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Home My WebLink About03-0281March 28, 2003 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 RE: EDWIN C. BLOUCH, DECEASED Dear Sir or Madam: I am enclosing herewith a check made payable to the Register of Wills, Agent in the amount of $30,000.00 representing the 90-day payment on the Pennsylvania Inheritance Tax. There is no need to probate this estate, therefore, I am enclosing the Estate Information Sheet for Revenue. Please record the payment and issue a receipt for the same. Thank you for your attention in this matter. Sincerely, JAMES, SMITH, DIETTERICK & CONNELLY, LLP Paralegal :slg Enclosure sESTATE ECURITY Stephanie L. Gaffey Paralegal slg~jsdlegal.com 134 SIPE AVENUE HUMMELSTOWN, PA 17036 MAILING ADDRESS RO. BOX 650 HERSHEY, PA 17033 TOLL FREE 1 800.9,423660 TEL. 717.533.3280 FAX 717.5337771 www jamesestateplan com THE . ESTATE bECURITY F~?~MULA P.O. BOX 650 HERSHEY, PA 17033 h,,lih,,llh,,,,,Ih,lh,,Ih,,Ihh,l,h,,llh,,,,,Ihlh,I REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE CARLISLE, PA 17013-3387 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 002366 JAMES GARY L ESQUIRE 134 SIPE AVENUE HUMMELSTOWN, PA 17036 fold ESTATE INFORMATION: SSN: 172-01-1016 FILE NUMBER: 2103-0281 DECEDENT NAME: BLOUCH EDWIN C DATE OF PAYMENT: 03/31/2003 POSTMARK DATE: 03~28/2003 COUNTY: CUMBERLAND DATE OF DEATH: 01/01/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $30,000.00 TOTAL AMOUNT PAID' $30,000.00 REMARKS: GARY L JAMES ESQUIRE SEAL CHECK//4447 INITIALS: JA RECEIVED BY' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS September 26, 2003 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 THE sE ;TATE ECURITY FC)RMULA RE: EDWIN C. BLOUCH, DECEASED 21-03-0281 Dear Sir or Madam: I am enclosing herewith the Pennsylvania Inheritance Tax return (3 copies) for the above- referenced decedent. I am enclosing a check in the amount of $15.00 representing the filing fee for the inheritance tax return, and a check in the amount of $5,041.50 representing the inheritance tax owing. There were no probate assets in this estate, therefore, no letters were ever granted. I have enclosed an Estate Information Sheet for the PA Department of Revenue. Please file the inheritance tax return. Please return a stamped copy to me in the enclosed, self-addressed, stamped envelope. Thank you for your attention in this matter. Sincerely, __ Stephanie L. Gaffey ~, Paralegal :slg Enclosures Stephanie L. Gaffey Paralegal slg~jsdc.com 134 SIPE AVENUE HUMMELSTOWN, PA 17036 MAILING ADDRESS P.O. BOX 650 HERSHEY, PA 17033 TOLL FREE 1.800.942.3660 TEL. 717.533.3280 FAX 717.533.7771 www. jsdc com FIR~; :11' CLASS MAIL COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003065 JAMES GARY L ESQUIRE 134 SIPE AVENUE HUMMELSTOWN, PA 17036 ........ fold ESTATE INFORMATION: SSN: 1 72-01-101 6 FILE NUMBER: 2103-0281 DECEDENT NAME: BLOUCH EDWIN C DATE OF PAYMENT: 09/29/2003 POSTMARK DATE: 09/26/2003 COUNTY: CUMBERLAND DATE OF DEATH: 01/01/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $5,041.50 REMARKS: TOTAL AMOUNT PAID: BEVERLY J BAKER-EXECUTRIX C/O GARY L JAMES ESQUIRE $5,041.50 SEAL CHECK# 4486 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 D E N T I~1' original Return C A P B 4. Limited Estate HpRL E P I O 6. Decedent Died Testate C R A C (Attach copy of Will) KoTK E S 9. Litigation Proceeds Received D E C Co" REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY R E C A P I T U L A T I O N C O M A xl T I O N DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Blouch Edwin C. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 01/01/2003 10/03/1909 (iF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) FILE NUMBER / COUNTY CODE YEAR NUMBER I SOCIAL SECURITY NUMBER 172-01-1016 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~247! Supplei~i~al Return U · Future Interest Compromise (date of death after 12-12_82) Decedent Maintained a Living Trust 1 (Attach copy of Trust) [~10. SpousaI Poverty Credit (d.ate of death 3. Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 6. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (date of death between 12-31-91 and 1-1-95) (Attach Sch O) COMPLETE MAILING ADDRES"~'*'" ....... ~':~'~:~*~'" ..................... ~~i ~ Gary L. James Esq. FIRM NAME(If Applicable) 134 Sipe Avenue tames, Smith, Dietterick & Connelly, LLP Hummelstown, PA.17036 TELEPHONE NUMBER ' i 717/533-3280 1. Real F~t~te (Schedule A) (1) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ~--] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. 13. 14. None None None None 2 , 341.84 15,772.07 825,015.83 27,956.86 1,385.14 ~ .*~OFFICIAL USE ONLY (8) 843,129.74 (11) 29,342.00 Net Value of Estate (Line 8 minus Line 11) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (lZ) 813,787.74 (13). (14) 813,787.74 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 813,787.74 X .0 0 x .0 45 X .12 X .15 (15) 0.00 (16) 36,620.45 (17) 0.00 (18) 0.00 19. Tax Due 20. ~ liiii~K~Ki~Ki~i~i~i~~i~i~K~b~ ~~ (19) 36,620.45 ~ ..... ~: ~ ~: ~: ~:~=~:~:~: ~: ~t= =:~ ~ '~' :=' *~' '~'~ ~ :~¥~ ~:' '"? ";;;~,~:=~;*;::~;~;/:::~:~t.;.;;~:~;.;~;.~' Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREw- ! ADDRESS 1359 Simpson Ferry Road CITY New Cumberland Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 30,000.00 1,578.95 STATE I ZIP PA (1) Total Credits ( A + B + C ) (2) 17070 36,620.45 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 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 · retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or .................................... d. receive the promise for fe of e}therpayments ............. benef ts or care* . . 2. If death occurred after December 17, 1982, did decedent transfer properly within one year of death without receiving adequate consideration? ................................ ~] ~] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. [~ ~X~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation.* ................................ ~-] ~'] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I declare that I have examined this return, including accu,.panylng echedules and statements, and to the best of my knowledge and belief, It is true, 31,578.95 0.00 0.00 5,041.50 0.00 5,041.50 correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Beverly J. Baker DATE C~ ~ W,~ ~,~,, 215 N. Locust Point Road { \ 1 .............. SIGNATU~OFPREPARER~HERTHANREPRESENTATIVE J~ES, SMI~, DIE'ITERICK & C0~E~Y LLP DATE ~ ~~~~-~ 134 Sine Avenue ' surviving sp~~7~ ~a) ( 1.1 ) (i)]. For dates of death on or after Janua~ 1, 1995, the mx rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutou require~nts for disclosure of assets and filing a tax return are still applicable even ~ the surviving spouse is the only beneficial. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twen~-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(aXl)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aZ1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in com~n with the decedent, whether by blood or adoption. Copyright (c) Z~O form software only The Lackner Group, I~. Form REV-1500 EX (Rev. 6-~) ADDITIONAL Personal Representatives Estate of Edwin C. Blouch SS# 172-01-1016 01/01/2003 Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. Signature NMfne Address Line 1 Address Line 2 City, State, Zip Date Natalie G. Blouch 917 Spring Circle Mechanicsburg, PA 17055 REV- 1508 EX * (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH. BANK DEPOSITS, & MISC. ~..ER,T^.CE T*X .ESIDE.T DECEDE.T PERSONAL PROPERTY ESTATE OF Edwin C. Slouch SS~/ 172-01-1016 01/01/2003 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 }{ighmark Blue Shield - refund on overpayment of bill 2 James, Smith, Durkin and Connelly LLP - refund of overpayment on legal services bill prior to death 3 Patriot News - refund on subscription 4 Refund from IRS on 2002 personal income tax 5 1983 Cadillac blue book value 6 Refund of county and school real estate taxes paid at settlement of real estate TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) FILE NUMBER VALUE AT DATE OF DEATH 110.01 189.00 65.40 51.00 600.00 1,326.43 $ 2,341.84 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV- 1509 EX + (1-97) SCHEDULE F COMMONWEALT, OF.E..SYLVA.~A JOINTLY-OWNED PR OPER TY INHERITANCE 3'AX RETURN RESIDENT DECEDENT ESTATE OF Edwin C. Blouch SS~/ 172-01-1016 01/01/2003 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER SURVIVINGJOINTTENANT{S)NAME ADDRESS RELATIONSHIPTO DECEDENT A. Beverly J. Baker 215 N.Locust Point Road Daughter Mechanicsburg, PA 17055- JOINTLY-OWNED PROPERTY: L~:II~:R DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of flnanclallnstltution and bank account number or similar Identifying number. DATE O F DEATH DECD'S VALUE OF NUMBER TENANT JOINT Attachdeed for jointly-held realestate. VALUE OF ASSET INTEREST DECEDENT'S INTERE$ 1 A 08/28/64 Allfirst Interest 31,544.13 50.00~ 15,772.07 checking account ~/0016046498; Account opened 08/28/1964; joint with daughter Beverly Jane Baker; Wife, Elva Mo Blouch )redeceased TOTAL (Also enter on line 6, Recapitulation) $ 15,772.07 si: Is insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) REV-1510 EX+ 0-97) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Edwin C. Blouch SS# 172-01-1016 01/01/2003 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THE TRANSFERE~THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER NUMBEF ATTACH ACOPYOF THE DEED FOR REAL ESTATE. ' VALUE OF ASSET INTEREST (IF APPLICABLE) i Beverly J. Baker, Daughter 80,000.00 100.00% 3,000.0¢ 77 000.00 gift of cash in October, ' 2002 2 Beverly J. Baker, Daughter 42,000.00 42,000 00 Gift of 1/2 of Blouch ' Warehouse, Inc. Note receivable in October, 2002 3 Natalie G. Blouch, Daughter 70,000.00 100.00% 3,000.00 67,000.00 - gift of cash in October, 2002 4 Natalie G. Blouch, Daughter 42,000.00 42 000.00 Gift of 1/2 of Blouch ' Warehouse, Inc. Note receivable in October, 2002 5 Blouch Warehouses stock - # 335,487.17 100.00% 335,487.17 of shares held in C Corp See attached Schedule C-1 6 Commerce Bank - Deposit 29,493.26 29,493.26 Account #26485; opened 07/26/2000; held in the name of the Edwin C. Blouch Jr. Living Trust 7 Commerce Bank - Accrued 43.83 43.83 interest on Deposit Account #26485; opened 07/26/2000; held in the name of the Edwin C. Blouch Jr. Living Trust 8 Miscellaneous household 2,000.00 2 000.00 furnishings ' 9 6,213 shares Morgan Stanley 64,991.57 64,991 57 Account - 6213 shares of ' Franklin PA Tax Free Income Fund Class; held in the name of the Edwin C. Blouch Living Trust dated 05/31/1996; opened 07/10/1996 Total of Continuat ion Schedule (s) 165,000. O0 TOTAL (Also enter on line 7, Recapitulation) $ 825,015.83 (If rn,-~r~ ~=~ ;~ ~ :-__~ _~:_. , .... si , insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97) Estate of: Edwin C. Blouch Soc Sec #: 172-01-1016 Date of Death: 01/01/2003 Continuation of Schedule C (Inter-Vivos Transfers & Misc. Non-Probate Property) Item Description of Property Date of Death ~ Decd Exclusion # Value of Asset Intrst Taxable Value 10 Real estate situate at 1359 Simpson Ferry Road, New Cumberland Borough, Cumberland County, Pennsylvania - Held in the name of the Edwin C. Blouch Living Trust dated May 31, 1996; sale value (see attached settlement sheet) 165,000.00 165,000.00 165,000.00 REV-1505 EX.- (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Blouch, Edwin C. SCHEDULE C- 1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT FILE NUMBER Name of Corporation Blouch Warehouses, Inc. Address P.O. Box 331 City New Cumberland Federal Employer I.D. Number 23-1489321 State PA Zip Code 17055 State on Incorporation Pennsylvania Date of Incorporation 05/01/57 Total Number of Shareholders 4 Business Reporting Year 5/31 Type of Business Rental PmductJService Real Estate TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK Voting/Non.Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Common Voting 640 100 246 $ 335,487.17 Preferred $ Provide all dghts and restrictions pretaining to each class of stock. 5. Was the decedent employed by the Corporation? ................................ [] Yes [] No If yes, Position Annual Salary $ '~me Devoted to Business 6. Was the Corporation indebted to the decedent? ................................. [] Yes [] No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ..... [] Yes [] No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer an stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-827 [] Yes ,[] No If yes, [] Transfer [] Sale Number of Shares Transferee or Purchaser Consideration $. Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? .... [] Yes [] No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? .................................................. [] Yes If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedenfs death? ................... [] Yes If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. [] No [] No 12. Did the corporation have an interest in other corporations or partnerships? ............. [] Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedents stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received fi'om the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. {If more space is needed, insert additional sheets of the same size) ESTATE OF EDWIN C. BLOUCH Pennsylvania Inheritance Tax Return Schedule C-1 Verification data Decedent owned 246 of 394 shares outstanding of the common stock of BIouch Warehouses, Inc., a Pennsylvania Corporation. The corporation's business is the rental of a warehouse which it owns at 4180-4200 Chambers Hill Road, Harrisburg, PA 17111. The warehouse is rented by two tenants who are unrelated to the decedent, the heirs of the decedent, and the other shareholders of the corporation. The attached appraisal was completed for one of the tenants who was contemplating an offer to purchase the warehouse which did not materialize in April of 2002, prior to decedent's death. The appraisal uses three approaches to value the warehouse: the Income Approach with current leases in effect (value $472,000); the Income Approach with market rents in effect (value $1,650,000); and the Sales Comparison Approach (value $1,370,000). The shareholders wish to sell the property and have been seeking a buyer for sometime prior to the decedent's death. The below market leases, which are renewable for many years to come, are negatively impacting the value of the building and the value of the the corporation which owns the building. We have used the highest value in the enclosed appraisal, using market value rents, as the starting point to determine the liquidation value of decedent's stock, which we believe is the fairest approach considering the controlling shareholders' intentions. Valuation of Blouch Warehouses, Inc. Stock Value of Real Estate Cost of Sale (6% estimate) Corporate Tax basis (approx.) A B C D E (SUM A-E) Gain on Sale PA Corp Net Income Tax (9.99%) Federal Taxable gain Federal Corporate Tax (34%) Less Notes Payable Net Distributable to Shareholders Estate's Share (38.4%) 1,650,000.00 (99,000.00) (112,000.00) 1,439,000.00 (143,756.10) 1,295,243.90 (440,382.93) (84,000.00) 882,860.97 335,487.17 ESTATE OF EDWIN C. BLOUCH Pennsylvania Inheritance Tax Return Other verification data Schedule C-1 Four years of corporate tax returns are attached The shareholders at date of death were as follows: Edwin C. Blouch - decedent Natalie G. BIouch - daughter of decedent Beverly Baker - daughter of decedent Harry Baker - son-in-law of decedent Total shares outstanding The officers of the corporation were as follows (no salaries or bonuses paid - corporation had no paid employees) # shares 246 184 105 105 64O Percentage 38.4% 28.8% 16.4% 16.4% 100.0% Natalie G. Blouch - President Harry Baker - Vice President Beverly J. Baker - Secretary/Treasurer The corporation has not paid dividends nor declared dividends in the memory of the surviving shareholders. See tax returns attached which indicate that no dividends were paid in the four years preceding the death of Edwin C. Blouch. REV- 1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Edwin C. Blouch SS# 172-01-1016 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. ITEM NUMBEF 01/01/2003 1 2 FUNERAL EXPENSES: Funeral luncheon Stone & Murray Funeral Home DESCRIPTION - funeral bill ADMINISTRATIVE COSTS: 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: Attorney's Fees James, Smith, Dietterick & Connelly, LLP Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Addies~ City Relationship of Claimant to Decedent State~ Zip to paint house at house 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Allfirst bank fee 2 American Water Resourses - water bill 3 B&B Coating Engineers, painters - bill 4 Barclay Electric - bill to repair wiring 5 Bekelja Fuel Service - bill 6 Borough of New Cumberland - sewer bill Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) FILE NUMBER AMOUNT 183.50 2,133.00 10,000.00 31.00 48.00 2,200.00 1,400.00 496.71 57.43 11,407.22 27,956.86 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rsv. 1-97) Estate of: Edwin C. Blouch Soc Sec #: 172-01-1016 Date of Death: 01/01/2003 Item Description Continuation of Schedule H-B2 (Attorney's Fees) Amount 1 James, Smith, Dietterick & Connelly, LLP - attorney fees 2 James, Smith, Dietterick & Connelly, LLP - attorney fees balance owing 4,050.00 5,950.00 10,000.00 Estate of: Edwin C. Blouch Soc Sec #: 172-01-1016 Date of Death: 01/01/2003 Item Description # Continuation of Schedule H-B7 (Other Administrative Costs) Amount 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Borough of New Cumberland - sewer bill Carl Zimmerman - bill to repair ceiling Eshenaur's Fuels, Inc. - bill Eshenaur's Fuels, Inc. - fuel bill at house Leon Walter, CPA - accountant fee to prepare 2002 income tax returns Mark Ulsh - snow removal fee for property Mark Ulsh - snow removal fee for property Mark Uish - snow removal fee for property Neai Wagner - roofer - charge to repair rubber and porch roofs at house PA American Water Company - water bill PA American Water Company - water bill Paint and supplies to paint house PennsylvaniaAmerican Water Company - water fill Pennsylvania American Water Company - water bill PPL Co electric bill PPL Co - electric bill PPL Co - electric bill PPL Co - electric bill R. F. Fager, plumber charge to fix commode at house Reserve for additional administration expenses Transfer tax due at settlement of real estate 57.43 100.00 88.50 436.50 150.00 37.00 44.00 110o00 6,800.00 12o76 12.23 280.08 11.71 13.84 29.39 36.74 28.22 29.85 146o38 1,000.00 1,650.00 Estate of: Edwin Co Blouch Soc Sec #: 172-01-1016 Date of Death: 01/01/2003 Item Description Continuation of Schedule H-B7 (Other Administrative Costs) Amount 28 Additional costs at settlement of real estate 29 Robert Wagner, plumber - replace faucet plus labor 30 Verizon telephone bill 31 Verizon - telephone bill 32 Verizon - telephone bill 33 Verizon - telephone bill 34 Verizon - telephone bill 106.00 154.14 14o31 13.89 14.72 13.48 16.05 11,407.22 REV-1512 EX + (1-g7) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESI DENT DECEDENT ESTATE OF Edwin C. Blouch SS~/ 172-01-1016 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS Include unreimbursed medical expenses. ITEM NUMBER 2 3 4 5 6 7 8 01/01/2003 FILE NUMBER Bekelja Fuel Service bill DESCRIPTION Eshenaur's Fuels, Inc bill Messiah Village final bill Messiah Village - final bill PA Department of Revenue - 2002 final personal income tax PA-American Water Co. - water bill PPL Co electric bill Verizon - telephone bill TOTAL (Also enter on line 10, Recapitulation) AMOUNT 457.34 88.50 185.00 240.20 358.00 11.70 31.13 13.27 1,385.14 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV- 1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA IN HERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Edwin C. Blouch SS# 172-01-1016 01/01/2003 NUMBER I1. SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and tra~fers under Sec. 91 l~a)(1.Z)] Beverly J. Baker 215 N. Locust Point Road Mechanicsburg, PA 17050-2621 Natalie G. Blouch 917 Spring Circle Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Daughter FILE NUMBER AMOUNT OR SHARE OF ESTATE 50% of residue 50% of residue ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DI$'~ HIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS $ 0.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHI=I:. I (If more space is needed, insert additional sheets of the same size) Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-0o) BUREAU OF ZNDZVZDUAL TAXES TNHERZTANCE TAX DIVZS/ON DEPT. 180601 HARRTSBURG) PA 17118-n60! CONNONNEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSMENT OF TAX GARY L JANES :~'~'~r JAHES ETAL 15q SIPE AVE ~.. HUNHELSTONN PA 17~;$6 RE¥-16~17 EX AFP C01-03) DATE 11-03-Z005 ESTATE OF BLOUCH EDNZN C DATE OF DEATH 01-01-2005 FZLE NUNBER 21 03-0281 COUNTY CUHBERLAND ACN 101 Amoun~ Remi~ad J HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REG[STER OF ~[LLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THTS LZNE ~ RETATN LONER PORTZON FOR YOUR RECORDS -M REV-1547 EX AFP (01-03) NOTZCE OF ZNHERTTANCE TAX APPRA]:SENENT, ALLONANCE OR DTSALLONANCE OF DEDUCTTONS AND ASSESSHENT OF TAX ESTATE OF BLOUCH ED,/TN CFZLE NO. 21 03-0281 ACN 101 DATE 11-03-2005 TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATZON CONCERN]:NG FUTURE TNTEREST - SEE REVERSF APPRAZSED VALUE OF RETURN BASED ON: ORIGZNAL RETURN 1. Reel Es~a~a (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Par~nership Zn~aras~ (Schedule C) ($) q. Hor~gages/No~as Receivable (Schedule D) (~) $. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) 6. Jointly Owned Propar~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Assa~s APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Cos~s/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabili~/as/Lians (Schedule 1) (10) 11. To,al Daduc~/ons 12. Ne~ Value of Tax Re*urn .O0 .00 .00 .0O 2~3ql .8q 15~772.07 825~015.85 27,956.86 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his form w/~h your ~ax payment. 13. NOTE: ASSESSHENT OF TAX: 15. Aaoun~ of L/ne lq a~ Spousal re~e (15) 16. Amoun~ of L/ne lq ~exeble a~ Lineal/Class A ra~a (16) 17. Amoun* of Line lq at Sibling re~:e (17) 18. Amoun* of Line lfi ~axabla a~ Collateral/Class B re~e (18) 19. Principal Tax Due rAX CREDTTS: 8qS,129.7q ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. DZ$COUNT [NTEREST/PEN PAID (-) 1,578.95 .00 AMOUNT PAZD 30,000.00 5,0ql.50 PAYMENT DATE 03-28-2005 09-26-2003 CD002566 CD005065 RECEZPT NUMBER · O0 X O0 = . O0 813,787.7~ x OqS= 36,620.q5 · O0 X 12 : . O0 · 00 X 15 = .00 (19)= 56,620.q5 TOTAL TAX CREDZT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE 56,620.q5 .00 .00 .00 ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU MAY BE DUE A REFUND· SEE REVERSE SZDE OF TH/S FORM FOR /NSTRUCTZONS.) Charitable/governmental Bequests; Non-elec~ed 9113 Trusts (Schedule J) (13) . O0 Ne~: Value of Es~:a~:e Sub.~ec~: ~:o Tax (1(,) 815,787.7q :Zf an assesseent t~as issued pr'eviously~ lines 1~, 15 and/oe 16, 17, 18 and 19 will ee~lect ~iguees that lnclude the tota! of ALL eetuens assessed to date. 1~585.1q (11) ~9 .~q2. (12) 815,787 RESERVATION: Estates of decedents dying on or before December 12, 1981 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate far life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DZSCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act ZS of ZOO0. (71 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Heke check or money order payable to: REGISTER OF NZLLS, AGENT A refund of a tax credit, ahich 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 Hills, any of the 13 Revenue District Offices, or by calling the special Z4-hour ansaering service for forms ordering: 1-B00-362-2050; services for taxpayers eith special hearing and / or speaking needs: 1-800-q47-3010 (TT only). Any party in interest not satisfied aith tho appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as sheen on this Notice must object aithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZSIOZ1, Harrisburg, PA 171Z8-1011, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviea Unit, Dept. ZS06Ol, Harrisburg, PA 17118-0601 Phone (717) 787-650S. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1SOl) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedant's death, a five percent (SI) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of death, to the date of payment. Taxes ehich became delinquent before January l, 19BI bear interest at the rata of six (61) percent per annum calculated at a daily rate of .000164. All taxes ehich became delinquent on and after January l, 1982 mill bear interest at a rate ahich mill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19BZ through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Yea.__r Rate Factor 1981 ZOZ .0005q8 1987 91 .000147 1999 71 .000191 1985 16X .000438 1988-1991 llZ .000301 ZOO0 8Z .OOOZI9 1984 llZ .000501 1991 91 .000247 ZOOZ 9Z .D00247 1985 131 .000556 1993-1994 7Z .O0019Z 2002 62 .000164 1986 lOX .000274 1995-1998 91 .000Z47 ZOOS 51 .000137 --Interest is calculated as folloas: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated.