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Home My WebLink About03-0701 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER - 0,,.3 O/TO I COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z Monacchio, Emma J 144 - 09 -2283 r'3 DATE OF DEATH (Mf¢-DD-YEAR) ' DATE OF BIRTH (IvI~!-DD-YEAR THIS RETURN MUST BE FILED IN DUPLICATE WITH THE L~ 4/17/2003 I 4/5/1907 REGISTER OF WILLS LLJ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER !. Origina[ Return 4 Limited Estate ~--'~ 6 Decedent Died Testate (At~a~.h ir'-~ g. Litigation Proceeds Received ~'~2. Supplemental Return L__j 4a Future Interest Compromise (date of dea'~, crier 12-12-82) ?-]7 Decedent Mainiained a Living Trust (Allach cop)' of T~sl) E~10. Spousal Poverty Credit (dale of dea~ b~tween 12-31-91 and '~]S. Remainder Return (6aI~ ofoe~ prior~e 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (A~tacf, S~ O) l,IJ NAME John S. Kostukovich FIRM NAME (,Ap¢ica~e) John S. Kostukovich, CPA TELEPHONE NUIvlBER (717) 730-0820 COMPLETEMAILINGADDRESS 1104 ~e=~oo~ A~e~ue Suite 302 Camp Hill, PA 17011 z 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporalion, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cesh, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ?--]Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property {7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (g) 10. Debts of Decedent, Modgage Liabilities, & Liens (Schedule I) (10) 2 8 11. To~al Deductions (total Lines 9 & 10) (11) 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 34,491 (8) 12,511 OFFICIAL USE ONLY 34,491 12,539 21,952 21,952 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) .......................................................................... x .0 ........(15) 21 , 952 16. Amount of Line 14 taxable at lineal rate ........................................................................... x .0 ......... 4 5 (16) 988 17. Amount of Line 14 taxable at sibling rate .......................................................................... x A2 (17) 18. Amount of Line 14 taxable at collateral rate .......................................................................... x .15 (18) 19. Tax Due (19) 988 20. ~ ' ~ ' Decedent's Complete Address: STREET ADDRESS 1414 Country Drive CiTY Mechanicsburg STATE PA ZP 1 7055 Tax Payments and Credits: 1. Tax Due (Page 1 Line !9) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits ( A + B + C ) 3. Interest/Penalty if applicable D. Interest F. Penalty Total interest/Penalty ( D -' z ) 4. If Line 2 is greater than Line ! "- Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. ~ ~ in~' 4 + Line ~ is ¢=',~ ~n.~. the difference. This is the TAX DUE. ...... grv~vr than Line 2, ,~ tar A. Enter the interest on the tax due. (1) 988 (5) (SA) (EB) 9 '8 8 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 9 8 8 Make Check Payab/e to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ~"~¢ [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. tnder penalties of perjury, I declare that I have examined th~ return, including accompanying schedules and stalements, and to the best of my knowledge and belief, i~ is true, correct and complete. ~edaration of preparer other than the personal representative is based on all information of which preparer has any knowledge ,DDRESS (3 ~,~ 1414 Country Drive, Mechanicsburg, PA 17055 Fernwood Ave, Suite 302, Camp Hill, PA 17011 or 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% '2 P.S. §9118 (al (1.1)(ill. or dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. he statute does not exemet 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 ~e surviving spouse is the only beneficiary. or dates of death on or after July 1, 2000: ne 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, · a stepparent of the child is 0% [72 P.S. §g118(a)(1.2)]. '~e tax rate imposed on the net value of transfers to or for the use of the decedent's iineat beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. qe tax rate imposed on the net value of transfers to or for the use of the decedent's siblinos is 12% F2 P.S. §9118(a)(1.3)). A sibling is defined, under Section 9102, as an dividual who has at least one parent in common with the decedent, whether by blood or adoptS'on. RE\/-1503 EX4- (6-95) COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDE NT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Moncchio, Emma J FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F, iTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I. Oppenheimer Capital Income Fund, Class A 7,064 2 Oppenheimer Global Fund, Class A The Hartford Growth Opportunities TOTAL (Also enter on line 2, Recapitulation) {if more space is needed, insed additional sheets of the same size) 18,075 9,352 3.4,491 REV-1511 EX+ (12-@9) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Monacchio, Emma J Debts of decedent must be reported on Schedule I, iTEM NUMBER DESCRIPTION AMOUNT 1. 5. 6. 7. FUNERALEXPENSES: Trinka-Faustini Funeral Sgobba's Monument Works Service ADMIN ISTRATWE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/ElN Number of Personal Representative(s) Street Address City State ~ Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedenI's address is not the same as claimant's, attach explanation) Claimant Street Address City State __ Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees John S. Kostukovich, CPA Tax Return Preparer's Fees TOTAL (Also enter on iine 9, Recapitulation} (If more space is needed, insert additional sheets of the same size) 11,726 385 400 12,511 S REV-!512 COMMONW=.-ALTH O? PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Monacchio, Emma J include unreimbursed medica[ expenses. iTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Pinnacle Health Hospitals TOTAL (Also enter on line 10, Recapitulation) 28 28 (If more space is needed, insert additional sheets of the same size) REV-!515 EX+ COMMONWEALTH OF PENNSYLVANIA INHERITANCE T;.vXRETURN RESIDENT DECEDENT SCHEDULE J ESTATE OF FILE NUMBER Monacchio, Emma J RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do No~. List Trustee(s) OF ESTATE I TAXABLE D',STRIBUTIONS [include outright spousal distributions, and transfers under Sec 9116 (a) (1.2)] Gerald Monacchio 1429 Pine Acres Blvd Bayshore, NY 11706-4949 son 100.0% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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) Pinnacle Health Hospitals P.O. BOX 2353 HARRISBURG, PA 17105 For Account Information, Please Call (717) 230-3717 Transaction Date Statement of/lccount 06/17/03 06/17/03 06/17/03 06/17/03 06/17/03 04/17/03 06/17/03 06/17/03 06/17/03 06/17/03 06/17/03 06/17/03 06/17/03 06/17/03 06/17/03 06/17/03 06/17/03 06/17/03 06/17/03 06/17/03 Es.___~timated Insurance Due: .00 Description PREVIOUS BALANCE 1EMER MED VISIT V P/F 99285 1 EMER MED VISIT V ~ 1 VISIT LEVEL 5 E 99285 AIRWAY INHALATION EX 96660 CBC & AU'FO DIFFERENTIA850Z5 CK 82550 PTT 85730 URINE MICROSCOPIC 81015 PROTHROMBIN TIME 85610 CKMB 82553 BASIC METABOLIC PANEL 80068 TROPONIN I 86686 BLOOD CULTURE BACTI 87060 BLOOD CULTURE BACTI 87060 SENSITIVITY 87186 ARTERIAL BLOOD GAS 82803 CHEST 1 VIEW 71010 PORTABLE 00000 PORTABLE 00000 ALBUTER 20HL BTL Total Patient Credits: Amount .00 363.00 .00 639.00 /30.00 61.00 60.00 37.00 18.00 37.00 62.00 75.00 57.00 160.00 160.00 59.00 205.00 107.00 163.00 163.00- 20.95 Account Balance: 28.40 CUSTOMER SERVICE HOURS MON-WED-FRI 7:00AM TO 4:00PM TUES-THUR 7:00AM TO 6:00PM CALL 717-230-3717 LOCAL OR 1-800-603-6064 OUT OF AREA ............................... : .............. _ ..... Please detach and return with ur lent ................... yq.- p.a~._. TRINKA- FAUSTINI VINCENT L. FAUSTIN! Il, Mg,". N.J. Lic. #4172 Tuesday, July 15, 2003 Mrs. Mary Ann Everett 1414 Country Drive Mechanicsburg, PA 17055 Dear Mrs. Everett, Reference: Emma J. Monacchio: PROFESSIONAL SERVICES, FACILITIES & AUTOMOTIVE Services Of Funeral Director And Staff Readjust/Reposition USE OF FACILITIES AND EQUIPMENT Use Of Facilities For Viewing/Visitation Building And/or Director For Ceremony AUTOMOTIVE EQUIPMENT Hearse (funeral Coach) SPECIAL SERVICES Receive Remains FUNERAL MERCHANDISE Outer Burial Container Monticello Vault TOTAL FUNERAL CHARGES (I-W & Pkg Services) CASH ADVANCED FOR YOUR CONVENIENCE Cemetery/Crematory Clergy Honorarium Funeral Day Attendants Newspaper Notices Record Total Gratuity PA Funeral Home Card of Thanks SUBTOTAL: Cash Disbursements TOTAL ESTIMATE (I-V & Packaged Services) LESS: Total Payments 14,257.89 6/14/03 Ck # 85052 700.00 125.00 800.00 5t5.00 265.00 200.00 ,220.00 $1,000.00 $ 325.00 $ 300.00 $ 324.00 $40.00 $ 5,860.50 $ 51.50 LESS: Refund of Overpayment $3,825.00 $7,9Ol.OO $11,726.00 $14,257.89 $2,531.89 PAID IN FULL $0.00 FUNERAL SERVICE ............................... June 27, 2003 Mary Ann Everett 1414 Country Drive Mechanicsburg, PA 17055 Malpezzi Funeral Home 8 Market Plaza Way Mechanicsburg, PA 17055 (717)697-4696 The Funeral Service for Emma J. Monacchio We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Other Preparation of Body ..................... $85.00 3. AUTOMOTIVE EQUIPMENT Out of town transportation ..................... $255.00 FUNERAL HOME SERVICE CHARGES ............ $340.00 SELECTED MERCHANDISE: Golden Sand ......................... $2955.00 Register, Memorial Cards, Ackn.. .................. $58.00 Keepsake Plaque ........................ $160.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED ............... $3513.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. C. SPECIAL CHARGES Forwarding of remains to New Jersey .................. CASH ADVANCES Newspaper Notices - Local ..................... $92.50 Certified Copies of the Death Certificate ................. $20.00 Flowers ........................... $490.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES ........ $2347.50 CONTRACT PRICE ................... $5860.50 HISTORY 06/27/2003 Payment ....................... $-5860.50 TOTAL AMOUNT DUE .................. $0.00 $1745.00 Please SGOBBA'S MONUMENT WORKS I TOTOWA AVENUE (TOTOWA AVE. AT LINCOLN BRIDGE), PATERSON, NJ 07502 (973) 595-8705 Date I hereby authorize SGOBBA'S MONUMENT WORKS to letter, repair, clean monument in .................................................................... ................................................. 22.1..r..:::.:,:::~.:: ...................................................................... Cemetery. Section ..................... ,!.:d ....................................... Lot ..................... .i..~i..Z_.;};, ................................... Block ....................................................... Grave ..................................................................... Family Name .................................................................... ~:~i~.'-% :5.!2~..:-Ji.; 2 ......................................................................................................................................................................................................... Inscription:~ ....................................................................................................................................................... : with pavmer~ Thank you .............................................. Inscrip'tio~.~ $ 335~00 Location: L 385 Amount $ .............................................. / / ///,,/, / The above work to be completed as soon as possible. Upon completion the amount of ........................................................................ to be paid to SGOBBA'S MONUMENT WORKS. Interest at the rate of 6% charged on all accounts past due. Mrs ;¢~ ,.* v = -,",',-, Everett Name ....................... ';'"i":"'~ ................ . ........... : .................................................................... SGOBBA'S MONUME~NT(WOi~KS~ ,~---~,. 'Address . ~k'"'B" ~~ - ~ ....................................................................................... ................................................................ ~... - ~,'~-~,.,~ ..... / · tr--'/4.~,'%' ~:<¢"~-,,:- .;' ;' ,.-,~ Y~/ ~ ~ ~'"';""'r~ ........... "'"i' ................................. ::'~ ..................................... ~'-"~:Y'":'t ................. . / ¢' .'" ~urcnaser Phone ......................... ::~,L.~...J....~...=.~....,..Z.=.,,:.:r~.,~.:J .............................................. ,, 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 O02944 KOSTUKOVICH JOHN S 1104 FERNWOOD AVENUE SUITE 302 CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 144-09-2283 FILE NUMBER: 2103-0701 DECEDENT NAME: MONACCHIO EMMA J DATE OF PAYMENT: 08/26/2003 POSTMARK DATE: 08/25/2003 COUNTY: CUMBERLAND DATE OF DEATH: 04/17/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $988.00 TOTAL AMOUNT PAID' $988.00 REMARKS: MARYANN J EVERETT C/O JOHN KOSTUKOVICH SEAL CHECK# 138 INITIALS: VZ RECEIVED BY.' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS U.S. POSTAGE .._ PAID AMOUNT McCHANZCSBUAG,FA 17055 oooo '~'~ .U~ h,,lll,,,;ll,,,,.,~,,.., First Class Mail I!elN sselo ts~!d Register of Wills 1 Courthouse Sq Carlisle, PA 17013 BUREAU OF ZNDZVZDUAL TAXES INHERITANCE TAX DZVZSZON DEPT. Z8060! HARRISBURG, PA 1712&-0601 CONNONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX JOHN S KOSTUKOV'rCH STE $OZ 110,4 FERNWOOD AVE 'r. CARP HILL PA 176~1 DATE ESTATE OF DATE OF DEATH FILE NUHBER *~COUNTY ACN REV-iSq7 EX AFP COl-nS) 10-15-2005 HONACCHIO EHHA J 04-17-2005 21 05-0701 CUHBERLAND 101 Amount Remitted I HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAZN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03} NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF HONACCHIO EHNA J FZLE NO. 21 03-0701 ACN 101 DATE 10-15-2005 TAX RETURN NAS: (X) ACCEPTED AS FILED ( } CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERS=. APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) ~. Hortgagas/Notes Receivable (Schedule D) (~) 5. Cash/Bank Daposits/Hisc. Personal Property (Schedule E) (5) 6. Jointly O~ned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expanses/Ada. Costs/Nisc. Expenses (Schedule H) (9) 10. Dabts/Nortgaga Liabilities/Liens (Schedule 1) (10) 11. Total Deductions 12. Nat Value of Tax Return 13. 1~. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Nat Value of Estate Subject to Tax .00 $4~491.00 .00 .00 .00 .00 .00 (8) 12,511.00 NOTE: To insure proper credit to your account, submit the upper portion of this fora w/th your tax payment. NOTE: $4,491.00 D/~CuUNT ZNTEREST/PEN PAID (-) .00 ANOUNT PAID 988. O0 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDZTZONAL INTEREST. tAX CREDITS: PAYNENT J RECE/PI DATE NUHBER 08-25-2005 CD002944 Zf an assessment was issued previously, 1/nas 1~, 15 and/or 16, 17, 18 and 19 will refZect figures that include the total of ALL returns assessed to date. .00 988.00 .00 .00 988.00 TOTAL TAX CREDZT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 988.00 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THZS FORN FOR ZNSTRUCTZONS.) ASSESSHENT OF TAX: 16. Amount of Line 1~ at SpousaZ rate (15) . O0 X O0 = 16. Amount of Line 1~ taxable at Lineal/Class A rate (16) 21,952. O0 X 045 = 17. Amount of L/no lq at Sibling rata (17) . O0 X 12 = 18. Amount of Line lq taxable at Collateral/Class B rate (18) . O0 X 15 = 19. Principal Tax Due (19)= 28. O0 (11) l~' .5~9. DO (~;) 21,952.00 (~3) . O0 (~) 21,952.00 RESERVATION: Estates of decadents dying on or baTora December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Co.monaaalth hereby expressly reserves tho right to appraise and assess transfer Inheritance Taxes at the lawful Class D (collateral) rate on any such ~utura interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (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: REGISTER OF HILLS; AOEHT 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 era available at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour ensnaring service for fores ordering: 1-800-362-Z050; services for taxpayers Nith special hearing and / or speaking needs: 1-800-q47-3020 (TT only), Any party in interest not satisfied Nith the appraisement, allowance, or disallo.ance of deductions, or assessment of tax (including discount or interest) as sho.n on this Notice must cbject within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to havethe matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assassoant should be addressed in ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Ravia. 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 correctable 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 allowed. The ISZ 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 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 with first day of delinquency, or nine (9) months and one (1) day fram the date of death, to the date of payment. Taxes ahich became delinquent before January l, 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. All taxes #hich became delinquent on and after January 1, 1982 Hill bear interest at a rate ahich 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 era: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Yea._._r Rate Factor 1982 ZOZ . 000548 1987 92 . 000247 1999 7X . 000192 1983 162 . 000438 1988-1991 III . 000301 2000 BZ . 000219 198fi 112 . 000301 1992 92 . 000247 ZOO1 92 . 000247 1985 132 .000356 1993-1994 72 .000192 ZOOZ 62 .000164 1986 lOX .000274 1995-1998 92 . O00247 2003 52 .000137 --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 ~ill 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. ~--~~~"--_.._--~-,-- --.J :;:" REV-1500 EX (0&.05) PA~ofR8wnJe *' BlnlII of....... Taxes INHERITANCE TAX RETURN PO BOX 2lDi01 HaniIIug. PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW SodaI ,~~ Date of Death 144-09-2283 ~ 04117/2003 15056051058 OFFICIAL USE ONLY ,~~Yea-__ ~I 103 Fit NtInber ;()70( Date of BIrth 04lO5I1907 Dec:edent's Last Name SuIIlx Oecedent's Fnt Name MI r------., .. ..._.,. .....~_,_"_ ___ ..__'____~__..__________~._._ . - Monacchio Emma J - - -~ '._,._--_._--~--~.__..- Spouse's Flrst Name MI -----------~-_..__..--- Spouse'. Social Sec:urfty "'!J~ THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ce:> 1. OrIginal Relum c:::J 2. SuppIemen1aI ReUn c::> 3. Remainder ReUn (dlIIB of death prior to 12-13-82) 5. Federal Estate Tax ReIum RaquinId c:::J 4. limlted Estate <:::) 6. DececIent Died Teslate (AtIach Copy of WII) c:::> 9. Uliga1lon Proceeds ~ c::::> 4a. Future Interest Compromise (dale of c:::; death after 12-12-82) c:::J 7. Oecedent MainfaIned a LIvIng Trust (AtIach Copy of Trust) c::> 10. Spousal Poverty CnllIil (d818 of death c:::J 11. Election to tax under See. 9113(A) belW88n 12-31-91 and 1-1-95) (AUach Sch. 0) CORRESPONDENT - THIS SEClIOII MUST BE COI8Il.ETED. ALL CORRESPOHDaI:E AJm CONFIDEJfIW.. TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Tefephone Number ,_. _. '.-.---,,).,.., '; . (717) 73()..()820-'..~ . _ _._-~-,._-~'~_._----_._-_._-----.~--"".; 8. TolaI Number of Safe 0ep0eIt Boxes John S Kostukovich ~ Name (If~u_ i John S Kostukovich, CPA REGISTER OF wni$ USE ONlY , ; ["'....J Fot line of address 3900 Trindle Road Second fine of address -"- I ! i ! I i j L___ DATE~_. ___ \1 c:ily or Post Office ; Camp Hill '__"J S1ate ZIP Code 17011 n_J '-..-~. .--,....-.-..--.--.-----__~___~~_b._ '__ _.__ ____._..._.,.____._______._____._,___.___..._~ Correspondenrs e-me/I address: JSKCPA@choiceonemail.com UndIIr perIlIIlIe8 01 ~ I dIId8nllh8t I '- examined liB nItum, ~ acco..lj)at~ Id1ecUlI5 and sIlIIlIt._.... and 10.. bell 01 my IlnlMledge and beIIlIf, It II true, CIIIRlCt and compIBIIt. D8cIInIon 01 pnIp8IW ot.Iwl.. ...... ............... .... on ..'nrom....., 01 wNcII....... '-1m)' Icnowledge. PERSON m::_ll_ fOR FlUNG IlIVE {7'~ ..J 1;1-/ IlIVE 3 /"kI-/ ~e~ Tr,,,Jt, 1)~,O C::~IJM// /J4 I?D// , "-LEASE U8E OIUWNAL FOIIII ONLY L 15056051058 Side 1 15056051058 --.J --.J 15056052059 i/ REV-1500 EX .f Dec:edenfs NlIme: Emma RECAPITULATION J Monacchio ~..SocIaI.~.~.. . 144-09-2283 ,. Real eslate (Schedule A). ............................................ ,. 2. Stocks and Bonds (Schedule B) ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corpculioo, Par1ner&h/p or SoIe-Proprietor (Schedule C) . . . .. 3. 127,102.00 4. Mortgages & Notes ReceIvable (Schedule 0). . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. i 5. Cash, Bank DeposlIs & MisceUaneous Per&onaI Property (Schedule E) . . . . . . .. 5. 6. Jolntty Owned Property (Schedule F) c.::> Separate BII/ng Recp I8Sted . . . . . .. 6.; 7. Inter-VIvos TI'8flSfeIs & Misc:eIIaneous Non-PItlbate Property (Schedule G) c:> Separate BlIIng Requested........ 7. '-"'-"-'~'_'____r~_'~..._.____~~_.___. 8. Total ~ Aas8I8 (total Unes 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. "'--.....>_.,..........~.'...-......._._.._-,..._-----_..----------- 127.102.00 j 11,726.00 i 9. Funeral Expenses &AdmInIs\dINe Costs (Schedule H)..................... 9.' 10. Debts of Decedent, Mortgage liabiIlties, & Uens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Tobit Deduc:tIons (total Unes 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11. 11.726.00 i 115,376.00 i 12. Net V.hIe of EsIlda (Line 8 ninus LIne 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govem.nental BequesIsISec 9113 Trusts forwhlch an eIedIon to tax has not been ma:Ie (Schedule J) . . . . . . . . . . . . . . . . . . . . . . .. 13. 14. Net Value Subject to Tu (LIne 12 minus LIne 13) ........................ 14. . TAX COMPUTATION. SEE INSTRUC1lONS FOR APPLICA8lE RATES 15. Amount of LIne 14 taxable at the spousal tax rale, or transfers under See. 9116 (a)(1.2) X .0_ 16. Amount of line 14 taxable at IneaI J8Ie X.O 45 17. Amount of line 14 taxable at sIbRng rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 115.376.00 i 15. 115,376.00 16. 5,192.00 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 5.192.00 i 20. ALL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c:> L 15056052059 Side 2 15056052059 --.J - -_._---_._--..__.._-_._--_._...._._~-'..._--'-.._._---_...-.-..---..------.- _ REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME Emma STREET ADDRESS 1414 Countl'Y"t>rtve file Number r--JD'I----------- ---) L----l 5._._ _ ., ~."",, ~. __.' ~! ..{. J Monacchio DECEDENrS SOCIAl. SEaJRf1Y HUllER 144-09-2283 CfTY Mechanicsburg I STATE PA I ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 line 19) 2. CredllrrIPaymen A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InterestIPenaly if applicable D.1nterest E. PenaIy (1) 5,192.00 ToIaI CmdiIs (A + B + C ) (2) ---- ToIaIlnterestIPenaly ( 0 + E) 4. If line 2 is gRlBIer than line 1 + line 3, enlIllr the diJfenlnc:e. This is the OVERPAYMENT. FIIIn oval on Page 2, Une 21 to IIICII*t a rafund. 5. If Line 1 + line 3 is greater than line 2, enter the dfinnce. This is lhe TAX DUE. 1,285.00 0.00 B. Enter the total of line 5 + SA. This is the BALANCE DUE. (3) 1,285.00 (4) (5) 6,4n.00 (SA) (58) 6,4n.OO A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT ---~-_._--~-_.~--~--_.._..._._---..~-.~-_.._.--- PLEASE ANSWER THE FOlLOWING QUESTIONS BY PLAQNG AN T IN THE APPROPRIATE BLOCKS 1. Did dec:edert maIre a transrer and: Yes No a retain the use<< lnmme 11 lie property tl'8115Ie"ecl;__.___..________.____._..____ 0 1iI b. retain the right to dasignale who shaI uselhe properly tJarWt..red <<i1s income; ___..__.____._ 0 1iI c. retain a I8V9lsilIlaIY inIeresI; <<-....-........-........--................._..._.....__.__.__..___..___ 0 iii d. receive tle pmlise b'.1I eIher paymanIs. benefiIs<< cam? ___.__________.._.__ 0 iii 2. If deaIh occ:med after 0ec8mber 12, 1982, did decadent transrer property wiIhi1 one year 11 deaIh wiIhout AlCIiving adaqualB CDI15id1lUlti0I1? .---..--..---___.___..._._____.__.._.. 0 iii 3. Did decedent own an "in 1rust for" or payable upon dealh bIIlk acmunt<< seariy at his << her deaIh? _._..._ 0 Ii] 4. Did decedent own an Indlvidual Relirementkcount, arudy, << other non-probate property which contains a bllllelidaly designation? .........-.......................-..........._........__....__...__.....__......._....._....._...... Ii] 0 _~'r____ _. _.."....~._.__._.__ ~ ____... ~.___._ .~.,..'~.>.~___~.__. ~,_ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YEs, YOU lUST COMPlETE SCHEDULE G AND FI.E IT AS PART OF THE RETURN. ,.......,,_..,. .-.--.-~._...-._..~-~--_..y_.,._v~~~~.,. -^-'-"....-......._~_._.__'__.._n._.'.._.... n"'~ __.", ~_._......, _'.....,.._ ~_r_K.'.._ ,.....~._~__-..,~.;. _.._ .~ For dates of death on or after July 1, 1994 and before January 1, 1995, the fax rate imposed on the net value d Iransfers to or for the use of the SI.NvIng spouse is tine (3) percent (72 P.S. 59116 (8) (1.1) (i)). For dates of death on or after Januaty 1, 1995. the tax rate imposed on the net value of 1ransfefs to or for the use of the stniYing spouse is zero (0) percent [72 P.S. 19116 (a) (1.1) (i)J. The statute does not 8X8I11pf a transfer to a SlI'Viving spouse from tax, and the sIalutory requirements for ciscIostn of assets and 1iIng a fax nUn are stiI applicable even if the surviving spouse is the only beneficiary. For dates of death on or after JOy 1, 2000: The tax rate imposed on the net value of transfers from a deceased dlid twenty-one years of age or yoooger at death to or for the use d a natInf parent, an adoptive parent, or a stepparent d the chid is zero (0) percent (72 P.S. S9116{a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the dec:edent's IlneaI beneIciaries is four and one-haIf (4.5) pen:enl, except as noled In 72 P.S. i9116(1.2) (72 P.S. 19116(8)(1)). The fax rate inposedon the net value of transfers to or for the use of the decedents siblings is twelve (12) percent (72 P.s. i9116(a)(1.3)). A sibling is defined, under Section 9102, as an indlviduaI who has at least one parent in common with the decedent. whether by blood or ~ REV-15..EX+...... .. COMMONI/I.I:AlTli OF PeNM.VANlA INHERITANCE TAX RE1\JRN RESIDENT DECEDENT SCHIDULI G INTER-VIVOS TRANSfERS & MISC. NON-PRo8.ATE PROPERTY ESTATE OF J FILE NUMBER Emma J Monnachio This ~ IlIlSt be ~ and lied If lie answer to Illy of lJIIlIIlans 111mJgh 4 on lie IlMlI1le side Of lie REV-1511O COVER SHEET is J8S. DESCRIPT10N OF PROPERlY ITEM IIICWDElJElWECFlJE1IW8B&. ntEIl_lODB:BlBIrMD IWE OF DEA1H "OF DECD'S EXClUSION "OOCA8lE lJEIMJECF1IlM&Bl R1lIafAtXll"fCFlJEl&DRlRI&II.EIIlll1E. VALUE OF ASSET IfIEREST fF~ VALUE 1. Hartford Annuity Q" -I-r~ #- 36bt.~o~ I ~.fO- dc..k. '-( '"l,..u~~ 127,102.00 100 127,102.00 TOTAL (Also enter on line 7 Recapitulation) $ (If ~ space Is needed.1nserI adcIIIonaI8heels of lie ..,..) 127,102.00 , - HUBSlTLEVEREtt MARYANN J.. E'icm:1 I . 1414 COUNTRY OR. 717.e974630 MECHANlCs8URG.PA' .11055-6106' .;:. -' .. , . . . '. . DA:=~/#I~os< '. . .' .' - - .'- "- .,. . ..... . . . '. . - .. ,- , ,-. . 1#.te....... . . - . . . -', - -, - - . . -." '. ... . . . . . ,'.. . . - . .. - . "", . .' - . .~~,-~---..,.. .... .... ...... '" :4'#77..' ..:.,. , -..'. '. IV.'...'-....~........ .... ..................... ....... ........... '. .........'... ...... ...... .'. ........................... ....... ....... '.. ...._....... _ ................................................. ~o;.:nE~O:;- .' ". '.' ...'. ....... .' .... ...............':.~~,H~dJ I, .1-...:<......-. __..:._.n~_ .. ...... ~~~~......_"CA"O.fu..~.. -~. ...._" '.' '.:' "...' '., .,............. .... " . .- -, - - - - - - . - " - - . ',- ". '. . . . . Ban){ . . , : '. ",. '-:.' ,".. -"'. .... . '~"" . ,.,.~..;..>..,....:-.... . . 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""....... ,,,,,,:) '.;~ :'....~;''i~ ..~ - llr~.:- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT EVERETT HUBERT L 1414 COUNTRY DRIVE MECHANICSBURG, PA 17055-5106 nn____ fold ESTATE INFORMATION: SSN: 144-09-2283 FILE NUMBER: 2103-0701 DECEDENT NAME: MONACCHIO EMMA J DATE OF PAYMENT: 04/07/2008 POSTMARK DATE: 03/21/2008 COUNTY: CUMBERLAND DATE OF DEATH: 04/17/2003 NO. CD 009510 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $6A 77.00 I I I I I I I I TOTAL AMOUNT PAID: $6A77.00 REMARKS: CHECK# 7006 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS ~ .~~~~~. M~"~~~'~"' ~~!l:', ~ -, ~ 0; ~ .~ . r'" ~ ,....; ij :..'.t..J ~.'.' .'1>' . ..' ?\<. ~ ~', ~~I' ',;0, '.. ,'f '~.~: ~.,'.. ~~~ ?It &t4.~~~ t" ~ ~ ~, ..,. M ,..; r"'",~. ir~ T"'! ::''"' .,... 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PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT EVERETT MARYANN 1414 COUNTRY DRIVE MECHANICSBURG, PA 17055 n__n__ fold ESTATE INFORMATION: SSN: 144-09-2283 FILE NUMBER: 2103-0701 DECEDENT NAME: MONACCHIO EMMA J DATE OF PAYMENT: 06/03/2008 POSTMARK DATE: 06/01/2008 COUNTY: CUMBERLAND DATE OF DEATH: 04/17/2003 NO. CD 009834 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $33.57 I I I I I I I I TOTAL AMOUNT PAID: $33.57 REMARKS: CHECK# 7038 SEAL INITIALS: CJ RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS <( ~ ... Z >< Z ~ < ~lU 0.... ...J::> ><-Ju. >Z <;10 enlU ..../1).... Z>IUQZ Z lU (j IU lU&:III: ~!X~ 0.11. ::;O~ 11.0 !X~::: 01- ~~< :z:Z ~~Q I-lU -Jz ...J% u.-J< <(I- 0</1) lU&:III: IU Z 3: <( (j": 0 Za. ....Z.... OlU~lUt> %Q zffi~ % /l)Q o .... IU U <Q !Xu. ~O < I,. C"-" .., ~:::... ("I') 19<:tE" '. cE'~ - C)'--'" Q;:~ C" '-...) {'...Ie &,~r;j (,,--~.;:0 c;:- ri;s~~ ~ ~ e .... 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' .~., .. ~ ~1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE -,~- NOTICE OF INHERITANCE TAX _~,: BUREAU OF INDIVIDUAL TAXE'S ~._~ ~.APPRAISEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX PO BOX 2B0601 _ , HARRISBURG PA 17128-0601 "' .~ ~.::~ :, =r s , r. r~ f I ~`-;~~ L~~ 4'~ T n ~" I JOHN S KOSTUaI~V,~W ~.~'~ 3900 TRINDLE RD CAMP HILL PA 17011 REV-1547 EX AFP C06-05) DATE 05-26-2008 ESTATE OF MONACCHIO EMMA J DATE OF DEATH 04-17-2003 FILE NUMBER 21 03-0701 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 07-25-2008 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS H REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MONACCHIO EMMA J FILE N0. 21 03-0701 ACN 101 DATE 05-26-2008 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRA:[SED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) C2) 127,102.00 credit to your account, 0 0 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) C3) . of this form with your 4. Mortgages/Notes Receivable (Schedule D) C4) .0 0 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) .00 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) I7) .00 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; 14. Net Value of Estate Subject to Tax ce) 127, 102.00 11,726.00 (9) clo) .00 C11) ~ 1 .7?6.00 clz) 115,376.00 Non-elected 9113 Trusts (Schedule J) C13) •00 c14) 137,328.00 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) • 00 X 00 = . 00 16. Amount of Line 14 taxable at Lineal/Class A rate C16) 137,328.00 X 045= 6,180.00 17. Amount of Line 14 at Sibling rate C17) •00 X 1 2 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) •00 X 15 _ .00 19. Principal Tax Due (19)= 6, 180.00 TAY I`iD CTTTC. PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 08-25-2003 CD002944 .00 988.00 03-21-2008 CD009510 1,285.00- 6,477.00 BALANCE OF UNPAID INTEREST/PENALTY AS OF ~ IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 03-22-2008 TOTAL TAX CREDIT 6,180.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. 33.57 TOTAL DUE 33.57 ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE /'( D RFFIINn_ SFF REVERSE STnF nF TNTS FnRM FnR TNCTRIICTTnNC 1 `-C COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX INHERITANCE TAX DIVISION ": '.STATEMENT O F AC C O U N T PO BOX 280681 HARRISBURG PA 17128-0601 l i.~'~8 J~JL ~ $ ~ 10= 1$ Cl.E~,E~ Lei JOHN S KOSTUKOVICH 4~~r{~,~~~ 4 t f~Z:~q~~ .,;.-~ 3900 TRINDLE RD r -`=i._, , ~ -- CU~.:._ CAMP HILL PA 17011 REV-1607 EX AFP (03-05) DATE 07-07-2008 ESTATE OF MONACCHIO EMMA J DATE OF DEATH 04-17-2003 FILE NUMBER 21 03-0701 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND 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 ~ --------------------------------------------------------------------------- REV-1607 EX AFP C03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ~~* ESTATE OF MONACCHIO EMMA J FILE N0. 21 03-0701 ACN 101 DATE 07-07-2008 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-19-2008 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID OS-25-2003 CD002944 .00 988.00 03-21-2008 CD009510 1,285.00- 6,477.00 06-01-2008 CD009834 33.57- 33.57 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. ~ IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), vnii Mev RG niiF o aEFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 6,180.00 6,180.00 .00 .00 .00