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HomeMy WebLinkAbout04-0934 PETITION FOR PROBATE and GRANT OF LETTERS also known as' To: Register of Wills for the County of ~ in thc Commonweahh of Pennsylvania · Deceased. Social SecuriLv No. ~-/ ' ~ ' Z05 ~ The petition of the undersigned respectfully represents that: Your petitioner(s), who s/are 18 ','ears of axe or o der an he execut$,~ itl /he last will of tile above deccdent~ dated ~:(_~ /1 named - 19Z~3 and codicil(s} dated ,-- Decelrdent was domiciled at death itl Count5.', Penns,~lvania, u, ith h~L~ last family or principal residence at I a[ Decendent, then ~:'~ years of age, died &u~t-).Sr~ '~ ,~t~q~ , Except as follows, decedeat did not marry, was not di',orced and did not have a child born or adopted after execution of the will offered for probate; `*as not ,*he victim of a killing and '*'as never adjudicated incompetent: Decendent at death o,,~ned property with estimated values as follov~s: (If domiciled in Pa.) All personal property $ 25 g'g'O (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: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant ofletters Y'~,~*r.~,q*.,_ r-.~.,.V theron. (testamentary; administration c t.a.; administration d.b.n.c.t.a.) _ I ,P,q/'.-o~4 Po~4o OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ COUNTY OF Cu*~e*~,~ f ss 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 well and truly administer the estate according to law. Sworn to or affirn]e,d and subscribed before me this /.',3 day of Estate Of · o, ,x. , Deceased DECREE OF PROBATE AND GRANI OF LETTERS AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated described therein be admitted to probate and filed of record as the last will of and Letters are hereby granted to 'Ti'[~13b?~R~ ({Ob[-%d!'L0 FEES Probate, Letters, Etc .......... S. Uu C rJ Short Certificates(Z) .......... $. k, C. C P~enxnclatlon .~%0.(-7L5. ....... $. (~ (C TOTAL S_ ~ Z. 0 0 Filed ................................... ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE AFFIDAVIT COMMONWEALTI I OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. 1, John M. Eakin, the witness whose name is signed to the attached or foregoing instrument, being duly qualified according to law. do depose and say that I was present and saw Testator sign and execute the instrument as her Last Will and Testament, dated December 11, 1978, that RITA M. RUSENKO signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that I, in the hearing and sight of the Testator signed the Will as witness; and that to the best of my knowledge the Testator xvas at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Swo-fn or affirmed to and subscribed to before me by' Jo~.~ ~ ~/~/<~ ,witness, this ]5/h dayof 5et?i-~/~,?be,: 2004. My Commission exptres: Notary Public COMMONWEALTH OF PENNSkVANIA Notadal Seal He~ M. Nelson Notary Public Mechanics, burg Boro, Cumberland ~oun~ I' MY Commissk~q Ex,pires June 27, 2007 J AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) ) COUNTY OF CUMBERLAND ) SS. I, Gladys P. Dean, the witness whose name is signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that I was present and saw Testator sign and execute the instrument as her Last Will and Testament, dated December 11, 1978, that RITA M. RUSENKO signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that L in the hearing and sight of the Testator signed the Will as xvitness; and that to the best of my knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by I~,L~t~....¢ ~ Z~--/~IO , witness, this /3~b/ da5' of ~77G~v~°~/~ 2004. tary Public My Commission expires: NOTARIAt SEAL JUOO M. AHRENS, NOTARY PUBLIC £CllAN CSBtJRG BORO., CUMBERLAND CO. MY COMMISSION EXP RES MAY 23~ 2005 OMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ~F~nale ~ 191 -- 28 -- 2058 Lab Technician Blccd B~rk ¥0,[~ u0[] 1~,~~ ~'~'~'~ Married ~,Theodore Rusenko Martin Zaledonis ,, Eleanor Sabestinas Theodore Rusenko 20~ 1 Shiloh Col~r~ Mechanics~urg, PA 17050 ] AND %%ST/L~L~'2]T 2F RI'P~ M. R JoLP r', ,~ ?' 0'~nberland and Statse o ' PeR~sylvani~. be~}8} of sound arid dis- posiT{;l mird~ memor2' ard LindeFs%andjN{: do r~ake, publish end void any and all prior Wills by me ah any bime here~{f,re made. I dire,:¥ h,'e pa'£mento~'-, all tV' jtnt ciebts arid ?ureral experses soon ai'ter rrt% decease the same car! ;,11 Bhe FesO: residue at,i remairder (f m? eeta%e, real, Der- serial arld mixed, ~ivo: devise and bequea%k erie in ree simple. 3. in t~e even% my' husband sb,~,uh{~ -pr~de~o," ' .... ~'~ mo wiLhir hhirty (30) days f'Pom ~ho date and boou?at, h my er]~;,irc esr, a%e as (;s). 'fo my' Ohit~a ~nd 0ryscal and (n). To my dau6il~,or ali Jewelry. (c). ?c! my 3{-06 Nirie. (d). To my son: 308 Re~ in6%or Rifie. (e To my J4e+~i', ,,"h h Ruse}ko ,r sh;~lld die ~'i ye devise my Roseul h~l beque at.h my -1 - (S). To my soF~ Day'id {. Rnsenko, i ~}eq~eahh ,~ L}e~lhlo 8&~rPel $i~otsun and my 32 Spe,~iai. ~',,11 5he Pes~ F~sid~e a}~d Pemainder ©£ my os%e%e~ I S~ve~ devise and eequeath in eqnal sN'~res to my £'i¥e children. I rim~i~a~e~ c,_,r~st, i},~r~e and ~'ppoin~ The 0oran ~}wealth National Bark to ~e t}e ~'uaFdian or ~}~e es%a%e or ary of' my {~ildPer who arc nob sr a~ o~ the dahe or my dearth w~t~e~ bord~ and diFec~ ShaS slid iuaFdian in i{5~- sole discFe~iol s~all apply pri~'oipa! as well ss in~eFest far ~he mai~he~a~ce~ 0d~oabioY and o~' su{h child or childFer when the same is iY ~heir hash iN~eFest Wi~hOU~ {~he ~ecessi'ty or pe%ibi0nina? ~he %~rp~ans~ 0o~xrb for pop- m~ss~on bs make suc~ expe~di~k~.res~ I direc~ h}~a~ said ~uaFdian shall ~ake possossion of all i}~snrancc of annuity centPaets my life ~o which said mir{~F OF ~R~rl PS ~re enhi~led a~d any a~d all ponsions OF death henofiss from n~i empleyeF CF fPcm any socie~ of oFsaniza%iol o~ which I am a memheP~ sai{ pFoceeds ~s be added %9 the s~.ar{ of eec~ c}ild ~der ~his Will. i r!omi,~.~a~e~ c©rstibu'~e a~d appoirt r}V husbsnd, '!~heodore Rusenko~ ~o be ~he Executor of ~his my ~a~ t Will a~d an{ in {}}~e event he sho~]d predecease me of f'or any reasoh be willin{2 of ~reb!2 %o ach as s~lc}/: %her~ i[ nomira%e~ c}}stiI3ute and appoin% my son~ David !. R~senk0~ Executor o~' this my Last~ Will and Tesbamer!t in his place end sI~ead. Ri%a H. Ruo:l.k,, Sisned~ sealsd; puhlis!,ed and declared by bhe above named Rir, a N. Ru. senko,, as and for er Lash Will and Tesbarner:~? ir: the pPesenee of ~2s who have subscNibcd cur names hereto as witnesses; al3 5he Feques¥ oF sai{~ :est. a~Fi:: irt hep rsFesence and i: Nhe pFese_r::e {If' each o%her. Name of Decedent: Date of Death: ~'~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Admin No: To the Register: I certify that notice of 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 // - cq ' 4~ a-] : Sai-ne Address Notice has now been given to all persons entitles thereto under Rule 5.6(a) except: ignature) / /¢//,< .Ou 5 Telephone(-?/?) ~¢'7' /C6C~: Capacity: Personal Representative '~-'/" Counsel for Personal Representative DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) : Rusenko, Rita M DATE OF DEATH (MM-DD-YEAR) ~ 5AT~OF BI~ ~MM:OD-YEAR) 08/03/2004 07/05/1936 F APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INFflAL) Ruscnko, Theodore ~ 1. Ddginal~etum [~ 2. ~upplemen~l Return REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT L NUMBER OFFICIAL USE ONLY 21 04 00934 QOUNTy CODE YEAR NUMBER SOCIAL SECURITY NUMBER 191-28-2058 THi~ ~ETURN M u~,r~E FiLEO iN DUPMCATE WiTH THi: REGISTER OF WILLS SOCIAL SECURITY NUMSER ~]3. Remai~be~etum (~i~of death piio~{~ 1~.i3-82~ Ahrens Law Offices, P.C. ~L~P"ONE ,UMBEa -'  717/697- ] 800 I I 4. Limited Estate [] 4a Future Interest Compromise (da e o daa h a tar r-I 5 Federal Estate Tax Return Required 12.12-82) [] 6. Decedent Died Testate (AItach copy [] 7 Decedent Maintained a Living Trust (Ai~ach 8. Total Number of Sate Deposit Boxes [] 9. Litigation Proceeds Received [] 10. Spousal Pove~ly Credit (date of death between [] 11, Election to tax under Sec. 9113(A) (Attach Sch O) :~RM NAME (If applicable) 5521 Carlisle Pike 2. Stocks and Bonds (Schedule B) Mechanicsburg, PA 17055 (1) Non e Or:F~CI^L USE ONLY (2) N o ~,, 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Pemonal Property (Schedule E) 6. Jointly Owned Property (Schedule F) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (3) No~ (4) Non~ (5) 23,003.00 (6) None (7) 63,201.00~ .; (9) (10) 12. Net Value of Estate (Line 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES , 15.Amount of Line 14 taxable at the spousal tax rate, 86,204.00 or transfers under Sec. 9116(a)(1.2) 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 x .00 x .045 x .12 x (8)r'~ 86,204.00 (11) (12) 86,204.00 (13) (14) 86,204.00 (15) 0.00 (16) (17) (18) (19) 0.00 i20. [] ' , ,- - , ,- ,, , . .., Copyright 2000 form software only The Lackner Group, Inc. Form REV-t 500 EX (Rev. 6-00) I~ecedent's Complete Address: TREETADDRESS I Shiloh Court [ClT;~ Mechanicsburg I S%TE zte ! PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 (~) Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page I Line 20 to request a refund 5. 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. (5A) B. Entar the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 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 properly transferred; .................................................................................. [] [] b. retain the right to designate who shall use the property transferred or its income; .................................... 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 benefic ary des gnat on? ................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Mechanicsburg, PA 17050 ll/Oq'/Oar SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN APDR~ ' Thomas J, 5521 Carlisle Pike DATE ~ Mechanicsburg, PA 17055 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 suwiving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenl's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ESTATE OF Rusenko, Rita M SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY FILE NUMBER 21-04-00934 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 New England Life - Survivorship Life Insurance Policy # 1 Z006190 Cash value at date of death VALUE AT DATE OF DEATH 23,003.00 TOTAL (Also enter on Line 5, Recapitulation) 23,003.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Rusenko, Rita M SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-04-00934 ITEM NUMBER This schedule must be completed and filed If the answer to anyof questions I through 4 on page 2 is yes. ,PT,ON o. InClude the name of the transferee, theh- relationship to decedent an(~ the date of transfer I ~J uc~rn ] ,-,m~-~,,o I EXCLU_S.I~_N TAXABLE VAL'm Attach e copy O he deed for real estate IVALUE OF ASSET/ · I [ INTEREST Pershin~ LLC IRA ~ 41H-142g~l, husb~d is ben;fiCi~ 63,201.00 100% ~ 63~7)61.00 · TOTAL (Also enter on line 7, Recapitulation) 63,201.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Rusenko, Ri~M NUMBER I. ! SCHEDULE J BENEFICIARIES i FILE NUMBER 21 - 04 - 00934 RElATioNSHip TO .ABE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT ~ OF ESTATE TAXABLE DISTRIBUTIONS (include outright spousal distributions) ThDodor¢ Ruscnko Husband [ntir¢ estate ] Shiloh Coup, ~ech~icsbur~, PA ]7050 II. Rev 1500 cover sheet Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on NON-TAXABLE DISTRIBUTIONS: iA. 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 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: RIff! M, RUSEILJk...O Date of Death: 8 - "S - 200 '-I Estate No.: 0 4 - CJ 9 3 '-I 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: I. State whether administration of the estate is complete: Yes ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: (date) 3. If the answer to No. I is yes, state the following: A. Did the personal representative file a final account with the court? Yes No ~ B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest? Yes V No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: 1- }2--b S ~t..1t Signature ~ ~....:- '-'.':':~ .- -(/-I tJ Mil J J . 14 ilte GN..s Name (Please tYEe or print) ,/) f ~52..( CJ'IJellJU!: n/.(: fvttECHAfJ>CSblJ1I.f.) I'll nOS D Address C'" l.J..._ o L.Ll r " ,---j G':: L1 . I c:-' "'-"'-, ~. IL, C,:"',. .,. -,,..,, n':. \-,< ....,:).- (~'ttjll/A~ U_jl..... v'? C1~~ g <'oJ C'? L.'--::-.','- 00 '::;LCO, CC::.".^ ~~~: O~") o 7/7- &'97- l!5ot? Telephone No. 0- Capacity: Personal Representative v Counsel for Personal Represe, R.W.-58 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ('"['i,e OJ: '. ,,--r'l\.Jl_ r NOTICE OF INHERITANCE TAX '. "!i! ~Ill'R~ISEMENT, ALLOWANCE OR DISALLOWANCE " ""'OF DEDUCTIONS AND ASSESSMENT OF TAX BUREAU OF INDIVIDUAL T~~O~{;Er, INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 17128-0601 2U05 JAN 10 M1 9: 49 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-10-2005 RUSENKO 08-03-2004 21 04-0934 CUMBERLAND 101 CLERK OF ORPHAN'S. cQIJm THOMAS J AHROON1!,,?' ^' ',I ' ',: AHRENS LAW OFFICES 5521 CARLISLE PIKE MECHANICSBURG PA 17055 *' REV-15UEX IF' U2-D4) RITA M Allount Rellitted I CMANGED III 121 131 141 151 161 171 .00 .00 .00 .00 23.003.00 .00 63.201.00 181 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-Y=isl'-;-Eit-AFP--riir=03Y-NOY-fCE-OF-i:-N'iiEifffANCE-YAinipiiRAfsEiiiNT~--Ar.UjWAiicE-b-R----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF RUSENKD RITA M FILE NO. 21 04-0934 ACN 101 DATE 01-10-2005 TAX RETURN WAS: I X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule OJ 5. Cash/Bank Deposits/Misc. Personal Property [Schedule E) 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subiect to Tax NOTE: I~ an assessment was issued previoUSly, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 .00 1111 1121 [131 [141 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 86,204.00 nn 86,204.00 .00 86,204.00 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. 86,204.00 X 00 = .00 X 045 = . DO X 12 = . DO X 15 = 1191= .00 .00 .00 .00 .00 ,+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID I-I TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" [CRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I Sf( Glenda Farner Strasbaugh Register of Wiils and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy KlrkS.Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 234 2/24/2005 RITA M. RUSENKO 21-2004-0934 JUDD AHRENS 5521 CARUSLE PIKE JA MErnANICSBURG, PA 17050 4,00 Total $4.00 Qty 1 Fee Description Additional Probate Fee Total: $4.00 Checks should be made payable to the Register of Wills. Tenns: Net 30. Please return one copy of this invoice with your payment. Thank you. Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OFV . rJ' COUNTY, PENNSYLVANIA Name ofDecedent:BfDt~j cV Date of Death:-StJ21. . "2 \1a::4 c. l€:sCA UfC-r tll\ - (jC\~3 File Number: Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion ofthe administration of the above-captioned estate: 1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . . . L DNo 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? . . . . . .. DY es ~o 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? ............................... DYes ~ d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk ofthe Orphans' Court and may be attached to th's report. Date OC10{&- (~UJJ1 a-. Capacity: ~onal Representative 0 COlillsel ~ ~~~Ii",&0 Le5l fJJ).Ef:-( MlCJrJl0fr\( 51. C:tttWStE {JA (1()1~ 1J1~Oq~5lS Telephone cry ,"'>J ""- 0- C-,,; cs PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES r AND F I L E PO BOX 280601 (~~~~ t~j~ ~ ~ HARRISBURG PA nlzB-0601 F _ ~'d E R RESPONSE AC N REV-1543 EX AFP (OB-0071 ~ ~`'~'~"' ~ S ~ DATE N0. 21 04-0934 11103531 01-19-2011 EST. OF RITA M RUSENKO CI~ERK~F ssx 191-28-2058 ,~ ~~~Rj DATE OF DEATH 08-03-2004 Q~a~~} }~~t~ ~y 1~'{1~'{`~~UNTY CUMBERLAND ~~4(;~~L-+`~`~`"~ ~~ REMIT PAYMENT AND FORMS T0: THEODORE A RUSENKO REGISTER OF WILLS 1200 MITCHELL DR 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050-3132 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. BLEOC COMMUNITY CU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a Soint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction frow the financial institution, attach a copy to this forty and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Cowmonwealth of Pennsylvania. Please call C717) 7B7-8327 with quesYiDns COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 086430 Date 06-17-1977 To ensure proper credit to the account, two Established copies of this notice ^ust accowpany 2,496.68 paywent to the Register of Wills. Make check Account Balance $ payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are wade within three Amount Subject to Tax ~ 416.12 wonths of the decedent's date of death, Tax Rate X .045 deduct a 5 Dercent discount on the tax due. Any Inheritance Tax due will becowe delinquent Potential Tax Due $ 18.73 nine wonths after the date of death. PART TAXPAYER RESPONSE A ~.. E. TO ;R~~'01~}~YIL~~RE~#kl~K 3~~i`71H.:y, H~~Ir21t1 SAX ,AS~SS#~tEf'tT A. ~ The above inforwation and tax due is correct. Rewit paywent to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. The above informs ion is incorrect and/or debts and deductions were paid. Cowplete PART 2~ and/or PART ~ below. PART If indicating a different tax fete, please state relationship to decedent: Ct_riI1S~ Q~~~~~L~'t~s~ ~tiLY.,~_ AAF': TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS F1sI1 ` ~'" '~' ~ "'~ - _,.-~-~ ,r~. ___ __LTNE 1. Date Established - _ 1 _ '~. _ ~ ., _ ~ . 2. Account Balance 2 +~ .t ~ ~ " _ ~. 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ !f 5. Debts and Deductions 5 -~.., =. ~' '" " `'°' _.. 6. Amount Taxable 6 S ~s ~- 7. Tax Rate 7 X ~ ~' ~ - ~' 8. Tax Due 8 $ ~. $ -'? PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reporteda^7bove are true, correct and J~omplete to the best of my knowledge and belief. HOME C /~~ ) '- ®' ~ /~ TAYDAVCD C7(_`IJA TIIDC WORKc~cn,~c ,I~uDC~~~ ~ O~ ~~ ~- TOTAL (Enter on Line 5 of Tax Computation) S PENNSYLVANIA INHERITANCE TAX yyy~~~!!~--INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES i. jl k -,~~ ! ~ AND FILE N0. 21 04-0934 PD Box zso6ol v+ TAXPAYER RESPONSE ACN 11103529 HARRISBURG PA 17126-0601 ~ ~ ;' ~!~°~ 1 C ~~~ ~ DATE 01-19-2011 REV-1543 E% ~FP (88 -08) W~:1 ~ ~~~~ _~ ~ 1 ~. t~ ~ TYPE OF ACCOUNT EST. OF RITA M RUSENKO ^ SAVIN C~..E~}E ~~ SSN 191-28-2058 ^ CHECK aR~~(C CGURT DATE OF DEATH o8-03-2004 ^ TRUST C~~~F~`,~j~j~ ~~ . ~A COUNTY CUMBERLAND ~ CERTI REMIT PAYMENT AND FORMS T0: THEODORE A RUSENKO REGISTER OF WILLS 1200 MITCHELL DR 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050-3132 CARLISLE PA 17013 BLEOC COMMUNITY CU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call (717> 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS GS ING F. Account No. 086430 Date 06-17-1977 To ensure proper credit to the account, twa Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 4,925.70 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 820.97 months of the decedent's date of death, Tax Rate ~( .045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 36.94 nine months after the date of death. PART TAXPAYER RESPONSE 1^ AIDE f* ,. ~l,.L~~ S T,~;<Z~ fi ~`;[} F3 i. T A A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C ONE B L 0 C K B. ^ The above asset has been or wlll be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. The above informs ion is incorrect and/or debts and deductions were paid. .Complete PART ~ and/or PART ~ below. PART If indicating a different tax rate, please state relationship to decedent:~5 TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINTfTRUST ACCOUNTS 1 2 3 X 4 $ 5 - 6 7 X 8 °.' t~~CTAL 13~E OHLY, ^ AAF ..~; PA-~IEPARTliENT 4F ~ REYEAtUf ,~ PAI3 :. i Z o ~~ 3 4 5 6 ~~~ ~ ~ s 7 ~l~. PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported abov-el are truGe~,^7corrve~ct and complete to the best of my knowledge and belief. HOME C ~ 1 ) ~ { / U v ~ ~~ WORK C ) `~ 0~ , ~ TAVDAVCD CTGAIATIIQC TFI FPNCINF NIIMAFR i)OTF TOTAL CEnter on Line 5 of Tax Computation) 8 USA~fIRST-CLASS FOREVER j USh FIRST-CLASS ;FdRCYER ~ ' !~ ;t.: ': .?` ~: ',„; .y :.a, ~; <s ;;~ ., ~ F ... ~~ ~ ,~ E a ~ra i v 3~Q ~~ ,vn' ""l J V _U l~lf 10~ S,N~~d~O 3~ }i~31~ f" t+~ ! ttii''"{~ ~ 3;~~~`~~ s.~~~iU~~d (1} ~~ r~:f ,_~~a .t~ 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 RUSENKO BARBARA 401 DELANCEY CT MECHANICSBURG, PA 17055-4484 fold ESTATE INFORMATION: SSN: 181-28-2058 FILE NUMBER: 2104-0934 DECEDENT NAME: RUSENKO RITA M DATE OF PAYMENT: 02/08/201 1 POSTMARK DATE: 02/07/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 08/03/2004 ACN ASSESSMENT CONTROL NUMBER -r-- REV-1162 EX111-96) NO. 'C'D 013993 AMOUNT 11103528 ~ $36.94 11 103530 ~ ', S 18.73 -'~ TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 5228 INITIALS: SAP RECEIVED BY: 555.67 GLENDA EARNER ~~'RASBAUGH REGISTER OF WILDS REGISTER OF WILLS BUREAU OF INDIYIDUAL TAXES Po Box z6o6o1 HARRISBURG PA 17126-0601 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE , ,~~; AND = '~~~ ~'' T,~!'"DYER RESPONSE REY-15f3 E% AFP FILE N0. 21 04-0934 ACN 11103530 DATE 01-19-2011 ZU~ L ~"EB -$ ~~I C ~ ? ~ TYPE OF EST. OF RITA M RUSENKO CLERK QF ssN 191-28-2058 Q,S CQUR~ DATE OF DEATH 08-03-2804 ~j~~~p~ COUNTY CUMBERLAND ~C3~~L.llivt/ "O'' ~~ REMIT PAYMENT AND FORMS T0: BARBARA A RUSENKO REGISTER OF WILLS 401 DELANCEY CT 1 COURTHOUSE SQUARE MECHANICSBURG PA 17055-4484 CARLISLE PA 17013 ACCOUNT SAYINGS ® CHECKING TRUST CERTIF. BLEOC COMMUNITY CU provided the Departwent with the inforwation below, which has bean ~se~ in calculating the potential tax due. Records indicate that at the death of the above-pawed decedent, you ware a ioint owner/b nafiieiary of this account. If you feel the inforwation is incorroct, please obtain written correction frog the financial institution, attadh a copy to this ion and return it to the abov address. This account is taxable in accordance with the Inheritance Tax laws of the Cowwonwealth of Pennsylvania. Pleaae_call C717) 787-,6327 with.gwstions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INStRI~CTIONS Account No. 086430 Dat• 06-17-1977 To ensure prooer credit to the account, two Established copies of this notic wUst aecowpsny pavwent to the Regis •r of Wills. Make check Account Balance ~ 2 496.68 ~ payable to "Registeriof!Wills, Agent". Percent Taxable X 16.667 NOTE: If tax paywen~s ere wade within throe Awount Subject to Tax $ 416.12 t's date of death, wonths of the decede Tax Rate X . 045 ~ deduct a 5 vercent d scount on tM tax due. Ary Inharitanca Tax w 'will becowe delinquent Potential Tax Duo ~ 18.73 nine wonths after th date of death. PART TAXPAYER RESPONSE A. ~~..II Ill Tha above inforwation and tax due is corroet. lfJ~ Rawit Daywant to the Rapistar of Wills with two copies of this notice to btain a discount or avoid interest, or chock box "A" and return this notice to ha .Rapistar of CHECK Wiils and an official assesswent will be issued by the PA Departwent of R vshue. C 0 NE ~ BLOCK B. ~ Tha above asset has been or will be reported and tax paid with the Pennsylvania inheritance Tax return 0 N L Y to b• f31ed by the estate reprosentative. C. ~ The abov info ion is incorr et and/or debts and deductions ware paid. Cowplete PART r 2 and/or PART ~ below. PART If indicating a different tax rate, plaasa state relationship to dacedant: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Dat® Establish®d 1 ` 2. Account Balance 2 3. Percent Taxable 3 X 4. Awount Subject to Tax 4 5. Debts and Deductions 5 - 6. Awount Taxable 6 7. Tax Rate 7 X 8. Tax Dua 8 $ PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Cowputation) ~ 3 Under penalties of perjury, I declare that the facts I have reported abov• era true cowplete to the best o wy knowledge and belief. HOME C ~ ~~ ) ~~5 ctb''rract/ and ~ ~~~ 10 C(. WORK c ~ a o~ I- TAXPAYER SIGNATURE TELEPHONE N MBER I DATE ~ __ PENNSYLVANIA INHERITANCE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ~._,- AND Po Box zeasol ~ ~~C.~ ~i~l~~(ER RESPONSE HARRISBURG PA 17128-0601 Qiy- jj ff REY•ISf3 E% ~FP f18-06) TAXI FILE N0. 21 04-0934 ACN 11103528 DATE 01-19-2011 20(i FEB -8 P~~ I CLERK ~JE ORi~iN'S COURT CUMBERC.AND CO.. P BARBARA A RUSENKO 401 DELANCEY CT MECHANICSBURG PA 17055-4484 4~EST. OF RITA M RUSENKO SSN 191-28-2058 DATE OF DEATH 08-03-2004 COUNTY CUMBERLAND A REMIT PAYMENT AND FORMS T0: ', REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAYINGS CHECKING TRUST ® CERTIF. BLEOC COMMUNITY CU provided the Department with the infonation below, which has bean sad fn calculating the potential tax due. Records indicate that at the death of the above-named decedent, you ware a Soint owner/b~nef,icfery of this account. If you feel the information is incorrect, please obtain written correction frw the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of ACTIONS .Penn COMPLETEe PART1171BELOW a*7 SEEpREVERSE SIDE FOR FILING AND PAYMENT INSTR Account No. 086430 Data 06 - 17 -1977 To ensure proper credit 'to the account, two Established copies of this notice most accompany payment to the Register of Wills. Make chock Account Balance 4,925 .70 payable to "Register of Wills, Agent". Percent Taxable X 16 .667 NOTES If tax payments era made within three Amount Subjaet to Tax ~ 820 .97 months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent d~sebunt on the tax due. Any Inharitanca Tax que'will become delinawnt Potential Tax Due g 36 .94 nine months after th+ d{te of death. A. '~(Tha above information and tax due is correct. ,J~ Remit payment to the Ragistar of Wills with two copies of this notice to pbtrin , ` a dfseount or avoid i nterest, or check box "A" and roturn this notice to the'Register of CHECK Wills and an official assessment will be issued by the PA Departwnt of ftlevahue. C ONE BLOCK B. ~ The above asset has boon or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions ware paid. Complete PART ~2 and/or PART ~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 - 6. Amount Taxable 6 7. Tax Rata 7 X 8. Tax Du• 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have raportad above are true cprrect and complete to the beat of m knowled a and belief. g HOME C ~ l'l ) ~ l S'" ~'~` ~{, ~ WORK C ) ~ ~ 6'~ 1) TeYpe FR SThNATl1RE TELEPHONE NUMBER DATE i i N i .yg~ { ioa' ~~ `~ o ~~~ i ~~ r. t ~. 4 Y M1~ WIMP ti :.:. ..r. '.... M V ~ rYr~ -- ~:. y ti ~~ ~~ ~ ~ c ~ o ~ .n 'o Ch ~ ~ ~~ - ~ ~ ~ ~. a ~ ~. ti ~ m ~. ~. 1 10 ~ !?I ~'{C1 8- 8~~ ~ itlt~i ti ,:;, ~` ~ rin~iaa, ssvv-isai, vsn COMMONWEALTH Of= PENNSY. AA`.IA DEPARTMENT OF REVEfJUE BUREAU OF INDIVIDUAL TAKE DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FEV-1'162 EX(11-96) NO. CC) ()14155 RUSENKO BARBARA A 401 DELANCY C-r MECHANICSBURG, PA 17055-4484 -------- fold ESTATE INFORMATION: ss-v: ~9~-28-2058 FILE NUMBER: 2104-0934 DECEDENT NAME: RUSENKO RITA M DATE OF PAYMENT: 03/ 21 / 201 1 POSTMARK DATE: 03/ 1 8/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 08/03/2004 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER 1 1 103528 ~ ,~ 12.81 1 1 103530 ;6.49 TOTAL AMOUNT PAID: $ "19.30 CHECK# 5250 INITIALS: HMW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 I~~HERITANCE TAX STATEMENT OF ACCOUNT ~' - - - ~ _.~_ - `,~ - - ~,, --- BARBARA A RUS~~NKO 401 DELANCEY CT MECHANICSBURG PA 17055-4484 pennsylvania ~ DEPARTMENT OF REVENUE REV-1607 EX AFP (12-10) DATE 03-07-2011 ESTATE OF RUSENKO RITA M DATE OF DEATH 08-03-2004 FILE NUMBER 21 04-0934 COUNTY CUMBERLAND ACN 11103528 Amount Remitted .,,: ,~~~ (~ ' MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE ~~+,~,.~.= CARLISLE PA 17013 •.. NOTE: To ensure prope r credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ _. ;.,_ . r pennsylvania .. , ~ ~ , , YYANCE TAX DEPARTMENT OF REVENUE I NHER BUREAU OF INDIVIDUAL TAxES , REV-1607 EX AFP (12-10) INHERITANCE TAX DIVISION S T A T E M E ~T O F A C C O U N T PO BOX 280601 HARRISBURG PA 17128-0601 - DATE 03-07-2011 ESTATE OF RUSENKO RITA M ~' -_-r' " DATE OF DEATH 08-03-2004 C_, ;~'~ ~'' FILE NUMBER 21 04-0934 ~'~,. --- - =';~ COUNTY CUMBERLAND BARBARA A RUSENKO ACN 11103530 401 DELANCEY CT Amount Remitted MECHANICSBURG PA 17055-4484 .~ ,, _. ~~' MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS ~ 1 COURTHOUSE SQUARE ";~ `' ~..~~ CARLISLE PA 17013 `° NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ........................... ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ..................~ ..............~ T..T .....~ .. ^............................. ~ a~nr r ~v ~ r nn„~,r ., .. ~c ......... /V 1/~-G , . G'~ ~ . ,x~,:,, ..~: ~ ~ _~_ ~- - =~ ,._ ~ ~ ; .. ~ C_: y 1 ~F ~~ ~ t~ ~. Q _. NOTICE OF INHERITANCE TAX ~`~~~~~~~~~~ • BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION '~ APPRAISEMENT, ALLOWANCE OR DISALLOWANCE '~ PO BOX 280601 = OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP C12-10) HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS BARBARA A RUSENKO '' 401 DELANCEY CT MECHANICSBURG PA 17055-4484 DATE 03-07-2011 ESTATE OF RUSENKO RITA M DATE OF DEATH 08-03-2004 FILE NUMBER 21 04-0934 COUNTY CUMBERLAND SSN/DC 191-28-2058 ACN 11103528 APPEAL BY DATE:05-06-2011 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~' ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-10) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 03-07-2011 ESTATE OF:RUSENKO RITA M DATE OF DEATH:08-03-2004 FILE NO.: 21 04-0934 S.S/D.C. NO.: 191-28-2058 COUNTY:CUMBERLAND ACN: 11103528 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: BLEOC COMMUNITY CU ACCOUNT NO.: 086430 TYPE OF ACCOUNT: ( )SAVINGS C ) CHECKING C )TRUST CX)TIME CERTIFICATE DATE ESTABLISHED 06-17-1977 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 4,925.70 X 0.166 820.97 - .00 820.97 x .045 36.94 NOTE: TO ENSURE 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 03-15-2011 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 36.94 INTEREST AND PEN. 12.92 TOTAL DUE 49.86 ~ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 BARBARA A RUSENKO 401 DELANCEY CT _ pennsylvania ~ NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE APPitAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 IX AFP (12-10) JOINTLY HELD OR TRUST ASSETS DATE 03-07-2011 ESTATE OF RUSENKO RITA M DATE OF DEATH 08-03-2004 _ FILE NUMBER 21 04-0934 - ~ COUNTY CUMBERLAND SSN/DC 191-28-2058 ACN 11103530 APPEAL BY DATE:05-06-2011 M E C H A N I C S B U R G P A 17 0 5 5- 4 4 8 4 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-10~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 03-07-2011 ESTATE OF:RUSENKO RITA M DATE OF DEATH:08-03-2004 COUNTY:CUMBERLAND FILE NO.: 21 04-0934 S.S/D.C. NO.: 191-28-2058 ACN: 11103530 TAX RETURN WAS: (X1 ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: BLEOC COMMUNITY CU ACCOUNT NO.: 086430 TYPE OF ACCOUNT: ( )SAVINGS (X) CHECKING t )TRUST ( TIME CERTIFICATE DATE ESTABLISHED Ob-17-1977 Account Balance 2,496.68 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.166 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 416.12 UPPER PORTION OF THIS NOTICE Debts and Deductions - •00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 416.12 REGISTER OF WILLS AT THE Tax Rate Y .045 ABOVE ADDRESS. MAKE CHECK Tax Due 18.73 OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID INTEREST IS CHARGED THROUGH 03-15-2011 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 18.73 INTEREST AND PEN. 6.55 TOTAL DUE 25.28 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~~ -. _ _ _ BUREAU OF INDIVIDUAL Tars ;~~' INHERITANCE TAX INHERITANCE TAX DIVISION _ _ , _ _$~ATEMENT OF ACCOUNT PO BOX 280601 HARRISBURG PA 17128-0601 r-. BARBARA A ~RU~~N`KO 401 DELANCEY CT MECHANICSBURG PA 17055-4484 pennsylvania ~ DEPARTMENT OF REVENUE REV-1607 EX AFP (12-10) DATE 03-07-2011 ESTATE OF RUSENKO RITA M DATE OF DEATH 08-03-2004 FILE NUMBER 21 04-0934 COUNTY CUMBERLAND ACN 11103530 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP C12-10~ *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF:RUSENKO RITA M FILE NO.: 21 04-0934 ACN: 11103530 DATE: 03-07-2011 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-28-2011 PRINCIPAL TAX DUE: 18.73 PAYMENTS CTAX CREDITS: PAYMENT RECEIPT DISCOUNT C+3 AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 02-07-2011 CD013993 .00 18.73 BALANCE OF UNPAID INTEREST/PENALTY AS OF 02-08-2011 TOTAL TAX PAYMENT 18.73 BALANCE OF TAX DUE .00 INTEREST AND PEN. b.49 TOTAL DUE 6.49 * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ;~,17=~ ~..., . __ _ _,_ Pennsylvania ~ __ _ . _ BUREAU OF INDIVIDUAL TAxES- INHERITANCE TAX DEPARTMENT OF REVENUE REV-1607 EX AFP (12-10) INHERITANCE TAX DIVISION .'._~ TAT E M E N T O F A C C O U N T PO BOX 280601 HARRISBURG PA 17128-0601 ' ~ ~ ~ __. DATE 03-07-2011 BARBARA A RUSENKO `' 401 DELANCEY CT MECHANICSBURG PA 17055-4484 ESTATE OF RUSENKO RITA M DATE OF DEATH 08-03-2004 FILE NUMBER 21 04-0934 COUNTY CUMBERLAND ACN 11103528 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NDTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP C12-10~ *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF:RUSENKO RITA M FILE NO.: 21 04-0934 ACN: 11103528 DATE: 03-07-2011 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-28-2011 PRINCIPAL TAX DUE: 3b.94 PAYMENTS CTAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-~ 02-07-2011 CD013993 .00 36.94 BALANCE OF UNPAID INTEREST/PENALTY AS OF 02-08-2011 TOTAL TAX PAYMENT 36.94 BALANCE OF TAX DUE .00 INTEREST AND PEN. 12.81 TOTAL DUE 12.81 * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. BUREAU OF INDIVIDUAL 'NSXES^ r ~~ {~f NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION '-1A~nn'¢12AISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 (9_FJ DEDUCTIONS, AND ASSESSMENT OF TAX ON HARRISBURG PA 17128-0601 ~ - JOINTLY HELD OR TRUST ASSETS CLERK OF oRPr{n,r,f ` ~~~~,~3 THEODORE AC~~s~dc~ ~ '' ~`' ~r~ 405 ALLISON AVE MECHANICSBURG PA 17055 Pennsylvania r i DEPARTMENT OF REVENUE REV-1548 EX AFP (12-10) DATE 04-25-2011 ESTATE OF RUSENKO RITA M DATE OF DEATH 08-03-2004 FILE NUMBER 21 04-0934 COUNTY CUMBERLAND SSN/DC 191-28-2058 ACN 11103529 APPEAL BY DATE:06-24-2011 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~"'> RETAIN LOWER PORTION FOR YOUR RECORDS ~-' REV-1548 EX AFP (12-10)-------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-25-2011 ESTATE OF:RUSENKO RITA M DATE OF DEATH:08-03-2004 COUNTY:CUMBERLAND FILE NO.: 21 04-0934 S.S/D.C. NO.: 191-28-2058 ACN: 11103529 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: BLEOC COMMUNITY CU ACCOUNT NO.: 086430 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST C)OTIME CERTIFICATE DATE ESTABLISHED 06-17-1977 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due 4,925.70 X 0.166 820.97 - 820.97 .00 x.045 .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID C-) NOTE: TO ENSURE 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 T0: "REGISTER OF WILLS, AGENT." AMOUNT PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 + IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ' IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. ~.; SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~,~ ~ ,,a- .,~ BUREAU OF INDIVIDU 'FIhX€S ' y INHERITANCE TAX DIVISIO~,_•~,,_ _ ~.~~•`~ PO BOX 280601 HARRISBURG PA 17128-0601 ~. - . ~ ~. ~ . , ... ~ f .. ~, ~ .,. INHERITANCE TAX STATEMENT OF ACCOUNT ,~ BARBARA A RUSENKO 401 DELANCEY CT MECHANICSBURG PA 17055-4484 pennsyLvania DEPARTMENT OF REVENUE REV-1607 EX AFP C12-10) DATE 04-18-2011 ESTATE OF RUSENKO RITA M DATE OF DEATH 08-03-2004 FILE NUMBER 21 04-0934 COUNTY CUMBERLAND ACN 11103530 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP C12-10) ~** INHERITANCE TAX STATEMENT OF ACCOUNT ~** ESTATE OF:RUSENKO RITA M FILE NO.: 21 04-0934 ACN: 11103530 DATE: 04-18-2011 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-28-2011 PRINCIPAL TAX DUE: 18-7~ PAYMENTS (TAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 02-07-2011 CD013993 .00 18.73 03-18-2011 CD014155 6.49- 6.49 TOTAL TAX PAYMENT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ~ IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. 18.73 .00 .00 .00 (r~ ar ~r ~r. ~ BUREAU OF INDIVIDUAL TA~8~ - ''~ a~INHERITANCE TAX INHERITANCE TAX DIVISION f" '~ 1 ~ PD Box 260601 _ St~ATEMENT OF ACCOUNT HARRISBURG PA 17128-O6D1 ! - n. -~ a ., _.i ~. __ :~ r1~~~~~~ .~~r-~: 1=~I = :~ BARBARA A R.l1S~NKd- ~ ~ l ~ ~ ~r` 401 DELANCEY CT MECHANICSBURG PA 17055-4484 Pennsylvania - i DEPARTMENT OF REVENUE REV-1607 EX AFP (12-10) DATE 04-18-2011 ESTATE OF RUSENKO RITA M DATE OF DEATH 08-03-2004 FILE NUMBER 21 04-0934 COUNTY CUMBERLAND ACN 11103528 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (12-10) *~(~( INHERITANCE TAX STATEMENT OF ACCOUNT **~( ESTATE OF:RUSENKO RITA M FILE NO.: 21 04-0934 ACN: 11103528 DATE: 04-18-2011 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-28-2011 PRINCIPAL TAX DUE: 36.94 PAYMENTS (TAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 02-07-2011 CD013993 .00 36.94 03-18-2011 CD014155 12.81- 12.81 TOTAL TAX PAYMENT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FDR INSTRUCTIONS. 36.94 .00 .00 .00 \._'__. L ~ Ur "` Pennsylvania ~ BUREAU OF INDIVIDUAL TAXES~- - INHERITANCE TAX DIVISION i' NOTICE ' d~'~I~ ~SEMENT OF INHERITANCE TAX ALLOWANCE DEPARTMENT OF REVENUE : `,_ L PO BOX 280601 HARRISBURG PA 17128-0601 A , OF DEDUCTIONS, OR DISALLOWANCE AND ASSESSMENT OF TAX ON REV-1548 Ex AFP cI2-I O) JOINTLY HELD OR TRUST ASSETS - ,~ ~ f; G a` ( . , .. DATE ~ ~, v~Ji1% THEODORE A RUSENKO 405 ALLISON AVE MECHANICSBURG PA 17055-6657 CUT ALONG THIS LINE ~"'> RETAIN LOWER PORTION FOR YOUR RECORDS 4~ REV-1548 EX AFP C12-10)-------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-25-2011 ESTATE OF:RUSENKO RITA M DATE OF DEATH:08-03-2004 COUNTY:CUMBERLAND FILE NO.: 21 04-0934 S.S/D.C. NO.: 191-28-2058 ACN: 11117287 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION 04-25-2011 ESTATE OF RUSENKO RITA M DATE OF DEATH 08-03-2004 FILE NUMBER 21 04-0934 COUNTY CUMBERLAND SSN/DC 191-28-2058 ACN 11117287 APPEAL BY DATE:06-24-2011 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 FINANCIAL INSTITUTION: BELCO COMMUNITY CU ACCOUNT NO.: 095790 TYPE OF ACCOUNT: CX)SAVINGS C ) CHECKING C )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 05-22-1979 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 10,223.23 X 0.500 5,111.62 - 5,111.62 .00 x .045 .00 NOTE: TO ENSURE 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. « j ~ IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. ~~. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. BUREAU OF INDIVIDUAL T~t~S~ Ci~~ ''~l; NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION P ~l1ISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 ('~, ,~11~~EDUCTIDNS, AND ASSESSMENT OF TAX DN HARRISBURG PA 17128-0601 -~--, JOINTLY HELD OR TRUST ASSETS CLFRK ~'~F THEODORE A ~[~11~~~'M~CD'I `,' ~ ,r^~ 405 ALLISON AVE MECHANICSBURG PA 17055 Pennsylvania ~ ; DEPARTMENT OF REVENUE REV-1548 EX AFP (12-10) DATE 04-25-2011 ESTATE OF RUSENKO RITA M DATE OF DEATH 08-03-2004 FILE NUMBER 21 04-0934 COUNTY CUMBERLAND SSN/DC 191-28-2058 ACN 11103531 APPEAL BY DATE:06-24-2011 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE '~ RETAIN LOWER PORTION FOR YOUR RECORDS F~ REV-1548 EX AFP C12-10~-------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-25-2011 ESTATE OF:RUSENKO RITA M DATE OF DEATH:08-03-2004 COUNTY:CUMBERLAND FILE NO.: 21 04-0934 S.S/D.C. NO.: 191-28-2058 ACN: 11103531 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: BLEOC COMMUNITY CU ACCOUNT NO.: 086430 TYPE OF ACCOUNT: C )SAVINGS CX) CHECKING ( )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 06-17-1977 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 2,496.68 X 0.166 416.12 - 416.12 .00 x.045 .00 NOTE: TO ENSURE 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ r1 IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. ~- SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.