person entitled to inherit under the intestate laws of Pennsylvania, do hereby each of us, acknowledge that due to the insolvency of the estate, there are no funds for distribution; Page 1 of 3 1 AND, I do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, I each agree that no filing of an account is necessary. IN WITNESS WHEREOF, I have hereunto set my hand and seal this / 8 ~ day of iT`~ ~ , 2004. Witness: (SEAL) t,1 ' LORIE L. YOS OWSER COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. p~ f~ On this, the ~a day of , 2004, before me, a notary public, the undersigned officer, personally appeared Lorie .Yost Bowser (known to me or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~~~ , Notary Public SEAL A8N B. SENSENICH, NOTARY P""1.1 CARLISLE BORO. CUMBERLAh~ ;".':;':;aT MY MMISSI011~ EXPIRES MAV + ^ ° 7 Page 2 of 3 1 ~~ EXHIBIT "A" STATEMENT OF ACCOUNT OF LORIE L. YOST BOWSER Adminstratrix ASSETS: 1. Personal Property: GM truck (1985) $ 500.00 TOTAL ASSETS $ 500,00 DEBTS and DEDUCTIONS: 1. Deductions: Funeral Expenses $ 5,986.20 Administrative Costs $ 693.63 Total Deductions $ 6,679.83 2. Debts: Court of Common Pleas of Cumberland County, PA $ 548.70 (support arrears) Total Debts $ 548.70 TOTAL DEBTS and DEDUCTIONS $548,70 Balance for Distribution to Heirs: None ($6,728.53) HEIRS: Lorie L. Yost Bowser Page 3 of 3