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HomeMy WebLinkAbout03-1036REV-~1500 EX + (6-00) i- Z W UJ O LU I- z Z O LU n,, O COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIA[ MEAD, LENA K. DATE OF DEATH (MM-DD-Year) 10/31/2003 REV-I$O0 INHERITANCE TAX RETURN RESIDENT DECEDENT IDATE OF BIRTH (MM-DD-Year) 1 1/30/1 910 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A OFFICIAL USE ONLY FILE NUMBER i 03(0 COUN'DY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 1 6 8-2 2-7 1 5 0 THIS RETURN MUST BE FILED IN DUPLICATE wrrH THE REGISTER OF WILLS SOCIALSECURITYNUMBER [-~1. Odginal Return r-~4. Limited Estate ["-~ 6. Decedent Died Testate {Attach copy of Will) [] 9. Litigation Proceeds Received E~2. Supplemental Return D4a. Future Interest Compromise (date of deatfl after 12-12-82) [~"1 7. Decedent Maintained a Living Trust (Attach copy of Tru.~ E~] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-§5) -"]3. Remainder Return (dateofdeathpdorto 12-13-82) r--] 5. Federal Estate Tax Retum Required O 8. Total Number of Safe Deposit Boxes [] 11, Election to tax under Sec, 9113(A) (A~ach Sch O) TELEPHONE NUMBER (717)761-1880 PA 17108-0825 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) E] 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. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an ele~on to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 134,895.52 OFFICIAL USE ONLY (8) 2,585.88 134~895.52 (11) 2~585.88 132~309.64 (12) (13) (14) 132,309.64 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(12) 16. 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 20. X X 1 32,309.64 x .12 X .15 __ (15) __ (16) (17) (18) (19) 15,877.16 15,877.16 Debedent's Complete Address: STREET ADDRESS 1100 GRANDON WAY CITY MECHANICSBURG, PA ISTATE PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount 793.86 Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) I zIP17050 (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If Line 1 + Line 3 is greater than 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 + SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT 15,877.16 793.86 0.00 15,083.30 15~083.30 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. .............................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare thal 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 o~ all informatio~ of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS _32,,~L,,W ES LEY/D R~E,¢/~'PT 3210 /rvlEC~IA~ICSBU RG SIGNATURE O~~HA~TIVE DATE 1 -11 .{o3 PA 17055 PA 17108-0825 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net 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 retum 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 benefidaries 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. REV'-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER MEAD, LENA K. This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OFTRANSFER. ATTACHA COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (~,m'UC~BLe VALUE 1. LENA K. MEAD LIVING TRUST DATED MAY 25, 1993. 134,895.52 100. 134,895.52 THE TRUST IS COMPOSED OF TWO ASSETS: A) LPL FINANCIAL SERVICES INVESTMENT ACCOUNT # 3905-4327 WITH DATE OF DEATH BALANCE OF $122,223.97 (SEE ATTACHED) B) PNC BANK CHECKING ACT #50861 WITH DATE OF DEATH BALANCE OF $12,871.55 SEE STATEMENT ATTACHED TOTAL (Also enter on line 7 Recapitulation) $ 134~895.57 (If mom space is needed, insert additional sheets of the same size) ~ Linsco/Private Ledger J [~1~ I Member NASD/SIPC r 'II~.IBI 9785 Towne Centre Drive, San Diego, CA 92121-1968 I~N^~e~]. One Beacon Street, 22n'd Floor, Boston, MA O2108,3106 SERVICES 220 V53A 003.0526 LENA K MEAD AND HAROLD J KNEPP TTEES LENA K. MEAD LIVING TRUST DTD 5'25-93 325 WESLEY DRIVE #3210 MECHANICSBURG PA 17055 h,,llh,,llh,,,hl,,hl,,,ll,,hl,ll,,,,l,,h,,lllh,,hl,,I Investment Account Statement Account Number: 3905-4327 Statement Period: October 1. 2003 to Octooer 31. 2003 Your Account Executive: Foster/Foster (717)901-3099 Total Portfolio Holdings: $122,223.97 Current Period Prior Period Value % of Assets Value % of Assets Cash Balance Money Market Funds 10,933.49 8.95 7.115.02 Equities and Options Mutual Funds Corporate Bonds Government and Agency Bonds 111,290.48 91.05 102.286.75 Municipal Bonds TOTAL PORTFOLIO HOLDINGS $122,225.97 Current Period Year-to-Date Securities Sold 224.31 1.768.78 Securities Purchased (15,183.46) 6.50 Money Market Fund Transactions (3,818.12) (10,932.23) Reinvestments (0.35) (1.26) Deposits 16.611.30 Withdrawals (1,000.00) (3,000.00) 93.50 Dividends and Interest 523.59 1,018.44 Dis tributions 4,070.57 9.718.43 1OO.OO% $'109,401.77 '100.00% NET PORTFOLIO ACTIVITY $0.00 $0.00 Current Period Prior Year End Dow Jones Industrial Average 9,801.12 8,341.63 S&P 500 Index 1,050.71 879.82 NASDAQ Composite Index 1,932.21 1,335.51 3-Month US Treasury Bill 0.95% 1.20% 30-Year US Treasury Bond 5.13% 4.78% Your Account Executive: Foster/Foster (717)901-3099 4813 Jonestown Rd . Harrisburg, PA 17109 Page 1 of 15 039054327 Ccysfx73E00220i003505 ~Monbtary Functions :Begin Session Deposit I ................. .- ......................... II Transfer I_..._¢__~,,~hCh,,,:, II w~,:,,-~,.,~, [ Balance ] i IB~ise" -I ; ~Oflte; Functions~ Referral J ~Warning Information, ~[ Proces~ .... I REV'-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MEAD, LENA K. Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 2. 3 4 5. FUNERAL EXPENSES: CREMATION SOCIETY OF PENNSYLVANIA - BAL DUE ON SERVICES BIXLER'S FLOWERS CLERGY HONORARIUM FUNERAL MEAL CUSTODIAN ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Sodal Secudty Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees LATSHA, DAVIS, YOHE & MCKENNA, P.C. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) Claimant Zip Street Address City State Zip Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS - FILING FEE FOR INHERITANCE TAX RETURN Accountant's Fees Tax Return Pmparer's Fees 77.88 53.00 50.00 150.00 25.00 2,000.00 15.00 215.00 TOTAL (Also enter on line 9, Recapitulation) $ 2,585.88 (If more space is needed, insert additional sheets of the same size) REV-I,513 EX + COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER MEAD, LENA K. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distdbulJons, and transfers under Sec. 9116 (a)(1.2)] HAROLD J. KNEPP 325 WESLEY DRIVE, APT 3210 MECHANICSBURG, PA. 17055 BROTHER ENTIRE TRUST ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART ]] - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) 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. CD REV-1162 EX(11-96) 0O334O CRIST JONATHAN M ESQUIRE P O BOX 825 HARRISBURG, PA 17108 fold ESTATE INFORMATION: SSN: 168-22-7150 FILE NUMBER: 2103- 1036 DECEDENT NAME: MEAD LENA K DATE OF PAYMENT: 12/17/2003 POSTMARK DATE: 12/16/2003 COUNTY: CUMBERLAND DATE OF DEATH: 1 0/31/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $15,083.30 REMARKS: TOTAL AMOUNT PAID: JONATHAN M CRIST ESQUIRE 5,083.30 SEAL CHECK# 5652 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX D/VIS/ON DEPT. zBn601 HARRISBURG, PA 17128-0601 CHARLES E SHIELDS 6 CLOUSER RD NECHANICSBUR6 COHMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT/CE OF INHERITANCE TAX APPRATSENENT, ALLO#ANCE OR DISALLONANCE OF DEDUCTTONS AND ASSESSMENT OF TAX ~ ~!i _~i DATE ~*~: ,.~.~ ~;;'!~ ~-,~!~ '~ ESTATE OF DATE OF DEATH FTLE NUMBER '04 [~_8 13 73:30COUNTY ACN PA 170t~5~.'~~:* :~i ~ ,.~ Cumber~ar~d Co., PA 02-16-200q BLOOM 12-19-2002 21 05-1056 CUMBERLAND 101 Aaoun~ Reai~'l:ed REV-I;~7 EX AFP (01-03) EVELYN R HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS L/NE ~ RETAIN LO#ER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF ZNHER]:TANCE TAX APPRA]:SEMENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF BLOOM EVELYN R FILE NO. 21 05-1056 ACN 101 DATE 02-16-200~ TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORZG~NAL RETURN 1. Real Es~a~e (Schedule A) (Z) .00 2. S~ocks and Bonds (Schedule B) (2) .00 3. Closely Held S~ock/Par~narship Zn~eres~ (Schedule C) ($) .00 ~. Not,gages/No,es Receivable (Schedule D) (~) .00 E. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) (E) ~00.00 6. Jointly Owned Propar~y (Schedule F) (6) 12;51~.56 7. Transfers (Schedule G) (7) .00 8. To'al Asse~s (8) APPROVED DEDUCTIONS AND EXEHPTZONS: ~,~95.$0 9. Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule H) (9) 10. Deb~$/Nor~gaga Liabilities/Liens (Schedule Z) (10) 1,989.Z5 11. To,al Deductions (11) 12. Ne~ Value of Tax Ra~urn (12) NOTE: To insure proper cradi~ ~o your account, subai~ ~he upper por~ion of ~his form wi~h your ~ax payaen~. 12,81~.56 6.~B~.55 6,$$0.01 13. 1~. NOTE: ASSESSMENT OF TAX.' 15. Aaoun~ of Line 1~ a~ Spousal ra~e 16. Amount of Line Ii taxable at Lineal/Class A rate 17. Aaount of Line lq at Sibling ra~e 18. Amoun~ of Line lq taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDTTS: PAYMENT RECETpT DTSCOUNT Chari~able/Governaen~al Bequests; Non-elected 9115 Trusts (Schedule J) (15) Ne~ Value of Es~a~e Subjec~ ~o Tax .00 6,530.01 Zf an assessment Nas issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 wlll reflect flgures that lnclude the total of ALL returns assessed to date. (is) .00 x O0 = .00 (16) 6,$$0.0! x 0~5= 28~.85 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (~9)= 28~.85 DATE 12-19-2005 NUHBER CD005575 INTEREST/PEN PAID (-) .O0 BALANCE OF UNPAID INTEREST/PENALTY AS OF 12-20-2005 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AHOUNT PAID 28~.85 TOTAL TAX CREDIT { Z8q.85 BALANCE OF TAX DUEl .00 INTEREST AND PEN. $.55 TOTAL DUE $.55 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)~ RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CA): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 198Z -- 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 life or for years, the Commonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act ZS of ZOOO. (72 P.S. Section 91q0). Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which ams not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special gq-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing end / or speaking needs: 1-800-qqT-3OZO (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as sheen on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81021, Harrisburg, PA 171Z8-10Z1, OR --election to have the matter determined at 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 Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1SO1) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) 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. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate ahich will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2003 are: Interest Daily Interest Daily Interest Daily Year Rata Factor Year Rate Factor Year Rate Factor 198Z ZOZ .O00Sq8 1987 9Z .O00Zq7 1999 7Z .O0019Z 1983 16Z .OOOq38 1988-1991 11Z .gO0301 ZOO0 8Z .O00gl9 198q Z1Z .000301 199Z 9Z .OOOZq7 ZOO1 9Z .O00Zq7 1985 132 .000356 Z993-Z99q 72 .00019Z 200Z 62 .00016q 1986 lOg .O00ZTq 1995-1998 92 .O00Zq7 2003 5Z .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINI~UENT 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. BUREAU OF TNDTVZDUAL TAXES TNHERTTANCE TAX DZVTSION DEPT. 280601 HARRISBURG, PA 17128-0601 JONATHAN M CRIST ESQ LATSHA ETAL PO BOX 825 HBG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTZCE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF BATE OF BEATH '04 FEB 13 P 3:28 FILE NUHBER COUNTY ACN PA z7~U~b~ri~nd Co., PA 02-09-200q MEAD 10-$1-2003 21 03-1036 CUMBERLAND 101 Aaoun'~ Ram1%'l'ad REV-l~47 EX &FP COl-OS) LENA K HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MEAD LENA K FILE NO. 21 05-1036 ACN 101 DATE 02-09-200~ TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es%a%a (Schedule A) (1) Z. S%ocks end Bonds (Schedule B) (2) $. Closely Held S%ock/Par%nership In%eras% (Schedule C) ($). ~. Nor%gages/No%as Receivable (Schedule D) (~) 5. Cash/Bank Daposi%s/Nisc. Personal Propar%y (Schedule E) 6. Join%ly Owned Propar%y (Schedule F) (6} 7. Transfers (Schedule O) (7) 8. To%al Assa%s APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expanses/Adm. Cos%s/Nisc. Expenses (Schedule H) (9) 10. Dab%s/Hor%gaga Liabili%ias/Lians (Schedule Z) (10) 11. To%el Deduc%ions 12. Ne% Value of Tax Re%urn 15. 1fi. Chari%abla/Govarnaan%al Baquas%s; Non-elac%ed 9115 Trus%s (Schedule J) Ne% Value of Es%a%e Subjac% %o Tax O0 NOTE: To insure proper O0 cradi% %0 your accoun%, O0 suba1% %he upper por%ion O0 of %his form w1%h your O0 %ax payaan%. O0 15~z895.52 (8) 2,585.88 .00 NOTE: 13~,895.52 ZF PAID AFTER DATE /NDZCATED, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST. (3.5) .00 x O0 = .00 (16) .00 x 0~5 = .00 (17) 132,309.6~ x 12 = 15,877.16 (~8) .00 x 15 = .00 (zg)= 15,877.16 AHOUNT PAID 15,083.30 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE ASSESSHENT OF TAX: 16. Aaoun% of L/ne lq 16. Aeoun% of Line 1~ %axabla a% Lineal~Class A ra%e 17. Aaoun% of LAne lfi 18. Aaoun% of Line 1~ %axable 19. Prlncipal Tax Due TAX CREDITS: PAYMENT RECE/PT DISCOUNT (+) DATE NUMBER TNTEREST/PEN PAID (- 12-16-2003 CD0033~0 793.86 15,877.16 .00 .00 .00 ( 'rF TOTAL DUE TS LESS THAN $1, NO PAYNENT IS REI~UTRED. 'rF TOTAL DUE TS REFLECTED AS A "CREDTT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF TH'rS FORN FOR I'NSTRUCTTONS.) ~ If an assessment was issued previously, 11nas 1~, 15 and/or 16, 17, 18 and 19 will reflect figures that /nclude the total of ALL returns assessed to date. (11) 2.58~ .88 (Ia) 152,309.6~ (15) . O0 (1~) 1:52,309.6~ RESERVATION: PURPOSE OF NOT[CE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decadents dying on or before December 12, 1982 -- 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 life or for years, the 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 fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Registmr of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of tho Register of Nills, any of the 23 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-562-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-5020 (TT only). Any party in interest nat satisfied with the appraisement, allowance, or disaXXoaance of deductions, or assessment of tax (including discount or interest) as sheen on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZHlOZ1, Harrisburg, PA 171Z8-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans* Court. Factual errors discovered on this assessment should be addressed in writing to.' PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17126-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (52) discount of the tax paid is alloaed. The 151 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. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (62) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 mill bear interest at a rate which mill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2005 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Yea.~r Rate Factor Yea..~r Rata Factor 1982 ZOZ .000548 1987 97. . OO0247 1999 77. .000192 1983 16X .000458 1988-1991 112 .000301 ZOO0 82 .000219 1964 11Z .000301 1992 9Z .000247 Z001 9X .000247 1985 132 .000556 1993-1994 7Z .000192 2002 62 .000164 1986 ZOZ .000274 1995-1998 92 .000247 2005 52 .000137 --Interest is calculated as folloms: 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 (15) days beyond tho date of the assessment. Xf payment is made after the interest computation date shown on the Notice, additional interest must be calculated.