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HomeMy WebLinkAbout03-0473 STEVENS & LEE ^ PROFESS~ON~ COR~OP, anON 111 North Sixth Street P. O. Box 679 Reading, PA 19603-0679 (610) 478-2000 Fax (610) 376-5610 www.stevenslee, com '03 JUN-9 A~1:54 Office of the Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 June 6,2003 Direct Dial: (610) 478-2109 Email: jrwa@stevenslee.com Direct Fax: (610) 988-0848 Re: Estate of Orpha M. West Late of 735 Green Spring Road, Newville, PA 17241 Social Security Number 227-74-9209 Date of death: March 13, 2003 File No. To Be Assigned Ladies and Gentlemen: With reference to the above-captioned estate matter, I enclose a check payable to "Register of Wills, Agent" in the amount of $19,000.00 representing a prepayment of Pennsylvania inheritance tax within the discount period. Please forward the official receipt in the envelope provided. For your information the decedent left no probate estate and, accordingly, Letters have not been issued. Thank you for your kind cooperation in this regard. Very truly yours, JRWA:pak Enclosures cc: Mrs. Carolyn S. Miller CERTIFIED MAIL, RETURN RECEIPT REQUESTED · Cherry Hill · Harrisburg · Lancaster · Reading · Scranton · Valley Forge SL1 357398vl/08085.416 · Lehigh Valley · Wilkes-Barre · Philadelphia · Wilmington STEVENS & LEE A PROFESSIONAL CORPORATION 111 North Sixth Street P.O. Box 679 Reading, PA 19603-0679 7002 0460 0000 9939 37B5 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 REV-1162 EX(11-96) NO. CD 002660 WAGNER JAY R. ESQUIRE 111 NORTH SIXTH STREET P O BOX 679 READING, PA 19603-0679 ........ fold ESTATE INFORMATION: SSN: 227-74-9209 FILE NUMBER: 2103-0473 DECEDENT NAME: WEST ORPHA M WEST DATE OF PAYMENT: 06/09/2003 POSTMARK DATE: 06/06/2003 COUNTY: CUMBERLAND DATE OF DEATH: 03/13/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 1 01 819,000.00 TOTAL AMOUNT PAID: 9,000.00 REMARKS: JAY RWAGNER SEAL CHECK#0093 INITIALS: CW RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS STEVENS & LEE A PROFESSIONAL CORPORATION 111 North Sixth Street P. O. Box 679 Reading, PA 19603-0679 (610) 478-2000 Fax (610) 376-5610 www.stevenslee, com Direct Dial: (610) 478-2109 Email: jrwa@stevenslee.com Direct Fax: (610) 988-0848 June 9, 2003 ATTN: Cheryl Office of the Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Rez Estate of Orpha M. West Late of 735 Green Spring Road (North Newton Township, Cumberland County) Newville, PA 17241 Social Security Number 227-74-9209 Date of death: March 13, 2003 File No. To Be Assigned Dear Cheryl: With reference to the above-captioned estate matter and pursuant to our telephone conversation today, enclosed is the executed Estate Information Sheet. Thank you for your kind cooperation in this regard. Very truly yours, STEVENS & LEE (Mrs.) Patricia A. Kramer Paralegal Enclosure · Cherry Hill · Reading · Harrisburg · Scranton · Lancaster · Lehigh Valley · Valley Forge · Wilkes-Barre · Philadelphia · Wilmington SLi 358633vl/08085.416 STEVENS & LEE A PROFESSIONAL CORPORATION 111 North Sixth Street P. O. Box 679 Reading, PA 19603-0679 (610) 478-2000 Fax (610) 376-5610 www.stevenslee, com September 12, 2003 Office of the Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Direct Dial: (610) 478-2109 Email: jrwa@stevenslee.com Direct Fax: (610) 988-0848 Re; Estate of Orpha M. West File No. 2103-0473 Date of death: March 13, 2003 Social Security No. 227-74-9209 Ladies and Gentlemen: Please accept for filing the enclosed inheritance tax returns for the Estate of Orpha M. West. Also enclosed is a check payable to the Register of Wills, Agent, in the amount of $2,202.97 to cover the inheritance tax owed. Please send your receipt to the undersigned. For your information the decedent left no probate estate and, accordingly, Letters have not been issued. , ~: Thank you for your kind cooperation in this regard. Very truly yours, ,J JRWA:pak Enclosures cc: Mrs. Carolyn S. Miller CERTIFIED MAIL, RETURN RECEIPT REQUESTED · Cherry Hill · Harrisburg · Lancaster · Lehigh Valley · Reading · Scranton · Valley Forge · Wilkes-Barre · Philadelphia · Wilmington SL1 378814vl/08085.416 U.$ POSTAGE H ~ETER 54702~ Office of the Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD OO3O 1 6 ........ fold WAGNER JAY R. ESQUIRE 111 NORTH SIXTH STREET P O BOX 679 READING, PA 19603-0679 ESTATE INFORMATION: SSN: 227-74-9209 FILE NUMBER: 2103- 0473 DECEDENT NAME: WEST ORPHA M WEST DATE OF PAYMENT: 09/15/2003 POSTMARK DATE: 09/12/2003 COUNTY: CUMBERLAND DATE OF DEATH: 03/13/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~2,202.07 REMARKS: TOTAL AMOUNT PAID' CAROLYN S MILLER C/O JAY R WAGNER ESQUIRE $2,202.07 SEAL CHECK# 108 INITIALS: DO RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT, 280601 HARRISBURG, PA 17128-0501 REV-1500 D E C E D E N T CAPB HpRL EpIO CRAC TK KOEs Co" R E C A P I T U L A T I O N C O M T I O N INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) West Orpha M. DATE OF DEATH {MM-OD-YEAR) I DATE OF BIRTH (MM-DO-YEAR) 03/13/2003 I 05/23/1911 (IF APPLICABLE} SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)  1. Original Return ~ 24i Supplemental Return 4. Limited Estate . Future Interest Compromise (date of death after 12-12-82) 6. Decedent Died Testate . Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) ~ 9. Litigation Proceeds Received [---] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-i-95) OFFICIAL USE ONLY FILE NUMBER 2103-0473 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 227-74-9209 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER  (date of death 3. Remainder Return priorto 12-13-82) 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME Jay R. Wagner, FIRM NAME (If Appli~ble) Stevens & Lee Esquire TELEPHONE NUMBER 610/478-2109 COMPLETE MAILING ADDRESS 111 N. 6th Street, P.O. Reading, PA 19603-0679 Box 679 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) $. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) r--] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Uens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 14. ii, d-ne None None None 4,799.24 164,651.07 None 14,497.15 6,939.33 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) OFFICIAL USE ONLY (6) 169,450.31 (11) 21,436.48 (12) 148,013.83 (13) (14) 148,013.83 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 X .0 0 0.00 x .o"~5 0.00 X .12 148,013.83 X .15 (lS) 0.00 (16) 0.00 (17) 0.00 (18) 22,202.07 (19) 22,202.07 Copyright (e) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 735 Green Spring Road CITY STATE Newville PA Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 19,000.00 1,000.00 O) 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 greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 22,202.07 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ......................... ~ ~ b. retain the right to designate who shall use the properbj transferred or its income; ........... c. retain a reversionary 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 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, 20,000.00 0.00 0.00 2,202.07 0.00 2,202.07 con'ect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU~OF PERSON RESPONSIBLE FOR FILING RETURN Carolyn S, Miller DATE --~/ f? - /~ 1 West Main Street SIGNA~/J~E/~)/~R~PARE?THER THAN REPRESENTATIVE Stevens & Lee DATE [ /~ ~ ]fA 111 N. 6Ch Street, P.O. Box 679 ~ 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. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) R £V- 1 S08 EX + (1-g7) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY ESYATE OF FILE NUMBER Orpha M. West SS# 227-74-9209 03/13/2003 2103-0473 Include the proceeds of litigation and the date the proceeds were received by the estate..All property Jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 2 3 AARP health insurance benefits Tangible personal property Miscellaneous personal assets TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 3,675.00 1,000.00 124.24 4,799.24 Copyright (c) 1996 form software only CPSystems, Inc, Form REV-1508 EX (Rev. 1-97) REV-1509 EX + (1-97) SCHEDULE F COMMO~WEA.~. OF FEN.SV'VA.,A JOINTLY--OWN ED PROPERTY '""E.~TANCE TAX RESIDENT DECEDENT ESTATE OF Orpha E. West SS~ 227-76-9209 03/13/2003 FILE NUMBER 2103 -0473 SURVIVINGJOINTTENANT(S) NAME ADDRESS RELATIONSHIPTO DECEDENT A. Carolyn S. Miller 1 West Main Street Niece Newville, PA 17241 Co JOINTLY-OWNED PROPERTY: L~ ~LR DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financialinstitution and bank accountnumber orsimil&ridentifying number. DATE OF DEATH DECD'S VALUE OF NUMBEF TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENTS INTERE5 1 A 01/11/99 370 shares Wachovia Corp. 12,345.05 50.00% 6,172.53 common stock, CUSIP 337358105, NYSE @ 33.365 Accrued dividend on above item at date of death 96.20 50.00% 48.10 2 A 09/05/00 Adams County National 6,225.50 50.00% 3,112.75 Bank, 1 W. Big Spring Ave., Newville, PA 17241, Checking Account No. 191892 3 A 09/05/00 Adams County National Bank 140,000.00 50.00% 70,000.00 Certificate of Deposit No. 4990934 Accrued interest through 81.28 50.00% 40.64 date of death on above item Totzl of Continuation Schedule(s) 85,277.05 TOTAL (Aisc enter on line 6, Recapitulation) $ 164,651.07 Copyright (c)1996 form software only CPSystems, Inc. space Is needed insert additional sheets of the same size) Form REV-1509 EX (Rev. 1-97) Estate of: Orpha M. West Soc Sec #: 227-74-9209 Date of Death: 03/13/2003 Item Ltr for Date # Jt Ten Joint Continuation of Schedule F (Jointly Owned Property) Description of property Total Val of Asset Dollar Val of Decds Interest 4 A 5 A 6 A 7 A A 09/19/00 Adams County National Bank Certifiate of Deposit No. 3990956 Accrued interest through date of death on above item 12/14/00 Adams County National Bank Certificate of Deposit No. 4991004 Accrued interest through date of death on above item 04/20/01 Adams County National Bank Certificae of Deposit No. 158280 Accrued interest through date of death on above item 03/08/02 Adams County National Bank Certificate of Deposit No. 49912032 Accrued interest through date of death on above item 02/09/01 Citizens Bank/Mellon Bank, 153 W. Orange Street, Shippensburg, PA 17257, Certificate of Deposit No. 01159253 Accrued interest through date of death on above item 55,245.00 50.00% 27,622.50 56.78 50.00% 28.39 31,000.00 50.00% 15,500.00 57.33 50.00% 28.67 6,590.66 50.00% 3,295.33 2.50 50.00% 1.25 7,519.60 50.00% 3,759.80 65.54 50.00% 32.77 70,000.00 50.00% 35,000.00 16.68 50.00% 8.34 85,277.05 REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Orpha M. West SS# 227-74-9209 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 03/13/2003 FILE NUMBER 2103-0473 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION FUNERAL EXPENSES: Ewing Brothers Funeral Home - funeral expense ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Secur'~ Number(s) / EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Zip Attorney's Fees Stevens & Lee Family Exemption: (If decedent's address is not the same as claJmant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees OtherAdministrativeCosts Stevens & Lee - charges for long copies, postage and filing fees distance telephone calls, TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 7,450.00 6,794.00 253.15 $ 14,497.15 Copyright (=) 1998 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Orpha M. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS West SS# 227-74-9209 03/13/2003 FILE NUMBER 2103-0473 Include unreimbursed medical expenses. ITEM NUMBER 3 4 5 6 DESCRIPTION Sarah Todd Nursing Home - medical expense Howard's Accounting - fee for preparation of decedent's 2002 individual income tax returns PA Dept. of Revenue - 2002 state individual income tax U.S. Treasury 2002 federal individual income tax Paul D. Dalbey, DPM- medical expense PharMerica - medical expense AMOUNT 4,995.75 85.00 299.40 154.00 7.50 1,397.68 TOTAL (Also enter on line 10, 6,939.33 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF )ha M. West SS# 227-74-9209 NUMBER SCHEDULE J BENEFICIARIES 03/13/2003 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DJS/HIBUTIONS [include outright spousal distri butions, an d tr&nsfe~ under Sec. 9116(aX1.2~ Carolyn S. Miller 1 West Main Street Newville, PA 17241 II. RELATIONSHIP TO DECEDENT Do Not List TrL~t_ee(s) niece FILE NUMBER 2103-0473 AMOUNT OR SHARE OF ESTATE 148,013.83 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 (If more space is needed, insert additional sheets of the same size) 0.00 Copyright (c) 2000 farm software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) DEPT. 280601 HARRISBURG, PA 17128-0601 JAY R WAGNER ESQ STEVENS S LEE PO BOX 679 READING COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT) ALLO#ANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSMENT OF TAX RE¥-1547 EX &FP [01-03) PA DATE 10-27-2005 ESTATE OF WEST DATE OF DEATH 03-15-2005 FZLE NUMBER 21 03-0q75 ;j UNTY CUMBERLAND ACN 101 Amoun~ RemA~md ORPHA -I MAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLZSLE, PA 1701:5 CUT ALONG TH/S L/NE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF WEST ORPHA M FTLE NO. 21 0:5-0q7:5 ACN 101 DATE 10-27-200:5 TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Es~a~e (Schedule A] (1) 2. S~ocks and Bonds {Schedule B) (2) 3. Closely Held S~ock/Par~norshAp In~eres~ (Schedule C) (3) q. Hor~gages/No~es Receivable (Schedule D) (q) E. Cash/Bank DeposA~s/MAsc. Personal Proper~y (Schedule E) (5) 6. Jo/n~ly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asso~s APPROVED DEDUCTZONS AND EXEMPTZONS: 9. Funeral Expenses/Ado. Cos*s/M/sc. Expanses (Schedule H) (9) 10. Debts/Mortgage L/ab/1/*/os/Liens (Schedule 1) (10) 11. To,al Deduc~/ons 12. Ne~ Value of Tax Re~urn q1799.Zq 16q~651.07 .00 .00 NOTE: To Ansure proper .00 cred/~ ~o your account, .00 sube/~ ~he upper portion .00 of ~hAs fore wl*h your ~ax payeen~. (8) lq,q97.15 13. lq. NOTE: 169,q50.:51 6 ~939.:5:5 (11) ?l .~3~.~8 (12) lq8,01:5.8:5 Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) Ne~ Value of Es~a~e Sub~ec~ ~o Tax (lq) :;f an assesseent was issued previously, lines 1~, 15 and/or 16, 17, reflect flgures that include the total of ALL returns assessed to date. .00 lq8,01:5.8:5 18 and 19 t~ill TOTAL TAX CREDZT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE ( ZF TOTAL DUE 1S LEGS THAN $1) NO PAYMENT ZS RE9UZRED. ZF TOTAL DUE IS REFLECTED AS A 'CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SZDE OF THIS FORM FOR ZNSTRUCTIONS.) ZF PAID AFTER DATE ZNDZCATED) SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. ZZ,20Z. 07 .00 .00 .00 19,000.00 2,202.07 ASSESSMENT OF TAX: 15. Amoun'l: of L/ne 1~ m'l: Spousal rm~o 16. Amoun~ of L/ne lq ~axebXo a~ LinemX/Class A rm~e 17. Amoun~ of L/ne lq a~ SAbling ra~e 18. Aeoun~ of LAne lq *axable a* Collar:oral/Class B ra~e 19. PrincApel Tax Due TAX CREDZTS: PAYHENT RECEZPT DX$COUNT DATE NUMBER INTEREST/PEN PAZD (-) 06-06-200:5 CDOOZ660 1,000.00 09-12-200:5 CD00:5016 . O0 AMOUNT PAID (1.6), .00 X O0 = .00 (16). .00 X Oq5 = .00 (17) .00 x 11 = .00 (18) lq8,01:5.83 x 15 = 22,202.07 (19)= 21,202.07 RESERVATZON= PURPOSE OF NOTZCE: PAYRENT: REFUND (CR): OBJECTZONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or be~ore December 12, 19DZ -- if any future interest in the estate is transferred in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for 1ifa 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 futura interest. To fulfill the requirements of Section 2160 of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S. Section 9160). Detach the top portion of this Notice and submit with your payment to the Register of #]11s printed on the reverse side. --Make check or money order payable to: REGXSTER OF NXLLS, 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-IS15). Applications ara available at the Office of the Register of Hills, any of the Z~ Revenue District Offices, or by calling the special 26-hour ensnaring service for forms ordering: 1-800-562-2050; services for taxpayers eith special hearing and / or speaking needs: 1-800-667-5020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) es shown on this Notice must 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 --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. Xf any tax due is paid within three (3) calendar months after the decadent's death, a five percent (52) discount of the tax paid is allowed. The XSZ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, tho first day after tho 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 end one (X) day fram the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rata of six (62) percent per annum calculated at a daily rate of .000166. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The appZicable interest rates for 1982 through Z005 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOX .000568 1987 92 ,000267 1999 72 .000192 1983 16X .000638 1988-1991 112 .OD0501 ZOO0 8Z .000219 1986 llZ .000301 1992 92 .000267 2001 92 .000267 1985 152 .000356 1993-1996 72 .000192 ZOOZ 62 .000166 1986 102 .000276 1995-1998 92 .000247 2003 5Z .O00XS7 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELXNQUENT X DAXLY TNTEREST 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 sheen on the Notice, additional interest must be calculated.