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HomeMy WebLinkAbout04-0694IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION PETITION FOR GRANT OF LETTERS also known as , Deceased Social Security No. 180-46-0425 ELIZABETH E, MIHMET Petitioner(s), who is/are 18 years of age or older, apply)les) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut __ Decedent, dated and codicil(s) dated named in the Last Will of the State relevant circumstances, e.g,, renunciation, C~- Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after exeCuitbn of th~locumer~.~,, .,, bred for probate; was not the victim of a killing and was never adjudicated incapacitated: ,, ,~ , ' ::~ ] B. Grant of Letters of .~::, i.:i t.~ .c2', Administration (c.t.a., d,b,n,c,t,a,: pendente lite, durante absentia; duranta minori{'~T~) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence ELIZABETH E. MIHMET SPOUSE 9 NORFOLK COURT MECHANICSBURG, PA 17055 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 9 Norfolk Court, Mechanicsbur9, PA 17055 (list street, number and municipality} Decedent, then 40 years of age, died June 27 ., 2004 , at UPMC Passavant ER, Cranberry, PA (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 ........................................................................................ $ Wherefore. Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Pet'~lon an~ the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence Elizabeth C. Mihmet Norfolk Court, Mechanicsbur~], PA 17055 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 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 Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this ~)~'~-~ day of ./¢J._ L DECREE OF REGISTER Estate of DOUGLAS ALLIE MIHMET also known as Deceased Social Security No: 180-46-0425 Dat~e of Death: ?.~.~2.. 004 . AND NOW, ~--..~-&~.t,_ ~:~ ,o~.OL~ , in con~e~ation ~the PE~i~ reverse side hereon, satisfactory proof having been presented before me IT IS DECREED that Letters ~ Testamentary ~ of Administration are hereby granted to Elizabeth C. Mihmet onthe ((c.t.a., d.b.n.c t.; pendente?e; duranteL~sentia; d~n, Ce,4minoriate in the above estate and that the instrument(s), if any, dated. described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... Short Certificates(s) ............... Renunciation .......................... Extra Pages ( ) ............... I.T.R ....................................... JCP Fee ................................. Inventory ................................ Other ...................................... ey: John D. Grigsby, Esq. I.D. No: 61 212 Address: 101 S. Market Street Mechanicsbur9 Telephone: 717-796-6537 PA 17055 his is to certify that the infbrmation here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanen~t filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 10544848 No. Local Registrar Date COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (Coroner) Allte Mihmet 7/31/1963 1~ ~"~m'~'"~ ~ UPMC Passavant ER Cranberry ,~. s~.,. Pe~ylvania ~ Cumberland ~..~.? Butler Cranberry Twp. 9 Norfolk Cou~ M~ch~csburg, PA 17055 Allie E. Mi~t 10:03 ~ne27, 2004 ~ ...... ~ , P~ENDING June 27, 2004 Whits Married 17O55 28, 2004 - _.. ,"~ '-'. ~ -. ,_.. -', COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS I : :~:~~ 9 REV-1548 EX AFP (06-05) ~-.., ," {i. DATE 10-24-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 FILE NUMBER 21 04-0694 COUNTY CUMBERLAND SSN/DC 180-46-0425 ACN 05143139 APPEAL DATE: 12-23-2005 (See reverse side under Objections) Amount Remitted L 1 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WIllS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ElISSAvtT MIHMET 1136 SNAPPER DAM RD lANDISVIllE PA 17538 CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REv=i54s-Ex-AFP-C03=05j--------------______________________________________________________ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-24-2005 : ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 CUMBERLAND COUNTY FILE NO. 21 04-0694 TAX RETURN WAS: S.S/D.C. NO. 180-46-0425 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 05143139 FINANCIAL INSTITUTION: WHEATlAND FCU ACCOUNT NO. 16066 TYPE OF ACCOUNT: ~ )SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE DATE ESTABLISHED 10-09-1996 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 12,808.26 0.500 6,404.13 .00 6,404.13 .45 288.19 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." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CD005822 .00 288.19 BALANCE OF UNPAID INTEREST/PENALTY AS OF 09-22-2005 TOTAL TAX CREDIT 288 . 19 BALANCE OF TAX DUE .00 INTEREST AND PEN. 7.03 TOTAL DUE 7.03 · IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAYBE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) pt COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUA1:'TAlCf:S INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 171Z8-0601 NOTICE OF INHERITANCE TAX , APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (06-05) ; I ")Q l...~ ...; DATE 10-24-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 FILE NUMBER 21 04-0694 COUNTY CUMBERLAND SSN/DC 180-46-0425 ACN 05143133 APPEAL DATE: 12-23-2005 (See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ELISSAVET MIHMET 1136 SNAPPER DAM RD LANDISVILLE PA 17538 CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +-- REY=is4S-EX-AFP-coi=osi--------------------------------------------------__________________ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-24-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 COUNTY CUMBERLAND FILE NO. 21 04-0694 TAX RETURN WAS: S.S/D.C. NO. 180-46-0425 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 05143133 FINANCIAL INSTITUTION: WHEATLAND FCU ACCOUNT NO. 12930 TYPE OF ACCOUNT: ()SAVINGS ~) CHECKING ()TRUST ()TIME CERTIFICATE DATE ESTABLISHED 02-28-1991 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due x 1,306.71 0.083 108.89 .00 108.89 .45 4.90 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." X TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CDo05822 .00 4.90 TOTAL TAX CREDIT 4.90 BALANCE OF TAX DUE .00 INTEREST AND PEN. .12 TOTAL DUE .12 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. * ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J pt. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL l.A>q=,S.,. INHERITANCE TAX DIVISION ',"!." . PO BOX 280601 . , HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX .-, -'-'I\PPRAISEHENT, ALLOWANCE OR DISALLOWANCE "OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (06-05) I i ,I :..i DATE 10-24-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 FILE NUMBER 21 04-0694 COUNTY CUMBERLAND SSN/DC 180-46-0425 ACN 05143136 APPEAL DATE: 12-23-2005 (See reverse side under Objections) AmDunt Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ELISSAVET 'MIHMET 1136 SNAPPER DAM RD LANDISVILLE PA 17538 CUT ALONG THIS LINE -to RETAIN LOWER PORTION FOR YOUR RECORDS +- REV=is4S-EX-AFP-r03=Osi---------------------------------___________________________________ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-24-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 COUNTY CUMBERLAND FILE NO. 21 04-0694 TAX RETURN WAS: S.S/D.C. NO. 180-46-0425 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 05143136 FINANCIAL INSTITUTION: WHEAT LAND FCU ACCOUNT NO. 12930 TYPE OF ACCOUNT: ~ )SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE DATE ESTABLISHED 02-28-1991 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due X 9,908.70 0.083 825.69 .00 825.69 .45 37.16 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." X TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CDo05822 .00 37.16 TOTAL TAX CREDIT 37.16 BALANCE OF TAX DUE .00 INTEREST AND PEN. .91 TOTAL DUE .91 · IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J Rt COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIiQilIAi:-tJ,i!Esn::-::- (: :"', ::- INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (06-05) DATE 10-24-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 FILE NUMBER 21 04-0694 COUNTY CUMBERLAND SSN/DC 180-46-0425 ACN 05143134 APPEAL DATE: 12-23-2005 (See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ". : ::'9 MARGARET M MIHMET C/O 1136 SNAPPER DAM RD LANDISVILLE PA 17538 CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV=is4S-EX-AFP-rOj=osi-------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-24-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 COUNTY CUMBERLAND FILE NO. 21 04-0694 TAX RETURN WAS: S.S/D.C. NO. 180-46-0425 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: WHEAT LAND FCU ACN 05143134 ACCOUNT NO. 12930 TYPE OF ACCOUNT: ()SAVINGS ~) CHECKING ()TRUST ()TIME CERTIFICATE DATE ESTABLISHED 02-28-1991 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 1,306.71 0.083 108.89 .00 108.89 .12 13.07 TAX CREDITS: PAYMENT DATE 09-21-2005 RECEIPT NUMBER CD005826 DISCOUNT (+) INTEREST/PEN PAID (-) .00 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." AMOUNT PAID 13.07 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, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J 13.07 .00 .32 .32 f(,( REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: MIHMET, DOUGLAS ALLIE Date of Death: 6/27/2004 Estate No. 2004-00694 SSN: 180460425 File No. Date Letters Granted: To the Register: Will or Administration No. I certify that Notice of Estate Administration 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 10/26/2004 Name Address Elizabeth C. Mihmet 9 Norfolk Court Mechanicsburg PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: 10/26/2004 Capacity: Personal Representative X Counsel for Personal Representative Name (Please type or print) John D. Grigsby Address 101 S. Market St. Mechanicsburg PA 17055 Te ephone No. 717-796-6537 STATUS REPORT UNDER RULE 6.12 BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND , PENNSYLVANIA Name of Decedent: DOUGLAS ALLIE MIHMET Date of Death: 6/27/2004 File No. 21 -04-00694 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the 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 Orphan's 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? 'I.. YES NO 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. r- . fl}a 1~ .' Signature 7/ /JOHN D. GRIGSBY, ESQ. Name (Please type or print) 101 S. MARKET ST. Address Date: 2/25/2005 c:'.) C",j MECHANICSBURG PA 17055 717 -796-6537 Tel. No. vA Capacity: Personal Representative X Counsel for personal representative REV1SOO EX. (6;001 '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128.0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT W I- :,:: ::!: en U 0::,:: w~u J: 0:9 u o..m 0.. <C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z UJ o UJ u UJ o MIHMET, DOUGLAS A. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 06/27/2004 07/31/1963 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL) MIHMET, ELIZABETH C. [XJ 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date 01 death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy oITrust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1.1.95) ".~.~ \). OFFICIAL USE ONLY FILE NUMBER 2 1 -0 4 0 0 6 94 "'COuNTY"'Co5E --YEA~ - - NuMsER- - SOCIAL SECURITY NUMBER 80- 4 6 - 0 4 2 5 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date of death priorto 12.13-82) o 5. Federal Estate Tax Return Required Q.. 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTlON MUST BE COMPLETED. ALL CORRESPONDENCE AND OONFIDENTlAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS JOHN D. GRIGSBY, ESQ. 101 S. MARKET ST. FIRM NAME (II Applicable) I- Z W o z o 0.. en w 0: 0: o U TELEPHONE NUMBER 717 -796-6537 1. Real Estate (Schedule A) (1) MECHANICSBURG 256,250.00 i OFFICIAL USE ONLY r'",,) z o i= S :::> t: a.. <( u UJ a: 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole.Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4). 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter. Vivos Transfers & Miscellaneous Non.Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1.7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= <( I- :::> a.. :iE o U ~ I- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 256,390.00 X 2-- (15) X _(16) X .12 (17) X .15 (18) (19) 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 PA 17055 . .~ r",,,) C) 8,000.00 ' _..-~,.:; ,.~ Q.) (8) 264,250.00 7,860.00 (11) (12) (13) 7,860.00 256,390.00 (14) 256,390.00 20. 0 Decedent's Comolete Address: . STREET ADDRESS 9 NORFOLK COURT CITY I STATE PA I ZIP MECHANICSBURG 17055 Tax Payments and Credits: 1 T ax Due (Page 1 Line 19) (1) 2 Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) Total Interest/Penalty ( 0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF 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; ........................................................................... 0 8" b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 ~ c. retain a reversionary interest; or ...................................................................................................... 0 Ga"" d. receive the promise for life of either payments, benefits or care? ............................................................. 0 1!3" 2 If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?........................................................ ..................... .......... ....... 0 g- 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 G:r 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ... .................... .......................... ....... .... ....... ................ ....... ..... ........ 0 [!3'" IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. PA 17055 DATE 2/14/2005 ADDRESS ADDRESS 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 PS. S9116 (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. 99116 (a) (1.1) (Ii)]. 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 PS. s9116(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 PS. 99116(1.2) [72 P.S. s9116(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, 99116(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 SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER MIHMET DOUGLAS A. 21 04 00694 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorshio must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 256,250.00 HOUSE AND LOT LOCTED AT 9 NORFOLK COURT, MECHANICSBURG, PA 17055 TOTAL (Also enter on line 1, Recapitulation) $ 256,250.00 ""'~",""', '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF MIHMET DOUGLAS A FILE NUMBER 21 04 00694 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 NUMBER 1. DESCRIPTION HARLEY DAVIDSON MOTORCYCLE VALUE AT DATE OF DEATH 8,000.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 8,000.00 REV: ,~,l'EX'" (1-97) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MIHMET. DOUGLAS A FILE NUMBER 21 04 00694 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MALPEZI FUNERAL HOME 7,860.00 8. ADMINISTRA TIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2 Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4, Probate Fees 5, Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 7,860.00 . . (If more space is needed, insert additional sheets of the same size) . Ma,""PI,ua Way. M,chanics"'", PA 17055 PI"",,: 697.4696 . Ma/perzi FUNERAL HOME STATEMENT OF FUNERAL GOODS AND SERVICES SELEC1)!D Charges are only for those Items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any Items, we will "llXPlain the reason In writing below. . . If you selected a funeral that may require embalmlng, such as a funeral with viewing, youmay have to pay for em~a1mlttg. You do not have to pay for embalm. ing you did not approve If yqu selected arrangements such as direct cremation or immediate burial. If we charged for embalmlng, we will explain why below. .For tbe Service of 'D...".( (" A '. /'i\; k 1'1'\~ -\- . '.. . ". , ". . . Date.of Death .1....... '?' 7, 1~'^'i 'Cbarge to: t!:/i <,A I.. ~ I. .^/U".."".j. 9 t L..~ {1/ (' ,..".. +- . jll", I'A h. J . I.", f~ 17/'. f( . Name . ddress City'.' State it Other clothing , .. .. , Mkhael J. Malpeu.i, Owner Jeremy J. Shartzer, Funeral Director A. CHARGE FOR SERVICES SELECTED I I. PROFESSIONAL SERVICES Services of Funeral Director/Staff . . . . '.3.!l..25 Embalinlng . . . . . . . . . . . . . . . . .. . . . ~ L_J:....:..L Other 'preparation of body ..It ~.. r ') v I . t"_. . '. I. i' . .. .~, . - . . I .- ..- Cremation urn . . . . . . . . . '. .. . . . . . .. ._ (Description) OTHER .- .- t .- TOTAL MERC~ANDIS~ SELECTED......,..~........ B'~ C. SPECIAL CHARGES: . Forwarding of remains to .....,................:..........,~ SUB.TOTAL OF PROFESSIONAL SERV~CE~.. ..:..... Al .~ 2. FACILITIES AND SERVICES Use of facilities and servlces.for vIewing (VlsltatlonlWake).. ....... .~ Use of facilities and services for funeral ceremony............ .~ Use of facilities and services for Memorial Service ............. ...____._ Use of equipment and services for graveslde service..........:,. .- Other use of facilities (Funeral Home) Receiving of remains fro!l1 .- .-. SUMMARY OF CHARGES I . A. Professional Services, !Facilitlesand Equipment, and Auto~otlve I Equipment. . . . .. . .j. . . . , .." . ~ .. .~ B. Merchandise..... ...;..........,.. .~ C. Special Charges ... . ; .. .. , . .. . ".. '..::.tl.:=- D. Cash Advances. . . . .J. ... . ~ . . . . . . ~. $1. f ~~,., TOTAL OF ALL SEctiONS. . . . . . . . . . . . . , . . , . . . . . ., ..:z&..!i.i. g'O Outer burial container............. .~ PAID AT TIME OF ~R PRIOR TO (Description) ,I. .,..:; l'," ARRANGEMENTS. ./.. ~,.."......;,..."........ .~ J') /' .." I J, /' BALANCEDUE..:.,.'.................,.,......... . "7l'",,'i.-"..'r. K... (I' ~.n J\;" l '''S'', ~ ,1/1' ,- ~"",. Acknbwledgement cards........... .~ REAS9N FOR. EMBALMING . . - ..-----,~glij~r.!u>.,e~~~).. .....11... .', . '.' . .,... I.~ - J .' . --- ..'. - - MemorY' folder'S";"'.;/'.; :!>;~'; ; ';h"" ,. . 4==,~lf3"y!~i. s;eme c;rY,()r !;~r)iat()ry rc;qulrements have r ulred the purchase Prayer cards . . . . . . . . . . . . . . .'. . . . .. . ~ of any of the items listed above the law or requirement Is explained below. Temporary grave marker....,...... __ /)I'.J,,~ 1'..", ,/ f~"/d' ,,,.... Burial clothing .................:..~ l?$" .',J AI ("01",,,,-1.,,...1' I agree that i have examined the Items of goods and services selected above and found them to be correct and accordlng~o the amngcinents I have requested.. acknowledge receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds ayallable fOr payment of the cash price for the goods arid services selected.. also agree to make payment of 1-7'<.5 ~ 1(';:' within ~c' , days.. agree to1be jointly and severally Uable with anyone else who signs below, A late charge of. . / "'L. per month amounting to. /7: ~L per year will be applied :to the unpaId balance beginning 7/ day. . from the date of this agreement. I will alSo pay to th~ Funeral Director all reasonable costs paid by the Funeral Director tQ collect' amounts . owe under this agreement. Those costs may Include allomeys' fees, court costs pndother costs. Any additional services or merchandise ordered or requested after the date of this agreement will be conslde" d art of t Is agr el!lcry and. h~ c st)hereof will be reflected on.the flnal bill or statement. : _ .... . . (Seal) .1, " ( i" , .' .j.l. (putchaser ....................."..........- . SUB.TOTAL OF FACILlTlES/EQUlPMENT....,...... A2 I~ 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home. Local............. .'. :............ I~ Hearse (Casket Coach) , Local........:.................. .~ Limousine Local.......................... ..- Family car . Lpcal............................ I~ Flower car or floral disposition '. . Local........................... I~ Lead car/clergy car . Local.........;................. I~ Car for pallbearers I Local........................... '-1--- Out of town transportation. . . . . . . .. . ~K .:. f- 1 -1--- 1 I SUB.TOTAL OF AUTOMOTlVEEQUlPMi!NT........ A3 I~ I TOTAL OF PROFESSIONAL SERVICES. FACILITIES AND AUTOMOTIVE EQUIPMENT ................................... A .~ B. CH~:~:r ~~~ .~~~~~~.~~~~~ .~~~~~~:bu (De~criptlon) 1.1,,,,.. /"f( 7/ '/' - J .... c:.~I/II,iI (,Q~v,.. (C ,1'.<1" .\.~I '> Other Receptacle . . . . . . . . . . . . . . . .. '-1____ (Description) . (Funeral Home) Immediate Burial. . . . . . . . . . . . . . . .. ._ Direct Cremation. . . . . . . . . . . . , . . .. ._ .- SUB.TOTAL OF SPECIAL CHAaGES. .. . . . . . . . . . . . .. C . - b - D. CASH ADVANCED Ocpenlng Grave .................. · 5;:! emetery Equipment. . , . . . . . . . . . .. . Lot and Deed. . . . :., . . . . . .. . . . . . .. ._ Newspaper NoHces-Locallh.,..... '~f(. b~ Newspaper Notices-Out.of.town.... .--=-- Telephone & Telegrams ........... ._ Airfare. . .... . . . . .'. .'. . . . ... .. . . .. ._ Clergy/Mass Offering. . . . . . . . . . . . ., .~ Pallbearers... .... ........... .... ._ Certified, CopIes of th~ Death CertIficate ..;2:~. cc.".:c..,.. (:z..pp.). ..!La..- Police Escort .. . .. .. .. . ..... . .. ... ._ Flowers. : . . . . . . . ... . . . . .. . . .... . ;::.....,.'y Vault Servtce Charge, . . . . . . . . . . . .. ,_ C"~r-"\ .~ ~t .I,,:' ~ .-==- . -l?' j I ~ . I e.; l:, -~~'" .~ pll~\;/~, :-:!.~>' $711.. $'0 /."" ~_J A.\~. ~ ~.. .~ . . i . . , .- SUB.TOTAL OF ADVANCES.................:..... D .~u i '. . We charge you for our servl~es In obfalning: (specify casb advances tbat",., "",rIled."p) . / (Seal) (Purchaser) . Cl Pennsylvania funeral DlreClors ""oelaUon BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE DF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX .. r ,-_.. t.' '.1. r-j' DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-07-2005 MIHMET 06-27-2004 21 04-0694 CUMBERLAND 101 OR::; . JOHN D GRI~~BV ESQ 101 S MARKET ST MECHANICS BURG PA 17055 *' REV-1541 EX AFP (03-05) DOUGLAS A AItount R..i tted 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 ~ It~V-"M4"'n.~.m~'lI!1.'lMtm.W.!MMAW4M.'r.mr.lWl1lmr.w1'~.Yt:r.WJlM.'r.IlJt'.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MIHMET DOUGLAS A FILE NO. 21 04-0694 ACN 101 DATE 06-07-2005 TAX RETURN WAS: I X I ACCEPTED AS FILED I CHANGED I~ an assessment was issued previously. lines 14. 15 and/or 16. 17. 18 and 19 will r~lect ~igures that include the total ~ ~ returns assessed to date. ASSESSMENT OF TAX: 15. A~unt of Line 14 at Spousal rat. liS) 16. A~unt of Line 14 taxable .t Lineal/Class A rat. (16) 17. A~unt of Line 14 .t Sibling rat. (17) 18. A~unt of Line 14 taxable at Coll.taral/Class Brat. (18) 19. Principal Tax Due RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..1 Est.t. (Schedule A) 2. Stocks and Bonds ISchedule BI 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule DJ S. Cash/Bank Deposits/"isc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets III 121 131 I'll 151 161 171 256,250.00 .00 .00 .00 8.000.00 .00 .00 IBI APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral ExPenses/Ad.. Costs/Hisc. ExPenses (Schedule H) 10. Debts/Mortgage Liebilities/Liens (Schedule X) 11. Total Deductions 12. Net Value of Tax R.turn 13. Chariteble/GovernBent.l Bequests; Non-elected 9113 Trusts (Schedul. J) 14. Net V.lue of Est.te Subject to Tax 191 1101 7,860.00 .00 1111 1121 1131 11'11 NOTE: 256,390.00 X .00 X .00 X .00 X NOTE: To insure proper credi t to your 8CCCKHlt, subeit the upper portion of this for. with your tax PIIYllent. 264,250.00 7.Riln nn 256,390.00 .00 256,390.00 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 1191= TAX CDEDTTS: l+j ANDUNT PAID DATE NUMBER INTEREST/PEN PAID I-I TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REllUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU MAY BE DUE ~ A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.I e>':7 """'~j lJ :) Y. . f"'l ;:'.c; 'co ( cr "::.~ " ',._\ ," .. .....:.--:.-/ i -g~ ~E~ E..~ ,sO~ 2 G; _ ~ ctCll CIl a...=: >.(\) > <<) c:.~ U) VJ "13 ta~ ~ ~-' . ~ - - ~~~ ~ ~c~ ~~ ~ -- -~~ ~ <1 ,\"", '" "0 '" ~ -'" ~~ ~ '$ ~..~ - - - ~ "'-. ~ K ""- J ,.... . ')\ \ 0" 'W .... ~~ (~ ,) .r\ ~ .~""'t\j-j,j :.k...- ... o N j') ..... r) ... o r; ,f~ II , COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIOUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 - INFORMATION NOTICE r,r:-c:'(';: (~:: AND T~XPAYER RESPONSE FILE ACN DATE , NO. 21 104- 0694 051~3133 I 09-107 -2005 REY-154S EX AFP tI9-DO> "n L",. ,-C) 2,2 Pi: ~~~OOF DOUGLAS A MIHMET S.S. NO. 180-46-0425 '::>. - DATE OF DEATH 06-27-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS IX] CHECKING D TRUST D CERTIF. (~'1 ,. REMIT PAYMENT AND FOR S TO: REGISTER OF WILLS CUMBERLAND CO COURT H USE CARLISLE, PA 17013 ELISSAVET MIHMET 1136 SNAPPER DAM RD LANDISVILLE PA 17538 WHEATLAND FCU has provided the Department with the information listed below which has been used ~n 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 written 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. QUBstions may be answered by cslling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR Account No. 12930 Date 02-28-1991 Established Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 1,306.71 8.333 108.89 .045 4.90 TAXPAYER RESPONSE To insure proper credit to your acco nt, two (2) copies of this notice must accom any your payment to the Register of Wills. M ke check payable to: nRegister of Wills, Agen n. x NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 57. discount of the ax due. Any inheritance tax due will become elinquent nine (9) months after the date of de tho PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. ~ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice 0 obtain a discount Dr avoid interest, Dr you may check box "A" and return this notice to the Reg"ster of Wills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has been Dr will be reported and tax paid with the PennSYlvania Inheritance ax return to be filed by the decedent's representative. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. 2 3 4 5 6 7 8 x If you indicate a different tax rate, please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION lINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 x PART @] DATE PAID TOTAL (Enter on Line 5 of Tax Computation) I $ I I AMor PAYEE DESCRIPTION PAID Under penalties of perjury, I declare that the facts I have reported above plete to the best of my knowledge and belief. are true, correc 9 r- go- S-t-?-: WORK ( /?> 37'3 -tJ7~ TELEPHONE NUMBER and t HOME ( DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WIll RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. 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 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 1 - 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 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. 2. 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 Individual Taxes, Dept 280601, HarriSburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your 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. LINE 1. Enter NOTE: TAX RETURN - PART 2 - TAX COMPUTATION the date the account originally was established or titled in the manner existing at date of death. For a decedent dying after 12/12/82: 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 $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (MM) 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. 2. 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 decedent's death: 1 OIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7% (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): DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE 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 100 50% (TAXABLE FOR EACH SURVIVDR) 4. The amount SUbject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the 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 4). 7. Enter the appropriate tax rate (line 7) as determined below. MThe tax rate lmposed on the net value of transfers from a deceased Chlld 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%. The lineal class of heirs 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 with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse lineal Sibling Collateral 07/01/94 to 12/31/94 3X 6X lSX lSX 01/01/95 to 06/30/00 OX 6X lSX 157- 07/01/00 to present OX 4.SX- 12X lSX CLAIMED DEDUCTIONS - PART 3 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 furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. II COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 '* INFORMATION NOTICE f"} ('('cc-\r , r-:-:.... N.D , :LJ,,"i'_TA.'xP.AVE:-RESPONSE REV-IS.S EX AFP [09-001 I,' ! FILE NO. 21 04-0694 ACN 05143136 DATE 09-07-2005 7n loti c' t:~ f) 'J? ['_ l.... TYPE IOF ACCOUNT ItSt?: r5RJ DOUGLAS A MIHMET [X] SAVINGS S.S. NO. 180-46-0425 0 CHECKING ''IrATE OF DEATH 06-27-2004 0 TRUST COUNTY CUMBERLAND 0 CERTIF. RE"IT PAY"ENT AND FORtS TO' REGISTER OF WILLS . CUMBERLAND CO COURT H USE CARLISLE, PA 17013 I I I ....}!... ELISSAVET MIHMET 1136 SNAPPER DAM RD LANDISVILLE PA 17538 NHEATLAND FCU has provided the Department with the information listed below which has been used iin 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 written 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 Pennsy!vcni3. Oucstion~ may be onswared by calling (717~ 78?-8327. COMPLETE PART 1 BELOW . . . SEE Account No. 12930 Date Established REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTI~NS 02-28-1991 To insure proper credit to your acco nt, two (Z) copies of this notice must accom any your payment to the Register of Wills. M ke check payable to: "Register of Wills, Agent". Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 9,908.70 8.333 825.69 .045 37.16 TAXPAYER RESPONSE NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5% discount of the' tax due. Any inheritance tax due will become elinquent nine (9) months after the date of de tho Tax x PART [!] A. [ CHECK ] ONE BLOCK B. ONLY C. I7l The above information and tax due is correct. ~l. You may choose to remit payment to the Register of Wills with two copies of this notice 0 obtain a discount or avoid interest, or you may check box "A" and return this notice to the Reg ster of Wills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance ~ax return to be filed by the decedent.s representative. I [] The above information is incorrect and/or debts and deductions were paid by you. I You must complete PART ~ and/or PART ~ below. : TAX ON JOINT/TRUST ACCOUNTS PART [3] TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: lINE 1. Oat. Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 x x PART ~ DATE PAID PAYEE DESCRIPTION AMO NT PAID TOTAL (Enter on Line 5 of Tax Computation) $ ~{\ Under penalties of perjury, I declare that the facts I have reported above are true, correo lete to the best of my knowledge and belief. ( I ) WORK (If 7 ) TELEPHONE NUMBER HOME GENERAL INFORMATION 1. FAILURE TO RESPOND WIll RESULT IN 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. 3. 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 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 1 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 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. 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 Individual Taxes, oept Z80601, HarriSburg, PA 171Z8-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and 3 according to the instructions below. 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. LINE 1. Enter NOTE: TAX RETURN PART 2 - TAX COMPUTATION the date the account originally was established or titled in the manner existing at date of death. For a decedent dying after lZ/IZ/8Z: 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 $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (ww) 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. 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 follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7% (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): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS DR TRUST BENEFICIARIES X 100 PERCENT TAXABLE 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 100 50% (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the 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 4). 7. Enter the appropriate tax rate (line 7) as determined below. wThe 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%. The lineal class of heirs 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 with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%. 12% 15% CLAIMED DEDUCTIONS PART 3 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 furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x II". 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 * INFORMATION NOTICE ,f', r, r:-[r.c ('r AND . ...,...1 ,J ".! T~')(PAYER RESPONSE I" FILE ACN DATE II I I I NO. 21 104- 0694 051'143139 09-.07-2005 TYPE OF ACCOUNT [i] SAVINGS D CHECKING D TRUST D CERTIF. REV-1543 EX ~Fp. 109~od)i_ ?f0S '- ~~ ,,~) A,-, / / c..~ \i.... PI: \2:E~~. OF DOUGLAS A MIHMET S.S. NO. 180-46-0425 DATE OF DEATH 06-27-2004 "'COUNTY CUMBERLAND ('\1 ELISSAVET MIHMET 1136 SNAPPER DAM RD LANDISVILLE PA 17538 REMIT PAYMENT AND FOR S TO: REGISTER OF WILLS CUMBERLAND CO COURT H USE CARLISLE, PA 17013 WHEAT LAND FCU has provided the Departllent with the information listed below which has been used ~n 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 inforllation is incorrect, please obtain written correction from the financial institution, a~tach 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 Comllonwealth of PQnnsylvAnia. QUB$tions mAY be ~n~wer9d by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR Account No. 16066 Date 10-09-1996 Established -= Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 12,808.26 50.000 6,404.13 .045 288.19 TAXPAYER RESPONSE To insure proper credit to your acco nt, two (2) copies of this notice lIust accom any your payment to the Register of Wills. M ke check payable to: "Register of Wills, Agen ". x NOTE: If tax payments are made with"n three (3) months of the decedent's date of death, you may deduct a 57. discount of the ax due. Any inheritance tax due will become elinquent nine (9) months after the date of de tho PART [!] ch ~e above inforllation and tax due is correct. DPri~ You may choose to remit payment to the Register of Wills with two copies of this notice 0 obtain a discount or avoid interest, or you may check box "A" and return this notice to the Reg"ster of Wills and an official assessment will be issued by the PA Department of Revenue. [CHECK ] ONE BLOCK ONLY B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance ax return to be filed by the decedent's representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You IIUst cOllplete PART ~ and/or PART ~ below. PART @] TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 4 5 6 7 8 x If you indicate a different tax rate, please state your relationship to decedent: x PART [!] DATE PAID PAYEE DESCRIPTION PAID TOTAL (Enter on Line 5 of Tax Computation) $ ~t\ ~ SIGNATURE facts I have reported above are true, correc and HOME (7/7) ?9fS.g-S-?-r I fljz-//OS- WORK (ll!) 3 '3 -C'.70-Y~ $/2//Pj- TELEPHONE NUMBER DATE Under penalties lete to the best GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based on inforllation subllitted by the financial institution. 2. Inheritance tax becolles delinquent nine 1I0nths after the decedent's date of death. 3. 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 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 1 TAXPAYER RESPONSE 1. BLOCK A - If the information and cOllputation 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 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. 2. 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 Oepartment of Revenue, Bureau of Individual Taxes, Oept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice inforllation is incorrect andlor deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your 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 assessllent (Form REV-1548 EX) upon receipt of the return from the Register of Wills. LINE 1. Enter NOTE: TAX RETURN PART 2 TAX COMPUTATION the date the account originally was established or titled in the manner existing at date of death. For a decedent dying after 12/12/82: 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 $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (MM) 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. 2. 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 decedent's death: OIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDEO BY 3 (JOINT OWNERS) OIVIOED BY 2 (SURVIVORS) = .167 X 100 16.770 (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): 1 OIVIOED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE 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 5070 (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the 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 4). 7. Enter the appropriate tax rate (line 7) as determined below. MThe tax rate lllposed on the net value of transfers from a deceased Chlld 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 heirs 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 with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%- 12% 15% - CLAIMED DEDUCTIONS PART 3 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 furnish proof of paYllent. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment lIay be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 !EX! 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT i NO. CD OO~822 I I I I I I A ACN SSESSMENT AMOU~ T CONTROL NUMBER -------- 05143133 I $4.9( 05143136 I $37.16 05143139 I $288. 9 I I I I I I AID: $330.~ 5 MIHMET ELISSA VET 1136 SNAPPER DAM RD LANDISVILLE, PA 17538 dn_U_ fold ESTATE INFORMATION: SSN: 1 80-46-0425 FILE NUMBER: 2104-0694 DECEDENT NAME: MIHMET DOUGLAS ALLIE DATE OF PAYMENT: 09/22/2005 POSTMARK DATE: 09/21/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2004 TOTAL AMOUNT P REMARKS: CHECK# 3667 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBA GH REGISTER OF WILLS REGISTER OF WILLS ?n C I.'''. F" '/;; '3 \ '121, -- - - r'l ~ ~J ~~~ ~\~ - - - - '~ } /' ~ ;Z "'- - - - -- - -.- "::r- ~ ~ <) ,'J (rl 1\) 1\) " 1\) ... I) r-- ... I "4.- .... Q I c) -U<o ......a::fri "E...... E",_ ,sQ<( ~~(l. " - t:: 0." " a.. "E >",> tOC:.!:2 ~V)"U .:.=-.oc. LU""", _-J COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE . ;::(\(\;~rYTj r-'~I.,AI;Ul . :/.'iTAXPAYERRESPONSE FILE ACN DATE NO. 21 04- 0694 05143135 09-07-2005 ? 2 E~iD PORl bOUGLAS A MI HMET S.S. NO. 180-46-0425 'DA~E OF DEATH 06-27-2004 COUNlY CUMBERLAND REMIT PAYMENT AND REGISTER OF WILLS CUMBERLAND CO COURT CARLISLE, PA 17013 REY-1545 EX AFP (09-00' 2('1.~r- !,' n~ ..J SONYA A BOHMANN 266 N ROLLING RD SPRINGFIELD PA 19064 II TYPE OF ACCOUNT D SAVINGS [Xl CHECKING D TRUST D CERTIF . i FOR~S TO: I HfUSE , I , , I I , , WHEATlAND FCU has provided the Departllent with the information listed below which has been used ~n 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 written correction from the financial institution, attach a copy to this forll 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 CiJ1:)werl;ld b,y ,cal.i.ing (,i,} 787-a327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 12930 Date 02-28-1991 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due 1,306.71 8.333 108.89 .12 13.07 TAXPAYER RESPONSE x Tax x To insure proper credit to your acco~nt, two (2) copies of this notice must accolI any your payment to the Register of Wills. M ke check payable to: "Register of Wills, Agen~". NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5% discount of the ~ax due. Any inheritance tax due will become ~elinquent nine (9) months after the date of de tho PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. J:1\ The above information and tax due is correct. 1 ~l. You may choose to remit payment to the Register of Wills with two copies of this notice 0 obtain a discount or avoid interest, or you may check box "A" and return this notice to the Reg'ster of Wills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance ax return to be filed by the decedent's representative. , [] The above information is incorrect and/or debts and deductions were paid by you. You lIust complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: P~RT @] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS :I. 2 3 X 4 5 6 7 X 8 LINE :I.. Dato established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART [!] DATE PAID PAYEE DESCRIPTION (Enter on line 5 of Tax Computation) I TOTAL Under penalties of perjury, I declare that the facts I omplete to the best of my knowledge and belief. CL-- a. YER SIGNAT I $ i are true, correc~ 6Y3#0-3~: .,L, have reported above HOME (q/()) WORK ( ) TELEPHONE NUMBER AMOIIJNT i PAID and '1/2.,'/?J 5- o DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. 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 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 1 - 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 subllit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Oepartment of Revenue will issue an official assessment (Forll REV-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax 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 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "c" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your 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. LINE 1. Enter NOTE: TAX RETURN - PART 2 - TAX COMPUTATION the date the account originally was established or titled in the lIanner existing at date of death. For a decedent dying after 12/12/82: Accounts which the decedent put in joint nalles within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (**) 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. 2. 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 decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 OIVIDEO BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 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): DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE 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 50X (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by lIultiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount texable (line 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 below. *The tax rate IlIposed 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 OX. The lineal class of heirs 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 with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3X 6X 15X 15X 01/01/95 to 06/30/00 OX 6X 15X 15X 07/01/00 to present OX 4.5XII 12X 15X CLAIMED DEDUCTIONS - PART 3 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 furnish proof of payment. C. Debts being claimed must be itemized fuUy in Part 3. If additional space is needed, use plain paper 8 1/2" x U". Proof of payment may be requested by the PA Department of Revenue. II COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 '* INFORMATION NOTICE '"'r, ,~.r'-,,, r'," AND _',Ji ED :,T~~VER RESPONSE FILE ACN DATE NO. 21 04-0694 05143138 09-07-2005 REY-154S EX AFP CD9.0Ul TYPE OF ACCOUNT [XJ SAVINGS o CHECKING o TRUST o CERTIF. ?? I... 1._ PH !~sXl OF DOUGLAS A MIHMET S.S. NO. 180-46-0425 DATE OF DEATH 06-27-2004 -,eOUNTY CUMBERLAND REHIT PAYHENT AND FO~HS TO: REGISTER OF WILLS ! CUMBERLAND CO COURT HloUSE CARLISLE, PA 17013 I ,r (-, : SONYA A BOHMANN 266 N ROLLING RD SPRINGFIELD PA 19064 WHEATLAND FCU has provided the Departllent 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 were 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 for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of PennsYivania. Questions may be answered by calling (717) 787-8321. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 12930 Date 02-28-1991 To insure proper credit to your accdunt, two Established (Z) copies of this notice must acco~pany your payment to the Register of Wills. ~ake check payable to: "Register of Wills, Age~t". ! NOTE: If tax payments are made wit in three (3) months of the decedent's date 0 death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of tho Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 9,908.70 8.333 825.69 .12 99.08 TAXPAYER RESPONSE Tax x PART IT] The above information and tax due is correct. ~ . You may choose to remit payment to the Register of Wills with two copies of this notice 0 obtain a discount or avoid interest, or you ..ay check box "A" and return this notice to the Reg'ster of Wills and an official assessment will be issued by the PA Department of Revenue. I B. [] The above asset has been or will be reported and tax paid with the PennsYlvania Inheritance ~ax return to be filed by the decedent's representative. ! C. [J The above information is incorrect and/or debts and deductions were paid by you. You must cOllplete PART ~ and/or PART ~ below. [CHECK ] ONE BLOCK ONLY PART ~ TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART ~ DATE PAID PAYEE DESCRIPTION AMOUNT I have reported above are true, correct land Sr'3-r9S-3'7 PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the cfmPlete to the best of my knowledge and belief. .J4~ a:.... a. 4L____ -'" 4~ ~ TAXPA R SIGNATURE facts I HOME ({, to) WORK ( ) TELEPHONE NUMBER .'V~kj- DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. 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 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 1 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 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. 2. 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 Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLDCK C - If the notice information is incorrect andlor deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your 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 NOTE: the date the account originallY was established or titled in the manner existing at date of death. For a decedent dying after 12/12/82: 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 $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (MM) appears before your first name in the address portion of this notica, the $3,000 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. 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 decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 l6.7X (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): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE 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 50X (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the 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 4). 7. Enter the appropriate tax rate (line 7) as determined below. MThe 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 ox. The lineal class of heirs 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 with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12131/94 3X 6X ISX ISX 01/01/9S to 06/30/00 OX 6X ISX ISX 07/01100 to present OX 4.SXlE 12X ISX CLAIMED DEDUCTIONS PART 3 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 furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. 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 II REV-1162 EX111-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BOHMANN SONYA A 266 N ROLLING RD SPRINGFIELD, PA 19064 ___u___ fold ESTATE INFORMATION: SSN: 180-46-0425 FILE NUMBER: 2104-0694 DECEDENT NAME: MIHMET DOUGLAS ALLIE DATE OF PAYMENT: 09/22/2005 POSTMARK DATE: 09/21/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2004 NO. CD 005824 ACN ASSESSMENT CONTROL NUMBER AMOUtj-JT 05143135 I $13.Q7 05143138 I $99.q8 I I , I " I , I I " I , I I ! I , , TOTAL AMOUNT PAID: $112.1\5 REMARKS: CHECK# 3669 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WillS GLENDA FARNER STRASBAUpH REGISTER OF WILLS .~ ~J ~ ~ ~ ~~~ ~ \~ ~ ~~ ~~~ ~ ~ l' :\J " \ ,c / -:t IT" ~ j ~ - ~ .., 'Y) -,.;~ 0....." 1 ,~<,/. ;'.'._'..,~, "i',.~Z ~~~ J~:,,:,~:,\~l.J ,...-,--.-" " ELO E "'~ ,!;Q<{ ~(j;o... t::Q,,' "Q..= >ftJ5 m~~ ~"-Oc W"" '" ~-J - - ... o I~) l~) .... N ... o r- .-t II ! COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 r,.r*.. , .'-- , . INFORMATION NOTICE r ,rr AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 P4-0694 051~3134 09-P7-2005 TYPE OF ACCOUNT D SAVINGS !Xl CHECKING D TRUST D CERTIF . REV"lS45 EX AFP !<<9-00l 7r~:'; (~' t~ ~ __J" " . ?I) . [I" ; I ' '.)9 ....:' EST. OF DOUGLAS A MIHMET 5.5. NO. 180-46-0425 DATE OF DEATH 06-27-2004 COUNTY CUMBERLAND MARGARET M MIHMET C/O 1136 SNAPPER DAM RD LANDISVILLE PA 17538 REMIT PAYMENT AND FOR S TO: REGISTER OF WILLS CUMBERLAND CO COURT H USE CARLISLE, PA 17013 WHEATLAND FCU has p..ovided the Depa..tment with the info..mation listed below which has been used i~ calculating the potential tax due. Thei.. ..eco..ds indicate that at the death of the above decedent, you we..e a joint owne../beneficia..y of this account. If you feel this info..mation is inco....ect, please obtain w..itten co....ection f..om the financial institution, a~tach a copy to this fo..m and ..etu..n it to the above add..ess. This account is taxable in acco..danca with the Inhe..itance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answe..ed by cailing (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR Account No. 12930 Date 02-28-1991 Established x 1,306.71 8.333 108.89 .12 13.07 TAXPAYER RESPONSE To insu..e p..ope.. c..edit to you.. acco nt, two (2) copies of this notice must accom any you.. payment to the Registe.. of Wills. M ke check payable to: "Registe.. of Wills, Agen ". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x NOTE: If tax payments a..e made within th..ee (3) months of the decedent.s date of death, you may deduct a SZ discount of the tax due. Any inhe..itance tax due will become elinquent nine (9) months afte.. the date of de tho PART [!] A. [ CHECK ] ONE BLOCK B. ONLY C. W1 The above info...ation and tax due is co....ect. ~ 1. You may choose to ..emit payment to the Registe.. of Wills with two copies of this notice 0 obtain a discount 0" avoid inte..est, 0.. you may check box "A" and ..etu..n this notice to the Reg ste.. of Wills and an official assessment will be issued by the PA Depa..tment of Revenue. [] The above asset has been 0.. will be ..epo..ted and tax paid with the Pennsylvania Inhe..itance ax ..etu..n to be filed by the decedent's ..ep..esentative. [] The above info..mation is inco....ect and/o.. debts and deductions we..e paid by you. You must complete PART ~ and/o.. PART ~ below. OF TAX ON JOINT/TRUST ACCOUNTS PART [!] TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART @J DATE PAID PAYEE DESCRIPTION AMO NT PAID I $ I TOTAL (Enter on Line 5 of Tax Computation) ~ perjury, I declare that the facts I have reported above are true, correc knowledge and belief. and . HOME (7/ 7 ) 7 (, ~ WORK ( ) TELEPHONE NUMBER '11 if S- ~/,t>:J- GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. 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 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 1 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 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. 2. 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 Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect andlor deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your 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. LINE 1. Enter NOTE: TAX RETURN PART 2 TAX COMPUTATION the date the account originally was established or titled in the manner existing at date of death. For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one [I) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk [MM) 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. 2. 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 decedent's death: DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 [JOINT OWNERS) DIVIDED BY 2 [SURVIVORS) = .167 X 100 16.7% [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): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE 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 50% [TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax [line 4) is determined by multiplying the account balance [line 2) by the percent taxable [line 3). 5. Enter the total of the 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 4). 7. Enter the appropriate tax rate [line 7) as determined below. MThe 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%. The lineal class of heirs 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 with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4,5%11 12% 15% CLAIMED DEDUCTIONS PART 3 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 furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x II". 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 *'" INFORMATION NOTICE c~__ AND ,T-4xPAYER RESPONSE , I i FILE NO. 21104-0694 ACN 05 43137 DATE 09 07-2005 REV-1545 EX AFP (09-00)' f'),..-.-.,,.. /. ~- - ~ ;-~, , . MARGARET M MIHMET C/O 1136 SNAPPER DAM RD LANDISVILLE PA 17538 ~. OF DOUGLAS A MIHMET S.S. NO. 180-46-0425 DATE OF DEATH 06-27-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT IX] SAVINGS D CHECKING D TRUST D CERTIF. REMIT PAYMENT AND FO MS TO: REGISTER OF WILLS CUMBERLAND CO COURT H USE CARLISLE, PA 17013 WHEATlAND FCU has provided the Departllent with the information listed below which has been used .n 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 written correction frail the financial institution, a~tach a copy to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Comllonwealth of Pennsylvania. Questions ilIay be answered by calling f7I7} 787-8327. I COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR Account No. 12930 Date 02-28-1991 Established Account Balance Percent Taxable Anount Subject to Tax Tax Rate Potential Tax Due x 9,908.70 8.333 825.69 .12 99.08 TAXPAYER RESPONSE x PART [!] To insure proper credit to your acc (2) copies of this notice lIust acco paymant to the Register of Wills. payable to: "Register of Wills, Age NOTE: If tax paYllents are lIade wit (3) 1I0nths of the decedant's date 0 you lIay deduct a 57. discount of the tax due. Any inheritance tax due will become delinquent nine (9) 1I0nths after the date of d ath. [CHECK ] ONE BLOCK ONLY A. [] The above information and tax due is correct. 1. You may choose to rellit payment to the Register of Wills with two copies of this notice 0 obtain a discount or avoid interest, or you lIay check box "A" and return this notice to the Reg ster of Wills and an official assessment will be issued by the PA Departllent of Revenue. B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance ax return to be filed by the decedent's representative. C. [] The above inforllation is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS I 2 3 X 4 5 6 7 X 8 LINE 1. Daie Established 2. Account Balance 3. Percent Taxable 4. Anount Subject to Tax 5. Debts and Deductions 6. Anount Taxable 7. Tax Rate 8. Tax Due PART ~ DATE PAID PAYEE DESCRIPTION I AMO NT PAID TOTAL (Enter on line 5 of Tax ConputationJ . . Under penalties of perjury, I declare that the , ~ conplete to the best of ny knowledge and belief. ~ ~.7fa~d. ~.~L.n4 TAXPA R SIGNATUR $ facts I have reported above are true, correc HOME (71"7 ) 7c.,t,-cr/9S- WORK ( ) TELEPHONE NUMBER J'-/~ /t:' ~r and DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WIll RESULT IN 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. 3. 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 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 1 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 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. 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 Individual Taxes, Oept Z80601, Harrisburg, PA 171Z8-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect andlor deductions are being claimed, check block "C" and complete Parts Z and 3 according to the instructions below. 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 NOTE: the date the account originally was established or titled in the manner existing at date of death. For a decedent dying after lZ/IZ/8Z: 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 $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (MM) 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. 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 follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 OIVIDEO BY TOTAL NUMBER OF OIVIOED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7% (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): 1 DIVIOED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE 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 100 50% (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the 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 4). 7. Enter the appropriate tax rate (line 7) as determined below. MThe 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%. The lineal class of heirs 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 with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse lineal Sibling Collateral 07/01/94 to 12/31/94 3X 6X lSX lSX 01/01/9S to 06/30/00 OX 6X lSX lSX 07/01/00 to present OX 4.SX. 12X lSX CLAIMED DEDUCTIONS PART 3 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 furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. 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 17128-0601 'I REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005826 MIHMET MARGARET M C/O 1136 SNAPPER DAM RD LANDISVILLE, PA 17538 ACN ASSESSMENT CONTROL NUMBER I I I I I I I I I I AMOUr I I -------- fold ESTATE INFORMATION: SSN: 180-46-0425 FILE NUMBER: 2104-0694 DECEDENT NAME: MIHMET DOUGLAS ALLIE DATE OF PAYMENT: 09/22/2005 POSTMARK DATE: 09/21/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2004 05143134 05143137 TOTAL AMOUNT PAID: $112.15 REMARKS: CHECK# 3668 SEAL INITIALS: JA RECEIVED BY: I GLENDA FARNER STRASBA~H I REGISTER OF WILLS ! REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVID~I..'lAXES-- INHERITANCE TAX DIVISIOk, " , ' PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX 'APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (06-05) SONYA A BOHMANN 266 N ROLLING RD SPRINGFIELD PA 19064 DATE 10-24-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 FILE NUMBER 21 04-0694 COUNTY CUMBERLAND SSN/DC 180-46-0425 ACN 05143138 APPEAL DATE: 12-23-2005 (See reverse side under Objections) Amount Remitted I I 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 4- REV=is4S-EX-AFP-r03=OSj-------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-24-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 COUNTY CUMBERLAND FILE NO. 21 04-0694 TAX RETURN WAS: S.S/D.C. NO. 180-46-0425 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 05143138 FINANCIAL INSTITUTION: WHEATLAND FCU ACCOUNT NO. 12930 TYPE OF ACCOUNT: ~ )SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE DATE ESTABLISHED 02-28-1991 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due X 9,908.70 0.083 825.69 .00 825.69 .12 99.08 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." x TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CD005824 .00 99.08 BALANCE OF UNPAID INTEREST/PENALTY AS OF 09-22-2005 TOTAL TAX CREDIT 99.08 BALANCE OF TAX DUE .00 INTEREST AND PEN. 2.42 TOTAL DUE 2.42 · IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAlTAl<iS:::-\ INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (06-05) . '-)el DATE 10-24-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 FILE NUMBER 21 04-0694 COUNTY CUMBERLAND SSN/DC 180-46-0425 ACN 05143135 APPEAL DATE: 12-23-2005 (See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 SONYA A BOHMANN 266 N ROLLING RD SPRINGFIELD PA 19064 CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV=is4S-EX-AFP-roi=osi----------------------------------------------------------------____ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-24-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 COUNTY CUMBERLAND FILE NO. 21 04-0694 TAX RETURN WAS: S.S/D.C. NO. 180-46-0425 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 05143135 FINANCIAL INSTITUTION: WHEATLAND FCU ACCOUNT NO. 12930 TYPE OF ACCOUNT: ()SAVINGS ~) CHECKING ()TRUST ()TIME CERTIFICATE DATE ESTABLISHED 02-28-1991 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due X 1,306.71 0.083 108.89 .00 108.89 .12 13.07 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." X TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CD005824 .00 13.07 TOTAL TAX CREDIT 13.07 BALANCE OF TAX DUE .00 INTEREST AND PEN. .32 TOTAL DUE .32 · IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J PI. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION 2:'~('C;,,'':T'; PO BOX 280601 '.' ,j, I. __,' HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX ~PRAISEMENT, ALLOWANCE OR DISALLOWANCE Of DEDUCTIONS, AND ASSESSMENT OF TAX ON ' JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (06-05) ')[i'~~ r, L. "-,,,f \._'J r'. -t"", (,J .,. c r". C c: i',j; .j: J \oJ DATE 10-31-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 FILE NUMBER 21 04-0694 COUNTY CUMBERLAND SSN/DC 180-46-0425 ACN 05143137 APPEAL DATE: 12-30-2005 (See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MARGARET M ~IHMET C/O 1136 S~APPER DAM RD LANDISVILLE PA 17538 CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV=is4S-EX-AFP-r03=OSj-----------------------------------------___________________________ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-31-2005 ESTATE OF MIHMET DOUGLAS A DATE OF DEATH 06-27-2004 COUNTY CUMBERLAND FILE NO. 21 04-0694 TAX RETURN WAS: S.S/D.C. NO. 180-46-0425 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 05143137 FINANCIAL INSTITUTION: WHEATLAND FCU ACCOUNT NO. 12930 TYPE OF ACCOUNT: ~ )SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE DATE ESTABLISHED 02-28-1991 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 9,908.70 0.083 825.69 .00 825.69 .12 99.08 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." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CD005826 .00 99.08 BALANCE OF UNPAID INTEREST/PENALTY AS OF 09-22-2005 TOTAL TAX CREDIT 99.08 BALANCE OF TAX DUE .00 INTEREST AND PEN. 2.42 TOTAL DUE 2.42 · IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J ~ COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG. PA 17128-0601 REV.1162 EXI11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MIHMET MARGARET M C/O 1136 SNAPPER DAM ROAD LANDISVILLE, PA 17538 _hn_h fold ESTATE INFORMATION: SSN: 180-46-0425 FILE NUMBER: 2104-0694 DECEDENT NAME: MIHMET DOUGLAS ALLIE DATE OF PAYMENT: 11/03/2005 POSTMARK DATE: 11/02/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2004 NO. CD 005964 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05143137 , $2.42 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: MARGARET MIHMET CHECK# 3691 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS $2.42 GLENDA FARNER STRASBAUGH REGISTER OF WILLS r----T- ,.- cr (,r .... r \"- " \. , , '\ ~~ .,....rJc~ C;; N "' CC ~ <c I ! ~ '7 ~l ? :/ ..,. 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REGISTER OF WIllS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 -+ RETAIN lOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF MIHMET DOUGLAS A FILE NO.21 04-0694 ACN 05143136 DATE 11-28-2005 THIS STATE HE NT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAVHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF lAST ASSESSMENT OR RECORD ADJUSTMENT: 10-24-2005 PRINCIPAL TAX DUE: 37.16 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CD005822 .00 37.16 10-31-2005 CD005957 .91- .91 TOTAL TAX CREDIT 37.16 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAVHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU HAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J pj( ~~H~~:~AN~~ ~~D:~Y;~~t(T~ PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REY-1607 EX AFP (03-05) ._0 P'" . ! 5 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-28-2005 MIHMET 06-27-2004 21 04-0694 CUMBERLAND 05143137 DOUGLAS A MARGAREI M MIHMET C/O 11~6 SNAPPER DAM RD LANDISVILLE PA 17538 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: CUT ALONG THIS LINE NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF MIHMET DOUGLAS A FILE NO.21 04-0694 ACN 05143137 DATE 11-28-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW 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 ADJUSTMENT: 10-31-2005 PRINCIPAL TAX DUE: 99.08 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CD005826 .00 99.08 11-02-2005 CD005964 2.42- 2.42 TOTAL TAX CREDIT 99.08 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFlECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J pt BUREAU OF INDIVIDUAl:r:f~~" INHERITANCE TAX DIVISIl1j(i ,I ;.". ," i .' PO BOX 280601 . '. HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) 2r'~~ I' - ,"1 ,-,,, "'. ,,... i" ,'. I J DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-28-2005 MIHMET 06-27-2004 21 04-0694 CUMBERLAND 05143133 DOUGLAS A ELISSA~~~ MIHMET 1136 SNAPPER DAM RD LANDISVILLE PA 17538 Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF MIHMET DOUGLAS A FILE NO.21 04-0694 ACN 05143133 DATE 11-28-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW 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 ADJUSTMENT: 10-24-2005 PRINCIPAL TAX DUE: 4.90 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CD005822 .00 4.90 10-31-2005 CD005957 .12- .12 TOTAL TAX CREDIT 4.90 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J pt - BUREAU OF INDIVIDUAL~:'~[T' INHERITANCE TAX DIVISION~'.,!i . I',.' PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) ? r .;.' -. r~ f*" ''''';'.. J r ,- L . '. f:j DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-28-2005 MIHMET 06-27-2004 21 04-0694 CUMBERLAND 05143134 DOUGLAS A r MARGARET .-M: MIHMET C/O 1136 SNAPPER DAM RD LANDISVILLE PA 17538 Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: CUT ALONG THIS LINE NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- ... INHERITANCE TAX STATEMENT OF ACCOUNT .._ ESTATE OF MIHMET DOUGLAS A FILE NO.21 04-0694 ACN 05143134 DATE 11-28-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW 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 ADJUSTMENT: 10-24-2005 PRINCIPAL TAX DUE: 13.07 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CD005826 .00 13.07 10-31-2005 CD005957 .32- .32 TOTAL TAX CREDIT 13.07 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 iii IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J RK BUREAU OF INDIVIDU~I'J'~':TI INHERITANCE TAX DIVISIOlf..'j',.: '.,-' PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT (1[ I _! REV-1607 EX AFP (03-05) ?r - - " , t' : L '_. I. r'>, !) , ;- ,J DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-28-2005 MIHMET 06-27-2004 21 04-0694 CUMBERLAND 05143138 DOUGLAS A r n , SONYA ~',' . A BOHMANN 266 N ROLLING RD SPRINGFIELD PA 19064 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this forn with your tax paynent. CUT ALONG THIS LINE ...... RETAIN LOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF MIHMET DOUGLAS A FILE NO.21 04-0694 ACN 05143138 DATE 11-28-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW 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 ADJUSTMENT: 10-24-2005 PRINCIPAL TAX DUE: 99.08 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CDo05824 .00 99.08 10-31-2005 CDo05957 2.42- 2.42 TOTAL TAX CREDIT 99.08 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO 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. ) r<K BUREAU OF INDIVID~,,~~~, INHERITANCE TAX DIVIS.OIt,.!. ie', .,-1/ PO BOX 280601 '. "'- ~. HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) ?r'C ~_ l~ ........ !",O ,'" ! 5 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-28-2005 MIHMET 06-27-2004 21 04-0694 CUMBERLAND 05143139 DOUGLAS A ELISSAVJ:t, MIHMET 1136 SNAPPER DAM RD LANDISVILLE PA 17538 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: CUT ALONG THIS LINE NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF MIHMET DOUGLAS A FILE NO.21 04-0694 ACN 05143139 DATE 11-28-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW 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 ADJUSTMENT: 10-24-2005 PRINCIPAL TAX DUE: 288.19 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CD005822 .00 288.19 10-31-2005 CD005957 7.03- 7.03 TOTAL TAX CREDIT 288.19 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 If IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO 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. ) r<K BUREAU OF INDIVIQaAlIj~~ INHERITANCE TAX DIVIS1dN.- -.- - PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) 7. C'~ r P' 15 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-28-2005 MIHMET 06-27-2004 21 04-0694 CUMBERLAND 05143135 DOUGLAS A SONYA ,. A BOHMANN 266 N .OLlING RD SPRINGFIELD PA 19064 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WIllS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS lINE --to RETAIN lOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF MIHMET DOUGLAS A FILE NO.21 04-0694 ACN 05143135 DATE 11-28-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW 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 ADJUSTMENT: 10-24-2005 PRINCIPAL TAX DUE: 13.07 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-21-2005 CD005824 .00 13.07 10-31-2005 CD005957 .32- .32 TOTAL TAX CREDIT 13.07 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l r<(