HomeMy WebLinkAbout03-0325PETITION
Estate of Mary A. MS]]Er No.
also known as Mary W. Miller To:
Mary B. Miller Register of Wills for the
Social Security No. ] 62-10-6095Deceased'
County
of
Cumberland
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of ag%or_older an the executrix
in the last will of the above decedent, dated ouly 21
and codicil(s) dated
FOR PROBATE and GRANT OF LETTERS
in the
named
,19 67
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
er .laslfamily or principal residence at 325 wesley Drive Mechanicsburq
/050
(list street, number and muncipality)
Decendent, then.. 91 years of age, died March 12, 2773 ~ ,
at Holy Spirit Hospital
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:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(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:
3538.38
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters
theron.
request(s) the probate of the last will and codicil(s)
testamentary
(testamentary; administration c.[.a.; administration d.b.n.c.t.a.)
-o o
OATH OF-PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA -~
COUNTY OF _~~_~ar~J _~ ss
The petitioner(g) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this /I -to day of
- ter
/ ~-/,~ ,V-/..2../
No.
Estate Of
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated
described therein be admitted to probate and filed of record as the last will of
and Letters I
are hereby granted to ~,e~ V-,I 0_~q~xto~,t~h-r
1~2.~_, in consideration of the petition on
FEES
Probate, Letters, Etc. $ ~.,O:D
S~__~_~ficates( ) .......... $ ~.eVo
R~hun~iafi0n ................ $. d,. o_ o
TOTAL $ ~.~. ~
Filed ...~. 1.. ! !t..~.OO~ ............
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat.
request of testat.__
other subscribing witness(es)).
., sign the same and that signed as a witness at the
in ~__ presence and (in the presence of each other) (in the presence of the
Sworn to or affirmed and subscribed before
me this day of
19.__
Register
(Name)
(Address)
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
testat~.~_ of (zv_e of thc.
that I ko ,~
to the best of--~. ,,,'n~ --I knowledge and belief.
Sworn to or affirmed and subscribed before
me this l ~ *~ day of
familiar with the signature of ~ac, t21 D3~llt:,o.~
......... : ....... ~) the will presented herewith and
codicil
believe~the signature on the will is in the handwriting of
(Name)
(Address) ~ - - ~ L'~OSg
(Name)
(Address)
of
Mary A. Miller
I, Mary A. Miller, of Huntington Township, Adams
County, Pennsylvania, do hereby make, publish and declare this to be my
last will and testament, hereby revoking and making void any and all former
wills by me at any time heretofore made.
FIRST: I direct my hereinafter named executrix to pay all of
my just debts, funeral and administration expenses as soon after my death
as practical.
SECOND: I give and bequeath the sum of One Hundred
($100.00) Dollars to Sunnyside Cemetery Association for perpetual care and
u~)keep of the Whitcomb lot.
THIRD: I give and bequeath the sum of One Hundred
($100.00) Dollars to the York Springs Methodist Church.
FOURTH: I give and bequeath unto my husband, Paul E.
Miller, a life estate in all my furniture, furnishings and home located on
Route 15 (East Side) in Huntington Township, Adams County, Pennsylvania
for and during the term of his natural life or until he should remarry.
FIFTH: In the event my husband, Paul E. Miller, dies or
remarries, in either event, I give, devise and bequeath all of my furniture,
furnishings and home unto my daughter, Karen E. Showers, or her issue,
in equal shares, share and share alike. In the event that any of the issue
of my daughter are under the age of twenty-one (gl) years of age said minor's
Mary A .~iller
(SEAL)
share I give, devise and bequeath unto the Gettysburg National Bank, IN
TRUST, NEVERTHELESS:
(a)
To take, manage, invest, sell and reinvest the same
from time to time in legal investments under the laws
of the Commonwealth of Pennsylvania, and to collect
and receive the rents, income, shares and profits
therefrom, and to accumulate the income thereof, and
(b)
To pay out of the income, or the corpus if necessary,
for the support, maintenance and education of said grand-
child, such sum as it shall in its discretion deem prudent.
(c)
Upon said minor grandchild reaching the age of twenty-one
(Z1) years to pay over any balance of income and
interest to said minor grandchild.
(d) This trust to remain open at all times to receive other
sums of money that may be added thereto.
SIXTH: I give and bequeath any vehicle I may own at my
death, my glassware in the china closet, and my silverware in the silver
chest, unto my daughter, Karen E. Showers.
SEVENTH: I hereby direct my executor in placing a construction
on my said will in the event that both my husband, Paul E. Miller, and I shall
die as the result of a common accident or disaster, that even if it is positively
proven that my husband survived me, yet, if his death followed mine so closely
that he did not have the actual enjoyment of the bequest and devises to him in
this will, my said will shall be considered as though he had died before me and
the provisions applicable to such event shall then be in force.
EIGHTH: I hereby direct that all inheritance tax, death transfer
tax or estate tax whether be local, state or federal should be paid out of the
residue of my estate and any bequest given herein shall be free and clear of
said tax.
NINTH:
I hereby nominate, constitute and appoint my daughter,
-Z-
MarS/A. M~er - -
(SEAL)
Karen E. Showers, executrix of this my last will and testament. In the event
that she predeceases me, I hereby nominate, constitute and appoint the
Gettysburg National Bank, executor of this my last will and testament. I aleo
direct that they shall not be required to give bond for the faithful performance
of their duties as such, and I hereby authorize and empower them to sell any
and all property, real or personal, upon such terms as they see fit, at public
or private sale, and power to effect the necessary conveyances therefor as I
could do if living.
IN WITNESS WHEREOF, I, Mary A. Miller, the testatrix,
have to this my last will and testament, written on three (3) sheets of paper,
set my hand and sealthis ~ f~ day of , 1967.
Signed, sealed, published and
declared by the above named
testatrix, Mary A. Miller, as
and for her last will and testa-
ment, in the presence of us,
who, at her request, in her
presence and in the presence
of each other have hereunto
subscribed our names as wit-
nesses hereto.
.~~ ~
Mary A. ~ller
-3-
Mary A. Miller
EUGENE R. HARTMAN
ATTOR N EZY AT LAW
GETTYSBURG, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Mot'"'] /4, flail/cc'
Date of Death:
WillNo. ~LI- 03--O,3)-~' I Lr)03-O031-~- Admin. NO.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orph~ans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on /4--30- 93 :
Name
Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: ~'- ~-'~- 03
Signature
Name Do ;pl O. wool..--/
.
Address ~71-F {._a¢ithOrt b°/]t'-3
b'~h 5p,','%5, P/~ /-2372
Telephone (?l'~) 5.)._3 -- a/c~'O q
Capacity: __ Personal Representative
Counsel for personal representative
COHHONHEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
DUREA~ OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 17128-0601
REV-i~Ii3 EX AFP C09-00)
ZNFORHATZON NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 05-0325
ACN 05117262
DATE 0q-25-2003
KAREN E CARTNRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
TYPE OF ACCOUNT
EST. OF HARY A MILLER ~-~SAVTNGS
S.S. NO. 162-10-6095 [] CHECK/HQ
DATE OF DEATH 03-12-2003 [] TRUST
COUNTY CUMBERLAND [] CERTIF.
REN/T PAYHENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ADAHS COUNTY NATIONAL BANK has provlded the Department Pith the information 11stad beloa which has been used in
calculating the potential tax duo. Their records lndicata 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 free 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 Laos of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART I BELOW # x x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 130519 Date 11-15-1995
Established
Account Balance 2,01~. q 7
Percent Taxable X 5 0.0 0 0
Amount Subject ~o Tax 1
Tax Rate X .0~5
Potential Tax Due q5
To insure proper credit to your account, two
(Z) copies of this notice must accompany your
payment to tho Register of Hills. Hake check
payable to: "Register of #ills, Agent".
.NOTE: If tax payments are made within three
$) months of the dacedent's date of death,
you may deduct a SZ discount of the tax due.
Any inheritance tax due Nil1 become delinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
CHECK
ONE
BLOCK
ONLY
A. ~Tha above information and tax due is correct.
1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
8. ~ The above asset has been or wilI ba reported and tax paid with
the
Pennsylvania
Inheritance
Tax
return
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 coepl,te PART [] and/or PART [] below. ~ ~
PART If you indicate a different tax rate, please s~ate your
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established
Account Balance 2
Percent Taxable $ ~
Amount Subject to Tax q
Debts and Deductions ~ -
Amount Taxable 6
Tax Rate 7 ~
Tax Due 8.
DEBTS AND DEDUCTIONS CLAIMED
PAYEE DESCRIPTION AMOUNT PAID
I I
TOTAL (Enter on Line $ of Tax Computation)
PART
DATE PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct end
COllplete to the best of my knowledge and belief. HOME C r~.~ ) r~qb_ tS|~
TAXPAYER S[GNAT~E ~ TELEPHONE NUHBER DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT ~N AN OFF/C~AL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance tax becomes delinquent nine months after the dacedent's date of death.
3. A joint account is taxable even though the decedant's name was added as a matter of convenience.
~. Accounts (including those held between husband and eife) which the decedent put in joint names within one year prior to
death ara ~ully taxable as transfers.
S. Accounts established jointly between husband and wi~e more than one year prior to death are not taxableo
6. Accounts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice are correct and deductions ara not being claimed, place an "X"
in block "A" of Part I of the "Taxpayer Response" section. Sign tad copies and submit them with your check ~or the amount of
tax to the Register of Nills of the county indicated. The PA Department of Revenue will issue an official assessment
(Fora REV-15fiB EX) upon receipt of the return from the Register of Nills.
Z. BLOCK S - If the asset specified on this notice has been or mill be reported and tax paid elth the Pennsylvania Inheritance
Tax Return filed by the decadant's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dapt Z80601, Harrisburg, PA 17128-0601 in the
envelope provided.
5. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts Z and
according to the instructions beloe. Sign two copies and submit thee with your check for the amount of tax payable to the Register
of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-15¢B EX) upon receipt
of the return from the Register of Nills.
TAX RETURN - PART 2 TAX COMPUTATION
LINE
1. Enter the date the account originaIly was established or titled in the manner existing at data of death.
NOTE: For a decedent dying after 12/12/82: 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 $5,000 par transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (xx) appears before your first name in the address portion of this notice, the $5,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
Enter the total balance of the account including interest accrued to the date of death.
5. 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 dacedent's death:
I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT ONNERS SURVIVING JOINT ONNERS
Example: A joint asset registered in the name of the decedent and two other persons.
1 DIVIDED BY ~ (JOINT ONNERS} DIVIDED BY 2 (SURVIVORS) = .167 X lO0 = 16.7Z (TAXABLE FOR EACH SURVIVOR)
B.The percent taxable for assets created within one year of the dacadent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 PERCENT TAXABLE
ONNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by
the decedent.
I DIVIDED BY 2 (SURVIVORS) = .50 X 100 = 50Z (TAXABLE FOR EACH SURVIVOR)
The aaount subject to tax (line ~) is determined by muLtiplying the account balance (line 2) by the percent taxable (line 5).
S. Enter the total of the debts and deductions Listed in Part 5.
The amount taxable (line 6) is deterainad by subtracting the debts and deductions (line 5) frae the amount subject to tax (line
7. Enter the appropriate tax rata (line 7) as detarained below.
Date of Death Spouse Lineal ' Sibling Collateral
07/01/9q to 12/$1/9q 3X 6X 15X
01/01/95 to 06/30/00 OX 6Z
07/01/00 to present OX q.SX~ 12Z 15X
xThe tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at
death to or ~or the usa of e natural parent, an adoptive parent, or a stepparent of the child is OZ.
The lineal class of hairs includes grandparents, parents, children, and lineal descendents. "Children" includes nature! children
whether or not they have been adopted by others, adopted children and step children. "LineaL descendents" includes a11 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 common with the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS PART $ - DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally ara responsible for payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must bo itemized fully in Part 5. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of
payment may be requested by the PA Department of Revenue.
CONNONNEALTH OF PENNSYLVANIA
DfPARTHENT OF REVENUE
~UR~AU OF~ IND/V~DUAL TAXES
DEPT. ZB0601
HARRISBURG, PA 17128-0601
REV-USdS EX AFP (09-00)__
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
ZNFORHATZON NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 05-03Z5
ACN 05117Z65
DATE 0q-25-2005
TYPE OF ACCOUNT
EST. OF MARY A MILLER [] SAVINGS
S.S. NO. 162-10-6095 [] CHECKING
DATE OF DEATH 05-12-Z005 [] TRUST
COUNTY CUMBERLAND [] CERTTF.
RENTT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
ADAHS COUNTY NATZONAL BANK has provided the Department aith the information listed bales ehich 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. ~f you feel this information is incorrect, please obtain written correction from the financia! institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance eith the Inheritance Tax Lams of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) ?87-&3ZT.
COMPLETE PART 1 BELOW x # # SEE REVERSE SIDE FOR FILING AND PAYMENT ZNSTRUCTIONS
Account No. 1~9092 Data 10-11-1999
EstabZished To insure proper credit to your account, two
(Z) copies of this notice must accompany your
Account Balance 19,155.92 Payment to the Register of Hills. Hake check
Percent Taxable X 50. 000 payable to: "Register of Rills, Agent".
Amount Subject to Tax 9 · 567.96 NOTE: Tf tax Payments are made .ithin three
~'* ($) months of the decedent's date of death,
Tax Rate X · 0~5 you may deduct a 57. discount of the tax due.
Potent/a! Tax Due qSO. 56 ~ 0~_. Any inheritance tax due ail! become delinquent
PART · nine (9) months after the date of death.
TAXPAYER RESPONSE
CHECK _~ a discount or avoid ]ntarest, or you may check box
ONE Hills and an official assessment mill be issued by the PA Department of Revenue.
BLOCK a. [] The above asset has been or will bo reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to be filed by the decedent0s representative.
C. [] The above information is incorrect and/or debts and deductions
You must coep~sta PART [] and/or PART [] below, were paid by you.
PART Tf you 1nd/cate a d~fferant tax rate~' please state your
[~ relationship to decadent:.
TAX RETURN - COMPUTATION OF TAX ON J~INT/TR~ST
LTNE 1. Data Established
2. Account Balance
~. Percent Taxable $.
q. Amount Subject to Tax
5. Debts and Deduct/ons $ -
6. Amount Taxable 6_
7. Tax Rate 7 X
8. Tax Due
PART
~ DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOT nter on L/ne $ of Tax Co
Under penalties of perjury, Z declare that the facts T have reported above are true· correct and
complete to the bast of my knowledge and belief.
TEL~ DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND #ILL RESULT ZN AN OFFICIAL TAX ASSESSHENT with applicable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the decadent's date of death.
$. A joint account is taxable even though the decedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and mile} which the decedent put in joint names within one year prior to
death ara fully taxable as transfers.
5. Accounts established jointly bat~ean husband and aife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others ara taxable fully.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
l. BLOCK A - If the information and computation [n the notice ara correct and deductions are not being claimed, place an
in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit thee aith your check for the amount of
tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1548 EX) upon receipt of the return fram the Register of Hills.
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 dacedant's representative, place an "X" in block "D" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to tho PA Department of Revenue, Bureau of Individual Taxes, Dept LB0601, Harrisburg, PA 171ZB-0601 in the
envelope provided.
5. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and comp[eta Parts Z and
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of Hills of the countY indicated. The PA Department of Revenue mill issue an official assessment (Form REV-1548 EX) upon race[pt
of tho return from the Register of Hilts.
TAX RETURN - PART Z - TAX COMPUTATION
LINE
1. Enter the data tho account originally mas established or titled in the manner existing at date of death.
NOTE: For a decedent dying after II/II/SI: Accounts ahich 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 $$,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (xx) appears before your first name in the address portion of this notice, the $5,000 exclusion
already has been deducted fram the account balance as reported by the financial institution.
Z. Enter the iota[ 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 falIows:
A. The percent taxable for joint assets established'more than one year pr[or to the decedant's death:
! DIVIDED BY TOTAL NUMBER OF DIVIDED DY TOTAL NUMBER OF X lO0 = PERCENT TAXABLE
JOINT ONNERS SURVIVING JOINT O#NERS
Example: A joint asset registered in the name of the decedent and two other persons.
I DIVIDED BY $ (JOINT OHNERS) D/VIDED BY Z (SURVIVORS) = .167 X lO0 = 16.7Z (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):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X lO0 = PERCENT TAXABLE OHHERS OR TRUST BENEFICIARIES
Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by
the decedent.
I DZVZDED BY Z (SURVIVORS) = .SO X 100 = 50Z (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (IJna 6) is determined by subtracting the debts and deductions Clina 5) from the amount subject to tax (Iina
7) determined below.
7. Enter the ap~
. Collateral
Da~e of Death Spouse Lineal S/bling
07/01/9~, ~o 12/$1/9q SX 6X
01/01/95 ~o 06/30/00 OZ 6Z
07/01/00 ~o presen~ OX
*~
,munger at
~The tax rate
death to or for the use of a natural parent, on adoptive parent, or a stepperant
The lineal class of hairs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or nat 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 mbo have at least one parent in common with the decedent, ahather by blood
or adoption. The "Co[lateral" class of halrs includes all other beneficiaries-
CLAIMED DEDUCTIONS - PART ~ - DEgTS AND DEDUCTIONS CLAIHED
Allowable debts and deductions ara determined as follows:
A. You legally ara responsible for payment, or the estate subject to administration by a personal representative is insufficien~
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claiaad must be itemized fully in Part
payment amy be requested by the PA Department of Revenue.
O~
COMMONHEALTH OF PENNSYLVANIA
DD~ARTHENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 17128-06D!
REV-25~5 EX AFP (09-00)
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 05-05Z5
ACN 0511726q
DATE 0q-25-2005
KAMEN E CARTNRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
EST. OF MARY A MILLER
S.S. NO. 162-10-6095
DATE OF DEATH 05-12-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
O SAVINGS
[] CHECKINg
[] TRUST
[] CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
ADAMS COUNTY NATIONAL BANK has provided the Department Nlth the information listed below which has been used in
calculating the potantial tax due. Their records indicate that at the death of the above decedent, you mere a joint owner/beneficiary of
this account. Zf you feel this information is incorrect, please obtain aritten correction free 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. Questions may be answered by calling (717) 787-8527.
COMPLETE PART ! MELON N N # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 13q259 Date 11-19-1996
Established
Account Balance Z, 016.15
Percent Taxable X 5 0 . 0 0 0
Amount Subject to Tax 1,008.08
Tax Rate X .045
Potential Tax Due
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Hills. Hake check
payable to: "Register of Hills, Agent".
(OTE: If tax payments are made within three
5) months of the decedmnt's date of death,
you may deduct a 5X discount of the tax due.
OC~) Any inheritance tax due will become delinquent
45.56 CL~, nine (9) months after the date of death.
PART TAXPAYER RESPONSE
A. ~The above information and tax due is correct.
You may choose to remit payment to the Register of Hills 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 ~ Hills and an official assessment will bm issued by the PA Department of Revenue.
BLOCK J a. [] The above asset has been or will be reported and tax paid with the Pennsylvania Tnheritance Tax return
ONLY to be filed by the decedent's representative.
C. [] The above information is~incorrect end/or__debts and deductions mere paid by you.
You must complete PART III and/or PART I~l 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 I
2. Account Balance 2.
3. Percent Taxable $ ~
q. Amount Subject to Tax ~
5. Debts end Deductions ~ -
6. Amount Taxable 6,
7. Tax Rate 7 ~
8. Tax Due 8.
PART
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line $ of Tax Computation) $
Under penalties of perjury~ Z declare that the facts I have reported above ere true. correct and
complete to the best of my knowledge end belief. HOME ( ~-~ ) ~-~c[(~_ I%~
TAXPAYER SIGNATURE 0'' TELEPHONE NUMBER DATE
GENERAL ZNFORHATZON
1. FAZLURE TO RESPOND #ZLL RESULT ~N AN OFFZCZAL TAX ASSESSNENT Nith applioable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the decadent's date of death.
3. A joint account is taxable even though the decedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly betaeen husband and wi~ more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or othersare taxable fully.
REPORTING iNSTRUCTiONS - PART ! - TAXPAYER RESPONSE
l, 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 I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Nagistar of Nills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-IS48 EX) upon receipt of the return from the Register of Hills.
2. 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, Dapt ga0601, Harrisburg, PA ITIZ&-060! in tho
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and 3
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of #ills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-IS4D EX) upon receipt
of the return from the Register of NAils.
TAX RETURN - PART Z - TAX CONPUTATION
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 la/Ia/BI: Accounts which the decedent put in joint names within eno (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 er the number of accounts held.
If a double asterisk (ma) 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.
The percent of the account that is taxable for each survivor is determined as
A. The percent taxable for joint assets established more than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X X00 = PERCENT TAXABLE
JOINT ONNERS SURVIVING JOINT ONNERS
Example: A joint asset registered in the name of the decedent and tad other persons.
! DIVIDED BY 3 (JOINT ONNERS) DIVIDED BY Z (SURVIVORS) = .Z67 X ZOO = 16.TZ (TAXABLE FOR EACH SURVIVOR)
B.The percent taxable for assets created within one year of the dacedent's death or accounts oanad by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 PERCENT TAXABLE
ONNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the nasa of the decedent and two other persons and established within Dna year of death by
the decedent.
1 DIVTDED BY Z (SURVIVORS) = .SO X ZOO = SOl (TAXABLE FOR EACH SURVIVOR)
The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line
Enter the total of the debts and deductions listed in Part 5.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line S) from the amount subject to tax (line
7. Enter the appropriate tax rate (line 7) ms determined beloa.
Date of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/$1/94 SZ 6Z
01/01/95 to 06/30/00 OZ 6Z ISZ lSZ
07/01/00 to present OZ
~Tha 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 stapparant of the child is OZ.
Tho lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
ahether or not they have been adopted by others, adopted children and stap children. "Lineal descendents" includes all children of the
natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings" ara defined as individuals who have at least Dna parent in common with the decedent, ahathar by blood
or adoption. The "Collateral" class cf heirs includes all other beneficiaries.
CLATHED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTTONS CLAZHED
Allowable debts and deduct[one are determined as follows:
A. You legally are responsible ~or payment, or the emote subject to administration by a personal representative ~s [nsu;;Jc[ent
to pay the deductible items.
B. You mc~aZLy paid the debts after death of the decedent ~d can furnish proof of payment.
C. Debts being clai;ed must be itemized fully in Part 5. If additional space Js needed, use plain paper 8 l/Z" x 11". Proof of
payment may be requested by ~g PA Department of Revenue.
0
COHHONHEALTH DF PENNSYLVANIA
DE~ARTHENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT, Z80601
HARRISBURG, PA 17128-0601
REV-15(i5 EX AFP (09-00)
ZNFORHATZON NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 05-0325
ACN 05117265
DATE 04-25-2005
KAREN E CARTNRIGHT
495 LEXINGTON AVE
MECHANICSBURG PA 17055
TYPE OF ACCOUNT
EST. OF MARY A MILLER [] SAVINGS
S.S. NO. 162-10-6095 [] CHECKING
DATE OP DEATH 03-12-2005 [] TRUST
COUNTY CUMBERLAND [] CERTIF.
REHIT PAYNENT AND FORHS TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ADANS COUNTY NATIONAL BANK has provided the Department with the information listed bales ahlch has been used in
calculating the potential tax due. Their records indicatm that at the death of the above decedent, you were a ~oint owner/bmneficiary 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 aith the Inheritance Tax Laws of the Coamonaaalth
of Pennsylvania. Questions may be ensnared by calling (717) 787-8327.
CONPLETE PART 1 BELON # # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account Ho. 149096 Date 10-11-1999
Established
Account Balance 11,590.37
Percent Taxable X 5 0.0 0 0
Amount Sub,act to Tax 5,795.19
Tax Rata X · 045
Potential Tax Due Z60.78
To insure proper credit to your account, tho
(Z) copies of this notice must accompany your
payment to the Register of Rills. Hake check
payable to: "Register of Rills~ Agent".
~t..~OTE: If tax payments arm mede eithin three
3) months of the dacedmnt's date of death,
you may deduct a 5Z discount of the tax due.
Any inheritance tax due ail1 become delinquent
PART TAXPAYER RESPONSE
A. ~ The above information and tax due is correct.
CHECK
ONE
BLOCK
ONLY
You may choose to remit payment to the Register of Hills with too copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
#ills and an official assessment will be issued by the PA Department of Revenue.
B. [] The above asset has been or will be reported and tax paid mith the Pennsylvania Inheritance Tax return
to be filed by the decadsnt's representative. ~-~; ~
C. The above information is incorrect and/or debts and deductions mare paid ~ ~D
You must complete PART [] and/or PART [] beloa. , ' ,,-,,:: ~:i::?
PART If you indicate a differen~ tax rate, please state your
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established I
DEBTS AND DEDUCTIONS CLAIMED
2. Account Balance
$. Percent Taxable
~. Amount SubSect to
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
DATE PAID
PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line $ of Tax Computation)
Under penalties of perjury, T declare that the facts ! have reported above are true, correct and
the best of my knowledge and ballef. HOME (
TAXPAYER SIGNATURE ~ TELEPHONE NUNBER DATE
GENERAL INFORHATZON
1. FAILURE TO RESPOND HILL RESULT XN AN OFFICIAL TAX ASSESSNENT ./th applicabla interest based on information
submitted by tho financial institution.
2. Inheritance tax becomes dalinquent nine months after the dacadant"s date of death.
3. A joint account is taxable even though the decedent's name ems added as a matter of convenience.
4. Accounts (including those held between husband and wife) ehich the decedent put in joint names within ane year prior to
death are fully taxable as transfers.
S. Accounts established jointly between husband and wife more than Dna year prior to death are nat taxabIa.
6. Accounts heLd by a decedent "in trust for" another or others are taxabLa fuIly.
REPORTTNG INSTRUCTIONS - PART I - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X"
in black "A" of Part 1 of the "Taxpayer Response" saction. Sign two copies and submit them with your check for the amount of
tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form RE¥-lS48 EX) upon receipt of the return from tha Register of Hills.
Z. BLOCK B - If the asset specified on this notice has been or wil! be reported and tax paid with the PennsyIvania inheritance
Tax Return filed by the decedant's rapresantative, piece an "X" in bLock "B" of Part ! of the "Taxpayer Response" section. Sign one
copy and return to the PA gapartment of Ravanue, Bureau of IndividuaL Taxes, Dapt ZBO60I, Harrisburg, PA 17LIB-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions are being ctaimed, check block "C" and comptete 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 Nitls of the county indicated. The PA Department of Revenue will issue an official assessment (Fore REV-154B EX) upon receipt
of the return frae the Ragister of Wills.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Enter the date the account originally was establishad ar titled in the manner existing at date of death.
NOTE: For a decedent dying after 1Z/lZ/Bg: Accounts which the decedent put in joint names within one (1) year of death ara
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 par transferaa regardlass of the value of
the account or the number of accounts held.
If a double asterisk (wu) appears befora your first male in the address portion of this notica, the $3,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to tha date of death.
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:
I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X IO0 = PERCENT TAXABLE
JOINT OHNERS SURVIVING JOINT ONNERS
Example: A joint asset registered in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OHNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR)
B.The percent taxable for assets created within one year of the dacadant's death or accounts ownad by the decadent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE
OHNERS OR TRUST BENEFICIARIES
Example: Joint account registered in tha name of the decedent and two other persons and established within one year of death by
the decedent.
I DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50Z (TAXABLE FOR EACH SURVIVOR)
The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (1ina
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line
7. Enter the appropriate tax rate (line 7) es daterained below.
Date of Death Spouse Lineal Sibling Collateral
07/01/9q ~o 12/$1/9q SZ 6Z
01/01/95 ~o 06/30/00 OX 6X
07/01/00 ~o presan~ OX
xThe tax rate laposed on the net value of transfers from a deceased child twenty-one years of age or younger at
death to or ~or the use of a natural parent, an adoptive parent, or a stepparent of the child is OZ.
The tinsel class of heirs includes grandparents, parents, children, and Lineal descendents. "Children" includes natural children
~hether or not they have been adopted by others, adopted chiIdren and step chiLdren. "LineaI descendents" includes aL1 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 common with the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS PART $ - DEBTS AND DEDUCTIONS CLATMED
Allowable debts and deductions are determined as follows:
A. You legally are resppnsible 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 ~urnish proof of payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/Z" x 11". Proof of
payment may be requested by the PA Department of Revenue.
COHNONNEALTH OF PENNSYLVANIA
DEP~RTNENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT, zeo601
HARRISBURG, PA 171Z8-0601
REV-~.$~i5 EX AFP
ZNFORHATZON NOTZCE
AND
TAXPAYER RESPONSE
KAREN E CARTNRIiHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
FZLE NO. 21 03-0325
ACN 05117266
DATE 0q-25-200:5
TYPE OF ACCOUNT
EST. OF MARY A MILLER []SAVTNGS
S.S. NO. 162-10-6095 [] CHECK/Ne
DATE OF DEATH 0:5-12-200:5 [] TRUST
COUNTY CUMBERLAND [] CERTTF.
RENTT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
ADAMS COUNTY NAT/aNAL BANK 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 Mere 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 Coeaonwealth
of Pennsylvania. Questions may be answered by calllng (717) 787-8327.
COMPLETE PART I BELON# # # SEE REVERSE SXDE FOR FXLZNG AND PAYMENT XNSTRUCTZONS
Accoun* No. 1r+909fi Da*a 10-11-1999 To insure proper credit to your account, tho
Established (Z) copies of this notice must accompany your
payment to the Register of Mills. Hake check
Accoun~ Balance 5,851.77 payable to: "Register of Milts, Agent".
Percen~ Taxable X 50.000
~.NOTE: If tax payments are aada within three
Amoun~ Subjec~ ~o Tax 2,925.89 ~r ($) months of the decedent's data of death,
Tax Ra~e X .0~5 you may deduct a 5Z discount of the tax due.
Po*an*ia1 Tax Due 1:51 67 ~L~S,~)~ Any inheritance tax due w111 become delinquent
· nine (9) months after the date of death.
PART TAXPAYER RESPONSE
I. ~The above information and tax due is correct.
1. You may choose to remit payment to the Register of Nills 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 ~ Mills and an official assessment will be issued by the PA Department of Revenue.
BLOCK J s. [] The above asset has been or ail1 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 ~ you.
You must complete PART and/or PART below. ~ ¢~ ~ ~
PART Tf you /nd/ca~e a diffaren~ ~ex ra~e, please s~a~e your
relationship ~o decedent:
TAX RETURN - COMPUTATZON OF TAX ON JOZMT/TRUST ACCOUNTS
L/NE 1. Da~e Established 1
2. Accoun~ Balance 2
:5. Percen~ Taxable $ ~[
~. Aeoun~ Subject: ~o Tax ~
$. Debts and Deduc~/ons 5 -
6. Amoun'l: Taxable 6
7. Tax Ra~e 7 }(
8. Tax Due 8
PART DEBTS AND DEDUCTZONS CLAZMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on L/ne $ of Tax Computation) $
Under penalties of perjury, / declare ~ha~ ~he fac~s / have reported above ara ~rue, correc~ and
complete ~o ~he bas~ of my knowledge and belief. HOME (
TAXPAYER' SIGNATURE J TELEPHONE NUMBER DATE
6ENERAL INFORHATION
1. FAILURE TO RESPOND HILL RESULT IN AN OFFICIAL TAX ASSESSNENT Nith applicable interest based on information
submitted by tho financial institution.
Z. lnheritanca tax becomes delinquent nine months after the decedant's date of death.
$. A joint account is taxable even though the decodent's name aaa added as a matter of convenience.
4. Accounts (including those held between husband and Nifo) which the decedent put in joint names Nithin one year prior to
death ara fully taxable as transfers.
S. Accounts established jointly betNeen husband and Nifo moro than one year prior to death are not taxable.
6. Accounts held by e decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART I TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice are correct and deductions ara not being claimed, place an
in block "A" of Part I of the "Taxpayer Response" section. Sign INa copies and submit thee uith your check for the amount
tax to the Register of Nills of the countY indicated. The PA Department of Revenue will issue an official assessment
(Form REV-15~8 EX) upon receipt of the return free the Register of Hills.
Z. BLOCK B - If the asset specified on this notice has been ar miII be reported and tax paid Nith the PennsyIvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in bIack "B" of Part I of fha "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dapt 180601, Harrisburg, PA 17128-0601 in tha
envelope provided.
5. BLOCK C - If the notice information is incorrect and/or deductions are being cIaimed, check bIock "C" and compIeto Parts Z and
according to the instructions beloN. Sign tho copies and submit thee Nith your check for the amount of tax payable to the Register
of #ills of the county indicated. The PA Department of Revenue ~ill issue an official assessment (Farm REV-154B EX) upon receipt
of the return free tho Register of NJlls.
TAX RETURN - PART Z - TAX COHPUTATION
LiNE
1. Enter the date tha account originally Nas established or titled in the mannar existing at date of death.
NOTE: For a decedent dying after 11/11/81: Accounts Nhich the decedent put in joint names Nithin one (1) year of death are
taxable fully as transfers. HaNover, there is an exclusion not to exceed $5,000 per transferee regardless of the value
the account or tha number of accounts held.
If a double astarisk (xe) appears before your first naae in fha address portion of this notice, the $5,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
Enter the total balance of the account including interest accrued to the date of death.
5. The percent of the account that is taxable for each survivor is determined as follo~s:
A. The percent taxable for joint assets established more than one year prior to the decedent's death;
1 DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUHBER OF X 100 = PERCENT TAXABLE
JOINT ONNERS SURVIVING JOINT ONNERS
Example: A joint asset registered in the name of the decedent and tho other persons.
I DIVIDED BY 5 (JOTNT O#NERS) DTVZDED BY Z (SURVIVORS) = .167 X 100 = 16.77. (TAXABLE FOR EACH SURVTVOR)
B.The percent taxable for assets created Nithin one year of the decedant's death cr accounts o~ned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE
OHNERS OR TRUST BENEFICIARIES
Exaaple: Joint account rag[stared in the name of the decedent and tho other persons and established Nithin one year of death by
the decedent.
I DTVIDED BY Z (SURVIVORS) = .50 X lO0 = 5OZ (TAXABLE FOR EACH SURVIVOR)
The amount subject to tax (line ~) is determined by multiplying tho account balance (line Z) by the percent taxable (line 5).
5. Enter the total of tha debts and deductions listed in Part 5.
6. Tha amount taxabla (1ina 6] ts determinad by subtracting the debts and deductions (line 5) from the amount subject to tax (line
7. Enter the appropriate tax rate (line 7) as determined bale..
Date of Death Spouse Lineal Sibling Collateral
07/01/9q ~o 12/$1/9~ SX 6Z
01/01/95 to 06/30/00 OX 6X
07/01/00 ~o presen~ OZ q.5Z~ 12X
aTha tax rate imposed on tha net value of transfars from a deceased child t~enty-one years of aga or younger at
death to or for the use of a natural parent, an adoptive parent, or a stepparont of the child is 07..
Tho linaal class of heirs includes grandparents, parents, children, and linaal descendents. "Children" includes natural children
Nhethar or not they have been adapted by others, adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descendents, ~hether or not they have been adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings" ara defined as individuals ~ho have at least ora parent in common Nith the decedent, ~hathar by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART $ - DE]ITS AND DEDUCTIONS CLAIMED
AlieNable debts and deductions are determined as folloNs:
A. You legally are responsible for payment, or tha estate subject to administration by a personal rsprasentative is insufficient
to pay the deductible [teas.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must bo itemized fully tn Part 5. [~ add[t[onal space ~s needed~ use plain paper 8 1/Z" x 11". Proof o~
payment may be requested by ~e PA Oepar~ent o~ Revenue.
CONNONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
BUREAU DF INDIVIDUAL TAXES
DEPT. 280601
~ARR~SBURg, PA 17128-0601
REV-151:i$ EX AFP CDg-OD)
ZNFORHATZON NOTZCE
AND
TAXPAYER RESPONSE
FILE NO. 21 03-0325
ACN 03117267
DATE 0q-25-2003
TYPE OF ACCOUNT
KAREN E CARTNRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
EST. OF MARY A MILLER [] SAVINGS
S.S. NO. 162-10-6095 [] CHECKINg
DATE OF DEATH 0 3-12- 200 3 [] TRUST
COUNTY CUMBERLAND [] CERTTF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
ADAMS COUNTY NATIONAL BANK has provided the Department with the information listed below ahich has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you aero a joint Donor/beneficiary of
this account. Zf you faa1 this information Js incorrect, please obtain arittsn 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. guastions amy be answered by calling (7173 787-8327.
COMPLETE PART I BELOW ~ # ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
PART
TAX
LINE
Account No. 6q0029785
Date 04- 23-1994 To insure proper credit to your account, two
Established (2) copies of this notice must accompany your
Account Balance 13,011.08 payment to the Register of Hills. Hake check
payable to: "Register of Nills, Agent".
Percent Taxable X 5 0.0 0 0
Amount SubSect to Tax 6 · 505.54 ~- ROTE: If tax payments ara made within three
(3) months of the decsdent's date of death,
Tax Rate X .045 you may deduct a 52 discount of the tax due.
C~r~g [[) Any inheritance tax due mill become delinquent
Potential Tax Due 292.75 nine (9) months after the Gate of ....
PART TAXPAYER RESPONSE
I. ~ The above information and tax due is
1. You amy choose to remit payment to the Register of Hills aith t~o 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
ONE Hills and an official assessment will ba issued by the PA Department of Revenue.
BLOCK ~ B. [] The above asset has been ar ail1 be reported and tax paid aith tho Pennsylvania Inheritance Tax return
ONLY to be filed by the dacadant's representative.
C.
You must complete PART [] and/or PART [] below.
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
1. Date Established
2. Account Balance 2
5. Percent Taxable $
q. Amount Sub3ect to Tax
5. Debts end Deductions $ -
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
DATE PAID
DEIITS AND DEDUCTZONS CLAZMEll
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line $ of Tax Computation) $
Under penalties of perjury, Z declare that the facts I have reported above ere true, correct and
~c°mplete to thR bast of I.,, knowledge end belief. HOME ( ~'~[~ ) ~q'~ - L~ i~
TAXPAYER SIGNATURE U TELEPHONE NUMBER
GENERAL INFORHATZON
1. FAILURE TO RESPOND #ILL RESULT ZN AN OFFICIAL TAX ASSESSNENT with applicable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the decadent's date of death.
5. A joint account is taxable even though the dacedent's name was added as a matter of convenience.
q. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife more than one year prior to death are net taxable.
6. Accounts held by a decedent "in trust for" another er ethers are taxable ~ully.
REPORTING INSTRUCT[OHS - PART ! - TAXPAYER RESPONSE
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 I of the "Taxpayer Response" section. Sign two copies and submit thee with your check ~or the amount of
tax to the Register of Nills of the county indicated. The PA Department of Revenue Nil! issue an official assessment
(Fora REV-ISq8 EX) upon receipt of the return from the Register of Nills.
Z. BLOCK B - If the asset specified on this notice has been or will ba reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the dacedant'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, Oept ZOO601, Harrisburg, PA 171Za-060i in the
envelope provided.
5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and
according to the instructions below. Sign two capias and submit them with your check for the amount of tax payable to tho Register
of #ills of the countY indicated. The PA Department of Revenue will issue an official assessment (Form REV-15q8 EX) upon receipt
of the return from the Register of Nills.
TAX RETURN - PART Z - TAX COMPUTATION
LINE
Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 1Z/ii/az: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $S,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (xx) 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.
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 folIows:
A. The percent taxable for joint assets established more than one year prior to the dacedent's death:
! DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X log = PERCENT TAXABLE
JOINT ONNERS SURVIVING JOINT ONNERS
Example: A joint asset registered in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT ONNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable ~or assets created within one year of the decadent's death er accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUHBER OF SURVIVING JOINT X log = PERCENT TAXABLE
ONNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the name of the decedent and twa other persons and established within one year of death by
the decedent.
1 DIVIDED BY Z (SURVIVORS) = .SO X 100 = 50Z (TAXABLE FOR EACH SURVIVOR)
The amount subject to tax (line ~,) is determined by multiplying the account balance (line Z) by the percent taxable (line
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amaunt subject to tax (line
7. Enter the appropriate tax rate (line 7) as datarainad below.
' Date of Death ' Spouse Lineal Sibling Collateral
07/01/9q to 12/$1/9q 3X 6X 15Z lex
01/01/95 to 06/30/00 OX 6X 1.6X 15X
07/01/00 to present OX q.SX~ 12X 15X
eThe tax rata imposed on th; nat va younger at
death to or for the use of a natural parent, an adoptive parent, or a stepparant of the child is OZ.
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 common with the decedent, whether by blood
or adoption. The "Collaterar' class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART 5 - DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as fallows:
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 payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x lr'. Proof of
payment may be requested by tho PA Department of Revenue.
COHNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPTo 280691
HARRISBURG, PA 171Z8-0601
REV-1GIi$ EX AFP C09-OO)_
KAREN E CARTt/RIGHT
495 LEXINGTON AVE
NECHANICSBURG PA 17055
ZNFORNATZON NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 03-0325
ACN 03117268
DATE 04-25-2003
TYPE OF ACCOUNT
EST. OF NARY A HILLER [] SAVINGS
S.S. NO. 162-10-6095 [] CHECKZNG
DATE OF DEATH 03-12-2003 [] TRUST
COUNTY CUMBERLAND [] CERTIF.
REN'rT PAYMENT AND FORMS TO:
REGISTER OF t/ILLS
CUHBERLAND CO COURT HOUSE
CARLISLE· PA 17013
ADAHS COUNTY NATIONAL BANK has provided the Department mith the information listed beloN 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 .rittan correction from the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance .ith the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-83Z7.
COMPLETE PART ! BELOt/ ~ ~ # SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS
Account No. 1300261 Data 04-25-1989
PART
Account Balance
Percent Taxable X
Amount SubSect to Tax
Tax Rata X
Potential Tax Due
Established
To insure proper credit to your account, tWO
(2) copies of this notice must accompany your
22·828.66 PaYment to the Register of Hills. Hake check
Payable to: "Register of Nills, Agent".
50.000
11 ·414.33 ~ NOTE: If tax payments are made .ithin three
(3) months of the decedent's date of death,
· 0~ you amy deduct a SZ discount o; the tax due.
Any inheritance tax due will become delinquent
CHECK~
ONE
BLOCK
ONLY
PART
TAX
LINE
[] TAXPAYER RESPONSE
A. ~The above information and tax due is correct.
1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Hills and an official assessment .ill be issued by the PA Department of Revenue.
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. []The above information is incorrect and/or debts and deductions .ere paid by you.
You must coaplata PART []and/or PART LrS---~below.
relationship to decedent:.
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
1. Date Established I
2. Account Balance 2
3. Percent Taxable 3X
q. Aeount Sub3ect to Tax q
$. Debts and Deductions E -
6. Amount Taxable 6.
7. Tax Rata 7 ~
8. Tax Due 8__
PART
DATE PAID
PAYEE
DEBTS AND DEDUCTIONS CLAZNED
DESCRIPTION AMOUNT PAID
Under penalties of perSury, I declare that the facts I have reported above ere true/ correct end
comp/eta to the bast of my knowledge and bezier. HOME (
TE~
GENERAL INFORHATION
1. FA/LURE TO RESPOND NZLL RESULT ZN AN OFFICIAL TAX ASSESSMENT aith applicable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the decedent's date of death.
5. k joint account is taxable even though the decedant's name ems added as a matter of convenience.
4. Accounts (including those held bet#men husband and wife) which the decedent put in joint names within one year prier to
death are fully taxable as transfers.
5. Accounts established jointly bataeen husband and wife more than one year prior to death ara not taxable.
6. Accounts held by a decedent "in trust for" another or others ara taxable fully.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1o BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an
in black "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Nills of the county indicated. The PA Department of Revenue will issue an officio! assessment
(Form REV-1548 EX) upon receipt of the return from the Register of Hills.
Z. BLOCK B - If the asset specified on this notice has been or will 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 I of the "Taxpayer Response" section. Sign one
copy end return to the PA Department of Revenue, Bureau of Individual Taxes, Dept ZB0601, Harrisburg, PA ITIZ8-060I in the
envelope provided.
5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and
according to the instructions belom. Sign two copies and submit them mith your check for the amount of tax payable to the Register
of Hills of the county indicated. The PA Department of Revenue mill issue an official assessment (Fora REV-lB48 EX) upon receipt
of the return from the Register of Rills.
TAX RETURN - PART Z - TAX COHPUTATION
LINE
1. Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 1Z/1Z/BZ: Accounts mhich the decedent put in joint names within one (1) year of death are
taxable fully as transfers. Hommvmr, there is an exclusion not to exceed $5,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (ex) appears before your first name in tho address portion of this notice, the $5,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
Z. Enter the tataI balance of the account including interest accrued to the date of death.
5o 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 dacedent's death:
1 DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUMBER OF X leo = PERCENT TAXABLE
JOINT ONNERS SURVIVING JOINT OWNERS
Example= A joint asset registered in the name of the decedent and two ether persons.
I DIVIDED BY 5 (JOINT O#NERS) DIVIDED BY Z (SURVIVORS} = .167 X 100 = 16.7X (TAXABLE FOR EACH SURVIVOR}
B. The percent taxable for assets created within one year of the decmdent's death or accounts owned by the decadent but held
in trust for another individual(s) (trust beneficiaries}:
1 DIVIDED DY TOTAl NUMBER OF SURVIVING JOINT X lO0 = PERCENT TAXABLE
OWNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the name of the decedent and tmo other persons and established within one year of death by
the decedent.
! DIVIDED BY Z (SURVIVORS} = .SO X 100 = SOZ {TAXABLE FOR EACH SURVIVOR}
4. The amount subject to tax (line 4} is determined by multiplying the account balance Cline Z} by the percent taxable {line
5. Enter the total of the debts end deductions listed in Part 5.
6. Tho amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (Zinc
7. Enter the epprol rate (line 7) as determined below.
Dete of Death ' Spouse Lineal Sibl/ng Colletiral
07/01/9~ to 12/$1/9~ 3X 6X
01/01/95 ~o 06/30/00 OX 6X 15X
07/01/00 ~o presen~ OX ~.$X~ 12X
younger at
~Thm tax rate imposq
death to or for the use of e natural parent, an adoptive parent, or e stepperent of the child is
The lineal class of heirs includms grandparents, parents, children, and lineal descendants. "Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. "Lineal descendants" includes ell children of the
nature1 parents end their descendents, whether or not they have been adopted by others, adoptad descendents end their descendants
and step-descendants. "Siblings" are defined es individuals who have at least Dna parent in common with the decedent, whether by blood
or adoption, The "Collateral" class of heirs includes all other beneficiaries.
CLAIHED DEDUCTIONS - PART 5 - DEBTS AND DEDUCTIONS CLAIHED
Allowable debts and deductions are determined as folloms:
A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
D. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itemized fully in Part 5. If additional space is needed, use plain paper 8 I/Z" x Il". Proof of
payment may be reque=LeG by the PA Department of Revenue.
CO,I~IONHEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171Z&-0601
REV-I$~5 EX AFP
ZNFORHATZON NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 05-0525
ACN 05117269
DATE 0q-25-2005
~ KAREN E CARTHRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
TYPE OF ACCOUNT
EST. OF MARY A HILLER [] SAVINGS
S.S. NO. 16Z-10-6095 [] CHECKING
DATE OF DEATH 05-12-2005 [] TRUST
COUNTY CUMBERLAND [] CERTIF.
REMIT PAYHENT AND FERNS TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
ADAHS COUNTY NATIONAL BANK has provided the Department eith the information listed belom Hhich has been used in
calculating the potantial tax due. Their records indicate that at the death of the above decedent, you acre a joint caner/beneficiary of
this account. If you feel this information is incorrect, please obtain Hritten 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 Inheritanca Tax LaHs of the Commonwealth
of Pennsylvania. Questions may bm ansHarmd by calling (717) 787-8527.
COMPLETE PART ! BELOH # ~ # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 156819 Date 0~-26-2002
Established
Account Balance Z6, lO9.8Z
Percent Taxable X 10 0.0 0
Amount SubSect to Tax 26,209.82
Tax Rate X .0~5
Potential Tax Due
PART
To insure proper credit to your account, tho
(Z) copies of this notice must accompany your
payment to the Register of Hills. Make check
payable to: "Register of Hilis, Agent".
~NOTE: If tax payments are made Hithin three
[3) months of the decedent's date of death,
you may deduct a SX discount of the tax due.
PART
TAX
LINE
__ , '~ Any inheritance tax due will become delinquent
1)179.44(:I! ~), L[9)nine (9) months after the date of death.
TAXPAYER RESPONSE
I. ~The above information and tax due is correct.
1. You may choose to remit payment to the Register of Hills with tee 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 9 Nilis and an official assessment Hill be issued by the PA Uepartaent of Revenue.
BLOCKJ B. [] The above asset has been or Hil! be reported and tax paid Hith the PennsYlvania Inheritance Tax return
ONLY to be filed by the decedent's representative.
C, O The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~-]and/or PART ['~---]balow.
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JO!ET/TRUST ACCOUNTS
1. Date Established I
2. Account Balance 2
3. Percent Taxable $ X
~. k.ount Subject to Tax q
5. Debts and Deductions 5 -
6. Amount Taxable 6
7. Tax Rata 7 X
8. Tax Due 8
PART
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line S of Tax Computation) $
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
i~lete to the best of m~ knowledge and belief. HONE (--21'-~) '-JC//~_ I,~ ~*~
TAXPAYER SIGNATURE U TELEPHONE NUMBER DATE
GENERAL INFORHAT[ON
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICZAL TAX ASSESSHENT with applicable interest based on inforoatian
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the dacadant's data of death.
$. A joint account is taxable oven though the dacadent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint naoas within one year prier to
death are fully taxable as transfers.
5. Accounts established jointly between husband and aife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others ara taxable fully.
REPORTING iNSTRUCTIONS - PART ! TAXPAYER RESPONSE
1. BLOCK A - Tf the information and computation in the notice ara correct and deductions ara not being claimed, place an
in block "A" of Part I of the "Taxpayer Response" section. Sign two capias and submit thee with your check for the amount of
tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment
(Fora REV-154B EX) upon receipt of the return from the Register of Hills.
2. BLOCK B - Zf the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the dacedant's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dapt ZB060i, Harrisburg, PA 17lZB-06Ol in the
envelope provided.
5. BLOCK C - [f the notice info,at Jan is incorrect and/or deductions are being c[a~aed, check block "C" and coap[ete Parts
according to th; instructions be[o~. S~gn t~o cop[as and submit them ~Jth your check ~or ~e amount o; tax payable to th; Register
of ~i[[s o~ the county indicated. The PA ~epartaent o; Revenue ~][[ issue an ofgJcia[ assess;ant [For; REV-]5~8
TAX RETURN - PART Z - TAX COMPUTATION
LIRE
1. Enter the date the account originaIly was estabIished or titled in the manner existing at date of death.
NOTE: For a decedent dylng after 1Z/12/82: Accounts which the decedent put in joint names ~Jthin one (1) year o~ death are
taxable ~ully as frans;ers. HoNever~ there Js an exclusion not to exceed $5~000 pe~ transferee regardless
the account or the number o~ accounts held.
[~ a double asterisk (*~) appears before your ~[rst name Jn the address portion of this not[ce, the $5,00~ exclus[on
already has been deducted ~roa ~e account balance as reported by the ~inancJal institution.
Enter the total balance o~ the account including interest accrued to the date ~ dea~.
The percent o~ the account that is taxable for each survivor is determined as ~olloNs:
A. The percent taxable ~or joint assets establlshed aero than one year prior to the decedent's death:
I DZVZDED BY TOTAL NUHBER OF DZVZDED BY TOTAL NUHSER OF X 100 PERCENT TAXABLE
JOINT OHNERS SURVZV[NG JOINT OWNERS
Example: A joint asset registered Jn ~e name o; ~e decedent and t~o other persons.
1 DZVIDED BY ~ (JOINT OHNERS) DZV[DED BY Z (SURVIVORS) = .~67 X 100 = 16.7Z [TAXABLE FOR EACH SURVZVOR)
B.The percent taxable ~or assets created ~JthJn one year o~ the dacedent's dea~ or accounts owned by the decedent but held
in trust ~o~ another individual(s) [trust bena;~cJarJes):
1 DZV[DED BY TOTAL NUHBER OF SURVZV[NG JOZNT X 100 = PERCENT TAXABLE
OWNERS OR TRUST BENEFZCIARZES
Example: Joint account rag[stared Jn ~e name o~ the decedent and tho o~er persons and established ~JthJn one year o~ death by
the decedent.
I DZV[DED BY Z (SURVZVORS) = .50 X ~00 = SOX (TAXABLE FOR EACH SURVZVOR)
The amount subject to tax (line q) Js detarmJned by multiplying the account balance (Zinc Z) by the percent taxable (1lee
5. Enter ~e total of the debts and deductions listed Jn Part 5.
6. The amount taxable (line 6) 1s determined by subtracting the debts and deductions (l~ne 5) ~roa the amount subject to ~x (line ~).
7. Enter the appropr[ate ~x rate (line 7) as determined below.
Date of Death Spouse L/nee1 Sibling Collateral
07/01/9q to 12/31/9q 3X 6X
01/01/95 to 06/30/00 OX 6X
07/01/00 to presen~ OZ ~.$Z~ 12Z
~Tha tax rate imposed on the nat value of transfers from a deceased child twenty-one years of ago or younger at
death to or for the use of a natural parent, an adoptive parent, or a stapparant of tho child is OZ.
The linaaI cIass of heirs includes grandparents, parents, children, and IineaI 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 common with tho decadent, whether by blood
or adoption. The "Collateral" class of heirs includes ali other beneficiaries.
CLAZNED DEDUCTZONS - PART 5 - DEBTS AND DEDUCTZONS CLAINED
Allowable debts and deductions ara determined as follows:
A. You legally are responsible for payment, or the estate subject to adainistration by a personal representative is insufficient
to pay the deductible items.
S. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itemized fully in Part 5. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of
payment may be requested by the PA Department of Revenue.
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.
RI:V-1162 EX(11-96)
CD 002585
CARTWRIGHT KAREN E
495 LEXINGTON AVENUE
MECHANICSBURG, PA 17055
fold
ESTATE INFORMATION: SSN: 162-10-6095
FILE NUMBER: 21 03-0325
DECEDENT NAME: MILLER MARY A
DATE OF PAYMENT: 05/19/2003
POSTMARK DATE: 05/1 6/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 03/12/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03117269 $1,120.47
TOTAL AMOUNT PAID:
$1,120.47
REMARKS' KAREN E CARTWRIGHT
SEAL
CHECK# 2583
INITIALS: CW
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
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.
CD
REV-1162 EX(11-96)
OO2584
CARTWRIGHT KAREN E
495 LEXINGTON AVENUE
MECHANICSBURG, PA 17055
........ fold
ESTATE INFORMATION: SSN: 162-10-6095
FILE NUMBER: 2103-0325
DECEDENT NAME: MILLER MARY A
DATE OF PAYMENT: 05/19/2003
POSTMARK DATE: 05/1 6/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 03/12/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03117268 $487.96
TOTAL AMOUNT PAID:
$487.96
REMARKS' KAREN E CARTWRIGHT
SEAL
CHECK# 2588
INITIALS: CW
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
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 002583
CARTWRIGHT KAREN E
495 LEXINGTON AVENUE
MECHANICSBURG, PA 17055
........ fold
ESTATE INFORMATION: SSN: 162-10-6095
FILE NUMBER: 2103-0325
DECEDENT NAME: MILLER MARY A
DATE OF PAYMENT: 05/19/2003
POSTMARK DATE: 05/1 6/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 03/12/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03117267 8278.11
REMARKS:
TOTAL AMOUNT PAID:
KAREN E CARTWRIGHT
8278.11
SEAL
CHECK# 2581
INITIALS: CW
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
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 O02582
CARTWRIGHT KAREN E
495 LEXINGTON AVENUE
MECHANICSBURG, PA 17055
........ fold
ESTATE INFORMATION: SSN: 162-10-6095
FILE NUMBER: 2103-0325
DECEDENT NAME: MILLER MARY A
DATE OF PAYMENT: 05/1 9/2003
POSTMARK DATE: 05/1 6/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 03/12/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03117266 $125.09
TOTAL AMOUNT PAID:
$125.09
REMARKS: KAREN E CARTWRIGHT
SEAL
CHECK# 2582
INITIALS: CW
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
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 002581
CARTWRIGHT KAREN E
495 LEXINGTON AVENUE
MECHANICSBURG, PA 17055
........ fold
ESTATE INFORMATION: SSN: 162-10-6095
FILE NUMBER: 2103-0325
DECEDENT NAME: MILLER MARY A
DATE OF PAYMENT: 05/19/2003
POSTMARK DATE: 05/16/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 03/12/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03117265 $247.74
TOTAL AMOUNT PAID:
$247.74
REMARKS: KAREN E CARTWRIGHT
SEAL
CHECK//2584
INITIALS: CW
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
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 002580
CARTWRIGHT KAREN
495 LEXINGTON AVENUE
MECHANICSBURG, PA 17055
........ fold
ESTATE INFORMATION: SSN: 162-10-6095
FILE NUMBER: 21 03-0325
DECEDENT NAME: MILLER MARY A
DATE OF PAYMENT: 05/19/2003
POSTMARK DATE: 05/1 6/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 03/1 2/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03117264 $43.09
TOTAL AMOUNT PAID:
$43.09
REMARKS: KAREN CARTWRIGHT
SEAL
CHECK# 2587
INITIALS: CW
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
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.
CD
REV-1162 EX(11-96)
002579
CARTWRIGHT KAREN
495 LEXINGTON AVENUE
MECHANICSBURG, PA 17055
........ fold
ESTATE INFORMATION: SSN: 162-10-6095
FILE NUMBER: 21 03-0325
DECEDENT NAME: MILLER MARY A
DATE OF PAYMENT: 05/19/2003
POSTMARK DATE: 05/1 6/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 03/12/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03117263 ~409.03
TOTAL AMOUNT PAID:
$409.03
REMARKS' KAREN CARTWRIGHT
SEAL
CHECK//2586
INITIALS: CW
RECEIVED BY.'
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
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.
CD
REV-1162 EX(11-96)
002578
CARTWRIGHT KAREN E
495 LEXINGTON AVENUE
MECHANICSBURG, PA 17055
........ fold
ESTATE INFORMATION: SSN: 162-10-6095
FILE NUMBER: 2103-0325
DECEDENT NAME: MILLER MARY A
DATE OF PAYMENT: 05/19/2003
POSTMARK DATE: 05/1 6/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 03/12/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03117262 $43.06
TOTAL AMOUNT PAID:
$43.06
REMARKS: KAREN E CARTWRIGHT
SEAL
CHECK# 2585
INITIALS: CW
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
TNHERTTANC£ TAX DTVTSTON
DEPT. Z80601
HARRTSBURG,, PA 17128-0601
KAREN E CARTWRIGHT
495 LEXINGTON AVE
HECHANICSBURG PA 17055:
COMHONWEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSENENT, ALLO#ANCE OR DZSALLONANCE
OF DEDUCTIONS, AND ASSESSNENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER MARY A
DATE OF DEATH 05-12-2005
. FILE NUMBER 21 03-0325
~:'~ ~? gOUNTY CUMBERLAND
SSN/DC 162-10-6095
ACN 05117262
Amoun~ Remi~ed
HAKE CHECK PAYABLE AND REMZT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
REV-IS,q8 EX AFP (01-OS)
CUT ALONG THIS LINE
~ RETAIN LOWER PORTION FOR YOUR RECORDS
REV-1548 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
NARY
A DATE OF DEATH 05-12-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0525 S.S/D.C. NO. 162-10-6095 ACN 05117262
TAX RETURN WAS: eX) ACCEPTED AS FILED ( ) CHANGED
dOZNT OR TRUST ASSET ZNFORHATZON
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO. 150519
TYPE OF ACCOUNT: C ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE
DATE ESTABLISHED 11-15-1995
Account Balance 2,014.47
Percent Taxable X 0.500
Amount Subject to Tax 1,007.24
Debts and DeductAons - .00
Taxable Amount 1,007.Z4
Tax Rate X .45
Tax Due 45.$$
TAX CREDZTS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBHIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYHENT
DATE
05-16-2005
RECEIPT
NUMBER
CD002578
DISCOUNT (+)
INTEREST/PEN PAID C-)
2.27
AMOUNT PAID
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
45.06
TOTAL TAX CREDIT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
~5.33
.00
.00
.00
PURPOSE OF
NOTICE:
To ~ulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S.
Section 9140).
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the
reverse side.
-- Hake check or money order payable to: REGISTER OF HILLS, AGENT.
A refund of a tax credit, which was not requested on the tax return, may ba requested by completing mn "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-151~). Applications era available at the Office of
the Register of Hills, any of the Z5 Revenue District Offices or by calling the specie1 Z4-hour answering service
for forms ordering: 1-BO0-56Z-ZO50; services for taxpayers with special hearing and er speaking needs:
1-800-447-50Z0 (TT only).
Any party in interest not satisfied aith the appraisement, alloeancm, or disallomance 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 Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 171ZB-IOZ1, OR
--electing to have the matter determined et the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should bm addressed in ariting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. Z80601, Harrisburg, PA 171Z8-060!
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (RE¥-1501) for an explanation of administratively correctable errors.
[f any tax due is paid within three (5) calendar months after the decedmnt's death, a five percent (BI)
discount of the tax paid is allomed.
The 15Z 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 and of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiao period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day
from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z
bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164.
All taxes which became delinquent on or after January [, 198Z mill bear interest at a rate which will vary from
calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable
interest rates for 198Z through 2005 are:
~nterest Daily Interest Dally Interest Daily
Year Rate Factor Year Rata Factor Year Rate Factor
198Z ZOZ .000548 1987 9X .000Z47 1999 7Z .000192
1985 16Z .000458 1988-1991 llZ .000501 ZOO0 8Z .000Z19
1984 llZ .000501 199Z 9Z .000247 ZOO1 9Z .000247
1985 15Z .000556 1993-1994 7Z .000192 2002 6Z .000164
1986 IOZ .000274 1995-1998 9Z .000247 2005 5Z .000157
--Xnterest is calculated as follows:
XNTEREST = BALANCE OF TAX UNPAXD X NUNBER OF DAYS DEL'rNQUENT X DATLy INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be catcuXated.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG.. PA 171Z8-0601
KAREN E CARTHRIGHT
q95 LEXINGTON AVE
NECHANZCSBURG PA 17055
COHHON#EALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
NOTICE OF ZNHERZTANCE TAX
APPRATSEHENT. ALLONANCE OR DISALLO#ANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
: ' DATE 08-11-2005
ESTATE OF MILLER
DATE OF DEATH 05-12-2005
FILE NUHBER
~ COUNTY
ACN
I
21 05-0525
CUHBERLAND
162-10-6095
05117Z63
Amount
MARY A
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THZS LINE ~ RETAIN LONER PORTZON FOR YOUR RECORDS *'~
REV-15q8 EX AFP (01-03)
NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOgANCE OR DISALLOgANCE OF
DEDUCTZONS, AND ASSESSHENT OF TAX ON JOZNTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF HILLER HARY A DATE OF DEATH 03-12-2003 COUHTY CUHBERLAND
FILE NO. 21 03-0325 S.S/D.C. NO. 162-10-6095 ACN 03117263
TAX RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED
dOINT OR TRUST ASSET INFORHATZON
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO. lq9092
TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE
DATE ESTABLISHED 10-11-1999
Account Balance 19,135.92
Percent Taxable X 0.500
Amount Subject to Tax 9,567.96
Debts and Deductions - .00
Taxable Amount 9,567.96
Tax Rate X .q5
Tax Due q30.56
TAX CREDITS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
gITH YOUR TAX PAYMENT TO THE
REGISTER OF gILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF gILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
05-16-2003 CD002579 21.55 q09.03
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER THIS DATE,, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. a
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A 'CREDIT' (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
q30.56
.00
.00
.00
PURPOSE OF
NOTICE:
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S.
Section 91qO).
PAYHENT:
Detach the top portion of this Notice and submit eith your payment to the Register of gills printed on the
reverse side.
-- Hake check or money order payable to: REGISTER OF gILLS, ADENT.
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
A refund of a tax credit, ehich ems not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications ere available at the Office of
the Register of gills, any of the Z$ Revenue District Offices or by calling the special Z4-hour ansaering service
for fores ordering: 1-800-561-1050; services for taxpayers eith special hearing and or speaking needs:
1-800-~47-$010 (TT only).
Any party in interest not satisfied with tho appraisement, allowance, or disalloaance of deductions or assessment
of tax (including discount or interest) as shown on this Notice may object eithin sixty (60) days of receipt of
this Notice by:
--Nritten protest tot he PA Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 17118-1011, OR
--electing to have the aattar determined at the audit of the account cf the personal representative) OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should be addressed in Nriting to: PA Department of Revenue)
Bureau of Individual Taxes) ATTN: Post Assessment Revie~ 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-IS01) for an explanation of administratively correctable errors.
If any tax due is paid eithin three (3) calendar months after the decedent's death) a five percent
discount of the tax paid is alloaed.
The 151 tax alnesty 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 mith first day of delinquency, or nine (9) months and one (l) day
from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982
bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164.
All taxes ehich became delinquent on or after January l, 1981 Niil bear interest at a rate ehich Niil vary from
calendar year to calendar year eith that rate announced by the PA
interest rates for 1982 through 2003 ars:
Interest Daily
Year Rate Factor
1981 201 .0005~8
1983 161 .000~38
1984 111 .000301
1985 131 .000356
1986 XOZ .00017~
Department of Revenue. The applicable
Interest Daily Interest emily
Year Rate Factor Year Rate Factor
1987 9Z .OOOZq7 1999 72 .000191
1988-1991 111 .000301 2000 6Z .000119
1992 92 .O00Z~7 ZOO1 91 .O00Zq7
1993-1996 7Z .000191 ZOOZ 6Z .000164
1995-1998 9Z .0002~7 2003 52 .000137
--Interest is calculated as falloas:
INTEREST = BALANCE OF TAX UNPAID X NUNBBR OF DAYS DELZNgIUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent .ill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sho~n on the
Notice, additional interest must be calculated.
v BUREAU OF INDIVIDUAL TAXES
XNHER'rTANCE TAX DTVTSTON
DEPT. 280601
HARRISBURG., PA 17128-060!
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF TNHERXTANCE TAX
APPRAXSEHENT, ALLOHANCE OR D'rSALLORANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
DATE OF DEATH 05-12-2005
FILE NUMBER
'C,3 ~*,i'2~ 1 ;coum'v ,
*-SSN/DC ~
ACN
'
21 05-0525
CUMBERLAND
162-10-6095
0511726q
Amoun'l: Remi~t:ed
REV-ISdi8 EX AFP (Ol-OS)
MARY A
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
~-: ~ ~'~ ' ~- '~ ~- - ~ 5~-5 ~- ...................................................................................
NOTICE OF XNHERXTANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTXONS, AND ASSESSMENT OF TAX ON dOXNTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
MARY
A DATE OF DEATH 05-12-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0525 S.S/D.C. NO. 162-10-6095 ACN 0511726~
TAX RETURN WAS: (X) ACCEPTED AS FILED ¢ ) CHANGED
dOXNT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO. 15q259
TYPE OF ACCOUNT: ¢ ) SAVINGS C ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 11-19-1996
Account Balance 2,016.15
Percent Taxable X 0.500
Amount Subject to Tax 1,008.08
Debts and Deductions .00
Taxable Amount 1,008.08
Tax Rate X .q5
Tax Due q5.56
TAX CREDITS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
'*REGISTER OF WILLS, AGENT.**
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
05-16-2005 CD002580 2.27 ~$.09
TOTAL TAX CREDIT
DALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
q5.$6
ZF PA/D AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT IS REQU/RED.
ZF TOTAL DUE 1S REFLECTED AS A '*CRED/T" (CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
.00
.00
.00
PURPOSE OF
NOTICE:
To fulfill the requirements of Section 1140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (71 P.S.
Section 9140).
PAYHENT:
Detach the top portion of this Notice end submit aith your payment to the Register of #ills printed on the
reverse side.
-- Hake check or money order payable to: REGISTER OF WILLS, AGENT.
REFUND (CA):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
A refund of a tax credit, ahich ams not requested on the tax return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of
the Register of Hills, any of the Z3 Revenue District Offices or by calling the special Z4-hour answering service
for fores ordering: 1-800-36Z-ZO50; services far taxpayers eith special hearing and or speaking needs:
Z-800-447-30ZO (TT only).
Any party in interest not satisfied aith the appraisement, alloaance, or disallowance of deductions or assessment
of tax (including discount or interest) as sheen on this Notice may object aithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--electing to have the matter determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Reviee Unit, DEPT. 180601, Harrisburg, PA 17118-0601
Phone (7173 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for · Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid aithin three (3) calendar months after the decedent's death, a five percent
discount of the tax paid is alioaed.
The 151 tax amnesty non-participation penalty is computed on the total of the tax and lnterest 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 seem 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 (1) day
from the date of death, to the date of payment. Taxes ehich became delinquent before January 1, 1981
bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164.
Al1 taxes mhich became delinquent on or after January 1, 1982 ail1 bear interest at a rate ahich ail1 vary from
calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable
interest rates for 1982 through ZOO3 are:
Interest Daily Interest Dally Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
19aZ ZOZ .00054B 1987 91 .000147 1999 71 .000191
1983 161 .0004~8 1988-1991 llZ .000301 2000 81 .000219
1984 11Z .000301 199Z 91 .000247 2001 9X ,000247
1985 132 .000356 1993-1994 7X .O00ZgZ ZOOZ 61 .000164
1986 102 .000Z74 1995-1998 91 .000247 2003 SZ .000137
--Tnterest is calculated as follows:
I'NTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELTNQUENT X DAI'Ly TNTERBST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
BUREAU OF TNDTVZDUAL TAXES
XNHERXTANCE TAX DTVZSTON
DEPT. 280601
HARRISBURG, PA 171Z8-0601
KAREN E CARTHRIGHT
q95 LEXINGTON AVE
NECHANICSBURG PA 17055
CONNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTXCE OF ZNHERXTANCE TAX
APPRAXSEMENT, ALLOHANCE OR DXSALLOHANCE
OF DEDUCTXONS, AND ASSESSMENT OF TAX ON
JOTNTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
DATE OF DEATH 05-12-2005
FILE NUMBER 21 05-0525
'0~ ,~L} OiO~NT, Y- CUNBERLAND
gS, N/D~C. ::.:.: i 162-10-6095
ACN 05117265
Amoun'~ Remi~:~:ed
REV-Z6gi8 EX AFP [n1-05)
NARY A
I
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1548 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLOHANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF HILLER NARY A DATE OF DEATH 05-12-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0525 S.S/D.C. NO. 162-10-6095 ACN 05117265
TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED
dOXNT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAHS COUNTY NATIONAL BANK ACCOUNT NO. lq9096
TYPE OF ACCOUNT: ( ) SAVINGS ¢ ) CHECKING ( ) TRUST (~ TINE CERTIFICATE
DATE ESTABLISHED 10-11-1999
Account Balance 11,590.57
Percent Taxable X 0.500
Amount Subject to Tax 5,795.19
Debts and Deductions - .00
Taxable Amount 5,795.19
Tax Rate X .~5
Tax Due 260.78
TAX CREDITS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
HITH YOUR TAX PAYMENT TO THE
REGISTER OF HILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF HILLS, AGENT."
PAYHENT
DATE
05-16-2005
RECEIPT
NUMBER
CD002581
DISCOUNT (+)
INTEREST/PEN PAID (-)
AMOUNT PAID
15.0q
2q7.7q
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
260.78
ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULAT/ON OF ADD/TZONAL INTEREST.
ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT 1S REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE S/DE OF THIS FORM FOR /NSTRUCTZONS. )
.00
.00
.00
PURPOSE OF
NOTICE:
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (7Z P.S.
Section 91q0).
PAYNENT:
Detach the top portion of this Notice and submit aith your payment to the Register of Wills printed on the
reverse side.
-- Hake check or money order payable to: REGISTER OF HILLS, AGENT.
REFUND (CR):
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
A refund of a tax credit, which mas 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 tho Z3 Revenue Oistrict Offices or by calling the special Zq-hour answering service
for fores ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and or speaking needs:
1-800-¢~7-30zo (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment
of tax (including discount or interest) as sheen on this Notice may object aithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 171ZD-IOZ1, OR
--electing to have the aa[tar determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should be addressed in arJting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, DEPT. Z80601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (Bi)
discount of the tax paid is alloaed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and nat
paid before January 18, 1996, the first day after the and 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 (1) day
from the date of death, to the date of payment. Taxes ahich became delinquent before January 1, 19DZ
bear interest at the rate of six (6g) percent per annum calculated at a daily rate of .00016¢.
All taxes which became delinquent on or after January 1, 1982 mill bear interest at a rate ahich ail1 vary from
calendar year to calendar year with that rate announced by the PA
interest rates for 1982 through ZOO3 ere:
Interest Daily
Year Rate Factor
198Z ZOX .O005qD
1983 16Z .000¢38
198¢ 11Z .000301
1985 13Z .000356
1986 lOX .O00ZTq
Department of Revenue. The applicable
lnterest Daily Interest Daily
Year Rate Factor Year Rate Factor
1987 9Z .O00Zq7 1999 7Z .OOO19Z
19DD-1991 11Z .000501 2000 DZ .OOOZ19
1992 9Z .0002¢7 2001 92 .000Z¢7
1993-199~ 7Z .OO019Z ZOOZ 62 .O0016q
1995-1998 9Z .O00Z~7 2003 5Z .0001~7
--Interest is calculated as failcas:
INTEREST = BALANCE OF TAX UNPA/D X NUMBER OF DAYS DELXNQUENT X DAILY XNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX DTVTSZON
DEPT. 280601
HARRISBURG,, PA 17128-0601
KAREN E CARTgRIGHT
495 LEXINGTON AVE
NECHANICSBURG PA 17055
CONNON#EALTH OF PENNSYLVANZA
DEPARTNENT OF REVENUE
NOTXCB OF ZNHERZTANCE TAX
APPRAXSEHBNT, ALLONANCE OR DZSALLOHANCE
OF DEDUCTZONS, AND ASSESSHENT OF TAX ON
JOZNTL¥ HELD OR TRUST ASSETS
- DATE 08-11-2003
ESTATE OF HILLER NARY A
DATE OF DEATH 03-12-2003
FILE NUNBER 11 03-0325
'03 ?:~0 ~OUNY~! CUNBERLAND
SSN/DC 161-10-6095
ACN 03117266
~ - I Amoun~ Rmmi~ed
I
HAKE CHECK PAYABLE AND REHXT PAYNENT TO:
REGISTER OF gILLS
CUNBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1548 EX AFP (01-03}
NOTZCE OF INHERITANCE TAX APPRAXSENENT, ALLOgANCE OR DZSALLONANCE OF
DEDUCTIONS, AND ASSESSNENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS
DATE 08-11-2003
ESTATE OF HILLER NARY A DATE OF DEATH 03-12-2003 COUNTY CUNBERLAND
FILE NO. 21 03-0325 S.S/D.C. NO. 162-10-6095 ACN 03117266
TAX RETURN gAS: (X) ACCEPTED AS FILED ¢ ) CHANGED
JOINT OR TRUST ASSET ZNFORNATZON
FINANCIAL INSTITUTION: ADANS COUNTY NATIONAL BANK ACCOUNT NO. 149094
TYPE OF ACCOUNT: ( ) SAVINGS ¢ ) CHECKING ¢ ) TRUST (~ TINE CERTIFICATE
DATE ESTABL/SHED 10-11-1999
Accoun~ Balance 5,851.77
Percent Taxable X 0.500
Amount Subject ~o Tax 2,915.89
Debts and Deduc~/ons - .00
Taxable Amoun~ 2,915.89
Tax Ra~e ~ .45
Tax Due 131.67
TAX CREDITS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBHIT THE
UPPER PORTION OF THIS NOTICE
gITH YOUR TAX PAYNENT TO THE
REGISTER OF gILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF gILLS, AGENT."
PAYNENT RECEIPT DISCOUNT (+)
DATE NUNBER INTEREST/PEN PAID (-) ANOUNT PAID
05-16-2003 CD002582 6.58 125.09
ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDZTZONAL INTEREST.
ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS RE~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. }
TOTAL TAX CREDZT
BALANCE OF TAX DUEI
INTEREST AND PEN.
TOTAL DUE
131.67
.00
.00
.00
PURPOSE OF
NOTICE:
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (7Z P.S.
Section 91q0).
PAYMENT:
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF HILLS, AGENT.
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
ZNTEREST:
A refund of a tax credit, ahich ems not requested on the tax return, may ba requested by completing an 'Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications ara available at the Office of
the Register of #ills, any of the Z3 Revenue District Offices or by calling the special Zq-hour ansmering service
for forms ordering: 1-BOO-36Z-ZOSO; services for taxpayers eith special hearing and or speaking needs:
1-B00-4~7-3020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disalloaance of deductions or assessment
of tax (including discount or interest) as shown on this Notice amy object within sixty (SD) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBlOZ1, Harrisburg, PA 171ZB-lOZ1, OR
--electing to have the matter determined et the audit of the account of the persona! representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should be addressed tn writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of tho booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (BX)
discount of the tax paid is alZoeed.
The 15Z tax amnesty non-participation penalty is computed an tho tote1 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 would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day
from the date of death, to the date of payment. Taxes ehich became delinquent before January 1, 19BE
bear interest at the rate of six (6g) percent par annum calculated at a daily rate of .000164.
A11 taxes which became delinquent on or after January 1, 198Z wiiZ bear interest at a rate which wilt 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 ara:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
19BZ ZOZ .000548 1987 9X .000247 1999 7~ .00019Z
1983 16Z .000q38 1988-1991 11X .000301 2000 BX .000219
1984 llX .000301 199Z 9~ .0002q7 2001 92 .000247
1985 132 .0D0356 1993-1994 72 .000192 ZOOZ 62 .000164
1986 102 .O00ZTq 1995-1998 92 .000247 2003 5X .000137
--Interest is calculated as folloas:
XNTEREST = BALANCE OF TAX UNPAXD X NUIIBER OF DAYS DELXNQUENT X DALLY XNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. Xf payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
TNHER/TANCE TAX
DEPT. 280601
HARRISBURG, PA 17128-0601
KAREN E CARTNRIGHT
q95 LEXINGTON AVE
HECHANICSBURG PA 17055
COHHONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT. ALLO#ANCE OR DISALLONANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-i$1i8 EX AFP C01-0S)
'O3
DATE 08-11-2005
ESTATE OF HILLER HARY
DATE OF DEATH 03-12-2005
FILE NUHBER 21 03-0325
~COUNTY 2 CUHBERLAND
ZssN~Bo~ 162-10-6095
ACN 03117267
Amoun~ Rem/~ed I
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
A
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *'~
REV-1548 EX AFP (01-03}
NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS
DATE 08-11-2003
ESTATE OF HILLER HARY A DATE OF DEATH 05-12-2003 COUNTY CUHBERLAND
FILE NO. 21 03-0325 S.S/D.C. NO. 162-10-6095 ACN 03117267
TAX RETURN WAS: eX) ACCEPTED AS FILED ( ) CHANGED
dOZNT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO. 6q0029785
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE
DATE ESTABLISHED O~-Z3-199R
Accoun~ Balance 13,011.08
Percen~ Taxable X 0.500
Amount Subject to Tax 6,505.5~
Debts and Deductions - .00
Taxable Amount 6,505.5R
Tax Rate X .q5
Tax Due 292.75
TAX CREDITS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-)
05-16-2003 CD002583 lq.6~
AMOUNT PAID
278.11
IF PAID AFTER THIS DATEz SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. }
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
292.75
.00
.00
.00
PURPOSE OF
NOTICE:
To fulfill the requirements of Section Il40 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (7Z P.S.
Section 9140).
PAYMENT:
Detach the top portion of this Notice and submit eith your payment to the Register of Hills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF #ILLS, AGENT.
REFUND (CR):
OBJECT/ONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
D[SCOUNT:
PENALTY:
iNTEREST:
A refund of a tax credit, which was not requested on tho tax return, may ba requested by completing an "Application
for Refund of Pennsylvania [nheritance and Estate Tax" (REV-1315). Applications are available mt the Office of
the Register of gills, any of the Z3 Revenue District Offices or by calling the special Z4-hour ansmaring service
for fores ordering: 1-800-56Z-Z050; services for taxpayers aith special hearing end or speaking needs:
1-800-qq7-Sozo (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disalloaanca of deductions or assessment
of tax (including discount or interest) as sheen on this Notice may object mithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81OZ1, Harrisburg, PA 171Z8-1021, OR
--electing to have the matter determined at thm audit of the account of the personal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should bm addressed in writing to: PA Department of Revenue,
Bureau of individual Taxes, ATTN: Post Assessment 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-IS01) ~or an explanation of administratively correctable errors.
Zf any tax due is paid within three (5) calendar months after the dacedmnt's death, a five percent (5Z)
discount of the tax paid is allomad.
The 1SI 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 tho the same tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day
from the date of death, to the date of payment. Taxes which bacamm delinquent before January 1, 1982
bear interest et the rata of six (SI) percent per annum calculated et a daily rate of
Ail taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from
calendar year to calendar year aith that rate announced by the PA
Department of Revenue.
The applicable
interest rates for 1982 through ZOO3 ara:
interest Daily interest Dally Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
198Z 2OZ .000548 1987 9Z .000247 1999 7Z .00019Z
1985 16Z .000438 1988-1991 llX .000301 logo 8Z .000219
1984 11Z .000501 1992 9Z .000247 2001 9Z .000247
1985 13Z .000556 1995-1994 7Z .000192 2002 6Z .000164
1986 lOX .000Z74 1995-1998 9Z .000Z47 ZOOS 5Z .OOOlS7
--Znterast is calculated as falloas:
ZNTEREST= BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELZNQUENT X DAZLY I'NTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calcutatad.
BUREAU OF ZNDZVTDUAL TAXES
TNHERTTANCE TAX DTyTSTON
DEPT. 280601
HARRTSBURG, PA 17128-0601
KAREN E CARTNRIGHT
495 LEXINGTON AVE
MECHANICSBURG PA 17055
CONNONHEALTH OF PENNSYLVANTA DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAXSEHENT. ALLORANCE OR DXSALLONANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOTNTL¥ HELD OR TRUST ASSETS
- ~ DATE 08-11-2005
ESTATE OF MILLER
DATE OF DEATH 05-12-2005
FILE NUMBER 21 05-0525
. ~ COUNTY CUMBERLAND
O~ /~g ~N/~ :?~ 162-10-60~5
ACN 05117268
Amoun't Rem/~ed
REV-ZS~B EX AFP COl-OS)
MARY A
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF gILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAXN LOHER PORTION FOR YOUR RECORDS ~
~¥: [~ - ~- -~ p~- -~ 5~=-5 ~y ...................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOHANCE OR DXSALLOHANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
NARY
A DATE OF DEATH 05-12-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0525 S.S/D.C. NO. 162-10-6095 ACN 0~117268
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
dOZNT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO. 1500261
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 04-25-1989
Accoun~ Balance
Percen~ Taxable X 0.500
Amoun~ Subjec~ ~o Tax 11,414.$5
Debts and Deduc~/ons - .00
Taxable Amoun~ 11,414.55
Tax Ra~e ~ .45
Tax Due 515.64
TAX CREDITS:
22,828.66 NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
HITH YOUR TAX PAYMENT TO THE
REGISTER OF gILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
**REGISTER OF gILLS, AGENT.**
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
05-16-2005 CD002584 25.68 487.96
ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.
TOTAL TAX CREDIT
BALANCE OF TAX DUEI
INTEREST AND PEN.
TOTAL DUE
515.64
.00
.00
.00
PURPOSE DF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNZN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirseents of Section glqO of the Inheritance and Estate Tax Act, Act ZS of ZOO0. (72 P.S.
Section 91q0).
Detach the top portion of this Notice end submit with your payment to the Register of gills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF HILLS, AGENT.
A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance end Estate Tax" (REV-ISIS). Applications ere available et the Office of
the Register of Mills) any of the ZS Revenue District Offices or by calling the special Iq-hour answering service
for fores ordering: 1-800-S6Z-Z050; services for taxpayers aith special hearing and or speaking needs:
1-800-q47-30ZO (TT only).
Any party in interest not satisfied aith the appraisement, allowance, or disallowance of deductions or assessment
of tax (including discount or interest) as shown on this Notice amy abject 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 17128-lOZ1, OR
--electing to hava the matter determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions ~or Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5X)
discount of the tax paid is aIIowod.
The 15Z tax a~nesty 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 would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning eith first day of delinquency, or nine (9) months and one (1) day
from the date of death, to tho date of payment. Taxes which became delinquent before January 1, 198Z
bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016q.
A11 taxes which became delinquent on or after January 1, 198Z ail1 bear interest at a rate which will vary frae
calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable
interest rates for 1962 through ZOO3 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
198Z 20Z .OOOSq8 1987 9X .0002¢7 1999 7Z .OOO19Z
1983 16Z .000¢$8 X988-1991 ZZZ .OO0301 ZOOO 8Z .O00ZZ9
198~ llZ .000301 199Z 9Z .000267 2001 9Z .000267
1985 13Z .000356 1993-1996 7Z .OOOZ9Z ZOOZ 6Z .000166
1986 ZOZ .000276 1995-1998 9Z .000267 2003 5Z .000157
--Interest is calculated
INTEREST = BALANCE OF
as follows:
TAX UNPAZD X NUNBER OF DAYS DELINQUENT X DAILY ZNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is sade after the interest computation date shown on the
Notice, additional interest must be calculated.
~ BUREAU OF ZNDZVTDUAL TAXES
INHERITANCE TAX DTVTSTON
DEPT. 18060!
HARRTSBURG., PA 17128-0601
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
HECHANICSBURG PA 17055
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAXSEHENT, ALLOHANCE OR DZSALLOHAHCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOXNTLY HELD OR TRUST ASSETS
REV-IG~i$ EX AFP C01-0S)
DATE 08-11-2005
ESTATE OF HILLER HARY
DATE OF DEATH 05-12-2005
FILE NUHBER 21 03-0525
162-10-6095
ACN 03117269
Amoun{
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
A
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~
REV-15&8 EX AFP (01-03)
NOTZCE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF HILLER HARY A DATE OF DEATH 03-12-2005 COUNTY CUHBERLAND
FILE NO. 21 03-0325 S.S/D.C. NO. 162-10-6095 ACN 03117269
TAX RETURN WAS: IX) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET ZNFORHATZON
FINANCIAL INSTITUTION: ADAHS COUNTY NATIONAL BANK ACCOUNT NO. 156819
TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE
DATE ESTABLISHED 0q-26-2002
Accoun~ Balance
Percent Taxable
Amoun~ Sub~ec* to Tax
Debts and Deduc~1ons
Taxable Amoun~
Tax Ra~e
Tax Due
TAX CREDITS=
26,209.82
X 1.000
26,209.82
- .00
26,209.82
X .~5
1,179.~
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBHIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYHENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT.ff
PAYMENT RECEIPT DXSCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
05-16-2005 CD002585 58.97 1,120.q7
TOTAL TAX CREDIT
BALANCE OF TAX DUE
TNTEREST AND PEN.
TOTAL DUE
TF pA'rD AFTER TH'rS DATE, SEE REVERSE FOR CALCULATTON OF ADDTTZONAL INTEREST. a
'rF TOTAL DUE TS LESS THAN $1, NO PAYMENT TS REI~UTRED.
'rF TOTAL DUE TS REFLECTED AS A "CREDI'T" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE STDE OF THTS FORM FOR INSTRUCT'rONS. )
1,179.qq
.00
.00
.00
PURPOSE OF
NOTICE=
PAYHENT:
REFUND (CR):
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To ~ulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the
reverse side.
-- Hake check ar money order payable to: REGISTER OF NILLS, AGENT.
A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of
the Register cf Nills, any of the 23 Revenue District Offices or by calling the special Z4-hour answering service
for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs:
1-800-4q?-3020 (TT only).
Any partY in interest not satisfied with the appraisement, allowance, ar disallowance of deductions or assessment
of tax (including discount or interest) as sheen on this Notice may object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--electing to have the matter determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax duo is paid mithin three (3) calendar months after the decedent's death, a five percent (52)
discount of the tax paid is allowed.
The 1SI 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 sams tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day
from the date of death, to the date of payment. Taxes which became delinquent before January l, 1982
bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .000164.
All taxes which became deIinquent on or after January 1, 1982 will bear interest at a rata which will vary from
calendar year to calendar year with that rata announced by the PA Department 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 ZOZ .000548 1987 92 .000247 1999 72 .000192
1983 16Z .000~38 1988-1991 112 .DO0301 ZOO0 82 .000219
1984 112 .000301 1992 92 .000247 Z001 92 .000247
1985 13Z .000356 1993-1994 72 .000192 2002 62 .000164
1986 IOZ .00027~ 1995-1998 92 .OOOZ~7 2003 52 .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBBR OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after tho tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
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 003171
WORLEY DANIEL DAVID ESQUIRE
225 LATIMORE VALLEY ROAD
YORK SPRINGS, PA 17372
........ fold
ESTATE INFORMATION: SSN: 162-10-6095
FILE NUMBER: 2103-0325
DECEDENT NAME: MILLER MARY A
DATE OF PAYMENT: 10/24/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 03/12/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 ~519.03
TOTAL AMOUNT PAID:
$519.03
REMARKS: KAREN E CARTWRIGHT C/O
DANIEL D WORLEY ESQ-NO CHECK #
SEAL
INITIALS: JA
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
REV-1500 EX (6-00)
COMMONWEALTH OF
PENNSLYVANIA
DEPARTMENT OF REVENUE
DEPT. 28O601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Miller, Mary, A.
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-ED-YEAR)
103-12-2003 109-07-1911
IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
21
03 0325
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
162-10-6095
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1. Original Return
4. Limited Estate
6. Decedent Died Testate (Attach copy of Will)
9. Litigation Proceeds Received
NAME
Daniel D. Worley
FIRM NAME (If Applicable)
Wodey & Worley LLP
TELEPHONE NUMBER
717)528-4500
U2.Supplemental Return L--J 3. Remainder Return(~.ofd,,,th ~,-to ~2-f~l
I I
4a. Future Interest Comprise (date of death alter 12-12-82) L_~ 5' Federal Estate Tax Return Required
7. Decedent Maintained a Living Trust (Altac~ a copy o~ Tr~s~)~ 8. Total Number of Safe Deposit Boxes
10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) U ~,l.;,~ls~echti~n to tax under Sec. 9113(A)
iii ;~DtRE~D TO:
COMPLETE MAILING ADDRESS
Wodey & Worley LLP
225 Latimore Valley Road
York Spdngs, PA 17372
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1) $'- 0.001
(2) S 0.001
OFFICIAL USE ONLY
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
[ --~ Separate Billing Requested
7. Inter-Vivos Transfers & Misc. Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
t 0. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10)
$ 0.00i·
$ 0'00i i';
$14,526.001
$49,637.94 i
$26,209.82
(8)
$8451.06
$5,954.59
11. Total Deductions (total Lines 9 & 10)
(11)
12. Net Value of Estate (Line 8 minus Line 11) (12)
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
$90,373.76
$14,405.65
$75968.11
$ 0.00
$75,968.11
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) x (15)
16. Amount of Line 14 taxable at lineal rate 75,968.11 x .045 (16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
$ 0.00
$3418.56
$ 0.00
$ 0.00
$3418.56
> > U SURE TO ~WER ~ :~ I~="VlE~ $tDE ~B RECHECK MATH < <
' Deced~nt's Complete Address
ISTREET ADDRESS
325 Wesley Drive
CiTY
Mechanicsburg
Bethany Village Retirement Center
STATE
PA
ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page I Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
$3418.56
2899.53
Total Credits (A + B + C) (2)
$2,899.53
$ 0.00
$ 0.oo
$519.03
$519.03
Total Interest/Penalty (D + E) (3)
If line 2 is areater than line I + line 3. enter the difference. This is the OVERPAYMENT
Check box on Page 1 Line 20 to request a refund (4)
If line I + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred; ~
b. retain the dght to designate who shall use the property transferred or its income;
c. retain a revisionary interest; or
d. receive the promise for life of either payments, benefits or care?
If death occurred after December 12, 1982, did decedent transfer property within on year of death
without receiving adequate consideration?
Did decedent own an "in trust for" or payable upon dealh ba~ account or security at his or her dealh?
Did decedent own an Individual Retirement Account, annuity, or other non-probate properbj which
contains a beneficiary designation?
No
IF THE ANSWER TO ANY OF THE ABOVE QUESTIOt~ IS YES, YOU MUST ~ SCHEDULE G AND RLE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Declaration of preparer other than the personal representative is based on all the information of which preparer has any knowledge.
SIGN,~TJJ~E OF PERSON rb~PON~IBLE F(~R FILlinG RETURN
ADDRESS
495 Lexington Ave, Mechanicsburg PA 17055
DATE
10-23-03
DATE
10-23-03
ADDRESS
225LatimoreValleyRoad, YorKSpdngs, PA17372
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3% [72 P.S. 9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116
(a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse .from tax, and the statutory requirements for disclosure of assets and filing a tax
return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is 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(a) (1)].
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(a)(1.3)]. A sibling is defined, under Section
9102, as an individual who haS at least one parent in common with the decedent, whether by blood or adoption.
' REV-1508E~(+ (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONALPROPERTY
ESTATE OF Mary A. Miller FILE NUMBER 21-03 0325
Include the proceeds of litigation and the date the proceeds w~e reCaved by the estate. All property jointly-owned with the right of sum~ivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CERTIFICATE OF DEPOSIT; BURIAL FUND 7,535.00
ACCT: 2110407
Refund from Bethany Village
3,423.00
3,568.00
TOTAL (Also enter on line 5, Recapitulation) $14,526.00
(If more space is needed, insert additional sheets of the same size)
' REV-1509E'X+ (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF Mary A. Miller FILE NUMBER 21-03 0325
If an asset was made joint within one ,,ear of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Karen E. Cartwdght 495 Lexington Ave, Mechanicsburg, PA 17055 Daughter
Bo
JOINTLY-OWNED PROPERTY:
ITEM LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
NUMBER FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. DATE OF DEATH DECD'S VALUE OF
TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. CD # 134259 (inheritance Tax previously paid) 2,016.15 5o% 1,oo8.o8
2. A. CD # 130519 (Inheritance Tax previously paid) 2,014.47 50% 1,oo7.24
3. A. CD # 149094 (Inheritance Tax previously paid) 5,851.77= 5o% 2,925.89
4. A. CD # 149092 (Inheritance Tax previously paid) 19,135.92 50% 9,567.96
5. A. CD # 1300261 (Inheritance Tax previously paid) 22,828.66 50% 11,414.33
8. A. i CD # 149096 (Inheritance Tax previously paid) 11,590.37 5o% 5,795.19
7. A. CD # 640029785 (Inheritance Tax previously paid) 13,011.08 50% 8,505.54
8. A. Pre1999 CHECKING ACCT: 1300261 22,827.41 50% 11,413.71
TOTAL (Also enter on line 6, Recapitulation) $49,637.94
(If more space is needed, insert additional sheets of the same size)
' REV-1510 E,~'+ (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF Mary A. Miller FILE NUMBER 21-03 0325
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF DECD'S
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH INTEREST EXCLUSION TAXABLE
NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET (~F APPLICABLE) VALUE
1. CD # 156819 (Inheritance Tax previously paid) 26,209.82 50% 26,209.82
TOTAL (Also enter on line 7, Recapitulation) $26,209.82
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF Mary A. Miller
FILE NUMBER 21-03 0325
Del~ts of decedent must be reported on Schedule I.
ITEM
NUMBER
5.
6.
7.
DESCRIPTION
FUNERAL EXPENSES:
Cocklin Funeral Home
]ocklin Funeral Home
Funeral
~,DMINISTRATIVE 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 Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State __ Zip
Relationship of Claimant to Decedent
Probate Fees Cumberland County Register of Wills and Advertisement
Accountant's Fees
Tax Return Preparer's Fees
PSERS
George Miller
AMOUNT
7,798.28
137.27
0.00
166.85
75.00
273.66
TOTAL (Also enter on line 9, Recapitulation) 8451.06
REV-1512 EX + (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
If more space is needed, insert additional sheets of the same size)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF Mary A. Miller FILE NUMBER 21-03 0325
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
2.
3.
4.
5.
Bethany Village
Alert Phy @ Bethany
Holy Spirit Hospital
Conner Rich Associates
The Foot Care
5,701.00
137.00
28.00
51.59
37.00
TOTAL (Also enter on line 10, Recapitulation) $5,954.59
(If more space is needed, insert additional sheets of the same size)
' REV-1513'EX + (9-00))
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF Mary A. Miller FILE NUMBER 21-03 0325
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I1.
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116 (a) (1.2)]
Karen E. Cartwright, 495 Lexington Ave, Mechanicsburg PA 17055
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
A~OR
(]FE~A~
100%
ENTER DOLLAR,AMOUNTS FOr DISTRIBUTIONS SHOWN ABOVE ON UNES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
$ Q00
(If more space is needed, insert additional sheets of the same size)
BUREAU OF ZNDTVZDUAL TAXES
INHERITANCE TAX nTVZSZON
DEPT. IR0601
HARRISBURG, PA 17128-0601
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
HECHANICSBURG PA 17055
COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE
NOTICE OF TNHERITANCE TAX
APPRATSEHENT. ALLOHANCE OR DISALLOHANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER MARY
DATE OF DEATH 05-12-2005
FILE NUMBER 21 05-0525
COUNTY CUHBERLAND
SSN/DC 162-10-6095
ACN 05117267
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
REV-IS~I8 EX &FP COl-OS)
A
CUT ALONG THIS LINE ~' RETAIN LOHER PORTIOM FOR YOUR "ECO~DS' ~
REV-1548 EX AFP ¢02-03)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF HILLER HARY A DATE OF DEATH 05-12-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0525 S.S/D.C. NO. 162-10-6095 ACN 05117267
TAX RETURN WAS: (X)' 'ACCEPTED AS FILED ( ) CHANGED
dOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK
~ACCOUNT NO. 6q0029785
TYPE OF ACCOUNT: ( ) SAVINGS () CHECKING C ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED Oq-25-199q
Account Balance 15,011.08
Percent Taxable X 0.500
Debts and 'Deductions .00
Taxable Amount 6,505.5fi
Tax Ra~e X .q5
Tax Due Z9Z.75
TAX CRED'rTS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER-PORTION OE TH/S-NOT[-CE_
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
05-16-2005 CD002585 lq.6q 278.11
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
TF 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. )
292.75
.00
.00
.00
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISRURG, PA 17128-n691
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
HECHANICSBURG PA 17055
COHMONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLONANCE OR DISALLOHANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF HILLER
DATE OF DEATH 05-12-2005
FILE NUHBER 21 05-0525
COUNTY CUHBERLAND
SSN/DC 162-10-6095
ACN 05117265
Amoun'l: Rem i'l:'l:ed
HARY A
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015 :
CUT ALONG THIS LINE ~'
RETAIN LOWER PORTION FOR YOUR RECORDS
REV-1568 EX AFP (01=03)
NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
MARY A DATE OF DEATH 05-12-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0325 S.S/D.C. NO. 162-10-6095 ACN 05117265
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET ZNFORHATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO.
169096
TYPE OF ACCOUNT:
DATE ESTABLISHED 10-11-1999
Account Balance
Percen~ Taxable X
__Amount_Subjec~.~--Ta~' -,,
Debts and Deductions -
Taxable Amoun~
Tax Rate X
Tax Due
( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
11,590.57 NOTE:
0.500
5,795,19
.00
TAX CRED'rTS:
5,795.19
260.78
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTIONOF THIS-NOT!CE
WITH YOUR TAX PAYMENT TO. THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
CDOOZ581 15.06 267.76
TOTAL TAX CREDIT
'~' ~' ' BALANCE OF TAX DUE
INTEREST AND PEN.
· * TOTAL DUE
IF PAID AFTER THIS DATE., SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
IF TOTAL DUE TS LESS THAN $1.~ NO PAYHENT TS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR}, YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORN FOR TNSTRUCTTONS. )
05-16-2003
260.78
.00
.00
.00
B~REAU OF ZNDTVTDUAL TAXES
INHERITANCE TAX DIVTSTON
DEPT. 280601
HARRISBURG, PA 1712&-0601
KAREN E CARTWRIGHT
~95 LEXINGTON AVE
MECHANICSBURG PA 17055
COMHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE
NOTZCE OF ZNHERZTAHCE TAX
APPRATSENENT, ALLOHANCE OR DISALLONANCE
OF DEDUCTIONS, AND ASSESSNENT OF TAX ON
JOTNTL¥ HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF HILLER
DATE OF DEATH 05-12-200:5
FILE NUMBER Z! 0:5-0:525
COUNTY CUMBERLAND
SSN/DC 162-10-6095
ACN 0:5117268
Amoun~ R®ml~ed
RE¥-1541 EX &FP (Ql-g5)
MARY A
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
CUT ALONG THIS LINE I~- RETAIN LOWER PORTION FOR YOUR RECORDS
REV-1548 EX AFP (01-031
NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS
DATE 08-11-200:5
ESTATE OF HILLER
HARY
A DATE OF DEATH 0:5-12-2005 COUNTY CUMBERLAND
FILE NO. 21 0:5-0:525 S.S/D.C. NO. 162-10-6095 ACN 0:5117268
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
dOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS,COUNTY NATIONAL BANK ACCOUNT NO.
1:500261
TYPE OF ACCOUNT:
DATE ESTABLISHED 0~-25,1989
Account Balance 22,828.66
Percent Taxable X 0.500
Amaun~_~Sub~e~+ ~o: Tax___ _ 11,~1~.:5:5
Debts and Deductions .00
Taxable Amount 11,q1~.:5:5
Tax Rate X '' .~5
Tax Due 51:5.6q
( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
NOTE:
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT ¢+)
DATE NUHBER ' INTEREST/PEN PAID ¢-) AHOUNT PAID
05-16-200:5 CD00258~ 25.68 ~87.96
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT~ SUBMIT THE
UPPER-PO~TtON~OF--TH~S NOT~CE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY'ORDER PAYABLE TO:
"REGISTER OF WILLS~ AGENT."
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
ZF PATD AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REI~UZRED.
TF TOTAL DUE ZS REFLECTED AS A "CREDIT" ( CR}~ YOU HAY BE DUE A REFUND.
SEE REVERSE STDE OF THIS FORH FOR ZNSTRUCTTONS. )
51:5.6~
.00
.00
.00
BUREAU OF ZNDTVZDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8060!
HARRISBURG,, PA 17128-0601
KAREN E CARTWRZGHT
695 LEXINGTON AVE
MECHANICSBURG PA 17055
CUT ALONE THIS-LINE
REV-1548 EX AFP (01-03)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTZCE OF ZNHERITANCE TAX
APPRAISEHENT. ALLONANCE OR DISALLOHANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
DATE OF DEATH 05-12-2005
MARY A
FILE NUMBER 21 05-0525
COUNTY CUMBERLAND
SSN,"DC 162-10-6095
ACN 05117262
I Amoun~ Remi~ed
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
R~TAIN-LOWER PORTION-FaR YOUR RECORDS
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF HILLER
HARY
A DATE OF DEATH 05-12-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0525 S.S/D.C. NO. 162-10-6095 ACN 05117262
TAX RETURN WAS: (X) ACCEPTED AS FILED *¢ ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK
TYPE OF ACCOUNT:
DATE ESTABLISHED
Account Balance
Percent Taxable
Debts and DeduCtions'
Taxable Amount
Tax Ra~e
Tax Due
TAX CRED'rTS:
ACCOUNT NO. 150519
( ) SAVINGS ( )'CHECKING ( ) TRUST (~ TIME CERTIFICATE
11-15-1995
2,016.67 NOTE:
X o.5oo
1,007.26
.00
1;007.26
65.55
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTTON OE~HIS~NOT!CF.~
WITH YOUR TAX PAYMENT TO'THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE
05-16-2005
RECEIPT
NUMBER
CD002578
DISCOUNT (+)
INTEREST/PEN PAID (-
2.27
AMOUNT PAID
63.06
TOTAL TAX CREDIT
BALANCE· OF TAX' DUE
INTEREST AND PEN.
· TOTAL DUE
IF PAID AFTER THIS DATE., SEE REVERSE FOR CALCULATION OF ADDZTTONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
TF TOTAL DUE IS REFLECTED AS A "CREDTT" (CH), YOU HAY BE DUE A REFUND.
SEE REVERSE STDE OF THIS FORM FOR INSTRUCTIONS.
65.33
.00
.00
.00
BOREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z&0601
HARRISBURG, PA 171Z&-060!
KAREN E CART'WRIGHT
q95 LEXINGTON AVE
HECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, &LLONANCE OR DTSAL~ONANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
DATE OF DEATH
FILE NUMBER Z1 05-0525
COUNTY CUHBERLAND
SSN/DC 162-10-6095
ACN 05117266
Am~oun'~ Remitted
KEV-~i$ EX &FP (01-05)
MARY A
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1548 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAISEMENT,'ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER MARY A DATE OF DEATH 05-.1Z-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0525 S.S/D.C. NO. 162-10-6095 ACN 05117266
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
dOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO.
1~9094
TYPE OF ACCOUNT:
( ) SAVINGS ( ) CHECKING ( ) TRUST'(~ TIME CERTIFICATE
10-11-1999
5,851.77
X 0.500
..... ~--. 2,925.891
- .00
2,925.89
.45
151.67
DATE ESTABLISHED
Account Balance
Percent Taxable
Debts and 'Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS=
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER POI~T/O~~S NOTICE
WITH' YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYHENT RECEIPT DISCOUNT (+)
DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID
05-16-2005 CD002582 6.58 125.09
TOTAL TAX CREDIT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
151.67
.00
.00
.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 HAY HE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.
BUREAU OF INDIVIDUAL TAXES
ZNHERTTANCE TAX DIVISION
DEPT. Z80601
HARRTSBURG, PA 171ZB-0601
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
COHMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLORANCE OR DISALLONANCE
OF DEDUCTIONS, AND ASSESSHENT OF T&X ON
JOINTLY HELD OR TRUST ASSETS
FILE NUMBER
COUNTY
SSN/DC
ACM
DATE 08-11-2005
ESTATE OF MILLER MARY
DATE OF DEATH OS-II-ZOOS
21 05-0325
CUMBERLAND
16Z-10-6095
0311726q
Amoun~ Remi~ed I
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE
REV-1548 EX AFP (01'03)
~'~ .... RETAIN 'LOWER poR'~ION FOR y-~UR RECORDS
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS
DATE 08-11-2003
ESTATE OF MILLER
MARY
A DATE OF DEATH 03-12-2003 COUNTY CUMBERLAND
FILE NO. 21 03-0325 S.S/D.C. NO. 162-10-6095 ACM 0311726~
TAX RETURN WAS: eX) ACCEPTED AS FILED ¢' ) CHANGED
dOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO.
13q259
TYPE OF ACCOUNT:
DATE ESTABLISHED 11-19-1996
Account Balance 2,016.15
Percent Taxable X 0.500
Debts and DeduC~i°ns - .00
Taxable Amount 1;008.08
Tax Ra~e X .' .q5
Tax Due ' q5.36
TAX CREDTTS:
05-16-2003
C ) SAVINGS C ) CHECKING C ) TRUST C~ TIME CERTIFICATE
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
:UPe~e PORT. TqN~F~HIS NnT~CE
WITH YOUR TAX PAYMENT TO' THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT 'PAID
CD002580 2.Z7 q3.09
TOTAL TAX CREDIT
~ ...... " BALANCE'OF 'TAX DUE
INTEREST AND PEN.
....... TOTAL DUE
IF PATD AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CA}, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
q5.36
.00
.00
.00
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HANRTSBURG., PA 17128-060!
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRATSEHENT. ALLOHANCE OR DISALLOHANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUS? ASSETS
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACM
08-11-2005
MILLER
05-12-2003
21 03-0325
CUMBERLAND
162-10-6095
03117269
Amoun~ Rmmi**od
REV-1S4$ EX AFP (11-15)
MARY A
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THZS ~ ~-.
REV-1548 EX AFP (01-03)
RETAIN LOWER PORtiON FOR YOU~R REcORDs
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOHANCE OR DZSALLOHANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2003
ESTATE OF MILLER
MARY A DATE OF DEATH 03-!2-2003
COUNTY CUMBERLAND
FILE NO. 21 03-0325 S.S/D.C. NO. 162-10-6095 ACN 03117269
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK
TYPE OF ACCOUNT:
DATE ESTABLISHED
Account Balance
( ) SAVINGS
0q-26-2002
ACCOUNT NO. 156819
C ) CHECKING C ) TRUST (~ TIME CERTIFICATE
26,209.82
1.000
26,209.82
.00
NOTE: TO INSURE PROPER CREDIT TO
Percent Taxable X
-.-bouEtc-Sub~i~cJcJ_~a TL_
Debts and Deductions -
Taxable Amount
Tax Rate X
Tax Due
TAX CREDZTS:
26,209.82
.q5
1,179.qq
YOUR ACCOUNT., SUBMIT THE
~UEPER_~OEI'~IDN~F ~HIS_NOTiCE.~
HITH YOUR TAX PAYMENT TO THE
REGISTER OF HILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF HILLS, AGENT."
PAYMENT
DATE
05-16-2003
RECEIPT
NUMBER
CD002585
i
DISCOUNT (+)
INTEREST/PEN PAID (-)
58.97
IF PAID AFTER THIS DATE~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
ZF TOTAL DUE ZS LESS THAN SI, NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" ( CR~, YOU NAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
AMOUNT PAID
1,120 .q7
TOTAL TAX CREDIT
BALANCE OF TAX DUEJ
INTEREST AND PEN.
TOTAL DUE
1,179.qq
.00
.00
.00
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT, Z&0601
HARRISBURG,, PA 17128-0601
KAREN E CARTWRIGHT
~95 LEXINGTON AVE
HECHANICSBURG PA 17055
COHMONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF /NHERITANCE TAX
APPRAISEHENT. ALLOHANCE OR DZSALLOHANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST &SSETS
DATE 08-11-200:5
ESTATE OF HILLER
DATE OF DEATH 03-12-2005
FILE NUHBER 21 03-0325
COUNTY CUHBERLAND
SSN/DC 162-10-6095
ACN 03117263
~Amoun'l: Remi"~ed
MARY A
CUT ALONG THIS LINE
REV-1548 EX AFP (01-03)
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
RETAIN LOWER PORTION FOR YOUR RECORDS
NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
~ATE 08-1________~1-2003
ESTATE OF MILLER
HARY
A DATE OF DEATH 03-!2-2003 COUNTY CUMBERLAND
FILE NO. 21 03-0325 S.S/D.C. NO. 162-10-6095
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
ACN 03117263
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO.
TYPE OF ACCOUNT:
DATE ESTABLISHED
Account Balance
1~9092
( ) SAVINGS ¢ ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
10-11-1999
19,135.92
0.500
9,567.96
.00
9,567.96
.~5
NOTE: TO INSURE PROPER CREDIT TO
Percent Taxable
---Aaaunt_Sub3~.*
Debts and Ded'uctions''
Taxable Amount
Tax Rate X
Tax Due
~30.56
TAX CRED'rTS:
YOUR ACCOUNT, SUBMIT THE
UPPER .PORTION-OF--THIS NOTICE - -
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT
RECEIPT
DATE NUMBER
05-16-2003 CD002579
DISCOUNT ¢+)
INTEREST/PEN PAID (-)
21.53
AMOUNT PAID
~09.03
ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADD] ;ONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
TOTAL TAX CREDIT
BALANCE OF TAX DUE~
' INTEREST AND PEN.
TOTAL DUE
~30.56
.00
.00
.00
4997
FUNERAL PURCHASE CONTRACT
(STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED)
(Chargel are only for lho~e Items that you ~elacted or U~St am required. If we are required by law or by
a cemetery or cmmstory to u~e any Items, we will explain the reasons in writing below.)
Section 13.204 o~ the Rules and Regulations of the Pennsylvania State Board of Funeral Directors refluires this contract
to be signed by ~he pers4~ o~ persons arranging Ior the funeral service and by the funeral director.
(A) OUR SERVICE:
BASIC SERVICES OF FUNERAL DIRECTOR & STAFF .... $
EMBALMING ...................................... $
If you ~etscted a funeral ~lat may requlre embalmlng such
aa a funeral With viewing, you may have to pay for
embalming. You do not have to pay for embalming you
did not approve if you selected arrangements such as a
direct cremation or Immediate burial, ff v~ charged for
embalming, we will explain why, below./~
OTHER PI~ARA~0N'OF THE BODY,..) ............. $
USE OF FACIMTIES, STAFF & EQUIPMENT:
Funs ral Ceremony ( c. mdu~ a r-~ P,o,~ ) ................ $
Visitation I Viewing ( c~ex~ -, r-u~ Ho,~ ) ............... $
Memorial Sewice ( co,du~ at r-u~,-aJ Hor~ ) ................ $
USE OF STAFF AND EQUIPMENT:
Funeral Ceremony ( c~r~=.~ .t ~t~y ) ............... $
Visitation / viewing ( cm~d -* a~m~ ~y ) .............. $
Memodal Sewlce ( C~du~ .., a~em~ ) .................. $
Graveside Service ................................ $
TRANSFER OF REMAINS TO FUNERAL HOME ......... $
( __ Miles Transported)
AUTOMOTIVE EQUIPMENT: ~'
Casket Coach (Hearse) ............................ $
Clergy Car ! Lead Car ............................. $
V
Flower Car ...................................... $
Sewice Car ...................................... $
MISCELLANEOUS MERCHANDISE:
Acknowledgment Cards ........................... $
Visitors Register ..................................
Memorial Folders / Prayer Cards ....................
Temlx)rary Grave Marker .......................... $
__ OUTER BURIAL ~ONTAINER (As Selected)
__ Receptacle (other than casket) $
__ Wearing Apparel
CRMN
FORWARDING OF REMAINS TO ANOTHER FUNERAL HOME ....................... $
RECEIVING OF REMAINS FROM ANOTHER FUNERAL HOME ....................... $
DIRECT CREMATION (As Seiscted) .............................................
IMMEDIATE BURIAL (As Selected) .............................................. $
COCKLIN FUNERAL HOME, INC.
e SCOTT D. BRENNEMAN. Supe~'isor
P.O. Box 424 · 30 North Chestnut Street
DILLSBURG, PENNSYLVANIA 17019
Phone (717) 432-5312
e Deceased is I t ~
· (~
(~) CASH ADVANCE ITEMS: Total
Flowers ..................................... ~4~ ..~ ..... $
C'~rtified copies of Death Certificate ............. .~.~ ....$
Clergy Honorarium ........................... ~ ..... $
Cemetery Property ................................... $
Cemetery Opening & Closing Charges .................. $
Cemetery Weekend & Holiday & Overtime Charges ........ $
Newspa. pe. r-Death Notices & Thank You Notices .......... $
Cutting Date off Stone in Cemetery ...................... $
Cemetery Equipment ................................. $
....... $
....... $
....... $
OTHER ITEMS:
No.
Date. [3, ~
Age ~
of person_arranging services.
· .
Total (B) $
Total (A) & (B)
Total (C) $ $
LESS:
Prenead Adjustment / Allowance [] INS [] TR
Payment / Date ( )
Other (Specify)
Total (A) (e) & (c
$(
$(
$(
Signature of Purchaser(s)
We egrse to provide em senace& ~ Indlcated above.
Co.kiln ~ Hame, ~
Street Address City and State Zip Code
Signature of Purcha.s~'(s)
LEGAL, C~[~l ETERY, CREMATO[:IY OR;QTH EI~_EQ U. I R E M EJ[~ITS. CQJVlPEIJ~G THE P~RC~[A,~,OF ANY ITEMS LISTED
ABOVE: .)~O ~ I~,,~_~..OU.[ (~.~~ (.,~ '
named deceam~:l. (2) I/We were shown a ~;aaket Price List eno an umm uurlal comalne~ ~nce Lm[ omore me mmm,,g u
and outer burial containers. (3) I/We w~e given/offered for retention a General Price List upon the beginning of a discu~lon o!
TERMS: Net due ~ ~ ~.~ ! ~?CA-~.._: . . A charge of 6% pe~
annum for unanticipate~ late payment will be charged on any amount unpaid after due date.
uc, derstands ~ this promme to jointly and severally ma.ks full payment means t .he runer_m.rmm, e' ne:s me ng~,~ _~_,,~L,_,::-_.~_,,.
~n v~'l~ or rn~re of the ourch~sers wJtho4Jt reso~ to any Claim against arty other purchasers I Ri~/'lgn! exists regaramss ~ w~eu ~u~ u~
~'~.:~e ~,~Jrchasers ha~e reed themselves how much each will comdbute to make full payment. Receipt of a copy of th~s cootract
v ' ' ~'~'3atur~ of Purchaser(s) ~ Street Address
City State Zip Code
BALANCES
~BUREAU OF TNDZVTDUAL TAXES
TNHERTTANCE TAX DTVIS/OH
DEPT. 280601
HARRISBURg, PA 171Z8-0601
COMMON#EALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISENENT, ALLO#ANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DANIEL D HORLEY
HORLEY & HORLEY
225 LATIHORE VLY RD
YORK SPRINGS
PA 1737'2
DATE 12-15-2003
ESTATE OF MILLER
DATE OF DEATH 05-12-Z003
F/LE NUHBER 21 05-0525
COUNTY CUMBERLAND
ACN 101
Amount Rem'ii:ted
MARY A
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS L/NE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01'03) NOTICE OF INHERITANCE TAX APPRA:ISEMENT, ALLOWANCE OR D:ISALLO#ANCE OF DEDUCT:IONS AND ASSESSMENT OF TAX
ESTATE OF MILLER MARY AFZLE NO. 21 05-0325 ACN 101 DATE 12-15-2003
TAX RETURN WAS: ( ) ACCEPTED AS F/LED (X) CHANGED SEE ATTACHED NOTICE
RESERVAT:ION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
:5. Closely Held Stock/Partnership Interest (Schedule C) (:5)
q. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposi~s/Hisc. Personal Property (Schedule E) ($)
6. Jointly O~ned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCT:iONS AND EXEHPT:IONS:
9. Funeral Expenses/Adm. Costs/Hisc. Expanses (Schedule H) (9)
10. Deb~:s/Hor~gaga Liabilities/Liens (Schedule I) (10)
11. To'al Deduct ions
12. Net Value of Tax Return
1~/526.00
11/q13.71
.00
.00 NOTE: To insure proper
.00 credit ~o your account,
.00 submit the upper portion
.00 of this form ~ith your
tax payment.
8,151.06
(8)
13.
14.
NOTE:
25,939.71
5~95~+.59
(ia) 11,53~.06
.00
AHOUNT PAID
519.03
TOTAL TAX CREDIT I 519.03
BALANCE OF TAX DUEl .01
:INTEREST AND PEN. .00
TOTAL DUE .01
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT 1S REQUIRED.
IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
ASSESSMENT OF TAX:
16. Amount of L/nm 14 at Spousal rata
16. Amount of Line 14 taxable at Lineal/Class A rata
17. Amount of Line 14 at Sibling rata
18. Amount of Line 14 taxable at Collateral/Class B rata
19. Principal Tax Due
TAX CREDITS:
PAYflENT RECEIPT DISCOUNT
DATE NUNBER INTEREST/PEN PAID (-)
10-2~-Z003 CDO0317Z .00
(1~) .00 x O0 = .00
(16) 11,53Q.06 x OR5= 519.0~
(17) .00 x 12 = .00
(18) .00 x 15 = .00
(19)= 519. O~
Charitable/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (13)
Nat Value of Estate Subject ~:o Tax (14) 11,53~.06
:if an assessment ~as issued previously, lines 14, 15 and/er 16, 17, 18 and 19 ~ill
reflect figures that include the total of ALL returns assessed to date.
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATLVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before DeceMber 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
11fa or for years, the CoMmonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S.
Section 9160).
Detach tho top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Make check or Money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which ~as not requested on the Tax Return, May be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Office
of the Register of Nills, any of the Z$ Revenue District Offices, or by calling the special gA-hour
answering service for fores ordering: 1-800-362-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-q67-3020 (TT
Any party in interest not satisfied with the appraisement, allowance, or disaIlowance of deductions, or assessment
of tax (including discount or interest) es shown on this Notice Must object ~ithin sixty (60) days of receipt of
this Notice by:
--~rittan protest to the PA DepartMent of Revenue, Board of Appeals, Dept. ZBIOgl, Harrisburg, PA 17IZB-IOZI, OR
--election to have the Matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA DepartMent of Revenue,
Bureau of Individual Taxes, ATTN: Post AssessMent Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-iS01) for an explanation of administratively correctable errors.
If any tax due is paid within three ($) calendar Months after the decedent's death, a five percent (SZ) discount of
the tax paid is allowed.
The ISZ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January lB, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in the same Manner and in tho the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) Months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at tho rate of
six (62) percent per annum calculated at a daily rate of .00016¢. All taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year ~ith that rate
announced by tho PA Department of Revenue. Tho applicable interest rates for 1982 through Z003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Yea.~r Rate Factor Year Rate Factor
198Z ZOZ .000S48 1987 9X .D00267 1999 7Z .000192
1983 162 .000438 1988-1991 112 .O0030X ZOO0 82 .000219
1986 112 .000301 199Z 92 .000267 2001 9X .000267
1985 132 .000556 1993-1996 7Z ,000192 2002 62 .000166
1986 102 .O00Z7q 1995-1998 92 .000267 Z003 5Z .000137
--Interest is calculated as follo~s:
INTEREST = BALANCE OF TAX UNPAID
X NUNBER OF DAYS DELINI~UBNT
X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an lnterost 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.
REV-1470 EX
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCETAX
EXPLANATION
OFCHANGES
DEPT. 280601
HARRISBURG PA 17128-0601 FILE NUMBER
DECEDEN'FS NAME 2103-0325
Mary A. Miller
ACN
REVIEWED BY ANITA MCCULLY 101
ITEM EXPLANATION OF CHANGES
SCHEDULE NO,
F 1 ,2,3, The value of the jointly held assets is being stricken from the assessment of this return
4,5,6 since they were previously assessed on 05-19-03 under Acn's 03117262, 03117263,
& 7 03117264, 03117265, 03117266, 03117267 and 05-16-03 under Acn's 03117268.
G The value of the jointly held assets is being stricken from the assessment of this return
since they were previously assessed on 05-19-03 under ACN 03117269.
ROW Page 1
FAMILY SETTLEMENT AND FINAL RELEASE
ESTATE OF MARY A. MILLER
KNOW ALL MEN BY THESE PRESENTS, that Mary A. Miller, late of Lower Allen
Township, Cumberland County, Pennsylvania, deceased, died testate on March 12,
2003, having first made his/her Last Will and Testament, which, was duly executed on
July 21,1967 and probated in the Office of the Register of Wills of Cumberland County,
on April 11,2003. ~
WHEREAS, the said Mary Miller, by the aforesaid Last Will and Testament,
named her Daughter, Karen Cartwright as Executrix of said Last Will and Testament;
WHEREAS, Letters Testamentary on the Estate of the said decedent were duly
issued by the Register of Wills of Cumberland County, Pennsylvania, to the said
Executrix, hereinafter called personal representative;
WHEREAS, the personal representative has gathered the assets of the Estate of
the said decedent and the assets consist of personal property with the total value of
$90,373.76 as set forth in Exhibit "A", which is a copy of the Pennsylvania Inheritance
Tax Return filed and approved by said personal representative, and which is attached
hereto and made a part hereof, and marked Exhibit "A";
WHEREAS, the debts and deductions, including the payment of inheritance tax
in the said Estate, which have now been paid, leave a balance for distribution of
$70,007.55, also as set forth in the statement of said personal representative, which is
attached hereto and marked Exhibit "B";
WHEREAS, the balance for distribution as shown in the said statement marked
Exhibit "B" has been reduced to cash and has been distributed as herein indicated in
accordance with the terms of the Last Will and Testament of the said Decedent;
NOW, THEREFORE, Karen Cartwright being the sole of the heir under the Last
Will and Testament of the said decedent, and being that person entitled to inherit under
said Last Will and Testament, do hereby acknowledge that I have this day had and
received from the aforesaid personal representative, in full satisfaction and payment of
all sums of money, legacies, bequests, and devises as are given, devised and
bequeathed to each of us respectively by the said Last Will and Testament, the
amounts due us under said Last Will and Testament, which amounts we have received
this day or prior to this day; and, do hereby stipulate that in order to avoid the expense
and time involved in the filing of a formal account and schedule of distribution, I agree
that no account is necessary and I do hereby agree that I do consent to distribution
being made without the filing of an account and schedule of distribution, the same to be
with the same force and effect as if they had been filed and confirmed by the Orphan's
Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania.
THEREFORE, I, do hereby remise, release, quitclaim and forever discharge the
said personal representative, Karen Cartwright, her heirs, executors, administrators and
assigned, of and from the said estate and from all actions, suits, payments, accounts,
reckonings, claims, and demands whatsoever for or by reason thereof, or for any other
use, matter, cause or thing whatsoever, touching upon the Estate of the said decedent,
and do further hereby covenant and agree that should any liability come due to the
estate of the said decedent after the signing of this Agreement, I do hereby covenant
and agree with each other and the aforesaid personal representative, that I will
contribute my share of the Estate to satisfy any and all claims, demands, suits or
causes of action which may be successfully prosecuted against the said Estate or the
aforesaid personal representative after the signing, sealing and delivery of this Family
Settlement Agreement and Final Release.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 19th day of
January, 2004.
Witness
Karen Cartwright
BUREAU OF INDIVIDUAL TAXES
I~ERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
DANIEL D WORLEY
WORLEY & WORLEY
225 LATIMORE VLY RD
YORK SPRINGS PA 17372
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE T/O(
APPRAISEHENT, ALLOH~J~CE OR DISALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
1Z-15-2003
MILLER
03-12-2003
21 03-0325
CUMBERLAND
101
Amoun~ Reml**ed
REV-15~7 EX AFP (01-03)
MARY A
MAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND C0 COURT HOUSE
CARLISLE, PA I7013
CUT ALONG THIS LINE ~ RETAZN LOWER PORTION FOR YOUR RECORDS -.~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DZSALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF MILLER MARY AFZLE NO. 21 03-0325 ACN 101 DATE 12-15-2003
TAX RETURN NAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A) (1).
2. S~ocks and Bonds (Schedule ,B) (2)
$. Closely Held S~ock/Par~cnarship In~eres~ (Schedule C)
q. Mor~cgagas/No~cas Receivable (Schedule D)
5. Cash/Bank Deposi~cs/Hisc. Personal Proper~y (Schedule E) ($)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To~al Assa~cs
APPROVED DEDUCTIONS AND EXEMPTZONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Hot,gage Liabili~ias/L/ens (Schedule T)
11. To~al Deductions
12. Ne~ Value of Tax Re~urn
.00
.00
.00
.00
lq/526.00
11~q13.71
.00
(8)
8,q51.06
NOTE: To insure proper
credi~ ~o your account,
submi~ ~he upper portion
of ~his form wifh your
~ax payment.
25,939.71
5,95q.59
(11) 14.605.65
(lz) 11,53q.06
15.
lq.
NOTE:
ASSESSMENT OF TAX:
15. Amoun~ of Line lq a~ Spousal ra~e
16. Amoun~ of Lina lq ~axabla a~ Lineal/Class A ra~a
17. Amoun~ of Line lq a~ Sibling ra~a
18, Amoun~ of L/ne lq ~axabZe a~ Collateral/Class B ra~e
19. Principal Tax Due
TAX CREDZTS:
PAYHENT RECEIPT DISCOUNT
DATE NUHBER INTEREST/PEN PAID
10-Iq-Z005 CD005~7~ .00
Chari~cabla/Governman~cal Bequests; Non-elected 9115 Trusts (Schedule J) (15) . O0
Na~ Value of Es~a~e Subjec* '1:o Tax (lq) 11,53q.06
Zf an assessment was issued previously, Z~nes 14, 15 and/or 16, 17, 18 and 19 w~l
reflect figures that include the total of ALL returns assessed to date.
(15) .00 X O0 = .00
(I6) 11,53~.06 X Oq5= 519.0q
(17) . O0 X 12 = . O0
(lB), .00 x 15 = .00
(19)= 519. Oq
AHOUNT PAZD
519.05
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDZTZONAL INTEREST.
TOTAL TAX CREDZT
BALANCE OF TAX DUEJ
ZNTEREST AND PEN.
TOTAL DUE
519.03
.Oi
.00
.0!
( IF TOTAL DUE ZS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SZDE OF THIS FORH FOR INSTRUCTIONS.)
'_v'-1470
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601 FILE NUMBER
DECEDENTS NAME Mary A. Miller 2103-0325
ACN
REVIEWED BY ANITA MCCULLY 101
ITEM EXPLANATION OF CHANGES
SCHEDULE NO,
F 1,2,3, The value of the jointly held assets is being stricken from the assessment of this return
previously assessed on 05-19-03 under Acn's 03117262, 03117263,
since
they
were
4,5,6
& 7 03117264, 03117265, 03117266, 03117267 and 05-16-03 under Acn's 03117268.
G The value of the jointly held assets is being stricken from the assessment of this return
since they were previously assessed on 05-19-03 under ACH 03117269.
ORIGINAL Page 1
REV-1500 EX (6-00)
COMMONWEALTH OF
PENNSLYVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21
03 0325
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
IMiller, Mar~, A. 162-10-6095
DATE OF DEAT. (MM-DD-YEAR) I DATE OF B,RT. (MM-DO-YEAR) MUST
0~12-2003 ~7-1911 REGISTER OF WI LES
'IF APPLICABLE) SURVIVING SPOUSE'S NAME (~ST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
1. Original Return
4. Limited Estate
6. Decedent Died Testate (Attach copy of Will)
9. Litigation Proceeds Received
U2. Supplemental Return L---J Remainder Retum<~eotd~h ~to 12
I I
4a. Future Interest Comprise (date of death after 12-12-82) U Federal Estate Tax Return Required
7. Decedent Maintained a Living Trust (A.ac~ a copy of Trust) 8. Total Number of Safe Deposit Boxes
10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)~ ~A.~¢~11. ElectiOns~ o~ to tax under Sec. 9113(A)
NAME
Daniel D. Worley
FIRM NAME (If Applicable)
Worley & Worley LLP
TELEPHONE NUMBER
(717)528-4500
COMPLETE MAILING ADDRESS
Wodey & Wofley LLP
225 Latimore Valley Road
York Springs, PA 17372
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Propnetorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
[ --~ Separate Billing Requested
7. Inter-Vivos Transfers & Misc. 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. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
$ 0.00i
$ 0.00i
$ 0.00i
$ 0.00[
$14,526.00i
$49,637.94[
OFFICIAL USE ONLY
$26,209.82!
(8)
$8451.06
$5,954.59
$90,373.76
(11) $14,405.65
(12) $75968.11
(13) $ 0.00
(14) $75,968.11
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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
19. Tax Due
20'~1
75,968.11
X
x .045
x .12
x .15
(15) $ o.oo
(16)
~ ~ ~ ~ RECI'IECK MATH < <
$3418.56
$ 0.00
(17)
(18) $ 0.00
(19) $3418.56
Decedent's Complete Address
STREET ADDRESS Bethany Village Retirement Center
325 Wesley Drive
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
$3418.56
2899.53
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4. If line 2 is areater 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 (5B)
$2,899.53
$ o.oo
$ o.oo
$519.03
$519.03
Make Check Payab/e to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ~
b. retain the right to designate who shall use the property transferred or its income;
c. retain a revisionary interest; or
d. receive the promise for life of either payments, benefits or care?
2. If death occurred after December 12, 1982, did decedent transfer property within on year of death
without receiving adequate consideration? ~ ~
3. Did decedent own an "in t]~st for'' or payable upon death bank acoount or security at his or her death?
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 RLE IT AS PART OF THE RETURN.
Under penalties of perjury. ~ deciare that I have exam[ned this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Declaration of preparer other than the personal representative is based on all the information of which preparer has any knowledge.
SIGN.~T,I~ff~E OF PERSON F~E~PON~IBLE FOR FILING RETURN DATE
ADDRESS (~
495 Lexington Ave, Mechanicsburg PA 17055
DATE
10-23-03
ADDRESS
225LatimoreValleyRoad, YorKSprings, PA17372
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3% [72 P.S. 9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116
(a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse ~'rom tax, and the statutory requirements for disclosure of assets and filing a tax
return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is 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(a) (1)].
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(a)(1.3)]. A sibling is defined, under Section
9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (1-97Xl)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONALPROPERTY
ESTATE OF FILE NUMBER
I~etheproceeds~litigationa~the~theproceedswerereceiv~ ~the~tate.~lpropertyjoi~y-ownedwiththe~gM~rvivorshipmuM~dl~losed~ ~hedu~ F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CERTIFICATE OF DEPOSIT; BURIAL FUND 7,535.00
ACCT: 2110407
Refund from Bethany Village
TOTAL(Alsoen~ronline5, Recapitulation
(Ifmomspaceisne~,inse~additionalshee~ ~thesamesize)
3,423. O0
3,568.00
$14,526.00
REV-1509 EX + (1-97X1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Karen E. Cartwright
495 Lexington Ave, Mechanicsburg, PA 17055
Daughter
JOINTLY-OWNED PROPERTY:
ITEM LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
NUMBER FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. DATE OF DEATH DECD'S VALUE OF
TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. CD # 134259 (Inheritance Tax previously paid) 2,016.15 50% 1,0o6.06
2. A. CD # 130519 (Inheritance Tax previously paid) 2,014.47 50% 1,0o7:24
3. A. CD # 149094 (Inheritance Tax previously paid) 5,851.77 5o% 2,925.89
4. A. CD # 149092 (Inheritance Tax previously paid) 19,135.92 50% 9,567.96
5. ^. CD # 1300261 (Inheritance Tax previously paid) 22,828.66 50% 11,414.33
6. A. CD # 149096 (Inheritance Tax previously paid) 11,590.37 50% 5,795.19
7. A. CD # 640029785 (Inheritance Tax previously paid) 13,011.08 50% 6,505.54
8. A. Pre1999 CHECKING ACCT: 1300261 22,827.41 50% 11,413.71
TOTAL (Also enter on line 6, Recapitulation) $49,637.94
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (1-97X1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF DECD'S
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH INTEREST EXCLUSION TAXABLE
NUMBER A3-rACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET (~F APPLICABLE) VALUE
1. CD # 156819 (Inheritance Tax previously paid) 26,209.82 50% 26,209.82
TOTAL (Also enter on line 7, Recapitulation) $26,209.82
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (1-97X1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
5.
6.
7.
DESCRIPTION
FUNERALEXPENSES:
Cocklin Funeral Home
Cocklin Funeral Home
Funeral
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 Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State __ Zip
Relationship of Claimant to Decedent
Probate Fees Cumberland County Register of Wills and Advertisement
Accountant's Fees
Tax Return Preparer's Fees
PSERS
George Miller
AMOUNT
7,798.28
137.27
0.00
166.85
75.00
273.66
TOTAL (Also enter on line 9, Recapitulation) 8451.06
r REV. 1512 E~ + (1-97X1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(If more space is needed, insert additional sheets of the same size)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
2.
3.
4.
5.
Bethany Village
Alert Phy @ Bethany
Holy Spirit Hospital
Conner Rich Associates
The Foot Care
5,701.00
137.00
28.00
51.59
37.00
TOTAL (Also enter on line 10, Recapitulation) $5,954.59
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00))
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
Ii.
TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and
transfers under Sec. 9116 (a) (1.2)]
Karen E. Cartwright, 495 Lexington Ave, Mechanicsburg PA 17055
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
lOO%
ENTER DOLLAR,NVIOUNTS FOR DISTPJ BLmONS SHOWN ABOVE ON UNES 15 THROUGH 18, AS N3PROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOT/~I. OF PART 11 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
$ 0.00
(If more space is needed, insert additional sheets of the same size)
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0&0!
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA I7055
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISE~IENT, ALLOHANCE OR DISAL'LONANCE
OF DEDUCTIONS, AND ASSESStiENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2003
ESTATE OF MILLER MARY A
DATE OF DEATH 05-12-2003
FILE NUMBER 21 05-0525
COUNTY CUMBERLAND
SSN/DC 162-10-6095
ACN 03117265
,Amount Remitted
MAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND C0 COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE
REV-1548 EX AFP (01-03)
RETAIN LOWER PORTION FOR YOUR RECORDS
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
MARY
A DATE OF DEATH 05-72-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0525 S.S/D.C. NO. 162-10-6095 ACN 05117265
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK
TYPE OF ACCOUNT:
DATE ESTABLISHED
Account Balance
Percent Taxable X
Amount Subj~+ t~.T .a~___
Debts and Deductions' -
Taxable Amount
Tax Rate X '
Tax Due
TAX CREDTTS:
ACCOUNT NO. Iq9092
( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
10-i1-1999
19,155.92
0.500
9,567.96
.00
9,567.96
.q5
q50.56
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF-~H[S NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE
05-16-2003
RECEIPT
AMOUNT PAID
NUMBER
CD002579
i DISCOUNT (+)
INTEREST/PEN PAID (-)
21.53
q09.05
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
q50.56
.00
.00
.00
IF PAID AFTER THIS DATE/ SEE REVERSE FOR CALCULATION OF ADDI'
( IF TOTAL DUE IS LESS THAN $1~ NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) '
TOTAL DUE
~ONAL INTEREST.
GU?EAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Za060i
HARRISBURG~ PA 17178-0601
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTICE OF INNERITANCE TAX
APPRAISENENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSNENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2003
ESTATE OF MILLER
DATE OF DEATH 03-12-2003
FILE NUMBER 21 03-0325
COUNTY CUMBERLAND
SSN/DC 162-10-6095
ACN 05117269
Amoun~ Remi~ed
MARY A
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA i7013
CUT ALONG THIS LINE
REV-1548 EX AFP (01-03)
RETAIN LOWER pORTIoN FOR YOUR RECORDS
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
MARY
A DATE OF DEATH 03-.12-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0325 S.S/D.C. NO. 162-10-6095 ACN 05117269
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK
TYPE OF ACCOUNT:
DATE ESTABLISHED
Account Balance
Percent Taxable X
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
TAX CREDTTS:
ACCOUNT NO. 156819
( ) SAVINGS ( ).CHECKING ( ) TRUST (~ TIME CERTIFICATE
0q-26-2002
26,209.82
1.000
26,209.82
.00
26,209.82
.q5
1,179.fiq
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT', SUBMIT THE
--U~PER-PO~TIDN~THIS_NOIICE_____
WITH YOUR TAX pAyMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT
RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
05-16-2005 C0002585 58.97 1,120.q7
. . . ..... TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER THIS DATE,, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST
( TF TOTAL DUE IS LESS THAN $1., NO PAYMENT IS REQUIRED. '
IF TOTAL DUE IS REFLECTED AS A "CREDTT" ( CR)., YOU NAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
1,179.qfi
.00
.oo
.oo
BUR,EAU OF INDIVIDUAL T~ES
INHERITANCE TAX I~IVISION
DEPT. 280601
HARRISBURG., PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLONANCE OR DISALLONANCE
OF DEDUCTIONS, AND ASSESSMENT OF T&X ON
JOINTLY HELD OR TRUST ~m~SSETS
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
MECHANICSBUR$ PA 17055
DATE 08-11-2005
ESTATE OF MILLER MARY
DATE OF DEATH 05-12-2005
FILE NUMBER 21 05-0~25
COUNTY CUMBERLAND
SSN/DC 162-10-6095
ACN 0511726q
Amount Remi~ed
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 08-11-2005
ESTATE OF MILLER MARY A DATE OF DEATH 03-12-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0325 S.S/D.C. NO. 162-10-6095 ACN 0311726q
TAX RETURN WAS: (X) ACCEPTED AS FILED (*)'CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO.
13q259
TYPE OF ACCOUNT:
C ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
2,016.15 NOTE:
0.500
1,008_~08
.00
1~008.08
' .q5
q5.56
DATE ESTABLISHED 11-19-1996
Account Balance
Percent Taxable X
Debts and Deductions -
Taxabie Amount
Tax Rate X
Tax Due "~
TAX CRED'rTS:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT`' SUBMIT THE
:UPRELPORTION'~F~HIS_~OI]CE
WITH YOUR TAX PAYMENT TO' THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO=
"REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER ' INTEREST/PEN PAID (-) AMOUNT PAID
05-16-2005 CD002580 2.27 q3.09
TOTAL TAX CREDIT
....' ' '.'". ~ALANCE OF 'TAX DUE
,. ZNTEREST AND PEN.
...... TOTAL DUE
IF PAID AFTER THIS DATE,, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1,, NO PAYHENT IS REQUIRED.
IF TOTAL DUE TS REFLECTED AS A "CREDIT" ( CR),, YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.
q5.56
.00
.00
.00
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 2Bo601
HARRISBURG, PA 171ZB-0601
KAREN E CART'WRIGHT
695 LEXINGTON AVE
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DiSALEOHANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX OH
JOINTLY HELD OR TRUST ASSETS
FILE NUMBER
COUNTY
SSN/DC
ACN
DATE 08-11-2005
ESTATE OF MILLER MARY A
DATE OF DEATH 05-12-2005
21 03-0525
CUMBERLAND
162-10-6095
05117266
Amount Remi~ed
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~'- RE~AZN LOWER PORTION FOR YOUR RECORDS ~
~-: i ~- [~- ~F- ~ ~=-6 ~3- ...................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS~ AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-11-200~
ESTATE OF MILLER
MARY
A DATE OF DEATH 05-.12-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0525 S.S/D.C. NO. 162-10-6095 ACN 05117266
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO.
169096
TYPE OF ACCOUNT:
DATE ESTABLISHED
Accoun~ Balance
Percent Taxable
Debts and Deductions
Taxabie Amounf
Tax Ra~e
Tax Due
SAVINGS C ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
10-11-1999
5,851.77
0.500
TAX CREDTTS:
2~925.89
- .00
2,925.89
X .65
151.67
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, .SUBMIT THE
UPPER POR_T~IDN~IS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS, MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
05-16-2005 CD002582 6.58 125.09
,.. TOTAL TAX CREDZT
~ALANCE OF TAX DUE
· INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. m
( IF TOTAL DUE IS LESS THAN SI, 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. )
131.67
.00
.00
.00
BUREAU OF INDIVIDUAL TAXES
INHFRITANCE TAX DIVI$IDN
DEPT. ;'80601
HARRISBURG, PA 17128-0601
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLONANCE OR DISALLONANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2003
ESTATE OF MILLER MARY A
DATE OF DEATH 05-12-2003
FZLE NUMBER 21 03-0325
COUNTY CUHBERLAND
SSN/DC 162-10-6095
ACN 03117262
Amoun~ Remi~c~ed
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIs-LINE ~
REV-l$48 EX AFP (O[-OS)
RETAIN LOWER PORT~ONF~R YOUR RECORDS
NOTZCE OF ZNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTZONS, AND ASSESSMENT OF TAX ON JOZNTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
MARY A DATE OF DEATH 03-12-2003
COUNTY CUMBERLAND
FILE NO. 21 05-0525 S.S/D.C. NO. 162-10-6095 ACN 03117262
TAX RETURN WAS: (X) 'ACCEPTED AS FILED '() CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO.
130519
TYPE OF ACCOUNT:
DATE ESTABLISHED
C ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
11-15-1995
Account Balance 2,01fi.fi7
Percent Taxable X 0.500
AmoJ~n_LSub~ec~ to Tax 1,007.2q
Debts and Deductions .00
Taxabie Amount 1,'007.2q
Tax Rate X '* ' .~5
Tax Due ' ~5,33
TAX CREDTTS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION~OE ~HIS ~O-T~CF_~
WITH YOUR TAX PAYMENT TO'THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE
05-16-2003
RECEIPT
NUMBER
CD002578
DISCOUNT (+)
INTEREST/PEN PAID (-)
2.27
AMOUNT PAID
q3.06
TOTAL TAX CREDIT
· BALANCE OF TAX'DUE
ZNTEREST AND PEN.
TOTAL DUE
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.
q5.33
.00
.00
.00
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 171Z~-0601
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX.
APPRAISEMENT, ALLOHANCE OR DISALLOHANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2003
ESTATE OF HILLER MARY A
DATE OF DEATH 03-12-2005
FILE NUMBER 21 05-0525
COUNTY CUMBERLAND
SSN/DC 162-10-6095
ACN 03117268
Amoun~ Remi~ed
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 -'~
~¥-:i~-[k-~--~i=-6~3- ...................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF HILLER
MARY A DATE OF DEATH 05-12-2003 COUNTY CUMBERLAND
FILE NO. 21 03-0325 S.S/D.C. NO. 162-10-6095 ACN 03117268
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
dOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS,COUNTY NATIONAL BANK ACCOUNT NO.
1300261
TYPE OF ACCOUNT:
( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 0q-25-1989
,!
Account Balance 22,828.66
Percent Taxable X 0.500
Amount_Subarea+ +o .Tax .... 11,~1q.33 .
Debts and Deductions - .DO
Ta×abIe Amoun~ ii,qiq.53
Tax Rate X ...... .~5
Tax Due 513.6q
TAX CREDITS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER--PO~TION~OF~TH~S NOT-ICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER : INTEREST/PEN PAID (-) AMOUNT PAID
05-16-2003 CDOO258q 25.68 q87.96
TOTAL TAX CREDIT /
BALANCE OF TAX DUE
INTEREST AND PEN.
'TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN SI, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.
513.6q
.00
.00
.00
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 250601
HARRISBURG, PA 17128-0601
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE; OF INHERITANCE TAX
APPRAISEMENT. ALLOiiANCE OR DISALLOH~NCE
OF DEDUCTIONS, AND ASSESSI~ENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
DATE OF DEATH 05-12-2005
FILE NUMBER 21 05-0525
COUNTY CUMBERLAND
SSN/DC 162-10-6095
ACN O5117265
Amount: Remi~:~ed
REV-15~iI EX AFP (Or-OS)
MARY A
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS L'rNE
RETAI'N LOWER PORTZON FOR YOUR RECORDS
REV-1548 EX AFP (01-03)
NOTICE OF ZNHER/TANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCT/ONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-11-2005
ESTATE OF MILLER
MARY A DATE OF DEATH 05-12-2005 COUNTY
CUMBERLAND
FILE NO. 21 03-0525 S.S/D.C. NO. 162-10-6095 ACN 03117265
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ACCOUNT NO.
1~9096
TYPE OF ACCOUNT:
DATE ESTABLISHED
Account Balance
Percent Taxable
.Amount Subjec+ &~_Tax'
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
i0-1i-1999
11,590.37 NOTE:
X 0.500
".L 5,795,!9
_ .00
5,795.19
X .~5
260.78
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTIONOF THIS-~O¥!CE
WITH YOUR TAX PAYMENT TO, THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE 'NUMBER iNTEREST/PEN PAID (-)
CD002581 13.0~ 2~7.7~
TOTAL TAX CREDIT
'~" ~* ' BALANCE OF TAX DUE
..... INTEREST AND PEN.
' TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" [ CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
05-16-2003
260.78
.00
.00
.00
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX I~IVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
KAREN E CARTWRIGHT
q95 LEXINGTON AVE
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLORANCE OR DISALLOHANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ~SSETS
DATE 08-11-2003
ESTATE OF MILLER
DATE OF DEATH 05-12-2005
FILE NUFtBER 21 03-0525
COUNTY CUMBERLAND
SSN/DC 162-10-6095
ACN 03117267
Amount Remi~ed
MARY A
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS '~
REV-lS48 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 08-11-2003
ESTATE OF MILLER
MARY
A DATE OF DEATH 03-12-Z003 COUNTY CUMBERLAND
FILE NO. 21 03-0525 S.S/D.C. NO. 162-10-6095 ACN 03117267
TAX RETURN WAS: (X) 'ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ADAMS COUNTY NATIONAL BANK ~ACCOUNT NO. 6q0029785
TYPE OF ACCOUNT:
DATE ESTABLISHED Oq-23-199q
Account Balance 13,011.08
Percent Taxable X 0.500
Debts and 'Deductions - .00
Taxable Amount 6,505.54
Tax Rate X .q5
Tax Due 292.75
TAX CREDTTS:
C ) SAVINGS (') CHECKING ( ) TRUST (~ TIME CERTIFICATE
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMI~ THE
UPPER~ORTION-OE THI-S~NOTICE-
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE
05-16-2003
RECEIPT
NUMBER
CD002583
DISCOUNT (+)
~INTEREST/PEN PAID (-)
lq.6q
AMOUNT PAID
278.11
TOTAL TAX CREDIT
.... BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
TF PAID AFTER THTS DATE, SEE REVERSE FOR CALCULATION OF ADDTTIONAL INTEREST. a
IF TOTAL DUE TS LESS THAN $1, NO PAYHENT IS REQUIRED.
TF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR)~ YOU PlAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
292.75
.00
.00
.OD
FUNERAL PURCHASE CONTRACT
4997 (STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED)
(Charg¢~ are only for thole Itema that you selected or that ere required. If we are required by law or by
a cemetery or crematory to use any Ifeml, we will explain the reasons in writing below.)
Section 13.204 of the Rules and Regulations of the Pennsylvania State Board of Funeral Directors requires this contract
to be signed by the pemon or persens arranging for the funeral service and by the funeral director.
(A) OUR SERVICE: $
BASIC SERVICES OF FUNERAL DIRECTOR & STAFF .... $
~' If you eelected a funeral that may require embalming euch
~ ~ es a funeral with viewing, you may have to pay for
~. ~ ~ embalming. You do not have to pay for embalming you
z~ did not approve if you eelectad errengementa auch ea ·
..
d
direct cremation or Immediate burial. If wff charged for
"' ' embalming, we will explain w_h,F, below. ~
R
O O ~ OTHER PI:~ARATION'OF THE BODY,..) ............. $
USE OF FAClLmES. STAFF & EQUIPME-'I~:
Funeral Ceremony ( C,o.e,~.d .~ r-.,.~ Ho~. ) ................ $.
Vlsitation / Viewing ( c.~uc~,d .~ r-.~ Horn* ) ............... $
Memorial Sen4ce ( C. on~lu~ed at Fune~ Home ) ................ $
USE OF STAFF AND EQUIPMENT:
Funeral Ceremony ( cor~u~ed -' .nom~ facalty ) ............... $
Visitation/Viewing ( Cor~uc~*d -, .~.rn~ ~:ay ) $
Memodal Service ( C.o~n~d" ancemr facmy ) .................
Graveside Sewice ................................ $
$
$__
TRANSFER OF REMAINS TO FUNERAL HOME ......... $
( __. Miles Transported)
AUTOMOTIVE EQUIPMENT:
Casket Coach (Hearse) ............................ $
Clef~gy Car / Lead Car ............................. $
V
Flower Car ......................................
Service Car ...................................... $
MISCELLANEOUS MERCHANDISE:
Ackno~l~mant Cards ...........................
Vi.~to~ R~li~ter .................................. SS
M~modal Fo~ ! Prayer Cards ....................
len'~ora~ Grave Marker .......................... $
__ ........... *' -
__ ONTt)A,.E. Se,.ed $ '7OO
__ Receptacle (other than casket) $
__ Weaflng Apparel $
'CRMN
S-7 PA
FORWARDING OF REMAINS TO ANOTHER FUNERAL HOME ....................... $ .
RECEIVING OF REMAINS FROM ANOTHER FUNERAL HOME .......................
DIRECT CREMATION (As Selected) ............................................. $
IMMEDIATE BURIAL (Aa Selected) ..............................................
COCKLIN FUNERAL HOME, INC.
ScoTr D. BRENNEMAN, Supervisor
P.O. Box 424 · 30 North Chestnut Street No.
DILLSBURG, PENNSYLVANIA 17019
Phone (717) 432-5312 Date
F~nameof~eceased ~'~:~_. ~, (~p~i~L'Ni~me).~nA Age~
CASH ADVANCE ITEMS: '~'lve~) F-orwaelaaeeshlPr~ $ ~),.~f~m~.~,~rrangingservices.
Cemeta~/ Pn:~ ...................................
Cemetegt Op~ning & Closing Cha~ea .................. $
Cemeta~ W~kend & Holiday & Ovefltme Charges ........ $
Cu~ing Date on Stone in Cametery ...................... $
Cemeta~/ Equipment ................................. $ ! ~)
....... $
Total ¢) $
OTHER ITEMS:
$ Total (A) & (e)
Total (C) $ $
Total (A) (B) & (C
LESS: Preneed Adjustment / Allowance [] INS [] TR $(
Payment / Date ( ) $(
Other (Spec,y) $(
BALANCE $
LEGAL, CI~ETERY, CFLEMATOEIY OR. OTH ER~EQUIREMEblTS CQMPELk4HG THE PU RCI-~A,?~....C)F ANY ITEMS LISTED
~OVE: )~O C6,w4Xii,~ t~6u~.Pt~ 0u4,~~ ~.
~h. u~k~d pu~l;~) h.m~y...{~,- f~ng: (~ve d~ ( ) d~k~.o~ ( ) e.,.~ ..n.,~g ot .~ ~o.v~
rmmed decealed. (2) I/We were iIx)wn a Casket Price Liat and an Outer Burial Container Price Ll~t before the ~ o~ ~
and outer burial container~. (3) I/We were give~Voffemd for retention · General Price Lilt upon Ute beginning of · dl~cuseion et
fum~at .rrmqleme~ _.~d/~r ~e~on of ~Le~_icea and merchs~be.
annum lo~ unan 't~pate8 late payment will be cha~d on any amount unpaid after due date.
I o~ we having r..e~:l, the above, ~ and approve same, and jointly and severally promise to make lu t payment therefor. Each purchasel
understands that th~s promise to jo?ly and severally ma? lull payment means the FuneraI.H~n~e has. the nght to collect the entire amount from
anyone Or more of the pumhasere without resort to any cla.'n against any other purchasers. This nght exists regardless of whether or no~ one or more
of thej?urchasers have agreed among themselves how much each will contribute to make tull payment. Receipt of a copy of this contract
v ' ' ~"lgnatur~ of Purchasel:(s) ~ · Street Address
S.S. No. City State Zip Code
Signature of Purcha~s) Street Address City end State Zip Code
Signature of Pumha.ser(s)
We agres la provide Ihe sen4ce & mef~h~q(les Indicated above.
EXHIBIT B
Distribution Statement
Descri ptio n Am o u nt
CD # 134259 1,008.08
CD # 130519 1,007.24
CD # 149094 2,925.89
CD # 149092 9,567.96
CD # 1300261 11,414.33
CD # 149096 5,795.19
CD # 640029785 6,505.54
CD # 156819 26,209.82
Checking Account 1300261 11,413.71
CD Burial Fund 7,535.00
Acct: 2110407 3,423.00
Refund from Bethany Village 3,568.00
EXP: Funeral expenses/bills - 14,405.65
EXP: Additional Probate/Administration Fees -42.00
EXP: Inheritance Tax Payment -3,418.56
EXP: Attorney Fees -2,500.00
Total Paid To Karen Cartwright 70,007.55
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
ofr)=th:
Will
Admin. No.:
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:
1. State w__~hether administration of the estate is complete:
Yes 1.~ No
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. 1 is Yes, state the following:
a. Did the personal re.~presentative file a final account with the Court?
Yes _ No
b. The separate Orphans' Court No. (if any) for the personal representative's
account is: ~
c. Did the personal r_,,~resentative state an account informally to the parties
in interest? Yes 1_~ No [-']
Co
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.
Signature
Name
Capacity:
Address
Telephone No.
ccorSOnal Representative
unsel for personal representative