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HomeMy WebLinkAbout03-0132Register of Wills of Cumberland, County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of HOFFMAN S. WAGNER , Deceased JEANNE M. WAGNER Social Security No. 195-07-3553 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner is the Executrix named in the Last Will of the Decedent, dated June 19, 1985 and codicil(s) dated State relevant circumstances, e.g. renunciation, death of Executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not to victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in principal residence at Cumberland County, Pennsylvania, with his last family or 24 College Hill Road, Summerdale, East Pennsboro Township. (List street, number and municipality) Decedent, then 92 years of age, died January 20, 2003, at (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ..................................................................... $ (If not domiciled in PA) Personal property in Pennsylvania ..................................... $. (If not domiciled in PA) Personal property in County .................................................... $. Value of real estate in Pennsylvania ...................................................................................................................... $ Total ......................................................................................................... $ Real Estate situated as follows: Holy Spirit Hospital 64,000.00 64~000.00 Wherefore, Petitioners respectfully request the probate of the last Will presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence Jeanne M. Wagner 24 College Hill Road Summerdale, PA 17093 OATH OF PERSONAL REPRESENTATIVE Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the f~egoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law, Sworn to and affirmed and subscribed before me this __~ (_-)-L-----~ day of ~'"-~k:~.v~ ~ ~. _, 2003 © NNE M. WAGNER DECREE OF REGISTER Estate of HOFFMAN S. WAGNER, Deceased Social Security No: 195-07-3553 Date of Death: January 20, 2003 AND NOW, ~-~c~,,.,.,,:~ ~_ i & ,2003, in consideration of the Petition on the reverse side hereon, satisfactory proof havin~been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Jeanne M. Waqner in the above estate and that the instrument(s) dated June 19, 1985 described in the Petition be admitted to probate and filed of record as the last Will of the Decedent. FEES Letters ........................... $ Short Certificate(s) $. Renunciation .............. $ Affidavit ( ) .................. $ Extra Pages ( ) .......$ Codicil ............................ $ JCP Fee ....................... $ Inventory ...................... $. Other .............................. $ TOTAL ......... Register of W~ll~ ~ - (~ 1 fg I /rD, ~ Attorney: Edmund G. Myers I.D. No: 20558 Address: Johnson, Duffie, Stewart & Weidner, 301 Market Street, P.O. Box 109, Lemoyne, PA 17043- $ //:-f.~.OO Telephone: 717-761-4540 9-11 o,.3 of HOFF1VIAN S. WAGNER I, HOFFMAN S. WAGNER, of East Pennsboro Township, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void any and all former Wills made by me. I direct my Executrix hereinafter named to pay all my just debts and funeral expenses as soon after my decease as conveniently may be. II. I give and bequeath unto my wife, JEANNE M. WAGNER, if she survives me, my tangible personal property. If my wife does not survive me I give and bequeath the same in accordance with a list which is attached to this Will and authenticated by my signature, to various of my children. Any item not included on such list shall be a part of my residuary estate. I direct that my Executrix in such event make available to my children any items not included in such list at appraised value. In the event a legatee shall have predeceased me survived by issue over fifteen (15) years of age, such issue shall succeed to the interest of the deceased parent by representation. Should a child predecease me survived by no issue or issue younger than fifteen (15) years of age, the gift to that child shall lapse. III. All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath unto my wife, JEANNE M. WAGNER. Should my wife fail to survive me, I give, devise and bequeath the same unto my children, GLENN WAGNER, DENNIS WAGNER, DAVID WAGNER, PAUL WAGNER and PRISCILLA ALLANDAR, share and share alike, the issue of any who may predecease me to take the share of the parent by representation. IV. I name, constitute and appoint my wife, JEANNE M. WAGNER to be the Executrix of this, my Will. Should my wife fail to qualify as Executrix or fail for any reason to complete the administration of my estate, I appoint CCNB BANK, N.A., to be the Executor in her stead. xITNESS WHEREOF, , 1985. I hereunto set my hand and seal this Iq ~day of ~FFMAN S. W,A.~NER (SEAL) Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other have hereunto subscribed our names as witnesses. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: I, HOFFMAN S. WAGNER, Testator, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by HOFFMAN S. WAGNER, the Testator, this }~day of ~.~_. , 1985. Notary Public NOTARY PUBUC ~Y (X)kiMI~SION EXPIRES DEC. 21, 198 ,,EMOYNE,, PA CUMBERLAND AFF IDAV IT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: We, .~q~. /. /~ ~ ~ and ~ ~, J~ ~ , the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the foregoing instrument as his Last Will and Testament; that he signed willing and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. 8worn o/r affirmed to and subscribed to before me by ~r / //~J~*7 and ~-,/6]a~,~. , witnesses, this Iq a'day of~_~. , 1985. Notary Public~ NOTARY PUBUC ~Y COMMI~ION EXPIRES DEC. ~ 1985 ,.EMOYNE, PA CUMBERLAND CO, OF HOFFMAN S. WAGNER MYERS, MYERS, FIOWER & JOHNSON ATTORNEYS AT LAW LEMOYN e, PENNSYLVANIA CARLISLE, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: HOFFMAN S. WAGNER Date of Death: January 20, 2003 Will No.: 2003-00132 Admin. No.: 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 12, 2003. Name Jeanne M. Wagner, Executrix, wife and sole beneficiary. Address 24 College Hill Road, P. O. Box 187 Summerdale, PA 17093 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. Date: March t'~, 2003 Capacity: Signature Name Edmund G. Myers, Esq. Johnson, Duffie, Stewart & Weidner Address 301 Market St. P. O .Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Personal Representative X__Counsel for personal representative TO Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 SUBJECT: Estate of Hoffman S. Wagner No. 21-03-00132 FROM .1OHNSON~ DUFFZE~ STEWART & WEZDNER Attorneys at Law P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 Fax: (717) 761-3015 DATE: May 14, 2003 Enclosed for filing in the above-captioned Estate are the following: 1. Original Inventory. 2. Original and copy of Inheritance Tax Return - no tax due - spouse is the beneficiary. 3. Check in the amount of $20.00 in payment of the filing charges. SIGNED: Edmund G. Myers csh COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAl.. USE ONLY FILE NUMBER 2] COUNTY CODE 03 00132 YEAR NUMBER i DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER [ WAGNER, HOFFMAN S. 195 - 07- 3553  ! DATE OF DEATH (MM-DD-YEAR) OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~ ]DATE .o, 01/20/2003 i 11/10/1910 REGISTER OF WILLS , (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) i SOCIAL SECURITY NUMBER Wagner, Jeanne M. i 201 - 18- 5289 [] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82) ] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes of Will) copy of Trust) [] 9, Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11.Election to tax under Sec. 9113(A) (Attach Sch O) -- 12-31-91 and 1-1-95)~ HAME coupLE-rE MAiLiNG ADDRESS ~:IR.M NAME (If applicable) I 301 Market Street I Johnson, Duffle, Stewart & Weidner P O Box 109 ~'ELEPHONE NUMBER Lemoyne, PA 17043-0109 717/761-4540 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) (1) (2) 86,219.12F (3) Nonei2:, (4) None (5) None ~: (6) None (7) None (9) 10,166.00 (lO) 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) (8) 86,219.12 10,166.00 76,053.12 76,053.12 (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, 76,053.12 or transfers under Sec. 9116(a)(1.2) x .00 (15) 0.00 0.00 16. Amount of Line 14 taxable at lineal rate x .045 (16) 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x .12 (17) x .15 (18) (19) 20. [] Copyright 2000 form software only The Lackner Group, Inc. Form REV-'I500 EX (Rev. 6-00) Decedent's Complete Address: [ ~TREET ADDRESS I CITY Summerdale ~ISTATE PA ZIP 17093 24 College Hill Road P. O. Box 187 Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits (A + B + C) (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 th6OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 5. if Line I + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) 0.00 0.00 0.00 0.00 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 consideration?. ................................................................................................................ [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death2 ....... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?. ............................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS ~J~nne M. Wagner, Executrix SIG~[TURE OF PERSON RESPON~LE FO~ ~JL"T-N8 RETL/~N SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE EDMUND O. MYERS 24 College Hill Road DATE P. O. Box 187 Sununerdale, PA 17093 ADDRESS 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 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 transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statutedoes not exempta 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 decedent'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% [72 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 PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF WAGNER, HOFFMAN S. FILE NUMBER 21 - 03- 00132 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE OF NUMBER DESCRIPTION UNIT VALUE DEATH 1 1,018 Shares - The Allstate Corporation 35,171.90 Common @ $34.55 per/share 550 Shares - Sears, Roebuck & Co. Common ~ $26.27 per/share 856 Shares - Morgan Stanley Dean Witter & Co. Common ~ $37.80 per/share 28 Shares - Prudential Financial $33.14 per/share 14,448.50 32,356.80 4,241.92 TOTAL (Also enter on line 2, Recapitulation) 86,219.12 COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINkS-"iRATIVE ~ ESTATE OF WAGNER, HOFFMAN S. FILE NUMBER 21 - 03- 00132 Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT ITEM NUMBER A. ! FUNERAL EXPENSES: Sullivan Funeral Home Rolling Green Cemetery ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Johnson, Duffle, Stewart & Weidner Family Exemption: {If decedent's address is not the same as claimant's, attach explanation) Claimant Jeanne M. Wagner Street Address 24 College Hill Road, P. O. Box 187 City Summerdale State PA Relationship of Claimant to Decedent Wife Probate Fees Register of Wills, Cumberland County Zip 17093 Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Register of Wills - file Inventory & Inheritance Tax Return Register of Wills - Short Certificate 3,565.00 435.00 2,500.00 3,500.00 143.00 20.00 3.00 TOTAL (Also enter on line 9, Recapitulation) i 10,166.00 REV-'I513 EX+ (9-00) ~ · COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF WAGNER, HOFFMAN S. FILE NUMBER 21 - 03- 00132 NUMBER I. 1 II. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Jeanne M. Wagner 24 College Hill Road, P. O. Box 187 Summerdale, PA 17093 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Wife Enter dollar amounts for distributions shown NON-TAXABLE DISTRIBUTIONS-. above on lines 15 through 18, as appropriate, on Rev 1500 cover sheE A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT IBEING MADE !B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS AMOUNT OR SHARE OF ESTATE Residue TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE ]9 P~ il REGISTER OF WILLS OFFifCE CUMBERLAND COUNTY COURTHOUSE i COURT,lOUSE SQUARE CARLISLE, PA 17013-3387 Register of Wills of Cumberland County, INVENTORY Estate of WAGNER, HOFFMAN S. also known as , Deceased Pennsylvania No. 21-03-00132 Date of Death 1/20/2003 Social Security No. 195-07-3553 Jeanne M. Wagner, Executrix The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: EDMUND G. MYERS I.D. No.: 20558 Address: Telephone: 301MarketS~eet P. O. Box 109 Lemoyne, PA 17043-0109 717/761-4540 Personal Property 1,018 Shares - The Allstate Corporation Common @ $34.55 per/share 550 Shares - Sears, Roebuck & Co. Common @ $26.27 per/share 856 Shares - Morgan Stanley Dean Witter & Co. Common ~ $37.80 per/share 128 Shares - Prudential Financial @ $33.14 per/share Personal Representative Signature: ~,~_"~}).~~ ' .~.~",,.~/ Jf~pnne M. Wagner,(Executrix Signature: Signature: Address: 24 College Hill Road P. O. Box 187 Summerdale, PA 17093 Telephone: (717) 732-9819 Dated: ._~ 35,171.90 14,448.50 32,356.80 Total personal Property 6£:Ld 6L ),'CA £0. 4,241.92 $86,219.12 (Attach additional sheets if necessary) Total Personal Property and Real Estate $86,219.12 BUREAU OF INDIVIDUAL TAXES TNHERITANCE TAX DIVISTON DEPT. 180601 HARRISBURG, PA 17128-0601 EDMUND G MYERS JOHNSON ETAL PO BOX 109 LEMOYNE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX Re. , . -'° ~;~ DATE 07-07-2005 ESTATE OF WAGNER DATE OF DEATH 01-Z0-Z003 FILE NUMBER 11 03-0131 ,- ........ COUNTY CUMBERLAND ACN 101 REV-lSq? EX AFP (11-15) HOFFMAN S . Amount Reaitted I I PA 170q3 MAKE CHECK PAYABLE AND REMTT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WAGNER HOFFMAN S FILE NO. 21 03-0132 ACN 101 DATE 07-07-2003 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (SchaduZa C) (3) q. Mortgages/Notes Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote1 Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. FunaraX Expanses/Ada. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Nat VaZua of Tax Return 15. O0 86~219.12 O0 O0 O0 O0 O0 (8) 10,166.00 Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) Net Va/ua of Estate Sub~ect to Tax NOTE: To insure proper credit to your account, subait the upper portion of this fora with your tax payment. 86,219.12 .00 (11) 10.166. fl0 (12) 76,053.12 (1-~) . O0 (14) 76,053.12 NOTE: ]:f an assessment was issued previously, lines 14, 15 and/er 16, 17, 18 and 19 will reflect f/gures that lnclude the total of ALL returns assessed to date. (15) 76,053.12 X O0 = .00 (16) .00 X 045 = .00 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= . O0 ASSESSMENT OF TAX: 15. Amount of L/ne lq at Spousal rate 16. Amount of Line lfi taxable at Lineal/Class A rata 17. Amount of Line lq at Sibling rata 18. Amount of Line 1% taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYMENT RECE/PT DISCOUNT DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAZD TOTAL TAX CREDZT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDZT/ONAL INTEREST. ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CA), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 11, 19BI -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves tho right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such futura interest. To fulfill the requirements of Section 1140 of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (71 P.S. Section Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which was not requested on the Tax Return, say 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 Z3 Revenue District Offices, or by calling the special Z4-haur enamoring service for fores ordering: 1-800-36Z-ZOSO~ services for taxpayers with special hearing and / or speaking needs: 1-800-447-$020 (TT only). Any party in interest not satisfied aith the appraisement, allowance, or disalloeance of deductions, or assessaent of tax (including discount or interest) as shown on this Notice must 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 --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 eriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviee 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-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 (5X) 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 time period as you would appeal the tax and interest that has been assessed as indicated an this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day free the data of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest et the rate of six (61) percent par annum calculated at a daily rate of .000164. Al1 taxes which became delinquent on end after January 1, ZgBZ will bear interest at a rate which mill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .000548 1987 9Z .000247 1999 71 .000191 1983 161 .000438 1988-1991 llZ .000301 ZOO0 81 .000219 1984 llZ .000301 1992 91 .000147 ZOO1 91 .000147 1985 I$Z .000356 1993-1994 7X .000192 ZOOZ 61 .000164 1986 101 .000274 1995-1998 91 .000247 2003 SZ .000137 --Interest is calculatad as folloas: INTEREST = BALANCE OF TAX UNPAID X NUNBBR OF DAYS DEL/N~UENT X DAILY INTEREST 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 sheen on the Notice, additional interest must be calculated. PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: HOFFMAN S. WAGNER Date of Death: January 20, 2003 Will No.: 21-03-00132 Admin No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account with the Court? Yes No X B. The separate Orphans' Court No. (if any) for the personal representative's account is:. C. Did the personal representative state an account informally to the parties in interest? Yes No X The Executrix is the surviving spouse and sole beneficiary. D. 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: ) 9£: ~t~:l 9[ ']~? kO. Signature Edmund G. Myers Johnson, Duffle, Stewart & Weidner 301 Market Street, P.O. Box 109 Lemoyne, PA 17043-0109 Address (717) 761-4540 Telephone No. Personal Representative X Counsel for Personal Representative