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HomeMy WebLinkAbout02-0306~NNO~k~ALTH O~ PENNSYLVANIA ~EPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RE¥-~K~I5 EX &FP (09-00) W K HULL 2717 LAUREL ST PO BOX 178 GRANTHAM PA 17027 ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE EST. OF DORIS M SWANK S.S. NO. 199-07-0625 DAT~ OF DEATH 12-28-2001 COUNTY CUHBERLAND I FILE NO. 21-~::)~ ACN 02105089 DATE 03-0q-Z00Z TYPE OF ACCOUNT [] SAVZNGS [] CHECKTNG [] TRUST [] CERTIF REHZT PAYHENT AND FORHS TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the Department aith the information listed below uhich has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you acre e joint euner/beneficiary of this account. If you feel this information is incorrect, please obtain aritten correction from the financial institution, attach a copy to this ~orm and return it to the above address. Thls account is taxable in accordance with the Inheritance Tax Lams of the Comaonaealth of Pennsylvania. Questions amy be ansuerea by calling (717) 787-83Z~. COMPLETE PART 1 BELOW ~ x N SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5070091166 Data 08-09-1983 Account Balan¢. ~ll~l~! Establish.d 1,762.q9 Percent Taxable X ~11~0 ~ Amount Sub,act to Tax ~/~d. ~ ~ Tax Rata X ,*0/~~ ~ Potential Tax Due /~ ~ To insure proper credit to your account, too (Z) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of gills, Agent". NOTE: if tax payments ers made ~]thin three (3) months of the decedent's date of death, you amy deduct a 5Z discount of the tax due. Any inheritance tax due ~ill become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of #ills aith tee copies of this notice to obtain CHECK a discount or avoid interest, or you nay check box ONE 7 Wills and an official assessment Pill be issued by the PA Department of Revenue. BLOCK] a. [] The above asset has been or Pill be reported and tax paid aith the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's C. [] The above information is incorrect and/or debts and deductions ~ere paid by you. You must complete PART [] and/or PART [] beloa. Tf you indicate a dlffarent taxjca~, please state your reZationship to decadent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Established PART TAX LINE 2. Account Balance 2 3. Percent Taxable $ ~ fi. Amount SubSect to Tax q $. Debts and Deductions E - 6. Amount Taxable 6 7. Tax Rata 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on L/ne S of Tax Computation) $ Unde.r pe_~rmlties of perjury, Z declare that the facts Z have reported above ara true, correct and comRlete +da"~:he best of my knowledge and belial. HOME ~ WORK ( TAXPAYER-STGNRTU~ - TELEPHONE NURSER /~ATE GENERAL ZNFORHATZON 1. FAZLURE TO RESPOND WZLL RESULT IN AN OFFICIAL TAX ASSESSNENT aith applicable interest based submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedant's date of death. $. A joint account is taxable even though the decedent's name Nas added as a Batter of convenience. 4. Accounts (including those held beteeen husband and #ifa) ~hich the decedent put in joint names eithin one ye~" death ara fully taxable as transfers. 5. Accounts established jointly bat#aah husband and aife mare than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or ethers are taxable fully. REPORTZNG [NSTRUCTZONS - PART I - TAXPAYER RESPONSE BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, in block "A" o~ Pert 1 a; the "Taxpayer Response" section. Sign t~o capias and submit thee Nith your chec~ tax to the Register of Hills of the county indicated. The PA Department of Revenue will issue an officio! (Fora REV-1548 EX) upon receipt of the return from the Register o~ Z. BLOCK B - If the asset specified on this notice has been or ~ill ba reported and tax paid ~ith the Pennsylvania Tax Return filed by the decedent's representative, place an "X" in block "B" ef Part I of the "Taxpayer R~sponse' copy and return to the PA Department of Revenue, Bureau o; [ndividuaL Taxes, Dept ZBO6OL, Harrisburg, PA envelope provided. BLOCK C - I; the notice information is incorrect and/or deductions are being claiaad~ check block "C" and according to the instructions belo~. Sign tee copies and submit them Nith your check for the amount of tax of Hills of the county indicated. The PA Department of Revenue mill issue an official assessment (Form REV-~3~8 o; the return from the Register of Hills. TAX RETURN - PART 2 - TAX COHPUTATZON LINE 1. Enter the date the account originally Nas established or titled in the manner existing at data of death. NOTE: For a decedent dying after L2/1Z/BZ: Accounts ~hlch the decedent put in joint names aithln one (lJ taxable fully as transfers. He,ever, there is an exclusion not to exceed SS,BOO par transferee the account ar the number o{ accounts held. If a double asterisk (~} appears before your first name in the address portion of this notice~ the already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 5. The percent o~ the account that is taxable far each survivor is determined as folloas: A. The percent taxable for joint assets established aero than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 = PERCENT TAXABLE JOINT OHNERS SURVIVING JOINT OHNERS Example: A joint asset registered in the name of the decedent and t~e other persons. L DIVIDED BY $ (JOINT ONNERS) DIVIDED BY Z (SURVIVORS) = .L67 X 100 16.7Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created ~ithin one year of the decedent's death or accounts o~nad by the in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUNBER OF SURV/VING JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEF/CIAR[ES Example: Joint account registered in the name o~ the decedent and tee other persons and established the decedent. I DIVIDED BY Z (SURVIVORS) = .50 X LOO = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent 5. Enter the total of the debts and deductions listed in Part 5. 6. The asount taxable (line 6) is determined by subtracting the debts and deductions (Line 5) free the amount 7. Enter the appropriate tax rata (Line 7) as determined bsloe. Date of Death Spouse Lineal S/bl/ng Colla~er;~ 07/01/9q to 12/$1/9fi 3Z 6X 01/01/95 ~o 06/30/00 OZ 6Z 07/01/00 to present OZ 4.$Zx 12Z 15Z aThe tax rate imposed on the nat value of transfers from a dec t~enty-one years death to CF far the use of a natural parent, an adoptive parent, er a stepparent of the child The lineal class of hairs includes grandparents~ parsnts~ childran~ and lineal descendents. "Children" includes ~hether or not they have bean adopted by o~ers~ adopted children and step children. "Lineal descendents" includ~ neural parents and ~eir descendents, ~he~er or not ~ey have been adopted by others, adopted descendents and and step-descend~ts. "S~bli~s" are defined as ~ndiv~duals Nho have at least one parent in common Nith the or adoption. The "Collateral" class of heirs includes all other baneficJarJes. CLAZHED DEDUCT[OHS - PART 5 - DE~TS AND DEDUCTZONS CLA[HE~ A11o~able debts and deduct[OhS are determined as follo~s: A. You Legally are responslble for pay;~t, or ~e estate subject to adlJnlstratJon by a personal representative to pay the deductible B. You ac~ally paid ~e debts after death of ~e decedent and can furnJsh proof of payment. C. Debts being claJ;ed must be itemized fully in Part ~. [f addJt/onal space Js needed, use plain paper payment may be requested by the PA Depar~ant a~ Revenue. CDH~ONI~EALTH O~ PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. ZB060Z HARRISBURg, PA 1712B-0601 REV-I545 EX AFP (09-00) N K HULL 2717 LAUREL ST PO BOX 178 SRANTHAH PA 17027 ZNFORHATZON NOTICE AND TAXPAYER RESPONSE I FILE NO. 21 ACN 02105087 DATE 05-04-2002 TYPE OF ACCOUNT EST. OF DORIS H SNANK [] SAVINGS S.S. NO. 199-07-0625 [] CHECKING DATR OF DEATH 12-28-2001 [] TRUST COUNTY CUHBERLAND [] CERTIF. RENTT PAYHENT AND FORNS TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided the Department uith tho information listed boloa mhich has been used in calculating the potmntial tax duo. Their records lndicata that at the death of tho above decedent, you were a joint owner/beneficiary of this account. Zf you Fool this information is incorrect, please obtain written correction from tho 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. Questions Bay be answered by calling (717) 787-85Z7. COHPLETE PART 1 BRIO# # x # SEE REVERSE SIDE FOR FILING AND PAYHENT INSTRUCTIONS Account No. 5030124082 Accoun* Balance ~)'~/~' Percent Taxable Aeount Subject to Tax Tax Rate Potential Tax Due Date 11-18-1985 Established 13,559.24 x .cV_F"' ~ To /nsure proper credit to Your account; two (Z) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: IF tax paysents ara made within three (3) months of the decodont's data of death, you Bay deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. [] Tho above information and tax due is correct. 1. You may choose to remit payment to the Register of NilZs with two copies of this notice to obtain  CHECK -~ a discount or avoid interest, or you may check box "A" and return this notice to the Register of ONE ,ills and an official assessment will be issued by the PA Department of Revenue. BLOCK J s. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's r~a~,~vt~e..5'~1/~'~/~/*~ ~g?~/~' ~J~/~ C. [] The above information is incorrect and/or debts and deductions were pald by you. You must complete PART [] and/or PART [] below. Tf you indicate a different ~/~to; please state your relationship to decadent: RETURN - COHPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Established I PART TAX LINE 2. Account Balance 2 3. Percent Taxable $ ~ q. Amount SubSect to Tax 4 5. Debts and Deductions $ - 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Duo 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAZHEa PAYEE DESCRIPTION AHOUNT PAID I TOTAL (Enter on Line $ of Tax Computation) Under ponal~e~ of perSury, I declare that tho facts I have reported above are true, correct and ce.plate/.//~../~--~/t° ~bes* of my knowledge and belief. HOHE C 7/7 ) 7~- ~/ TA TELEPHONE NUHBER DATE Zg~ X~ xZg'~ ZO ~ueseJd o~ 00/~0/£0 XE! Zg! X9 XO 00/0£/90 o~ g6/~O/~O 3SNOdS3a &3AVdXVl - T l~Vd - SNOII3n~ISNI 8NIlaOd3~ -;ttr~ etqexe.1, aJe SJBLR-O JO Jeq~oUe .JO) ~SnJ~ U;. tuepeoep e ;q pTeU s~unooov '9 · etqexe~ ~ou eJe t~eep o~ Jo[Jd JeO; euo ueq~ eJOm o~;a pue pueqsnq ueea%eq ;T~u~a[ peqs;Tqe~se s~unooo¥ 'S o~ ao!Jd aee~ euo u;q~!, s.mBu ~u!o; u! ~nd ~uepeoep eq~ No!q- (e~;. puc pueqsnq ueem~.eq p;s~ esoN~ BuspnTuu~) stunoooy -~ · eoue;uehuo= ~o Je%~em ~ se peppe se, e.eu s.~uepe=ep eLR q6noq~ UeAe eTqexe~ s~ ~unoooe ~u!o~ V '~ · q~eep ~o e~ep s.~uepeoep .LR de~e sq~.uom eu~u %uenbu;Tmp seiooeq xet eoue~$dequ! 'Z · uo!~n~su; Te$oueu;~ e~p, ;q pe~$.qns uo$~em~o~u$ uo peseq ~se~e~u~ eTqeo;~dde ~;, ~N;H$$;SSY XY~ qYZ~ZddO NY N! ~qRS~a qlZH ONOd$~a O~ ~a~qZYd '! NOI.lVW~JOdNI ]Va3N39 COHHONR~ALTH ~F PENNSYLVANIA , DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z8060! HARRISBURG~ PA 171Z8-0601 ZNFORMATZON NOTZCE AND TAXPAYER RESPONSE FZLE NO. 21 ACN 02105088 DATE 05-04-200Z JUDY G HULL 2717 LAUREL ST PO BOX 178 GRANTHAN PA 17027 TYPE OF ACCOUNT EST. OF DORIS N SHANK [] SAVTNGS S.S. NO. 199-07-0625 [] CHECKTNG DATE: OF DEATH 12-28-2001 [] TRUST COUNTY CUHBERLAND [] CERTTF. · RENTT PAYHENT AND FORHS TO: REGISTER OF NTLLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 PNC BANK has provided the Department ,iththa information [istad bale..hich has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you .ars a joint aNnar/beneficiary of this account. If you fee! this information is incorrect, please obtain .rittan correction from the fJnancia! institution, attach a copy to this form and return it to the above address. This account is taxable in accordance ,1th the Znheritance Tax La.s of the Coamon.aalth of Pennsylvania. Questions may ba answered by ceiling (717) 787-85Z7. COHPLETE PART I mELON x x . SEE REVERSE SZDE FOR FZLZNG AND PAYNENT ZNSTRUCTZONS Accoun~ No. 5070091166 Accoun*Balanc. ~1'~1~ Percen~ Taxable Amoun~ Subjec~ ~o Tax Tax Ra*e Po~en~Aal Tax Due Date 08-09-198~ Established 1,76Z.49 To insure proper credit to your account, tuo (Z) copies o~ this notice must accompany your payment to the Register of #ills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments ara made .ithin three (3) months of the decadsnt's date of death, you may deduct a SZ discount of the tax due. Any inheritance tax due ell1 become delinquent nine (9) months after the date o~ death. PART TAX PART TAXPAYER RESPONSE I. ~The above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills .ith tho copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of  ONE ~ Hills and an official assessment Hill be issued by the PA Department of Revenue. BLOCK J B. ~Ths above asset has been or .il1 be reported and tax paid ,ith the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's ~. ~'~V)~u/~ ~/~,~ ~/~, C. liThe above information is incorrect and/or debts and deductions Nero paid by you. You must complete PART ~ and/or PART ~belo.. Zf you indicate a differen~ ~ax ra~e, please s~a~e your reZa~onsh~p ~o deceden~: RETURN - COHPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS 1. Oa~e Established 2. Accoun~ BaZance 2 3. Percen~ Taxable 3 ~ ~. Amoun~ Subjec~ ~o Tax fi $. Debts and Deductions $ - 6. Amoun~ Taxable 6 7. Tax Ra~o 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAZHE]) PAYEE DESCRIPTION ANOUNT PATD TOYAL (Eh*er on Line $ of Tax Computation) Under penalties of perjury, Z declare ~ha~ ~he fec~s *r have reported above are *rue, correc~ and TA~PAYER-~IGNATURE TELEPHONE NUHBER GENERAL ZNFORMATION 1. FAILURE TO RESPOND NILL RESULT IN AN OFF/C/AL TAX ASSESSHENT aith applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacedant's date of death. $. A joint account is taxable even though the decadent's name ams added as a matter of convenience. 4. Accounts (including those held bet. eon husband end mile) ahich the decedent put in joint names .ithin one year prior to death are fully taxable as transfers. S. Accounts established jointly batuaan husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable ~ully. REPORTING INSTRUCTIONS - PART ! - TAXPAYER RESPONSE 1. 5LOCK A - If the information and computation in the notice ara correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign too copies and submit them with your check for the amount of tax to the Register of Mills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of WiI1s. Z. BLOCK B - [f the asset specified on this notice has been or mill be reported and tax paid aith the Pennsylvania Inheritance Tax Return filed by the dacsdant's representative, place an "X" in block "D" of Part 1 o~ ~e "Taxpayer Response" section. S~gn one copy and return to the PA Department o~ Revenue, Bureau o~ individual Taxes, Dept ZeG601~ Harr[sburg, PA 171Z8-0601 in the envelope provided. 5. BLOCK C - [f th. notice in,or.at(on is incorrect and/or deductions are being claJmed, check block "C" and complete Parts according to the instructions bela.. S~gn t.o copies and submit the. ,[~ your check ~or ~e amount of ~x payable to ~e Rag[star o~ H~lls o~ ~a coun~ ~nd[cated. The PA Department o~ Revenue ,~11 issue an o~[c[al assessment (Form REV-15~8 EX) upon rece~pt 0~ the return fro. the Register of TAX RETURN - PART 2 - TAX COHPUTAT[ON LZNE 1. Enter ~e date the account originally .as established or titled in the manner existing at date o~ death. NOTE: For a decadent dying a~ter l~lZ/eZ: Accounts .h~ch the decedent put Jn joint names .~th[n one [1) yaa~ o~ death ara tax~le ~ully as transfers. Ho.ever, there is an exclusion not to exceed $5,000 par transferee regardless o~ the value the account or ~e numb8~ o~ acco~ts held. [~ a double asterisk (~") appears be~ore your ~irst name in the address part Jan of this notice, the S~ODO exclusion already has been deducted ~ro. ~e account balance as repo~ted by the ~inanc[al institution. Z. Enter ~e total balance o~ the account [nclud~ng [armrest accrued to the date o~ death, The parc~t o~ the account that is t~abte ~or each surv~vo~ is determined as ~110~s: A. The percent taxable ~or joint assets establlshed more than one year pr[or to the decedant's death: I DZVZDED BY TOTAL NUNBER OF DZVZDED BY TOTAL NUMBER OF X 100 ~ PERCENT TAXABLE JOINT O~NERS SURVIVZNG JOZNT OHNERS Example: A joint asset registered in ~e name o~ ~e decedent and t.o o~er per,ns. ~ D[VZDED BY ~ (JOINT OHNERS) DIVIDED BY Z [SURVZVORS)- .167 X ~00 = 16.7Z (TAXABLE FOR EACH SURVZVOR) B.The percent ~xabLe ~o~ assets created .(thin one year o~ ~e decedent's death or accounts o.ned by ~e decedent but held in tmst ~or ano~er ~nd[v~dual(s) (trust beneficiaries): ~ DZV[DED BY TOTAL NUMBER OF SURViViNG JOINT X 100 = PERCENT TAXABLE OHNERS OR TRUST BENEFICIARIES Example:Joint account registered ~n the name o~ the decadent and t.o o~er persons and established .Jthin one year ~ decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50Z (TAXABLE FOR EACH SURVZVOR) The amount subject to tax (llne q) is deter. Jned by multiplying ~e account balance (l[ne Z) by the percent ~xable [l[ne 5. Enter ~. total o{ the debts and deductions listed in Pa~t 5. 6. The .ount taxable [line 6) [s determined by ~btracting the debts and deductions (line 5) ~ro. ~e amount subject to ~x (L~ne 7. Enter ~e appropr[ate ~x rata (line 7) as determ[ned bela.. Da~e of Death Spouse L/naa1 S/blAh9 Collateral 07/01/9q ~o 12/31/9q 01/01/95 ~o 06/$0/00 OZ 6Z 07/01/00 ~o presen~ OZ q.BZ~ 12Z I~Z ~The tax rata imposed on thi net value of transfers deceased V y younger at death to or for the usa of a natural parant~ an adoptive parant~ or a stapparsnt of the child is The lineal class of hairs includes grandparants~ parsnts~ childrsn~ and lineal descendants. "Children" includes natural children ahathar or not they have been adopted by ~ers~ adopted children and stap children. "Lineal descendents~ ~ncludes all children o~ the natural parents and ~ei~ da~endants~ ~ha~ar or not ~ey have bean adopted by othars~ adopted de.endears and ~eir de~ndants and stap-descendants. "Siblings" a~e deC,ned as individuals ~ho have at least one parent ~n common ~[th the decedant~ ~hethe~ by blood or adopt(ne. The "Collateral" class o~ he~s ~ncludes al1 otha~ beneficiaries. CLAIMED DEDUCTIONS - PART 5 - DE~TS AND DEDUCTIONS CLAIMED Allo~able debts and deducttons are detera[ned as ~ollo~s: A. You legally are responsible ~or payaent~ or ~e estate subject to administration by a personal representative is inefficient to pay the deductible B. You at,ally paid ~e debts a~ter death o~ the decedent and can ~sh proo~ o~ payeent. C. Debts beJng claimed must be item~zed fully in Part 5. 1~ additional space pa~m~t may be requested by ~e PA Oepar~ent o~ Revenue. · :3HH~Nk~ALTH OF PENNSYbVANZA DEPARTHENT OF REVENUE · BUREAU OF ZNDIV/DUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-I$~S EX AFP ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE JUDY G HULL. 2717 LAUREL ST PO BOX 178 GRANTHAM PA 17027 I FZLE NO. 21 ACN 02105086 DATE 05-0~-2002 TYPE OF ACCOUNT EST. OF DORIS M SWANK [] SAVINGS S.S. NO. 199-07-0625 [] CHECKZNG DATE OF DEATH 12-28-2001 [] TRUST COUNTY CUMBERLAND [] CERTIF. REMTT PAYMENT AND FORMS TO: REGTSTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PNC BANK has provided the Department with the information listed below which has been used tn calculating the potential tax due. Their records indicate that at the death of the above decedent, you ware a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain aritten correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the ~nheritance Tax Laws o~ the Commonwealth of Pennsylvania. guestions may be answered by calling [717) 787-85Z7. COMPLETE PART I BELOW ~ ~ ~ SEE REVERSE SIDE FOR FZLZNG AND PAYMENT ZNSTRUCTZONS Date 11-18-1985 Established 15,559.2~ Account No. 505012q082 To insure proper credit to your account, two ~/~ (Z) copies of this notice must accompany your Account Balance :~ payment to the Register of Nills. Make check payable to: "Registar o~ Hills, Agent~. Percent Taxable Aeoun~ SubSact to Tax NOTE: Tf tax payments are made within three (5) months of the decadent's data of death, Tax Rata you may deduct a 5;: discount of the tax due. Any inheritance tax due #~11 become delinquent Potential Tax Duo /~x~,J~ '-~ nine (9) months after the date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LINE A. ~ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Hills and an official assessment ~ill be issued by the PA Department of Revenue. B. [] The above asset has been or will be reported and tax paid aith the Pennsylvania Inheritance Tax return to be ~iled by the decedant's r~f~em=em~a~.t=~. ~,~}~/~}~ ~/'~/A/~ 0~.4/,~,.5'. C. [] The above information is incorrect and/or debts and deductions oars paid by you. You must complete PART F~ and/or PART ~ below. If you indicate a different ~ax ra~a~ please state your relationship to decadent: RETURN - COMPUTATZON OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 $ 6 7. 8. Data Established 1 Account Balance 2 Percent Taxable 3 ~ Amount Sub~ect to Tax q Debts and Deductions ~ - Amount Taxable 6 Tax Rata 7 ~ Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAZMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line S of Tax Computation) Under penalties of perSury, Z declare that the facts Z have reported above ara true, correct and ~ata to tha~ast of~y knowledge and belief. HOME ( TELEPHONE NUMBER ~ DATE T~ ~[GNATURE ' GENERAL INFORMATION 1. FA/LURE TO RESPOND N/LL RESULT IN AN OFF/C/AL TAX ASSESSHENT .ith applicable interest basedon information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decadent's date of doeth. 3. A joint account is taxable even though the decmdent's name ems added as a matter of convenience. 4. Accounts (including those held batmeen husband and milo) #hich the decedent put in joint names aithin one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and milo more than one year prior to death arm not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable ~ully. REPORTING [NSTRUCT[ONS- PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation [n the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit thee with your check for the amount of tax to the Register of Wills of ~a coun~ indicated. The PA Depart;ant o~ Revenue a111 issue an o;~icial assessment (Form REV-lSd8 EX) upon receipt o~ the return from the Register o~ Hills. Z. BLOCK B - I~ the asset specified on ~is notice has been or ~ill be reported and tax paid ~ith the Pennsylvania lnhori~nce Tax Re~rn ~11ad by ~a decedent's repre~ntative~ place an "X" in block "B" o~ Part I o~ the "Taxpayer Re~onse" section. Sign one copy and return to the PA Department o~ Revenue, Bureau o~ /ndividual Taxes~ Oept Z80601, Har~isbur9~ PA 171Z8-0601 in the envelope provided. 5. BLOCK C - [f the notice in~omation is incorrect and/or deductions are being claimed~ check block "C" and complete Parts according to the instructions below. Sign t~o copies ~d ~beit thee ~1~ your check Tot ~e amount o~ ~x payable to the Register o~ Hills o~ ~e county indicated. The PA Depar~ent o~ Revenue ~i11 issue an o~cJal assos~ent (Form REV-15~& EX) upon receipt o~ the return ~roe the Register o~ Hills. TAX RETURN - PART 2 - TAX COHPUTAT[ON L/NE 1. Enter ~a date the account originally ~as established or titled in the manner existing at date of death. NOTE: For a decoder dying a~ter 1Z/1Z/eZ: Accounts ~hich the decedent put in jo/or names ~ithin one (1) year o~ death are taxable ~ully as transfers. Ho~ever~ there is an exclusion not to exceed $~000 per transferee regardless o~ the value the account or ~e number o~ acco~ts held. [~ a double asterisk (ex) appears before your ~irst name in ~a address portion o~ ~[s notlce~ the S~,000 exclusion already has been deducted ~roe the account balance as reported by the ~nancial [nsti~tion. Enter ~e to~l balance o~ the account including interest accrued to the date o~ death. The percent of the account that is taxable ~or each survivor is determined as ~ollo~s: A. The percent ~xable ~or joint assets established nora ~an one year prior to the dacedent's death: I DIVIDED BY TOTAL NUHBER OF D/V[DED BY TOTAL NUHBER OF X 100 = PERCENT TAXABLE JOINT OHNERS SURVIVING JOINT OHNERS Example: A joint asset registered in the name of ~e decedent and t~o o~e~ persons. I DZV[DED BY ~ (JOINT OHN~S) DIVIDED BY Z (SURVIVORS) - .167 X 100 - 16.7X (TAXABLE FOR EACH SURV[VOR) B.The percent taxable ~or assets created ~[thin one year o~ ~e decadent's dea~ or accounts o~ned by ~e decadent but held in trust for ano~er individual(s) (trust bene~ciaries): 1 D[VIDED BY TOTAL NUHBER OF SURV[V[NG JOINT X 100 = PERCENT TAXABLE OHNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name o~ the decedent and t~o o~er persons and established HithJn one year o~ death by the decedent. I DIVIDED BY Z (SURVIVORS) ~ .50 X 100 = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to ~x (line ~) is determined by multiplying ~e account balance (line Z) by ~e percent ~xabZe (line 5. Enter ~a to~l o~ the debts and deductions listed in Part 5. 6. ~e amount tax~le (line 6) is determined by subtracting the debts and deductions (line 5) ~rom ~e amount subject to ~x (line 7. ~ter ~e appropriate ~x rate (line 7) as determined belo~. Da~e of Death Spouse I L/nme1 S/blin9 Collateral 07/01/9q *~o 12/51/9q 5Z 6X 15X 15X 01/01/95 ~o 06/50/00 OX 6Z 07/01/00 ~o presen~ OX ~.5Xx 12X eThe tax rata imposed on th~ net value of transfers from a deceas :y-one years mgm younger at death to or for the uso of a natural parent, an adoptive parent, or a stepparent of the child is OX. Tho lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children ehether or not they have been adopted by others, adopted children and stap children. "Lineal descendents" includes all children of the natural parents end their descendents, ahather or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" arm defined es individuals who have et least one parent in common with the decadent, whether by blood or adopt[on. The "Collateral" class of heirs includes ali other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCT[OHS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to admin[straticn by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death cf the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper S l/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. 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 O01004 SUNDAY WILLIAM L 39 W MAIN STREET MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 199-07-0625 FILE NUMBER: 2102-0306 DECEDENT NAME: SWANK DORIS M DATE OF PAYMENT: 03/26/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/28/2001 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $6,412.50 REMARKS: TOTAL AMOUNT PAID: WILLIAM L SUNDAY ESQUIRE $6,412.50 SEAL CHECK#0150 INITIALS: JA RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS REV. 1500 EX COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 ~HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ,~ 8. IJJ 9. 10. 11. 12. 13. 14. DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Swank Doris A a/k/a Doris M DATE OF DEATH (MM-DD-YEAR) t DATE OF BIRTH (MM-DD-YEAR) I December 28, 2001 April 13, 1918 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A FILE NUMBER COUNTY CODE YEAR OFFICIAL USE ONLY SOCIAL SECURITY NUMBER 199 - 07 NUMBER [~'~ 1. Odginal Return E~4. Limited Estate r-~'] 6. Decedent Died Testate (Attach copy of Will) [~9. Litigation Proceeds Received "-]2. Supplemental Return E~4a. Future Interest Compromise (date of death after 12-12-82) r-'-~ 7. Decedent Maintained a Living Trust (A~ch copyof Trust) [~10. Spousal Poverty Credit (date of death between t2-31-91 and 1-1-95) - 0625' THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER r----~ 3. Remainder Return (date of death prior ~o 12-13-82) [~5. Federal Estate Tax Return Required _~O 8. Total Number of Safe Deposit Boxes ~'-~ 11. Election to tax under Sec. 9113(A) (A~tach Sch O) i .3['HIS :SEC.'I'~I~,~J. JST'BEiiCOMPLEi ~u?ALL~'~ORRESP. ONDENCE ~D~C~.NFIDE .N'II.I.I.I.I.I.I.~L~,.~. JN F~OaMA~TIO~HOUL'D~!E::DiREC~D~O::~ .N.~rv~E, . w~-~zam L Sunday 39 West Main Street FIRM NAME (IfAppli~Dle} I Mechanicsburg, PA 17055-6230 TELEPHONE NUMBER (717) 766-9622 Real Estate (Schedule A) (1) Stocks and Bonds (Sched. ule B) (2) Closely Held Corporation, Partnership or Sole-Proprietorship (3) Mortgages & Notes Receivable (Schedule D) (4) Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) Jointly Owned Property (Schedule F) (6) [~ Separale Billing Requested Inter-Vivos Transfers & Miscellaneous Non-Probate Prope~ (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11) 1095.15 2629.05 251714.83 6808.43 17111.86 5585.68 (8) (11) (12) ~FFiCIAL USE ONLY 262247.46 22697.54 239549.92 0 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (13) (14) 239549.92 X 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) 16. Amount of Line 14 taxable at lineal rate 239549.92 x .0 45 (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) 10779.75 10779.75 Deceddnt's Complete Address: STREET ADDRESS Green Ridge Village 210 Big Spring Road ISTATE PA ZIP17241 CITY Newvi lle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty 6412.50 337.50 Total Credits ( A + B + C ) Total Interest/Penalty ( D + E ) 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) 10779.75 (2) 6750.00 (3) O (4) 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. (5) 4029.75 (5A) 0 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 4029.75 Make Check Payab/e to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PI,.AC!N.G A.N "X" IN THE APPROPRIATE BLOCKS *Except as an znczQen~: 1. Did decedent make a transfer and: of Joint Ownership Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] * b. retain the fight 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? ...................................................................... [] [] If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ..............[] [] 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,.,J,,dectare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer,pitier than the personal representative is based on all information of which preparer has any knowledge· 2717 Laurel Driver .Cranthamt PA 17027 SIGNATUR,_~E~OF ./B~cPARER OT~ER TJ~N REPRESENTATIVE DATE ADDRESS / 39 West Main Street, Mechanicsburq~ PA 17055-6230 For dates of death on or after July 1, 1994 and before January 1, 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even 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 RS. §9116(1.2) [72 RS: §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use 0f'th~ 'd~Cedent's siblin~s is' 12% [72 P.S.::§gi16(a)(1.3)]. A, Sibling is defined, 6nder'Section 9102 as an individual who has at least one parent in COmmon with the decedent, whethe~'by"j~lood or adoption. : REV.1503 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Doris A Swank a/k/a Doris M. Swank SCHEDULE B STOCKS & BONDS FILE NUMBER 21-02-0306 All property jointly.owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. 35 shs MetLife received in Demutualization @ 31.29 TOTAL (Also enter on line 2, Recapitulatior (If more space is needed, insert additional sheets of the same size) $1095.15 VALUE AT DATE OF DEATH $ 1095.15 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Doris A. Swank a/k/a Doris M. Swank SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-02-0306 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshi ~ must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Checks' received prior to death from AmeriHealth Administrators deposited in Joint Checking Account #50-7009-1166 (Item 1 Schedule F) on Decemer 31, 2001 for the following: Prescription Drugs - 8/13/01 Prescription Drugs - 8/13/01 Prescripton Drugs - 8/13,14,20 and 30/01 Prescription Drugs - 9/12/01 Prescription Drugs - 9/12/01 Prescription Drugs - 9/12,19,24 and 29/01 Prescription Drugs - 10/1, 4 and 12/01 Prescription Drugs - 10/12/01 Prescription Drugs - 10/12 and 29/01 Prescription Drugs - 8/10 and 13/01 Prescription Drugs - 8/30, 9/10 and 12/01 Doctors Fee - 10/4/01 Total Checks Deposited 12/31/01 $255.47 61.36 63.02 164.90 70.65 58.11 201.30 61.96 239.90 122.11 291.70 6.43 Checks received after death from AmeriHeaalth Administrators deposited in Joint Account #50-7009-1166 (Item 1 Schedule F) on Jan 28, 2002 and February 4, 2002 respectively Checks received after death from AmeriHealth Administrators deposited in Joint Account #50-7009-1166 (Item 1 Schedule F) cn March 14, 2002. 2/11/02 Lab (Swan Health Care) and Office/Clinic 2/19/02 2/19/02 2/19/02 2/19/02 2/19/02 2/19/01 2/19/02 (Townsend) 29.67 Prescription Drugs- 11/2, 9 and 11/01 147.46 Prescription Drugs - 11/11/01 115.81 Prescription Drugs - 11/11/01 262.49 Prescription Drugs - 11/26,12/6&10/01 128.26 PrescrIption Drugs - 12/11/01 22.01 Prescription Drugs - 12/11 nd 26/01 91.17 Prescri )tion Drugs - 12/26 and 27/01 187.68 Total Reimbursement Deposited 3/14/02 984.55 TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) 1596.91 41.16 6.43 984.55 $ 2629.05 COMMONWEALTH OF PENNS5 LVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Doris A. Swank a/k/a SCHEDULE F JOINTLY-OWNED PROPERTY Doris M. Swank FILE NUMBER 21-02-0306 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 W. Kenneth Hull Judy G. Hull, a/k/a Judith G. Hull ADDRESS 2717 Laurel Drive Grantham, PA 17027 2717 Laurel Drive Grantham, PA 17027 RELATIONSHIP TO DECEDENT Son Daughter-in-law JOINTLY-OWNED PROPERTY: LE~ER DATE DESCRIPTION OF PROPER~ % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of flnanciat ins~on and bank ~count numar or similar iden~ing numar, A~h DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed ~r join~y-hetd mai estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES' 1. A. 10/3/84 Joint Checking Account #50 7009 1166 in and PNC Bank, N.A. established as a Joint B Account with right of survivorship on :October 3, 1984 in names of Doris M. Swank, Judy G. Hull or W. Kenneth Hull 1762.49 50% 881.25 A W. Kenneth Hull 25% $440.63 B Judy G. Hull 25% 440.62 TOTAL $881.25 2. A Prior Joint Money Market (Savings Account) #50 and to 3012 4082 in PNC Bank N.A. established B 6/8/0( as a Joint Account with right of survivorship prior to June 8, 2000 in names of Doris M. Swank, Judith G. Hull or W. Kenneth Hull Principal $13555.31 Accrued Interest 3.93 13559.24 50% 6779.62 A W. Kenneth Hull 25% 3389.81 B. Judith G. Hull 25% 3389.81 TOTAL $6779.62 CARRIED FORWARD 15321.73 TOTAL~e~R~~n) $ 7660.87 (If more space is needed, insert additional sheets of the same size) REV-t~Og EX · (1~17) ~ COMMONWEALTH OF PENNS'~ ~.VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Doris M. Swank 21-O2-0306 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. W. Kenneth Hull Son Judy G. Hull, a/k/a Judith G. Hull 2717 Laurel Drive Grantham, PA 17027 2717 Laurel Drive Grantham, PA 17027 Daughter-in-law JOINTLY-OWNED PROPERTY: LE~ER DATE DESCRIPTION OF PROPER~ % OF DATE OF D~TH ITEM FOR JOINT ~DE Include name of financial institution ~d bank ~count numar or similar Jdenti~ing numar. AU~h DATE OF D~TH DECD'S VALUE OF NUMBER TENANT JOINT deed ~r jointly-held mai es~te. VALUE OF ASSET INTEREST DECEDENT'S INTERES 3 A. .~?.,/'1_4/9~, BI~EC~ 15321.73 7660.87 and Joint Brokerage Account #77692340 in B Janney Montgomery Scott opened on December 14, 1995 as a Joint Account (right of survivorship) in names of Doris M. Swank, W. Kenneth Hull and Judith G. Hull. 4400 shs General Electric @ $40.77 179388.00 600 shs Storage USA Inc @ 42.125 25275.00 700 shs Sun Communities @ 37.36 26152.00 2000 shs Town & Country Tr @ 21.625 43250.00 * 9300 shs General Electric - Margin Account * @ 40.77 379161.00 TOTAL MARKET VALUE 653226.00 Less: *Margin Account Balance* (169946.41)* Market Value less Margin Balance 483279.59 Plus: Money Market Fund Balance 4828.32 TOTAL ACCOUNT VALUE 48810.7.91 50% 244053.96 A 12/14/9f_' W. Kenneth Hull, 25% $122026.98 B ~/14/95 Judith G. Hull, 25% 122026.98 $244053.96 503429.64 TOTAL(Alsoenteronline6, R~apitulation) $ 251714.83 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Doris M. Swank SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-02-0306 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 % OF ITEM ~NCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER ArrAC~ A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF.APPLICABLE) 1. IRA #65001005651 in name of Doris M. Swank in PNC Bank, N.A. payable to W. Kenneth Hull and Judith G. Hull, son and daughter-in-law respect ively, as named beneficiaries as tenants by entireties Principal 6799.24 100% 6799.24 Accrued Interest 9.19 100% 9.19 TOTAL (Also enter on line 7, Recapitulation) $ 6808.43 (If more space is needed, insert additional sheets of the same size) REV-1'511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Doris A. Swank a/k/a Doris M. Swank 21-02-0306 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION / AMOUNT A. 1. e 5. 6. 7. FUNERAL EXPENSES: Malpezzi Funeral Home - _Funeral Expense (Paid 1/23/02 by Check #4929 issued on Joint Checking Account #50-7009-1166 (Item 1Sch $)). Conestoga Memorial Park - Memorial - (Paid 1/14/02 by credit card of W. Kenneth Hull and Judith G. Hull, two of Joint Owners of Joint Checking Account #50-7009-1166 (Item 1Sch F)). Willow Valley Restaurant - Funeral Meal (Paid 1/2/02 by credit card of W. Kenneth Hull and Judith G. Hull, two of Joint Owners ~~l~~..g Account #50-7009-1166 (Item 1 Sch F)). Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s1 Street Address City State __ Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees (350.00 + 1250.OO) Register of Wills - Filing PA INH Tax Return __ Zip TOTAL (Aisc enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 8648.00 1420.00 208.86 5220.00 1600.00 15.00 $ 17111.86 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Doris A. Swank a/k/a Doris M. Swank 21-O2-O306 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 2. 3. 4. 5. 6. 7. 8. The following Items 1 thru 8 were paid from the Joint Checking Account #50-7009-1166 (Item 1 Sch F) DATE CHECK PAID NO. 1/7/02 4923 1/22/02 4924 1/22/02 4925 1/23/02 4926 1/23/02 4927 1/23/02 4928 1/23/02 4930 1/23/02 4931 PAYEE The Sentinel - Final Bill Newville Comm Ambulance - Ambulance Paul J. Creeden, D.P.M. - Foot Continuing Care RX - Account Payable MSHMC Physicians Group - Acct Payable Presbyterian Homes, Inc. - Final Bill Internal Revenue Service - 2001-1040ES PA Dept of Revenue - 2001PA-40ES The following Items 9 thru 10 were paid from Account of W. Kenneth Hull and Judith G. Hullin Fulton Bank 4/15/02 U.S. Treasury - Balance 2001 Form 1040 4/15/02 PA Dept of Rev. - Balance 2001-PA-40 1748.00 259.00 85.29 34.73 20.00 1218.29 24.12 1566.25 300.00 330.00 TOTAL (Also enter on line 10, Recapitulation) $ 5585.68 (If more space is needed, insert additional sheets of the same size) RI~V-1~513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Doris A. Swank a/k/a Doris M. SCHEDULE J BENEFICIARIES FILE NUMBER Swank 21-02-0306 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under NUMBER I 1. Se II 1. Sec. 9116 (a)(1.2)] W. Kenneth Hull 2717 Laurel Drive Grantham, PA 17027 Judith G. Hull 2717 Laurel Drive Grantham, PA 17027 Son Daughter-in~law One-half (½) of $oint Accounts PLUS Dne-half (½) of ~ransfers (Non- Probate Property) Dne-half (½) of ~oint Accounts PLUS One-half (½) of Transfers (Non- Probate Property) 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 1. 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) 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 001 646 SUNDAY WILLIAM L ESQUIRE 39 W MAIN STREET MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: SSN: 199-07-0625 FILE NUMBER: 2102-0306 DECEDENT NAME: SWANK DORIS M DATE OF PAYMENT: 09/24/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/28/2001 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4,029.75 REMARKS: TOTAL AMOUNT PAID: WILLIAM L SUNDAY ESQUIRE $4,029.75 SEAL CHECK#0161 INITIALS: JA RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS BUREAU OF TNDTVZDUAL TAXES TNHERI'TANCE TAX DTVTSTON DEPT. 280601 HARRTSBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN REV-IliS$ EX AFP COl-D2) WILLIAM L SUNDAY $9 W MAIN ST HECHANICSBURG PA 17055 DATE z z-Oq-2OOZ ESTATE OF SWANK DATE OF DEATH 1Z-Z8-ZO01 FILE NUMBER 2z 02-0506 COUNTY CUMBERLAND ACN 201 d Amount Remitted DORIE M MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 NOTE: To insure proper credit to your account`, submit the upper portion of this fore with your tax payment. CUT ALONG THIS LINE ~'~ RETAIN LOWER PORTION FOR YOUR FILES ~ REV-q83 EX AFP (01-02) ~- NOTICE OF DETERMZNATZON AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN #~ ESTATE OF SWANK DORIE M FILE N0.21 02-0506 ACN Z01 DATE 11-Oq-ZOO2 ESTATE TAX DETERHZNATZON 1. Credit For State Death Taxes as Vet/f/ed .00 2. Pennsylvania Inheritance Tax Assessed CExcluding Discount and/or Interest) 10~2.25 Inheritance Tax Assessed by Other States .00 or Territories of the United States (Excluding Discount and/or Interest) ~. Total Inheritance Tax Assessed 10~q2.25 5. Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYHENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (- AMOUNT PAID TOTAL TAX CREDZT I .00 BALANCE OF TAX DUEl .00 INTEREST AND PEN. .00 TOTAL DUE . O0 ~'rF pA'rD AFTER THTS DATE,, SEE REVERSE STDE (I'F TOTAL DUE TS LESS THAN $1`, NO PAYHENT 'rs REQU'rRED FOR CALCULATTON OF ADDTTTONAL 'rNTEREST. .rF TOTAL DUE .rS REFLECTED AS A "CREDI'T" (CR)`, YOU HAY BE DUE A REFUND. SEE REVERSE S.rDE OF TH'rS FORM FOR 'rNSTRUCT'rONS.) PURPOSE OF NOTICE: PAYMENT: To fulfill the raquirements of Section ZlqO (b) of tho Inharitanca and Estate Tax Act, Act Z3 of ZOO0. (72 P.S. Sactlon 9140). Detach the top portion of this Notica and submit with your payment to the Register of Hills printed on the reverse sida. -- Hake check or money order payable to: REGISTER OF NZLLS, AGENT. REFUND (CA): A refund of a tax credit may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available et the Office of the Register of Hills, any of the Z$ Revenue District Offices or from the Department's Iq-hour answering service for fores ordering: 1-800-56Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-q47-~OgO (TT only). OBJECTIONS: Any party in interest not satisfied with the assessment of tax as shown on this notice may object within sixty (603 days of receipt of this Notice by: --written protest to the PA Dapartmant of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 171ZB-10Z1, --electing to have the matter determined at audit of tha personal representative, OR --appeal to the Orphans' Court. ADH/N- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Texas, ATTN: Post Assessment Revlew Unit, Dept. ZB0601, Harrisburg, PA 171Z8-0601, Phone (717) 787-6S05. Sea page 5 of the booklet "[nstructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. OR PENALTY: INTEREST: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after tha end of the tax amnesty perlod. This non-participation penalty is appaalabla in the same manner and in the the same time period as you would appeal the tax and intarast that has been assessed as indicated on this notice. For dates of death on or after 10-$-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of nine (09) months from the date of death. For dates of death prior to 10-5-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of eighteen (18) months from the date of death. Taxes which became delinquent before January 1, 19BE bear interest at the rate of six (6g) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on or after January 1, 19BZ will bear intarast at a rate which will vary free calendar year to calendar year eith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Intarest Factor m 1982 ZOZ .O005~B 1992 9Z .OOOZq7 1983 162 .000~$8 199~-199~ 7~ .00019Z 198~ 112 .000~01 1995-1998 92 .O00Z~7 1985 132 .000356 1999 72 .O0019Z 1986 IOZ .O00Z7q ZOO0 8Z .000219 1987 9X .OOOZq7 2001 9Z .O00Zq7 1988-1991 llZ .000501 ZOOZ 6Z .00016q --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DEL/NQUENT X DA/LY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notica, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES ZNHER][TANCE TAX DIVTSION DEPT. 180601 HARRTSBURG, PA 17118-0601 WILLIAlq L SUNDAY $9 W HAIN ST HECHANICSBURG PA 17055 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF ZNHERTTANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 11-04-Z002 ESTATE OF SWANK DATE OF DEATH 12-18-2001 FILE NUHBER 21 02-0306 cOunTY CUHBERLAND ACN 101 I Amoun1: Remi1:1:ed REV-I;4? EX AFP (DI-D2} DORIE lq HAKE CHECK PAYABLE AND REMIT PAYHENT TO= REGISTER OF WILLS CUlqBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAZN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-OP) NOTICE OF ZNHERTTANCE TAX APPRATSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF SWANK DORIE Iq FILE NO. 21 02-0306 ACN 101 DATE 11-Oq-ZOOZ TAX RETURN NAS: (X) ACCEPTED AS FTLED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Es1:e1:e (Schedule 2. S1:ocks end Bonds (Schedule B) $. Closely Held S1:ock/Par1:nershJp Zn1:eres1: (ScheduZe C) ($) 4. Mor1:gages/No1:es Rece/veble (Schedule D) (4) $. Cash/Bank Deposi1:s/Misc. PersonaZ Proper1:y (Schedule E) (6) 6. Joln1:ly Owned Proper1:y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To1:al APPROVED DEDUCTIONS AND EXElqPTZONS: 9. Funeral Expenses/Adm. Cos1:s/Misc. Expenses (Schedule H) (9) 10. Deb1:s/Mor1:gage Liabili1:ias/Liens (Schedule Z) (10) 11. To1:al Deduc1:ions 12. Ne1: Value of Tax 1~095.15 .00 2~629.05 251171~.83 6~808.~3 (8) .00 NOTE: To insure proper credi1: 1:o your accoun1:, submi1: 1:he upper por1:/on .00 of 1:his form wi1:h your 262,2~7.~6 17,111.86 5,585.68 (11) 22.&g7.~4 (la) 239,549.91 Cheri*abZe/Governmen1:el Beques1:s; Non-elec1:ed 911:5 Trus1:s (Schedule J) (1:5) Ne1: Value of Es1:a1:e Subjec1: t:o Tax (14) ]:f an assesseent Has issuecl previously, 11nes la, 15 and/or 16, 17, 1:5. 14. NOTE: reflect figures that include the total of ALL returns assessed to date. .00 139,5~9.91 18 and 19 will (15) .00 x O0 = .00 (16) 239,549.92 x 045 = 10,779.75 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= 10,779.75 ASSESSHENT OF TAX: 15. Amoun1: of L/ne Zfi al: Spousal 16. Amoun1: of Line lfi 1:exable al: L/neal/Cless A 17. Amoun1: of L/ne 14 al: S/bl/ng 18. Amoun1: of L/ne 14 1:exeble al: Colle1:erel/Class B 19. Pr/nc/pal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT DATE NUHBER ~NTEREST/PEN PAZD (-) 03-26-2002 CDO0100q 337.50 09-24-2002 CD0016~6 .00 IF PAZD AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADD/TIONAL INTEREST. AMOUNT PAID 6,412.50 q,0Z9.75 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 10,779.75 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS RE~UZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SZDE OF THIS FORM FOR ZNSTRUCTZONS.) RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laeful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section Zl~O of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit mith your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara ava[labia at the Office of the Register of Nills, any of the Z5 Revenue District Offices, or by calling the special Z~-hour answering service for Forms ordering: 1-800-56Z-lOS0; services for taxpayers with special hearing and / or speaking needs= 1-800-~7-~0Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --erittan protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17IlS-lOll, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1SOI) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this not[ce. Interest is charged beginning with first day of delinquency, or nine (9) months and one (i) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rata of six (SI) percent par annum calculated at a daily rate of .00016q. All taxes which became delinquent on and after January l, 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 ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1981 ZOZ .0005q8 1991 9Z .O00Zq7 1985 161 .000q58 1995-199~ 71 .000192 198~ 111 .000501 1995-1998 9X .0002~7 1985 132 .000356 1999 7Z .OOOlgZ 1986 IOZ .OOOZ7~ ZOO0 8Z .000119 1987 91 .O00Zq7 ZOO1 9Z .O00Zq7 1988-1991 llZ .O00SO1 ZOOZ 62 .00016~ --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the data of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF ZNDZVZDUAL TAXES I'NHERTTANCE TAX DI'VI'STON DEPT. Z80601 HARRI'SBURG,. PA 17].28-069]. WILLIAH L SUNDAY HAIN ST HECHANICSBURG COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTZCE OF DETERHZNATZON AND ASSESSHENT OF PENNSYLVANTA ESTATE TAX BASED ON FEDERAL CLOSTNG LETTER ~.::. ;.: ,~i DATE ESTATE OF DATE OF DEATH __FILE NUHBER '03 JUN 30 A? :b~COUNTY ACN I 06-50-2005 SWANK 1Z-28-ZOOZ Z1 02-0506 CUHBERLAND Z02 Amoun~ Remi'l:'l:ed REV-?$6 EX AFP DORIE N NAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his form w).'~h your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES REV-736 EX AFP (01-02) ## NOTICE OF DETERHZNATZON AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ESTATE OF SWANK DORIE H FILE NO.Z1 02-0306 ACN 202 DATE 06-30-2003 ESTATE TAX DETERHZNATZON 1. CPedit FoP State Death Taxes as VeP/fied .00 2. Pennsylvania InhePitance Tax Assessed (Exclud/ng D/scount and/DP 5. InheP/tance Tax Assessed by OtheP States DP TePP/toP/es of the Un/ted States (Excluding Discount and/DP 4. Tote1 InhePitance Tax Assessed 5. Pennsylvan/a Estate Tax Due 6. Amount of Pennsylvan/a Estate Tax PPeviously Assessed Based on FedePal Estate Tax RetuPn .00 7. Add/t/Dna1 Pennsylvania Estate Tax Due .00 TAX CREDZTS: 10,442.25 .00 .00 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID ~ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATZON OF ADDZTZONAL INTEREST. TOTAL TAX CREDZT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 (ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THZS FORM FOR ZNSTRUCTZONS.) PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. -- Make check or money order payable to: REGISTER OF NILLS, AGENT. A refund of e tax credit may be requested by completing an "Application far Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available at the Office of the Register of Mills, any of the Z5 Revenue District Offices or from the Department's lq-hour answering service for forms ordering: 1-800-56Z-ZO50~ services for taxpayers with special hearing and/or speaking needs: 1-800-447-$0Z0 (TT only). Any party in interest not satisfied with the assessment of tax as shown on this notice amy object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81021, Harrisburg, PA 171la-lOll, --electing to have the matter determined at audit of the personal representative, OR --appeal to the Orphans' Court OR Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of [ndividua! Taxes, ATTN: Post Assessment Review Unit, Dept. Z8060[, Harrisburg, PA 171Z8-0601, Phone (717) 787-6505. See page 5 of the booklet "instructions for inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 16, 1996, the first day after the end of the tax amnesty period. This non-participatian penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Additional Pennsylvania Estate Tax assessed as a result of a change on the Federal Estate Tax closing 1attar becomes delinquent at the expiration of one (X) month from the date the final notice of the increase in Federal Estate Tax is received. Taxes which became delinquent before January 1, 19SZ bear interest at the rate of six (6g) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on or after January 1, lgBZ 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 198Z through ZOOg are: Year Interest Rate Daily Interest Factor Yea.~r Interest Rate Daily Interest Factor 198Z lOX .OOOSqB 199Z 9Z .OOOgq7 1983 X6Z .000438 1993-1994 7Z .OOOZgZ 1984 Ill .000301 1995-1998 9Z .000247 1955 13Z .000356 1999 7Z .00019Z 1986 iOZ .000Z74 logo 8Z .OOOZl9 1987 9Z .000247 ZOO1 9X .OOOgq7 1988-1991 llZ .000301 ZOOZ 6Z .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELTNQUENT X DATLY 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.