The URL can be used to link to this page

Home My WebLink About04-0940COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVIDUAL TAXES DEPT280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 004756 NICKLOW TRUDY A 21 SOUTH WEST AVENUE SHIREMANSTOWN, PA 17011 ....... fold ESTATE INFORMATION: SSN: 162-14-1147 FILE NUMBER: 2104-0940 DECEDENT NAME: HARRIS DOROTHY O 12/21/2004 DATE OF PAYMENT: POSTMARK DATE: 12/21/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/01/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~1,035.00 TOTAL AMOUNT PAID: 91,035.00 REMARKS: TNICKLOW SEAL CHECK# 1007 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Estate of Dorothy O. Harris also known as Social Security No. ] fi ?- 14-1167 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executrix in the last will of the above decedent, dated_ April 1, and codicil(s) dated N/A PETITION FOR PROBATE and GRANT OF LETTERS No. To: Register of Wills for the Deceased. County of Cumberland in the Commonwealth of Pennsylvania named , 19 98 Decendent was domiciled at death in Cumberland County, Pennsylvania, with h_ er last family or principal residence at 1057 G Allendale Road ..... ¥, ~t- Mochanle~bnrg. l~echanicsburg, PA 17055 Decendent, then 83 3'ears of age, died October 1, 2006 , lX)x at n,~l,, _q,,iri~-u_o~pltal. C. nm? ltill: Pennsylvania Ex~t~(as (ollows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: H/A Decendent at death owned property with estimated values as follows: unknown (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ none situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.t.a4 administration d.b.n.c.t.a.) theron. TruOy lA. NlCkiow 21 South West Avenue Shiremanstown, PA 17011 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF cta~BEm.~q~) 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 dec~dent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed r before me this 19th __ day of · October 200V47-- ~x ~ ?~ - ~ / ,-, ~ ~ ~gister Trudy A. Nicklow No. zl-oq- :qqO Estate Of Dorothy O. Harris , Deceased DECREE OF PROBATE AND GRANT OF LETTERS ANDNOW thin I-I day of October the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated April 7, 1998 described therein be admitted to probate and filed of record as the last will of Dorothy O. Harris and Letters Testamentary are hereby granted to Trudy A. Nicklow 2004, in consideration of the petition on FEES Probate, Letters, Etc .......... Short Certificates( )c .......... ~da~ton . ..X.-.~ES... TOTAL Filed ................................... ATTORNEY(Sup. C:.I.D. No.) Keith O. Brenneman #47077 44 W. Main Street~ Mechanicsburg~ PA 17055 ADDRESS 717-697--8528 PHONE , OT 0 4 2~0~ CERTIFICATE OF DEATH Mecha~icsburg, Penns lvania ~'~~ n ~5[~,[A~Connei~sv~lle, PennsFlvan~a 1542~ = ................. ~~ ~ i ~1Zl5~~]~7~ ~ P~~ aa Lemoyn e, Pennsylvania r' ~E~~ ~ I'' 200~ 17043 LAST WIT,T, AND TESTAMENT OF DOROTHY O. HARRIS I, DOROTHY O. HARRIS, of Mechanicsburg: Cumbe~ land County, Pennsylvania, being of sound and disposing mind, Memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. 1. I direct that all my debts and funeral expenses be paid as soon as practical after my death by my Executrix hereinafter named. I direct that all taxes that may be assessed as a consequence of my death shall be paid from my residuary estate as part of the expenses of the administration of my estate. personal I give, devise and bequeath TRUDY A. NICKLOW, KENNETH B. absolutely. Ail the rest, residue and remainder of my estate, real, and mixed, and wheresoever the same may be situate, in equal shares to my children, HARRIS, JR. and LINDA MAE RITTER, In the event any of my children above named should predecease me, I direct that the share such deceased child would have received hereunder shall pass to his or her issue surviving me per stirpes and if there shall be no such issue, then such share shall lapse. 3. I hereby nominate, constitute and appoint my daughter, TRUDY A. NICKLOW, as Executrix of this my Last Will and Testament, but should she predecease me or fail to qualify, I nominate, constitute and appoint my daughter, LINDA MAE RITTER, as Executrix of this my Last Will and Testament. I further direct that no person serving as Executrix hereunder shall be required to post any bond to secure the faithful performance of her duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on Two (2) pages this 7th day of April, 1998. Dorothy-O. Harris Signed, sealed, published and declared by DOROTHY O. HARRIS, the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. 2~j ~ ( /?' ~"? ~'~- ( SEAL ) (SEAL) -2- COMMONWEALTH OF PENNSYLVANIA) : SS. COUNTY OF CUMBERLAND) We, DOROTHY O. HARRIS, KEITH O. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness /land that to the best of his or her knowledge the Testatrix was at //that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ' ' ~Testatrix Witness Wit iubscribed, sworn to and acknowledged before me by DOROTHY O. [ARRIS, Testatrix, and subscribed and sworn to before me by KEITH D. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, witnesses, this 7th day of April, 1998. LAW OFFICES SNELBAKER. BRENNEMAN & SPARE Name of Decedent: Date of Death: No. 21-04-0940 To the Register: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Dorothy O. Harris October 1, 2004 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 beneficiary of the above-captioned Estate on October 20, 2004. Name Kenneth B. Harris, Jr. Linda M. Ritter Trudy A. Nicklow Address 2205 Timberlake Place Highpoint, NC 27265 756 Allenview Drive Mechanicsburg, PA 17055 21 South West Avenue Shiremanstown, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None. Date: October 20, 2004 Keith O. Brenneman, Esquire Snelbaker, Brenneman & Spare, P. C. 44 W. Main Street Mechanicsburg, PA 17055 (717) 697-8528 Counsel for Personal Representative 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. REV-1162 EX(11-96) CD 0O4836 BRENNEMAN KEITH O 44 W MAIN STREET MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 162-14-1147 FILE NUMBER: 2104-0940 DECEDENT NAME: HARRIS DOROTHY O DATE OF PAYMENT: 01/13/2005 POSTMARK DATE: 01/1 3/2005 COUNTY: CUMBERLAND DATE OF DEATH: 1 0/01/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4.08 REMARKS: TOTAL AMOUNT PAID: SNELBAKER & BRENNEMAN $4.08 SEAL CHECK//1022 INITIALS: RSK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA '~. COUNTY OF CUMBERLAND j TRUDY A. NICE, LOW being duly sworn according fo law, deposes and says the+ She is Lhe Executrix of the Estate of Dorothy O. Harris late of the Borough_~o_~M_e_c_hanicsbu_~§ , Cumberland County, Pa., deceased and that the within is an inventory made by Trudy A. Nicklow , the said Executrix of the enHre estate of said decedent, cons~stlncj of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures oppos~te each ;tern of +he Inventory represent it's fair value as of +he date of decedent's death. Sworn and subscribed before me, MONWEALTI~ OF PENNSYLVANIA Susan L Mabazi, Notary Public Mechanicsburg Bom, Cumbedand Counbj My Commission ~ Nov. 24, 2007 Member, Pennsylvania Association Of Notaries 2005 Trudy A. Nic{I~~r' Admin{strator 21 West South West Avenue Shiremansto~n, PA 17011 Addrass Date of Death 1 October 2004 Day Month Year INSTRUCTIONS I. An inventory must be filed wifhin three months after appolnfmen+ of personal representative. 2. A supplement inventory must be filed within fhlrfy days of discovery of additional assets. 3. Additional sheets may be attached as fo personalty or realty 4. See Article IV, Fiduciaries Act of 1949. , I I Inventory of the real and personal estate of Dorothy O. Harris deceased PERSONALTY 1. M&T Bank checking account No. 32011148, date of death value: REAL ESTATE NONE TOTAL VALUE, ALL PROPERTY: $2,098.92 $2,098.92 REV-15~O EX (6-,30) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN 2 i 0 4 0 0 9 RESIDENT DECEDENT i 4 0 DECEDENT'SNAME(LAST, FIRST, ANDMIDDLEINITIAL) Harr£s, Dorothy O. D~EOFDE~H(MM-DD-YEAR) D~EOFBIRTH(MM-DD-YEAR) 10--I--2OO4 12--17--1920 8. 9. 10, 13. 14. o SOCIAL SECURITY NUMBER 162 -- 14 - 1147 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER N/A _ _ ~.1. Odginal Retum [~4. Limited Estate ~---~6. Decedent Died Testate (Attach copy of Will) ~-~9. Litigation Proceeds Received [(e"~:~, o. ~r~nneman, ~.squir~ FIRM NAME (IfApplicab,~) Snelbaker & Brenneman, P. C. J~J2. Supplemental Return [~4a. Future Interest Compromise (d~le of death a~ter 12-12-82) J-'--J 7. Decedent Maintained a Living Trust (A~ch ~opy of Trust) J---'l0. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) Jointly Owned Property (Schedule F) (6) [~] Separate Billing Requested Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Modgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11) ~J3, Remainder Return (date of death prior to 12-13-82) J---J 5. Federal Estate Tax Return Required _~O 8. Total Number of Safe Deposit Boxes J~J11. Bection to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS 44 W. Main Street Mechanicsburg, PA 17055 2,098.92 5~109.65 28,139.31 9,249.30 1,858.00 Charitable and Govemmental 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) (8) (11) ¢2) (13) 35,347.88 11,107.30 24~240.58 (14) 24,240.58 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15) 24,240.58 45 16. Amount of Line 14 taxable at lineal rate x .0 ___ (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 1,090.83 1,090.83 Decedent's Complete Address: STREET ADDRESS .... 1057 G Allendale Road STATE PA ziP 17055 Cl~ Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 1,035.00 51.75 3. Interest/Penalty if applicable D. Interest E. Penalty 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) (4) (5) (5A) (5B) 1,090.83 1,086.75 4.08 4.08 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. tf 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 foe' or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, il is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE Q.F-~ERSON RESPC}NSIB. J~ FOR FILING RETURN . x,,ff~~//~./2*~)"~'J , Executrix ADDRESS 21 South West Avenue, Shiremanstown, PA 17011 D~TE SIGN AT UR]~~AN REPRESEN TAT IVE ADDRESS 44 w. Main Street, 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 surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal 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. REV-1508 EX+ (6-98) ~ -.~' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Dorothy O. Harris 21-06--0096-0 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. I.I&T Bank, checking account 1~o. 32011148 2,098.92 TOTAL (Also enter on line 5, Recapitulation) $ 2,098.92 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98~ -~, COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Dorothy O. Harris 21-06-00960 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A.Trudy A. Nicklow Daughter 21 South West Avenue Shiremansto~m, PA 17011 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 DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 2/23/92 H&T Checking account No. 98299816 $10,219.30 50Z $5,109.65 TOTAL (Aisc enter on line 6, Recapitulation) $_5,109.65 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Dorothy O. Harris 21-04-00940 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIRRELATIONSHIPTODECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. M&T Certificate of Deposit No. Z8,139.31 100Z N/A $28,139. 031003913820790. Trudy A. Nicklow, Decedent's and Trustee's daughter, named beneficiary and transferee. Date of Transfer: October 1, 2004 TOTAL (Also enter on line 7 Recapitulation) $ 28,139.31 31 (If more space is needed, insert additional sheets of the same size) SCHEDULE H co+a4eNw~m OF.mNS~tVmA FUNERAL EXPENSES & .e~rANcE TAX eEnJ.N ADMINISTRATIVE COSTS RESIDENT OECEDENT ESTATE OF FILE NUMBER Dorothy O. Harris 21-04-00942 Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. 1. o 5. 6. 7. FUNERAL EXPENSES: Brooks Funeral Home Maryann Long - Pastor's honorarium Sandcimier Memorial - headstone engraving ADMINISTRATIVE COSTS: Personal Representative s Commissions Nome of Personal Representative (s) wa ive d Social Security Number(s) / EIN Number of Personal Represenative(s) Street Address City Sate Year(s) Commission Paid: At~meyFees to Snelbaker & Brenneman, P. C. Family Exemption: (If decedent s address is not the same as claimant $, attach explanation) Claimant Z~p Street Address City sma ~p ~ations~pofClaimanttoDeced~t ProbataFees to Register of Wills Acc0un~tsF~s, notary fees, filing fees and reserve ~~~ Cumberland Law Journal - advertise letters The Patriot News - advertise letters TOTAL (Also enter on line 9, Recapitulation $6,562.00 100.00 100.00 $2,000.00 53.00 250.00 75.00 109.30 $ 9,249.30 (If more space is needed, insert additionai sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES J ESTATE OF Dorothy O. Harris FILE NUMBER 21-04-00940 NUMBER o NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLEDISTRIBUTlONS[includeoutdghtspousaldistdbutions, andtransfersunder ~- _~ec. 9116(a)(1.2)] Trudy A. ~ZCK~OV 21 South West Avenue Shiremansto~n, PA 17011 Kenneth B. Harris, Jr. 2205 Timberlake Place Highpoint, NC 27265 Linda M. Ritter 756 Allenview Drive Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Son Daughter AMOUNT OR SHARE OF ESTATE 1/3 of residue 1/3 of residue 1/3 of residue 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-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & UENS ESTATE OF FILE NUMBER Dorothy O. Harris 21-04-00940 Re ~ort debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Medical insurance (supplemental) deductible payment and medical expense payment to Holy Spirit Hospital PP&L - payment on account of electric service Comcast - payment on account of cable service Verizon - payment on account of telephone service TOTAL (Als0 enter on line 10, Recapitulation) $ $1,752.00 37.12 12.88 56.00 1,858.00 (If more space is needed, insert additional sheets of the same size) SNELBAKER, SPARE LAST WILL AND TESTAMENT OF DOROTHY O. HARRIS I, DOROTHY O. HARRIS, of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. 1. I direct that all my debts and funeral expenses be paid as soon as practical after my death by my Executrix hereinafter named. I direct that all taxes that may be assessed as a consequence of my death shall be paid from my residuary estate as part of the expenses of the administration of my estate. 2. All the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath in equal shares to my children, TRUDY A. NICKLOW, KENNETH B. HARRIS, JR. and LINDA MAE RITTER, absolutely. In the event any of my children above named should predecease me, I direct that the share such deceased child would have received hereunder shall pass to his or her issue surviving me per stirpes and if there shall be no such issue, then such share shall lapse. 3. I hereby nominate, constitute and appoint my daughter, TRUDY A. NICKLOW, as Executrix of this my Last Will and Testament, but should she predecease me or fail to qualify, I nominate, constitute and appoint my daughter, LINDA MAE RITTER, as Executrix of this my Last Will and Testament. I further direct that no person serving as Executrix hereunder shall be required to post any bond to secure the faithful performance of her duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on Two (2) pages this 7th day of April, 1998. / 4~ (SEAL) Dorothyro. Harris Signed, sealed, published and declared by DOROTHY O. HARRIS, the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. (SEAL) (SEAL) -2- COMMONWEALTH OF PENNSYLVANIA) : COUNTY OF CUMBERLAND) SS. We, DOROTHY 0. HARRIS, KEITH O. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the )resence and hearing of the Testatrix, signed the Will as witness ~nd that to the best of his or her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~Testat~ix~ Witness Wit~gs ~ubscribed, sworn to and acknowledged before me by DOROTHY 0. HARRIS, Testatrix, and subscribed and sworn to before me by KEITH D. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, witnesses, this 7th day Df April, 1998. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX '* REV-1547 EX AFP (03-05) KEITH 0 BRENNEMAN SNELBAKER ETAL 44 W MAIN ST MECHANICS BURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-28-2005 HARRIS 10-01-2004 21 04-0940 CUMBERLAND 101 DOROTHY o Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~ ~!~-nrl:"Yf.m.m~'U'J'.Wm!l!.w.!MftArr4M!'t.m."M"mlllYM~.-rt:tW4M!!'.r.Tr.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HARRIS DOROTHY 0 FILE NO. 21 04-0940 ACN 101 DATE 03-28-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank DepositslHisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 2.098.92 5.109.65 28,139.31 (8) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 35,347.88 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 9,249.30 1.858.00 (11) (12) (13) (14) 11.10] 30 24,240.58 .00 24,240.58 I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due XCEIT: NOTE: .00 24,240.58 .00 .00 X 00 = X ;O~~= X 12~J'J= ---I X 15,_~~:) ( 19}'J- ::; I" .00 ...... ;';;jl, 090. 8'3 :.:: .00. .."":'$"- ,O:O~ 11,090; 83\ + AMOUNT PAID 1,035.00 4.08: DATE 12-21-2004 01-13-2005 NUMBER " CD004756 ........ CD004836 INTEREST/PEN PAID (-) 54.47 .00 (.Ai (JI TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 1,093.55 2 .72CR .00 2.72CR . 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" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)~~~ I' , STATUS REPORT UNDER RULE 6.12 Name of Decedent: Dorothy O. Harris Date of Death: October 1, 2004 Will No.: ?1-04-00Q40 Admin. No.: 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 Qx No 0 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? Yes No Jli] 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? Yes @ No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. W~ Date: ~2, 2005 Signature ,.";, Keith o. Brenneman Name 44 W. Main Street Mechanicsburg, PA 17055 Address (717)697-8528 Telephone No. Capacity: 0 Personal Representative lXJ Counsel for personal representative 2 J" LAW OFFICES SNELBAKER & BRENNEMAN, P.C. RE: ESTATE OF DOROTHY O. HARRIS NO. 21-04-00940 RECEIPT AND RELEASE WHEREAS, DOROTHY O. HARRIS, late of the Borough of Mechanicsburg, County of Cumberland and Commonwealth of Pennsylvania, died October 1,2004, having first made her Last Will and Testament in writing dated April 7, 1998, which since her decease was duly robated before the Register of Wills of Cumberland County and Letters Testamentary were issued to TRUDY A. NICKOW, the Executrix named in the Last Will and Testament of said NOW KNOW ALL MEN BY THESE PRESENTS, that we, TRUDY A. NICKLOW, ENNETH B. HARRIS, JR. and LINDA M. RITTER, being the only beneficiaries and istributees named in the Will of said decedent and the persons entitled to share in the residuary istribution of the Estate of said decedent, do hereby declare and say that we have examined the ttached Account and Schedule of Proposed Distribution attached hereto and incorporated herein s "Exhibit A", and find the same to be true and correct, and in strict accordance with the terms nd provisions of said Will, and we do hereby acknowledge that we this day have, had and eceived of and from TRUDY A. NICKLOW, Executrix of the Estate of DOROTHY O. ARRIS, the cash and/or personalty, if any, set opposite our names in the above stated Schedule f Proposed Distribution, in full satisfaction, payment and discharge of all such sum or sums of oney, legacies and bequests, share or shares, purparts and dividends which were due, owing d payable and belonging to us by any means whatsoever, for or on account of our full share, art or dividend ofthe Estate of DOROTHY 0, HARRIS, Deceased, and all interests accrued hereon. NOW, THEREFORE, we, the said TRUDY A. NICKLOW, KENNETH B. HARRIS, JR. d LINDA M. RITTER, do by these presents, remise, release, quit-claim and forever discharge e said TRUDY A. NICKLOW, her heirs, executors and administrators, of and from our said hare or dividend of the Estate aforesaid, and of and from all actions, suits, payments, accounts, eckonings, claims and demands whatsoever, for or by reason thereof, or of any act, matter, cause r thing whatsoever, from the beginning of the world to the day and date ofthese presents. AND, desiring to avoid the delay and expense of the settlement of said Estate by filing a onnal Account of said administration in the Office of the Register of Wills of Cumberland ounty and by having any balance in the hands ofthe Executrix, as shown by said Account, istributed by the Court of Common Pleas of Cumberland County - Orphans' Court Division, we o hereby agree that the foregoing schedule concerning the matter of settlement may be recorded ith the same effect upon us as ifthe same had been reported upon by said Court, in a Decree of istribution made on such report by the said Court of Common Pleas - Orphans' Court Division. AND in consideration of the aforesaid settlement being made without the aid of such ourt of Common Pleas - Orphans' Court Division, that we, the undersigned, do hereby agree hat if any debts or demands other than those included in the First and Final Account of the said RUDY A. NICKLOW, Executrix of the Estate of DOROTHY O. HARRIS, Deceased, as ereinbefore set forth, shall be hereafter recovered against the Estate of said decedent and be egaIly payable out of the same, that we will retum to the said Executrix such amounts thereof as ay be necessary to pay such debts or demands. LAW OFFICES SNELBAKER & BRENNEMAN, P .C. -2- LAW OFFICES SNELBAKER & BRENNEMAN, P.C. IN WITNESS WHEREOF, we have hereunto set our hands and seals the respective dates s set forth below. ITNESSED BY: (! .0-., ;( A) .!J "Jtdk; Tru~iCk!o: Date: if-/.f -115 )~ /J1b4 Kenneth B. Harris, Jr. Date: .tI/1. C/ S- ~4~ Lin a M. Ritter Date: /f- 4- OS- -3- (SEAL) (SEAL) (SEAL) OMMONWEALTH OF PENNSYLVANIA) SS. OUNTY OF CUMBERLAND ) On this the /,;}~" day of Iff?.<-/ L ,2005, before me, a Notary Public in and or said Commonwealth and County, the undersigned officer, personally appeared TRUDY A. ICKLOW, known to me (or satisfactorily proven) to be the person whose name is subscribed to he within instrument and acknowledged that she executed the same for the purposes therein ontained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. (/ , My Commission Expires: COMMONWEALTH OF PENNSYLVANIA Notarial Seal Susan L. Matrazi, Notary Public Medlanicsburg Boro. Cumbenand County My CommlSSlOI1 Expires Nov. 24, 2007 Member, Pennsylvania ASSOciation Of Notaries LAW OFFICES SNELBAKER & BRENNEMAN, P.C. LAW OFFICES SNELBAKER & BRENNEMAN, P,C. OMMONWEAL TH OF PENNSYLVANIA) SS. OUNTY OF CUMBERLAND ) On this the;J g-fh day of It f' /2..1 ~ ,2005, before me, a Notary Public in and or said Commonwealth and County, the undersigned officer, personally appeared LINDA M. TTER, known to me (or satisfactorily proven) to be the person whose name is subscribed to he within instrument and acknowledged that she executed the same for the purposes therein ontained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~ Notary Public My Commission Expires: COMMONWEALTH OF PENNSYLVANIA Notanal Seal Susan L. Matrazi. Notary Public Mechanlcsburg Bora. Cumbenand County My Commission Expires Nov. 24, 2007 Member, Pennsylvania Association Of Notaries STATE OF NORTH CAROLINA COUNTY OF DAv'rEo,,) ) SS. ) On this the 1'1+1:- day of Ap 1 ; I ,2005, before me, a Notary Public in and for said Commonwealth and County, the undersigned officer, personally appeared KENNETH B. HARRIS, JR., known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ""nUfl"'I/ ,"'\.\.E L e"', ~,,~\.~ .......... ~;'''i} ~ G'.' "~(': '.I" g~.." r;:fCAf1 L.....J.%. ""-flt::.~' r._ :: . ,-- 'J~'" =*: 0=0 : ~:; "'" . . - '~q:.. ;OUBL\v,.iff} "~,^Y.IJ..-:", .~. ..;,:: ..;. '7/"10" .' ~ , un ...... ,\'1 ~~ ......",oON CO\> \\\", IllillrmU\\\ ~L~~b f~~ "--.../ Not Pu I' My Commission Expires: .:2(1 ~{ 0 Co LAW OFFICES SNELBAKER & BRENNEMAN, P.C. LAW OFFICES SNELBAKER & BRENNEMAN. P .C. ESTATE NO. 21-04-00940 FIRST AND FINAL ACCOUNT OF TRUDY A. NICKLOW, EXECUTRIX OF THE ESTATE OF DOROTHY O. HARRIS, LATE OF THE BOROUGH OF MECHANICSBURG, CUMBERLAND COUNTY, PENNSYLVANIA TRUDY A. NICKLOW, EXECUTRIX aforesaid and Accountant herein avers as follows: DATE OF DECEDENT'S DEATH: DATE LETTERS TESTAMENTARY ISSUED: DATE EXECUTRIX' NOTICE ADVERTISED The Cumberland Law Journal: October 1, 2004 October 19, 2004 October 29, November 5 and 12,2004 The Patriot News: November 9,16.23.2004 DATE OF RULE 5.6(A) CERTIFICATION: PERSONALTY - PRINCIPAL ACCOUNT DEBITS The Accountant charges herself with receipt of the following items of Decedent's personalty as noted in the Inventory and Appraisement filed in the Office of the Register of Wills on January 13, 2005 M&T Bank, checking account No. 32011148 TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS: EXHIBIT A October 20, 2004 $2.098.92 $2.098.92 PERSONALTY - PRINCIPAL ACCOUNT CREDITS The Accountant claims credit for payment of the following items from Decedent's personalty principal account: Brooks Funeral Home Maryann Long - Pastor's honorarium Sandcimier Memorial - headstone engraving Snelbaker & Brenneman, P. C. - attorneys fees Reimburse costs advanced by Snelbaker & Brenneman, P. C.: Probate fee to Register of Wills Advertising fee - The Patriot News Advertising fee - Cumberland Law Journal Payment of Inheritance tax Filing fee to Register of Wills Certified mailing postage $ 53.00 109.30 150.00 4.08 30.00 4.42 Total Costs Reimbursed: Reserve for filing costs and final attorney's fees Medical insurance deductible payment and medical expense payment to Holy Spirit Hospital PP&L - payment on account of electrical service Comcast - payment on account of cable service erizon - payment on account of telephone service egister of Wills - additional probate fee OTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS: To the extent this credit exceeds all debits and income, the Executrix has paid such ounts from non-probate assets owned by her. LAW OFFICES SNELBAKER 8:: BRENNEMAN. P.C. -2- $6,562.00 100.00 100.00 1,170.00 350.80 750.00 1,752.00 37.12 12.88 56.00 5.00 $10.895.80* LAW OFFICES SNELBAKER 8: BRENNEMAN, P.C. PERSONALTY - INCOME ACCOUNT DEBITS The Accountant charges herself with receipt of the following items of income from Decedent's personalty: Partial refund of inheritance tax from Department of Revenue: $2.72 TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS: $2.72 PERSONALTY - INCOME ACCOUNT CREDITS The Accountant claims credit for payment ofthe following items from personalty income: NONE TOTAL, PERSONALTY, INCOME ACCOUNT, CREDITS: NONE REAL ESTATE - PRINCIPAL ACCOUNT DEBITS he Accountant charges herself with receipt of Decedent's real estate as follows: NONE OTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS: NONE -3- L-AW OFFICES SNELBAKER & BRENNEMAN, P.C. REAL ESTATE - PRINCIPAL ACCOUNT CREDITS The Accountant claims credit for payment of the following items from real estate principal: NONE TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS: NONE REAL ESTATE - INCOME ACCOUNT DEBITS The Accountant charges herself with receipt of the following income received from Decedent's real estate: NONE TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS: NONE REAL ESTATE - INCOME ACCOUNT CREDITS The Accountant claims credit for payment of the following items from Decedent's Real Estate Income Account: NONE TOTAL, REAL ESTATE, INCOME ACCOUNT, CREDITS: NONE -4- LAW OFFICES SNELBAKER & BRENNEMAN, P .C. I. PERSONALTY A. PRINCIPAL ACCOUNT Debits Credits Balance B. INCOME ACCOUNT Debits Credits Balance RECAPITULATION $ 2,098.92 -10.895.80 $ 2.72 -0- C. NET BALANCE OF PERSONALTY: II. REAL ESTATE III. NET BALANCE OF ESTATE FOR DISTRIBUTION: -5- ($8,796.88) $ 2.72 ($8,794.16) NONE -0- LAW OFFICES SNELBAKER & BRENNEMAN, P.C. SCHEDULE OF PROPOSED DISTRIBUTION 1. To Trudy A. Nicklow per Item 2 of Decedent's Will (1/3 of residue): -0- 2. To Kenneth B. Harris, Jr., per Item 2 of Decedent's Will (1/3 of residue): -0- 3. To Linda M. Ritter per Item 2 of Decedent's Will (1/3 of residue): -0- Total Proposed Distribution: -0- COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) TRUDY A. NICKLOW, being duly sworn according to law deposes and says: that she is the Executrix of the Estate of Dorothy O. Harris, Deceased; that she is the Accountant herein; that the foregoing Accounting is true and correct; that the below list or schedule [*J contains the names and addresses of all persons who have given notice of their claims, and whose claims remain unpaid; that the below list or schedule [**J contains the names of all persons interested in the distribution of said Estate; and that the facts set forth in the within Account are true and correct to the best of her knowledge, information and belief. * PERSONS HAVING CLAIMS AGAINST ESTATE NONE ** PERSONS INTERESTED IN DISTRIBUTION OF THE ESTATE Trudy A. Nicklow Kenneth B. Harris, Jr. Linda M. Ritter low, Executrix and Accountant Sworn to and subscribed before me this 12th day of April, 2005. I eX:' Notary Public (," LAW OFFICES SNELBAKER & BRENNEMAN, P.C. COMMONWEALTH OF PENNSYLVANIA Notanal Seal Susan L. Matrazi, Notary Public Mechanlcsburg Bora, Cumbenand County My Commission Expires Nov. 24, 2007 Member, Pennsylvanie As:.>ocialion Of Notaries BUREAU OF INDIVlDUAlij~ES==~' ;, :; ::::;;:: INHERITANCE TAX DIVISION .,,; PD BOX 280601 i',; HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-16D7 EX AFP (03-05 ZUDS MAY 16 Pi 2: 45 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-25-2005 HARRIS 10-01-2004 21 04-0940 CUMBERLAND 101 AIIOW\t R..itted DOROTHY o ('I rr<( .r,C -'o...tM:\ ur ORPf-'A\!'S CC URT KEITH 0 O$!~l:MAN;) C) R'\ SNElBAKER ETAl 44 W MAIN ST MECHANICSBURG PA 7055 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credi to your account, sub.it the Upper pOrtion of this fora with your tax pay..nt. CUT ALONG THIS lINE _~ RETAIN lOWER PORTION FOR YOUR RECORDS ~ ................................ ............................................................................... REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF HARRIS OROTHY 0 FILE NO.21 04-0940 ACN 101 DATE 04-25-2005 THIS STATEKENT IS PROVIDED TO AD ISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TA DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF lAST ASSESSMENT O~ RECORD ADJUSTMENT: 03-28-2005 PRINCIPAL TAX DUE, 1,090.83 PAYMENTS (TAX CREDITS): PAYMENT DATE 12-21-2004 01-13-2005 04-11-2005 RECEIPT NUMBER CD00475 CD00483 REFUND DISCOUNT (+) INTEREST/PEN PAID (-) 54.47 .00 .00 AMOUNT PAID 1,035.00 4.08 2.72- TOTAL TAX CREDIT 1,090.83 ~. BALANCE OF TAX DUE .00 INTEREST AND PEN. IF PAID AFTER THIS DATE, SI~ REVERSE SIDE FOR CALCULATION OF ADI~TIONAL INTEREST. I IF TOTAL DUE IS LESS THAN U, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED S A "CREDIT" ICU, YOU "A Y BE DUE A REFUND. S E REVERSE SIDE OF T"IS FORH FOR INSTRUCTIDNS. ) TOTAL DUE .00 .00