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Home My WebLink About02-0632 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT REV-1500 EX + (6-00) CAPB HpRL EplO CRAC KOTK ES 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 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) Case John M. DATE OF DEATH (MM-DD~YEAR) a OFFICIAL USE ONLY FILE NUMBER 21 02. ~2. NUMBER COUNTY CODE YEAR SOCIAL SECURITY NUMBER 192-14-6520 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS so IAL S CURl Y NUMBER 3 date at death . Remainder Return prior to 12~ 13-82) 5. Federal Estate Tax Return RequIred 8. Total Number of Safe DeposIt Boxes 11. EJection to tax under Sec. 91 13(A) (Attach Sch 0) ..-MIJl:!llil I':: DATE OF BIRTH (MM-DD-YEAR) 04/15 1926 VIVING SPOUSE'S AME LAST, F!RST,AND MIDDLE INITIAL Case, Bett W. X 1. Original Return 4. Limited Estate X 6. Decedent Died Testate 2. 4.. 7. Supplemental Return Future Interest Compromise (date of death after 12~ 12-82) Decedent Maintained a LIving Trust o o One West Main Street Shiremanstown c.PA 17011 copyright (c) ZOOO form software only The Lackner Group. Inc. (Attach copy of Will) o 9. LItigation Proceeds Received (Attach copy of Trust) Spousal Poverty Credit (date of death between 12.-31-'31 and 1-1 ~'3S) 010. ;'.II1Il11ei: iU.141m NAME James D. Bo ar FIRM NAME (If Applicable) uire COMPLETE MAILING ADDRESS 1. Real Estate (Schedule A) 2. Stocks 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 (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule]) (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 Subject to Tax (Line 12 minus Line 13) TELEPHONE NUMBER (1) (2) (3) Npne None None None None 7,719.83 None 3,130.18 320.36 x X X X .0 0 .0 45 .12 .15 ~) ,.--- OFfiCIAL USE ONLY (8) 7,719.83 (11) 3,450.54 (12) 4,269.29 (13) (14) 4,269.29 (15) (16) (17) (18) (19) 0.00 173.70 0.00 0.00 173.70 R E C A P I T U L A T I o N (4) (5) (6) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rat9 19. Tax Due 20. 409.38 3,859.91 FormREV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 1001 ADDle Drive CITY I STATE I ZIP Mechanicsbur" PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 173.70 Total Credos ( A + B + C) (2) 0.00 3. Interest/Penalty if applicable D.lnterest E. Penalty Total Interest/Penalty ( 0 + E) (3) 4. If Line 2 is greater than Line 1 -t Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) S. 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 S + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WillS, AGENT ." .-." ""'''''''''''''''''''!;;jijijHUiHiHHHi ii[ijii!iijiHi:;;!i:!;;!:'iii;i'!"""" "jUji!!i !HHLjj!jj'![;'" """"'::'[;i,;:%:",;;;:,rj,:i:'jr"r]j;;',Jji:,:,]j!i;;;,;',"'j'i'"J';J;i[,J,iinii!i!,,!:'ii!;iii:;i:',;i;i!,!:ii;it'';'i,;,;',i;'J,j]:;%,;:,;;;;;,:,;,;','ti,;',i,Jiiii;:;;:;;:;%;'::,';i',!,;:n,H",;J;' ",,,;:;;;;;:;;:;,;::;;;;;;:;;;::;;;;;;;;;:,:,;'",jjJJ",;!;:j,i;JJi;,;jJ'j;':j:::;j"::;,%,;;i!t;:'ij;:;;;:!,;;i'n,"!!:;;::'",,,,!;,;;,:;,%,,,,' . 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; . . ~ ;Xi 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? . D []] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 [!J 4. Did decedent own an Individual Retirement Account. annuity, or other non-probate property which contains a beneficiary designation? . 0 [!J IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 0.00 0.00 173.70 0.00 173.70 Under penalties of perjury, I declare that I have examined thIs returl'l, 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. SENTATIVE Betty W. Casey .. .1.Qg}-. App.1.<:. P.r.! ,,~............... _ _ _ _ _ _. no -- -. -- Mechanicsbur , PA 17055 James D. Bogar Esquire One West Main Street - - -Shir-e~~nst;';,m - - FA' - ii6ii - - - - -. - - - - - -. - - - - - -- DATE SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN 7/10/2002 DATE For dates of death on 0 July 1. 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5'>;", except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(a)(I)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3}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. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV~ 1509 EX t (1~97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF John M. Casey SCHEDULE F JOINTL V-OWNED PROPERTY FILE NUMBER SSIJ 192-14-6520 02/27/2002 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. A. SURVIVING JOINT TENANT(S) NAME Betty W. Casey ADDRESS 1001 Apple Drive Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT Spouse B. Kathleen D. Roth 119 Cambridge Drive Mechanicsburg, PA 17055 Daughter c. JOINTLY-OWNED PROPERTY, LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial Institution and bank DATE OF DEATH DECD'S VALUE OF account number or similar Identifying number. NUMBER TENANT JOINT Attach deed for Jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A&B 10/17/79 Waypoint Bank - Waypoint 5,045.32 33.33% 1,681. 77 Bank - Savings Account No. 10114798, date of death balance $5040.87, accrued interest $4.45 2 A&B 11/20/85 Waypoint Bank - Waypoint 1,518.64 33.33% 506.21 Bank - Savings Account No. 10151755, date of death balance $1,517.51, accrued interest $1.13 3 A&B 03/02/90 Waypoint Bank - Waypoint 1,587.59 33.33% 529.20 Bank - Certificate of Deposit No. 5000189412, date of death balance $1,5B2.51, accrued interest $5.08 4 A&B 03/27/99 Waypoint Bank - Waypoint 8,182.91 33.33% 2,727.64 Bank - Certificate of Deposit No. 8000054076, date of death balance $B,lB2.91, accrued interest $25.23 S A&B 10/2S/B3 Waypoint Bank - Waypoint 3,023.92 33.33% 1,007.97 Bank - Checking Account No. 90252172, date of death balance $3,023.92, accrued Tota 1 of Continu ation Schedule(s) 1,267.04 TOTAL (Also enter on line 6, Recapitulation) S 7,719.B3 (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only Cpsystems.lnc. Form REV..1509 EX (Rev. 1-97) Estate of: John M. Casey Soc Sec #: 192-14-6520 Date of Death: 02/27/2002 Continuation of Schedule F (Jointly Owned Property) Item Ltr for If Jt Ten Description of property Date Joint Total Val of Asset Dollar Val of Decds Interest interest $0.00 6 A&B 09/15/86 Waypoint Bank - Waypoint Bank - Checking Account No. 90443490, date of death balance $3,801.05, accrued interest $0.06 3,801.11 33.33% 1,267.04 1,267.04 ~l WaYRqipKt LOOK FOR US. WE'LL GET YOU THERE. 04/18/2002 JAMES BOGAR ONE WEST MAIN ST SHIRESMANTOWN P A 17011 The information which you requested on the account(s) of JOHN CASEY DECEASED (Social Security Number 192-14-6520) is/are as follows: Account Number Class of Account 10114798 SA VINaS 10/1 7/79 5040.87 4.45 5045.32 10151755 SAVINGS 5000189412 8000054076 CERTIFICATE 03127/99 8157.28 90252172 Ch'ECK1'N G 10/25/83 3023.92 90443490 CHECKING 09/15186 3801.05 .06 3801.11 Date Opened Principal Balance Accrued Interest 11/20185 1517.51 1.13 1518.64 CERTIFICATE 03102/90 1582.51 5.08 1587.59 25.63 8182.91 3023.92 Balance at Date of Death Account Ownership no no JTO no no no Name of Joint BETTY CASEY BETTY CASEY BETTY CASEY BETTY CASEY BETTY CASEY BETTY CASEY Owner. ifany KATHLEEN KATIlLEEN KATHLEEN KATHLEEN KATHLEEN KATHLEEN . ,.fonl teOJl.I R~IU Rti/U Ro7l-f RoTll Date OwnershIp 10/17/79 11120185 03/02/90 03/27/99 10/25/83 09/15/86 Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner. if any Date Ownership Was Established Additional Information Requested Sii~erelY~. 11M f( KA TtfJ. LWG SENIOR SERVICES REP. P.O. Box 171:' HARRISBURG. PENNSYlVANIA 17105-1711 ToU Free 1-866-WAYPOINT (1-866-929-7646) . IN YORK AREA 717/815-4500 . www.waypointbankcom REV~1511 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAl EXPENSES & ADMINISTRATIVE COSTS ESTATE OF John M. Casey Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. FILE NUMBER SS!! 192-14-6520 02/27/2002 DESCRIPTION AMOUNT 1 FUNERAL EXPENSES, Camp Hill United Methodist Women - Reception after Service 223.44 2 Cremation Society of Pennsylvania - Cremation 1,300.00 3 Joe Holtizinger Custodian for Service 25.00 4 Linda Fortney - Soloist for Service 30.00 Total of Continuation Schedule(s) 876.74 1. ADMINISTRATIVE COSTS, Personal Representative's Commissions Name of Personal Representative{s) Social Security Number{s) I ErN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. 3. Attorney's Fees James D. Bogar Esquire Family Exemption; (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 665.00 City Relationship of Claimant to Decedent State Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Register of Wills - Filing Fee for lnheritance Tax Return 10.00 TOTAL (Also enter on line 9, Recapitulation) $ 3 ,130.18 (If more space is needed, insert additional sheets of the same size) copyright (c) 1996 form software only CPSystems, Inc. Form REV..1511 EX (Rev. 1-97) Estate of: John M. Casey Sac See #: 192-14-6520 Date of Death: 02/27/2002 Continuation of Schedule H-A (Funeral Expenses) It ern # Description Amount 5 Lorelle Wright - Organist for Service 75.00 6 Mt. Calvary Episcopal Church - Nitch Fee 750.00 7 Royer's Flowers - Funeral Flowers 51. 74 876.74 REV-1512 EX +(1~97) COMMONWEALTH OF PENNSYLVANlA INHERITANCETAX RETURN RESIDENT DECEDENT ESTATE OF John M. Casey SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS FILE NUMBER SSf! 192-14-6520 02/27/2002 Include unreimbursed medical expenses. ITEM NUMBER 1 Andrews & Patel DESCRIPTION Medical Expense AMOUNT 101.79 2 Andrews & Patel Medical Expense 22.56 3 Central Pennsylvania MRI - Medical Expense 37.63 4 Internist of Central PA - Medical Expense 3.85 5 PinnacleHealth - Medical Expense 117.46 6 Pulmonary & Critical Care - Medical Expense 9.67 7 Quantium Imaging - Medical Expense 4.10 8 Quantum Imaging Medical Expense 5.29 9 Smith Radiology Medical Expense 15.16 10 Zlotoff, Gilfert and Gold - Medical Expense 2.85 TOTAL (Also enter on line 10, Recapitulation) $ 320.36 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV..1512 EX (Rev. 1-97) REV~1513 EX +(9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF John M. Casey SSit 192-14-6520 FILE NUMBER 02/27/2002 NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (Include outright spousal distributions, and transfers under Sec. 9116(aX1.2)j RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1 Betty W. Casey 1001 Apple Drive Mechanicsburg, PA 17055 Wife Rest, residue and 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 11- ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. 0.00 Form REV-1513 EX (Rev. 9-00) '~ ",:;:s. " '~ , '.". J~- , ~ ~ 1l.LCl5t 3ll1Iill Clttb We5tClmettt OF JOHN M. CASEY I, JOHN M. CASEY, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I direct the payment of all my just debts and funeral expenses, including my grave marker and all expenses of my last illness. shall be paid from my residuary estate as soon as practical after my decease as a part of the expenses of the administration of my estate. ~_~.f.9~: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, together with any insurance policies thereon, unto my wife, BETTY W. CASEY. provided she survives me by sixty (611) days. THIRD: Should my wife, Betty W. Casey, predecease rue or die on or be- fare the sb.:ty-fir8t (618t) day followi.ng my death, I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate. together with any insurance policies thereon, unto my children, KATHLEEN D. ROTH and JOHN W. CASEY, lH their issue per stirpes, in equal shares. ~OlJRTH: In addition to all powers granted to them by law and by other provisions of this Hill. I give the fiduciaries acting hereunder the following powers. applicable to all property, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sale, exchanges or leases, for such prices and upon such terms or conditions as are deemed proper. (8) To partition, snbdiv'ide, OT improve real estate and to enter into agreements concerning the partition. subdIvision, improvement, zon'ing or manage- ment of real estate and to impose or extinguish restrictions on real estate. , '" ~ ' "'\. ~ , \\' j'>. , ~ ":\ (Jc'" (C) To compromise any claim or controversy and to abandon any property which is of little ot no value. (D) Tn invest in all furms of prop~rty. ineluding stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduciaries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but oot necessarily being limited to, personal income, gift and estate or inheritance tax laws. (C) To make distributions to my herein named beneficiaries in cash or in kind or partly in each. !!E-~l! : I direct that all inheritance, estate. transfer, succession and death taxes. of any kind whatsoever, which may be payable by reason of my death. \vhether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. ~,~XTH : All interests hereunder, whether principal or income, while undistributed and in the possession of the fiduciaries acting hereunder, even though vested or distributable, shall not be subject to attachment, execution or sequestration for any debt, contract, obligation or liability of any beneficiary~ and furthermore, shall uot be subject to pledge, assignment, con- veyance or anticipation. ~EVENT~: I nominate and appoint my wife, BETTY W. CASEY, Executrix of this, my Last Will and Testament. In the event of the death, resignation or in- ability to serve for any reason whatsoever of the said Betty W. Casey, I nominate and appoint KATHLEEN D. ROTH and JOHN W. CASEY, or the survivor thereof, as Co-Executors of this, my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties as such in any jurisdiction in which she may be called upon to act insofar as -2- r am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seat to this~ my Last Will and Testament, this If day of ~~ , 1986. ... Q~k 1:?'.kif> ~. Casey (/ (SEAL) Signed, sealed, published aud declared by the above named Testator as and for his Last Will a.nd Testament in our presenc.e. who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. LL'il-ijr/}.t: .-Ie).- . Address )).--,,?: "P?t.0~A<-"0~r-.- _ .", r!? ". "l., 2JL.....d,,(.({ 0L<!.- l.._/l..iJ(..'t. ~ Address / " &,~ )1" .0..-......} f /1JUCI."'4' 9tlt.r...--- ,. -1- MEl!ORAND~ In conjunction with my Last Will and Testament. dated J'l9i-""-<-oJ'J., , personal representa- 1986, the following information may be of some help to my tives in the admInistration of my estate. This information is in no way intended to be a part of my Will nor to alter in any way anything contained in my said Will. 1. I direct that my last remains be cremated if at all possible. I prefer cremation as opposed to a conventional funeral and burial. /1 , '\ /l..(tlt-~ , t 1986. /'7-'7Y-/// \, COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 28D601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIDNS AND ASSESSMENT OF TAX JAMES D BOGAR E~Q iJ 1 W MAIN ST SHIREMANSTOWN, PA 17011 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-19-2002 CASEY 02-27-2002 21 02-0632 CUMBERLAND 101 *' REV-15UEX AFP (01-02) JOHN M Allaunt 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=is4rEif-iiiip--foFii2Y-NoYicE--oF-YNHEii'iTANCE-i:Ax-A'pPRA'isEMEN'r.--iiL.l"OwANCE-oR"----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CASEY JOHN M FILE NO. 21 02-0632 ACN 101 DATE 08-19-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: IS. haunt of Line 14 at Spousal rat. nS) 16. Allount of Line 14 taxable at Lineal/Class A rat. (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 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. "ortgages/Notes Receivable (Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule El 6. JoIntly Owned Property (Schedule FJ 7. Transfers (Schedule G) 8. Tot.l Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 .00 7.719.83 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Kisc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule Xl 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governm.ntal Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (91 (10) 3,130.18 320.36 (11) (12) [13) (14) NOTE: 409 .38 X 3,859.91 X .00 X .00 X NOTE: To in$ure proper credit to your account, submit the upper portion of this form with your tax paYllent. 7,719.83 3.41;0 1;4 4,269.29 .00 4,269.29 00 = 045 = 12 = 15 = .00 173.70 .00 .00 173.70 (19)= TAX C DITS: ,+, AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) PAYMENT MUST BE MADE BY 11-27-2002*. TOTAL TAX CREDIT .00 BALANCE OF TAX DUE 173.70 INTEREST AND PEN. .00 TOTAL DUE 173.70 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, ND PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRM FOR INSTRUCTIONS.) RESERYATION: Estatas of d8ced8nts dying on or before Dece_bar 12, 1962 -- if any futura interest in the astate 1s transferred in possession or enjoY.ent to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Co..onweslth hereby expressly N1sarv8S the right to appraise and ass.ss transf.r Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the require.ents of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the revarse side. --Make check or .oney order payable to: REGISTER OF MILLS, AGENT A refund of a tax credit, which was not requestad on the Tax Return, .ay be requested by co.pleting an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REY-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: )-800-362-2050; sarvices fat taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). Any party in intarast not satisfied with tha 8PpraiS8~nt, allowance, Dr disallowanca of deductions, or asssssmant of tax (including discount or interest) as shown on this Notica must objsct within sixty (60) days of recaipt of this Notice by: --written protest to thlil PA Depart.ent of Revenue, Board of Appeals, Dept. 281021, HarriSburg, PA 17128-1021, OR --slection to have the Battsr deter.ined at audi t of the account of the personal reprasentative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bursau of Individual Taxes, ATTN: Post Assess~nt Review Unit, Dept. 280601, HarriSburg, PA 17128~0601 Phone (717) 787-65DS. See page 5 of the booklet "Instructions for InheritancliI Tax Return for a Resident Decedent" (REY-ISOI) for an explanation of administrativelY correctabls errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5~) discount of the tax paid is allowed. The l5~ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Janua~y 18, 1996~ the first day aftar the end of the tax amnesty period. This non-participation penalty is appealable in the sa_e .anner and in the the same ti.e period as yOU would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of ds1inquency, or nina (9) months and one [I) day fro_ the date of death, to the date of payment. Taxes which became dalinquent before January 1, 1982 bear interest at the rate of six (6~) parcent per annum calculated at a daily rate of .000164. All taxes which becs.. dslinquent on and after January 1, 1982 will bssr interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. Tha applicable interest rates for 1982 through 2002 are: Ysar Interest Rate Daily Interest Factor Yelllr Interest Rate Daily Intarest Factor 1982 20~ .000548 1992 .x .000241 1983 167- .000438 1993-1994 n .000192 1984 117- .000301 1995-1998 9% .000247 1985 137- .000356 1999 7% .000192 1986 107- .000274 2000 8X .000219 1987 'X .00D241 2001 9~ .000247 1988-1991 117- .000301 2002 OX .00D164 --Interest is calclJlated os follows: INTEREST = BALANCE OF TAX UNPAID X NUlIBER OF OAfS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax beco_es delinquent will reflact an interest calculation to fifteen (15) days beyond the date of the assessllent. If payment is made after the interast co.putation date shown on the Notice, additional intarest .ust be calculated. /;; - ;; 7"- /Y ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-IU7EX AFP 101-02) JAMES D BOGAiP/ 1 W MAIN ST SHIREMANSTD,WN DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-26-2002 CASEY 02-27-2002 21 02-0632 CUMBERLAND 101 JOHN M Allount Re..itted PA 17011 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 for.. with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=ir.o-j-EX-AFP--foFiizy------iiiEii-iNHE'iiiTANC'E--filx-STATEH'E-tif-oTilcciiiiiW-.iiii--------------------- ESTATE OF CASEY JOHN M FILE NO.21 02-0632 ACN 101 DATE 08-26-2002 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: 08-19-2002 PRINCIPAL TAX DUE: 173.70 PAYMENTS (TAX CREDITS): PAYMENT RECE! PT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-12-2002 CDOO1403 .00 173.70 TOTAL TAX CREDIT 173.70 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIDNAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl1 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PAVMENT: Dstach ths top portion of this Notice and sub.it with your payment made payable to the name and address printed on the reverse side. If RESIDENT DECEDENT .ake check or .oney order payable to: REGISTER OF WILLS, AGENT. If NON-RESIDENT DECEDENT !lake check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CRl: A refund of l!l tax credit~ which was not requQstBd on the Tax Return~ lIay be requestBd by cOllpleting an "Application far Refund of PlInnsylvania Inheritsnce and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills~ any of the 23 Revenue District Offices or fro. the Departllent's 2it-hour ansMBring ssrvice for forlls ordering: 1.800-362-2050s services for taxpaysrs with special hearing and I or speaking neads: 1-800-447-3020 (TT only). REPL V TO: Questions re9arding errors contained on this notice should be addressed to: PA Department af Revenue~ BYreau of Individual Taxes~ ATTN: Past Assessllent Review Unit~ Dept. 280601~ Harrisburg~ PA 17l28-D601~ phone (717J 767-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death. a fiva parcant (52') discount af the tax PElid is allowed. PENALTY: The 157. tax amnesty non.partlcipation penalty is co~uted on the total of the tax and interest assessed~ and not paid before January 18~ 1996~ the first day after the end of tha tax amnesty periOd. INTEREST: Interast is charged bauinning with first day of dslinquancy, or nina (9J Booths and Dna (I) day fro. the data of death~ to the date of pay.ent. Taxes which becaBa delinquent before January l~ 1982 baar interest at the rate of six (67.) percent per annu. calculated at a daily rate of .000164. All taxes which beca.s delinqusnt on and after January l~ 1982 will bear interest at a rats which will vary from calendar year to calendar year with that rate announced by the PA Departmsnt of RsvenYe. The applicable interest ratss for 198Z through ZOOZ are: Year Intsrest Rats Daily Interest Factor YSlllr Interest Rats Daily Interest Factor 198Z ZOi: .000548 199Z 9% .000Z47 1983 167. .000438 1993-1994 n .000192 1984 11i: .000301 1995-1998 9% .000Z47 1985 13i: .000356 1999 1% .00Dl9Z 1986 10i: .000Z74 ZOOO 8% .000Z19 1987 .% .000Z47 ZOO! .% .000Z47 1968-1991 Hi: . DDD3Dl 20O'Z 6% .000164 --Interest is calculatsd as follows: INTEREST = BALANCE OF TAX UNPAID X NUftBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR nAny Notice issued after the tax becomes delinquent win reflsct an intsrest calculation to fifteen (15) days beyond the date of the aSSBss.ent. If payment is made aftsr the intsrest co.putatlon dats shown on the Notice, additional interest must be calculated. '-6- CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: John M. Casey Date of Death: February 27, 2002 will No. OJ-l..;32 Admin. No. To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on May 22, 2002: . Name Address Betty W. Casey 1001 Apple Drive 1001 Apple Drive Mechanicsburg, PA 17055 Kathleen D. Roth 119 Cambridge Drive Mechanicsburg, PA 17055 John W. Casey 23 South Oak Street Ephrata, PA 17522 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: July 10, 2002 Capacity: Esquire One West Ma'n treet Shiremanstown, PA 17011 (717) 737-8761 Personal Representative X Counsel for Personal Representative I ~ '," \ '" f),'; ./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 JAMES D BOGAR ESQUIRE 1 W MAIN STREET SHIREMANSTOWN, PA 18011 n_hh. fold ESTATE INFORMATION: SSN: 192-14-6520 FILE NUMBER: 2102-0632 DECEDENT NAME: CASEY JOHN M DATE OF PAYMENT: 07/12/2002 POSTMARK DATE: 0010010000 COUNTY: CUMBERLAND DATE OF DEATH: 02/27/2002 NO. CD 001403 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $173.70 I I I I I I I I TOTAL AMOUNT PAID: $173.70 REMARKS: JAMES D BOGAR ESQUIRE CHECK# 1038 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS MARY C. lEWIS REGISTER OF WillS C/t/ 1/ STATUS REPORT UNDER RULE 6.12 Name of Decedent: John M. Casey Date of Death: February 27, 2002 Will No. Q2/,n~ ,lO.3~ Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes XX No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b, The sepa ra te Orphans' Court No. (i f any) for the personal representative's account is: N/A c, Did the personal representative state an a~count informally to the parties in interest? Yes X No d. Copies 0 f rece ipts, re leases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: 7/10/02 James D. Esquire Name (P lease, type or print) Oh1ej West Ma~n St. shiremanstown, PA 17011 Address (;h) 737-8761 Te 1. No, h ~': ,< t liT") Capacity: Personal Representative (MAH: rmf! AM3) x Counsel for personal representative