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HomeMy WebLinkAbout03-0202 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION also known as To: Register of Wills for the Deceased. County of Cc~,n< t~ E-~(_a~c~ in the Social Security No. 1 c~ ._ i Cb '-7 c] ~(~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, app[ for letters of administration (d.b.n.; pendente lite; durante absentia; durante minoritate) on the estate of the above decedent. Decendent was domiciled at death in C ~ ~ ~ ~ C~ County, Penns· Ivania with hE~ last f~ily or principal residence at ~2 ~LLEy U~C~ D~ ~'~iC~ b~ ~ ~ (list street, number and municipality) ~ ~ ~ ~ ~ Decendent, then ye~s of age, died ~ C~ ~ ~ ~ , ~ ZO03, Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $ ~O C~O '~ (If not domiciled in Pa.) Personal property in Pennsylvania $. (If not dOmiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: ~ ~ ~ Petitioner after a proper search ha .5 ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship Residence THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF 0..~r'r~:~ e~la ~r~ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~[~ ~ ~ ~'~ before me this ~A-~ day of - ' ' ~.~~ister [ ~ No. Es~te of ~~ ~ ~ ~ ~ , Deceased GRANT OF LETTERS OF ADMINIST~TION AND NOW ~(~L~"C~'~ ---I i ;~ OO~ ~ , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to ~--~ CC'x ~_~c~-~--~_<~ in the estate of ~O.3~ FEES Letters of Administration ..... $ Short Certificates( ) .......... $~ ^TTO~NE¥ (Sup. Ct. LD. No.) Renunciation ................ $ TOTAL ~ $ ~-ff--~])--~-- ^DDRESS Filed .~.~.-/--.-.Q~ ....... A.D. 19 - · PHONE RENUNCIATION In Re Estate of m I~y ~'LI~C.~I~EI~ (~CCLC~I~) ~lL~,l/Vl~lgx deceased. To the Register of Wills of 0_~ LkVVx (~ ~ ~ ~o-4& CL County, Pennsylvania. the above d~edent, hereby renounce(s) the dght to admiffister the estate and resp~tfully ~k(s) that Letters '. this lOth da (Address) (Silaatur~) (Address) (Signature) (Addr~s) This is to certify that the infbrmation here given is correctly copied rS'om an original certificate Local Registrar. The original certificate will be. £or,varded to thc 5tare Vital Records Ofl~cc WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this ccrtificate, $2.00 ::,~ ~s~,,'; JAN 6 2003 No. ~ [)ate m~.:~ ~,. z,a? COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS ~"~ CERTIFICATE OF DEATH ~ ~.., ~Po~8 ~. ~;,~ ~~~,, ~ ~ ,~ ~ ,o I' '-- --~ . .. COHtlONNEALTH OF PENNSYLVANTA ~ QEPARTMENT OF REVENUE ZNFORMATZON NOTZCE t~UREAU OF~ INDTVZDUAL TAXES FILE NO. DEPT. ZBOeO1 ~' AND HARRISBURG, PA 171Z8-0601 TAXPAYER RESPONSE ACN 05114494 ,EV-~. EX AE~ ~.-O0~ DATE 04-10-2005 Recor:}~Q C~:-ii~;~ et TYPE OF ACCOUNT Re©i--:te? ,.:',f %,ilts EST. OF NARY E HUMER [] SAVINGS S.S. NO. 18~10-9456 [] CHECKING DATE OF DEATH 01-04-~005 [] TRUST '03 HAY 12 P4 .'01 COUNTY CUMBERLAND [] CERTIF. REHIT PAYHENT AND FORHS TO: ANN M GATES REGISTER OF MILLS 642 VALLEY Vl'Et(~k-~::: : ::.-_:O,~Ft CUMBERLAND CO COURT HOUSE BOILING SPGS CU~C]f~'~I~ ~.:o,, PA CARLISLE, PA 1701:5 HEHBERS 1ST FCU has provided the Department mith the information listed beloe mhich has been used in calculating ~e potential tax due. Their records indicate that at the death o~ the above decedent, you were a joint owner/beneficiary o~ ~is account. ~; you ~ael ~Js information is incorrect, please obtain arittan correction ;roe the ;inancial institution, attach a copy to this ~ore and return it to the above address. This account is taxable in accordance eith the Inheritance Tax La~s a~ the Coaeoneaalth of Pennsylvania. Questions may be ansmered by calling (717) 787-83?7. COMPLETE PART ! 8ELON x x # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Accoun~ No. 40267-00 Da~e 07-05-1984 To insure proper credit to your account, Established (z) capias o~ this notice must accompany your payment to the Register o~ Wills. Make check Accoun~ Balance 84~.Z5 payable to: "Register of Nills, Agent". Percen~ Taxable X 50.000 NOTE: Z; tax payments ara mode within three Aaoun* SubSec~ *o Tax 420.65 (5) months of the dacedent's date of dea~, Tax Ra~e X .045 you may deduct a 5Z di~aunt of the tax due. Any inheritance tax due will become delinquent Po~en~ial Tax Due 18.9~ nine (9) eonths after the date of death. PART TAXPAYER RESPONSE A. ~Tha above information and tax due is correct. 1. You may choose to reeJt payment to the Register of Nills aith tee copies af this notice to obtain  CHECK -~ a dlscount or avoid interest, or you may check box "A" and return this notice to the Registbr of ONE #ills and an official assessment ail1 be issued by the PA Department of Revenue. BLOCK ~ B. ~The above asset has been ar e]11 be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's representative. C. ~Tha above information is incorrect and/or debts and deductions mere paid by you. You must complete PART ~ end/or PART ®belom. PART Zf you indicate a differen~ ~ax ra~e~ please s~a~e your relationship ~o decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Da~e Established 1 2. Accoun~ Balance 2 3. Percen~ Taxable 3 ~. Amoun~ Sub~ec* ~o Tax E. Debts and Deductions $ - 6. Amoun~ Taxable 6 7. Tax Ra~e 7 8. Tax Due 8 PART DE~TS AND DEDUCTIONS CLAZNEa DATE PAID PAYEE DESCRIPTION AHOUNT PAID I TOTAL (Enter on Line $ of Tax C~e~u~a~ion) Under penalties of perjury, I declare ~ha~ ~he fac~s I have reported above ara ~rue, correc~ and complete ~o ~he bes~ of my knowledge and belief. HOME C ) ~~ER S ~1~ EqO~J NORK ( ) TA IGNATUR GENERAL INFORHATION 1. FAILURE TO RESPOND NZLL RESULT ~N AN OFFICIAL TAX ASSESSNENT aith 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 beteeen 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 betaaan husband and aife 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 I - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed) place an in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit thee with your check for the amount of tax ta the Register of Nills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1S4B EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified an this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decadent's representative) place an "X" in block "B" of Part i 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 Z and 3 according to the instructions below. Sign two copies and submit thee 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-154B EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COHPUTAT[ON LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/ii/aZ: Accounts which the decedent put in joint names aithin one (1) year of death are taxable fully as transfers. Hoaever) there is an exclusion net to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (MN) appears before your first name in the address portion of this notice) the s3,a0o exclusion already has been deducted fram the account balance as reported by the financial institution. Z. Enter the total balance of tho account including interest accrued to the date af death. 3. The percent of the account that is taxable for each survivor is determined as follaes: A. Tho percent taxable for joint assets established more than one year prior to the dacedent's death: 1 DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER 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. I DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable far assets created within one year of the decedent's death or accounts owned by the decedent but held Jn trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within cna year of death by the decedent. ! DIVIDED BY Z (SURVIVORS) = .50 X lO0 = SOZ (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by muItiplying the account balance (line Z) by the percent taxable (line 3). S. 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) free the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined below. Data of Death Spouse LinaaZ Sibling Collateral 07/01/9fi to 12/$1/94 SX 6X 15Z 01/01/95 to 06/50/00 OX 6Z 15X 15X 07/01/00 to present OX 4.$Xx 12Z 15Z xThe tax rata imposed an the net value of trot;f;-- . ...... ~ -,;,d ~.o.~y .... years h; ;fie nr younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OX. The Linea! class of heirs includes grandparents, parents, children) and linea! 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" ara defined as individuals who have at least one parent in common aith the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIHED DEDUCTIONS - PART $ DEBTS AND DEDUCTIONS CLAIHED A11oaable debts and deductions are determined as folloas: A. You legally ara 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 I/Z" x ll". Proof of payment may be requested by the PA Department of Revenue. CONHONHEALTH OF PENNSYLVANIA ~ _ DEPARTHENT OF REVENUE BUREAU OF TNDTVTDUAL TAXES ZNPORMATZON NOTZCE FILE NO gZ '°~)~' ~ DEPT. 280601 AND ' NARRISBURC, PA l?lZa-O6Ol TAXPAYER RESPONSE ACN 0511qq79 REV~i$~iS EX AFP (09-00) DATE 0q-10-2005 Recoi~J-~'i:" :~,~ C'[ TYPE OF ACCOUNT Reg[st.-?~. ,~ ~"~:"-,:.. u:~ EST. OF HARY E HUMER [] SAVZNOS S.S. ~0. 18~-10-9~56 [] CHECKING DATE OF DEATH 01-0q-2005 [] TRUST '03 12 P4:0qOUNTY CUMBERLAND [] CERT'rF. REHTT PAYHENT AND FORHS TO: ANN M GATES REGISTER OF HILLS 6~Z VALLEY VTEN DR (,:,t~ k-.~ -: ~ ~._..:~,L~i'~ CUHBERLAND C0 COURT HOUSE BOILING SPGS PA 17ooTc,Almberla~d ~.:o.. PA CARLISLE, PA 1701:3 HEHBERS 1ST FCU has provided the Depar[ment 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 aarp a joint caner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial instJtution~ attach a copy to this fora and return it to the above address. This account is taxable in accordance ~ith the Inheritance Tax La~s of the Commonwealth of Pennsylvania. Questions may be ans~ared by calling f717) 787-8327. COHPLETE PART 1 ~ELOH x # x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Accoun~ No. ~0267-11 Da~e 07-05-198q To insure proper credit to your account, tee Established (2) copies of this notice must accompany your Accoun~ Balance 9:39.7~ payment to the Register of Rills. Hake check payable to: "Register of #ills~ Agent". Percen~ Taxable X 50. 000 Amoun~ SubSec~ ~o Tax q69,87 NOTE: Zf tax payments ara made aithin three (3) months of the decadent's date of death, Tax Ra~e X .0~ you may deduct a SZ discount of the tax due. Any inheritance tax due ailZ become delinquent Pedantic! Tax Due ZI.I~ nine (g) months after the date of death. PART TAXPAYER RESPONSE A. ~The abeva inforletion end tax dua is corract. 1. You lay choose to relit payment to the Register of Hills Nith tva copies of this notice to obtain  CHECK q a discount or avoid interest, or you may check box ONE Rills and an official assessment will be issued by the PA Department of Revenue. BLOCK J B. [] The above asset has been or vii1 be reported and tax paid Pith the Pennsylvania Inheritance Tax return ONLY to be filed by the decmdent's representative. C. []The above information is incorrect and/or debts and deductions mere paid by you. You must complete PART ~ and/ar PART ~ belcH. PART ~f you indicate a differen~ ~ex re~e~ please s~a~e your relationship ~o decedent: TAX RETURN - COMPUTATION OF TAX ON JOiNT/TRUST ACCOUNTS LINE 1. Da~e Established 1 2. Accoun~ Balance 2 3. Percen~ Taxable $. q. Amoun~ Subjec~ ~o Tax 5. Debts and Deductions 5 - 6. Aeoun~ Taxable 6 7. Tax Ra~e 7 8. Tax Due 8 PART DE~TS AND DEDUCTIONS CLAZME9 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) $ Under penalties of p~rjury~ ~ declare ~he~ ~he feces ~ have reported above ar~ ~ue~ correc~ and comple~e/~ ~o ~he bes~ of my knowledge and belief. HOME ( ) GENERAL INFORMATION 1. FA/LURE TO RESPOND #/LL RESULT ZN AN OFFZC/AL TAX ASSESSHENT 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 [n joint names mithin one year prior to death ara fully taxable as transfers. 5. Accounts established jointly bet#men 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 I - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the not[ce are correct and deductions are not being claimed, place an in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Nilis of the county indicated. The PA Department of Revenue miL! issue an official assessment (Form REV-1548 EX] upon receipt of the return from the Register of Hills. Z. BLOCK B - If the asset specified on this notice has been or will ba reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decadant's representative, place an "X" in block "B" of Part i of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dspt 180601, Harrisburg, PA 171Z8-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts Z end according to the instructions below. Sign tad copies and submit them with your check for the amount of tax payable to the Register of Nills of the county indicated. The PA Department of Revenue aJ11 issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART Z TAX COHPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/BI: Accounts which the decedent put in joint names within one (1) year of death ars taxable fully as transfers. Homevar, 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 doubIa asterisk (ia) appears before your first name in the address portion of this notice, the $3,000 exclusion aIraady 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 folloes: A. The percent taxable for joint assets established more than one year prior to the decedsnt's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT D#NERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT O#NERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.?Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedant's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT K 100 = PERCENT TAXABLE O#NERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. I DIVIDED BY Z (SURVIVORS) = .50 X lO0 = 301 (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 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 S) from the amount subject to tax (line 7. Enter the appropriate tax rata (line 7) as determined below. Oe~e of Oee~h Spouse LineaZ Sibl/ng CoZla~eral 07/01/9q ~o 12/31/9q 3X 6X 15Z 15X 01/01/95 ~o 06/30/00 OX 6Z 15Z 07/01/00 ~o presen~ OX q.EXx 12Z ~Tha tax rata imposed an th~ nat value of transfers from a d ...... a *kale ~=n~y-nna ~a~r~ n; aaa ar younger at death to or for the usa of a natural parent, an adoptive parant~ or a stepparant of the child is OZ. The lineal class of hairs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have bean 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" ara defined as individuals who have at [east one parent in common with the decedent, mhether by blood or adoption. Tho "Collateral" class of heirs includes ali other beneficiaries. CLAIMED DEDUCTIONS - PART 5 - DEBTS AND DEDUCTIONS CLAIMED Allomable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a persona[ representative [s insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent end can furnish proof of payment. C. Debts being claimed must ba itemized fuIly in Part 3. If additional space is needed, use pIain paper B 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EX(11-96) BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002558 GATES ANN M 642 VALLEY VIEW DR BOILING SPRINGS, PA 17007 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 03114479 $21.14 ESTATE INFORMATION: SSN: 180-10-9456 FILE NUMBER: 2103-0202 DECEDENT NAME: HUMER MARY E DATE OF PAYMENT: 05/12/2003 POSTMARK DATE: 05/10/2003 COUNTY: CUMBERLAND DATE OF DEATH: 01/04/2003 TOTAL AMOUNT PAID' $21.14 REMARKS: CHECK# 20O9 INITIALS: CW SEAL RECEIVED BY' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EX(11-96) BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002559 GATES ANN M 642 VALLEY VIEW DR BOILING SPRINGS, PA 17007 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 03114494 $18.93 ESTATE INFORMATION: SSN: 180-10-9456 FILE NUMBER: 2103-0202 DECEDENT NAME: HUMER MARY E DATE OF PAYMENT: 05/12/2003 POSTMARK DATE: 05/10/2003 COUNTY: CUMBERLAND DATE OF DEATH: 01/04/2003 TOTAL AMOUNT PAID: $18.93 REMARKS: CHECK# 2010 INITIALS: CW SEAL RECEIVED BY.' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Will No. Admin. No. ~ C)C9 ~_~'--~.bC3~-~ ~) ~ To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on · Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Signature mam Address & ~ ~~ V~ Capacity: Personal Representative Counsel for personal representative 1/~- /~ ~ _ ,~- CONNONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTNENT OF REVENUE ZNHERZTANCE TAX DEPT. 28060! HARRZSBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAZSENENT. ALLONANCE OR DZSALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS · ~ DATE 07-21-2005 ESTATE OF HUHER HARY E DATE OF DEATH 01-04-2005 FILE NUNBER 21 05-020Z ~.~ COUNTY CUHBERLAND '03 ,JUL 21 /-~a :0~ SSN/DC 180-10-9456 ANN H GATES ACN 05114479 642 VALLEY VIEW DR HAKE CHECK PAYABLE AND RENIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-21-2005 ESTATE OF HUHER HARY E DATE OF DEATH 01-04-2005 COUNTY CUHBERLAND FILE NO. Z10$-OZOZ S.S/D.C. NO. 180-10-9456 ACN 05114479 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED dOZNT OR TRUST ASSET ZNFORNATZON FINANCIAL INSTITUTION: HEHBERS 1ST FCU ACCOUNT NO. 40267-11 TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIHE CERTIFICATE DATE ESTABLISHED 07-05-1984 Account Balance 959.74 NOTE: TO INSURE PROPER CREDIT TO Percent TaxabZe X 0.500 YOUR ACCOUNT, SUBHTT THE Amount Subject to Tax 469.87 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYHENT TO THE Taxable Amount 469.87 REGISTER OF WILLS AT THE Tax Rate X .45 ABOVE ADDRESS. HAKE CHECK Tax Due 21.14 OR HONEY ORDER PAYABLE TO: **REGIfiTER OF WILLS, AGENT.** TAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID 05-10-200:5 CD002558 . O0 Z1.14 TOTAL TAX CREDIT [ 21.14 BALANCE OF TAX DUEI .00 INTEREST AND PEN. [ .00 TOTAL DUE [ .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE ZS LESS THAN $1, NO PAYHENT IS REQUIRED. XF TOTAL DUE XS REFLECTED AS A '*CREDXT"(CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 9140). PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Nake check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of · tax credit, ahich ems not requested on the tax return, amy be requested by completing an "Application for Refund of Pennsylvania Tnherttance and Estate Tax" (REV-IS15). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices or by calling the special Z4-hour ans~ering service for forms ordering: 1-800-362-Z050; services for taxpayers with special hearing and or speaking needs: 1-800-447-$020 (TT only). ODJECTZONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessaent of tax (including discount or interest) as shown on this Notice may object aithin sixty (60} days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the setter determined et the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADNIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Departeant of Revenue, Bureau of Individual Taxes, ATTN: Pest Assessment Review Unit, DEPT. ZB0601, Harrisburg, PA 17128-0601 Phone (7173 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for e Resident Decedent" (REV-1501) ~or an explanation of adeinistratively correctable errors. DISCOUNT: If any tax due is paid aithin three (5) calendar months after the decedent's death, a five percent discount of the tax paid is alloaed. PENALTY: The 152 tax amnesty non-participation penalty is computed on the tatar 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 tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Tnterest 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, 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on or after January 1, 1982 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 1982 through Z003 are: Interest Daily Znterest Daily Znterest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOX .000548 1987 92 .000247 1999 72 .000192 1983 16Z .000438 1988-1991 IZZ .000301 ZOO0 8Z .000219 1984 112 .000301 1992 92 .000247 ZOOX 92 .000247 1985 132 .000356 1993-1994 7;( .000192 2002 62 .000164 1986 lOX .000274 1995-1998 92 .000247 2003 52 .000137 --Znterest is calculated es folloas: 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 is made after the interest computation date shown on the Notice, additional interest must be calculated. CONMONgEALTH OF PENNSYLVANIA ~ BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAXSEHENT. ALLONANCE OR DXSALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-IS~SEXAFPCO~-OS) ;.~..,., .~ DATE 07-Z1-2003 ~-~, . ESTATE OF HUMER MARY E DATE OF DEATH 01-04-2003 FILE NUMBER 21 03-0202 COUNTY CUHBERLAND ANN M GATES '03 JUL 21 /~8:04 SSN/DC 180-10-9456 ACN 03114494 642 VALLEY VIEg DR BOILING SPGS PAL~07 Amoun~ Remi~ed MAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF gILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS REV-X548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOgANCE OR DZSALLOgANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-21-2003 ESTATE OF HUMER MARY E DATE OF DEATH 01-04-2003 COUNTY CUMBERLAND FILE NO. 21 03-0202 S.S/D.C. NO. 180-10-9456 ACN 03114494 TAX RETURN gAS: eX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: HEHBERS 1ST FCU ACCOUNT NO. 40267-00 TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 07-05-1984 Accoun* Balance 841.25 NOTE: TO INSURE PROPER CREDIT TO Percen* Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount: Sub~ec~ ~:o Tax 420.63 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 gITH YOUR TAX PAYMENT TO THE Taxable Amount q20.63 REGISTER OF gILLS AT THE Tax Ra~=e X .45 ABOVE ADDRESS. MAKE CHECK Tax Due 18.93 OR HONEY ORDER PAYABLE TO: "REGISTER OF gILLS, AGENT.** TAX CREDITS: PAYHENT RECEIPT DISCOUNT DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 05-10-2003 CD002559 .00 18.93 TOTAL TAX CREDIT I 18.93 BALANCE OF TAX DUEl .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To ~ulfill the requirements of Section 21q0 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 91q0). PAYMENT: Detach the tap portion of this Notice and submit with your payment to the Register of #ills printed un the reverse side. -- Hake check or money order payable to: REGISTER OF #ILLS, AGENT. REFUND (CR): A refund of a tax credit, ehich ems not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Tnheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of #ills, any of the 25 Revenue District Offices or by calling the special gq-hour answering service for fores ordering: 1-D00-362-Z050; services for taxpayers with special hearing and or speaking needs: 1-800-qq7-3020 (TT only), OBJECTIONS: Any party in interest not satisfied with the appraisement, alloaance, or disalloaance of deductions or assessment of tax (including discount or interest) as sheen on this Notice nay object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTTONS: 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. gDO601, Harrisburg, PA 17128-0601 Phone (717) 787-650S. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. DISCOUNT: Tf any tax due is paid within three (3) calendar months after the decedent's death, a five percent (EX) discount of the tax paid is alloasd. PENALTY: The 152, tax aannsty non-participation psnalt~ is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealabZa in the sane manner and in the the sane time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Intarast is charged beginning with first day of deZinquency, 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, 1982 hear interest at the rate of six (62) percent per annum calculated at a daily rate of .00016q. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily lntarast Daily Year Rate Factor Year Rate Factor Yea__r Rate Factor 1982 202. .0005¢8 1987 9Z .0002q7 1999 72. .000192 1983 162. .00D¢38 1988-1991 112 .000301 2000 8Z .000219 198¢ 117. .000501 1992 92 .0002¢7 2001 9Z .0002q7 198~ 13Z .000356 1993-199q 72. .000192 2002 62. .00016¢ 1986 102 .00027¢ 1995-1998 92 .0002q7 2003 52 .000137 --Interest is calculated as follows: XNTEREST = BALANCE OF TAX UNPAZD X NUNBER OF DAYS DBLXNQUENT X DA'rLy XNTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. Xf payment is made after the interest computation date shown on the Notice, additional interest must be calculated. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/01/2004 GATES ANN M 642 VALLEY VIEW DR BOILING SPRINGS, PA 17007 RE: Estate of HUMER MARY E File Number: 2003-00202 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 1/04/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STP~ASBAUGH REGISTER OF WILLS cc: File Counsel Judge STATUS REPORT UNDER RULE 6.12 Date of Death: LT/ ."j-O.A~ Will No.: g OO-)'~ - ~ ~ O ~-- Admin. No.: ~'~ Pursuant to Rule 6.12 of the Supreme Court OChans' Court Rules, I report the following with respect to completion of the adrn/rfistration of the above-captioned estate: 1. State wh,~,e, ther administration of the estate is complete: Yes ]5:5I No F-] 2. If the answer is No, state when the personal representative reasonably bel/eves 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 b. The separate Orphans' Com't No. (if any) for the personal representative's account is: Did the personal r~epr/~entative state an account informally to the parties in interest? Yes J.__M' No F'-] c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Cleric of the Orphm~s' Court and may be attached to this report. Signature Address Telephone No. Pe~ son~l Rev .... n2~ve [--] Counsel for personal representative -.J 15056051047 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return C) 2. Supplemental Return C) C) 6. Decedent Died Testate C) (Attach Copy of Will) C) 9. Litigation Proceeds Received C) 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) C) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required C) 4. Limited Estate C) 8. Total Number of Safe Deposit Boxes C) 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Da time Telephone Number ':::-'0 ~dT] '-- :0 ::o--J ~J"'::' " ::J: 1'3 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, includin accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG~SO(7tONr;E ~ RETURN ADDRES DATE 20 ~_O~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 --.J \ ~ .--J 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: H~ER V'V\A E RECAPITULATION 8. Total Gross Assets (total Lines 1-7). 8. 1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .' 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) c::J Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c::J Separate Billing Requested. . . 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)......... .......................... 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X .o~ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 18. 15. 16. 17. 19. TAX DUE. . . . . . . . . . . ................................ . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c::::> Side 2 DL t. \~ ~ \ 15056052048 15056052048 ~ REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME -f} YY\ A ~ S Ct c 0-..:6 c:;: Iv, STREET ADDRESS <.0 L{ -z yo... cLE '/ v I G W !-{ L.L/vv\ E R DR CITY a L (.)0 1 I I\J 5 r~ Y\J STATE PA- ZIP · l7oo'7 3 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) dO 0.- 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (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 property transferred;.......................................................................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 B 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent [72 P.S. 99116 (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 zero (0) percent [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 zero (0) percent [72 P.S. 99116(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 four and one-half (4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [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. REV-1508 EX+ (6-98) .- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF H (.)vVv\. E a (y\ A CUj E= Include the.p~oceeds of Iiliga~ion and the date the proceeds were received by the estate. All property Jomtly-owned wIth right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION J . ME M e,eR~ 1sT Feu. -~EC.J.c;NC) IVl ~ I~ e (L S I ST F C- u - So- V I IV cr S :2 FILE NUMBER "71 0 '30'2-0Z VALUE AT DATE OF DEATH Of 3 q . 7'1 'Yr'-l , .25 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) J 7 '60, <19 REV-1511 EX+ (12-99) . ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ,. I N u... VV\. 'ER FILE NUMBER MA~ ~ 1::.. 2 l 03, 020"2- Debts of decedent must be reported on Schedule 1. ITEM NUMBER A. I FUNERAL EXPENSES: DESCRIPTION AMOUNT J~ 0 Ll \ ~\J 9 e R F~ rvE~ l'idYvl ~ Gtoi Co 1. B. ADMINISTRATIVE 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 1) .5 0 .~ 5o~ 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) CJ57 oc REV-1512 EXt (12-03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ;..I LJ.. tv'- E (2. (YlA~ t:;- FilE NUMBER Zt O~ 0"2.02.. Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. R.>c-Cj i 0 NJ fY1 E cJ \ cu.. L C:if! ~ r2..- Ll S LE 3roCb I t../.OCb I 50 De- I Z 500 J 2 5'<<'- ~ '3'40 TOTAL (Also enter on line 10, Recapitulation) $ CO'lo-~ Co (If more space is needed, insert additional sheets of the same size) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE - -- - INHERITANCE TAX STATEMENT OF ACCOUNT J. 'Ci~~ ~,~~ 29 ~~l 1 ~ ~ ~ I J~r~ , , ter, ~ .. :-..~ ANN M GATES ~i t "' "" F?~, 642 VALLEY VIEW DR BOILING SPGS PA 17007 REY-1607 EX AFP (03-05) DATE 08-18-2008 ESTATE OF HUMER MARY E DATE OF DEATH 01-04-2003 FILE NUMBER 21 03-0202 COUNTY CUMBERLAND ACN 03114479 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: 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 ~ RETAIN LOWER PORTION FOR YOUR RECORDS f- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ~~* ESTATE OF HUMER MARY E FILE N0. 21 03-0202 ACN 03114479 DATE 08-18-2008 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: 07-31-2008 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): .00 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 05-10-2003 CD002558 .00 21.14 05-10-2003 CD002559 .00 18.93 08-04-2008 REFUND .00 40.07- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUNP_ SFF REVERSE S7nC nc 7uic FnDM cno TAICTDIIPTTAAIC ~ .00 .00 .00 .00 COMMONWEALTH OF PEN SYLVANIA DEPARTMENT OF RE ENUE BUREAU OF INDIVIDUAL rnxes ~`FNHERITANCE AX INHERITANCE TAX DIVISION '-~$ 7~AT ~ M E N T O F A C O U N T PO BOX 280601 ~~ ;', '~; -U-RRISBURG PA 17128-0601 "" Z~DB AUG -$ P~ 12.~ ~4 c~~r~, c OPPH~,PJ'_ ~;, al~f~T ANN M GATES ~`~~' ~`' ;~"` ( ~,1 , P~ 642 VALLEY VIEW DR BOILING SPGS PA 17007 REV-1607 EX AFP (03-05) DATE OS-04-2008 ESTAT OF HUMER MARY E DATE F DEATH 01-04-2003 FILE UMBER 21 03-0202 COUNT CUMBERLAND ACN 03114479 Amount Remitted MAKECHECK PAYABLE AND REMIT PAYMENT T0: EGISTER OF WILLS UMBERLAND CO COURT HOUSE ARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upp r portion of this form with your tax payment. CUT ALONG THIS LINE ~-- RETAIN LOWER PORTION F R YOUR RECORDS ~ --------------------------------------------------------------------------- REV-1607 EX AFP C03-05) *** INHERITANCE TAX STAT MENT OF ACCOUNT ~** ESTATE, OF HUMER MARY E FILE N0. 21 03-0202 ACN 03114479 DATE 08-04-2008 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 PAYMENT , THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-3 1 2008 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): .00 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 05-10-2003 CD002558 .00 21.14 05-10-2003 CD002559 .00 18.93 08-04-2008 REFUND .00 40.07- TOTAL TAX CREDIT ANCE OF TAX DUE INTEREST AND PEN. ~ IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN 81, 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 IN TRUCTIONS. ) .00 .00 .00 .00 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIYISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF RE ENUE - '~''' INHERITANCE AX ~i~ `,.:,STATEMENT OF AC OUNT Z~t~$ I~Uil -8 P~ ~~~ ~~ DATE ESTA CLEF,~~C Vr DATE ~R~1'~fi,(~4'`, U';7U~;T FILE Cl'(r ,~ , ~- ;' '1 FA COON ANN M GATES ACN 642 VALLEY VIEW DR BOILING SPGS PA 17007 MAKE REV-1607 EX AFP (03-05) 08-04-2008 OF HUMER MARY- E F DEATH 01-04-2003 UMBER 21 03-0202 CUMBERLAND 03114494 Amount Remitted HECK PAYABLE AND REMIT PAYMENT T0: EGISTER OF WILLS UMBERLAND CO COURT HOUSE ARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upp r portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ -------------------------------------------- REV-1607 EX AFP C03-05) *** INHERITANCE TAX STAT MENT OF ACCOUNT *** ESTATE OF HUMER MARY E FILE N0. 21 03-10202 ACN 03114494 DATE 08-04-2008 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 PAYMENT , THE CURRENT BALANCE, AND, IF APPLICABLE, w non ,c rTCT TAITCGCCT FTGIIRF_ __ DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-31-12008 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): .00 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR I STRUCTIONS. ) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF~ INDIVIDUAL TAxES - INHERITANCE TAX INHERITANCE. TAX DIVISION RECORD ADJUSTMENT Po Box zaorol --~ ~ -'' ~bINTCY HELD OR TRUST ASSETS HARRISBURG PA 17128-0601 ~'~~ ~^ ~~' E7 ~ ~ ~ ~~ ~;~ ANN M GATES C~ li42 VALLEY VIEW DR BOILING SPGS PA 17007 REV-1604 DC AFP ((8-05) DATE 08-01-2008 ESTATE OF HOMER MARY E DATE OF DEATH 01-04-2003 FILE NUMBER 21 03-0202 COUNTY CUMBERLAND SSN/DC 180-10-9456 ACN 03114494 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1604 EX AFP C03-05) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE 08-01-2008 ESTATE OF HOMER MARY E DATE OF DEATH 01-04-2003 COUNTY CUMBERLAND FILE NO. 21 03-0202 S.S/D.C. N0. 180-10-9456 ACN 03114494 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1sT FCU ACCOUNT N0. 40267-00 TYPE OF ACCOUNT: CX) SAVINGS C ) CHECKING ( ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 07-05-1984 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS .00 NOTE: X 0.500 .00 _ nn .00 X .45 .00 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 ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOT~4L DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED.oy IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), .,.... .. ..,. ..~ ..~~~ . .,~~~~.~.. nrr nr.,r~or nrnr nr rurc rn rno rucronrTrnuc ~ ~i COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL raxes `YNHEI~'ITANCE TAX INHERITANCE TAX DIVISION •'!RECORD `'ADJUSTMENT PO BOX 280601 J07NTLY~ HELD' OR TRUST ASSETS HARRISBURG IPA 17't28-0601 REV-1604 EX AFP (03-05) t1L~~f~ ~~~~ ~~ ~~~ ~`~' `E~TATE OF HUMER-2008 MARY E ~,,~~, DATE OF DEATH 01-04-2003 ~ FILE NUMBER 21 03-0202 „la~~~~~ ;j ~ ~; COUNTY CUMBERLAND _:1~ r G„ '~ SSN/DC 180-10-9456 ANN M GATES ~ ~y ACN 03114479 642 VALLEY VIEW DR Amount Remitted BDILING SPGS PA 17007 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE '--) RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ REV-1604 EX AFP C03-05) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE 08-01-2008 ESTATE OF HUMER MARY E DATE OF DEATH 01-04-2003 COUNTY CUMBERLAND FILE N0. 21 03-0202 S.S/D.C. N0. 180-10-9456 ACN 03114479 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1sT Fcu ACCOUNT N0. 40267-11 TYPE OF ACCOUNT: C ) SAVINGS (X) CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 07-05-1984 Account Balance Percent Taxable Amount. Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX (:REDITS: 00 X 0.500 .00 .00 .00 X .45 .00 NOTE: TO INSURE PROPER CREDIT TD YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 05-10-2003 CD002558 .00 21.14 05-10-2003 CD002559 .00 18.93 TOTAL TAX CREDIT 40.07 BALANCE OF TAX DUE 40.07CR INTEREST AND PEN. .00 TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF T~DTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), - - -- -••- - -~~~~.~+. ~r~ erveoer erne na TNrS FORM FOR INSTRUCTIONS.) REV-1470 EX (888) COMMONWEALT'i OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG. PA 17128-0601 MARY E HOMER INHERITANCE TAX EXPLANATION OF CHANGES FILE NUMBER 2103-0202 Judy Watts ~v~ 03114494 & 03114479 ITEM SCHEDULE NO, EXPLANATION OF CHANGES The above ACN's have been zeroed out since they have been reported and paid on the inheritance tax return, and you will receive your refund in 4-6 weeks. Row Page 1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES ,M-pPiZipFSEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION ,- OF~ ,DEDUCTIONS AND ASSESSMENT OF TAX PO BOX 2806111 HARRISBURG PA 17128-0601 - - ~~ - •~• ?CCU ~~~ -~ t ~~ I2.~ 46 ~~~~~si ~._.,r ./ ~~~ ~J~ OFP, ;~}~ ~ , ~ ~°, ~T ANN M GATES ^~ 1., C,Q 642 VALLEY VIEW t~ BOILING SPRGS PA 17007 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 . CUT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS 4'- ------------------------------------------------------------------------------------------- REV-1547 EX AFP C03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HUMER MARY E FILE N0. 21 03-0202 ACN 101 DATE 08-04-2008 TAX RETURN WAS: C X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 2. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 00 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) (3) . of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 1,78 0.99 6. Jointly Owned Property (Schedule F) C6) .00 7. Transfers [Schedule G) C7) .00 8. Total Assets fig) 1 , 780.99 APPROVED DEDUCTIONS AND EXEMPTIONS: 957.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 84 0 .0 0 11. Total Deductions C11) 1.7 97.00 12. Net Value of Tax Return C12) 16 . O1 - 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedu le J) (13) .00 14 Net Value of Estate Subject to Tax (14) 16.01- . NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assess ed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) •00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = . 00 17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due C19)= .00 TaV AO~TfT T[•. PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID REV-1547 EX AFP C06-05) DATE OS-04-2008 ESTATE OF HUMER MARY E DATE OF DEATH 01-04-2003 FILE NUMBER 21 03-0202 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 10-03-2008 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .DO INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. FOR. CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE • ~~~~~.~., ccc orvrasF ST1]E OF THIS FORM FOR INSTRUCTIONS.)