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Home My WebLink About04-1019 COMMONWEALTH OF PENNSYLVANIA DEPARRVlENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER OFFICIAL USE ONLY DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Greene, Ethel E. Z iii DA3E OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-DO-YEAR) t.u 02/14/200~, 03/05/1915 ILl IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ I r~7] 1, Odginal Return [~ 2 Supplerneata~ Ratum uJ ~.(,1 [~ 4a. Future Interest Compromise (date of death after 1212~2) 6. Decedent Died Testate (Attach copy of Will) ~ 7, Decedent Maintained a LMng Trust (Attach cc~oyof'~rust) COUN~ CODE YEAR NUtV~ER SOCIAL SECURITYNUMBER 013-07-7352 ~ RETU~ MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIALSECURITYNUMBER [~3, Remainde Re um (date of death pdo~ ID 12-13~2) [~5. Federal Estate Tax Return Required -- 8. Total Number of Safe Deposit Boxes [~ 9. Litigation Proceeds Recalved ~"~ 1 0. Spousal P overb/Credit (da,e of dealh between 12 31.91 and 1.l.gS) E~ t t. Election to tax under Sec. 9113(A)(^tt~h sch o) NTAHIMSE SECTION MUST BE COMPLETED. ALL CORRESPONDENcE AND CO~MENTiAL TAX iNfORMATiON 8H~D BE DiREctED TO: COMPLETE MAILING ADDRESS Heath L. Allen, Esquire 210 Walnut Stree~ FIRM NAME (If Applicable) Keefer Wood Allen & Eahal, LLP /P-O. Box 11963 TELEPHONE NUMBER _~Harrisburg, PA 17108-1963 717-255-8011 LU Z 1. Real Estate (ScheduleA) (1) 0.0~ 2 Stocks and Bonds (Schedule B) (2) 0.0 0: 3. Closely Held Colworation, Partnership or Sole-Pmpedtorship (3) 0.00 4. Mortgages & Notes Receivable (Schedule D) (4) 0.00 5. Cash, Bank Deposits & MiscalJaneous Personal Property (Schedule E) (5) 0.00 6. J~ Owned Property (Schedule F) (6) 42,546.11~ ~Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0. 00 (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8} 9, Funeral Expenses & Administrative Costs (Schedule H) (9) 3,441.16 I 0. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) _. 2 80 · 3 8 I 1. Total Deductions (total Lines 9 & 10) (11 ) _ 12. Net Value of Eetats (Line 8 minus Line 11) (12) 13. CharitableandGovernmentaIBequests/Sec9113Tmstsferwhichanelectiontotaxhasnatbeen made (Schedule J) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) BEB INSTRUCTIONS ON REVERSE SIDE FOR APP~ ~'z~mLE RATES ~'"~FF~,N- uSE o~[_Y 42,546.11 3,721.54 38,824.57 0.00 38,824.57 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 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 0.00 x.o0 (ts) 0.00 0.00 xo,~s (t6) 0.00 0.00 x.t2 (t7) 0.00 38,824.57 x.t5 (ts) 5,823.69 5,823.69 -- 20 [] ' · ,' ' e ' ' ~ · , · --, (19) · > BE SURE TO ANSWER ALL~o~ ~= c~u~= ANU RECHECK MATH 2W4645 1 000 Decedent's Complete Address: · Coun~ryMeadows 14905 East Trindle Road IMechanicebur~ Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments 0. O0 C. Discount 0.0 0 3. Interest/Penalty if applicable D. Interest 0.00 E. Penalty 0.00 Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) 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 (1) 5. 823.69 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) A. Enter the interest on the tax due. (5) 0.00 0.00 5,823.69 (5A) 0.00 B. Enter the total of Line 5 + 5A. Tnis is the BALANCE DUE. (5B) 5. 823.69 Make Check Pa able to: REGISTEROFWlLL$, 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 properly transferred; ....................... ~ b. retain the right to designate who shall use the property transferred or Es income; ......... r--] c. retain a reversionary interest; or ................................ r--] d. receive the promise for life of either payments, benefits or care? ................. [~] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? [] 4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .............................. [] ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE iT AS PAR~' OF THeE RETURN. ~ Prese~'ti'~'ba~edo~all,nfom~atic~wh,ch~reparerhasa~yknowledge. ,~: /(~ SIGNA~ OF PERSON RESPONSIBLE FOR FILING RETURN ADORESS /.~5 W:t..Lson Lane A~31:: l13U Mechan£csburg, ~A 17055-6764 Walnut ~t~O' Box 11963 Harrisbur PA 17108-1 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. § 9916 (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 usa of the su~,ivin g spouse is 0% [72 P.S. § 9t 16 (a) ( 1.1 ) (ii)] The stet ute.~loes not exam pt a traneter to a su rvivJng spouse from tax, and the statutory reduJmments for disclosure of assets and filing a tax return are still applicab fe even if the surviving spouse is the only bener~ia~J. For dates of death on or after July 1, 2000: The tax rate im posed on the net value of transfers from a deceased child t~mty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a steppamnt of the child is 0% [72 P.S. § 9116(a)(1.2)], The tax rate imposed on the net value of transfem 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 )J, Thetaxrateimposedonthenetvalueof ransferstoorfortheuseofthedecedenrssiblin s s 2% 7 . . . . - 2w4s,~thwdual who has at least one parent in common ~th the deCedent, whether by blood ~rgadoption, ( 2 P S § 9116(a)(1 3)J A s~blmg is defined, under Section 9102, as an SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RE'~JRN F~SID~NT DECEDENT ESTATE OF SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Greene, Myrtle Sister-in-law 1225 Wilson Lane Apt 1138 Mechanicsburg, PA 17055-6764 JOINTLY-OWNED PROPERTY: 1. A )9/06/1998 PNC Bank CD account 26,053.17 50.00 13,026.$8 #31500138?52 Joint with decedent~s sister-in-law, Myrtle E. Greene 2 A 09/06/1998 PNC Bank CD account 26,053.17 50.00 13,026.58 #31900138851 joint with decedent~s sister-in-law, Myrtle E. Greene 3 A 09/06/19~8 PNC Bank CD account 1,877.93 ~0.00 938.97 #31%0013908~ joint with decedent~s sister-in-law, Myrtle E. Greene 4 A 06/09/1997 PNC Bank Checking account 5,058.35 50.00 2,529.18 #5001002182 joint with decedent~s sister-in-law, Myrtle E. Greene 5 A 09/06/1998 PNC Bank Savings account 26,0~9.61 50.00 13,02~.81 #500~404582 joint with Myrtle E. Greene TOTAL(Alsoenteronline6, R~apitulation) $ ~2,546.11 ~eets of same size) NOU-O?-2004 20:46 PNCBRNK 412 ?68 34S8 P.01 PNCBAN( Septemb~23, 2004 Cayle D. Swindler 415 Fallowficld Road, Suite 301 Camp Hill, PA i7011-4906 Estate of Ethel E. Greene, deceased SSN: 013-07-7352 DOD: 2/14/2004 Dear Ms. Swindk~. In respons~ to your request for Date of Death balances for the c~stom~r noted above, our reoords show the following: Certificates of Deposit Account #31500138752 ETHEL E GREENE MYRTLE E GREENE DOD balance: $26,047.50 + $5.67 accrued interest Established 09/06/1998 Account #31900138851 ETHEL E GREENE MYRTLE E GREENE DOD balance; $26,047.50 + $5.67 accrued interest Established 09/06/1998 Account #31400139084 ETHEL E GREENE MYRTLE E GREENE DOD balance: $1,877.52 + $.41 accrued intexcst Established09~06~1998 Checking Account Account #:5001002182 ETHEL E GREENE MYRTLE E OREENE DOD balance: $5,057.89 + $.46 accrued intel~st Established 06/09/1997 Page 1 of 2 NOU-O?-~004 ~0:4~ PNCD~NK Savings Aeeount Account #5004404582 ETI-IF~ E GREENE MYRTLE E GREENE DOD b. la-ce: $26,044.66 + $4.95 accrued interest Established 09/06/1998 Please note that this office only provides date of d~ath bnlances for deposit accounts (IRAs, CDs, Ch~cking and Savings accounts). We do not process any financial transactions or provide statements, If you need assistance with any of these items, please oall I*SSS-PNC_BANK (I-88S-762-2265) or stop by yom local PNC Bank branch office. Smcerel¥, Rachelle Wells 1-800-762-1775 P7-PF$C-04.-F 500 first Aw.. Pittsburgh PA 15219 Page 2 of 2 Member FDIC REV-1511 EX ~- (%97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Greene, Ethel E. FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION FUNERAL EXPENSES: Cremation Society of Pennsylvania 5. 6, 7. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State _ Zip _ Year(s) Commission Paid: Attorney Fees Name.- Keefer Wood Allen & Rahal, LLP Family Exemption: (if decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees State Zip Tax Return Preparer's Fees .~umberland County Register of Wills, filing fee AMOUNT 1,426.16 0.00 2,000.00 0.00 0.00 0.00 0.00 15.00 TOTAL (Aisc enter on line 9, Recapitulation) $__ 3,441.16 2W46AG 2000 (If more space is needed, insert additional sheets of same size) REV-1512 EX + (I-97} SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RE~JRN RESIDENT DECEDENT ESTATE OF Greene, Ethel E. FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBEF Verizon Community Team Life EMS Hospital Services West Shore EMS DESCRIPTION AMOUNT 14.52 80.00 51.00 134.86 TOTAL (Also enter on line 10, Recapitulation) $ 280.38 2W46AH 2000 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER Greene, Ethel E. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DO Not List Trustee(s) OF ESTATE I1. underSec. 9116(a)(1.2)] Greene, Myrtle 1225 Wilson Lane Apt 1138 Mechanicsburg, PA 17055-6764 TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers Sister-in-law 38,824.57 iNTER 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 2W46AI 1.000 TOTAL OF PART Il - 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) 0.0 0 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 REV 1162 EX(11 96) NO. CD 004609 ALLEN HEATH L PO BOX 11963 HARRISBURG, PA 17108-1963 ........ fold ESTATE INFORMATION: SSN: 013-07-7352 FILE NUMBER: 2104- 1019 DECEDENT NAME: GREENE ETHEL E DATE OF PAYMENT: 11/09/2004 POSTMARK DATE: 11/09/2004 COUNTY: CUMBERLAND DATE OF DEATH: 02/1 4/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $5,823.69 TOTAL AMOUNT PAID: $5,823.69 REMARKS: SEAL CHECK# 2807 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS HEATH L. ALLEN N. DAVID RAHAL CHARLES ~ RUBENDALL Tr KEEFER WOOD ALLEN ~ RAHAL, LLP ATTORNEYS AT LAW 41S FALLOWFIELD ROAD, SUITE 301 CAMP HILL, PA 17011-4906 PHONE 717- 61:~-5800 www,keeferwood.com November 9, 2004 HARRISBURG OFFICE: · 10 WALNUT STREET HARRISBURG, PA 17101 PHONE 717-2S5-S000 717-612-5808 cswindler~kee~rwood.com Via: Hand Delivery Cumberland County Register of Wills Cumberland County Courthouse I Courthouse Square Carlisle, PA 17013 Re: Estate Ethel E. Greene SS~ 013-07-7352 Dear SirfMadam: Enclosed herewith for filing please find the following: Pennsylvania Inheritance Tax Return (filed in duplicate;) Check in the amount of $5,823.69 as payment of tax due; Check in the amount of $15.00 in payment of your filing fee. Kindly acknowledge receipt of these documents by time-stamping the enclosed copy of this letter and returning it to our office. Thank you. Sincerely yours, Legal Assistant to Heath L. Allen /cds 62303 Enclosure cc:Myrtle E. Greene BUREAU OF ZNDZVTDUAL TAXES TNHERXTANCE TAX DTVTSTON PO BOX IS0601 HARRISBURG, PA 171Z8-0601 HYRTLE E GREENE lqZ8 RAVEN HILL RD HECHANICSBURG CONNONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAXSEHENT. ALLO#ANCE OR DXSALLO#ANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE ESTATE OF DATE OF DEATH FILE NUNBER COUNTY ACN PA 17055 REV-~.61~8 EX AFP 11-29-200q GREENE ETHEL E o2- lq-~oq. CUHBERLAND 013-07-7552 0~119779 Amoun~ Rmmi~ed I HAKE CHECK PAYADLE AND RENZT PAYNENT TO: REGISTER OF HILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~.~ RETAIN LOHER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAXSENENT, ALLOHANCE OR DZSALLOHANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-Zg-ZO0~ ESTATE OF GREENE ETHEL E DATE OF DEATH 02-1q-ZOOq COUNTY CUMBERLAND FILE NO. S.S/D.C. NO. 013-07-7352 ACN TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED 0q119779 JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 500qqOq58Z TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ( ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 09-06-1998 Account Balance Percent Taxable Amount Subject to Tax Debts and DeductAons Taxable Amount Tax Rate Tax Due TAX CREDTTS: Z6,0q9.61 NOTE: X 0.500 13,02q.81 - .00 13,0Zq.81 X .12 1,562.98 TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE HITH YOUR TAX PAYMENT TO THE REGISTER OF HILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: **REGISTER OF HILLS, AGENT.** PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 1Z-O7-ZOOq AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CRED'rT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDZTTONAL TNTEREST. ( TF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. TF TOTAL DUE ZS REFLECTED AS A "CREDTT" ( CR}., YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTTONS. .00 1,562.98 3.95 1,566.93 PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADNIN- ISTRATXVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, which was not requested on the Tax Return, amy be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS15). Applications are available online at www.revenue.state.na.us, any Register of Hills or Revenue District Office, ar from the Department's Z4-hour answering service for forms orders: 1-800-56Z-ZO50; services for taxpayers with special hearing and/or speaking needs: 1-800-447-50Z0 (TT only). Any party tn interest not satisfied with the appraisment, a11awance ar disallowance of deductions or assessment of tax (including discount or interest) es shown on this Notice amy object within 60 days of the date of receipt of this notice by filing Dna of the following: A} Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at wwm.boardafappsals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals website. You may alsu send a aritten protest to PA Department of Revenue, Board of Appeals P.O. Box Z810Z1, Harrisburg, PA 171ZB-lOZ1. Petitions may not be faxad. B) Election to have the matter determined at the audit of the account of the personal representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revtem Unit, P.O. Box Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-650S. See page S of the booklet "[nstructtons for Inheritance Tax Return for a Resident Decedent' (RE¥-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedant's death, a five percent discount of the tax paid is allowed. The 1SZ tax amnesty non-participation penalty is computed on the toter of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and tn the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning eith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes mhtch became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198'"~ ZOZ .000548 198'~8-1991 11Z .000501 200'~'-~ 9X .OOOZ47 1985 16Z .000458 199Z 92 .000247 ZOOZ 6Z .000164 1984 11Z .000301 1995-1994 72 .00019Z ZOO5 5Z .000157 1985 15Z .000556 1995-1998 9Z .000247 ZOO4 4Z .000110 1986 lex .000Z74 1999 7Z .O0019Z 1987 9Z .000247 ZOO0 8Z .000Z19 --Xnterest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. r:' !:[)i: UC n:l~,;,',_,' ,.....\j CID.>,-I,..,I:-;, \ ,I.! I II I ,. ,. < .,,' .~ ',;. '-_,A MYRnE" . E G~EENE \.f'" , 1428 RAVEN HILL RD MECHANICSBURG PA COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN *' . WllEAU 1II'-,llt\l"j";tJ1UKI;C:~""(!C :"ftHERITANtiCtAWIDlVlISIOW' ,:t::iC ~, PO BOX 2806&1-"-":''"'::: ", :-',". " 1 HARRISBURG t~.xli28~,060'l " REV-UD4 EX AfP [12-04) 'nO" 1'" 11. Pi; 3: 39 LUUJ .....~-,l.~ Y. 17055 01-04-2005 GREENE 02-14-2004 21 04-1019 CUMBERLAND 013-07-7352 04119779 Allount Rellitted ETHEL E 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 ~ ---------------------------------------------------------------------------------------------------------------- REV-1604 EX AFP (01-031 -- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __ DATE 01-04-2005 ESTATE OF GREENE ETHEL E DATE OF DEATH 02-14-2004 COUNTY CUMBERLAND FILE NO. 21 04-1019 ADJUSTMENT BASED ON: S.S/D.C. NO. 013-07-7352 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 04119779 FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 5004404582 TYPE OF ACCOUNT: (X) SAVINGS () CHECKING () TRUST () TIME CERTIFICATE DATE ESTABLISHED 09-06-1998 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.500 .00 .00 .00 .12 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE nn . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAVMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" [CR), VDU MAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~"- REV.1470EX 88) '*' INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENrs NAME ETHEL GREENE FILE NUMBER REVIEWED BY ACN 2104-1019 04119779 SCHEDULE ITEM NO. EXPLANATION OF CHANGES The above referenced ACN has been reduced to zero, as this account was reported on the probate return. PaQe 1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ~C"'\f""r'i'T-, BUREAU OF INDIVIDUAL TAXES Rt~ '\)i~ij-J_,' INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 ,",_-"~,,,! r\':" ! ::-:'\lJ: V'NOTICE OF INHERITANCE TAX r .;:AP~lI;sEMENT, ALLOWANCE OR DISALLOWANCE '" 'OF-DEDUCTIONS AND ASSESSMENT OF TAX Z005 JMl 10 At; 9: 50 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-10-2005 GREENE 02-14-2004 21 04-1019 CUMBERLAND 101 HEATH L ALLEN KEEFER ETAL PO BOX 11963 HBG elml\ OF ORPHPN'S COURT "",..t~Dr:T)! ,\'"T', (,,'/j ~~\~iLLI'I- '."" * REV-1547ElIAFP1l2_04l ETHEL E Allount Re..itted PA 17108 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 4f iiEV =is4'-iiC<iFP--riiFo3Y-r'iiiY"ici-oF-i:N'iiiififAi"-cli-YAX-A-PPR7iisiiiir'ii':--ALi.owANcli-iirf----------- - -- - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GREENE ETHEL E FILE NO. 21 04-1019 ACN 101 DATE 01-10-2005 TAX RETURN WAS: I X I ACCEPTED AS FILED I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. stocks and Bonds (Schedule BJ 3. Closely Held stock/Partnership Interest (Schedule CJ 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. ~ointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (11 121 131 [41 151 161 171 .00 .00 .00 .00 .00 42.546.11 .00 181 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad~. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax R.turn 13. Charitabl./Govern~.ntal Bequestsj Non-elected 9113 Trusts (Schedule 4) 14. Net Value of Estate Subject to Tax 191 (101 3,441.16 280.38 1111 (121 (131 (141 NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ~ ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rat. (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 X C ITS: NOTE: To insure proper credit to your account, su~it the upper portion of this form with your tax paYllent. 42,546.11 3.771 ~4 38,824.57 .00 38,824.57 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = .00 X 045 = .00x12= 38,824.57 X 15 = (191= DATE 11-09-2004 + INTEREST/PEN PAID I-I .00 AMOUNT PAID 5,823.69 NUM8ER CD004609 -01 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 5,823.69 5,823.69 5,823.69 .00 .00 .00 I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU MAY 8E DUE01( A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I