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Home My WebLink About04-0721COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 Z ILl W =~oo REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT X DECEDENT'S N~E (LAS], FIRST, AND MIDDLE INITIAL) DA~E OF DEATH (MM-OD*YEAR) "~ DATE OF BIR'~H (MM-OD-YEAR) APPLICABLE) SU~IVING SPOUSE'S NAME (~ST, FIRST, ~D MIDDLE INITIAL) Fp'E'I~UMBER i'-~ 'q SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WiTH THE REGISTER OF WILLS [ SOC~L SECURITY NUMBER r _ _ [~4, Limiled Estste [~9. Litigation Proceeds Received n~2. Supplemenlal Re[urn []?. Decedent Maintained a Living Trust (^t~ copy gl T~Jst) THIS SECTION MUST BE COMPLETED~!ALL CORRESPONDENCEiAI FIRM NAME (llAppli~blet TELEPHONE NUMBER 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Parlnership or Sole-Prophe!orship (3) 4. Morlgages & Notes Receivable (Schedule D) (4) 5, Cash, Bank Deposits & Miscellaneous Personal Property (5) ~--~5. Federal Estate Tax Return Required __ 8, Total Number of Sate Deposit Boxes ~-1 11. Electio~ to tax under Sec. 9113(A) l^t~ch ach O) !~C,0~F~D,ENTIAL TAX~iNI~,ORMAT~ON SHOU ED BE DIRECTED TO~i~ COMPLETE MAILING ADDRESS N,'l], I /"/0// (Schedule E) ~ Separats Eilllng Requested 7. Inter-~vos Transfers & Mis~t~aneous Non-Probats Property (7) (S~edule G a L) 8. Total Gross ~sets (tolal Lines 1-7} (8) 9. Funeral ~pen.s & Adminis~alive Costs (S~edule H) (9) 10. Debts of De.dent, Morlg~e Uabili~es, & Liens (Schedule I) (10) 11. Total DeducBons (Io~1 Lines 9 & 10) 01) 12. Net Value of Estate (Line 8 minus Line 11) (~2) 13. Charitable and Governmental BoquestdSec 9113 Trusts for which an el~ti~ to tax has not been (13) made (S~edule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable al the spousal tax rate, or ffansfers under Sec. 9116~ (a)(12) x.0 .... (15) ~_~ 17, Amc~nl of Uno 14 taxable at s~bling rate ~-~ x .!2 (17) 7' ~ '~ · > BE SURE TO?AN sWE R 'AL,I.~:QOIESTIO N~'Oi~ ' REVE R~ E} ~, DE~AND RECHECK, MATH Decedent's Complete Address: STREET ADDRESS CITY I STATE I ZIP Tax Payments and Credits: Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credi{ B. Prior Payments C. Discount ,~'~'j~ 3. Interesl/Penalty if applicable D. Intaresl E. Penalty (f) / ' Total Credils (A+ B + C ) (2) ,1~ ~t~ ~- Total Intarest/Penally ( O + E ) (3) 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) / .v"9/ '" 5. If Line 1 + Line 3 is greater lhan Line 2, enter the difference, This is the TAX DUE. (SA) A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the preperty transferred; .......................................................................................... [] ~ b. retain the right to designata who shall use the property transferred or ils income; ............................................ [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] ~ contains a beneficiary designation? ........................................................................................................................ [] ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DAI'E '712 Io,q For dates of death on or after July f, 1994 and before January 1, 1995, the lax rate imposed on the net value of transfers lo or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1)(i)]. For da[es of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does nol exemot a transfer Io a surviving spouse frern tax, and the s~alutory requirements for disclosure of assets and filing a tax return are sPll 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 ~om 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 s(epparenl of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax tale imposed on the eel value of transfers to or for ihe use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of Iransfere to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1,3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-9~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER 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 survlvomhlp must be disclosed on Schedule F, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-I$08 EX+ (e-cel ~~ SCHEDULE E COMMO.W~^LTH O, PE.NSYLV^..^ CASH, BANK DEPOSITS, & MISC. I N H~EE~sI ~AEN~CTEDTEA~E~DEET UNT~ N PERSONAL PROPERTY ESTATE Include Ihe proceeds of J~gation and the date the proceeds were received by the es a e. All property Jointly-owned with right of survivorship must he disclosed on Schedule F. FILE NUMBER ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ) TOTAL (Also enter on line 5, Recapitulation) (If more space Is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98~,~ SCHEDULE F COMMON'WEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT - ' was n~a(e Joint within/one year of the decedent s date of death, It must be ~eported on Schedule SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOIN~ MADE ~NCLUDE NAME OF FINANCIAL INSTITUTION AND ~NK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECDS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH GEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST TOTAL (Also enter on line 6, flecapitulation) t ~ q~l.~ (If mom space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99)~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of deceSent must be reported on Schedule I. FiLE NUMBER ITEM NUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Represenlative's Commissions Name o! Personal Representative(s) Social Security Number(a)/EIN Number of Personal Representative(s) Street Address State Zip Year(s) Commission Paid: Allomey Fees Family Exemplion: (If decedent's address is not the same as claimant's, allach explanation) Claimant Street Address City Stats -- Zip Relationship o! Claimanl to Deceden~ Probale Foes Accountant's Foes Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets o[the same size) REV-1512 EX+ (12-03) ~ -~- COMt~ONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FiLE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER iH, IE' DESCRIPTION VALUE AT DATE OF DEATH (1! more space is needed, insert additional sheets of Ihe same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFIND~VlDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV 1162 EX(11 96) NO. CD 004225 MIDDLETON TINA A 11 WALNUT LANE CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 087-20-5542 21ee= . oq- 'qzl EICHHOLZER JOSEPH P FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: 08/03/2004 POSTMARK DATE: 08/03/2004 COUNTY: CUMBERLAND DATE OF DEATH: 00/00/0000 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,581.00 REMARKS: TOTAL AMOUNT PAID: 91,581.00 SEAL CHECK# 1801 INITIALS: JA RECEIVED BY' GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS '04 ~£p 27 ~]0:25 TINA MIDDLETOH 11 NALNUT LN ~'~7~11 CAMP HTLL ZNFORHATZON NOTICE AND TAXPAYER RESPONSE FILE NO. 21 0q-0721 ACN 0q135278 DATE 09-1~-200~ TYPE OF ACCOUNT EST. OF JOSEPH P EICHHOLZER I~SAVZNGS S,S, NO, 087-20-55~Z E]CHECKING DATE OF DEATH 06-15-200q [~TRUST COUNTY CUMBERLAND [--]CERTIF. REHZT PAYHENT AND FORHS TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEHBERS 1ST FEDERAL CREDIT UNN has provided the Department with the information listed balo~ which has bean used in COMPLETE PART i BELON ~ ~ # SEE REVERSE SIDE FOR FILTNG AND PAYMENT INSTRUCTIONS Account No. ZZqSZS- 05 Dot. 12-31-2002 Established Account Balance 7,190.79 Percent Taxable X 50.000 Amount Subject to Tax 3,595,q0 Tax Rate X . O~S Potential Tax Due 161.79 PART TAXPAYER RESPONSE ONE You must COllpleta PART [] and/or PART [] balo~, PART Tf you indicate e different tax rata, please state your ] relationship to decedent: TAX RETURN - COMPUTATTON OF TAX ON JOTNT/TRUST ACCOUNTS LTNE 1. Date Established 1 2. Account Balance 2. $. Percent Taxable 3 X 4. Amount Subject to Tax ~. S. Debts and Deductions S - 6. Amount Taxable 6 7. Tax Rate 7 ]~ 8, Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PATD TOTAL (Enter on L/ne $ of Tax Computation) Under penalties of perjury, Z declare that the facts Z have reported above ere true, correct end ~COllplete to the best of my knowledge and belief. HOME ( /T~PAYER S~HATURE TELEPHONE NUHSER DATE COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 004427 MIDDLETON TINA A 11 WALNUT LANE CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 087-20-5542 FILE NUMBER: 2104-0721 DECEDENT NAME: EICHHOLZER JOSEPH P DATE OF PAYMENT: 09/27/2004 POSTMARK OAT__.._E: 09/27/2004 TY:_ ~ CUMBERLAND OF DEATH: 06/15/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04133278 $161.79 TOTAL AMOUNT PAID: $161.79 REMARKS: SEAL CHECK# 1803 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WELLS BUREAU OF INDTVTDUAL TAXES INHERITANCE TAX DIVISION DEPT. 180601 HARRISBURG, PA 17118-0601 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOT/CE OF INHER/TANCE TAX APPRA/SEMENT, ALLOHANCE OR D/SALLOWANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX RE¥-lSq7 EX AFP (Dl-OS) CUT ALONG THZS LZNE ~ DATE 09-27-200q ESTATE OF EICHHOLZER DATE OF DEATH 06-15-200q FZLE NUMBER 21 0~-0721 COUNTY CUMBERLAND ACN 101 I Aaoun~ Rami~ad JOSEPH MAKE CHECK PAYABLE AND RENZT PAYMENT TO: REGZSTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 RETAZN LOWER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLOWANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF EZCHHOLZER JOSEPH P FZLE NO. 21 0~-0721 ACN 101 DATE 09-27-200~ TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERN/NG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schadula B) $. Closaly Held S~ock/Par~narshAp In~aras~ (Schedule C) ($) q. Mor~gagas/No~as Racaivable (Schedule D) (q) $. Cash/Bank Deposits~Misc. Parsonal Proper~y (Schedula E) (5) 6. Join*ly Owned Propar~y (Schedule F) (6) 7. Transfars (Schadula G) (7) 8. To~al Assa~s APPROVED DEDUCTZONS AND EXEMPTZONS: 9. Funeral Expansas/Ade. Cos~s/Misc. Expanses (Schadula H) (9) 10. Dab,s/Mortgage Liabili~1as/Lians (Schedule Z) (10) 11. To~al Daduc~ions 12. Ne~ Value of Tax Ra~urn 15. lq. Chari~abla/Govarnean~al Baquas*s; Non-alac~ad 9115 Trus*s (Schadula J) Na~ Value of Es~a~e Subjac~ ~o Tax .00 .00 .00 .00 30/000.00 Zq/7qZ.90 .00 (8) 17,7qr+.56 .00 NOTE: To insura proper crad/~ ~o your account, subei~ ~ha upper portion of ~his form wi~h your ~ax payment. 5q,7qZ.90 (11) 17.7~ . ;& (12) 36,998.5q (15) . O0 (1~.) ;56,998.3~ NOTE: Z~: an assessment Nas issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that /nclude the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Aeoun~ of Lina lq a~ Spousal ra~a 16. Aeoun~ of L/no Xfi ~axabla a~ Llnaal/Class A ra~a 17. Aeoun~ of L/nm lfi a~ Sibling ra~a 16. Aeoun~ of Line Xfi ~axabla a~ Colla~araX/CXass B ra~a 19. Principal Tax Due TAX CREDXTS: PAYMENT RECEXPI' DXSCOUNT DATE NUMBER INTEREST/PEN PAZD (-) 08-03-200q CDOOqZZ5 83.21 (xs) .00 x 00 = .00 ('t6) 56,998.$q x 0q5= 1,665.00 (17) . O0 x 12 : . O0 (18) .00 x 15 : .00 (19)= 1,665. O0 AMOUNT PAZD 1,581.00 ZF PAZD AFTER DATE ZND/CATED, SEE REVERSE FOR CALCULATZON OF ADD/TZONAL INTEREST. TOTAL TAX CREDZT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE 1,66q.21 .79 .00 .79 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT" (CR), YOU MAY BE DUE ~-~ A REFUND. SEE REVERSE SZDE OF THZS FORM FOR ZNSTRUCTZONS.) RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, tho Commonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECT[ORS: ADNIN- ISTRATIYE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To ~ulfill the requirements of Section 21¢0 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Hake check or money order payable to: REGISTER OF N/ELS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of the Register of Hills, any of the ZS Revenue District Offices, or by calling the special Z4-haur ansaering service for forms ordering: 1-800-S6Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object aithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZaiOZ1, Harrisburg, PA 171Za-lOZI, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should bm addressed in eriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decadent" (REV-IS01) for an explanation of administratively correctable errors. if any tax due is paid within three (5) calendar months after the decadent's death, a five percent (SI) discount of the tax paid is alloeed. Tho iSZ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period es you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6X) percent per annum calculated et a daily rate of .000164. All taxes ehich became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 arm: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .000548 ~)'~6-1991 iXZ .O00SOX ~ 9Z .O00247 1983 16Z .000438 1992 9Z .000247 2002 62 .000164 1984 ilZ .O00SO1 199S-1994 7Z .O0019Z MOOS 5Z .000137 1985 13Z .000356 1995-1998 9Z .000247 2004 4Z .O00110 1986 IOZ .000274 1999 7X .O0019Z 1987 IOZ .000Z74 2000 ?Z .OO019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAllY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES XNHERXTANCE TAX DTVTSZON DEPT. Inn601 HARRTSBURG, PA 171IS-G601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT. ALLOHANCE OR DZSALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS TINA NIDDLETON'~1 11 WALNUT LN CAMP HILL PA ~7011 DATE 11-08-200¢ ESTATE OF EICHHOLZER JOSEPH DATE OF DEATH 06-15-200¢ FILE NUMBER 21 0¢-0721 COUNTY CUMBERLAND SSN/DC 087-20-55¢2 ACN 0¢155278 Amoun~ HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS DATE 11-08-200¢ ESTATE OF EICHHOLZER JOSEPH P DATE OF DEATH 06-15-200¢ COUNTY CUMBERLAND FILE NO. 21 0¢-0721 S.S/D.C. NO. 087-20-55¢2 ACN 0¢133278 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED dOZNT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FEDERAL CREDIT UNN ACCOUNT NO. 22¢528-05 TYPE OF ACCOUNT: ( ~ SAVINGS ( ) CHECKING C ) TRUST ¢ ) TINE CERTIFICATE DATE ESTABLISHED 12-$1-2002 Accoun~ Balance 7,190.79 Percen~ Taxable X 0.500 Amount Subject to Tax Debts and Deductions - .00 Taxable Amount 3,595.¢0 Tax Rate X .q5 Tax Due 161.79 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYNENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO: ""REGISTER OF WILLS, AGENT."" PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID ¢-) AMOUNT PAID 09-27-200¢ CD00¢¢27 .00 161.79 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 161.79 ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) .00 .00 ,00 PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To ~ulfill the requirements of Section 2160 of the Inheritance and Estate Tax Act, Act 23 oF ZOO0. (7Z P.S. Section 9160). Detach the top portion of this Notice and submit with your payment to the Regis[ar of Nills printed on the reverse side. -- Make chock or money order payable to: REGISTER OF NILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-iS13). Applications are available at tho Office the Rag[star of Nills, any of the Z3 Revenue District Off[cas or by calling the special ZS-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and or speaking needs: 1-800-667-3020 (TT only). Any party in interest not satisf[ed with the appraisement, allowance, or disallomanca of deductions or assessment of tax (including discount or interest) as shown on this Not[ce may object within sixty [60) days of race[pt of this No[ica by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 171Z8-1021, OR --electing to have the matter da[arm[ned at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed tn writing to: PA Department of Revenue, Bureau of IndivJdua! Taxes, ATTN: Post Assessment Rev[aw Un[t, DEPT. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death, a five percent discount of the tax paid [s allowed. The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18j 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable [n the same manner and in the tho same time parted as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest Es charged beginning with first day of delinquency, or nine (9) months and one (1) day from tho date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of sex (6Z) percent per annum calculated at a daily rate of .000166. A11 taxes which became delinquent on or after January 1, 19B2 will bear in[aras[ at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2006 ara: Interest Daily Interest Daily Interest Da[Iy Year Rate Factor Year Rate Factor Year Rate Factor lQB'"~ 20Z .0005~8 1988-1991 llZ .00030X ZOOl 9Z .000Z67 1983 16Z .00063B 199Z 92 .000267 ZOOZ 6Z .000Z19 1986 11Z .000301 1993-1996 7Z .OOOZgZ ZOOS 5Z .000137 1985 132 .000356 1995-1998 92 .000267 200q 62 .000110 1986 lOZ .000276 1999 72 .O00Xgz 1987 9Z .000267 ZOO0 8Z .O00Z19 --Interest Es calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment Es made after the interest computation date shown on the Notice, additional interest must ba calculated.