Loading...
HomeMy WebLinkAbout03-0263 *' /7 -1.20~( c.., COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 00 d-v3 BUREAU OF INDIVIDUAL TAXES AND DEPT. Z806Dl ACN 03110254 HARRISBURG, PA 171Z8-06Dl TAXPAYER RESPONSE DATE 03-17-2003 REV-154S EX AFP 109-001 TYPE OF ACCOUNT EST. OF EMMA M ROBINSON liJ SAVINGS S.S. NO. 192-14-0638 D CHECKING DATE OF DEATH 11-22-2002 D TRUST COUNry CUMBERLAND D CERTIF. REMIT PAYMENT AND FORMS TO: DONALD E SHUE REGISTER OF WILLS LOT 107 CUMBERLAND CO COURT HOUSE 7073 CARLISLE PIKE CARLISLE, PA 17013 CARLISLE PA 17013 MEMBERS 1ST FCU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a COpy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co.monwealth of Pennsylvania. Quest;~ns may b@ answererl hy r.elling (7171 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 162740-00 Date 10-05-1996 To insure proper credit to your account, two Established (Z) copies of this notice .ust accompany your Account Balance 336.33 payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax 168.17 NOTE: If tax pay.ents are .ade within three (3) months of the decedent.s date of death, Tax Rate X .15 you .ay deduct a 5% discount of the tax due. Potential Tax Due 25.23 Any inheritance tax due will become delinquent nine (9) .onths after the date of death. PART TAXPAYER RESPONSE [!]liii!ii!I~I_iiii.!i!illl~liiil~I~liiiillll~liillllliii.!I!I_~~I~.iiilil~II!li~"lImilii_iiii.lili.~I!i!1.~~II!iiil A. [] The above infor.ation and tax due is correct. 1. You .ay choose to re.it payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of [ ONE ] Wills and an official asses~ent will be issued by the PA Depart.ent of Revenue. BLOCK B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent.s representative. C. [] The above infor.ation is incorrect and/or debts and deductions were paid by you. You .ust co.plete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your !1!1!llllill:I!!!I!I!!!i!l!i!llillilllllllllllll~11111illllll!il [!] relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS !iill~li~lii:;iijji!i!j!i!!!I!I!!~!j!l:;:j!!!!!!!!!!!!!!!!:!:i!::I:;:j!lii;!!I!j!j~!!JiliJi!iil!!!!!I!l!i!I!I!!!!!!1!!i!!i!!!i!!I!!!I!I!I!!I!!!ll!l!i!!! lINE 1. Date Established 1 Account Balance .-...........................-.-...................-.-.-...-.-.............................................-.....-.....................-.-.-.-...................-.....-. 2. 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 - 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED [!] DATE PAID PAYEE DESCRIPTION AMOUNT PAID I I I TOTAL (Enter on line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts I have reported above are true,~ect and te to t~f my knowledge and belief. HOME ( ) 7(.t - >911 TA r WORK () -o/2--4-/""J PAYER SIGNATURE TELEPHONE NUMBER DATE GENERAL INFORMATION l. FAILURE TO RESPOND WIll RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax beco.es 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 .atter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint na.es within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit the. with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official asses~ent (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent.s representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept Z80601, Harrisburg, PA 171Z8-0601 in the envelope provided. 3. BLOCK C - If the notice infor.ation is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION 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 lZ/IZ/8Z: Accounts which the decedent put in joint na.es within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (RR) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted fro. 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 deter.ined as follows: A. The percent taxable for joint assets established .ore than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Exa.ple: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT 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 one year of death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is deter.ined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The a.ount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse lineal Sibling Collateral 07/01/94 to 12/31/94 370 670 1570 1570 01/01/95 to 06/30/00 070 670 1570 1570 07/01/00 to present 070 4.570- 1270 1570 RThe tax rate I.posed on the net value of transfers from a deceased ChIld twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in com.on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter.ined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being claimed must be ite.ized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" xli". Proof of payment .ay be requested by the PA Department of Revenue. ~~t.,;IE~IIR:r:MEN:r:;;o.f,1"J~e~ENu.E.;.I;liS:r:RiIll1i:r:;, o.f1f,f,l~E'iJ)R;.,~~~~;; 3~I1IE;...,Iu.Re~u.;;o.f1,.,;..;;.;.;;;;;,..,;,;;,."""",,;",;;;;;",""".""",';;" / l--l (jo- g' C-, COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 o"?:> ~\.o~ BUREAU OF INDIVIDUAL TAXES AND DEPT. Z80601 ACN 03110255 HARRISBURG, PA 171Z8-0601 TAXPAYER RESPONSE DATE 03-17-2003 REV-1SU EX AFP 109-001 TYPE OF ACCOUNT EST. OF EMMA M ROBINSON D SAVINGS S.S. NO. 192-14-0638 !XJ CHECKING DATE OF DEATH 11-22-2002 D TRUST COUNTY CUMBERLAND D CERTIF. REMIT PAYMENT AND FORMS TO: DONALD E SHUE REGISTER OF WILLS LOT 107 CUMBERLAND CO COURT HOUSE 7073 CARLISLE PIKE CARLISLE, PA 17013 CARLISLE PA 11'013 MEMBERS 1ST FCU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. QUAstion~ may be answered bv c~Jling (717) 787-~327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 162740-11 Date 10-05-1996 To insure proper credit to your account, two Established (ZI copies of this notice .ust accompany your Account Balance 560.01 payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax 280.01 NOTE: If tax payments are .ade within three (3) months of the decedent's date of death, Tax Rate X .15 you .ay deduct a 5% discount of the tax due. Potential Tax Due 42.00 Any inheritance tax due will become delinquent nine (9) .onths after the date of death. PART TAXPAYER RESPONSE [!]lliliii!I~I.llililtiiill_il!il~l~iliiillll~iliiilllill.iliiE~~I~.ii!lil~liil!~_lIIImilii._llil.liii.~lllil.~~lij~~ A. [] The above information and tax due is correct. 1. You may choose to re.it payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of [ ONE ] Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your [!] relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS lINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 S. Debts and Deductions S - 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED [!] DATE PAID PAYEE DESCRIPTION AMOUNT PAID I I I TOTAL (Enter on line S of Tax Computation) $ of perjury, I declare that the facts I have reported above are true,~rect and of my knowledge and belief. HOME ( ) CC. ~"-91f WORK ( ) ~ '3-y. P ~ TELEPHONE NUMBER DA E GENERAL INFORMATION l. FAILURE TO RESPOND WIll RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor.ation submitted by the financial institution. Z. Inheritance tax beco.es delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent.s na.e was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint na.es within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife .ore than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE l. BLOCK A - If the infor.ation and co.putation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official asses~ent (Form REV-1548 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept Z80601, Harrisburg, PA 171Z8-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and co.plete Parts Z and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official asses~ent (Form REV-1548 EX) upon receipt of the return fro. the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION 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 lZ/IZ/8Z: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (MM) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Exa.ple: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) 4. The a.ount subject to tax (line 4) is determined by .ultiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The a.ount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse lineal Sibling Collateral 07/01/94 to 12/31/94 3X 6X 15X 15X 01/01/95 to 06/30/00 OX 6X 15X 15X 07/01/00 to present OX 4.5XIli 12X 15X -The tax rate Imposed on the net value of transfers from a deceased ChIld twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in co..on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for pay.ent, or the estate subject to administration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed .ust be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" xli". Proof of payment may be requested by the PA Department of Revenue. f!llL..mEPtfR1r:"EN1r:"D.F:LJ~EYEN~E.JUS1r:RICilL.D.~IffiI~;U$...QR..~"t:t!,..ltf,U!it..I~REld:t.D.E......,.................................................... COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES OEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002341 SHUE DONALD E LOT 107 7073 CARLISLE PIKE CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ---------- -------- 03110254 I $25.23 ESTATE INFORMATION: SSN: 192-14-0638 03110255 I $42.00 FILE NUMBER: 2103-0263 I DECEDENT NAME: ROBINSON EMMA M I DA TE OF PAYMENT: 03/26/2003 I POSTMARK DATE: 00/00/0000 I COUNTY: CUMBERLAND I DATE OF DEATH: 11/22/2002 I I TOTAL AMOUNT PAID: $67.23 REMARKS: DONALD E SHUE CHECK# 3649 INITIALS: JA SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS '/' \., //,/./( COMMONWEALTH OF PENNSYLVANIA '* BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX , APPRAISEKENT~ ALLONANCE OR DISALLONANCE OF DEDUCTION~, AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-'s'8 EX OFP lOl-031 DATE 06-23-2003 ESTATE OF ROBINSON EMMA M DATE OF DEATH 11-22-2002 l;~E NUMBER 21 03- 0263 '03 JUN 20 1\11 :Otl'uNTY CUMBERLAND SSN/DC 192-14-0638 DONALD E SHUE ACN 03110255 LOT 107 ..0' I A.o"o' R..".., I 7073 CARLISLE PIKE \,_.':' \_',<., ir", CARLISLE PA 17013Cl1tn>.!t;:""" MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 06-23-2003 ESTATE OF ROBINSON EMMA M DATE OF DEATH 11-22-2002 COUNTY CUMBERLAND FILE NO. 21 03-0263 S.S/D.C. NO. 192-14-0638 ACN 03110255 TAX RETURN WAS: (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 162740-11 TYPE OF ACCOUNT: () SAVINGS (X> CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 10-05-1996 Account Balance 560.01 NOTE: TO INSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 280.01 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 280.01 REGISTER OF WILLS AT THE Tax Rate X .15 ABOVE ADDRESS. MAKE CHECK Tax Due 42.00 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (_) AMOUNT PAID 03-26-2003 CD002341 .00 42.00 TOTAL TAX CREDIT 42.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. * ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU 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 2000. C7Z P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and subMit with your payment to the Register of Wills printed on the reverse side. -- Make check or .oney order payable to: REGISTER OF WILLS, AGENT. REFUND (CR). 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-1313). Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs. 1-800-447-3020 (TT only). OBJECTIONS. 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 may object within sixty (60) days of receipt of this Notice by. --written protest to the PA Depart.ent of Revenue. Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021. OR --electing to have the .atter determined at the audit of the account of the personal representative. OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTI ONS. Factual errors discovered on this assessment should be addressed in writing to. PA Department of Revenue, Bureau of Individual Taxes. ATTN. Post Assess.ent Review Unit. DEPT. Z80601, Harrisburg, PA 17128- 0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of ad.inistratively correctable errors. DISCOUNT. If any tax due is paid within three (3) calendar .onths after the decedent's death. a five percent (5%) discount of the tax paid is allowed. PENALTY. The 15% 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 .anner 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. 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 beca.e delinquent before January 1, 19B2 bear interest at the rate of six (6%) percent per annUM calculated at a dailY rate of .000164. All taxes which beca.e 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 Depart.ent of Revenue. The applicable interest rates for 1982 through 2003 are: Interest DailY Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZO% .000548 19B7 9% .000247 1999 7% .000192 1983 16% .00043B 1988-1991 11% .000301 2000 8% .000Z19 1984 11% .000301 1992 9% .000247 2001 9% .000247 1985 13% .000356 1993-1994 7% .000192 Z002 6% .000164 1986 10% .000274 1995-1998 9% .000247 2003 5% .000137 --Interest is calculated as follows. INTEREST = BALANCE OF TAX UNPAID X NUKBER 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 .ust be calculated. /')., /, ~( COMMONWEALTH OF PENNSYLVANIA ~. BUREAU OF INDIVIDUAL TAXES '* DEPARTMENT OF REVENUE INHERITANCE TAX OIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-0601 APPRAISEKENT, ALLOHANCE OR DISALLOHANCE OF DEDUCTION , AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-lS48 EX AFP (01.05) DATE 06-23-2003 He' ESTATE OF ROBINSON EMMA M DATE OF DEATH 11-22-2002 FILE NUMBER 21 03-0263 JUN 20 '3~OUNTY CUMBERLAND .03 m 1. SSN/DC 192-14-0638 DONALD E SHUE ACN 03110254 LOT 107 I Amount Remitted I 7073 CARLISLE PIKE (;l;;li CARLISLE PA 170:(},lInb,j i~. r.'j~ MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN lOWER PORTION FOR YOUR RECORDS ...... ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 06-23-2003 ESTATE OF ROBINSON EMMA M DATE OF DEATH 11-22-2002 COUNTY CUMBERLAND FILE NO. 21 03-0263 S.S/D.C. NO. 192-14-0638 ACN 03110254 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 162740-00 TYPE OF ACCOUNT: ()() SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 10-05-1996 Account Balance 336.33 NOTE: TO INSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 168.17 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 168.17 REGISTER OF WILLS AT THE Tax Rate X .15 ABOVE ADDRESS. MAKE CHECK Tax Due 25.23 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-26-2003 CD002341 .00 25.23 TOTAL TAX CREDIT 25.23 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. * ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOOO. (72 P.S. Section 9140). PAYMENT. Detach the top portion of this Notice and sub.it with your payment to the Register of Wills printed on the reverse side. -- Make check or .oney order payable to: REGISTER OF WILLS, AGENT. REFUND (CR). 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-1313). Applications are available at the Office of the Register of Wills. any of the 23 Revenue District Offices or by calling the special 24-hour answering service for for.s ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs. 1-800-447-3020 (TT only). OBJECTIONS. Any partv in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assess.ent of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice bY, --written protest to the PA Depart.ent of Revenue. Board of Appeals, Dept. 2810Z1, 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 CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to. PA Depart.ant of Revenue, Bureau of Individual Taxes. ATTN. Post Assess.ent Review Unit, DEPT. 280601, Harrisburg. PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5X) discount of the tax paid is allowed. PENALTY: 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 appealable in the same manner and in the the same ti.e period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) .onths and one (1) day from the date of death. to the date of pay.ent. Taxes which became delinquent before January 1. 198Z bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. 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 with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are. Interest Da ily Interest Daily I nt erest DailY Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOX .000548 1987 9X .000247 1999 7X .000192 1983 16X .000438 1988-1991 llX .000301 2000 8X .000219 1984 llX .000301 1992 9X .000247 2001 9X .000247 1985 13X .000356 1993-1994 7X .00019Z 2002 6X .000164 1986 lOX .000274 1995-1998 9X .000247 2003 5X .000137 --Interest is calculated as follows. INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax beco.es delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is .ade after the interest computation date shown on the Notice, additional interest .ust be calculated. - Register of Wills of Cumberland County e : -,---- PETITION FOR PROBATE and GRANT OF LETTERS Estate of Emma Robinson No. ~/ - ()3-0J~3 also known as To: Register of Wills for the , Deceased. County of Cumberland in the Social Security No. 192-14-0638 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, and the execut~ named in the last will of the above decedent, dated September 24 ,20 1996 and codicil( s) dated (state relevant circumstances. e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Silver Spring Township, Cumberland County, Pennsylvania, with hZClast family or principal residence at 7073 Carlisle Pike, Lot 107, Carlisle, Pennsylvania 17013 (list street, number and municipality) Decedent, then ~ years of age, died November 22 , 20~, at Carlisle, Pennsylvania Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 0 (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: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) thereon. # Signatur~fPetitioner(S) Residence(s) of Petitioner( s) ....... () '-::"':> /( F. ALl .r, . ~~ .:0 7073 Carlisle Pike, Lot 107, Carlisle, PA 17013 C_'-l ~) --,'-, r-f-1 ,- t-~'l C''') :.::J :"::'") "C ..,) , ""J ,-;-~ .,';r=J, c""', ~ '" ,..::-.:) , -.. '" -.,', "T., -" ::-5 " rrj C) (--) - ~1 - . - Register of Wills of Cumberland County o , , r-.> ~~;~;,'t ---~ (2 ,;;;:;.' :-:-~l \..-of C- ,.:: ~-~5 C~: 1'- _l) \_~) OATH OF PERSONAL REPRESENTATIVE [',) I. i j ,:::) . ~; ':::J ,....~ .,.' } _...~ COMMONWEAL TH OF PENNSYLVANIA ----- SS: .. COUNTY OF CUMBERLAND \.....J ~. ~ The petitioner(s) above-named swear(s) or affinn(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief ofpetitioner(s) and that as personal representative(s) of the above d~'drn' ""titioo",) w;]l well rnd 'ml, ",'m'o',,", <h, "WID ""~ruro 'ow. ~ Sworn to or affinned and subscribed . { ~ f Before m~_!hi, ,lO+ 11 r of Vl 00' JJt.Z ;C~ iitJ: '" 0> ~ 3 Reg/fl- C Tkp:Jb No. 0( / - o3-0<.{J Estate of EMMA ROBINSON , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW July 20~, in consideration of the petition on the reverse side hereof, satisfactory ~roofhaving been prcsented before me, IT IS DECREED that the instrument(s), dated September 24. 199 , described therein be admitted to probate filed of record as the last will of EMMA ROBINSON ; and Letters are hereby granted to DONALD EUGENE SHUE FEES -~ Probate, Letters, Etc. ............. $ Jo .Ob Will................................. $ \s.ao Renunciation...... ................. $ Short Certificates ( ). . . . . . . . . . .. $ JCP.................................. $ 10.{){) Automation Fee....... ............ $ S.Ot> IfflntL .C;.......c ~1"'"'''' '" $~ 717-243-6222 Total_ $ 90,CD Filed 20_ Phone ~. t' \<> 1 \\ (j'{ ~ \\\I;~\v . "r-- ~ 'Dot-- ,,0 '><. 0~ ."" "'" "L' "',,1, t'e'!"' [1;', t 1." ,.. )rll1a:io;] here given is correcrlv copied IJorn an origin,d c~,:rit.catc of death duly f.led with me as J.(I, ! ~ ' ~1'-1 r;; t ! I"~. or,:;' .d lllld.c'ate will Iw I(lrw'lrdcd to the Snee Viral Records Office lor pennanL'/l[ hhng. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fe,- h) hi...; CuttlIC~lll'- S2.()\) ~;f~GlfD?ph'-~~ LL. ~,:f:;,:,~~ ",,~ /--'. *;"'- I~~\ ~'oo "y. '~. .. 0' ~" .,:a. . ';Z. ~ ~ S: .{Cj';~' ,h~ ~ * "~ . -~. >-; * $ \~, -' .~l~ -_t.___~BJ,3 ~~_ '""'%''- ,/~\\\ .NOV 25 700? "- ',1';;"-- O''t.'<: ",v ------_ MENT \\~ ",J'!1 """"""OIIJIIJ1}~~ Date No "" CJ c:::> C"::l =0 c;o '-..:.:'1 fT1 --,.., C" 0 :--::-:~ c..:> - -:< (-) ~- =0 ,-- r,] C'J L,::J i""i.., /-( Cl ")l~ - CJ -n "-Tl - -q c=s - rTl Hl05, 1(4 Rev. 1/91 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS , .. (:::) . CERTIFICATE OF DEATH c:; --'1 "R/NT (CorOner) .:::- , \NENT ST,fdEFIlENUMBER <INK SEX socr9!l':1~:Nb'~~~ DATE Of DEATH (Month, Oay. 'I'M,) M Robinson .. Female .. November 22, 2002 UNDER 1 DAY DATE OF BIRTH BIRTHPLACE (Crty aod PLACE Of: DEATH (Ch<<;k Only one - _ inSl'UC1t(lns 00 other side) "~~ Miflutes (MDnIh,DaY,Ysarl StateorFOfeignCount,y) HOSPITAL: Penn-6y,evan-i.a 1..,111f1'l10 g'~D ,. FACilITY NAME (n '101 'l'ISlitUhOl1,!1ive IIrl!el and number) RACE .Am~lcan Indian, SlIIclc. White, e1C ~"'Wh,ite ... ". DECeDeNT'S USUAL OCCUPATION WAS DECEDENT EVER IN MARITAL STArUS. Married SURVIVING SPOUSE (gl":;.t,~Iif~~u~r;~,~nl U_S. ARMEDF~? Neve'MI"Ied,~. (II wife, give mlid&n Ilem8l Ve.D No W-i.3O'rffe&-' Hou-6e t1b, oeCEDENT'S MAILING ADDRESS (Shel, CrtyiTown. Stele, Zip Code) DECEDENT'S savelt 7073 Calt,e-i.-6,ee P-i.ke Lot 707 ACTUAL O. ..,. RESIDENCE d8C11dem CMU-6,ee, PA 77073 (Seeinmructions live ii'll OIl O1rler SIde) Cumbelt-fand township? T7d.D =h::::7'r.~ol 11. 17b.Courn fMHERR NAME (Flr!Il. Mt;]. Lam) MOTHER'S NAME (Firs!. Middle. MaiOlIn &Jrr.ame) 11. 0 lteeOk ". No keeoltd INFm~,!{j_;r"E~-Shte INFOROANT'S 'C;lllN~OD1sS (s~eeJ~ityrror: Site. ZiP~7e) . PA 7 73 alt ~-6 e ~ e 0 7 ,Cak-f~-6-fe, 77073 PLACE OF DISPOSITION. Name 01 Cemelery, C'emllOry LOCATION .CilylTown. Stlte, Zip Code Removal/rom SIlleD orOthe,PIaA / To the bntgfmyknawledge,d'llhoct:urrlld.tlhelirne, dll..ndplaCllIlIted (Signal\JrelilnclTdle) .... ".. "'- TIME OF DEArH DATE PRONOUNCED DEAD (Monlh. ::>.ay, )Gl!ti WAs CASE REFERRED TO ME~ EXAMINERlCORONER'/" 10:55 P. .. November 22, 2002 ,., .lfl NOD ... ... ... %7. PART I; Enl~ the e1iM_. injuritrsor complication. whIctI ellll$ed the death. 00 nol 8fllllill'Ine modeol dyIng. SUCh" cardiac or respifllll)/)' arr8$l,llIock 0' hel" lli1ure :Appro.lmll. PARTU: OIhe'lIignl1lcenlcondllionllCOrltrlbutingIOdllalh,1M Lietonlyoneo:auseonllChline ,lmervalbetw..n notresulling.nllleunderty!ngcauaegivenlnPAATI. .. Acute M ocardial Infarction fonsetlndde&l'h DUE TO (OR AS A CONSEQUENCE OF); , b , DUE TO (OR AS A CONSeQUENCE OF): ,. DUE TO tOA ASA CONSCQUENCE OF): d WERE AUlOPSY FINDINGS MANNER OF DEATH DATE Of INJURY INJURY AT WORK? OiSCRIBE HOW INJURY OCCURRED. ~LABlE PRIOR TO (MOIlIII. Day. ""'r) COMPLETION Of CAUSE il( 0 ,.,0 NoD OF DEATH'/" Nllu,.l -... No~ No 0 .....m 0 PendlnglnVltStigelion 0 .... .. Oo ,.,0 0 o PLACE OF INJURY -AI hom., fl'm. "'efll. factory, Office ""- Couldnot:betlltllill'tni~ building, lie. (SPlIC:IIy) '"'- .... ... 'Do. CERTlAER (CtIeck oo/y one) .CiRTIFYINQ PHYSICIAN (Ptlyslclafl Certifying CIIO!le r:J mill when another ph)'llician has pronounced d8alh lInd COfnplllled 1l$ll1 23) 0 Coroner Tolttebeeto'mJknowledge,..tnOCCUlTlldduetothtClluM(.).ncrm.MIIr.....lecI. ... .... ... .... ... .... .... ,.... '.' ..., .,. ........ DiIJ"E SIGNED tMonth. Day. "'-r) .PAONouNerNQ AND CEATIFYtNQ PHYSICIAN (Ph)'liCian boIh pronouncing dMlh and c8l'1ilying 10 cau. ct deBlhJ o 31c. 31d.November 25, 2002 TO.....""'ofrny~, deMI'IOCcuf"l'lldelth-ll~.dete, .ncIpIICII, IndduetobCII"*ll(.'lrtClmenne'..lI1flecl.........."., .........., NAME AND ADDRESS OF PERSON WHOCOMPLETEDCAUSE Of DEATH "MEDtCAL EXAMINEAiCORONER (1t1lm27)TypeorprlntMichael L. Norris, Coro.ner O'l1he MIIII of examlnltlon Ind/or Irweatlgellon,ln my opinion, death OCCurred eI the time, d.te, Ind pilei, Ind dUI fo thl CIUH(I)lnd pit ... 6375 Basehore Road, Suite #1 mannlf'..ateled..,...,.,..,.......,...,..,....,...,....,..,.......,........,................"..,.......,...,... , Mechanicsburg, Pa. 17050 311. REGISTRAR'S S'GNATURE AND NUM A I~\ ~I\,ol DATE FlLEO,._. ""t:S;' ". \},~.f) ~ . ~ ~-=: r-:.") .~' '--" ..,.7 (~ ;"';1 1 ("j"1 c , <-- ie'") -'-, ,'-"~ ) I.:) ., .-',) r'~,.> --j l,~-.J THE STATE OF TEXAS ! ,-'1 C -=-J -D ~, c=) COUNTY OF LIBERTY 1-." '-rl ('") -- rn , .. (::) C) ,"1 ~:- I, Emma Robinson of Liberty County, Texas, do hereby make, declare and publish this to be my Last Will and Testament, hereby revoking any and all wills, and any and all codicils to wills at anytime heretofore made by me. I. I do will, devise, and bequeath any and all of my property, whether real, personal or mixed, an of whatever character, kind or description the same may be, wheresoever situate, belonging to me at my decease, or in which I have any right, title, share, claim, demand or interest, unto my friend and companion, Donald Eugene Shue. II. I hereby appoint the said Donald Eugene Shue, independent executor of this my Last Will and Testament and I direct that no bond or security shall be required of him as such executor; that his actions in such capacity shall be free from the control of the probate court or any other court; that no action shall be had in the administration of my estate other than to probate this my Last Will and Testament and to return a statutory inventory . and apppaisement and list of claims of said estate, and of all claims due or owing by me at the time of my demise if required by law. III. Witness my Last Will and Testament and sign the same the .............day of ~~........, 1996 . e MARY ANN ABSHIRE ~ I~ Nolllry Public, Slate Of Texas ~ My Commission EXpires ............ ................. FEBRUARY 21, 2000 Emma Robinson On this, the d' L/,~ day of #~...., ....... ."....... 1996, appeared Emma Robinson and she declared the same to be her Last Will and Testament and signed the same in our presence and in the presence of each other, and we hereby set our hand and signature to this instrument, in his presence, and in the presence of each other. Jd~~.... e MARY ANN ABsHIIIE C~~ Nolllry Public, Slale Of Texas My Commission Expires FEBRUARY 21, 2000 .......... .... ........ Orlene Mullins Cumberland County - Register of Wills One Courthouse Square Carlisle, PA 17013 Phone: (71 7) 240 - 6345 Date: 11/02/2005 FLOWER JAMES D JR 26 W HIGH STREET CARLISLE, PA 17013-2922 RE: Estate of ROBINSON EMMA M File Number: 2003-00263 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.6 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing is due by: 10/30/2005 Your prompt attention to this matter will be appreciated. Thank You. s~cere10 ~ ~~. vWt-h.<tV. . / (_.J GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court cc: File Personal Representative(s) Judge Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 11/02/2005 SHUE DONALD E 7073 CARLISLE PIKE, LOT 107 CARLISLE, PA 17013 RE: Estate of ROBINSON EMMA M File Number: 2003-00263 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.6 (a) 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 ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing is due by: 10/30/2005 Your prompt attention to this matter will be appreciated. Thank You. z:e~~ GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court cc: File Counsel Judge ~ Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 N fD d t Emma M. Robinson ame 0 ece en : Date of Death: November 22, 2002 Estate No.: 21-03-0263 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete: Yes 0 No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No 0 b. The separate Orphans' Court No. (ifany) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0. No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ames D. Flower, Jr., Esquire Name Saidis, Shuff. Flower & Lindsay 26 West High Street, Carlisle, PA 17013 Address Date: July 27, 2005 c~"" ' ',:j ('..j ~" t_' ,^") t 717-243-6222 Telephone No. L<'"':'> (~;1 C:::., C-''''~ l_. Capacity: o Personal Representative o Counsel for personal representative uVf ___! 1505610101 PA Department of Revoenue P Bureau of Indfvldual Taxes INHERITANCE TAX RETURN Po Box Zso6oi Hsrri~ur+D, PA ~~ai~8-o6oi RESIDENT DrECNT ___ _ _ . Spouse's Social Security Number ____ _ _ FILL IN APPiROPiR1ATE OVALS BELOW r 1. Original Retum OFFICIAL tf8E ONLY _ County Code Year File Nutrd~ ~1 b~, aaz~ Date of Birth MMDDYYW : ........................................................................................................................... ....... De is First me MI .. Spouse's First Name MI THIS RETURN MUST ®E FILE~3 IH DUPLICATE Yli~TH THE REGfSTER ~f V!VILLS O 2. Supplemental Retum O 3. Remainder Retum (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) tiiil• 6. Decedent Died Testate O 7. Decedent Maintained a Uving Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of WiN) (Attach Copy of Trust) O 9. Ligation Pnxeeds Received O 10. Spousal Poverty Credit (date ~ death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTbN MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDiENTUI. TAX INFORMATN~l1 SHOULD BE DIRECTED TO: Name _ __ _ __ D me Tole _. _ ..... phone Number 1 RECli18T ~ tMLLS U B~NLY .. ~ ', First line of address . ~» ran C7 C-- .~ ~' c ' -; __. __ __. ............................................ ............... ............... ............. . ~ 6 (,~~ ......... ............ . '~"t y ~, V .,. ; - ... ........ .~ .......... ............... .... Second line of address ........... ................ ............ ............ ....... .........: .. .... ......... \..Vf i / ~ ~Y.~/ ~ ~ . ~ ~ ~: . , i ~~ - - ~ .. ,~ __ ____ _ _. _ City or Post Office tate....... ZIP Code fILED . "' C~~-~.~ _.. _ . _ .. ,~- ~.~c............... _ _ _ _ ___ __ _ ___ ~ ~ 3 'Z~o Correspondent's o-rmaN addr+sss: ` ~.,,. ~ . Utxbr penaitles of perjuryr,l decqu~s that 1 eoa~enined this ntu including acoompanying schedules and istetiernenbs, and m the best d mY knowledge and t~ef, it is true, oarroct and compisls. ©adaradon of pnrparar iothsr than the personal n3pressr~tative is based on sIN ~tFxms~tlon of which preparer has any knowledge StGI~yEtE OF PERSON.$ESP.E FOR FILING RETURN f1ATL' side t L 1505610101 150561010] :. J~ c.r '~ - ~"~'~- _ too /Z ~ /std 1 D J 1505610105 REV 1500 EX ~ Decedents Social Security Number Deaeda+t's Name: RECAPiTUiLATiON 1. Real EstaN (Sdiedule A) ............................................ . 2. Stocks and Bonds (Schedule B) ...................................... . 3. Closely Held Corporation, Partnership or Sole-Proprieton;hip (Schedule C) .... . 4. Mortgages and Notes Receivable (Schedule D) .......................... . 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Properht (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total t3roes Assets (total Lines 1 through 7) ............................. 8. ~, o W_. ~~ i 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ~~ ~ ~ -~ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule 1) .............. 10. .. ~^.~.~, 11. Total Deductions (total Lines 9 and 10) ................................. 11. .... ...., ._~... ~_. .~ ~...~ _.,_ ., ...~ ..., ,k._~ _ ~.~.., 12. Nst Value of Estate (Line 8 minus Line 11) .............................. 12. J ~ 13. Charitable and Governmental BequestsJSec 9113 Trusts for which ~ .: ~...: .,..:..:...: „ .:,~ an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Une 13) ........................ 14. -__ TAX CALCUiLA'I'K~IN -SEE tNSTRUCTiONS FOR APPLiCABii.E RATES 15. Artaunt of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .©~ 15. 16. Amount of Una 14 taxable ._.:.... ...:.:... ...:.: ...... ~ . . at lineal rate X .0 _ 16. 1 T. Amount of Line 14 taxable _..~ ....... .....:.:.._.......,~...H......_. _ .~.... ~.. . ~, _....., . . ,...,_... ...., . at sibling rates X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. 20. FILL iN THE OVAL IF YOU ARE iREQUESTiNG A REFUND OF AN OVERPAYMENT O sia. s 1505610105 1505610305 J REV 1500 EX Page 3 Flle Number Decedent's Complete Address: oEc b STREET ADDRESS !'~- cmr sra zEP ~. ~~~ ~ Tax Payments and Ored~ts: 1. Tax Due (Page 2, Line 19) 2. Credits/Payrr~nts ~ ~ . ~ .,3 A. Prior Payments B. Discount 3. Interest 4. ff Une 2 is greater than Line 1 + Line 3, eater the ~f~ence. This is the OVERPAY~tr'f. F~ th anal on Page 2, t.Nw 20 to nq~wst a refund. (1) Total Credits (A + B) (2) ~ ~ r (3) (4) ~ ~ .~ 5. ff Line 1 + Line 3 is greathr than Line 2, enter the c~er+ence. This is the TAX DUE. (5) Make check pay~lble to: REGISTER OF WILLS, AGENT. PLEASE ANS~IA~~t THE FOLLOWfNG QUESTIONS BY PLACING AN "X" IN THE APPFtOPHIATE BLOCKS 1. Did decedent make a tram arM: Yes No a. rotas fits I~ae or inoclrtle ~ the properly transfarred :.......................................................................................... ^ b. retain the right to deaignale who shall use the property transferred ~ its incxxr~ : ............................................ ^ [~ c. retain a reversionary ingest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ ('' 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without r~eoenting adequate cx>nsideration? .............................................................................................................. ^ ©' 3. Did decedent own an "in trust for" or payable-upon-death bank acx;ount or security at his or her death? .............. ^ ©' 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a benefiaary designation? ........................................................................................................................ ^ IF THE ANSVI~R TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COLETE SCHEDULE G AHD FILE IT AS PART OF THE RE~IlRN. ~s ,. , _ ~.. For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviv~g spouse is 3 percent [72 P.S. §9116 {a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the u~ of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (i~]. The statute does not exempt a transfer to a surviving spouse from tax, and the steltutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficlary. For dates of death on or after July 1, 2000: The tax rate irr~osed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed ~ the net value of transfers to or for the use of the decedent's lineal benefiaaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a}(1)]. The tax rate imposed ~ the net value of transfers to or for the use of the decedent's sidings is 12 percent [72 P.S. §9116(a}(1.3)]. A siring 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-1511 EX+ (10-09) pennsylv~nia SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF ~ ~~ NUMBER Decedent's debt Must be r~arbed on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES.: 1. c _ B. aaMxNxsTRarnE cosTS: 1, Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: 3. Famiiy 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: , ~ ~`-~ C~ 5. Accountant Fees: ~~ 's 6. Tax Return Preparer Fees: TOTAL (Also enter on Line 9, Recapituiation~ ; If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) penns~rhrana SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERTT'ANCE TAX RETURN MORTGAGE LIA~~~S & ~~NS ReswENr ot~Nr ESTATE OF ~ ~~ Rgiort debt: incamid by the deft prior to death that remained unpaid et the date oi* deirtl+, indudha~ unr~l medicei ems. ITEM VALUE AT DATE w ~~~FQ DESCRIPTION OF DEATH e~..c~=c~ r~s~~e ~, ti~ a. e1a.~- w~~.~# 3w{tc ~~?-GAP D` (~ Gu,G.~ TviS~ ~~ a~as~ TOTAL (Also enter on Line 14, Recapituia~on) `~ If more space is needed, insert addi~onal sheets of the same size. JAN t ~ 2~Q3 ST M~~1 e FEDERAL CREDIT UNION ~e-v~,AC u~r: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Created ~~ AiCCO Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Jo'rnt Owner Date Joint Ownership Created INSURANCE DEPARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 1-800-283-2328 or (717) 697-1161 162740 -00 10/01 /1996 $335.99 $.34 $336.33 Donald E. Shue 10/01 /1996 182740 -11 10/05/1996 $560.01 $.00 $560.01 Donald E. Shue 10/05/1996 BER 1ST - L CREDIT UNION Denise A. Anders Insurance Products Supervisor January 13, 2003 Estate of: EN~III~- J. ROBINSON Date of ~~L: 111,2/2002 St~cial Security Number: 192-14-0638 ~' 70'1~ork Rd . Carlisle., I'A ~ 7013 Carlisle-~~-~~~ ~4~3=22-15 Harrisburg (717) 2340662 1-800-745-4$1.1 Fax (717) 249-1437 To James D Flower. The 1997 Ford F-150 with vin # 2FTD)C08W9VCA10452 owned by Donald E. Shue & Emma M. Robinson has a value of $ 7,200.00 as of December 05 2002. The above value is based on~information provided by the December issue of NADA. Sincerely, Jerry Trolinger - .r .. ` APPROVED OMB NO. 0938-0279 2 3 PATIENT CONTROL NO. 2 4 6 PAR,T~E R SCI' MAR 0 3 2403 CARLISLE PA 17 013 s s7ATIrMENTCflvERs 5 FED. TAX N0. 7 COV D. 8 N-C D. 9 C-FD. 10 L-R D. 11 TELEPHONE (717) 218-8852 - 12PATIENT NAME 13 PATIENT ADDRESS `' r. _, ROBINSON, EMMA M 7073 CARLISLE PIKE-1 07 CA~lL . ISLE PA 17013 14 BIRTHDATE 15 SEX 16 MS 17 A I~ t9 ~ ~ 21 D HR 22 STAT 23 MEDICAL RECORD N0 , . . 74 31 320 32 OCCURRENCE 34 OCCURRENCE C ~E D E '- ~° <~ ; b ' ~~~.° ; ,:~ ~ f?CCtIRf~NCE S~i4~i 37 - ATE ~ .CODE FROM a A . b g' ~ ~ ~ ~i °;; :' ~ E 6 707 CAx.`LISLE PIKE-107 - 3s vuuE ems nag ~ ,; VALUE C:F~S C a a ARLISLE .~ PA 17013 b ' b c c d 1 42 REV. CD. 43 DESCR4PTION 44 HCPCS /RATES 45 SERV. DATE 48 SERV. UNITS 47 TOTAL CHARGES 48 NON-COVERED CHARGES 49 . - d • 2~ S'4 H1~i~lA.C.Y 6~ 1 1 t3 4 ~ 0 4 1 . .3 X58 V SOLUTIONS 2 4 235:.06 ~4 27Q ED-SU1~ ;3'i3PPLZ~:~ 3 ; ~.2 ~15~. ~#3 272 TERILE SUPPLY a s 2 7` 88 . 3Ofl QRAT~RY ~ s 5 7 `119?Q _' 3 0 1 AB j`CHEMT STI2Y s 7 7 3 6 4 7 8 . 3 4 5 A$ / ~E~+lATf3L+DGY 7 8 3 1Q2. 5Q ; 306 AB/BACfi-MICRO 8 . 9 3 151 25 ~. ~~~50 320 X X-RAY - 10 1 209; ~ 84 . . ~ 5.1 T SCAN / HE L? 11 , 1 ~~$ . ~5 j' ' 420 ~' HYSICAL THERP' 12 4 220 02 . 42~ ~ HYE THER;~EV.;,~%L ~ 13 ~. 2 ~ $ ~. ~ ~ 4 5 0 MERG ROOM ' ' 14 ~s 1 650;.00 7 3 0 KG/ EOG 15 ,,~ l 271; 15 , 001 OTAL CHARGES is ~ 7056:44 ~8 17 ,~ 18 ,.. ~ 19 . -~ ~~ ~ ~ 2Q ~, , " 21 AGE 1 OF ,1 22 50 PAYER 51 PROVIDER NO. 54 PRIOR PAYMENTS 55 EST. AMOUNT DUE 56 23 i 4 ~ --~--...,,.~ {G ~ , 57 ~ ~ ~, ~ ~~ ~ : ' 58 INSURED'S NAME 59 P.REL 60 CERT. - SSN - H1C. - ID N0. 61 GROUP NAME 62 INSURANCE GROUP NO:. ~' ~ '~ A C B 63 TREATMENT AUTHORIZATION CODES 64 ESC 65 EMPLOYER NAME 66 EMPLOYER LOCATION C !< A B s7 PRIN. DIAL. CD. • COt3ES '' C ~ ~., s 76 ADM. DIAL. CD. 77 E-CODE 78 °~ f' 7~f CQt~ :-s, 320 79P.C. ~ PRINCIPAL PROCEDURE ~. ~, "„,~ ~ CODE DATE DALE ~:,4 , e , 8d AT1'E~ PHYS tQ . a ~` ~ ~ b CODE DATE e -' b 8~ 84 REMARKS ~ r~+YS: ~o a b ~ ~, b ~~ ~ ~ d ~~ ~ UB-92 HCFA-1450 OC t?RIGINAL Ic ~cERn FlCATIO REVERSE APPLY TO THIS BILL AND ARE MADE A PART EREOP f . ,. RB 02/25/03 PAYMENT DUE DATE N BALANCE Mt IMUM DUE 01/31/03 ~ 7,866.63 ~ ~315.00 Chagge your New Address: addglss end llelepl7one number anlins. b0 «, to wwwd,~ise.comlcards a print hVe+e: Telephone: ~ 1 EMMA M ROBI N50N 51ss~c 1073 CARLISLE PIKE TRLR CARLISLE PA 17013-9761 Ir~~lll~rrllirrrt~rli~rlltl~i~rl~r~i~li~~t~~ltl~irrltlrtl~~~ll ACGC3UNT WUM~3~R: 518 4500 84Z513~9 Enter Amount Enclosed In Boxes Below ase malts aMok of order payable bo: CHASE PLATINUM MA8TE CARD. Yasl 1 want to help prdect my cxedit rating. Please enrdl me in the Chaos Payment Protector Plan. I have read and understand the endosed offer. I understand that enrollment Is optional and 1 may cancel at any lane. Signature (D5ENM ) P.O. BOX 15583 WILMINGTON DE 19886-1194 I~t~IIIJ~rl~tl~l~rir~lltl-t~~lit~~lll~i~~rit~li~l-I~l-fii~~rl~N 51844500d425Z30900796663000315009200308 ~ ~~ >blee~:'6td 1t~:~t~BfT ~1~: r 6` "~08 ., ~rr~.;- . F~nric>Iw Bal~oo ..._ ?,8#~51~ t*l ,mss C~a 3S~.OU t~? ~w-estelir'roe 7,966:8` 1~irnutn t3ue f 66 00 card-..Par 1 x.00 ~+Bt~" :~ ~ sat ~ ~'~e ~- cE -- F :~ t LA't'8 ~£ - Imo` P'1rlY~#' U DrRTE D1JE 3b.Q@ T`O#~10~ ~vtx t>r~'!36 A[1d' 0.00 35.00 , ~,~ .....~..,~ .,.~ ~~~.,.r,,n,.~s ~ r~t~frR~f~e i.~>R's~",= f~1T£ gWt.AliC~ >p~'i~M! ~~1~AE~B PurC~res CaN#t _ Y t~:O~~~ V 6t.064~ ~1,1fl0:Bfi ~ X17.22' ~ ~~-22 7.24% 7.24% Tr11~1i~rnad 8a~laxwes Y O! O'"f9rr ~4,77 4.~2 ~t i 7.83 ~r4.00 ~l~f7.83 f9.99% 49.24'%r 0:00% 19.24% ., r ;~ i - -- N ry .,, .~ o a ... sss rtwrae s+dr br Ibalmtgo oattil~~t,l mt~lod arid' dl~r ~~ infiortrlstic~t. ~~~~ ~ ~~rt~ ~ ~ a~ stl0~n? 1 t~a~w Cuter B~Vio~ 24 hours a ,,~ 1~ 9~~i0.64Q2. a~ P81'a ~ii'~~C a~ ~Q tflrll ~ '^ Kt. , ~ h ~.~ ' ; ; A FAY RE1lAtN0ER: Y(~C1R 14t3T ~ PA&'fi DiJE. PLEJ~f3E f3fl~ PAYMENT Tt? PROTECT YOUR CREDtfi p'RfliiLE~GE3. tF YOU'VE ~ .~ ~, K i AL~t~ ~-Il1~T #iMIK YQ~. r t .. .rte "1' ENR~t., IM CHASE PAYir1E~lYT`PROTBCt'CJA Pf.AN tQQAY. 'F4+iE PfJW THAT HELPS PRE7TECT YOUA CREDR RAT~,1. q 'M1 ~ ~ ~ ...~. ~' .~... ~ ~ ~;. ~.'' Send Pay~treMs to: ll~~ P«~ 807t ~ ~ Writs ytux aooolunt number ~n y~oul~ r~>isok cry m+t~nsy andot. N~anrfalr ~srtd oosh.:~s~ ,, ~~ P~ i a# i __ ~'-t w~trr~Otkarts. ~- LAW OFFICES SAIDIS, SNUFF, FLOWER & LINDSAY A PROFESSIONAL CC~RI'ORATION 26 WEST HIGH STREET CARLISLE, PENNSYLVANIA 17013 JOHN E. SLIKE TELEPHONE: (717) 243-6222 -FACSIMILE: (717) 243-6486 ROBERT C. SAIDiS EMAIL: attorneyQssfl-law.com GEOFFREY S. SNUFF www.ssfl-law.com JAMES D. FLOWER, JR. CAROL J. LINDSAY MATTHEW J. ESHELMANt THOMAS E. FLOWER KIRK S. SOHONAGE LINDSAY GINGRICH MACLAY JACLYN M. SMITH June 8, 2004 Adam S. Cohen, Esquire Phillips & Cohen Associates 695 Ranco~s Raad Westampton, NJ 08060 RE: CHASE MANHATTAN BAN~C USA CREDIT CARD #59844540842~13a9 CRE©IT CARD BILL ©F EMMA M. ROBINSON Dear Mr. Cohen: FILE COPY CAMP HILL OFFICE: 2109 MARKET STREET CAMP HILL, PAi 17011 TELEPHONE: (717) 7317-3405 FACSIMILE: (717) ?3!7-3407 tBoard Certified Creditors' Righb Representation REFLY TO CAR~..ISLE in accordance with our letter of May 26, 2004, enclosed please find check No. 3800,. in the amount of $2,425.00, from Donald E. Shue, representing payment in full of the above referenced account. Very truly yours, SAIDIS, SNUFF, FLOWER & LINDSAY THE STATE OF TEXAS COUNTY OF LIBERTY I, Emma Robinson of Liberty County, Texas, do hereby make, declare and publish this to be my Last Will and Testament, hereby revoking any and all wills, and any and all codicils to wills at anytime heretofore made by me. I. I do will, devise, and bequeath any and all of my property,_ whether real, personal or mixed, an of whatever character, kind , or description the same .maybe, wheresoever situate, .belonging to me at my decease, or in which I have any right, title, share, claim, demand or interest:, unto my friend. and. companion, Donald Eugene Shue. II. I hereby appoint the said Donald Eugene-Shue, independent executor of this my Last Will and Testament and I direct that no bond or security shall be required of him as such executor; that his actions in such capacity shall be free from the control of the probate court or any other court; that no action shall be had in the administration of my estate other than to probate this any Last Will and Testament. and to return a statutory inventory and apppaisement and list of claims of said estate,. and of all claims due or owing by me at the time of my demise if required by law. III. Witness my Last will and Testament and sign the same the ..."~ 'l ...........day of ~~~........, 1996. ~--~-~ MiARY ~I A~l~RE ~ ,/ Molar Pnbl~c, of Tews .s.--~---- ,c~'JC-t.~f.¢.s-.._ AAy Cron E~t~esa ............ ............... . FEBRUARY 21, 2000 Emma Robinson his the ....°.?~'~.1..... day of .. ~............., On t , 1996, appeared Emma Robinson and she declared the same to be her Last Will and Testament and signed the same in our presence and in the presence of each other, and we hereby set our hand and signature to this instrument, in his presence, and in the presence of each other. Aii~N~tE ~ ~~ ~ ~i'ibtRY 21, 20tp -1:1~....... ............... Harriett Selln ,. elicia Walthall ...... . .. .... .. ..... Orlene Mullins REV-t5og EX+ (ot-so) ~E11115~~V-i DEPARTMENT OF REVENUE UNiERITANCE TAX RETIAtN RESIDENT DECeD9~IT ~~ 34TNTLY-OWNE© PROPERTY es~rA~ oF: ~, ~ ~R: ~ ~H.Qc. G~/t- ~ ~ ~ ~~ 021.--d ~ ` f.~ ~. ~ 3 If an beciinne - earned within one year of the deoed~t's dada of , R nwrt bye nport~A erg ~ ti, SURVMNG JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT' .. ~fl 7 _ _ __ _ __ B. h ~' VY D K.. C. ~QINTLY ~ i~PERTY: ITEM NIMBI` LErrER FoR xxKT TERIANT a~Te MADE NT DESCRIPTION OF PROPERTY tNauoE NAB of FINANCtAI ~ISTINTION AND BANK AaoouNT oR SMIILAR I NUNI A1TAt~1 DEED JOIFITLY HELD REAL ESTATE. DATE of ~-TH VALUE. t!F ~ of lf!'1'ERESr acre of DEATH vALUE of DECEfl~IT"S INTEREST . . .. t Q,..~`'~ __. _.. _ . _ ~l~se,~,~„yy ~~,~.r.~.. ~~%t9'ti~G- ~ ~-', Q, d Fl ...D ~ p 1 C ~'-..~:'W ~ --~ d ~- ~~d ~ a ~r,ti , a 1 3 ~ t 2R 7 ~ ~ '7 F- ~- ~~~ 9 -~, a. ~ _~ Sa 3 b e-~, Tt'lTAL (Also enter on Line 6, Recapituiattorl) ; ~ ay~',p ~ If more space is needed, use additional sheets of paper of the same size. NOTICE OF INHERITANCE TAX f `"n' ~1,1?~'RA~~~ME1~T, ALLOWANCE OR DISALLOWANCE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION ~ OF .D.LDt1QTIONS AND ASSESSMENT OF TAX PO BOX 280601 { '` `` `~ -" ' HARRISBURG PA 17128-0601 ~~,, ~~~. ~^~[^J '~' "~ 'r JAMES D FLOWER ~-` `"' SAIDIS ETAL 2b W HIGH ST CARLISLE PA 17013 cl) .00 c2) .00 c3) .00 c4) .00 c5) .00 c6) 4, 048. O1 c7) .00 CUT ALONG THIS LINE _ -~i R_ETA_IN LOWER POR_TION_ FOR YOUR RECORDS F-- _ ___ ___________ REV-1547 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR - DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: ROBINSON EMMA MFILE N0.:21 03-0263 ACN: 101 DATE: 11-22-2010 TAX RETURN WAS: CX) ACCEPTED AS FILED t ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property tSchedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses tSchedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) _~ pennsytvania ~~ ~ ~ DEPARTMENT OF REVENUE REV-1547 EX AFP (12-09) NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax. payment. c8) 4 , 048.0 1 c9) 1 , 012.00 clo) 3,237.00 11. Total Deductions (11) 4,249.00 12. Net Value of Tax Return (12) 200.99- 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) t13) .0 0 14 Net Value of Estate Subject to Tax C14) 200.99- . NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 a nd 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) .0 0 X 0 D = .0 0 16. Amount of Line 14 taxable at Lineal/Class A rate C16) .0 0 X 0 4 5 = .0 0 17. Amount of Line 14 at Sibling rate C17) .0 0 X 12 = .0 0 18. Amount of Line 14 taxable at Collateral/Class B rate C18) .0 0 X 15 = .0 0 19. Principal Tax Due (19)= .0 0 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. DATE 11-22-2010 ESTATE OF ROBINSON EMMA M DATE OF DEATH 11-22-2002 FILE NUMBER 21 03-0263 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 01-21-2011 (See reverse side under Objections ) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013