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HomeMy WebLinkAbout03-0607 PETITIONnl~Ig'R PROBATE and GRANT OF LETTERS 6 No. also known as ~ To: Register of Wills for the Social Security No. [ g/-~l. .~-r~o'_) Deceased. County of Ctanlo~rland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of a.g.e or older an the executj~t in the last wilt of the above decedent, dated and codicil(s) dated / - in the named ,19__ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in fO& ,~. ~:~g~dt~.~f ._ .County, Pennsylvania, with h ~ last family or princioal residence at q--~;~ ~,' 1(~~) ~['~,~~ ~ist street, number and muncipality) Decendent, then ~ _yearsofag~died ~p,~ [ ]~)~0~ ~0 ~ at ~'~ k ~a~ ~,l~.dr~/~ ,~ ' '. Except as followd decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: WHEREFORE, petitioner(s) respectfully, request(s) ~e probate of the last will and codicil(s) presented herewith and the grant of letters (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ :ss COUNTY OF Cumberland The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief o_fj~etitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will~.we~p,y ~mi~n~h.e es.,~a_t~ a.~tording to law. Sworn to or affirmed and subscribed before me,:his 25~ch day of J ' v../s¥'_ 7 No. 21-2003-607 Estate Of JOSEPH O. crm~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW July 25th XlX)2003, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated Janua_r3r 30. 2002 described therein be admitted to probate and filed of record as the last will of Joseph O. Clark ; and Letters Teste~nentary are hereby granted to Sharon K. NeiberE' FEES Probate, Letters, Etc .......... $ 270.00 Short Certificates(5 ) .......... $ 15.00 Renunciation . .(.1 ) ........... $ 5.00 - x-Pages ( 3 ) $ 9.00 JCP TOTAL __ $~ Filed .~.u.ly...2.5.t.h.: .299.3. .................. Donna M. Ottt~i~§~fI~Juty ~ ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE CALL EXECUTRIX ON 7/25/2003. Jul 17 03 09:47a Knauer & Rssociates,LSC 71779S77~3 p.2 21-2003-607 .RENUNCIAITON In Re Estate of Joseph Omar Clark, deceased: To the Register of Wills of Cumberland county, Pennsylvania. The undersigned, Robed Brashears, co-executor of the above decedent, hereby renounces and refuses to act as an executor under the aforesaid will and respectfully requests that Letters Testamentary be issued to Sharon Neibed, only, co-executrix under the aforesaid Last Will and Testament of the decedent Joseph Omar Clark. Robed Brashears, Co-executor ACKNOWLEDGMENT On this, the i'q th day of July, 2003, before me the undersigned officer, personally appeared---R-~ober~ Brashears, known to me, (or satisfactorily proven) to be the person whose name subscribed to the within instrument and acknowledged that she executed the same for the purpose herein contained. IN WITNESS WHEREOF, I hereunto set my NOTARY PUBLIC My commission expires: ~y Commission F,~ires August ~ ~ (each) a subscribinl~tness to the will pres~S~d,.herewith, (each) being ~,.qualified according to ~ llw, depose(s) and si~~m 'N~ ",,.x~resent and saw, t etes~ ,s'g t sane~that ~ signed as a w~s at the request of t~__ in h pre'~e and (in the presence b4x~ch other)(in the presenc~Nf the ,~ubscribin~.~ss(es)). ~ ~ ~ Sworn~.or affirmed ai~l. subscribed before ~x_ xx ~ me this % xx'x.N dayof ~ (Name)~ % 19__ ) x~ (Address) 21-2003-607 REGISTER OF WILLS OF C~nberland COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that They /are familiar with the signature of Joseph O. Clark , codicil testat or of ( -- .,;t ~ to) the (will) presented herewith and codicil that They believ~ the signature on the (will ~s in the handwriting of Joseph O. Clark to the best of their knowledge and belief. 17/' f ,// ~ _ , Sworn to or affirmed and subscribed before ~ ' ~~_ ~5~ _~r-~~~~.~~ me this __25th day of ( ~ ~ ~ ~a~e~ ~ .... 2003 (Address) LAST WILL AND TESTAMENT OF JOSEPH OMAR CLARK I, Joseph Omar Clark, a resident of the Commonwealth of Pennsylvania, make, publish and declare this to be my Last Will and Testament, revoking all wills and codicils at any time heretofore made by me. I am retired from the military service of the United States. FIRST: I direct that the expenses of my last illness and funeral, the expenses of the administration of my estate, and all estate, inheritance and similar taxes payable with respect to property included in my estate, whether or not passing under this will, and any interest or penalties thereon, shall be paid out of my residuary estate, without apportionment and with no right of reimbursement from any recipient of any such property. SECOND: It is my desire that, upon my death, I be buried with full military honors at Memorial Gardens in Montgomery, AL. THIRD: I give all my real estate to Sharon Neibert, if she survives me. FOURTH: I give Joel S. Neibert my 1987 Dodge Van. FIFTH: I give all other tangible personal property owned by me at the time of my death, including without limitation personal effects, clothing, jewelry, furniture, furnishings, household goods, automobiles and other vehicles, together with all insurance policies relating thereto, to Sharon Neibert, if Sharon Neibert survives me. SIXTH: I give all the rest, residue and remainder of my property and estate, both real and personal, of whatever kind and wherever located, that I own or to which I shall be in any manner entitled at the time of my death (collectively referred to as my "residuary estate"), as follows: (a) If Sharon Neibert survives me, to Sharon Neibert. (b) If Sharon Neibert does not survive me, my residuary estate shall be paid and distributed to any then living issue of Sharon Neibert, per stirpes. SEVENTH: If any property of my estate vests in absolute ownership in a minor or incompetent, my Executors, at any time and without court authorization, may: distribute the whole or any part of such property to the beneficiary; or use the whole or any part for the health, education, maintenance and support of the beneficiary; or distribute the whole or any part to a guardian, committee or other legal representative of the beneficiary, or to a custodian for the beneficiary under any gifts to minors or transfers to minors act, or to the person or persons with whom the beneficiary resides. Evidence of any such distrib.ution or~refor executed by the person to whom the distribution is made shall be a full discharge of my Executors from any liability with respect thereto, even though my Executors may be such person. If such beneficiary is a minor, my Executors may defer the distribution of the whole or any part of such property until the beneficiary attains the age of eighteen (18) years, and may hold the same as a separate fund for the beneficiary with all of the powers described in Article ELEVENTH hereof. If the beneficiary dies before attaining said age, any balance shall be paid and distributed to the estate of the beneficiary. EIGHTH: I appoint my niece, Sharon Neibert and my accountant, Robert Brashears as Co-Executors of this will. If either of my Executors shall fail to qualify for any reason as Executor or, having qualified shall die, resign or cease to act for any reason as Executor, the other Executor may act alone as my Executor. I direct that no Executor shall be required to file or furnish any bond, surety or other security in any jurisdiction. NINTH: I grant to my Executors all powers conferred on executors under the Pennsylvania Probate, Estates and Fiduciaries Code, as amended, or any successor thereto, and all powers conferred upon executors wherever my Executors may act. I also grant to my Executors power to retain, sell at public or private sale, exchange, grant options on, invest and reinvest, and otherwise deal with any kind of property, real or personal, for cash or on credit; to hold, manage, insure, repair, improve, demolish, divide, and otherwise deal with and dispose of any property; to borrow money and mortgage, encumber or pledge any property to secure loans; to divide and distribute property in cash or in kind; to exercise all powers of an absolute owner of property; to compromise and release claims with or without consideration; and to employ attorneys, accountants and other persons for services or advice. The term "Executors" wherever used herein shall mean the executors, executor, executrix or administrator in office from time to time. TENTH: I direct that for purposes of this will a beneficiary shall be deemed to predecease me unless such beneficiary survives me by more than thirty days. ELEVENTH: I have ~erved in the Armed Forces of the United States. I therefore request that my Executors make appropriate inquiries to ascertain whether there are any benefits to which I, my dependents or my heirs may be entitled by virtue of any military affiliation. I specifically request that my Executors consult with a retired affairs officer at the nearest military installation, the Department of Veterans Affairs, and the Social Security Administration. IN WITNESS WHEREOF, I, Joseph Omar Clark, sign my n. ame and publish and declare this instrument as my last will and testament this $O'~ day of ~uta~ , 2002. I also have affixed my signature on the bottom of each of the preceding I~ges helteof. The foregoing instrument was signed, published and declared by Joseph Omar Clark, the above-named Testator, to be his last will and testament in our presence, all being present at the same time, and we, at his request and in his presence and in the presence of each other, have subscribed our names as witnesses on the date above written. having an address at having an address at / .b ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA, COUNTY OF C I/~1_~,~t~[~ h/_l~ , ss. OmarClark and £S ~e-g ~ c'-o ~ _~.al_ ~.e U.Z/ _~.__ _,_~__F,~_ _n~_ t~__ _ , We, Joseph --------- .... _, the/Testator and the" witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator, Joseph Omar Clark, signed and executed said instrument as his last will and testament in the presence and hearing of the witnesses, and that he had signed willingly, and that he executed it as his free and voluntary act and deed for the purposes therein expressed, and that each of the witnesses at the request of the Testator, in the presence and hearing of the Testator and each other, signed the will as witness, and that to the best of his or her knowledge the Testator was at the time at least eighteen years of age, of sound mind and under no constraint, duress, fraud or undue influence. Witness Wi{ness'' Subscribed, sworn to and acknowledged before me by the said Joseph Omar Clark, Testator, and subscribed and sworn to before me by the above-named witnesses, this ~gOel dayof ~nltlua, r~ ,2002. /O~fficer. er~~~ I, the undersigned officer, do hereby certify that I am, on the date of this certificate, a person with the power described in Title 10 U.S.C. 1044a of the grade, branch of service, and organization stated below in the active service of the United States Armed Forces, and that by statute no seal is required on thih certificgl.% under authority granted to me by Title 10 U.S.C. 1044a. Name of Officer and Position ": oh,q- E. xr_ ' y SSN, Grade and Branch of Service: Comm~d or Org~ization: 0 -.I I11 Name of Decedent: Date of Death: ._.~.1 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) ~ "~ Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of~,e Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ~_.~, ....... lo ~ - ~5 Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Ll;':~ztd LI B_]J I:,0. Signature Name Address Capacity: __ Personal Representative L~Counsel for personal representative CERTIFICATION OF NOTICE UNDER RULE 5.6(3) Name of Decedent: Joseph O. Clark Date of Death: 4-18-2003 Will No.: 2003-00607 Admin. No.: To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 7-25-2003 Name Address Sharon Neibert 9 Pine Hill Avenue. MechanicsburQ PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except None """. ~ C.' ~~ U10~"v SI na ure Name: David W. Knauer Date: Januarv 19, 2005 L) C',._ Address: 411A E. Main Street C) Mechanicsburq, PA 17055 Telephone: (717) 795-7790 Capacity: _ Personal Representative --L Counsel for personal representative \F Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 198 2/4/2005 TOSEPH O. aARK 21-2003-0607 DAVID W. KNAUER, ESQ. 411AE MAINST JA MEGIANlCSBURG, PA 17055 Qty 1 Fee Description Additional Probate Fee 35.00 Total $35.00 Total: $35.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. l)ue: aos.oo t\'P b 35 c:o '""Po ~.,o.oo . REV-1500 OFFICIAL USE ONLY R.E~-1S1)1)cXill-j)j)) . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128.0601 FILE NUMBER 2L-O~ COUNTY CODE YEAR INHERITANCE TAX RETURN RESIDENT DECEDENT o ls;:> 01 _ NUMBER SOCIAL SECURITY NUMBER 181 -18 93&-1 OECEOENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Joseph O. Clark DATE OF DEATH (MM-DD-YEAR) 4-18-2003 I- Z W C W o W C THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-YEARI 8-9-1922 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) o 3. Remainder Return (date of death prior to 12.13-82) o 5. Federal Estate Tax Return Required B. Total Number of Safe Deposll Boxes o 11. Election to tax under Sec. 9113(A) (Attacl\ Sct\ 0) o 2. Supplemental Return o 4a. Future Interest Compromise (date a/death after 12-12-82) 07. Decedent Maintained a Living Trust(Atl.act100?~olTrust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1.95) ~ 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9, Utigatlon Proceeds Received W 0- ::.:::!!:(I) 0"'''' w"o ",00 0"'--' ..Ill .. " COMPLETE MAILING ADDRESS ,#1 1 A E. Main street Mechanicsburg, PA 17055 NAME David W. Knauer, Esquire FIRM NAME (I/Applicable) TELEPHONE NUMBER 7JZ 7~5 7790 OFFICIAL USE ONLY (1) (2) (3) (4) (5) 1, Real Estate (Schedule Al 2. Stocks and Bonds (Schedule B) 3. Closely Held Col'poratkm, Partnership or Sole-Proprietorship 209,000 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscenaneous Personal Property (Sct\edule E) 6, Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) R Total Gross Assets {total Lines 1-7} I C...J 91,408 -,,"1 z o ~ ::l I- ~ < o W II:: (6) o (7) 300,408 (8) 7,912 (9) (10) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts 01 Decedent, Mortgage liabililies, & liens (Schedule I) 11. Total Deductions (total Lines 9 & 10J 12. Net Value of Estale (Une 8 minus Line 11) (11) 7,912 (12) 292.496 (13) 292,496 (14) 13. Charitable and Govemme!'\tal BequestslSee 9113 Trusts for which an election to tax has nol been made (Schedule J) 14. Net Value Subject 10 Tax (Line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;;: J-O ::l a.. ::E o o g 15. Amount of Une 141axable al the spousal lax rate, or lransfers under Sec. 9116 (a)(1.2) )(,.0_ (15) x.O_ (16) x .12 (17) x .15 (18) 43.874 (19) 43,874 16. Amount of Une 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibiing rate 292 , 496 18. Amount of Line 14 taxable at collateral rate 19. Tax Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 200 ~ Decedent's Complete Address: STREET ADDRESS 9 Pine Hill Avenue CITY Mechanicsburq I STATE PA I ZIP 17050 Tax Payments and Credits: 1. Tax Due {Page 1 Line 19) (1) 43.874 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A' B . C ) (2) 3. InteresUPenalty if applicable D. interest E. Penalty Total InleresUPenalty ( D · E ) (3) 1, 8 8 5 4. If Line 2 is greater than Line 1 . Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 . Line 3 is 9reater than Line 2, enter the difference. This is the TAX DUE. (5) 45,759 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SA) See Line 3 (5B) 45,759 A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transterred;....................... .................... ............................................. 0 IX] b. retain the right to designate who shail use the property transferred or its income; ...... ..................................... 0 IX] c. retain a reversionary interest; Of........... ....."'m....................... .....................................m."................ 0 Ii] d. receive the promise for life of either payments, ben~fits or care? ................................................... .................. 0 IX] 2. If death occurred after December 12, 1962, did decedent transfer property within one year at death without receiving adequate consideration? .............. .................................................................................. .. 0 ~ 3. Did decedent own an "in trust fo~ or payable upon death bank account or securily al his or her death?... .......... 0 IX] 4. Did decedent own an Individual Retirement Account, annuity, Of other non-probate property which contains a beneficiary designation? .............. ........................ ...................................... ..... 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE 1 19-2005 PA 17050 DATE 1-19-2005 ADDRESS 411A E. Main street, Mechanicsburg, PA 17055 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net vaiue of transfers to or for the use of the surviving spouse is 0% 172 P.S. ~9116 (a) (1.1) (ii)). The statute does not exemDt 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 Juiy 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 adopnve parent, or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(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. 99116(a)(1.3)1. A sibling is defined, under Seelion 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. "REV-1503 EX+ (6-98) r, . -~."&~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Joseph o. Clark FILE NUMBER 2003-00607 All property JOintly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Morgan Keegan & Company, Inc. Acct# 60107786 (Bond Mutual Funds) VALUE AT DATE OF DEATH 209,000 TOTAL (Also enter on line 2, Recapitulation) $209, 000 (\1 more space is needed, insert additional sheets of the same size) """'".,,':'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DE EDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Joseph o. Clark FILE NUMBER 2003-00607 Include the proceeds of litigation aoo the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH M & T Bank Account # 8892310288 ~1 ,408 TOTAL IAlso enter on line 5, Recapitulationl $91, 408 IIf more space is needed, insert additionai sheets of the same size) REV_15tlEX_(t_S7\ SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHE.RlTANCE TAX RETURN RESIDENT DECEDENT Joseph O. Clark FILE NUMBER 2003-00607 ESTATE OF Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES 1. Myers Funeral Home 1,248 2 Airline tickets 2,283 3. Hotel accommodation 279 4. Car rental 128 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 5% of 300,408 1,502 Name of Personal Representative (5) C;;hilrOl' N'Qibgrt Social Security Number(s) f EIN Number of Personal Representative{s) Street Address 9 Pine Hill Avenue City Mer-hFu1i ~~hl1rg StateDll Zip 17050 Year{s} Commission Paid: 2. Attorney Fees David W. Knauer, Esguril:te 2,000 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) N/A Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland Co. Register of Wills 309 5. Accountant's Fees None 6. Tax Retum Preparer's Fees INcluded in Attorney fees 7. Advertising - Cumberland Law Journal 775 The Sentinel 88 TOTAL (Also enter on line 9, Recapitulation) $ 7,912 (If more space is needed, insert additional sheets of the same size) AE\;I-1513 EX+ (9-00) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Joseph o. Clark FILE NUMBER 2003-00607 NUMBER I RELATIONSHIP TO DECEDENT NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 00 Not List Truslee(s) TAXABLE DISTRIBUTIONS {include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Sharon Neibert Niece 9 Pine Hill Avenue Mechanicsburg, PA 17050 1. AMOUNT OR SHARE OF ESTATE 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE. ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART" - 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} Register of Wills of Cumberland County, . Pennsylvania INVENTORY Eslate of Joseph O. Clark No. 2003-00607 also known as Date of Death 4-18-2003 . Deceased Social Security No. 1 8 1 18 \l 3 (; 1 Personal Representatlve(s) of the above Eslate, deceased, verify that the i1ems appearing in the following Inventory include all of the personal assets wherever situate and all of the reel eslate in the Commonwealth of Pennsylvania of said Decedent, Ihatthe valuation placed opposite each Item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no reel estsla outside of the Commonwealth of Pennsytvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and oorrect I/We understand that false slatements herein are made subject to the penalties of 18 Pa C.S. Section 4904 relating to unsworn falsification to authorities. Attorney David W. Knauer, E~Qujre 1.0. No.: 7.1'iR2 Address: 411A E. Main Street Dated Dec. 13. 2004 Mechanicsburq. FA 17055 Telephone: 717-795-7790 DescrIption Value (AIlach addlllonal sheets If necessary) Total: NOTE: The Memorandum of reel estate outside the Commonweallh of Pennsytvania may, at the elecllon of personal rep- resentative, include the value of each Item, but such figures should not be ex1ended into the total of the Inventory. ..;>.. RELEASE KNOW ALL MEN BY THESE PRESENTS, that I, Sharon Neibert, of Mechanicsburg, Pennsylvania, do hereby acknowledge as for divers and other good causes and valuable considerations, have remised, released, quitclaimed, and forever discharged, and by these presents for myself, my heirs, executors and administrators, do remise, release, quitclaim, and forever discharge the said Sharon Neibert, Executrix of the Estate of Joseph O. Clark, his heirs, executors and administrators, of an from all, and all manner of action and actions, cause and causes of action and actions, suits, debts, dues, duties, sum and sums of money, accounts, reckonings, bonds, bills, specialties, covenants, contract, agreements, promises, variances, damages, judgments, extents, executions, claims and demands, whatsoever in law or equity, or otherwise howsoever, which equity, or otherwise howsoever, which against the said Sharon Neibert, Executrix of the Estate of Joseph O. Clark, I ever had, now have, or which I, my heirs, executors, or administrators, hereafter, can, shall, or may have, for, or by reason of any manner, cause or thing whatsoever, from the beginnings of the world to the day of this date of these presents. IN WITNESS WHEREOF, I have hereunto set my hand and seal, this 19th day of January, 2005. c;/~u \)'- Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/15/2005 KNAUER DAVID W 411A E MAIN ST MECHANICSBURG, PA 17055 RE: Estate of CLARK JOSEPH 0 File Number: 2003-00607 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 4/18/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge ~ Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: " / 198 \ 2/4/2005 TOSEPH O. CLARK 21-2003-0607 J7 / DAVID WKNAUER ESQ 411AE MAINST ( , " MErnANIC5BURG, PA 17055 Qty 1 Fee Description Additional Probate Fee Total 35.00 $35,00 ....' Total: $35,00 1"0 ~~\, ~ \{\ 0 L\ () J \\)-~ Second Request *********** Please pay promptly Checks should be made payable to the Register of Wills. TetmS: Net 30. Please return one copy of this invoice with your payment. Thank you. '. . Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name ofDecedent: '- J kL f /:1 {'J. (!~tvJ( Date ofDeath: O.tf . - / ~ ~ 0 3 Estate No.: tJ... DO 3 - () 0 tr> (j 7 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: . Yes ~ No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be Date:~~r/ t/-O ~hed to tlrisreport J ~)riAJJ Slgnrue c, ,,-S aren K NCf'/kr-t. Name . 't I1n.-lltt 4vvn"eJ,A~..~ Address (7'e1so ) /7 7C:Ct- ss~3 Telephone No. Capacity: 0 Personal Representative o Counsel for personal representative vof I N R E ESTATE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOSEPH O. CLARK ORPHANS' COURT DIVISION C7 o r.y DECEASED NO. ~~- O~--Q~~rjl' n _o ~ ~ , `, ~' '- ~/ -~' c7 ~ > s -v ~.rn ~ _ 1 "- PETITION FOR CITATION ~~;~ ~ ~ ~ -, _ ; _, ~ -, _ ,, ~ ~ , -, . ~ , ~. - TO THE HONORABLE THE JUDGE OF SAID COURT: ..~=° ~ ~--~-~ ~-„ AND NOW, this ~~ ~, day of J~~~~c~ ~~eC' y. ~ , ~ _. ~ ~ ~ comes the Commonwealth of Pennsylvania, by Robert Freedenberg, Deputy Secretary for Taxation, for Thomas W. Wolf, Secretary of Revenue, who avers: 1. That Joseph O. Clark, deceased, (hereinafter referred to as"the Decedenfj died on April 18, 2003. 2. That a Petition for Letters of Administration was made by Sharon K. Neibert, Executrix (hereinafter referred to as "the Executrix"). Letters of Administration were granted to the Executrix on July 25, 2003. Attached hereto and made a part hereof is a copy of a document attesting to said date on which Letters were granted marked Exhibit "A." 3. That the Pennsylvania Department of Revenue did cause to have entered an appraisement and a "Notice of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions, and Assessment of Tax," was mailed to the Estate's Representative on April 18, 2005. Attached hereto and made a part hereof is a copy of said Notice of Appraisement and Assessment marked Exhibit "B." 4. That as of the date of this Petition, the balance of Pennsylvania Inheritance Tax remaining due and unpaid is $43,874.00, plus interest at the applicable statutory rates from January 19, 2004 until the date of payment. 5. That on January 11, 2008, a certified demand letter was mailed to the Executrix outlining the nature and amount of tax due and the consequences if not paid. A receipt was signed and returned to the Department of Revenue. Attached hereto and made a part hereof is a copy of said letter and receipt marked Exhibit "C." 6. That under Section 2176 of the Act of August 4, 1991, P.L. 97, No. 22, (72 P.S. § 9176), the Secretary of Revenue is authorized to request the Court to issue a Citation directed to those subject to any duty imposed by the aforesaid Act, commanding such persons to appear and show cause why the requirements of this Act should not be met. WHEREFORE, your Petitioner prays your Honorable Court to issue a Citation upon the Executrix, directing the Executrix to appear and show cause why said Inheritance Tax in the estate of the Decedent should not be paid as required by law; and to further direct that the costs of this action shall be borne by the Executrix. COMMONWEAL~`Isj O>I~PENNSYLVANIA BY Roba~ Deputy Taxation FOR: Thomas W. Wolf Secretary of Revenue COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF DAUPHIN Robert Freedenberg, Deputy Secretary for Taxation, for Thomas W. Wolf, Secretary of Revenue, being duly sworn according to law, deposes and says that the facts set forth in the foregoing Petition are true and correct to the best of his kno~w`i~d information and belief. Robert Freeden erg Deputy Secretary for For: Thomas W. Wolf Secretary of Revenue Sworn to and Subscribed before me this day of ' page. 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'? __ ~ an t"'enU!~1rlv,~ina {l~ laac s3zan:v-ilcd :n Fa~.3 i'st ~:aai l-?. ~ ~saax ~~srt C"u~nty y.~ p b°a~iar n; i~ il e~ aar rn fTrr+n,raz ¢n trlin~l J r 7~•~rlilti~~ ~ ~.~'d',r.._. 15_ ._:,,._.... '~4'F3Ei2(:FC)Et! . ;artltionet(5; _rr~~4,.ttu3ly ret ucMzta! t ~ pr~al> ca! zlac l~azY amx;M ar~l3 crnllci!(s~ y+r~-swntr~d lsaat,aiah and ¢Iso lssatar. rx€ kztczc„~~acaGa3~C~ alarrtxsa. t=cx,.r,»en r}: <rdan~r~xar~l~ar c c.a.: ;a~,iasrmrerntcH v7 b A e,t.a l 'R/rl'~~.1[7k ~JC Xy i:,.UR:'l YJ~1~&s Jti.~[-1R:lC .~3~'.T.I.Y l:~f. 6~Y 4 1!, T~f~;~a3itu'Cea'(%k s1 Gi7vrg•aat~5a~4 a,w cal(sy nr ~f'~irrr~cl tla at Stsx~ cs ialarrre!as in liar, iv7~~nysld$ ~ CSi6't~ri ~!'~ zrrrc acrd 4orac~~a t>a lhr fiac~z of rttr k.r:u+~i~~~,e ,tne3 krlic rrf~.cal?Irrrt:~rl+) ~n:3 a::a~ ax ~atrtii~;ttl a~~r~z+~n- a~,tivy~sl taC Yhi eztx+s~c Iiac•s~.iLrs4 Ix# iittratrstzD ~til +~r,l a~,vly .r,~•r~Iris1 r, ~ hr c~.raar s~~ rartfirtg t~c) 1~w. Sea»ca~yy tm car a#'filmeii anca ~uh~c`tltr~~ ~`a~_..',~`'-.~'~?_ 1.L_ ~ la~lrrre rrr~ is w.~S:~,._ w.,~_ e>• cal" - {.~~4 i:.__._ sn ~ l~yatl.t:;t tar , . _~__~_ _____ _. -_......._._ ~ aupcpu or :MDmouRL TgHE9 RtRIYI FRAME E 18 spp COMMONWEALTH OF PENNSYLVANIA INxERnmmr. Tqx DIVISION DEPAkTMENT OF REVENUE DEPT. 2a6cn1 NRRRID 11196. PR 1}12D-0601 NOTICE OF INNER ITp NCE ipN gPPRAI DC MONT. AL40NANC[ OD D78pLLONANCE Or OCDUCTf 0116 AND A59[Si REIIT DRTF 04-18-2005 REV-1547 EX aFF ((17 -b5> [9TRT[ or CLARK JOSEPH 0 ORTE Or OERTM 04-18-2003 FILE N0M0[R 21 D3-D607 couHTV CUMBERLAND pcM 101 DAVID W KNAUER ESD KNAUER a ASSOCS p.wvm, p,,,,,,, 411 A E MAIN ST MECHANICSBURG PA 17055 MAKE ERCCK PRYRDLC pN R[MIT PRYMCNT TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE > RETAIN LOWER PORTION FOR YOUR RECORDS < REV-1547 EX AFP (1-91) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CLARK JOSEPH 0 FILE N0.21 03-0607 ACN 101 DATE04-18-2D05 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( ) CHANGED RESERVA.ION CONCERNING FUTURE INTEREST - SEE R VERSE R - R ASE IG AL RETURN 1. Reel Estate (Schedule A) C1) 2. Stooks antl Bonds (Sohetlule B) (2) 209,00 00 . 3. Closely Held Stock/Partnership Interest (Schedule C) f3) ~- p~j 4. Morteasas/Notes Receivable (Schedu]al D) C4) --`p~ 5. Cash/Bank Deposits/Misc. Personal Property (Sohedule E)(5) 9 _ 6. Jointly Owned Property (Schedule F) (6) 0 7. Transfers (Schedule G) C7) +-~ 8. Total Assets (8) 300.408.00 APPROVED DEDUCTIONS AND EXEMPTIONS: (9) 7.912.00 9. Funeral Expenses/Administrative Costs/ Misoelleneous Expenses (Sohedule H) (l0) Dp , 10. Debts/Mortee9e Liabilities/Liens (Schedule I) (11) 1 7.912.00 1. Total Deduotlons (12) 12. Nst Value of Tax Return 29 4 6.00 (13) 13. Charitable/Governlrtental Bequests (Schedule J) (14) 1 D 2~Dp 4. Net Value of Estate Sub]ect to Tax NOTE: If en afcsassment was lssusd previously, lines 14, 15 and/or 16 and 17 will reflect 4ipures that include the total of ALL returns assessed to data . ASSESSMENT OF TAXs (IS) .OD X 00 00 15. Amount of Line 14 taxable at Spousal rate (16) .00 X 045 '~0 16. Amount of Line 14 taxable et Lintel/Class A rate (17) ~ pb X 12 , 17. Amount of Line 14 taxable et Collateral/Class B rata 292,496.00 1~ 9) 18. Pt•incipal Tex Due 43 874,pD TAX CREDITS: 4 4. D PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST (-) AMOUNT PAID TOTAL TAX CREDIT INTEREST IS CHARGED THROUGH 05-03-2005 BALANCE OF TAX DU Ri THE RATES APPLICABLE AS OUTLINED ON THE INTEREST 43 874 00 REVERSE SIDE OF THIS FORM TOTAL DUE , . 2,418.82 46,292.82 H If paid after date ]nd]cated, see reverse for oelouletlon of additional interest . ( If total due Ss less then $1, no payment is required. If total due ]s reflected es a "credit" (CR) you may be due a refund. Sae reverse side of th]s form for instructions.) ; euauu or IHRlvxoupL TAXES p•p FRAME F 18 ~** COMMDNWERLTB OF PENNSYLVANIA pIN [9JiA)IC[ rqx DI UICTON DERARTMENT OF REVENUE DCPT. 200601 NRR RI6DUR6. PR TFt 39-0001 HOTIC[ OF INN[gITR NCC TRx APPRg1DENElIi. ALLONRHC[ OR 078gLLONANCC OF DC DVCTIONS AHD R36E69MEHT egTE E9TRTE Or epTC OF UEpTM rILC HUMDER CQUNTY pCN `~ REV-7547 EX qFP [07-98 Y ~rrH~e~r e COMMONWEALTH OF PENNSYLVANIA HARRtssuxc cxsTRtcroFP~rE DEPARTMENT OF REVENUE STRAWBERRY SCE 4TH & WALNUT STS H.4RRISBURCS PA 1?123-0101 SHARON K NEIBERT 9 PINE HILL AVE MECHANICSBURG PA 17050 DATE: Estate of: REV-875F0 AFP (10-071 1/11/2008 JOSEPH 0 CLARK Date of Death: 4/ 18/2 0 03 File Number: 21 0 3- 0 6 0 7 A C N(s): (See Reverse Side) Dear SHARON K NEIBERT: (Certified Mail-Return Receipt Requested) This is to again advise you that the above estate is in a delinquent status. According to Depamnent records, the estate still is not settled. As of this date, you have failed to respond to prior contacts to resolve this matter. The Inheritance and Estate Tax Act mandates the filing of a tax return and payment of all outstanding liabilities by the personal representative, transferee, or beneficiary of the estate within nine months of the decedent's death. The Department's records show that this estate remains open because: CURRENT TAX LI_ABILITY OF $ 54632.43 INCLUDING INTEREST CALCULATED TO 2/5/2008 HAS NOT BEEN PAID. Accordingly, you are directed to pay all tax due including interest within thirty days fi-om the date of this letter. If you fail to comply with this directive, your case will be refen-ed for local enforcement and may result in the filing of a citation by this Depamnent with the Orphans' Court Division of the Court of Common Pleas, requiring you to appear in court to show cause for your failure to comply with the law. In order to protect the Commonwealth's interest, the Department of Revenue may also file a lien in Cumber 1 a n d County . Under Act 40 of 2005, additional collection costs including but not limited to fees of up to thirty-nine percent (39%) of the amount due, and attorney fees incurred in securing payment, may be imposed on any liability not paid prior to referral to a collection agency or contract counsel. MAKE CHECKS PAYABLE TO REGISTER OF WILLS AGENT Any questions regarding the tax liability of this estate, please CONTACT: HARRISBURG DISTRICT OFFICE STRAWBERRY SQ 4TH ~ WALNUT STS HARRISBURG PA 17128-0101 TDD# 1-800-447-3020 (Services for taxpayers with special hearing and/or speaking needs} Sincerely, ANASTASIA DIBARTOLOMEO (717)787-3863 cc: ~CHIB~ ~ EXHiB~?' ~" _~ ~ ~. ~ oA 1, s ~ ~ z~Q?~ ~ `S ~ b g~ m o ~ 5 ~ m ~ ~ ~ ~ ~'. m o ". v ~ E r9 v.. m a ~ ~ $::: ~ ~ ~ o a ~ o E~moE C` L T m ~_~ C. ~ w .... a N ~ `~~.0 ~ G Q -., '~ Z` ~ U U ~j o W p, . ~, ~ ~, 8 ~ a JO __~ _.: N~ m~ Q W " mSll~ ~~ _ ~in~ ~ YJV c ~ ~ e MF.. . `t ~ L U C m~ 11J = Q i V` C ~E ~"~° o ~ `?rJ ° o ~d ~ ~ ca~a ~iQ `0 6 c0.ig N ~ N ~.. ^ ~{~it'~:~ ~i I N R E ESTATE IN THE C URT OF COMMON PLEAS OF CUMBER ND COUl'~TTY, PENNSYLVANIA JOSEPH O. CLARK ORPHANS' COURT DI~ISION ~ C' ° ~ C © r ,aa 3~~~0 DECEASED NO. TERM ~r ~ ` . T'1 -~ I = fJ? ~ Gjl ORDER ,'"1l .~ ! ~z ~ a --+ ~- r~ ~ _ j Now, to wit this the (~ day of S ~ ~ P , Z a o ~ti ,upon consideration of the foregoing Petition, it is ORDERED and DECREED that OU, Sharon K. Neibert, Executrix for the Estate of Joseph O. Clark, deceased, are hereby cited t be and apfjear at Courtroom No. ~ , on the ~ day of ~~;~,•~ , in the Courthouse of Cu berland County, Pennsylvania, ate: 30 ~.M., then and there show cause, if any there be, why the I eritance Tax in said estate should not be paid; and to further direct that the cost of this action be orne by the said Executrix; said citation returnable at .M., on the day of 20 BY THE COURT -~J r-~ :-~ 4_~ ~~ t _ ~..j .. a ..~] l i 7"S ~~ --, ~--~ - i7 " '`l "'°_ ~~~' .,'~ ,--, T DrI~ISION J. IN RE ESTATE OF JOSEPH O. CLARK IN THE C URT OF I,IOMMON PLEAS CUMBER AND COUNTY, PENNSYLVANIA ORPHAN COURT D~VISION N n o ~r~ DECEASED NO. ~~ ~ - O~a~r `~.~- vpa ~~;-, '_ 7 PETITION FOR CITA TO THE HONORABLE THE JUDGE OF SAID LOUR' AND NOW, this c~i~ day ~ ' , ~ - _~ ~ . '~'r~ ~ ~ f j ~ ~ --=t ~N { > ,- ~ -~ lS.l '' _ i ~ 1 ~'~~~~~QC' ~ , `o ;, comes the Commonwealth of Pennsylvania, by Robert Fr edenberg, Dleputy Secretary for Taxation, for Thomas W. Wolf, Secretary of Revenue, who avers: 1. That Joseph O. Clark, deceased, (herein fter referred to as"the Decedenfj died on April 18, 2003. 2. That a Petition for Letters of Admini Executrix (hereinafter referred to as "the Executrix"). the Executrix on July 25, 20'03. Attached hereto and attesting to said date on which Letters were granted n 3. That the Pennsylvania Department of R• appraisement and a "Notice of Inheritance Tax Appraisem~ Deductions, and Assessment of Tax," was mailed to the Es 2005. Attached hereto and made a part hereof is a copy of Assessment marked Exhibit "B." ion was ma!~e by Sharon K. Neibert, ;rs of Administration were granted to apart herec-f is a copy of a document l Exhibit "AF." venue did dause to have entered an nt, Allowance or Disallowance of ate's Representative on April 18, paid Notice Hof Appraisement and 4. That as of the date of this Petition, the b Tax remaining due and unpaid is $43,874.00, plus intere~ January 19, 2004 until the date of payment. 5. That on January 11, 2008, a certified dE Executrix outlining the nature and amount of tax due and was signed and returned to the Department of Revenue. , is a copy of said letter and receipt marked Exhibit "C." 6. That under Section 2176 of the Act of P.S. § 9176), the Secretary df Revenue is authorized to re. directed to those subject to any duty imposed by the afore appear and show cause why the requirements of this Act s WHEREFORE, your Petitioner prays your upon the Executrix, directing the Executrix to appear and in the estate of the Decedent should not be paid as require costs of this action shall be borne by the Executrix. BY dance of Pennsylvania Inheritance at the applicable statutory rates from id letter vas mailed to the consequences if not paid. A receipt shed her~to and made a part hereof zst 4 1 I, 9~1, P.L. 97, No. 22, (72 a the Court to issue a Citation Act, commanding such persons to Auld not be' met. [onorable Court to issue a Citation -ow cause ~vhy said Inheritance Tax bylaw; and to further direct that the COMMONWEALjI`~j O~PENNISYLVANIA Ro Taxation FOR: T mas W. Wb~f Se retary of Revenue COMMONWEALTH OF ~'ENNSYLVANIA ss COUNTY OF DAUPHIN Robert Freedenberg, Deputy Secretary for Taxation, fdr Thomas W. Wolf, Secretary of Revenue, being duly sworn according to law deposes and says that the facts set forth in the foregoing Petition are true and correct to the best o his kn~~i~, in~'orrrnation and belief. For: Sworn to and Subscribed before me this day of -ert Free enGerg -uty Secr tary for T x Thomas ~V. Wolf Secretary of Revenge Page. I of I ~icr. ~ ~- ~.~tsptr~ayoryf ~,.~~_w IaYc~ar~N/oy.~ c1~~,~~n nc r , ~.wc+~i~ i/A~~/141llriN V# A ~V'L'Ii1Y Yv ~I.7~~ 0.J•~!"~.~. ~A. 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C:mnn 4', P rates lvaaia. withi h.~kS.,.~... , last fttmi!!^ t> ;hritmrti I rrttttsatce at ~~.~..~j ~ ~. ,trot, ~~ :rte tnatr,,~rntr, ~" FhY'ettdettt, tbtn ~ _ ... yr x of tiisd ~,~I _ ~ , .. _.. _ ., r~,,_~_ 1~5~°/~.__. ~ ~7L~..,.~'~~I~n4~~w~~[~Sr~.__...._._.__.. ~ _ t:ac zsE Ccatltxw . t~lrrtr did ttcht rnaxr ~, was tttxt d:ioarcr;9 atmd rd ttcx taaavca rhildrtu#rn M aeiatstcri, after excrwtismrt of tha ia~i~ utFerr¢f fsxr psobast, wttx not ctec tiurirrt taf a kitfin~ and +>;ax tak>•sr atijtutir,~xctil !)eeaxlrnt at Beath tewt##xS f#rc+y+tr:y with ewticntttscJ vattte4 ax Ptalttx r; ~y {!3'dpntlai~d to #'x.) Afl P~sanet y?raPatrty s~yr~ ... {If tlac rlat>ti;riaer3 in Ya:! Peru Im,cr{yerty~ u, Prnr~ylvanea C3~ {!{ nrrt dzrnsicr`Irct In Ima.) ~rratatcut pru~crty in C;narner W __.__...._........... _.. value of recd astats itj AaFnnsv9vansa cttnattrcl a3 d#tt~iux ~ _..__... ___..___............__._,_........ .._ ......._.._.w.. ~ ..~...._~._w._,.~I wliEt2C~tl[tl. tactttsonem(xl rt:.sRcrafutty rrruestfsi t t>r • ~ t#xt fa$t wmli staid c+adreaKsa' }#rexr#stad lterecith aad tht Prranr. ea3` krteerx_~i&~~.tr`~e r ~..._~ ..__. _...~».~._ _.. tac~inmxe y: txi,~nt +rrarawa F.t.tr.. aairrriwvkretiaw rf.D.ti.c.t.m.m tltCY{Ylr. n ._o. ....,~,a ~yr~.~.,,»., ~+~ ~t,~~t yyg~~irt+CAYtn{ 3ES3 ~~7L~ ~L;~~a~,«~1.I~E)a RlgF,t+~~ ~JRTi~74A.~ 4~'4J'~tTY~1•#T !.w17t 1.~,~! ~` ~Ca~f t~tw7 L4 ~aT ~ifkA ~ . T'tma peeisir(x} atsopc•#tama! m:weatr{s! nr aslPirtmm{s) tlxat the at: ixvt sad ~tre~.t to 1tm ~+rst aC tits kesau~kztge ttnd It«~#ie!' f xttM caui.cgs! ~fi ohr a~t~.'c c~cs~tr#£t ticisruarta) will wsMl y ~ ~~ to s» uffir and subscxibt~t! ~. ~~~~~ ~. ~x in tI#c f~ x~! ilzac as t~~tlee ~ >jang pesaion aec Banat :rt+t~ten- ~ rsr Inw. II ,~ ---- Page ~ of I IN A l:Kt!)tTS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+I INTEREST (-) AMOUNT PAID , OTAL TAX CREDIT 8 LANCE OF TAX DU INTEREST TOTAL DUE N If paid after data indicated, sae reverse for calculation of edditi ( If total d S nal interest. ue s less than S1, no payment is required. If total due may be tlue a re#und. Sea reverse side of this form for instruotions. is reflected as a "credit" (CR), you OUR[RB Oi INDIVIDURL TRN[9 R`w~ FRAME E 18 ~~• COMMONWEALTN OF PENNSYLVRN A ~' INNLRITRRCE Tpx DIVIYION DEPARTMENT OF REVENUE avT. ,{acol MRRRIi,VRO. •p T7r2{-8801 NOTICC Oi INNERITRNCC TRN APPRpI BC MFHT. ACED NR NCC OR {({pLLONp '. CE Or O[DUCTIONB RNO pitC {BNC11T DRTE ~I REV-1547 E% RFF f07-L61 04-18-20D5 '~. ''~. CBTRTE or CLARK ' JOSEPH ''~ 0 ogre or OCRTN 04-18-2003 rILE NUMBER 21 D3-D6D7 EouNTV CUMBERLAND DAVID W KNAUER ESO pON 101 KNAUER b ASSOCS R.wNq, 411 A E MAIN ST R..Ir*„ MECHANICSBURG PA 17D55 nReE N P Re E R acntT vRVncax ro REGISTER F WILLS CUMBERLAN CO COURT HOUSE CARLISLE. PA 17013 CUT AI:ONO THIS LINE > RETAIN LOW R PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (1-91) NOTICE OF INN RITA CE TAX APP AISEMENT, ALLOWA E OR DISALLOWANCE QF DEDUCTIONS AND ASSESSMENT OF T ESTATE OF CLARK JIDSEPH 0 FILE N0.21 03-0607 CN 101 rDATE04-18-2p05 TAX RETURN WA ( ) ACCEPTED AS FILED ( ) CHANG D VA. ION ONC RN G FUTUR TER T - S E S _ AL ,RETURN 3. Real Estate (Sohsdule A) (1) 2. Stooks and Bonds (Sohedule B) (2) 3. Closely Hsld Stock/Partnership In~erast (Schedule C) C3) 4. Mortgages/Notes Raosivab3a (S heduie D) (4) _ 5. Cash/Bank Deposits/Miso. Persgnal Property (Schedule E)(5) 6 J 1 408 00 _ . ointly Owned Property (Schadyie F) (6) . 7. Transfers (Schedule 0) (7) e. Total Assets (d) _ 300.40$.00 APPROVED DEDUCTIONS AND EXEMPTIONS: (qJ 9. Funeral Expenses/Administrativie Casts/ Hisosllanaous Expenses (Sohedulle H) (10) 0 10. Debts/Mortgage Liabilities/Liens (Schedule Y) 13. Total Diduotions (13',7 12. Nst Value of Tax Return (12 (13 13. Charitable/Oovernigental BegNests (Schedule J) (147 14. Net Value of Estate Subieot to Tax NOTE: If an sssessmen! Yes issued preViousiy, sines 14, 15 and/or 16 and 17 Yiii rsfisot ~isares that include !hs totes o} ALL returns assessed ASSESSMENT OF TAX= to date. (15) 35. Amount of Lins 14 taxable st S ousel rata (16) .0 X DO' 00 (17) 37. AAeiount of Line 14 taxable at C~llatsral%Cla seHe X 049 X 12 s rate 1B. Pr•inoipal Tex Dus 2 •4 1~ ~ 8 0 TAX CREDITS= ) . • PAYMENT DATE RECEIPT NUM R DISCOUNT (+) INTEREST (-) A OUNT PAID INTEREST IS CHARGED Tf~ROUGH 05-03-2005 T BAL AL TAX CREDIfi NCE OF TAX DU RT THE RATES APPLICAB E AS OUTLINED ON THE REVERSE SIDE OF THIS ~ORM INTEREST 43j,874.U0 TOTAL DUE 2'~,418.8Z N 461, 292.82 If paid after data intlioeted, sea rewarss for oaloulation of addition ( if total due is sass than S1 no t 1 interest. , paylman Ss required. If total due i may be due a refund. See reverse side of this form for instruotions.) reflected aS a "credit"'(CR): you euaceu or INBIYIBURL TRNE9 *'*Ir FRAME F 16 •*• COMMONWEALTH OF PENNSYLVRNIR 1xN[RITRIIC[ iRZ D/V18I011 DEPARTMENT OF REVENUE {FPT. a{ocoT NRR RI{{VRO. Pq 'I T1 ,1-0801 NOTIC[ 0i IHN[RIiRNtC TRx ' pPPRRI{CMCNT, pLLONRHCE OR DI{gLLONpNCC Or DCDUCTI ONB qND p{BEBBNE117 ORT[ REV-7547 EX qFA 107-96)' [eTRT[ Or DRTE Or DERTN FILE NUMe[R couNTV RcN ~e~~~ f HARRISBURG DISTRICT OFFICE STRAWBERRY SO 4TH &c WALNUT STS HARRISBURG PA 1?128-0101 SHARON K NEIBERT 9 PINE HILL AVE MECHANICSBURG PA COMMONWEALTH OF PEr DEP.~RTMENT OF RE 17050 Dear SHARON K NEIBERt: YLVANIA REV-875F0 AFP (IO-07) DATE: 1/11/2008 Estate of: JOSEPH O CLARK Date of Death: 4/18/'20 03 File Number: 21 0 3' - 0 6 0 7 A C N(s}: (See Reverse Side) CCertifi~d Mail-F2eturn Receipt Requested) This is to again advise you that the above estate is in a d linquent status. According to Depamnent records; the es(ate still is not settled. As of this ate, you have failed to respond to prior contacts to resolve this matter. The Inheritance and Estate Tax Act mandates the filing f a tax return' and paylnetlt of all outstanding liabilities by the personal representative, tra sferee, or beneficiary of the estate within nine months of the decedent's death. The Departlnent's reco>xls show that this estate remains c~nen because:. CURRENT TAX LIABILITY OF $ 54632.43 kNCLUDIN(~ INTEREST CALCULATED TO 2/ 5/ 2 0 0 8 HAS N T BEEN PAID. Accordingly, you are directed to pay all tax due includi g interest within thirty,days fiom the date of this letter. If you fail to comply with this dire rve, your case will be re~'erred for local enforcement and may result in the filing of a citation y this Departient with tl~e Orphans' Court Division of the Court of Common Pleas, requii ng you to appear in court to show cause for your failure to' comply with the law. In order t protect the Commonweiilth's interest, the Department of Revenue may also file a lien in Cumber 1 a n d County . Under Act 40 of 20051, additional collection costs in luding but riot lunited t~ fees of up to thirty-nine percent Q39%) of the amount due, and orney fees incurred in', securing payment, may be irlnposed on any liability not pai prior to referral to a collection agency or contract counsel. MAKE CHECKS PAYABLE TO REGISTER OF WILLS, AGENT Any questions regarding the'... tax liability of this estate, please CONTACT: HARRISBURG DISTRICT OFFICE STRAWBERRY SQ 4TH K WALNUT STS HARRISBURG PA 17128-0101 TDD# 1-800-447-3020 (Services for taxpayers with special hearing and/or speaking needs) Sincerely AN.AST~ISIA DIBA''RTOLDMEO~ (717)87-3863 cc: ~Ft18~ C ~(H1B1T r• In Re: JOSEPH O CLARK ORP NS' COURT DIVISION COU T OF COMMON PLEAS OF CUM ERLAND COUNTY PENN YLVANIA N0.2 -03-0607 CERTIFICATE OF SERVICE F ORDER ORDER DATE: 9/16/2008 JUDGE'S INITIALS: JWO TIME STAMP DATE: 09/15/2008 IN ~~ ORDER SERVICE TO: PA DEPT nF RFV_e~.re c~r~ ~~~ METHOD OF MAILING: ® USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: 9/ 16/08 r;N VEL PES PROM ED BY: ® PET TIONER ^ JUD E ', ^ CLE OF ORPHANS COUR'~ SERVICE TO: METHOD OF MAILING: ^ USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: ~NVELCPES PROVIDED BY: ^ PETI IONER ^ JUDG ^ CLE OF ORPHANS COURT '. Deputy Clerk of Orph s' Court ESTATE OF JOSEPH O. CLARK, TO: Ms. Sharon K. Neibert 9 Pine Hill Avenue Mechancisburg, PA 17050 THE REGISTER OF WILLS OF LAND COUNTY, PENNSYLVANIA N .21-03-0607 c-n `~' ~© ~ - ~ cn ~ _ ~~ -~ r- - . r r"i - CITATION '_ rJ ~ ~ - -- ~_ -r -,-, - ~. ~ --~ rv _ , c,a .. v~ GREETINGS. YOU ARC HEREBY CITED to be and a pear before the Honorable Uudges of the Common Pleas Orphans' Court Division on or before the 7th day of Octob r , 2008 , in Court Room Alo. 1 , at 3 : 3 0 o'clock, P.M., to show cause why Intheritance Tax should not be paid 'n the Estate of Joseph O.I Clark, now deceased, docketed to 21-0_ 3_06p7. Q Date a Farner Strasbaugh, Regis er of • ~~' NS' COURT DIVISION In Re: JOSEPH O CLARK COU T OF COMMON PLEAS OF CUM ERLAND COUNTY • PENN YLVANIA • NO. 2103-0607 CERTIFICATE OF SERVICE F ORDER ORDER DATE: 9/16/2008 JUDGE'S INITIALS: GFS TIME STAMP DATE: 09/15/2008 IN ~' CITATION SERVICE TO: PA DEPT nF T?~v ~,.,. ~... ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, -' /Ll\ METHOD OF MAILING: ® USPS ENVE ^ RRR ®PE' DELIVERED ^ OTHER ~ CLl MAILED: 9/16/08 OF ORPHANS COURT SERVICE TO: ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, METHOD OF MAILING: ^ USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: ^ PETITIi ^ JUDGE ^ CLERK Deputy Clerk of Orphans' ORPHANS COURT IN RE: ESTATE OF IN THE COURT OF COMMON PLEAS OF JOSEPH O. CLARK, CUMBERLAND COUNTY, PENNSYLVANIA Deceased ORPHANS' COURT DIVISION No. 21-03-0607 IN RE: PETITION FOR CITATION ORDER OF COURT AND NOW, this 7th day of October, 2008, upon consideration of the Petition for Citation filed by the Commonwealth of Pennsylvania, Secretary of Revenue, respecting the payment of the inheritance tax in the above-captioned matter, and pursuant to an agreement reached between the Commonwealth in the person of Lora A. Kulick, Esquire, and the Estate in the person of David W. Knauer, Esquire, it is ordered and directed that the Respondent enter into a payment plan with the obligation to pay $100.00 per month, and her husband Smith Neibert will co-sign a mortgage lien in favor of the Commonwealth on property situated at 9 Pine Hill Avenue, Mechanicsburg, Pennsylvania, 17050, which shall be entered of record in the Office of Recorder of Deeds for Cumberland County. Lora A. Kulick, Esquire Senior Counsel Office of Chief Counsel Strawberry Square P.O. Box 281061 Harrisburg, PA 17128-1061 For Petitioner n ~-- O ":-; ~ -° n '` :r ~ m --~ ~-, '-" =~ :: .._ _~ ~4 N m c~ c-~ --~ tx~ z.. ~.o cn -~t _ ,~ _. j r, . David W. Knauer, Esquire 411-A-East Main Street Mechanicsburg, PA 17055 For Estate :mae By the Court, 1 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF In Re: JOSEPH O CLARK CUMBERLAND COUNTY PENNSYLVANIA N0.21-03-0607 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 10/7/08 JUDGE'S INITIALS: JWO TIME STAMP DATE: 10-08-08 IN ~: ORDER OF COURT SERVICE TO: LORA A KULICK DAVID W KNAUER METHOD OF MAILING: ® USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: 10/8/08 SERVICE TO: ENVELOPES PROVIDED BY: ^ PETITIONER ® JUDGE ^ CLERK OF ORPHANS COURT METHOD OF MAILING: ^ USPS ^ RRR ^ HAND DELIVERED ^ OTHER MAILED: ENVELOPES PROVIDED BY: ^ PETITIONER ^ JUDGE ^ CLERK OF ORPHANS COURT Deputy Clerk of Orphans' Court Pennsylvania Depaitmcnt of Rey°enue Bwriu of Individual Taxes Inheritance Tax Divi.,ion Post Assessment Rc~enue 'nit PO [3os 2g0001 ~~alrlS~lir~, PA ~~~-~~-11(>I)~ Date: November 13, 2005 Subject: Lien Entry To: Register of Wills iLu~Il {~.~'~#~ ~ ~ t ~~' V~ ORP' 1 ~' ~~'T CUt~":'~ ' ;~ . Ph ~~. `r,~ y-, s~,~y From: Laurel Fulmer Supervisor Attached are copies of liens entered against estates in your county. Please mark the estate records to indicate the entry of the lien and the lien filing cost due to the Department. ;loseph O. Clark LF:sej attachments 21 03-0607 08-6505 Civil ~~ BUREAU OF COMPLIANCE DEPT 280948 HARRISBURG, PA 17128-0946 8 ~(a~ t ~ n, LU:?C1 C~E~I ~ ~ ~ E'i~ ~L' Q . Ph .~ . REV-I59 CM AFP (07105) DocxET # 0~ - t, S ~ 5 e,,i,~ T~ DATE FEES COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 21 03-0607 NAME AND ADDRESS: JOSEPH O CLARK DATE OF DEATH: 04/18/03 PROPERTY LOCATION: 9 PINE HILL AVENUE MECHANICSBURG PA 17050 TO THE PROTHONOTARY OF SAID COURT: PURSUANT TO THE LAWS OF THE COMMONWEALTH OF PENNSYLVANIA TO EEENTERED OF RE ONRD N YOUR CORT~IF~D COPY OF LIEN CERTIFIED COPY OF LIEN DATE OF CLASS OF TAX PERIOD ASSESSMENT IDENTIFYING TAX TOTAL TAX (OR DUE DATE) DETERMINATION NUMBER OR SETTLEMENT INH/EST 01/18/04 04/18/05 2103-0607 $43,874.00 $56,873.16 ~ ~; N c~ ~ :~: -f-, --_ ~~-i _ - - _ I C;J =7 tit y ~- ...Jf R ' • -f _ t - ..1' C.-3 CJ"5 "~ TOTALS $43,874.00 $56,873.16 FILING FEE (S) $19,00 INTEREST COMPUTATION DATE 01/19/04 - 10/28/08 The undersigned, the Secretary of revenue (or his authorized delegate) o(the Commonwealth ADDITIONAL INTEREST of Pennsylvania, cenif es this to be true and correct copy of a lien against the above named interest, additions or penalties thereon due from such taxpayer and taxpayer for unpaid tax , which, after demand for payment thereof, remains unpaid. The amount of such unpaid tas, Interest, additions or penalties is a lien in favor of the commonwealth of Pennsylvania upon SETTLEMENT TOTAL as the case may be r onal or bout l ' h $56,892.16 . , , s properly, rea , pe s e taxpayer t f~' __ SECRETARY OF REVENUE DATE (OR AUTHORIZED DELEGATE) PART 2 - TO BE RETURNED TO THE DEPARTMENT OF REVENUE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NEIBERT SHARON 9 PINE HILL AVENUE MECHANICSBURG, PA 17050 -------- fold ESTATE INFORMATION: ssN: iai-~s-s3s~ FILE NUMBER: 2103-0607 DECEDENT NAME: CLARK JOSEPH O DATE OF PAYMENT: 1 2/02/2008 POSTMARK DATE: 1 2/01 /2008 couNTY: CUMBERLAND DATE OF DEATH: 04/18/2003 REV-1162 EX111-96) NO. CD 010579 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ S 100.00 TOTAL AMOUNT PAID: REMARKS: CHECK# 0769 SEAL INITIALS: AJW RECEIVED BY: S 100.00 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~,~ .~~r~\~_ t...! ~~~. '^` ~~ ~. • f ':~ ,~ "~ .~ / 1 ~~ t ^,.. ~~ ;: tt 1~ ;i t ~ ~ii. ~l~ ie t.'} ~.: ..t COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2$0601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NEIBERT SHARON 9 PINE HILL AVENUE MECHANICSBURG, PA 17050 fold ESTATE INFORMATION: SSN: ~8~-~8-9361 FILE NUMBER: 2103-0607 DECEDENT NAME: CLARK JOSEPH O DATE OF PAYMENT: 07/28/2009 POSTMARK DATE: 07/27/2009 couNTY: CUMBERLAND DATE OF DEATH: 04/18/2003 REV-1162 EX(11-961 N0. CD 01 1536 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $ 800.00 TOTAL AMOUNT PAID: REMARKS: CHECK# 830 SEAL INITIALS: CJ $800.00 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS :~ ;; t i 3 ~t .~t M:> i.+~ ~ t; { t¢ .~: ,;f ,ter ~~'~,"~~ ~1 O GL z°'°° Q=` ~- o=~ . sx-~ ~~~ ~a~ ; i I `J ._ ~ _ ~ ~~ ~ .~ V ~' v 'off _~~ .... '~ ~ :?1 ~ .~ Q ~ 601 ~~~ r. - ., . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: REV-1162 EX111-961 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NEIBERT SHARON 9 PINE HILL AVENUE MECHANICSBURG, PA 17050 NO. CD 01 1829 ACN ASSESSMENT AMOUNT CONTROL NUMBER told ESTATE INFORMATION: ssN: is~-is-s3s~ FILE NUMBER: 2103-0607 DECEDENT NAME: CLARK JOSEPH O DATE OF PAYMENT: 10/05/2009 POSTMARK DATE: 10/02/2009 couNTY: CUMBERLAND DATE OF DEATH: 04/18/2003 101 ~ 5200.00 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 0880 INITIALS: DM RECEIVED BY: 5200.00 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~„~ .~ ~ '~' ;~;r,~~.,-.,~,., r ~.~ , ~„ . ~~ ~ 1.24 fi' C!J; ;ART ~' .,~ . Pis fi.:. .... i l ~~f !~` E~~ ~'+i !iF !t 7"~ ~i ~1~ 11~ v ``XX'~ ' ~ ,VY~R '~. ~ r ~~ 1f/~ l { } . 1 ;:~ ~;~: ~= .~ ,..; ux. ~; 11 ~~ ~., ~- >k. ,~ ~: w~ -~~ '._1 ~r e BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 SHARON K NEIBERT 9 PINE HILL AVE MECHANICSBURG PA 17050 pennsylvania ~ DEPARTMENT OF REVENUE REV-1165 IT DOCEXEC (12-10) NOTICE OF ASSESSMENT TAX AMNESTY NONPARTICIPATION PENALTY FILE NUMBER :............................ 2103-0607 ESTATE NAME ............................ JOSEPH O CLARK NOTICE DATE :............................. December 17, 2010 ASSESSED PENALTY DUE:........$2,955.16 Inquiries: 717-787-8327 Special Speaking/Hearing Needs Hotline: 1-800-447-3020 Appeal Due Date: February 15, 2011 If due date is on a weekend, petition may be filed the next business day. BASIS OF ASSESSMENT TAX AMNESTY NONPARTICIPATION PENALTY The account identified above was notified of the opportunity to participate in Pennsylvania's Tax Amnesty program, which ran from April 26 to June 18, 2010. During the Tax Amnesty program, the Department of Revenue waived all penalties and half the accrued interest for anyone who filed and paid state taxes delinquent as of June 30, 2009. In accordance with Act 48 of 2009, any taxpayer who failed to take advantage of this limited opportunity is subject to a 5 percent nonparticipation penalty. Department records indicate this taxpayer did not participate in the 2010 Tax Amnesty program or the taxpayer's tax amnesty application was denied. Therefore, the 5 percent nonparticipation penalty applies to all amnesty-eligible periods and was calculated on the balance of remaining tax, penalty and/or interest. This assessment may be appealed by petitioning the Board of Appeals. However, the board will only consider petitions contesting the 5 percent nonparticipation penalty assessment, because the appeal period(s) expired for the overdue tax, interest and/or other penalties that serve as the basis of this assessment. See reverse for appeals information. The assessed penalty due includes only the 2010 Tax Amnesty 5 percent nonparticipation penalty. To make payment, call 717-787-8327 for the current balance, then make check payable to REGISTER OF WILLS, AGENT. Include the file number on the check, provide a copy of this assessment notice along with the check and mail payment to: REGISTER OF WILLS 1 COURTHOUSE SQUARE ~.~ CARLISLE PA 17013 c7 ` ~" ~~a~Jry ~ { -.1-. ^ ' .SFr ~. _ ~1..~ ~. ~~} C "~ 'Y~Ja t: ,~} ~ ~;, GENERAL APPEAL INFORMATION PETITION FOR REASSESSMENT An appeal may be filed electronically at www.boardofapaeals.state.pa.us or Any taxpayer against whom an assessment is made may petition for a in writing using a petition form (REV-65) and appeal schedule (REV-39). record adjustment electronically or in writing within 60 days of the Forms are available online at www.revenue.state.pa.us or by calling assessment notice date. Petitions must set forth in reasonable detail the 1-888-728-2937, grounds upon which the taxpayer claims the assessment is erroneous or unlawful. Each Petition must contain the following: 1. Name and Address of Taxpayer The department may require the filing of a bond or other security from 2. File Number anyone petitioning for reassessment. If required, a bond must be issued by 3. Notice Date a surety company authorized to do business in Pennsylvania and approved 4. Estate Name by the Insurance Commissioner. 5. Assessed Penalty Due (call 717-787-8327 for current amount due) FILING OF LIEN Each Petition must be signed and include an affidavit or affirmation that the The department must receive full payment or an appeal petition in the facts contained are true and correct. If filing electronically, refer to the allotted time or a lien may be filed against the taxpayer for the assessed "signature" tab on the Board of Appeals online petition form. liability. If filing an appeal by mail, send to: PA DEPARTMENT OF REVENUE BOARD OF APPEALS PO BOX 281021 HARRISBURG, PA 17128-1021 An appeal is considered to be timely if: (a) It is electronically submitted by 11:59 p.m. Eastern Time on or before the appeal due date; or (b) It is submitted in writing and bears a U.S. Postal Service postmark on or before the appeal due date. The Board of Appeals will hold hearings upon petitions as necessary, and a taxpayer will be notified of the time and place of any hearings. PAYMENT OF ACCOUNT: The assessed penalty due includes only the 2010 Tax Amnesty 5 percent nonparticipation penalty. To make payment, call 717-787-8327 for the current balance, then make check payable to REGISTER OF WILLS, AGENT. Include the file number on the check, provide a copy of this assessment notice along with the check and mail payment to the appropriate County Register of Wills. OTHER CHARGES • Per Act 40 of 2005, any case referred to a collection agency may be subject to additional fees, including but not limited to attorney's fees and collection fees up to 39 percent of the liability not paid before referral. G~uestions to the Board of Appeals may be directed to 717-783-3664. Other options for voicing objection include appealing to the Orphans' Court or filing election to have the matter determined at the audit of the account of the personal representative. •~ - =.. FILE NUMBER :............................ 2103-0607 CALCULATION DETAIL: 2010 TAX AMNESTY NONPARTICIPATION PENALTY ESTATE NAME JOSEPH O CLARK TAX TYPE: INHERITANCE TAX ACN Liability NPP Penalty ACN Liability NPP .Penalty ACN Liability NPP Penalty 101 59,103.20 2,955.16 Total 2010 Tax Amnest Non artici ation Penalt $2,955.16 NOTE: Liability includes tax, interest and/or penalties. NPP Penalty is the 2010 Tax Amnesty 5 percent nonparticipation penalty authorized by Act 48 of 2009. For the current payoff amount call the BUREAU OF INDIVIDUAL TAXES at 717-787-8327.