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HomeMy WebLinkAbout03-1050(E'~500 ~X ~6-00)  COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I- z UJ iii iii Z UJ C3 Z o D~ o REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEATH (MM-DD-YEAR)f DATE OF BIRTH (MM-DD-YEAR) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER .J~l. Original Return F--~ 4. Limited Estate []6. Decedent Died Testate (Attach copy of Will) ---1 Litigation Proceeds Received [~2. Supplemental Return r~4a. Future Interest Compromise (dale of death after 12-12-82) E~7. Decedent Maintained a Living Trust (Attach copy of Trust) ~]10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) COUNTY CODE YEAR FIRM NAME (If Applicable) I05 10. 11. 12. 13. 14. 17, 18. 19. 20. NUMBER Amount of Line 14 taxable at collateral rate x .15 Tax Due (12) (13) (15) (17) (18) (19) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ Amount of Line14 taxable at lineal rate ~'~¢ //,j~'*"c..~, d~/. , x.0__ Amount of Line 14 taxable at sibling rate x .12 OFFICIAL USE ONLY Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) TELEPHONE NUMBER 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) J~)~ "~7c~" "~'6 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Modgages & Notes Receivable (Schedule D) (4) 5 I Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) Jointly Owned Properly (Schedule F) (6) ~-~ Separate Billing Requested 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) COMPLETE MAILI[~c,ADDRF~S~ - - _, ] 3. Remainder Return (date of death prior to 12-13-82) --'] 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ---]11. Election to tax under Sec. 9113(A) (Attach Sch O) SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER /?/ - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS Decedent's Complete Address: STREE¥'ADDRESS ~' 'l /'_ / / I I //~n~. /-... /'~/¢,~d~-// c / ..... Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount z,P / Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) 4. 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 / (3) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) ~ A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF VVILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS AS PART OF THE RETURN. 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'D, ecember 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? .............. [] J~ 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 6 AND FILE IT Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of.,~r,~arer other than the personal representative is based on all information of which preparer has any knowledge. SIGN/~RE/0F PER,SON REg~_ONS~L"~R FILING _j?TUI~N ,...--k¢,,2..,¢.,.,,,,,2//2. /WADQR~,~S .... SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADBRESS 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 return are still applicable even 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 paren or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or 'for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as a 'ndividual who has at least one parent in common with the decedent, whether by blood or adoption. REV- :,~03 EA * (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) [U's. Savings Bond Branch ID: 96 Verna L ~ 191-40-8462 70 Hickory Rd. Carlisle, PA 17013 Redempt ionI Receipt Redempt ion Date: 11/17/2003 Transaction Number: 2574550 Teller ID: ebrn6mw L202763t136-E L2025127580-E L2019437808-E L20!1369406-E L2008402084-E 52008385321-E 52004977697-E 52004178322-E Lli12426085-E Ll10!337535-E Ll10448i770-E L1104175288-E Ll101182490-E L1097605231-E LI100945240-E 51082644610-E 51085218662-E L1085453344-E 51082568754-E E E E E E E E E E E E E E E E E F, $50i soi 5~ 50 50 50I 50i 50 50 50 50 oz/197~ 12/1975 1~/1978 10/1975 09/1975 08/1975 07/1975 06/1975 05/~978 04/1975 03/1975 02/1975 0]/1975 12/197a 1o/1974 11/1974 09/1974 o8/z~74 07/1974 o6/1974 37.50 206.601 37 . 50 210 . 94~ 37.50 37.50 37.50 37.50 37.50 37.50 37.50 37.50 37.50 37.50 37,F0 37.50 37.50 37.50 37.50 37.50 37.50 208.52 208.52 208.52 208.52 208.52 212.84 210.46 210.46 210.46! 210.46 210.50 212.44 214.82 212.44~ 212.44i 212.44i 212 $244.12 244 10 248 44 246 02 246 02 246 02 246 02 246 02 250 34 247 96 247.96 247,.96 247.96 248.00 249.94 252.32 249.94 249.94 249.94 249.94 Spring Garden Office 100 South Spring Garden St Carlisle, PA 17013 240-4525 Page 1 Of 2 i~U s savings Bond RedemPtion Receipt ~ ' Redemption Date: 11/17/2003 Verna L ~1 191-40-8462 Transaction Number: 2574550 Issue ! Interest Redemption ISe lria Number Series Denom I Date IssUe Price I Earned Value 51080326355-E E i $50i~ 05/1974 I' i $37·50I 216.84f~, 254.34 i i 37 50t 214 42I L1080069!28-E E t 50i 04/1974 I i . 251 92 T,1076203397-E E i 50i 03/1974 I 37.50 i 214 42, 251.92 ~ 50i 02/1974 37 50t 1,10731954!3-E E ~ : · 214.421 251.92 L1068191913-E E ~ 50! 01/5974 i : 37.50 ! 214.421 251.92 L1065298t~20-E i E 501 12/19~3 ' 37.50 214 42I 251 92 Li050449779-E~ E i 50. 08/1973 37.50i 225.98! 263,,48 LI0503058i0-Ei E [ 501 08/1973 i 37.50 ~ 225.98~ 263.48 L1044567537-E I E 50~ 06/1973 i 37.50 222 90 260.40 [ } 05/1973 ~ 222.28 259.78 ~1042057~60-~i E f 5°1 Total number of bonds redeemed: 33 Total Total TOtal Pri ce Interest Value $~,237.50~ ~073.10 ~310.60 Customer Signature Customer ID: known Sprin~ Garden Office 100 South Spring Garden St Carlisle, PA 17013 240-4525 Page 2 Of 2 MetLifd Statement of Trust Interests February, 2000 At the time MetLife demutualizes, you will be a~tocated shares of MetLife, Inc. Common StocK, which will be held for you in the MetLife Policyholder Trust. The number of Trust Interests you own is equal to the number of shares of MetLife, Inc. common Stock held for you in the Trust. This Statement of Trust Interests tells you how many Trust Interests you will own at th..e time MetLife demutualizes (in other words, how m~ny shares of MetLife, Inc. Common Stock wit! be aflocated to you and held for you in the Trust). tf you want to buy more st~ares of MetLife, Inc. Common Stock to be held for you in the 'lrust, you should use the form printed below to submit a Purchase Instruction. You are only eligible to purchase additional shares if you are being allocated tess than 1,000 shares. Stock can be purchased through the Purchase and Sale Program on the first trading day Iollowinp the 90th day after the date MetLife's demutualization becomes effective. Purchase Instructions received before the purchase program begilBs will not be processed until the commencement of the purchase program, If you want to sell the shares of MetLife, Inc. Common Stock held'.for you in the Trust, you Should use the form printed on the reverse side of this page to submit a Sell Instruction. Stock held in the trust can: be sold after the IPO distribution is completed, which should be no more than 30 days after the plan effective date. Sell Instructions received before the sale program begins will not be processed until the commencement of the sale program. All such purchases and sales will be or~ a commission-free basis. AUTO #]'N"#lmi##N 5'DXGXT ],7023 VERNAL #ADOELL PC) BOX 80:) CARLZSLE PA X701~S-0602 h,,lll,.,lll,.,,,,Ih,lhll..,h,l,lh,,,,I,IIh,,,,hl,lh,I Please be sure the correct address appears in the window of the envelope if you are submitting a Purchase or Sale Instruction. The attached instruction card identifies the correct address for each type of transaction. LLJ NS969& PI~EASE RETAIN FOR YOUR RECORDS Retain this number for future reference Nume investor ID Number of Truat Intereu, Sequence Number VENHA L gMN)ELL 8062 4560 40 110079463O8 PLEASE READ THE IMPORTANT INFORMATION ON THE BACK OF THIS!FORM AND IN THE ENCLOSED BROCHURE Use ONLY if a transaction is requested. Unless you wish to tnttiate a transaction, no action is required. PURCHASE INSTRUCTION 801,2 43l.,FI 411,4 Change of address: (See reverse side to SELl.) VERNAL #ADDELL ChaseMellon Shareholder Services PO Box 382200 Pittsburgh PA 15250-8200 h,,ll,l,h,,hhhhll.,h,l,,,I,IIl,,,li,,,Ih,,ll,,,h,,H Please be sure this address appears in the e~vetope window for Purchases ONLY! 0000101 102 806243604164 8 Signature: lit address heine chaflaecl~ Make check, in U.S. dollars, payable to: MetLife Purchase ProDrarn Amount Enclosed Minimum investment $250.00 (except as described in the 'nclosed brochure) LLJ N59696 · MetLife° Statement of Trust Interests February, 2000 At the time MetLife demutualizes, you will be allocated shares of Me[Life, thC. Common Stock, which wilt be held for you in the MetLife Policyholder Trust. The number of Trust Interests you own is equal to the number of shares of MetLife~ IRc. Common Stock held for you in the Trust. This Statement o~ Trust Interests tells you how many Trust Interests you wilt own at the time MetLife demutualizes (in other words, how many shares of MetLife Inc. Common Stock will be allocated tc you and held for you in the Trust). tf you want to buy more shares of MetLife, Inc. Common Stock to be held fcr you in the Trust, you should use the form printed below to submit a Purchase Instruction. You are only eligible to purchase additional shares it you are being allo=ated less then 1.000 shares. Slock can he purchased through the Purchase and Sale Program on the first trading day following the gOth day after the date MetLife's demutualization becomes effective. Purchase Instructions received before the purchase program begiOs will not be processed until Ihe commencement of the per, base program, if you want to sell the shares of M~tLife, Inc. Common Stock held ifor you in the Trust, you should use the form printed on the reverse side of this page to submit a Se!i Instruction. Stock held in the trust can !be sold after the IPO distribution is completed, which . should be no more than 30 days after the plan effective date. Sell Instructions receivdd before the sale program begins will not be processed until the commencement of the sale program. All such purchases and sales will be on; a commission-free basis. AUTO IN#~##i~##~ $-DZGZT 17013 VERNAL itADDELL PO BOX 802 CARLZSLE PA 17013-0802 I,,,lll,,,llh,,,,,ll,,ll,lh,,h,i,lh,,,,I,IIl,,,,,I,l,ll,,g Please be sure the correct address appears tn the window of the envelope If you are submitting a Purchase or Sale Instruction. The attached instruction card identifies the correct address for each type of transaction. r PLEASE RETAIN FOR YOUR RECORDS Retain this number for future reference Name i VER#A L gAl)DELL lnveator ID I &o6s z899 6s60 Number of Trust Intareet~ 21 Sequence Numar ~ Ho87~63o7 LLJ PLEASE READ THE IMPORTANT INFORMATION ON THE BACK OF THIS !ORM AND IN THE ENCLOSED BROCHURE Use, ONLY if a transaction is requested. Unless you wish to initiate a transaction, no action is required, PURCHASE INSTRUCTION 8065 2899 6360 Change of address: (See reverse side to SELL) VERNAL tIADOELL 02 ChaseMetion Shareholder Services PO Box 382200 Pittsburgh PA 15250-8200 I,,,ll,hh,,I,I, hhlh,,h,h,,hlll.,Ih,,ll,,,ll,,,I,,,ll Please be sure this add'ess appears in the envelope window for Purchases ONLY! 0000101 102 806528996360 3 ~~, bein~ chan~edl Make check, in U.S. dollars, payable to: MetLife Purchase Program Amount Enctosed Minimum investment $250.00 (except as described in the enclosed brochure) LLJ N~9696 2a7,2~1 MetLifd Statement of Trust Interests Februa~,2000 At the time MetLife demutualizes, you will be allocated shares of MetLife. Inc. Common Stock, ;which will be Ileld for you in the MetLife Policyholder Trust. The number of Trust Interests you own is squat to the number of shares of MetLife, Inc. Common Stock held for you in the Trust. ~'rhis Statement of Trust Interests tells you how many Trust Interests you wild own at the time MetLife demutualizes (in other words, how many shares of MetLife, Inc. Common Stock will be allocated to you and held for you in the Trust). If you want to buy more shares of MetLife, Inc. Common Stock to be held for you in the!Trust, you should use the form printed below to submit a Purchase Instruction. You are only eligible to purchase additional shares if you are being allocated less than 1,000 shares. $1ock can he !purchased through the Purchase and Sale Program on the first trading day following the goth day after the date aetLife's demutuafization becomes effective. Purchase Instructions received before the purchase program begins will not be processed until the commencement of the purchase program, If you want to sell the shares of MetLife, Inc. Common Stock held for you in the Trust, you should use the form printed on the reverse side of this page to submit a Soil k~struction. Stock held in the trust can be sold after the IPO distribution Is completed, whlch ;should be no more than 30 days after the plan effective date. Sell Instructions received before the sale program begins will not be processed :until the commencement of the sale program. Ail such purchases and sales will be on a commission-free basis. iAUTO #N#.#N###~. 6*DZGZT 17013 ~VERNA #ADDELL ,PO BOX 802 CARLISLE PA 17015-0a02 Jl,aJJJ.lJJJ.llllJJllJJlJJ.t JllJlJJlllllJllJJ JJllllJlJlJJllJ Please be sure the correct address appears in the window of the envelope if you are submitting a Purchase or Sale Instruction. The attached instruction card identifies the correct address for each type of transaction. LLJ NS969& P~EASE RETAIN FOR YOUR RECORDS Nome Retain this number for future reference Inventor ID Number of Truat Interee Sequence Number PLEASE READ THE IMPORTANT iNFORMATION ON THE BACK OF THIS VERNA gAl)DELL 8066 6902 dk699 FORM AND IN THE ENCLOSED BROCHURE Use ONLY if a transaction is requested. Unless you wish to initiate a transaction, no action is required. PURCHASE INSTRUCTION 8066 5flOP 41-,fl9 Change of address: (See reverse side to SELL) VERNA gAOl)ELL ChaseMellon Sharehclder Services PO Box 382200 Pittsburgh PA 15250-8200 I,,,ll,l,l,,,I,l,l,l,il,,,I,,I,,,hlll,,,Ih,,ll,,,ll,,,I,,,ll Please be sure th~s address appears in the e.~velepe window for Purchases ONLY! 0000101 102 806659024699 0 ~;!g_nature: Iii address beiria changed1 Make check, in U.S. dollars, payable to: MetLife Purchase Program Amount Enclosed Minimum investment $250.00 (except as described in the enclosed brochure) LLJ N59696 COMMONWEALTH OF PENNSYLVANIA SCHEDULE E CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RES,~ENT ~ECE~ENT PERSONAL PROPERTY Include the prods of litigation and the date the pr~eds were m~iv~ by the ~te. All prope~ jointly-o~ed ~h the right of su~ivomhip must ~ disclosed on Schedule F. ITEM J VALUE AT DATE NUMBER ~ DESCRIPTION, OF D~TH TOTAL {Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) ACCOUNT NO. 212022~.9 ACCOUNT TYPE DIRECT D[~'OSIT C.ECYYNC 0 0o128M NM 017 STATEMENT PERIOD SEP.I7-OCT.l~,2005 PAGE 1 OF 1 VERNA I_ wA[!DELL OR JANICE ~ DURKIN PO BOX 8C. CARLIS(~ A [7013-0802 CARLISLE WESr ACCOUNT SUMMARY BEGZNNZNG '1 DEPOSITS gI'~ -- j OTHER BALANC£ NoOTHER ADDITIONS j CHECKS PAID I SUBTRACTIONS AMOUNT - __NO I ANOUNT T NO. J AMOUNT 6,e75.72 J '5~ :'.oo8.58 ~ 'qi S,e65.2~, I 3 | 410.00 CURRENT J INTEREST PD o.00 J ENDING BALANCE 2,306.8b A~DUNT POSTING DATE TRANSACTION DESCRIPTION 0c~-17-05 oq-17-O~ BEGINNING BALANCE DEPOSIT MIT ATN CASH WITHDRAWA: ON 0~,17 CARLISLE GIANT £ARLZSL~ CHECK NUIflBER ~2~ HIT AT'~ CASH WITHDRAWAL ON 0~/Iq iSPRING GARD,100 S SPRING GARDEN 0e-30-0SlCHECK NUMBER 1225 ~0-01-0~IFIDEL. ITY :NVESTM PENSION 10-02'031VGI-GNMA INV INVESTMEN? 10-02-03/CHEC~ NUNBER 122~ TREASURY ~10 SOC S~ ACTIVITY DEPOSITS,INTERESTI OTHER ADDITIONS . O0 ~ 70 r CHECKS & OTHER SUBTRACTIONS 300.00 5,e58.82 100.00 IO-Ob-O31CHECK NUMBER 1~?. IO-le-031SERV~CE CHARGE 10'16'0~/DIRECTENDING BALANCE DEPOSIT REBATE 1223 Oq-2q-03 122e lO-Oe-03 CHECKS PAID SUMMARY 12'2w 10'02'03 71.10 1225 DAILY BALANCE $e,67S.72 eBq, 90 2,3oe.86 $2,3oe.86 ~ + (1-97) ' ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE Or If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule O. FILE NUMBER SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate, VALUE OF ASSET INTEREST DECEDENTS INTERES TOTAL (Also enter on line 6, Recapitulation) $ ~_~zj ~,/~. ~0 (If more space is needed, insert additional sheets of the same size) Ms. Janice M. Durkin 70 Hickory Road Carlisle, PA 17013-0802 THEVall~~ROUP® November 20, 2003 Estate of Verna L. Waddell Dear Ms. Durkin: We are responding to your telephone call requesting the value of the following account. Please accept our sincere condolences for the loss of Ms. Waddell. As of September 26, 2003, the number of shares, the price per share, and the value of the account were as follows: Verna L. Waddell & Janice M. Durkin Joint Tenants With Right Of Survivorship Account #9954535855 Fund Name Shares GNMA Fund Inv 12,191.447 Price Value $10.55 $128,619.77 Accrued Dividends: $392.50 If you have any questions, please contact your Voyager Service Team at 1-800-284-7245. Voyager's business hours are Monday through Friday from 8 a.m. to 10 p.m. and Saturday from 9 a.m. to 4 p.m., Eastern Time. One of our dedicated Voyager Associates will be pleased to assist you. Sincerely, Steve Mazzio Registered Representative Correspondence Number 20018231 Vanguard Voyager Service® Post Office Box xi2o, V;,tlley Forge, Pennsylvania 19482-i120 (800) 284-7245 · www. vangmard.com REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES J FILE NUMBER NUMBER I 1. II 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF 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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) REV-1511EX* (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER 5. 6. 7. DESCRIPTION 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 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address City State __ Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation (If more space is needed, insert additional sheets of the same size) AMOUNT USC SE~S ~ ~ ~ECT~ & STAFF ~E~ F~I~ES. ~F & E~P~: ........ USE OF $T~F AND E~PME~: M~,n-,c~ Sew,ce ( c.,~am,~ ,. ~ k.~ ) ........ S G~ ~ce ................ $ T~AN~ OF REMAINS TO FU~ (M~ T~) .............. $ AUT~TI~ E~E~: C~ Cr~ !H~) ........ P~er Car ............ F~mly Car (E~I PT~er Le~ / C~y ~ E~r .......... ~$C EL ~NF~ ~HANDI~E ~B) CASH ADVANCE ITEMS: Total (A) Forward $ ~~__ Opo.~ Grave .................................. $ ~ (c) LE$~: PreneedAdl~t~r~n~,Ailow3nce i::..; ,NS ~ TR Net due. 30 days A cl--a~ge of 1 ~% Der ar~m~r, f~r ~i~t~ ~te ~nt ~1 ~ ~ ~ any ~,ne ~n ~~c~ ~ ~. · ~ - ~ .;~ 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) 003363 DURKIN JANICE M 70 HICKORY RD CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: FILE NUMBER: 21-03'-1050 191-40-8462 DECEDENT NAME: WADDELL VERNAL DATE OF PAYMENT: 12/22/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/26/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $2,571.56 TOTAL AMOUNT PAID' $2,571.56 REMARKS: SEAL CHECK# 93 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX DTVZSTON DEPT. 280601 HARRISBURG, PA 17128-0601 JANICE H DURKIN 70 HICKORY RD CARLISLE COMMONWEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLOHANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE OF DEATH FZLE NUHBER 'I~ FEB 13 P 3 C~NTY ACN C, umbe~iand Co., PA OZ-16-ZOOq WADDELL 09-26-2005 21 03-1050 CUHBERLAND 101 Amount Reeitted REV-15q? EX AFP (01-05) VERNA L HAKE CHECK PAYABLE AND RENZT PAYHENT TO: REGISTER OF WZLLS CUHBERLAN]) CO COURT HOUSE CARLISLE, PA 1701:5 CUT ALONG THIS LINE ~ RETA'rN LOWER PORTZON FOR YOUR RECORDS REV-1547 EX AFP (01-03} NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WADDELL VERNA L FILE NO. 21 03-1050 ACN 101 DATE 02-16-200q TAX RETURN #AS: { X} ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE INTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: 1. Real Estate (Schedule A) 2. :5. 4. 5. 6. 7. B. ORZGZNAL RETURN (1) Stocks and Bonds (Schadula B) (2) Closely Hold Stock/Partnership Interest (Schedule C) ($) Nortgages/Notes Receivable (Schedule D) Cash/Bank Deposits/Misc. Personal Property (Schedule E) Jointly Owned Property (Schadula F) (6) Transfers (Schedule G) (7). Total Assets APPROVED DEDUCTZONS AND EXEHPTZONS: 9 10 11 12 Funeral Expanses/Ado. Costs/Misc. Expenses (Schedule H) Debts/Nortgago Liabilities~Liens (Schedule Z) Total Deductions Nat Value of Tax Return (9) (10) Charitable/governmental Bequests; Non-elected 911:5 Trusts (Schedule J) Net Value of Estate Subject to Tax .O0 10~72.76 .00 .00 78~.90 6~$10.00 .00 (8} 15,qlq.20 .00 NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payment. NOTE: 75,567.66 (11) 1S.~16.20 (12) 60,155.q6 (13) . O0 (14) 60,155. ~6 18 and 19 #ill zf an assess, ant Nas issued prevlousZy, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of Line lq at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rata 18. Amount of Line 14 taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDZTS: ! PAYMENT RECEZPT DISCOUNT DATE NUMBER ZNTEREST/PEN PAZD (-) 12-22-2005 CD00~$65 155.$5 (1.~) .00 X O0 = .00 (16) 60,153.q6 X Oq5 = 2,706.91 (17) .00 x 12 = .00 (ZS) .00 x 15 = .00 (19)= 2,706.91 ZF PAID AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATION OF ADDZTZONAL INTEREST. AMOUNT PAID 2,571.56 TOTAL TAX CREDZT I 2,706.91 BALANCE OF TAX DUEl .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS RE~UZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S~DE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOT[CE: PAYMENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATZVE 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 S (collateral) rate an any such futura interest. To fulfill the requirements of Section ZIqO of the Inheritance and Estate Tax Act, Act 23 of Z000. (72 P.S. Section 91fi0). Detach the top portion of this Notice and submit with your payment to the Register of Nills 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-1313). Applications ara available at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z¢-hour answering service for forms ordering: 1-800-36Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-¢¢7-30Z0 (TT only). Any party in interest not satisfied aith the appraisement, allowance, or disallowance of deductions, or assessment of tax (includlng discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to tho PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 2B060I, Harrisburg, PA 17lIB-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (52) discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid 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 time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes mhich became delinquent before January 1, 1982 bear interest at the rate of six (62) percent par annum calculated at a daily rate of .00016¢. All taxes ahich became delinquent on and after January 1, 1982 ai11 bear interest at a rate which mill vary from calendar year to calendar year mith that rate announced by the PA Department of Revenue. The applicable interest rates for lgBZ through 2003 ara: Interest Daily Interest Daily Interest naiXy Year Rata Factor Year Rate Factor Yea.~r Rate Factor 1982 lOX .0005¢8 1987 97. .0002¢7 1999 7Z .000192 1983 16X .000¢3B 1988-1991 llZ .000301 ZOO0 82 .000219 198¢ 112 . 000301 1992 92 . 0002¢7 2001 92 . 0002¢7 1985 13Z .000356 1993-199¢ 77. .000192 ZOOZ 61 .00016¢ 1986 lO[ .000Z7¢ 1995-1998 92 .0002¢7 2003 SZ .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NURBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the data of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated.