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HomeMy WebLinkAbout03-0511BUREAU OF INDIVIDUAL TAXES ZHHERTTANCE TAX DI*VTSZON DEPT. 280601 HARRTSBURG~, PA 17128-0601 JEFFREY M SIHPSON C/O 5 SUNSET DR MECHANICSBURG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLONANCE OR DISALLONANCE OF DEDUCTION~, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-i~¢8 EX AFP · ~ - ~ATE 02-16-200A. ~ ~;~ ~ ~i. ¥~ii~ESTATE OF SIMPSON ~' ':DATE OF DEATH 12-02-2002 FZLE NUMBER 21 03-0511 '04 FEB 1 ACM CUMBERLAND 203-10-5595 03111037 Amount Remi t'l:ed GLADYS HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 M CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS REV-1548 EX AFP NOTZCE OF INHERITANCE TAX APPRAZSEMENT, ALLOWANCE OR DZSALLONANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE OZ-16-ZO0~ ESTATE OF SIMPSON GLADYS M DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND FILE NO. 21 03-0511 S.S/D.C. NO. 203-10-5595 ACN 03111037 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED dOZNT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0203105595 TYPE OF ACCOUNT: ¢ ) SAVINGS ¢ ) CHECKING ( ) TRUST C~ TIME CERTIFICATE DATE ESTABLISHED 09-19-1966 Accoun* BaZance Percen~ Taxable X 0.166 Amoun~ Subjec* ~o Tax 1,383.~6 Debts and Deductions - .00 Taxable Amoun~ 1,383.~6 Tax Ra~e X .~5 Tax Due 62.26 TAX CRED'rTS: 8,300.59 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 HONEY ORDER PAYABLE TO: ""REGISTER OF WILLS, AGENT."' PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID INTEREST IS CHARGED THROUGH 02-2~-200~ TOTAL TAX CREDZT AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE REVERSE SIDE OF THIS FORM ZNTEREST AND PEN. TOTAL DUE ~ ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL ZNTEREST. ( ZF TOTAL DUE TS LESS THAN $1, NO PAYHENT ZS REI~UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" ( CR)., YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. .00 62.26 1.~0 63.66 BUREAU OF TNDTVZDUAL TAXES I'NHERTTANCE TAX DTVTSTON DEPT. 280~, 0:]. HARRI'SBURG, PA l?']ZB-OGD1 JEFFREY H SIHPSON C/O 5 SUNSET DR HECHANICSBURG COHNONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 02-16-200q ESTATE OF SIHPSON DATE OF DEATH 12-02-2002 21 05-0511 CUMBERLAND 205-10-5595 05111055 GLADYS H Aeoun'lc Remitted I HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE OZ-16-ZOOq ESTATE OF SIHPSON GLADYS H DATE OF DEATH 12-02-2002 COUNTY CUHBERLAND FILE NO. 21 05-0511 S.S/D.C. NO. 205-10-5595 ACN 05111055 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORHATZON FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0205105595 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE DATE ESTABLISHED 09-16-1966 Account Balance 15,262.69 Percent Taxable ~ 0.166 Amount Subject to Tax Z,5~$.8~ Debts and Deductions - .00 Taxable Amount Z,5~.85 Tax Rate X .~5 Tax Due 11~.q7 TAX CREDITS= NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYHENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID INTEREST IS CHARGED THROUGH 0Z-Zq-Z00q TOTAL TAX CREDIT I AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE I REVERSE SIDE OF THIS FORM INTEREST AND PEN. TOTAL DUE a ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( TF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REC)UZRED. IF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) .00 1lq.fi7 Z.57 117.0q BUREAU OF TNDZVZDUAL TAXES INHERTTANCE TAX DTVZSION DEPT. 280601 HARRZSRURG, PA 171Z8-0601 JEFFREY M SIMPSON C/O 5 SUNSET DR MECHANICSBURG COHHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENTj ALLO#ANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP [01-0S) ..... ~+DATE 02-16-200q ~ ESTATE OF SIMPSON ~'~ DATE OF DEATH 12-02-2002 FILE NUMBER COUNTY '04 FEB 13 P3 :~bN/DC ACN 21 05-0511 CUMBERLAND 203-10-5595 0311103! Amount Remitted GLADYS C~mben~d Co., PA HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 M CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-15~8 EX AFP ~01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS~ AND ASSESSMENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS DATE 02-16-200q ESTATE OF SIMPSON GLADYS M DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND FILE NO. 21 03-0511 S.S/D.C. NO. 203-10-5595 ACN 03111031 TAX RETURN WAS: (X) ACCEPTED AS FILED ¢ ) CHANGED dOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0203105595 TYPE OF ACCOUNT: ¢ ) SAVINGS ¢ ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 09-19-1966 Accoun~ Balance 8,100.33 Percen~ Taxable ~ 0.166 Amoun~ Sub~ec~ to Tax 1,350.08 Deb*s and Deductions - .00 Taxable Amoun~ 1,350.08 Tax Ra~e ~ .~5 Tax Due 60.75 TAX CREDTTS: 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. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID INTEREST IS CHARGED THROUGH OZ-Zq-ZOOq TOTAL TAX CREDIT AT THE RATES APPLICABLE AS OUTLINED ON THE ~ALANCE OF TAX DUE REVERSE SIDE OF THIS FORM INTEREST AND PEN. TOTAL DUE ~ TF PATD AFTER THTS DATE, SEE REVERSE FOR CALCULATION OF ADDITTONAL INTEREST. ~ { IF TOTAL DUE IS LESS THAN $1, NO PAYMENT TS REQUIRED. TF TOTAL DUE TS REFLECTED AS A "CREDTT" { CR), YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORM FOR TNSTRUCTIONS. ) .00 60.75 1 6Z.1Z BUREAU OF ZNDZVTDUAL TAXES ZNHERTTANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 JEFFREY M SIMPSON C/O 5 SUNSET DR MECHANICSBURG COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT. ALLOHANCE OR DZSALLO#ANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOTNTLY HELD OR TRUST ASSETS ~ . ~ : ~ ~7~ i,i DATE 02-16-2004 ~;:~ ~ ¥~I~ ESTATE OF SIMPSON DATE OF DEATH 12-02-2002 FILE NUMBER 21 0~-0511 COUNTY CUMBERLAND '04 FEB 13 P3:31 SSN/DC 205-10-5595 ACN 0511104~ REV-lSd8 EX AFP COl-05) GLADYS M Amoun'~ Remitted I HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~'~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-15~8 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS DATE 02-16-2004 ESTATE OF SIMPSON GLADYS M DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND FILE NO. 21 05-0511 S.S/D.C. NO. 205-10-5595 ACN 0~111045 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0205105595 TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 09-19-1966 Accoun~ Balance 16,626.09 PePcen~ Taxable X 0.166 Amoun~ Subject ~o Tax 2,771.07 Debts and Deducfions - .00 Taxable Amoun~ 2,771.07 Tax Ra~e X .45 Tax Due 124.70 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE NITH YOUR TAX PAYMENT TO THE REGISTER OF MILLS AT THE ABOVE ADDRESS. MAKE CHECK OR HONEY ORDER PAYABLE TO: "RESISTER OF MILLS, AGENT." PAYHENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID INTEREST IS CHARGED THROUGH 02-24-2004 TOTAL TAX CREDIT AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUEl REVERSE SIDE OF THIS FORM INTEREST AND PEN. TOTAL DUE ~ TF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATTON OF ADDTTZONAL INTEREST. ~ ( ZF TOTAL DUE TS LESS THAN $1, NO PAYHENT ZS RE{~UZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) .00 124.70 Z .80 1Z7.50 BUREAU OF INDIVIDUAL TAXES 'rNHERTTANCE TAX DI*VTS'rON DEPT. Z80601 HARRXSBURG., PA 17XZ8-0601 JEFFREY M SIMPSON C/O 5 SUNSET DR MECHANICSBURG COHHONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT., ALLONANCE OR DZSALLONANCE OF DEDUCTIONS** AND ASSESS~fENT OF TAX ON JOINTLY HELD OR TRUST ASSETS . ; _ iii. ::~ 2-~ DATE 02-16-200~ ~ ~ ~.:~ O~ v~ ~ ESTATE OF SIHPSON GLADYS DATE OF DEATH 12-02-2002 FZC~ NU~E~ ~ O~-OSl~ '~ FEB 13 R3:3POUNTY CUHBERLAND SSN~DC Z0~-10-5595 ACN 051110~1 PA 170~:i:?~~ .: :. ::~;j[-[ Amoun* R.mi*~ed Cumben~ Go., PA HAKE CHECK PAYABLE AND REHXT PAYHENT TO= REG/STER OF NXLLS CUHBERLAND CO COURT HOUSE CARLXSLE, PA 17015 REV-1G~i8 EX AFP [DX-DS) H CUT ALONG THIS LINE ~'* RETAIN LOHER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOHANCE OR DZSALLOHANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 02-16-200~ ESTATE OF SIHPSON GLADYS M DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND FILE NO. 21 03-0511 S.S/D.C. NO. 203-10-5595 ACN 051110~1 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED dOXNT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0205105595 TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ( ) TRUST ( ) TINE CERTIFICATE DATE ESTABLISHED 09-19-1966 Account Balance ~,099.~5 Percent Taxable X 0.166 Amount Subject to Tax 685.Z6 Debts and Deductions - .00 Taxable Amount 68:5.26 Tax Rate X .~5 Tax Due :50.75 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: ffREGISTER OF HILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AHOUNT PAID INTEREST IS CHARGED THROUGH OZ-2~,-ZO0~ TOTAL TAX CRED'rT AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUEl i REVERSE SIDE OF THIS FORM INTEREST AND PEN. TOTAL DUE ~ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( ZF TOTAL DUE ZS LESS THAN SI, NO PAYHENT ZS REI~UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) .00 :50.75 .69 :51 .~ BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX DTVTSZON DEPT. ID0601 HARRISBURg, PA 17128-0601 JEFFREY H SIMPSON C/O 5 SUNSET DR MECHANICSBURG COMHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLO#ANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 02-16-200~ ESTATE OF SIMPSON DATE OF DEATH 12-02-2002 FILE NUMBER . ;OUNTY '04 FEB 13 P3.:SSN/DC ACN PA 1705~:i~17,~ '' ; ~;' j Cumberiand Co., PA 21 03-0511 CUMBERLAND 203-10-5595 031110~7 Amount Remi~*ed REV-IS~8 EX &FP GLADYS HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE REV-IS48 EX AFP (01-03) RETAIN LOWER PORTION FOR YOUR RECORDS NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTZONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 02-16-200~ ESTATE OF SIMPSON GLADYS H DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND FILE NO. 21 03-0511 S.S/D.C. HO. 203-10-5595 ACN 031110~7 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0203105595 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 09-19-1966 Accoun~ Balance 7,806.52 Percent Taxable X 0.166 Amoun~ Sub~ec~ ~o Tax 1,301.11 Debts and Deduc~/ons - .00 Taxable Amoun~ 1,301.11 Tax Ra~e ~ .~5 Tax Due 58.55 NOTE: TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 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." INTEREST IS CHARGED THROUGH 02-2q-Z00q TOTAL TAX CREDIT AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE REVERSE SIDE OF THIS FORM 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 TS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CA), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THTS FORM FOR INSTRUCTIONS. ) .00 58.55 1.32 59.87 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. ZBn601 HARRISBURG, PA 17128-0601 JEFFREY M SIHPSON C/O 5 SUNSET DR MECHANICSBURG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTZCE OF INHERZTANCE TAX APPRAZSENENT. ALLOHANCE OR DZSALLOHANCE OF' DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS ~i, - i~. ~ :'~ DATE 02-16-200q ....... ~ ~:~iilS ESTATE OF SIMPSON DATE OF DEATH 12-02-2002 FILE NUMBER FEB 13 P 3:31 COUNTY SSN/DC , ACN PA 17D~50~:~ :ii i"~ ~o~rt Ct!ff~L)etian~ Co., PA 21 05-0511 CUMBERLAND 205-10-5595 051110q5 RE¥-ISq8 EX AFP C01-03) GLADYS Amount Remitted MAKE CHECK PAYABLE AND REHIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LZNE ~ REV-Z548 EX AFP (01-03) RETAIN LOWER PORTION FOR YOUR RECORDS NOTICE OF INHERITANCE TAX APPRAZSEHENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTZONS~ AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 02-16-200~ ESTATE OF SIHPSON GLADYS M DATE OF DEATH 12-OZ-Z002 COUNTY CUMBERLAND FILE NO. 21 05-0511 S.S/D.C. NO. 203-10-5595 ACN 051110~5 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0203105595 TYPE OF ACCOUNT: C ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 09-19-1966 Account Balance 8,02~.17 Percen~ Taxable X 0.166 Amoun~ Sub~ec~ ~o Tax 1,5~7.$9 Deb*s and Deduc*/ons .00 Taxable Amount 1,$$7.$9 Tax Ra~e ~ .~5 Tax Due 60.18 NOTE: TAX CREDITS: PAYHENT RECEIPT DISCOUNT ¢+) DATE NUMBER INTEREST/PEN PAID ¢-) AMOUNT PAID 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." INTEREST IS CHARGED THROUGH OZ-Zq-ZOOq TOTAL TAX CREDIT [ AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE I REVERSE SIDE OF THIS FORM INTEREST AND PEN. TOTAL DUE ~ ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REI~UZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' { CR}, YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORM FOR INSTRUCTIONS. } .00 60.18 I .$5 61.55 STATUS REPORT UNDER RULE 6.1 ?, Name of Decedent: Date of Death: .. l '~ ~/o g Will No.: -~ .7 --co Y// Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Com-t Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether admirfistration of the estate is complete: Yes ~ 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: ac Did the personal representative 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~epr,,0sentative state sm account informally to the parties in interest? Yes ~ No [-']. Date:/i Copies of receipts, releases, j oinders and approval of formal or informal accounts may be filed w/th the Clerk of the Orphm~s' Court and may be attached to this report. Signature Name Capacity: Address Telephone No. ~sonal Representative [--] Counsel for personal representative Estate of also known as Deceased. Social Security No. 9. o 3 - t a ~ 3'" · '~ s' The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executen- in the last will of the above decedent, dated and codicil(s) dated PETITION FOR PROBATE and GRANT OF LETTERS To: Register of Wills for the County of z:,~-'~ ~ ~-,~n o Commonwealth of Pennsylvania in the named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C1 ,-,,q h ~;n- last family or principal residence at County, Pennsylvania, with (list street, number and muncipality) Decendent, then 'fi:l_ years of age, died '-t_. ,-'1'9 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: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CumberlandJ~ SS 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 the estate according to law. rn to or affirmed and subscribed r X LX/~ ore mexthis ~ 24th ~ day of I _ Donna M. otto', l&'lSep~ty --! -/~/s~er l~/~.--w_.,'_~ No. 21-2005-~1]~ Estate Of GLADY$ M- s~mo~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS June 24th AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated May 14~-h: 200? described therein be admitted to probate and filed of record as the last will of GLADYS M, SIMPSON and Letters TRSTAMENTARY are hereby granted to WALTON D. SIMPSON , JR. 1~1~?13fl2. in consideration of the petition.on FEES Probate, Letters, Etc .......... $ 200.00 Short Certificates(1 ) .......... $ 3.00 ~ ..x-Poges(-2.)-. $ 6.00 JCP $. 10.00 TOTAL . $ 219.00 Filed .... .J..uq .e..2.4.t.h., 2.0.0.3 .............. Mailed letters to Executor on 06/24/03 ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHOI~ fO. his is to certi~ that the information here given is correctly copied 6'(,m z,~ original ccrtii]catc o[ death duly i~lud w~th ~,~; ~. Local Registrar. The original certificate will be forwarded to thc ~tatc Vital Records ()ti]cc (or t)erm~,,nent t]iin~. WAR~G: ~t is illegal tO duplicate this copy by photostat or photograpi~. Fee for this certificate, $2.00 P 8818381 NO. Dxtc J ~. 82 *- : ~. Dauphin COMMONWEALS, :!::f PENNSYLV%,qlA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ,.Ferule 3. 203 -- 10 -- 5 · ~ ~ ' ' ' ' I,. ' ' ' [,~n[ce 3 ~ rY. 21-2003-511 OZ:dV lZZ:NFIP E'O. LAST WILL AND TESTAMENT OF GLADYS M. SIMPSON I, GLADYS M. SIMPSON of the Township of Silver Spring, Cumberland County, Pennsylvania, this to be my Last Will and revoke any will or codicil previously made by me. ITEM 1: I direct that the body be cremated using the services of Fackler-Weidman Funeral Home in Harrisburg, Pennsylvania and my ashes be buried in the plot next to my late husband, Walton D. Simpson, Sr. in Rolling Green Memorial Park, Lower Allen Township, Cumberland County, Pennsylvania. ITEM 2: I direct that all my just debts and funeral expenses be paid as soon as practical after my death. ITE~M 3.' I direct that all taxes and interest and penalties thereon that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from ~- ~ I Imy residuary estate as a part of the expense of the administration of my Estate. , gl l ITEM 4: I give, devise and bequeath the sum of FIVE THOUSAND DOLLARS ~ 1($5,000.00) each to my granddaughter, KELLEY K. SIMPSON and to my granddaughter, DANIELLE N. SIMPSON. ITEM 5: I give, devise and bequeath the rest, residue and remainder of my estate of every nature and wheresoever situate, together with insurance thereon to my sons, in equal shares, namely, WALTON D. SIMPSON, JR. or his issue and JEFFREY M. SIMPSON. In the event the said JEFFREY M. SIMPSON predeceases me, I give, devise and bequeath his share of my estate to his brother, WALTON D. SIMPSON, JR or his issue. ITEM 6: Should any beneficiary entitled to a share of my estate not have attained the age of eighteen (18) years at the time of distribution to him or her, I devise and bequeath the share of such beneficiary to WALTON D. SIMPSON, JR., of 5232 Stuart Drive, Mechanicsburg, PA 17055 as guardian of each minor's estate. ITEM 7: Until distributed, no gift or beneficial interest shall be subject to anticipation or voluntary or involuntary alienation. ITEM 8: I appoint my son, WALTON D. SIMPSON, JR., Executor of this my Last Will. Should my son, WALTON D. SIMPSON, JR., fail to qualify or ceases to act for any reason as my Executor, I appoint my son, JEFFREY M. SIMPSON, alternate Executor of this my Last Will. ITEM 9: I direct that my personal representatives, guardian, or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this [ ~/' day of /~[/4 ~/ ,2002. GLADYS M. ~hMPSON .~ Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. residing at residing at 2 COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) We, GLADYS M. SIMPSON, ~15 ~ ~ ~rz 1~ ('o.vn/~ , and ! ~t_ Pt.,~o ~,.~..~ , the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose therein expressed, and that each of the wimesses, in the presence and hearing of the Testatrix, signed the will as wimess and that to the best of his or her knowledge, the Testatrix was at the time eighteen (18) years of older, of sound mind and under no constraint or undue influence. GLADYS I~ SIMPSON Wimess q/~lay of /~/~q~ Subscribed, sworn and acknowledged before me ff-emr? /C_. ffuT,~.~? by GLADYS M. the Testatrix, and subscribed and sworn to before me by this and /4~c /~. t.b~ t~ ~ , the witnesses, ,2002. Notary Public (* ~ "~' - (S~AL) 4 ~ast tltill anil ~estament GLADYS M. SIMPSON HENRY F. COYNE ATTORNEY AT LAW 3901 MARKET STREET CAMP HILL, PENNSYLVANIA 1'7011 TELEPHONE '717-737-0464. IN RE: WALTON D. SIMPSON AND GLADYS SIMPSON IN ORPHAN'S COURT OF CUMBERLAND COUNTY PENNSYLVANIA AFFIDAVIT I GLENDA FARNER STRASBAUGH, CLERK OF ORPHAN'S COURT, DO HEREBY CERTIFY THAT I HAVE CHECKED OUR PROBATE ESTATE RECORDS FOR CUMBERLAND COUNTY PENNSYLVANIA THE SEARCH OF RECORDS PROVIDES THE FOLLOWING: AS OF APRIL 23, 2004, I HAVE ISSUED NIETHER LETTERS TESTAMENTARY NOR LETTERS OF ADMINISTRATION IN THE ESTATE OF WALTON D. SIMPSON. IN THE MATTER OF THE ESTATE GLADYS M SIMPSON FILE NO 2003- 511, LETTERS TESTAMENTARY WERE GRANTED ON JUNE 24,2003 TO WALTON D. SIMPSON, JR. CLERK OF ORPHANS' COURT SWORN & SUBSCRIBED BEFORE ME THIS 23Rr~ DAY OF APRIL, 2004 COHHON#EALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 28060! HARRISBURG, PA 17128-0601 REV-15q$ EX AFP (Dg-O0) WALTON D SIMPSON JR 5232 STUART DR NECHANICSBUR$ PA 17055 ZNFORNATZON NOTICE AND TAXPAYER RESPONSE FILE NO. 21 05 511 ACH 03111050 DATE 03-20-2003 'O3 EST, OF GLADYS N SIMPSON S.S. HO. 203-10-5595 DATE OF DEATH 12-02-2002 COU'N"9¥~ CUMBERLAND TYPE OF ACCOUNT [] SAVZNOS [] CHECKTNG ]TRUST [] CERT]:F. REH'rT PAYHENT AND FORHS TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 PSECU 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 ware a joint owner/beneficiary of this account. If you feel this information ls incorrect, please obtain written correction from the financial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance eith the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART i BELOW x x x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Acceun* No. 0203105595 Da~e 09-19-1966 Established Account Balance 8,10 0.33 Percen~ Taxable X 16.6 67 Aeoun~ Subject *o Tax 1,350.08 Tax Rata X . Oq5 Po*eh*ia1 Tax Due 60.75 PART TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice must accompany your Payment to the Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments era made within three (SS months of the decedent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. CHECK ONE BLOCK ONLY PART TAX LINE A. ~/The above information and tax due is correct. ~ 1. 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 Hills 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 with the Pennsylvania Inheritance Tax return to ba filed by the dacedent's representative. C. D The above information is incorrect and/or debts and deductions were paid by you. You must complete PART [] and/or PART []below. Zf you indicate a different tax ra~e, please state your relationship to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Es*ab/ished 2. Account Balance 3. Percent Taxable ~. Amount Sub~e¢~ to Tax E. Debts and Deductions 6. Amount Taxable 7. Tax Rata 8. Tax Due PART DATE PAID DEBTS AND DEDUCTIONS CLATH;:q PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) $ Under penalties of perjury, ! declare that the feets I have reported above are true, correc~ and complete ~o *he bes~ of ay knowledge and belief. HOME ( L~C/~~ ~ WORK TAXPAYER SIGNATURE/ TELEPHONE NUMBER OAT--~ GENERAL [NFORHATION 1. FAILURE TO RESPOND gill RESULT ZN AN OFFICIAL TAX ASSESSHENT aith applicable interest based on information submittmd by the financ[a! [nstitutlon. 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. 4. Accounts (including those held betaeen husband and wife} ahich the decedent put in joint names within one year prior to death ara fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable; 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCT[OHS - PART I TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice arm correct and deductions are not being claimed, place an [n block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit thee aith your check ~or the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-154& EX) upon receipt ef the return free the Rag[star of Nills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid aith the Pennsylvania Inheritance Tax Return filed by the dmcedent's representative, pXace 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 Tnd[vidual Taxes, Dapt 180601, Harrisburg, PA 1711&-0601 in the envelope provided. 3. BLOCK C - If the not[ca information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and according to the instructions below. Sign two cop[es and submit them aith your check for the amount of tax payable to the Register of Hills of the county indicated. The PA nepartmant of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART 2 - TAX COHPUTATTON LINE 1. Enter the date the account originally was established or titled [n the manner ex[sting at date of death. NOTE: For a decedent dying after 1Z/II/BI: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,00D per transferee regardless of the value of the account or the number of accounts held. Tf a double asterisk (e~) appears before your first name [n the address portion of this notice, the $3,n00 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 the date of death. 3. The percent of the account that [s taxable far 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 NUHBER OF DIVIDED BY TOTAL NUNBER OF X lO0 = PERCENT TAXABLE JOINT OWNERS SURVIV/NG JOINT ONNERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 3 (JOINT ONNERS) DIVIDED BY Z (SURVTVORS) = .167 X 100 = 16.71 (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 NUHBER OF SURVIVING JOTNT X 100 PERCENT TAXABLE O#NERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and too other persons and established aithin one year of death by the decedent. I DIVTDED DY Z (SURVIVORS) = .50 X 100 50X (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 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) [s determined 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 below. Da~e of Death I Spouse I Lineal Sibling Collateral 07/01/9q ~o 12/$1/9~ SX 6X 151 15X 01/01/95 ~o 06/30/00 OX 6X 07/01/00 ~o presen~ OX q.EX~ 12Z 15X ~Thm tax rate laposad on th, net va younger et death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 07.. The [ineal class of hairs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children ahather 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, ahether 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 one parent in common ~ith the decedent, ehether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTTONS - PART 5 - DEBTS AND DEDUCTIONS CLAIMED AllowabIe debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay tho 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 1/2" x 11". Proof of payment nay be requested by the PA Department of Revenue. COMMONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF ZNDZVZDUAL TAXES DEPT. gDO60! HARRISBURG, PA 17128-060! ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE NALTON D SIMPSON JR 5252 STUART DR MECHANICSBURG PA 17055 FZLE NO. 2! Ob 511 ACN 0511103q DATE 05-ZO-ZO05 ': TYPE OF ACCOUNT EST. OF GLADYS M SIMPSON [] SAVINGS S.S. NO. Z05-10-5595 []CHECKING DATE OF DEATH 12-02-2002 [] TRUST '0.~ ~,t~L} 27 /~Pq~TY CUMBERLAND [] CERTZF. REMTT PAYMENT AND FORMS TO: REGISTER OF HILLS ~' CUMBERLAND CO COURT HOUSE ,,,t:l!;~ CARLISLE, PA 17015 PSECU 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. [f you faa1 this information is incorrect, please obtain ~ritten 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 Lams of the Commonwealth of Pennsylvania. Questions cay be answered by calling (717) 787-8327. COMPLETE PART ! BELON # # . SEE REVERSE SZDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0205105595 Date 09-16-1966 TO insure proper credit to your account, two Established (2) copies of this notice must accompany your Account Balance 15,262.69 payment to the Register of NilEs. Make check payable to: "Register of Mills, Agent". Percent Taxable X 16.667 Amount Subject to Tax 2,5~5.85 NOTE: if tax payments ara made .ithin three (3) months of the dacedent's date of death, Tax Ra~a X .0~5 you amy deduct a 5Z discount of the tax due. Any ~nherJtance tax due ~[[[ become delinquent Po~en~[aZ Tax Due [iq. ~7 n~ne (9} .onths a~ter the date o; death. PART TAXPAYER RESPONSE A. ~he 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 CHECK ONE BLOCK ONLY PART TAX LZNE a discount or avoid interest, or you may check box "A" and return this notice to the Register of Hills and an official assessment will be issued by the PA Department of Revenue. B. [] The above asset has been ar ~ill be reported and tax paid with the Pennsylvania inheritance Tax return to be filed by the decedent's representative. C. U The above information is incorrect and/or debts and deductions ware paid by you. You must coepZate PART []end/or PART []baZow. If yOU indicate a differan~ tax ra~a, please sta~a your relationship ~o decaden~: RETURN - COMPUTATZON OF TAX ON dOINT/TRUST ACCOUNTS 1. Date Established 1. 2. Accoun~ Balance 2 $. Percent Taxable $ ~ q. A.oun~ Subject to Tax q 5. Debts and Deductions $ - 6. Amount Taxable 6,, 7. Tax Ra~e 7 ~ 8. Tax Due 8 PART DATE PATD DEBTS AND DEDUCTTONS CLATME11 PAYEE DESCRZPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Coepu~a~ion) Under pane/ties of perSury, ! declare that the facts ! have reported above ara true, correct and cm. plata ~o ~he bes~ of my knowledge and belief. ,, ~ORK ('7/~) ~$~ TAXPAYER SIGNATUR~ TELEPHONE NUMBER GENERAL INFORHATION 1. FAILURE TO RESPOND NZLL 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 decadant's date of death. $. A joint account is taxable even though the dacedant'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 aithin one year prior 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 are taxable fully. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice ara correct and deductions ara not being claimed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them 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 (Fora REV-IS48 EX) upon receipt of the return from the Register of NiIls. 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 "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept ZOO601, Harrisburg, PA 171Z8-0601 in the envelope provided. $. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and according to the instructions below. Sign two capias 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 will issue an official assessment (Fora REV-154B EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART 2 - 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 1Z/1Z/BZ: Accounts ahich 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 transferee regardless of the value of the account or the number of accounts held. If a double asterisk (ax) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the dacedent's death: I DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUHBER OF X 100 = PERCENT TAXABLE JOINT ORNERS SURVIV[NG JOINT OHNERS Example: A joint asset registered in the name of the decedent and two other persons. ! OIYZBED BY 3 (JOINT ONNERS) DIVIDED BY Z (SURVIVORS) = .L67 X ZOO = IB.TX (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the decedant's death or accounts oaned by the decedent but held in trust for another individual(s) (trust beneficiaries): L DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and too other persons and established within ane year of death by the decedent. I DIVIDED BY Z (SURVIVORS) = .50 X 100 = SOX (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 amount subject to tax (line ~). 7. Enter the appropriate tax rate (Line 7) as determined below. De{e of Death Spouse I Lineal Sibling I Cella{era1 07/01/9q ~o Z2/$1/gq 01/01/92 ~o 06/30/00 OX 6X 07/01/00 ~o presen~ OX eTha tax rate imposed on th; net valu Fats ; younger at death to or for the use of a natural parent, an adoptive areaL, or a stepparent of the child is OX. The Lineal class of heirs includes grandparents, parents, chitdren, and lineal descendents. "Children" includes natural children ehethar or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes ali chiIdren of the natural parents and their descendents, whether or not they have bean adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at [east one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes a11 other beneficiaries. CLAZHED DEDUCTIONS - PART $ - DEI~TS AND DEDUCTIONS CLAIHED Allocable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must ba itemized fully in Part 3. If additional space is needed, use plain paper B l/Z" x IL". Proof of payment may be requested by the PA Department of Revenue. CONNONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-15~i3 EX AFP (09-00: '03 ..... D 27 NALTON D SIMPSON dR 5252 STUART DR MECHANICSBUR6 PA 1705~; ZNFORMATZON NOTZCE AND *TAXPAYER RESPONSE ACN DATE FILE NO. 210~ ~ll 05111056 05-20-Z005 EST. OF GLADYS M SIMPSON S.S. NO. 205-10-5595 DATE OF DEATH 12-02-2002 FOUNT¥ CUMBERLAND TYPE OF ACCOUNT L-'-~ SAV,.rNGS [] CHECK]:NG [] TRUST [] CERTTF. REHTT PAYHENT AND FORHS TO: REGISTER OF NILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PSECU has provided the Department eJth the information listed below ahich has been used in calculating the potential tax due. Their records indlceta that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you faa1 this information is incorrect, please obtain written correction from tho financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance aith the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-B327. COMPLETE PART ! DELON x x x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0205105595 Data 09-19-1966 To insure proper credit to your account, two EstabZished (z) copies of this notice must accompany your Account Balance 8 · 500.59 payment to the Register of Nilts. Hake check payable to: 'Register of Nills, Agent". Percent TaxabZe X 16.66 7 Amount Subject to Tax [ · 585. ~6 NOTE: Tf tax payments are made ~JthJn three [5) .onths of the decadent's date o~ death, Tax Ra~e X .0~5 you may deduct a 52 discount o{ ~; tax due. Any inheritance tax due ~11 become delinquent Po~en~ial Tax Due 62. Z~ nine (9] .on~s aster th; date of death. PART TAXPAYER RESPONSE PART TAX LTNE 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 CHECK ~ e 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 be issued by the PA Department of Revenue. BLOCK B. [] The above asset has been or will be reported and tax paid aith the Pennsylvania Inheritance Tax return ONLY to ba filed by the decedent's representative. C. D The above information is incorrect and/or debts and deductions were paid by you. You must complete PART []end/or PART []below. Zf you indicate a d[ffarent tax rate· please state your relationship to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Data Established 1. 2. Account Balance $. Percent Taxable ~. Amount Subject to $. Debts and Deductions 6. Amount Taxable 7. Tax Rata 8. Tax Due PART DATE PAID DEDTS AND DEDUCTIONS CLAZMEll PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on L/ne $ of Tax Computation) $ Under penalties of perjury, ! declare that the facts ! have reported above are true, correc~ and complete to the bast of my knowledge and bal/ef. TAXPAYER SISNATURE~ TELEPHONE NUMBER ~ GENERAL INFORMATION 1. FAILURE TO RESPOND N~LL RESULT ~N AN OFFICIAL TAX ASSESSMENT aith 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 dacadent's name Nas added as a matter of convenience. q. Accounts (including those ha[d between husband and mile) which the decedent put in joint names within cna year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others ara taxable fully. REPORTING 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 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 Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Mills. Z. BLOCK B - If the asset specified on this notice has been or will ba reported and tax paid with the Pennsylvania Tnheritanca Tax Return filed by the dacadant's representative, place an "X" in b[ock "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 ZBnBOl, Harrisburg; PA [7lZ8-060[ in the envelope provided. 5. BLOCK C - If the notice information is incorrect end/or deductions are being c[aimed, check block "C" and complete Parts Z and 5 according to the instructions below. Sign two cop[as and submit them with your check ~or the amount of tax payab[e to the Rag[star of Mills of the county indicated. The PA Department of Revenue will issue an official assessment (Form RE¥-[SqB EX) upon receipt of the return from the Register of Wills. TAX RETURN PART Z - TAX COMPUTATTON LINE Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: Far a decedent dying after 1Z/lZ/82: 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 $5,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (ax) appears before your first name in the address portion of this notice, the S5,000 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 the date of death. 5. The percent of the account that is taxable for each survivor is datarmined as follows: A. The percent taxable for joint assets established more than cna year prior to the dacedent's death: 1 DIVIDED BY TOTAl NUMBER OF OI¥IDEn BY TOTAl NUMBER OF X lO0 PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 5 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created mithin 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 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. I DIVIDED BY Z (SURVIVORS) = .SO X 100 = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line fi) is determined by multiplying the account balance (Ilea Z) by the percent taxable (line 5). 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (1ina 6) is determined by subtracting the debts and deductions (line 5} from the amount subject to tax (line q). 7. Enter the appropriate tax rate (line 7) as etarminad below. Oe~o of Death Spouse L/naa1 ] Sibling I Collateral 07/01/9q ~o 12/$1/9q SX 6Z 15Z 157. 01/01/95 ~o 06/30/00 OX 6X l~Z 07/01/00 ~o proson~ OX NThe tax rate imposad on th net va[ua of tr ~ younger at death to or for the use of a natural parent, an adoptive arent, or a stepparent of the child is OX. 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" ara defined as individuals who have at [east one parent in common eith the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMEO DEDUCTIONS - PART $ - DEBTS AND OEOUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, ar 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 5. 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. COHHONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171Z8-0601 REV-~4$ EX AFP (09-00) WALTON D SIMPSON JR 5252 STUART DR MECHANICSBURG PA 17055 ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 21 0 ACN 05111058 DATE 05-20-2005 EST. OF GLADYS M SIMPSON S.S. NO. 205-10-5595 DATE OF DEATH 12-02-2002 ~Q,~NT¥ CUMBERLAND TYPE OF ACCOUNT [] SAV/NGS [] CHECK/MW [] TRUST [] CERT/F. REMZT PAYMENT AND FORMS TO: REGISTER OF WILLS (.',._ CUMBERLAND CO COURT HOUSE Ct:I':' CARLISLE, PA 17015 PSECU has provided the Department aith the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with tho Inheritance Tax Laws of the Comeonwealth of PannsyZvania. Questions may be answered by calling (717} 787-83Z7. COMPLETE PART ! BELOW ~ # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0Z03105595 Date 09-19-1966 To insure proper credlt to your account, two Established (z) capias of this notice must accompany your payment to the Register of Hills. Hake check Account Balance 1 1 · 8 0 1 . 0 1 payable to: "Register of Hills, Agent". Percent Taxable X 16. 667 Amount Subject to Tax 1,966.87 NOTE: If tax payments are made within three (3) months of the decedant's date of death, Tax Rate X .045 you amy deduct a 5;( discount of the tax due. Any inheritance tax due .Jl1 become delinquent Po~en~ial Tax Due 88.5[ nine (9) months a~ter the data o~ death. PART TAXPAYER RESPONSE A. ~ Tho 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 CHECK ONE BLOCK ONLY PART TAX L/NE a discount or avoid interest, or you may check box "A" end return this notice to the Register of Hills 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 aith the Pennsylvania Inheritance Tax return to be flied by the decedent's representative. C. ~The above information is incorrect and/or debts and deductions ware paid by you. You must complete PART [] and/or PART ~ below. /f yOU indicate a different tax rate, please state your reIationsh~p to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Established I 2. Account Balance 2 $. Percent Taxable ~. Amount Subject to Tax $. Debts and Deductions 6. Amount Taxable 6 7. Tax R~te 7 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAZH;q PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line S of Tax C~jutation) Under penalties of perjury· Z declare that the facts / have reported above are true, correct and complete to the best of my knowledge and belief. WORK (~/~) ~3~ ~/ TAXPAYE; SIGNATURE TELEPHONE NUHBER GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent'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 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 Dna year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another er others ara taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the infarBaticn and coaputetJon 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 tad copies and subBit them with your check for the amount tax to the Regis[ar of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-1548 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this no[ica has been or ail1 be reported and tax paid aith 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 and return to the PA Department of Revenue, Bureau of Individual Taxes, Oept ZOO601, Harrisburg, PA 171Z8-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claieed, check block "C" and complete Parts Z and according tn the instructions beZoa. Sign two copies and submit them eith your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Doper[Bent of Revenue will issue an official assessment (Form REV-1S48 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter the date the account originally ems established or ti[lad in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/BI: Accounts ahich the decedent put in joint names eithin one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $5,000 per transferee regard[ess 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. 2. 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 Bore than Dna year prior to the decedent's death: I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 5 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created aithin one year of the dacedant'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 OWNERS 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. I DIVIDED BY g (SURVIVORS} = .SO X 100 = SOZ (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 S. 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 (Iine 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as laterained beloa. Date of Death Spouse 07/01/9q to 12/31/9q 31 6Z O[/o[/gE to 06/30/00 OX 6X 07/0[/00 to present OX q.$Zx Z2X [EX xThe tax rate imposed on thc net vaX insfers a ~ounger et death to or for the use of natural parent, an adoptive parent, or a stepparent of the child is OX. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by ethers, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendants, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" ara defined es individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes ali other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deterBined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible iteas. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claiBed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of payment Bay be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDI¥IDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 171Z&-0601 R£V-2~ll$ EX AFP (O~-OD) ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE FZLE NO. 21 ACN 051110q0 DATE 05-20-2003 '03 !~U~ 27 WALTON D SIMPSON JR 5232 STUART DR MECHANICSBURG PA EST. OF GLADYS M SIMPSON S.S. NO. 203-10-5595 DATE OF DEATH 12-02-2002 ;~:i :,!~COUNTY CUMBERLAND TYPE OF "ACCOUNT [] SAVZNGS [] CHECKZNG []TRUST [] CERTZF. REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PSECU 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 ware a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain eritten correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance aith the Inheritance Tax Laws of the Commonwealth of Pennsylvania. guestions may be answered by ca/ling (717) 787-&3IT. COMPLETE PART I BELOW ~ ~ ~ SEE REVERSE SIDE FOR FZLZNG AND PAYMENT INSTRUCTIONS Account No. 0Z05105595 Data 09-19-1966 To insure proper credit to your account, two Established cz) copies of this notice must accompany your Account Balance q) 099 q5 payment to the Register of Hills. Make check · payable to: "Register of Hills, Agent". Percent Taxable X 16. 667 Amount SubSect to Tax 683.26 NOTE: If tax payments ara made within three (3) months of the decedent's date of death, Tax Rate X . 045 you may deduct a 5Z discount o~ the tax due. Any inheritance tax due will become delinquent Potent/al Tax Due 30.75 nine (9) months after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LTNE A. The above information and tax due is correct. ~l. You may choose to remit payment to the Register of Hills aith 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 Mills and an official assessment will be issued by the PA Department of Revenue. S. E~ The above asset has been or will be reported and tax paid aith the Pennsylvania Inheritance Tax return to ba filed by the decedent's representative. C. ~The above in~oraation is incorrect and/or debts and deductions ware paid by you. You must complete PART ~ and/or PART ~balo~. Zf 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 3. Percent Taxable q. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAZHFq PAYEE DESCRIPTION AMOUNT PAID [ __ TOTAL (Enter on Line $ of Tax Computation) $ Under penalties of perSury) ! declare that the facts Z have reported above are true) correct and complete to the best of ay knowledge and belief. WORK ( ?/~ ) ~t~ TAXPAYER SIGNATURE ¢~~ TELEPHONE NUMBER GENERAL INFORMATION 1. FAZLURE TO RESPOND N/LL RESULT IN AN OFFZCZAL TAX ASSESSHENT with 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. i joint account is taxable even though the dacedent's name was added as a matter cf 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 between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others ara taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice ara 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 Register of #ills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-154B 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 decedant'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, Oapt Z80601, Harrisburg, PA 171Z8-0601 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 below. Sign tam 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 will issue an official assessment (Form REV-154B EX) upon receipt of the return from the Register of Hills. TAX RETURN PART Z - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at data of death. NOTE: For a decedent dying after 1Z/Il/aZ-' 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 $5,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (a*) 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. Z. 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 decadent's death: i DIVZDED BY TOTAL NUMBER OF DZVIDED BY TOTAL NUMBER OF X lO0 = PERCENT TAXABLE JOZNT OHNERS SURVIVZNG JOZNT ONNERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 5 (JOINT OHNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7X (TAXABLE FOR EACH SURVIVOR) B.The percent taxable far assets created within one year of the dacadent's death or accounts omned by the decedent but held in trust for another individual(s) (trust benaflciarias)= I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OHNERS 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 OIVTOED BY Z (SURVIVORS) = .50 X 100 = 50Z (TAXABLE FOR EACH SURVTVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 5. Enter the total of the debts end deductions listed in Part 5. 6. The amount taxabte (1ina 6) is determined by subtracting the debt~ and deductions (1ina 5) from the amount subject to tax (1ina 7. Enter the appropriate tax rate (1ina 7) as determined below. Da~e of Death Spouse L/nee1 Sibling Collateral 07/01/94 ~o 12/31/94 3X 6X 01/01/95 ~o 06/$0/00 OX 6X 07/01/00 {o presen{ OX xTha tax rate imposed on th~: net value of transfers from a younger at death to or for the use of e natural parent, an adoptive parent, or a stepparent of the child is OZ. The lineal class cf 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 descendants, 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 $ DEISTS AND DEDUCTIONS CLAIMED Alloaabla debts and deductions ara determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 5. [f additional space is needed, use plain paper 8 l/Z" x 11". Proof of payment amy be requested by the PA Department of Revenue. CONNONREALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF ZNDZVZDUAL TAXES DEPT. ZD060Z HARRZSBURG, PA 171Z8-0601 REV-1;,,i$ EX AFP (09-00) ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE FZLE NO. 21 O~ 511 ACN 031110q2 DATE 05-20-2005 WALTON D SZMPSON JR 5252 STUART DR NECHANZCSBURG PA 1705~:-, EST. OF GLADYS M SIMPSON S.S. NO. 20:5-10-5595 DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND ZI! :dl TYPE OF ACCOUNT r-*l SAVINGS [] CHECKI'NG [] TRUST [] CERTTF. RENTT PAYMENT AND FORHS TO: REGTSTER OF WILLS CUHBERLAND CO COURT HOUSE CARL]'SLE, PA 1701:5 PSECU has provided fha Department with tho information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. Zf you feel this information is incorrect, please obtain written correction fram the financial institution, attach a copy ta this form and return it to the above address. This account is taxable in accordance with tho Inheritance Tax Laws of fha Commonwealth of Pennsylvania. Questions may be answered by c~!!.ing (717) 787-B327. COMPLETE PART 1 BELOW x x ~ SEE REVERSE SIDE FOR FZLZNG AND PAYMENT [NSTRUCTZONS Account No. 020:5105595 Date 09-19-1966 To insure proper cradit to your account, two Established (2) copies of this notice must accompany your Account Balance 16 · ~2~. 09 payment to tho Register of Hills. Hake check payable to: "RagJstar of gjZis, Agent". Percent Taxable X [ 6.6 6 7 Amoun~ Sub5ec~ ~o Tax ~ ~ 77[. 07 NOTE: Zf tax payments are made ~[~in three (5) months of ~e decedent's date of death, Tax Rate X . 0~ you may deduct a 5Z d~scount of ~e tax due. Any ~nheritanc. tax due .~11 become delinquent Po~en~ial Tax Due ~. 70 nine (9) months after the date of uuau, PART TAXPAYER RESPONSE PART TAX LTNE A. [~Tha above information and tax due is correct. L You may choose to relJt payment to ~e Register of Hi[is ~Jth t~a cop~es of this notice to ob~Jn CHECK ~ a discount or avoid interest, or you may check box 'A" and return this notice to the Register of ONE ~i~ts and an o;~JcJal assessment ~Jll be issued by the PA Department o; Revenue. ~LOCK e. ~ The above asset has been or ~Jll be reported and tax paid ~ith the Pennsylvania inheritance Tax return ONLY to be ~Jled by the decedent's representative. C. ~ The above information Js ~ncorrect and/or debts and deductions ~ere paid by you. You oust complete PART ~and/or PART Zf yOU indlca~e a dlfferen~ ~ax ra~e~ please s~a~e your rela~ionsh[p ~o deceden~: RETURN - COMPUTATION OF TAX ON JOiNT/TRUST ACCOUNTS 1. Da~e Established 2. Account Balance 2. $. Percent Taxable $ ~ q. Amount SubSect to Tax q $. Debts end Deductions $ - 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8.. PART DATE PAID DEBTS AND DEDUCTZONS CLAZMEn PAYEE DESCRIPTION AMOUNT PATD TOTAL (Enter on Line $ of Tax Computation) $ Under penalties of perjury, Z declare ~hat the facts Z have reported above are true· correct and complete to the best of ay knowledge and HOME (7/7 ) '~g~) V'~.,~" AI~Xp~I~GN~ WORK (?/~) ~,~ T TELEPHONE NUMBER GENERAL INFORHATZON 1. FAILURE TO RESPOND NELL RESULT ZN AN OFFZCZAL TAX ASSESSHENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedant's data 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 wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. S. Accounts established jointly between husband and wife acre than one year prior to death ara not taxable. 6. Accounts held by a decadent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS PART ! - 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 two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-lA48 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has bean 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 and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept ZB0601) Harrisburg) PA 171EB-0601 in the envelope provided. $. BLOCK C - If the notice information is incorrect and/or deductions are being claimed) check block "C" and complete Parts 2 and according to the instructions below. Sign two copies and subelt them aith your check for the amount of tax payable to the Register of WiI1s of the county indicated. The PA Department of Revenue mill issue an officieI assessment (Form REV-!548 EX) upon receipt of the return from the Register of gills. TAX RETURN - PART 2 - TAX COHPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at data of death. NOTE: For a decadent dying after 1Z/12/BZ: 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 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 the address portion of this notice) the $$)000 exclusion already has bean deducted free the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the data 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 decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other parsons. I DIVIDED BY 5 [JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created mithin one year of the decedent's death or accounts owned by the decedent but held in trust for another individual[s) [trust beneficiaries): 1 DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. I DIVIDED BY 2 [SURVIVORS) = .50 X 100 = 5nE (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (Iine 2) by the percent taxable /line S. Enter the total of the debts and deductions listed in Part $. 6. The amount taxable /1ina 6) is determined by subtracting the debts and deductions /line 5) from the amount subject to tax (line 7. Enter the appropriate tax rata /line 7) as determined below. Date of' Death Spouse I Lineal Sibling Collateral 07/01/94 to 12/31/94 01/01/9.6 to 06/30/00 OX 6Z 157. 1.67. 07/01/00 to present OX eThe tax rate imposed on th; value ; younger at death to or for the use of a natural parent) an adoptive arent) or a stepparent of the child is The lineal class of heirs includes grandparents, parents) children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children end step children. "Lineal descendents" includes ail children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals mho have at least one parent in common with the decedent, whether by blood or adoption. The "CollateraL" class of heirs includes all other beneficiaries. CLA[HED DEDUCTIONS - PART 5 - DEBTS AND DEDUCTIONS CLA[NED Allowable debts and deductions are determined as folLows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay tho deductible items. B. You actually paid the debts after death of the decedent and can ~urnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed) use plain paper 8 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 17128-0601 REV-15~i$ EX AFP (09-00) 'O3 WALTON D SIMPSON JR 5252 STUART DR MECHANICSBURG PA 170S~il~ii. iL: 2'7 ZNFORMATZON NOTZCE AND TAXPAYER RESPONSE EST. OF GLADYS M SIMPSON S.S. NO. 203-10-5595 DATE OF DEATH 12-02-2002 ~.~C~OUNTY CUMBERLAND ;ZLE NO. 21 O~-_~ ~[[ ACN 051110qq DATE 0:5-20-200:5 TYPE OF ACCOUNT ~1 SAVTNGS [] CHECKTNG [] TRUST [] CERTZF. REH/T PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA I70I:5 PSECU has provided the Department with fha information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction 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 Znharitanca Tax Laws of the Coemonwaalth 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 Accoun* No. 0203105595 Date 09-19-1966 Established Account Balance 8,02q. 17 Percent Taxable X 16.6 6 7 Amount Subject to Tax 1, :5:57. :59 Tax Rate X .045 Potential Tax Due 60.18 PART TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". NOTE: If tax payments are made within three (3) months of the decedant's date of death, you may deduct a 5Z discount of the tax dua. Any inharitanca tax due will bacoma daI[nquent nine (93 months after the date of death. PART TAX LINE A. ~The above information and tax due is correct. You may choose to remit paymant to tho Register of Wills with two copies of this notice to obtain CHECK ~ a discount or avoid interest, or you may check box "A" and return this notice to the Register of ONE wills and an official assessment will be issued by the PA Department of Revenue. BLOCK B. [] The above asset has been or will ba reported and tax paid with the PannsylvanJa Znharitanca Tax return ONLY to be filed by the dacadent's representative. C. ~The above information is incorrect and/or debts and deductions were paid by you. You must complata PART [] and/or PART ~balow. If you indicate a different tax rate, please state your relationship *o decedent: RETURN - COMPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS 1. Date Established I 2. Account Balance 2. $. Percent Taxable q. Amount SubSect to Tax q $. Debts and Deductions 6. Aeoun~ Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTZONS CLAZM~q PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) $ Under penalttes of perjury, Z declare that the facts [ have reported above ere true, correct and complete to the best of ay knowledge end belief. HOME (7/"7 ) ~L/~'-~/./.~.~ L~~4f~ '~----' ~ - WORK ( '7'7 ) ~)~ TAXPAYER SIGNATURB~' TELEPHONE NUMBER GENERAL ZNFORHATZON 1. FA!LURE TO RESPOND WILL RESULT ~N AN OFFICIAL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacedent's date of death. 3. A joint account is taxable even though the decedent's name Has 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 ara fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others ara taxable fully. REPORTING INSTRUCTIONS - PART ! TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice ara correct end deductions are not being claimed, place an in block "A" of Part 1 of the "Taxpayer Response" section. 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 H111 issue an official assessment (Fora REV-1548 EX) upon receipt oF the return from the Register of Hills. Z. BLOCK B - If the asset specified on this notice has bean or will be reported and tax paid Hith the Pennsylvania Inheritance Tax Return filed by the dacedent'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, Oapt lB0601, Harrisburg, PA lT1ZB-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 3 according to the instructions below. Sign two copies and submit thee with your check for the amount of tax payable to the Register of Nills of the county indicated. The PA Department of Revenue Hill issue an official assessment (Fora REV-15fiB EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART 2 - TAX COHPUTATTON 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/II/BI: 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 transferee regardless of tho value of the account or the number of accounts hold. If e double asterisk (xe) 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 follows: A. The percent taxable for joint assets established aura than one year prior to the decadant's death: I DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUHBER OF X 100 PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT OHNERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY 5 (JOINT ONNERS) DIVIDED BY 2 (SURVIVORS] = .167 X 100 = 16.?Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year cf the decadent's death ar accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X lO0 = PERCENT TAXABLE ORNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and tho other persons and established Hithin one year of death by the decedent. I DIVIDED BY Z (SURVIVORS) TM .SO X lO0 = SOX (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The 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) as determined below. Date of Death Spouse Lineal Sibling Collateral I 07/01/94 to 12/$1/94 3X 6X 01/01/95 to 06/30/00 OX 6X 07/01/00 to present OX 4.EZ~ HTha tax rata imposed on thl~ nat younger at death to ar for the usa of a naturaI parent, an adoptive parent~ or a stepparent of the child is OX. The lineal class of hairs includes grandparents, parents, children, and lineal descendants. "Children" includes natural children Hhethar or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes ali children of the natural parents and their descendants, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes aZ1 other beneficiaries. CLATHED DEDUCTIONS - PART 5 - DEBTS AND DEDUCTTONS CLATNED ALloHabla debts and deductions are determined as follows: A. You legally ara responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decadent and can furnish proof of payment. C. Debts being claimed oust be itemized fully in Part 5. If additional space is needed, usa plain paper B l/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. CONNONHEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Za-D601 REV-iS,iS EX ~FP (Dg-DO) INFORMATION NOTICE AND TAXPAYER RESPONSE FZLE NO. 21 O~ ~1~ ACN 05111046 DATE 05-20-Z005 '03 %0 27 WALTON D SINPSON JR 5252 STUART DR HECHANTCSBUR6 p~il:~QS$ EST. OF GLADYS N SINPSON S.S. NO. 205-10-5595 DATE OF DEATH 12-02-2002 COUNTY CUHBERLAND TYPE OF ACCOUNT E~ SAVINGS [] CHECKING [] TRUST [] CERTIF. REHIT PAYHENT AND FORHS TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 PSECU has provided tho Department with tho 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 Nero a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions amy be ans.ered by calling (717) 787-8327. COHPLETE PART 1 BELOW # x x SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS Account No. 0Z03105595 Data 09-19-1966 To insure proper credit to your account, two Established (z) copies of this notice oust accompany your Account Balance 7 ·806.52 payment to the Register of Hills. Hake check payable to: "Register of Hills, Agent". Percent Taxable X 16. 667 Amount Subject to Tax ! · 301. [ ] NOTE: If tax payments are made within three (3) months of the decedent's date of death, Tax Rata X · 045 you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 58.55 nine (9) months after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LINE A. ~The above information and tax due is correct. I. Vou may choose to remit payment to the Register of Mills 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 will 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 bo filed by the decadent's representative. C. []The above information is incorrect and/or debts and deductions ware paid by you. You must complete PART [] and/or PART [] below. If you indicate a different tax rate, please state your relationship to decedent: RETURN - CONPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS 1. Date Established 1 2. Account Balance 2 $. Percent Taxable $ ~ q. Amount Sub3act to Tax ~. 5. Debts and Deductions $ - 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8., PART DATE PAID DEBTS AND DEDUCTIONS CLAZNEP PAYEE DESCRIPTION TOTAL (Enter on Line S of Tax Computation) ANOUNT PAID Under penalties of perSury, Z declare that the facts ! have reported above ara true~ correct and complete to the best of my knowledge and belief. NORK ( 7/'7 ) ~.~¢ TAXPAYER SIGNATURE TELEPHONE NUNBER DA~'~ GENERAL INFORMATION 1. FAZLURE TO RESPOND HZLL RESULT ZN AN OFFZC/AL TAX ASSESSNENT eith applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacadent's date of death. 5. A joint account is taxable even though the decedant's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decadent 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 ara not taxable. 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 ara correct and deductions ara 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 for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decadent'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, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. $. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts g 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 Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/BI: 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 $$,000 per transferee regardless of the value of the account or the number of accounts held. Ifa double asterisk (aa) 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. Z. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than Dna year prior to the dacadent's death: I D[VZBED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT ORNERS Example: A joint asset registered in the name of the decedent and two other persons. ! DIVIDED BY $ (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .[67 X lO0 = lB.TZ (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the dacadant's death or accounts owned 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 OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. i DIVIDED BY g (SURVIVORS) = ,50 X 100 = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (1ina 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 $. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. Da:ke of Dea:kh Spouse Linea! Sibling 07/01/9q :ko 12/$1/9q SZ 6X 157. 157. 01/01/95 ~o 06/50/00 OX 6Z 07/01/00 ~o proson~ OX q.EZ~ 12Z __~ .._,..- z · · gcc; ~ deceased child ~enty-one years o; age or younger at ~Tha tax rate imposed on th; death to or far the usa of a natural parent, an adoptive parent, or a stapparent of the child is 07.. 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 descendants" includes all children of the natural parents and their descendants, ahathar 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 be itemized fully in Part $. If additional space is needed, use plain paper 8 l/Z" xll". Proof of payment may ba 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. REV-1162 EX(11-96) CD 002948 SIMPSON WALTON D JR 5232 STUART DRIVE MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 203-10-5595 FILE NUMBER: 2103-0511 DECEDENT NAME: SIMPSON GLADYS M DATE OF PAYMENT: 08/27/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/02/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 03111030 $60.75 03111034 $114.47 03111036 $62.26 03111038 988.51 03111040 930.75 03111042 9124.70 03111044 960.18 03111046 958.55 REMARKS: TOTAL AMOUNT PAID: WALTON D SIMPSON JR 9600.17 SEAL CHECK# 2943 INITIALS: JA 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 002947 SIMPSON WALTON D JR 5232 STUART DRIVE MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 203-10-5595 FILE NUMBER: 2103-051 1 DECEDENT NAME: SIMPSON GLADYS M DATE OF PAYMENT: 08/27/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/02/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,926.47 REMARKS: TOTAL AMOUNT PAID: WALTON D SIMPSON JR $3,926.47 SEAL CHECK# 10009 INITIALS: JA 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 003146 SIMPSON WALTON D JR 5232 STUART DRIVE MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 203-10-5595 FILE NUMBER: 2103-0511 DECEDENT NAME: SIMPSON GLADYS M DATE OF PAYMENT: 10/20/2003 POSTMARK DATE: 10/18/2003 COUNTY: CUMBERLAND DATE OF DEATH: 12/02/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 88.20 REMARKS: TOTAL AMOUNT PAID: WALTON D SIMPSON JR $8.20 SEAL CHECK# 2991 INITIALS' DO RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS JEV-1500,EX (6-00)  COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV- 1 500 INHERITANCE TAX RETURN RESIDENT DECEDENT / H- Z LU UJ (J -.~oo, Z LIJ Z o LM n, o DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEATH (MM-DB-YEAR) I DATE OF BIRTH (MM-DB-YEAR) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) L~l. Original Return [~4. Limited Estate ~]6. Decedent Died Testate (Attach copy of Will) [~]9. Litigation Proceeds Received ~-~2. Supplemental Return [~4a. Future Interest Compromise (date of death after 12-12-82) ~-~7. Decedent Maintained a Living Trust (Attach copy of Trust) I'~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ] 3. Remainder Return (date of death prior to 12-13-82) [~5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ]11. Election to tax under Sec. 9113(A) (z~tach Sch O) NAME FIRM NAME (If Applicable) TELEPHONE NUMBEI~ COMPLETE MAILING ADDRESS 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 (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [~] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (8) (11) (12) 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) (13) (14) 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 .0 __ (15) 16. Amount of Line 14 taxable at lineal rate x .0 ¥'~"- (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) 20.[~ · ' ' ' 'el ,- - es ,~ , - I~s · ,,~ ev --,-~ ,~ Decedent's Complete Address: STREET ADDRESS ~ STATE CITY ~ Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) 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) 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 + SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; .......................................................................................... [] E~ - b. retain the right to designate who shall use the property transferred or its income; ............................................ [] ~ c. retain a reversionary interest; or .......................................................................................................................... [] [~ d. receive the promise for 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 6 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 than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS~..-j,.,~.t... ~ Tvtl-z-T l¢~.-I Vf~- ~¢..1¢~1c,¢~ 4't~ /)//- i.'1~]".[" SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 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. 99116 (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. 99116 (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 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 paten 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. 99116(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 a 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 ESTATE OF .~'/~, t} ~',)' /~4 ~"1,~/~ $~/v FILE NUMBER All real property owned solely or as a tenant in ¢,(~iiiiion must be reported at fair market value. Fair market value is defined as the price at which properly would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorshi must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. OF DEATH TOTAL (Also enter on line 1, Recapitulation (If more space is needed, insert additional sheets of the same size) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA /CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshi ITEM NUMBER DESCRIPTION 1. TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) must be di;c;¢s~ on Schedule F. VALUE AT DATE OF DEATH REV-1511EX + (1-97) ,~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN 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. FUNERAL EXPENSES: DESCRIPTION ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attomey Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip Probate Fees Accountant's Fees Tax Retum Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) (if more space is needed, insert additional sheets of the same size) AMOUNT ..~= REV-1512 EX + {1 97} ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ SCHEDULE I DEBTS OF DECEDENT, MORTGAGE L~___JlABILITIES, & LIENS__[ FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 10, Recapitulation) {If more space is needed, insert additional sheets of the same size) AMOUNT REV-1513 EX,,+ (9 00.~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER NUMBER II 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY ! TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF 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 (If more space is needed, insert additional sheets of the same size) TOTAL OF PART [I- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 180601 HARRISBURG, PA 17128-0601 CONNON#EALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX NALTON D SIHPSON 5232 STUART DR NECHANICSBURG PA 17055 RE¥-1~47 EX AFP DATE 10-15-2003 ESTATE OF SIHPSON GLADYS M DATE OF DEATH 12-02-2002 FILE NUHBER 21 03-0511 *~*~OUNTY CUMBERLAND ACN 101 Amount Remitted 1 HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE I~ RETAIN LONER PORTION FOR YOUR RECORDS ~ ~':~-~'~-'(01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR ESTATE OF SIMPSON DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX 9LADYS HFZLE NO. 21 03-0511 ACN 101 DATE 10-13-2003 TAX RETURN NAS: (X) ACCEPTED AS FTLED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. RaaZ Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) (~) ~. Nortgegas/Notas RacaivabZa (Schedule D) (~) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote/ Assets APPROVED DEDUCTIONS AND EXENPTIONS: 9. Funeral Expensos/Adm. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Hortgaga Liabilities/Liana (Schedule Z) (10) 11. Total Deductions 12. Nat Value of Tax Return 13. CheritabZe/Govorneontal Bequests; Non-oZoctad 9115 Trusts (Schedule J) 91/000.00 .00 .00 .00 869.00 .00 .00 (8) NOTE: To insure proper credit to your account, submit tho upper portion of this for. with your tax payment. 91,869.00 4,336.30 96.81 (11) , (12) (13) 87,435.89 .00 14. Nat Value of Estate Sub,oct to Tax (14) 87,~$5.89 NOTE: Zf an assessment ~as issued previousZy, lines 1~, 15 and/or 16, 17, 18 and 19 ~ill reflect figures that lnclude the total of ALL returns assessed to date. ASSESSNENT OF TAX: · 16. Amount of Line 14 at Spousal rate (15) .00 X 00 = 16. Amount of L/ne 1~ taxable et Lineal/Class A rata (16) 87,~$5.89 X Oq5 = 17. Aeount of Line 1~ at Sibling rate (17) .00 X 12 = 18. Amount of Line lfi taxable at Collateral/Class B rate (18) .00 X 15 19. Principal Tax Duo : (19)~ RECEIPT NUMBER CD002917 rAX CREDITS: PAYMENT DATE 08-27-2005 DISCOUNT (+J INTEREST/PEN PAID (-) .00 INTEREST IS CHARGED THROUGH 10 -28-2005 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM AMOUNT PAID ~ $,926.~7 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDZTZONAL INTEREST. .00 5,934.61 .00 .00 3,93~.61 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 5,926.47 8.1~ .06 8.20 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 12, I982 -- if any future interest in the estate is transferred in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Cimss B (collateral) rata on any such future interest. PURPOSE OF NOTICE: To ~ulfill the requirements of Section Il40 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. itl P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side. --Make check or money order payable to: RESISTER OF #ILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Re~und of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Mills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with specie1 hearing and / or speaking needs: 1-BOO-447-30ZO iTT only). OBJECTIONS: Any partY in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice .ust 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-lOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: 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. lB0601, Harrisburg, PA 171Z8-0601 Phone i717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the dacadent's death, a five percent iBZ) discount of the tax paid is allowed. PENALTY: The 1SI tax amnesty non-participation penaltY is computed on the total of the tax and intermst 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 tiaa period es you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one ii) day from the date of death, to the data of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (BX) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after January 1, 1982 will bear interest at a rata 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 ZOO3 are: Interest Daily Interest Daily Interest Daily Yeer Rata Factor Yaa.__r Rate Factor Vsa__r Rate Factor 19aZ 20Z .00054B 1987 9Z .000Z47 1999 7Z .00019Z 1983 16Z o00043B 19BB-1991 11Z .0O0301 ZOO0 B~ .000219 1984 11~ .000301 199Z 9Z .000Z47 ZOO1 9Z o000Z47 19B5 13~ .000356 1993-1994 7~ .00019Z ZOOZ 6~ .000164 19B6 10~ .000Z74 1995-199B 9~ .000Z47 2003 5~ .000137 --Interest is calculated es follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY /NTEREST FACTOR --Any Notice issued after the tax becmaes delinquent eill reflect an interest calculation to fifteen i15) days beyond the data of the assessment. If payment is eade after the interest computation date shoan on the Notice, additional interest must be calculated. BUREAU OF TNDTVTDUAL TAXES /NHER/TANCE TAX DIVZSTON DEPT. 280601 HARRISBURG,. PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-].6ii? EX AFP (01-03) WALTON D SIMPSON 5232 STUART DR MECHANICSBURG nUT ALONG THZS LZNE PA 17055 DATE 10-15-2005 ESTATE OF SIMPSON DATE OF DEATH 12-02-2002 FILE NUMBER 21 03-0511 COUNTY CUMBERLAND ACN 101 Amoun't GLADYS M MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 RETAIN LOWER PORTZON FOR YOUR RECORDS *M RESERVATION: Estates of decadents dying on or be~ora December IZ, [98Z -- if any futura interest in the estate is transferred Mr. Simpson · 5232 Stuart Dr. Mechanicsburg PA 17055-3559 BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX DI¥ZSZON DEPT. 280601 HARRISBURG, PA 17128-0601 WALTON D SIHPSON JR 5232 STUART DR HECHANTCSBURG PA 1705S COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF /NflERITANCE TAX APPRAISENENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-27-2003 ESTATE OF SIHPSON DATE OF DEATH 12-02-2002 FILE NUHBER 21 03-0511 . . ~OUNTY CUHBERLAND i_::~. ~'? . SSN/DC 203-10-5595 ACN 03111030 Amount Remlt~ed REV-IS48 EX AFP (01-05) GLADYS H HAKE CHECK PAYABLE AND REHIT PAYHENT TO.' REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE REV-1548 EX AFP (01-03) 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 DATE lO-Z7-ZO03 ESTATE OF SZHPSON GLADYS H DATE OF DEATH 12-02-2002 COUNTY CUHBERLAND FILE NO. 21 03-0511 S.S/D.C. NO. 203-10-5595 ACN 03111030 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORHATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0203105595 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE DATE ESTABLISHED 09-19-1966 Account Balance 8,100.33 Percent Taxable X 0.166 Amount Subject to Tax 1,350.08 Debts and Deduct/ons - .00 Taxable Amount 1,350.08 Tax Rate X .~5 Tax Due 60.75 TAX CRED'rTS: 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 PAVABLE TO: "REGISTER OF WILLS, AGENT." PAYHENT DATE 08-27-2003 RECEIPT NUHBER CDOOZ9~8 DISCOUNT ¢+) INTEREST/PEN PAID (- .00 AHOUNT PAID ZF PAID AFTER THZS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. ZF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR}, YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. } 60.75 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 60.75 .00 .00 .00 PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act) Act 13 of ZOOO. (71 P.S. Section 91~0). 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 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-1315). Applications are available at the Office of the Register of Nills, any of the 15 Revenue District Offices or by calling the special Z~-hour answering service for fores ordering: 1-800-362-2050) services for taxpayers with special hearing and or speaking needs: 1-800-4~7-3020 iTT only). Any party in interest not satisfied with the appraisement) allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt cf this Notice by: --written protest to the PA Department of Revenue) Board of Appeals) Dept. Z&IOZ1) Harrisburg) PA 17128-10Z1) 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) Dureau of Individual Taxes) ATTN: Post Assessment Review Unit, DEPT. 180601) Harrisburg) PA 17118-0601 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 (3) calendar months after the decedent's death) a five percent discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed) and not paid before January iD) 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 parted 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, 1981 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) 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 2003 are: Interest Daily Interest Dally Interest Daily Year Rate Factor Year Rate Factor Yeast Rate Factor 1982 202 .0005~8 1987 9Z .0002~7 1999 7Z .000192 1983 161 .000fi38 1988-1991 11Z .000301 2000 8Z .000219 198q 111 .000301 1992 91 ,0002q7 2001 91 .0002fi7 1985 13Z .000356 1993-199~ 71 .000192 2002 61 .000164 1986 101 .00027~ 1995-1998 9X .000247 2003 5Z .0001~7 --Interest is calculated as folloes: TNTEREST = BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELZNQUENT X DAZLY ZNTEREST 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 calculatad. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 WALTON 5252 STUART DR NECHANICSBURG CONHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISBHBNT. ALLO#ANCE OR DXSALLO#ANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS D SIMPSON JR ~: PA 17055 REV-iSd$ EX AFP C01-0S) DATE 10-27-2005 ESTATE OF SIHPSON GLADYS M DATE OF DEATH 12-02-2002 FILE NUHBER 21 05-0511 COUNTY CUMBERLAND SSN/DC Z05-10-5595 ACH 0511105q Amoun~ Remi~ed I HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO 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 APPRAISEHENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-27-2005 ESTATE OF SIMPSON GLADYS M DATE OF DEATH 12-02-2002 COUNTY CUHBERLAND FILE NO. 21 05-0511 S.S/D.C. NO. 205-10-5595 ACN 0511105q TAX RETURN WAS: eX) ACCEPTED AS FILED ¢ ) CHANGED JOINT OR TRUST ASSET INFORNATZON FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0205105595 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 09-16-1966 Account Balance 15,262.69 Percent Taxable X 0.166 Amount Subject to Tax Z,5~5.85 Debts and Deductions - .00 Taxable Amount 2,5~5.85 Tax Rate X .~5 Tax Due 11~.q7 NOTE: TAX CREDZTS: PAYMENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AMOUNT PAID 08-27-2005 CDOOZgq8 .00 11~.q7 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." TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 1lq.q7 ] .00 .00 .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL ~NTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT 1S REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: PAYNENT: REFUND OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 1140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (71 P.S. Section 9140). Detach the top portion of this Notice and submit Nith your payment to the Register of Nills printed on the reverse side. -- Hake check or money order payable to: RESISTER OF HILLS, AGENT. A refund of a tax credit, Nhich Nas not requested on the tax return, may ba requested by completing an "Application For Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the OFfice of the Register of Nills, any of the 2S Revenue District Offices or by calling the special Z4-hour ensnaring service For fores ordering: 1-800-361-Z050~ services for taxpayers Nith special hearing and or speaking needs: 1-800-447-3010 (TT onZy}. Any party in interest not satisfied aith the appraisement, alloaance, or disalloaance of deductions or assesseent of tax (including discount or interest} as sheen on this Notice may object Nithin sixty (60} days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 1810Z1, Harrisburg, PA 17118-1011, 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 Nrlting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 180601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-ISOI) for an explanation of administratively correctable errors. If any tax due is paid Nithin three (3) calendar months after the decedent's death, a five percent discount of the tax paid is allowed. The 1SZ tax amnesty non-participation penalty is computed on the total cf the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same ti.e period as you Nould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning Nith 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 rata of six (61) percent per annum calculated et a daily rate of .000164. All taxes Nhich became delinquent on or after January 1, 1982 Nil1 bear interest et a rate Nhich Nil1 vary from calendar year to calendar year Nith that rate announced by the PA interest rates for 1981 through 2003 are: Interest Daily Year Rata Factor 1981 ZOZ .000548 198S 161 .000438 1984 111 .000301 1985 X3Z .000356 1986 IOZ .000Z74 Department of Revenue. The appllcoble Interest Daily Interest Daily Year Rate Factor Year Rate Factor 1987 9Z .000147 1999 7X .000191 1988-1991 llZ .000301 ZOO0 81 .000219 1991 91 .000147 ZOOX 91 .000147 1993-1994 72 .000192 ZOOZ 6Z .000164 1995-1998 91 .000247 2003 52 .000137 --Interest is calculated as folloNs: XNTEREST = BALANCE OF TAX UNPAXD X NUNBER OF DAYS DELXNQUENT X DAXLY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent Nil1 reflect an interest calculation to fifteen (1S) 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 INHERITANCE TAX DIYTS/ON DEPT. 280601 HARRISBURG, PA 1712B-0601 WALTON D SIMPSON JR ~ ' 5252 STUART DR MECHANICSBURG PA 17055 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT/CE OF TNflERITANCE TAX APPRAXSEHENT, ALLO#ANCE OR DXSALLONANCE OF DEDUCT]'ONS, AND ASSESSHENT OF TAX ON JOXNTLY HELD OR TRUST ASSETS DATE 10-27-2005 ESTATE OF SIMPSON DATE OF DEATH 12-02-2002 FILE NUMBER 21 05-0511 COUNTY CUMBERLAND * ,:. SSN/DC 203-10-5595 ACN 03111036 Amoun~ Remi~ed KEV-16iI8 EX AFP C01-03) GLADYS MAKE CHECK PAYABLE AND REMIT PAYMENT TO.' REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE REV-15q8 EX AFP (01-03) RETAIN LOWER PORTION FOR YOUR RECORDS ~'~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DZSALLO#ANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS DATE 10-27-2003 ESTATE OF SIMPSON GLADYS M DATE OF DEATH 1Z-OZ-ZOO2 COUNTY CUMBERLAND FILE NO. 21 03-0511 S.S/D.C. NO. 203-10-5595 ACN 03111036 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0203105595 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING C ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 09-19-1966 Account Balance 8,300.59 Percent Taxable X 0.166 Amount Subject to Tax 1,383.q6 Debts and Deductions - .00 Taxable Amount 1,383.q6 Tax Rate X .q5 Tax Due 62.26 TAX CRED'rTS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (- 08-27-2003 CDOO29q8 . O0 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: ffREGISTER OF WILLS, AGENT." AMOUNT PAID 62.26 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PATD AFTER THIS DATE, SEE REVERSE FOR CALCULATTON OF ADDTTTONAL TNTEREST. ( 'rF TOTAL DUE 'rs LESS THAN $1, NO PAYMENT TS RE{)U'rRED. 'rF TOTAL DUE 'rS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S'rDE OF TH'rS FORM FOR TNSTRUCT*rONS. 62.26 .00 .00 .00 PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S. Section 91q0). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on tho reverse side. -- Make check or 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 of #ills, any of the Z3 Revenue District Offices or by calling the special Zq-hour answering service for forms ordering: 1-800-$62-Z050; services for taxpayers with special hearing and or speaking needs: 1-800-q47-~OZO iTT only). Any party in interest not satisfied with tho appraisement, alloaanca, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --mrittan protest to the PA Department of Revenue, Board of Appeals, Dept. ZBiOZ1, Harrisburg, PA 171Z8-1021, OR --electing to have the matter determined at the audit cf 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 Raviaa Unit, DEPT. 280601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) far an explanation of administratively correctable errors. If any tax duo is paid within three (~) calendar months after the dacedent's death, a five percent (SI) discount of the tax paid is allowed. Tho 15Z 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 the thm 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 1, 198Z bear interest at the rate of six (6Z) percent par annum caXcuXatad at a daiXy rate of .000164. All taxes which became delinquent on or after January 1, 198Z wili 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 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1981 lOX .000548 1987 9X .000Z47 1999 7X .000191 1983 162 .000438 1988-1991 112 .000301 ZOO0 8Z .000219 1984 11Z .000301 1992 92 .000147 ZOOX 92 .000147 19&5 132 .000556 1993-1994 72 .000192 ZOOZ 62 .000164 1986 lOX .000274 1995-1996 9Z .000147 ZO0~ 5X .000137 --Interest is calculated as follows: TNTBREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DBLI'NI~UENT X DATL¥ /NTERBST 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 data shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DIVISION DEPT. Z80601 HARRTSBURG, PA 17128-0601 WALTON D SINPSON JR 5252 STUART DR NECHANICSBURG PA 17055 COMNONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAXSEHENT. ALLONANCE OR DZSALLOHANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-27-2005 ESTATE OF SIMPSON GLADYS H DATE OF DEATH 12-02-2002 FILE NUMBER 21 03-0511 ..COUNTY CUMBERLAND - SSN/DC 203-10-5595 ACN 03111038 Amount HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ REV-X548 EX AFP (01-03) RETAIN LOWER PORTION FOR YOUR RECORDS NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON dOINTLY HELD OR TRUST ASSETS DATE 10-27-2003 ESTATE OF SIMPSON GLADYS N DATE OF DEATH 12-02-2002 COUNTY CUHBERLAND FILE NO. 21 03-0511 S.S/D.C. NO. 203-10-5595 ACN 03111038 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED dOXNT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0203105595 TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE DATE ESTABLISHED 09-19-1966 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Ta×able Amount Tax Rate Tax Due 11,801.01 X 0.166 1,966.87 - .00 1,966.87 X .~5 88.51 NOTE: TAX CREDZTS: PAYHENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) ANOUNT PAID 08-27-2003 CDOOZgq8 .00 88.51 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.** TOTAL TAX CREDZT BALANCE OF TAX DUE] INTEREST AND PEN. TOTAL DUE TF PATD AFTER THTS DATE, SEE REVERSE FOR CALCULATTON OF ADDTTZONAL TNTEREST. a TF TOTAL DUE TS LESS THAN $1, NO PAYMENT TS REI~UTRED. TF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORM FOR TNSTRUCTTONS. ) 88.51 .00 .00 .00 PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To ~ulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 15 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit aith your payment to the Register of Mills printed on the reverse side. -- Make check or money order payable to: REGISTER OF NILLS, AGENT. A refund of a tax credit, which ams not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-iS15). Applications are available at the Office of the Register of Hills, any of the Z$ Revenue District Offices or by calling the special Z4-hour ans~aring service for forms ordering: 1-800-$61-Z050~ services for taxpayers ~ith special hearing and or speaking needs: 1-800-447-5010 (TT only). Any party in interest not satisfied ~ith the appraisement, allowance, or disallowance of deductions or assessment of tax [including discount or interest) as sho~n an this Notice amy object aithin sixty (60) days of receipt of this Notice by: --aritten protest to the PA Department of Revenue, Board of Appealsj Dept. ZBIOZIj Harrisburg~ PA 17118-1021, OR --electing to have the matter determined at the audit of the account of the personal roprasentativa~ OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in ~riting to: PA Department of Ravenue~ Bureau of Individual Taxes, ATTN: Post Assessment Rsvie~ Unit, DEPT. Z80601~ Harrisburg, PA 17lZS-060l Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for e Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid ~ithin three (5) calendar months after tho decodent's death, a five percent discount of the tax paid is a11oued. 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 end of tho 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 ~ith first day of delinquency, er nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 19aZ bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes ~hich became delinquent on or after January l, 1981 ail1 bear interest at a rate ehich ~ill vary from calendar year to calendar year eith that rate announced by the PA Department of Revenue. Tho applicable interest rates for 198Z through 2005 are: Interest Daily Interest Oaily Interest Daily Year Rate Factor Yoa.~r Rata Factor Year Rate Factor 1981 ZOZ .00054B 1987 91 .000247 1999 7Z .000191 1985 161 .000458 1988-1991 llZ .O0030X ZOO0 8Z .000219 1984 llZ .000501 1991 9Z .000247 Z001 9Z .000147 1985 152 .000556 1995-1994 7X .000192 2002 61 .000164 1986 lOZ .000274 1995-1998 91 .000147 Z005 51 .000157 --Interest is calculated as follo~s: ZNTEREST = BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELZNqUENT X DAZEY /NTEREST 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 sho~n on the Notice, additional interest must be calculated. '~,, BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURg, PA 17128-0601 NALTON D STHPSON JR 525Z STUART DR NECHANTCSBURG PA 17055 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTXCE OF XNHERXTANCE TAX APPRAISEMENT, ALLONANCE OR DXSALLONANCE OF DEDUCTXONS, AND ASSESSHENT OF TAX ON JOXNTL¥ HELD OR TRUST ASSETS FXLE NUMBER COUNTY SSN/DC ACN REV-lSd8 EX IiFP (01-05) DATE 10-27-2005 ESTATE OF STNPSON GLADYS DATE OF DEATH ZZ-OZ-ZO02 21 05-0511 CUMBERLAND 205-10-5595 051110q0 Amount Remitted } HAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF WTLLS CUMBERLAND CO COURT HOUSE CARLTSLE, PA 17015 CUT ALONG THIS LXNE ~ REV-[S48 EX AFP (01-03) RETAIN LOWER PORT[ON FOR YOUR RECORDS NOT[CE OF ZNHERTTANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-27-2005 ESTATE OF SZMPSON GLADYS M DATE OF DEATH 1Z-OZ-ZOOZ COUNTY CUMBERLAND FILE NO. 21 05-0511 S.S/D.C. NO. 205-10-5595 ACN 051110q0 TAX RETURN WAS: (X) ACCEPTED AS FTLED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FZNANCTAL INSTTTUTTON: PSECU ACCOUNT NO. 0205105595 TYPE OF ACCOUNT: (~ SAVTNGS ( ) CHECKTNG ( ) TRUST ( ) TTME CERTTFTCATE DATE ESTABLTSHED 09-19-1966 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due ~,099.~5 X 0.166 685.26 - .00 685.26 X .~5 30.75 NOTE: TAX CREDITS: PAYMENT RECETPT DTSCOUNT (+) DATE NUMBER TNTEREST/PEN PAZD (-) AMOUNT PATD 08-[T-ZOO5 CDOOZgq8 .00 $0.75 TO ZNSURE PROPER CREDTT TO YOUR ACCOUNT, SUBMTT THE UPPER PORTTON OF THTS NOTTCE WTTH YOUR TAX PAYMENT TO THE REGTSTER OF WTLLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGTSTER OF WTLLS, AGENT." TOTAL TAX CREDXT BALANCE OF TAX DUE XNTEREST AND PEN. TOTAL DUE ZF PATD AFTER THIS DATE, SEE REVERSE FOR CALCULAT3EON OF ADDXT/ONAL ZH¥~REST ( ZF TOTAL DUE TS LESS THAN $1, NO PAYMENT XS REQUTRED. ' TF TOTAL DUE TS REFLECTED AS A 'CREDTT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S[DE OF THXS FORM FOR INSTRUCTIONS. ) 50.75 .00 .00 .00 PURPOSE OF NOTICE= PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To ~ulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 91¢0). Detach the top portion of this Notice and submit aith your payment to the Register of Rills printed on the reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, ehich was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Office of the Register of Hills, any of the g$ Revenue District Offices or by calling the special Iq-hour answering service for fores ordering: 1-800-$6Z-ZOSO~ services for taxpayers eith special hearing and or speaking needs: 1-800-~qT-SOZO (TT only3, Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60} days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZB10Z1, Harrisburg, PA 17128-10Z1, 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. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. Sea page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decadent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the dacadant's death, a five percent (SI) discount of the tax paid is allowed. 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 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 (l) 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 [6g) percent par annum calculated at a daily rate of .OOO16q. All taxes which became delinquent on or after January 1, 198Z will bear interest at a rate which wi1! 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 1982 lOX .000568 1987 92 .OOOZq7 1999 7Z .00019Z 1983 16Z .000q38 1988-1991 llZ .000301 ZOOO EX .000Z19 198~ 11Z .000301 199Z 9Z .O00Zq7 Z001 9X .O00Z~7 1985 132 .000356 1993-199~ 7X .O0019Z ZOOZ 6Z .00016~ 1986 lOX .00027~ 1995-1998 9Z .O00Z~7 2003 SZ .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DALLY 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. Tf payment is made after the interest computation date sheen on the Notice, additional interest must bo calculated. BUREAU OF ZNDZVZDUAL TAXES TNHERZTANCE TAX nT¥ISTON DEPT. 280601 HARRTSBURG, PA 171zG-n601 WALTON D SIMPSON JR 5252 STUART DR NECHANICSBURG PA 17055. CONNONNEALTN OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF TNHER/TANCE TAX APPRATSEHENT. ALLORANCE OR DISALLO#ANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-27-2005 ESTATE OF STMPSON DATE OF DEATH 12-02-2002 FILE NUHBER 'i!: i · ?-,~ . COUNTY .... gSN/DC ACN 21 03-0511 CUMBERLAND 205-10-5595 03111042 A~oun't REV-l;48 EX AFP COl-OS) GLADYS N HAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LZNE ~ REV-1548 EX AFP (01-03) RETAIN LONER PORTION FOR YOUR RECORDS NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLONANCE OF DEDUCTZONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-27-2003 ESTATE OF SIMPSON GLADYS M DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND FILE NO. 21 05-0511 S.S/D.C. NO. 205-10-5595 ACN 05111042 TAX RETURN WAS: (X) ACCEPTED AS FILED ¢ ) CHANGED dOZNT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0205105595 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 09-19-1966 Account Balance 16,626.09 Percen~ Taxable ~ 0.166 Amount Subject ~o Tax 2,771.07 Debts and Deduc~/ons - .00 Taxable Amoun~ Z,771.07 Tax Ra~e Tax Due 124.70 NOTE: TAX CREDZTS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PATD (-) AMOUNT PAID 08-27-2005 CD002948 .00 124.70 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. HAKE CHECK OR HONEY ORDER PAYABLE TO: ffREGISTER OF MILLS, AGENT." 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 BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) TOTAL TAX CREDIT BALANCE OF TAX DUE ZNY~KEST AND PEN. TOTAL DUE 124.70 .00 .00 .00 PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 15 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Nat[ce end 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 was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-15LB). AppLications are available at the Office of the Register of NiLLs, any of the Z5 Revenue District Offices or by caLLing the special [4-hour answering service for forms ordering: 1-BOO-56Z-ZOSO; services for taxpayers with special hearing and or speaking needs: L-800-447-3010 (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 shown on this Not[ce amy object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of AppeaLs, Dept. ZBLOZL, Harrisburg, PA L7LZB-LOZL, 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, OEPT. 180601, Harrisburg, PA 17LZB-0601 Phone (717) 787-6S05. Sea pare S of the booklet "instructions for Inheritance Tax Return for a Res[dent Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due ts paid within three (2) calendar months after the decedant's death, a five percent (BX) discount af the tax paid is allowed. The LSZ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of daLinquency~ or nine (9) months and one (L) day from the date of death, to the date of payment. Taxes which became deIinquent before January L, 1981 bear interest at the rata of six (BX) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on or after January 1, 1981 will bear interest at a rata which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through ZOO5 are: Interest DaiLy Interest DaiLy Interest Daily Year Rate Factor Yeast Rate Factor Year Rate Factor 198Z ZOZ .000S48 1987 9Z .000247 1999 7Z .O00Lgz 1982 16Z .000438 1988-1991 11Z .000301 ZOO0 8Z .000219 1984 11Z .000301 199Z 9Z .000Z47 ZOO1 9Z .000247 1955 15Z .000556 1995-1994 7Z .00019Z 200Z 61 .000164 1986 lO[ .000Z74 1995-1998 9Z .000Z47 2003 5Z .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAZD X NUHBER OF DAYS DELZNQUENT X DALLY ZNTEREST 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 ZNDZVTDUAL TAXES INHERITANCE TAX DTVZSZON DEPT. 280601 HARRISBURG,, PA 17128-0601 WALTON D SIHPSON JR 5252 STUART DR MECHANICSBURG PA 17055 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF XNHERZTANCE TAX APPRATSEHENT. ALLO#ANCE OR DXSALLONANCE OF DEDUCTXONS, AND ASSESSHENT OF TAX ON JOXNTLY HELD OR TRUST ASSETS DATE 10-27-2003 ESTATE OF SIHPSON DATE OF DEATH 12-02-2002 FILE NUMBER 21 03-0511 'i ..': -' ~;* COUNTY CUHBERLAND sSN/Dc 203-10-5595 ACN 031110qq Amoun~ Remi~ed GLADYS H HAKE CHECK PAYABLE AND REHIT PAYMENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THZS LINE ~ REV-Z548 EX AFP (01-03) RETAIN LOWER PORTION FOR YOUR RECORDS NOTZCE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-27-2003 ESTATE OF SIMPSON GLADYS H DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND FILE NO. 21 03-0511 S.S/D.C. NO. 203-10-5595 ACN 031110Q~ TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0203105595 TYPE OF ACCOUNT: ( ) SAVINGS ¢ ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 09-19-1966 Account Balance 8,02~.17 Percent TaxabZe X 0.166 Amount Subject to Tax 1,357.59 Debts and Deductions - .00 TaxabZe Amount 1,557.39 Tax Rate X .q5 Tax Due 60.18 TAX CREDZTS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (- 08-27-2003 CD0029q8 .00 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 OROER PAYABLE TO: ""REGISTER OF WILLS, AGENT." AMOUNT PAID 60.18 ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT"(CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THZS FORH FOR ZNSTRUCTZONS. ) TOTAL TAX CREDIT BALANCE OF TAX DUEJ ZNTEREST AND PEN. TOTAL DUE 60.18 .00 .00 .00 PURPOSE OF NOTZCE: PAYMENT: REFUND OBJECTIONS: ADMZN- ZSTRATZVE CORRECTZONS: DZSCOUNT: PENALTY: ZNTEREST: To fulfill tho requirements of Section glqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (72 P.S. Section 91~O). Detach the top portion of this Notice and submit eith your payment to the Register of Nills printed on the reverse side. -- Make check or money order payable to: REGZSTER OF NZLLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may bm requested by completing an "Application for Refund of Pennsylvania Znheritanca and Estate Tax" (RE¥-l~lS). Applications are available at the Office of the Register of Nills, any of the 25 Revenue District Offices or by calling tho special lq-hour answering service for fores ordering: 1-&OO-56Z-ZO50~ services for taxpayers with special hearing and or speaking needs: 1-800-qq7-5OZO iTT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 2810Z1, Harrisburg, PA 171la-lOll, 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 cf Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. ZaOBOi, Harrisburg, PA 171Z8-0601 Phone [717) 787-6505. Sea page 5 of the booklet "Instructions for 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 dmcedant's death, a five percent (5Z) discount of the tax paid is allowed. The lex 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 end of the tax amnesty period. This non-participation panaIty is appealebIm 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. lnterest is charged beginning with first day of delinquency, or nine (9) months and one (1) day frae the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6g) percent par annum calculated at a daily rate of .00016¢. All taxes which became delinquent on or after January l, 198Z 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 2005 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Yea___r Rate Factor 1982 lOX .0005¢8 1987 9X .0002¢7 1999 7X .O0019Z 1985 162 .000¢~8 1988-1991 11Z .000301 ZOO0 82 .000Z19 198¢ 112 .000501 199Z 92 .000Z¢7 2001 92 .000Z¢7 1985 13X .000356 1993-199¢ 72 .00019Z ZOOZ 62 .00016¢ 1986 102 .00027q 1995-1998 92 .0002¢7 2005 5~ .000137 --Interest is calculated as follows: ZNTEREST = BALANCE OF TAX UNPAZD X NUHBER OF DAYS DELZNI;~UBNT X DALLY ZNTBREST 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 bm calculated. ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DZVTSZON DEPT. 280601 HARRTSBURG, PA 17128-0601 WALTON D SIMPSON JR 5252 STUART DR HECHANICSBURG PA 17055 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOHANCE OR DISALLORANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-27-2005 ESTATE OF SIMPSON DATE OF DEATH 12-02-2002 FILE NUMBER 21 05-0511 *..j.j !_i..i ?-/ COUNTY CUMBERLAND .... SSN/DC 203-10-5595 ACN 051110q6 Amoun~ Remi~ed RE¥-16~18 EX AFP (0].-05) GLADYS M MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE REV-1548 EX AFP (01-03) RETAIN LONER 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 10-2~7-2005 ESTATE OF SIMPSON GLADYS M DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND FILE NO. 21 05-0511 S.S/D.C. NO. 205-10-5595 ACN 051110q6 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0205105595 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTABLISHED 09-19-1966 Account Balance 7,806.52 Percent Taxable X 0.166 Amount Subject to Tax 1,$01.11 Debts and Deductions .00 Taxable Amount 1,$01.11 Tax Rate X .~5 Tax Due 58.55 NOTE: TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID 08-27-Z005 CDOOZ9q8 .00 58.55 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." IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 58.55 .00 .00 .00 PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill fha requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z$ of ZOOO. (72 P.S. Section 91q0). 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 payabla to: REGISTER OF NILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may bm requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Qffice of the Register of Nills, any of the Z5 Revenue District Offices or by calling the special Zq-hour answering service far forms ordering: 1-800-56Z-ZOSO; services for taxpayers with special hearing and or speaking needs: Z-BOO-4qT-BOZO (TT onlY). Any party in intarast not satisfied eith the appraisament, allowanca, or disallowance of daductions or assessment of tax (including discount or intarest) as shown an this Notica may object Nithin sixty (60) days of receipt of this Notice by: --eritton protest to the PA Department of Revenue, Board of Appaals, Dept. Z810Z[, Harrisburg, PA 171Za-lOZ1, OR --electing to have tha .attar detarainad at the audit of the account of the personal reprasantativa, OR --appeal to tha Orphans' Court Factual errors discoverad on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individua! Taxes, ATTN: Post Assessment Review Unit, DEPT. Za060I, Harrisburg, PA 17[ZB-060[ Phone (7[7) 787-6505. Sea paRe 5 of the book[at "Instructions for inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively corractabla errors. If any tax due is paid eithin three (5) calandar months after the dacadant's death, a five percent (5Z) discount af the tax paid is alia.ed. The lSg tax amnesty non-participation penalty is computed on the total of the tax and interest assassad, and not paid before January ID, 1996, the first day after tho and of the tax amnesty period. This non-participation penalty is mppm.labia in the same manner and in the the same tima period as you mould appeal the tax and inter, st that has been assessed as indic.tad on this notice. interest is charged beginning eith first day of delinquency, ar nina (9) months and Dna (1) day from the date af death, to the date of payment. Taxes which became delinquent before January [, [9BZ bear interest at tha rate of six (6g) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January i, I982 mill bear interest at a rate ahich wi[[ vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2005 are: Interast Daily Interest Daily Interest Daily Year Rate Factor Yea.~r Rate Factor Year Rate Factor 19az ZOZ .00054B 1987 9Z .O00Zq7 [999 7Z .00019Z 1985 16Z .O00q58 1988-1991 llZ .000301 ZOO0 8Z .000Z19 1984 1IX .000301 199Z 9Z .O00Z~7 ZOO1 9Z .000247 1985 15Z .000356 199~-199q 7Z .00019Z ZOOZ 6Z .00016q 1966 10X .OOOZ7q 1995-1998 9Z .000Z47 ZOO~ 5Z .0001~7 --Intarast is calculated as folloes: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquant will reflect an interest calculation to fifteen (15) days beyond the data of the assessment. If payment is made after tha interast computation date sheen on the Notice, additional interest must be calculatad. BUREAU OF ZNDZVZDUAL TAXES TNHERTTANCE TAX DTVTSZON DEPT. Z8060! HARRTSDURG, PA 171Z8-060! WALTON D SIMPSON 5252 STUART DR MECHANICSBURG COMHONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT PA 1~055 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-10-2005 SIHPSON GLADYS M 12-02-2002 21 05-0511 CUMBERLAND 101 Amount Rem/fred I HAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper cred/t to your account, subm/t the upper port/on of this form with your tax payment. CUT ALONG THIS LTNE ~ RETATN LOWER PORTTON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~ TNHERTTANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF SIMPSON GLADYS M FZLE NO. 21 05-0511 ACN 101 DATE 11-10-2005 THTS STATEHENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHONN BELO# ZSA SUNNARY OF THE PRZNCZPAL TAX DUE, APPLZCATZON OF ALL PAYNENTS, THE CURRENT BALANCE, AND, ZF APPLZCABLE, A PROJECTED ZNTEREST FZGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-15-2005 PRINCIPAL TAX DUE: PAYHENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 08-27-2005 CDOOZ947 10-18-2005 CD005146 5,954.61 ZF PAID AFTER THZS DATE, SEE REVERSE S/DE FOR CALCULATZON OF ADDZT/ONAL INTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT 1S REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" .00 .05- 5,926.47 8.20 TOTAL TAX CREDIT 5,954.62 BALANCE OF TAX DUE .01CR ZNTEREST AND PEN. .00 TOTAL DUE .01CR YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORH FOR 'rNSTRUCTTONS. ) PAYHENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NTLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COHHONNEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application far Refund of Pennsylvania Inheritance and Estate Tax" (REV-l~13). Applications are available at the Office of the Register of Nills, any of the Z3 Revenue District Offices or from the Department's Z4-haur ansmering service for forms ordering: 1-800-36Z-ZO50; services for taxpayers with special hearing and / or speaking needs: 1-BOO-447-30ZO (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Pest Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601, phone (717) 767-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, e five percent (SZ) discount af the tax paid is allowed. PENALTY: 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 end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day free the date of death, to the date of payment. Taxes which became deIinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes mhich became delinquent on and after January 1, 198Z 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. Interest Daily Year Rate Factor The applicable interest rates for 198Z through ZOOS are: Interest OaiIy Interest Daily Year Rate Factor Year Rate Factor 1982 20Z .000548 1987 9Z .O00Zq7 1999 7Z .00019Z 1983 16Z .000~8 1988-1991 llZ .000301 2000 BX .000219 1984 112 .000301 1992 9Z .000247 2001 9Z .000247 1985 132 .000~56 1993-1994 7Z .OO019Z Z002 6Z .000164 1986 102 .000274 1995-1998 92 .000247 2005 5Z .000137 --Interest is calculated as follows: XNTEREST= BALANCE OF TAX UNPATD X NUHBBR OF DAYS DEL/NQUENT 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 shown on the Notice, additional interest must be catcutated. SUREAU OF ZNDIVTDUAL TAXES TNHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG.. PA 17128-0601 JEFFREY H SIMPSON C/O 5 SUNSET DR MECHANICSBURG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE Cumbedan~ Co., PA NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DXSALLOHANCE OF DEDUCTXONS, AMD ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS ~-:!'~.:~i;C!~ O~ DATE 02-16-200q F~:~j:gi~ Oi ~!ilt$ ESTATE OF SIMPSON GLADYS M DATE OF DEATH 12-02-2002 FILE NUMBER 21 05-0511 FEB 13 P3:30 COUNTY CUMBERLAND SSN/DC 205-10-5595 ACN 05111059 Amoun~ RemL~ed HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 REV-15~8 EX AFP 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 DEDUCTZONS~ AND ASSESSMENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS DATE 02-16-200q ESTATE OF SIHPSON GLADYS H DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND FILE NO. 21 03-0511 S.S/D.C. NO. 205-10-5595 ACN 05111059 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED dOXNT OR TRUST ASSET ZNFORHATZON FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0205105595 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C~ TIME CERTIFICATE DATE ESTABLISHED 09-19-1966 Accoun~ Balance 11,801.01 PePcen~ Taxable X 0.166 Amoun~ Sub~ec~ to Tax 1,966.87 Debts and Deduc~/ons - .00 Taxable Amoun~ 1,966.87 Tax Ra~e X .~5 Tax Due 88.51 NOTE: TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 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."' NTEREST IS CHARGED THROUGH OZ-2q-ZOOq TOTAL TAX CREDIT AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE REVERSE SIDE OF THIS FORM ZN~-I~REST AND PEN. TOTAL DUE ~ ZF PAID AFTER THZS DATE, SEE REVERSE FOR CALCULATION OF ADDZTTONAL ZNTEREST. ~ ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REI~UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTZONS. } .00 88.51 1.99 90.50 PURPOSE OF ROTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (72 P.S. Section 9140). PAYHENT: 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 NILLS) AGENT. REFUND (CR): A refund of a tax credit) which was not requested on the tax return) may be requested by completing an "Application for Refund of Pennsylvania /nheritanca and Estate Tax" (REV-1513). 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-BOO-36Z-ZOSO; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement) allowance) or disalloeanca 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. ZBlOZ1)Harrisburg, PA 171ZB-lOZ1, OR --electing to have the matter determined at the audit of the account of the peFs°nalrepresantativa) OR --appeal to the Orphans' Court ADHIN- ISTRATIVE CORRECTIONS= DISCOUNT: PENALTY: INTEREST: 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. 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-iSOl) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the docedent's death, a five percent (SI) 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 tho end of the tax amnesty period. This non-participation penalty is appealable in tho 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 free the date of death) to the date of payment. Taxes which became delinquent before January 1, 19BI bear interest at the rate of six (BI) percent per annum calculated at a daily rate of .000164. Ail taxes which became delinquent on or after January l, 198Z 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 ZOO3 are: Interest Daily Interest Daily Year Rate Factor Yea.~..c Rate Factor.. Yea.~r 1982 ZOZ .000548 1987 92 .000Z47 1999 1983 16Z .000458 1988-1991 llZ .000501 ZOO0 1984 llX .000301 199Z 9Z o000Z47 ZOO1 1985 13Z .000556 1995-1994 7Z .00019Z ZOOZ 1986 IOZ .000Z74 X995-1998 9Z .000Z47 ZOO5 --Interest is calculated as follows: Interest Daily Rate Factor 7Z BZ .OOOZI9 9X .000247 6Z .000164 5Z .000137 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 iflterast 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 oust be calculatedo Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/10/2004 SIMPSON WALTON D JR 5232 STUART DRIVE MECHA/qICSBURG, PA 17055 RE: Estate of SIMPSON GLADYS M File Number: 2003-00511 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 12/02/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/01/2005 SIMPSON WALTON D JR 5232 STUART DRIVE MECHANICSBURG, PA 17055 RE: Estate of SIMPSON GLADYS M File Number: 2003-00511 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 12/02/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~ 'v~~)J~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge \f~~ Ll_ c--;'c~, 1..1...1 .,1 (~i'.-:c-: ~[~; C,::J r-:"- ~h:f i."-'~ c:c ' C) c.:> U} cr- Register ofvVills of Cumberland County STATUS REPORT UNDER RULE 6~12 Name of Decedent: c;. t,ltj)'($ fI4 S' / tw p-;&>,'o/ " Date of Death: /1-/ t:I "Z- II;? 'f Estate No.: /.,(It) '3 t:)p r I I 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 wh~er administration of the estate is complete: Yes ur No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did t~ersonal representative file a final account with the Court? Yes h::::!' No 0 ' b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes u:;y No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: II-eX, -i7r'"' " \AI~~ 7./"7- Signature ::". :2 -r:.. Ll~ (,"::::J. = ~ -:so ('.J w,4- v'TV tV .1 ~ ( t/"'l PfptV J IV . Name " - '*='-- I-_C' c~ ~- 0: c:: ("~~~:" ". '-/ 0.: LLJ S v J 1- 'i'T r/~ -r f) 11..1 t/IL ps.f ~th4- /11 &?- Q v~ if, f If Address a 0, 7/7 7b6 J '!-z,,& Telephone No. Capacity: ~rsonal Representative o Counsel for personal representative ........,'.... !~ ;', - ---- -,. ,- '---' ,'"1 \It: 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 014521 SIMPSON WALTON D JR 5232 STUART DRIVE MECHANICSBURG, PA 17055 -------- fold ESTATE INFORMATION: SSN: 203-10-5595 FILE NUMBER: 2103-051 1 DECEDENT NAME: SIMPSON GLADYS M DATE OF PAYMENT: 05/31 /201 1 POSTMARK DATE: 05/09/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 12/02/2002 REMARKS: CHECK# 5295 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 03111047 ~ $83.67 03111031 ~ $86.81 031 1 1035 ~ $163.58 031 1 1037 ~ $ 88.97 031 1 1039 ~ $126.48 031 1 1043 ~ S 178.20 03111045 ~ $85.16 TOTAL AMOUNT PAID: INITIALS: HMW REV-1162 EX(11-96) $812.87 RECEIVED BY: GLENDA F~ARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVID ~~~~,:~ ~,.,.,;~ (~ INHERITANCE TAX DIVISIO ~~<<.~ . r ~-, ~` ~" ~ J,:y ,1 . PO BOX 280601 HARRISBURG PA 17128-0601 L ~ ~ ~ {..~~ ~ ~ i ~ ~ -; it GI.ERK ~F OFPK~N'S ~Ot~RT J E F F R E Y~v~`~~' `S I`M~~~`S~O~n ~ ~~~ C/0 5 SUNSET DR MECHANICSBURG PA 17050 INHERITANCE TAX STATEMENT OF ACCOUNT ._,,-~ Pennsylvania ~ DEPARTMENT OF REVENUE t REV-1607 EX AFP C12-10) DATE 06-27-2011 ESTATE OF SIMPSON GLADYS M DATE OF DEATH 12-02-2002 FILE NUMBER 21 03-0511 COUNTY CUMBERLAND ACN 03111039 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~_ RETAIN LOWER PORTION FOR YOUR RECORDS ~ _ _ _ REV X1607 SEX AFP C12 10~~~~ ~~ *** INHERITANCE TAX, STATEMENT~~F ACCOUNT ~~*** ~ ~~ ~~~~~ ~~~~~~~~~~ ESTATE OF:SIMPSON GLADYS M FILE NO.: 21 03-0511 ACN: 03111039 DATE: 06-27-2011 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2006 PRINCIPAL TAX DUE: 88.51 PAYMENTS CTAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID t-) 05-09-2011 CD014521 37.86- 126.48 TOTAL TAX PAYMENT 88.62 BALANCE OF TAX DUE .11CR INTEREST AND PEN. .00 TOTAL DUE .11CR * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~ "~''~-'-` ~~'~C~C~ ~~~ INHERITANCE TAX BUREAU OF INDIVIDUA ~,,,,, l,~ E,,.'i 1 l INHERITANCE TAX DIVISIO~' „:, .` ;-, ;-•~ ~a.,r~! ~' STATEMENT OF ACCOUNT PO BOX 280601 ~ t "' `", `,~ s ;: d I_.L. ~: HARRISBURG PA 17128-0601 ~i...~_d~.r - CLERK ~~ a~~.~~v~s C~~~~T JEFFREY ~J~~,~~~1 ~.;~ ~ C/0 5 SUNSET DR MECHANICSBURG PA 17050 Pennsylvania ~ DEPARTMENT OF REVENUE REV-1607 EX AFP (12-10) DATE 06-27-2011 ESTATE OF SIMPSON GLADYS M DATE OF DEATH 12-02-2002 FILE NUMBER 21 03-0511 COUNTY CUMBERLAND ACN 03111037 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG_ THIS LINE _~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ___ _ _ REV X1607 EX AFP C12 10~~~ ~~~ *** INHERITANCE TAX STATEMENT~~F ACCOUNT~~***~~~~~~~~ ~~ ~~~~ ~~ ESTATE OF:SIMPSON GLADYS M FILE NO.: 21 03-0511 ACN: 03111037 DATE: 06-27-2011 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2006 PRINCIPAL TAX DUE: 62.26 PAYMENTS CTAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-~ 05-09-2011 CD014521 26.63- 88.97 TOTAL TAX PAYMENT 62.34 BALANCE OF TAX DUE .08CR INTEREST AND PEN. .00 TOTAL DUE I .08CRI * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 CLERK ~JE ORPr-!~,^1'S CJ~lRT ~FQ~ ;"'~,1~ Ctn., PA, JEFFREY M SIM C/0 5 SUNSET DR MECHANICSBURG PA 17050 ~~'~`""'~=~~~F-r fM''rF~1RITANCE TAX '`++`_1`iF ti~4 •-t._1 ,- ` ENT OF ACCOUNT I'~L~;t~ • ~ . ~~i~. ennsylvania ~ ~ ~^ DEPARTMENT OF REVENUE ___. . REV-1607 EX AFP C12-10) DATE Ob-27-2011 SIMPSON GLADYS M ESTATE OF DATE OF DEATH 12-02-2002 FILE NUMBER 21 03-0511 COUNTY CUMBERLAND ACN 03111045 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 it to your account, submit the upper portion of this form with your tax payment. NOTE: To ensure proper cred NE ~- RETAIN LOWER PORTION FOR YOUR RECORDS '~ UT ALONG THIS LI ~~~~~~~~~~~~~ ...............•~ TAX STATEMENT~~F ACCOUNT ~~~~~~~~~~••••••••••••••••^ C *** INHERITANCE ........................ REV-1607 EX AFP C12-10~ ___.. r_IenYS M FILE N0.:21 03-0511 ACN: 03111045 DATE: 06-27-2011 . ~.. w CIIMM~RY OF THE PRINCIPAL t, lA1 c v, ...,_..- - -•-- THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED .,.,~rrwTTf1N of ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INT TAX DUt, /+rr~~~-•+• ---.. -- DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2006 60.18 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): RECEIPT DISCOUNT C+~ AMOUNT PAID PAYMENT NUMBER INTEREST/PEN PAID C-~ DATE _ 85.16 CD014521 24'98 ,76 05-09-2011 .00 06-24-2011 SBADJUST b0.18 TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. TOTAL DUE .00 * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULAyTgENDUE ADREFUNDALSEETREVERSE SIDE OF THIS FORM IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU M FOR INSTRUCTIONS. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 JEFFREY M SIMPSON C/0 5 SUNSET DR PA 17050 MECHANICSBURG ~~~~~~ ~ f ~~~~°~ rN'C TAX ~~ JF ! ,: ennsylvan~a ~ • DEPARTMENT OF REVENUE REV-1607 EX AFP (12-10) 06-27-2011 DATE SIMPSON GLADYS M ESTATE OF 12-02-2002 DATE OF DEA TH 21 03-0511 FILE NUMBER CUMBERLAND COUNTY 03111035 ACN Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: CLERKK rF aRP~~~~f~ ~~~a~T CU~~~~~~_~a"~'~ C~~ , P~ REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 account, submit the upper Portion of this form with your tax payment. NOTE• To ensure proper credit to your RETAIN LOWER PORTION FOR YOUR R ACCOUNT IS LINE ~ ..........................TATEMENT~OF..................................... CUT ALONG TH *** INHERITANCE TAX S REV X1607 SEX AFP C12 10~ ~~~ ILE NO.: 21 03-0511 ACN: 03111035 DATEF OH PRINCIPAL GLADYS M F ESTATE OF:SIMPSON RREN7 STATUS OF THE STATED ACN IN TDE rFMAPPLICABLE,BALPROJECTED INTEREST FIGURE. THIS STATEMENT PROVIDES CU _,,.~ ~~ ni ~ PAYMENTS, THE CURRENT EALANCE, A TAX DUE, Arr~l~~~ L~~~ -~ F LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2006 DATE 0 114.47 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): RECEIPT DISCOUNT C+) PAYMENT NUMBER INTEREST/PEN PAID C-) DATE 48.96- 05-09-2011 CD014521 AMOUNT PAID 163.58 ~- 114.62 TOTAL TAX PAYMENT .15 BALANCE OF TAX DUE .00 INTEREST AND PEN. TOTAL DUE ~ .1= D AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATIENDUE ADREFUNDALSEET REVERSE SIDE OF THIS FORM * IF PAI IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY FOR INSTRUCTIONS. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 ~~~~~ ~~~~~; ~ ~ E TAX ' ~-~ ACCOUNT ~~,~, pennsylvan~a ~ ~L. 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CUT ALON *** INHERITANCE TAX REV X1607 EX AFP C12 10? ~~ M FILE N0.: 21 03-0511 ACN: 03111047 DAToF OH PRINCIPAL r_i AT1Y4 ~.~ Tl^ n ciuMMARY ESTATE OF : SIMF'SUn THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. w~TTnu nG •LL ~AYM TAX DUE, Arr~l~H~ ~~~~ -• --- OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2006 DATE 58.55 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS: RECEIPT DISCOUNT C+~ PAYMENT NUMBER INTEREST/PEN PAID C-) DATE 25.04- 05-09-2011 CD014521 AMOUNT PAID 83.67 TOTAL TAX PAYMENT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATgENDUE ADREFUNDALSEETREVERSE SIDE OF THIS FORM * IF IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MA FOR INSTRUCTIONS. 58.63 .08 .00 .0 ~ ~ ~,~-- R f F-_}~ N r r~~# '~ TAX ;~E~J~i"~±~~.~.> ~,f- ;"i HERITA CE BUREAU OF INDIVIDUAL TAXES ~= ~~v ~ ~~:,' +.~ '`;••$;~!.p~-~-EMENT OF ACCOUNT INHERITANCE TAX DIVISION ~1 ~ T, ennsylvan~a ~ • -~ DEPARTMENT OF REVENUE REV-1607 EX AFP C12-10) PO BOX 280601 HARRISBURG PA 17128-0601 A~ ' 4_ ~,,~ t ~ :~. DATE 06-27-2011 LADYS M C~.ERK CF oRP~;~~~~s c~~r SIMPS~ON~~~,''~~ ~^~~ , PA. JEFFREY M C/0 5 SUNSET DR PA 17050 MECHANICSBURG SIMPSON G ESTATE OF DATE OF DEATH 12-02-2002 FILE NUMBER 21 03-0511 COUNTY CUMBERLAND ACN 03111031 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 account, submit the upper Portion of this form with your tax payment. roper credit to your NOTE: To ensure P INE ~- RETAIN LOWER PORTION FOR YOUR RECORDS *** IS L .^ .....................•^`TATEMENT~OFACCOUNT ••••••••••••••••••••••••••• CUT ALONG TH *** INHERITANCE TAX S REV 1607 SEX AFP C12 10~ ~~~~~~ LE NO .: 21 03- 0511 ACN : 03111031 DAToF TOHE PRINCIPAL ~~ wnvc M FI _ __. „~.~ T~ n cIIMMARY THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED _..r.,.~ nc el L PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJEC TAX DUE, ANr~l~N~ ~.... -~ F LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2006 DATE 0 60'75 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): _ RECEIPT DISCOUNT C+) PAYMENT NUMBER INTEREST/PEN PAID C-) DATE 25.98- 05-09-2011 CD014521 AMOUNT PAID 86.81 60.8; TOTAL TAX PAYMENT .0 BALANCE OF TAX DUE .0~ INTEREST AND PEN. TOTAL DUE ~ .0 AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATI~NDUE ADREFUNDALSEETREVERSE SIDE OF THIS FORM * IF PAID IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY B FOR INSTRUCTIONS. ~ ,,~j-.,;.;~ 1 `"~'~~~ ~~ INHERITANCE TAX ~~ -, ; ~~ ,~,,,~+ + `STATEMENT OF ACCOUNT BUREAU OF INDIVIDUAL(~~ ITANCE TAX DIVISION ~~i^ ~ ;.,~ , ~ ~ i''. `,,J ennsylvania ~ • DEPARTMENT OF REVENUE REV-1607 EX AFP C12-10) INNER ~a~~; . ,... ~ •w Po Box zao6ol 06_27-2011 HARRISBURG PA 17128-0601 DATE SON GLADYS M .~ .a + ~° ~'" ~ ~ .~ ~. ESTATE OF SIMP ~.C++ ~~~ -'~ ~'k~ 12-02-2002 DATE OF DEATH 21 03-0511 CL~~K ~ir FILE NUMBER CUMBERLAND COUNTY T ~~K~~~S C~~~~ ~ 03111043 ~r~ p~ ACN JEFFREY ~~~41 ~~'''} ~ Amount Remitted C/0 5 SUNSET DR PA 17050 MECHANICSBURG MAKE CHECK PAYABLE AND REMIT PAYMENT T REGISTER OF WILLS 1 COURTHOUSE SQ70R3 CARLISLE PA bmit the upper Portion of this form with your tax payment. to your account, su NOTE: To ensure proper credit YOUR RECORDS ... ........................................................... RETAIN LOWER PORTION FOR T OF ACCOUNT ~*~ THIS LINE ~ *** INHERITANCE TAX STATEMEN ....•607 SEX ' ................................ 2011 CUT ALONG AFP C12-10~ REV-1 03111043 DATE: 06-27- 21 03-0511 ACN: GLADYS M FILE NO.: P SO N N IN THE NAMED ESTATE. BELOW ~ECTED INTEREST FIGUREINCIPA A PRO ESTATE OF:SIM THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED AC OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, TAX DUE, APPLICATION ESSMENT OR RECORD ADJUSTMENT: 01-21-2006 124.70 DATE OF LAST ASS PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): PAYMENT DATE 05-09-2011 RECEIPT NUMBER CD014521 DISCOUNT C+) INTEREST/PEN PAID C-) 53.34- AMOUNT PAID 178.20 TOTAL TAX PAYMENT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE TE, SEE REVERSE SIDE FOR CALCULATION OF pDREFUNDALSEET REVERSE SIDE OF THIS FORM * IF PAID AFTER THIS DA F TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE I FOR INSTRUCTIONS. 124 .8=