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Home My WebLink About03-0862PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of Elmer R. Warner_. Sr. No. also known as To: Social Security No. 174-05-3670 Register of Wills for the Deceased. County of C,,~er!ana_ in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(/), who is/ffr]~ 18 years of age or older, appl~ (d.b.n.; pendente lite; durante absentia; duranie minoritate) for letters of administration on the estate of the above decedent. Decedent was domiciled at death in Cumberland County, Pennsylvania, with h is last family or principal residence at 801 bi. Hanover St. Carlise, C~mherlond .County, (list street, nmnber, Twp. Or Boro.} Decedent, then 91 years of age, died October 3 , ~J 2003 at Carlisle, C-mberlana County, Pennsylvania ' Decedent 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: '~0/000 - 0 o PA Petitioner afterapropersearchha the ~llowingspouse(ifany) and heirs: Name Elmer R. Warner, Jr. s ascertained that decedent left no will and was survived by Relationship Residence son 1941 Enole Road, Carli/;le, Pa. 1701: THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration 'in the appropriate form to the undersigned. El~r R. Warner~ Jr. 1941Enola Road Carlisle, PA 17013 / 7.- /'2/- OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland Donna M. 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 of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~g') ;'7'~[ "~ ~ , to or Ji~"i~re me this 21st day of ,{ Zlmer R. Warner, Jr. '- (,/,, ---~~ . ~m~.o.o~ J Otto, 1st Deputy 'rR'~'4 -") No. 21-2003-862 Estate of Elmer R. Warner, sr. , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW October 22nd [9~ 2003, in consideration of the p~ition on the reverse side hereof, satisfactor)f_ proof having been presented before me, IT IS DECREED that Elmer 1~. Warner, Jr. is/are entitled to Letters of Administration, and in accord with such f'mding, Letters of Administration are hereby granted to. Elmer R. Warner, Jr. in the estate of Elmer R. Warner, . Sr. FEES Letters of Administration ..... $200.00 Short Certificates(5) .......... $ 15.00 Renunciation ................ $ -0e'~ JCP Fee $ 10.00 TOTAL __ $ 225.00 Filed . .O?.t.o..b??..2..2~: .29p. a A.D. H~xxxxxx Call Attorney Douglas when letters are ready on 10/22/03. George F. Douglass III ID# 61886 A'I'I'ORNEY (Sup. Ct. I.D. No.) 1;~ITvine Rows Carlisle, Pa. 17013 ADDRESS 717-249--7780 PHONE 105.805 REV 9/86 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 P 9749525 No. Local Registrar OCT 9 2003 Date H10s.~4.1 R.v. 2m7 COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS ..T CERTIFICATE OF DEATH ~] m ~apa J.~; Mi~leton ~_~ ~urch of ~ H~ .~u~ ...~.. PA ,~.~ ~.~ .~s,~ ~ North Middleton ~1 ~h H~over St. ,~ ~rlisle, Pa 17013 ,.~.s...~ ~,~.~,.; ,,. Bessie J~ ~,~ UI ~t 6, 2~3 I Rolling Green I *'~ ~.~.~.,~. 1~7~.~ .......... ~,,~..~,.~ ...... ' ,.~.~;;.,-- ........... ~r~xsxe, PA 17013 ~ ~.~v~ ] ~ s c~: , ................. m "' ....................... ' ; ............ ---- ' '" Z ' - ' .................. . .... 0' ~[G~S~R~R'S S~6N~rUR~ ~0 NUMe~ ............. ' .......... ~. 21-2003-862 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 003325 DOUGLAS GEORGE F III ESQ 1 IRVINE ROW CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 1 74-05-3679 FILE NUMBER: 2103-0862 DECEDENT NAME: WARNER ELMER R SR DATE OF PAYMENT: 12/1 O/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 10/03/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 95,000.00 REMARKS: TOTAL AMOUNT PAID: ELMER R WARNER JR EXECUTOR C/O GEORGE F DOUGLAS III ESQ 95,000.00 SEAL CHECK# 0098 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003405 DOUGLAS GEORGE F III ESQ 1 IRVINE ROW CARLISLE, PA 17013 fold ESTATE INFORMATION: SSN: 174-05-3679 FILE NUMBER: 2103-0862 DECEDENT NAME: WARNER ELMER R SR DATE OF PAYMENT: 01/02/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/03/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $13.72 TOTAL AMOUNT PAID: $13.72 REMARKS: GEORGE F DOUGLAS III ESQUIRE SEAL CHECK# 99 INITIALS: AC RECEIVED BY: GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL REV'-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT Warner Elmer R., Sr. DATE OFDEATH (MMDD-Yea') ] DATE OF BIRTH (MMC)D-Ye~ar) 1010312003 ] O8/28/1912 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER 2 1 -0 3 0 8 6 COUNTY COOE YEaR NUMBER 2 SOCIAL SECURITY NUMBER 1 7 4-0 5-3 6 7 9 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER r~"] 11 Original Return D4. Limited Estate r--] 6. Decedent Died Testate (~ad~ c~w ~fwa) [-'-~ 9. Litigation Proceeds Received r-~ 21 Supplemental Return [~] 4a. Future Interest Cotnpromise (date of deam alter 12-12.82) -"-]7. Decedent Maintained a Living Trust (Atta~ MY of Tm..ff) [~] 10. Spousal Poverty Credit (da{e ~fda~ between 12-31-91 and 1-1-95) I--'1 3. Remainder Return (date of dealh prior to 12-13-82) r'-] 5. Federal Estate Tax Return Required 0.~ 8. Total Number of Safe Deposit Boxes Oll. Election to tax under Sec. 9113(A) (A,.ach a~ O) NAME FIRM NAME (IfAppicabb) Hartman & Douglas, P.C. TELEPHONE NUMBER 717-249-7780 AND CONFIDENTIAL TAX INFORMATION SHOULD BE OI~CTED TO: COMPLETE MAILING ADDRESS I Irvine Row Carlisle, PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Padnership or Sole-Proprietorship (3) 4. Modgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Pemonal Property (5) (Schedule E) 6. Jointly Owned Properly (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 Dedudions (total Lines 9 & 10) 12. Net Value of Estate tune 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 80,984.39 42,859.84 OFFICIAL USE ONLY (8) 123,844.23. 6,563.38 (11) (12) (13) 6,563.38 117,280.85 (14) 117,280.85 SEE IN;~ m KUCTiONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9110 (a)(12) 10. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due X 117,280.09 x X X .045 .12 .15 (15) (16) (17) (18) (19) 5,277.60 5,277.60 DecederWs Complete Address: ADDRESS I lrvine Row I C~TY Cadisle JSTATE ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A, Spousal Poverty Credit B. Pdor Payments C. Discount 5.o00,o~ 263.88 Interest/Penalty if applicable D. Interest E. Penalty ,pa (1) , 5,277.60 Total Credits ( A + B + C ) (2) 5,263,.88 No Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) If Line 1 + Line 3 is greater then Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a b'ensfer and: Yes a. retain the use or income of the property b-ansferred; ......................................................................... [] b. retain the right to designate who shall use the property lransfen'ed 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 bust fo¢' or payable upon death bank account Or security at his Or her death2 ............... [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designatton2 .................................................................................................. [] 13.72 13.72 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND fiLE IT AS PART OF THE RETURN. SIGNATURE OF PERSON PONSIBLE F ' IN ' TURN~~,,,~,~ SIGNATURE' OF~ PREPARER'OTHER THAN REPRESENTATIVE U ...... DATE ADDRESS ' ' ' For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rote imposed on the net value of Imnsfers to or for the use of the surviving Spouse is 3% [72 P.S, §91t6 (a) (1.1) 0)]. For dates of death on or after Jenuary 1, 1995, the lax rote imposed on the net value of lrensfers 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 Iransfer 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 rote Imposed on the net value of Iransfers fram 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 decedenffs lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)('l)], The lax rate irnoosed on the net value of fransfem to or for the use of the decedent's siblinos is 12% 172 P.S. ~9116(a1(~ 311. A s~lino is defined, under Section 9102_ as an SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN __ RESIDENT DECEDENT , , ~STATE OF .... ' 'FILE NUMBER' ~VVarner. EImer,R., sr. 21 ~ 03 If an asset was made joint w~hin one year of the decedent's date of death, it must be reported on Schedule G. ,086~ SURVIVING JOINT TENANT(S) NAME Elmer R. warner, Jr. ADDRESS 1941 Enola Road Carlisle, PA 17013 son RELATIONSHIP TO DECEDENT JOINTLY-OWNED PROPERTY: I J: ~ i ~-r~DATE DESCRIFTION 'OF PROPERTY '% OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financialinstitutkm e~d bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER,, TENANT JOINT deed br joirrtly-hsid reel estate. VALUE OF ASSET INTEREST DEe',FO_ ENFS INTERES 1. A. 7/15/03 American Home Bank 77,899.26 50. 38,949.63 check # 0000110493 portion of 2. A. 6/20/89 The VanGuard Group 1,814.74 50. 907.37 Account # 001303141 3. A. 6/20/89 M&T Bank 6,005.68 50. 3,002.84 Checking Account # 88839702 TOTAL (Also enta- on line 6, Recapitulation) $ 42.859.84 REV- 1508 EX, * (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT :ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPEETY FILE NUMI:II:H _Warner, Elmer R., Sr. 21 03 .0862 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 DESCRIPTION VALUE AT DATE 1. Sale of Vehicle OF DEATH 1,200.00 Portion of American Home Bank checking account # 0000110493 79,423.68 Refund Highmark Blue Shield 234.12 Sprint Telephone Refund 0.73 Refund Highmark Blue Shield 25.17 6. Refund Medicare 100.69 TOTAL (Also enter on line 5, $ 80,984.39 REV-~511EX + (1-97) CO'MMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS _Warner, Elmer R., Sr. Debts of decedent must be reported on Schedule I. ITEM FILE NUMBER 21 03 NUMBER FUNERAL EXPENSES: DESCRIPTION Luncheon after Funeral, Ladies Guild of Church 0862 AMOUNT 169.95 8. 9. 10. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s} Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State . Year(s) Commission Paid: Attorney Fees Duncan, Hartman & Douglas, P.C. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) Claimant None Zip Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills, Cumberland County Accountant's Fees State Zip Tax Return Preparer's Fees Cumberland Law Journal (legal ad) Brockie Health Care Church of God Home (final bill) M&T Bank Check Charge 4,953.74 290.00 75.00 100.69 952.00 22.00 TOTAL (Also enter on line 9, Recapitulation) $ 6,563.38 1513 EX + (1-9'/) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT -ESTATE oF ~/Varner. ~lmer R.. st, NUMBER I. 1, II. 1. 1. SCHEDULE J BENEFICIARIES FILE NUMBER 21 03 RELATIONSHIP TO DECEDENT NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) TAXABLE DISTRIBUTIONS (include oulfight spousal disb'ibutions) Elmer R. Warner, Jr. son ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE 086~ AMOUNT OR SHARE OF ESTATE 100% 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 SHEE1 (If mnra..~..~, i.~ n~arl~ad in.~J'f ~ldifinn~l .~h~f~ nf fh~ .~am~ _~i?~.~ 88839702 CLASSIC CHECKTNG OCT.OH-NOV.03,2003 ! OF 1 O0 0 06~.26H NH 0'17 ELMER R WARNER SR OR ELMER WARNER JR 1941ENOLA RD CARLISLE PA 17013 325 HZGH STREET-CARLISLE ACCOUNT SUHMARY iBEGTNNZNG 6,A$O.OB I -- "I AH ,. NT .0:'1 .... .... NO. IAMOUNT ol.' o.oo $1 544.40 o I 0.00 0.00 6, 00s.68 ACCOUNT :: ..................... ~.::~ ..... ~A~T~: DES~RZP~ZON~H~ H ~;~ :~::: :;: :::::'::': :~HOTHER~;~D~'~Z~ ~?~ ~~?? ~; ~ ~:~;~BA'L~E~ ~ ~:~:~:~:::~:~: 10"0~-0~ BEGINNING BALANCE ~6~550.08 10-06-0~ CHECK NUHBER 1706 S~6.00 6~21~.08 10-07-0S CHECA NUHBER 1~05 S8.~5 6,175.6~ 10-1~-0~ CHECK NUHBER 1707 100. O0 10-1~- OS CHECK NUHBER 1708 50. O0 6,025.6~ 0-21-03 CHECK NUHBER 1709 19.9~ 6, 00~. 68 ENDING BALANCE .~ ~6~ OOS. 68 :.H: ~:;':::: .. :: ::~: :: :: :~ .~ ~:~ ;~;~:~:?;;~ ~:;~.~ ~:~:~:~.~:;:~:~:;:~:~:~;;:~ ~:~:~:~ ~:~.~:~;~:;:~:~::;: :::::::::.::::: :::: ........ ............................... 170.5 10-07-03 38.46 1706 10-06-03 336.00 1707 10-14-0-~ 100.00 1708 10-14-03 $0.00 1709 10-21~0~ 19.95 REFER A FRIEND TO HgT BANK AND GET A FREE GIFT! NOH, HHEN YOU ASK A FRIEND TO OPEN A CHECKING ACCOUNT NITH H&T) NOT ONLY frILL YOU GET A FREE GIFT - SO gILL YOUR FRIEND. STOP BY ANY N&T BRANCH OR CALL NgT'S TELEPHONE BANKING CENTER AT 1-800-72~-2~0 TO GET A REFER-A-FRIEND COUPON. HURRY, GIFT QUANTITIES ARE LZHZTED. FREE GIFT PROVIDED AT TIHE OF ACCOUNT OPENING. September 30, 2003, year-to-date Page 1 of 1 TRANSACTION DETAIL ELNER R WARNER SR & ELNER R WARNER JR JT TEN WROS & NOT AS TEN CON · 3061 SPRING RD , CARLISLE PA 17013-8713 I,,,lll,,,lll,,,,,,ll,,ll,l,,I,l,,,h,,ll,,ll,lll,,h,ll,,hll Statement number: (800) 662-2739 - www.vanguard.com (800) 662-6273 001303141 Client Services Website Tele-Account TRANSACTION ACTIVITY Vanguard Prime Money Market Fund Fund / Account no. 0030 / 0986283621 Trade date Transaction description Dollar amount Share price Shares transacted Total shares owne~l Balance on 12/31/2002 $100,839.85 $1.00 100,839.880 1/31 Income dividend 103.66 1.00 103.660 100,943.510 2/24 Checkwriting 1042 'To ,-; ~ I/d,~./~," '~- -20,000.00 1.00 -20,000.000 80,943.510 2/28 Income dividend 82.29 1.00 82.290 81,025.800 3/31 Income dividend 71.35 1.00 71.350 81,097.150 4/30 InCome dividend 63.74 1.00 63.740 81,160.890 5/30 Income dividend ,62.23 1.00 62.230 81,223.120 6/30 Income dividend 59.13 1.00 '59.130 81,282.250 7/16 Checkwriting 1043 '-~c) ~F.~hV ~5, /~',~'{, -2,000.00 1.00 -2,000.000 79,282.250 7/16 Checkwriting 1044 7/31 Income dividend ' ~: ~'' '~'" ~''" ":"'~" ;~ '~'"~" -77,500.00 1.00 -77,500.000 1,782.250 28.66 1.00 28.660 1,810.910 8/29 Income dividend 1.18 1.00 1.180 1,812.090 9/30 Income dividend 1.13 1.00 1.130 1,813.220 Balance on 9/30/2003 $1,813.22 $1.00 1,813.220 Year-to-date Purchases / Annualized Compound Distrbution Income dividends Redemptions yield annual yield payable dat.. $ 473.37 $ 0.00 0.76% 0.76% 10/01/2003 99,500.00 yANGUARD PRIME MONEY MARKEr FUND *Do not alter this Invest-By-Mail slip. *Visit www.vanguard.com or call !o change your address. ELMER R WARNER SR & ELMER R WARNER JR JTTEN WROS & NOTAS TEN COM Make checks payable to: 'lhe Vanguard Group - 0030 THE VANGUARD GROUP PO BOX 13750 PHILADELPHIA PA 19101-9897 h,,llhl,,,,,llll,,,,,,llhl,,h,l,l,l,,I,,,I,l,l,I Fund / Account no. 0030 / 0986283621 00301 09862836219 307 2 :' 6 1- 1 085998 6014 10413 M1 gX ELMER R WARNER. SR ELMER R WARNER. JR 1941 ENOLA ROAD CARLISLE PA 17013 AMERICAN HOME BANK Lancaster, PA 17601-213! (717) 537-4AHB ($37-4242) (877) B ANKAH, B,.~(2i56-5242) h,,llh,,llh.,,,Ih,lh,l,,ll www. bankahb.com STATEMENT DATE' 09/20/03 0000110493 1 *se CHECKING *** MONEY ~4ARKET ACCOUNT NLTMBER 0000110493 PREVIOUS STATEMENT BALANCE AS OF 08/20/03 PLUS 2 DEPOSITS AND OTHER CREDIT~ ....................... 77.683.90 LESS 0 CHECKS AND OTHER DEBITS ................... 79.642.04 CURRENT STATEMENT BALANCE AS OF 09/20/03 ...................... / :00 NUI~BER OF DAYS IN THIS STATEMENT PERIOD ''~ ............ . ......... 57.325.94 ACCOUNTNO, C¥CLE-020 BEGINNING RATE 2.23000 *** CHECKING ACCOUNT TRANSACTIONS *** DATE DESCRIPTION 09/02 DEPOSIT. 09/20 INTEREST PA¥~4ENT DEBITS CREDITS 79.423.68 218.36 *** BALANC~ 3;-£2~;-222 .......................................................... 08/20 77.683.90 09/02 157.107.58 09/20 157.325.94 PAYER FEDERAL ID NLTMBER 23-3087841 INTEREST PAID YEAR TO DATE 402.26 ~z~ ~N PERIOD ......................... 31 ...... 2.10% PLEASE NOTE: THE TOLL-FREE PHONE ~ PRINTED AT THE TOP OF YOUR STATEMENT IS INCORRECT. THE CORRECT TOLL-FREE PHONE ~ IS 1-877-226-5242. TO REPORT A LOST OR STOLEN DEBIT CARD. PLEASE CALL 1-800-523-4175. NOTE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION COYNE & COYNE P.C. ATTORNEYS AT LAW 3901 MARKET STREET CAMP HILL, PA 17011-4227 TO: Registe: of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Elmer R. Warner, Sr. Date of Death: October 3, 2003 Will No. 21-03-0862 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration 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 October 21, 2003 : Name Address Elmer R. Warner; Jr., 1941Enola Road, Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none Date: Signature Name George F. Douglas, III, Esquire Address 1 Irvine Row Carlisle, PA 17013 Telephone ~17) 249-7780 Capacity: __ Personal Representative x Counsel for personal representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171ZB-0601 COHHONNEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT REV-1607 EX AFP (01-05) GEORGE F DOUGLAS I'l'! '04 FEB 27 P1:03 DUNCAN ETAL I IRVINE RON (.~r~, : CARLISLE PA ~;~ifl*~c~;'ia. nd Co., PA DATE 02-25-2004 ESTATE OF NARNER SR DATE OF DEATH 10-05-2005 FILE NUMBER 21 05-0862 COUNTY CUMBERLAND ACN 101 Amoun'l: Rem'; 'l:'l:ed ELHER HAKE CHECK PAYADLE AND RENZT PAYHENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credJ~: ~o your account:, submit: ~he upper portion of ~his for. wi4:h your ~ax payment. CUT ALONG THIS LINE ~-* RETA'rN LONER PORT'rON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ### INHERITANCE TAX STATEMENT OF ACCOUNT ESTATE OF NARNER SR ELHER R F'rLE NO. 21 05-0862 ACN 101 DATE 0Z-ZE-ZO04 THIS STATEMENT TS PROV/DED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACM TN THE NAHED ESTATE. SHO#N BELO# TS A SUHHARY OF THE PR/NCZPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND.. TF APPLICABLE, A PROJECTED TNTEREST F/GURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 02-24-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 5,277.60 PAYMENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AMOUNT PAID Z65.16 12-10-2005 01-02-2004 CD005525 CD005405 .72 5,000.00 15.72 ZF PAID AFTER TH/S DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 5,277.60 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORH FOR TNSTRUCTZONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NZLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA. REFUND [CR): A refund of a tax credit) which was nat requested on the Tax Return) may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315}. Applications ara available at the Office of the Register of Hills) any of the Z5 Revenue District Offices or from the Department's IS-hour answering service for fores ordaring: 1-800-36Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-4qT-50ZO (TT only}. REPLY TO: guestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes) ATTN: Post Assessment Review Unit) Dept. Z8060l, Harrisburg) PA 171ZB-0601) phone (717) 787-6505. DISCOUNT: If any tax due is paid aithin three (5) calendar months after the decadent's death, a five percent (SI) discount of the tax paid is allowad. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996) the first day after the and of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of death, to tho date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6X3 percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. Interest Daily Year Rate Factor Year The applicable interest rates for 1982 through 2003 ara: Interest Daily Interest Daily Rate Factor Year Rate Factor 1982 lOX .000568 1987 9Z .000247 1999 7Z .OOOZ9Z 1983 162 .000658 1988-1991 llZ .000501 2000 8Z .O00Z19 1984 11Z .000501 199Z 92 .000Z67 ZOO1 92 .000Z47 1985 15Z .000556 1993-1996 72 .O0019Z ZOOZ 6X .000164 1986 lOX .000Z74 1995-1998 9Z .000Z47 ZOO5 SZ .000157 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen IlS) days beyond the date of the assessment. If payment is made after the interest computation date shoen on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DTVTSTON DEPT. 280601 HARR/SBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-15~7 EX AFP (01-05) GEORGE F DOUGLAS III DUNCAN ETAL I IRVINE ROW CARLISLE ~.~DATE DATE OF DEATH FILE NUHBER 02-24-200q WARNER SR 10-05-2005 21 05-0862 CUMBERLAND 101 Amoun~ Remi ~:'~ed ELMER R HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF ZNHER/TANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WARNER SR ELMER R FILE NO. 21 03-0862 ACN 101 DATE 02-24-200q TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~a (Schedule A) (1) 2. S~ocks and Bends (Schedule B) (2) $. Closely Held S~ock/Par~nership Interes~ (Schedule C) ($) q. Mortgages/No,es Receivable (Schedule D) (~) E. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) (5) 6. Jointly O~ned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asse~s APPROVED DEDUCTIONS AND EXEMPTIONS: 9 10 11 13 Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule H) Debts/Mortgage Liabilities/Liens (Schedule 1) To,al Deductions Ne~ Value of Tax Ra~urn (9) (10) ChIri~abla/Governmen~al Bequests; Non-elected 9113 Trusts (Schedule J) Ne~ Value of Estate Subject ~o Tax 80z98~.39 ~2~859.8R .00 .00 NOTE: To insure proper .00 credi~ ~o your account, .00 subIi~ the upper portion .00 of this form with your ~ax payment. (8) 6,565.~8 .O0 NOTE: 125,8R~.25 (11) ~ .563.38 (12) 117,280.85 (13) . O0 (1~) 117,280.85 1~ an assessment #as issued previously, lines 1~, 15 and/er 16, reflect flgures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amoun~ of Line 1~ It Spousal ra~e (15) 16. Amoun~ of Line 1~ taxable a~ Lineal/Class A ra~e (16) 17. Amount of L/ne 1~ a~ Sibling ra~e (17) 18. Amoun~ of Line 1~ ~axable a~ Collateral/Class B rate (18) ~al Tax Due 17, 18 and 19 ~ill .00 5,277.60 .00 .00 5,277.60 DATE 12-10-200~ NUHBER CD003325 OISCOUNT INTEREST/PEN PAID (-) 263.16 PAYMENT MUST BE MADE BY 07-03-200q~. ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AHOUNT PAID 5,000.00 TOTAL TAX CREDIT I 5,263.16 BALANCE OF TAX DUEl l~.q~ ~NTEREST AND PEN. .00 TOTAL DUE 1~.~ ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT 1S REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE AK A REFUND· SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.) RECExrl 19. Princi TAX CREDZTS PAYH~NT · O0 x O0 = 117,280.09 x Oq5= · O0 x 12 = · O0 x 15 = (19)= STATUS REPORT UNDER RULE 6.12 Name of Decedent: Elmer Warmer~ Sr. Date of Death: August 28, 2003 Will No. 21-03-0862 Admin. No. 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 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. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x 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 x No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: 5/,,1~ (MAH:rmf/AM3) George F. Douglas, III, Esquire Name (Please type or print) 1 Irvine Row, Carlisle, PA 17013 Address .(717 ) 249-7780 Tel. No. Capacity: X ~Personal Representative Counsel for personal representative IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION IN RE: ESTATE OF ELMER R. WARNER, : DECEASED : No. 2003-862 NOTICE OF CLAIM County of Cumberland, Claremont Nursing & Rehabilitation Center files this Claim against the Estate of Elmer R. Warner in the sum of $16,866.79 in accordance with the invoice attached hereto. This Claim is a non-priority claim under 20 Pa. C.S.A. § 3392(6). LATSHA DAVIS YOHE & MCKENNA, P.C. Date: //O' ff' ~[ By: St~v~'n-M. Montresor, Esq. Attorney No. 74244 P.O. Box 825 Harrisburg, PA 17108-0825 (717) 761-1880 Attorneys for Claimant, Cumberland County, Claremont Nursing & Rehabilitation Center L~'' :dd £L 93062 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION IN RE: ESTATE OF ELMER R. WARNER, : DECEASED : No. 2003-862 CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing Notice of Claim was served via Certified Mail, Return Receipt Requested and First-Class United States Mail, postage prepaid, upon the following: Dated: George F. Douglas, Esquire 1 Irvine Row Carlisle, PA 17013 ~2 Charges due and owing as of May 2004: October 2002 Private Pay November 2002 Private Pay December 2002 Private Pay January 2003 Private Pay $2,923.65 $5,993.88 $6,166.19 $17783.07 TOTAL OWED $16,866.79 ~12/19/2003 Resident Open A/R File [PA614] Page 1 4211 Elmer R Warner G/L Due Fin Type Notes Fac State Bill date From C1 Level Chg. Balance 1 PA 10/31/2002 mcb PP SNF AIqC 1,044.68 1 PA 10/31/2002 PP PP SNF /%NC 193.65 1 PA 10/31/2002 PP PP SNF RB 2,730.00 I PA 11/30/2002 PP PP SNF AIqC 433.88 1 PA 11/30/2002 PP PP SNF RB 5,560.00 1 PA 12/31/2002 PP PP gNF ~M~C 431.19 1 PA 12/31/2002 PP PP SNF RB 5,735.00 1 PA 01/31/2003 PP PP SNF ANC 28.07 1 PA 01/31/2003 PP PP SNF RB 1,755.00 12/19/2003 Open A/R Summary [PA375] Page 1 4211 Elmer R Warner Due From Description Balance mcb MEDIC~gE PART B 1~'044~68 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE * INHERITANCE TAX RECORD ADdUSTMENT REV-I~gS EX AFP (DI-DS) GEORGE F DOUGLAS DUNCAN ETAL i IRVINE ROW CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-Z5-200q WARNER SR ELMER 10-05-2005 21 05-0862 C~. RLAND. MAKE CHECK PAYABLE AND I~MIT PAYHENT TO: RE~ISTER OF CUHBERLAND CO COURT~0USE:j CARLISLE, R NOTE: To insure proper credi~ to your account, submit ~he upper portion of ~his fore wi~h your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTTON FOR YOUR RECORDS ~ ESTATE OF WARNER SR ELMER R F/LE NO. Z1 05-086Z ACN 101 DATE 08-25-200q ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION VALUE OF ESTATE: 1. Real Estate (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) q. Mortgages/No~es Receivable (Schedule D) (q) .6. Cash/Bank Deposi~cs/Misc. Personal Proper~y (Schedule E) ($) 6. Jointly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule g) (7) B. To,al Asse~s DEDUCTIONS AND EXEMPTTONS: 9. Funeral Expenses/Administrative Costs/ 10. 11. 12. 15. lq. TAX: 15. 16. O0 O0 O0 O0 80~98q $9 qZ~859.8q O0 Miscellaneous Expanses (Schedule H) (9) Debts/Mortgage Liabilities/Liens (Schedule Z) (10) To,al Deductions Ne~ Value of Tax Return Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) Ne~ Value of Es~a~e Sub~ec~ ~o Tax Amount of Line lq at Spousal ra*e Amoun* of Line lq ~axable a~ Lineal/Class A re*e 17. Amoun~ of Line lq e~ Sibling ra*e 18. Amoun~ of Line lq ~axable a~ Colla*eral/Class B ra~e 19. Princi)al Tax Due K~C~I~I UI~CUUNI ~+J NUMBER INTEREST/PEN PAID (-) (15) (16) (17) (18) CD003325 CDOO3q05 225.93 .00 TAX CRED/TS rAY fl~.M I DATE 1Z-10-2003 Ol-OZ-ZOOq IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (8) 123,8qq. Z3 6,563.38 16,866.79 (12) 23;q30.17 (12) 100/~1q.06 (13) .00 (2q) lOO/qlq.06 .OOX O0 = .00 lOOzqlq.06 x Oq5= q~518.65 .OOX 12 = .00 .OOX 15 = .00 (19) q/518.6q AMOUNT PAID 5,000.00 13.72 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 5,239.65 7ZI.01CR .00 721.01CR ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE 1S REFLECTED AS A 'CRED/T" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. REFUND (CR]: A refund of a tax credit, which Has not requested on the Tax Return) may be requested by completing an "Application for Refund of Pennsylvania inheritance and Estate Tax" (REV-15/3). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices or from the Department's Zq-hour answering service for forms ordering: 1-800-562-ZOS0~ services for taxpayers with special hearing and / or speaking needs: 1-DO0-qqT-30ZO (TT only). REPLY TO: questions regarding errors contained on this notice should be addressed to: PA Department af Revenue) ~ureau of Individual Taxes, ATTN: Post Assessment Review Unit) Dept. ZD060I, Harrisburg, PA 17liD-0601) Phone (717) 787-6505. DISCOUNT: PENALTY: INTEREST: If any tax due is paid within three (3) calendar months after the decedent's death) a five percent (52) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. Interest is charged beginning with first day of delinquency or nine (9) months and Dna (1) day from the date of death to the date of payment. Taxes which became delinquent before January l, 19DZ bear interest at the rate of six (62) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after January l, 1982 Nil! bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 Z02 .O00Sq8 1988-1991 llX .000301 2001 92 .000247 1983 162 .000438 1992 92 .O00Zq7 ZOOZ 62 .000164 1984 112 .000301 1993-1994 72 .O00Xgz 2003 52 .000137 1986 102 .000274 1999 72 .000192 1987 92 .000247 ZOO0 82 .000219 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DEL/NQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. REV-1470 EX ~6-88) INH'-E~IT,~,NCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 P~CEDEN3~S NAME FILE NUMBER ELMER R WARNER SR 2103-0862 PFVIEWED BY ACN Dianne McClain 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The Notice of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions and Assessment of Tax has been adjusted to allow an additional debt submitted by the Estate. ROW Pa.qe 1 BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX DTVTSTON DEPT. 280601 HARRTSBURG.. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-1607 EX AFP (01-OS) GEORGE F DOUGLAS III'O'~i DUNCAN ETAL I IRVINE ROW CARLISLE P A'-': Z?Q13 DATE lO-Off-ZOO4 ESTATE OF WARNER SR DATE OF DEATH 10-05-2005 FILE NUMBER 21 03-0862 COUNTY CUMBERLAND ACN 101 Amoun~ Remi~ed ELMER R MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credL~ ~o your account, submi~ ~he upper por~:ion of ~his form wi~h your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~ REV-1607 EX AFP (01-03) ### INHERITANCE TAX STATEMENT OF ACCOUNT ESTATE OF WARNER SR ELMER R FILE NO. 21 03-0862 ACN 101 DATE 10-04-Z004 THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHOWN BELOW ZSA SUHNARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE:. AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 08-24-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 4,518.64 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 225.93 12-10-2005 01-02-2004 09-14-2004 CD005325 CD005405 REFUND .00 .00 5,000.00 15.72 721.01- IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" {CR), TOTAL TAX CREDIT 4,518.64 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- Zf RESIDENT DECEDENT make check or money order payable to: REGISTER OF ~/ILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COHMONNEALTH OF PENNSYLVANTA. REFUND (CA): A refund of a tax credit, ahich Nas not requested on the Tax Return, amy be requested by completing an 'Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Nills, any of the 23 Revenue District Offices or from the Department's Z4-hour ensnaring service for forms ordering: 1-800-$62-Z050; services for taxpayers with special hearing and / or speaking needs: 1-B00-447-3020 (TT REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. lB0601, Harrisburg, PA 17liB-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount of the tax paid is aIIoaed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: [nterest is charged beginning with first day af delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, lgBZ bear interest at the rate of six [6Z) percent per annum calculated at a daily rate of .OOO16q. All taxes which became delinquent on and after January 1, lgBZ will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through zooq are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year 1982 lOX .0005q8 1988-1991 11Z .000301 2001 1983 198q IIX .000301 1993-199~ 72 .000192 2003 1985 132 .0D0356 1995-1998 92 .000247 2004 1986 ZOZ .O00Z7q 1999 72 .000192 1987 9Z .O00Zq7 ZOO0 8X .000219 Interest Daily Rate Factor 92 .O00Zq7 62 .00016q 52 .000137 q2 .000110 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.