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Home My WebLink About04-0714 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENI'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Gates, H. Ruth z DA~E OF DEATH (MM-DD-YEAR) DAT~ Of BIRTH (MM-DD-YEAR) .q 11/08/2003 05/30/1925 Ct IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INIT~A L ) ........ ~-'~. ~)ri~r~al ~eturn -- --~' 2. Supplemental Return o~ [] 4. Limited Estate [] 4a'FumrelnterestC°mpmrnise(da~e°fdeathafter 12-12~2) O~ ~~ [] 6~ of Decedentwm) Died Testate (Attach copy [] 7 copyDecedentof Trust)Maintained a Living Trust (Aitach ~ [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit ((~ate of death bet~veen FILE NUMBER z.t o,4 SOCIAL SECURITY NUMBER 175-20-3802 THfS RETURN MUST BE FILED IN DUPUCATE ~ITH THE REGISTER OF WILLS SOCIAL SECURn~ NUMEER ] 3. Remainder Return (date of death pdor to 12-1322) [] 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [] 11.Election to ta.x under Sec. 9113(A) (Attach S~ O) 12-31-91 an(] 1-1-g5) THIS SECTION MUST BE coMPLETED~ AJ.L coRREs~DENcE AND CONFi~ENTi~ TAX iNFORMATiON SHOULD BE DIRECTED T~ COMPLETE MAILING ADDRESS Scott M. Dinner Law Office of Scott M. Dinner 717/761-5800 3117 Chestnut Street Camp Hill, PA 17011 1. Real Estate (Schedule A) (1) Non.e~ 2. Stocks and Bonds (Schedu~ B) (2) 1,546.7~ 3. Clusely Held Co~oration, Partnership or Sole-Proprietorship (3) Non~ 4. Mortgages & Notes Receivable (Schedule D) (4) Non~ 5. Cash, Bank Deqosits & Miscellaneous Personal Property (5) Non~,:: (Schedule E) 6. Jant*y owned Propmy (Schedule F) (6) 13,504. [] Separate Billing Requested 7. Inter-V'rvos Transfers & Miscellaneous Non-Probate Pr(:perty (7) Non~ (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10,371.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (1 O) 11. Total Deductions (total Lines 9 & 10) OFFICIAL USE ONLY I (8) 15,051.1 l (11) 10,371.00 (12) 4,680.11 (13) (14) 4,680.1] 12. Net Value of Estate (Line 8 minus Line 11 ) 13. Charitable and Governmental Bequests/Sen 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 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Ses. 9116(a)(1.2) 16. Amount of Line14 taxable at lineal rate 4,680.ll x .045 (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x ,t5 (18) 19. Tax Due (19) Copyright 2000 form software only The Lackner Group, Inc. 210.60 210.60 Form REV*IS00 EX (Rev. 6-00) 'Decedent's Complete Address: STREET ADDRESS 5500 H. Gloucester Street Mechanicsburg PA / 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount (1) Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. IfLine2isgreaterthenLinel+Line3, enter the difference. ThisistheOVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 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) El. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 210.60 0.00 0.00 210.60 210.60 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. ratain the use er incame of the property transferred; ..................................................................................... b. retain the fight to designate who shall use the property transferred or its income; ......................................... c. retain a reversionary interest; or ..................................................................................................................... r-'l 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' er payable upon death bank account or security at his or her death? ............... [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which centalns a beneficiary designaden? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. SIG~IA~ R E OF' PERSON RESPONSIB~JL~FOR FILING RE'tURN ADDRESS ADDRESS ADDRESS 31 ] 7 Chestnut Sh'eet DATE Camp Hill, PA 17011 JUL 2 0 For dates of death on er after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jenua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the su~ving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute dces net ex~mpt a transfer to a surMving spouse from tax, and the statutory requirements fer disclesure of essets and filing a tax return are still applicable even if the sumfving 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, er a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except es noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rae imposed on the net value of transfers to er 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 indMdual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE B STOCKS & BONDS ESTATE OF ! FILE NUMBER Gates, H. Ruth All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 50 shares MetLife DESCRIPTION 30.935 TOTAL (Also enter on line 2, Recapitulation) VALUE AT DATE UNIT VALUE OF DEATH 1,546.75 1,546.75 COMMONWEALTH OF PENNSYLVANIA INHERFFANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Gates, H. Ruth If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A James E. Gates B Richard L. Gates C Lorraine M. Gates 3603 Bonnyview Road Harrisburg, PA 17109 2020 Lincoln Street Camp Hill, PA 17011 283 Plainfield Road Edison, NJ 08820 Son Son Daughter JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY iTEM LETTER DATE DATE OF DEATH NUMBER -'OR JOINT MADE Include name of financial institution and bank account number or TENANT JOINT similar identifying number. Attach deed for jointly-h~d real eatate VALUE OF ASSET I A, B, C 10/1999 10,279.94 A,B,C A,B,C A A 10/1999 10/1999 07/30/1985 07/30/1985 1166.849 shs. - State Street Research Investment Trust CIA acct. # 574/4234260 2700.481 shs, - State Street Research Asset Allocation Fund CIA acct. # 528/5280090105 761.799 shs. - State Street Research Gov't. Income Fund CIA acct. # 531/5260231647 PSECU checking acct.# 0 t 75203802 [see attached information notice] PSECU savings acct.# 0175203802 [see attached information notice] 26,752.77 9,579.62 3,200.82 501.71 DATE OF DEATH VALUE OF DECEDENT'S iNTEREST 2,569.99 6,688.19 2,394.91 50% 1,600.41 50% 250.86 TOTAL (Also enter on line 6, Recapitulation) 13,504.36 SCHEt3ULE H FUNERAL ~ & ADI~ISTRATNE COSTS ESTATE OF FILE NUMBER Gates, H. Ruth Debts of decedent must be reported on Schedule I. ~TEM NUMBER DESCRIPTION AMOUNT 2 FUNERAL EXPENSES: C. Frederick Bowser Funeral Home, Inc. honorarium to clergyman, household expenses for food and refreshments during funeral period and rental of house of worship ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Pemonal Reprasentative(s): Street Address City State __ Zip Year(s) Commission paid Attorney's Fees Scott M. Dinner, Esquire Family Exemption: (if decede~t's address is not the same as claimant's, attach explanation) Claimant Stre~ Address City Relationship of Claimant to Decedent Probate Fees State __ Zip Accountant's Fees Tax Retum Preparer's Fees Other Administrative Cuts 8,521.00 500.00 1,350.00 TOTAL (Also enter on line 9, Recapitulation) 10,371.00 STATE STREET RESEARCH INVESTMENT SERVICES December 12, 2003 JAMES E GATES RICHARD M GATES LORRAINE M GATES 208 SENATE AVE APT 311 CAMP HILL PA 17011-2342 REFERENCE: 01961002 INVESTMENT TRUST-CLASS A ACCOUNT NUMBER 00004234260-3 H RUTH GATES, JAMES E GATES, RICHARD M GATES & LORRAINE M GATES JT TEN Dear Shareowners: I am writing as requested, to provide the following information concerning the above referenced account as of the close of business on the following dates (November 8 was a weekend): November7,2003 Account# # of Shares Net Asset Value Dollar Value 574/4234260 1,166.849 $8.85 $10,326.61 528/5280090105 2,700.481 $9.95 $26,869.79 531/5260231647 761.799 $12.58 $9,583.43 November 10, 2003 Account # # of Shares Net Asset Value Dollar Value 574/4234260 1,166.849 $8.77 $10,233.27 528/5280090105 2,700.461 $9.67 $26,635.75 531/5260231647 761.799 $12.57 $9,575.81 You may contact an Investor Service Representative at 1-87-SSR-FUNDS(1-877-773_ 8637) or by e-mail at INFO@SSRFUNDS.COM with questions or concerns. Our representatives are available Monday through Friday 8:00am-6:00pm EST and would be happy to assist you. Please use fund/account number 531/5260231647 when contacting our office. P.O. Box 8408 BOSTON, MA 02266-8408 PHONE: 1-87-SSR-FUNDS ( 1-877-773-86371 · E-MAIL ADDRESS: INFO@SSRFUNDS.COM Thank you for investing with State Street Research. Sincerely, Cornelie S. Dikland Investor Communications COflHUNNEALTR OF PENNSYLVANIA DEPARTNERT OF REVENUE BUREAU OF [RDZ¥ZBUAL TAXES DEPT. 28060! JAMES E GATES 5605 BONNYVIEH RD HBG PA 17109-4806 ZNFORNATZON NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ACN 0~105950 DATE 02-06-2004 TYPE OF ACCOUNT EST. OF H R GATES [~'IsAvZNGS S.S. NO. 175-20-5802 E~CHEC~ING DATE OF DEATH 11-08-2005 []TRUST COUNTY CUMBERLAND F~CERTZF. REHZT PAYHENT AND FORHS TO: REGISTER OF HILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 CONPLETE PART ! BELOH ~ ~ ~ SEE REVERSE SXDE FOR FXLING AND PAYMENT INSTRUCTIONS Account No. 0175205802 Bate 07-50-1985 Established Account Balance 501.71 Percent Taxable X 50 · 000 Amount Subject to Tax 250 · 86 Tax Rate X · 045 Potential Tax Due 11 PART TAXPAYER RESPONSE [~ I r'" r '~' rr 'r~:: ::- ,:e ,-:~.,-*.,~r .rr ;,.,...,~ ~..:r-.a: ::; ~ '::'=p: '~i[~ 'i~:'r; '~i;~rr:~' F'?~[i*i]i'"r i.','i]~[' '!p'~r ','rS?','~r!'rt;r:' '!~ii~'H'r:' 'iiF'~ F'~" ~"ei~i~" !V,5! A. I'-] The above in(ormetJon and tax due is correct, - CHECK ~ Ri:Us and an official assessment ~[11 be issued by the PA Eepartment o~< Revenue. ONE You must complete PART [] and/or PART [] beZow. PART Tf you tndicate a different ~ax rate/ please stance your ] relationship to decadent: TAX RETURN - COMPUTATION OF LINE 1. Da~e EstabZished 2. Account Balance 2. $. Percent TaxabZa q. Amount Sub~ect to Tax 5. Debts and Oeductions 5. 6. Amount Taxable 6 7. Tax Rate 7 8, Tax Due 8 PART DATE PAID TAX ON JOINT/TRUST ACCOUNTS DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line E of Tax Computer/on) Under penal~:[es of parjury~ ! declare that the facts T have raperS:ed above are ~ru~ oorreo~: and WORK C7/~ ) Z~Z' ~ OOHRONREALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE JAMES E SATES 3605 BONNYVIEW RD HBS PA 17109-q806 ZNFORMATZONAND NOTICE I TAXPAYER RESPONSE ACN DATE FILE NO. Z! OqlO39q9 OZ-O6-ZOOq TYPE OF ACCOUNT EST. OF H R GATES []SAV/NGS S.S. NO. i75-20-3802 []CHECKING DATE OF DEATH 11-08-2003 []TRUST COUNTY CUMBERLAND ~]CERT~F. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 COMPLETE PART I BELOW K K ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0175203802 Date 07-30-1985 Established Account Balance 3,200.82 Percent Taxable X 50.000 Aeoun~ Subjec~ to Tax 1,600.~1 Tax Rate X .Oq5 Potential Tax Due 72.02 PART TAXPAYER RESPONSE [ONE] 'ills and an official assessment will be issued by the pA Department o~ R.v.nue. ONLY ' , YoU must complete PART [] and/er PART [] below. PART Tf you ~nd~ca~e a dlfferen~ tax rata~ please state your ] relationship ~o decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percen~ Taxable 3 ~ q. Amount SubJec~ ~o Tax q 5. Deb~s and Deductions S 6. Amount Taxable 6 7. Tax Rata 7 ~ 8, T~x Duo 8 PART DATE PAID PAYEE AND DEDUCTTONS CLAZM£1~ DESCRIPTION AMOUNT PAID TOTAL (Enter on Line ~ of Tax Computation) Under penalties of perSury~ I declare ~hat ~he facts T have reported above ore, rue, correc~ and complete to ~he blat of my knowledge and hal:tel. HOME ....................... 7,. 77 ' . ~, HELEN RUTH GATES ,of the Borough of Homer City, County of Indiana and State of Pennsylvania berg of sound mind, memo~ and understanding, do make and publish this my ~t Will and Testament. hereby revok~g and making void all former Wills by me at any t~e heretofore made. FIRST I direct that all my just debts and funeral expenses be paid as soon as conveniently may be after my decease. SECOND I give, devise and bequeath all of my property, real, personal or mixed, wheresoever situate which I may own or have the right to dispose of at the time of my death to my children, James E. Gates, Richard L. Gates and Lorraine M. Gates, in equal shares. THIRD I hereby nominate, constitute and appoint my children, James E. Gates, Richard L. Gates and Lorraine M. Gates, as the executors of this my last Will and Testament. ~n ~i£n~s ~trtof, ], Helen Ruth Gates the Testat rix above, ~amed, have here~nto s'~d~scribed m?/ uame and affixed my seal, the 29th day of August in the year of o~r Lo?'d o~e thousand nine hundred eighty-three. ~ ..... ~ ~:~v_~_._..~. ~,_]~!.,.~ ............. Helen Ruth Gates Signed, sealed, published and declared by the above named Helen Ruth Gates as and for her last Will and Testame~t, in the presence of us, who have hereant~ subscribed oar names at her request os witnesses thereto in the presence of the saidTe,~t~~ ~~ ~...zx. f eae ~ther ACKNOWLEDGMENT COMMONWEALTH OF P~NNSYLVANIA '~ COUNTY OF Indiana I, Helen Ruth Gates , testatrix , whose n~e is signed to the at~ched or foregoing i~trument, having been duly qualified acceding to law, do hereby k~wledge that I signed a~ executed the i~tr~ment ~ my l~t Will; that I signed it willingly; a~ t~t 1 signed it ~ my free and voluntary act for the pu~oses thereiv expressed. S~rn or a~ed to and acknowledged before me, by Helen Ruth Gates t~ testat rix , this 29th day of ~ August , 19 83. ' Helen Ruth Gates // ~/P nt ~1~ UOROUGH. INDIANA COUNIY ~I~I7I~ ~ ....... ' ~O~MISS[ON EXPIRES MAR. 5, ]984 COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~nd~ana We, Edwin ~. C~ark, Jo., Charlotte Yaka~ and Suzanne C. Greene, the witnesses w~se names are sig~ed to the attached or foregoing i~trument, bei~g d~dy quali- fi~ ~rding ~o ~w, ~ depose and say that we were present a~d saw testat ~x sig~ execute the i~t~ment ~ h'~ Last W~l; that she sig~ed willingly a~d that she executed it ~ her free a~d volunta~ act for the pu~oses therei~ expressed; t~t each of us in the hearing and sig~ of the testatrix signed ~he will ~ witnesses; and that to the best of our knowledge the testat rix w~ at that time 1~ or more years of age, of sound mind and ~der no constraint or '~e i~- fl~e. Swo~ or a~rmed to and subscribed to bef~re me by Edwin M. Clark, Jr. , Charlotte Yakal a~ Suzanne C. Greene , witnesses, th~ 29th ~y of ...... Witness ........... "~"'"""'"'"'-~ ....... (SEAL) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 004217 DINNER SCOTT M ESQ 3117 CHESTNUT STREET CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 175-20-3802 FILE NUMBER: 2104-0714 DECEDENT NAME: GATES H RUTH DATE OF PAYMENT: 08/02/2004 POSTMARK DATE: 08/02/2004 COUNTY: CUMBERLAND DATE OF DEATH: 11/08/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $210.60 TOTAL AMOUNT PAID: 8210.60 REMARKS: SEAL CHECK# 1248 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES TNHERITANCE TAX DTVTSION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ~ ..... DATE 09-27-2004 o~ ESTATE OF GATES ~- DATE OF DEATH 11-08-2005 J FILE NUMBER 21 04-0714 c~ COUNTY CUMBER LAND SCOTT M DINt~ER ACN 101 51.17 CHESTSUJT ST .:-i I Amoun~ Rem/~ed CAHP HILL ~ *:~ 17011 I r~ REV-1547 EX AFP C01-05) HELEN R HAKE CHECK PAYABLE AND REMZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 CUT ALONG THIS LINE ~ RETAIN LOWER PORTZON FOR YOUR RECORDS ~ REV-15&7 EX AFP C01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GATES HELEN R FILE NO. 21 04-0714 ACM 101 DATE 09-27-2004 TAX RETURN NAS: (X} ACCEPTED AS F/LED ( ) CHANGED RESERVATZON CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B} {2} $. Closely Held S~ock/Par~nership /n~eres~ (Schedule C) (S) ~. Hor~gages/No~es Receivable (Schedule D) (~) $. Cash/Bank Deposi~s/Hisc. Personal Proper~y (Schedule E) 6. Jo/n~ly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8, To,al Asse~s APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/H/sc. Expenses (Schedule H) (9) 10. Dab~s/Nor~gage Liabilities/Liens (Schedule 1) (10) 11. To,al Deduc~/ons 12. Ne~ Value of Tax Ra~urn 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) Ne~ Value of Es~a~e Subjec~ ~o Tax lz546.75 .00 .00 NOTE: To /nsure proper cred/~ ~o your account, subm/~ ~he upper portion .00 of ~h/s form w/~h your .00 ~ax payment. (8) 10,571.00 .00 (11) 11] .371.00 (12) 4,680.11 (13) . O0 (~) 4,680.11 NOTE ASSESSMENT OF TAX: 15. Amoun~ of L/ne 1~ a~ Spousal ra~e 16. Amoun~ of L/ne 1~ ~axable a~ Lineal~Class A ra~a 17. Amoun~ of L/ne lfi a* Sibling ra~e 18. Amoun~ of L/ne lq ~exable a~ Collateral/Class B ra~a 19. Principal Tax Due TAX CREDITS: PAYHENT RECEZPT DZSCOUNT (+) DATE NUHBER ~NTEREST/PEN PA~D (-) 08-02-2004 CD004217 .00 {15), . O0 X (16) 4,680.11 x (17) . O0 x (18) . O0 x AHOUNT PAID Zf an assess, ent Nas issued prevlously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. O0 = .00 045 = 210.60 12 = .00 15 : .00 (19)= 210.60 210.60 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADD/TZONAL INTEREST. 15,051.11 18 and 19 Nill TOTAL TAX CREDIT I 210.60 BALANCE OF TAX DUEl .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( ZF TOTAL DUE IS LESS THAN $1, NO PAYflENT 1S REBUZRED. ZF TOTAL DUE IS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF THIS FORH FOR INSTRUCT/OHS.) 13z504.$6 .00 RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, tho Cammon,ealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the Zawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NZLLS~ 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-1215). Applications ara available at the Office of the Register of Hills, any of the 22 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-26Z-2050~ services for taxpayers with special hearing and / or speaking needsc 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 within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBlOZ1, Harrisburg, PA 17128-10ZIj OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-150I) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after tho decedant's death, a five percent (SI) discount of the tax paid is allowed. The 15X 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 appaaIabla in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of daath~ to the date of payment. Taxes which became delinquent before January 1, 19BZ bear interest at the rate of six (6X) percent par annum calculated at a daily rate of .000164. All taxes which 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 IgBz through 2004 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 20X .000548 ~7'~'8-X991 Ill .O0020l ~ 9Z .000247 1982 16Z .000438 1992 9Z .000247 2002 6Z .000164 1984 Ill .000201 1993-1994 7Z .00019Z 2002 5Z .000137 1985 12Z .000356 1995-1998 9Z .000247 ZOO4 4~ .000110 1986 lOZ .000Z74 1999 7Z .O0019Z 1987 lOZ .000274 2000 7Z .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUtIBBR OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after thm tax becomes delinquent will reflect an interest calculation to fifteen (1S) days beyond the date of tho assessment. If payment is made after the interest computation date shown on the Notice, additional Interest must be calculated.