HomeMy WebLinkAbout03-0595~X~ BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX DTVTSTDN
DEPT. 280601
HARRISBURG, PA 17128-0601
GERALD R FORRY
705 CHARLES STREET
NECHANICSBURG
PA 17055
CONHON#EALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAXSEHENT, ALLO#ANCE OR DXSALLONANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1;I~8 EX AFP (01-03)
DATE 12-29-2003
ESTATE OF FORRY L
DATE OF DEATH 05-17-2005
FILE NUHBER 21 03-0595
COUNTY CUHBERLAND
SSN/DC 18~-09-4159
ACN 03005558
Amoun~ Rmm/~ed
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOHER PORTION FOR YOUR RECORDS
~-:[~-~-~--~p~--~5~-~~- ...................................................................................
NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOHANCE OR DXSALLOHANCE OF
DEDUCTXONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 1Z-Zg-ZO0~
ESTATE OF FORRY
R DATE OF DEATH 05-17-2005 COUNTY CUHBERLAND
FILE NO. 21 05-0595 S.S/D.C. NO. 184-09-4159 ACN 05003538
TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: VARIABLE ANNUITY CONTRACT ACCOUNT NO. C2858661
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST ( ) TIHE CERTIFICATE
DATE ESTABLISHED 05-17-2005
Account Balance 72,025.67
Percent Taxable X 0.555
Amount Subject to Tax 2~,007.65
Debts and Deductions - .00
Taxable Amount 2~,007.65
Tax Rate X .~5
Tax Due 1,080.$4
TAX CREDTTS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBHIT THE
UPPER PORTION OF THIS NOTICE
HITH YOUR TAX PAYHENT TO THE
REGISTER OF HILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY ORDER PAYABLE TO:
**REGISTER OF HILLS, AGENT."
PAYHENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
AHOUNT PAID
PAYMENT HUST BE HADE BY 02-18-200~.
TOTAL TAX CREDZT
BALANCE OF TAX DUE
TNTEREST AND PEN.
TOTAL DUE
ZF PAID AFTER THZS DATE., SEE REVERSE FOR CALCULATION OF ADDZTZONAL ZNTEREST. ~
( ZF TOTAL DUE TS LESS THAN $1, NO PAYMENT ZS REEUZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT"( CR}, YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR ZNSTRUCTZONS. )
.O0
1,080.3~
.00
1,080.$~
PURPOSE OF
NOT[CE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
D/SCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Rills printed on the
reverse side.
-- Hake check or money order payable to: REgiSTER OF HILLS, AGENT.
A refund of a tax credit, which mas not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of
the Register of Rills, any of the 25 Revenue District Offices or by calling the special 24-hour answering service
for forms ordering: 1-600-562-Z050; services for taxpayers with special hearing and or speaking needs:
1-600-447-50Z0 (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 Notice may object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 171ZB-lOZ1, OR
--electing to have the matter determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
Xf any tax due is paid within three (5) calendar months after the decadent's death, a five percent (5Z)
discount of the tax paid is aLLowed.
The 15X 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 mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of deIinquency, 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 (BZ) percent par annum caIculated at a daiIy rate of .000164.
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
interest rates for 1982 through 2005 are=
Interest Daily
Year Rate Factor
198Z ZOZ .000548
1985 16Z .000458
1984 llZ .000301
1985 13Z .000556
1986 lOX .000274
Oeparteent of Revenue. The applicable
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
1987 92 .000Z47 1999 7Z .OO019Z
1988-1991 11Z .000501 ZOO0 8Z .OOOZX9
199Z 9Z .000Z47 ZOO1 9Z .000Z47
1995-1994 72 .00019Z ZOOZ 62 .000164
1995-1998 92 .000Z47 ZOO5 5Z .000157
--Interest is calculated as follows:
TNTEREST = BALANCE OF TAX UNPA'rD X NUNBER OF DAYS DELTNQUENT X DAI'Ly 'rNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) 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 DIVISION
DEPT. ZB0601
HARRISBURG, PA 17128-060I
GERALD R FORRY
705 CHARLES STREET
HECHANICSBURG
PA 17055
COHHONWEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF ZNHERZTANCE TAX
APPRAXSEHENT. ALLOHANCE OR DZSALLO#ANCE
OF DEDUCTXON~, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-ISiS8 EX AFP COX-DS)
DATE 12-29-2003
ESTATE OF FORRY L
DATE OF DEATH 05-17-2003
FILE NUHBER 21 03-0595
COUNTY CUHBERLAND
SSN/DC 184-09-4159
ACN 03003537
Amoun~ Remi~ed
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
R
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
~-:~-~-~--~--[5i~-5~~- ...................................................................................
NOTICE OF INHERITANCE TAX APPRAXSENENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON dOXNTLY HELD OR TRUST ASSETS
DATE 1Z-Z9-ZO03
ESTATE OF FORRY
R DATE OF DEATH 05-17-2003 COUNTY CUHBERLAND
FILE NO. 21 03-0595 S.S/D.C. NO. 184-09-4159 ACN
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
03003537
dOZNT OR TRUST ASSET XNFORNATZON
FINANCIAL INSTITUTION: WAYPOING BANK ACCOUNT NO. 100169473
TYPE OF ACCOUNT: ( ) SAVINGS C~ CHECKING ( ) TRUST ¢ ) TIHE CERTIFICATE
DATE ESTABLISHED 04-23-2001
Accoun~ Balance 10,996.61
Percent Taxable X 0.500
Amoun~ Sub~ec~ ~o Tax 5,498.31
Debts and Deduc*1ons - .00
Taxable Amoun~ 5,498.31
Tax Ra~e
Tax Due
TAX CREDITS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBHIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYHENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYHENT RECEIPT DISCOUNT (+)
DATE NUHBER INTEREST/PEN PAID ¢-) AHOUNT PAID
PAYHENT HUST BE HADE BY 0Z-18-2004~. TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST. ~
TF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS RE~iUZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. )
.00
247.42
.00
247.42
PURPOSE OF
NOTICE:
To fulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act 15 of ZOO0. (71 P.S.
Section 91~0).
PAYNENT=
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Detach the top portion of this Notice and submit aith your payment to the Register of Hills printed on the
reverse side.
-- Naka check or coney order payable to: REGISTER DF HILLS, AGENT.
A refund of a tax credit, which aaa net requested on the tax return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (RE¥-1513). Applications ara available at the Office of
the Register of Nills) any of the Z5 Revenue District Offices or by calling the special Zq-hour anseering service
for forms ordering: 1-800-SSZ-ZOSO; services for taxpayers with spec[a[ hearing and or speaking needs:
I-BOO-~qT-5OZO (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 Notice may object within sixty (60) days of receipt of
this Notice by:
--aritten protest to the PA Department of Revenue, Board of Appeals, Dept. Z81OZ1, Harrisburg, PA 171ZB-lOZ1, OR
--electing to have the matter determined at the audit of the account of the personal representative, OR
--appeal to tho Orphans' Court
Factual errors discovered on this assessment should ba addressed in ~riting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Reviea Unit, DEPT. ZOO601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (aZ)
discount of the tax paid is a11oaad.
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. This non-participation
penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day
free the date of death, to the date of payment. Taxes which became delinquent before January l, i98Z
bear interest at the rate of six (BZ) percent per annum calculated at a daily rate of .00016~.
Ail taxes ahich became delinquent on or after January l, 1982 will bear interest at a rate which will vary from
calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable
interest rates for 1982 through 2005 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 ZOZ .0005~6 1987 91 .0002~7 1999 71 .000191
1985 161 .000~58 1988-1991 llZ .000301 Z000 81 .000119
198~ 111 .000301 1991 91 .0001~7 Z001 91 .000247
1985 152 .000556 1993-199~ 71 .O00lgz ZOOZ 62 .00016~
1986 iOZ .00027¢ 1995-1998 92 .0002~7 2005 52 .000157
--Interest is calculated as follo~s:
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 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
INHERTTANCE TAX DTVTSZON
DEPT. 280601
HARRISBURG, PA 17128-0601
GERALD R FORRY
705 CHARLES STREET
HECHANZCSBURG
PA17055
COHHONHEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLONANCE OR DISALLOHANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
SSN/DC
ACN
REV-i~gi8 EX AFP (01-05)
1Z-Zg-2005
FORRY L R
05-17-2003
21 03-0595
CUHBERLAND
184-09-4159
03005537
Amoun~ Remi~*ed
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~
RETAIN LOHER PORTION FOR YOUR RECORDS
PURPOSE OF
NOTICE~
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (TZ P.S.
Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the
BUREAU OF INDIVIDUAL TAXES
TNHERZTANCE TAX D/VZSXDN
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
DELVIN E FORRY
30341 LOGAN STREET
CAMP HILL
PA 17011
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAXSEHENT, ALLO#ANCE OR DISALLORANCE
OF DEDUCTXONS, AND ASSESSHENT OF TAX ON
JOXNTL¥ HELD OR TRUST ASSETS
REV-15q8 EX AFP C91-0S)
DATE 12-29-2003
ESTATE OF FORRY L
DATE OF DEATH 05-17-2003
FILE NUMBER 21 03-0595
COUNTY CUMBERLAND
SEN/DC 184-09-4159
ACN 03003539
Amoun~ Rmmi~sd
HAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS *~
REV-1548 EX AFP (01-03}
NOTICE OF XNHERXTANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTXONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 12-29-2003
ESTATE OF FORRY
R DATE OF DEATH 05-17-Z003 COUNTY CUMBERLAND
FILE NO. 21 03-0595 S.S/D.C. NO. 184-09-4159 ACN 03003539
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
dOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: VARIABLE ANNUITY CONTRACT ACCOUNT NO. C2838661
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 05-17-2003
Accoun~ Balance 7Z,OZ3.67
Percen~ Taxable X 0.333
Amoun~ Sub~ec~ ~o Tax 24,007.65
Debts and Deduc~/ons - .00
Taxable Amoun~ 24,007.65
Tax Ra~e X .45
Tax Due 1,080.34
TAX CREDZTS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR fAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
*'REGISTER OF WILLS, AGENT.**
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
PAYMENT MUST BE MADE BY OZ-18-ZOOq~. TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
~ TF pAID AFTER THIS DATE, SEE REVERSE FOR CALCULATXON OF ADDITIONAL INTEREST.
( TF TOTAL DUE TS LESS THAN $1, NO PAYMENT ZS REG~UIRED.
TF TOTAL DUE TS REFLECTED AS A "CREDIT" ( CR)., YOU MAY BE DUE A REFUND.
SEE REVERSE STDE OF THIS FORM FOR INSTRUCTIONS.
.00
1,080.34
.00
1,080.34
PURPOSE OF
NOT[CE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADH[N-
[STRAT[VE
CORRECTIONS:
DZSCOUNT:
PENALTY:
iNTEREST:
To fulfill the requirements of Section ZlqO of the inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S.
Section 91qO).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF N[LLS, 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" (RE¥-1313]. Applications ara available at the Office of
the Register of Nills, any of the Z3 Revenue District Offices or by calling the special Iq-hour answering service
for forms ordering: 1-aOO-36Z-ZOSO; services far taxpayers with special hearing and or speaking needs:
1-DOO-q~7-30ZO (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallomance of deductions or assessment
of tax (including discount or interest) as shomn 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 17128-1021, OR
--electing to have the ;attar 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. 28060[, Harrisburg, PA 17128-060l
Phone (7[7) 787-650S. See page S of the booklet "instructions for inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
if any tax 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 lB, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day
free the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z
bear interest at the rata of six (6g) percent par annum calculated at a daily rate of .00016q.
All taxes which became delinquent on or after January 1, 19BI will bear interest at a rate which will vary from
calendar year to caZandar year with that rate announced by tho PA
interest rates for 1982 through ZOO3 ara:
Interest Daily
Year Rate Factor
1982 ZOZ .0005~8
1983 16Z .000q38
198q llZ .000301
1985 13Z .000356
1986 lO[ .o00gTq
Department of Revenue. The applicable
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
1987 9Z .OOOZ~7 1999 7Z .OO019Z
1988-1991 llZ .000301 ZOO0 8Z .O00Z19
1992 9Z .O00Z~7 ZOO1 92 .O00Z~7
1993-199~ 72 .O0019Z ZOOZ 6Z .00016~
1995-[998 92 .O00Zq7 ZOO3 52 .000137
--Interest is calculated as follows:
ZNTEREST= BALANCE OF TAg UNPAZD X NUIJBER OF DAYS DELZNQUENT X DAI'LY 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 INDIVIDUAL TAXES
TNHERZTANCE TAX DXVISTOH
DEPT. 280601
HARRTSBURG, PA 17128-0601
DELVIN E FORRY
3031 LOGAN STREET
CAMP HILL
PA 17011
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLO#ANCE OR DXSALLO#ANCE
OF DEDUCTIONS, AND ASSESSNENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-15~$ EX AFP
DATE 12-29-2005
ESTATE OF FORRY L
DATE OF DEATH 05-17-2005
FILE NUMBER 21 05-0595
COUNTY CUMBERLAND
SSFD'DC 18q-O9-q159
ACM
Amount Rmm/ttmd d
HAKE CHECK PAYABLE AND REMIT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~
REV-15q8 EX AFP (01-03}
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS
DATE 12-29-2003
ESTATE OF FORRY L R DATE OF DEATH 05-17-2003 COUNTY CUMBERLAND
FILE NO. 21 03-0595 S.S/D.C. NO. 18q-O9-q159 ACN 030055q5
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
dOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: AMERICAN EXPRESS ACCOUNT ACCOUNT NO. 008099271770001
TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING ¢ ) TRUST ¢ ) TIME CERTIFICATE
DATE ESTABLISHED 05-16-2003
Account Balance 6,573.41
Percent Taxable X 0.333
Amount Sub~ect to Tax 2,191.11
Debts and Deductions - .00
Taxable Amount 2,191.11
Tax Rate X .45
Tax Due 98.60
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. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
**REGISTER OF WILLS, AGENT.**
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
PAYMENT MUST BE MADE BY 0Z-18-2004~.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER THTS DATE, SEE REVERSE FOR CALCULATTON OF ADDITTONAL INTEREST. ~
( TF TOTAL DUE KS LESS THAN $1, NO PAYMENT KS REQUTRED.
TF TOTAL DUE KS REFLECTED AS A "CREDTT" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE STDE OF THTS FORM FOR TNSTRUCTIONS. )
.00
98.60
.00
98.60
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 25 of ZOOO. (7Z P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the
reverse side.
-- Make check or money order payable to: REGISTER DF NILLS, AGENT.
A refund of a tax credit, ahich ams not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at the Office of
the Register of Nills, any of the Z3 Revenue District Offices or by calling the special lq-hour answering service
for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and or speaking needs:
1-800-qqT-30ZO (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment
of tax (including discount or interest) as sheen on this Notice may object within sixty (60) days of receipt of
this Notice
--written protest to the PA Department of Revenue, Board of Appeals, Oapt. ZeIOZl, Harrisburg, PA 17IZB-lOZ1, 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 bo addressed in writing to: PA Department of Revenue,
Duraau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. ze0601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (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 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day
from the date of death, to the date of payment. Taxes which became delinquent before January 1, 19BE
bear interest at the rata of six (6g) percent per annum calculated at a daily rate of .000164.
A11 taxes which became delinquent on or 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
interest rates for 198Z through 2003 ere:
Interest Dally
Year Rate Factor
19&Z ZOZ .O005qB
1983 16Z .000438
1984 11Z .000301
1985 15X .000356
1986 IOZ .00027~
Department of Revenue. The applicable
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
1987 9Z .o00gq7 1999 7Z .OOOlgZ
1988-1991 11Z .000301 ZOO0 8Z .000Z19
1992 9Z .000247 2001 9Z .000247
1993-1994 7Z .O0019Z ZOOZ 6Z .000164
1995-1998 9Z .O00Zq7 ZOO3 5Z .000137
--Interest is calculated as follows:
TNTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINI~UENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
TNHERZTANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 17128-0601
HARLZN H FORRY
50 HAHTHORNE DRIVE
JIH THORPE PA 18229
COHHONgEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE
NOTICE OF TNHERZTANCE TAX
APPRAZSEHENT. ALLO#ANCE OR DZSALLOHANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 12-29-2005
ESTATE OF FORRY
DATE OF DEATH 05-17-2003
FILE NUHBER ZZ 03-0595
COUNTY CUHBERLAND
*" SSN/DC 184-09-4259
ACN 03003543
Amoun~ Remi~ed
REV-ISiS8 EX AFP
L R
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF gILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1548 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOgANCE OR DZSALLO#ANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 12-29-2003
ESTATE OF FORRY
R DATE OF DEATH 05-17-2003 COUNTY CUHBERLAND
FILE NO. 21 03-0595 S.S/D.C. NO. 184-09-4159 ACN 03003543
TAX RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET ZNFORHATION
FINANCIAL INSTITUTION: AMERICAN EXPRESS ACCOUNT ACCOUNT NO. 008043552713001
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST ( ) TIHE CERTIFICATE
DATE ESTABLISHED 05-16-2003
Account Balance 10,548.41
Percent Taxable X 0.333
Amount Subject to Tax 3,516.10
Debts and Deductions - .00
Taxable Amount 3,516.10
Tax Rate X .45
Tax Due 158.22
TAX CREDITS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBHIT THE
UPPER PORTION OF THIS NOTICE
gITH YOUR TAX PAYHENT TO THE
REGISTER OF gILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY ORDER PAYABLE TO:
ffREGISTER OF gILLS, AGENT."
PAYNENT RECEIPT DISCOUNT (+)
DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID
PAYHENT HUST BE NADE BY 02-18-2004~. TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
TF pATD AFTER THTS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.
.00
158.22
.00
158.22
PURPOSE OF
NOTICE:
To fulfill the requirements of Section 21q0 of the Inheritance and Estate Tax Act, Act Z3 of ZOOO. (TI P.S.
Section 91q0),
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF 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-IS13). Applications are available at the Office of
the Register of Rills, any of the 2S Revenue District Offices or by calling the special Iq-hour answering service
for forms ordering: 1-800-36Z-2050~ services for taxpayers with special hearing and or speaking needs:
1-800-qqT-30ZO (TT only).
Any party in interest not satisfied with the appraisement, allowance, ar disalloeanca of deductions or assessment
of tax (including discount or interest) as shown on this Notice amy object within sixty (603 days of receipt of
this Notice by:
--erittan protest to the PA Dapartaent of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZS-10Z1, OR
--electing to have the aatter daterainad at the audit of the account of the personal rsprasantativa, 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. ZOO601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (RE¥-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SI)
discount of the tax paid is alleaad.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax end 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 appealabZe in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day
from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z
bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016~.
Ali taxes ehlch became delinquent on or after January 1, 1982 #i11 bear interest at a rate which ail1 vary from
calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable
interest rates for 198Z through ZOOS are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rata Factor
198Z gOZ .0005q8 1987 92 .ooogfi7 1999 7X .00019Z
1983 162 ,000~38 1988-1991 112 .000301 ZOO0 82 .OOOZl9
198q 112 .0D0301 1992 92 .O00Zq7 2001 92 .0002q7
1985 13X .000356 1993-1996 7X .OOOlgZ Z002 62 .OOOl6q
1986 lOX .00027~ 1995-1998 92 .0002~7 2003 52 .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sheen on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DZVZSTON
DEPT. 260601
HARRISBURG, PA 1712D-O601
DELVIN E FORRY
3031 LOGAN STREET
CAMP HILL
PA 17011
COHHONWEALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT. ALLO#ANCE OR DZSALLORANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
RE¥-1548 EX AFP
DATE 12-29-2003
ESTATE OF FORRY L
DATE OF DEATH 05-17-Z003
FILE NUHBER 21 03-0595
COUNTY CUHBERLAND
SSN/DC 18~-09-4159
ACN 030035~Z
Amoun~ Remi~sd
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1548 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS
DATE 12-29-2003
ESTATE OF FORRY
R DATE OF DEATH 05-17-2003 COUNTY CUHBERLAND
FILE NO. 21 03-0595 S.S/D.C. NO. 184-09-4159 ACN 030035~2
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
dOZNT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: AHERICAN EXPRESS ACCOUNT ACCOUNT NO. 008043552713001
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST ( ) TINE CERTIFICATE
DATE ESTABLISHED 05-16-2003
Account Balance 10,548.41
Percent Taxable X 0.333
Amount Subject to Tax 3,516.10
Debts and Deductions - .00
Taxable Amount 3,516.10
Tax Rate
Tax Due 158.22
TAX CREDITS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBHIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYHENT RECEIPT DISCOUNT (+) _),!
AHOUNT
PAID
DATE NUHBER INTEREST/PEN PAID (
PAYMENT MUST BE MADE BY OZ-18-ZO04~.
TOTAL TAX CREDZT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR ZNSTRUCTZONS. )
.00
158.22
.00
158.22
PURPOSE OF
NOTICE:
To fulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (TI P.S.
Section 91~0).
PAYHENT:
REFUND {CR):
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Detach the top portion of this Notice and submit with your payment to the Register of gills printed on the
reverse side.
-- Hake check or money order payable to: REGISTER OF RILLS) AGENT.
A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of
tho Register of Hills, any of the Z$ Revenue District Offices or by calling the special 2~-hour answering service
for forms ordering: 1-800-562-2050; services for taxpayers with special hearing and or speaking needs:
1-800-q~7-SOZO (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 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. Z810Z1, Harrisburg, PA 17IlS-IaI1) 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. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (5) calendar months after the decedent's death, a five percent
discount of the tax paid is alloaed.
The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the 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 (1) day
from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z
bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016~.
All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from
calendar year to calendar year with that rate announced by the PA Department of Revenue.
The applicable
interest rates for 198Z through ZOOS are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rata Factor
198Z ZOZ .000S~8 1987 9Z .O00Z~7 1999 7X .00019Z
1985 16Z .000~8 1988-1991 11Z .000301 ZOO0 8Z .O00Z19
198~ llZ .OOOSO1 1992 9Z .0002~7 2001 9Z .O00Z~7
1985 13Z .000S56 1993-199~ 7Z .00019Z ZOOZ 6Z .00016~
1986 IOZ .00027~ 1995-1998 9Z .O00Z~7 ZOOS 5Z .000157
--Xnterest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAXD X NUNBER OF DAYS DELINQUENT X DAILY XNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days
beyond the date of the assessment. Xf payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
ZNHERTTANCE TAX DZVZSION
DEPT.
HARRTSBURG, PA 17lIB-n601
MARLIN H FORRY
50 HAWTHORNE DRIVE
JIM THORPE
PA 18229
COMMONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE
NOTICE OF /NHERZTANCE TAX
APPRAI'SEHENTj ALLO#ANCE OR DTSALLO#ANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 12-Z9-2005
ESTATE OF FORRY
DATE OF DEATH 05-17-2005
FILE NUMBER 21 05-0595
COUNTY CUHBERLAND
SSN/DC 184- 09 - 4159
ACN 05005546
Amoun~
RE¥-1548 EX AFP {01-05}
I
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
R
CUT ALONG THIS LINE ~ 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 1z-zg-zo05
ESTATE OF FORRY
R DATE OF DEATH 05-17-Z005 COUNTY CUHBERLAND
FILE HO. 21 03-0595 S.S/D.C. NO. 184-09-4159 ACN 03003546
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORHATION
FINANCIAL INSTITUTION: AHERICAN EXPRESS ACCOUNT ACCOUNT NO. 008099Z71770001
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST ( ) TIHE CERTIFICATE
DATE ESTABLISHED 05-16-2005
Account Balance 6,575.41
Percent Taxable X 0.555
Amoun~ Sub~ec~ ~o Tax 2,191.11
Debts and Deduc~/ons - .00
Taxable Amoun~ 2,191.11
Tax Ra~e X .45
Tax Due 98.60
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."
PAYHENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
PAYMENT MUST BE MADE BY 0Z-18-2004~. TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
~ ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
{ ZF TOTAL DUE ZS LESS THAN $1., NO PAYHENT ZS REI~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THZS FORH FOR INSTRUCTIONS. )
.00
98.60
.00
98.60
PURPOSE OF
NOTICE=
To ~ulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S.
Section 91~0).
PAYNENT:
REFUND (CR):
OBJECTZONS:
ADH[N-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY=
ZNTEREST:
Detach the top portion of this Notice and submit ~ith your payment to the Register of Nills 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, amy be requested by completing an "Application
for Refund of Pennsylvania inheritance and Estate Tax" (REV-i~13). Applications are available at the Office of
the Register of Hills, any of the Z5 Revenue District Offices or by calling the special Iq-hour answering service
for fores ordering: 1-800-36Z-Z050; services for taxpayers Nith special hearing and or speaking needs:
1-800-qqT-3OZO (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 Notice may object within sixty (60) days of receipt of
this Notice by:
--mrittsn protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--electing to have the matter determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Revie~ 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-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (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 the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day
from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982
bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016~.
Al1 taxes mhich became delinquent on or after January 1, 198Z will bear interest at a rate which will vary from
calendar year to calendar year mith 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 Yea.~r Rate Factor Yea.~.r Rate Factor
1982 lOX .O005qB 1987 9Z .O00Zq7 1999 7Z .00019Z
1983 162 .OOOq38 1988-1991 llZ .000301 ZOO0 82 .OOOZX9
198fi 11Z .000301 1992 9Z .O00Zq7 2001 92 .O00Zq7
1985 132 .000356 1993-199q 72 .00019Z 200Z 62 .00016~
1986 lOX .O0027~ 1995-1998 9Z .O00Zq7 2003 5Z .000137
--Interest is calculated as folloms:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY 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 sho~n on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
INHERTTANCE TAX DTVTSTON
DEPT. Z80601
HARRTSBURG, PA 17128-0601
GERALD R FORRY
705 CHARLES STREET
HECHANICSBURG
PA 17055
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISENENT~ ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS~ AND ASSESSNENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE
ESTATE OF
DATE OF DEATH
FZLE NUHBER
COUNTY
~SSN/DC
ACN
12-29-2005
FORRY
05-17-2005
Z1 03-0595
CUHBERLAND
184-09-4159
03003541
Amoun*
RE¥-1548 EX I~FP (01-
HAKE CHECK PAYABLE AND REHIT PAYHENT T{
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE
RETAIN LOWER PORTION FOR YOUR RECORDS
PURPOSE OF
NOTICE:
To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3
Section 9140),
PAYHENT: Detach the tod Dertion of this Notice and submit with your pavment to the Reqister of Nills printed on th.
BUREAU OF TNDZVZDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRTSBURG, PA 171Z8-0601
MARLIN H FORRY
50 HAWTHORNE DRIVE
JIH THORPE
PA 18229
COHNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRATSBHENT. ALLOHANCB OR DISALLO#ANCE
OF DEDUCT'fONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 12-29-2005
ESTATE OF FORRY
DATE OF DEATH 05-17-2003
FILE NUMBER 21 03-0595
COUNTY CUHBER LAND
SSN/DC 184- 09-4159
ACN 03005540
Amoun~ Rem/~'ked
HAKE CHECK PAYABLE AND REMIT PAYHENT TO:
REGISTER OF MILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
R
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
~': ~ ~-~ - ~- -~ P~- ' [ ~'6 ~Y ...................................................................................
NOTICE OF INHERITANCE TAX APPRAISEHENT~ ALLONANCE OR DISALLONANCE OF
DEDUCTIONS~ AND ASSESSHENT OF TAX ON dOINTLY HELD OR TRUST ASSETS
DATE 1Z-Zg-2005
ESTATE OF FORRY
R DATE OF DEATH 05-17-2003 COUNTY CUMBERLAND
FILE NO. 21 03-0595 S.S/D.C. NO. 184-09-4159 ACN 03003540
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORHATZON
FINANCIAL INSTITUTION: VARIABLE ANNUITY CONTRACT ACCOUNT NO. CZ838661
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST ( ) TIHE CERTIFICATE
DATE ESTABLISHED 05-17-2003
Accoun~ Balance
Percen~ Taxable
Amoun~ Sub~ec~ to Tax
Debts and Deductions
Taxable Amoun~
Tax Ra*e
Tax Due
TAX CREDITS:
72,023.67
X 0.333
24,007.65
- .00
24,007.65
X .~5
1,080.34
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
NITH YOUR TAX PAYHENT TO THE
REGISTER OF gILLS AT THE
ABOVE ADDRESS. HAKE CHECK
OR HONEY ORDER PAYABLE TO:
"REGISTER OF MILLS, AGENT."'
PAYHENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID ¢-) AHOUNT PAID
PAYHENT MUST BE HADE BY 02-18-2004~. TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
ZF pATD AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL /NTEREST. ~
ZF TOTAL DUE ZS 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 ZNSTRUCTTONS. )
.00
1,080.34
.00
1,080.34
PURPOSE OF
NOTICE:
PAYHENT:
REFUND ¢CR):
OBJECTIONS:
ADHIN-
ZSTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill tho requirements of Section Il40 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the
reverse side,
-- Hake check ar money order payable to: REGISTER OF HILLS, AGENT.
A refund of a tax credit) ahich was not requested on the tax return) may ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available et the Office of
the Register of Hills) any of the 23 Revenue District Offices or by calling the special Z4-hour ansaering service
for forms ordering: 1-800-36Z-ZOSO; services for taxpayers with special hearing and or speaking needs:
1-800-447-30Z0 (TT only).
Any party in interest not satisfied eith the appraisement, alloeanca, ar disalloaanca of deductions er assessment
of tax (including discount or interest) as shown on this Notice may object eJthin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals) Dept. 281021, Harrisburg, PA 171Ze-lOZ1, 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. See page 5 of the booklet "Instructions for Xnheritanca 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 (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 tn the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning eith first day of delinquency) or nine (9) months and one (1) day
frae the date of death) to the date of payment. Taxes which became delinquent before January 1) 19az
bear interest at the rate of six (6X) percent par annum calcuteted at a daily rate of .000164.
AIl taxes which became delinquent on or after January 1, 198Z aill 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
Year Rate Factor Year Rata Factor Year Rate Factor
1982 goZ .000548 1987 92 .000247 1999 72 .OOOleZ
1983 162 .000438 1988-1991 112 .000501 ZOO0 eX .000Z19
1984 llX .000301 1992 9X .OOOZ~7 ZOO1 9Z .OOOZ47
1985 15Z .000356 1993-1994 7Z .OOO19Z ZOOZ 6Z .000164
1986 IOZ .000274 1995-1998 9g .000247 2003 5Z .000137
--Interest is calculated as folloes:
ZNTEREST= BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELZNQUENT X DAXLY ZNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
'rNHER'rTANCE TAX D'r¥'rs'roN
DEPT. Z80601
HARR'rSBUR(~, PA 171Z8-0601
GERALD R FORRY
705 CHARLES STREET
HECHANICSBURG
PA 17055
COHHONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISENENT. ALLONANCE OR DISALLONANCE
OF DEDUCTION~, AND ASSESSNENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
SSN/DC
ACN
REV-i~,~8 EX AFP (gl-gS)
12-29-2003
FORRY L R
05-17-2003
Z1 03-0595
CUNBERLAND
18R-09-~159
03003538
Amoun~ Remi~ed I
HAKE CHECK PAYABLE AND RENIT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE
PURPOSE OF
NOT/CE: To fulfill the raquJrements of Saction Z140 of the Xnheritanca and Estata Tax Act, Act Z$ of ZOO0. (7Z P.S.
SactJon 91403.
BUREAU OF INDIVIDUAL TAXES
TNHERZTANCE TAX DZVTSTON
DEPT. 280601
HARRISBURG, PA 17118-0601
GERALD R FORRY
705 CHARLES STREET
MECHANICSBURG
PA 17055
COMHONHEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAXSEHENT, ALLORANCE OR D/SALLO#ANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-154a EX AFP (01-0,3)
DATE 12-29-2005
ESTATE OF FORRY L
DATE OF DEATH 05-17-2005
FILE NUHBER 21 05-0595
COUNTY CUMBERLAND
SSN/DC 18q-Og-q159
ACN 050055q1
Amoun~ Rmm/~ed J
HAKE CHECK PAYABLE AND REMIT PAYHENT TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
R
CUT ALONG THIS LINE ~ RETAIN LOHER PORTION FOR YOUR RECORDS ~
REV-1548 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOHANCE OR DISALLO#ANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 12-29-2005
ESTATE OF FORRY L R DATE OF DEATH 05-17-2005 COUNTY CUHBERLAND
FILE NO. 21 05-0595 S.S/D.C. NO. 18q-09-~159 ACN 050055ql
TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: AMERICAN EXPRESS ACCOUNT ACCOUNT NO. 0080~$552715001
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 05-16-2005
Accoun~ Balance 10,5R8.~1
Percen~ Taxable X 0.553
Amoun~ Subjec~ ~o Tax 5,516.10
Debts and Deductions - .00
Taxable Amoun~ 5,516.10
Tax Ra~e X .q5
Tax Due 158.22
TAX CREDITS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
HITH YOUR TAX PAYMENT TO THE
REGISTER OF HILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF HILLS, AGENT."
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
PAYMENT MUST BE MADE BY 01-18-200q~. TOTAL TAX CREDIT I
BALANCE OF TAX DUEI
INTEREST AND PEN.
~ TOTAL DUE
~ TF PA/D AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDXTTONAL TNTEREST. ~
( XF TOTAL DUE TS LESS THAN $1, NO PAYMENT XS REQUXRED.
TF TOTAL DUE XS REFLECTED AS A 'CREDTT' (CR), YOU NAY SE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR TNSTRUCTTONS. )
.00
158.22
.00
158.22
PURPOSE OF
NOTICE:
PAYNENT:
REFUND
OBJECTIONS:
ADNIN-
ISTRAT[VE
CORRECT[OHS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section Z140 oF the Inheritance and Estate Tax Act, Act Z$ of ZOOO. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the
reverse side.
-- Hake check or money order payable to: RESISTER OF HILLS, AGENT.
A refund of a tax credit) which was not requested on the tax return) may be requested by completing an "Application
for Refund of Pennsylvania [nheritance end Estate Tax" (REV-1513). Applications are available at the Office of
the Register of Hills, any of the 23 Revenue District Offices or by calling the speciaL Z4-hour answering service
for forms ordering: 1-80G-36Z-ZOSO~ services for taxpayers with special hearing and or speaking needs:
1-800-447-3020 (TT only).
Any party in interest not satisfied with the appraisement, allowance) or disallowance of deductions or assessment
of tax (including discount or interest) es shown on this Notice may object eithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue) Board oF Appeals) Dept. Z810Z1, Harrisburg) PA 171ZS-lOZ1, 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. 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 (5Z)
discount of the tax paid is allowed.
The 15X 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 delinquency) or nine (9) months and one (1) day
from the date Df death, to the date of payment. Taxes which became delinquent before January 1, 198Z
bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164.
All taxes which became deIinquent on or after January 1, 198Z w111 bear interest at a rate which will vary from
calendar year to calendar year with that rate announced by the PA
interest rates for 198Z through 2003 are:
Interest Daily
Year Rate Factor
198Z ZOZ .000548
1983 16Z .000438
1984 11Z .000301
1985 13Z .000356
1986 X0Z .000Z74
Department of Revenue. The applicable
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
1987 9Z .O00247 1999 7Z .O0019Z
1988-1991 llZ .000301 ZOO0 8Z .O00Z19
199Z 9Z .000247 200Z 9Z .000247
XQQ3-X99~ 72 .O0019Z ZOOZ 6Z .000164
1995-1998 9Z .000Z47 2003 5Z .000137
--Interest is calculated as fOllOWS:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELIN~IUENT X DAILY TNTERE-ST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (XJ) 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 DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
GERALD R FORRY
705 CHARLES STREET
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE
NOTICE OF' INHERITANCE TAX
APPRAISEMENT, ALLONANCE OR DISALLOWANCE
OF DEDUCTIONSj AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 12-29-2003
ESTATE OF FORRY
DATE OF DEATH 05-17-2003
FILE NUMBER 21 05-0595
COUNTY CUMBERLAND
SSN/DC 18q-Og-q159
ACN 050035q~
Amoun~ Rem ~.'l:ted
REV-15~8 EX AFP (01-05)
L R
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE I~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-15q8 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 12-29-2005
ESTATE OF FORRY L R DATE OF DEATH 05-17-2005 COUNTY CUMBERLAND
FILE NO. 21 03-0595 S.S/D.C. NO. 18~-09-~159 ACN 030055~q
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: AMERICAN EXPRESS ACCOUNT ACCOUNT NO. 008099271770001
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 05-16-2005
Account Balance 6,573.~1
Percent Taxable X 0.533
Amount Sub~ec~ to Tax 2,191.11
Debts and Deductions - .00
Taxable Amount 2,191.11
Tax Rate X .~5
Tax Due 98.60
TAX CREDITS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
**REGISTER OF WILLS, AGENT."
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
AMOUNT PAID
PAYMENT MUST BE MADE BY OZ-18-ZOOq~. TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
~ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS RE{iUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
.00
98.60
.00
98.60
PURPOSE OF
NOTICE:
To ~ulfi11 the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (72 P.S.
Section
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADH/N-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the
reverse side.
-- Hake check or money order payable to: REGISTER OF HILLS, AGENT.
A refund of a tax credit, which was not requested on the tax return, may ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of
the Register of Hills, any of the Z5 Revenue District Offices or by calling the special Z~-hour answering service
for forms ordering: 1-800-56Z-ZO50; services for taxpayers aith special hearing and or speaking needs:
1-800-4q7-$OZO (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 Notice may object within sixty (60) days of receipt of
this Notice by:
--written pretest to the PA Department of Revenue, Board of Appeals, Dept. ZSIOZ1, Harrisburg, PA 171Z8-1021, OR
--electing to have the matter determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctabIe errors.
If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (SI)
discount of the tax paid is alloead.
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. This non-participation
penalty is appealable in the same manner and in the the same tiaa per[od as you would appeal the tax and interest
that has been assessed as indicated on this nat[ce.
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 (BI) percent per annum calculated at a daily rate of .000164.
All taxes which became delinquent on or after January 1, 198Z ail1 bear interest at a rate ahJch #ill vary from
calendar year to calendar year aith that rate announced by the PA Department of Revenue.
The applicable
interest rates for 1982 through ZOO5 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Yea__r Rate Factor
1982 ZOZ .OOOS~8 1987 9Z .O00Z~7 1999 7X .00019Z
1985 16Z .000~38 1988-1991 11Z ,000~01 ZOO0 8Z .000Z19
1984 llZ .O003Ol 1992 9Z .OOOZq7 ZOO1 9Z .OOOZ47
1985 lSZ .000556 1995-199fi 72 .00019Z ZOOZ 6Z .00016~
1986 102 .O0027~ 1995-1998 92 .000247 2005 52 .000157
--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. If payment is made after the interest computation date shown on the
Notlca, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX DTVTSTON
DEPT. Z80601
HARRTSBURG, PA 17128-0601
GERALD R FORRY
705 CHARLES STREET
HECHANICSBURG
PA 17055
CONHONHEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLO#ANCE OR DISALLONANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 12-29-2005
ESTATE OF FORRY
DATE OF DEATH 05-17-2005
FILE NUNBER 21 05-0595
COUNTY CUHBER LAND
SSN/DC 184- 09- 4159
ACN 050055~
I Amount: Rem'i 'l:*~ed
REV-1548 EX AFP (01-
HAKE CHECK PAYABLE AND RENIT PAYNENT T(
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS
PURPOSE OF
NOTICE:
To fulfil! the requirements of Section 21q0 of the Inheritance and Estate Tax Act, Act 23 of 2000. (TZ P.S.
Section 91q0).
PAYHENT; Detach the top portion of this Notice and submit with your payaent to the Register of #i!ls printed on the
REV 1500 EX (8-00)
~,~~ COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
UJ
..tO0
~...j
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(IFFIrTI/~I IIq~' (ir, il y
FILE NUMBER
-O__& 5_q__5
COUNTY CODE YEAR NUMBER
I'"- SOCIAL SECURITY NUMBER
z 104 - 09 - [1.159
THIS RETURN MUST BE FILED IN DUPLICATE WITH TH[
REGISTER OF WILLS
0
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
]:';'ORH' -"_~, T,. ]?om~.ne (a]ca) FOI~R¥, l,aura R.
DATE OF DEATH (MM-DD-YEAR) 1 DArE OF BIRTH (MM-DD-YEAR)
(IF APPLIGABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INIIIAL)
N/A
I, LI
SOCIAL SECURITY NUMBER
~--~1. Original Return
[~]4. Limited Estate
[~6. Decedent Died Testate (Atlaeh copy of Will)
[~9. Litigation Proceeds Received
[~2. Supplemental Return
[~4a. Future Interest Compromise (date of dealh after 12-12-82)
~]7. Decedenl Maintained a Living Trust (Aftach copy of Trust)
[] 10. Spousal Poverty Credit (date of dealh between 12 31-91 and 14-95)
[~]3. Remainder Return (date ofdeath prior to 12-13-82)
F-J5. Federal Estate Tax Return Required
O 8. Total Number of Safe Deposit Boxes
~-] 11. Election to tax under Sec. 9113(A) (Aftach Sch O)
THiS SECTION MUST bE COMPLI~/~:D. ALL CORRESPONDENCE AND ~ONIFti~N~I'~,L ~/riX:llq~Ol~M/~t!l~ tiHI~i,J~ lll![~Jll~i~l~.~l~i:
NAME
a. el~ald R. Foz, z~y
FIRM NAME {ff~pplicable)
N/A
TELEPHONE NUMBER
9.
10.
12.
13.
14.
717-766-3991
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Padnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Properly (Schedule F) (6)
ri~ 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)
COMPLETE MAILING ADDRESS
7()~ Charles St.
He chani csbur g,
O.OO
0,00
O. O0
0.00
O, O0
5,498.3:]_
89,].45. 9
(8)
0.00
0.00
PA 17 055
94,643.80
Total Deductions (total Lines 9 & 10)
Net Value of Estate (Line 8 minus Line 11)
Charilable and Governmental Bequesls/Sec 9113 Trusts for which an election to lax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
(11)
(12)
(13)
(14)
O.OO
94,643.80
0.00
94,643.80
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 rale
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
O.OO x.0__ (15)
94,643.80 x .o 45 (16)
O,OO x .12 (17)
O.OO x .15 (18)
(19)
0,00
4,2.~8.97
0.00
o.o0
4,258.97
Decedent's Complete Address:
STREETADDRESS ll~l4 Soy. th I'.~arlr. et St.
A~t. ].
c,-¥ t I
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
InterestJPenalty if applicable
D. Interest
E. Penalty
0.00
0.00
O. O0
0. O0
0. O0
(1)
Total Credits ( A + B + C ) (2)
Total Interesl/Penalty ( D + E ) (3)
4,2,58.97
0.00
0.00
O. O0
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
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(4)
(5)
(5A)
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
h., 2~8.97
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the propedy transferred; .......................................................................................... [] []
b. retain the right to designate who shall use the properly transferred or ils 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 properly within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and 1o lhe 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 RESPO~ISIBJ,..E ~~RN,,~~ ,,~" DATE
ADDRESS ~
70~ Charles St., chanicsb'urg,
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 RS. §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 PS. §9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 RS. §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 PS. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV 1'~'~ EX ~ {1 97)
COMMONWEAl tH ()r PENNS'~ t VAHIA
INHERIIANCE lAX RETURN
RESIDENI DECEDENI
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
I1' an asset was made joint within one year of the decedenl's date of death, it Inust be repoded on Schedule G,
SURVIVING ,1( )IH I If/NAH I (S) NAME Al )[ )RESS REIA [IONStIIP [O DF CE DE-I ~l
SoT]
JOINTLY-OWNED PROPERTY:
LE HER DAtE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial inslilulion and bank ~ccomd number or similar identifying number. Attach DATE OF DEATIt DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly held real eslate, VALUE OF ASSET INTEREST DECEDENT'S INTERES
1. A. 11./2;3/ ~'¢a~jpO:Lt~b ]3a.n|¢, C]').ec]cit'~; Accout'l'c
2001 Ho. 1001691.173. 3_0,996.61
TOTAL (Also enter on line 6, Recapitulation) $
(il more space is needed, insed additional sheels of the same size)
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
L. t~OMAINE FORRY aka
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
T,AU)~A 1~ t O)lNY
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions t through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE I'HE NAME OF THE TRANSFEREE, 1HEIR RELATIOI~SHIP TO DECEDENT AND THE DAT~ OF I'~,'~NSFER
NUMBER A~'~^C. A COPY OF THE DEED FOR REAL ~¢FA1 E. DATE OF DEATH DECD'S EXCLUSION TA~BLE VALU
VALUE OF ASSET INTEREST (IF AP~ICABLE)
1. ThriventF'. ~nanczal' for Lutherans,
Variable Annuity Contract No.
C2838661. 72,023.67 ~O~ N/A 72, O23.~
2. American ~xpress Account
0 . 2713ooz. lo, 48.4.1 lo(:.¢ iO, 48.
~. American Express Account No. 008-
0992~11~0001. 6,~7}.41 10~ N/A 6,~7~.]
TOTAL (Also enter on mine 7, Recapitulation) $ 89,
(If more space ~s needed, insert additional sheets of the same size)
REV-IS13 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
L. ROMAINE FORRY aka LAURA R. FORRY
SCHEDULE J
BENEFICIARIES
FILE NUMBER
NUMBER
$
5
II.
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Gerald R. Forry
705 Charles St.
Mechanicsburg, PA 17055
Delvin E. Forty
3031 Logan St.
Camp Hill, PA 17011
Marlin H. Forty
50 ttawthorne Drive
Jim Thorpe, PA 18229
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
So~
Son
Son
AMOUNT OR SHARE
OF ESTATE
A 100% interest
in item 1 of
Schedule F and
one-third inter~
in items l, 2,
3 of Schedule G.
A one-third in-
terest in items
1, 2 and 3 of
Schedule G.
A one-third in-
terest in items
1, 2 and 3 of
Schedule G.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE~ 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
BUREAU OF ZNDZVZDUAL TAXES
ZNHERZTANCE TAX DZYTSZON
DEPT. 28n601
HARR/SBURG, PA 17128-0601
GERALD R FORRY
705 CHARLES ST
MECHANZCSBURG
COHNON#EALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
PA 17055
NOT/CE OF INHERZTANCE TAX
APPRAISEMENT, ALLO#ANCE OR DISALLO#ANCE
OF DEDUCTZONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FZLE NUNBER
ACN
RE¥-15~? EX AFP {01-05)
08-18-2005
FORRY L R
05-17-2005
21 05-0595
CUMBERLAND
101
Amoun~ ReaLiZed I
MAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGZSTER OF N~LLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THZS LZNE ~ RETAZN LONER PORTZON FOR YOUR RECORDS ~
REV-154? EX AFP [01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLO#ANCE OR
DZSALLO#ANCE OF DEDUCTZONS AND ASSESSMENT OF TAX
ESTATE OF FORRY L R FZLE NO. 21 05-0595 ACN 101 DATE 08-18-2003
TAX RETURN #AS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~a (Schedule A) (1)
2. Stocks and Bonds (Schedulo B) (2)
3. Closely Held S~ock/Par~narship Zn~oras~ (Schedule C) (3)
q. Mor~gages/No~as Roce/vablo (Schedule D) (q)
5. Cash/Bank Daposi~s/Hisc. Parsonal Propar~y (Schedula E) (5)
6. Jointly Ownad Propar~y (Schedule F) (6)
7. Transfers (Schedule G)
8. To*al Assa~s
APPROVED DEDUCTZONS AND EXEHPTZONS:
9. Funeral Expansas/Adm. Cos~s/MLsc. Expanses (Schedule H)
10. Dob~s/Mor*gago LLabili~ias/Lions (Schedule [) (10)
11. To~al Deductions
12. Na~ VaZua of Tax Ra~urn
15.
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
No~ Value of Es~a~e Subjac~ to Tax
.00 NOTE: To insure proper
.00 cradi~ ~o your account,
.00 subei~ ~ho upper portion
.00 of ~his form wi~h your
.00 ~ax payment.
5~R98.31
89~1~5.R9
.00
.00
NOTE:
9~,6~3.80
(11) . Off
(12) 9~,6~3.80
(~$) .00
(~) 9~,6~3.80
'r.p an assessment was issued previously, 11nas 14, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Aaoun~ of Line 1~ a~ Spousal ra~e (15)
16. Aeoun~ of Line lq ~axable a~ Lineal/Class A ra~e (16)
17. A.oun~ of Line 1~ e~ Sibling ra~e (17)
18. Aaoun~ of Line lq ~axable a~ Collateral/Class B ra~a (18)
19. Principal Tax Due
RECEXPT
NUMBER
TAX CREDZTS:
PAYHENT
DATE
· O0 x O0 =
9~,6~3.80 x 0~5=
· O0 x 12 =
· O0 x 15 =
(19)=
AMOUNT PAZD
PAYMENT MUS'
BE MADE BY 02-17-Z00q~.
18 and 19 gill
TOTAL TAX CREDZT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
.00
q,258.97
.00
q,Z58.97
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUZRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SZDE OF THZS FORM FOR ZNSTRUCTZONS.)
IF PAZD AFTER DATE ZNDICATED, SEE REVERSE
FOR CALCULAT/ON OF ADDZTZONAL /NTEREST.
DZSgOUNT (+)
ZNTEREST/PEN PAZD (-)
.00
q,Z58.97
.00
.00
q,Z58.97
RESERVATION:
Estates cf decedents dying on or before December 1Z, 19az -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collatara1) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Coemcnaeelth hereby expressly reserves the right to appraise and assess transfer Znheritance Taxes
at the laaful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CA):
OBJECTIONS:
ADNZN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 22 of ZOO0. (72 P.S.
Section 91q0).
Detach tho top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, ahich aaa not requested on the Tax Return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-l$15)o Applications are available at the Office
of the Register of #ills, any of the 25 Revenue District Offices, or by calling the special Iq-hour
ansaering service for fores ordering: 1-800-562-Z050; services for taxpayers eith special hearing and / or
speaking needs: 1-800-q~7-2020 (TT only).
Any party in interest not satisfied aith the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--arittan protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 1712B-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-650S. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
Zf any tax due is paid aithin three (2) calendar months after the decedent's death, a five percent (5X) 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 lB, 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 aith 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, lgBz bear interest et the rate of
six (6X) percent per annum calculated at a daily rate of .gO016q. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which ail1 vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z005 are:
Interest Daily Interest Daily Interest Dally
Year Rate Factor Yea__r Rate Factor Yea__r Rate Factor
1982 ZOZ .O00S~B 1987 9Z .OOOZq7 1999 7Z .O0019Z
1982 162 .000q58 1988-1991 XlZ .000301 ZOO0 82 .000219
198q 112 .000501 1992 92 .0002q7 Z001 92 .0002~7
1985 122 .0002S6 1993=199~ 7Z .000192 2002 62 .OOOl6~
1986 lOZ .O00Z7q 1995-1998 92 .0002q7 2002 52 .000157
--Interest is calculated as folloas:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELZNI~UENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003504
FORRY GERALD R
705 CHARLES ST
MECHANICSBURG, PA
17055
........ fold
ESTATE INFORMATION: SSN: 184-09-4159
FILE NUMBER: 2103-0595
DECEDENT NAME: FORRY L ROMAINE
DATE OF PAYMENT: 01/30/2004
POSTMARK DATE: 01 ~28~2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/17/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03003538 $1,080.34
REMARKS:
TOTAL AMOUNT PAID:
$1,080.34
SEAL
CHECK#4079
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
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 003503
FORRY GERALD R
705 CHARLES ST
MECHANICSBURG, PA
17055
........ fold
ESTATE INFORMATION: SSN: 184-09-4159
FILE NUMBER: 2103-0595
DECEDENT NAME: FORRY L ROMAINE
DATE OF PAYMENT: 01/30/2004
POSTMARK DATE: 01/28/2004
COUNTY: CUM BERLAN D
DATE OF DEATH: 05/17/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03003537 $247.42
TOTAL AMOUNT PAID:
$247.42
~REMARKS'
CHECK#4078
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
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 003505
FORRY GERALD R
705 CHARLES ST
MECHANICSBURG, PA
17055
........ fold
ESTATE INFORMATION: SSN: 1 84-09-41 59
FILE NUMBER: 2103-0595
DECEDENT NAME: FORRY L ROMAINE
DATE OF PAYMENT: 01/30/2004
POSTMARK DATE: 01/28/2004
COUNTY: CUM BERLAN D
DATE OF DEATH: 05/17/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03003541 $158.22
TOTAL AMOUNT PAID:
$158.22
REMARKS:
SEAL
CHECK# 4O8O
INITIALS: JA
RECEIVED BY'
GLENDA FARNER STRASBAUGH
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 O03506
FORRY GERALD R
705 CHARLES ST
MECHANICSBURG, PA
17055
fold
ESTATE INFORMATION: SSN: 184-09-4159
FILE NUMBER: 2103-0595
DECEDENT NAME: FORRY L ROMAINE
DATE OF PAYMENT: 01/30/2004
POSTMARK DATE: 01/28/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/17/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03003544 $98.60
TOTAL AMOUNT PAID:
$98.60
REMARKS'
SEAL
CHECK# 3921
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
· D2PART~ENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
i~ DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003547
FORRY GERALD R
705 CHARLES ST
MECHANICSBURG, PA
17055
ESTATE INFORMATION: SSN: 184-09-4159
FILE NUMBER: 2103-0595
DECEDENT NAME: FORRY L ROMAINE
DATE OF PAYMENT: 02/1 0/2004
POSTMARK DATE: 02/09/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/17/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03003539 91,080.34
03003542 9158.22
03003545 998.60
REMARKS'
TOTAL AMOUNT PAID:
RECEIVE DELVIN E FORRY
91,337.16
SEAL
CHECK# 1374
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPART~MENT OF R'~VENUE
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 003552
FORRY GERALD R
705 CHARLES ST
MECHANICSBURG, PA
17055
.... ~--- fold
ESTATE INFORMATION: SSN: 184-09-4159
FILE NUMBER: 2103-0595
DECEDENT NAME: FORRY L ROMAINE
DATE OF PAYMENT: 02/11/2004
POSTMARK DATE: 02/1 0/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/17/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03003540 $1,080.34
03003543 $158.22
03003546 $98.60
:REMARKS:
TOTAL AMOUNT PAID'
$1,337.16
CHECK# 5110
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF 'rNDZV'rDUAL TAXES
I*NHERTTANCE TAX D*rvTsi*ON
DEPT. 280601
HARRTSBURG, PA 171Z8-0601
COHHONNEALTH OF PENNSYLVANZA
DEPARTHENT OF REVENUE
'rNHERZTANCE TAX
STATEMENT OF ACCOUNT
:~DATE
ESTATE OF
DATE OF DEATH
FZLE NUHBER
DELVIN E FORRY ACN
$051 LOGAN STREET
CAHP HILL PA 17011C:~i;
RE¥-1607 EX AFP (gl-OS)
03-08-ZOOR
FORRY L
05-17-2003
21 03-0595
CUHBERLAND
030035~5
Amoun~ Remi~ed
HAKE CHECK PAYABLE AND REH.rT PAYHENT TO:
REGISTER OF MILLS
CUNltERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper cr'~d/~ ~o your account, submi~ ~he upper portion of *hi$ form wi~h your ~ax p~ymen~.
CUT ALONG TH'rS L.rNE ~* RETAZN LONER PORT.rON FOR YOUR RECORDS *-~
REV-1607 EX AFP (01-03) ### .rNHERZTANCE TAX STATEHENT OF ACCOUNT
ESTATE OF FORRY L R F'rLE N0.21 03-0595 ACN 030035~5 DATE 03-08-Z00~
THTS STATEHENT TS PROV*rDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN 'rN THE NAHED ESTATE. SHO#N BELO#
TS A SUNHARY OF THE pR'rNc*rPAL TAX DUE, APpLTCAT'rON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, 'rF APPL'rCADLE,
A PROJECTED TNTEREST F'rGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 12-29-2003
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
98.60
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
0Z-09-200~ CD0035~7 .00 98.60
ZF PAID AFTER THIS DATE, SEE REVERSE
SZDE FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYHENT ZS RE~U/RED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR),
TOTAL TAX CREDZT
98.60
BALANCE OF TAX DUE .00
XNTEREST AND PEN. .00
TOTAL DUE .00
YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF TH'rS FORH FOR INSTRUCT]:ONS.
PAYMENT:
Detach the top portion of this Notice and submit aith 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 #TLLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVAN:IA.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, amy ba requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-iS13). Applications ara available at
the Office of the Register of Nills, any of the Z3 Revenue District Offices or from the Department's Z~-hour
answering service for fores ordering: 1-800-36Z-lOS0; services for taxpayers with special hearing and / or
speaking needs: l-8OO-4qT-3OZg (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxesj ATTN: Post Assessment Review Unit, Oept. ZB060I, Harrisburgj PA lTIZB-060I, phone
(717) 787-6S05.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (BI) discount
of the tax paid is allowed.
PENALTY:
The 15X 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 mith first day of deZinquency~ or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 19aZ bear interest at the rate of
six (SI) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after
January l, 198Z wil! 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 19aZ through gO0~ are:
Interest Deity Interest Daily Interest
Year Rate Factor Year Rate Factor Year Rate
198Z lOX .0005~8 1988-1991 X1Z .000~01 ZOO1 9Z
1983 16X .000q38 1992 9Z .000Z¢7 ZOOZ 62
lgBq 11X .000301 1993-199~ 7Z .00019Z 2003 5g
1985 Z3X .000356 1995-1996 9Z .O00Z~7 ZOO~ ~Z
1986 lOZ .OOOZ7q 1999 7Z .O0019Z
1987 9Z .000247 ZOO0 8Z .000Z19
Daily
Factor
.O00Zq7
.O0016q
.0001~7
.000110
--Interest is calculated as follows:
ZNTEREST= BALANCE OF TAX UNPAI'D X NUHBER OF DAYS DELZNQUENT X DALLY :iNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must bo calculated.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 171Z8-0601
MARLIN H FORRY
50 HAWTHORNE DRIVE
JIM THORPE PA 18Z29
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEHENT OF* ACCOUNT
DATE~ 05-08-ZOOq
ESTATE OF FORRY
DAT:~ OF DEATH 05-17-2005
FILE NUH~ER 21 05-0595
12 CUHBE.LAND
ACN--
030035~6
Amoun~ Remi~ed
I
REV-1607 EX AFP (01-OS)
L R
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To Jnsur,o pr,oper, cr,edi~ ~o your` accoun~c, submi~c ~he upper` por'~ion of ~hJs for,m wi'l:h your` ~cax payllen~:.
CUT ALONG THIS LINE ~'* RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1607 EX AFP (01-03} ~ INHERITANCE TAX STATEMENT OF ACCOUNT ~
ESTATE OF FORRY L R FILE NO. 21 05-0595 ACH 050035q6 DATE 03-08-200q
TH'rS STATEMENT 'rs PROV'rDED TO ADV'rSE OF THE CURRENT STATUS OF THE STATED ACM 'rN THE NAMED ESTATE. SHONN BELON
'rS A SUHMARY OF THE pRI'NC'rPAL TAX DUE.. APPL'rCAT'rON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, 'rF APPL'rCABLE,
A PROJECTED 'rNTEREST F'rBURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-29-2005
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
98.60
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
OZ-lO-ZOOq CDOO$55Z .00 98.60
'rF PAID AFTER TH'rS DATE, SEE REVERSE
S'rDE FOR CALCULATION OF ADDZT'rONAL 'rNTEREST.
{ ZF TOTAL DUE 'rS LESS THAN $1,
NO PAYMENT 'rS REQU'rRED.
ZF TOTAL DUE 'rS REFLECTED AS A 'CRED'rT' {CR),
TOTAL TAX CREDIT 98.60
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR 'rNSTRUCTZONS. )
PAYNENT:
Detach the top portion of this Notice and submit aith 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 #ILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COHHON#EALTH OF PENNSYLVANIA.
REFUND (CR):
REPLY TO:
DISCOUNT:
PENALTY:
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-Z313). Applications are available at
the Office of the Register of Nills, any of the 23 Revenue District Offices or from the Department's Z~-hour
answering service for fores ordering: 1-800-36Z-ZO50; services for taxpayers with special hearing and / or
speaking needs: 1-800-~7-30Z0 (TT only).
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Suraau
of Individua! Taxes, ATTN: Post Assessment Revise Unit, Dept. Za060I~ Harrisburg, PA 171Za-0601, phone
(717) 787-6505.
If any tax due is paid aithln three (3) calendar months after the decedant's death, a five percent (SZ) 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 end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of
six feZ) percent per annum calculated at a daily rate of .00016~. AZ! taxes which became delinquent on and 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 198Z through ZO0~ are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 lOX .0005~8 1988-1991 llZ .000301 ZOO1 92 .000Z~7
1985 162 .000~38 1992 92 .O00Z~7 ZOOZ 62 .00016~
1981 112 .000301 1993-199~ 72 .OOD19Z ZOO3 5Z .000157
1985 13Z .000356 1995-1998 9Z .O00Z~7 ZOOq ~Z .000110
1986 lOZ .O0027~ 1999 72 .O0019Z
1987 9Z .O00Z~7 ZOO0 8Z .000Z19
--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 date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
BUREAU OF ZNDZVZDUAL TAXES
'rNHERI*TANCE TAX DZVTS%ON
DEPT. 18060!
HARRISBURG,, PA 17118-0601
COMMONHEALTH OF PENNSYLVAN'rA
DEPARTMENT OF REVENUE
ZNHERZTANCE TAX
STATEHENT OF ACCOUNT
GERALD R FORRY
705 CHARLES STREET
MECHANZCSBURG
'04 12
REV-Ii;0? EX AFP (Di-O$)
DATE 05-08-200~
ESTATE OF FORRY L
DATE OF DEATH 05-17-2003
FZLE NUMBER 21 03-0595
: I : OUNTY CUMBERLAND
ACN 030035~
Amoun~ Remi~ed
MAKE CHECK PAYABLE AND REMZT PAYNENT TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
NOTE: To insure proper credi~ ~o :your account, submi~ ~he upper portion of ~:his fore ~i~h :your ~ex payment.
CUT ALONG THZS LZNE ~ RETAZN LOHER PORT%ON FOR YOUR RECORDS ~
REV-1607 EX AFP (01-03) ~# *rNHERZTANCE TAX STATEHENT OF ACCOUNT ~
ESTATE OF FORRY L R FZLE N0.21 03-0595 ACN 050035~ DATE 03-08-?00~
TH'rS STATENENT 'rs PROVZDED TO ADV'rSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAILED ESTATE. SHO#N BELON
TS A SUNNARY OF THE PR.rNC.rPAL TAX DUE., APPL/CAT'rON OF ALL PAYNENTS., THE CURRENT BALANCE., AND., 'rF APPL'rCABLE.,
A PROJECTED ZNTEREST F'rGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT= 1Z-Zg-2005
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS)=
PAYMENT RECEIPT DISCOUNT ¢+)
DATE NUMBER INTEREST/PEN PAID ¢-) AMOUNT PAID
01-ZS-Z00~ CD005506 .00 98.60
98.60
'rF PA'rD AFTER TH'rS DATE., SEE REVERSE
S'rDE FOR CALCULAT'rON OF ADDZT'rONAL 'rNTEREST.
( 'rF TOTAL DUE 'rS LESS THAN $1.,
NO PAYNENT 'rS REQU'rRED.
IF TOTAL DUE IS REFLECTED AS A 'CRED'rT' (CR).,
TOTAL TAX CREDZT 98.60
BALANCE OF TAX DUE .00
ZNTEREST AND PEN. .00
TOTAL DUE .00
YOU NAY BE DUE A REFUND. SEE REVERSE S'rDE OF TH'rS FORN FOR zNSTRUCT'rONS. )
PAYMENT:
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 NILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at
the Office of the Register of Hills, any of the 23 Revenue District Offices or from the Department's Iq-hour
answering service far farms ordering: 1-800-362-ZOSO; services for taxpayers with special hearing and / or
speaking needs: 1-BO0-q~7-30ZO (TT only).
REPLY TO:
guestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone
(7173 787-6~05.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount
of the tax paid is allowed.
PENALTY:
The 152 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.
INTEREST:
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, 1982 bear interest at the rate of
six (62) percent per annum calculated at a daily rate of .O0016q. Al! taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department sf Revenue. The applicable interest rates for 1962 through ZO0~ are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor --Year Rate Factor
198Z ZOZ .000548 1988-1991 llg .O003fll gOOl 9X .O00Zq7
1983 162 .000q38 1992 9X .O00Z~7 ZOOZ 62 .00016~
198q llX .000301 1993-199~ 72 .000192 ZOO3 52 .000137
1985 132 .00fl~56 1995-1998 92 ,O00Z~7 ZOOq ~X .000110
1986 IOZ .OOOZTq 1999 7Z .00019Z
1987 9Z .O00Zq7 ZOO0 82 .000Z19
--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. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DZVTSZON
DEPT. 280601
HARRISBURg, PA 17128-0601
CONNON#EALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
INHERITANCE TAX
STATEHENT OF ACCOUNT
GERALD R FORRY
705 CHARLES STREET
HECHANICSBURG PA 17055
~ i3ESTATE OF
DATE OF DEATH
FILE NUMBER
ItE¥-1~07 EX AFP
05-08-2004
FORRY L
05-17-Z005
21 03-0595
P]i~INTY CUHBERLAND
ACN 05003541
Amoun~ Remi~ed
HAKE CHECK PAYABLE AND REHIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credi:t :to your eccoun:t, submi:t :the upper por:tion of :this fore wi:th your
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV'1607 EX AFP (01-03) ~#x INHERITANCE TAX STATEHENT OF ACCOUNT x..
ESTATE OF FORRY L R FILE NO. 21 03-0595 ACN 03003541 DATE 03-08-Z004
THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHOWN BELOW
TS A SUNHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPL/CABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-29-2003
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
158.22
PAYHENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
01-28-2004 CD003505 .00 158.22
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN
NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT"
TOTAL TAX CREDIT 158.22
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
PAYMENT:
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 OECEDENT make check or money order payable to: REGISTER OF #ZLLS~ AGENT.
-- Zf NON-RESIDENT DECEDENT make check or money order payable to: COMNON#EALTH OF PENNSYLVANIA.
REFUND (CA): 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 are available at
the Office of the Register of Nills, any of the 23 Revenue District Offices or from the Department's Zq-hour
answering service for forms ordering: 1-BOO-36Z-ZO50; services for taxpayers with special hearing and / or
speaking needs: 1-800-qq7-3OgO (TT only).
REPLY TO:
Ouestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. gS060l, Harrisburg, PA 171gB-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Z) discount
of the tax paid is aIIowed.
PENALTY:
The 15X 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 from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 19BZ bear interest at the rate of
six (6Z) percent par annum calculated at a daily rate of .O0016q. AIl taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for lgSZ through ZOOq are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
198Z ZOZ .O00SqB 1988-1991 XXZ .000301 ZOO1 9Z .'O00Z~7
X983 X6Z .000~38 199Z 9Z .O00Z~7 ZOOZ 6Z .00016q
19B~ llZ .000301 1993-199~ 7Z .O0019Z ZOO3 SZ .000137
1985 lSZ .000356 1995-X998 92 .0002~7 ZOOq ~Z .O00110
1956 ZOZ .O00Z7q 1999 7Z .O0019Z
Z987 9Z .000Z¢7 ZOO0 8Z .O00Z19
--Znterest is calculated as follows:
TNTEREST = BALANCE OF TAX UNPATD X NU~IBER OF DAYS DELTNI;~UENT X DATLy ZNTEREST FACTOR
--Any Notice issued after tho tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest oust bo calculated.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG,, PA 171ZD-0601
COHHONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
TNHERZTANCE TAX
STATEHENT OF ACCOUNT
Reco
RO:,~:~:!~ ?.-~ ESTATE OF FORRY
BATE OF BEATH 05-17-;'003
FTLE NUHBER 21 03-0595
DELVTN E FORRY 'OZI r'IAR 1~ P1 .~OUNTY CUHBERLAND
* '-~CN 0~00~5~9
~0~1 LOGAN STREET
CARP H~LL PA
I
REV-i~07 EX AFP (01-03)
HAKE CHECK PAYABLE AND REHTT PAYHENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ ~o your account, subei* ~he upper pot*ion of ~his form wi*h your *ax p~ymen~,
CUT ALONG THZS LZNE ~'- RETAZN LONER PORTZON FOR YOUR RECORDS ~,~
REV-1607 EX AFP (01-03) ~#~ ZNHERZTANCE TAX STATEHENT OF ACCOUNT ~
ESTATE OF FORRY L R FILE NO. 21 03-0595 ACN 03003539 DATE 03-08-2004
THIS STATEHENT ZS PROVZDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAHED ESTATE. SHONN BELON
ZSA SUNNARY OF THE pR'rNCZPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 12-29-2003
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYHENTS (TAX CREDITS):
1,080.~4
PAYHENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID ¢-) AHOUNT PAID
02-09-2004 CD003547 .00 1,080.34
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYNENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR),
TOTAL TAX CREDIT
1,080.34
.00
YOU NAY BE DUE A REFUND. SEE REVERSE SZDE OF THIS FORN FOR ZNSTRUCT/ONS. )
BALANCE OF TAX DUE
INTEREST AND PEN. .00
TOTAL DUE .00
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payabla to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGTSTER OF #ILLS~ AGENT.
-- IF NON-RESIDENT DECEDENT make check or money order payable to: COMMONHEALTH OF PENNSYLVANTA.
REFUND [CR): A refund of a tax cradit, which Has not requested on the Tax Return, may be requested by comp[aline an
"Application for Refund of Pennsylvania Inheritance and Estate Tax"' [REV-1315). Applications ara available at
tho Office of the Register of Hills, any of the Z5 Revenue District Officas or from the Department's gq-hour
answering service for forms ordering: 1-800-$SZ-ZO50~ services for taxpayers with special hearing and / or
speaking needs: 1-BOO-qqT-~OZO (TT only).
REPLY TO:
Questions regarding errors contained on this notice should ba addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ga0601, Harrisburg, PA 17liS-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three ($) calendar months after the dacedent's death, a riva percent (SI) discount
of the tax paid is allowed.
PENALTY:
The 1SI tax amnesty non-participation penalty is computed on tha total of the tax and interest assessed, and not
paid before January [8, [996, the first day after the end of the tax amnesty pariod.
INTEREST:
Interest is charged beginning with first day of da[inquancy, or nine (9) months and one [[) day from fha date of
death, to tha date of payment. Taxes ~hich became delinquent before January l, 198Z bear interest at tha rate of
six (6X) percent per annum calculated at a daily rate cf .O00[6q. Ali taxes which became da[inquant on and after
January l, 198Z will bear interest at a rate ~hich will vary from calendar year to calendar year with that rate
announced by tha PA Department of Revenue. The applicable interest rates for 19BI through 200q are:
Interest gaily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 gOZ .OOOSq8 1988-1991 llZ .OOO301 gO01 9Z .o00gq7
1983 16Z .000q38 [992 92 .O00Zq7 gooz 6Z .000164
lg&¢ llZ .000501 [995-199q 7Z .O0019Z ZO0~ 5Z .000157
1985 l~Z .000556 1995-1998 92 .ooogq7 gOOq qZ .OOOllO
1986 102 .o00gTq 1999 72 .000192
1987 9Z .o00gq7 2000 8Z .O00Z19
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on tha
Notice, additional intarest must ba calculated.
BUREAU OF ZNDZVZDUAL TAXES
INHERITANCE TAX DTVTSTON
DEPT. Z80601
HARRI'SBURg,, PA ].7'128-060].
GERALD R FORRY
705 CHARLES STREET
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
ZNHERZTANGE TAX
STATEMENT O; ACCOUNT
03-08-ZOOq
FORRY
05-17-Z003
21 03-0595
CUMBERLAND
03003538
Amoun'l: Rem i'l:'lced
REV-I&O7 EX AFP ¢D1-03)
L R
HAKE CHECK PAYA2LE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ ~o your accoun~:, submi~ ~hm upper por~:ion of ~his form wi~:h your ~ax payment.
CUT ALONG THTS LTNE ~ RETATN LOWER PORTTON FOR YOUR RECORDS ~
REV-1607 EX AFP (01-03) mN# INHERITANCE TAX STATEMENT OF ACCOUNT aN~
ESTATE OF FORRY L R F'rLE NO. 21 03-0595 ACN 03003538 DATE 03-08-200q
THTS STATEMENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACM TN THE NAMED ESTATE. SHONN BELON
TS A SUMMARY OF THE PR/NC/PAL TAX DUE, APpLTCATTON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, TF APpLTCABLE,
A PROJECTED TNTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-29-2003
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
PAYHENT
DATE
01-28-200q
RECEIPT
NUMBER
CDOO350q
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
ZF PAID AFTER THZS DATE, SEE REVERSE
SZDE FOR CALCULATION OF ADDZTZONAL ZNTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF THIS FORM FOR INSTRUCTIONS.
1,080.3q
AMOUNT PAID
1,080.3q
TOTAL TAX CREDIT 1,080.3q
2ALANCE OF TAX DUE .00
ZNTEREST AND PEN. .00
TOTAL DUE .00
PAYHENT:
Detach the top portion of this Notice and submit with your payment mede payable to the name and address
printed on the reverse side.
-- If RES[DENT DECEDENT make check or money order payable to: REGISTER OF NZLLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COHHON#EALTH 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 for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at
the Office of the Register of Nills, any of the Z3 Revenue District Offices or from the Department's Iq-hour
answering service for fores ordering: [-800-36Z-ZOSO; services for taxpayers with special hearing and / or
speaking needs: [-800-q~7-30ZO (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
af Individual Taxes, ATTN: Post Assessment Review Unit, Dept. [BO601, Harrisburg, PA 171Ia-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SZ) discount
of the tax paid is allo~ed.
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, ar nine (93 months and one (1) day free the date of
death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rate of
six (SX) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after
January 1, 19BI will bear interest at a rate ~hich will vary from calendar year to calendar year ~ith that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZO0~ are:
Interest Daily Interest Daily Interest
Daily
Year Rate Factor Year Rate Factor Year Rate Factor,
X98--~ ZOZ .0005q8' X98~-1991 llZ .000~01 ZOO1 9Z .OOOZq7
1983 162 .OOOq38 199Z 92 .O00Z~7 ZOO2 62 .00016q
198q 11Z .000501 1993-199q 7X .00019Z Z003 SZ .000137
1985 13Z .000356 1995-1998 9Z .OOOZq7 ZOOq qZ .000110
1986 lOX .O0027~ 1999 7Z .00019Z
1987 9Z .O00Zq7 2000 8Z .000219
--Interest is calculated as follows:
ZNTEREST= BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELTNQUENT X DAZLY ZNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent Hill 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 'rNDTVZDUAL TAXES
%-_~; ZNHERZTANCE TAX DZVZSTDN
)., ~,,~ DEPT. 28060!
HARRTSBURG, PA 171:~8-0601
COMMONNEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
ZNH£R'rTANCE TAX
STATEMENT OF ACCOUNT
MARLIN H FORRY 'C)~ I'IAR 12 P1:46
50 HANTHORNE DR'rYE
JZM THORPE
DATE 03-08-200q
ESTATE OF FORAY
DATE OF DEATH 05-17-2003
FZLE NUMBER 21 03-0595
COUNTY CUMBERLAND
ACN 030035q3
Amount Rem J.*l:'l:ed
RE¥-I[O? EX AFP (01-05)
L R
MAKE CHECK PAYABLE AND REMZT PAYMENT TO:
RE$ZSTER OF NTLLS
CUMBERLAND CO COURT HOUSE
CARLTSLE, PA 17013
NOTE: To insure proper credA~ ~o your account, subm/~ ~he upper portion of ~his form wi~h your ~ax payment.
CUT ALONG TH*rS LZNE ~ RETA'rN LONER PORT*tON FOR YOUR RECORDS ~
REV-1607 EX AFP (01-03) ##a 'rNHERZTANCE TAX STATEMENT OF ACCOUNT ~
ESTATE OF FORAY L R FTLE ND. Z1 03-0595 ACN 030035q3 DATE 03-08-Z00q
TH'rS STATEMENT IS PROVIDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHO#N BELON
TS A SUMMARY OF THE pR'rNc'rpAL TAX DUE,, APPLTCAT'rON OF ALL PAYMENTS., THE CURRENT BALANCE,, AND., TF APPLTCABLE.,
A PROJECTED 'rNTEREST F'rGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-29-Z005
PR/NCZPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDZTS):
158.22
PAYMENT RECEIPT DZSCOUNT (+)
DATE NUMBER ZNTEREST/PEN PAZD (-) AMOUNT PAZD
OZ-lO-200q CD003552 .00 158.22
ZF PAID AFTER TH/S DATE., SEE REVERSE
SZDE FOR CALCULATZON OF ADDITZONAL 1NTEREST.
( ZF TOTAL DUE ZS LESS THAN $1.,
NO PAYMENT IS REQUIRED.
ZF TOTAL DUE 15 REFLECTED AS A 'CRED/T' (CA).,
TOTAL TAX CREDIT 158.22
BALANCE OF TAX DUE .00
*rNTEREST AND PEN. .00
TOTAL DUE .00
YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF TH*rS FORM FOR *rNSTRUCT'rONS.
PAYMENT:
Detach the top portion of this Notice and submit aith 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 WZLLSj AGENT.
-- If NON-RES[DENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, mhich ems not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IBIS). Applications are available at
the Office of the Register of Hills, any of the g5 Revenue District Offices or fram the Department's gq-hour
answering service for forms ordering: [-SOO-$6Z-ZOSO; services for taxpayers with special hearing and / or
speaking needs: 1-SO0-qq7-$OgO £TT only).
REPLY TO:
questions regarding errors contained on this notice should be addressed to: PA Oepartaent of Revenue, Bureau
of Individual Taxes, ATTN: Past Assessment Review Unit, Dept. g8060[, Harrisburg, PA 171Z8-0601) phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (Bi) discount
of the tax paid is alIowed.
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 from the date af
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January l, 1982 will bear interest at a rate which mill vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198g through ZOOq are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year__ Rate Factor
19~ ZOZ .O00Sq8 1988-1991 llg .000501 ZOOl 9Z .0002q7
1985 162 .OOOq58 1992 9Z .OOOZq7 ZOOZ 6Z .O0016q
1984 112 .000301 1995-199q 7X .OOOleZ 2005 SZ .000157
1985 132 .000556 1995-1998 92 .O00Zq7 gOOq qZ .000110
1986 lOX .O00Z7q 1999 7Z .00019Z
1987 9Z .OOOZq7 ZOOO 8Z .000Z19
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINI;IUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
BUREAU OF ZNDZVZDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG,, PA 17118-0601
NARLIN H FORRY
50 HANTHORNE DRIVE
JIM THORPE PA ~8229
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEHENT OF ACCOUNT
DATE OF DEATH
FILE NUMBER
REV-].~$7 EX AFP COZ-OS)
03-08-ZOOq
FORRY L R
05-17-Z003
2! 03-0595
FC~I[J~I~'y CUMBERLAND
ACN
Amoun~ Remi~ed
MAKE CHECK PAYABLE AND RENZT PAYMENT TO:
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ ~o your account*' submi~ ~he upper portion of ~his form wi~h your ~ax payment.
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS *~
REV-1607 EX AFP (01-03) ~# ZNHERZTANCE TAX STATEHENT OF ACCOUNT ~
ESTATE OF FORRY L R FILE NO. 21 03-0595 ACN 030035q0 DATE 03-08-200q
THZS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHONN BELO#
ZSA SUMMARY OF THE PRZNCZPAL TAX DUE, APPLICATION OF ALL PAYMENTS., THE CURRENT BALANCE., AND., ZF APPLICABLE*'
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-29-2003
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
1,080.3q
PAYMENT
DATE
OZ-lO-ZO0~
RECEIPT
NUMBER
CD005552
ZF PAID AFTER THIS DATE*' SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR),
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
AMOUNT PAID
1,080.3q
TOTAL TAX CREDIT 1,080.3q
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR TNSTRUCTZONS. )
PAYMENT:
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 NZLLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA.
REFUND (CR): 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-IS13). Applications are available at
the Office of the Register of Nills, any of the Z3 Revenue District Offices or from the Department's Iq-hour
answering service for fores ordering: 1-BOO-36Z-Z050~ services for taxpayers with special hearing and / or
speaking needs: 1-800-qqT-3OZO (TT only}.
REPLY TO:
guestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Reviea Unit, Dept. lB0601, Harrisburg, PA 17LIB-0601, phone
C7L7) 787-6S0S.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the dacedant's death, a five percent CSX) discount
of the tax paid is allowed.
PENALTY:
The 15Z tax amnesty non-participation penalty is computed on tho 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.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, L9BZ bear interest at the rate of
six (6Z) percent par annum calculated at a daily rate of .O0016q. AL! taxes mhich became delinquent on and after
January l, lgBZ wiL! bear interest at a rate ahich wiL! vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 19BI through ZOOq are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 LOX .0005~8 1988-199L ZLZ .000301 2001 9X .OOOZ~7
1983 16X .000q38 199Z 9Z .O00Zq7 gOOZ 6X .00016~
198~ X1X .000301 1993-1994 7X .O00Lgz 2003 52 .000137
1985 13X .000356 1995-1996 92 .O00Zq7 ZO0~ q2 .000110
1986 lOX .O00Z7~ 1999 7Z .00019Z
1987 9Z .000Z47 ZOO0 8Z .000219
--Interest is calculated as follows:
ZNTEREST = BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELZNI~UENT X DAZL¥ ZNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (lS) 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 'rNDZVZDUAL TAXES
TNHERTTANCE TAX DTVTSI*ON
DEPT. 28D601
HARRI*SBURG.. PA 171Z8-0601
COMNON~/EALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEt4ENT OF ACCOUNT
'CH MAR 12
DELVIN E FORRY
$0:31 LOGAN STREET
CAMP HILL P~:;~?011
DATE 0:3-08-2004
ESTATE OF FORRY
DATE OF DEATH 05-17-Z00:3
FILE NUMDER 21 0:3-0595
COUNTY CUHBERLAND
ACN 0:300:3542
Amoun~ Remi~ed
REV-I(~O? EX AFP (01-OS)
HAKE CHECK PAYABLE AND REHZT PAYMENT TO:
REGTSTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 1701:3
NOTE: To insure proper credi~ ~o your account:, submi'l: ~he upper portion of ~:his ~orm wi'l:h your ~ax payment:.
CUT ALONG THIS LTNE ~ RETA'rN LOI,/ER PORT'rON FOR YOUR RECORDS ~
REV-1607 EX AFP (01-03) #~ 'rNHER'rTANCE TAX STATEHENT OF ACCOUNT
ESTATE OF FORRY L R FILE NO. 21 05-0595 ACN 05005542 DATE 0:3-08-2004
THTS STATEHENT IS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHONN BELO#
TS A SUMMARY OF THE PRTNCTpAL TAX DUE,, APPLTCATTON OF ALL PAYHENTS.' THE CURRENT BALANCE.' AND., TF APpLTCABLE,
A PROJECTED TNTEREST FTGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-29-2005
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
158.22
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
02-09-2004 CD00:3547 .00 158.22
ZF PAID AFTER TH/S DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADD/TZONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1.'
NO PAYHENT ZS REQU/RED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT"
TOTAL TAX CREDIT
158.22
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORM FOR TNSTRUCT'rONS. )
PAYNENT:
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 NILLS~ AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COHHONNEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which ams not requested on the Tax Return, may ba 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 23 Revenue District Offices or from the Department's Z4-hour
answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-30Z0 (TT only).
REPLY TO:
guestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601, phone
[717) 767-6505.
DISCOUNT:
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (BZ) discount
of the tax paid is alloaad.
PENALTY:
The 15Z tax amnesty non-participation penalty is computed on the tote! 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 frae the date of
death, to the date of payment. Taxes ahich became delinquent before January 1, 198Z bear interest at the rate of
six (BI) percent per annum calculated at a daily rate of .000164. All taxes ahich became delinquent on and after
January l, 198Z will bear interest at a rate ahich will vary from calendar year to calendar year with that rata
announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z004 are:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year__
198Z ZOZ .000548 1988-1991 llZ .000301 ZOO1
1983 16Z .000438 199Z 9Z .000Z47 ZOOZ
1984 llX .000301 1993-1994 7X .000192 2003
198S 13Z .000356 1995-1998 92 .000Z47 ZOO4
1986 102 .000274 1999 7Z .O0019Z
1987 92 .000247 ZOO0 82 .000219
lntarast Daily
Rate Factor
91 .000247
6Z .000164
5Z .000157
41 .000110
--Interest is calculated as folloas:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (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
TNHERITANCE TAX DIVISTON
DEPTo Z80601
HARRISBURG, PA 171Z8-0601
GERALD R FORRY
705 CHARLES STREET
NECHANICSBURG PA 17055
COMHONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'rNHERZTANCE TAX
STATEMENT OI= ACCOUNT
DATE OF DEATH
FILE NUHBER
'04 ~R 12
? ~dl~l~l'Y
ACN
REV-1607 EX AFP
05-08-Z00~
FORRY L R
05-17-2005
Z1 03-0595
CUHBERLAND
03003537
Aeoun~ Remi~ed
HAKE CHECK PAYABLE AND REMIT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credl~ ~o your account, submi~ ~he upper portion of ~his form wi~h your ~ex payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS
REV-160? EX AFP (01-03) ~#~ INHERITANCE TAX STATEHENT OF ACCOUNT
ESTATE OF FORRY L R FILE NO. 21 03-0595 ACN 03003537 DATE 03-08-Z00~
THTS STATEMENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAHED ESTATE. SHO#N BELON
TS A SUNHARY OF THE PR/NC/PAL TAX DUE, APPLTCATTON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, TF APPLTCABLE,
A PROJECTED TNTEREST FTGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 12-29-2003
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
ZR7.~2
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
01-Z8-200~ CD005503 .00 Z~7.~2
ZF PAID AFTER THIS DATE, SEE REVERSE
SZDE FOR CALCULATZON OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT'
TOTAL TAX CREDIT
2~7.4Z
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR TNSTRUCTZONS. )
PAYNENT:
Detach the top portion of this Notice and submit with your payment made payabla to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NXLLS, AGENT.
-- If NON-RES[DENT DECEDENT maka check or money order payable to: CONNONNEALTH OF PENNSYLVANIA.
REFUND (CR): A rafund of a tax cradit, which was not requested on the Tax Return, may be requested by completing an
· 'Application for Refund of Pannsylvania Inharitance and Estate Tax" (REV-1315). Applications ara availabla at
the Office of the Register of Wills, any of the Z3 Revenue District Offices or from the Department's Z~-hour
answering service for forms ordering: 1-800-56Z-lOS0; services for taxpayers with special hearing and / or
speaking needs: l-BOO-q~7-5OZO (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenua, Bureau
of Individual Taxes, ATTN: Post Assessment Revie~ Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601, phone
(7[7) 787-6505.
DISCOUNT:
If any tax dua is paid within three (5) calendar months after the dacedent's death, a five percent (SI) discount
of tha tax paid is allo~ed.
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 baginning with first day of delinquency, or nine (9) months and one (1) day from the date of
daath, to the date of payment. Taxes which became delinquent before January 1, 198Z bear intarast at the rate of
six (BI) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after
January l, 198Z Hill bear interast at a rate ahich aili vary from calendar year to calendar year aith that rate
announced by the PA Dapartaant of Revenue. The appllcabla intarast rates for 19BI through ZO0~ are:
lnterast Daily Interest Daily Interest Daily
Year Rata Factor Year Rate Factor --Year Rate Factor
1982 20Z .0005~8 1988-1991 llZ .000501 ZOOl 9Z .O00Z~7
1985 16Z .000~$8 199Z 9Z .O00Z~7 ZOOZ 6Z .00016~
1981 IIZ .000501 1995-199~ 7Z .O0019Z 2005 5Z .000137
1985 15Z .000556 1995-1998 9Z .O00Zl7 ZOOl IZ .000Il0
1986 IOZ .O00ZT~ 1999 72 .00019Z
1987 9Z .O00Z~7 ZOO0 8Z .000Z19
--Xnterast is calculated as folloas:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DEL'rN{~UENT X DALLY INTEREST FACTOR
--Any Notice issuad after the tax becomes delinquent mill raflect an interest calculation to fiftaan (15) days
beyond tha date of the assessment. If payment is mede after tha interest computation date shoNn on the
Notice, additional interest must be calculated.
BUREAU OF ZNi~IVIDUA~ TAXES
INHERITANCE TAX I}TvZSTON
DEPT. 280601
HARRISBURG, PA 171Z8-0601
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTHENT
REV-I;9$ El( AFP (01-03)
GERALD R FORRY
705 CHARLES ST
HECHANICSBURG
PA 17055
DATE 12-19-2005
ESTATE OF FORRY
DATE OF DEATH 05-17-2003
FILE NUHBER 21 03-0595
COUNTY CUHBERLAND
ACN 101
Aeount Remitted
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure 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
ESTATE OF FORRY
L R F/LE NO. 21 03-0595 ACN 101 DATE 12-19-2003
ADJUSTNENT BASED ON:
ADHINISTRAT[VE CORRECTION
VALUE OF ESTATE:
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Hortgages/Notes Receivable (Schedule D) (4)
$. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Tote1 Assets
DEDUCTTONS AND EXEHPTTONS:
9. Funeral Expenses/Administrative Costs/
10.
Il.
12.
13.
ltl.
TAX:
15.
16.
Niscelleneous Expenses (Schedule H) (9)
Debts/Nortgage Liabilities/Liens (Schedule I) (10)
Tote1 Deductions
Net Value of Tax Return
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate Subject to Tax
Amount of Line 14 et Spousal rate
Amount of Line 14 taxable et Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of LAne 14 taxable et Collateral/Class B rate
19. Principal Tax Due
K~CblYl UI~CUUNI
NUNBER INTEREST/PEN PAID (-)
TAX CREDTTS:
i"AYIII=N I
DATE
(15)
(16)
(17)
(18)
O0
O0
O0
O0
O0
O0
O0
(8)
.00
.00
(11)
(12)
(15)
.OOx O0 =
.OOX 045=
.OOx 12 =
.OOX 15 =
(19)
ANOUNT PAID
TOTAL TAX CREDIT I .00
BALANCE OF TAX DUE1 .00
INTEREST AND PEN. .00
TOTAL DUE .00
( IF TOTAL DUE XS LESS THAN $1, NO PAYNENT IS REQUIRED.
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE XS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE S/DE OF THIS FORN FOR INSTRUCTIONS.)
PAYNENT:
Detach the top portion of this Notice and submit aith your payment made payable to the name and address
printed on the reverse side.
-- Hake check or money order payable to: REGISTER OF HILLS, AGENT.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-131$). Applications are available at
the Office of the Register of Hills) any of the 2S Revenue District Offices or from the Department's Z4-hour
answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers mith special hearing and / or
speaking needs: 1-80D-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: Post Assessment Reviea Unit) Dept. Z80601, Harrisburg, PA 171Z8-0601, Phone
(717) 787-6505.
DISCOUNT:
PENALTY:
INTEREST:
If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SI) discount
of the tax paid is alloeed.
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.
Interest is charged beginning eith first day of delinquency or nine (9) months and one (1) day from the date of
death to the dote of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of °000164. All taxes which became delinquent on and after
January 1, 1982 mill bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
198Z ZOZ .000548 1987 9Z .000Z47 1999 7Z .00019Z
1983 16Z .000438 1988-1991 llZ .000301 2000 8Z .000219
1984 llZ .000301 1992 92 .000247 ZOO1 9Z .000247
1985 13Z .000356 1993-1994 72 .O0019Z ZOOZ 6Z .000164
1986 IOZ .000274 1995-1998 9Z .000247 2003 5Z .000137
--Interest is calculatad as folloas:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sheen on the
Notice, additional interest must be calculated.
:~v.~,o~xl~-~ ~ INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 28O6O1
HARRISBURG~ PA 17128-0601
3ECEDENT'S NAME FILE NUMBER
L R FORRY 2103-0595
ACN
REVIEWED BY Dianne McClain 101
ITEM
SCHEDULE NO, EXPLANATION OF CHANGES
The Notice of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions
and Assessment of Tax has been adjusted to zero, Assets reported on Schedules F and G
billed directly to the joint owner and beneficiaries,
ROW Pa.qe 1