HomeMy WebLinkAbout04-1116ESTATE OF WILLIAM J. COOPER, JR.
DECEASED
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: NO. I Il~P of 2004
ORDER OF DISTRIBUTION
AND NOW, this __ day of _, 2004, upon presentation and
review of the attached Petition for Distribution of Small Estate Under 20 Pa. Cons. Stat.
Ann. Section 3102, it is hereby Ordered and Decreed that payment of the assets of the
Estate of William J. Cooper, Jr., deceased, in the total sum of $11,474.99, be awarded
and paid as follows:
1. To Carl G. Wass, Esquire, for attorney fees and costs associated with the
within Petition, the sum of $825.00;
2. To Mark A. Cooper, for reimbursement of funeral expenses, inheritance
taxes paid by him, and debts of the deceased paid by him, in the sum of $8,348.90;
3. To Mark A. Cooper, for the purposed of paying the following debts of the
Decedent to the following:
a. West Shore EMS ($669.87),
b. Conner-Rich Associates ($259.87), and
c. Moffitt Heart & Vascular Group ($80.00).
4. To Mark A. Cooper, the remaining sum of $1,291.35, in payment of the
bequest made under the Last Will and Testament of the Decedent.
It is further Ordered and Decreed that, upon payment of the foregoing sums, the
Small Estate of William J. Cooper, Jr., shall be closed and the Petitioner, Mark A.
Cooper, thereupon is discharged from his duties.
BY THE COURT,
04-761/81777
ESTATE OF WILLIAM J. COOPER, JR.
DECEASED
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DVISION
: NO. of 2004
PETITION FOR DISTRIBUTION OF SMALL ESTATE
UNDER 20 Pa. CONS. STAT. ANN. SECTION 3107
TO THE HONORABLE, THE JUDGES OF SAID COURT:
AND NOW COMES, Carl G. Wass, Esquire, attorney for Mark A. Cooper, and presents
the following Petition to settle a small estate pursuant to Section 3102 of the Probate, Estates and
Fiduciaries Code, and in support thereof, avers as follows:
1. William J. Cooper, Jr., (Decedent), 74 years of age at the time of his death, resided
a 90-R Winter Lane (East Pennsboro Township, Cumberland County) Enola, Pennsylvania,
17025, and died testate, on September 5, 2004.
2. Your Petitioner is Mark A. Cooper, an adult individual, w~d3esidot~at 44
Meadow View Drive, Phillipsburg, New Jersey, 08865, and is the grandson of the[Decedent and
the sole, designated beneficiary of the Estate of the Decedent pursuant to the Last mill and
Testament of the Decedent. The Last Will and Testament of William J. CooPer, th~::Decedent;
dated June 28, 2001, is attached hereto, identified as Exhibit , ana ~ncorporated here~n by
reference.
property:
The probate estate of which Decedent died seized consisted of the following
Balance contained in M&T Bank
Checking Account No. 24020494 (Exhibit "B")
Several pieces of furniture in bachelor apartment
of Decedent, having no value
$11,474.99
k o.oo
$11,474.99
4. At the time of his death, Decedent was the co-owner of a number of Certificates
of Deposit issued by Fulton Bank. All of the co-owners of the Certificates of Deposit are living,
have been notified by your Petitioner that each is a co-owner ora Certificate of Deposit, and
each co-owner has been directed to Fulton Bank for the purpose of redeeming such co-owned
Certificate of Deposit and paying the Pennsylvania Inheritance Taxes pertaining thereto.
5. The family exemption has not been claimed since there are no heirs of the
Decedent who were members of the household of Decedent.
6. A Pennsylvania Inheritance Tax Return has been prepared and filed and, after
deduction for expenses and debts of the Estate, inheritance tax (at discount) has been computed
and has been paid in the discounted sum of $57.51.
7. The following administration expenses and debts are claims against the Estate by
Mark A. Cooper who has advanced and paid such expenses and debts, to wit:
a. Sullivan Funeral Home $7,250.00
b. Pamela's Flowers 82.63
c. Funeral Luncheon 86.44
d. Travel Reimbursement to Mark A. Cooper 232.00
e. Summerdale Apartment Rent for September 570.00
f. Decedent's Final Comcast Cable Bill 7.81
g. Decedent's Final Electric Bill (ppL) 52.10
h. Decedent's Final Verizon Telephone Bill 10.41
i. Pennsylvania Inheritance Tax ~ 57.51
TOTAL $8,348.90
8. In addition, the following administrative expenses are claims or debts against the
Estate which have not yet been paid because the Estate lacks the liquid funds necessary to make
such payment, to wit:
a. Caldwell & Kearns, P. C. (fees and costs)
b. West Shore EMS (Ambulance Charges)
c. Conner Rich Associates (Medical Debt)
825.00
669.87
259.87
2
ESTATE OF WILLIAM J. COOPER, JR.
DECEASED
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DVISION
: NO. of 2004
AFFIDAVIT
STATE OF PENNSYLVANIA
COUNTY OF DAUPHIN
: SS:
Mark A. Cooper, Executor of the Estate of William J. Cooper, Jr., being sworn according to law,
deposes and says that he is the Petitioner in the foregoing matter, and that the facts set forth in the
foregoing Petition are tree and correct.
Sworn to and. subscr/bed before me this
Day of ~~:~ ,2004.
otary Publigq - --
U COMMONWEALTH OF PENNSYLVANIA
[ NOTARIAL SEAL
I ~cv g mEeKS, ~ ~e |
· ~.
ark A. Cooper, Ex~.m~:l:[~- --
Estate of William/7~ooper, Jr.
04761/81226
LAST WILL AND TESTAMENT
OF
WILLIAM J. COOPER, JR.
I, WILLIAM J. COOPER, JR., of East Pennsboro Township, Cumberland
County, Pennsylvania, being of sound mind, memory and understanding, do make and
~ublish this my Last Will and Testament, hereby revoking and making void all former
Wills by me at any time heretofore made.
ITEM I. I direct that all my just debts, funeral expenses
and inheritance taxes which may become due as a result of my death be fully paid and
satisfied as soon as conveniently may be after my decease.
ITEM II. I have already made provision for the
disposition of the major portion of my assets by taking those assets, comprised of
certificates of deposit, and placing those certificates of deposit in joint names with
myself and other members of my family. Therefore, the provisions of this Will will make
disposition of the remaining assets as to which I remain the sole and exclusive owner. I
do give, devise and bequeath all of my assets of every nature and wherever situate to
my grandson, Mark A. Cooper, with full authority in Mark to retain all such assets, or to
make a disposition or transfer of those assets to any person he may choose.
ITEM III. I appoint my grandson, Mark A. Cooper, of
Phillipsburg, New Jersey, to be and act as Executor of this, my Last Will and
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA '
SS:
COUNTY OF DAUPHIN
I, WILLIAM J. COOPER, JR., Testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I signed it
willingly and that I signed it as my free and voluntary act for the purposes therein
expressed.
IN WITNESS WHEREOF, I, William J. Cooper, Jr., have hereunto set my hand
and seal this ,~,~ day of ~/~/v,,,%_ _, 2001.
Sworn to and subscribed
before me this~day
of~, 2001.
-- N~tary Public (~
W~f'am J. ¢~,d'0per,(.,~¢"
IM NOTARIAL SEAL
FAY L. POTTEIGER Notary Public
Harrisburg, Dauphin County
y Commisstorl Expires July 1, 2003
Il
AFF DAVIT
COMMONWEALTH OF PENNSYLVANIA .
COUNTY OF ~:
witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, do depose and say that we were present and saw William J.
Cooper, Jr. sign and execute the instrument as his Last Will and Testament; that he
signed willingly and that he executed it as his free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of William J. Cooper, Jr.
signed the Last Will and Testament as witnesses; and that to the best of our knowledge
he was at the time eighteen (18) or more years of age, of sound mind and under no
constraint or undue influence.
Sworn to and subscribed
me this,~2zC&day
_, 2001.
Nota Public
] FAY L. PO'I-rEIGER, Notary Public
~ .L_ Harrisburg, Dauphin County
2~,q~,y Commission Expires July 1,200~/
I--
Z
LEI
W
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~ECEDENT'S NAME (LAST, FIRST, AND MIDDLE iNITIAL
Cooper~ Jr, William J.
DATE OF DEATH (MM-DU-Yea~) DATE OF BIRTH (M~DD-Year}
09/05/2004 05/22/1930
IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
21-04
COUNT~COOE YEAR
SOCIAL SECURITY NUMBER
2 0 0-2 2-6 4 6 3
THiS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
r~l. Odginal Retum
--] 4. Limited Estate
J'~6. Decedent Died Testate
r'-~ 9. LitJgaUon Proceeds ReceNed
r'~2. Supplemental Retum
r-] 4a. Future Interest Compromise (dae or death ~ 12-12-82)
[~]7. Decedent Maintained a Living Trust {At. ch copy of Trust)
"-']10. Spousal Poverty Credit {~ of dea~ ~tw~e, I2-31-9t end 1-1-95)
Iii5. Federal Estate Tax Retum Required
0__ 8. Total Number of Safe Deposit Boxes
Ei}11 Election to tax under Sec. 9113(A) IAr~ch Sch O)
NAME
Carl G. Wass
FIRM NAME (If Applicab~)
3ALDWELL & KEARNSI P.C.
TELEPHONENUMBER
1232-7661
COMPLETE MAILING ADDRESS
3631 North Front Street
1. Real Estate (Schedule A) (1)
2 Stocks and Bonds (Schedule B) (2)
3 Closely Held Co~oratieo. Partnership or Sole-Proprietorship (3)
4 Mortgages & Notes Receivable (Schedule D) (4)
5. Cash. Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
§~ Jointly Owned Properly (Schedule F) (6)
] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Pmper[y (7)
(Schedule G or L)
8. Total Gross Assets (totel Lines 1-7)
9. Funeral Expenses & Administrative Costa (Schedule H) (9)
10. Debts of Decedent. Mortgage Liabilit!es, & Liens (Schedule I) (10)
11. Tots[ Deductions (tOtal Lines 9 ~, 10)
12. Net Value of Estate (Line 8 minus Line 11)
111474.99
17110
Eli
OFFI~IA~ USE ONlY
(8) 11,474.99
8~476.07
1,650.06
(11) 10,126.13
(12) 1~348.86
13. Charitable and Govemmental Beque, sts/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14 Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
1~348.86
15. Amount of Line 14 taxable at t~e spousal tax
rate, or transfers under Sec. 9116 (a)(1 2)
16. Amount ot Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rata
18. Amount of Line 14 taxable at collateral rote
19. Tax Due
20.
x (15)
1,348.86 X .045 (16) 60.70
x .12 (17)
x .15 (18)
(19) 60.70
Decedent's Complete Address:
STREETAODRESS 90-R Winter Lane
ISTATE IZIP
CITY Enola PA 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discounf
3.19
3. Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E ) (3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund (4)
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
60.70
3.19
0.00
57.51
57.51
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ........................................ [] []
c. retain a reversionary interest; or ...................................................................................................... [] []
d. receive the premise for life of either payments, benefits or care? ............................................................. [] []
2. If death occurred after December 12, 1982, did decedent transfer preperty within one year of death
without receiving adequate consideration?. .............................................................................................. [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this relurth including ~ccompanythg schedules and statements, and te the best of my knowledge and belief, it is hue, correct and complete.
Declara~n of p~epe~er other than the personal representative is based on all informalion of which prepe~er has any knowledge.
ADDRESS 44 Meadovvview ~
Phillipsbur,q NJ 08865
SIGNATURE OF PREPARER OTHER TI~N REPRI~NTATIVE
ADDRESS 363~ ~orth Fron~'~6tre~t
Harrisburg
DATE
~-o -~ o, ~ooV-
PA 17110
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)
The statule 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
[he 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,
3r a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
1'he 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 '/2 P.S. §9116(1.2) [72 P.S. §9116(a}(1)].
I-he tax rate imposed on lhe net value of transfers to or for the use of the decedent's siblings is 12% 172 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
ndividual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (6-96)
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE QF
Cooper, Jr., William J.
FILE NUMBER
21 04
Include the proceeds of litigation and the date the proceeds were received by the estate
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUM~3ER
1
DESCRIPTION
M&T Bank Checking Account #24020494
Exhibit #1)
4iscellaneous used furniture in decedent's apartment -- no value
TO~AL (Also enter on line 5, Recapitulation)
VALUE AT DATE
OF DEATH
11,474.99
0~00
$ 11,474.99
(If more space is needed, insed additional sheets of the same size)
REV-1511 EX + (12-99)
COMMONWEAL~'H OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE ,OF FILE NUMBER
Cooper. Jr.. William J. 21 04
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A
1
2.
3.
3
1.
5
6.
7
8.
DESCRIPTION
FUNERAL EXPENSES:
Sullivan Funeral Home, Enola, PA 17025
Pamela's Flowers
Mark A. Cooper, reimbursement, funeral luncheon
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
AttomeyFees Caldwell & Kearns, P.C.
Family Exemption: (If deceder~t's address is not the same as claimants, atiach explanation}
Claimant
Zip
Street Address
City Slate . Zip
Relationship of Claimant to Decedent
Probate Fees
Tax Return Prepare(s Fees
Register of Wills, Cumberland County - File inheritance tax return, release and Small
Estate Petition
Mark A. Cooper - mileage reimbursement, round trip between Phillipsburg, NJ, and
Enola, PA - 3 trips
TOTAL {Also enter on line 9, Recapitulation) j
more. space is needed, insed additional sheets of the same size)
AMOUNT
7,250.00
82.63
86.44
750.00
75.00
232.00
$ 8~476.07
REV-1512 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE !
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Cooper, Jr,, William J.
FILE NUMBER
21 04
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
2.
3.
4.
5.
6.
7.
Summerdale Apartments - Sept. rent
Comcast Cable - final cable bill
PPL Electric Utilities - electric bill
¢erizon - final telephone bill
West Shore EMS - ambulance bills
Conner-Rich Associates - medical bill
Moffitt Head & Vascular Group
VALUE AT DATE
OF DEATH
570.00
7.81
52.10
10.41
66987
259.87
80~00
TOTAL (Also enter on line '10, Recapitulation) $
1,650.0G
more scece is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE DF FILE NUMBER
Cooper,, , William J. 21 04
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee{s) OF ESTATE
TAXABLE DISTRIBUTIONS [include outrightspousaldislributions, and transfers under
Sec. 9116 (a) (12)]
Mark A Cooper
44 Meadowview Drive
Phillipsburg, NJ 08865
Grandson
Entire estate
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 tS NOT BEING MADE
B CHARITABLE AND GOVERNMENTAL DISTRII3UTIONS
TOTAL OF PART ]1 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, inset1 additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
WILLIAM J. COOPER, JR.
I, WILLIAM J. COOPER, JR., of East Pennsboro Township, Cumberland
County, Pennsylvania, being of sound mind, memory and understanding, do make and
publish this my Last Will and Testament, hereby revoking and making void all former
Wills by me at any time heretofore made.
ITEM I. I direct that all my just debts, funeral expenses
and inheritance taxes which may become due as a result of my death be fully paid and
satisfied as soon as conveniently may be after my decease.
ITEM II. I have already made provision for the
disposition of the major portion of my assets by taking those assets, comprised of
certificates of deposit, and placing those certificates of deposit in joint names with
myself and other members of my family. Therefore, the provisions of this Will will make
disposition of the remaining assets as to which I remain the sole and exclusive owner. I
do give, devise and bequeath all of my assets of every nature and wherever situate to
my grandson, Mark A. Cooper, with full authority in Mark to retain all such assets, or to
make a disposition or transfer of those assets to any person he may choose.
ITEM III. I appoint my grandson, Mark A. Cooper, of
Phillipsburg, New Jersey, to be and act as Executor of this, my Last Will and
Testament. No bond shall be required by my Executor in Pennsylvania or any other
jurisdiction.
IN WITNESS WHEREOF
day of J¢,~t/~_~
I have hereunto set my hand and seal this
2000.
The preceding instrument, consisting of this and one (1) other typewritten page, was on
the date hereof signed, pub}ished and declared by WILLIAM J. COOPER, JR., the
Testator therein named, as and for his Last Will, in the presence of us, who at his
request in his presence and in the presence of each other, have subscribed our names
Residing at
Residing at
26485
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA '
SS:
COUNTY OF DAUPHIN
I, WILLIAM J. COOPER, JR., Testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I signed it
willingly and that I signed it as my free and voluntary act for the purposes therein
expressed.
IN WITNESS WHEREOF, I, William J. Cooper, Jr., have hereunto set my hand
and seal this ,~2o0 day of v'//~/v'/'"Z ,2001.
Sworn to and subscribed
before me this~Z:~;~day
of ~,~,,.,~___, 2001.
-- N~ary Public (~
i'" NOTARIAL SEAL
FAY L. POTTEIGER, Notary Public
Harrisburg, Dauphin County
My Commission Expires Jury 1, 2003
W~Jtf/am J. CO'oper,(.Jc¢'. '
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA '
COUNTY OF
We, CLiN,,N-'~L_ C~ . ~(~%% and
, the
Sworn to and subscribed
befor..% me t h is ¢.~¢..d ay
of~, 2001.
-~o{a (~ Public ~
~"' NOTARIAL SEAL
~ FAY L. POTTEIGER, Notary Public
] Harrisburg, Dauphin County
264~y Commission Expires July 1,2003
constraint or undue influence.
witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, do depose and say that we were present and saw William J.
Cooper, Jr. sign and execute the instrument as his Last Will and Testament; that he
signed willingly and that he executed it as his free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of William J. Cooper, Jr.
signed the Last Will and Testament as witnesses; and that to the best of our knowledge
he was at the time eighteen (18) or more years of age, of sound mind and under no
M&TBank
499 Mitchell Road, Mitlsboro. DE 19966 Mail Code DE-MB-I 2
Caldwell & Kearns
Attorneys At Law
3631 North Front Street
Harrisburg, PA 17110-1533
Phone (888) 5024349
Fax (302) 934-2955
September 27, 2004
Re: Estate o£ William d. Coot~er dr
Social Security: 200-22-6463
Date of Death' September 5, 2004
Dear Sir or Madam:
Per your inquiry dated September 17, 2004, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1. Type of Account
Account Number
Ownership (Names oJ)
Opening Date
Balance on Date of Death
Accrued Interest
Total
Checking Account
24020494
William d Cooper dr
8/28/64
$11,474. 70
$ 0.29
$11,474.99
Please be advised, there was no safe deposit box found for the above decedent.
~-~ further account information, regarding ownershio, closures and/or reimbursement of funds, etc., please call the
%mmerdale Plaza Office # 717-255-2261.
Sincerely,
Nancy Clagett
Records Management
EXHIBIT 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-O601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11 96)
NO. CD 004703
WASS CARL G
3631 NORTH FRONT ST.
HARRISBURG, PA 17110
ESTATE INFORMATION: SSN: 200-22-6463
FILE NUMBER: 2104- 111 6
DECEDENT NAME: COOPER WILLIAM J JR
DATE OF PAYMENT: 1 2/06/2004
POSTMARK DATE: 1 2/03/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $57.51
TOTAL AMOUNT PAID:
~57.51
REMARKS:
SEAL
CHECK#5672
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
I!eW ssq:) ~s~!:I
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o-mnbS osnoq?~noD ouO
osnoqlanoD ~lunoD puul.~oqmnD
~II.~ ~o .z~r[?.xB~t
01,1,~, VlNVA-IASNN:Id 'DMrlssII:II:tyH
/:I:IM/~ J. NOM.:I HJ.I:ION I,$9~
NOI&YUOd~O0 nVNOISS3dOUd V
ESTATE OF WILLIAM J. COOPER, JR.
DECEASED
: 1N THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: NO. ~_1 I Lp of 2004
.OR~R OF DISTRIBUTION
AND NOW, this t ¢_dayof_0 , ,2004, upo. presentation and
review of the attached Petition for Distribution of Small Estate Under 20 Pa. Cons. Stat.
Ann. Section 3102, it is hereby Ordered and Decreed that payment &the assets of the
Estate of William J. Cooper, Jr., deceased, in the total sum orS11,474.99, be awarded
and paid as follows:
l. To Carl G. Wass, Esquire, for attorney fees and costs associated with the
within Petition, the sum of $825.00;
2. To Mark A. Cooper, for reimbursement of funeral expenses, inheritance
taxes paid by him, and debts of the deceased paid by him, in the sum of $8,348.90;
3. To Mark A. Cooper, for the purposed of paying the following debts of the
Decedent to the following:
a. West Shore EMS ($669.87),
b. Conner-Rich Associates ($259.87), and
c. Moffitt Heart & Vascular Group ($80.00).
c,~ 4. To Mark A. Cooper, the remaining sum of $1,291 35, in payment of the
b~uest m~er~nder the Last Will and Testament of the Decedent.
It is further Ordered and Decreed that, upon payment of the foregoing sums, the
Small Estate of William J. Cooper, Jr., shall be closed and the Petitioner, Mark A.
Cooper, thereupon is discharged from his duties.
BY THE COURT,
04-761/81777
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG~ PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER~SPONSE
FILE
ACN
DATE
NO. 21 04-1116
05103566
02-18-2005
II:EV-1545 EXAFI' (D9-0Dl
L'
7ES/f;', 10.1' rY'~ L LIAM J COOPER
5.5. NO. 200-22-6463
DATE OF DEATH 09-05-2004
.COUNT~ CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IX] CERTIF.
JOSEPH D KN08LE
1621 MOUNTAIN RD
DAUPHIN PA 17018
REHIT PAYHENT AND FDRHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FULTON BANK has provided ths Department with the infor.ation listed below which has bliilen ussd in
calculating the potential tax dus. Their records indicate that at the death of the above dscedent~ you were a joint owner/benliilficiary of
this account. If you feel this infor.ation is incorrect~ please obtain written correction fro. the 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 .ay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 010-0102575 Oat. 01-06-2000
Established
Account Balance 1 , 040 . 20
Percent Taxable X 50.000
Allount Subiect to Tax 520.10
Tax Rate X .15
Potential Tax Due 78.02
PART TAXPAYER RESPONSE
[!]1I:1~~.i!i!m!!!i..j!j!~~~~!i!i!~.~~!!!I!~~I!I!.!!!I'~~1~~~~!ID!il!!I~"I!li_I!!!!~!!!!.~~I!I!I.~.ili!il
To insure proper credit to your account, two
(2) copIes of this notice must aCCOMpany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
NOTE: If tax pay.ents are .ade within three
(3) .onths of the decedent's date of death,
you .ay deduct a 5X discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. ~The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box nAft and return this notice to the Register of
Wills and an official assessment will be issued by the PA Depart.ent of Revenue.
B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent.s representative.
C. c=J The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust cOlllplete PART 0 and/or PART ~ below.
TAX ON JOINT/TRUST ACCOUNTS
PART
@]
TAX RETURN - COMPUTATION OF
If you indicate a different tax rate, please state your
relationship to decedent:
LINE 1. Dat. E~~ablish.d
2. Account Balance
3. Percent Taxable
4. Amount Subiect to Tax
5. Debts and Deductions
6. Allount Taxable
7. Tax Rate
8. Tax Due
1
2
3 X
4
S
6
7 X
8
PART
@J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax COIIPutation)
nder penalties of periury, I declare that the facts I
to, the best of 1.y;kn~Wledge and belief.
c'& ~/"!l:--
SIGNATURE
have reported above are true, correct and
HOME (7/7 ) '},l-I- $'r~ y
WORK ( )
o UMBER DATE
\)--
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforMation
sub.itted by the financial institution.
Z. Inheritance tax becomes delinquent nine Months after the decedent's date of death.
3. A joint account is taxable Bven though the decadent's name was added as a matter of convenience.
4. Accounts (inCluding those held between husband and wife) which the decedent put in joint na.es within one year prior to
death are fully taxabla as transfers.
5. Accounts established jointlY between husband and wife .ore than one year prior to death ara not taxable.
6. Accounts held by a decedent Hin trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the information and co~putation in the notice are correct and deductions are not being claimed~ place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and subllit them with your check for the allount of
tax to the Register of Wills of the county indicated. The PA Departllent of Revenue will issue an official assessment
(For~ REV-1548 EX) upon receipt of the return from the Register of Wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent.s representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed~ check block "C" and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit thell with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Departllent of Revenue will issue an official assessment (Forll REV-1548 EX) upon receipt
of the return froll the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originallY was established or titled in the manner existing at date of death.
For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3~000 per transferee regardless of the value of
the account or the nUllber of accounts held.
If a double asterisk (MM) appears before your first nalle in the address portion of this notice, the $3,000 exclusion
already has been deducted fro. the account balance as reported by the financial institution.
2. Enter the total belance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as fallows:
A. The percent taxable for joint assats established lIore than one year prior to the decedent's death:
DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Example: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) '" .167 X 100
16.7~ (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent.s death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Example: Joint account registered
the decedent.
1 DIVIDED BY 2 (SURVIVORS) = .50
in the name of the decedent and two ather persons and established within one year of death by
X 100
50~ (TAXABLE FOR EACH SURVIVOR)
4. The allount SUbject to tax (line 4) is deterllined by multiplying the account balance (line 2) by the percent taxable (line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as deterlllned below.
death to or for the use of a natural parent, an adoptive perent, or a stepparent of the child is 07..
The lineal class of heirs includes grandparents, parents, children~ and lineal descendents. "Children" includes natural children
whether or not they have been adapted by others, adopted children and step children. "Lineal descendents" includes all childran of the
natural parents and their descandents~ whether or not they have been adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals who have at least one parent in COllmon with the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
Date of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3Y. 6Y. 15Y. 15Y.
01101195 to 06/30/00 OY. 6% 15Y. 15Y.
07/01100 to present OY. 4.5%- 12Y. 15Y.
MThe tax rate 1mposad on the not value .f transfers from a deceased chlld twenty-one years of age ., Y
ounger at
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally are responsible for paYllent, or the estate subject to adllinistration by a person~l representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being clai_d INst be itemized fully in Part 3. If additional space is needed~ use plain paper 8 112" x 11". Proof of
payment Nay be requested by the PA Department of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2.80601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER.. RESPONSE
FILE
ACN
DATE
NO.21 04-1116
05103570
02-18-2005
ItEV-1H5ElIAFPtO'-ODl
'."
'~ ,
.ES:r. 'OF .+'IILLIAM J COOPER
's .'s'.'NO :'. cj 200-22-6463
DATE OF DEATH 09-05-2004
CDQ~rX CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
IX] CERTIF.
JODI D KNOBLE
1621 MOUNTAIN RD
DAUPHIN PA 17018
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
FULTON BANK has provided tha Dapartment with tha information listed balow which has baan usad in
calculating the potantial tax dua. Their rBCDrds~indicate that at the death of tha above decadent~ YOU wera a joint owner/benaficiary of
this account. If you feal this inforllatJ~_u..rect, please obtain written correction from tha financial institution, attach a copy
to this for. and raturn it to tha abova address. This account is taxable in accordance with the InheritancB Tax Laws of thB Commonwaalth
of Pennsylvania. Questions .ay bB answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 010-0102574 Oat. 01-06-2000
Established
x
1,040.20
50.000
520.10
.15
78.02
To insure proper credit to your account, two
(2) copies of this notice IIUst acco.pany your
payment to the Ragister of Wills. Haka chBck
payable to: "Register of Wills, Agant".
Account Balance
Percent Taxable
AMount Subiect to
Tax Rate
Potential Tax Due
x
NOTE: If tax paymants are .ade within thraa
(3) months of the decedant's date of daath,
you may deduct a 5~ discount of the tax dua.
Any inharitance tax dua will beco.a delinquent
nine (9) 1I0nths after the date of death.
Tax
PART TAXPAYER RESPONSE
[!]~~!~~~~.!liii.li!i"'!I!i~~~~iiiii.I~!!ii!~~iiii~I!!!!.~I~~~[i!!i~~I!iil~.I!.~llll.g]ili!'!!li~I~~lli!.~!1I!i!!il
[CHECK ]
ONE
BLOCK
ONLY
A. IJI The above infor.ation and tax due is corract.
~ 1. You Ilay choose to ramit payment to the Registar of Wills with two copies of this notice to obtain
a discount or avoid intarast, or you may check box "A" and return this notice to tha Ragister of
Wills and an official assassmant will be issuad by the PA Depart.ant of Revanue.
B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent.s represantative.
c. D The above information is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART 0 and/or PART ~ below.
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. AMount Taxable
7. T.x Rate
8. Tax Due
1
2
3 X
4
5
6
7 X
8
PART
@]
TAX RETURN - COMPUTATION
If you indicate a different tax rate~ please state your
relationship to decedent:
OF TAX ON JOINT/TRUST ACCOUNTS
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line S of Tax COMputation)
I
$
rjury~ I declare that the facts I
nowledge and belief.
h.ve reported above .re tru.~ correct and
HOME (717) "l.;l/- Rr~-.:;
WORK ( )
TELEPHO NUMBER DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicablB interest based on information
submitted by the financial institution.
Z. InheritancB tax becomes delinquent nine months after tha dacedent's date of death.
3. A joint account is taxable even though the decedent's na.e was added as a matter of convenience.
4. Accounts (including those held betwBsn husband and wife) which the decadent put in joint names within one year prior to
death are fully taxable as transfars.
5. Accounts established jointlY batwBen husband and wife more than one year prior to death arB not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A _ If the information and computation in the notice are correct and deductions are not being claimed~ place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it them with your check for the amount of
tax to the Register of Wills 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 Wills.
Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative~ place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
COpy and return to the PA Department of Revenue~ Bureau of Individual Taxes~ Dept Z80601~ Harrisburg~ PA 171Z8-0601 in the
envelope provided.
3. BLOCK C _ If the notice inforllation is incorrect and/or deductions are being claillled~ check block "e" and complete Parts Z and 3
according to the instructions below. Sign two copies and sub.it thell with your check for thill allount of tax payable to the Register
of wills of the county indicated. The PA Departllent of Revenue wUl issue an officiar"asslB!lriiBnt (Form REV-1548 EX) upon receipt
of the return frail the Register of wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originallY was established or titled in the manner existing at date of death.
For a decedent dying after lZ/IZ/8Z: Accounts which the decedent put in joint names within one (I) year of death are
taxable fully as transfers. However~ there is an exclusion not to exceed $3~DDO per transferee regardless of the value of
the account or the nUllber of accounts held.
If a double asterisk (MM) appears before your first nalle in the address portion of this notice~ the $3~OOO exclusion
already has been deducted from the account balance as reported by the financial institution.
Z. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is deterllined as follows:
A. The percent taxable for joint assets established 1I0re than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Exemple: A joint asset ragistered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the nalle of the decedant and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100
16.77. (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent.s death or accounts owned by the decedent but held
in trust for another individual{s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Exallple: Joint account registered
the decedent.
1 DIVIDED BY Z (SURVIVORS) = .5D
in the name of the decedent and two other persons and established within one year of death by
X IDD
5D7. (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is deterllinad by lIultiplying the account balance (line Z) by the percent taxable (line 3),
5. Enter the total of the debts and deductions listed in Part 3.
6. The allount taxable (line 6) is deterllined by subtracting the debts and deductions (line 5) frail the allount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
p ounlller at
death to or for the use of a natural parent~ an adoptive parent~ or a stepparent of the child is D7..
The lineal class of heirs includes grandpBrents~ parents~ children~ and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others~ adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their d8scendants~ whether or not they have been adopted by others~ adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals who have at least one parent in com.on with the decedent~ whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
Date of Death Spouse Lineal Sibling Collateral
07101/94 to 12/31/94 37. 67. 157. 157.
01/01/95 to 06/30/00 07. 67. 157. 157.
07101/00 to present 07. "+.5%'- 127. 157.
_The tax rate 111 osed on the nBt value of transfers from 8 deceased Ch1ld twenty-one years of age or .
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are ~eterllined as follows:
A. You legally are responsible for payment~ or the estate subject to ad.inistration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent.
C. Debts being claimed dust be itemized fully in Part 3. If additional space is needed~ use plain paper 8 1/2" x 11". Proof of
pay.ent may be requested by the PA Departllent of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV.1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
KNOBLE JOSEPH D
1621 MOUNTAIN RD
DAUPHIN, PA 17018
_nnn_ told
ESTATE INFORMATION: SSN: 200-22-6463
FILE NUMBER: 2104-1116
DECEDENT NAME: COOPER WilLIAM J JR
DATE OF PAYMENT: 03/07/2005
POSTMARK DATE: 03/04/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2004
NO. CD 005029
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05103566 I $78.02
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 3341
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$78.02
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRIS8URG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
KNOBLE JODI 0
1621 MOUNTAIN RD
DAUPHIN, PA 17018
____uu fold
ESTATE INFORMATION: SSN: 200-22-6463
FILE NUMBER: 2104-1116
DECEDENT NAME: COOPER WilLIAM J JR
DATE OF PAYMENT: 03/07/2005
POSTMARK DATE: 03/04/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2004
NO. CD 005030
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05103570 I $78.02
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$78.02
REMARKS:
CHECK# 1240
SEAL
INITIALS: HA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU Of I"IDIVlDUALTAxES -
INHERITANCE T~XDI~IS10H
PO BOX 2806Dl
HARRISBURG PA 17128-0601
NOTICE Of INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLDWANCE
Of DEDUCTIONS AND ASSESSHENT Of TAX
, "
"';, :~3
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-14-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
101
r>--'
CARL,SWASS
CALDWELL & KEARNS
3631 N FRONT ST
HBG PA 17110
'*'
REV-I!j~7 EK iFP U2-04)
WILLIAM
J
A.aunt Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV :r~~-Ex--Ai!"--rDr--6!"-Ni5T"fcE.iiF-1:NHIR-i'i'liilcE-i"Ax-A-PPRA"i'sEMiNT;-.ACLiiwliilcE.bli--..._.__.._- - ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF COOPER JR WILLIAM J FILE NO. 21 04-1116 ACN 101 DATE 02-14-2005
TAX RETURN WAS.. (X I ACCEPTED AS fILED
I CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule AJ
2. Stocks and Bonds (Schedule 8)
3. Closely Held stock/Partnership Interest (Schedule CJ
4. Mortgages/Notes Receivable (Schedule OJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
III
121
131
141
151
161
171
.00
.00
.00
.00
11,474.99
.00
.00
181
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad... Costs/Misc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
191
1101
8,476.07
1.650.06
1111
1121
1131
1141
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax paYllent.
11,474.99
1 n .126 13
1,348.86
.00
1,348.86
14, IS and/or 16, 17, 18 and 19 will
returns assessed to date.
TAX CREDTTS:
eft" l<' AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID I-I
12-03-2004 COO04703 3.03 57.51
TOTAL TAX CREDIT 60.54
BALANCE OF TAX DUE .16
INTEREST AND PEN. .00
TOTAL DUE .16
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
.OOXOO=
1,348.86 X 045=
.00 K 12 =
.00XI5=
1191=
~
.00
60.70
.00
.00
60.70
. If PAID AfTER DATE INDICATED, SEE REVERSE
fOR CALCULATION Of ADDITIONAL INTEREST.
If TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
If TOTAL DUE IS REfLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
A REfUND. SEE REVERSE SIDE Of THIS fORM fOR INSTRUCTIONS. I
J2t;i
5\""
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
*'
INFORMATION NOTICE
T~r.~ r- AND
TAXPAYER RESPONSE
'1;
FILE NO. 21 04-1116
ACN 05103712
DATE 02-18-2005
REV-lS45 EX.FP !D9-GDJ
TYPE OF
ACCOUNT
D SAVINGS
D CHECKING
D TRUST
IX] CERTlF.
TO:
^. ,
Ll
;Z;~9. OF WILLIAM J COOPER
5.5. NO. 200-22-6463
DATE OF DEATH 09-05-2004
COUNTY CUMBERLAND
REMIT PAYMENT ANO
REGISTER OF WILLS
CUMBERLAND CO COURT
CARLISLE, PA 17013
FORMS
MARK A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
HOUSE
FULTON BANK has provided the Deparblent with the in for_at ion listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent. YOU were a joint owner/beneficiary of
this account. If you feel this information is incorrect. please obtain written correction from the financial institution. attach a COpy
to this form and return it to thB abOVB addrBss. This account is taxable in accordancB with the InhBrltance Tax laws of the Co.monwBalth
of PBnnsylvania. Questions .ay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING ANn PAYMENT INSTRUCTIONS
Account No. 010-0152793 Oata 04-18-2001
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
3,058.32
50.000
1,529.16
.15
229.37
To insure proper credit to your account, two
(2) copies of this notice must acco_pany your
payment to the Register of Wills. Make chBck
payable to: nRegister of WillS. Agent".
x
NOTE: If tax pay.ents are _ade within thrae
(3) months of thB decedent's date of dBath.
you may deduct a 5X discount of the tax due.
Any inheritancB tax dUB will become delinquent
nine (9) .onths aftBr the date of death.
Tax
PART TAXPAYER RESPONSE
[!].I~~.i!!!.I!!!._!!!i~~~~!!!!!II.~!lli~~!!!I.!!II.~~~~~!mmlt.il!!~__!i!!~g~II!!iml!!!.~~!!!!!.~~!!!!!!1
[CHECK ]
ONE
BLOCK
ONLY
A. D The above information and tax dUB is correct.
1. You .ay choose to rBmit payment to the Register of Wills with two copies of this noticB to obtain
a discount or avoid interest. or you flay check box "An and return this notice to the Register of
Wills and an official assessment will be issued by thB PA Department of Revenue.
B. 0 The above asset has beBn or will be rBportBd and tax paid with the PBnnsylvania InheritancB Tax return
to be filed by thB decedent's representative.
C. rl1 The above infor.ation is incorrect and/or debts and deductions were paid by you.
~ou .ust co.plete PART 0 and/or PART ~ below.
PART If you indicate a different tax rat., lpl~a,e~state your
[!l relationship to decedent: (1t'b." d ~)~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TR~ ACCOUNTS
LINE I. Date Establi.hp~ 1 S'i \)~ l.f-I~ .Zov/
2. Account Balance 2 ""'?, {)~tS. ::\'"'1-
3. Percent Taxable 3 X ~O
4. Allount Subject to Tax 4 I '5 l.. '1. I (0
5. Debts and Deductions.5 I ~~~. /t;.?
6. Amount Taxable 6
7. Tax R.te 7 X
8. Tax Due 8
IO<t~
&
PART
[!]
DATE PAID
~/~/".l~
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
:;;zj'
C,vl/ /~,r/ ;"-.wlt"'rc
DESCRIPTION
G,"'....:IluH".f rvl'lC''-d.
AMOUNT PAID
I
TOTAL
(Enter on Line 5 of Tax Computation)
I
$
~,oo
Z 0,'00
Under penalties of
;:7~
AXPAYER IGNATURE
declare that the facts I
nd belief.
have reported above are true, correct
HOME (/).)~) Z/3-G?bb
WORK ( )
TELEPHO MBER
and
v.......
'$-<;-05- .
DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforllation
sub.itted by the financial institution.
2. Inheritance tax becomes delinquent nine .onths after the decedent's date of death.
3. A joint account is taxable even though the decedent's na.e was added 8S a .atter of conveniance.
4. Accounts (including those held between husband and wifs) which the decedent put in joint na.es within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife .ora than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust forn another Dr others are taxable fully.
REPORTING INSTRUCTIONS
PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the infor.ation and computation in the notice are correct and deductions are not being clai.ed, place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit the. with your check for the amount of
tax to the Register of Wills of the county indicated. The PA Depart~ent of Revenue will issue an official assess.ent
(Form REV-1548 EX) upon receipt of the return from the Register of Wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Depart~ent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BlDCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and cOllplllllte Parts 2 and 3
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (For. REV-1548 EX) upon receipt
of the return from the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
lINE
1. Enter
NOTE:
the date the account originallY was established or titled in the manner existing at date of death.
For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the nullber of accounts held.
If a double asterisk (MM) appears before your first name in the address portion of this notice, the $3,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established .ore than one year prior to the decedent.s death:
I DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Example: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the na.e of the decedent and two other persons.
I DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100
16.7X (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent.s death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Exa.ple: Joint account registered
the decedent.
I DIVIDED 8Y Z (SURVIVORS) = .50
in the name of the decedent and two other persons and established within one year of death by
X 100
sox (TAXABLE FOR EACH SURVIVOR)
4. The amount SUbject to tax (line 4) is determined by .ultiplying the account balance (line 2) by the percent taxable (line 3).
5. Enter the total of the debts and deductIons listed in Part 3.
6. The Mount taxable (line 6) is deterllined by SUbtracting the debts and deductions nine 5) froll the amount subject to tax nine 4).
7. Enter the appropriate tax rate (line 7) as determined below.
Dat. of Death Spouse Lineal Sibling Collateral
07101/94 to 12/31/94 3% 6'- 15'- 15%
01/01/95 to 06/30/00 0'- 6'- 15'- 15'-
07101/00 to present 0'- 4.5%- 12'- 15'-
MThe taX rate l.posed on the not value 0' transfers from a deceased chIld twenty-one years of age or y
ounlller at
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the chIld is OX.
The lineal class of heirs includes grandparents, parents, chIldren, and lineal descendents. "Children" includes natural chIldren
whether or not they have been adopted by others, adopted children and step children. "lineal descendents" includes all children of the
natural parents and theIr descendents, whether or not they heve been adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are deter.ined as follows:
A. You legally are responsible for payment, or the estate subject to ad.inistration by a personal representative is insufficient
to pay the deductible ite.s.
8. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed .ust be itedzed fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of
payment day be requested by the PA Depart.ant of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG~ PA 17128-0601
*:r'.
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 04-1116
ACN 05103713
DATE 02-18-2005
UV-15UEXAFP (09-00)
r: .". r'" '.' ~ r.~ r, I
Ll-u~ rihi\ L
( "I':':
1 ,j J._
')(1
(..U
TVPE OF
ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IX] CERTIF.
EST. OF WILLIAM J COOPER
5.5. NO. 200-22-6463
DATE OF DEATH 09-05-2004
COUNTY CUMBERLAND
MARK A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FULTON BANK has provided the Department with the inforllation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent~ you were a joint owner/beneficiary of
this account. If you feel this information is incorrect~ please obtain written correction from the financial institution~ attach a copy
to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
Date
Established
REVERSE SIDE FOR
04-18-2001
FILING AND PAVMENT INSTRUCTIONS
COMPLETE PART 1 BELOW.
Account No. 010-0152792
. . SEE
x
10,194.30
50.000
5,097.15
.15
764.57
To insure proper credit to your account~ two
(2) copies of this notice .ust acco.pany your
pay.ent to the Register of Wills. Make check
paYable to: "Register of Wills~ Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
NOTE: If tax pay.ents are .ade within three
(3) .onths of the decedent's date of death~
you ..ay deduct a SX discount of the tax due.
Any inheritance tax due will beCOMe delinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
[!]R~~~.i!i!.iiil..!!I:I~~~!!!!!~.~!!!!!~I!i!i.!i!i.~~~~~1!1!!~.!!!!~."~ii!!.!I!!i!.!!!~I~~!!!!!.~.!i!!~
[CHECK ]
ONE
BLOCK
ONLY
A. D The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills 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
Wills and an official assessment will be issued by the PA Department of Revenue.
B. 0 The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. ~he above infor.ation is incorrect and/or debts and deductions were paid by you.
~~~u .ust co.plete PART 0 and/or PART @] below.
PART If you indicate a different tax rat. I ple,se state your
[!l relationship to deced.nt: (, ~ "" ~ ~) ~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Oat. E.tablished 1 ., ~ _.J- Lf-lfT-zuJI
2. Account Balanc. 2 /0, /7'/.30
3. Percent Taxable 3 X ~O.
4. Amount Subject to Tax 4 S-. 0 'j 7./ S-
5. Debts and Deductions 5 '~.....9t;/ ,.;-
6. Allount Taxable 6 0
7. Tax Reta 7~ ~t.--w5..
8. Tax Due 8 0
PART
@]
DATE PAID
4/"i/t>f
DEBTS AND DEDUCTIONS CLAIMED
PAVEE
:SU11,'~l'r,.v F~If7t!!!',..Gc.--/
DESCRIPTION
r"'I"u",J< .h-.I-t..-A ~t.h1~rr..... tJ.
I
$
AMOUNT PAID
~~Z ~ 'f
zS-O . to)
I
TOTAL (Enter on Line 5 of Tax COIIPutation)
Under penalties
c~!l.~to the best
d../~
TAXPAV SIGNA E
perjury I I declare that the fects I
"ledge and belief.
have r.por~d above ere tru81 correct
HOME (7P'$') z/3-c, 7tb&
WORK ( )
TELEPHO NUMBE
....d
0--
3-{ -o.5~
DAT
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance tax becomes dalinquent nine months after the decedent"s date of death.
3. A joint account is taxable even though the decadent's nama was added as a _attar of convanience.
4. Accounts (including thosB held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly batwsan husband and wife mars than one year prior to death are not taxabla.
6. Accounts held by a decedent "in trust for" another or othars are taxable fully.
REPORTING INSTRUCTIONS
PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the infor.ation and co.putation in the notice are correct and deductions are not being clai.ed~ place an "X"
in block "A" of Part 1 of the "Taxpayer Responseft section. Sign two copies and submit the. with your check for the a.ount of
tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent
(Form REV-1548 EX) upon receipt of the return fro. the Register of Wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative~ place an ")eft in block "Bft of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue~ Bureau of Individual Taxes~ Dept 280601~ Harrisburg~ PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice infor.atIon is incorrect and/or deductions are being clailled~ check block ftC" and co.plete Parts 2 and 3
according to the instructions below. Sign two copies and sub.it them with your check for the a_ount of tax payable to the Register
of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (Form REV-1548 EX) upon receipt
of the return fro. the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originally was established or titled in the manner existing at date of death.
For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However~ there is an exclusion not to exceed $3~000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (MM) appears before your first na.e in the address portion of this notice, the $3,000 exclusion
already has been deducted fro. the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxabla for each survivor is deterllined as follows:
A. Tha percent taxable for joint assets established more than one year prior to tha decedent.s death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Exampla: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the na.e of tha decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) - .167 X 100
16.71. (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent"s daath or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries);
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Example:
Joint account registered
the decedent.
BY 2 (SURVIVORS) ;; .50
in the na.e of the decadent and two other persons and established within ona year of death by
I DIVIDED
X 100
501. (TAXABLE FOR EACH SURVIVOR)
4. The amount SUbject to tax (line 4) is deter.ined by mUltiplying the account balance (line Z) by the percent taxabla (line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The a.ount taxable (line 6) is deter.ined by subtracting tha debts and deductions (line 5) from the allount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
Date of De.th Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3r. 6r. 15r. 15r.
01/01195 to 06/30/00 Or. 6r. 15r. 15r.
07/01/00 to present Or. q..Sr.- 12r. 15r.
MI he tax rate J..posetl on the not valua of transfers fro. a decaased Chlld twanty-one years of age or y
ounger at
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 01..
The lineal class of heirs includes grandparents~ parents. children~ and lineal descendents. nChildren" includas natural children
whether or not they have been adopted by others~ adopted children and step children. "Lineal descandentsft includes all children of the
naturel parents and their descendents~ whether or not they hava been adopted by others. adopted descendents and their descendants
and step-dascendants. ftSiblingsft are defined as individuals who have at least one parent in co..on with the decadent~ whether by blood
or adoption. The "Collateralft class of hairs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally are responsible for payment, or the estate subj8ct to ad.inistration by a personal representative is insufficient
to pay'the dsductible ite.s.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed ~ust be ite.ized fully in Part 3. If additional space is needed~ use plain paper 8 1/2" x 11". Proof of
payment may be requested by the PA Depart.ent of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z8D60l
HARRISBURG, PA 171Z8-D6Dl
c*c
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 04-1116
ACN 05103567
DATE 02-18-2005
:'R~V~lS45EX AFP m-OGI
2
L~:: ~~O
EST. OF WILLIAM J COOPER
5.5. NO. 200-22-6463
DATE OF DEATH 09-05-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IX] CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
MARK A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
FULTON BANK has provided the Department with the inforllation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the 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 lIay be answered by calling (717) 787-83Z7.
Dat.
Established
REVERSE SIDE FOR
01-06-2000
FILING AND PAYMENT INSTRUCTIONS
COMPLETE PART 1 BELOW.
Account No. 010-0102576
. . SEE
x
1,040.20
50.000
520.10
.15
78.02
To insure proper credit to your eccount, two
(Z) copies of this notice lIust accompany your
pay.ent to the Register of Wills. Make check
payable to: "Register of WillS, Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
NOTE: If tax paYllents are made within three
(3) lIonths of the decedent's date of death,
you may deduct a 5X discount of the tax due.
Any inheritance tax due will becolle delinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
[!]e~~~.ilil.i:IIBl!Eillil~~~ilill_~illll~IIII!.I:II.I~~~~~iil!:~I!II~__ll:!..illl.iii!~~~llil!.~~I~i!!1
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The above information and tax due is correct.
1. You .ay choose to rellit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you lIay check box "A" and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA Department of Revenue.
B. 0 The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
c. ~ The above inforllation is incorrect and/or debts and deductions were paid by you.
~You lIust cOBPlete PART ~ and/or PART ~ balow.
lINE
1. Date Established
2. Account Balance
3. Percent Taxable
4. A.ount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rat.
8. Tax Due
OF TAX ON JQINT/TR4ST ACCOUNTS
1 <-r 6.- tJ "t: J..::k::ZpClJ
2 I.04-().lJ:)
3 X ~D.tXJ
4 S2.0.IO
5 ">:zu..,..LD
6 !
7 X , <2"15
8 '0__
DEBTS AND DEDUCTIONS CLAIMED
PART
[!]
TAX RETURN - COMPUTATION
If you indicate a different ~x rate~ ;t~~e~ate your
relationship to decedent: f~~
PART
~
DATE PAID
~/"},0'Y
PAYEE DESCRIPTION
_ ~v//;J..J rJH',""PI te'Mr/ ~A ,^JH"" f I
TOTAL (Enter on Line 5 of Tax Computation) $ ~~~).
facts I have reported above are tru.~ correct and
(90S'-) z13--6 7& b
( )
ONE NUMB
AMOUNT PAID
2~, S'D rCY)
\)-
HOME
WORK
TEL
3-Y.6S'.
DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSI1ENT with applicab1lil interest based on information
sub.lttsd by the financial institution.
2. Inheritance tax beeo.es delinquent nine months after the decedent.s date of death.
3. A joint account is taxabla even though the deCBdent's na.e was added as a matter of convenience.
4. Accounts {including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife more than one year prior to death are not taxable.
6. Accounts held by 8 decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS
PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice are correct and deductions are not being clai.ed, place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit the. with your check far the aIIount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(For. REV-1548 EX) upon receipt of the return from the Register of Wills.
Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
COpy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect andlor deductions are being claimed, check block "C" and complete Parts 2 and 3
according to the instructions below. Sign two copies and sub. it them with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assess.ent (Form REV-1548 EX) upon rec8ipt
of the return from the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
lINE
1. Enter
NOTE:
the date the account originally was Bstablished or titled in the manner existing at date of death.
For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (MM) appears before your first na.e in the address portion of this notice, the $3,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is deter.ined as follows:
A. The percent taxabla for joint assets established more than one year prior to the decedent"s death:
DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Example: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100
16.7% (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets creat8d within one year of the decedent"s deeth or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X IDo
PERCENT TAXABLE
Example: Joint account registered
the decedent.
1 DIVIDED BY 2 (SURVIVORS) = .So
in the name of the decedent and two other persons and established within one year of death by
X 100
SO% (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3).
S. Enter the total of the debts and deductions listed in Part 3.
6. Tha a.ount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as deter.ined below.
p ounger at
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is n%.
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. ftLineal descendents" includes all children of the
natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants
and stap-descendants. "Siblingsft are defined as individuals who have at least one parent in com.on with the decedent, whether by blood
or adoption. The ftCollateral" class of heirs includes all other beneficiaries.
Dat.e of Death Spouse lineal Sibling Collat.eral
07/01/94 to 12/31/94 3" 6" 15" 15"
01/01/95 to 06/30/00 0" 6" 15" 15"
07/01/00 to present. 0" 4.5%- 12" 15"
MThe tax rate 1m osed on the not value 0' transfers froR a deceased chIld twenty-one years of age or y
CLAIMED DEDUCTIONS
PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are deter.ined as follows:
A. You legally are responsible for payment, or the estate subject to adRinistration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed BlUst be itemized fully in Part 3. If additional space is needed, use plain paper B 112" x 11ft. Proof of
payment .ay be requested by the PA Department of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT DF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
-'TAXPAV~N~ESPONSE
FILE NO. 21 04-1116
ACN 05103711
DATE 02-18-2005
REV-15~S E~ UP (D9~.DIl
21
SSr2DbF WILLIAM J COOPER
5.5. NO. 200-22-6463
DATE OF DEATH 09-05-2004
:RIjlUNTY CUMBERLAND
TVPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
!Xl CERTIF .
MARK A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FULTON BANK has provided the Departllent with the inforllation listed below which has been used in
calculating ths potsntJaJ tax due. Their records indicate that at the death of the above decedent, YOU were 8 joint owner/beneficiary of
this accoynt. If you feel this information is incorrect, please obtain written correction from the 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 Co~monwealth
of Pennsylvania. Questions !lay be answsred by calling (717) 787-8321.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 010-0152794 Oat. 04-18-2001
Established
K
3,058.32
50.000
1,529.16
.15
229.37
To insure proper credit to your account, two
(2) copies of this notice .ust accollpany your
pay_snt to the Register of Wills. Make check
payable to: "Register of Wills, Agsnt".
Account Balance
Percent T&lxable
Amount Subject to
Tax Rat.
Potential Tax Due
K
NOTE: If tax paYflents ars ",ads within three
(3) 1I0nths of the decedent's dats of death,
YOU .ay deduct a 5X discount of the tax dus.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART TAXPAYER RESPONSE
ill 1lI,~.mlllTI..t.l.':!:!I!....:,::.m.~1I.iIIIl\i!~.i~.t..~1iI1...lfml
,..,........--.....,.......,.>........,.... .."...',.,......-.,~,.,.,.....~.,.,,'...,....... .."",.........,...".,......",.,..,....... ,',',.,.........-,,',.,.,........,.,.,.,.,........,....,........
..'.....,.,..............,.,.......-.,.......,.,.... .........,.,.....-................. .................. ..........,..........,.,.,.....-....,.,...... ....,.,......<:<;<..,......
..".,.,...,....
...........,.............................................,.,............,............,.....-..............................,................................................,........-.....,............
,.,.......................,......................................................................-.......................
[CHECK ]
ONE
BLOCK
ONLY
A. c=J The above information and tax due is correct.
1. You .ay choose to re_i1; pay.ent to the Register of Wills with two copies of this notice to obtain
8 discount or avoid interest, or you may check box nA" and return this notice to the Register of
Wills and an official asssssment will be issued by the PA Depart.snt of Revenue.
B. 0 The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent. 5 representative.
c. ~ The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust cQ.plete PART 0 and/or PART ~ below.
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date Esteb~i=hed
2. Account Balance
3. Percent Taxable
4. A.ount Subject to Tax
S. Debts and Deductions
6. A.ount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
6
7
8
K
TAX ON JOINT/TRUST ACCOUNTS
5 - - r LI-:Jk:.?<XJ(
-",oS"8.:">::J
5b
IS2<J,/b
,
._ 0
15;;;J.'],/(P
/o'lS __
'-f?8/
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rajr.' ~ase state your
relationship to decedent: qh.... on. c:;,n .
K
PART
@]
DATE PAID PAYEE
~/~k)t11 S-hA't, v?;7""P/-/- ~ ~/.
I
TOTAL (Enter on Line S of Tax Computation)
DjSCRIPTION
/ftP~ ~
AMOUNT PAID
570.XI.
I
$
perjury, I declare that the facts I
ledge and belief.
have reported above are true, correct
HOME ( ~) ZI3.G, 7&1"
WORK ( )
T EP UMB R
and
,)-
i - ']- -CJ5"
ATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforllation
sub.itted by the financial institution.
Z. Inheritance tax beco.es delinquent nins months after tha decedent"s date of death.
3. A joint account is taxable even though the decedent"s name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint nBlles within one year prior to
death are fully taxable as transfars.
5. Accounts established jointlY between 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 ara taxable fully.
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
1. BLOCK A - If ths inforllation and cODlputation in tha notica ara corract and daductions are not being clailled, place an "X"
in block "A" of Pa...t 1 of the "Taxpaye... Response" sectiDn. Sign two cDpies and submit thell wi th YOU... check fa... the allDunt of
tax to thB Ragista... Df Wills Df tha cDunty indicated. Tha PA Depa...tDlent Df Revenua will issue an official assessment
(Fo...m REV-1548 EX) upon "'Bceipt of the ...etu...n f...om the Registe... Df Wills.
2. BLOCK B - If the asset specified Dn this notice has been D'" will be repo...ted and tax paid with the Pennsylvania Inheritance
Tax Retu...n filed by the decedent's ...ep...esentative, place an "X" in block "B" of Pa...t 1 Df the DTaxpayer RespDnse" section. Sign one
CDPY and return tD the PA Departllent of Revenue, Bureau of Individual Taxes, Dept 280601, Ha......isbu...g, PA 17128-0601 in the
envelope providad.
3. BLOCK C - If the notice information is incor...ect and/or deductions are being claimed, check block "C" and cOllplete Parts 2 and 3
according tD the instructions below. Sign two copies and submit thell with your check for the amount of tax payable to the Register
Df Wills of the county indicated. The PA Departlllent of Revenue wIll issue an official asssssllent (Form REV-1548 EX) upDn ...eceipt
of the ...eturn frolll tha Register of Wills.
TAX RETURN
PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the dats the account originally was established or titled in the lIanner existing at date of death.
For a decedant dying after 12/12/82: Accounts which the decedent put in joint nallles within Dne (1) yea... Df death are
taxable fully as transfers. Howeve..., there is an exclusion not to axceed $3,000 par transferee regard lass of the value of
the account or the nUlllbar of accounts hald.
If a double asterisk (..) appears before YDU... fi...st nallle in tha address portion of this notica, tha $3,000 exclusion
alraady has been deducted f...olll the account balanca as ...epo...ted by the financial institutiDn.
2. Enter the total balance Df the account including interest accrued to the date Df death.
3. The percent of the account that is taxable fo... each su...vivor is deterllined as follDws:
A. The percent taxable for joint assets established 1I0...e than one year prior tD the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
EXBllple: A jDint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the name of the decedent and two othe... pe",sDns.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) ; .167 X 100
16.7X (TAXABLE FOR EACH SURVIVOR)
B. The pe...cent taxable for assets c...eated within one year of the decedent's death 0... accDunts owned by the decedent but held
in trust fo... another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Exallple: Joint account registe...ed
the decedent.
1 DIVIDED BY 2 (SURVIVORS) ; .50
in the nalle of the decedent and two other parsons and established within one yea... of death by
X 100
sox (TAXABLE FOR EACH SURVIVOR)
4. The alllDunt subject to tax nine 4) is dete"'lIIined by lIultiplying the account balance nine 2) by the pe...cant taxable (line 3).
5. Enter the total Df tha debts and deductions listed in Part 3.
6. The amount taxabla (lina 6) is deterllined by sUbt...acting the debts and deductions (line 5) f...oll the amount subject to tax (line 4).
7. Enter the appropriate tax ...ate (line 7) as determined below.
p ounger at
death to or for the use of a natu...al pa...ent, an adoptive pa...ent, 0... a steppa...ent Df the child is OX.
The lineal class of heirs includas grandpa...ents, parents, childran, and linaal descandants. "Childran" includas natu...al children
whether or nDt thay have been adopted by others, adDpted children and step children. "Linaal descendents" includas all childran Df tha
natural parents and their descendents, whathe... Dr nDt thay hava baan adopted by Dthars, adDpted descendants and thei... descendants
and step-descendants. "Siblings. are defined as individuals who have at least one parent in comllon with the decedent, whether by blood
or adoption. The "Collateral" class of hairs includas all othar benaflclaries.
Date of D..th Spouse lineal Sibling Collateral
07/01/94 to 12/31/94 3X 6X 15% 15%
01/01/95 to 06/30/00 OX 6X 15X 15X
07/01/00 to present OX ~..5%. 12X 15X
.The tax rata~ osad Dn tha net value of transfars froll a deceasad Ch11d twenty-ona years of aga or y
CLAIMED DEDUCTIONS
PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable dabts and deductiDns are deter~Ined as follows:
A. You lagally are ...esponsibla for pay~ent, or the estate subject to adllinist...ation by s pa...sonsl rap...esantativa is insufficient
to pay the deductible itells.
B. You actually paid the dabts after death of the decedent and can furnish proof of paYllent.
C. Debts being clai.ad lIust be ltellized fully in Part 3. If additional specs is needed, use plain paper 8 112" x 11". Proof of
payment may be requested by the PA Dapart.ant Df Revanua.
CDHHDNWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*.............
........ .. .....
, .',
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 04-1116
ACN 05103569
DATE 02-18-2005
REV~1545 EX AFP (og-Oo>
,'~~ 2 i FV,12: 2
EST. OF WILLIAM J COOPER
5.5. NO. 200-22-6463
DATE OF DEATH 09-05-2004
COUNTY CUMBERLAND
TVPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IXI CERTIF.
MARK A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FULTON BANK has provided thlll Departlllllnt with the inforllation listed below which has blllsn used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this infor_atien is incorrect, please obtain written correction froll the financial institution, attach a coPy
to this forll and return it to the above address. This account is ta~able in accordance with the Inheritance Tax laws of the Co~monwealth
of Pennsylvania. Questions .ay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
Account No. 010-0120569 Oat. 06-06-2000
Established
K
2,033.96
50.000
1,016.98
.15
152.55
To insure proper credit to your account, two
(2) copies of this notice must aCCOllpany your
pay.ant to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Perceni Taxable
Amount Subject to
Tax Rat.
Potential Tax Due
K
NOTE: If tax paYflents are lII'ada within three
(3) Months of the decedent's date of death,
yoU .ay deduct a 5~ discount of the tax due.
Any inheritance tax due will beco_e delinquent
nine (9) lIonths after the date of death.
Tax
PART TAXPAYER RESPONSE
[!] Jf,J~.'!.".I!!!!BIII~'J!~t.~.I.__"'i!i!.ii~~I~t..
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The above InforlUltion and tax due is correct.
1. You .ay choose to rBllit paYllent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you lIay chlilck box "A" and return this notice to the Register of
Wills and an official assass~t will be issued by the PA Depart.ent of Revenue.
B. 0 The abovlII iI!lSSliIt has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent"s rlilpresentative.
c. ~The above infor.ation is incorrect and/or debts and deductions were paid by you.
.~You lIust cOllplete PART 0 and/or PART ~ below.
LINE
1. Data Estab1i3hed
2. Account Balance
3. perceni Taxable
4. Amount Subject io Tax
S. Debts and Deductions
6. AMouni Taxable
7. Tax Raie
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1 L. -/p - zoocJ
2 '2. o~:,.4 t>
3 K 5b.oO
~ I, C> 1l1l'"'T'6'
5 - <::;)
6-l.o/(p8R
7 K '.~S-
8_ 'I~ ,(,
DEBTS AND DEDUCTIONS CLAIMED
PART
I!I
TAX RETURN - COMPUTATION
If you indicate a differeni iax rai., ~1ease siat. your
rel.tionship to decedent: '1.rE~nA -;"1\....')
PART
~
DATE PAID
~"# 'AI'
, r
b
""
I
$
AMOUNT PAID
.0...
PAVEE
JL
,4 "
(dl ~.
TOTAL (Enter on Line S of Tax Computation)
/
k,../
DESCRIPTION
facts I
have reported above are tru., correct
HOME (-70.P) 2/3-(" 7b0
WORK ( )
TE EP NE NU ER
and
.J-
{;~-a;-
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infer_ation
sub.itted by the financial institution.
2. Inheritance tax becomes delinquent nine months after the decedent.s date of death.
3. A joint account is taxable even though the decedent's name was added as a _atter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint nages within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between 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 ara taxable fully.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the inforllation and cOllputation in the notice are correct and deductions are not being clailled~ pll!lce an "X"
in block "A" of Part 1 of the "Taxpayer Responsa" section. Sign two capias and submit them with your check for the l!IlIount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessllent
(Form REV-lS48 EX) upon receipt of the return froll the Register of Wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative~ place an "X" in block "BOO of Part 1 of the "Taxpayer Response" section. Sign one
COpy and return to the PA Department of Revenue~ Bureau of Individual Taxes~ Dept 280601~ Harrisburg~ PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions are being clailled~ check block "COO and complete Parts 2 and 3
eccording to the instructions below. Sign two copies and submit them with your check for the ~ount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assassllent (Forll REV-lS48 EX) upon receipt
of the return frail the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originally was established or titled in the lIanner existing at date of death.
For a decedent dying after 12/1Z/8Z: Accounts which the decedent put in joint nBlles within one (1) year of death are
tl!lxable fully as transfers. However~ there is an exclusion not to exceed $3~000 per transferee regardless of the value of
the l!Iccount or the nUllber of accounts held.
If a double asterisk (..) appears before your first n8lle in the address portion of this notice~ the $3~000 exclusion
already has been deducted from the account balance as reported by the financial institution.
Z. Enter the total balance of the account inclUding interest accrued to the dl!lte of death.
3. Tha percent of the l!Iccount that is taxable for each survivor is determined as fallows:
A. The percent taxable for joint assets established more than one year prior to the decedant's death:
I DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Exallple: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the nalle of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100
16.7X (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable far assets created within one year of the decedent.s death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Example: Joint account registered
the decedent.
1 DIVIDED BY 2 (SURVIVORS) = .50
in the nl!llle of the decedent and two other persons and established within one year of death by
X 100
50X (TAXABLE FOR EACH SURVIVOR)
4. The l!IIIount subject to tax (line 4) is deterllined by mUltiplying the account ball!lnce (line Z) by the percent taxable (line 3).
5. Enter the total of tha debts and deductions listed in Part 3.
6. The Mount taxable Cline 6) is deterllined by subtracting the debts and deductions Cline 5) froll the amount subject to tax Cline 4).
7. Enter the appropriate tax rate (line 7l l!IS determined below.
Dat. of De.th Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3X 6X 157. 15X
01/01/95 to 06/30/00 OX 6X 15X 15X
07/01/00 to present OX 4.5,.- 12X 15X
_The tax rate i.posed on the not vl!llue of transfers froll a deceased Chlld twenty-one years of age or y
ounger at
death to or for the use of a natural parent~ an adoptiva parent~ or a stepparent of the child is OX.
The lineal class of heirs includes grandparents~ pl!lrents~ childrBn~ and lineal descendents. "Children" includes natural children
whether or not they have been adopted by Dthers~ adopted children and step children. "lineal descendents" includes all children of the
natural parants and their descendents~ whether or not they have been adopted by others~ adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals who have at least one parent in co..on with the decedent~ whether by blood
or adoption. The "Colleteral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS
PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are deterllined as follows:
A. You legally are responsible for pl!lYII.nt~ or the estate subject to adllinistration by a personal representative is insufficient
to pay ths deductible itells.
B. You actually paid the debts after death of the decedent and can furnish proof of paYllent.
C. Debts being clai.ed lIIust be !tuized fully in Part 3. If additional space is needed~ use plain paper 8 1/Z" x 11". Proof of
paYllent lIay be requested by the PA Depart.ent of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 17128-0601
*
INFORMATION NOTICE
AND
1AXPAYER RESPONSE
FILE NO. 21 04-1116
ACN 05103568
DATE 02-18-2005
REV-1S~$.ElfAFP 119~Oo)
2i
1':'\1 '? 'i
I, [,,' <:0
EST, OF WILLIAM J COOPER
S. S. NO. 200-22-6463
DATE OF DEATH 09-05-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IX] CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MARK A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
FULTON BANK has provided the Department with the inforntion listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the 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 .ay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 010-0120566 Date 05-25-2000
Established
x
5,097.36
50.000
2,548.68
.15
382.30
To insure proper credit to your account, two
(2) copies of this notice must accompany your
pay~ent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax payments are made within three
(3) .onths of the decedent's date of death,
you .ay deduct a 5% discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) months after the date of death.
Tax
PART TAXPAYER RESPONSE
[!]lj!j!!!fhl~~.!i!i.!!~"!iiil~~~!!!!i_~!i!il~liiii.i!!i.~~.~~i!!i!~I!!i!ji__!I!!..~!I.~!!~I~lii!i.~~li!!!11
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The above information and tax due is correct.
1. You .ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you .ay check box "An and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA Department of Revenue.
B. 0 The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent"s representative.
C. ~he above information is incorrect and/or debts and deductions were paid by you.
You must complete PART 0 and/or PART ~ balow.
3
4
5
6
7
8
x
ON JOINT/TRUST ACCOUNTS
<; I, ,-.~ S--2S' 2D<. -
~oC; --, .:',(0
~o
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~.W
19~fcg-
.6't.':> ._
~'7,()t,C
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rat.~ tl.a~stat. your
relat ionship to decedent: 't V"" LA. W'\ ~
PART
@]
TAX RETURN - COMPUTATION
lINE 1. Data E$tabliahed
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
S. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX
1
2
x
PART
@]
DATE PAID
&j//"'./1?1
PAYEE
~UV1'7bJe'-r"/6 .f!p
~.
I
TOTAL (Enter on Line S
DESCRIPTION
/.-'.... nr-/'
AMOUNT PAID
"70.0U
of Tax Co~utatlon)
I
$
.....-"
Under penalties of perjury I
~~.Ykn
TAXPAYER GNATU
facts I have repor .d above are true, correct
HOME (~:4?) 21'5-"76:>
WORK ( )
EPHONE NUM R
and
63-7-0$-:
DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable intlarest based on inforllation
subllitted by the financial institution.
2. Inheritance tax beco.as delinquent nine .onths after ths decedent.s date of death.
3. A joint account Is taxable even though the decedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint na.es within one year prior to
death are fully taxable as transfers.
5. AccQunts established jointly between husband and wife .ore than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust forn another or others are taxable fully.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the inforMation and co.putation in the notice are correct and deductions are not being claimed~ place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it them with your check for the a.ount of
tax to the Register of Wills of the county indicated. The PA DepartMent of Revanue will issue an official asseSSMent
(Form REV-1548 EX) upon receipt of the return from the Register of Wills.
z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative~ place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue~ Bureau of Individual Taxes~ Dept 280601~ Harrisburg~ PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice info~ation is incorrect andlor deductions are being claimed~ check block "C" and co.plete Parts Z and 3
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of WIlls of the county indicated. The PA Depart.ent of Revenue will issue an official asseSSMent (For. REV-1548 EX) upon receipt
of the return from the Register of Wills.
TAX RETURN - PART
z
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originally was established or titled in the manner existing at date of death.
For a decedent dying after lZ/1z/8Z: Accounts which the decedent put in joint na.es within one (1) year of death are
taxable fully as transfers. However~ there is an exclusion not to exceed $3~OOO per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (MM) appears before your first name in the address portion of this notice~ the $3~OOO exclusion
already has been deducted from the account balance as reported by the financial institution.
Z. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established more than one year prior to the decedent"s death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Exa.ple: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BV Z (SURVIVORS) = .167 X 100
16.7r. (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent"s death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Example: Joint account registered
the decedent.
1 DIVIDED BY Z (SURVIVORS) = .50
in the name of the decedent and two other persons and established within one year of death by
X 100
50r. (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax Uine 4) is determined by multiplying the account balance (line 2) by ths psrcsnt taxable Uine 3).
5. Enter the total of the debts and deductions listsd in Part 3.
6. The amount taxable (line 6) is deter.ined by subtracting ths debts and deductions (li~e 5) from the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
D.t. of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3% &% l5Y. 15%
01/01/95 to 0&/30/00 0% &% 15% 15%
07/01/00 to present 0% 4.5%- 12% 15%
MThe tax rate 1mposed on the not value of tran sfers fro. a dsceassd chlld twenty-one years of age or y
ounger at
death to or for the use of a natural parsnt~ an adoptive parent~ or a stepparent of the child is Dr..
The lineal class of heirs includes grandparents, parents~ chlldren~ and lineal descendents. "Children" includes natural children
whether or not thsy have besn adopted by others~ adopted children and step children. "Linsal dsscendsnts" includes all children of ths
natural parents and their descendents~ whether or not they have been adopted by others~ adopted descendents and their descendants
and step-descendants. .Siblings" are dBfined as individuals who have at least one parent in co..on with the decBdent~ whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally are responsible for payment~ or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid ths debts after death of the decedent and can furnish proof of payment.
C. Debts being clahed IIIUSt be it_lzed fully in Part 3. If additional space is needsd~ use plain paper 8 1/Z" x 11". Proof of
pay.ent lIIay be requested by the PA Department of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128,0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
COOPER MARK A
44 MEADOWVIEW DR
PHllLlPSBURG, NJ 08865
__nu__ fold
ESTATE INFORMATION: SSN: 200-22-6463
FILE NUMBER: 2104-1116
DECEDENT NAME: COOPER WilLIAM J JR
DATE OF PAYMENT: 03/21/2005
POSTMARK DATE: 03/21/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2004
NO. CD 005098
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05103711 I $68.81
05103569 I $45.76
05103568 I $89.04
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 5810
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$203.61
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 04-1116
ACN 05103571
DATE 02-18-2005
REY~154' EX AFP (O'.DD)
C-j
EST. OF WILLIAM J COOPER
i~. n NO. 200-22-6463
DATE OF DEATH 09-05-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
IX] CERTIF .
PAIGE
C/O 90R
ENOLA
M COOPER
WINTER LN
PA
REHIT PAYHENT AND FDRHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
17 025
FULTON BANK has provided the Departtlent with the inforllation listBd below which has been used in
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 written correction froll the 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 May be answered by calling (7l7) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AN~ PAYMENT INSTRUCTIONS
Account No. 010-0102577 Date 01-06-2000
Established
x
1,040.20
50.000
520.10
.15
78.02
To insure proper credit to your account, two
(2) copies of this notice must aCCOlllpany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
A.ount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax paYMents are lIade within three
(3) Months of the decedent's date of death,
you llIay deduct a SA: discount of the tax due.
Any inheritance tax due will becolle delinquent
nine (9) months after the date of death.
Tax
PART TAXPAYER RESPONSE
I!JI:iliiifhl_~.iiii.!i!I":iill~~~!!!!!"~iiiii~lili!.!j!!.~~i~aiiili~.I!I!Il..!IIlI!I!_i!!j~I!I!.~~~.~.!iliil
[CHECK ]
ONE
BLOCK
ONLY
A. D The above information and tax due is correct.
1. You may choose to re.it paYllent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "An and return this notice tq the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. D The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by tha decadent.s representative.
C. n The above inforlll8tion is incorrect and/or debts and deductions ware paid by you.
You Must cOMplete PART ~ and/or PART ~ below.
PART If you indicate a different tax ritte, ,elease jstajl:e your, _.... J,/"
~ relationship to decedent: "1i1F'lA...:!:: ~t""'~1~ (l/~1'71A~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Esiablished 1 \- - l.J;- - Z-OOU
2. Account Balance 2 I oLt o. L C>
3. Percent Taxable 3 X os- <.;)
4. Allount Subject to Tax 4 5 "ZO. l 0
5. Debts and Deduciions 5
6. AMount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
52.0.\0
,D,-\Y
")..""2,,1./0-
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
Under pena ties of perjury, I
cOllplet to ~owle
TAXPAYER SIGNATURE
I
TOTAL (Enter on Line 5 of Tax COllpuiaiion)
that the facts I
lief,
I
$
\/
have reported above are true, correct and
(05") 7- J '3 - (p 7(., to
WORK ( )
TELEPHONE NUMBER
HOME
~--7~_S-.
D TE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest basad on inforllation
sub.itted by the financial institution.
Z. Inheritance tax becomes delinquent nine .onths after the dacedent.s date of death.
3. A joint account is taxable even though the decedent's name was added as a .atter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife more than one year prior ta death are not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A _ If the infor.ation and co.putation in the notice are correct and deductions are not being claimed~ place an "X"
in block "A" of Pl!lrt 1 of the "Texpayer Response" section. Sign two oopies and sub. it them with your check for the allount of
tax to the Register of wills of the county indicated. The PA Department of Revenue will issue an offioial assessment
(For. REV-1548 EX) upon receipt of the return from the Register of Wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative~ place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
COPy and return to the PA Department of Revenue, Bureau of Individual Taxes~ Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notioe inforMation is inoorrect andlor deduotions are being Claimed, cheok block "C" and oomplete Parts 2 and 3
sccording to the instructions below. Sign two copies and submit the. with your check for the aMount of tax psyable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon recaipt
of the return from the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originallY was established or titled in the manner existing at dste of desth.
For a decedent dying after 12/12/82: Accounts which the decedent put in joint na.es within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the nUMber of accounts held.
If a double asterisk (~M) appears before your first name in the address portion of this notice, the $3,000 exclusion
already has been deducted frOM the account balance as reported by the finsncial institution.
2. Enter the total balsnce of the account including interest accrued to the date of death.
3. The percent of the account that is texable for each survivor is deter.ined as follows:
A. The percent taxable for joint assets established .ore than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
ExaMple: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100
16.77. (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for sssets created within one year of the decedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TDTAl NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Example: Joint eccount registered
the decedent.
1 DIVIDED BY 2 (SURVIVORS) = .50
in the name of the decedent and two other persons and established within one year of death by
X 100
507. (TAXABLE FOR EACH SURVIVOR)
4. The e.ount subject to tax (line 4) is deter.ined by .ultiplying the account balance (line 2) by the percent taxable (line 3).
S. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is deter.ined by subtracting the debts and deductions (line 5) fro. the amount subject to tax (line 4).
7. Enter the appropriate tax rats (line 7) as dstsrMinsd below.
~The tax rate l.possd on the net value of transfers frail a deceesed Chlld twenty-one ysars of age or youngsr at
death to or for the use of a natural parent~ an adoptivs parent, or a steppsrent of the child is 07..
The lineal class of heirs includss grandparents~ parents~ children, and linsal descsndents. "Children" includes natural children
whether or not they have besn adopted by others, sdopted children and step childrsn. "Lineal descendents" includss all children of the
natural parsnts and their descendants~ whether or not they havs been adopted by othsrs~ adopted descendents and their dsscendBnts
and step-descsndants. "Siblings" sre dsfined as individuals who havs st lsast one parent in COMllon with the decedent~ whethsr by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
Date of Death Spouse lineal Sibling Collateral
07101/94 to 12/31/94 370 670 1570 157.
01/01/95 to 06/30/00 070 670 1570 1570
07101/00 to present 070 4.51.- 1270 1570
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and dsductions are dstsrmined as follows:
A. You legally are responsible for pay.snt, or the estate subject to ad.inistration by a personal rspressntative is insufficient
to pay ths deductible itsms.
B. You actually paid ths debts after death of the decedsnt and csn furnish proof of paYlIsnt.
C. Debts being claimsd lIuSt be iteMized fully in Part 3. If additional space is needsd~ uss plain paper 8 1/2" x 11". Proof af
pay.snt may be requssted by the PA Depart.snt of Rsvenus.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG~ PA 171Z8-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 04-1116
ACN 05103573
DATE 02-18-2005
REV-15~S EX IF' !09-0n
TYPE OF
ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IXJ CERTIF.
r
J
~;
J~S;: p~ WIllIAM J COOPER
IS :S'. iNO. 200-22-6463
DATE OF DEATH 09-05-2004
,"COUNTY CUMBERLAND
OF" "
" i..-'
REHIT PAYHENT AND FORMS TO:
REGISTER OF WIllS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
DANIEL
C/O 90R
ENOlA
J COOPER
WINTER lN
PA
17025
FULTON BANK has provided the Department with the information listed below which has been used in
calculating thB potential tax dUB. Their records indicate that at the death of the above decedent~ you were a joint owner/beneficiary of
this account. If you feel this information is incorrect~ please obtain written corrBction from the 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 may be answered by calling (717) 787-83Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING ANU PAYMENT INSTRUCTIONS
Account No. 010-0102579 Oat. 01-06-2000
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
1.040.20
50.000
520.10
.15
78.02
To insure proper credit to your account~ two
(Z) copies of this notice .ust accompany your
pay.ent to the Register of Wills. Make check
payable to: "Register of Wills~ Agent".
x
NOTE: If tex pay_ents are made within three
(3) .onths of the decedent's date of death~
you .ay deduct a 57. discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) .onths after the date of death.
Tax
PART TAXPAYER RESPONSE
[!]liii!I!~I~ij.!iji.!IIII!"i!iil~~~!~ii~.~iiiii~l!i!I.~iii.~I~~~i!lii~.i!!i_!I!i~~~.ii!!.!i!!~~~~ii!i.[~~.
[CHECK ]
ONE
BLOCK
ONLY
A. c=l The above inforllation and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest~ or you may check box "An and return this notice to the Register of
Wills and an official assessment will be issued by the PA Depart.ent of Revenue.
B. c=l The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. ~he above inforllation is incorrect and/or debts and deductions were paid by you.
You lIust complete PART 0 and/or PART ~ below.
If you indicate a different ~ax rats} pl~stat
rel.tionship to decedent: ~ 1""&I..J.. '1'&1 ~O
your
PART
[!]
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. A.ount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
6
7
8
TAX ON JOINT/TRUST
)-1..-=0
I. vYc,. ,_U
,
~n. (')0
1Il '520.10
ACCOUNTS
x
x
SW.IO
. oLl$'.
-;\..~LlD
DEBTS AND DEDUCTIONS
CLAIMED
PART
@]
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Comput.tion)
facts I have reported above are true I corr.ct
HOME (9.c'.9-) 2/3-(" 7(i;,v
WORK ( )
lEPHo N MBER
and
v.
5-7 -or
DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infer.aHon
submitted by the financial institution.
Z. Inheritance tax beco.Bs delinquent nine months after the decedent's date of death.
3. A joint Bccount is taxable aven though the decedent's name was added as a matter of convenience.
4. Accounts (inCluding those held betwaan husband and wife) which the decedent put in joint na.es within one year prior to
death are fully taxable as transfers.
5. Accounts Bstablished jointly between husband and wife ~orB than one year prior to death are not taxable.
6. Accounts hsld by a decedent "in trust for" another Dr others are taxable fully.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the infor.ation and co.putation in the notice are correct and deductions are not being clai~ed, place an "X"
in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and sub.it them with your check for the amount of
tax to the Register of Wills 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 Wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
COpy and return to the PA Depart.ant of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice infor~ation is incorrect and/or deductions are being clai.ed, check block "C" and co.plete Parts 2 and 3
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt
of the return fro. the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originally was established or titled in the manner existing at date of death.
For a decedent dying after 12/12/82: Accounts which the decedent put in joint na.es within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (*M) appears before your first na~e in the address portion of this notice, the $3,000 exclusion
already has been deducted frOM the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxeble for each survivor is determined as follows:
A. The percent taxable for joint assets established more than one year prior to the decedent's death:
I DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Example: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the na~e of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) '" .167 X 100
16.7~ (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Example: Joint account registered
the decedent.
1 DIVIDED BY 2 (SURVIVORS) = .50
in the name of the decedent and two other persons and established within one year of death by
X 100
50Z (TAXABLE FOR EACH SURVIVOR)
4. The a.ount subject to tax (line 4) is deterMined by Multiplying the account balance (line 2) by the percent taxable (line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is deter.ined by subtracting the debts and deductions (line 5) fro. the amount SUbject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
MThe tax rate l.posed on the net value of transfers fro. a deceased chIld twenty one years of ege or younger at
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is O~.
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or not they heve been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descendents, whether or not they have been adopted by others, adopted descendents end their descendents
and step-descendants. "Siblingsft are defined 8S individuals who have at least one perent in co..on with the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
Dat. of Death Spouse lineal Sibling Collateral
07/01/9~ to 12/31/9~ 3X 6X 15X 15X
01/01/95 to 06/30/00 OX 6X 15X 15X
07/01100 to present OX 4.57.if 12X 15X
-
CLAIMED DEDUCTIONS
PART
3
DEBTS AND DEDUCTIONS CLAIMED
Alloweble debts and deductions are deter_ined es follows:
A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent.
C. Debts being clai.ed MUst be ite.ized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x II". Proof of
payment may be requested by the PA Depart.ent of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 17128-0601
.
INFORMATION NOTICE
AND
TAXP~~E~ RESPONSE
REV-1545EX lFP<09-GD)
';,i \
FILE NO. 21 04-1116
ACN 05103572
DATE 02-18-2005
~ I h~~T: O{ WILLIAM J COOPER
,-, IS.Is:: \-ill. 200-22-6463
DATE OF DEATH 09-05-2004
'YCOUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IX] CERTIF.
BRIDGETTE M COOPER
C/O 90R WINTER LN
ENOLA PA 17025
REHIT PAYHENT AND FDRHS TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
FULTON BANK has provided the Department with the info....llation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this infor_ation is incorrect, please obtain written correction from the 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 may be answered by calling (717) 787-83Z7.
Date
Established
REVERSE SIDE FOR
01-06-2000
FILING AND PAYMENT INSTRUCTIONS
COMPLETE PART 1 BELOW.
Account No. 010-0102578
. Jl SEE
Account Balance I} 040.20
Percent Taxable X 50,000
Allount Subject to Tax 520,10
Tax Rata X .15
Potential Tax Due 78.02
PART TAXPAYER RESPONSE
[!]liii!ii!I~~.lj!!!m!i!!I._ii!!I~~~!i!ii_~i!!!!~li!~~1!ii!.~I~~!i!i!~~!,fii!!!.._!!ii_ii!iaj!i!.~~i!i!i.~.l1
To insure proper credit to your account, two
(Z) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
NOTE: If tax payments are .ade within three
(3) months of the decedent's date of death,
you may deduct a 5X discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. D The above information and tax due is correct.
1. You .ay choose to re.it payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of
Wills and an official assessment will ba issued by the PA Department of Revenue.
B. D The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. E11 The above information is incorrect and/or debts and deductions were paid by you.
You .ust co~plete PART ~ and/or PART ~ below.
LINE 1. Data Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Allount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
~
DATE PAID PAYEE
X
JOINT/TRUST ACCOUNTS
I - lD - "Z(.XJO
l,n<Jo:W
SL>
52.0.\0
5).0.\"0
X . f)4<"~.
&"' .40
DEBTS AND DEDUCTIONS CLAIMED
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate} please state your
relationship to decedent: ~ "''''-\;''0..'\ dt....AJ'1 LWv
OF TAX ON
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
perjury} I declare that the fects I
IIY knowledge and belief.
I
$
have report.d above are true} correct and
HOME ('7",&-) U3 -G,;:tb
WORK ( )
TELEPHO E N
3-<; -oS;.
DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine .onths after the dBcedBnt's data of death.
3. A joint account is taxable Bven though the decedent's name was added as a .atter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between 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 arB taxable fully.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the infor.ation and co.putation in the notice are correct and deductions are not being claimed~ place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-lS48 EX) upon receipt of the return from the Register of Wills.
Z. BLOCK B - If the asset specified on this notice has been or will be reported end tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative~ place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue~ Bureau of Individual Taxes, Dept ZS0601, Harrisburg, PA 171Z8-060l in the
envelope provided.
3. BLOCK C _ If the notice infor.ation is incorrect andlor deductions are being claimed, check block "C" and complete Parts Z and 3
according to the instructions below. Sign two copies and sub.it them with your check for the a.ount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-lS48 EX) upon receipt
of the return from the Register of Wills.
TAX RETURN
PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originallY was established or titled in the .anner existing at date of death.
For a decedent dying after lZ/lZ/8Z: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3~000 per transferee regardless of the value of
the account or the nu.ber of accounts held.
If a double asterisk (MM) appears ~efore your first name in the address portion of this notice, the $3~000 exclusion
already has been deducted from the account balance as reported by the financial institution.
Z. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is deter.ined as follows:
A. The percent taxable for joint assets established more than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Example: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100
16.7X (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Example: Joint account registered
the decedent.
1 DIVIDED BY Z (SURVIVORS) = .50
in the name of the decedent and two other persons and established within one year of death by
X 100
sox (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is deter.ined by .ultiplying the account balance (line Z) by the percent taxable (line 3).
s. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
_The tax rate l.posed 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 O~.
The lineal class of heirs includes grandparents~ parents~ children, and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descendents, whether or nat they have been adopted by others~ adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals who have at least one parent in com.on with the decedent~ whether by blood
or adoption. The nCollateral" class of heirs includes all other beneficiaries.
Oat. of Death Spouse lineal Sibling Collateral
07/01/94 to 12/31/94 3% 6% 15% 15%
01/01/95 to 06/30/00 0% 6% 15% 15%
07/01/00 to present 0% 4.57.- 12% 15%
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally are responsible for payment~ or the estate subject to administration by a personal representative is insufficient
to pay the deductible ite_s.
B. You actually paid the debts after death of 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 plein paper 8 Ill" x 11". Proof of
payment .ay be requested by the PA Department of Revenue.
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAl TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
COOPER BRIDGETTE M
44 MEADOWVIEW DR
PHllLlPSBURG, NJ 08865
____un fold
ESTATE INFORMATION: SSN: 200-22-6463
FILE NUMBER: 2104-1116
DECEDENT NAME: COOPER WilLIAM J JR
DATE OF PAYMENT: 03/21/2005
POSTMARK DATE: 03/18/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2004
NO. CD 005100
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05103571 I $23.40
05103573 I $23.40
05103572 I $23.40
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 5809
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$70.20
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
-----,
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG~ PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 04-1116
ACN 05103581
DATE 02-18-2005
REV-15UEX"P 109-On
EST. OF WILLIAM J COOPER
5.5. NO. 200-22-6463
DATE OF DEATH 09-05-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
iii CERTIF.
PA 17048
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
MELISSA
533 S 2ND
LYKENS
MAUS
ST
FULTON BANK has providsd the Oepartmsnt with the information listed below which has bsen used in
calculating the potsntial tax due. Their rscords indicate that at the death of the abovlIiI decedent~ you were a joint owner/beneficiary of
this account. If yOU fesl this information is incorrect~ please obtain written correction from the financial institution~ attach a COpy
to this forM and return it to ths above address. This account is taxabls in accordance with the Inheritance Tax Laws of the COMMonwealth
of Pennsylvania. Questions May be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SlUE FOR ~ILING AND PAYMENT INSTRUCTIONS
Account No. 010-0120521 Oat. 03-06-2000
Established
Account Balance
Percent Taxable
A~unt Subject to
Tax Rate
Potential Tax Due
x
1,031.57
50.000
515.79
.15
77 .37
To insurs proper credit to your account~ two
(2) copies of this notice Must aCCOMpany your
paYMent to the Register of Wills. Make check
payable to: "Register of Wills~ Agent".
x
NOTE: If tax paYMents are made within three
(3) months of the decedent's date of death~
you May deduct a 5~ discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) Months after the date of dsath.
Tax
PART TAXPAYER RESPONSE
[!]'lilll['fhl~~.IIII~IIII__IIIII~~~!IIIII_~IIIII~lllliRilil.~I~I~IIIII.IIII._IIII.~!I!i.I!II.~~!IIII.~~'1
A. 1\1 The above information and tax due is correct.
Jf\ 1. You may choose to rSMit payment to the Registsr of Wills with two copies of this notics to obtain
a discount or avoid intsrsst~ or you may check box "A" and rsturn this notice to ths Register of
Wills and an official assessment will be issued by the PA DepartMent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inhsritance Tax return
to be filed by the decedent.s representative.
c. c=J The above inforMation is incorrect and/or debts and deductions wers paid by you.
You Must COMplete PART 0 and/or PART [I] below.
3
4
5
6
7
8
x
If you indicate 8 different tax rate~ please state your
relationship to decedent:
PART
@J
TAX RETURN - COMPUTATION
LINE 1. DQte Establish.d
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
S. Debts and Deductions
6. A.ount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
x
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Ent.r on line S of Tax Computation)
Under penalties of perjury~ I declare that the facts I
complete to the best of my knowledge and b.li.f.
\)'- ~~~, ~tQm:rnn Ili.l)
have report.d abovB ar. tru.~ correct and
~~=~ ~I n ~ .3(,,;)- 7~'72J ~
TELEPHONE NUMBER DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
Z. Inheritanca tax becomes delinqusnt nins aonths after ths decedent's date of death.
3. A joint account is taxable even though the decedent's nadB was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointlY betwesn husband and wife .ore than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable fUlly.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the inforation and CC*putatlon in the notice are correct and deductions are not being clailled, place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and subllit thell with your check for the Mount of
tax to the RBQister of Wills of the county indicated. The PA Departll.nt of Revenue will issue an official asses~ent
(Forll REV-1548 EX) upon receipt of the return from the Register of Wills.
2. BLOCK B - If tha asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's rej:lresentative, place an "X" in block "B" of Part 1 of the "Taxpayer Rs5p011ss" section. SIgn one
COpy and return to the PA Departllent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice inforllation is incorrect end/I)r deductions are being clailled, check block "Cn and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit thell with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Departllent of Revenue will issue an official assessllent (forll REV-1548 EX' upon receipt
of the return frail the RegIster of Wills.
LINE
1. Enter
NOTE:
TAX RETURN - PART
2
- TAX COMPUTATION
the date the account originally was established or titled in the .anner existing at date of death.
For a decedent dying efter 12/12/8Z: Accounts which the decedent j:lut in joint names within one (1' year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (MM) appears before your first nalle in the address portion of this nl)tice, the $3,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
Z. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint ass_ts established more than one year prior to the decedent's death:
I DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Exallpl_: A joint asset registered
DIVIDED BY TOTAL NUMBER Of X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the nalae of the decedent and two other persons.
I DIVIDED BY 3 (JOINT OWNERS' DIVIDED BY Z (SURVIVORS) ~ .167 X 100
16.7~ (TAXABLE FOR EACH SURVIVOR'
B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries':
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
E~ampIB: Joint account registered
the decedent.
1 DIVIDED BY Z (SURVIVORS) = .50
in the name of the decedent and two other persons and established within one year of death by
X 100
50~ (TAXABLE FOR EACH SURVIVOR)
4. The a.ount subject to tax (line ~, is determined by lIultiplying the account balance (line 2) by the percent taxable (line 3).
S. Enter the total of the debts and deductions Jisted in Part 3.
6. The a.ount taxable (line 6) is determined by subtracting the debts and deductions (line 5' from the amount subject to tax Cline 4).
7. Enter the appropriate tax rate (line 7' as deter.ined below.
D.i. of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3X 6% 1.57- 15%
01/01/95 to 06/30/00 OX 6X 15X 15X
07/01/00 to present OX 4.57._ 12X 15X
"The tax rate IlIposed on the nst value of transfers fro. s deceased child twenty-one years of age or y
ounger at
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OZ.
The linesl class of hairs includes grandparents, parents, children, iIlnd lineal descendants. "Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. wlineal descendants" includes all children of the
natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their desc_ndants
and step-descendants. wSiblings" are defined as individuals who have at least one parent in cOII.on with the decedent, whether by blood
or adoption. The "Collateral" class I)f hairs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are deterllined as follows:
A. You legally are responsible for payment, or the estate SUbject to adminIstration by a personal repressntative is insufficient
to pay the deductible itells.
B. You actually paid the debts after death of the decedent and can furnish proof of paYllent.
C. Debts being claj.ed BlUst be He.iUd fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of
payMent lIay be requested by the PA Departllent of Revenue.
CDMMDNWEALTH DF PENNSYLVANIA
DEPARTMENT DF REVENUE
BUREAU DF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 04-1116
05103582
02-18-2005
REV-15~3 EX AFP {D9-DDI
EST. OF WIllIAM J COOPER
5.5. NO. 200-22-6463
DATE OF DEATH 09-05-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IX] CERTIF.
PA 17 048
REHIT PAYHENT AND FORHS TO:
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
KAITlYN
533 S 2ND
lYKENS
N MAUS
ST
FULTON BANK has provided the Depart.ent with the infor_ation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain writtan correction fro. the financial institution, attach a copy
to this for. and return it to tha above address. This account is taxable in accordance with the Inheritance Tax Laws of tha Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 010-0120522 D.t. 03-06-2000
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rat.
Potential Tax Due
x
1,031.57
50.000
515.79
.15
77 .37
To insure proper credit to your account, two
(2) copies of this notice .ust accompany your
payment to the Register of Wills. Make check
payabla to: "Register of Wills, Agent".
x
NOTE: If tax payments are made within three
(3) months of the decedent"s date of death,
YOU may deduct a 5~ discount of the tax due.
Any inheritance tax due will become dalinquent
nine (9) .onths after the date of death.
Tax
PART TAXPAYER RESPONSE
[!]ii~iill~~.r:i!.ii!I"'I!lil~~~!!!!!~_~ii!il~l!ili.!I!I.~1~~~!jljj~~!iii!~!il!~jl!j.ll!i.~~llj!I.~.!!I!1
A. The ebova information and tax due is correct.
1. You may choose to remit payment to the Register of Wills 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
Wills and an official assessment will be issued by tha PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. c=J The above asset has bean or will be reported and tax paid with the Pannsylvania Inheritance Tax return
to be filed by the decedent"s representative.
C. c=J Tha above information is incorrect and/or debts and deductions were paid by you.
You must complete PART 0 and/or PART ~ below.
x
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. Dete Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
&. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
6
7
8
x
PART
I!I
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line S of Tax Computation)
Under penalties of perjury, I declare that the facts I
complete to the best of my knowledge and belief.
I
$
->-
have reported above are tru., correct and
HOME n \I ) ,?J...,;:). - '7 '9, '72>
WORK ( )
TElEbuO E NUMBER
~
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable intBrest basad on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine Months after thB decedant's data of death.
3. A joint account is taxable even though the decedent"s name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife .ore than on8 year prior to death arB not taxable.
6. Accounts held by a decedant "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A _ If the information and co.putation in the notice are correct and deductions are not being claimed~ place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1548 EX) upon rsceipt of the rsturn from the Register of Wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decadent's representative~ place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Depart.ent of Revenue~ Bureau of Individual Taxes~ Dept 280601~ Harrisburg~ PA 17128-0601 in the
envelope provided.
3. BLOCK C _ If the notice infor.ation is incorrect and/or deductions are being clai.ed~ check block "C" and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit the. with your check far the amount of tax payable to the Register
of Wills of the county indicated. The PA Dapartment of Revenua will issue an official assess.ent (For. REV-1548 EX) upon receipt
of the return from the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originally was established or titled in the manner existing at date of death.
For a decedent dying after 12/12/82: Accounts which the decedsnt put in joint names within one (1) year of death are
taxable fully as transfsrs. However~ there is an exclusion not to sxceed $3~ODD per transferee regardless of the value of
the account or the nu.bar of accounts held.
If a daub Is asterisk (MM) appaars bsfore your first na.e in the address portion of this notice~ the $3~DDD exclusion
already has been deducted fro. the account balance as reported by the financial institution.
Z. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is deter.ined as follows:
A. The percent taxable for joint assets established .ora than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Exa.ple: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the name of the decedent and two ather persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) . .167 X 100
16.7% (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent.s death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Example: Joint account registered
the decedent.
I DIVIDED BY 2 (SURVIVORS) = .50
in the name of the decedent and two other persons and established within one year of daath by
X 100
50% (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is deter.inad by multiplying the account balance (line 2) by the percent taxable (line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount SUbject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as deter.lned below.
death to or for the use of a natural parent~ an adoptive parent~ or a stepparent of tha child is OZ.
The lineal class of heirs includes grandparents~ parents~ children~ and lineal descendents. "Children" includes naturel children
whether or not they have been adapted by othe~s~ adopted children and step children. "lineal descendents" includes all children of the
natural parents and their descendents~ whether or not they have been adopted by others~ adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuels who have at least one parent in co..on with tha decedent~ whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
Oat. of Death Spouse Lineal Sibling Collateral
07101/94 to 12/31/94 3Z 6Z 15Z 15Z
01/01/95 to 06/30/00 OZ 6Z 15Z 15Z
07101/00 to present OZ 4.5X- 12Z 15Z
MIne tax rate Imposed on-the not value of transfers from a deceased chIld twenty-one years of age or y
ounger at
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions ara determined as follows:
A. You legally are responsible for pay.ent~ or the estate SUbject to ad.inistration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts baing clai.ed must be ite.ized fully in Part 3. If edditional space is needed~ use plain paper 8 1/l" x 11". Proof of
peyment may be requested by the PA Depart.ent of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2:80601
HARRISBURG, PA 1712:8-0601
*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 04-1116
05103580
02-18-2005
REVM1545 EX AFP [Q9MGOl
PA 17048
REMIT PAYMENT AND
REGISTER OF WILLS
CUMBERLAND CO COURT
CARLISLE, PA 17013
TVPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IX] CERTlF.
FORMS TO:
Est. GF WILLIAM J COOPER
S. S. NO. 200-22-6463
DATE OF DEATH 09-05-2004
COUNTY CUMBERLAND
NATHAN
533 S 2ND
LVKENS
D MAUS
ST
HOUSE
FULTON BANK has providad the Department with the information listed below which has been usad in
calculating the potential tax dua. Their records indicate that at the death of the abova decadent, youwera a joint owner/baneficiary of
this account. If you feal this infori[ation is incorrect, please obtain written corraction fro~ tha financial institution, attach a copy
to this for_ and raturn it to the above address. This account is taxable in accordance with the Inharitance Tax Laws of the Commonwaelth
of Pennsylvania. Quast ions may be answarad by calling (717) 787-832:7.
COMPLETE PART 1 BELOW . . . SEE RE~ERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
Account No. 010-0120523 Data 03-06-2000
Established
x
1,031.57
50.000
515.79
.15
77 .37
To insure proper credit to your account, two
(2:) copias of this notice .ust acco.pany your
pay.ant to tha Register of Wills. Make check
payabla to: "Registar of Wills, Agentn.
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax pay.ents are .ade within three
(3) .onths of the dacedent's date of death,
you may deduct a 5% discount of the tax dua.
Any inheritance tax due will beco.e dalinquent
nine (9) months after the date of death.
Tax
PART TAXPAYER RESPONSE
[!]1ll;~f~~lIi!i!.!!!!"!!!!I~~~!j!i!~.~!j!!!~~!!!!.!!!i.~1~1!!j!i!~.!!!!~.~!~I..!i!j..!!!!.!!i!~I~lli!!.~~lj!!i!~
A. 1\if The above infor_ation and tax due is corract.
)D( 1. You may choose to ramit paymant to the Register of Wills with two copies of this notica to obtain
a discount or avoid interest, or you may check box nAn and return this notice to the Register of
Wills and an official assassment will be issued by the PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. D The above asset has baan or will be raported and tax paid with the Pennsylvania Inheritance Tax return
to ba filed by tha decedent's representativa.
c. D Tha above infor_ation is incorrect and/or debts and deductions ware paid by you.
You .ust co_plate PART 0 and/or PART @J below.
x
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rateJ please state your
relationship to decedent:
TAX ON JOINT/TRUST ACCOUNTS
lINE
1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. rax Due
OF
1,
2
3
4
5
6
7
8
x
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAVEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Computation)
have reported above are trueJ correct
HOME (117) 2>lp':J. -, 'X /.">
WORK ( )
TELEPHONE NUMBER
an~
31
V'.
Under penalties of perjurYJ I declare that the facts I
complete to the best of my knowledge and belief.
~J\o.t Rr.ffi () 1)\01<,(\)( mi~ ')
TAXPAV'fR IGNATURE \~c.0 ~, .11lcLLW
DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable intBrest based on information
sub.itted by the financial institution.
z. InheritancB tax becomes delinquent nine .onths after the decedent's date of death.
3. A joint account is taxable even though the decedent"s name was added 8S a .atter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint na.es within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wifs more than onB year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" anoths; Dr others arB taxable fully.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the inforgation and computation in the notice are correct and deductions ara not being clai.ed~ place an ftXft
in block ftA" of Pert 1 of the ftTaxpayer Response" section. Sign two copies and sub.it thliilm with your check for the amount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1548 EX) upon receipt of the return fro. the Register of Wills.
2. BLOCK B - If the asset spacified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent.s representative~ place an "Xft in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
COpy and return to the PA Depart.ent of RavenuliiI~ Buraau of Individual Taxes~ Dept 280601~ Harrisburg~ PA 17128-0601 in tha
envalope provided.
3. BLOCK C - If the notice infortllatlon is incorrect and/or deductions ara being clailled~ chack block "c" and co.plate Parts 2 and 3
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Oepa~t.ent of Ravenue will issue an official assessment (Forlll REV-1548 EX) upon receipt
of the return from the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date tha account originallY was established or tltlad in tha ganner existing at date of daeth.
For a decedent dying after 12/12/82: Accounts which the decadant put in joint names within one (1) year of death are
taxabla fully as transfers. However~ there is an exclusion not to exceed $3~000 per transferee ragardless of the value of
the account or the number of accounts held.
If B double asterisk (MM) appears before your first na.e in tha address portion of this notica~ the $3~000 exclusion
already has been deducted frolll the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The parcent of the account that is taxable for each survivor is datermined as follows:
A. The percent taxable for joint assets established .ore than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Exa.ple: A joint asset registerad
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the na.e of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) . .167 X 100
16.7X (TAXABLE FOR EACH SURVIVOR)
B. The percant taxabla for assats creatad within ana year of the decadent's death or accounts ownad by the decedent but held
in trust for anothar individual(s) (trust benaficiaries):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Exa.ple: Joint account registerad
the decadant.
1 DIVIDED BY 2 (SURVIVORS) = .50
in tha name of tha decedent and two other persons and astablished within one yaar of death by
X 100
50X (TAXABLE FOR EACH SURVIVOR)
4. The a.ount subject to tax (lina 4) is dete~inad by .ultiplying tha account balance (line 2) by the percent taxable (lina 3).
5. Enter the total of tha debts and deductions listad in Part 3.
6. The amount taxabla (line 6) is deter.ined by subtracting the debts and daductions (line 5) fro. tha a_aunt subject to tax (line 4).
7. Enter tha appropriate tax rate (line 7) as determined below.
death to or for the usa of a natural parent~ an adoptive parent~ or a stepparent of the child is OX.
The linaal class of heirs includas grandparents~ parents~ children~ and lineal descendents. "Children" includes natural children
whether Dr not they have been adopted by others~ adopted childran and step children. ftLineal descendents" includes all children of the
natural parents and their descendents~ whather or not they have been adopted by others~ adopted descendents and their descendants
BOd step-descendants. "Siblings" ara dafined as individuals who have at least one parant in common with the dacedent~ whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
Date of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3" 6" 15" 15%'
01/01/95 to 06/30/00 0" 6" 15" 15"
07/01/00 to present 0" 4.57.- 12" 15"
MThe tax rate l.posed on the not value of transfers fro. a deceased ch11d twenty-one yaars of age or y
ounger at
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and daductions are detarmined as follows:
A. You legally are responsible for paymant~ or the estate sUbjact to ad.inistration by a personal representative is insufficient
to pey the deductible lta_s.
B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent.
C. Dabts baing clai.ed must be 1t8llized fully in Part 3. If additional space is nlilladlilld~ use plain papsr 8 112" )( 11ft. Proof of
payment .ay be requested by the PA Depart-ent of RavenuB.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MAUS MELISSA
533 S 2ND ST
lYKENS, PA 17048
____uu fold
EST A TE INFORMATION: SSN: 200-22-6463
FILE NUMBER: 2104-1116
DECEDENT NAME: COOPER WilLIAM J JR
DATE OF PAYMENT: 03/14/2005
POSTMARK DATE: 03/12/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2004
NO. CD 005052
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05103581 I $77.37
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$77.37
REMARKS:
CHECK# 4778
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MAUS MELISSA
533 S 2ND ST
lYKENS, PA 17048
nn told
ESTATE INFORMATION: SSN: 200-22-6463
FILE NUMBER: 2104-1116
DECEDENT NAME: COOPER WilLIAM J JR
DATE OF PAYMENT: 03/14/2005
POSTMARK DATE: 03/12/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2004
NO. CD 005053
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05103582 I $77.37
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$77.37
REMARKS: PAID FOR KAITl YN MAUS BY
MELISSA MAUS
CHECK# 4779
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MAUS MELISSA
533 S 2ND ST
lYKENS, PA 17048
-------- fold
ESTATE INFORMATION: SSN: 200-22-6463
FILE NUMBER: 2104-1116
DECEDENT NAME: COOPER WilLIAM J JR
DATE OF PAYMENT: 03/14/2005
POSTMARK DATE: 03/12/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2004
NO. CD 005054
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05103580 I $77.37
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$77.37
REMARKS: FOR NATHAN MAUS PAID BY
MELISSA MAUS
CHECK# 4777
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
0,
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG~ PA 17128-0601
*'
INFORMATION NOTICE
"(';:: '~;::AND
TAX~A~ER RESPONSE
FILE NO. 21 04-1116
ACN 05103584
DATE 02-18-2005
REV-l!i43 EX AFP {09-DOl
"'",. r,')
; 'EST~: 'OF WIL LIAM J COOPER
S.S. NO. 200-22-6463
DATE OF DEATH 09-05-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
IX] CERTIF.
JENNIFER
556 HIGH
STEEL TON
L RUSH
ST
'"lvr'4"-<A'"
REHIT PAYHENT AND FDRHS TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
PA 17113
FULTON BANK has providllild the Departllent with the information listed below which has been used in
calculating the potential tax due. Their rllilcords indicate that at the death of the above decedent~ YOU Wllilr8 a joint owner/beneficiary of
this account. If yOU feel this information is incorrect~ please obtain written correction from the 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 COllmonwealth
of Pennsylvania. Questions may be answered by calling (717) 787..8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SID~ FOR FIL~NG AND PAYMENT INSTRUCTIONS
Account No. 010-0102580 Date 01-06-2000
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rete
Potential Tax Due
K
1,040.20
50.000
520.10
.15
78.02
To insure proper credit to your account~ two
(2) copies of this notice IIUSt accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills~ Agent".
x
NOTE: If tax payments are made within three
(3) months of tha decedent's date of death~
you lIay deduct a 57. discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months aft8r the date of death.
Tax
~RT TAXPAYER RESPONSE
[!]~!i!i!~'~~.!!!!~~!i_i!!II~~~!i!I!I_~lilii~llil!.!I!1.1~1~~~ilili~.I!I!I!_!I!I~_i!il.lil!.~~I!I!I.~~!!lill
A. c=J The above inforeation and tax due is correct.
1. You may choose to remit payeent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest~ or you /lay check box "A" and retur;n this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Rev8nue.
[CHECK ]
ONE
BLOCK
ONLY
B. c=J The above asset has been or will b8 reported and tax paid with the Pannsylvania Inheritance Tax return
to be filad by the decedent's representative.
C. ~The above information is incorrect and/or debts and deductions were paid by you.
You lIust cOllplete PART 0 and/or PART ~ below.
PART If you indicate . different~ax rate~~_ stat~ y~~
~ relationship to decedent: ory('y-~ .....r-~ 'I)~_~ t(""
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
~INE 1. D~te EstGbllshed 1
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tex Rate 7 X
8. Tax Due 8
\nU(").~n
Sf'> Din
';)~(').\()
-
F-. -;)D I f')
.(')US
~ ~~. U{)
DEBTS AND DEDUCTIONS
PART
@]
DATE
CLAIMED
PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
perjury~ I declare that the facts I
my knowledge and belief.
I
$
have reported above are truel correct and
~~=~ ~~'~ ~ ;:i~"~)~~to
TELEP E NUM
'3 br JD"\
DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest basad on information
sUbmitted by the financial institution.
Z. Inheritance tax b8co.es delinquent nine months after the decedent's date of death.
3. A joint account is taxable even though the decedent's na.e was added as a matter of convenience.
4. Accounts (including thOSB held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfurs.
5. Accounts established jointly between husband and wife _ore than one year prior to death are not taxable.
6. Accounts held by a decedent Win trust for" another Dr others are taxable fully.
REPORTING INSTRUCTIONS - PART
I
TAXPAYER RESPONSE
1. BLOCK A - If the information and co.putation in the notice are correct and deductions are not being clai_ed~ place an "X"
in black nAn of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Wills of the county Indicated. The PA Depart.ent of Revenue will issue an official assessment
(For_ REV-1548 EX) upon receipt of the return fro. the Register of Wills.
Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representativ.~ place an "X" in block "B'" of Part I of the "Taxpayer Response" section. Sign one
COpy and return to the PA Depart~ent of Revenue~ Bureau of lndiv!dual Taxes, Dept 280601, Harrisburg, PA 11128-0601 in the
envelope provided.
3. BLOCK C - If the notice infor.atlon is incorrect and/or deductions are being clai.ed, check block "C" and cOllplete Parts 2 ilnd 3
aCCOrding to the instructions below. Sign two copies and submit the. with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assess.ent (For_ REV-lS48 EX) upon receipt
of the return fro. the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originally was established or titled in the .anner existing at date of death.
For a decedent dying after 12/12/82: Accounts Which the decedent put in ioint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the nu.ber of accounts held.
If a double asterisk (MM) appears before your first na.e in the address portion of this notics, the $3,000 exclusion
already has bean deducted from the account balance as reported by the financial institution.
Z. Entsr the total balancs of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established ~ore than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
EX8llPIe: A joint assat registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAKABLE
SURVIVING JOINT OWNERS
in the na.e of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) - .161 X 100
16.1% (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
)( 100
PERCENT TAXABLE
Example: Joint account registered
the decedent.
I DIVIDED BV Z (SURVIVORS) - .50
in the name of the decedent and two other persons and established within one year of death by
K 100
SD% (TAXABLE FOR EACH SURVIVOR)
4. The amount SUbject to tax (line ~) is determined by .ultiplying the account balance (line 2) by the percent taxable (line 3).
5. Enter the total of the debts and deduCtions listed in Part 3.
6. The a.ount taxable (line 6) is deter.ined by subtracting the debts and deductions (line 5) fro. the aMount subject to tax (line 4J.
1. Enter the appropriate tax rate (line 7) as determined below.
Date of Death Spouse lineal Sibling Collateral
07101/94 to 12/31/94 3% 6% 15% 15%
01/01/95 to 06/30/00 0% 6% 15% 15%
07101/00 to present 0% 4.5%- 12% 15%
"'he tax rata IMposed on 'the not Value of transfers froN a deceased child twenty-one years of age ory
ounger at
death to or for the use of a natural parent, an adoptiva parent, or a stepparent of the child is OZ.
The lineal class of heirs includes grandparents, parents, Children, and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. -tineal descendents" includes all children of the
naturel parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings" arB defined as individuals who have et 1a8st one parent in co..on with the decedant, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally \!Ire responsible for paY.llilnt, or the estate Subject to ad_inistraUon by a personal representative is insufficient
to pay the deductible ite.s.
B. VQU actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being clai.ed IIUst be ite.h:ed fully in Part 3. If additional space is needed.. use plein paper 8 1IZ'" x 11". Proof of
pay.ant .ay be requested by thllil PA Depart.ent of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
TURNER JENNIFER l
556 HIGH ST
STEEL TON, PA 17113
-----Iold
ESTATE INFORMATION: SSN: 200-22-6463
FILE NUMBER: 2104-1116
DECEDENT NAME: COOPER WilLIAM J JR
DATE OF PAYMENT: 04/12/2005
POSTMARK DATE: 04/11/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2004
NO. CD 005194
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05103584 I $23.40
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$23.40
REMARKS:
CHECK#1249
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
'_.' -' '-,', ,','"
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIYIStON. -.
PO BOX Z80601
HARRISBURG PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1548 EX AFP (03-05)
, ~. ') 9
~ i . L
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
04-18-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103581
Allount R.llitt.d
WILLIAM
J
MELISSA MAUS
533 S 2ND ST
LYKENS
PA 17048
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1~-~'1ri!I:~~.~~~~'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 04-18-2005
ESTATE OF COOPER JR
WILLIAM
J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103581
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0120521
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST ()() TIME CERTIFICATE
DATE ESTABLISHED 03-06-2000
X
1,031.57
0.500
515.79
.00
515.79
.15
77 .37
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-12-2005 CD005052 .00 77 .37
TOTAL TAX CREDIT 77 .37
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU HAY BE DUE A REFUND.
__... "r'''r'I''I~r' roTI'''': ftr TUT~ cnD" lenD Tuc:.TDllrTTnNI!::. 1
<<;;LS ~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVloUAt'TAXES
INHERITANCE TAX DIVIszmt. . ...
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISE"ENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESS"ENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (03-05)
.,.,,'
il: 30
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN.lDC
ACN
04-18-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103582
Allount Rellitted
WILLIAM
J
KAITLYN N MAUS
533 S 2ND ST
LYKENS
PA 17048
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .... RETAIN LOWER PORTION FOR YOUR RECORDS ""4
1~-;[!'1ri!!:~'.1rG~"J'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 04-18-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103582
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0120522
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 03-06-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,031. 57
0.500
515.79
.00
515.79
.15
77 .37
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-12-2005 CD005053 .00 77 .37
TOTAL TAX CREDIT 77.37
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU "AY BE DUE A REFUND.
---- 1I"Il~1."''!Bro~ rTftc n~ TUTc. I:'nDM I='nll TN~TRUr:T:rDNS & )
~~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVI8ijA~~i~XES:
INHERITANCE TAX DIYISiON.. .
PO BOX Z80601
HARRISBURG PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1548 EX AFP [03-05)
~ 1: 30
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSNI'DC
ACN
04-18-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103580
Allount R_i tt.d
WILLIAM
J
NATHAN
533 S 2ND
LYKENS
PA 17048
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
A~-~'1r1!!:~'.~~~"J1....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 04-18-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103580
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0120523
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 03-06-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,031.57
0.500
515.79
.00
515.79
.15
77 .37
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-12-2005 CD005054 .00 77 .37
TOTAL TAX CREDIT 77 .37
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU MAY BE DUE A REFUND.
--- --..---.. ......." n" TUT<:' ~nDM FnR YNSTRUCTIONS. J
Q...CS~
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FILE NO.21 04-1116
ACN 05103578
DATI 02-18-2005
~ TVPE OF ACCOUNT
'Est, OF WILLIAM J COOP'ER 0 SAVDKlS
5,5, NO. 200-22-6463 DCH~QUNfi
C'DAn: OF DEATH 09- 05-200~ 0 T_T
COUNTY CUMBERLAND Iil CUTX' .
RlHIT "AYH~Jn" AND fllllMS TD,
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
04/12/2005 03:59
724225191'l5
ATC
C~~'ALTH OF P€~Vl~ANIA
DEJlI...I'l'~NT OF IlfEYENut
aulrtU OF INDIVIDUAL TA_es
DEPT. 1I06l)1
loI.amnSIIJAG, PA '1.7U,"OUl
.~.);:
~L
,.':i
Ml~.I.~I'M ." C"~UJ
tNFOR"AT%ON NOTteE
AND "
TAXPAYER RESPONSE
[" 'n")
JlI; i\
('
','
ELIZABETH l CASTEEL
211 6TH AVE
BROWNSVILLE fA 15417
PAGE 01/05
,U1. T~ IlANK, ~. provhtltd tt1.. D.PIiI,t..,t .ith the ll'lfOr..tlc" lltt~ blION which ~, b..n ",.1Id 1n
l:l!Illcll'/l..tAng thtl put.l'ldel t1I_ due. Their .-.oords lncllcat. ~.t It th. ..th Q' 'tn. Illbo'4 ...,t, YrI# .,..,... tJ joint .,.",.rl___f!cbry uf
,~ls ~eeount. If y~ ~l t~!. l"~or..tlo" 1s lnBOrrlCt, pl..,. obtaIn written 90rr.~taqn fr~ ~~ fl"lncl.l in*tltutlon, IttBch . ~~
to ~h 10,." .-nd return it tp the eQV9 IilIddr.15Ii1. Thb IU~l:!iClUrtt b ttI.8IIlI J" aocc".d..... with thfl rnh.r1t~. T~~ "Ill.... M' ttt.. COllllIOlWUUh
of ''ltnn1lylnni.. Qu..Uonll ~~ ~tm~r"d, by tl..U1nv [7111 717.aSZ7.
C:OMPl.!n PART- 1 .f-Loli .. ii-II 9IIRElIlRSI IUDI'1=UIl FILING ANIl PAVMENT II'ISTRUCTlll1'lS
A.........t,..,. 010-01Z0525 D.t. OS-Q6-Z000 T. In..... ...... ._It.. YOU. ....unt, boo
Esteblished tl) 00,1., of 'tt..ls nl2itJoe IIMfIIt .l:~1IIn)' ~l"
p~t to ttl, It.,hter gf tf!J.b. "Illk. en.dt
plwble tv: "Rqbwl" Of Will., .........
NOTE! ~f ~ P.y-.ntc 8'" ..0. within thre~
t~) .on~h. ,f 1ne -.~.~"t.. d*t. of "'t~.
)10\1 "IY "I;t .. SIr O'ftoOUrtt Of tM tit1&' due.
Anv lnh'rlt.~ t~ dUa .tll '-D~ dll1nQUlnt
...the t,) ItOI'Ith. .ft... the ....._ of ..,.th.
'[~.r. , " . ", TA)(PAY~R RElSPO__
l. vou '" .h..... t. ...It p.._t t. th. ...Is... .f .Uh wi'" ..... ....1"' .f ~I. noU.. to ....In
" d.iIl~Q\lnt Qr IjIIvoi.ct Il"1t'l'"ost, al'" YOU ny chftk boJC ....- ..,'" rwtvt'1'l thh flCltllMl ta the ~lh1:.r 9f
WillS and .... offl,lll .s....M~t ~11l b. is.u.d by t~. PA DIp.rtft~i ~~ ~.
Account ..l.nc.
Pare."t T.)II:..1.
~~t Subj.ct to T..
Ttll< Ret.
..obnU.1 T.~ IN.
x
1,0n.57
5D.000
51S~79
x
.15
77 .$7
r' CHECK -,
'ONE J
L BLOCK
ONLY
8. 0 thlt .bon ItPJI.t h.. tt"'" or .u,J. be "~I'tu end tp PIItd IIItth th. P"nnnlv1ll\1. lMel'lt1Il"lH flK r.turn
\0 tMl fUod b~ th. ....I'lt., reprenn'tti!U"..
C. 0 frttt 8Dov. tnfo,.qtJon 'Mrw:orrnt .,W'crr: Mt$ tmd dllldUtlthwlo. we... paid DY yQU~
You .....t '"OIlPl.h PART l!J .,111/0" PART [!] bolOtil.
"ART
[!]
TAX RETURN - COMPUTATION
-c..;Na...a. -De.... ...~..,lj.......
2. Ac~ownt "lence
-S ~ Pe~cllnt f..lllite
4. A.CM.Irtt S-..j..t to T.x
5, Dtol>t$ end _Uon.
6. -.....t T.......
7. r... ht.
G. r",,_
If YOV Snd1c. . . diff.~"~ __ rat.J pi.... .t.t. you~
r.1etlonohlp to c1ec.cl8nt,
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
J X
4
Ii -
6
7 X
8
PilR:T
[!J
DATE PAID
PAYEE
DESCRIPTION
,.... .. co. , .. ,.. '"'""'""'
i
TllTAL
AMOUNT PAID
I
.
1 he.. _..t8cl _.. .... t.... eoI'I'...t
MOME (7 J.. 'f) 7 8 ~ - b 3 {, 0
WORK ('7 '() 7 ss - S 00
....,
'ti/ j -oS-
D T
~~
04/12/2005 04:34
7242251305
r:..~c
Pr:..GE 05/05
6EMfRAL INFORMATION
1. 'AlLURE TO JlIS'Ofe WIL.L IlESULT IN AM O""JCtAL rlX ASSISSNENT tIli'l:h "PpliCllbb l"tlJro..t "-Md en l"ftlr-~tJgn
wNftUd by tI:W flNr\alel Inl.'t.t.tlJ.tian.
g. Inl1l11"'ltwtcs ~ DR_I cfIl1J"'ILI.nt 1"1&"" 1ICltl'th1il alUI" thl _taont's d.tt; IlIf ~.
,. . joint ..atl~t i. ~"'l. evan ~ ~~. d.~~t'5 ~. ~. wd4.d *~ . ~Btt.r ~4 CG"v~i~..
4. 'u:IC~wnb Uncludlf'lO trw.. f1.1d bIItwMtr hu...,.d .,d lIi~J w,",:i,c;h the dRII_t FfUt: in jolft't l'1a_s IIttl'1ln I'JIN 1"" pr-jar te
lfI.th ....... fully -.h .s "trRn....r-s.
!i. kcld'1b ....lht,.d jl'd,M,lJ' bl!tM/l'Oft hueIberId W\d ""l" JI...n ~ ... ~I" Ptivf' tti _..i:h ..... l'\ot ~11l.
.. AecDU'\'tt ....111 ISV . r;IeeMIIlnt -in trull1: ......r.. .1'ID,tttrar cr O'tl'llt-li' 1If. tn;*ble .....ll:!!'.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. I\.oac."..:tf t!'Iit infarn'thm arid otl.pubrtfDPI th thII noUI:IIIJ ere tl~ff"l;lt Itf'd d*r;fvr;:lU_ a" nat bIlt,.,. chi_, p11l1C111 lII"l "1)1"
in blue'" wAr. pf P..t 1 of tiI. "TI!lMfl"''' lbI...an.... ngt:wtl. Sl1" two co,I16lS .,d IILlblllt u,.. Nitti yoUr .... 'F<lr- the _l:l1oll'lt ctf
-mil: to ... 11",.1.&... eo. NUts !if t.hll alllntY Indi.cat.l. Tha 1:1.. o.,.."..."t. uf ~II ..1;11 1~ lit! offioial ......_-"'t
(Fura REV-;uM1!l I!lC) UIlIan ,...ltJt ",f thit rlltl.lm fr-t11t ~ Pttetstar Q-f IUlh.
t.. .LOCI e .. If the ....t ,,"olfl_ M. thb ngtlc. hils bill" ar lIliu bI f'C!POrt., .rw:I telll peld lIIah the ~"""lo'1v..d. rftl'l.,.ltgnc.
'!'eK ltilturn -fUlICt by tIw dR.....t.~ "'IIFW..,aU".., ilI)..o.. "" "M" In bl._ ..... of Part 1 flf ttl. ""TlIlCf'til!lr h.-:stt_n ..-cUo". Usn 01'1.
QGPY .m "'turn te 'tttII ,... DeIMl,.t~t 0" '-1rWWII) IUl"'tIIiIol ~f Indlv~dP.-l "'*'c, a_t ralt'a;J.~ HlI"r-hbLlf"v) Il'A 171I'.06U 11'1 ~
..."1111"1 !'ravJdl".
:So BlacK C - If tfI$I NUn f"~"IIII!1t1ll1l'l i. :lnc::IN'llut ....vIII'" dDductiotll _Mil bid". I(fl.i.lI'l!Ili~ ."iMk bJ.Qdc. "C" 1Jtld CQlIIJIIlllb ,..tp Z 8nd 3
lliGtlr-dinq om tn. tnstl"LJOtJDlt1 bII1Cltol. U." tlllO ccrpi.. Md ~""lt ~1I~ .U" If OUr chw4k ftll'" th" 1flIRIuM: df bill; puettlt11 'to thll 1il'."i,Ulllr
of WSUI lit' 'd'l. ccnmty 1rK:Ilctttll1. The PA tJtn,tlrt..,t ail Rttlfllnlltl 11'111 ill:tllR en C1oFftc1d .C"llIl11N1f1't: lJitlNl R~V-l~8 DO \.IPIm NUIIJpt
oJ th8 rattJrn f".. tM """,ht'll;- ;;If WHls.
TAX RETURN - PART Z - TAX CDMPUTATION
lI"
1. IinWI'" ~ utl!l 1.tlIi IKONI'It Ddl,,i'AltllY "'-5 uteu....ect: Qr titled in the n...r vlstlag .t d8ta G'I' ckIl1f.:t\,
11]1'1: Fat ~ __ant cb'J..... .net lZlUI'8Z: ~ts "lC!l1 thII CIM:fJd."t Jlut: ll't jgint ".-as tilth!" 0l'i8 El) ,...r of dMth el"e
~.l. fu~ll .. t~"'rs. How8va~~ ~ ir 1ft IlMgJu.l'" Rot t~ ~.Id .~,'OO pet tt~s~~ ~.,.~~1... af ~ ~Blv. of
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~. "... ,.,.tlMt: gf tN tlllacNT1t ..., b '\!!I"m1. fQr lIBGh SUM',t\/lor II lfII'flIIlI"Il~_ U faUI;IWII
A. t'hll """"."t .,..bl. ~l" jalf1t ._._ .st'alolh~ _n ~ QnII YMlt' "r~Qr 'to ttw dM9dl~t.s dilIllllth:
1 IU\lID[D BY TOTAL NlJIfiR OF' DIVIDED av TOTAL ~lR OF Ie llNl . PUCDff tAII:ABL(
JaM ~ 5\11'1:1;'1'" JOtMl ONIftIIi
ii:.!IlllIitlll A jlllJnt tlll". I"IIt1ftl1r.d i.'ft tl'I. ftlIlPfil of ttl. .~t end t,." Dthat- '''5IxIS.
l DInDI!llln' 5 C.JQllfI' a~l lJIVlBiIl'V t (BlINlVQM) . .117 .. t'it\) ~ l'.n nAU',,! ~ DCW SlIiI~)
I, Ttq, PWCBMt: ~1. for lI.-tI tl.....t~ .dttd.n Dnf )l'''~ 1114 tl1l111 ~ni;'1B d..t:h ar ",ClJt.mu rM1IlId If3r tttIl dM.llIent but "'..1",
1n 1:hI8t fa.. tl'lt)ther Indlvldud!w) C'tl"u.wt b.UCI~J:"i'iU't..)(
1 Di~~OED ev TOTAL ~...~ OF ~YIVIHg JOINT
(II_ OR TM'LhiT 8IHEF!cIAIUP
EM_b, .Joint anu"lt r..ilil__ In_ ~ C!lF thlli dIoMI.m 1lI'ld tINt 1Itt.l" ,.rbtiS ~ ..'tlbl1,hItd IIILtI'lJI'I C"" )ll'Hr Of dMttl ...
th8 "'.""'1:'0
1 IIYlDED IV . tSURVtYDRS) . .Su X 101 a 5UX (T~A~l~ JeR EACH 1URV1~)
X ~QO ~ PERCENT YAKAaLi
ft. TIIII.-.mt ~j'Clt tD ttil U.i..". 4J ~s *ttNlbIld by IIl.iUJlflYlnl 'tM. lIOiCcmnt IMIJ.'-:Il 0.ln8 ZJ bY' ttll!l perollht t_JQlbh (11"", I).
S. Int.!" -ttu. tebl Of .... cM6t.. 1I'nd 0ItuGt:1QrlV 'U1't1ld lI\ ,.,., ;,.
,. ~ ~t ~1. {lin. ., 1. ~'I:~~lneU ~y subtrlotl~ thI d.btl and GedUctian. (11~ S) fro~ the .-uu"~ ~j.o~ ~g t.~ tlih. a).
7. Enter ttl. IIIf'ropl".l._ ~ twUi C 11M n .s liet...:t.1i1ilCl _latll.
_ .. U..th _.. U.....t Sibll"lJ C.ll.at.Nl
VII"" "'"!llt,y' nx . :dr."
11'11". t. IV$l/n IY. "" 117. 1'Y.
171'111' to p.....nt IY. ....Jr.. 127. lJ~
r mMlI Dr'l r'HI V.lUII I) .. _ l1li ~ IIn "1::I.'I'I1iIlo yu.",' tI W' ~our.pr lOt
....... .. ltt far 'lttll' u.. of . nIItc.1il.ll palWYt, ., IldeCtti\#ll "".,t. lI1f" !I IIt..rilltlt Of h c!dlr:f iii u:il.
".. U~.:L ellisill' gf _t,.. Jn~l_. .MII'Id"'~IIlJit.J p.,...t;lil GhUIlt'8n,J !IN Il".l ..e.oIIt'IICI~l. "'Ch.i.llOfnn'" !nol..-. natur.) cnl1d"..
_iha:r Ot ilQt tIWY _. Man .a,I_a by ctttl..r., aduUld -mllllt'M'l ~ .talll tIhlldNft. "l.ir1IIIIIIl ..~a....,t... 1"011*8 .U otliu'd..." of the
nst\r.l pr'fl'b ."d u.11'" ....lCNnt.~ Wfl....,. e,. I'IDt ~ .... _art .di;ptlNf by Uharl, ..P'ttcl ...ulltth ..a ~.it' dal!JHl'ldlmt.
... ....dMHrldlrrb. "'1bl,lIrq. .,.. .lf1n_ 'III. Ifll!Uvi~. ""11 hflw, et I.....t.. ",",Mt :lI'I ea.on .Jttl thII .__t, wh.thIc- b blaa
or .",tion, TN "eau.t.re.1"" a1... of "'.11'. ha1ul;M. a11 a-tt.r b......ki..ltlS.
CLAIMED D!DUCTIONS . PART 3 DEITS AND DEDUCTIONS CLAIMED
.l1._1a ~. lIn' ftdl.Ili;Uans .\"a cht",,..$.ned .. "OU.;I~J
&. Yt:Iu 1...lh .... .......,.J;l'tJ4 for- ..."...l'It.. or tbiI .S~_ _JilIo'l; .. ".b'l"ri'l'IIdllll1 bY I .....sanlll... f'1III".NI1tdJ". ill .l.n""'fiel.nt
to PO thIl d.-cUbae ltu..
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PII:flI....t py .. rllqu.....t1 t'~ .. No ~"Mnt of I.JmIIWI.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRIS8URG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WASS CARL G
3631 NORTH FRONT ST.
HARRISBURG, PA 17110
fold
EST A TE INFORMATION: SSN: 200-22-6463
FILE NUMBER: 2104-1116
DECEDENT NAME: COOPER WilLIAM J JR
DATE OF PAYMENT: 04/26/2005
POSTMARK DATE: 04/13/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2004
NO. CD 005245
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05103578 I $77.37
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$77.37
REMARKS:
CHECK# 3200
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
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COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG~ PA 17126-0601
'*'
*
kEV~1545 EX lFP {O9-00l
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
* REVISED NOTICE ~ **
FILE NO. 21 04-1116
ACN 05103577
DATE 03-16-2005
ES~, OF WILLIAM J COOPER
': '. r-... r.. ,",.
8;S; 'NIl.! "zlllI'-2a-6463
DATE OF DEATH 09-05-2004
COUNrY -CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
00 CERTIF.
THERESA M TAYLOR
Z20 FRANKLINTOWN RD
DILLSBURG PA 17019
(~"
'~',
i REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FULTON BANK has provided the Departlllent with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent~ you were a joint owner/beneficiary of
this account. If you feel this infor~ation is incorrect~ please obtain written correction frolll the 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 .ay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * . . 3~~ REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 010-010Z573 Date 01-06-2000
Established
PART
ill
1,040.20
50.000
520.10
.15
78.02
TAXPAYER RESPONSE
iiiiii~~~~.ljj!!imj!i!~g_!!!!I~~~!j!iiM!g.l!ij!!~~!!!!~~!!i,II~~,~~!!i!j~lfJi!i~~~~.I,ii~I~~jiji!~j!i!~i~~lijjl~~I~~lj!ijjii
Account Balance
Percent Taxable
A.ount Subject to
Tax Rate
Potential Tax Due
To insure proper credit to your account~ two
(2) copies of this notice must accolllpany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
x
NOTE: If tax paYIIl&nts ars mads within three
(3) lIIonths of the decedent's date of death~
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) 1II0nths after the date of death.
Tax
[CHECK ]
ONE
BLOCK
ONLY
A. The above inforllation and tax dus is correct.
1. You may choose to remit pay.gnt to the Register of Wills with two copies of this notice to obtain
a discount 01' avoid interest~ or you may check box "An and rsturn this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by ths decadent's rspressntative.
c. c=J The above infor~ation is incorrect and/or debts and deductions were paid by you.
Vou must complete PART 0 and/or PART ~ below.
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PART
@]
TAX RETURN - COMPUTATION
If you indicate a different tax rate) please state your
relationship to decedent:
tINIt ].
Date Established
2. Account Balance
3. Percent Taxable
4. A~ount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
declare that the facts I
and belief.
I
$
correct and
HOME
<;
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance tax beco.es dslinquent nine months after the decedent's date of death.
3. A joint account is taxable even though the decedent's na.e was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointlY between husband and wife .ore than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed.. place an "X"
in block "A" of Part 1 of thB "Taxpayer Response" section. Sign two copies and submit thlill. with your check for the alllount of
tax to thB RBgister of Wills of thB county indicatBd. The PA DBpartment of Revenue will issue an official assessment
(Form REV-1548 EX) upon receipt of the return from the Register of Wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative.. place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue.. Bureau of Individual Taxes, Dept 280601.. Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions are being Claimed, check block "C" and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit thelll with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of RevenuB will issue an official assessmBnt (Form REV-1548 EX) upon receipt
of the rBturn from thB Register of Wills.
LINE
1. Enter
NOTE:
TAX RETURN - PART
2
- TAX COMPUTATION
the date the account originally was established or titled in the manner existing at date of death.
For a decedent dying after 12/12/82: Accounts which the dBcedent put in joint names within one (1] year of death are
taxable fully as transfers. However.. therB is an exclusion not to exceed $3..000 per transferee regardless of the value of
the account or the nUlllber of accounts held.
If a double asterisk (MM) appears before your first name in the address portion of this notice, the $3,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established more than one year prior to the decedent's death:
1 DIVIDED BV TOTAL NUMBER OF
JOINT OWNERS
Example: A joint asset registered
DIVIDED BV TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the name of the decedent and two other persons.
1 DIVIDED BV 3 (JOINT OWNERS) DIVIDED BV 2 (SURVIVORS) = .167 X 100
16.7Z (TAXABLE FOR EACH SURVIVOR]
B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries]:
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Exalllple: Joint account registered in the name of the decedent and two other persons and established within one year of death by
the decliildent.
1 DIVIDED BV 2 (SURVIVORS] = .50 X 100 50Z (TAXABLE FOR EACH SURVIVOR]
4. The amount subject to tax (line 4] is determined by multiplying the account balance (line 2) by the percent taxable (line 3].
5. Enter the total of the debts and deductions listed in Part 3.
6. The alllount taxable (line 6) is determined by SUbtracting the debts and deductions (line 5] from the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
MThe tax rate Imposed on the net value of transfers frolll 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 OZ.
The lineal class of heirs includes grandparents.. parents.. children.. and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others.. adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descendents.. whether or not they have been adopted by others.. adopted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals who have at least one parent in cOlllmon with the decedent.. whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
Data of Death Spouse lineal Sibling Collateral
07/01/94 to 12/31/94 3% 6% 15% 15%
01/01/95 to 06/30/00 0% 6% 15% 15%
07/01/00 to present 0% 4.5%_ 12% 15%
CLAIMED DEDUCTIONS
PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are deterlllined as follows:
A. You legally are responsible for paYlllent.. or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claillled lIIuSt be itelllized fully in Part 3. If additional space is needed.. use plain paper 8 1/2" x 11". Proof of
payment lIIay be requested by the PA Department of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-,162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
TAYLOR THERESA M
220 FRANKLlNTOWN RD
DILLSBURG, PA 17019
--- laId
ESTATE INFORMATION: SSN, 200-22-6463
FILE NUMBER: 2104-1116
DECEDENT NAME: COOPER WILLIAM J JR
DATE OF PAYMENT: OS/27/2005
POSTMARK DATE: OS/26/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2004
NO. CD 005376
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05103577 I $78.02
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$78.02
REMARKS:
CHECK# 1989
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BUREAU OF INDIVIDU4C1A)(E:=-
INHERITANCE TAX DIVis~ON
PO BOX 2&0601 .-
HARRISBURG PA 17126-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLONANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (03-05)
'1"11"",
.j~j ;-~ i.J
'-I
V
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-13-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103578
_t R_1Ued
WILLIAM
J
Ci FP'.( r-,p
ORPL~;.\;'~< (\-':
ELlZAB~l~J~ CAST(El
211 6TH AVE
BROWNSVILLE PA 15417
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1~-~l1ri!!:~~~5~""'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-13-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS,
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103578
FINANCIAL INSTITUTION, FULTON BANK
ACCOUNT NO.
010-0120525
TYPE OF ACCOUNT, () SAVINGS ( ) CHECKING ( ) TRUST (Xl TIME CERTIFICATE
DATE ESTABLISHED 03-06-2000
AccDunt Balance
Percent Texeb1e X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,031.57
0.500
515.79
.00
515.79
.15
77 .37
NOTE, TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO,
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-13-2005 CD005245 ....... .00 77.37
TOTAL TAX CREDIT 77.37
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REllUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRI, YDU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS. I
C) s, V-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
~:' r"'TD:E(~(If INHERITANCE TAX
APPRAISE"ENt,' ALLOWANCE DR DISALLOWANCE
OF DEDOC,.IDNS, AND ASSESSHENT OF TAX ON
JOINTLY HELD DR TRUST ASSETS
REV-1548 EX AFP (03-05)
1"'.-,- ""1
- ;:~ ....)
i I 1.1 I: 57
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-20-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103712
AltOunt R...i tted
WILLIAM
J
MARK A CDOPER
44 MEADOWVIEW DR
PHILLIPSBURG
--,I
'~,"-
NJ 08865
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1~-:t.I'1ri!sr~~.irG~""'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-20-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO.
21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
() ACCEPTED AS FILED (X) CHANGED SEE
JOINT OR TRUST ASSET INFORMATION
ACN 05103712
ATTACHED NOTICE
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0152793
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (lO TIME CERTIFICATE
DATE ESTABLISHED 04-18-2001
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
3,058.32
0.500
1,529.16
.00
1,529.16
.45
68.81
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 06-28-2005 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 68.81
REVERSE SIDE OF THIS FORM INTEREST AND PEN. .22
TOTAL DUE 69.03
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl, YOU HAY BE DUE A REFUND.
___ __..____ ............ ....... ...u..~ .,....a.. .,....11I T~TDlIII'"TTn..c:. l
q..S ~
BUREAU OF INOIVlDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z8D6Dl
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
.. NbtICE OF 1NIIEllnANCE TAX
APPRAISE~NT, ALLoW~E OR OISALLOWANCE
OF DEOUCTIPNS, AND,ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
*'
REV-1548 EX AFP (03-05)
,-; ; Ii ~~TE OF
DATE OF DEATH
FILE NUMBER
~COUNTY
'SSN/DC
ACN
06-20-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103713
AIIount R...i Had
WILLIAM
J
MARK A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...
1~-;[!&1ri!i:~J.irGJ:-~'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-20-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO.
21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
() ACCEPTED AS FILED (X) CHANGED SEE
JOINT OR TRUST ASSET INFORMATION
ACN 05103713
ATTACHED NOTICE
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0152792
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (lO TIME CERTIFICATE
DATE ESTABLISHED 04-18-2001
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
10,194.30
0.500
5,097.15
.00
5,097.15
.45
228.92
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 06-28-2005 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 228.92
REVERSE SIDE OF THIS FORM INTEREST AND PEN. .72
TOTAL DUE 229.64
. IF PAlO AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR], YOU KAY BE DUE A REFUND.
...lee III:IIC:~C e:Tnc nc TUT<:. cnDM I='ng T~TIPIlr.:TTONS_ 1
~'S,'L
BUREAU OF INOIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOtn:sCOf.J:NHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
Of DEDUCTIONS, AND ASSESSMENT OF TAX ON
~OINTLY HELD OR TRUST ASSETS
*'
REY-1548 EX AFP (03-051
p, ;--
,-j i I
',,' "::;7
I:; . ~
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-20-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103567
Anount R_i tted
WILLIAM
J
MARK A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1~-;[!'1ri!!:~J.irG~~'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-20-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO.
21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
() ACCEPTED AS FILED (X) CHANGED SEE
JOINT OR TRUST ASSET INFORMATION
ACN 05103567
ATTACHED NOTICE
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0102576
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (Xl TIME CERTIFICATE
DATE ESTABLISHED 01-06-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,040.20
0.500
520.10
.00
520.10
.45
23.41
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 06-28-2005 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 23.41
REVERSE SIDE OF THIS FORM INTEREST AND PEN. .07
TOTAL DUE 23.48
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YDU NAY BE DUE A REFUND.
~EE DEUED~E ~TnE DE THT~ FORM FOR YNSTRUCTYDNS. 1
~~
REV_1470EX~8)
'*
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMEN1' OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
WILLIAM J COOPER
FILE NUMBER
REVIEWED BY
ROBIN GRAFF
ACN
2104-1116
05103712,05103713 &
05103567
ITEM
SCHEDULE NO.
EXPLANATION OF CHANGES
THE CLAIMED DEDUCTION PERTAINING TO THE FUNERAL ARE NOT ALLOWED
AGAINST THESE JOINTLY HELD ACCOUNTS (A C N' S 05103712,05103713 & 05103567)
THESE EXPENSES WERE REPORTED ON THE PROBATE RETURN, ON SCHEDULE H.
AN ADJUSTMENT HAD BEEN MADE TO REFLECT THIS CHANGE.
ROW
Page 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVIDUAL TA~ES
IMHERI1ANCE TA~ DIVISION
PO BOX Z8D6Dl
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
~l'l>RAISEHENT, ALLOIIANCE OR DISALLOIIANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1511i8 EX AFP (03-05)
~ ..- ~I: S:D
1/ r" -
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN,DC
ACN
06-20-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103568
A.aunt Helli tt.d
WILLIAM
J
Oi:."'H....
MARK A COQP~R
44 MEADOWVIEW'OR
PHILLIPSBURG NJ 08865
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGIST~R OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
A~-:r.I'1ri!I:~J.irG~1J.!'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLOWANCE OF
DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-20-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO.
21 04-1116
TAX RETURN WAS,
S.S/D.C. NO. 200-22-6463
() ACCEPTED AS FILED (X) CHANGED SEE
JOINT OR TRUST ASSET INFORMATION
ACN 05103568
ATTACHED NOTICE
FINANCIAL INSTITUTION, FULTON BANK
ACCOUNT NO.
010-0120566
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (Xl TIME CERTIFICATE
DATE ESTABLISHED 05-25-2000
Account Balance
Pe~cent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
5,097.36
0.500
2,548.68
.00
2,548.68
.45
114.04
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-21-2005 CD005098 .00 89.04
INTEREST IS CHARGED THROUGH 06-28-2005 TOTAL TAX CREDIT 89.04
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 25.00
REVERSE SIDE OF THIS FORM INTEREST AND PEN. .08
TOTAL DUE 25.08
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRU~TIONS_ 1
q,..s, '<-
REV-1470EX(ll-88)
'*
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDlVIDUAL TAXES
PO Box 280601
HARSISBURG.PA 17128-0601
DECEDENrS NAME
FILE NUMBER
WILLIAM J COOPER
REVIEWED BY
ACN
2104-1116
05103711,05103568 &
05103569
ROBIN GRAFF
ITEM
SCHEDULE NO.
EXPLANATION OF CHANGES
THE CLAIMED DEDUCTION PERTAINING TO THE RENTAL OF THE SUMMERDALE
APARTMENT ARE NOT ALLOWED AGAINST THESE JOINTLY HELD ACCOUNTS
(A C N' S 05103711, 05103568 & 05103569) THESE EXPENSES WERE REPORTED
ON THE PROBATE RETURN, ON SCHEDULE I.
AN ADJUSTMENT HAD BEEN MADE TO REFLECT THIS CHANGE.
ROW
Page 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION-
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (03-05)
: -, I,: rJ. 7
j i
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-20-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103569
Mount R..ittad
WILLIAM
J
MARK 0UiA COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1~-~'1ri!I:~J.~ft~~,....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-20-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103569
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0120569
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (Xl TIME CERTIFICATE
DATE ESTABLISHED 06-06-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
2,033.96
0.500
1,016.98
.00
1,016.98
.45
45.76
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-21-2005 CD005098 .00 45.76
TOTAL TAX CREDIT 45.76
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDlr' ( CRJ, YDU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I
Q.. "S +-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION -
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEI1ENT, ALLDWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
RE\I-l$ctB EX AFP (03-D5)
, I"' I',' .J~"l
i I (;;
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-20-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103571
Mount R_itt.d
WILLIAM
J
PAIGE U-M COOPER
C/O 90R WINTER LN
ENOLA PA 17025
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1~-;[!~1ri!I;~J.lra!:-",.'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-20-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103571
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0102577
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (lO TIME CERTIFICATE
DATE ESTABLISHED 01-06-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,040.20
0.500
520.10
.00
520.10
.45
23.40
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDI:TS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-16-2005 CD005100 .00 23.40
TOTAL TAX CREDIT 23.40
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl, YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE DF THIS FORM FOR INSTRUCTIONS. 1
o'S'L
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 28D601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
.JOINTLY HELD OR TRUST ASSETS
REV-151f8 EX AFP (03-05)
I J
I. ::-7
I' J
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN,DC
ACN
06-20-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103572
AIlaunt R_itt.d
WILLIAM
J
BRIDGEiJ'i;'M COOPER
C/O 90R WINTER LN
ENOLA PA
17025
MAKE CHECK PAYABLE AND REMIT PAYMENT TO,
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
1~-iOI~1ri!I:~J.lrG~~1....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-20-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103572
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0102578
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (Xl TIME CERTIFICATE
DATE ESTABLISHED 01-06-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,040.20
0.500
520.10
.00
520.10
.45
23.40
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDXTS,
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-18-2005 CD005100 .00 23.40
TOTAL TAX CREDIT 23.40
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" { CRI, YOU HAY BE DUE A REFUHD.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. 1
<:> 'S '-l-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INOIVIOUAL T~XE~
INHERITANCE TAX DIVISION
PD BDX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
.. .. lifl'li1,IsEHENT, ALLOlIANCE OR DISALLOllANCE
. ,bf DEDUCTIONS, AND ASSESSHENT OF TAX ON
.JOINTLY HELD OR TRUST ASSETS
RE~-1548 EX AFP [93-05)
DANIEL
C/O 90R
ENOLA
J comtii.
WINTSBUl't( ,
PA 17025
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN....DC
ACN
06-20-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103573
Allount R_1 tted
WILLIAM
J
! j -~ \. c
Jl..; l j I:. . .Jb
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1~-;[I~1ri!!:~'.ir5J:-"J'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-20-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO.
21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
() ACCEPTED AS FILED (X) CHANGED SEE
JOINT OR TRUST ASSET INFORMATION
ACN 05103573
ATTACHED NOTICE
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0102579
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (lO TIME CERTIFICATE
DATE ESTABLISHED 01-06-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,040.20
0.500
520.10
.00
520.10
.45
23.40
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PDRTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAVABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDI:TS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-18-2005 CD005100 .00 23.40
TOTAL TAX CREDIT 23.40
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF AOOITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRI, YOU MY BE OUE A REFUND.
SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS_ 1
REV-1470EX(6-88)
*'
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 26061J1
HARRISBURG PA 1712a-.0601
DECEDENTS NAME
FILE NUMBER
WILLIAM J COOPER
REVIEWED BY
ACN
2104-1116
05103571,05103572 &
05103573
ROBIN GRAFF
ITEM
SCHEDULE NO.
EXPLANATION OF CHANGES
CHANGED TAX RATE FROM 15 PERCENT TO 4.5 PERCENT SINCE A GRAND DAUGHTER
IS A LINEAL BENEFICIARY.
AN ADJUSTMENT HAD BEEN MADE TO REFLECT THIS CHANGE.
ROW
Page 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVIDU~L TAXElj
IMHERIU.NCE 'TAX DIVISIOH._ .
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
. APPRAISEKENT, ALLOIIAKCE OR DISALLOIIAIICE
OF DEDUCTIONS, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
RE"-l~ EX AFP (03-05)
o~,:c
: -1I ~i
MARK :> i\\'COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
DATE
ESTATE OF
DATE OF DEATH
FILE MUMBER
COUNTY
SSN/DC
ACN
06-20-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103711
A.ount R..i tted
WILLIAM
J
,-,' ,; Fil I: 56
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...
1"'-;[I'1ri!!:~~.~~~"J'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLONANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-20-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/O.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103711
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0152794
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (lO TIME CERTIfICATE
DATE ESTABLISHED 04-18-2001
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
3,058.32
0.500
1,529.16
.00
1,529.16
.45
68.81
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-21-2005 COO05098 .00 68.81
TOTAL TAX CREDIT 68.81
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU KAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS. J
QS~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO 80X 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEKENT, ALLOlIANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JQINTL Y HELD OR TRUST ASSETS
REV-1548 EX AFP (03-05)
"j
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
07-04-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103577
AIIol.l'1t R..i tt.d
WILLIAM
J
THERESA M TAYLOR
220 FRANKLINTOWN RD
DILLSBURG PA 17019
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1~-:t.I~1r1!!:~'.~a~1nI1....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 07-04-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103577
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0102573
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (lO TIME CERTIFICATE
DATE ESTABLISHED 01-06-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,040.20
0.500
520.10
.00
520.10
.15
78.02
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT.n
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-26-2005 CD005376 .00 78.02
TOTAL TAX CREDIT 78.02
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( cn, YDU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS fORK fOR INSTRUCTIONS. )
G..':;' '<-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
BUREAU OF INDIVIDUAL TAxES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOIIANCE OR DISALLOIIANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-lS48 EX AFP (03-05)
:',(,
:~' ::I
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
07-04-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
200-22-6463
05103584
AoIaunt R..l Heel
WILLIAM
J
JENNIFER L
556 HIGH ST
STEEL TON
RUSH-TURNER
PA 17113
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1~-~~1ri!!:~J.~a~""'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 07-04-2005
ESTATE OF COOPER JR
WILLIAM J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103584
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0102580
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (lO TIME CERTIFICATE
DATE ESTABLISHED 01-06-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,040.20
0.500
520.10
.00
520.10
.45
23.40
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 07-12-2005 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 23.40
REVERSE SIDE OF THIS FORM INTEREST AND PEN. .12
I TOTAL DUE 23.52
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl, YDU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORK FDR INSTRUCTIONS. l
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV.1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005587
COOPER MARK A
44 MEADOWVIEW DR
PHllLlPSBURG, NJ 08865
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
______n fold ---------- --------
05103713 I $229.64
ESTATE INFORMATION: SSN: 200-22-6463 05103567 I $23.48 ,
FILE NUMBER: 2104-1116 05103712 I $69.03 ,
DECEDENT NAME: COOPER WilLIAM J JR 05103568 I $25.08 ,
DATE OF PAYMENT: 07/18/2005 I
POSTMARK DATE: 07/16/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 09/05/2004 I
I
TOTAL AMOUNT PAID: $347.23
REMARKS:
CHECK# 5938
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WillS
REGISTER OF WILLS
q~('npnCf) nm"c: n:
BUREAU Of INDIVI~;r~ ~ . vL ~'
INHERITANCE TAX DIVISICtt.l ...~' 11- M \
PO BOX 280601 ..--.,--' I -' , -'
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-}&07 EX AFP (03-05)
200S AUG 19 PH 12: 33
CL~~;!:<
CR'=':-'/;
"I" ..-
MARK \_, A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-15-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
05103567
A.oU'1t Reni tt.d
WILLIAM
J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this for. with your tax paynant.
CUT ALONG THIS LINE
--+ RETAIN LOWER PORTION FOR YOUR RECORDS
-
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF COOPER JR WILLIAM J FILE NO.21 04-1116 ACN 05103567 DATE 08-15-2005
THIS STATEHENT IS PROVIDED TO ADVISE Of THE CURRENT STATUS Of THE STATED ACN IN THE NAKED ESTATE. SHDIIN BELOll
IS A SUHHARY Of THE PRINCIPAL TAX DUE, APPLICATION Of ALL PAYHENTS, THE CURRENT BALANCE, AND, If APPLICABLE,
A PRCUECTED INTEREST fIGURE.
DATE Of LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-20-2005
PRINCIPAL TAX DUE: 23.41
PAYMENTS (TAX CREDITS):
~
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID ( -)
07-16-2005 CD005587 .07- 23.48
TOTAL TAX CREDIT 23.41
BALANCE OF TAX DUE .00
INTEREST AND PEN. .06
If PAID AfTER TNIS DATE, SEE REVERSE TOTAL DUE .06
.
SIDE fOR CALCULATION Of ADDITIONAL INTEREST.
I :If TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REqUIRED.
If TOTAL DUE IS REfLECTED AS A "CREDIT" ICRI,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE Of THIS FORK fOR INSTRUCTIONS. I
BUREAU OF INDIVIDUALFm€lRDED nFrTF n::
INI-ERITANCE TAX DIYISION v v__
PO BOX 280601 ~
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-1607 EX AFP (03-QSl
ZOOS AUG 19 PN 12: 33
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-15-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
05103712
lulount R_l tted
WILLIAM
J
t,~ C::'j
\";'-'-".\
C,S;-)"---",'," ..., T)T
MARK C!,Il'CDDPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
KAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, sub.it the upper portion of this for. with your tax payment.
CUT ALONG THIS LINE
--+ RETAIN LOWER PORTION FOR YOUR RECORDS
-
--------------------------------------------------------------.--.--.--.---
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT *--
ESTATE OF COOPER JR WILLIAM J FILE NO.21 04-1116 ACN 05103712 DATE 08-15-2005
THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE HA"ED ESTATE. SHOWN BELOW
IS A ~RY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-20-2005
PRINCIPAL TAX DUE: 68.81
PAYMENTS (TAX CREDITS):
~
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-16-2005 CD005587 .22- 69.03
TOTAL TAX CREDIT 68.81
BALANCE OF TAX DUE .00
INTEREST AND PEN. .17
TOTAL DUE .17
. IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDlr' (CR),
YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FO~ FOR INSTRUCTIONS. )
m::('nQn~n (n:Y'~ n:
BUREAU Of INOIvIblMtvtm9' vh JvL ,~
INI-ERIUNCE TAX DIYIS~M/~::c:'r::o r::
PO BOX 280601 _.~_Ull_', '-
HARRISBURG PA 17128-0601
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REV-16U1 EX AFP (03-05)
ZOOS AUG 19 P/'i 12: 33
^,
MARK t,j A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG
r"
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-15-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
05103713
Aooo..,t RNitt.d
WILLIAM
J
NJ 08865
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account I submit the upper portion of this for. with your tax payment.
CUT ALONG THIS LINE
--+ RETAIN LOWER PORTION FOR YOUR RECORDS
-
----------------.---------------------------------------------.--.---------
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT KKK
ESTATE OF COOPER JR WILLIAM J FILE NO.21 04-1116 ACN 05103713 DATE 08-15-2005
THIS STATEHENT IS PROVIDED TO ADVISE Of THE CURRENT STATUS Of THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY DF THE PRINCIPAL TAX DUE, APPLICATION Of ALL PAYHENTS, THE CURRENT BALANCE, AND, If APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 06-20-2005
PRINCIPAL TAX DUE, 228.92
PAYMENTS (TAX CREDITS):
~
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-16-2005 CD005587 .72- 229.64
TOTAL TAX CREDIT 228.92
BALANCE OF TAX DUE .00
INTEREST AND PEN. .57
TOTAL DUE .57
. If PAID AFTER THIS DATE, SEE REVERSE
SIDE fOR CALCULATION Of ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REqUIRED.
If TOTAL DUE IS REfLECTED AS A "CREDIT" (CRI,
YOU HAY BE DUE A REfUND. SEE REVERSE SIDE Of THIS fORK fOR INSTRUCTIONS. I
BUREAU OF INOIVI~Ttd("' OCCI"[ ,,-
INHERITANCE TAX DIV~UI";lJtU I I 11\),- U~'
PO BOX 280601 c;r_~'r':c.'-TC:'"\
HARRISBURG PA 17128-o6Dt,~ '.)! ~~"
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-1607 EX AFP (03-05)
200S AlJG 19 P1l12: 33
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-15-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
05103568
Amount R_i tt.d
WILLIAM
J
CLEi~~<
C":-'! u, \:rl,,-.,.~, t~,.~
MARK !:i r';~A-~ttiOpe/(..i il,.
44 MEADOWVIEW DR ..
PHILLIPSBURG NJ 08865
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your 8ccountl submit the upper portion of this form with your t.x pa~nt.
CUT ALONG THIS LINE
--+ RETAIN LOWER PORTION FOR YOUR RECORDS
-
----------.--.--.--.-------------------.--.--.----------------.------------
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT KKK
ESTATE OF COOPER JR WILLIAM J FILE NO. 21 04-1116 ACN 05103568 DATE 08-15-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE H~ED ESTATE. SHDWH BELOW
IS A SUNNARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-20-2005
PRINCIPAL TAX DUE: 114.04
PAYMENTS (TAX CREDITS):
~
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-21-2005 CD005098 .00 89.04
07-16-2005 CD005587 .08- 25.08
TOTAL TAX CREDIT 114.04
BALANCE OF TAX DUE .00
INTEREST AND PEN. .06
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .06
.
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. I
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280801
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
COOPER MARK A
44 MEADOWVIEW DR
PHILLlPSBURG, NJ 08865
----~~-- fold
ESTATE INFORMATION: SSN: 200-22-6463
FILE NUMBER: 2104-1116
DECEDENT NAME: COOPER WILLIAM J JR
DATE OF PAYMENT: 08/31/2005
POSTMARK DATE: 08/29/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2004
NO. CD 005742
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05103567 I $.06
05103713 I $.57
05103712 I $.17
05103568 I $.06
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 5967
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$.86
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
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~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
!::':rriiY)::m~;n;f1ENT OF ACCOUNT
..' ,f,.L"., __ , "..
REV-1607 EX AFP (03-05)
2n:]..~
-- r
!
Pi;
!: 21
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-26-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
05103567
WILLIAM
J
MARK A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
... INHERITANCE TAX STATEMENT OF ACCOUNT .__
ESTATE OF COOPER JR WILLIAM J FILE NO.21 04-1116 ACN 05103567 DATE 09-26-2005
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PRO~ECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-20-2005
PRINCIPAL TAX DUE: 23.41
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-16-2005 CD005587 .07- 23.48
08-29-2005 CD005742 .06- .06
TOTAL TAX CREDIT 23.41
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
It IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
cO/'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
J;NtiI=;RI.r~,N,C,~_ T~X
ST ATE'MI:MT'OF 'ACCOUNT
REV-1607 EX AFP (03-05)
MARK A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
DATE
~ 1UTAtt: bF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-26-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
05103713
WILLIAM
J
Anount Renitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subnit the upper portion of this forn with your tax paynent.
CUT ALONG THIS LINE
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
4-
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
*** INHERITANCE TAX STATEMENT OF ACCOUNT KKK
ESTATE OF COOPER JR WILLIAM J FILE NO.21 04-1116 ACN 05103713 DATE 09-26-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-20-2005
PRINCIPAL TAX DUE: 228.92
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-16-2005 CD005587 .72- 229.64
08-29-2005 CD005742 .57- .57
TOTAL TAX CREDIT 228.92
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
II IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
~(f'/
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
Iyn('r,r--/":-" :;tNtt~ITANCE TAX
f::I,-;U:~:$T'ATE,~eN.1 OF ACCOUNT
REV-1607 EX AFP (03-05)
20D!1
-- I
~" , r, I DATE
! : L ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-26-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
05103712
WILLIAM
J
MARK A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
.....
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF COOPER JR WILLIAM J FILE NO.21 04-1116 ACN 05103712 DATE 09-26-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-20-2005
PRINCIPAL TAX DUE: 68.81
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-16-2005 CD005587 .22- 69.03
08-29-2005 CD005742 .17- .17
TOTAL TAX CREDIT 68.81
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
lIE IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
lW\
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
r'-," r\~E.IU-;r~~E TAX
i-'~j:~l"Ef.U;N~j'E)F::- ACCOUNT
REV-1607 EX AFP (03-05)
-~ I
I
,D~T~
rEStATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-26-2005
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
05103568
WILLIAM
J
MARK A COOPER
44 MEADOWVIEW DR
PHILLIPSBURG NJ 08865
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE
.....
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
*** INHERITANCE TAX STATEMENT OF ACCOUNT ***
ESTATE OF COOPER JR WILLIAM J FILE NO.21 04-1116 ACN 05103568 DATE 09-26-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-20-2005
PRINCIPAL TAX DUE: 114.04
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-21-2005 CD005098 .00 89.04
07-16-2005 CD005587 .08- 25.08
08-29-2005 CD005742 .06- .06
TOTAL TAX CREDIT 114.04
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1.
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ.
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
~VV'-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES '
INHERITANCE TAX DIVISIOk.:
PO BOX 280601
HARRISBURG PA 17128-060~
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-154B EX AFP (06-05)
2 L. J 5 ",i ,~:~t ~ I I 3 1: :l J
DATE 01-16-2006
ESTATE OF COOPER JR WILLIAM J
DATE OF DEATH 09-05-2004
FILE NUMBER 21 04-1116
COUNTY CUMBERLAND
SSN/DC 200-22-6463
ACN 05103574
APPEAL DATE: 03-17-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
(\:;:.:\~.J t?_i' :::' '-"'. ,-"-,
AMANDA Ct tc~BiIhER
C/O 90R WINTER LN
ENOLA PA 17025
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
REY:is4S-EX-AFP-roj:osi------------------------------______________________________________
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-16-2006
ESTATE OF COOPER JR
WILLIAM
J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103574
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0120514
TYPE OF ACCOUNT: ()SAVINGS () CHECKING (>TRUST ex )TIME CERTIFICATE
DATE ESTABLISHED 03-06-2000
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
1,031.57
0.500
515.79
.00
515.79
.15
77 .37
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 01-24-2006 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 77 .37
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.57
TOTAL DUE 79.94
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
pt
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVloUAL TAXES '
INHERITANCE TAX DIVISION.
PO BOX Z80601
HARRISBURG PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (06-05)
~L~~~i:-: : 3 P i:'~ r: 5 S
DATE 01-16-2006
ESTATE OF COOPER JR WILLIAM J
DATE OF DEATH 09-05-2004
FILE NUMBER 21 04-1116
COUNTY CUMBERLAND
SSN/DC 200-22-6463
ACN 05103575
APPEAL DATE: 03-17-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CEDRIC ";:j'A. COOPER
C/O 90R WINTER LN
ENOLA PA 17025
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
REV=is4S-EX-AFP-roi=osj---------------------------------___________________________________
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-16-2006
ESTATE OF COOPER JR
WILLIAM
J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103575
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0120515
TYPE OF ACCOUNT: ()SAVINGS () CHECKING (HRUST Q( )TIME CERTIFICATE
DATE ESTABLISHED 03-06-2000
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
1,031.57
0.500
515.79
.00
515.79
.15
77 .37
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 01-24-2006 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 77 .37
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.57
TOTAL DUE 79.94
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
pi.
'-',-''-'''',,,",
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDU~:~XES
INHERITANCE TAX DIVISION -
PO BOX 280601
HARRISBURG PA 17128-0601
~; f ,~~,! f " C r:: I. r- ".
-oJ ,-", , I J I i I j. -..'0
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (06-05)
0; :,', ,1
SARAH <"[ BENTZ
C/O 90R WINTER LN
ENOLA PA 17025
DATE 01-16-2006
ESTATE OF COOPER JR WILLIAM J
DATE OF DEATH 09-05-2004
FILE NUMBER 21 04-1116
COUNTY CUMBERLAND
SSN/DC 200-22-6463
ACN 05103576
APPEAL DATE: 03-17-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +-
REY=is4S-EX-AFP-C03=OSj--------------------------------____________________________________
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-16-2006
ESTATE OF COOPER JR
WILLIAM
J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103576
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0120516
TYPE OF ACCOUNT: ()SAVINGS () CHECKING ()TRUST ~ )TIME CERTIFICATE
DATE ESTABLISHED 03-06-2000
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
1,031.57
0.500
515.79
.00
515.79
.15
77 .37
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 01-24-2006 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 77 .37
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.57
TOTAL DUE 79.94
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
pt
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVI~AL,TAxES
INHERITANCE TAX DIVISION_
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (06-05)
:~[JJJ.r; 13 P;>;
, - r
i: :Jb
DATE 01-16-2006
ESTATE OF COOPER JR WILLIAM J
DATE OF DEATH 09-05-2004
FILE NUMBER 21 04-1116
COUNTY CUMBERLAND
SSN/DC 200-22-6463
ACN 05103579
APPEAL DATE: 03-17-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
OR~'Hi\;\.
WILLIAM G,yJ-'CODPER
318 N MAIN ST
MANCHESTER PA 17345
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
REY=is4S-EX-AFP-fo3=Osi-------------------------------_____________________________________
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-16-2006
ESTATE OF COOPER JR
WILLIAM
J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103579
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0120524
TYPE OF ACCOUNT: ()SAVINGS () CHECKING ()TRUST ~ )TIME CERTIFICATE
DATE ESTABLISHED 03-06-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,031.57
0.500
515.79
.00
515.79
.15
77 .37
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 01-24-2006 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 77 .37
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.57
TOTAL DUE 79.94
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
Rf.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (06-05)
ICY::_' i "::; (,-',
PAUL n~JC:tmPE~" '.
703 S 2Srfi'ST
HBG PA 17111
DATE 01-16-2006
ESTATE OF COOPER JR WILLIAM J
DATE OF DEATH 09-05-2004
FILE NUMBER 21 04-1116
COUNTY CUMBERLAND
SSN/DC 200-22-6463
ACN 05103583
APPEAL DATE: 03-17-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
''j ,. I .~; ~. 1 /'1 f'] '_~ I +._,..
'03"",;0 'j; i:~)o
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +-
REv=i54s-Ex-AFP-roi=o5j------------------------____________________________________________
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-16-2006
ESTATE OF COOPER JR
WILLIAM
J DATE OF DEATH 09-05-2004
COUNTY
CUMBERLAND
FILE NO. 21 04-1116
TAX RETURN WAS:
S.S/D.C. NO. 200-22-6463
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05103583
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
010-0120512
TYPE OF ACCOUNT: ()SAVINGS () CHECKING ()TRUST ~ )TIME CERTIFICATE
DATE ESTABLISHED 03-06-2000
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
1,031.57
0.500
515.79
.00
515.79
.15
77 .37
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 01-24-2006 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 77 .37
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.57
TOTAL DUE 79.94
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
pt
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRIS8URG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP (03-05)
CARL G WASS
CALDWELL & KEARNS
3631 N FRONT ST
HBG PA 17110
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-08-2006
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
101
WILLIAM
J
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
NOTE: To insure proper credit to your account. submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
~
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF COOPER JR WILLIAM J FILE NO.21 04-1116 ACN 101 DATE 05-08-2006
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-14-2005
PRINCIPAL TAX DUE: 60.70
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
12-03-2004 CD004703 3.03 57.51
, ,
--
\
--'I
.,.-.-
TOTAL TAX CREDIT 60.54
BALANCE OF TAX DUE .16
INTEREST AND PEN. .01
!Ii IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .17
/
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1.
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REflECTED AS A "CREDIT" (CRJ.
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 E:( AFP (03-05)
JENNIFER L RUSH-TURNER
556 HIGH ST
STEEL TON PA 17113
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-08-2006
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
05103584
WILLIAM
J
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE
--+ RETAIN LOWER PORTION FOR YOUR RECORDS
+-
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF COOPER JR WILLIAM J FILE NO.21 04-1116 ACN 05103584 DATE 05-08-2006
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYHENTS. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-04-2005
PRINCIPAL TAX DUE: 23.40
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-11-2005 CD005194 .00 23.40
I
< ---
TOTAL TAX CREDIT 23.40
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
III IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1.
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ.
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J
Ju
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX( 11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT NO. CD 007252
SENFT MELANIE S
4335 BOARD RD
MANCHESTER, PA 17345
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ---------- --------
05103579 I $83.54
ESTATE INFORMATION: SSN: 200-22-6463 I I
FILE NUMBER: 2104-1116 I
DECEDENT NAME: COOPER WILLIAM J JR I
DATE OF PAYMENT: 09/25/2006 I
POSTMARK DATE: 09/18/2006 I
COUNTY: CUMBERLAND I
I
I
DA TE OF DEATH: 09/05/2004 I
I
TOTAL AMOUNT PAID: $83.54
REMARKS: NAME ON SLIP WILLIAM J COOPER
RECEIPT TO CHECK ENDORSER
CHECK# 1178
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
,:-,--::r'IN'HERITANCE TAX
"- <STATEMENT OF ACCOUNT
'*
,-:' i
2nD7 JMJ 16 Pl'112: 00
REV-1607 EX AFP (03-05)
AMANDA
C/O 90R
ENOLA
CLERf< OF
ORC)L!i' \!,'c; ('n' Pf
I d r-,'...\" '; U "--'''-''1.....; 1
C BEITLE~Ur. ,-"\
WINTER LN
PA 17025
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-02-2007
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
05103574
WILLIAM
J
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
CUT ALONG THIS LINE
NOTE: To insure proper credit to your account, submit the Upper portion of this form with your tax payment.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
... INHERITANCE TAX STATEMENT OF ACCOUNT .__
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
ESTATE OF COOPER JR
WILLIAM
J FILE NO. 21 04-1116
ACN 05103574 DATE 01-02-2007
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-14-2006
PRINCIPAL TAX DUE: 77.37
PAYMENTS (TAX CREDITS):
INT
AT
REV
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
EREST IS CHARGED THROUGH 01-17-2007 TOTAL TAX CREDIT .00
THE RATES APPLICABLE AS OUTLINED ON THE
ERSE SIDE OF THIS FORM.. BALANCE OF TAX DUE 77.37
INTEREST AND PEN. 7.93
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 85.30
1I
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
C6
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
ri~rr~t;fERITANCE TAX
.', ~T~1~MENT OF ACCOUNT
*'
'. I '
REV-1607 EX AFP (03-05)
PAUL J COOPER
703 S 25TH ST
HBG
('\ q::'\( ry:
v....L.; 11\ ,,-".< _
1 I,..' l:i-' r~"("\~ \Q r
f'\IlDrv-\" ',1 ,) ;-,1),>' ,I
VI d ._.....t. n,~
("'1 l~,_"H"~;." - I , I ,I ~'l~\
I....;.......'.
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-02-2007
COOPER JR
09-05-2004
21 04-1116
CUMBERLAND
05103583
WILLIAM
J
ZOOl ..!I\N I 5 P?\ 12: 00
PA 17111
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
....
RETAIN LOWER PORTION FOR YOUR RECORDS
~
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF COOPER JR
WILLIAM
J FILE NO. 21 04-1116
ACN 05103583 DATE 01-02-2007
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-14-2006
PRINCIPAL TAX DUE: 77.37
PAYMENTS (TAX CREDITS):
INT
AT
REV
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
EREST IS CHARGED THROUGH 01-17-2007 TOTAL TAX CREDIT .00
THE RATES APPLICABLE AS OUTLINED ON THE
ERSE SIDE OF THIS FORM.* BALANCE OF TAX DUE 77 .37
INTEREST AND PEN. 7.93
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 85.30
*
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
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