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HomeMy WebLinkAbout95-018321-g5 ' D(83 r .. ~~ 0 W W 0 W U W O O w 7 z This is to certify that the certificate hereunto attached is a true and accurate copy of the original death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L. 304. AUG 1 ~6 20pT Date Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 Hioa.i+~n«. ~ COMMONWEALTH OF PENNSYLWNIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH 014 813 REV-1500 EX + (I-94) COWi9-lIOIk,4l~EALTH OF PENNSYLVANIA i DEFF~C~TMENT OF REVENUE DEPT. 280601 "HARRISBURG, PA 17128-0601 DECEDENTS NAME (LAST, FIRST, AND MI WALKER, HELEN V. SO L4L SE URnY NUMBER 206 -10 - 8989 ~ REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFIC~~ ~LY FILE NUMBER 9 21 95 0183 COUNTY CODE YEAR NUMBER FEBRUARY 27,1995 - - ~-err°^~°..~~ ~aca,.~~~ - s. Kemamder Retum - 4. Limited Estate - 4a. Future Interest Compromise _ 5. Fed Estate Tax~Retum Required ) (for dates of death after 12-12-82) X 6. Decedent Died Testate - 7. Decedent Maintained a Living Trust _ 8. Total No. of Safe Deposit Boxes (Attach copy of Will) EX. A (Attach copy of Trust) - 9. Litigation Proceeds Received -10. Spousal Poverty Credit (date of death _ 11. Elect to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch O) HAROLD S. IRWIN, III TELEPHONE NUMBER 717-243-6090 .. ......, ...~aaaav wan ~cuwo n/ (~~ 0.00 2. Stocks and Bonds (Schedule B) (2) 0.00 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 0.00 4. Mortgages and Notes Receivable (Schedule D) (4) 0.00 5. Cash, Bank Deposits & Miscellaneous Personal (5) Property (Schedule E) 0.00 6. Jointly Owned Property (Schedule F) (g) 0.00 7. Transfers /Misc. Property(Schedule G) (Schedule L) (7) 0.00 8. Total Gross Assets (total Lines 1-7) 9. Funeral Exp & Administrative Costs (Schedule H) (9) 945.00 10. Debts, 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 Governmental Bequests (schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 15. Amount of Line 14 taxable at the spousal rate . Amount of L 14 taxable at 6°k rate x0.00 17. Amount of Line 1 xable at 15% rate 98. Tax due 9. X (8) -`. 0.00 ~:. 945.00 -945.00 (13) 0.00 (14) ~x~ -945.00 x . _ (15) 0.00 x .06 = (16) 0.00 x . _ (17) 0.00 (18) 0.00 -- -- - ----•••~ •••-•--•^n °~~.ro..~.~,y wnwu~oa anal amlesrnen[s, ana >:o Ale oast Of my knowledge and belief, t is t rrect and comp/ .Declaration of preparer other than personal representative is based on all information of which preparer has any knowledge. ATI IRF -,•.P S conucml c rr.e ~;; ;. ,._ per; ;_~; . _____ _ __ 35 EAST HIGH STREET, SUITES 201/202 CARLISLE, PA 17013 4905 CARLISLE PIKE, MECHANICSBURG, PA 17055 FEBRUARY J 0,2000 SIGNAT E REPARER OTHER THAN REPRESENTATIVE ADDRESS DATE ~~ 35 EAST HIGH STREET, CARLISLE, PA 17013 FEBRUARY f U, 2000 Decedent's Complete Address: 325 WESLEY DRIVE BETHANY TOWERS 21P MECHANICSBURG PA a 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 18) 2. Credits !payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) S Total Credits (A+g+C) (2) 3. Interest /Penalty if applicable D. Interest E. Penalty Total InteresUPenalty (D+E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 19 to request a refund (4) ti. 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. Enter the total of Line 5+5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use of income of the property transferred : ...................................... X b. retain the right to designate who shall use the property transferred or its income; ........ X c. retain a reversionary interest; or ........................................................................... X d. receive the promise for life of either payments, benefits or care? ............................... X 2. If death occurred on or before December 123,1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................... NIA 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ...................................................................................................... X 4. Did decedent own an individual retirement account, afinuity; or other non-probate property? ...... X IF•THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST'COMPLETE SCHEDULE G AND FILE IT AS PART OF THE F 72 P.S. Section (a) (1.1) (i) provided for the reduction of the tax rate imposed on the net value of transfers to or for the use spouse From 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995. 72 P.S. Section (a) (1.1) (ii) provided for the reduction of the tax rate imposed on the net value of transfers to or for the use of the surviving spouse from 3% to 0% for dates of death on or after January 1, 1995. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requi~ ements 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 JANUARY 1, 1995 -Please answer the following question by placing an "x" in the appropriate space. Did the decedent create a trust or similar arrangement which is solely for the surviving spouse's benefit for his or her entire Ilfetime? Yes No X If you answer yes to the above question, the tax on the trust or similar arrangement is postponed until the death of the second spouse, at which time it will be fully taxable at the rate(s) applicable to the remainder beneficiary(ies). Enter the value of the trust on Schedule J, part II, in order to remove it from the calculation of the tax due in this estate. You may wish to file Schedule O in order to make the election available under Section 9113. If the election is made, the trust or similar arrangement is taxed in the estate of the first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse is taxed at the zero tax rate, and the remainder is axed at the rates) applicable to the remainder beneficiary(ies). If you choose to make the election, you must attach Schedule O to a timely filed tax return, along with Schedule(s) K and/or M in order to shoe the apportionment of the trust or similar arrangement between the surviving spouse and the remainder beneficiary(ies). REV-1502 Ex + (~z-85> Cft1MMONVIIEALTH OF PENNSYLVANIA SCHEDULE A ' INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN V. WALKER 1995 - 0183 (Property jointly-owned wkh Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relwant facts. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH .NONE ~ ~ ~ A~ ~fuso enter on une i Regpltulation) ~ NONE (If more space is needed, inse-f additional sheets of same size.) REV-15Q,3 EX + (4.86) CQMMONWEALTH OF PENNSYLVANIA SCHEDULE B INHERITANCE TAX RETURN STOCKS AND BONDS RESIDENT DECEDENT ca~r~~C Vr HELEN V. WALKER rn.e nuMdeR 1995 - 0183 _~ •e~wer,~ v~+IC NUMBER OF DEATH NONE ~ ~+~.+~ ~wso en~er on une z, Reppitulatlon) NONE Qf more space is needed, fnsert addlNona! sheets of same size.) REV-15Q4 EX + (392) m y• COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT HELEN V. WALKER NUMBER NONE SCHEDULE C CLOSELY HELD STOCK PARTNERSHIP AND PROPRIETORSHIP r1LG nY1~lOGR 1995 - 0183 OF DEATH on (!f more space is needed, Insert additbna! sheets of same size.) REV-1507 EX + (6-86) s> COMMONWEALTH OF PENNSYLVANIA SCHEDULE D INHERITANCE TAX RETURN MORTGAGES AND NOTES RESIDENT DECEDENT RECEIVABLE HELEN V. WALKER on NUMBER NONE FILE NUMBER 1995 - 0183 OF DEATH w i w~ ~PUSO enter on une a Reppituiatlo~) ~ NONE (ff mope space is needed, Insert additional sheets of same size.) REV-150$ EX + {2-8T) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH. BANK DEPOSITS AND INHERITANCE TAX RETURN MISCELLANEOUS RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER HELEN V. WALKER 1995 - 0183 NUMBER NONE OF DEATH rvrw~ (~vso enter on une 5 Regpitulatlon) ~ _ NONE (If more space Is needed, Insert addU/onal sheets of same size.) REV-1509 EX + (12-88) COMMONWEALTH OF PENNSYLVANIA SCHEDULE F INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN V. WALKER 1995 - 0183 Joint tenant(s): A. B. C. Jointly-owned orooartv: ITEM NUMBE R LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY TOTAL VALUE OF ASSET DEC D'S •/. INT. DOLLAR VALUE OF DECEDENTS INTEREST NONE T TAL {Also enter on Line 6. Recaoit ulation- Nnu~ (If more space is needed, insert additional sheets of same size.) REV-1510 EX + (2-8T) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G TRANSFERS cv ~ e. ~ c yr FILE NUMBER HELEN V. WALKER 1995 - 0183 THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES. ITEM NUMBE R DESCRIPTION OF PROPERTY tndude name wthe hans-eres, thehro/ationship ro decedent, date d transle~ EXCLUSION TOTAL VALUE OF ASSET DECD.'S '/~ OF INT. DOLLAR VALUE OF DECEDENTS INTEREST NONE TeTet r ate,, e.,.e~.,., ~ ~.,e ~ oe,.., ..:...:...:....~ ........ (If mope space is needed, insert additional sheets of same size.) REV-1511 EX + (7-88) ' SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES, INHERITANCE TAX RETURN ADMINISTRATIVE COSTS AND RESIDENT DECEDENT MISCELLANEOUS EXPENSES w ~ r~ ~ e yr FILE NUMBER HELEN V. WALKER 1995 - 0183 ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: 1• JOHN E. NEUMYER FUNERAL HOME INC. S 895.00 2. 3. 4. B. Administrative Coats: 1. Personal Representative Commissions: Sociai Security Number of Personal Representative:: Year Commissions Paid: 2. Attorney Fees: 3. Family Exemption: Claimant Relationship Address of Claimant at decedent's death: Street Address City State Zip Code 4• Probate Fees: REGISTER OF WILLS 35.00 C. Miscellaneous Expenses: 1 • REGISTER OF WILLS -File Appraisement 15.00 2. 3. 4. 5. 6. 7. 8. 9. 10. '1. 12. 13. 14. , 15. 16. 17. 18. TOTAL (Also enter on Line 9, Regpitulation) s 945.00 ~~ r (!f more space is needed, insert additional sheets of same size.) REV-1511 EX + (7-88) COMMONWEALTH OF ENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGES, LIABILITIES AND LIENS es i n ~ t vF FILE NUMBER HELEN V. WALKER 1995 - Q183 NUMBER NONE on (If more space is needed, insert addH/onal sheets of same size.) REV-1513 EX + (2.87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HELEN V. WALKER SCHEDULE) BENEFICIARIES FILE NUMBER 1995 - 0183 ITEM NAME AND ADDRESS OF BENEFICWRY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE A. Taxable Bequests: ~• MARY V. WISE DAUGHTER ~~~ ENTIRE ESTATE 4905 CARLISLE PIKE ~ ~ ~~ MECHANICSBURG PA 17055 d NUMBER 1. I NONE SHARE OF ESTATE on (If mole space is needed, insert additional sheets of same size.) ~ct~~ ~lt~i11 ~tit1~ UL}~t~11LL'lt~ OF ' BELEN V. WALKER ,\ ~. I, HELEN V. WALKER, of Mechanicsburg, Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, to my daughter, MARY V. WISE. SECOND: If MARY V. WISE predeceases me, I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, to my. son, ROBERT L. KERSHAW, provided, however, that should he predecease me, then to his issue per stirpes by representation. THIRD: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all property, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or condi- tions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivision, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. (G) To make distributions to my herein named benefici- cries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust .administration expenses, to protect or improve any property held under my will, and for investment purposes. 1 (I) To select a mode of payment under any qualified .~ retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever manner they consider advisable. FOU T I direct that all inheritance, estate, trans- fer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the princi- pal of my residuary estate. 2 4 • FIFTH: i nominate and appoint MARY V. WISE, Executrix of this, my Last Will and Testament. In the event of the death, resignation orsinability to serve for any reason whatsoever of the said MARY V. WISE, I nominate .and appoint ROBERT L. KERSHAW, Executor of this, my Last Will and Testament. I direct that my Executrix or Executor, as the case may be, and their successors, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ! " day of ~;~~~ , 1992. ~y 1~.yli~ (SEAL) HELEN V. WALKER Signed, sealed, published and declared by the above- named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address Address 3 t- ~' ~~ } e My attorney-in-fact shall be entitled to reasonable compensation for services performed hereunder. IN WITNESS WHEREOF, and intending to be legally bound hereby, I have signed this Power of Attorney this 1992. ~ '.S Notary is My Commission Expires: .~~ NOTARIAL SEAL CA111ERINE 18ARRA, NOTARYlIts[~ SHIREMANSIOWN 8080, G1N18ERLANO OQ ~, MY COMMISSION EXPIRES SEP19. l99S WITNESS: ,~r~ ~ l ''1 ~ ~~^ ~l/~ ~ l~ HELEN V. WALKER day of ~ (SEAL) COMMONWEALTH OF PENNSYLVANIA: • SS. COUNTY OF CUMBERLAND On this, the ~' day of ~ ~~, 1992, before' me, a Notary Public, personally appeared HELEN V. WALKER, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. r ~~t~t i11 ~tltl~ VL~tc`L11tL'ltt oa HELEN V. 11AL1CER ~. I, HELEN V. WALKER, of Mechanicsburg, Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRS: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, to my daughter, MARY V. WISE. SECOND: If MARY V. WISE predeceases me, Z devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance poli~:ies thereon, to my. son, ROBERT L. KERSHAW, provided, however, that should he predecease me, then to his issue per stirpes by ~ representation. THIRD: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all property, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of-time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or condi- tions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivision, d improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. (G) To make distributions to my herein named benefici- arses in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. (I) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever manner they consider advisable. OURT I direct that all inheritance, estate, trans- fer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the princi- pal of my residuary estate. 2 ._ .FIFTH: I nominate and appoint MARY V. WISE, Executrix of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of the said MARY V. WISE, I nominate and appoint ROBERT L. KERSHAW, Executor of this, my Last Will and Testament. I direct that my Executrix or Executor, as the case may be, and their successors, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~~ day of ~~~'~ , 1992. /SIJ' ~1/GIJ (SEAL) HELEN V. WALKER Signed, sealed, published and declared by the above- named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address Address T ~ ~ ;, 3 II ~ '-5 Notary is My Commission Expires: N0IARIAI SEAL d1111ERINE 1.9ARRA, NOTARY M1SUC SHIREMANSTOWN BORO, CUMBERLAND GOi. IA, MY COMMISSION EXPIRES SEP19.1995 t ~: r s My attorney-in-fact shall be entitled to reasonable compensation for services performed hereunder. IN WITNESS WHEREOF, and intending to be legally bound hereby, I have signed this Power of Attorney this day of 1992. WITNESS: r-~ ~ f l ~`) i -' .. fJ HELEN V. WALKER (SEAL) COMMONWEALTH OF PENNSYLVANIA: : SS. COUNTY OF CUMBERLAND ~ . On this, the y ~` day of ~ ~~, 1992, before me, a Notary Public, personally appeared HELEN V. WALKER, known to me or satisfactorily proven to be the person whose name is •subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. z h pennsyLvania DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TINHERITANCE TAX REV-1607 EX AFP (12-14) INHERITA%n"IS IN OF' 2O PO BOX STATEMENT OF ACCOUNT HARRlSBURGftff(28-0-6,V1 DATE 02-09-2015 ESTATE OF WALKER HELEN v DATE OF DEATH 02-27-1995 FILE NUMBER 21 95-0183 CUMBERLAND IROWCOUNTY YN HAROLD J�J,701', , - I S ACN 101 T—2 0 2 Amount Remitted 35 E HIGH ST CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: 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 4— ---- -------- -- - -HC REV-1607- ex l -AFP C12-14)- - - - -*;;-&HiiffAH TAX YiAilif O� iCCOUNT ESTATE OF:WALKER HELEN V FILE NO. : 21 95-0183 ACN: 101 DATE: 02-09-2015 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: 03-26-2001 PRINCIPAL TAX DUE: .04 PAYMENTS (TAX CREDITS) : PAYMENT RECEIPT DISCOUNT AMOUNT PAID DATE NUMBER INTEREST/PEN PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 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 FOR INSTRUCTIONS.