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HomeMy WebLinkAbout02-0308 PETITION also known as FOR PROBATE and GRANT OF LETTERS ,,at-o.t- Deceased. Social Security No. ~ ~1 o~ -7.. O- ~["~ k, ~" The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or~ot~o d~r at, the execut in the last will of the above decedent, dated ~ \ g.\% \ and codicil(s) dated To: Register of Wills for thc County of ~ pa_~h~v\~ ~c~ in the Commonwealth of Pennsylvania named ,19 I5~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) *q) ~%.e \~ ~. ~c~C°unty' Pennsylvania, with .Decendent was domiciled at death in Q u h ~ c3 last family or principal residence at b g .~ "~ ~ ~ ,^ -~,, n (list street, number and muncipafity) Deceudent, then '-[ ~ years of age, died C~ [ \ox \ ~ \ , 19. Except as ftollows} 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: Decendent at death owned property with estimated values as follows: (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 $ 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; administration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed e m hi 26th . befor e t s __ __ __ day of .Mp~C_H 2002 .-,, , .~ ~ _~ MA~Y" C L~IS -- / -- R~g~ster No. Estate Of ¢~a~.s w Ta~, , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW MARCH 26, 2002 xxlgcxx , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 04-06-1951 described therein be admitted to probate and filed of record as the last will of CHb~RLES N LONE and Letters TESTb3~-W~ARY are hereby granted to F,T,TZAI~Rq~q T, FEES Probate, Letters, Etc .......... $. 25.00 Short Certificates( ) .......... $. 3.00 jc'p $, 5. O0 36.00 TOTAL $ Filed 3-26-2002 MARY/C LEWd_ Re.gister of Wills / ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE ~'~gister REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBIN~V-I~NESS (each) a subscribing witness to the will preseh~ herewith, (each) being duly qualified'a~ording to law, depose(s) and say(s) that ~. presen¥,,and saw the testat ,~'sigxLthe same and that ~ signed as a witness at'~h; request of testat presence and (in the presence~each other)(in the presence of th~ other subscribing witness(es)). ~ Sw__.orn to or affirmed and subscribed before x~ (Address) ~me) ~% (Address) REGISTER OF WILLS OF ~r~o.r-c~. COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that --(-~,, ~,~c- familiar with the signature of 0¼~l~_~ [, ) Lc~t,~E , testat c~.- of (one--of tho *-h,crib(rig :vkne~oses to) the will presented herewith and that I ~e ~ j believe~, the signature on the will is in the handwriting of to the best of'-~e'~ ~ knowledge and belief. Sworn to or affirmed and subscribed before ~-Y~ me this 26th day of (Name) MARCH 2002 1~ c/fig' ~t46 .f'ftgrC D~L, I£rre¢.r j~,~.177i . (AddF~ess) lVLARY C LEWIS Register ~ ~o--~.~ %- ~ (Name) t (Address) 21-02-308 OF CHARLES W. LOWE BE IT REMEMBERED, that I, CHARLES W. LOWE, of 1555 Simpson Ferry Road, New Cumberland Boro, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: Ail the rest, residue and remainder of my estate, of whats( ever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my wife, Elizabeth L. Lowe, absolutely, provided she survives me for a period of thirty (50) days. ITEM 5: Should my wife, Elizabeth L. Lowe, predecease me, fail to survive me for a period of thirty (50) days, or should we die simulta- neously, I then give, devise and bequeath my entire residuary estate unto my two sons, William C. Lowe and Thomas E. Lowe, in equal shares per stirpes. ITEM 4: I appoint Commonwealth National Bank of Harrisburg, Pennsy[ vania, as guardian over any property which passes either under this or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provide~ that this appointment of a guardian shall not supersede the right of an~ fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income, from time to time for the WITNESS: CHARLES W. LOWE (SEAL minor's Support and education, (including college education, both graduate and undergraduate), without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility to the minor's parent or to any person taking care of the minor. ITEM 5: I direct that my hereinafter named Executrix pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my Estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, and may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, or any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enact- ed, shall be prorated among the persons interested in my Estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 6: I appoint my wife, Elizabeth L. Lowe, as Executrix of this my Last Will and Testament. Should my wife predecease me, fail to qualify, cease to act or renounce probate, I then appoint my son, William C. Lowe, as alternate Executor of this my Last Will and Testa- ment. ITEM 7: I direct that my Executrix, guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of ~z,'[ , 1981. CHARLES W. LOWE The preceding instrument, consisting of this and one other typewrit- ten page was on the day and date thereof signed, sealed, published and declared by CHARLES W. LOWE, the Testator, herein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have subscribed our In~s as witnesses hereto. REV- 1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 171Z8-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DE I DECEDENT'SNAME(LAST'FIRST'ANiMIDDLEINITIAL)Lowe Charles W. C DATE OF DEATH (MM-Db-YEAR) DATE OF BIRTH (MM-Db-YEAR) E D 09/19/2001 10/13/1927 E N T Lowe, Elizabeth L. CAPB HpRL EpIO caAC ~TK cg R E C A P I T U L A T I O N C O M T I 0 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER 21-02-0308 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 174-20-7165 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER  (date of death 1. Original Return 2. Supplemental Return 3. Remainder Return prior to 1Z-13-8Z) 4, Limited Estate 4a. Future Interest Compromise (date of death after 12-1Z-8Z) 5. Federal Estate Tax Return Required 6. Decedent Died Testate 7, Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach copy of Trust) ['---I 9. Litigation Proceeds Received [--I10. SpousalPovertyCredlt r-I 11. Election to tax under Sec. 9113(A) (date of death between 1Z-31-91 and 1-1-95) (Attach Sch O) NAME James D. Bogar Esquire FIRM NAME (If Applicable) TELEPHONE NUMBER 717,/737- 8761 COMPLETE MAILING ADDRESS One West Main Street Shiremanstown, PA 17011 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [-~ Separate Billing Requested 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8, Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate/Line 8 minus Line 11) 13. 14. None 3,630 .jO.Q- None None None None None None OFFICIAL USE ONLY (8) 3,630.00 (11) 0.00 (12) 3,630. O0 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (14) 3,630.00 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) 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 3,630.00 X .0 0 X .0 45 X .12 X .15 (15) 0.00 (16) 0.00 (17) 0.00 (18) 0.00 (19) O. 00 copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 1355 Simpson Ferry Road CITY New Cumberland STATE PA ZIP 17070 Tax Payments and Credits: 1. Tax Due (:Page 1 Line 19) :~. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits ( A + S + C ) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 0.00 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 (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (SA) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 0.00 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 ;. retain the use or income of the property transferred; ......................... ~ ~ · 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. 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 a beneficiary designation? ................................ [] [] which contains 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, it 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 OF PERSON RESPONSIBLE FOR FILING RETURN Elizabeth L. Lowe DATE , ^ ~ ~ 1355 Simpson Ferry Road ................... SIGNATUR4~.~R~F ~~..,. R OTHER THAN REPRESENTATIVE 3~es D . Bo~ar Esquire DATE /../~,.. ~P~~ One West Main Street surviving spouse is 3% [72 P.S. 9116 (al (1.1) (ill. For dates of death on or after Janua~ 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 (al (1.1) (ii)]. The statute does not exempt a transfer to a su~iving spouse from tax, and the statuto~ requirements for disclosure of assem and filing a tax return are still applicable even E the surviving spouse is the only beneficial. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twen~-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 (al (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(al( 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. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS Charles W. Lowe SS~/ 174-20-7165 09/19/2001 All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER 21-02-0308 ITEM VALUE AT DATE NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 132 shares Prudential Financial, Inc. Common Stock 27.50 3,630.00 TOTAL (Also enter on line 2, Recapitulation) 3,630.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, inc. Form REV-1503 EX (Rev. 1-97) REV-1513 EX + (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Charles W. Lowe SS# 174-20-7165 09/19/2001 21-02-0308 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(aX1.?)] Elizabeth L. Lowe 1355 Simpson Ferry Road New Cumberland, PA 17070 Spouse Rest, residue and remainder ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 0 o 00 (If more space is needed, insert additional sheets of the same size) Copyright (c) ?000 form software only The Lackner Group, [nc. Form REV-1513 EX (Rev. 9-00) OF CHARLES ~/. LO~/E BE IT REMEMBERED, that I, CHARLES ~. LO~E, of 1355 Simpson Ferry Road, ~e~ Cumberland Boro, Cumberland Counky, Pennsylvania, beinU of sound mind, memory and understandinu, do mare, publish 8nd declare this as and for my Last ~ill and Testament, hereby revokinU and makinU null and void any and all ~ills and Testaments and ~ritinUs in the nature thereof by me at any time heretofore made. ITE~ 1: I direot t~at all my jus~ debts and funeral expenses be paid as soon after my demise as may be convenient. ITE~ 2: All ~he rest, residue ~nd remainder of my estaee, of ~hats~ ever nature ~nd ~heresoever situate, ~he~her ~t be real, personal or mixed, inoludinU property over whioh I have 8 power of appointment, I ~ive, devise and bequeath unto my ~ife, Elizabeth L. Lowe, absoluCely provided she survives me for ~ period of t;hirLy (~0) clays. ITEM ~: Should my ~ife, Elizabeth L. [.owe, predecease me, fail survive me for a period of tNirky (BO) days, or sNould ~e die simulta- neously, I ~hen uive, devise and bequeath my entire residuary estake unto my two sons, ~illiam C. Lo~e and TNomas E. Lowe, in equal per stirpes. ITEM a: I appoint Commonwealth NaCional BanR of Harrisburu, Pe~nsy vania, 8s uuardian over 8ny proper~y ~hich passes either t~der Chis ~.] or okher~ise to a minor ~nd ~ith respeot to ~hioh I am autNorlzed to appoint a uuardian and Nave not otherwise specifically done so, provide~ eNae ehi~ ~ppolnement of a uuardian snail noE ~upersede the riuht o~ Eidueiary in its di~oretion ~o dis~ribuEe a share ~Nere posslble Eo the minor or to another for the minor's benefit. Suoh uu~rdian shall have the po~er to use principal as well as income, from time ~o time for the minor's Support and education, including college education, both graduate and undergraduate), without regard to h~s o~' her parenl.'s ability to provide for such support and education, or to make payment for these purposes, without further responsibility to the minor's parent or to any person taking care of the minor. ITEM 5: I direct that my hereinafter named Executrix pay all inherJ tance, estate, succession and legacy taxes of whatsoever nature and kind, to which my Estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, and may be subject and to charge such taxes against my residuary estate, it. bei~g my intention that none of the aforesaid taxes, either federal or state, or any property require~ to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter e~act- ed, shall be prorated among the persons interested in my Estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 6: I appoint my wife, Elizabeth L. Lowe, as Executri× of [;his tmy Last Will and Testament. Should my wife predecease me, fail to qualify, cease to act or renounce probate, I then appoint my son, william C. howe, as alternate Executor of this my baal Wi] I and Tesb~- men t. ITEM 7: I direct that my Executrix, guardian or their successors ;hall not be required to give bond for the faithful performance of thei Juties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and sea]. this ~(/~ day of ~?~)"' ~ , 1981. CHARLES W. LOWE The preceding instrument, consisting of this and one other typewri ten page was on the day and date thereof signed, sealed, published lared by CHARbES W. LOWE, the Testator, herein named, as a~]d for =ast Will and Testament, in the presence of us, who, at his request, his presence and in the presence of each other, have subscribed o~r names as witnesses hereto. · i"~c_,~ -. ~, ~.J ..L~,-,. o~ OF STATUS REPORT UNDER RULE 6.12 Name of Decedent: Charles W. Lowe Date of Death: September 19, 2001 Will No. 21-02-0308 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: 1. State whether administration of the estate is complete: Yes xx No 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 XX b. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A c. Did the personal representative state an acccunt informally to the parties in interest? Yes XX No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: 5/15/02 /~k~- '~c~ Signature o~ga ~.z.~ James D. B r, Esquire ~ Name (Please type or print) One West Main St. Shiremanstown, PA 17011 Address 1717 ) 737-8761 Tel. No. Capacity: __Personal Representative (MAH: rmf/AM3 ) X __Counsel for personal representative CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Charles W. Lowe Date of Death: September 19, 2001 Will No. 21-02-0308 Admin. No. To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on April 23, 2002: Name Address Elizabeth L. Lowe William C. Lowe Thomas E. Lowe 1355 Simpson Ferry Road New Cumberland, PA 17070 25 DeWalt Drive Mechanicsburg, PA 17055 696 Sand Spur Drive Etters, PA Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: 5/15/02 Capacity: Shiremanstown, PA 17011 (717) 737-8761 Personal Representative X Counsel for Personal Representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 180601 HARRISBURG, PA 17118-0601 JAMES D BOGAR ESQ ! W MAIN ST SHIREMANSTOWN COMHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT/CE OF INHERITANCE TAX APPRAISEHENT) ALLO#ANCE OR DZSALLOHANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-l$47 EX &FP ($1-g2) PA 17011~.: :: , DATE ESTATE OF DATE OF DEATH FILE NUMBER ~C~NTY 06-17-1002 LOWE 09-19-Z001 Z1 02-0508 CUMBERLAND 101 Amoun~ Remit'tad CHARLES MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP [01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LOWE CHARLES WFZLE NO. 21 02-0508 ACN 101 DATE 06-17-Z002 TAX RETURN NAS: { X} ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks end Bonds {Schedule B) $. Closely Held Stock/Partnership Interest (Schedule C) ($) ~. Nortgagos/Notes Receivable (Schedule D) (~) $. Cash/Bank Deposits/Misc. Personal Property (Schedule E) iS) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Exponsos/Ade. Costs/Misc. Expansos (Schodula H) (9) 10. Dabts/Hortgaga Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Nat Value of Tax Return 15. lq. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subject to Tax .O0 5t650.00 .00 .00 .00 .00 .00 (8} .00 .00 NOTE: To insure proper credit to your account, submit the upper portion of this fora wi~h your tax payment. 5,630.00 (11) .oo (12) 5,650.00 (t$) .00 (l~) 5,650.00 NOTE: ASSESSMENT OF TAX: 15. Amount of Line 1~* at Spousal rate 16. Amount of Line 1~ taxable at L~naal/Class A rata 17. Amoun~ of Line lq at Sibling rata 18. Amount of Line 1~ taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYHENT RECETPI DISCOUNT DATE NUHBER TNTEREST/PEN pATD (- If an assessment was issued previously, lines 14, 15 and/er 16, 17, 18 and 19 will reflect figures that lnclude the total of ALL returns assessed to date. (15) 5,650.00 X O0 = .00 (16) .00 X 045= .00 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= . O0 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ANOUNT PA/D TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN, TOTAL DUE .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT ZS REQUIRED. ZF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADHZN- ISTRATZVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1981 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Comeonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such futura interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (71 P.S. Section 9140). Detach tho top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NZLLS~ AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ars available at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-600-$62-Z050~ services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT 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: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17118-1011, --election to have the matter determined at audit of the account 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 Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "/nstructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (51) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of tho 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 ]n 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. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and 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 2002 ara: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 ZOg .000548 1992 9Z .0002~7 1983 162 .000~38 1993-1994 71 .OO019Z 1984 111 .000301 1995-1998 91 .000247 1985 13Z .000356 1999 71 .000192 1986 lOX .000274 2000 82 .000219 1987 9Z .O00Zq7 2001 9Z .OOOZq7 1988-1991 111 .OOO3Ol 2001 6X .00016q --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD X NUHBER OF DAYS DELZNI;IUENT X DAZLY ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of tho assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.