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HomeMy WebLinkAbout03-0715Estate of also known as Cumberland Register of Wills of County, Pennsylvania PETITION FOR GRANT' OF LETTERS Walter T. Young, Sr. No. AI-~--~ · Deceased Social Security No. 160 - 30 - 3264 (COMPLETE "A' OR "B' BELOW:} A. Probate arid Grant of Letters and aver that Petitlonerls} is/are the execut Decedent. dated and cod,cilia} dated named in the Last Will of the Except as follows. Decedent did not merry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing end was never adNdicated incompetent: B. Grant of Letters of Administration Petit,oner(st after a proper search has/have ascertained that Decedent left no Wdl and was survived by the following s0ouse any) and he,rs: Name Relationship Res,dance Walter T. Youn~ Jr. (COMPLETE IN ALL CASES:'}' Azrach add,(,oriel ! Son ~eets if necasea~¥. Decedent was domiciled at death in Cumberland res,dance at 506 Front Streetr West Fairview~ DeceOent. then 65 ,tears of age, OmO July 3~r 2003 1540 Braewood Drive Harrisburg PA 17111 Count1,, Pennsylvania. w,th h,s/her last fam,Ly, or principal PA 17025 · at 506 Front Street, West Fairvie~ PA 1702S"' ....... [Decedent at death owned property w~[h esr,ma[ed values as follows: (If do'micdad ,n PAl All personal property ................ $ (If not cloture,led ~n PAl Personal p~oper~v ~n Penns¥1vama ............ $ (Il' no[ domiciled ~n PAl Pergonal property ~n County ........................ $ Value of reel estate ~n Pennsylvama ....................................... $ Total . . . Real Estate s,luared as ~OIIows: 6,000.00 ........................................ s 6fOOO,OO Wherefore. Prtlll,oner(s; re.';pcctf~lly r,:,l,,~.'-;[(.H the probalc o! th. la'~[ W,II and Cod~cdlsl presented w.lh th~s Petition and [he grant Of letters in the appropriate form tO th~'. undersigned $,gnaturc Typed or pr,nted ,~a~c. a,~d residence J / / ' Walter T. Young Jr. 1540 Braewood Dr. Harrisburg PA 17025 t-1'2_ Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(si and affirm(si that the statements in the for c~o~ing Petition are true and correct to the best of the knowledge and belief of Pefifionerls} and thai. as personal representative{s) of the Decedent, Petitioner(si will well and truly administer the estate according to law. Sworntoa.daffirmeda.dsubscribe day of before me this .DECREE OF REGISTER Estate of W~lter T. Young~ ~r. Deceased No. also known as ;It- O,% - -11,5 Social Security No:150-30-3264 Date of Death: July 33, 2003 AND NOW, .~..~4~J391LOA z:~ , ~:~1~_% . in consideration of the Petition on-the reverse s,de hereon, satisfactory proof having been presented before me. IT IS DECREED that Letters l'-I Testamentary ~ of Administration are hereby granted to in the above estate and that the instrument(st)'?if any, dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........................... Short Certificate(si .......... Renunciation .................. Affidavit ( ) ................. Extra Pages ( ) ............ Codicil .......................... JCP Fee ........................ Ioven[ory & Tax Forms... Other ............................ /.~ .00 $ lo.oO $ d q-2-o3 Jeffrey M. Mottern Attorney: I.D. No: 26020 Address: 28 E. Main Street Hummelstown PA 17036 717-566-3718 TOTAL ................ $ t,.~J? ,0-'0 Telephone: I05.805 RE",.' 9/g6 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 Local Registrar ~/' No. [)ate ~05.144 Rev. 1/91 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH //29-082 (Coroner) ~SEX ~SOCIAt~ SECURITY NUMBER IDATE OF DEATH (Month Day Yea') Walter T Young Sr. 12. Male ia. 160-30-3264 [, Jul,, 30,' 2'003 Teacher J.~, District I v..~ m~ ] ~-~ ~' ~'~'~' ,,. c azrv~ew, ua I/uz~ [~) ~.~ Cumberland ,~? ~.~,~ John T. Young [,,. Mary J. Plamer Walter T. Young Jr. ~NFO ' ~=,~raewo~. ~rr[~6u~g, PA 17111 ~'~ ~1 ~,b. August 5, 2003 ,,~ Hillside Cemetery [;,,. Roslyn, PA 19001 ~ -- a~FD-OI2774-~ ;=~[cha;dson ~.~. 29 S.Eno[aD~.[no[a,~A 17025 ~,~h)~ ,. Ca;dtomyopath~ ~ ~u~ ~ ~y c. ~ ~sY WERE A~SY FININGS ~NNER ~ ~ --- I I°;~"~ I"""'" ~ ~a~ ~ I I I ~ ~ I · ' ..... :'.V~ ..................................................................................... ,~. Mechanicsburg, Pa. 17050 Z .CERTIFICATION OF NOTICE UNDER RULE 5.6¢;I} Na,ne of Decedent: WALTER T. YOUNG SR. D:,tc of Death: July 30 , 2003 Estate No. 2003-0071 5 To the Register: ! certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served oil or mailed to thc follosving beneficiaries of thc abovc-captioncd estate o. Name Address WALTER T. YOUNG JR. 1540 BRAEWOOD DRIVE, HARRISBURG PA 17111 Notice has now been given to all pcrsoas eutitled thereto under Rule 5.6(a) except Date: Capacity: Persol, al Representative JEFFREY M. MOTTERN N.~mc (Print) Cou,isci for Pcrsollai 28 E. MAIN STREET Rep,'esc.tative Address c:"i HUMMELSTOWN PA 17036 Telepho.e No. (717 ) 566-3718 COMMONWEALTH OF PENNSYLVANIA I. Re: The Estate of: WALTER T YOUNG SR Deceased NOTICE OF CLAIM COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION Coud File No: 2t=2003-715 TO: THE CLERK OF THE ORPHANS' COURT DIVISION Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). Claimant's name: Claimant's address: 1) 2) 3) 4) 5) 6) 7) BANK ONE cio NCO Financial Systems, Inc Probate Department,~f450 1804 Washington Boulevard Baltimore, MD 21230 (443)263-3300, ext 3304 Creditor listed below is the owner and holder of a claim in the amount of $6,632.52 The facts upon which this claim is based is a credit agreement between Creditor and Decedent, identified as account number which is evidenced by the attached affidavit of account stated. Decedent's address: 506 FRONT STREET, ENOLA, PA 17025 Date of Death: 07/30/03 That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by On behalf of the claimant, I do solemnly decJ~re and affirm un. der the,e'analties of perjury that they Information and represent~i'ons mja~jile hel~ are tl~.~jiV~and correct to the best of my knowledge, information~ ~/. /~d,. Dated:October21,2003 It ~' ~.~' ,AGENT Claimant J39355 Written notice of claim was given to Personal Representative and/or his/her counsel as stated below: WALTER YOUNG JR Name 1540 BRAEWOOD DRIVE Address HARRISBURG, PA 17111 City/State/Zip October 21, 2003 ~' ~ r- Date notice mailed ~' REV - t~ EX COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280~01 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I' OFFICIAL USE ONLY FILE NUMBER I 21 03 00715 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Young, Walter T. DATE OF DEATH (MM-DD-YEAR) / DATE OF I~|RTR-(MM-DD-YEAR) 07/30/2003 [ 11/10/1937 SOCIAL SECURITY NUMBER 160-30-3264 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS a IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ 1. Original Return [] [] 4. Limited Estate [] []: 6, Decedent Died Testate (Attach copy [] of Will) I-I 9. Litigation Proceeds Received [] 2. Supplemental Retum 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 4AME Jeffrey M. Mottern -'IRM NAME (If applicable) Jeffi'ey M. Mottern, Attorney at Law r'ELEPHONE NUMBER 717/566-3718 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] ~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. 13. 14. [] i 3. Remainder Return (date of death pdor to 12-13-82) [] i 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [] i 11.Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS 28 East Main Street Hummelstown, PA 17036 Net Value of Estate (Line 8 minus Line 11) None None None None 3,652.58 None None 6,203.00 Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x .00 or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate x .045 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .15 19. Tax Due OFFICIAL USE ONLY (8) 3,652.58 6,203.00 insolvent (11) (12) (13) (14) Copyright 2000 form software only The Lackner Group, Inc. (15) (16) (17) (18) (19) Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 506 BI. Front Street CITY WcstFairview STATE PA ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 5. If Line I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. I1 1. 0.00 0.00 0.00 0.00 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (5) (5A) (5B) PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ............................................................................. [-I [] 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 secudty at his or her death? ...... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE ADDRESS 1540 Braewood Drive Harrisburg, PA 17111 $1~IATU~E OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE I/[_ Z /l / '"' "~ ."f-~J"~,~ hSt EastMainStreet . I _,.,qJ ,,~ v ru, .ua.~ o[ ueam on or a~er Ju y 1, 1994 and before January 1, 1995, the tax rate imposed on the net va ue of transfers to or for the use of the i surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 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. §9116 1.2) [72 P.S. §9116 (a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ESTATE OF Young, Walter T. SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONALPROPERTY FILE NUMBER 21-03-00715 Include the proceeds of litigation and 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 Miscellaneous Personal Property sold at public sale by Charles Bricker, auctioneer net of costs and commissions 1994 Chevrolet Pick up Truck VIN 1GCEK14Z7RZ112639 Fair condition Susquehanna Valley Credit Union Savings Account No. 841600 TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE Of DEATH 770.00 2,870.00 12.58 3,652.58 ESTATE OF Young, Walter T. FILE NUMBER 21 - 03 - 00715 Debts of decedent must be reported on Schedule I. ITEM NUMBEF FUNERAL EXPENSES: Rlchardson's Funeral Home 2 Hillside Cemetery DESCRIPTION ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Jeffrey M. Mottern, Attorney at Law -- Jeffxey M. Mottern Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills Probate Fees Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs TOTAL (Also enter on line 9, Recapitulation) AMOUNT 4,668.00 1,029.00 450.00 56.00 6,203.00 Register of Wills of Cumberland County, Pennsylvania INVENTORY , Deceased Estate of Young, Walter T. also known as No. 21 -03- 00715 Date of Death 7/30/2003 Social Security No. 160-30-3264 Walter T. Young, Jr. The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania 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 correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: Jel]i'oy M. Mottern I.D. No.: 26020 Address: 28 East Main Street Hummelstown, Pa 17036 Personal Representative Signature: W~~~ ~ ~01~ .~ ter T. Young, Jr. Signature: Signature: Address: 1540 Bracwood Drive Harrisburg, PA 17111 Telephone: (717) 566-3718 Personal Property Miscellaneous Personal Property sold at public sale by Charles Bricker, auctioneer net of costs and commissions 770.00 1994 Chevrolet Pick up Truck VIN 1GCEK14Z7RZ112639 Fair condition 2,870.00 Susquehanna Valley Credit Union Savings Account No. 841600 12.58 Total Personal Property $3,65238 (Attach additional sheets if necessary) Total Personal Property and Real Estate $3,652.58 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION Name of Decedent: STATUS REPORT UNDER RULE 6.12 WALTER T. YOUNG SR Date of Death: JULY 30, 2003 Estate No.: 2003-0071 5 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: State whether administration of the estate is complete: Yes x No Date:10/24/03 (MAH:rmffAM3) If the answer is No, state when the personal representative reasonably believes that the admifiistration will be complete: (date) If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. Did the personal representati~state an account informally to the parties in interest? Yes I/ No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. REY M. MOTTERN, ESQ Name (Please type or print) 28 E. Address MAIN STREET, HUMMELSTOWN PA 717-566-3718 17036 Telephone No. K.W. - 5B Capacity: Personal Representative Counsel for Personal Representative NCO Financial Systems, Inc.* Attorney Network Services Dept, 450 1804 Washington Blvd. Baltimore, MD 21230 ESTATE OF MARY LYNN BORTEL, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA · NO. 2003-00716 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: MARY LYNN BORTEL Date of Death: August 29, 2003 ESTATE NO. 2003-00716 To the Register: STATE FILE NO. 21-03-716 Ms. Mildred Griffith 220 Third Street Southeast Apartment 202 Barberton, OH 44203 Ms. Phyllis Glenn 242 North River Road Munroe Falls, OH 44262 Ms. Jeanne Griffith 508 Vosello Avenue Akron, OH 44313 Ms. Jennifer L. Bortel 4508 North Delaware Street Indianapolis, IN 46205 Ms. Joan L. Green 635 North Lime Street Elizabethtown, PA 17022 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None. Respectfully submitted, CUNNINGHAM & CHERNICOFF, P.C. Date: Novembe{"21, 2003 By: Marc W. Witzig, Esquire Pa. Atty. Id. No. 29929 2320 North Second Street P.O. Box 60457 Harrisburg, PA 17106-0457 (717) 238-6570 Counsel for the Personal Representatives I certify that the Notice of Beneficial Interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or sent by first class, prepaid U.S. Mail, to the following actual or potential beneficiaries of the above-captioned estate, on November 20, 2003: IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF WALTER T YOUNG ) ) Register's # Deceased) 21-2003-00715 CLAIM To the Clerk of the Orphans' Court Division : Index and make proper entry in your official records of the claim of CITIBANK (SOUTH DAKOTA) NA in the amount of 12~612.41 against the estate of the above-named decedent. This claim is filed under Section 3532 (b) (2) PEF Code, 20 Pa. C.S. ss. 3532 (b) (2) The said decedent, whose last known residence was at 506 FRONT ST ENOLA, PA 17025 Written notice of this claim was given to WALTER YOUNG JR 1540 BRAEWOOD DR HARRISBURG, PA 17111 on November 12~ 2003 SHAWN HARMER,manager of Citicorp Credit Services, Inc. USA under limite, power of attorney for CITIBANK (SOUTH DAKOTA) NA. 7930 NW 110T" ST KANSAS CITY~ MO 64153 (Claimant' s Address) kccount:%(s) ~'$491130186801452 BUREAU OF TNDIVZDUAL TAXES TNHERITANCE TAX DTVTSTON DEPT. 2:80601 HARRISBURG, PA 17128-0601 JEFFREY H NOTTERN ATTY 28 E HAIN ST HUHHELSTOWN PA 17056 COHHONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOT/CE OF .tNHERITANCE TAX APPRA.tSENENT, ALLO#ANCE OR DXSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-IS~7 EX AFP (n1-~5) DATE 12-29-2005 ESTATE OF YOUNG SR DATE OF DEATH 07-$0-2005 FZLE N~HBER 21 05-0715 COUNTY CUHBERLAND ACN 101 I Aaoun~ Ramified WALTER T HAKE CHECK PAYABLE AND REHZT 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 ASSESSNENT OF TAX ESTATE OF YOUNG SR WALTER T FILE NO. 21 03-0715 ACH 101 DATE 12-29-2003 TAX RETURN NAS: (X) ACCEPTED AS FXLED ( ) CHANGED RESERVATION CONCERNING FUTURE ZNTEREST- SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON.' ORIGINAL RETURN 1. Reel Es~a~a (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (:>) $. Closely Held Stock/Partnership Znteres~ (Schedule C) ($) q. Nora:gages/No,es ReceLvab/e (Schedule D) (4) $. Cash/Bank Deposits~H/sc. Personal Proper~:y (Schedule E) ($) 6. JoLn~ly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Assa~:s APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expanses/Adm. Cos~:s/Nisc. Expanses (Schedule H) (9) 10. Dab~s/Hor~gaga L/abili~ias/LLans (Schedule I) (10) 11. Total Daduc~Lons 12. Na~ Value of Tax Return 1:3. 14. Charitable/Governmental Bequests; Non-alac*ad 911:3 Trusts (Schedule J) Na~ Value of Estate Subjac~ ~o Tax 3~652.58 .00 .00 NOTE: To /nsura proper .00 crad/t ~o your account, .00 submit ~ha upper portion .00 of th/s fora w/th your ~ax payment. .0O (8) 6,205.00 .00 NOTE: 5,652.58 (11) &.20~. no (~2) 2,550.~2- (1:3) . O0 (14) 2,550. ~2- Zf an assessment ~as issued previousZy, 1/nas 1~, 15 and/or 16, 17, 18 and reflect f/gures that include the total of ALL returns assessed to date. 19 will ASSESSNENT OF TAX: 15. Amoun~ of LLna 14 at Spousal ra~a 16. Aeount of L/ne 14 ~axabla a~ Lineal/Class A ra~a 17. Amoun~ of L/ne 14 at SiblLng rata 16. Amoun~ of Line 14 ~axebla a~ Collateral/Class B ra~a 19. Pr/nc/pal Tax Due TAX CRED;TS: PAYHENT KECE/PT' DISCOUNT (*) DATE NUNBER INTEREST/PEN PA.tD (-) ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATZON OF ADDITIONAL INTEREST. ('ts) .00 x O0 : .00 ('t6) .00 x 0~5= .00 (].7) .00 x lZ = .00 (.ts) .00 x 15 = .00 (19)= . O0 ANOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE · °°I .00 .00 .00 ZF TOTAL DUE .tS LESS THAN $1, NO PAYHENT ZS REQU.tRED. TOTAL DUE .tS REFLECTED AS A 'CRED.tT' (CR), YOU HAY BE DUE REFUND. SEE REVERSE S.tDE OF THIS FORH FOR .tNSTRUCTZONS.) RESERVATION: PURPOSE OF NOT[CE: PAYMENT: REFUND (CR): OBJECTZONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 198g -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for lira or for years, tho Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such futura interest. To ~ulfill the raquireeents of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit aJth your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may bm requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara availabIa at tha Office of the Register of Rills, any of the 25 Revenue District Offices, or by ca[Ling the special Z4-haur answering service for fores ordering: 1-800-362-Z050; sarvicas for taxpayers with special hearing and / ar speaking needs: 1-800-447-5020 (TT only). Any party in interest not satisfied with the appraisaeent, allowance, or disallowance of deductions, or assasseant of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of rscaipt of this Notice by: --written protest to the PA Dapartmant of Revenue, Board of Appeals, Oept. ZBIOZI, Harrisburg, PA 17128-1021, OR --eLection to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discavarad on this assasseant should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviaw Unit, Dapt. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6SOS. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (52) discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid befora January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the s-ama manner and in the the same time period as you would appeal fha tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nina (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent befora January 1, 1982 bear interest et tha rate of six (62) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January l, 1982 will bear intarest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z005 ara: Interest Daily Interest Daily Intarast Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 lOX .000548 1987 9Z .000247 1999 7Z .OO019Z 1982 162 .000438 1988-1991 112 .000301 ZOO0 82 .000219 198q 112 .000301 1992 9Z .000247 Z001 92 .000247 1985 13X .000356 1993-1994 72 .000192 2002 6Z .000164 1986 102 .000Z74 1995-1998 9Z .000247 2003 52 .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELZNI~UENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after tha interest computation date shown on tha Notice, additional interest must be calculated.