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Home My WebLink About03-0130.r,'~testoc~, PETITION FOR GRANT OF LETTERS OF ADMINISTRATION !ntestac¥ ADMINISTRATION Estate of...c.~.~.~..~....c.h~.~.i. ~.o, Jr. No. ~ ~--O 3-- 1,30 Also known as ................................... To: ........................................ Deceased. Social Security No .... 2.2.1.-..26:-.4.53.1. ................. Register of Wills for the Cumberland in the County of tFx~khx~Xk~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner~/, who is'are 18 years of age or older, applies. ............ for letters of administration ................................................................... on the estate of the above decedent. (db n pendente hie durante abs en la, durar, le mmcntate) Cumberland Decedent was domiciled at death in Hopewell Township/ County, Pennsylvania, with hi.s .... last family or principal residence at 29 Peebles Road, Newburg, PA 17240 .... '/),0~, ............................. Decedent, then 63 years of age, died November !1~ 2002 :,~: ..... t numbe ......... pa y~ at Chambersburg Hospital, Chambersburg, Pennsylvania decedent at death owned property with estimated values as follows: (if domiciled in Pa.) (if not domiciled in Pa.) (if not domiciled in Pa.) Value of real estate in Pennsylvania All personal property Personal property in Pennsylvania Personal property in County $ ...3~,.QQQ,09 .................. Situate as follows: Petitioner... after a proper search ha .s.. ascertained that decedent left no will and was survived by the followingspouse(ifany) and heirs: Name Relationship Susan L. Chirico Spouse Shannon L. Chirico Daughter Angela M. Alwood Daughter 29 Peebles Roa~esidence Newburg, PA 17240 '436'B6sl'd~'A~&flh~',"S~d6fl~'~Id6~" .Lemoyn~.,. ~A..~7053 ........... 1312 Prospect Street ' ' · York,.Pg ..1740B .................... THEREFORE, petitioner(s) respecfully request(s) the grant of letters of administration in the appropriate form to the undersigned. Signature(s) and Residence(s) 29 Peebles Road ' h;;;~d;~;' ~X' "ifil6 ....................................................................... OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ss COUNTY OF ~ CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the said decedent petitioner(s) will well and truly administe~ the estate to law. Sworn to or affirmed and sub- / ........ §~ah' '~.' '~hii:'i'c'6 ............................. scribed before me this .12.thday of m ....................................................... _ .F. ebruarg....~ ~ ..... :¢~.,c~2003 <, ....................................................... For the Register/o'I~~~ ................................................... Donna ~.Otto, 1st Deputy Estate of...C.a.r.1..F....C.h.i.r.i.c..o :..,J.r.. ................... Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW ... Febkquary. ll.th ............ X]~.. 2003, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me. IT IS DECREED that ...... Carl .F.. Chirico,. ar. ..................................................... is/acmxentitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to ...S.u.s.a.n...L....C.h.i.r.i..c.o ........................................................... in the estate of ... Carl..F.,. Cb~_.r.i.c.o. ,. Jx: ............................................................ ./rD .... J,.q ..... /;,2~',('~,:,,,';, '~,5' is apl~r,~.eqt_and~l- and bond, if required, fixed in the sum of $ ........... Documents Attached: Donna ~, Otto, ,lst Deputy ~ ~egister of Wills~ Bonds ........................ [] Letters of Administration $ 60.00 Short Certificate (1) $ 3.00 Renunciation(s) [] ~enuncJ.ation (0) $ -0- JCP $ 10. O0 ......................................................... S' Register of Wi]Is David C. Cleaver 07283 ATTORNEY (Sup. Ct. I.D. No.) 1035 Wayne Avenue Chambersburg, PA 17201 Address 717-264-1110 Mailed Letters on 02-11-03 Phone to Administratrix 21-2003-130 CERTIFICATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: Date of Death: File No.' Carl F. Chirico, Jr. November 10, 2002 21-03-0130 To the Register: I certify that Notice of Beneficial Interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above captioned estate on February 18, 2003' Susan L. Chirico 29 Peebles Road Newburg, PA 17240 Shannon L. Chirico 436 Bosler Ave., 2nd Floor Lemoyne, PA 17043 Angela M. Alwood 1312 Prospect Street York, PA 17403 Notice has now been given to all persons entitled thereto under Rule 5.6(A). Date: May 22, 2003 1035 Wayne Avenue Chambersburg, PA 17201 DISCLAIMER OF INTEREST IN ESTATE PURSUANT TO 20 PA. C.S. SECTION 6201 c IN RE: ESTATE.OF CARL F. CHIRICO, JR. WHEREAS, Carl F. Chirico, Jr. died intestate on November 10, 2002, in Hopewell Township, Cumberland County, Pennsylvania; WHEREAS, intestate heirs, to wit: daughters; Carl F. Chirico, Jr. was survived by the following named individuals as his Susan L. Chirico, wife; Shannon L. Chirico and Angela M. Alwood, WHEREAS, Letters of Administration were granted on the estate of Carl F. Chirico, Jr. on February 11, 2003, to Susan L. Chirico, the decedent's wife; WHEREAS, the undersigned, as intestate heirs of the aforesaid decedent, Carl F. Chirico, Jr., wish to disclaim any interest in the estate of the said decedent; NOW, THEREFORE, KNOW YE, that the undersigned, Shannon L. Chirico and Angela M. Alwood, hereby declare and disclaim as follows: The undersigned hereby disclaim any interest that they may have in the estate of Carl F. Chirico, Jr., deceased, and hereby authorize and direct Susan L. Chirico, as Administratrix of the estate of the decedent, to distribute the estate of the decedent as though the undersigned had predeceased the said Carl F. Chirico, Jr. and distribute the estate to such persons as are entitled thereto under the laws of the Commonwealth of Pennsylvania. This is an unqualified disclaimer, the undersigned disclaimants disclaim any interest whatsoever from any source, and this disclaimer shall be final and absolute. This disclaimer shall be filed with the Clerk of the Orphans Court, Cumberland County, Pennsylvania, pursuant to 20 Pa. C.S. Sec. 6204. IN WITNESS WHEREOF, the undersigned have executed this Disclaimer with full intent to release, remise, and disclaim any interest in the estate of Carl F. Chirico, Jr., this /~/~4 day of ~ ,2003, intending to be legally bound hereby. Chirico (SEAL) ~rAngela M. Alwood STATE OF PENNSYLVANIA COUNTY OF FRANKLIN : SS On this, the /,B",'~,9 day of {~~ fl ,2003, before me, a Notary Public, the undersigned officer, p' ersonally appea~d~}hannon L. Chirico and Angela M. Alwood, (known to m or satisfactorily proven) to be the persons whose names are subscribed to the within instrument, an4 acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. Notary Public My commission expires I maintain my office in Linda L. McNew, Notary Public Chambersburg Boro, Franklin County My Commission Expires Oct. 20, 2005 COMMONWEALTH OF I REV-1500 PENNSYLVANIA I DEPARTMENT OFREVENUE IINHERITANCETAX RETURN DEPT. 280601 J "ARRISBURG'PA17128~)601 ] RESIDENT DECEDENT 09/05/1939 <[ 8. (.) LLI 9. 10. DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) CHIRICO, CARL F.~ JR. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 1 1/10/2002 (IF APPLICABLE) SURVIV NG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A ['~'1 1. Original Return OFFICIAL USE ONLY FILE NUMBER 2 1 -0 3 0 1 3 0 NUMBER SOCIAL SECURFrY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS socIAL SECURITY NUMBER --'1 4. Limited Estate [~6. Decedent Died Testate ~--~ 9. Litigation Proceeds Received F-J2. Supplemental Return ] 4a. Future Interest Compromise (~e of ~am a~er 12-12-82) F-'] 7. Decedent Maintained a Living Trust [~ copy of Trus~) ]10. Spousal Poverty Credit (~, of death belwee~ 12-31-91 a~d 1-1-95) Chambersburg []3. Remainder Return (dateofdeathp~im'ta 12-13-82) D5. Federal Estate TaX Return Required 0__ 8. Total Number of Safe Deposit Boxes [--] 11. Election Io tax under Sec. 9113(A) (A~a~ S~ O) · .-:.~. ~G~-.~S~-.BE".~:'~.~.E~-~.~I~EE~DENGE:~:~I~EN~tAE:.~. NAME COMPLETE MAILING ADDRESS David C. Cleaver 1035 Wayne Avenue FIRM NAME (If Appicabb) David C. Cleaver & Associates 717-264-4.14.0- 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Padnership or Sole-Proprietorship {3) Modgages & Notes Receivable (Schedule D) (4) Cash, Bank Deposils & Miscellaneous Personal Property (5) (Schedule E) Jointly Owned Property (Schedule F) (6) ] Separate Billing Requested Inler-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (lotal Lines 1-7) Funeral Expenses & Administrative Cosls (Schedule H) (9) Debts of Decedent, Modgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (tolal Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) : 30~987.95 PA 17201 OFFICIAL USE ONLY (8) (11) 11 ~900.00 516.73 30~987.95 12,416.73 18~571.22 (12) (13) (14) 18,571.22 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 18,571.22 x .0 (15) x .0 (16) x .12 (17) x .15 (18) I SEE INI5 ~ RUCTIONS ON REV~-KsE SIDE FOR APPLICABLE P. ATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due (19) Decede, nt's Complete Address: STREET ADDRESS 29 Peebles Road Newburg STATE PA JziP 17240 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits ( A + B + C ) (1) (2) 3. Interest/Penalty if applicable D. interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 5. If Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ......................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ...................................... [] [] c. retain a reversionary interest;.or .................................................................................................. [] [] d. receive the promise for life of either payments, benefits or care? .......................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate considerati~rt? .......................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death2 ............... [] [] 4. Did decedent own an Individual Retirement Account, annuity, er other non-probate property which contains a beneficiary designation2 .................................................................................................. [] [] IF THE ANSVVER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. I~.~ara~a '.ti? of pequ~, I .d~c. br~.. that I hav~,examined II, is ~elum, incbding accompanying schedubs and statements, and to the best of my knowbdge and belef it is true, comsct and complete. of preparer omer man me persona~ representative ~s based on aJ information of which preparer has any knowbdge. ' SIGNATURE OF PER~S)ON RESPONSIBLE FOR FILI%R.~IJRN DATE ADDRESS 29 Peebles Road ~ Newl2~g ADDRESS '~-W/ne Avenu ~ Chambersburg PA 17240 DATE PA 17201 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of lransfers to or for the use of the surviving spouse is 0% 172 P.S. §9116 (a) (1.1) (iO]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For. dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the dacedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% 172 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PEE~NSYLVANIA INHFRITANOF TAX RETURN ~E$1DENT DEOEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER CHIRICO, CARL F., JR. 21 03 0130 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly, owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Legg Mason Money Market Account No. 36601382 30,987.95 TOTAL (Also enter on line 5, Recapitulation) $ 30~987.95 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER CHIRICO, CARL F., JR. Debts of decedent must be reported on Schedule L ITEM NUMBER 5. 6. 7. 21 03 0130 DESCRIPTION FUNERAL EXPENSES: FogelsangerBricker Funeral Home - funeral ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees David C. Cleaver Family Exemption: (If decedent's address is not the same as claimant's, altach explanation) Claimant Susan L. Chirico Zip Street Address 29 Peebles Road City Newburg Relationship of Claimant to Decedent Spouse Probale Fees Cumberland County Register of Wills Accountant's Fees Tax Return Preparer's Fees Clerk of the Orphans Court - filing Disclaimer Slate PA Zip 17240 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 7,000.00 1,300.00 3,500.00 94.00 6.00 11T900.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF CHIRICO, CARL F., JR. FILE NUMBER 21 03 0130 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION Cumberland Valley Neurosurgical Cons. - final billing Rosa Kurtz, M.D. - final doctor bill Chambersburg ALS - West Shore - balance due for ambulance service Neurosurgical Specialists, LLC - final bill Cumberland Valley EMS - ambulance bill Pulmonary Associates - final bill Dr. Allen Kantrowitz - final bill TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 16.00 20.00 41.00 20.00 183.20 33.70 202.83 516.73 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER ,CHIRIC~ NUMBER II. ', CARL F., JR. 21 03 0130 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal dislributions) Susan L. Chirico 29 Peebles Road Newburg, PA 17240 Note: Decedent had two daughters who have both disclaimed any interest in the estate. Disclaimer has been filed with the Clerk of the Orphans Courts of Cumberland County, PA RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Spouse ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART [! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) AMOUNT OR SHARE OF ESTATE 100% ON REV 1500 COVER SHEET STATUS REPORT UNDER RULE 6.12 Name of Decedent: Carl F. Chirico, Jr. Date of Death: November 10, 2002 Admin. No.: 21-03-0130 Will No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above captioned estate: A. State whether administration of the estate is complete: Yes B. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: C. If the answer to No. 1 is Yes, state the following: 1. Did the personal representative file a final account with the Court? No 2. The separate Orphans' Court No. (if any) for the personal representative's account is: 3. Did the personal representative state an account informally to the parties in interest? Not necessary, as surviving spouse is sole beneficiary. 4. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: August 22, 2003 /f)awd C.~Cleaver 1035 Wayne Avenue Chambersburg, PA 17201 (717) 264-1110 Counsel for Personal Representative BUREAU OF ZNDZVZDUAL TAXES ZNHERITANCE TAX DIVTSZON DEPT. 280601 HARRZSBURG, PA 17128-o601 CONNONNEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX DAVID C CLEAVER D C CLEAVER & ASSOCS 1035 NAYNE AVE CHAHBERS~URG CUT ALONG THZS LZNE REV-1547 EX AFP (01-03) DATE :' ESTATE OF DATE OF DEATH '0~ ~ 26 ~_~ .~ZLE NUHBER "~; "~COUNTY ACN PA 08-18-2003 CHIRICO JR 11-10-2002 21 03-0130 CUHBERLAND 101 Amoun1: Rem'i 1:'l:ed REV-1647 EX AFP COl-OS) CARL d HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~ RETAZN LONER PORTZON FOR YOUR RECORDS ~ NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSNENT OF TAX ESTATE OF CHIRICO JR CARL J FZLE NO. 21 03-0130 ACN 101 DATE 08-18-2003 TAX RETURN NAS: (X) ACCEPTED AS FTLED RESERVATZON C'3HCERNZNG FUTURE ]:NTEREST - SEE REVERSe. ( ) CHANGED APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN z. Reel Es1:e~e (Schedule A) (1} 2. S1:ocks and Bonds (Schedule B) (2) $. Closely Held S1:ock/Par1:nershtp Zn1:eres1: (Schedule C} ~. Nor1:geges/No1:es Rece/vable (Schedule D) $. Cash/Bank DeposL~s/Nisc. Personal Proper1:y (Schedule E) ($) 6. Jointly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To1:el APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Cos1:s/NLsc. Expenses (Schedule H) (9) 10. Deb1:s/Hor1:gege LiebllLtLes/LLens (Schedule 1) (10) 11. To~el Deduc1:ions 30z987.95 .00 .00 NOTE: To /nsure proper .00 cred/1: 1:o your eccoun1:, .00 submi1: 1:he upper .00 of 1:hAs fora wASh your ~ex peymen1:. .0O (8) 11,900.00 12. 15. 1~. NOTE: 516.73 (11) Ne1: Value of Tax Re~urn (12) Cheri1:eble/Governmen1:el Beques1:s; Non-elec1:ed 9115 Trus1:s (Schedule J) (15) Ne1: Value of Es1:a1:e Subjec1: t:o Tax Tf an assess.ent ~as issued previously, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to data. ASSESSHENT OF TAX= 30,987.95 12.~1~.73 18,571.22 .00 18,571.22 ZF PAZD AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADDZTIONAL INTEREST. ANOUNT PAZD .00 .00 .00 .00 ZF TOTAL DUE TS LESS THAN $1, NO PAYHENT TS REI;)UZRED. ZF TOTAL DUE TS REFLECTED AS A 'CREDZT' (CR}, YOU HAY BE DUE REFUND. SEE REVERSE SIDE OF THZS FORN FOR ]:NSTRUCTZONS.) 15. Amoun1: of L/ne 1~ 16. Amoun1: of L/ne 1~ 17. Aeoun1: of L/ne 1~ 18. Amoun1: of Line lfi 19. Pr/ncipel Tax Due TAX CREDZTS: PAYN~NT RECEZP] DISCOUNT DATE NUHBER ZNTEREST/PEN PAZD (-) TOTAL TAX CREDZT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE (~;) 18,571.22 x O0 = .00 (~6) .00 x 0~5= .00 (17).. . O0 x 12 = . O0 (~8) .00 x 15 = .00 (19)~ . O0 18 and 19 v/ll RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonaeelth hereby expressly reserves the right to appraise end assess transfer Inheritance Taxes at the lawful Class D (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Zl~O of the Znheritanca and Estate Tax Act, Act g$ of ZOO0. (7Z P.S. Seotion 91q0). Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side. --Make check or money order payable to: REG/STER OF NXLLSj AGENT A refund of a tax cradlt, Nhich wes not requested on tho Tax Return, amy ba 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 Wills, any of the Z3 Revenue District Offices, or by calling the special Iq-hour ansaaring service for fores ordering: 1-800-362-Z050; services for taxpayers eith special hearing and / or speaking needs: 1-800-~fi7-30ZO (TT only). Any party in interest not satisfied eith the appraisement, elloeance, or disallowance of deductions, or assessment of tax [including discount or interest) as shown on this Notice must object within sixty C60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZB-lOZ1, OR --election to have the matter determined at 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 Reviea Unit, Dept. Z80601, Harrisburg, PA 171ZB-0601 Phone (717) 787-6505. Sea 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 dug is paid within three (3) calendar months after the dacedant's death, a five percent (SI) discount of the tax paid is allowed. The 157. 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 seem 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 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 1, 1982 will bear interest at a rate which will vary free calendar year to calendar year eith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2003 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Yeast Rate Factor Year Rata Factor 1982 207. .0005q.8 1987 9Z .000267 1999 7Z .000192 1983 16Z .000~38 1988-X991 llZ .000301 2000 8Z .O00Z19 1984 llZ . O 00301 X99Z 9Z . O00Z~7 ZOO1 9Z . O00Z~7 1985 lS7. .000356 1993-1994 7Z .000192 ZOOZ 6Z .OO016q 1986 IOZ . O0027~ 1995-1998 9Z . O00Zq7 ZO0S 57. .000137 --Interest is caXculated as foXlows: INTEREST = BALANCE OF TAX UNpATD X NUMBER OF DAYS DELINQUENT X DAZLY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent wi11 reflect an interest calculation to fifteen (153 days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must ba calculated.