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Home My WebLink About02-0514 COMMONWEALTH OF PENNSYLVAN~ DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2806Dl HARRISBURG~ PA 17128-0601 * / )--(,6 -/0 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE c2/ "'OJ-Slc! NO ;-T2 02123471 05-16-2002 REV-15~3 EX AFP ID~-DD) :J1vu/vM Uj/f1 ~~ .~ ,AtA", ~ d:... 4JV 4 ~/17 ~J:.I/J" 17"fC-'V I };;"v ~' TYPE OF ACCOUNT D SAVINGS D CHECKING D TRUST [i] CERTIF. TO: JAMES F NOONE 215 LAFAYETTE ST HBG PA 17109-270&:[: EST. OF ELEANOR A NOONE 5.5. NO. 203-01~7993 DATE O.F DEATH 03-04-2002 c~/_.. COUNT!) 1l.^.UPIHN ~U/l(~=::HM/P REHIT PAYMENT AND FORMS ,.~REGISTER OF WILLS M"t~ll1fJ"BAllPIIIN CD Cub.., f1uu:>E ~ HARRISBURG, PA 17101 PSECU has provided the Departllent with the information listed below which has been used in alculating the potential tax due. Their records indicate that at the death of the above decedent~ yoU were a joint owner/beneficiary of his account. If you feel this information is incorrect~ please obtain written correction from the financial institution~ attach a copy o this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Comeonwealth Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE No. 0203017993-550 Date Established REVERSE SIDE FOR 02-03-2000 FILING AND PAYMENT INSTRUCTIONS PART [!] 44,706.03 50.000 22,353.02 .045 1,005. TAXPAYER RESPONSE !!!!!!~~!~~.I!!!!~~!!!!~~I!!!!I~~~i!i!!_~~!I!!!~,li!!!~lm!~~~~~~~~!!i!i~.!!!!~!lI~.!!I!I..!!!!!,.i!!!I!1~~i!!!!I!~~~I!! Acc Balance Percent ble Allount Subject Tax Rate Potential Tax Due x To insure proper credit to your account~ two (2) copies of this notice .ust acco.pany 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 .ay deduct a 5% discount of the tax due. Any inheritance tax due will becolle delinquent nine (9) months after the date of death. ax [CHECK ] ONE BLOCK ONLY A. 0 The above infor.ation 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 lIay check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Depart.ent 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. 0 The above information is incorrect and/or debts and deductions were paid by you. You must co.plete PART 0 and/or PART @J below. If you indicate a different tax rate} please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account BalancB 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 4 5 6 7 8 x x PAYEE DESCRIPTION '.' AMOUNT PAID I TOTAL (Enter on line 5 of Tax Computation) I $ Under penalties of P8rjury~ I declare that the facts I have reported above are true} correct and complete to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE (,.-H1 O'i,<JO'i RfV.(O<JIOO1 This IS to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. \,'II,'I~~\1~'oTpEi###-~ l'~~" .... . :t<'l-,\. ..~~... ~\ l=~" "_, -, ~~ ~ --" _'-'._~ ;0,.- ",'" 1:: \ * ~ .' ., - '. ,~* I ;;.* ,-,,: A.~'" "\.~ ' -, ~l '-----~1MfNl ~\ 't-'<;","" ""'''''''''''''HIHll1llljl ~!I~ C\~5.~/~. Robert S. <Zi.uJnerman, Jr., MPH Secreuf)' of Health Charles Hardester State Registrar @ 1862562 MAR 1 lZ00Z Date .' H105.;.:lAev,2J87 COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH rv__T . PEAIAAMi.NT ~- NAME OF DECEDENT(f..., M_. L_l SWiFILEHI,/IlOllER SEX SOClAl. SECURITY J<UMBER UNDER1're1oft - .... NOONE UHDER1D111' -1- ,FEMALE .203 - 01 7993 DATEOFDERIi_.Da\.'_J .. 03/05/02 1. ELEANOR AGEIL""'8ont>aIo1'l 8lAT1U'lACE(C;,yand SlallOIF"...",c.:..no-v1 ~EOFDERH'CI><Ido~""" _....,~""__t HOSPIl'-l.; 1__0 E~O :;::;"'0 89 YrL 1_SCRANTON, FA FACILITYNAMEJIlo"OOl"'""""""',_...___, . COUNTY OF DERH HOME 1:t; '- (1_."'~+1 IolAAIT.'lSwus._ __ied._. ......- RACl:..............-._k._."". - 10. WHI TE ...........,"", (Il__~"--_ d..-I DECEOENl'SUSUALOCCUPAlION l~...=:~",=::==r 11... HOMEMAKER "Il. OWN CECEDEHTS r.wLINOAOOAESS(S1r...c.yfbwo1.-'~Codel _.~CSBURG K MESSIAH K1HDOFIWSINESS/lNOUSTRY -SDECEDEHTEVERIN us foRMED FOACES1 _0 Nolj VILLAGE DECEDEHT'SEOUCATION .. CUMBERLAND ,~ '" - h.. CUMBERLAND -....1 17d] :;"'-:=:=al MF.~HANTr.~'RTJRG MOT1iER'S_lF..I._._SuuIamel 1.. WINIFRED MORAN _ORMAHTSMAlUNGADORESSlSnet.CiIvfTown.s...~CD) 215 LAF PlACEOFOISPOSITICIN._alc.n.toory.Cr..-y 0_- 1.. W l?c.O....__.. ~ , z . o . ~ o ~ ~ 100 MOUNT ALLEN DRIVE ,.MECHANICSBURG,PA. 17055 MJHER.S_IF...._.lMIl 1L F TYRRELL IHRlI'\UANT'SNMlE(TypelPrinll __ J AMES NOONE ~OFOISP06ITION O _XX~O __SlMeO _ OII.-~ ". DECEDEHT.S ""~ "".,"'" - -- ,~... ..Jr. lOCRlON.~.~.ZipCade ~ . , ~ o < ". CATHEDRAL CEMETERY NAME AHOAOORESSOF r.o.cIUTY _.lXlRKAN-CUFF-KEARNEY F .H, 12 LICENSE NUMBER :tt... SCRANTON, PA. 18504 SCRAN'I'ON laNSENUIoIBER 01l659-L I ...._0 (MonII.o.v.~ - ' -SColSEREFERREDlOMEDlCALElC.AMINERICORClNER7 _0 No~ ~w~ DUElOlOf!l<SACONSEOUENCEOF): a ,- '-- l--- : PlUtT.:ou.-tiQllif__c:onI1lbulino;IlOolNlh.\IUI ....._lingin_.-.p.g__..p,r,fIf1. :M. M.2I. 17.PlUlTI: EnIer__........."'campIiCaI__....-Ihe_tn,ea............__olaylng.luchac;arollKor....... LiOl""'t____on__. SO to. r . [: OIJElOlOf!ASACONSEOUENCEQFJ' OUElOCORASACON5EOUENCEOFl: weRE Al/1QP$Y FINOlNGS MANNER Of cu.rH _l..A8lEPRlORlO ~"'CAUO< - IiiI - 0 "'''''''''' - 0 P........~llon 0 - 0 ~iil _0 ~O -~ 0 C<><lIcI.....""...........- 0 OATEOFINJURY (_.Or,.~ TIMEOFlN.IUflY INJUflYRWC)FlK? DESCRlBEl1OWlN./lIRYOCClIfIReD. _ 0 NoD - - CERTF_<Cned<",""""" .CEJnlfYING""YSlClAN(""_~cauM"'___phyoIc:_ha$pr""""""""'_"""t""'...."""_131 To..._ol''''Y~...llIocc__..._~.I__'.._.. a Pl.ACEOFINJUflY.Al_...............IacIory._ lluiIdIng._.~ _. o 'd- .. .PftONOUNCING-'NDCERTIFYINOIItlYSlClAN(Pl>yM:....boI~"'''''''''''''",o_..-.:I~lOcauMot''"'''l To__ol....,_......_"'oc"'...-....._.......ondpIK..__to_.........I_m................_. .MEDICAL EXAMINERlCOfIDNEA 0.._ be...ol......I...lIon ondIot In_'lIllOlIon.ll1 my opinion. ....tI\oc"'..rr... at ....11..... dOl_..ncl pI.c_. .ncl"ue 101...""'..(.,..... 3'"~..S1.1.............,....................................................................................... REG'STFIAIl'SSIGNAI'UREANDNUt,l8ER J3 c:., '" -"1 O'""",,,~er/ a. ~ _!1C!!dt'. o U. ORE ~ILED'Mo""', ~y, ....'J MAR 11 2002 ~. : - !~.... _ill: &I ')';' '. ... '1 ~ > <I:. t(!.. '..1 - ~ ~ ..... - .... ~ ;, "- CL - c.; <l. ... I ... ... 13- .q... - ~~ 8 :~ ~ 0 I ~~ C''J i~V ~ i~f~ ~ ~~~~ :'lit 11II .. ... .. ~ ... Pq, '''' IJ t:-.... V) C>c ~ ~ ~ ~ ':::) ~()V~ ~ ~<i3 ~ ~ ~-::> ~ ~Jv)'~ 4....0 ~ "= ~V)~ ~ ~ 1 ~- I/) <:. ~~ , ... ~ :> JV) ~i'u1: ~U-o .... '- ,.""0 " I' " ~ <( I\;. Cl. (') . 0::: -.J \, ([) (f' . ) ... "::t -. ... -. - .. ~ - .- ~ ~ -. .......... ...,; ''1> ., ... ...... ,~ ...... 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 NOONE JAMES F 215 lA YFA YETTE STREET HARRISBURG, PA 17109 _n_un fold ESTATE INFORMATION: SSN: 203-01-7993 FILE NUMBER: 2102-0514 DECEDENT NAME: NOONE ELEANOR A DATE OF PAYMENT: OS/28/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 03/04/2002 NO. CD 001228 ACN ASSESSMENT CONTROL NUMBER AMOUNT 02123471 I $1,676.57 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: JAMES F NOONE CHECK# 1327 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS ~ $1,676.57 MARY C. lEWIS REGISTER OF WillS ~ w ,., ,,:Sg'" u'" w" %~J u.... .. .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ z W Q W U W Q DECEDENTS ~M, (lAST FIRST, AND MIDDLE INITIAL) 1\ .. NO<:::.N e Ei~I'tNCr rrN f.( DATE OF DEATH (MM'()D-YEAR) DATE OF BIRTH (MM-DD-YEAR) f?Rrc. S. 2-00"2- Se ~b€l' I~ 1112- (IF APPLICABLE) SU VIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL) tV lit- OFFICIAL USE ONLY 0./ ~. Original Return o 4. Limited Estate o 6. Decedent Died Testate (AIIachcopyofWil) o 9. litigation Proceeds Rerei"ved o 2. Supplemental Return o 4a. Future Interest Compromise (dale of dealh atter 12-12-82) o 7. Decedent Maintained a living Trust (AtlachcopyofTl\Jst) 010. Spousat Poverty Credit Idate (Ildealh between 12-31-91 andH.95) / 'l-ro~ -10 FILE NUMBER ,fJ.L - -4 ~ 11 fJ6- L ~ COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 2,.03 - 0 I '79'13 THIS RETURN MUST BE FILED IN DUPLICI>.TE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER "'1ft o 3. Remainder Return (liMe 01 tleillh ~ \/J 12-1J-ll2) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach SchO) I- Z w Q Z ~ '" ll! 3 u FIRM NAME (If Appleable) Ci6~AD~ 5fn::?ef- wr;sil!) I fA.. J1/(J/ TELEPHONE NUMBER OFFICIAL USE ONLY ...--..,. .- C 1'-. f':? (8) S09'7'f.1-1 z o 5 :::J ~ ii: c( u w II/: 1, Real Estate (Schedule AI 2. Stocks and Bonds (Schedu", B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4, Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank. Deposits & Miscellaneous Personal Property (Schedule E) 6, Joindy Owned Property (Schedule F) o Separate BiHing Requested (1) (2) (3) (4) (5) (11) (12) (13) I I ~ '1'7, ~ 0 ::3 q -1;) I, -:')b (6) 5097,/.'-.1 (14) :.;:, '; .:. - 7. Inter-VIVos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 6. Total Gros,......to (total Lines 1-1) (7) 17'-77A 17<D? 7A (g) (10) (;,'IoL/.' 5'-'13.00 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11, Total Deductions (total Lines 9 & 10) 12. Net Value of Estat. {Une 8 minus line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts fOf whleh an electioo to tax has 001 been made (Schedule J) 14. Net Value Subject to Tax (line 12 minus Une 13) SEE INSlRUCTIONS ON REVERSE SIDE FOR I>.PPUCI>.BLE RATES z o ~ I-" :::J II. ~ o u ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.o_ (15) ,0 'fS- (16) x .12 (17) , .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate c; c; 3;L 7, '0 11. Amount of line 14 taxable at sibling rate 18. Amount of Une 14 taxable at collateral rate 19. 1ax Due 20.0 CHECK HERE IF YOU ARE REQUESTING I>. REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS CITY . itt.l- ritJe..> Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPaymenls A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 7 ?J, I i./ ( .oS"~3) Total Credils (A + B + C) (2) "f 3.1 'I 3. InteresUPenalty n applicable D.lnterest E. Penalty TotallnteresUPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) . , 'II 17"9 n. 5. n Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 1e""7C,, t:; 7 A. Enter the interest on the tax due. (5) (SA) (5B) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. ! b 7C;,S7 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 a. retain the use or income of the property transferred;.......................................................................................... 0 b. retain the right to designate who shali use the property transferred or ils income; ............................................ 0 c. retain a reversionary interest; or..........,............................................................................................................... 0 d. receive the promise for life of either payments, benefils or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property wrthin one year of death without receiving adequate consideration? ......................................................... ....................................... 3. Did decedent own an "in trust fo~ 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? ................... .......................... ........................................................ No /tj I'll fa [iJ ~ I'll SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of trensfen; to or for the use of the surviving spouse is 3% [72 PS. 99116 (a) (1.1) Ii)). For dates of death on or after January 1, 1995, the lax rate imposed on the net value of transfen; to or for the use of the surviving spouse is 0% [72 P.S. 99116 la) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse Is Ihe only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfen; from a deceased child twenty-one yean; of age or younger at death to or for the use of a natural parent, an adoptive parent, or a 'tepparent of the child is 0% [72 P.S. 99116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(111. The tax rate imposed on the net vaiue of transfen; to or for the use of Ihe decedent's sitJIings ;s 12% [72 P.S. 99116(a)(1.3)J. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. r , r Rf\I.l502 EX + (12-85) '* SCHEDULE A REAL ESTATE . ESTATE OF COMMONWEALTH OF PENNSYLVANIA INHERITA.HCE TAX RETURN RESIDENT DECEDENT FilE NUMBER (Property ;ointly...owned with Right of Survivorship must b. disclosed on Schedule F) All real .stat. should b. reported at fair mark.t vaJue which is defined as the price at which property would b. exchanged between 0' willing buyer and a willing seller, neither being compeUed to buy or s.lI, bath hoving reason.oble knowledge ofth. relevant facts. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. IV 1ft Rl'I-Is.u~.tl.Wl *' COMMONWEAlTH OFPEWlSYlVANlA INHERITANCE r AX RETURN RESIDENT DECEOENT . SCHEDULE B STOCKS & BONDS . ESTATE OF FilE NUMBER All property jointly...owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. JJIr:r 1 TOTAl (Also enter on line 2, RecaprtulatiOl1) $ (If more spxe is needed, insert additional sheets of !he same ,i7"1 \ R!f.1SMa,..(J.91'J . '* SCHEDULE C CLOSELY .HELD CORPORATION, PARTNERSHIP or SOLE-PROPRIETORSHIP COMMONWEAlTH Of PENNSYlVANIA INHERITANCE TAX RETURN RESlOtNT DECEDENT FILE NUMBER EST ATE OF Sd1e<lu1e C-' or C-2 (Including aD supporting infonnalion) mus! be attached for each cIosely-l1e1d corporntion/pill1neo;hip inl'''''l ofllle dl>Cedent olller Ihan a sole-proprielorship. See instructions for \he supporting information to be submitted fa( sole-proprietorships. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE Of DEATH f/lrt TOT At (Nso enter on line 3, Recapitulation) S (If more space is needed, insert adcfitional sheets of thP. ~M'lP ".t7~\ -'_.~. COMMONwEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIOOIT DECEDENT ~/ff SCHEDULE C.1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF FIlE NUMBER 1. Name of Gorporntion Address City 2 FedetaI Employer 1.0. Number 3. Type of Business State of Incorporation Dale of Incorpotation Total Number o( Shareholders Business Reporting Year Zip Code State Product/Service 4. TYPE TOT At NUMBER OF NUMBER OF SHARES VALUE OFTHE STOCK Voting f Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENTS STOCK Common $ Preferred $ Provide all rights and reslridions pertaining to each dass of stock. 5. Was the decedent employed by the GOrpotation? 0 Yes DNa If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted 10 the decedent? 0 Yes o No If yes, provide aOlQ\lnt of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? 0 Yes 0 No If yes, Cash Sumender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock of this company within one year pfior to death or within two years ff the date of death was prior to 12.31-82? DYes 0 No If yes, 0 Transfer 0 Sale Number of Shares T ransteree or Purchaser Attadl a sepcyate sheet for aM,oonal transfers and/or sales. Consideration $ Date .' 9. Was lIlere a written shareholder's agreement in effect at the time of the decedenrs death? If yes, provide a copy of the agreement 10. Was the decedents stock sold? 0 Yes 0 No If yes, provide a copy 01 the agreement of sale, etc. 11. Was thecorpo<ation dissolved or liquidated after the decedenfs death? 0 Yes 0 Na If yes, provide a breal<down of distributions received by the estate, induding dales and amounts received. o Yes 0 No 12. Did the corpo<ation have an interest in other corpo<ations or partnerships? 0 Yes 0 No If yes, report the necessaty information on a separate sheel indulling a Schedule C-l or C-2 for each interest. ." . .-. ~-:oMN~~CYJ' ~.- _ - ~:!M~~'eSUB1f~EW~~~!rifli~CHEbUD~'-~~~~~~~~ "jl~~.___';.!l~f,Q~,!~ ,.!!m.._.,,~_my..~~"""~<__,,<__ ,",Il~~~~~ A. Detailed calculations used in the valuation of the decedenfs stadt B. Complete copies offinancial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. n the corporation owned real estate, submit a list showing the complete address/es and estimated fair mar1<et value/s. If real estate appraisals have been seaned, attach copies. D. Ust of principal slocl<holders at the date of death, number 01 shares held and their rela1ionship to the decedent E. list of officers, the~ salaries, bonuses and any other benelits received from the corporation. F. Statement of dividends paid each year. US! those dedared and unpaid. G. Any other informa1ion relating to the valuation of the decedenfs stock. . . ~.lS)SE(.\I}lln '* ~ 1ft SCHEDULE C.2 PARTNERSHIP INFORMATION REPORT . COMMONWEALTH OF PENNSYLVIIN1A INHERITANce T>X RETURN I NT DE EOENT ESTATE OF FILE NUMBER 1. Name 01 Partnership Address City Federal Employer 1.0. Number Type of Business Decedent was a 0 General 0 Dale Business Commenced Business Reporting Year State Zip Code 2. 3. 4. ProductlSetvice Umited partner. If decedent was a limited partner, provide initial investment $ 5. PERCENT OF PERCENT OF BALANCE OF PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A. B. C. O. 6. Value of the decedenfs interest $ 7. Was the Partnership indebted to the decedenf7 ff yes, provide amount 01 indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? 0 Yes 0 No If yes, Cash Surrender Value $ Net proceeds payabie $ Owner of the policy DYes 0 No 9. Did the decedent sail or transfer an interest in this partnership within one year priDr to death or within two years if the date of death was prior to 12-31-82?' o Yes 0 No If yes, 0 Transfer 0 Sale Percentage transfemldlsold Transferee or Purchaser Consideraiion $ Date AlIad1 a separate sheet for additional transfefs and/or sales. 10. Was there a wrilten partnership agteement in effect at the time of the decedenfs death? If yes, provide a copy of the agreement. o Yes 0 No 10. Was the decedenfs partnership interest sold? ff yes, provide a copY of the agreement of saie, ete. 11. Was the partnership dissolved or liquidated after the decedent's death? 0 Yes 0 No If yes, proVide a breakdown of distributions received by the estate, including dates and amounts received. o Yes 0 No 12 Was the decedent reiated to any oflhe partners? 0 Yes 0 No if yes, explain 13. Did the partnership have an interest in other corporations or partnerships? . 0 Yes 0 No If yes, report the necessary infonnation on a sepanate sheel. including a Schedule C-' or C-2 for each interest A. Detailed calculations used in the valuation of the decedenfs partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax retUms (Fol1l\ 1065) for the year of death and 4 pceceding years. C. If the partnership owned real estate, submit a Ust showing the complete addTesSIes and estimated fair market vaiue/s. If real estate appcaisals have been secured, attach copies. D. Any other infol1l\ation relating to the valuation of the decedenfs partnership interest. . RfV.l507JX. j1.3s1 [J7ft -!i& COMMONWEA1.7H OF PENNSYlVANtA INHERITANCE tAX JlEIlJRN RESIDENT DECED!NT SCHEDULE D MORTGAGES AND NOTES RECEIVABLE ESTATE OF (All property iointly~owned with ,he Right of SlJrvivo~hip rn...~d be disclosed on Schedule f.) .--......-.--: . Please Print or Type I filE NUMBER ITEM NUMBER DESCRIPTION VALUE AT DATE Of DEATH TOTAL (Also enter on line 4, Re<apitulotion) S (If more space is needed, inserl additional sheets of same size.) ., . ^ I J , t I ,ReI,'ftaU.iJ-W) '*' M/4 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMOJONWEAL TH Of PENNSYLVANIA INHERlTANCE TAX REf URN RESIDENT DECEDENT ESTATE OF FILE NUMBER Include 1he proceeds of itigation and !he date the proceeds were received by !he estate. All property jointiy-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 5, Recapitulation) $ (tf more soace is needed. insert additional sheP.1~ of the. c:.~ ..i...,.\ -- Rft.U09U... [12-811 . SCHEDULE F JOINTlY -OWNED PROPERTY COMMONWfAll"H Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT PECEDENT ESTATE OF FILE NUMBER 1J o"vl:': E I ""h"b~ ;r"v,N Joint tenont(s): NAME Jrt"" 5 r- "'CdAJC ADDRESS 2 I S- L;;-f;rJ ~ tl., 'Sf !-I ",;,r.)},,,,) ,I,.. 1110., RELATIONSHIP TO DECEDENT A. So"; B. c. Jointly-owned property: LETTER , ITEM fOR DATE TOTAL VALUE DECO'S DOLLAR VALUE OF NUMBER JOINT MADE DESCRIPTION Of PROPERTY Of ASSET % INT. DECEDENT'S INTEREST TENANT JOINT 1. A 5/"'" f1iP"'~1 I'l..~k{f if{c ,,~4 >'-IytJ :<(. >,,-;. 0-"" AO~ f>3 c.-I,',.,..-:, tv",~'>.-..I a",,1c A'f....'f- o 'f -1/ - (p()OS/pl Cl,.c'k,'~) /t".-f so'!. I <.{I 't . 5~ tJAf,\I~1 6-1-k ~,..q /7 .2 A c('f.''1--f-; " ",~ Q ~ - II- I ., '6''1 :L 7;l.:;53. . ~ c...::!) 4L/7d(" 0, 'So 1 3 . (l5E c..V M, 'f ;l.,O, .01 .7 '19 3 - T01 AL {Also enter on tine 6, .Rec.opitulolion} S S' 0 'f7Lj,-:l" .. m mort!' sooce is n@eded insert odditjnnnl ch.,....... _L ~~ REV.ISle EX... (1-B7) Ntk Cl..t~.J "::<,:J~...,,, ':"':~r.:~ COMMONWeALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT SCHEDULE G TRANSFERS PLEASE PRINT OR TYPE ESTATE ci'F fiLE NUMBER THIS SCHEDULE MUST BE COMPLETED AND fILED If THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OFTHE COVER SHEET IS YEs. ITEM I DESCRIPTION OF PROPERTY TOTAl VALUE DECO. ! DOllAR V AlU E EXClUSION % , OF DECEDEN1'S NUM8ER lndlld~ nome of the tramleree, their relalionship 10 dl:cedenl, dote of transfer. OF A55E1 INT. i INTEREST : , I I I. I I I I I , I I . I - TOTAL (Also enter on line 7. Recapill,llotion} I S (If more space is needed, insert additiane/ sheets of sOme size.) RPM~11ex:t"'l7] '*' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYlVANIA INHERITANCE r AX RETURN RES1DENT DECEDENT ESTATE OF N ~OtJ i: ./ f I ~i+JV~1{ A",,,, FILE NUMBER Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 7J v V' kit,", . c...J.f- rw",,,,,,, ) fh-... k'V~'IN~'1 (.oo'1.<'>~ :J "'7 , en 1-,,-;..,) C F-'v,j) f:. t,.... '1 v ,<. f" ho~ ) 39S.. " ~ 8. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Sodal Securt\y Numlleljs} J EIN Number of Persol1<l1 Representative(s} Street Address City State Zip Year{s} Commission Paid: 2. Attorney Fees 3. Famity Exemptioo: (11ljecedent's address is notlhe same as c1aimanfs. attach explanation) Claimant Street Address . City State Zip Relationsnip of Claimant to Decedent 4. Probate F~t3 5. Accountan(s Fees 6. Tax Return Prepare(s F~ 7. - TOTAL (Also enter on line 9, Recapitulation I $ (., L/ () '{. eO (If more soace is needed. insert additional. "h~ cd tho. "",_0. "';.......t ltl!Y.1512l!X+ (1.9JI . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS ptease Print or Type FilE NUMBER COMMQNwtAlTH OF I'!NNSYlV.o\.NI", INHUIT.o\.NCE TAX RETURN llESIOENTQEC!OENT ESTATE OF Noo,(j~ E(eANolt A",- ITEM NUMBER DESCRIPTION AMOUNT ').. {>1(5,.'",h V..I!~(_ (l hM AIV1-l' ,. ,If S('ro/fl. I (/lYe /) I . / {t 7U..)f1J,,-~ / VN,j fJO f (D.Jl't) hl 1'~5VY,t?t(r.- 5 ;Z II . os 1. 3/ 9 '1 I TOTAL {Also enter on line 10, Recapilulalion) s .';;- :t 'f :3 , 0 (1/ more space is needed, insert additintlnl d.......~ ....$ ~___ _:-- I ,JIlt- l(V.I"l::st):'+\H~ ,. SCHEDULE J BENEFICIARIES COMMONWfALTH 01 '(NNS~LV"'MI'" tNJtERITANCI TAX RETURN RES.IOEHTOl(,ltllNT ESTATE OF FILE NUMBER ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE A. .T axoble BeqIJe!lts: 1. .. . . .. . . . ITEM . ..,.. NUMBER. NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and GO'lernmentol Bequests: 1. TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enler on line 13, Recopltulotlonl S {If more space is ne.d.d, insert additional she.U of same sizel ',' ~/ft 1l:n'.1.514 ~X+ (10-9'" '*' SCHEDULE K LIFE ESTATE/ANNUlTyj TERM CERTAIN COMMONWEAlnt Of PENNSYLVANIA INHERITANCE. TAX RETURH RESIDENT OECEDENT ESTATE OF I FILE NUMBER This schedule is to be used for all single life, joint or successive life estates and term certain cakulation~. For dotes of death oHer 12.31-61 and before 5-1-89, actuarial factors for single life calculation, can be found in Revenue Booklet (REV-1501B), For dote, of death on or after 5-1-89 actuarial factors con be found in IRS Publication 111457 Actuarial Values, Alpho Volume, The in,trument creating the life inferest i, a: (PI.ase attach a copy of instrum.nt) o Will 0 Intervivo, De.d of Tru,t 0 Other LIFE ESTATE INTEREST CALCULATION Nam.I') a' Lif. T.nont(.) Oafe of Birth Present Age Term of Years li.f. Esta'te is Payable (N.or..t Birthday) o Ufe or 0 Term of Years o life or 0 Term of Years o life or 0 Term of Years . o life'or 0 Term of Years 1. Value of Fund from which Life E,tate(,} i, payable: """""'"''''''''''''''''''''''''''''''''',''''''''''' $ 2, Actuarial 'Factor per appropriate Table .."..""...,.".".".,......"."""."."."."..."..""".""". Intere,t Table rate - 0 3Y,% 06% 0 10% 0 Variable Rate % 3. Value of LifeE,tate (lin. 1 x Lin. 2) """.""""""""..""""...."""."."".""""".""".."" $ -. , ANNUITY INTEREST CALCULATION ...~om.l') a' Annuitant(.) Date of Birth Present Age Term of Yeors Annuity is Payable .. (Nearest Birthday) - o life or 0 Term ofYeo~s .-. .. .. ~ o liFe or 0 Term of Yea~s ,. . '. o LiEeo: 0 Ter~ of Years o life or 0 Term of Years '.1. Value of Fund from which annuity i, payable- .....................:......... S 2. Check appropriate block below and enter corre'ponding (number) in column ..................... Frequency of payout - 0 Weekly (521 o Quarterly (4) 0 Se;"i-Annually (2) OBi-weekly (26) 0 Monthly 112) o Annually 11) 0 Other I 3. Amount of payout.p.r period....................................................................................:., 4. Aggr.gate Annual payment, Line 2 x Line 3 ................................................................. 5. Annuity Factor (.ee in'tructian'l Int.r~'t Tabl. rate. 0 3V,% 06% 0 10% 0 Variable Rat. % 6. Adju,lment Factor-{,e. in,tructians) ............................................................................... 7. ~f~u:ri~~~;~I~iJa;i~~ ~:~n(i;:'1\ 6~~.] ~': o~~f. v~~~~.~.I~.:~~~..~.~~.:.~~~~~.:.~:.~~~.i.~.~.t.~~~. If using variable rate and period payout is. at beginning of periodJ cclcuJation is: . (lin.4 x line 5 X line 6) + line 3. ...................................... NOTE: The value, of the fund, which create the above future intere'ts mu,t be reported os part of the E,tate Asset" line 1 through Line 7. Th. R.,ultina Life/Annuity Inter.,t/,I ,hould b. reMrt~.-l ~. .k. _u___ . .. ---.-. .. AT.lit, REV.lb4.t EX+ (:J.&AI . COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT INHERITANCE TAX SCHEDULE "l" REMAINDER PREPAYMENT OR INVASION OF TRUST PRINCIPAL fiLE NUMBER I. Estate of II. Ilo~1 Nome) (Fiest Nom&) {Middle Initiolj Thi. schedule i. appropriate only for estates of decedents dying on or before December 12, 1982. This schedule i510 be used for all remainder returns when an election to prepcy has been filed under the provisions of Sedian 714 of the Inheritance and Estate Tax Ad of 1961 or 10 report the invasion of trvst principal. Remainde~,Prepayment: A. Election to pr~pay filed with the Register. of Wills o~. (attach copy of election) . B. Name(s) of life T enant(s) Dote of Birth or Annuilonl(s) (Dale) Age on dote of election Term of years income or annuity ;s payable C. Assets: Complete Schedule L-1 1. Real biat. 2. Slacks and Bonds - 0 3. Closely Held Stock/Partnership' . ".J) 4. Mortgages and Noles .- 5_ o Cosh/Misc. Personal Property 6. Total from Schedvle L,l O. Credits: 0 Complete Schedule L-2' .1. Unpaid liabililies 2_ Unpaid Bequests 3. VoIue of Unindudable.Assets S $ $ $ $ $ $ .$ ,. :l $ III. 4. Total from Schedule L.2 E,_ Total value of Irvsl assets (Line C-6 minus line 0-4) F. Remainder factor (see Table.1 or Table II in InstrudionBaoklel1 G. Taxable Remainder value (Line E x Une F) (Also enter on Line 7~ Reca itvlatian) Invasion of Corpus: '0 A. Invasion of corpus $ $ $ tMonth, Day I Year) 'i ~ l . B. Name(s) af life T enanl(') or Annuilant(s) Date 01 Birth Age on dale corpus consumed Term of years income or annvity is payable C. Corpus conslJmed D. Remainderfador (see Table I or Table 11 in Instruction Booklel) $ $ i . 1 I 0' ~ T ..........hl... ...~lll.. ,.,; l'OM"lU!l. l:'on~umed lune C x Une 0\ ~ 1J 1ft ,-,'+-~'-"_.~""---'...., REV.16....s EX+ (7..a5} INHERITANCE TAX * . SCHEDULE L-l COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -ASSETS- FilE NUMBER I. Estate of (loSi Nome) (firsl Namel lMiddle InihaJI II. Item No. Description Value A. Real Estate (please describe) . Total value of reol estate S (include on Section II, line C.l on Schedu/eL) B. Stocks and Bonds (pleose list) .. . . Total value of stocks and bonds S (include on Section II, line C-2 on Schedule lJ C. Closely Held StocklPortnership(ottoch Schedule C 1 ondlor C.2) (please list) Total value of Closely H eldlPortnership S (indude on Section II, line C-3 on Schedule l) D. Mortgages and Notes (please list) T 0101 volue of Mortgages and Nates . S (indude an Section II, line (..4 on Schedule l) E. Cosh and Miscellaneous Personal Property (please list) - Toto/ value of CashlMisc. Pers. Property S (include on Section II, line C.5 an Schedule l) III. TOTAL (Also enter on Section II, Line C.6 on Schedule l) S . (If more space is needed, attach additional 8 V, x 11 shee"J t/ift , I REV.lo...o EX. (J-Uj INHERITANCE TAX . ~ SCHEDULE l-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT elECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -CREDITS- FilE NUMBER I- E3tcte of (lost Ndmll) (fint Nome) \Middlo Initial) II. Item No. Description I Amount A, Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule l.l (please list) " .' - - ... T alaI ,unpaid liabilities S . (include on Seaion II, line D.l on Schedule l) 8. Unpaid Beguests payable "from. assets reported on Schedule l.l (please list) I .. . .. .. - - -, ~":"."'-".;'. -.. I. : -- -- . ., . - " .. .- Total unpaid bequests . S - - (include an Section II, line D-2 on Schedule l) C. Value of assets reported on Schedule loT [other than unpaid bequests lisled under - liB" above) that are riot included for tax purposes or that do not form a port of the trust. Computation as follo~s: , , . , , .- .. , r- ,- T 0101 unincludable assets IS (indude on Seelion II, line D-3 on Schedule l) 111.1 TOTAL fAlso enter on Seelion II. line D.4 on <:;,I,..A"IA 1\ 1- ~ Revt11141 ex. (10-94) *' SCHEDULE M . FUTURE INTEREST COMPROMISE COI.MJNVl/EAl TH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER This schedule is appropriate only for Estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in Dossession and eniovment cannot be established with certainty. The instrument creating the future interest is: (Please attach copy of instrument) o Will o Trust o Other .. Beneficiaries NAME OF . DATE OF AGE TO I BENEFICIARY RELATIONSHIP BIRTH NEAREST BIRTHDAY 1. 2. 3. 4. 5. . II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise one of the following within 9 months of the decedent's death, check the appropriate block and supply a copy of the document in which the surviving spouse exercises such withdrawal right. o Unlimited right of withdrawal o limited right of withdrawal III. Explanation of Compromise Offer: (If more space is needed, attach additional 8.5 X 11" sheets) . , . . IV. Summary of Compromise Offer: 1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . .-~ . . . . . . . . $ 2. Value of Une 1 exempt from tax as amount passing to charities, etc. . . . . . . . . . . . . $ . (also include as part of total shown on Une 13 of Cover Sheet) 3. Value of Une 1 passing to spouse at appropriate tax rate. . . . . . . . : . . . . . . . . . . . . $ Check 1 Block 06% ,03%,02%,01%,0 Exempt (also include as part of total shown on Une 15 of Cover Sheet) $ 4. ValueofUne 1 Taxable at Lineal Rate .................................. (also include as part of total shown on Line 16 of Cover Sheet) $ 5. Value of Line 1 Taxable at Collateral Rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (also include as part of total shown on Line 17 of Cover Sheet) $ 6. Total Value of Future Interest (sum of Lines 2 thru 5 must equal Line 1) . . . . . . . . . IJ/It . .. REV. rOd ex 1\.9'2) ~D ~ CclMMONWEAlTH OF PENNSYLANIA INHERITANCE TAX DIVISION ESTATE OF AJ.... J..---.--.. . /1 ..fJ . SCHEDULE N SPOUSAL POVERTY CREDIT AVAILABLE fOR DECEDENTS DYING AfTER 12/31191 I FilE NUMBER This schedule must be completed and filed if you checked the spousol poverty credit box. on the cover sheef. PART I - CALCULATION OF GROSS ESTATE 1. Taxable Assets totol from line 8 (cover sheef) .................................................................... 1. 2. Insurance Proceeds 'On life of Decedent .......~.................................................................... 2. 3.' Retirement Benefi1s ...................... ....................... .......... ....-....... ..~....... .......... ....., ........ ..... 3. A. Joint Assets with Spouse.........................:...............,..........................,............................ A. 5. P A lottery Winnings ......,............................ .... .... ................. ............................ ...... ......... 5. , 6c. 60. Other N?nt~~xoble Assets: List {Attach schedule if necessary).. 60. '- ....' ".,;.,,*. .,'~;-,- -. : ~. - -,' ~~-.>~~.,.. .." , 6b. 6d. 6. SUBTOTAL (Un'e, 60, b, c, d) ......................................................................................... 6. 7. T~tol Gross Assets [Add Jine, 1 thru 61............................................................:................. 7. 8. T 0101 Adoof 'liabilities ...........~_................. ..................................:........................ ........... B. 9. Net Value of Estate (Subtrod line 8 from line 7).,.............................................................. 9. If line 9 is greoterthanS200;OOO. STOP. The estate is 'nof eligible to dotm fhe credit. If not, continue to Pari /1. PART \I - CALCULATION OF JOINT EXEMPTION INCOME - (Attoch copies of Federol lridividuol Income Tox Returns for decedent and spouse.) Income:. 1. TAX YEAR: 19 2. TAX YEAR:,19 . 3. TAX YEAR: 19 .. . . o. Spous.e...............;......: 10 20 30. b. .Decedent ......,.~',.......,.. 1b . 2b. 3b. . . .. c. Joint .......................... 1<. 2c. 3c. d.. Tex Exempt Income..... ld. 2d 3d e. Other Income not listed above ........... le. 2e. 3e. . I. Tolol.......................... 11. 21. 31. - 4. Averoge Joint Exemption Income Calculation 40. Add Joint Exemption Income from above: (1l) ... (21) ... (3l) = t+ 3) Ab. Average Joint Exemption Income .........................hh........................................................ = Illino 4rb) i, greater than $40,000 .. STOP. The e,tate i, not eligible fa claim. the credit. II not, continue /0 Porll/l. PART III - CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT ESTATES .--'- 1. InseM amount of taxable transfers to spouse or S 100,000, whichever is less.......................... 1. 2. Multiply by credit percentage {see instructions) .................................................................. 2. 3. This i3 the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on Hne 1 a of the cover sneet. ............................................ 3. A. For' Nonresidents, enter tlte ratio of the decedent's gross estate in PA to the VCIUA n~ .~.... . AlJA- , REV-1649 EX+ (819~) . *' SCHEDULE 0 TRANSFERSTOSURvnnNGSPOUSE C'O).0,4O'NW!.ALnlOPnNNnLVAN1A lNHDn'~a TAX u:IlJRN """""""""'''''" ESTATE OF File-Number PART A: Entci the description and value of aU interests., both taxable and non~tuable. regardless oflocation, (net of deductions) which pass to the decedent's surviving spouse by will, intestacy. open.tion of law, or otherwise. Descri tion of items Amount 1 'lo'- Part A Total: Enter the amount sho'Ml on the recapitulation sheet in the Decedent Infonn2.tion Section. Election To Snbject Property To Tax Under Section 2113(A) As A Taxable Transfer By This Dccedent. If a trust or similar arrangement meets the requirements of Section 2113(A). and: a. The ~ or similar arrangement is listed on Schedule 0, and b. The value aCthe trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then'thc transferor-'s personal representative may specifically idc:ntifythe trost (all or a fractional portion or percentage) to be included in the election to have such trust or similar ~ trcaicd as a taxable transfer in this estate. If less than the entire value of the trust or similar property is inc[uded as a taxable transfer on Schedule 0, the penonal representative shall be considered to have made: the election only as to a fraction of the trust or simibr arrangement The numerator of this hction is equal tothc amount oCthe trust or similar arrangement included a5 a taxable asset on Schedule O. The denominator is equal to the. total value of the trust or similar arrangement. . ELECI'ION: Do you elect and~r Section 2113(A)to treat u. tusble transfer hi this estate all or s portion o( s trust or :!Ilmilar arnnc~m~nt created Cor the sole use orth.b decedent's sun1vtnzspouse durinZ the survlvinZ :!Ipouu's entire lifetime? YES D NO D Sirna..... D... Note: It the ded10n appUes to more than one tnDt or slmiIar arr:ancement, then a upante ronn must he :!Iicned and filed. Part B: Enter the dcsaiption and value of all interests. both taxable and non-taxablc, regardless of location., (net of deductions) which pass 10 the dcccden1's surviving spouse for which a Scdion 2113 (A) elcdion is being made. DescriDtion of items Amo,"" 1 Part B Total \.. /"}-66 -/0 BUREAU OF INOIVIOUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG1 PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR OISALLOWANCE OF OEOUCTIONS AND ASSESSHENT OF TAX JAMES F NOONE 215 LAFAYETTE HBG , I U DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-22-2002 NOONE 03-04-2002 21 02-0514 CUMBERLAND 101 ST *' RU-1541 EXAFP UI-DZl ELEANOR A Allount Remitted PA 17109 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 ~ iiEV=is4TEX--AFP--foFiizY-iioT"icniF-YNHEifiTANClrTAX-'A-PPRAisE.~fEii:r,--AL.DiWAifcE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF NOONE ELEANOR A FILE NO. 21 02-0514 ACN 101 DATE 07-22-2002 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 BJ 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 fJ 7. Transfers (Schedule G) 8. Total Assets 111 (21 (31 (41 (51 (61 (71 .00 .00 .00 .00 .00 50.974.21 .00 (81 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule IJ 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule JJ 14. Net Value of Estate Subject to Tax (91 1101 6,404.00 5.243.00 (111 (121 1131 1141 NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. 50,974.21 11.647 nn 39,327.00 .00 39,327.00 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate llSI .00 X 00 = .00 16. Allount of Line 14 taxable at Lineal/Class A rate 1161 39,327.00 X 045 = 1,769.72 17. Amount of Line 14 at Sibling rate 1171 .00 X 12 = .00 18. Allount of Line 14 taxable at Collateral/Class B rate n81 .00 X 15 = .00 19. Principal Tax Due 1191= 1,769.72 -AX CREDITS: "AT"." ril l+J AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-I PAYMENT MUST BE MADE BY 12-04-2002*. TOTAL TAX CREDIT .00 BALANCE OF TAX DUE 1,769.72 INTEREST AND PEN. .00 TOTAL DUE 1,769.72 . 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" (CRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I /7-66-/0 "-- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-I6D7EKlFI'CDI-021 JAMES F NOONE 215 LAFAYETTE ST HBG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-29-2002 NOONE 03-04-2002 21 02-0514 CUMBERLAND 101 ELEANOR A Allount Rellitted I"A 17109 I"~ 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 ~ RE\i:ii.'iWEX-AF'P-foFii2y-m--.....--ZNHER'ii,'ANcriii'iCSTA-fEHE-tii-oF"-iic-couiff--..-...--------m---------- ESTATE OF NOONE ELEANOR A FILE NO.21 02-0514 ACN 101 DATE 07-29-2002 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: 07-22-2002 PRINCIPAL TAX DUE:~ 1,769.72 PAYMENTS (TAX CREDITS), PAY PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-28-2002 CDOO1228 88.24 1,676.57 ME NT MUST BE MADE BY 12-05-2002~. TOTAL TAX CREDIT 1,764.81 BALANCE OF TAX DUE 4.91 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 4.91 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" ICRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 28D60l HARRISBURG, PA 17128-06Dl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* ~ REV-UD7 EX AFP (Dl-DZl JAMES F NOONE 215 LAFAYETTE ST HBG " I;" DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-29-2002 NOONE 03-04-2002 21 02-0514 CUMBERLAND 101 ELEANOR A Allount Remitted If, ~ I PA 17109 ti, 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 pay.ent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=i6ifj-EiCAFP-[oFii2r---u..;.j,--INiiiRITANcririicusTATEHENi-O-"-;.c-ciiiJiif--j,...--------------------- ESTATE OF NOONE ELEANOR A FILE NO. 21 02-0514 ACN 101 DATE 07-29-2002 THIS STATEMENT IS PROVIDED TO AOVISE OF TME CURRENT STATUS OF TME STATED ACN IN THE NAMEO ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX OUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-22-2002 PRINCIPAL TAX DUE:, 1,769.72 PAYMENTS (TAX CREDITS): PAY PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-28-2002 CDOO1228 88.24 1,676.57 MENT MUST BE MADE BY 12-05-2002*. TOTAL TAX CREDIT 1,764.81 BALANCE OF TAX DUE 4.91 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 4.91 SlOE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL OUE IS REFLECTED AS A "CREDIT" ICRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J 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 NOONE JAMES F 215 lA YFA YETTE STREET HARRISBURG, PA 17109 _uu___ told ESTATE INFORMATION: SSN, 203-01-7993 FILE NUMBER: 2102-0514 DECEDENT NAME: NOONE ELEANOR A DATE OF PAYMENT: 08/19/2002 POSTMARK DATE: 08/16/2002 COUNTY: CUMBERLAND DATE OF DEATH: 03/04/2002 NO. CD 001540 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4.91 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: JAMES F NOONE CHECK#1424 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $4.91 MARY C. lEWIS REGISTER OF WillS \J7~ NootJE ~i~ 2-1.5 Lo.fo. ~ S-b Jlwr'I's bty I Pl}., (1 J 6r f<f'.J.is-f.er of fJj;JIs GJtf)'h~b.rJJ., Co. ClJlor+-Aot)S~ Cltf'/i-s/el PA. )7013 1 tC: i ..::.....::::~:.::.:::: r",lIf",Iif,.,."II"ifll,III1,II,.,I,I,.II,/,',,/,/.,/,/,'/ \ /'7-66-/0 " BUREAU OF INOIVIOUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-UOl EX AFP (01-02l JAMES F NOONE 215 LAFAYETTE ST HBG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-03-2002 NOONE 03-04-2002 21 02-0514 CUMBERLAND 101 ELEANOR A PA 17109 Alllount Reltitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: 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 CUT ALONG THIS LINE ___ RETAIN LOWER PORTION FOR YOUR RECORDS ... R'ifv; i 6ifj-ix--AFP--fOFii2Y-----...--iNifERIi:ANci;--YiiX--STATEiiifN"Y-ifF-iiifciiuNT--.iiii---------------- __ ___ ESTATE OF NOONE ELEANOR A FILE No.21 02-0514 ACN 101 DATE 09-03-2002 THIS STATEMENT IS PROVIOEO TO AOVISE 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: 07-22-2002 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-28-2002 CDOO1228 88.24 1,676.57 08-16-2002 CDOO1540 .00 4.91 TOTAL TAX CREDIT 1,769.72 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 "CREDIP' (CRJ" YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )