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HomeMy WebLinkAbout03-0403Estate of Emma S. Stokes No. also known as To: PETITION FOR PROBATE and GRANT OF LETTERS ,:~2/- O,~ - ~t9.~ Social Security No. 202-20-7057' Deceased. The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut or in the last will of the above decedent, dated July 22, and codicil(s) dated Register of Wills for the County of Cumberland Commonwealth of Pennsylvania in the named ,1992 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland , County, Pennsylvania, with h er last family or principal residence at Thornwald Nursing ~ome 422 Walnut Bottom Road, Carlisle, PA 17013 (list street, number and muncipality) Decendent, then 81 years of age, died November 6, at Carlisle Hospital X~, 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: $1,000.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) 1 ldYates S't r e~t Mt. Holly Springs, PA 17065 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CLTHBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer_tb, e estote according to law. to or af, rm,, before me this /~i_~-r o day of 1 ~-~'~" '~':~'"/~Cc~,~ /~ ~, ~,. l , , ~ -'Y,_~-'.~r~/ Reg~ter L No. ~2/-t9,9'- ~t9.-~ Estate 0f , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JT~lqcJ / .~ ~Oo~'~, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated.. ,.~biu ~0 , Iq ~ ~ described therein be admitted to probate and filed of record as the last will of are hereby granted to ~t ;c~e / ~ CTcc~t<~ ~ FEES Probate, Letters, Etc .......... Short Certificates( ) $., /.2/9 r &-;~ ' ......... ~nuncmtwn ................ $ - $ Filed ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE PETITION FOR PROBATE and GRANT OF LETTERS Estate of also known as , Deceased. No. Social Security No. The petition of the undersigned~Presents that: Your petitioner(s), ~bho~dl~eacreedleSntYec~e~f age o~.~n the execut in the last wilt of the a , and codicil(s) dated ~'"'~ (state relevant circumstances, e.g. renunciation, death of executor,'ot, c.) T~°:"'Re. gister of Wills for the county of CommonWealth of Pennsylvania in the named Decendent was domiciled at death in County;~.p...ennsylvania, with h _ last family or principal residence at (~'~'"~'~treet, number and muncipality) .... d ,19 , at Decendent, then _ years ot ag'~ -- t as follows, decedent did not marry, was n~t~divorced and did not have a child born or adopted aftEe~C;xPecution of the will offered for probate; was not~t~tim of a kllhng and was never adjudicated incompetent: ~-- - Decendent at death owned property with estimated values as (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 tn Pennsylvania situated ~ WHEREFORE, petitioner(s) r"~9~_ ctfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of tler°n ................... ~inistration c.t.a.; administration d.b.n.c-t.a.) '~'~ OATH OF PERSC iTATIVE ~uMNMgN~~.H~OF PENNSYLVANIA · ' r s above-name wear(s) oi--affirm(s) that the statem~nt~ In. t.he foregoing p.ennon are The p, etlnone ( ) ~- - ~~..,~.,~,.,. ~nd belief of petitioner(s) ania that as personm repre, sen- true aaa correct to me oest ol thc ,,,,~-,~,~ . . . · tative(s) of the above dece~t~tt;~t~t~11 well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~ '.~ ~' re me this day of I '"~--. ~ ~ befo ..... '~9 J "--~ ~' 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 ., sign the same and that signed as a witness at the request of testat__ in h.. presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19__ Register (Name) (Address) (Name} REGISTER OF WILLS OF CU~BE~T.Am~ COUNTY OATH OF NON-SUBSCRIBING WITNESS Wendy Stokes and Judd Ahrens .Leac.~a".,ub,c,~l~r ,hc, cto, (each) being duly qualified according to law, depose(s) and say(s) that choy nfo familiar with the signature of ~,,,,,,~ S~ Stok_es , testatnr of '' ' ) the will presented herewith and that they believes the signature on the will is in the handwriting of l~m~= S: Stokes to the best of their __ knowledge and belief. Sworn to or affirmed and subscribed before me this I~.~ 7t-t day of Register Wendy Stokes ~~ (Name~ 110 Yates Street, Mt. Holly Springs, PA udd Ahren V , 501 W. North Street, Carlisle, PA (Address) WILL OF EMMA S. STOKES I, EMMA S. STOKES, domiciled and resident of Hegins Township, Schuylkill County, Pennsylvania, declare this to be my Last Will and revoke all other wills and codicils. ITEM ONE I appoint my son, EUGENE D. STOKES, Executor of this Will to serve without bond in any jurisdiction. If my son, EUGENE D. STOKES, fails to survive me, ceases to act as Executor hereunder, or fails to qualify, I appoint my sister, MARY J. RUNKLE, Substitute Executrix in his place to serve without bond in any jurisdiction. ITEM TWO I direct that all my just debts and funeral ex- penses be paid as soon as conveniently may be after my death. ITEM THREE I ~4~ o~ ~ .... my estate as follows: A. I give, devise and bequeath my entire estate including real property, and tangible and intangible per- sonal property, to my son, EUGENE D. STOKES, provided he survives me for a period of thirty (30) days after the date of my death. B. If my son, EUGENE D. STOKES, predeceases me or fails to survive me for a period of thirty (30) days after the date of my death, such share shall pass to his issue, per stirpes. C. In the event my son, EUGENE D. STOKES, predeceases me, fails to survive me, and does not leave any issue to survive him, then, I give, devise and bequeath my estate, in equal shares, to my brothers and sisters, namely; WILSON E. SCHNALMv CATHERINE I. WARFIELDv MARK X. SCHNALM~ GEORGE H. SCHWALM, FRANK H. SCHWALM and MARY J. RUNKLE, provided each of them survives me for a period of thirty (30) days after the date of my death· If any of them predeceases me, or fails to survive me for a period of thirty (30) days after the date of my death, such share or shares of each shall pass to my remaining brothers or sisters hereinabove named· ITEM FOUR I authorize my Executor, Substitute Executrix, and their successors, to exercise the following powers, in addition to those given by law, to be exercised in their sole discretion: To retain any real and personal property which may at any time form part of my estate. To invest and reinvest in any real or personal property without restriction to legal invest- ments. To repair, alter, improve or lease, for any period of time, any real or personal property and to give options for leases. ® To sell at public or private sale, for cash or credit with or without security, to exchange or to partition any real or personal property and to give options for sales or exchanges. To compromise claims. To make distribution in cash or in kind or partly in each. IN TESTIMONY OF ~ICH I now sign this Will, con- sisting of three (3) typewritten sheets of paper, in the presence of the witnesses whose names will appear below, and request that they witness my signature and attest to the ex- ecution of this Will, this ~1.-- day of July, 1992. (SEAL) E~I~A S. STOKES, in our presence, signed this Will. Before she signed it, she declared to us that it was her Will and requested that we act as witnesses to its ex- ecution. We now, in her presence, and in the presence of each other, sign below as witnesses, all on this ~2_ day 0 CERTII"ICATION OF NOTICE UNDER RULE 5,6(a) To tile Register: I certify that notice of estate admiaistral, ion required by Rule 5.6(a) of tike Orphans' Court Rules was set'veal on or mailed to the following beneficiaries of the above-captioned estate o, 2/~,,q? Z.L) L&o'_~ Name Address Nolicc has now been given lo all persons catillcd fl~erclo under Rule 5.6(a) exccpl Capacity: l'ersomd Rcprcseatative Signature Address No. ~.,,7/7 I F_.4 7- / t~ o v REV - 1500 E~; + ($*~0) O0 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Stokes, Emma S REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 1/06/2002 11/06/1921 APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) [] 1. Original Return [] 2. Supplemental Return ! 21 03 0403 · COUN'[Y C~OD~E YEAR NUMB~ER SOCIAL SECURITY NUMBER 202-20~?057 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ] 3. Remainder Return (date of rieath prior to 12-13-82) [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes i of Will) copy of Trust) --. [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11, Election to tax under Sec. 9113(A) (Attach Sch O) ~-- ~ ..... 12-31-91 and 1-1-95 THIS SECTtON MUST BE COMPLETED AL~ coRR~S,ON~ENCE AN~NFiDENT AE RM~TI0N E']0ULD BE DIREctED TO: NAME Thomas J. Ahrens COMPLETE MAILING ADDRESS ............ :IRM NAME (If spplioable) Ahrens Law Offices, P.C. 5521 Carlisle Pike tELEPHONE NUMBER A 71_7/697-1800 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) Mechanicsburg, PA 17055 13. 14. z None 1,051.40 ~ Non~:, None None 1,082.25 Non&' (9) __. 7,582.59 (10) 38,485.94 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES i 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. (8) 2,133.65 (11) (12) (13) 46,068.53 insolvent (14) x .00 (15) x .045 (16) .12 (17) .15 (18) (19) Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Dec'edent's Complete Address:  TREET ADDRESS Thornwald Nursing Home 422 Walnut Bottom Road CITY Carlisle STATE PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) I 17013 (1) (2) 0.00 0.00 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page I Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 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 ts income; .................................... [] c. retain a reversionary interest; or ..................................................................................................... F~ ~ d. receive the promise for life of ether payments, benef ts or care? .......................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other tha_n the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS S-~ G~A~O~~1~ ADDRESS SIGNA U'R~E OF P R~A R E~O TH-E R~h'-'-~N REP~ E~ENTA'F~ ADDRESS DATE I l 0 Yates Street Mt. Holly, PA 17065 DATE DATE 5521 Carlisle Pike Mechanicsburg, PA 17055 Thomas J. Ahrens 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Stokes, Emma S FILE NUMBER 21 - 03 - 0403 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION I , Prudential Stock 30.04 i,o~i.40 TOTAL (Also enter on line 2, Recapitulation) 1,051.40 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Stokes, Emma S I FILE NUMBER _ __. I 21 - 03 - 0403 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 Eugene D. Stokes 110 Yates Street ' Son Mt Holly Springs, PA 17065 JOINTLY OWNED PROPERTY: · ......... [ DESCRIPTION OF PROPERTY ~.: ~ ~ =r~ ~'~- In I ' ' · ~ ~ % OF DATE OF DEATH ~ ~.~,rr ~J^-- c ude name of financial ~nst~tut~on and bank account number DATE OF DEATH , , NUMBERITEM r-~j~,,I,~. ,,~,~ Iorsimilaridenti ino number. Attachdeed fori i v-h Jw~,~, ........ I DECDS J VALUEOF Jestate -~..~..- o~.~ ~ _ ,o nfl. eld real ~ A 02/o8/]999r Co~erce B~ C~ecking a~count¢5 i30~9)8 ' 2}i6~50[ ~0% 1~082~25 TOTAL (Also enter on line 6, Recapitulation) J 1,082.25 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stokes, Emma S SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 - 03 - 0403 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION FUNERAL EXPENSES: Trefz & Bowser Funeral Home, Inc. Cocoa Catering - Funeral luncheon ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Ahrens Law O£fices, P.C. Family Exemption: If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Cumberland County State ~ Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Estate Notice - The Sentinel Estate Notice - Cumberland Law Journal Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) AMOUNT 5,518.40 857.60 1,000.00 40.00 81.59 75.00 10.00 7,582.59 ~ Schedule H COMMONWE^'TH OF PEN~S~'V^~,^ Funeral Expenses & 'NHER,T^NCE T^X RE*U~N Administrative Costs continued ~R. ESIDENT DECEDENT ESTATE OF Stol<cs, Emma S !FILE NUMBER , ~ I 21 - 03 - 0403 3 PA Inheritance tax filing fee 10.00 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Stokes, Erama S Include unreimbursed medical expenses. FILE NUMBER 21 - 03 - 0403 ITEM NUMBEF 1 DESCRIPTION PA Department of Public Welfare Class 3 Claim PA Department of Public Welfare Class 6 Claim TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 22,070.67 16,415.27 38,485.94 REV-151,3 EX+ (9-00~' ~ COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Stokes, Emma NUMBER II. TF' E i 21 - 03 - 0403 RELATIONSHIP TO AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT ~o_NoJLList Tr~stee~,~) , OF ESTATE TAXABLE DISTRIBUTIONS (include outright spousal distributions) Eugene D. Stokes Son Entire Estate Enter dollar amounts for distributions shown above on lines 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 REGISTER OF WILLS OF CUMBERLAND COUNTY COMMONWEALTH OF PENNSYLVANIA ESTATE OF Emma S. Stokes * NO. 2003-0403 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Will No.: 2003-0403 Emma S. Stokes November 6, 2002 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 whether administration of the estate is complete: Yes X 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: ao Did the personal representative file a final account with the Court? Yes No X bo The separate Orphans' Court No. (if any) for the personal representative's account is: Did the personal representative state an account informally to the parties in interest? Yes X No Date: d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. / Signature Thomas J. Ahrens, J.D. Name (Please type or print) 5521 Carlisle Pike Mechanicsburg, PA 17050 Address (717)697-1800 Telephone No. Capacity: __ X Personal Representative Counsel for Personal Representative BUREAU OF INDIVIDUAL TAXES /HHERTTANCE TAX DIVXSTON DEPT. 180601 HARRTSBURG, PA 17118-0601 COHHON#EALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX THOMAS d AHRENS AHRENS LAN OFFICES 5521 CARLISLE PIKE '"' MECHAN[CSBURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-18-2003 STOKES 11-06-Z002 11 03-0fi03 CUMBERLAND 101 Amount Remitted RE¥-15¢i7 EX AFP [01-05) EMMA S MAKE CHECK PAYABLE AND REMTT PAYMENT TO: REGTSTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG TH]:S LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (:01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR '- DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STOKES EMMA S FILE NO. 21 03-0q03 ACN 101 DATE 08-18-2003 TAX RETURN #AS: (X) ACCEPTED AS FTLED ( ) CHANGED RESERVAT]:ON CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. S~ocks end Bonds (Schedule B) (2) 3. Closely Held S~ock/PartnershAp Interest (Schedule C) (3) q. Mortgages/Notes Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($) 6. JoAntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expmnsms/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule 1) (10) 11. Total Deductions 12. Nat Value of Tax Return 1~051.q0 .00 .00 NOTE: To Ansurm proper credit to your account, submit the upper portion .00 of this form wAth your .00 tax payment. lz082.25 .00 (8) 7,582.59 13. lq. NOTE: ASSESSMENT OF TAX: 15. Amount of LAne lq e~ Spousal rata 16. Amount of Linm lq taxable at Lineal/Class A rata 17. Amount of Linm lq at Sibling rate 18. Amount of Line lq ~axablm at Collateral/Class B rm4:e 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIP1 DISCOUNT DATE NUMBER INTEREST/PEN PAID (-) 38~q85.9q (11) (12) Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (1:5) Net Value of Estate Subject to Tax (1fi) Zf an assessment was Assued prev$ously, 1Shes 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT[ON OF ADDITIONAL INTEREST. 2,133.65 q3,93q.88- .00 q3,93q.88- 18 and 19 will ( ZF TOTAL DUE 1S LESS THAN $1, NO PAYMENT IS REQUIRED. ZF TOTAL DUE 1S REFLECTED AS A 'CRED/T' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) .00 .00 .00 .00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE AMOUNT PAID (is) .00 x O0 = .00 (16) .00 x O,q. 5 = .00 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= . O0 RESERVATION: Estates of decedents dying on or ba~ore December 1Zj 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 life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements cf Section ZlqO of the Inheritance and Estate Tax Act, Act Z~ of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS~ AGENT 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-IS13). Applications are available at the Office of the Register of Nills) any of the 25 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-361-Z050~ services for taxpayers with special hearing and / or speaking needs: 1-800-q47-30ZO iTT only). Any party in interest not satisfied with the appraisement, alia..nc., or disallowance of deductions, or assessment of tax iincluding discount or interest) as shown on this Notice must object within sixty (603 days of receipt of this Notice by: --mritten protest to the PA Depart"ant of Revenue, Board of Appaalsj Dept. 181021, Harrisburg, PA 171Z8-1011, OR --election to have the .attar 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 Depart"ant of Revenue, Bureau of Individua! Taxes, ATTN: Post Assessment Ravia. Unit~ Dept. Z8060i, Harrisburg, PA 171ZB-O60I Phone I7173 787-650S. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" IREV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three IS) calendar months after the dec.dent's death, a five percent ISZ) discount of the tax paid is allowed. The iSX tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, end not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning aith first day of delinquency, or nine (9) months and one (i) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest et the rate of six (61) percent per annum calculated et a daily rate of .00016q. All taxes which became delinquent on and after January 1, 1981 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Yea__r Rate Factor Year Rate Factor 1982 ZOZ .O00Sq8 1987 9Z .000147 1999 7Z .000191 1983 16X .000~38 1988-1991 llZ .000301 ZOO0 81 .000119 1984 llZ .000301 1991 91 .0002~7 2001 91 .0002~7 1985 131 .000356 1993-1996 71 .00019Z 2002 61 .000164 1986 101 .O00Z7q 1995-1998 9Z .000147 2003 51 .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) 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.