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HomeMy WebLinkAbout04-0638CONNONHEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 171Z&-0601 REV-15~5 EX &FP ¢09-00) INFORMATION NOTICE AND TAXPAYER RESPONSE FI'E .0. 21 L0%% ACN Oq12q708 DATE 06-22-200q SARA J BASEHORE 801SHULER ST MECHANICSBURG PA 17055 TYPE OF ACCOUNT EST. OF DOROTHY V RONE [] SAVINGS S.S. NO. 262-ql-6q56 [] CHECKINg DATE OF DEATH 0~-15-Z00~ [] TRUST d~UNTY CUHBERLAND [] CERTZF. REN/T PAYHENT AND FORHS TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided the Department with the information listed bales which has been used in calculating the potential tax due. Their records indicate that at the death o; the above decedent, you were a joint owner/beneficiary of this account. If you fas1 this information is incorrect, please obtain written correction from the financial institution, attach a copy to this ~ors and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 7&7-8527. CONPLETE PART 1 BELON # ~ # SEE REVERSE S/DE FOR FILING AND PAYNENT INSTRUCTIONS Accoun~ No. 51600226552 Da~e 05-27-2005 Established Accoun~ Balance 15,565.78 Percen~ Taxable X 16. 667 Amoun~ SubSec~ ~o Tax 2,59~.55 Tax Re~e X .0~5 Potential Tax Due 116.75 To insure proper credit to your account, two CZ) copies of this notice must accompany your payment to the Register of Hills. Make check payable to: "Register of Nills, Agsnt". NOTE: [f tax payments ara made within three (3) months of the decedent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. [] The above information and tax due is correct. I. You amy choose to rasit payment to the Register of Nills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of  ONE ~ Hills and an official assessment will be issued by the PA Department of Revenue. BLOCK J B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to bo filed by the dscadsnt's representative. C. [] Tho above information is incorrect and/or debts and deductions were paid by you. You must complete PART [] and/or PART [] below. TAX RETURN - CONPUTATION OF TAX ON JOINT/TRUST ACCOUNTS iii~iiii[ii!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!i}!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!}!!!!!!!!!!!!!!!!!!!!![!!!!!!!!!!!!!!! L/NE 1. De~e Es~ebl/shed 1 2. Accoun~ Balance [ 3. Percen~ Taxable 3 ~ q. Aeoun~ Sub~eo~ ~o Tax ~ $. Deb~s and Deductions E 6. Aeoun~ Taxable ~ 7. Tax Ra~e 7 ~ 8. Tax Due ~ PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID '1 TOTAL (Enter on L/ne $ of Tax Computation) $ Under penalties of per.~ury~ T declare ~:he~ ~he fe¢~s / have repot*ed above are ~rue, oorrec~ end complete ~o ~he bes~ of ay knowledge end belief. HOME ._ :~'~/i~/ )[~ TAXPAYER~ SIGNATURE TELEPHONE NUH~ER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND HILL RESULT IN AN OFF/CZAL TAX ASSESSHENT aith applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and aifm) which the decedent put in joint names aithin one year prior to death are fully taxable as transfers. S. Accounts established jointly between husband and aife mare than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxabZm fully. REPORTING INSTRUCTIONS - PART ! - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X' in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit thom with your check for the amount of tax to tho Register of Wills of the county indicated. The PA Department of Revenue ail1 issue an official assessment (Form REV-154B EX) upon receipt of tho return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or ail1 bo reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dopt Z80601, Harrisburg, PA 171Z8-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and according to the instructions beloa. Sign two copies and submit them with your check 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 originally was established or titled in the manner existing at date of death. NOTE= For a decedent dying after IZ/IZ/BZ: Accounts ahich the decedent put in joint names aithin one (1) year of death arm taxable fully as transfers. However, there is an exclusion not to exceed $$,000 per transferee regardless of the vaIue of the account ar the number of accounts held. If a double asterisk (ax) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the totaI balance of the account including interest accrued to the data of death. 5. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: I DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUHBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and too other persons. I DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the decedont's death or accounts caned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE O#NERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and rue other persons and established eithin one year of death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X 100 = SOX (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line q) is determined by multiplying the account baZance (line Z) by the percent taxable (Line S. Enter tho total of the debts and deductions listed in Part 3. 6. The amount taxable (Iine 6) is determined by subtracting tho debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined below. Da{e of Dea{h Spouse Lineal Sibling I Cella{era1 07/01/9q ~o 12/$1/9q 01/01/95 ~o 06/50/00 OX 6X 07/01/00 ~o presen~ OX aThe tax rate imposed on the net value of transfers from a deceased y-one years age younger at death to or for the usa of a natural parent, an adoptive parent, or a stepparent of the child is OZ. Tho Lineal class of heirs includes grandparents, parents, children, and lineal descendents. "ChiLdren" includes nature! children whether or not they have been adopted by others, adopted children and stap children. "Lineal descendents" includes ail children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of hairs includes a11 other beneficiaries. CLAIMED DEDUCTIONS - PART 5 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. S. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being cIaimed must be itemized fuIly in Part 3. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of payment may bo requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 004137 BASEHORE SARA J 801 SHULER ST MECHANICSBURG, PA 17055 ........ foJd ESTATE INFORMATION: SSN: 262-41-64§6 FILE NUMBER: 2104-0638 DECEDENT NAME: ROWE DOROTHY V DATE OF PAYMENT: 07/08/2004 POSTMARK DATE: 07/07/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/13/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04124708 $110.91 TOTAL AMOUNT PAID: $110.91 REMARKS: SEAL CHECK# 6559 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ,Mrs. Sara J. Basehore 80t Shuler St M¢chanicsburg, PA 17055-4049 COMMONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171Z8-0601 REV-164J EX AFP (09-00) ZNFORMATZON NOTZCE AND TAXPAYER RESPONSE ACN OqlZq71Z DATE 06-ZZ-ZOOq SARA J BASEHORE 801SHULER ST MECHANICSBURG PA 17055 TYPE OF ACCOUNT EST. OF DOROTHY V RONE F~SAVZNGS S.S. NO. Z62-ql-6q56 []CHECKING DATE OF DEATH Oq-l$-ZOOq []TRUST COUNTY CUMBERLAND []CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you ~ere a joint o~nar/beneficiary of this account. ~f you feel this information is incorrect, please obtain ~rittan correction free the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance ~ith the Inheritance Tax La~s of the Commonaealth of Pennsylvania. Questions may be ansaered by calling (717) 787-8327. COMPLETE PART 1 BELON x # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5070095825 Date 05-27-Z005 Established Account Balance 2,7q6.05 Percent Taxable X 16. 667 Amount Subject to Tax qS7.68 Tax Rate X .0q5 Potential Tax Due ?0.60 To insure proper credit to your account, tho (Z) copies of this notice must accompany your payment to the Register of Nills. Make check payable to: "Register of Hills, Agent". NOTE: If tax payments are made .ithin three (3) months of the decedent's date of death, you may deduct a Sg discount of the tax due. Any inheritance tax due ail1 become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. ~-~ The above information and tax due is correct. ~ 1. You may choose to remit payment to the Register of Hills aith tad copies of this notice to obtain CHECK e discount or avoid interest, or you may check box 'A" and return this notice to the Register of ONE q Hills and an official assessment ~i11 be issued by the PA Department of Revenue. BLOCK a s. [] The above asset has been or will bo reported and tax paid ~ith the Pennsylvania Inheritance Tax return ONLY to be filed by the dacedent's representative. C. [] The above information is incorrect and/or debts and deductions ~era paid by you. You must complete PART [] and/or PART [] baloa. PART TAX LINE 1. Date Established 2. Account Balance $. Percent Taxable q. Amount Subject to 5. Debts and Deductions 6. Amount Taxable 7. Tax Rata 8. Tax Due PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury~ I declare that the facts I have reported above ara true, correct and complete to the best of my knowledge and belief. HOHE (~/? ) TAXPAYER¢SZGRATURE TELEPHONE NUMBER ~ATE ' GENERAL INFORMATION 1. FA/LURE TO RESPOND NILL RESULT ZN AN OFF/C/AL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decadent's date of death. $. A joint account ls taxable even though the decedant's name was added as a matter of convenience. q. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. S. Accounts established jointly between husband and wife more than one year prior to death ara not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART i TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Nills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1Sq8 EX) upon receipt of the return from the Register of Nills. Z. BLOCK S - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 180601, Harrisburg, PA 171Z&-060i in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Nills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-15~8 EX) upon receipt of the return from the Register of Nills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/BI: Accounts which the decedent put in joint names within one (1) year of death are taxabIe fulIy as transfers. However, there is an exclusion not to exceed $-%,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (xx) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as ~ollows: A. Tho percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT O#NERS SURVIVING JOINT ONNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY .% (JOTNT ONNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.71 (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the decadent's death er accounts owned by the decedent but held [n trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 PERCENT TAXABLE OHNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and tee other persons and established within one year of death by the decedent. I DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50X (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter the total of tho debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line ~). 7. Enter the appropriate tax rate (line 7) as determined beloa. Da~e of Death Spouse I Lineal I Sibling I Collateral 07/01/9q ~o 12/31/9q 3Z 6Z 15X 15X 01/01/96 ~o 06/30/00 OX 61 07/01/00 ~o presen~ OX q.$Xx 12Z wThe tax rate imposed on the net value of transfers from a deceased tmenty-one years age younger at death to or for the usa of a natural parent, an adoptive parent, or a stapparent of the child is OX. The lineal class of hairs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. 'Siblings" are defined as individuals mhd have at least one parent Jn common with the decedent, whether by blood or adopt[on. The "ColLateral" class of heirs incLudes all other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can fur~ish proof of payment. C. Debts being claimed must be itemized fully in Part 5. [f additional space ts needed, use plain paper 8 1/Z' x 11". Proof of payment may be requested by the PA Department o~ Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 F~ECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 004136 BASEHORE SARA J 801 SHULER ST MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 262-41-6456 FILE NUMBER: 2104-0638 DECEDENT NAME: ROWE DOROTHY V DATE OF PAYMENT: 07/08/2004 POSTMARK DATE: 07/07/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/1 3/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04124712 $19.57 TOTAL AMOUNT PAID: $19.57 REMARKS: SEAL CHECK# 6556 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMON#EALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF ZNDZV/DUAL TAXES DEPT. 280601 HARRISBURg, PA l?lZB-0601 KE¥-l;~iS EX J, FP (09-00) INFORMATION NOTICE AND TAXPAYER RESPONSE .,, .o. :,1 ACN 0q].Zq710 hATE 06-22-200q SARA J BASEHORE 801SHULER ST MECHANICSBURG PA 17055 EST. OF DOROTHY V ROWE S.S. NO. 262-ql-6q56 DATE OF DEATH Oq-l$-ZOOq C~UH?Y CUMBERLAND TYPE OF ACCOUNT [] SAVINGS [] CHECKTNG [] TRUST [] CERT/F. REMTT PAYMENT AND FORMS TO: REGTSTER OF NILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided the Department with the information listed below ahich has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain Hrittan correction free the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax LaHs of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART I BELOW x # x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Accoun.k No. 5030118889 Da.ke 05-27-2005 Es.kablished Accoun.k Balance 6q, $q6.79 Percen.k Taxable X 16. 667 Aeoun.k Subjec.k .ko Tax 10,7Zq. 68 Tax Re.ko X . Oq5 Po.ken.kiel Tax Duo q87.61 To insure proper credit to your account, tho (2) copies of this notice must accompany your payment to the Register of Hills. Make check payable to: "Register of Nills, Agent". NOTE: If tax payments ara made within three (3) months of the dacedent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due Hill become delinquent nine (9) months altar tha date of death. PART TAXPAYER RESPONSE ! A. ~ The above information and tax dua is correct. 1. You may choose to remit payment to the Register of Mills with twa copies of this notice to obtain CHECK · discount or avoid interest, or you may check box "A" and return this notice to the Register of  ONE 9 Nills and an official assessment will be issued by the PA nepartaent of Revenue. BLOCK J s. [] The above asset has been or a/Il be reported and tax paid with the Pannsy[vania Inheritance Tax return ONLY to be filed by the decedent's representative. C. [] The above information isr_~incorrect and/or debts and deductions aero paid by you. You must complete PART III and/or PART [] beloH. PART Tf yOU indica.ke a differen.k .kax re.ko, please s.ka.ke your rela.kionsh/p 'ko decadent: TAX RETURN - COMPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS LTNE 1. Da.ko Es.kablished I 2. Accoun.k Balance 2 3. Percen.k Taxable $ ~ q. Amoun.k Subjec.k .ko Tax q 5. Deb.ks and Doduc.kions $ - 6. Aeoun.k Taxable 6 7. Tax Rata 7 ~ 8. Tax Duo 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAZMED PAYEE DESCRIPTION AMOUNT PAID ,I TOTAL (En.ker on Line 5 of Tax Compu.ke.k[on) $ Under penal.kiDs of perjury, I declare .kha.k .khe fac.ks I have ropor.kad above ara .kruo~ correct and colnple.ke ~:o .kb. bos.k of my kno.ledge and belie~. HOME (/~/7 ) ~- ~2~ ~/~_,/c~. ~ ~_./~.~,~-*'L,,. WORK ( ) TAXPAYER/ SIGNATURE TELEPHONE NUMBER DATE GENERAL INFORHATION 1. FAILURE TO RESPOND #ILL RESULT ZN AN OFFICXAL TAX ASSESSHENT eith applicable interest based on information submitted by the financial instltutian. Z. Inheritance tax becomes delinquent nine months after the dacedent's data of death. 5. A joint account is taxable even though the dacadent's name was added as a matter of convenience. 4. Accounts (including those held between husband and mile) which the decadent put in joint names within one year prior to death ara fully taxable as transfers. 5. Accounts established jointly between husband and aifa more than one year prior to death ara nat taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART ! - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign too copies and submit thee with your check for the amount of tax ta the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1S48 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid aith the Pennsylvania Inheritance Tax Return filed by the dacadant's representative, place an "X" in block "S" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dapt Z80601, Harrisburg, PA 171Z8-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts 2 and 5 according to the instructions baloa. Sign too capias and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue ail1 issue an official assessment (Form REV-1S4D EX) upon receipt of the return from the Register of Wills. TAX RETURN PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/Il/AZ: Accounts which the decedent put in jolnt names aithin one (1) year of death are taxable fully as transfers. However, there is an exclusion nat to exceed $5,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (xx) appears before your first name in the address portion of this notice, the S3,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the tatar balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as folloas: A. The percent taxable for joint assets established more than one year prior to the decadent's death: 1 DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUNDER OF X lO0 PERCENT TAXABLE JOTNT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and too other persons. i DIVIDED BY 5 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the decedant's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUHBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established aithin one year of death by the decadent. 1 DIVIDED BY Z (SURVIVORS) = .SO X lO0 = SOl (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 5). 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (1ina 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined baloe. Da~e of Death Spouse Lineal Sibling Collateral 07/01/9q ~o 12/31/9~ 3Z 6Z 01/01/96 ~o 06/30/00 OX 6Z 07/01/00 ~o presen~ OX mThe tax rate imposed on the nat value of transfers from a deceased twenty-one yuma age younger Bt death to or for the use of a natural parent, an adoptive parent, or a stapparent of the child is OZ. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children ehethar or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of tho natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and stap-descendants. "Siblings" ara defined as individuals aha have at least one parent Jn common aith the decedent; ahether by blood or adoption. The "Collateral" class of heirs includes aXX other beneficiaries. CLAXHED DEDUCTTONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined es foXXoas: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 5. Xf additional space is needed, use plain paper 8 X/Z" x 11". Proof of payment may bo requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004135 BASEHORE SARA J 801 SHULER ST MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 262-41-6456 FILE NUMBER: 2104-0638 DECEDENT NAME: ROWE DOROTHY V DATE OF PAYMENT: 07/08/2004 POSTMARK DATE: 07/07/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/13/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04124710 $458.48 TOTAL AMOUNT PAID: $458.48 REMARKS: SEAL CHECK# 6557 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171ZB-0601 REV-1E4$ EX AFP ZNFORNATZON NOTZCE AND TAXPAYER RESPONSE SARA J BASEHORE 801SHULER ST MECHANICSBURG PA 17055 FILE NO. Z10q ~P~ ACN Oq12q71q DATE 06-22-200q TYPE OF ACCOUNT EST. OF DOROTHY V ROWE T--ISAVINGS S.S. NO. Z6Z-Rl-6R56 [] CHECKING DATE OF DEATH 0~-15-200~ [] TRUST CO~q~Y CUMBERLAND [] CERTIF. REMIT PAYHEiNT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided the Department with the information listed below whlch has been used in calculating the potential tax duo. Their records indicate that at the death of the above decedent, you were a joint eerier/beneficiary of this account. If you feel thls information is incorrect, please obtain arlttan correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART I BELOW ~ ! ! SEE REVERSE SIDE FOR FTLTNG AND PAYMENT INSTRUCTIONS Account No. $1ZOOZ$5187 Data O$-Z7-ZO0$ Established Account Balance 35,028.59 Percent Taxable X 16.6 6 7 Amount Subject to Tax 5,838.7Z Tax Rate X . Oq5 Potential Tax Duo Z6Z. 7Z To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Hills. Make check payable to: "Register of Hills, Agent". NOTE: If tax payments ara made within three ($) months of the dacadent's date of death, you may deduct a SZ discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. [] The above information and tax due is correct. 1. You amy choose to remit payment to the Register of Hills with two copies of this notice to obtain CHECK · discount or avoid interest, or you may check box 'A" and return this notice to the Register of  ONE ~ Nills and an official assessment will ba issued by the PA Department of Revenue. BLOCK J S. [] The above asset has been or mill be reported and tax paid eith the Pennsylvania Inheritance Tax return ONLY to ba filed by the dacadent's representative. C. [] The above information is incorrect end/or debts and deductions mere paid by you. PART TAX LINE You must complete PART [] and/er PART []beloe. If you indicate a different tax rate, please state your relationship to decedent: RETURN - COMPUTATION OF TAX ON JOTNT/TRUST ACCOUNTS 1. Data Established 1 2. Account Balance 2 $. Percent Taxable $ ~ q. Amount Subject to Tax q S. Debts and Deductions $ - 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) Under penalties of perjury, I declare that tho facts I have reported above era true, correct and complete to the best of my knowledge and belief. HOME (,71/7,) (~c/~_ ~6.~ ~~~ ~, WORK ( ) - 7/~o J~ TAXPAYE~ SIGNATURE - TELEPHONE NUHSER DATE' GENERAL INFORNATZON 1. FAILURE TO RESPOND #ILL RESULT ZN AN OFFICIAL TAX ASSESSMENT aith applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the decedent's name was added as a matter of convenience. ~. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. S. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others ara taxable fully. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions ara not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1518 EX) upon receipt of the return from the Register of Hills. Z. BLOCK B - If the asset specified on this notice has bean or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dapt 280601, Harrisburg, PA 171Z8-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts Z and 5 according to the instructions below. Sign two copies and submit them with your check for the aaeunt of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-15~B EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART 2 - TAX COHPUTATION LINE 1. Enter the date the account originally was established or titled in the manner axlsting at date of death. NOTE: For a decedent dying after 1Z/12/az: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $2,000 per transferee regardless of the value of the account or the number of accounts held. If a doubIe asterisk (ax) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decadent's death: I DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OHNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 5 (JOINT O#NERS) DIVIDED BY 2 (SURVIVORS) = .167 X 1OD = 16.7X (TAXABLE FOR EACH SURVIVOR) B.The percent taxable 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 X lO0 PERCENT TAXABLE OHNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. I DIVIDED BY 2 (SURVIVORS) = .SO X 100 SOZ (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line ~) is determined by muttiplyJng the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line ~). 7. Enter the appropriate tax rate (line 7) as determined below. Da~o of Death I Spouse I Lineal I Sibling Collateral 07/01/9~ ~o 12/31/9~ 3Z 6X 15Z 01/01/95 ~o 06/30/00 OX 6X lex 15Z 07/01/00 ~o presan~ OX ~.$Xx 12X 15X mTha tax rate imposed on the net value of transfers from a .~uuu.sed younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OZ. Tho lineal class of hairs includes grandparents, parents, children, and lineal descendents. "Children' includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of tho natural parents and their descendants, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes alL other beneficiaries. CLAIHED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLA[HED AlieNable debts and deductions are determined as ~ollo~s: A. You legally are responsible ~or payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death o~ the decadent and can furnish proo~ of payment. C. Debts being claimed must be itemized SulLy in Part ~. I; additional space is needed, use plain paper 8 1/2' x 11". Proo~ o; payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004134 BASEHORE SARA J 801 SHULER ST MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 262-41-6456 FILE NUMBER: 2104-0638 DECEDENT NAME: ROWE DOROTHY V DATE OF PAYMENT: 07/08/2004 POSTMARK DATE: 07/07/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/13/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04124714 $249.57 TOTAL AMOUNT PAID: $249.57 REMARKS: SEAL CHECK# 6558 INITIALS: JA RECEIVED BY' GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COHHONNEALTH OF PENNe" ~AN~ DEPARTHENT OF REVEa~ BUREAU OF INDIVIDUAL TAXES DEPT, Z80601 HARRISBURG, PA 17128-0&01 DONNA M STONE q7 GREENSPRING DR MECNANICSBUR6 REV-1S~i3 EX AFP (09-00) ZNFORMATZON NOTZCE AND TAXPAYER RESPONSE ACN Oq12R711 DATE 06-Z2-200q PA 17050 TYPE OF ACCOUNT EST. OF DOROTHY V ROWE [] SAVINGS S.S. NO. 25Z-R1-6~56 [] CHECKING DATE OF DEATH Oq-l$-ZO0~ [] TRUST · COUNTY CUMBERLAND [] CERTTF. REMIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided the Department with tho information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you Here a joint oHner/banaficiary of this account, if you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance Hith the Inheritance Tax Laws of the CemmonHealth of Pennsylvania. Questions may be ansHered by calling (717) ?BT-8327. COMPLETE PART 1 BELOW x x x SEE REVERSE SZDE FOR FZLZNG AND PAYMENT INSTRUCTZONS Account No. 5050118889 Date 03-27-2003 Established Account Balance 6~, $~6.79 Percent Taxable X 16. 667 Amount SubSact to Tax 10,7Z~. 68 Tax Ra~e X .0q5 Potential Tax Due To insure proper credit to your account, tho (Z) copies of this notice must accompany your payment to the Register of #ills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments are made Hithin three (3) months of the dacedant's date of death, you may deduct a 5Z discount of the tax due. ~-~ /~-~,~Any inheritance tax due Hill becoae delinquent ~8Z. nine (9) months after the data of death. PART TAXPAYER RESPONSE A. [] Tho above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of  ONE ~ Hills and an official assessment will be issued by the PA Department of Revenue. BLOCK~ s. [] The above asset has been or Hill be reported and tax paid with the Pennsylvania inheritance Tax return ONLY to be filed by the decadent's representative. C. [] Tho above information is incorrect and/or debts and deductions Here paid by you. You must complete PART [] and/or PART [] bales. PART [f you indicate a d/fferen~ tax rate, please state your relationship to decedent: TAX RETURN - COHPUTAT~ON OF TAX ON JOiNT/TRUST ACCOUNTS LINE 1. Data Established 1 2. Account Balance 2 $. Percent Taxable $ ~ q. Amount Subject to Tax q 5. Debts and Deductions E 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts z have reported above ara true, correc~ end complete to the best of my kno. ledge and belief. HONE ( ~'/~' ) ~/~ ~ ~~ /~ ~ WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE GENERAL ZNFORNATZON 1. FAILURE TO RESPOND #ILL RESULT ZN AN OFF/C/AL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the decedent's name was added as a matter of convenience. ~. Accounts (including those held between husband and ~ife) which the decedent put in joint names within one ~ar prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others ara taxable fully. REPORTING [NSTRUCT[ONS- PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place mn "X"' in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-lSd& EX) upon receipt of the return from the Register of Hills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign on[ copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept Z&0601, Harrisburg, PA 1711&-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts 2 and according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-15~8 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART Z - TAX COHPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 11/11/82: Accounts which the decedent put in joint names within one (1) year of death ara taxable fully as transfers. However, there is an exclusion net to exceed $5,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (xe) appears before your first name in the address portion cf this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including lnterest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUNBER OF DIVIDED DY TOTAL NUNBER OF X 100 = PERCENT TAXABLE JOINT OHNERS SURVIVING JOINT O#NERS Example-' A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY '4 (JOINT ONNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 = 16.71 (TAXABLE FOR EACH SURVIVOR) B.The percent taxable ~or assets created within one year of the dacedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): i DIVIDED BY TOTAL NUHBER OF SURVIVING JOINT X 100 PERCENT TAXABLE ONNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 = 501 (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter tho total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 73 as determined below. Da~e of Death Spouse Lineal [ Sibling Collateral 07/01/9~ ~o 12/51/9~ 01/01/95 ~o 06/30/00 OZ 6Z 07/01/00 ~o presen~ OX ~.$X~ 12Z xThe tax rate imposed on the net value of transfers from a deceased twenty-one years age ar younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children ,hether or not they have been adopted by others, adopted children and step children. "Lineal descendents" ~ncludes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Sibllngs" are defined as individuals who have at least one parent in commen with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAZNED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLATHED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and Gan furnish proof of payaent. C. Debts being claimed must be itemized fully in Part 5. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD OO4133 STONE DONNA M 47 GREENSPRING DR MECHANICSBURG, PA 17050 fold ESTATE INFORMATION: SSN: 262-41-6456 FILE NUMBER: 2104-0638 DECEDENT NAME: ROWE DOROTHY V DATE OF PAYMENT: 07/08/2004 POSTMARK DATE: 07/07/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/13/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04124711 $458.48 TOTAL AMOUNT PAID: $458.48 REMARKS: DONNA RSTONE SEAL CHECK# 1124 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CONNONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF /NDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171ZB-0601 REV-16,q5 EX AFP ZNFORHATZON NOTICE AND TAXPAYER RESPONSE ACN OqlZqT09 DATE 06-2Z-200q DONNA M STONE R7 GREENSPRING DR ~" MECHANICSBURG PA 1705~*, EST. OF DOROTHY V ROWE S.S. NO. 262-ql-6q56 DATE OF DEATH 0q-15-200,~ :i.~0UNTY CUMBERLAND TYPE OF ACCOUNT [] SAVTNGS [] CHECKTNG [] TRUST [] CERTTF. REHZT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 PNC BANK has provided the Department with tha information listed below which has been used in calculating tho potantial tax duo. Their records indicate that at the death of tho above decedent, you ware a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. guestions may be answered by calling (?l?) 787-85Z7. COMPLETE PART I BELOW # # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Accoun* No. :516002265:52 Dais 0:5-27-200:5 Established Accoun~ Balance 15,565.78 Percen~ Taxable X 16. 667 Aaoun'l: Subjec~ ~o Tax Z · 59q. Tax Ra~a X . Oq5 Po~an~ial Tax Due 116.75 To insure proper credit to your account, two (a) copies of this notice must accompany your payment to the Register of Hills. Hake check payabla to: "Register of Hills, Agent". NOTE: If tax payments ara made within three (3) months of the decedent's date of death, you nay deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE I ~i~i~iiiiiiiiiiiiiiiiiiiiiiiii~i~iiiii~iii;i~iiiiiiiiiiiiiiiii~i~i~iiiii~i~iii~iiiii~iiiiiii~iiiii~iii~iiiiiiiiiiiiiiiiii i i iiiililililililili~ililil ii ~ilil!iil iiiiiilili iiiilililili ilil iili ililililililil i ~iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii~iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii~i~iii~iiiiiii~i~iiiiiiii iiii~iiiiiilillililiiiiiiililili ! ! ililililililill ilili~iiiiiiil ! A. ~Tha above information and tax due is correct. '-~ 1. You may choose to remit payment to tho Register of Hills aith two copies of this notice to obtain a discount or avoid interest, or yau amy check box "A" and return this notice to the Register of CHECK -~ #ills and an official assessment will be issued by the PA Department of Ravenua. ONE BLOCK J B. [] The above asset has been or will bo reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the dacodant's representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You ~ust co.plate PART ~ and/or PART ~ belo~. PART If you indicate a differen~ ~ax rate~ please sta~e your relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Dais Established I 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount SubSec~ to Tax 4 5. Dab~s and Deductions $ - 6. Aaoun~ Taxable 6 7. Tax Ra~a 7 X 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line ~ of Tax Computation) $ Under penalties of parSury, T declare tha~ ~ha fac~s T have reported above ara tr~e, correct and complete ~o ~he bas~ of ay knowledge and belief. HOME ( ~/~ ) ~y~y_~ ~ WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUHBER DATE GENERAL INFORMATION 1, FAILURE TO RESPOND NILL RESULT ~N AN OFFiCiAL TAX ASSESSHENT eith applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacedent's data of death. 5. A joint account is taxable avon though the decedent's name ~as added as a matter of convenience. 4. Accounts (including those held between husband and ~ifa) ehich the decedent put in joint names ~ithin one year prior to death are fully taxable as transfers. S. Accounts established jointly between husband and .ifa more than one year prior to death are not taxable. 6. Accounts held by a decadent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART ! - TAXPAYER RESPONSE BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part i of the "Taxpayer Response" section. Sign t.o copies and submit thee .ith your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue ~ill issue an official assessment (Form REV-lS48 EX) upon receipt of the return from the Register of Hills. Z. BLOCK B - If the asset specified on this notice has been or .ill be reported and tax paid .ith the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "S" of Part i of the "Taxpayer Response" section. Sign eno copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept Z80601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts Z and 5 according to the instructions bales. Sign t.o copies and submit them mith your check for the amount of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART Z - TAX COHPUTATION LINE 1. Enter the data the account originally ~as established er titled in the manner existing at data of death. NOTE: For a decadent dying after II/ii/aZ: Accounts ahich the decedent put in joint names ~ithin one (1) year of death are taxable fully as transfers. Homevar, there is an exclusion not to exceed $5,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (~N) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as follo~s: A. The percent taxable for joint assets established acre than one year prior to the decedent's death: I DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 PERCENT TAXABLE JOTNT ONNERS SURVIVING JOTNT O#NERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 3 (JOINT OgNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable far assets created ~ithin one year of the decadent's death or accounts o~ned by the decedent but held in trust for another individualCs) (trust beneficiaries): I DTVIDED BY TOTAL NUHBER OF SURVIVING JO:IHT X 100 = PERCENT TAXABLE OgNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and t~o other parsons and established within one year of death by the decedent. i DIVIDED BY Z (SURVIVORS) = .50 X 100 = SOl (TAXABLE FOR EACH SURVIVOR} The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line S) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined below. I Da~o of Death I Spouse I Lineal I Sibling Collo~oral I 07/0119q *~o 12/31/9q 3Z 6Z ISX 1.RI I 01/01/95 *o 06/30/00 ] OZ 6Z 1El I 07/01/00 ~:o proson~ I OX 4.$X~ 12X xThe tax rate imposed on the net value of tran-;er; ;roe a decaa ad chlld twenty-one years of age or younger at death to or for the usa of a natural parent~ an adoptive parent, or a stepparent of the child is OZ. The lineal class of hairs includes grandparents, parents, children~ and lineal descendents. "Children" includes natural children ehether or not they have been adopted by others, adopted children and stap children. "Lineal descendents" includes all children of the natural parents and their descendents, ~hether or not they have been adopted by others, adopted descendents and their descendants and stap-descendants. "Siblings" are defined as individuals ~he have at least one parent in common ~ith the decedent~ ~hether by blood or adoption. The "Collateral" class of hairs includes aL1 other beneficiaries. CLATMED DEDUCTTONS PART 3 - DEItTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as folloas: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid tho debts after death of tho decadent and can furnish proof of payment. C. Debts being clalmed aust be itemized fully in Part 5. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004139 STONE DONNA M 47 GREENSPRING DR MECHANICSBURG, PA 17050 ........ fold ESTATE INFORMATION: SSN: 262-41-6456 FILE NUMBER: 2104-0638 DECEDENT NAME: ROWE DOROTHY V DATE OF PAYMENT: 07/08/2004 POSTMARK DATE: 07/07/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/13/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04124709 $110.91 REMARKS: D R STONE TOTAL AMOUNT PAID: $110.91 SEAL CHECK#II26 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COHNONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-06D1 REV-I$~5 EX AFP ZNFORHATZON NOTICE AND TAXPAYER RESPONSE ACN 041Z~715 DATE 06-22-Z00~ DONNA M STONE ~7 GREENSPRING DR MECHANICSBURG PA 1705D. t EST. OF DOROTHY V ROWE S.S. NO. 262-~1-6456 DATE OF DEATH 04-15-200,~ :::~OUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS [] CHECKTNG [] TRUST [] CERTTF. REHTT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 PNC BANK has provided the Department mith the information 11sted below which has been used Jn calculating the potential tax due. Their records indicate that at the death of the above decedent, you mere a joint omner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coemonwaalth of Pennsylvania. Questions may be ansmered by calling (717) 787-8527. COMPLETE PART 1 BELOW # ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 507009:582:5 Date 0:5-27-200:5 Established Account Balance Z, 7~6.0:5 Parcent Taxable X 16. 667 Amount Subject to Tax 457.68 Tax Rata X .0~5 Potent/al Tax Due ZO.60 To insure proper credit to your account, two (Z) copies of thls notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Mills, Agent". ~'~/,~ /~,_~ nine (9) months after the date of death. NOTE: Zf tax payments are made mithin three (3) months of the decedent's date of death, you may deduct a SZ discount of the tax dug. Any inheritance tax due will become delinquent PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LTNE A. ~The above information and tax due is correct. 1. You may choose to remit payment to the Register of Nills with tmo copies of this notice to obtain a discount or avoid interest, or you may check box "A' and return this notice to the Register of Mills and an official assessment will be issued by the PA Department of Revenue. B. [] The above asset has been or mill be reported and tax paid mith the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. O The above information is incorrect and/or debts and deductions mere paid by you. You must complete PART []and/or PART [~belom. If you indicate a diffarent tax rate, please state your reletionsh/p to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Established I 2. Account Balance ~ $. Percent Taxable $ ~ q. Amount Subject to Tax q 5. Debts end Deductions $ - 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLATMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on L/ne $ of Tax Computer/on) Under penalt/es of perjury, Z declare that the facts T have reported above are true, correct and complete to the best of ay knowledge and belief. HOME ( TAXPAYER SigNATURE TELEPHONE NUHBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND NZLL RESULT ZN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the decedent's name Has added as a matter of convenience. q. Accounts (including those hold between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART ! TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice ara correct and deductions are not being claimed, place an in block "A" of Part 1 of the "Taxpayer Response" section. Sign tho copies and submit them Hith your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-iS4S EX) upon receipt of the return fram the Register of Nilts. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept Z80601, Harrisburg, PA 171Z8-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and according to the instructions balom. Sign tho copies and submit them Hith your check for the amount of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-iS48 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/1Z/&Z: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $5,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (xx) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as folloHs: A. The percent taxabZe for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT ONNERS SURVTVING JOINT ONNERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 5 (JOINT ONNERS) DIVTDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) S. The percent taxable for assets created within one year of the decedent's death or accounts oHned by the decedent but held in trust for another individual(s) (trust beneficiaries): ! DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X ZOO = SOZ (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 5). 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) [s determined by subtracting the debts and deductions (line 5) from the amount subject to tax [line 7. Enter the appropriate tax rate (line 7) as determined beloH. Da~e of Death Spouse Lineal [ S/bl/ng Collateral 07/01/9~ '~o 12/$1/9~ 01/01/95 ~o 06/$0/00 OZ 67. 15X 15X 07/01/00 ~o presen~ OX ~.BX~ 12X wTha tax rata imposed on th~ younger at death to or for the use of a natural parent, an adopt[va parent, or a stepparent of the child is OZ. The lineal class of he[rs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common Hith the decedent, whether by blood or adoption. The "Collateral" class of ha[rs includes al1 other beneficiaries. CLAIMED DEDUCTIONS PART $ - DEBTS AND DEDUCTIONS CLAIMED AlloHable debts and deductions are determined as follows: A. You legally ara responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible [tees. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 5. If additional space is needed, use pIain paper B 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004141 STONE DONNA M 47 GREENSPRING DR MECHANICSBURG, PA 17050 ........ fold ESTATE INFORMATION: SSN: 262-41-6456 FILE NUMBER: 2104-0638 DECEDENT NAME: ROWE DOROTHY V DATE OF PAYMENT: 07/08/2004 POSTMARK DATE: 07/07/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/1 3/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04124713 $19.57 REMARKS: D R STONE TOTAL AMOUNT PAID: 819.57 SEAL CHECK#II27 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Mrs. Donna M. Stone 47 Greenspring DR _Mechanicsburg PA 17050 . 4// ~/ o CDHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIV/DUAL TAXES DEPT. 280601 HARRISBURG, PA 171Z8-060! REV-15~$ EX AFP (09-00) DONNA M STONE q7 GREENSPRING DR MECHANICSBURG PA 17050 ZNFORNATZON NOTICE AND TAXPAYER RESPONSE ACN 0q1ZR715 DATE 06-Z2-Z00R TYPE OF ACCOUNT EST. OF DOROTHY V ROWE [] SAVTNOS S.S. NO. 26Z-~l-6q56 [] CHECKING DATE OF DEATH Oq-l:5-ZO0~ [] TRUST CUMBERLAND [] CERTZF. REHZT PAYHENT AND FORHS TO: REGISTER OF WTLLS CUMBERLAND CO 'COURT HOUSE CARLISLE, PA 1701:5 PNC BANK has provided the Department Hith the information listed beloe ehich has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you mare a joint oHner/beneficiary of this account. Zf you feel this information is incorrect, please obtain aritten correction from the financial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance aith the Inheritance Tax LaHs of the CoemonHealth of Pennsylvania. Questions may be ansHered by calling (717} 787-85ZT. COMPLETE PART I BELOW # x x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. :51ZOOZ:55187 Dote 0:5-Z7-ZO0:5 Established Account Balenco :55,028.59 Percent Texable X 16 · 6 6 7 Amount Subject to Tax 5,8:58. ZZ Tax Rate X .0~5 PotentiaZ Tax Due 262.72 To insure proper credit to your account, tho (Z) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of NilXs, Agent". NOTE: If tax payments are made eithin three (3) months of the decedent's date of death, you may deduct a 5g discount of the tax due. Any inheritance tax due ail1 become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. I~The above information and tax due is correct. ~1. You may choose to remit payment to the Register of Hills aJth tho copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of CHECK --I Nins and an official assessment aill be issued by the PA Department of Revenue. ONE J BLOCK B. [~The above asset has been or ail1 be reported and tax paid eith the Pennsylvania Inheritance Tax return ONLY to be fi!ed by the dacedant's representative. I I The above information is incorrect and/or debts and deductions mare paid by C. you. You must complete PART []and/or PART []beIoe. LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable $ X q. Amount Subject to Tax q $. Debts and Deductions 5 - 6. Amount Texable 6 7. Tax Rets 7 X 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line E of Tax Computetion) Under peneXties of perjury, X declera that the fects Z have reported above ere true, correct and COlnpXete to the best of ay knowXedge and belief. HOME (ff/~') ~ ~/-- ~'~/ ~ /~ WORK ( ) TAXPAYER SXGHATURE TELEPHONE NUH~ER DATE GENERAL ZNFORHATZON 1. FAILURE TO RESPOND #/LL RESULT ZN AN OFFICIAL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the dacedent's name was added as a matter of convenience. q. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. S. Accounts established jolntly be(wean husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART i - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an in block "A# of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount tax to the Register of Nills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-ISq8 EX) upon receipt of the return from the Register of Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue) Bureau of [ndividual Taxes, Ompt 280601, Harrisburg, PA 17128-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Nills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-15~B EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART Z TAX COMPUTATTON LTNE 1. Enter the date the account originally was established or titled in the manner existing at data of death. NOTE: For a decedent dying after 12/12:/62: Accounts which the decedent put in joint names within one (1) year of death ara taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value the account or the number of accounts held. If a double asterisk (ax) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as fellows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT O#NERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 5 (JOINT OIJNERS) DIVIDED BY Z (SURVIVORS) = .167 X ZOO = 16.7X (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEFICIARIES Example: Joint account registered in tho name of the decedent and two other persons and established within one year of death by the decedent. I DIVIDED BY Z (SURVIVORS) = .50 X 100 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (1ina ~) is determined by multiplying the account balance (line Z) by the percent taxable (line 5). 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line S) from the amount subject to tax (line 7. Enter the appropriate tax rata (line ?) as determined below. Da~e of Death Spouse Lineal I Sibling Collateral 07/01/9q ~o 12/$1/9q 01/01/95 ~o 06/50/00 OX 6Z 07/01/00 ~o presen~ OX q.BX~ 12Z mThe tax rate imposed on the net va[ua of transfers from a deceased ¢ twenty-one years of age or younger at death to or for the use of a natural parent) an adoptive parent, or a stepparent of the child is OZ. The lineal class of hairs includes grandparents, parents, children, and 11nea1 descendents. "Children" includes nature1 children whether or net they have been adopted by others) adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether ar not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" ara defined as individuals who have at [east one parent in common with the decedent) whether by b]ood or adoption. The -Collateral" class of heirs includes a11 other beneficiaries. CLATMED DEDUCTTONS - PART $ - DEBTS AND DEDUCTTONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally ara responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. [f additional space is needed, use plain paper B I/Z" x Il". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004138 STONE DONNA M 47 GREENSPRING DR MECHANICSBURG, PA 17050 ........ fold ESTATE INFORMATION: SSN: 262-41-6456 FILE NUMBER: 2104-0638 DECEDENT NAME: ROWE DOROTHY V DATE OF PAYMENT: 07/08/2004 POSTMARK DATE: 07/07/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/13/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04124715 $249.58 TOTAL AMOUNT PAID: $249.58 REMARKS: DONNA R STONE SEAL CHECK# 1125 INITIALS: VZ RECEIVED BY' GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 180601 HARRISBURG, PA 17126-0601 SARA J BASEHORE 801SHULER ST HECHANICSBURG PA 17055 CONNONWEALTH OF PENNSYLVANXA DEPARTNENT OF REVENUE NOTICE OF INHER/TANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1645 EX AFP R~ .... ~ ~ ~'DAT .~_.-- ,-,~ 08-02-200~. ~L~,~ ...... EST~E~F RONE DOROTHY V r~ -~::~DATE:OF DEATH 0~-1~-200R FILE NUH~ER 11 0~-06S8 COUNTY CUH~ER LAND '04 JUL ~/~ :30 262-~1-6~56 ACN 0~12~708 ~'~ ~ Amoun~ HAKE CHECK PAYABLE AND REH~T PAYHENT TO: REGISTER OF HILLS CUH~ERLAND CO COURT HOUSE CARLISLE, PA 1701S CUT ALONG THIS L'rNE ~ RETAIN LOWER PORT'rON FOR YOUR RECORDS ""~ REV-15~8 EX AFP (01-03) NOTICE OF XNHERZTANCE TAX APPRAXSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-02-200~ ESTATE OF ROWE DOROTHY V DATE OF DEATH 0~-15-200~ COUNTY CUHBERLAND FILE NO. 11 0~-0658 S.S/D.C. NO. 262-~1-6R56 ACN TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED 0~12~708 JOINT OR TRUST ASSET XNFORHATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. $1600226552 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE DATE ESTABLISHED 05-27-2005 Accoun~ Balance Percent Taxable X 0.166 Amoun~ Sub~ec~ ~o Tax 2,59~.$5 Debts and Deduc~/ons - .00 Taxable Amoun~ Z,59q.$5 Tax Ra~e ~ .q5 Tax Due 116.75 TAX CREDZTS: 15,565.78 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYHENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO: **REGISTER OF WILLS, AGENT.** PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) PAYHENT HUST BE HADE BY 01-1R-2005~. TOTAL TAX CREDIT [ BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF pATD AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL TNTEREST. ~ ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REgUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) .00 116.75 .00 116.75 PURPOSE OF MOT]CE~ PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of 2000. (72 P.S. Section Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side. -- Make check or money order payable to: REGISTER OF MILLS) AGENT. A refund of a tax credit, which ems not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (RE¥-ISZS). Applications ara available at the Office of the Register of Hills) any of the 23 Revenue District Offices or by calling the special gq-hour answering service for forms ordering: 1-800-56Z-Z050; services for taxpayers with special hearing and or speaking needs: 1-800-q47-30ZO (TT only). Any party in interest not setisfisd with the appraisement, allowance, or disallowance of deductions ar assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appealst Dept. gSlOZlt Harrisburg~ PA 17128-10Z1, OR --electing to have the matter determined at tho audit of the account of the personal representative) OR --appeal to tho Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue) Bureau of individual Taxes) ATTN: Post Assessment Review Unit) DEPT. 280601, Harrisburg) PA 171Z8-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (2) calendar months after the dacedent's death) a five percent discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed~ and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .000164. All taxes Nhich became delinquent on or after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198'-'~ 20X .000548 198~8-1991 llX .000301 2009 92 .000247 1983 162 .000458 1992 9X .000247 200Z 62 .O00Z19 1984 112 .000501 1995-1994 72 .000192 2002 52 .000127 1985 132 .000356 1995-1998 92 .000247 2004 42 .OOOXlO 1986 102 .000274 1999 72 .000192 1987 92 .000Z47 ZOO0 82 .O00Z19 --Interest is calculated as follows: I'NTEREST = BALANCE OF TAX UNPAI'D X NUNBER OF DAYS DELTNQUENT X DAILY ~NTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice) additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES - INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 17128-0601 DONNA M STONE q7 GREENSPRING DR MECHANICSBUR6 PA 17050 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS Re¢;F~-!~,~.~:~/~T~f os-oz-zooq '> ...... U~ATE OF ROWE ..... ~ DA?[ OF DEATH 0q-l~-~00~ 'O4 FILE NUMBER 21 0~-0658 COUNTY CUMBERLAND JUL 30 sAg/ O 262- 1-6 56 ACN 0q12~709 Amoun'l: R,,m i 'l:'~d REV-16gi$ EX AFP (01-03) DOROTHY V HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701~ CUT ALONG TH'rS L'rNE ~* RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF 'rNHER'rTANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON ,JOINTLY HELD OR TRUST ASSETS DATE 08-02-200~ ESTATE OF ROWE DOROTHY V DATE OF DEATH 0~-15-Z00~ COUNTY CUMBERLAND FILE NO. 21 0q-0658 S.S/D.C. NO. 262-~1-6~56 ACN TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED 0~12~709 JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. ~1600226552 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 0~-27-2005 Accoun~ Balance 15,565.78 Percen~ Taxable ~ 0.166 Amoun~ Sub~ec~ ~o Tax Z,59q.~5 Debts and Deductions - .00 Taxable Amoun~ Z,59q.~5 Tax Ra~e ~ .q5 Tax Due 116.75 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: ffREGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID ¢-) PAYMENT MUST BE MADE BY 01-1q-ZO05~. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. .00 116.75 .00 116.75 PURPOSE OF NOTICE: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S. Section 9140). PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: A refund of a tax credit, which Nas not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-Z313). Applications ara available et the Office of the Register of Hills) any of the 13 Revenue District Offices or by calling the special Z4-hour enamoring service for forms ordering: 1-DO0-561-ZOSO; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281011, Harrisburg, PA 17118-1011, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factua! errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviee Unit, DEPT. 180601, Harrisburg, PA lT1Ze-060l Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. A11 taxes which became delinquent on or after January 1, 1981 et11 bear interest at a rate which Nil1 vary from calendar year to calendar year eith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 19D~'~ 20Z .000548 198'--~-1991 llZ .000301 ZO0"~ 9Z .OOOZ47 1983 161 .000438 1991 91 .000147 Z002 6X .000119 1984 111 .000301 1993-1994 7Z .OOOlgZ 2003 5Z .000137 1985 131 .000356 1995-1998 9X .000147 2004 41 ,000110 1986 101 .000174 1999 71 .000191 1987 9Z .OOOZ47 ZOO0 8Z .000Z19 --Interest is calculated as folloes: /NTEREST = BALANCE OF TAX UNPA/D X NUHBER OF BAYS DEL/Nt;)UENT X DATLy INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be caIculated. BUREAU OF INDIVIDUAL TAXES TNHERITAHCE TAX DZVISTON DEPT. 280601 HARRTSBURG, PA 17128-0601 SARA J BASEHORE 801SHULER ST MECHANICSBURG PA 17055 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLO#ANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS ~e,--:-;~ :~- ES?&T~ OF ROWE :~ .... DAy£'~bF DEATH 0q-13-200~ FILE NUMBER '04 JUL JL~sk~De30 ACN 21 0~-0638 CUMBERLAND 262-~1-6~56 0~12~712 Amount Rem1 ~c~ced DOROTHY MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-1548 EX AFP NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTZONS~ AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-OZ-ZO0~ ESTATE OF ROWE DOROTHY V DATE OF DEATH 0~-13-Z00~ COUNTY CUMBERLAND FILE NO. 21 0~-0638 S.S/D.C. NO. 262-~1-6~56 ACN 0~12~712 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED dOZNT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 5070093823 TYPE OF ACCOUNT: ¢ ) SAVINGS (~ CHECKING ( ) TRUST ¢ ) TIME CERTIFICATE DATE ESTABLISHED 03-27-2003 Accoun~ Balance Z,7q6.03 Percent Taxable ~ 0.166 Amoun~ Sub~ec~ ~o Tax ~57.68 Debts and Deductions - .00 Taxable Amoun~ ~57.68 Tax Ra~e ~ .~5 Tax Due 20.60 TAX CREDZTS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) PAYMENT MUST BE MADE BY Ol-lq-ZO05~. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, HO 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. ) .00 20.60 .00 20.60 PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADNIN- ZSTRATZVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of SsctJon ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Sect[on 9160). Detach the top portion of this Notics and submit with your payment to ths Rsg[stsr of #ills prJntsd on ths reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by coeplet[ng an "Application for Rsfund of Pennsylvania Inhsritance and Estate Tax" (REV-IS13). Applications ere available at the Office of the Register of N[Zls, any of the Z3 Revenue District Off[css or by calling the spsc[a! IS-hour answering service for forms ordsr[ng: 1-800-361-ZOS0; services for taxpayers with specie! hearing and or speaking needs: 1-&00-667-3010 (TT only). Any party [n intsrest not satisfied with the appra[ssment, allowance, or disallowance of deductions or assessment of tax [including discount ar interest) as shown on this Notice may object within sixty [60) days of receipt of this Not[os by: --written protest to ihs PA Dspartaent of Rsvsnus, Board of Appeals, Dspt. 181011, Harrisburg, PA 17118-1011, OR --electing to have the matter dstere[nsd at the audit of ihs account of ihs psrsonal reprssentativs, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in er[ting to: PA Dspartesnt of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Rsvisw Unit, DEPT. Z80601, Harrisburg, PA 17115-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inhsr[tancs Tax Return for a Resident Decedent" (REV-IS01) for an explanation of adetn[strat[vsly corrsctabls errors. If any tax dus is paid aith[n three (3) calendar months after the decsdsnt's death, a five percent discount of the tax paid is allowed. The 15Z tax amnesty non-part[oipat[on psnalty is computed on the total of ihs tax and intsrsst assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in ths same manner and in the the same ties parted as you would appeal the tax end interest that has been assessed as indicated on this not[cs. Interest is charged beginning with first day of delinquency, or nine [9) months and one (1) day from the date of dso[h, to the date of payment. Taxes which became dslinqusnt before January 1, 1981 bear interest at ths rata of six [6Z) percent per annum caloulatsd at e daily rate of .000166. AIl taxes which became dslinquent on or after January 1, 1981 will bear interest at a rata which will vary free calendar year to calendar year with that rate announced by the PA Dspartesnt of Revenue. Ths applicable [ntersst rates for 1982 through 2006 are: Interest Daily Intsrest Daily Intsrsst Daily Year Rate Factor Year Rate Factor Year Rate Factor 198~ 20Z .000568 198'--~-1991 11Z .OOO~OX 2001 91 .000267 1983 161 .O006~& 1992 9Z .000267 ZOOZ 61 .OOOZl9 1986 1II .000301 1993-1996 71 .000191 Z005 SZ .000137 1985 l~Z .000356 1995-1998 91 .000267 2006 61 .O0011O 1986 lOX .000276 1999 71 .000192 1987 91 .000267 2000 8Z .000219 --Interest is caZculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of the assessment. If payment is made after tbs interest computation date shown on the Not[cs, additional interest must bs calculatsd. SUREAU OF INDIVIDUAL TAXES - INHER'rTAHCE TAX DIVTSTON DEPT. Z80601 HARRTSBURg, PA 17128-0601 DONNA H STONE q7 GREENSPRING DR MECHANICSBURG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOMANCE OR DISALLO#ANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS -. - -.- ~-ttATE ..... 08-02-200q '~ ~:.~:, ~A~E ~DF ROWE DATE OF DEATH Oq-l$-ZOOq FILE NUMBER 21 0~-0658 PA 17050 CUMBERLAND ACN 0~12q711 REV-15~i8 EX RFP (Ol-OS) DOROTHY V MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~-* RETAIN LONER PORTION FOR YOUR RECORDS REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DZSALLONANCE OF DEDUCTZONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-02-ZOOq ESTATE OF ROWE DOROTHY V DATE OF DEATH Oq-l$-2OOq COUNTY CUMBERLAND FILE NO. 21 0q-0658 S.S/D.C. NO. 262-ql-6q56 ACN OqlZq711 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PHC BANK ACCOUNT NO. 5050118889 TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-27-2005 Account Balance 6q,$~6.79 Percent Taxable X 0.166 Amount Subject to Tax 10,72q.68 Debts and Deduct/ons - .00 Taxable Amount 10,7Zq.68 Tax Rate X .q5 Tax Due q82.6! TAX CRED'rTS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF MILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) PAYMENT MUST BE MADE BY 01-1q-2005~. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REDUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) .00 q82.61 .00 q82.61 PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To ~ulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOOO. (72 P.S. Section 91qO). Detach the top portion of this Notice and submit with your payment to the Register of Rills printed on the reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, ~hich ~as not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of the Register of Hills, any of the 13 Revenue District Offices or by calling the special Iq-hour answering service far forms ordering: 1-800-561-Z050; services for taxpayers ~ith special hearing and or speaking needs: Z-BOO-qq7-30ZO (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --~rittan protest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 1711&-1011, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should ba addressed in uriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. Z&0601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page 5 of the bookZet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three ($) calendar months after the decadent's death, a five percent discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you ~ould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning ~ith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016q. All taxes which became delinquent on or after January 1, 1981 will bear interest at a rate ~hich ~ill vary from calendar year to calendar year with that rate announced by the PA Oapartaent of Revenue. The applicable interest rates for 1981 through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor lgB'--~ ZOZ .OOOSqB 198~-1991 XZZ .O00$OZ 200~-~ 91 .goozq7 1982 162 .O00qSB 1992 92 .O00Zq7 ZOOZ 62 .D00219 198& 112 .000301 1993-199~ 72 .000191 ZDO3 52 .000157 1985 122 .000256 1995-1998 92 .0002~7 ZOO~ qZ .OOOllO 1986 lOZ .000E74 1999 72 .000192 1987 92 .O00Zq7 ZOO0 SZ .000219 --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD X NUHBER OF DAYS DELINQUENT X DALLY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF TND'rv'rDUAL TAXES TNHER/TANCE TAX DTVTSTOH DEPT. Z80601 HARRTSBURG, PA 171Z8-060! SARA J BASEHORE 801SHULER ST NECHANICSBURG PA 17055 COHNONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOT/CE OF ZNHERZTANCE TAX APPRAISEHENT, ALLO#ANCE OR DISALLO#ANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS Reco ~:! ~! Ei ~i~ i!i ~T~? 08- 02- 2004 ,--:~- ~!~ATE OF ROWE DOROTHY V DATE OF DEATH 04-13-Z004 FILE NUMBER 21 04-0658 262-41-6456 ACN 04124714 HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS ""~ REV-15&8 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-02-2004 ESTATE OF ROWE DOROTHY V DATE OF DEATH 04-15-Z004 COUNTY CUHBERLAND FILE NO. 21 04-06~8 S.S/D.C. NO. 262-41-6456 ACN TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED 04124714 JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. $1200255187 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TINE CERTIFICATE DATE ESTABLISHED 0~-27-Z005 Accoun~ Balance $5,0Z8.59 Percen~ Taxable X 0.166 Amoun~ Sub~ec~ ~o Tax 5,838.22 Debts and Deductions - .00 Taxable Amount 5,858.ZZ Tax Ra~e ~ .45 Tax Due 262.72 TAX CREDTTS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYHENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF WILLS, ASENT." PAYMENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) PAYHENT HUST BE MADE BY 01-14-Z005~. TOTAL TAX CREDIT I I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PA/D AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADD/T/ONAL INTEREST. ( ZF TOTAL DUE [S LESS THAN $1, NO PAYHENT 1S RE~U/RED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) .00 262.72 .00 262.72 PURPOSE OF NOT[CE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfi11 the requirements of Section Il40 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Make check or money order payable to: REGISTER OF NILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Nills, any of the Z3 Revenue District Offices or by calling the special Z4-hour ansaering service for forms ordering: 1-800-36Z-Z050; services for taxpayers ~ith special hearing and or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied aith the appraisement, allowance, or disalloaance of deductions or assessment of tax (including discount ar interest) as shown on this Notice may object ~ithin sixty (60) days of receipt of this Notice by: --~rittan protest to the PA Department of Revenue, Board of Appeals, Dept. ZBlO21, Harrisburg, PA 171ZB-lOZ1, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to tho Orphans' Court Factual errors discovered on this assessment should be addressed in mriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, DEPT. 280601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid ~ithin three (33 calendar months after the dacedent's death, a five percent discount of the tax paid is altoaad. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, end not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning ~ith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January I, 198Z bear interest at the rate of six (6g) percent per annum calculated at a daily rate of .000164. Al! taxes ~hich became delinquent on or after January 1, 1982 ail! bear interest at a rate ahich ~il! vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z 20Z .OOO546 198'~"~-1991 IZZ .OO030l ZOO1 9Z .000247 1983 16Z ,000456 1992 92 .000247 200Z 6Z .000Z19 1984 11Z .000301 1993-1994 7Z .00019Z ZOO3 5Z .000137 1985 13Z .D00356 1995-1998 92 .000247 2004 42 .000110 1986 102 .000Z74 1999 72 .O0019Z 1987 92 .OOOZ47 2OOO 8Z .OOOZl9 --Interest is calculated as follo~s: I'NTEREST = 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 (1S) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must ba calculated. BUREAU OF ZNDTVZDUAL TAXES · INHERITANCE TAX DTVTSTON DEPT. 280601 HARRTSBURG, PA 17128-0601 DONNA M STONE 47 GREENSPRING DR MECHANICSBURG PA 17050 CONNON#EALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRATSENENT. ALLO#ANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS ~e~:ii i:~' ':f ~, E~TATE OF ROWE DATE OF DEATH FILE NUH~ER 21 0~-06~8 CUMBERLAND 262-41-6456 ACN 04124713 I REV-I;48 EX AFP (gl-OS) DOROTHY V HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF XNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-02-2004 ESTATE OF ROWE DOROTHY V DATE OF DEATH 04-13-2004 COUNTY CUMBERLAND FILE NO. 21 04-0638 S.S/D.C. NO. 262-41-6456 ACN 04124713 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 5070093823 TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) TINE CERTIFICATE DATE ESTABLISHED 03-27-2003 Accoun~ Balance Percen~ Taxable X 0.166 Amoun~ Subjec* ~o Tax 457.68 Debts and Deduc~/ons - .00 Taxable Amoun~ 457.68 Tax Ra~e ~ .45 Tax Due 20.60 TAX CRED'rTS: 2,746.03 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE W/TH YOUR TAX PAYHENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO= "REGISTER OF WILLS, ASENT." PAYMENT DATE RECEIPT NUHBER AMOUNT PAID DISCOUNT (+) INTEREST/PEN PAID (-) =AYMENT MUST BE MADE BY 01-14-2005~. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CRED/T" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. .00 20.60 .00 20.60 PURPOSE OF NOTICE: To Tulfill the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 91~0). PAYHENT: Detach the top portion of this Notice and submit wi~n your payment to tho Register of Hills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF HILLS, AGENT. REFUND (CR): OBJECTIONS: ADH/N- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Hills, any of the ZS Revenue District Offices or by calling the special Z~-hour answering service for forms ordering: 1-800-362-Z050; services for taxpayers with special hearing and or speaking needs: 1-800-~7-5020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 171ZB-IDZI, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 171Z6-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-iSO1) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ehich becalm delinquent before January l, 198Z bear lnterast at the rate of six (62) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200q are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .0005fi8 198~-1991 112 .000301 ZO0'~ 92 .O00Zq7 1985 16X .OOOq38 1992 92 .0002~7 Eooz 62 .000219 198~ IIX .000301 1993-199q 7Z .000192 2003 SZ .000137 1985 13Z .000356 1995-1998 92 .O00Zq7 ZO0~ fix .000110 1986 lOX .OOOZT~ 1999 7Z .000192 1967 9Z .OOOZ¢7 ZOOO 8Z .000219 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINI~UENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must bm calculated. BUREAU OF TNDZVZDUAL TAXES · XNHERTTANCE TAX DXYZS/OH DEPT. Z80601 HARRTSBURG, PA 171ZG-O6G1 SARA J BASEHORE 801SHULER ST MECHANICSBURG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTTCE OF 'rNHERXTANCE TAX APPRAXSEHENT, ALLOHANCE OR DXSALLOMANCE OF' DEDUCTZONS, AND ASSESSHENT OF TAX ON' JOXNTL¥ HELD OR TRUST ASSETS R~..,~ .., :~,~ ............of DATE 08-02-Z00q R.:~C;i~:i'*~;- ~' ~ ~; :g ESTATE OF ROME DATE OF DEATH OR-1S-ZO0~ FILE NUH~ER Z1 '04 ~t ~0 ' ~ '~qCOUNTY CUHBERLAND ~ ......... SSN/DC 252-~1-6~56 ACN 0~12~710 Amoun~ PA 17Q55 REV-15gI8 EX AFP COX-OS) DOROTHY MAKE CHECK PAYABLE AND REM'rT PAYMENT TO.' REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 V CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEMENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS DATE 08-02-200q ESTATE OF ROWE DOROTHY V DATE OF DEATH Oq-15-ZOOq COUNTY CUMBERLAND FILE NO. 21 0q-0658 S.S/D.C. NO. 262-ql-6q56 ACN TAX RETURN WAS: eX) ACCEPTED AS FILED ( ) CHANGED dO~NT OR TRUST ASSET INFORMATION Oq12q710 FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 5050118889 TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ¢ ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-IT-ZOO5 Account Balance Percent Taxable X 0.166 Amount Sub~ec~ to Tax 10,7Zq.68 Debts and Deductlons - .00 Taxable Amount 10,7Zq.68 Tax Ra~e X .q5 Tax Due qGZ.61 TAX CREDITS: 6q,Sq6.79 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: ffREGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) PAYMENT MUST BE MADE BY 01-1q-ZO05~. TOTAL TAX CRED'rT BALANCE OF TAX DUE 'rNTEREST AND PEN. TOTAL DUE IF PATD AFTER TMTS DATE, SEE REVERSE FOR CALCULATTON OF ADDTTTONAL TNTEREST. TF TOTAL DUE IS LESS THAN $1, NO PAYMENT TS REI~U'rRED. TF TOTAL DUE TS REFLECTED AS A "CREDTT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF TH'rS FORM FOR TNSTRUCT'rONS. .00 q82.61 .00 q82.61 PURPOSE OF NOTICE: To fulfill the requirements of Section 1140 of the Inheritance and Estate Tax Act, Act 15 of ZOO0. (7Z P.S. Section 9140).. PAYHENT: REFUND (CR): OBJECTIONS: ADNIN- ZSTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Detach tho top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit) Nhich Nas not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of the Register of Hills, any of the Z5 Revenue District Offices or by calling the special Z4-hour ansNering service for forms ordering: Z-800-56Z-ZO50; services for taxpayers Nith special hearing and or speaking needs: 1-800-447-5020 (TT only). Any party in interest not satisfied with the appraisement, alZoNance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue) Board of Appeals, Dept. 281021) Harrisburg) PA 17128-1021) OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue) Bureau of Individual Taxes) ATTN: Post Assessment Review Unit) DEPT. 280601) Harrisburg) PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death) a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed) and not paid before January 18) 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you Nould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death) to the date of payment. Taxes Nhich became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate ahich Hill vary from calendar year to calendar year Nith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .000548 198'~8-1991 111 .000501 2OO"~ 91 .000147 1985 161 .0004~8 1992 91 .000247 2002 61 .000219 1984 111 .000501 1995-1994 71 .000192 2005 51 .000157 1985 132 .000556 1995-1998 91 .000247 2004 41 .O00IlO 1986 101 .000274 1999 7Z .000192 1987 92 .000147 ZOO0 8Z .000119 --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD X NUHBER OF DAYS DELZNQUENT X DAZLY TNTEREST 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 shoNn on the Notice, additional interest must be ca[culated. BUREAU OF INDIVIDUAL TAXES INHERTTANCE TAX DTVZSZOH DEPT. 280601 HARRISBURG, PA 171Z8-060! DONNA H STONE ~7 GREENSPRING DR MECHANICSBURG PA 17050 COHHONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOT/CB OF TNHERTTANCE TAX APP~TSENEST,. ~d, LO#ANC_~ OR DISALLO#ANCE OF ~~._.~~O~SHENT OF TAX ON ~N~1'1~¥ SELI~ ORs. TRUST ASSETS DATE 08-02-200~ ESTATE OF ROME *04 ~ ~ '~p/~l~l~ OF DEATH 0~-15-Z00~ FILE NUHBER COUNTY ACH 21 0~-0658 CUHBERLAND 262-~1-6~56 0612R715 Amoun'~ Rem i'l:'Eed DOROTHY HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS REV-1548 EX AFP (01-03} NOTICE OF INHERITANCE TAX APPRAZSEHENT~ ALLONANCE OR DZSALLONANCE OF DEDUCTZONS~ AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-0Z-200~ ESTATE OF ROME DOROTHY V DATE OF DEATH 0R-15-200~ COUNTY CUHBERLAND FILE NO. 21 0R-0658 S.S/D.C. NO. Z62-R1-6R56 ACN 0~12~715 TAX RETURN HAS: eX) ACCEPTED AS FILED ¢ ) CHANGED dOINT OR TRUST ASSET INFORHATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. $1Z00255187 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 05-ZT-Z005 Accoun~ Balance $5,028.59 Percen~ Taxable ~ 0.166 Amount Subject ~o Tax 5,858.22 Debts and Deductions - .00 Taxable Amoun~ 5,858.2Z Tax Ra~e X .~5 Tax Due 262.72 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE NITH YOUR TAX PAYHENT TO THE REGISTER OF HILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF HILLS, AGENT." TAX CREDITS: PAYHENT RECEIPT DISCOUNT ¢+) AHOUNT PAID DATE NUMBER INTEREST/PEN PAID ¢-) ~AYHENT HUST BE HADE BY 01-1R-ZO05~. TOTAL TAX CREDZT BALANCE OF TAX DUEI ZNTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL /NTEREST. ( ZF TOTAL DUE 1S LESS THAN $1, NO PAYHENT 1S REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" ( CR}, YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) .00 Z6Z.7Z .00 Z6Z.7Z PURPOSE OF NOTICE: To fulfill the requirements of Section Z160 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (71 P.S. Section 9160). PAYHENT: REFUND (CR): OBJECT/OHS: ADNIN- ISTRATIVE CORRECTZONS: DISCOUNT: PENALTY: INTEREST: Detach the top portion of this Notice and submit with your payment to the Register of gills printed on the reverse side. -- Nake check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, ehich was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-I$I3). AppLications are available at the Office of the Register of Nills, any of the 13 Revenue District Offices or by calling the special ZB-hour answering service for forms ordering: 1-800-361-Z050; services for taxpayers .ith special hearing and or speaking needs: 1-800-667-30Z0 (TT only). Any party in interest not satisfied .ith the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17118-102L, OR --electing to have the matter determined at tho audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should bo addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 180601, Harrisburg, PA 17LIB-060! Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. Zf any tax due is paid within three (3) calendar months after the decadent's death, a five percent (51) discount of the tax paid is allowed. The 1SZ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one fL) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 1981 bear interest at the rate of six (61) percent par annum calcuXatad at a daily rate of .000166. AIL taxes which became deXinquant on or after January 1, 1981 wiI1 bear interest at a rate which wiII vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z006 are: Interest Daily Interest Daily Interest DaiLy Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .000568 198'~8-1991 IZZ .000301 ZO0~ 91 .000267 1983 161 .000638 1991 91 .000267 ZOOZ 61 .000219 1986 111 .000301 1993-1996 71 .000192 Z003 5X .000137 1985 13X .000356 1995-L998 91 .000267 2006 61 .000110 1986 LOX .OODZ76 1999 7Z ,000191 1987 9Z .000Z67 ZOO0 81 .000Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent wiX1 refXect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. - E~.IREAU OF TNDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG,, PA 171Z&-0601 COMMONWEALTH OF PENNSYLVANTA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT RE¥-160? EX AFP C01-03) SARA J BASEHORE 801SHULER ST MECHANICSBURG PA 17055 DATE 08-16-200~ ESTATE OF ROWE DATE OF DEATH Oq-l$-ZOOq FILE NUMBER 21 0q-0658 COUNTY CUMBERLAND ACN OqlZqT08 I Amount: Remi~ed DOROTHY V MAKE CHECK PAYADLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit: ~:o your account, submit: ~he upper por~ion of ~chts form wi~h your ~ax payment. CUT ALONG THIS LINE ~ RETA'rN LOWER PORT'tON FOR YOUR RECORDS *-~ REV-1607 EX AFP (01-03) a~ INHERITANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF ROWE DOROTHY V FTLE NO. 21 0q-0658 ACN Oq12q708 DATE 08-16-200q THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHO#N BELO# IS A SUMMARY OF THE PRINCIPAL TAX DUE., APPLICATION OF ALL PAYMENTS., THE CURRENT BALANCE, AND,, IF APPLICABLE., A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADdUSTMENT: 08-02-200q PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 116.75 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 07-07-200q CDOOql$7 5.8q 110.91 TOTAL TAX CRED/T ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE 1S LESS THAN $1.' NO PAYMENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. 116.75 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DZVTSTON DEPT. Z80601 HARRISBURG, PA 171Z8-0601 CONHONWEALTH OF PENNSYLVAN'rA DEPARTHENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-I60? EX AFP (01-0S) SARA J BASEHORE 801SHULER ST HECHANICSBURG PA 17055 DATE 08-16-ZOOR ESTATE OF ROWE DATE OF DEATH OR-13-ZOOR FILE NUHBER 21 COUNTY CUHI}ERLAND ACN 0~1Z~71~ I Amount Remitted DOROTHY V HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form w/th your tax payment. CUT ALONG THXS LXNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~ REV-1607 EX AFP (01-03) ~ 'rNHER'rTANCE TAX STATEHENT OF ACCOUNT ~ ESTATE OF ROWE DOROTHY V FZLE NO. 21 0~-0638 ACN 0q12~71~ DATE 08-16-200~ THIS STATENENT 1S PROV'rDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHO#N BELO# 1S A SUHNARY OF THE pR'rNc'rpAL TAX DUE, APPL'rCAT/ON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, 'rF APPL/CABLE, A PROJECTED TNTEREST F'rGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 08-02-200~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... 262.72 PAYHENTS (TAX CREDITS): PAYHENT DATE 07-07-200~ RECEIPT DISCOUNT (+) NUHBER INTEREST/PEN PAID (-) AHOUNT PAID CDOOq13~ 13.1~ 2R9.57 TOTAL TAX CREDIT ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULAT/ON OF ADD/TKONAL KNTEREST. ( KF TOTAL DUE KS LESS THAN $1, NO PAYHENT KS REQUKRED. ZF TOTAL DUE KS REFLECTED AS A 'CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SKDE OF THIS FORH FOR KNSTRUCTZONS. 262.71 BALANCE OF TAX DUE .01 INTEREST AND PEN. .00 TOTAL DUE .01 BUREAU OF INDIVIDUAL TAXES I'NHERTTANCE TAX DI'VZSTON · DEPT. 280601 HARRTSBURG.. PA 17126-0601 CONHONWEALTH OF PENNSYLVAN'rA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT RE¥-16D? EX AFP (BI-DS) SARA d BASEHORE 801 SHULER ST MECHANICSBURG PA 17055 DATE 08-16-200R ESTATE OF ROWE DATE OF DEATH 0~-13-200q FILE NUMBER 21 0~-0658 COUNTY CUMBERLAND ACN 0~12~712 Amour'l: DOROTHY V MAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper crmdi~ ~co your account, submi:~ ~he uppmr portion of ~his form wi~h your ~ax payment. CUT ALONG TH~'S L'rNE ~ RETA'rN LOWER PORT'rON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~-~ ZNHER'rTANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF ROWE DOROTHY V FILE NO. 21 0~-0658 ACN 0~12q712 DATE 08-16-200~ THIS STATEMENT ZS PROVZDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHO#N BELO# ZSA SUHHARY OF THE PRZNCTPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-OZ-ZO0~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS CTAX CREDITS): 20.60 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 07-07-200~ CD00~156 1.05 19.57 ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDZTIONAL INTEREST. IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SZDE OF THIS FORM FOR INSTRUCTIONS. ) TOTAL TAX CREDIT 20.60 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .0§ , BUREAU OF INDIVIDUAL TAXES INHERTTANCE TAX DTVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANTA DEPARTHENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT RE¥-1607 EX AFP DONNA N STONE q7 GREENSPRING DR MECHANICSBURG PA 17050 DATE 08-16-200q ESTATE OF ROWE DATE OF DEATH 0~-13-Z00~ FILE NUMBER 21 0~-0658 COUNTY CUMBERLAND ACN 0~12q711 Amoun'~ Remi~:~ed DOROTHY V HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701) NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his for. wi~h your ~cax pay.en~c. CUT ALONG THIS LTNE ~ RETA'rN LOWER PORT'rON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) --# INHERITANCE TAX STATEHENT OF ACCOUNT .~. ESTATE OF ROWE DOROTHY V FILE NO. 21 0~-0658 ACN 0~1Z~711 DATE 08-16-200~ THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHO#N BELON ZSA SUHMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-02-200q PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): ~82.61 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 07-07-200q 2q.15 qS8.q8 CDOOql$$ ., EL~ TOTAL TAX CREDIT q82.61 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCT/ONS. -- BUREAU OF TND*rV'rDUAL TAXES THHERTTANCE TAX DTVTSTON · DEPTo ZB0601 HARRTSBURG,, PA 17118-06D1 DONNA H STONE 47 GREENSPRING DR MECHANICSBURG PA 17050 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE 'rNHERZTANCE TAX STATEHENT OI= ACCOUNT DATE 08-16-2004 ESTATE OF ROWE DATE OF DEATH 04-15-2004 FZLE NUMBER 21 04-0638 COUNTY CUHBERLAND ACN 04124709 Amoun'l: Remi~ed RE¥-i~O? EX AFP (01-05) DOROTHY V MAKE CHECK PAYABLE AND REMZT PAYMENT TO= REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 NOTE: To insure proper cred/~ ~o your account, submit ~he upper portion of ~his form wi'th your '(:ax payment. CUT ALONG THZS L'rNE ~ RETA'rN LOWER PORTZON FOR YOUR RECORDS *~ REV-1607 EX AFP (01-03) ~ ZNHERZTANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF ROWE DOROTHY V FZLE NO. 21 04-0658 ACN 04124709 DATE 08-16-2004 THZS STATEMENT ZS PROVZDED TO ADVZSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHOWN BELOW TS A SUMMARY OF THE PRZNCZPAL TAX DUE., APPLZCATZON OF ALL PAYMENTS., THE CURRENT BALANCE., AND., ZF APPLZCABLE., A PROJECTED ZNTEREST FZOURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-02-2004 PRZNCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 116.75 PAYMENT RECEZPT DZSCOUNT C+) DATE NUHBER ZNTEREST/PEN PAZD (-) AHOUNT PAZD 07-07-2004 CD004159 5.84 110.91 ZF PAZD AFTER THZS DATE., SEE REVERSE SZDE FOR CALCULATION OF ADDZTIONAL INTEREST. ZF TOTAL DUE IS LESS THAN $1., NO PAYMENT IS REQUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" YOU MAY BE DUE A REFUND. SEE REVERSE SZDE OF THIS FORM FOR ZNSTRUCTIONS. TOTAL TAX CREDZT 116.75 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 . BUREAU OF INDIVIDUAL TAXES TNHERITANCE TAX DTVTSTOH DEPT. Z8060! HARRTSBURG, PA 171Z8-0601 DONNA M STONE ~7 GREENSPRING DR HECHANICSBURG PA 17050 COMMONNEALTH OF PENNSYLVAN'rA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF ACCOUNT DATE 08-16-200~ ESTATE OF ROME DATE OF DEATH 0~-13-Z00~ FZLE NUMBER 21 0~-0638 COUNTY CUMBERLAND ACN 0~12R715 REV-1607 EX AFP C01-03) DOROTHY Amoun'~ Remi'l:'l:ed MAKE CHECK PAYABLE AND REM'rT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his form wi~h your ~ex payment. CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ ESTATE OF ROME DOROTHY V F'rLE NO. 21 0~-0658 ACN 0~,1Zq715 DATE 08-16-200~ THTS STATEMENT TS PROV'rDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHO#N BELOW/ 'rs A SUMMARY OF THE pR'rNCTpAL TAX DUE, APPL'rCATI'ON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, TF APPL'rCABLE, A PROJECTED TNTEREST FTGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-OZ-ZOOR PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 20.60 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 07-07-Z00~ CDO0~I~I 1.05 19.57 KF PAKD AFTER THKS DATE, SEE REVERSE SKDE FOR CALCULATKON OF ADDKTKONAL INTEREST. IF TOTAL DUE KS LESS THAN $1, NO PAYMENT KS REQUKRED. .rF TOTAL DUE KS REFLECTED AS A "CREDKT" YOU MAY BE DUE A REFUND. SEE REVERSE SKDE OF THKS FORM FOR KNSTRUCTKONS. TOTAL TAX CREDIT 20.60 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 BUREAU OF /NDTVTDUAL TAXES THHERTTAHCE TAX D/VISTON ' DEPT. Z80601 HARRISBURG, PA 171ZD-0601 DONNA H STONE ~7 GREENSPRING DR MECHANICSBURG PA 17050 COHHONWEALTH OF PENNSYLVANTA DEPARTNENT OF REVENUE INHERITANCE TAX STATEMENT OI= ACCOUNT DATE 08-16-200~ ESTATE OF ROWE DATE OF DEATH 0~-15-Z00~ FZLE NUHBER Z1 0~-0658 COUNTY CUMBERLAND ACN 0~12~715 Amoun'~ Remi~:ed REV-1607 EX AFP (rtl-OS) DOROTHY V HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUMIIERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To lnsure proper cred/~ *o your account, submit: ~:he upper por~lon of *his for. wl*h your ~ax pay.en~c. CUT ALONG THZS LINE ~ RETAIN LOWER PORTZON FOR YOUR RECORDS *-~ REV-1607 EX AFP (01-03) ~x~ ZNHERZTANCE TAX STATEHENT OF ACCOUNT ~x~ ESTATE OF ROWE DOROTHY V FZLE NO. 21 0~-0658 ACN 0~124715 DATE 08-16-200~ THIS STATENENT ZS PROVIDED TO ADVZSE OF THE CURRENT STATUS OF THE STATED ACH ZN THE WANED ESTATE. SHO#N BELO# ZSA SUNNARY OF THE PRINCIPAL TAX DUE, APPLZCATZON OF ALL PAYNENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED ZNTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 08-02-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 262.72 PAYHENT RECEIPT DISCOUNT (+) DATE NUH~ER INTEREST/PEN PAID (-) AHOUNT PAID 07-07-2004 CD00~158 1~.1~ 2~9.58 TOTAL TAX CREDIT 262.72 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN NO PAYNENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. ) BUREAU OF TNDTVTDUAL TAXES 1NHERTTANCE TAX DTVISTON DEPT. 280601 HARRTSBURG, PA 171Z6-0601 SARA J BASEHORE 801SHULER ST HECHANICSBURG PA 17055 COHNONWEALTH OF PENNSYLVANTA DEPARTHENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN RE¥-16D? EX AFP (D1-05) 08-16-200q ROWE DOROTHY V Oq-l$-ZO0~ 21 0~-0658 CUMBERLAND 0RIZ~710 Amoun~ Remi~ed HAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, subei~ ~he upper por~:ion of ~chis fore wi~h your ~ax payment. CUT ALONG TH'rS L'rNE ~ RETA'rN LOWER PORT'rON FOR YOUR RECORDS REV-1607 EX AFP (01-03) ~ ZNHER'rTANCE TAX STATEHENT OF ACCOUNT ESTATE OF ROWE DOROTHY V FILE NO. 21 0q-0658 ACN 0~12~710 DATE 08-16-200~ TH'rS STATEMENT 'rs PROV'rDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN .rN THE NAHED ESTATE. SHO#N BELOW .rS A SUHNARY OF THE PR.rNC'rpAL TAX DUE, APpLTCAT.rON OF ALL PAYHENTS, THE CURRENT BALANCE.. AND, 'rF APPLTCABLE, A PROdECTED .rNTEREST F.rGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-02-200~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): q82.61 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 07-07-Z00~ CD00~155 Z~.15 ~58.q8 TOTAL TAX CREDIT ~82.61 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 'rF PA'rD AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULAT.rON OF ADDITIONAL 'rNTEREST. 'rF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )