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Home My WebLink About03-0304BUREAU OF TNDTVTDUAL TAXES INHERITANCE TAX DTVISION DEPT. 280601 HARRTSBURG, PA 17128-0601 DEBRA S SMITH 185 QUARRY HILL RD SHIPPENSBURG COHHON#EALTH OF PENNSYLVAN DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLONANCE OR DZSALLONAN£ OF DEDUCTION~, AND ASSESSHENT OF TAX Oa JOINTLY HELD OR TRUST ASSETS REV-~.;~8 EX AFP PA 17257-9629 DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY SSN/DC ACN I 05-$1-Z005 BURCHFIELD HARGARET OZ-Zq-ZO02 CUMBERLAND 179-$0-$211 02120080 Amoun*l: Remi~ed I HAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF NILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAZN LOgER PORTZON FOR YOUR RECORDS ~ REV-15q8 EX AFP (01-03) NOTICE OF INHERZTANCE TAX APPRAZSEHENT, ALLOgANCE OR DISALLOgANCE OF DEDUCTZONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-31-2003 ESTATE OF BURCHFIELD MARGARET L DATE OF DEATH 02-2q-2002 COUNTY CUMBERLAND FILE NO. S.S/D.C. NO. 179-30-3211 ACN 02120080 TAX RETURN HAS: eX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET ZNFORNATZON FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT NO. 0010603751 TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIHE CERTIFICATE DATE ESTABLISHED 0~-19-199~ Account Balance 7,508.~0 Percent Taxable X 0.166 Amount Subject to Tax 1,Z51.~$ Debts and DeductAons - .00 Taxable Amount 1,251.q3 Tax Rate X .15 Tax Due 187.71 TAX CREDZTS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE gITH YOUR TAX PAYMENT TO THE REGISTER OF gILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF gILLS, AGENT.ff PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID INTEREST IS CHARGED THROUGH 0q-08-2003 TOTAL TAX CREDIT AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE REVERSE SIDE OF THIS FORM INTEREST AND PEN. TOTAL DUE ~ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDZTIONAL ZNTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REDUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THZS FORM FOR INSTRUCTIONS. .00 187.71 3.66 191.37 PURPOSE OF NOTICE: PAYMENT: REFUND (CR}: OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (TZ P.S. Section 91qO). Detach the top portion of this Notice and submit aith your payment to the Register of Ni115 printed on the reverse side. -- Make check or money order payable to: REGISTER OF NILLS, AGENT. A refund of a tax credit, ahich was not requested on the tax return, amy be requested by completing an "Application for Refund of Pennsylvania Inheritance end Estate Tax" (REV-l~13). Applications ara available at the Office of the Register of Nills, any of the 23 Revenue District Offices or by calling the special Zq-hour answering service for fores ordering: 1-B00-562-2050; services for taxpayers aith special hearing and or speaking needs: 1-800-qq7-30Z0 (TT only). Any party in interest not satisfied eith the appraisement, alloeanca, or disallowance of deductions or assessment of tax (including discount or interest} as shown on this Notice may object aithin 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 ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, DEPT. ZB0601, Harrisburg, PA 17128-060! Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1SOI) for an explanation of administratively correctable errors. If any tax due is paid aithin three (3) calendar months after the decadent's death, a five percent (5Z) discount of the tax paid is allowed. The lSZ tax amnesty non-participation penalty is computed on the tats! 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 time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1} day from the date of death, to the data of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (62) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January l, I982 will bear interest at a rate which wil! vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 2OZ .000548 1987 9Z .000247 1999 7Z .000192 1983 162 .000¢38 1988-1991 112 .000301 ZOOO 82 .000219 1984 112 .000301 1992 92 .000247 2001 92 .O00Zq7 1985 132 .000356 1993-1994 72 .000192 Z002 6Z .000164 1986 102 .000274 1995-1998 9Z .000247 2003 5Z .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DALLY 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 Notica, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX D]'VISI*ON DEPT. 280601 HARRISBURG., PA 171:~&-060,1 BRENDA K BURCHFIELD LOT 7 5qO FOX HOLW ESTATES SHERHANS DALE PA 17090 CONNONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLO#ANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-15,~8 EX &FP COl-OS) DATE 05-31-Z005 ESTATE OF BURCHFIELD DATE OF DEATH OZ-Zq-2002 FILE NUMBER COUNTY SSN/DC ACN I NARGARET CUMBERLAND 179-50-$211 02120081 Amoun'l: MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~* RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-033 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS DATE 05-51-2003 ESTATE OF BURCNFIELD MARGARET L DATE OF DEATH 02-2q-2002 COUNTY CUMBERLAND FILE NO. S.S/D.C. NO. 179-50-5211 ACN 02120081 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT NO. 0010605751 TYPE OF ACCOUNT: ( ) SAVINGS C~ CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED Oq-19-199q Account Balance Percent Taxable Amount Subject to Tax Oebts and Oeductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 7,508.q0 X 0.166 1,251.~5 - .00 1,251.q5 X .15 187.71 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.~w PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID INTEREST IS CHARGED THROUGH 0q-08-2005 TOTAL TAX CREDIT AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUEl REVERSE SIDE OF THIS FORM 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 "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) .00 187.71 5.66 191.57 PURPOSE OF NOTICE: To fulfill tho requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 cf ZOO0. (72 P.S. Section 9140). PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Detach thm top portion of this Notice and sub.it with your payment to the Register of Nills printed on tho reverse side. -- Nake check or money order payable to: REGISTER OF #I£LS, AGENT. A refund of a tax credit, which mas not requested on the tax return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at tho Off[ca of the Register of #i118, any of the Z5 Revenue District Offices or by calling the special Z4-hour answering service for fores ordering: 1-800-562-2050; services for taxpayers with specie! ha. ring and or speaking needs: 1-800-447-5020 (TT only). Any party in interest not setisfJmd with the appraisement, allowance, or disallowance of deductions or assess.ant 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 Depart.ant of Revenue, Board of Appeals, Dept. Z81021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the pmrsonal representative, OR --appeal to the Orphans' Court Factual errors discovered an this assessment should be addressed in eriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sea 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 eithin 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 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 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 (l) day free the date of death, to the date of payment. Taxes which became delinquent before January i, I982 bear interest at tho rate of six (82) 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 which will vary from calendar year to calendar year eith that rate announced by the PA Department of Revenue. Tho applicable interest rates for 1982 through ZOO3 ars: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .000548 1987 9X .000247 1999 72 .000192 1983 Z6Z .000438 1988-1991 Ill .000301 ZOO0 82 .000219 1984 llZ .000301 1992 9Z .000247 ZOO1 92 .000247 1985 132 .000356 1993-1994 72 .000192 2002 6X .000164 1986 IOZ .000274 1995-1998 92 .000247 Z003 SZ .000137 --Interest is calculated as folloes: /NTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNQUENT X DAZLY ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill 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 TNDTVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ~; ~ . ' '~DATE 06-10-2005 .. ESTATE OF BURCHFIELD DATE OF DEATH OZ-Zq-ZOO2 FILE NUMBER BRENDA K BURCHFIELD LOT 7 SqO FOX HOLM ESTATES SHERMANS DALE pA '03 JUN 20 "~ ~GOUNTY CUMBERLAND ~u{ :~SN/DC 179-30-3211 ACN 02120081 A.oun'l: Re.'; 'l:4:ed MARGARET HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 ~y_T__A_~_N_~__T_I'I_~__L_~__ ~'- RETAZN LONER PORTZON FOR YOUR RECORDS REV-1604 EX AFP (01-03) ~ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE 06-10-2005 ESTATE OF BURCHFIELD MARGARET L DATE OF DEATH OZ-Z~-ZO02 COUNTY CUMBERLAND FILE NO. S.S/D.C. NO. 179-~0-~211 ACN 02120081 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOZNT OR TRUST ASSET ZNFORMATZON FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT NO. 0010605751 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED Oq-19-199q Account Balance Percent Taxable X Amount SubSec~ to Tax Debts and Deductlons Taxable Amount Tax Ra~e ~ Tax Due TAX CREDZTS: 7,508.q0 NOTE: 0.166 1,251.~$ 1,$00.00 .00 .q5 .00 TO INSURE PROPER CREDZT TO YOUR ACCOUNT, SUBMZT THE UPPER PORTZON OF THIS NOTICE N~TH YOUR TAX PAYMENT TO THE REGISTER OF HILLS AT THE ADDRESS SHONN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF HILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT I I BALANCE OF TAX DUE TNTEREST AND PEN. TOTAL DUE TF PAID AFTER THTS DATE., SEE REVERSE FOR CALCULATTON OF ADDTTIONAL TNTEREST. ZF TOTAL DUE TS LESS THAN $1., NO PAYHENT TS REQUTRED. ZF TOTAL DUE TS REFLECTED AS A "CRED'rT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORH FOR TNSTRUCTTONS. ) .00 .00 .00 ,00 PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- Make check or money order payable to: REGTSTER OF NTLLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications arm available at the Office of the Register of NiIls, any of the Z3 Revenue District Offices or from the Department's Zq-hour answering service for fores ordering: 1-800-56Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-qqT-SOZO (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Dureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZS06Ol, Harrisburg, PA 17liS-0601, Phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the dacedant's death, a five percent (5Z) discount of the tax paid is allowed. PENALTY: The lSZ 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. INTEREST: 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, 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 and after January l, 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 198Z through Z005 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 207. .0005~8 1987 9Z . O00Zq7 1999 7Z . O0019Z X985 16Z .000~58 1988-199X XXZ .O00~O1 ZOO0 8Z .000219 198q llZ . OOOSO1 1992 97. , O00Z~7 ZOOZ 97. .0002~7 1985 152 .000556 1993-199q 72 .000192 ZOOZ 62 .00016~ 1986 lOX .O00Z7~ 1995-1998 92 .O00Zq7 ZOO5 5Z .000157 --Intmrest is calculated as follows: I'NTEREST = BALANCE OF TAX UNpATD X NUNBER OF DAYS DELI'NI~UENT X DA'rLY TNTERBST 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. REV-1470 EX (6-88) INHERITANCE TAX EXPLANATION COMMONWE~ rH Of .PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF IND,V,DUAL T~XES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME FILE NUMBER MARGARET L BURCHFIELD 21/179-30-3211 REVIEWED BY ACN SCOTT ELLISON 02120081 ITEM SCHEDULE NO. EXPLANATION OF CHANGES DEDUCTIONS HAVE BEEN APPLIED TO THIS ACCOUNT. NO TAX IS DUE. ROW Paqe 1 BUREAU OF TNBTVTDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG,, PA 17128-060! COHHONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE ZNHERZTANCE TAX RECORD ADJUSTHENT JOZNTLY HELD OR TRUST ASSETS ..... -DATE 06-10-2005 !,;~ESTATE OF BURCHFIELD DATE OF DEATH 02-2q-2002 F'rLE NUHDER '03 ,_JUN 20 ,/i~] .t~UNTY '$$N/DC DEBRA S SMITH ACN SHIPPENSBURG PA 1725 ~ .:~:~ !:~i.£ ~ : i-,, CUMBERLAND 179-30-3211 O212OO8O Amoun'~ Relli~:~:ed REV-I'rOdi EX AFP (01-05) HARGARET L HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORT'rON FOR YOUR RECORDS *-~ REV-1604 EX AFP (01-03) #~ ZNHERZTANCE TAX RECORD ADJUSTHENT JOZNTLY HELD OR TRUST ASSETS DATE 06110-2005 ESTATE OF BURCHFZELD HARGARET L DATE OF DEATH 02-2q-2002 COUNTY CUHBERLAND FILE NO. S.S/D.C. NO. 179-$0-$211 ACN 02120080 ADJUSTHENT BASED ON: ADHINISTRATIVE CORRECTION JOINT OR TRUST ASSET ZNFORHATZON FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT NO. 0010603751 TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TIHE CERTIFICATE DATE ESTABLISHED 0~-19-199~ Accoun~ Balance Percen~ Taxable X. Amount Sub~ec~ *o Tax Debts and Deduc~Aons Taxable Amount Tax Rate X. Tax Due TAX CREDZTS: 7,508.~0 NOTE: 0.166 1,251.~$ 1,$00.00 .00 .45 .00 TO XNSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHZT THE UPPER PORTION OF THIS NOTXCE WITH YOUR TAX PAYHENT TO THE REGXSTER OF WILLS AT THE ADDRESS SHOWN ABOVE. HAKE CHECK OR HONEY ORDER PAYABLE TO: W*REGZSTER OF WXLLS, AGENT." PAYHENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AHOUNT PAID TOTAL TAX CREDXT BALANCE OF TAX DUEI XNTEREST AND PEN. TOTAL DUE ZF PAZD AFTER THZS DATE~ SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS RE~UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT' (CR)~ YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORH FOR ZNSTRUCTZONS.) .00 .00 .00 ,00 PAYNENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- Hake check or money order payabte to: REGISTER OF NILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application ~or Refund of Pennsylvania Inheritance and Estate Tax"' (REV-1Sl~). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or free the Department's lC-hour ansaering service for forms ordering: 1-800-56Z-ZOSO; services for taxpayers eith special hearing and / or speaking needs: 1-800-¢¢7-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment RavieN Unit, Dept. ZBO601, Harrisburg, PA 171Z8-0601, Phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SZ) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty ]s 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. INTEREST: 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 payeant. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016¢. All taxes ehich became delinquent on and after January 1, 1982 will 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 far 1982 through 2003 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .0005¢8 1987 9Z .000247 1999 7Z .O0019Z 1983 16Z .000¢~8 1988-1991 11Z .000301 2000 8Z .000219 198¢ llZ .000301 1992 97. .DOOZ¢7 ZOO1 97. .000Z¢7 1985 137- .000~56 1993-199¢ 77- .OOOZgZ ZOOZ 6X . 00016¢ 1986 lOX .000Z7¢ 1995-1998 92 .000Z¢7 2003 5Z .000137 --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD X NUI~BER OF DAYS DELZNQUENT X DAZEY INTEREST 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 the interest computation date sheen on the Notice, additional interest must be calculated. REV-1470 EX (6-88) INHERITANCE TAX EXPLANATION COMMONWEA~fH OF P~NNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF ~ND~WDUAL T~XES DEPT. 280601 HARRISBURG~ PA 17128-0601 DECEDENT'S NAME FILE NUMBER MARGARET L BURCHFIELD 21/179-30-3211 REVIEWED BY ACN SCOTT ELLISON 02120080 ITEM SCHEDULE NO. EXPLANATION OF CHANGES DEDUCTIONS HAVE BEEN APPLIED TO THIS ACCOUNT.NO TAX IS DUE. ROW Pa.qe 1 LATSHA DAVIS YOHE & McKENNA, P.C. VENDOR: DEP_T~2~D /"~1~ xxttt t e r'tt~ro~Dt a*.,tD COtmrrY (OuR,EF. NO. I '--w~'"w~E'~¢~, .... 1--~'v~r~'~A*E ~' IN~O,cE AMOUNT 16860 633-04 07/26/2004 ~.00 CHECK NO: AMOUNT PAID 5.00 0.( 07/26/2004 LATSHA DAVIS YOHE MCKENNA, PC. ATTORNEYS AT LAW PLEASE REPLY TO: Harrisburg WRITER'S E- MAIL: smontres@ldylaw.com July 26,2004 Register of Wills Orphans' Court Division Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 RE: Estate of Margaret Burchfield, Deceased Estate No.: 21-03304 Our File No.: 633-04 Dear Sir/Madam: Enclosed for filing please find an original and one (1) copy of a Notice of Claim in the above-referenced matter, along with a check in the amount of $5.00 for the filing fee. Kindly date- stamp the copy of the Claim and return it to our office in the enclosed self-addressed stamped envelope. Thank you for your attention to this matter. Sincerely, Steven M. Montresor SMM/dlj Enclosures CC.' Mary Kimmel, Finance Manager (w/enc.) Kimber L. Latsha, Esq. (w/o enc.) 92047 Post Office Box 825 * Harrisburg, PA 17108-0825 4720 Old Gettysburg Road, Suite 101 · Mechanicsburg, PA 17055 · (717) 761-1880 · FAX (717) 761-2286 7 Great Valley Parkway, Suite 221 · Malvern, PA 19355 · (610) 251-6985 · FAX (610) 407-9265 3000 Atrium Way, Suite 251 · Mt. Laurel, NJ 08054 · (856) 231-5351 · FAX (856) 231-5341 Maryland Telephone: (410) 727-2810 LATSHA DAVIS YOHE & MCKENNA, PC. A'I-rORNEYS AT LAW PLEASE REPLY TO: Harrisburg WRITER'S E- MALL: smontres@ldylaw.com July 26,2004 Register of Wills Orphans' Court Division Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 RE: Estate of Margaret Burchfield, Deceased Estate No.: 21-03304 Our File No.: 633-04 Dear Sir/Madam: Enclosed for filing please find an original and one (1) copy of a Notice of Claim in the above-referenced matter, along with a check in the amount of $5.00 for the filing fee. Kindly date- stamp the copy of the Claim and return it to our office in the enclosed self-addressed stamped envelope. Thank you for your attention to this matter. Sincerely, Steven M. Montresor SMM/dlj Enclosures CC: Mary Kimmel, Finance Manager (w/enc.) Kimber L. Latsha, Esq. (w/o enc.) 92047 Post Office Box 825 · Harrisburg, PA 17108-0825 4720 Old Gettysburg Road, Suite 101 · Mechanicsburg, PA 17055 · (717) 761-1880 · FAX (717) 761-2286 7 Great Valley Parkway, Suite 221 · Malvem, PA 19355 · (610) 251-6985 · FAX (610) 407-9265 3000 Atrium Way, Suite 251 · Mt. Laurel, NJ 08054 · (856) 231-5351 · FAX (856) 231-5341 Maryland Telephone: (410) 727-2810 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION IN RE: ESTATE OF MARGARET BURCHFIELD, : DECEASED : No. 21-03304 NOTICE OF CLAIM Claremont Nursing & Rehabilitation Center files this claim against the Estate of Margaret Burchfield in the sum of $2,817.90 in accordance with the invoice attached hereto. LATSHA DAVIS YOHE & MCKENNA, P.C. Date: 7- ~fi~- Of By: Steven M. Montresor, Esq. Attorney No. 74244 P.O. Box 825 Harrisburg, PA 17108-0825 (717) 761-1880 Attorneys for Claimant, County of Cumberland, Claremont _~sing~ Rehabilit~ki~t~ Ce~er 92042 66/23/2004 History from 01/01/1900 thru 06/23/2004 Billing & Payment Inquiry 3907 Margaret L Burchfield [PA948] Page 1 Billed Facility F/C From CTyp Billed Qty/Days Payment Net Facility Charge Description 255.16 CLAREMONT NURSING & REHAB R&B Nursing Care- Se -255.16 CLAREMONT NLrRSING & REHAB R&B Nursing Care- Se 279.78 CLAREMONT NURSING & REHAB R&B Nursing Care Se 2309.94 CLAREMONT NURSING & REHAB R&B Nursing Care- Se -2309.94 CLAREMONT NURSING & REHAB R&B Nursing Care- Se 2538.12 CLAREMONT NURSING & REHAB R&B Nursing Care Se .00 CLAREMONT NURSING & REHAB Resident Income 09/30/1999 1 MAP MAP RB 09/30/1999 1 MAP MAP RB 09/30/1999 1 PP PP RB 10/31/1999 1 MAP MAp RB 10/31/1999 1 MAP MAP RB 10/31/1999 1 PP PP RB 10/31/1999 1 RI RI RI 255.16 002.00 .00 -255.16 002.00 .00 300.00 002.00 20.22 2309.94 018.00 .00 -2309.94 018.00 .00 2700.00 018.00 161.88 .00 000.00 .00 Subtotal for Billed MAP .00 PP 3000.00 RI .00 Payment Net .00 .00 182.10 2817.90 .00 .00 ,laremonL Nursing ~ ~enau 2 ,75:arli..:leC~:aremontpA 17013Drive ts ~D.T~. 9~ I 3907 717) 243-2031 23-600311 092999 093099 002I ~L~.N7 NAME 13 PARENT AOORESS )urch~iteld, Margaret L IlII~~~l ~ OCCU~NCE S~N 137 :laremon% Nrsg & Rehab Ctr ~E'/ SD. I,k3 DESCRIPTION I12¢ ROOM & BOARD - SEMI PRIM TOTAL CHARGES 44 HCPCS / RATES 150.00 ~ SERV. DATE ~001 OTI'iER PROCEDURE ~EMARK$ 46 SERV. UNITS PRIOR PAYMENTS 51 GROUP NAME 66 EMPLOYER LOCATION 47 TOTAL CHARGES 300[00 300 00 t55 EST. AMOUNT OUE 48 NON-COVERED CHARGES 62 INSURANCE GROUP NO. 3109 82 ATTEN01NG PHYS. 10 IDaTE )2 HCFA-1450 OCR/Original E93950 JOSEF, MD ERNEST M ~ ~ER ~[ I0 0~ ~S, ID X 05/16/2000 )75 Claremont Drive I ] 3907 :arltsle PA 17013 I $ FEQTAXNO. J6STA~T~NTCO~3~H~G~ ~''17COV0.I 8N.C0. I 9C~D.I ,0L.RD.I ~T~ENT>~A~E ~ 13 PA~E~ADORE~ )u:ch~ teld, Ma~gaget )821192 Iargaret L Burchfteld I~1 l ~ 1 :1 aremont Nrsg c ~E*! '~D. !.~ 0ESCRIP~ON )12~ ROOM & BOARD - $~.MI TOTAL CHARGES PHARMACY TOTAL DUE )001 >RIVATE PAY NAME )urchfield Margaret L --- ,t4 HCPCS / RATES 150.0¢ 51 PROVIDER NO. CLAR~.MONT ~109 71690 , - ! SO PRINCIPAL PROCEDURE OTHER PROCEDURE 45 SERV. DATE 46 SERV. UNITS 1 ~54 PRIOR PAYMENTS 51 GROUP NAME t 66 EMPLOYERLOCATION 47 TOTAL. CHARGES 48 NON-COVERED CHARGES 27OO[00 2700 00 5.~ 76 2705. ~76 55 EST. AIvlOUNT DUE 58 62 FNSURANCE GROUP NO ~z '" '3tO9 .... ATTENDING PHYS. tD ~EMARKS OTHER PROCEDURE DATE CODE 83 OTHER PHYS. 10 OTHER PHYS. ID ~5 PROVIDER REPRESENTATIVE 86 DATE X O5/16/2000 c~2 HC FA- ! 450 O C R / Origin al , CERTTFY THE CERTIFICATIONS ON mE REVERSE APPI. y TO THIS SILL AND ARE .AOE A F~RT HEREOF* IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION IN RE: ESTATE OF MARGARET BURCHFIELD, : DECEASED : No. 21-03304 CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing Notice of Claim was served via Certified Mail, Return Receipt Requested and First-Class United States Mail, postage prepaid, upon the following: Deborah Smith 185 Quarry Hill Road Shippensburg, PA 17257 Brenda Burchfield 340 Fox Hollow Estates Lot #7 Shermans Dale, PA 17090 Linda McGuire 100 Regency Woods South Carlisle, PA 17013 Dated: Steven M. Montresor 92042