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HomeMy WebLinkAbout02-0831 ~ OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT //}- f?tf- ~ REV-1500 EX + (6-00) CAPB HpRL EplO CRAC KOTK ES FILE NUMBER 21-02$/ D E C E D E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST,AND MIDDLE INITIAL) Brownawe11 Richard L. DATE OF DEATH (MM-DD-YEAR) NUMBER DATE OF BIRTH (MM~DD-YEAA) COUNTY CODE YEAR SOCIAL SECURITY NUMBER 196-14-0516 THIS RETURN MUST BE FILED IN OUPUCATEWlTH THE 04 26 1994 IF APPllCA L UR IVING SPOU 04/13 1925 '5 NAME LAST, FIRST. AND MIDDLE INITIAL) REGISTER OF WILLS SOCIAL SECURt Y NUM Brownawe1l, Semone H. X 1. Original Return 4. Limited Estate X 6. Decedent Died Testate o 3 date of death . Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 2. 4a. 7. Supplemental Return Future Interest Compromise (date of death after 12-12 -82) Decedent Maintained a Living Trust NAME (Attach copy of Trust) 010. SpousalPavertyCredlt 0 11. Electlan to tax under Sec. 9113(A) (dateaf death between 12-31-91 and 1-1-95) (Attach Sch 0) , j_~~."L1;;CC/R\IlESPOHDENCE t CaNFI~NTIAL'I"AX 1NF000MATIQl\lfilatltD;.IllMCTl!~1G~;j COMPLETE MAILING ADDRESS C P o 0 R N R D E E S N T C o M P T U A T X A T I o N (Attach copy of WIIQ o 9. Litigation Proceeds Received Ro er B. Irwin Es . FIRM NAME (If Appllcable) IRWIN McKNIGHT & HUGHES TELEPHONE NUMBER 60 West Pomfret Street West Pomfret Professional Carlisle, PA 17013 Bldg. 17,307.;00 None None (1) (2) (3) "OFFICIAL USE ONLY R E C A P I T U L A T I o N 1. Real Estate (Schedule A) 2. Slocks and Bonds (Schedule 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. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (tolal Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Sub'ect to Tax (Line 12 minus Line 13) (8) 17,307.00 (11) 4.735.50 (12) 12,571.50 (13) (14) 12,571.50 (4) (5) None None (6) None None 4,735.50 None SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax 1.1") C. c:T\ rate, or transfers under Sec. 9116(aX1.2) ~ 71\JLJ 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. x ,0 6 (15) 761./.;),,4 X ,0 6 (16) X ,12 (17) 0.00 X ,15 (18) 0.00 (19) 754.29 Copyright (c) 2000 farm software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: ~ STREET ADDRESS 225 Mt. Zion Road CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit S. Prior Payments C. Discount (1) 754.29 Total Credits ( A + 8 + C) (2) 3. Interest/Penalty jf applicable D. Interest E. Penalty 0.00 480. 71 "'ii"";,:"" WiUi!!!iiUi Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. 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 + SA. This is the BALANCE DUE. (5B) Make. Check Payable 10: REGISTER. OF. WILLS, AGENT :":'::';';":"'.":':;':';;'11;;"': :nHij!iji] ",. """"""'''i::,iiUii:;':::::.;..,.:::!Urii'' ::'i !;:i!!l~:';!iC:!i:::';:'i::::':':'::" ,'.' ....-_. ..__ ..._.....,....,.__-.. _' ._.."..'..'.....",..",.._..._"'..,.,..,, ",_"'",_""___"'_"'",___,__,_""""__,_"",,,,,,.,",""""_,_,_""",_"".,.""",,,,_'' '_''''''_''''_'_,_,."':',,,__....,,'......,.._...,. .",',',:.,'",,_.' ,.,c":,",'.""''',::..-....-._... PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BL.OCKS 1. 480. 71 0.00 1,235.00 0.00 1,235.00 Wi!l!!)! Did decedent make a transfer and: 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 promise for life of either payments. benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Ves No ~~ o o o []] []] []] Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and belief, It is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU E OF PERSON RESPONSIBLE FOR FILING RETURN Semone H. Brownawell 230 Mt. Zion Road --------------------------------------------------- Carlisle, PA 17013 IRWIN McKNIGHT & HUGHES 60 West Pomfret Street -- -c~i-].-isi,;,-PA-- - i i613-- - - - - --- -- ----- ----- -- ---- DATE 'f1/6(Vv DATE For dates of de 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) (iJ]. 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) (i0]. 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 return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116( 1.2) [72 P.S. 9116(aX 1 J]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.$. 9116(aX1.3)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. Copyrlght (c) 2000 form software only The lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REII-1502 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Richard L. Brownawe11 SS# 196-14-0516 04/26/1994 21-02- All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledne of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 lot, Middle Road, Lower Mifflin Township, Cumbo Co. - 1994 17,307.00 assessment (12.82) X common level ration SCHEDULE A REAL ESTATE TOTAL (Also enter on line 1, Recapitulation) $ 17,307.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1~97) " REV-1511 EX +(1-97) ESTATE OF Richard L. Brownawe11 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS SSfj 196-14-0516 04/26/1994 FILE NUMBER 21-02- Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES, 1 Egger Funeral Home 3,296.00 2 Westminster Cemetery 650.00 B. ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions Name of Personal Representative(s} Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attorney's Fees IRWIN McKNIGHT & HUGHES 750.00 3. Family Exemption: (If decedent's address is not the same as claimant's. attach explanation) Claimant Street Address City State Zip - Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Recorder of Deeds - recording fee 29.50 2 Register of Wills - filing fee 10.00 TOTAL (Also enter on line 9. Recapitulation) $ 4,735.50 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Ine. Form REV-1511 EX (Rev. 1-97) REV-1513 EX +(9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Richard L. Brownawe11 SCHEDULE J BENEFICIARIES SSff 196-14-0516 04/26/1994 FILE NUMBER 21-02- NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS {inc.ludeOl.ltdght spousal di~tributions. and transfers under Sec. 9116(a)(1.2)] 1 Semone H. Brownawe11 230 Mt. Zion Road Carlisle, PA 17013 RELATIONSHIP TO DEqDENT AMOUNT OR S~Rr Do Not List Trustee(s) OF ESTATE Spouse remainder ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS . TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S 0.00 (If more space is needed. insert additional sheets of the same size) Copyright(e) looo form software only The LaCKner Group. Inc. Form REV-1513 EX (Rev. 9~OOI lLagt DiU anb m:egtament I, RICHARD L. BROWNAWELL, of Lower Frankford Township, Cumber- land County, Pennsylvania, do make and publish this as and for my last will and testament, hereby revoking any and all wills hereto- fore made by me. 1. I direct my executrix to pay all of my debts, funeral and administrative expenses a6 Boon as convenient after my decease. 2. I authorize and empower my executrix to sell any realty owned by me at my death at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. My executrix is authorized and empowered to continue to en- gage in any business in which I may be engaged at my death, for a period of one year after my death. 3. All the rest, residue and remainder of my property, real and personal, I give, devise and bequeath to my wife, Semone K. Brownawell. 4. If' Semone K. Brownawell should not survive me, then I give, devise and bequeath all of my property, real and personal, to my children, share and share alike. Should any child be under the age of twenty-one years at my death, then all of my property given herein shall be held in trust by Farmers Trust Company, Carlisle, Pennsyl- vania. The trustee, a5 well as my executrix, are hereby authorized to retain, unconverted, any property, real or personal, that I may own at my death, and shall be undHr no dut)r to convert the same into legal investments. The trustee shall have the power and authority to sell, transfer, convey, invest and I".:'linvest and to pay over the net income of the trust property, to Qr for the UBe and benefit of any of said children, whet,her under or ove::.' twenty-one y,~ars, or to accumu- late the same in the sole discretion of the trustee. The trustee shall be under no duty to distribute or use the income equally for each of said chll dren, but may distribute or use it unequally in its discretion. The trustee is also authorized and empowered to pay over ta, or for the use and benefit of any of said children, whether under or over twenty-one years, such portj.on of 1 or all of 1 the principal of the trust estate as in its sole discretion seems proper, for the maintenance, education or setting up of a child in business or in a . -, profession or for similar purposes The trustee shall be under no duty to distribute or use the principal equally for each of said children but may distribute or use principal unequally in its discre- tion. My primary object is to insure the proper support, maintenance etc., of such children as may be under twenty-one years of age. When the youngest of said children reaches the age of twenty-one years, then whatever remains of income or principal of the trust estate shall be distributed equally to saId children, share and share alike; the child or children ot: any deCe8<3ea cnlld taking "he ShdI'e theiX' parent would have taken if living, and subject to the same trust pro- visions if under twenty-one years of age at that time. 5. I nominate and appoint Semone K. Brownawell, to be the exe- cutrix of this my last will and testament without the filing of any bond. Should she die before my death, renounce, or refuse to serve for any reason, or die leaving any of my estate unadministered, my eldest child being under the age of twenty-one years, I nominate and appoint Farmers Trust Company as substitute executor with the same powers as are given herein to my executrix, and also without the filing of any bond. If, however, at my death, any child of mine is twenty-one years or older, such child or children shall be the sub- stltutt: eiCecutor or executors of t.;'""\ls m:{ 1ast: ~.!111 a..YJ.d t~'~tarrent.. without bond and with the same pO','lers as are given above to my execu- trix. 6. I direct my executrix to retain the services of Irwin, Irwin & Irwin, as attorneys in the settlemen~ of my estate. , """ 6 WITNESS my hand and seal this,q day of December, 19 3. 1<< /if,ilf ; A cl~a t )jrownaw 11 (SEAL) Signed, sealed, published and declared by the within named tes- tator, as and for his last will and testament, in our presence, who, at his request, and in his presence and in the presence of each other, have hereunto set our nBmnf', 201.AT_Warranty Deed, Short Form, Act of 1909. Henry Hall. Inc., Indiantt, Par ,::OMM'.:;-NWfi\L' . 'l !'-~.-Jl'; '1'. ,',NI': !'iU~\Rfr,'~Nr Of i::!_i'.: I u t.6; I , -, REcor,DcO - OFF'CE OF THE ;"~ i:C<:. ! I) ::: i1S JUt::",!:; 'J?' ,WI. zn ;,;,) Z '" (I] t!tbi~ meeb, .\ L.\ i -"1"/"1' "iM~~~r\THE 7 r- of Ollr Lord one thol/sand nine hundred day of -::r"Lf hi. theyeo.r BETWEEN WILLIAM S. BROWNAWELL, GEORGE B. BROWNAWELL, RICHARD L. BROWNAWELL, AND PAULINE E. HELLER, all of cumberland County, pennsylvania Grantm' 5 and RICHARD L. BROWNAWELL of R.D. 9, carlisle, cumberland County, pennsylvania Grantee WITNESSETH, that in consideration of One and 00/100 ( $ 1.00 ) in hand paid, the recp-ipt whereof is hereby acknowledged, the said grantor sdo and convey to the said grantee . his heirs and assigns Dollars, hereb1/ grant ALl. that certain tract of land situate in Lower Mifflin Township, Cumberland County, pennsylvania, ~ore fully bounded and described as follows; BEGINNING at a point on the southern right of way line of Township Route T-402 at point of lands now or formerly of Lee Burkholder; thence along lands of said Burkholder South 32 degrees 42 minutes32 seconds west, 234 feet to a point, thence along same and lands now or formerly of Paul Sheaffer North 84 degrees 08 minutes 44 seconds West, 1287.77 feet to a point; thence along lands now or formerly of Andrew E. Bonnie, the following courses and distances; N 17 degrees 04 minutes West, 123.9 feet to a point; North 42 degrees 48 minutes East, 132 feet to a point; North 76 degrees 22 minutes East, 283.97 feet to a point, Ncrth 20 degrees 36 minutes 54 seconds East, 998.46 feet to a point in the right of way of T-402; thence within said right of way South 41 degrees S4 minutes 3S seconds East, 401.47 feet to a point; thence along same South 28 degrees 16 minutes 33 seconds East 967.88 feet to a point, the place of BEGINNING. Containing 21.692 Acres. BEING further described as Lot No, 3 on the Subdivision Plan of the Bertha Bro~mawell Estate as recorded in Cumberland County Plan Book 40r Page l19~A. AND BEING part of a certain larger tract of land which Richard L. Brownawell and Pauline E. Heller, Co-Executors of the Estate of Bertha Bell Brownawell. by deed dated ,-'Tuly 10, 1978, and recorded in cUI11ber1and County Deed Book P, Volume 28, Page 277, granted and conveyed to Richard L, Brownawell, Pauline E, Heller, C~orge D. Brownawell, and William S. Brownawe11, Grantors herein. The Grantors' spouses execute this deed to grant and convey any right, title and interest that they may have in and to the subject tracts of land. . ;~ )ii-(Ic.:- , Pa ,l~-afe, fa)!: -,_ " f ,',7>- l:. 7--~~'-"ti "/ l~ <:::;:'~fi.^,~-<:~ '. N i/ _::'=:';" 1..,..'1.... '...... ',~l \...,H kbt......t.-S ,/J ,; '(;'., , , V -Ai Ji-v'- f SchoOl' D'lsl. Cumt)~ tn., Pa- 1'1k1 Real ~:.state Transfer ~- ? / , c. 3--- 7,/ '7-;>'-0.&---' 1.../ Da1"=~-Q::.Am\ 4~~ .c--~ . ~~.~'- If {. .. ~~ CUmb. CG. DiSt. tal ,... eooKfuo PAtE 242 CJ><: mJ OCj+ XOOg '.m'!Iio 10 -moL ;~i ~~ '~)~' C,' ' '.~:;;riT7 Pin 7' . (iJ1:'?li!){'/U . ,. 'lV'JS t1J!Jlli () pun pU'/J1f {iw. ps OJUniMJ'1[ I 'dO:ilH3Hill SS:ilN..LIA1 Sf 'pJu:l1>jUOJ pnfJ pa/Jp'Jl')Wu'l;)}} pU'o (JU'J1U'il.~JI>'U~ uJ'/OJat 01 (uww,ul fil}-wPIJJSJIVJ! .w) JUt 01 lWWUJf #11~~uMo~a .~ auomas #ltaMeuMO~g .~ ~n~~~V l~altaH "a eUltned 'ttaMeuMOxg .~ a.o.Io~ pa,t1JJddv tilJlYuosJ,Jd './a;ryfo pJutJ'.tS-.I,'Pi.-ut lIl{J " -....t,:, ",'.. ", - ,~I" .- "".' -<~"':u:ial.tJrql'8~.soll;ind J10 .wj ,)1<<,-1)8 WIn p:JplJiJ;!'a I. JlA- , r,nn OJ fJaq1.M)"sQns axe S ()1U1JU Jsrnpl S U08,{Jd ;n/1 Jq .S meltl1M 'ttaMEUMOxg .~ pIe4~~ 'XattaH I...rEW 'tlaMEuMO..rB .~ 1.~~a8 '11aMEuMoxg "8 'Jut 'J,taJaq '(8 61' Atnr 10 flop Vl t. ,..-.~~ 'J1{1 'iI,no ""0 puet.laqurrL;) jo filuno:) .ss{ eruPAt};c:uuad /0 tJ}1JIS n77?YN VI", n-,1~(;; yr J<Jde-.;;[ , ~'77~~-Z~f1 n ?);J~~~-';Ftcr1f yp)t: ';;:J~'2~ . ~u .urvrJP/'l3,"YD,Q \U ~~~~~I ~uu1J7(l;;<z;c"'~r!{J~' s roas puv spurn, 'uaU!--1in ::uwqv lUY .waf[ puv ti;l)p i)'ln .l1"8tf.l p8 orUIl3.ta'lf aAD1f S .to/uv,tO P!1)8 '.!103H3HA1 SS3N,LJ,it NI };atI:l 'pafta,wo'J flq3.l31f nl.u.ldo.ul 'inn ..~:-Ite.:Iaua6 luv.Lwm mm {010 (J<f.tDv pUlJ juvu/JaoJ fiqa.tJII 5 ,wlUD.1D pros &1{1 aNY 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 IRWIN ROGER B ESQUIRE 60 WEST POMFERT ST CARLISLE, PA 17013 -------- fold ESTATE INFORMATION: SSN: 196-14-0516 FILE NUMBER: 2102-0831 DECEDENT NAME: BROWN A WELL RICHARD L DATE OF PAYMENT: 09/16/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/26/1994 NO. CD 001622 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,235.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: ROGER B IRWIN ESQUIRE CHECK# 1051 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $1,235.00 MARY C. LEWIS REGISTER OF WILLS .~ /"'/-e?t?- ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z8D6Dl HARRISBURG, PA 171Z8-D6Dl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* NOTICE OF INHERITANCE TAX APPRAISEMENT, AllOWANCE OR DISAllOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-15~7 EX AFP I Dl-021 ROGER B IRWIN ESQ IRWIN ETAL 60 W POMFRET ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER ~~TY ACN ., 10-28-2002 BROWNAWELL 04-26-1994 21 02-0831 CUMBERLAND 101 RICHARD L 4 -t Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=is4-j-EX--AFP--("OY:OZY-NO"ficE--OF-YNHEifiTANCE-i'-A")rAPPRA-isEifiNT~--Ai:i-oWANCE-ifR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BROWNAWELL RICHARD L FILE NO. 21 02-0831 ACN 101 DATE 10-28-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 17.307.00 .00 .00 .00 .00 .00 .00 (8) NOTE: To insure proper credit to your account, submit the upper portion of this forll with your tax paYllent. 17,307.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage liabilities/liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) 1l0) 4,735.50 .00 (11) (12) (13) (14) 4.735 50 12,571.50 .00 12,571.50 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: 15. Allount of line 14 at Spousal rate (15) 16. Allount of line 14 taxable at lineal/Class A rate (16) 17. Allount of line 14 at Sibling rate (17) 18. Allount of line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due NOTE: .00 12,571.50 .00 .00 X 00 = X 06 = X 00 = X 15 = (19)= .00 754.29 .00 .00 754.29 TAX CREDITS: n____. . l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-16-2002 CDOO1622 480.71- 1,235.00 TOTAL TAX CREDIT 754.29 BALANCE OF TAX DUE .00 INTEREST AND PEN. .01 TOTAL DUE .01 . IF PAID AFTER DATE INDICATED, 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.)