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HomeMy WebLinkAbout03-1022REV-346 EX (8-92) PA DEPARTMENT OF REVENUE ESTATE INFORMATION SHEET FOR REGISTER'S OFFICE USE ONLY County Code I Year File Number DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the department. (First) (Middle) Denton Name (Last) Miller IDecedent's Social Security Number 194 I 2 6 16835 Robert Date of Death 01/05/03 Date of Bi~h 08/09/33 TYPE FILING: Enter check (~,) mark to indicate the nature of the return to be filed with the department. [] Probate Return r-]Joint Assets Only [] Estate Tax Only [] Litigation Purposes (No Other Assets) Enter check (~,) mark to indicate the nature of the proceedings at the Register of Wills LETTERS GRANTED: Office. (Attach additional sheets if explanation is necessary.) [] Testamentary [] Administration [] No Letters [] Other (Please Explain) ATTORNEY/CORRESPONDENT Enter all data concerning the attorney or other individual to receive all INFORMATION: tax information and correspondence. Name (Last) (First) (Middle) Griffie Bradley L. Supreme Court I.D. # 34349 Street Address 200 North Hanover Street City State Carlisle PA Zip Code 17013 Telephone Number (717) 243-555l PERSONAL REPRESENTATIVE INFORMATION: Executor/Administrator Enter all data concerning the personal representative(s) of the estate authorized by the Register of Wills Name (Last) (First) (Middle) Social Security Number Kreitzer Lois Ann 2 0 6I 6 0 I 8 5 7 1 Street Address 18 M~fitain View Terrace City State Zip Code Telephone Number Newvi lle PA 17241 (717) 776-9206 Co-Executor/Administrator Name (Last) (First) (Middle) Street Address Social Security Number City State Zip Code Telephone Number Co-Executor/Administrator Name (Last) (First) (Middle) Street Address Social SecuritYl Number City State Zip Code Telephone Number Prepared By Bradley L Griffie, Esquire PETITION FOR PROBATE and GRANT Estate of Robert Dm~ Miller _ ./ No. also known as ~'{)l~'~T PgCTObI D/llCl-t~g~) To: Deceased. Social Security No. 194-26-6835 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut rix in the last wilt of the above decedent, dated January 3, 2003 and codicil(s) dated (none) OF LETTERS Register of Wills for the County of Cumberland Commonwealth of Pennsylvania in the named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in c, umberland County, Pennsylvania, with is last family or principal residence at 6 Brandy Run Road~ Newville, PAy 17241 (Lower Mifflin Twp.) (list street, number and muncipality) Decendent, then 69 years of nee, ~d January 57 2003 at 18 Mountain View Terrace, Newville, Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: (none,~ 4~000.00 0.00 0.00 WHEREFORE, petitioner(}} respectfully request(s) the probate of the last will ~ presented herewith and the grant of letters testamentry {testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. ~ '~ Lois Arm Kreitzer -" ~.=o 18 Mountain View Terrace ~"-' Newville~ PA 17241 3o OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF 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 represen- tative(s) of the above decedent petitioner(s) will ~!J.~(~d truly administer the~es/3me according to law. Sworn to or affirmed and subscribed ci-~ 0 ~) before me this _ _ _ day of ~ Lois Arm Kreitzer ! Register ~ No. Estate Of ROBER? DENTON MILLER , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW 2003 f9X , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(l) dated January 3.. 2003 described therein be admitted to probate and filed of record as the last will of Robert Denton Miller ; and Letters Testamentary are hereby granted to Lois Ann Kreitzer FEES Probate, Letters, Etc .......... Short Certificates( ) .......... Renunciation ................ TOTAL Filed ................................... · Register of Wills ~ 34349 ~radley L. Griffie, E~quir'e °~ North" Carlisle, t~D~F~i 3 (717) 245-5551 PHONE his is to certify that the inf'ormation here given is correctly copied ti'om ~m original ce,'dficatc of deali~ duly t~,'c'~ ~ ,s Local Registrar. The original certificate will be-fbrwardcd to the State \qtal Records ()f'fice (et permancm,,mm~. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8869999 No. local Registrar I)acc 0s.:~ ~,. 2/87 COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Robert D. Miller 6'/ ,.,. Cumberland ,,~ Me["~ani c SEX ,~:~IAL SE URITY N R DATE OF OEATH ,MOr~ ,Male , lq~ ~ 6835 - --'~ 9n03 I ' I ' -- -- 14.danuary I ~' . '--'{ 7~'~' ' I Ne:~~ I I ~ugo Mecnanzc } ~ ~ 1;'~1 ~ ,,~ Pe~ A, Lindsa-- I.~ 1,. I.. 1~~ I ' "" ~ ..... IACm ,..mm PA ~ -..~.~o~ T.nv~, Mifflin 6 Brandy Run Rd 'Newvilfe PA 17241 ~'SNA~-- --' ~ ............ {,,. Mabel C. Hefflefinger " ....... Lois A. Kreitzer ~ I~ Moungaln view Ter. Newville PA 17241 ~U ~ U ,,~ ,,, I/7/0~ I& Crematory { 17065 '~c~;=~'i Ho~e lnc 15 Bi S rln Ave I LAST WILL AND TESTAMENT OF R OBER T DENTON MILLER I, Robert Denton Miller, of 6 Brandy Run Ro, Pennsylvania, revoke my former Wills and Codicils and declare this to be my Last Will and Testament. ARTICLE I IDENTIFICATION OF FAMILY I am married to Peggy Ann Miller. and all references in this Will to "my spouse" are references to Peggy Ann Miller.. The names of my children are Wanda May Shriner, Donna Rhoads & Lois Ann Kreitzer. All references in this Will to "my children" are references to the above-named children. ARTICLE II PAYMENTS OF DEBTS AND EXPENSES I direct that my just debts, fimeral expenses, and expenses of last illness be first paid from my estate. ARTICLE III DISPOSITION OF PROPERTY A. Specific Bequests. I direct that the following specific bequests be made fi'om my estate. 1. My Estate shall be distributed to Lois Ann Kreitzer & Peggy Ann Miller. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. 2. My remaining tangible personal property shall be distributed to Lois Ann Kreitzer & Peggy Ann Miller. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. B. Residuary_ Estate. I direct that my residuary estate be distributed to the following beneficiaries in the percentages shown: 50.00 % to my spouse, Peggy Ann Miller .. If my spouse does not survive me, this share shall be distributed with the share for my children listed under this provision. 50.00 % to my child(ren) in equal shares. Ifa child of mine does not survive me, such deceased child's share shall be distributed in equal shares to the children of such deceased child who survive me, by right of representation. If a child of mine does not survive me and has no children who survive me, such deceased child's share shall be distributed in equal shares to my other children, if any, or to their respective children by right of representation. If no child of mine survives me, and if none of my deceased children are survived by children, this share shall be distributed with the share for my spouse listed under this provision. 100.00 % - Percent Total C. No Survivors. If my spouse, Peggy Ann Miller., my children, and all of my children's children fail to survive my death, my residuary estate shall be distributed to the following beneficiaries in the percentages as shown: 50.00 % to my heirs-at-law, their identities and respective shares to be determined under the laws of the State of Pennsylvania, then in effect, as ifI had died intestate at the time fixed for distribution under this provision. 50.00 % to my spouse's heirs-at-law, their identities and respective shares to be determined under the laws of the State of Pennsylvania, then in effect, as if my spouse had died intestate at the time fixed for distribution under this provision. 100.00 % - Percent Total ARTICLE IV NOMINATION OF tgXECUTOR I nominate Lois Ann Kreitzer, of 18 Mt. View Terrace, Newville, Pennsylvania, and Peggy Ann Miller, of 6 Brandy Run Rd.. Newville, Pennsylvania, as Co-Executors (the "Executor"), without bond or security. If one of the above nominees does not serve for any reason, the remaining nominee shall serve as sole Executor without bond or security. ARTICLE V EXECUTOR POWERS My Executor, in addition to other powers and authority granted by law or necessary or appropriate for proper adminimration, shall have the right and power to lease, sell, mortgage, or otherwise encumber any real or personal property that may be included in my estate, without -2- order of court and without notice to anyone. My Executor shall have the right to administer my estate using "informal", "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. ARTICLE VI MISCELLANEOUS PROVISIONS A. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of this Will in interpreting its provisions. All words used in this Will in any gender shall extend to and include all genders, and any singular words shall include the plural expression, and vice versa, specifically including "child" and "children", when the context or facts so require, and any pronouns shall be taken to refer to the person or persons intended regardless of gender or number. B. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will, no person or organization shall be deemed to have survived me unless such person or entity is also surviving on the thirtieth day after the date of my death. C. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fiaudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and my estate shall indemnify such natural person f~om any and all claims or expenses in connection with or arising out of that fiduciary's good faith actions or nonactions as the fiduciary, except for such actions or nonactions which constitute fi'audulent conduct or bad faith. D. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and if not, by my Executor. IN WITNESS WHEREOF, I have subscribed my name below, this 3 day of ,./:m,, , Testator Signature: Robert Denton Miller -3- PENNSYLVANIA Self-Proving Clause COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND COUNTY I, Robert Denton Miller, the Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly and as my t~ee and voluntary act for the purposes expressed in the instrument. Sworn to or affirmed and acknowledged before me by Robert Denton Miller, the Testator, this 2> dayof ~ , Q.~3. Testator Signature Robert Denton Miller Signature of officer Official capacity of officer ~ne Notadal Seal M Galena, Not ~ . .Mt'dd/es~ '1:~'~ .... ary Public · ' - · ~", ',-'umoertand ~My Commission Exnires ~.,- _C_ounty Member p,~ ....... ~"~' .... v~ov. 22, 2004 ~numoer, Pennsyl~ AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND COUNTY the ~tne~s who~ ~es ~e si~ed to the a~ached or forego~ ~t~ent, ~ d~y q~ed accordhg to ~w, do de~ ~d ~y ~t we were pre~nt ~d ~w the Testator si~ ~d execute the ~ment ~ the Teaator's L~ W~; t~t the Testator si~ed ~g~ ~d executed it ~ the Teaator's flee ~d vol~t~ act for the p~ses e~ressed h it; tMt each of us h the he~ ~d si~t of the Testator signed the W~ ~ a ~tness; ~d tMt to the ~ of o~ ~owledge the Testator w~ at tMt t~e 18 or more ye~s of age, of ~d ~d ~d ~der no co~r~t or ~due ~uence. Swom to or affirmed and subscribed to before me by ~(A¢'~Ct~_ + k~, [.% *~, and ]CCwA~.~ ~ ~e,~l~ , ~tnes~s, t~ ~ ~y of Witne~ Si~t~e: ~_~~~ ~ Nme: ~ m ~,_ ~4 City: ~1~ ~ur~lle ~ State: ~5~,S] % ~_ /~/~ Witness Signature: Name: City: State: Notarial Seal Catherine M. Galena Public Notary idd~esex Twp. Cumberland County M~ commission Expires Nov. 22,200~ L-----r--- 5~a~,a~ociat on et Notaries MemPer ;'~'"-"v.~" ' Seal and official capacity of officer COMMONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171Z8-0601 REV-15~3 EX &FP / -- '7 ZNFORHATZON NOTICE AND TAXPAYER RESPONSE LOIS A KREITZER 18 NOUNTAIN VIEW TER NEWVILLE PA 172ql FZLE NO. Z1 ACN 05122q17 DATE 06-16-Z005 EST. OF ROBERT D HILLER S.S. NO. 19R-Z6-685~5~" DATE OF DEATH 0~2005~ COUNTY CUMBERLAND TYPE OF ACCOUNT [--]$AV~NGS ~-]TRUST []CERTIF. REH/T PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEHBERS 1ST FCU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indlcate that at the death of the above decedent, you were a joint owner/beneFiciary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this ~orm and return it to the above address. This account is taxable in accordance aith the [nheritance Tax Laws of the Ccsmonwcelth of Pennsylvania. Questions may be answered by cai!lng (7173 787-8~27. COMPLETE PART I BELOW # # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. ZOZ828-11 Date 03-17-2001 Establ/shed Account Balance ~6 0.29 Percent Taxable X 50.000 Amount Sub,oct Tax Rate X · Potential Tax Duo 10.36 To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of Nills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments are made within three ($) months of the decedent's data cf death, you may deduct a 5Z discount of the tax due. Any inheritance tax due mill become delinquent nine (9) months after the date cf death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LINE A. r-~The abave information and tax due ls correct. ~1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Nills and an official assessment will be issued by the PA Department cf Revenue. B. [] The above asset has been or mill be reported and tax paid eith the Pennsylvania Inheritance Tax return to be filed by the decedsnt's representative. C. O The above information is incorrect and/or debts and deductions were paid by you. You must complete PART [] and/or PART F-] below. If you indicate a d~fforont tax rate, please state your relationship to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS Date Established 1 Account Balance 2 Percent Taxable 3 X Amount Sub,oct to Tax 4 Debts and Deductions ~ - Amount Taxable 6 Tax Rata 7 X Tax Duo 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare ~hat tho facts have reported above are true, correct and ~c~l~e to tho bes.~_ of my k~t~l~dge and bo~jj~f. ~A~PAYER SIGNATURE ~ TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND NZLL RESULT ZN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the dacedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fuZly taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others ara taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed) place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit thee with your check for the amount of tax to the Register o; Nills of the county indicated. The PA Department of Revenue ~ill issue an official assessment (Fora REV-1548 EX) upon receipt of the return from the Register of NiLXs. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Tnharitance Tax Return filed by the dacadant's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue) Bureau of Tndividual Taxes, Dept Z80601, Harrisburg, PA 171ZB-0601 in the envelope provided. 5. BLOCK C - If the notice infor~ation is incorrect and/or deductions are being claimed, check block "C" and compIate Parts Z and 5 according ta the instructions below. Sign two copies and submit them ~ith your chock for the amount of tax payabIe to the Register of Mills of the county indicated. The PA Department of Revenue mill issue an official assessment (Fora REV-IS48 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/az: Accounts ahich the decedent put in joint names within one (1) year of death ara taxable fully as transfers. However, there is an exclusion not to exceed $~,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (wa) appears before your first name in the address portion of this notice, the $5,000 exclusion -already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including lnterest accrued to the date of death. 5. The percent of the account that is taxable far each survivor is determined as foItows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: ! DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT ORNERS Example: A joint asset registered in the name of the decedent and tme other persons. ! DIVIDED BY 5 (JOINT ONNERS} DIVIDED BY Z (SURVIVORS) = .I67 X 100 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the decadant's death er accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decadent. I DIVIDED BY Z (SURVIVORS) = .SD X 100 = SOX (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 63 is determined by subtracting the debts and deductions (line S) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined below. De~e of Death Spouse Lineal Sibling Collateral 07/01/9fi ko 12/$1/9q 01/01/95 ko 06/$0/00 OX 6X 1EX 15X 07/01/00 ko present OX q.$Xa 12X mThe 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 chiId is OZ. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the naturaI parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decadent, ehathar by blood or adoption. The "Collateral" class of hairs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions ara determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decadent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 5. If additional space is needed) usa plain paper 8 l/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2806O1 HARRISBURG, PA 17~ 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 003330 KREITZER LOIS A 18 MOUNTAIN VIEW TERRACE NEWVILLE, PA 17241 ........ fold ESTATE INFORMATION: SSN: 194-26-6835 FILE NUMBER: 2103- 1022 DECEDENT NAME: MILLER ROBERT D DATE OF PAYMENT: 12/11/2003 POSTMARK DATE: 12/10/2003 COUNTY: CUMBERLAND DATE OF DEATH: 01/15/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT r03122417 $10.36 REMARKS: LOIS A KREITZER TOTAL AMOUNT PAID: $10.36 SEAL CHECK# 164 INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF TNDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 LOIS A KREITZER 18 MOUNTAIN VIEW TER NEWVILLE PA 17Z~1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-164$ EX AFP (hi-OS) DATE 01-Z7-200~ ESTATE OF MILLER ROBERT DATE OF DEATH 01-15-Z005 FILE NUMBER Z10$-IOZZ COUNTY CUMBERLAND SSN/DC 19~-26-6855 ACN 05122~17 Amoun~ Remi~ed HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 D CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-15~8 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 01-Z7-200~ ESTATE OF MILLER ROBERT D DATE OF DEATH 01-15-2005 COUNTY CUMBERLAND FILE NO. 21 05-1022 S.S/D.C. NO. 19~-26-6855 ACN 05122~17 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOZNT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 20Z8Z8-11 TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-17-Z001 Account Balance R60.29 Percent Taxable X 0.500 Amount Subject to Tax 250.15 Debts and DeductAons - .00 Taxable Amount Z50.15 Tax Rate X .~5 Tax Due 10.56 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-10-2005 CD005550 .00 10.56 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 10.56 .00 .08 .08 ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE IS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" ( CR}, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PURPOSE OF NOT~CE~ To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (72 P.S. Section 9140}. PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side. -- Make check or money order payable to: REGXSTER OF NXLLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Applicat[on for Refund of Pennsylvania [nheritance and Estate Tax" (REV-1315). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices or by calling the special Z4-hour answering service for forms ordering: 1-800-362-Z050; services for taxpayers a[th specie1 hearing and or speaking needs: 1-800-447-3010 iTT only). Any party in interest not satisfied eith the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this No[ica may object aJth[n sixty (60) days of receipt of this Not[ce by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1011, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Un[t, DEPT. 180601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page S of the booklet "~nstructJons far Inheritance Tax Return for a Res[dent Decedent" (REV-1501) 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 (51) discount of the tax paid is allowed. The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty per[od. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this not[ce. Interest is charged beginning with first day of del[nquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became deIinquent before January 1, 1981 bear interest at the rate of six (6X) percent per annum calculated et e daily rate of .000164. All taxes which became delinquent on or after January 1, 198Z will bear interest at a rate which w[11 vary from calendar year to calendar year eith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through Z003 are: Interest Daily Xnterest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1981 ZOZ .000548 1987 9Z .000Z47 1999 71 .000191 1983 161 .000438 1988-1991 11Z .000301 ZOO0 az .000119 1984 llZ .000301 1991 91 .000247 2001 91 .000247 1985 131 .000356 1993-1994 ?Z .000192 ZOOZ 6Z .000164 1986 10Z .000274 1995-1998 9Z .000247 2003 5Z .000157 --Interest is calculated as foX1ows: TNTEREST = BALANCE OF TAX UNPAI'D X NUNBER OF DAYS DEL'rNQUENT X DAI'Ly XNTEREST 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 shown on the Notice, additionaX interest must be caXculated.