Loading...
HomeMy WebLinkAbout03-0524REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-I$O0 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER COUNTY CODE YEAR HUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INmAL SOCIAL SECURITY NUMBER MarthaD. 0 5 2- 2 O- 8 8 5 6 DATE OF DEATH (UU-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 02/13/2003 10/25/1924 REGISTER OF WILLS IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND ME)DEE INITIAL) SOC1AI_ SECURITY NUMBER 1. Original Return -']4. Limited Estate r~-]6. Decedent Died Testate (~ach cop~ ofwa) r--~ 9. Litigation Proceeds Received [~]2. Supplemental Return [~46. Future Interest Compromise (~ of death ~er 12-12-82) [~7. Decedent Maintained a Living Trust (Altach copy of Tmst) n'] 10. Spousal Povedy Credit (dae of death bmv, ea~ 12-31.91 and 1-1-95} r--~ 3. Remainder Return (date of death prior to 12-13~82} n']5. Federal Estate Tax Return Required O~ 8. Total Number of Safe Deposit Boxes E~11. Election to tax under Sec. 9113(A) NAME Judith T. Walz FIRM NAME (ff Appicabb) TELEPHONE NUMBER 717-567-6993 9. 10. 11. 12. 13. & Scadn 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 Properly (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10} Total Deductions (total Lines 9 & 10) COMPLETE MAILING ADDRESS 341 Market Street (8) (11) 117,19.01 2,154.57 5,509.75 679.81 14. 17074 ONLY Net Value of Estate (Line 8 minus Line 11) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) 4,415.58 (12) (13) 6,189.56 -1,773.98 (14) -1~773,98 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. X X .O45 X .12 X .15 (15) (16) (17) (16) (19) Decedent's Complete Address: iSTREE~'ADDRE$S 35 East Gate Drive Apartment 303 ~TY 'Carlisle I STATEpA ZIP 17013 Tax Payments and Credits: 1~ Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) {3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a Iransfer and: Yes No a. retain the use or income of the property lransferred; ......................................................................... [] [] b. retain the dght 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 considera~rt? .......................................................................................... [] [] 3. Did decedent own an "in lrust for" or payable upon death bank account or secudty at his or her death2 ............... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designatien2 .................................................................................................. [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DUnd,er ,.p~nalti.es of pequ~,, I d,,ecta~,, that ~ ha~, examined. ~is m~m, i ,ncbd~.g .accompanying sdnedubs and statements, and to the best of my knowledge and belef, it is true, co~mct and compbte. ec~araaon of preparer omer man me persona~ repmsema~ve ~s nase~ on al ~nTormation of w~Jh preparer has any knowledge. SIGNATURE OF PEI:~,F~N~ESP~NSIBLE FOR FILI~IG RETURN / DATE ADDRESS 770 Bower Road-- ' Shermans Dale PA, 17090 SIGNATURE OF P~R OTHER THAN REPRESENTATIVE ADDRESS Street ~ 341/b~a"~et Nee'pod PA 17074 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a t~'ansfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviwng spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. {}9116(a)(1.2)]. The tax rate imposed on the net value of Imnsfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {}9116(1.2) [72 P.S. {}9116(a}(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116(a)(1.3}]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~/ALZ & WALZ NEWPORT, PA. LAST WILL AND TESTAMENT OF MARTHA D. HUNTER I, MARTHA D. HUNTER, of Upper Allen Township, Cumberland County Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereb revoking all Wills and Codicils at any time heretofore made by me. FIRST. I direct payment of the expenses of my last illness, funeral and buri~ costs and administration e~penses from my Estate, be paid by my Estate, as an expense c my Estate, as soon after my death as conveniently may be done. All Federal, State an, other death taxes payable because of my death with respect to the property forming m gross Estate for tax purposes, whether or not passing under this Will, including any intere~ or penalty imposed in connection with such tax, shall be considered a part of th~ administration of my Estate and shall be paid from my residuary Estate withou apportionment or fight to reimbursement. SECOND. I give, devise, and bequeath those articles of my personal property a set forth in a Separate Memorandum which I shall place with my Will or which shall b, found with my important papers in my home to the persons therein designated. In th, event that I leave no Separate Memorandum then this paragraph SECOND shall be ignore{ and my Executrix shall follow the below written paragraph THIRD. ALZ & WALZ N£WPORT, PA. THIRD. All the rest, residue and remainder of my estate whatsoever am wherever situate not given in my Separate Memorandum shall be liquidated and proceeds received therefrom shall be distributed in four (4) equal shares to my children ORA ROBERT HUNTER, ARTHUR PHILLIP HUNTER, ADELAIDE C KOPENHAVER, and JOHN WAYNE HUNTER, or if any of the four children predeceas, me, then to my then living issue, per stirpes. FOURTH. I nominate and appoint my daughter, ADELAIDE C. KOPENHAVER Executrix of my Last Will; she is to serve without bond. Should my daughter, ADELAID! C. KOPENHAVER, predecease me or be unable to serve as Executrix, I nominate my tw~ sons, ORA ROBERT HUNTER and ARTHUR PHILLIP HUNTER, Co-Executors of this m Last Will; they also are to serve as such without bond. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 5th da of April, 2000. MARTHA~ D. HUNTER The preceding instrument, consisting of this and one (1) other typewritten page,, each identified in the margin thereof by the signature of the Testatrix, was on the dat~ thereof signed, published and declared by her, the Testatrix therein named, who at request, in her presence, and in the presence of each other have subscribed our names a: witnesses hereto. CAROLYN W. N~"Y G~IL"'F~. AND REWS (SEAL) (SEAL) IALZ & WALZ ATfORNEY~ AT LAW N~wPO~X, PA. COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF PERRY · We, MARTHA D. HUNTER, CAROLYN W. NEY, and GAIL F. ANDREWS, th, Testatrix and the witnesses, respectively, whose names are signed to the attached foregoing instrument, being first duly sworn, do hereby declare to the undersigned that the Testatrix signed and executed the instrument as her Last Will and that she signed willingly, and that she executed it as her free and voluntary act for the therein expressed, and that each of the witnesses, in the presence and hearing of Testatrix', signed the Will as witness and that to the best of their knowledge the was at that time eighteen years of age or older, of sound mind and under no constraint undue influence. WITNESS: GAIL F. ANDREWS Subscribed, sworn to and acknowledged before me by MARTHA D. HUNTER, the and subscribed and sworn to before me by CAROLYN W. NEY and GAlL F. witnesses, this -~'P~ day of~, 20~00./~ My Commission Expires: ~~lic~ ~_  - Notarial Seal .... Judith T W317 ,',lotary ' ~ ~'~.r County ~NeW or~ 6r~ ', .. ry 1 VALZ & WALZ ATTORNEYS AT LAW ~EWPORT, SEPARATE MEMORANDUM MARTHA D. HUNTER THIS DOCUMENT is prepared as the Separate Memorandum referred to in ?aragraph sECOND of my Will and is intended only for that purpose. It is not deemed a Codicil or subsequent Will; and is signed along the margin of this document for identification purposes only. 2. 3. 4. 5. 6. 7. 8. 9. 10. The following are the names of the persons and the articles they are to receive: ARTICLE PERSON 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. REV-1502EX* (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hunter. Martha [~ SCHEDULE A REAL ESTATE FILE NUMBER All real property owned solely or as a tenant in common 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 survivorship must be disclosed on Schedule F. ITEM NUMBER None DESCRIPTION TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 0.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Hunter, Martha D. All property jointly-owned wilh right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Cumberland Valley Cooperative Association 10.00 U.S. Savings Bond, E.E. (e) Eastgate Apartments, Refund of Security Deposit 100.00 432.00 TOTAL (Also enter on line 2, Recapitula§on) $ 542.00 (If more space is needed, insert additional sheets of the same size) REV-~504 EX * (1-97) ~ COUUONWEALTH OF P~HNSYLV^NI^ INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP or SOLE-PROPRIETORSHIP ESTATE OF Hunter. Martha D, FILE NUMBER Schedule C-1 or C-2 (Including all supporting information) must be attached.for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship See instructions for the suppoding information to be submitted for sole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. None 0.O0 TOTAL (Also enter on line 3, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1507 EX ~ (1-97} ~ · COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hunter. Martha D, SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. None VALUE AT DATE OF DEATH 0.00 TOTAL (Also enter on line 4, Recapitulafionl $ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hunter, Martha D, SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY 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 sur~ivorshi iTEM NUMBER DESCRIPTION Household goods valued at Refund from Myers Funeral Home, Inc., from prepaid portion of the funeral account Sprint, refund TOTAL (Also enter on line 5, Recapitulalior (If more space is needed, insert addilJonal sheets of the same size) must be disclosed on Schedule F. VALUE AT DATE OF DEATH 1,500.00 200.00 19.01 1~719.01 REV-1509 E~ * (1-9T) ~ COMMDNW~TH DF PENNSYLVANIA INHERITANC~ TAX RETURN RESDENT DECEDENT ESTATE OF Hunter. Martha D. If an asset was made joint within one year of the decedents date of death, it must be reported on Schedule G. SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Adelaide Kopenhaver 770 Bower Road daughter Shermans Dale, PA 17090 B C JOINTLY-OWNED PROPERTY: L~-~ ~ ~-H DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Incbde name of financial institution and bank account number or s~milar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-heU real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1. A. 6/29/99 Members 1st FCU Account ~81281-00 Savings 5000 Louise Drive, PO Box 40 Mechanicsburg, PA 17055 Date Account opened July 10, 1986 196.27 50. 98.14 Principal Balance (Date of Death) 194.44 Accrued Interest 1.83 2. A. 6/29/99 Members 1st FCU Account ~1281 5000 Louise Drive, PO Box 40 Mechanicsburg, PA 17055 Principal Balance (Date of Death) 4112.66 4,112.86 50. 2,056.43 Accrued Interest .20 TOTAL (Also enter on line 6, Recapitulation) $ .................... 2~154.57 (If more space ~s needed, insert additional sheets of the same see) Membersl FEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 1-800-283-2328 or (717) 697-1161 REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Created CHECKING ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Created 81281 -00 07/10/1986 $I 94.44 $1.83 $196.27 Adelaide C Kopenhaver 06/29/1999 81281 -11 07/10/1986 $4,112.66 $.oo $4,112.66 Adelaide C Kopenhaver 06/29/1999 BERS 1s'r F E ~.~..~Z,~~ CREDIT~_UNION Denise A. Anderg'----'~ Insurance Supervisor March 20,2003 Estate of: MARTHA D. HUNTER Date of Death: 02/13/2003 Social Security Number: 052-20-8856 2 1 2003 RE~-1510 EX. (1-97) ~ O0~ONWEALTH OF PENNSYLVANIA INHEP, FFANOE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-ViVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Hunter. Martha D. This schedule must be completed and filed if the answer to any of questions 1 through 4 on lhe reverse side of the REV-1500 COVER SHEET is /es. DESCRIPTION OF PROPERTY % OF ITEM INCI-LIDE THE NN~E OF ~I'{E TRANSP-E~EE, T~..JR RELATIONSHIP TO OECE:D~IT Ak~ THE DAYE OF TR/~FER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER AI~rAC~IA (~OPY OF TI"~ DE~D FOR REAL E'~TATE' VALUE OF ASSET INTEREST 1. None TOTAL (Also enter on line 7, R~apitulafion) $ (If more space is needed, inset ad~tional sheets of the same size) REV-1511EX * (1-97} ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hunter. Martha D, SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION FUNERAL EXPENSES: Myers Funeral Home - balance of funeral bill which was not prepaid Funeral Dinner at Brothers Family Dining ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees Walz, Walz, Scadngi & Scadngi Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills Nonprobate filing fee for Inheritance Tax Return Accountant's Fees Tax Return Preparer's Fees Gingrich Memorials, gravemarker for two (2) persons- $2061.20; Decedent 1/2 TOTAL (Also enter on line 9, Recapitulation) (If rf~o~e space is needed, insert additional sheets of the same size) AMOUNT 3,582.00 132.15 750.00 15.00 1,030.60 5r509.75 ~-V-1512 EX + (1-97).'· j~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hunter. Martha D. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. 49.51 Outstanding checks on Checking Account ~81281-11, as of date of death: Sprint- phone bill Eastgate Apartments; apartment rent for March 2003 Sprint, final phone bill Paul Storall, storage Dr. Dalbey, pediatdcts Cumberland County Office of Aging, home health Care TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) 294.00 108.84 174.90 2.95 49.61 679.81 REV-1513 EX + (9-00) qOIvlMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hunter. I~ lartha D, NUMBER I. 2. 3. 4. 1. 1. SCHEDULE J BENEFICIARIES FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [inc ude outright spousal distributions and transfers under Sec. 9116 (a)(12)] ' Ora R. Hunter 2224 Bishop Bddge Road Knoxville, TN 37922 John W. Hunter 502 Centennial Street Schwenksville, PA 17473 Arthur P. Hunter 136 Croatan Estates Newport, NC 28570 Adelaide C. Kopenhaver 770 Bower Road Shermans Dale, PA 17090 son son son daughter 25% of residue 25% of residue 25% of residue 25% of residue 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 None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None TOTAL OF PART I1 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of lhe same size) BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX n/V/SXON DEPT. 280601 HARRTSBURG, PA 17118-0601 JUDITH T WALZ $ql MARKET ST NEWPORT CONNONNEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT) ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 08-18-Z005 ESTATE OF HUNTER DATE OF DEATH 02-15-2005 FZLE NUMBER 21 05-0524 COUNTY CUMBERLAND ACN 101 Aeount Remitted REV-ISgi7 EX AFP COl-n3) MARTHA D MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HUNTER MARTHA D FILE NO. 11 05-0524 ACN 101 DATE 08-18-2005 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) 4. Hortgagas/Notas Rece/vabla (Schedule D) (4) 5. Cash/Bank Deposits/M/sc. Personal Property (Schedule E) ($) 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expanses/Ada. Costs/Misc. Expanses (Schedule H) (9) 10. Debts/Mortgage L/ab/I/ties/Liens (Schedule Z) (10) 11. Total Daduct/ons 12. Net VaZue of Tax Return O0 542 O0 O0 O0 1~719.01 2~154.57 O0 (8) 5,509.75 679.81 (11) (12) 15. 14. NOTE: ASSESSMENT OF TAX: 15. Amount of Line 14 a~ Spousal rata 16. Aeoun'1' of L/ne 14 taxable at Lineal/Class A rata 17. Amount of Line 18. Amoun~ of Line lq ~axable a~ Collateral/Class B ra~e 19. Principal Tax Due TAX CREDITS: ~AYNENT R~CEZPT DISCOUNT DATE NUMBER ZNTEREST/PEN PAID Charitable/Governmental Bequests; Non-mlectmd 9115 Trusts (Schedulm J) (13) Nat Value of Estatm Sub~ect to Tax (14) Zf an assessment was issued previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. NOTE: To /nsurm proper crmdit to your account, submit thm upper port/on of this form with your tax payment. 4,q15.58 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADD/T/ONAL INTEREST. 1,773.98- .00 1,77~.98- 18 and 19 ~ill (15) .00 x O0 = .00 (16) .00 x 045= .00 (17) .00 x 12 = .00 (16) .00 x 15 = .00 (19)= . O0 AMOUNT PAID TOTAL TAX CREDZT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 ( ZF TOTAL DUE XS LESS THAN $1, NO PAYMENT ZS RE~UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR}: OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1981 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collataral) beneficiaries of the decedent after the expiration of any estate far life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class S (collateral) rate on any such future interest. To fulfill the requirements of Section E16`0 of the Inheritance and Estate Tax Act, Act ES of ZOO0. (72 P.S. Section 916`0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF RILLS, 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-1515). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special ZD`-hour enamoring service for forms ordering: 1-800-362-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-6`6`7-5010 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assasseent of 'tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281011, Harrisburg, PA 17128-1021, --election to have the matter determined at audit of tho account of the personal representative, OR --appeal to the Orphans' Court. OR 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. 180601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return far a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three ($) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January lB, 1996, the first day after tho and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has bean assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from tho date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (61) percent per annum calculated et a daily rate of .000166`. All taxes which became delinquent on and after January 1, 1981 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Dapartaent of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest De Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .00056,8 1987 91 .00026,7 1999 71 .000191 1983 161 .0006`38 1988-1991 111 .000501 ZOO0 81 .000119 1986` llZ .000301 1991 91 . 1985 132 .000556 1993-1996` 71 .000192 ZOOZ 62 .000166` 1986 107. .000276` 1995-1998 97. .00026`7 2003 51 .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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 data of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.