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Home My WebLink About07-07-10~~ - q~~ FAMILY SETTLEMENT AND FINAL RELEASE IN ESTATE OF MARY R. MELVIN, DECEASED KNOW ALL MEN BY THESE PRESENTS, that WHEREAS, MARY R. MELVIN, late of Hampden Township, Cumberland County, Pennsylvania, deceased, died testate on July 20, 2009, having made her last will and testament, which was duly executed on October 15, 2004; WHEREAS, letters testamentary for the estate of the said decedent were duly issued on October 5, 2009, by the Register of Wills of Cumberland County, Pennsylvania, to GERALDINE M. MELVIN, Executrix, hereinafter called personal representative, for the Estate of MARY R. MELVIN, Number 21-09-0932; WHEREAS, the said personal representative has gathered the assets of the estate of the said decedent and the assets consist of personal property, as set forth in Exhibit A, which is the estate tax return prepared by the said personal representative, and which is attached hereto and made a part hereof, and marked Exhibit A; WHEREAS, the debts, including the payment of inheritance tax in the said estate, have been paid; WHEREAS, the balance for distribution has been reduced to cash and has been distributed as herein indicated in accordance with the last will and testament of the said decedent; Q O :;3 T~:i _....Z r'}~; ; 7 "~7 1 5 J y ~ r `'~ 1 ~ t~~ NOW, THEREFORE, KNOW YE, that we, VALERIE M. GREEN, ELAINE D. CONNOLLY, DAVID L. MELVIN, SEAN MELVIN, and GREG MELVIN, being the testamentary heirs of the said decedent, and being the persons entitled to inherit under said last will and testament, do hereby, acknowledge that we have this day had and received from the aforesaid personal representative, in full satisfaction and payment of all sum or sums of money, the amount due him or her under said last will and testament, as illustrated in Exhibit A, which amount he or she has received this day, and which amount, or proportion, is set opposite his or her name in the table and schedule of distribution in said statement attached hereto and marked Exhibit A, unless modified herein; AND, we do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, we agree that no account is necessary and we do hereby agree that we consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphans Court Division of the Court of Common Pleas, Cumberland County Branch. THEREFORE, we do hereby remise, release, quitclaim and forever discharge the said personal representatives, their heirs, executors, and administrators and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent, and we do further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this agreement, we do hereby covenant and agree that we will contribute our share of the estate to 2 satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate or the aforesaid personal representative after the signing, sealing and delivery of this family settlement agreement and final release. IN WITNESS WHEREOF, WE, VALERIE M. GREEN, ELAINE D. CONNOLLY, DAVID L. MELVIN, SEAN MELVIN, GREG MELVIN, and GERALDINE M. MELVIN, Executrix, hereunto set our respective hands and/or seals on the date indicated beside our respective names; WITNESS: ~~~ (SEAL) 7~/-~~Date) VALERIE M. GREEN ELAINE . CONNOLLY )1 2. v _ // / (Date) DAVID L. MELVIN w. ~i. /f `~- (SEAL) ~- l /~ (Date) SEAN MELVIN (SEAL) 7 " ~ ~ ~~ (Date) GREG MELVIN ' (Date) GERALDINE M. MELVIN, Executrix 4 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND : t ~ On this, the ~ `~ day of , 2010, before me, a Notary Public, the undersigned officer, personally appe ed VALERIE M. GREEN, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. NO RTA IAL SEAL ~ ~ ~(. ~ ~.. CAROIE A ROSE Notary Public Notory public LOWER ALLEN TWP, CUMBERLAND COUNTY My Commission Expires: ~ • ~-+ 1 My Commission Explrea Dec 6, 2011 -~--~~.. COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND On this, the ~ ~ day of , 2010, before me, a Notary Public, the undersigned officer, personally appe ed ELAINE D. CONNOLLY, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. NOTARIAL SEAL CAROLE A ROSE Notary Public LOWER ALLEN TWP, CUMBERLAND COUNTY My Commtaalon Expirsa Dec 6, 2011 Notary Public My Commission Expires: ~C • ~-t, ~(~ 5 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND : On this, the ~ ~ day of ~ , 2010, before me, a Notary Public, the undersigned officer, personally appeared DAVID L. MELVIN, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. NOTARIAL SEAL ~ ~~ CAROLE A ROSE Notary Pub11c LOWER ALLEN T1NP, CUMBERLAND COUNTY Notary Public My Commlaalon Explrea Dec 6, 2011 My Commission Expires: ~C • (..p ~ ~~' COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: f On this, the ~ S` day of~~_, 2010, before me, a Notary Public, the undersigned officer, personally appeared SEAN MELVIN, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. NOTARIAL SEAL ~ ~ ' '"~" 'l ~-- CAROLE AROSE Notary Public Notary Public LOWER ALIENTWP,CUMBERLAND000NTY My Commission Expires: ~C . L.Q 1~ My Commlaalon Explrea Dec 6, 2011 6 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND . SS: On this, the ~_ day of , 2010, before me, a Notary Public, the undersigned officer, personally appea ed GREG MELVIN, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. NOTARIAL SEAL l )1 l A 1\~ i] V I i CAROIE A ROSE \ V~V~JII1~~..__.. V~ 1'~u Notary Public Notary Public LOWER ALIENTWP,CUMBERLAND000NTY M Commission Ex Ir ~CL- ~.Pt Z.~<< My Commisston Expires Dec 6, 2011 Y p' es: COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: On this, the ~ ~ day of , 2010, before me, a Notary Public, the undersigned officer, personally appea d GERALDINE M. MELVIN, Executrix, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. NOTARIAL SEAL ~ ~ A ,~~~ ~ ~ ^ CAROLE A ROSE J~-9~/ ~\ ~..(_J Notary Public Notary Public LOWER ALLEN TWP, CUMBERLAND COUNTY My Commission Expires: ~ - C,, , 20 ~ ~ My Commisston Explrea Dec 6. 2011 7 J 15056051058 REV-1500 EX (os-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of ItMividual Taxes County Code Year Fb Number PO BOX 280801 INHERITANCE TAX RETURN Hanieburg, PA ~nZa-oeot RESIDENT DECEDENT 21 09 0932 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 180-28-2072 07/20/2008 11 /04/1917 Decedent's Last Name Su(Bx Decedent's First Name Melvin MI Mary R (HAppliwble) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRUITE OVALS BELOW • 1. Original Relum 2. Supplemental Retum 3. Remainder Relurn (date of death 4. Limited Estate Prior to 12-13-82) 4a. Future Interest Compromise {date of death after 12-12-82) 5. Federal Estate Tax Return Required 6. Decedent Died Testate 7. Decedent Maintained a Livin Trust (Attach Copy of Will) (Attach Copy of Trust) 9 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between 12.31-9t and 1-1-95) ti. Election to tax under Sec. 9113(A) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number James W. Kollas (717) 731-1800 Firm Name (ifAppllcable) ru Kollas and Kennedy REGISTE~ bfILLS USE ~-Y ',' ~'y CCJJ~ ~ ' First line of address ' ~ - ,z~ x~ 1104 Fernwood Avenue -`~ i-n - -~ Second line of address _ - Suite104 -~~`tn ~ - ~.~ ,_~1 ~ rt Clty Of POSt O$ICB State ZIP Code Di~ FILED fV ~i C-~ Camp Hill PA 17011 •-.I ; Correspondents a-mail address: jamesl~kollasandkennedy.com Under penakiea of perjury, I deGere that 1 have examined this relum, includl accom it is trya, cortect and complete. t')edaratbn of n9 panying schedules antl statements, and to the beat of my knowbtlge and belief, !! l1 PJaparer oth~clFan the personal representative is based on all informatwn of whkh preparer has any knowledge. SIGI~I~tE OF PERSON RESPON9IBL FILIN Ti iou- ADD ER SS ---`~11v+llii(c~'1.._.:-,(-_ __._---~ -- ~~-_ a , z~-- -- _ __ _ _ _ _ - Tl~'. to _ SIGNATUF3EpgR OTHER THAN REPRESENTATIVE --- ~- ~ ~-~ - AQ6!/ !/ DATE - - ._ RESS _ _ _ ~~I~~v - ..-- - _ //o~i ~e~,, mow:, e,/ ; ~ c C"u ..r r f/7/ i4 / ~v// L 1 505605 1 058 Slde 1 15056051058 J 1505ti05L059 REV-1500 EX Decedent's Social Security Number Decadence Nams: Mary R Melvin 180-28-2072 RECAPITULATION 1. Reai estate (Schedule A) ......... ................................ .... 1. 0.00 2. Stocks and Bonds (Schedule B) ....... ............................ .... 2. 0.00 3. Closely Held Corporstlon, Partnership or Sole-Proprietorship (Schedule C) . .... 3. 0.00 4. Mortgages 8 Notes Receivable (Schedule D) ......................... .. . . 4. 0.00 5. Cash, Benk Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 25,915.68 6. Jointly Owned property (Schedule F) Separate Billing Requested .... ... fi. 8 876 60 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property , . (Schedule G) Separate Bllting Requested..... ... 7. 0.00 8. Totsl Gross Assets (total Lines 1-7) .... ............................. ... 8. 34,792.28 9. Funeral Expenses 8 Administrative Costs (Schedule H) .................. ... g, 8,021.23 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...... 10 ....... ... . 360.38 11. Total Deduetiona (total Lines 9 & 10) .... ............................ .. . it. 8,381.61 12. Nst Vslua of Fatale (Line 8 minus Line 11) . ...... ............... . 13. Charitable and Governmental Bequests/Sec 9113 Trusts for wh~h . .. 12. 26,410.67 an election to tax has not been made (Schedule J) .................. 13 .... .. . 0.00 14. Nat Value SubJact to Tax (Line 12 minus Line 13) ................... . .. TAX COMPUTATION • SEE INSTRUCTIONS FOR APPLICABLE RATES .. 14, 28,410.67 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) x .o_ is 16. Amount of Line 14 taxable . at lineal rate X .off 26,410.67 1g. 1 188 48 17. Amount of Line 14 taxable at sibling rate X .12 78. Amount of Line 14 taxable 17 at collateral rate X .15 ifi 19. TAX DUE ......................................... ........... . ts. 1,188.48 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT t_ 15056052059 Side 2 15056052059 REV•1500 EX Page 3 Decedent's Complete Address: FIM Number 21 09 0932 Hoary R Melvin "` STREET ADDRESS 4837 East Trindle Road cITY Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credk B. Prior Payments C. Discount StxIAL SECURITY NUMBER 180-28-2072 j ZIP - FA ; 17050-3680 (1) 1,188.48 3. InteresUPenalty if applicable Total Credits (A + 9 + C) (2) 0.00 D. Interest E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal InteresUPenalty (D + E) (3) 0 00 Fill in oval on Pegs 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. l5) 1,188.48 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 1,188.48 Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer d• an . a. retain the use or income of the ro P party transferred :.................................. Yes ^ No b. retain the right to designate who shall use the property transferred or its income : ............................... ............. ^ c. retain a reversionary interest; or ......................................... . d. receive the promise for life of either payments, benefits or care? .................. ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......... 3 Did decedent "i " . own an n trust for or payable upon death bank account or security at his or her death? .. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ............ wntains a beneficiary designation? ............................................................................................................. ........... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate Imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)). The statute does not 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-ane years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent (72 P.S. §9116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)J, Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF scN~ou~e E CASH, BANK DEPOSITS, 8 MISC. PERSONAL PROPERTY Mary R. Melvin FILE NUMBER 21-09-0932 Include the ploC@eds of Iltigatlon and Me date the MnrtnaAs Wye ..~w:.ew ~....~_ __.~_ REV-1509 EX+ (6-9e) - SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary R Melvin FILE NUMBER 21-09-0932 H an asset was made JoIM tII111tit11 one year of the decedenri deb of death, it must be reporbd on Schedule 0. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A' Elaine D. Connolly 51 W. Main Street New Kingston, PA 17072 Grandchild B. C. JOINTLY•OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT GATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME Of FINANCIAL INSTITUTION ANO BANK ACCOUNT NUMBER OR SIMIIAR DATE OF DEATH ~ OF ' DATE OF DEATH ~ A IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE VAWE OF ASSET OECD S INTEREST VALUE OF DECEDENTS !NTERESi . 04/29/04 PNC Bank NA 2,517.78 50 1,258.89 Checking Account: 5004823605 2. A. 04/29/04 PNC Bank NA 15,235.42 50 7,617.71 Checking Account 5004577723 _ TOTAL (Also enter on line 6 Recapitulation) I S 8 876 60 (If more space Is needed, Inserl addltbnal sheets of the same size) BUREAU OF INDIVIDUAL TAXES Po eaX zsseol fNRRISeUt6 PA 1712e-06e1 aY-loft IX IIFP ue-OI 51/LVXNIA INHERITANCE INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 09-0932 ACN 09169267 DATE 10-26-2009 T ELAINE D CONNOLLY 51 W MAIN ST NEW KINGSTOWN PA 17072 EST. OF MARY R MELVIN SSN lao-2e-2a7z DATE OF DEATH 07-20-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. PNC BARK NA provided th• Departaent with the inforaatian bales, which has boon used in caltulatine the potential tax duo. Records indicate that at th• loath of the above named doeedent. you wars a ioint wnar/beneficiary of this account. If you foal the informetien is incorrect, please obtain written correction frog the financial institution. attach a copy to this fon and return it to the above address. This account is te:abl• in accordance with th• Inhe ri tane• Tax laws of th• Coaaonwaslth of Pennsylvania. Pleaae tall C717) 7a7-8327 with euastions. COMPLETE PART 1 BELDW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 000005004577723 Dat• 04-29-2004 T Account Balanco Porcont Taxable Amount Subject to Tax Tax Rat• Potential Tax Duo Establiahad $ 15,235.42 X 50.000 t 7,617.71 X .045 S 342.80 o ensure proper credit to the account, two copies of this notice oust accompaly payaent to the Raoistar of Wills. Make chock peya6l• to "Raoistar of Wills, Aaent". NDTE~ If tax payments era aade within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any Inheritance Tex duo wfll bacoae delinquent nine aonths after the date of death. TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balanco 3. Porcont Taxable 4. Amount Subject to Tax 5. Debts and Doductlona 6. Amount Taxable 7. Tax Rata e. Tax Duo PART a DATE PAID PAYEE 2 $ 3 X 4 $ 5 - 6 7 X 8 ~ DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL (Enter on Llne 5 of Tax Computatlonl ~ Under penalties of perjury, I declare that the facts I have reported above are true, correct and edmplete to the best of my knowlodpe and bell •f. HOME ( ~ WORK C ~ TAXPAYER SIGNATURE Tc1 t:ounur ulluorn ,,,__ GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance Tax becomes delinquent nine months of tar the decedent's date of death. 3. A joint eecount is taxable oven when the decedent's name was added as a matter of convenience. 4. Accounts (including those held beMeen husband and wife) the decadent put in joint names wlthin one year prior to death era fully taxable. 5. Accounts •stablished jointly between husband and wife more then one year prior to death are not taxable. 6. Accounts hold by a decedent "in trust for" another or others are fully taxable. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice era correct and deductions are not being claimed, place an "X" in Block A of Part 1 of the "Taxpayer Response" section. Sion two copies and submit them with a cheek for the amount of tax to the register of wills of the county indicated. The PA Oaparteent of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the ragistar of wills. 2. BLOCK B - If the asset spa cified on this notice has bean or will be reported and trot paid with the Pennsylvania Inheritance Tax Return filed by the estate's representative, place an "X" in Block B of Pert 1 of the "Taxpayer Response" section. Sign one copy end return to the ragistar of wills of the county indicated. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check Block C and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with Your chock for the amount of tax payable to the register of wills 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 wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account arieinally was established or tltled in the manner ex istine at date of death. NOTE: For a daeadant who died after 12/12/82, accounts the decadent put in ioint names within one year of death are fully tro:a6la. However. there is an exclusion not to exceed 03.000 oar transferee, re0ardless of the value of the account or the number of accounts held. If a double asterisk I+•) appears betore your first nam• in the address portion of this notice, the 03,000 exclusion was deducted from the eecount balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percentsge of the account that is taxable to each survivor is determined as follows: A. Th• percentage taz able of joint assets astablishad sore than one year prior to Lhe decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER DF MULTIPLIED BY 100 = PERCENT TAXABLE JOINT OWNERS SURVIYIN6 JDINT OIfNERS Example: A joint asset registered in the nam• of the decedent and two other persons: 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7 percent (TAXABLE TD EACH SURVIVOR) B. The percenta0e texsbl• for assets created within one year of the decedent's death or accounts owned by the decadent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT MULTIPLIED BY 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Exewple: Joint account re eistered in the name of the decadent and two other parsons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50 percent (TAXABLE FOR EACH SURVIVOR) 4. Tha amount subject to tax (Line 4) is determined 6y multiplying the account balance CL ine 2) by the percent taxable (Line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. Tha amount taxable CLina 6) is determined by subtracting the debts and deductions (Line 5) from the amount subject to tax CL ine 4). 7. Enter the avpropriat• taX rata CLina 7) as daterainad below. + • ax ra o imDOSed on t a net va ue a transfers from a deceased child 21 years o age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent. The lineal class of hairs includes ersndDarents, parents, children and other lineal descendents. "Children" includes natural children whether ar not they have boon adopted ta/ others, adopted children and step children. "Lineal descendants" includes all children of the natural parents and their de seendents, whether or not they have been adopted 6v othe raj adopted descendants and their descendants; and stab-descendent s. "Siblings" era defined as indivitluals who have at least one parent in common with the decedent, whether by blood or adovtion. Tha Collateral class of hairs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: Data of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3 portent 6 percent 15 percent 15 percent 01/01/95 to 06/30/00 0 portent 6 percent 15 percent 15 percent 07/01/00 to present 0 percent 4.5 percent ^ 12 percent 15 percent A. You are legally 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 of tar the death of the decedent and can furnish proof of payment. L. Debts being claimed must b• itemized fully in Part 3. If additional space is needed, use B 1/2" x 11" sheet of Daoer. Proof of payment may be reoua stud by the PA Department of Revenue. BUREAU OF INDIVIDUAL TAXES Po Boz zggsBl H1IRRISBUR6 PA 17128-0601 If Sndicating a different tax relationship to daeadant: _ PENNSYLVANIA INHERITANCE INFORMATION NOTICE AND TAXPAYER RESPONSE T FILE NO. 21 09-0932 ACN 09169266 DATE 10-26-2009 ELAINE D CONNOLLY 51 W MAIN ST NEW KINGSTOWN PA 17072 EST. OF MARY R MELVIN SSN 180-28-2072 DATE OF DEATH 07-20-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. PNC BANK NA provided the Dapsrtaent with the inf creation below, which has boon used in calculating the votantial tax due. Records 3ndieat• that at the death of the above-naaad daeadant, you ware a joint owner/beneficiary of this account. If you Taal the intonation is incorrect, please obtain written correction frw the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with th• Inheritance iax laws of the Coronwealth of Pannsvlvmia. Please call C717) 7a7-8327 with Questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 000005004823605 Dat• 04-29-2004 T Account Balance Portent Taxable Amount Subject to Tax Taz Rate Potential Tax Duo atv-)sN a ~cr toe•N) Established $ 2,517.78 X 50.000 $ 1,258.89 X .045 g 56.65 o ensure proper credit to the account, two copies of this notice oust aeeompary pevaent to the Register of Wills. Mek• check pavabl• to "Ragistar of Wills, Agent". NOTE, If tax pavaants era ^ade within three aonths of the decedent's date of death, deduct a 5 percent dSaeount on the tax due. A)ry Inheritance Tax due will becoaa dalinauant ni no aonths of tar the data of death. A. ~ The above inforaation and tax due fs eorract. Raait payaent to the Ragistar of Wills with two topics of this notice to obtain CHECK a discount or avoid interest, or Will chock box "A" and return this notice to the Ragistar of C ~ ONE s end an off ieial assassaent will b• issued by the PA Departaent of Revenue. BLOCK ON L Y B. ~ The ebova asset has boon or will be reported and tax paitl with the Pennsylvania I h to ba filed by the estate representative. n eritance Tax return C. ~ Tha ebova infor~ion is ineorree and/or debts and deductions ware paid. Cwplat• PART 2 and/or PART 3 below. PART TAX LINE . plaesa state RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Established 2. Account Balanea 3. Percont Taxable 4. Amount SubSeet to Tax 5. Debts and DeductSons 6. Amount Taxable 7. Tax Rat• 8. lax Du• PART DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax ComputatSon) ~ Under penaltios of perjury, I declare that the facts I have reported above are true, eorract and complete to the best of my knowledge and belief. HOME C ) WORK C ) TAXPAYER SIGNATURE rcicounur u„Nnrn „-__ 1 2 3 X 4 5 6 7 X 8 $ GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inf orwation submitted by the financial institution. 2. Inheritance Tax beeves delinquynt nine months after the decedent's date of death. S. A 3oint account 1s taxable even when the decedynt's name was added as a natter of convenience. 4. Accounts (including those held between husband and wife) the decadent out in ioint names within one Year prior to death era fully taxably. 5. Accounts established joinLlY between husband and wife more then one year prior to death are not taxable. 6. Accounts held 6y a decedent "in trust for" another or others are fully taxable. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in th• notice are correct and deductions are net being el aimed, place an "X" in Block A of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with a check for the amount of tax to the register of wills of th• county indicated. The PA Dypartment of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the register of wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax void with th• Pennsylvania Inheritance Tex Return filed by the estate's raps sentative, place an "X" in Block B of Part 1 of the "Taxpayer Rssponso" section. Sign one copy and return to the ragistar of wills of the county indicated. 3. BLOCK C - If the notieo information is incorrect and/or deductions era being claimed, check Block C and complete Parts 2 and i according to the instructions below. Sign two copies and submit them with your chock for the amount of tax payable to the ragistar of wills of the counSV indicated. Tha PA Department of Revenue will issue an official assassmant (Form REV-1548 EX) upon receipt of the return from the register of wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the data the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent uho died of tar l2/12/82, accounts the decadent put in iolnt names within one Year of death era f ul lY taxable. However. there is an exclusion not to ex ceyd 13,000 per transferee. regardless of the value of the account or the number of accounts hold. If a double asterisk (••) appears before your first name in the address portion of this notice, the 63.000 exclusion was deducted frw the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. The Dereentage of the account that is taxable to each survivor is datarwinad as follows: A. The percentage tax able of joint assets ystablished mare than one near prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BY 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the nerve of the dacadant and two other parsons: 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BV 2 (SURVIVORS) _ .167 X 100 = 16.7 percent (TAXABLE TO EACH SURVIVOR) Tha Dereantega tax able for assets created within one Yeer of the decedent's death or accounts awned by the decedent but hold in trust for another individual(s) (trust beneficiaries): 1 DIVIDED 8Y TOTAL NUMBER OF SURVIVING JOINT MULTIPLIED BY 100 = PERCENT TAl(ABLE OWNERS OR TRUST BENEFICIARIES 4. 5. 6. 7. vT • tax ra a imposetl on the ne va ua of transf ors froa a ecaased child 21 Years of p v 0 t death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent. Th• lineal class of hairs includes grandparents, parents. children and other lineal descendents. "Children" includes natural children whether or not Shay have been adopted by others, adopted children and stop child ran. "Lineal descendents" includes all children of the natural parents and their descendents. vhathar or not they have been adopted by others; adopted descendants and their descendants; and step-descendants. "Siblings" era def inad as individuals who have at least one Darent in comron with the decedent, vhathar by blood or adoption. The Collateral class of hairs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: Example: Joint account repisterad in the name of the decedent and two other persons and established within one Year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50 percent (TAXABLE FOR EACH SURVIVOR) Tha amount subjaet to tax (Line 4) is determined by multiplying the account balance (Lino 2) by the percent taxable (Line 3). Enter the total of the debts and deductions listed in Part 3. Tha amount taxable (Line 6) is datarwinad by subtracting the debts and deductions (Line 5) from the amount subjaet to tax Cline 4). Enter the appropriate tax rata (Line 7) as datarwinad below. Datm of Death Spouse Lineal SShlSng Collateral 07/01/94 to 12/31/94 3 portent 6 percent 15 percent 15 percent 01/01/95 to 06/30/00 0 percent 6 percent 15 percent 15 poreont 07/01/00 to prmsmnt 0 percent 4.5 percent ~ 12 poreont 15 a e percent or oun •r e A. You are legally re sponsi6le for pavaent, or the estate subject to administration by a personal raps santativs is insufficient to pay the deductible items. ^. You actually paid the debts of ier the death of the decadent and can furnish proof of paywent. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use 8 1/2" x 11" shoot of paver. Proof of eaw.oat .aw ha reaues[ed by the PA Department of Revenue. PJSv-75:2 EXw .~-C8; Pennsylvania INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8e LIENS FILE NUMBER Mary R. Melvin 21 09-0932 Report debts incurrod br Me decedent orinr ee a..rh e+~ . ~ W .. REST-i;;1 ER+,;O-09) pennsylvania DEPARTMENT aF REVENUE iNNERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary R. Melvin ITEM VUMBE A. 1. FILE NUMBER ' 21-09-0932 Detedent'a debts must be reported on Schedule I. FUNERAL EXPENSES: Funeral Expenses - Malpezzi Funeral Home Z• Head Stone Inscription - Woodburn Memorials 3 Opening Gravesite - St. Bernard's Cemetery e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Geraldine M. Melvin Street Address 51 W. Main Street -- C;ry New Kingstown _ __ _ _ - _..__._ ._. _ - - State- PA_ ZIP 17072 Year(s) Commission Paid: 2010 Z• Attorney Fees: 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City --- - _- -_ State- -- ZIP --- Relationship of Claimant to Decedent 4• Probate Fees: S• Accountant Fees: 6• Tax Return Preparer Fees: 1. 2,512.00 162.00 200.00 2,337.54 2, 337.54 0.00 472.15 0.00 0.00 TOTAL (Also enter on Line 9, Recapitulation) I S 8,021.23 SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS IF more space is needed, use additional sheets of paper of the same size. pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary R. Melvin SCHEDULE ,7 BENEFICIARIES FILE NUMBER 21-09-0932 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY "`u+"~N~nlr (u utt,tuENT AMOUNT OR SHARE Do Not llrt Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outri ht s sus I d' t 'b 1 2. 3. 4. 5. 1 1 g p a !s n utlons and transfers under Sec. 9116 (a) (1.2).] Valerie M. Green Grandchild 1926 Princeton Avenue, Camp H[II, PA 17011 Elaine D. Connolly Grandchild 51 W. Main Street, New Kingstown, PA 17012 David L. Melvin Grandchild 2014 Carlisle Road, Camp H[II, PA 17011 Sean Melvin Grandchild 2014 Carlisle Road, Camp Hill, PA 17011 Greg Melvin Grandchild 819 W. Trindle Road, Mechanicsburg, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE 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 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE i3 OF REV-1500 COVER SHEET. if 1/5 1/5 1/5 1/5 1/5 u more space is needed, insert additional sheets of the same size. r