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HomeMy WebLinkAbout02-0974 REV-1S00 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 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 17 - 4'1- II OFFICIAL USE ONLY 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} Dunkle Mabel I. DATE OF DEATH (MM-DD-YEAR) COUNTY CODE YEAR SOCIAL SECURITY NUMBER 174-05-2807 THIS RETURN MUST BE ALED IN DUPUCATE WITH THE DATE OF BIRTH (MM-DD-YEAR) 07/31/2002 01/08 1913 (IF APPLICABLE SURVIVING SPOUSE'S NAME (LAST, FIRST,AND MIDDLE INITIAL) 21-02. 91 ~ NUMBER REGISTER OF WILLS SOCIAL SECURITY NUMBER X 1. Original Return 4. Limited Estate X 6. Decedent Died Testate 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent MaintaIned a living Trust 0 (Attach copy of Trust) (Attach copy of Will) o 9. litigation Proceeds Received 3. (date of death . Remainder Return prior to 12-13-82) S. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit 0 11. Election to tax under Sec. 9113(A) (date of death between 12~31-91 and 1-1-95) (Attach Sch 0) THIs SECTION MUSt BE cOMPl,ETEIt.ALL CORRESPONDENCE &. CoNFItlENTIALTAX INFORMATION sHOULD BilllAECTEIt 10: ; NAME COMPLETE MAILlNGADDRESS Ro er B. Irwin Es . FIRM NAME(lf Applicable) IRWIN McKNIGHT & HUGHES TELEPHONE NUMBER 60 West Pomfret Street West Pomfret Professional Bldg. Carlisle, PA 17013 R E C A P I T U L A T I o N 49-2353 Real Estate (Schedule A) Stocks and Bonds (Schedule B) 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 LI 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 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) (1) (2) (3) None NODEr None (4) (5) None 500.00 (6) 59,496.88 None 1,686.70 180.40 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 58,129.78 X X X X .0 0 .045 .12 .15 Copyright (c) 2000 form software only The Lackner Group, Inc. OFFICIAL USE ONLY I, (8) 59,996.88 (11) 1.867.10 (12) 58,129.78 (13) (14) 58,129.78 (15) (16) (17) (18) (19) 0.00 2,615.84 0.00 0.00 2,615.84 Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address. STREET ADDRESS 5010 South West Street CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 2,615.84 130.79 Total Credits ( A + B + C) (2) 130.79 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 ":!:~'t~~~~:~~~~~~!y'~~I'~~tt~~i~~"~G~~Y'I~~~:I~~I:~t~~I'~~I~~::::'!~!!":~~"y~,~:~~~:~I~~!~:I~y~I'~t~@k~I" 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ~ ~ix 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. Totallnterest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Cheek 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 + 5A. This is the BALANCE DUE. (5B) Make Check Payable 10: REGISTER OF WillS, AGENT 0.00 2,485.05 0.00 2,485.05 o o o [!l [!l [!l Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my k:nowledge 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. Robert L. Dunkle 201 Buckthorn Drive ----------------------------------------------------- Carlisle, PA 17013 IRWIN McKNIGHT & HUGHES 60 West Pomfret Street -- -carYisi~---PA-- -i i6i3-- -- -- - ----- - - --- ---- --- --- DATE tl)/'Il/f))... DATE For dates of dea on r 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 /.[72PS.9116(a)(11)(;)]. 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) Oil]. 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(aXlI]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings IS 12% [72 P.S. 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-001 REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mabel I. Dunkle SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY SSiI 174-05-2807 07/31/2002 FILE NUMBER 21-02 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION Miscellaneous personal property sold VALUE AT DATE OF DEATH 500.00 TOTAL (Also enter on line 5, Recapitulation) $ 500.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mabel I. Dunkle SCHEDULE F JOINTL V-OWNED PROPERTY SSII 174-05-2807 07/31/2002 FILE NUMBER 21-02 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 Ralph H. Dunkle ADDRESS RELATIONSHIP TO DECEDENT 2018 SW Brisbane St son Port Saint Lucie, FL 349 B. Robert L. Dunkle 201 Buckthorn Dr Carlisle, PA 17013 son c. JOINTLY-OWNED PROPERTY, LETTER DATE DESCRIPTION OF PROPERTY %QF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank DATE OF DEATH DECO'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 B 03/11/98 First Union, certificate 20,938.22 50.00% 10,469.11 1116270 2 A 03/11/98 First Union, certificate 20,938.22 50.00% 10,469.11 ~16279 3 B 09/01/67 M&T Bank, checking account 16,957.03 50.00% 8,478.52 4 B 04/24/96 Waypoint Bank, certificate 30,080.14 50.00% 15,040.07 111754286694 5 A 04/24/96 Waypoint Bank, certificate 30,080.14 50.00% 15,040.07 111754286695 TOTAL (Also enter on line 6, Recapitulation) S 59,496.88 (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Mabel I. Dunkle Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. SSfl 174-05-2807 FILE NUMBER 21-02 07/31/2002 DESCRIPTION AMOUNT 1 FUNERAL EXPENSES, Cumberland Valley Memorial Garden 590.00 2 Grace United Methodist Church 200.00 1. ADMINISTRATIVE COSTS, 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. 3. Attorney's Fees IRWIN McKNIGHT <5< HUGHES 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 750.00 4. Probate Fees S. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs F. Potteiger, Auctioneer - expenses 131.70 2 15.00 Register of Wills TOTAL (Also enter on line 9, Recapitulation) $ 1,686.70 (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) REV-1512 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mabel I. Dunkle SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES. AND LIENS SSfI 174-05-2807 07/31/2002 FILE NUMBER 21-02 Include unreimbursed medical expenses. ITEM NUMBER 1 Comcast Cable DESCRIPTION AMOUNT 40.39 2 Penn Power & Light Co. 40.86 3 Sprint Telephone 99.15 TOTAL (Also enter on fine 10, Recapitulation) S 180.40 (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 Mabel I. Dunkle SSff 174-05-2807 07/31/2002 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) son son FILE NUMBER 21-02 AMOUNT OR SHARE OF ESTATE one-half remainder one-half remainder ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU la, 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 NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 0.00 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 (cl 2000 form software only The Lackner Group, Inc. 1. Ralph H. Dunkle 2018 SW Brisbane St. Port St. Lucie, FL 34984 2. Robert L. Dunkle 201 Buckthorn Drive Carlisle, PA 17013 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Form REV-1513 EX (Rev. 9.00) h~ mill anb ~t5tanntnt I, MABEL I. DUNKLE of Carlisle, Cumberland County, Pennsylvania, do make and publish this as and for my last will and testament, here- by revoking any and all wills heretofore made by me. 1. I direct my executors to pay all of my debts, funeral and ad- ministrative expenses as soon as convenient after my decease. 2. I authorize and empower my executors to sell any real and/or personal property owned by me at my death, at either public or private sale or sales, and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My executors are authorized and empowered to continue to engage 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 two sons, Ralph H. Dunkle, Jr., and Robert L. Dunkle, share and share alike. 4. Should either of my children die before my death, leaving a child or children under the age of twenty-one years, to take the in- terest of their parent by substitution, then I give devise and be- queath the share of such grandchild, to be held in trust, by Farmers Trust Company, Carlisle, Pennsylvania. The trustee, as well as my executors, are hereby authorized to retain, unconverted, any property, real or personal, that I may own at my death, and shall be under no duty to convert the same into legal investments. The trustee shall have the power and authority to sell, transfer, convey, invest and re invest and to pay over the net income of the trust property to or for the use and benefit of any such grandchild or to accumulate the same in the sole discretion of the trustee. The trustee is also authorize and empowered to pay over to, or for the use and benefit of said grandchild, such portion of or all of the principal of the grandchild trust estate as in its sole discretion seems proper, for the mainten- ance, education or setting up of said grandchild in business or in a profession or for similar purposes. When the said grandchild reaches the age of twenty-one years, then whatever remains of income or prin- cipal of the trust estate shall be distributed to said grandchild. 5. I nominate and appoint Ralph H. Dunkle, Jr., and Robert L. Dunkle, to be the executors of this my last will and testament with- out the filing of any bond. 6. I direct that Irwin,Irwin & Irwin, Carlisle, Pennsylvania, be retained as attorneys in the settlement of my estae. WITNESS my hand and seal this 13'tfr;""day of September, 1965. /7~ Ii I J://a '1-'. . / G~. ,/J-<_~j~IlJ.SEAL) Signed, sealed, published and declared by the within named testatrix as and for her last will and testament, in our presence, who at her request, in her presence and in the presence of each other, have hereunto set our names as s. '~~L.-.- .t;. Lh~ /) . ~u, ....,~"_,."._,~,....,-..,.."~.., '."_~.'"'" "^"_"'..''''_''''~ ','U '_NO Re:fercnce 10: 409561 First UnionJWachovia Atm: Balance Confiunation Services POBox 40028 Roanoke VA 24022-73 I 3 October 29, 2002 IRWIN MCI<NIGHT & HUGHES 60 WEST POMFRET STREET CARLISLE,PA 17013.3222 SUBmCT, Verification I ConfU'lnarioD of AccOllDt and Balance Information provided for: Customer: MABEL I DUNKLE (SSN# 174-05-2807) Date oCDeatll: Joly 31, 2002 Dennsit Aecount Information ACCOllnr Type ACCQunt Number OatlofDel:lth. Bala.nc:.: Avcrnge Balance. Date Op",.d Maturity Int&'e5t Accrutd Y'fD Date D:l:te Rate In~[ Interesl Paid Clo~ea CERTIFICATE OF DEPOSIT 247412041716270 LfC,\L TITLE; MABEL (DUNK.LE ROBERT L DUNKLE S20.917.J9 3/1112002 9/lli.I002 $20.83 $120.60 8/6/2002 CERTIFlCAT(; OF DBPOS1T 247412041716279 LEGAl, TITLE; MABEL 1 DUNKLE ~~. DUNKLE $20.9\7.39 3/1112002 9/11'2002 520.83 5120.60 S/B/20D2 . Dur to sysr::1n Jimitltianli, wr: can only prOvide a twelvE: month average ba,lanc:r: on dltpOsitory acCQunts, Other Tnformatinn THE ABOvE REFF.RENCED ACCOUNT NUMBERS ARE A ROLLOVER. FR.OM CD 247412041481999 WHlCtl CLOSED 03.11-2oo2. ojo Date of death balance does not include accrued interest. .. If dare of death occuns on a weekend or a holiday, date of death balance does not Include lUly transactions that were ;;; ma<lc durirt8 that nme poriod ~ ~......UL- Brenda Allen Scrvlcenter Ali60ciatc Ocrober 29,2002 (540)S63-7323 Phon. Number ab!;Ii~ 001032 F!'!M&TBank Manufacturers and Traders Trust Company, 1100 Wehrle Drive. P.O. Box 767, Buffalo, NY 14240-0767 October 18, 2002 RE: Estate Search The Estate of: Date of Death (D.O.D.) ~~~~UW[~ OCT 26 2002 MABEL I DUNKLE 7/31/2002 IRWIN, McKNIGHT & HUGHES To Whom It May Concern: Identified below is the account information requested. 1. 1\II&T Bank accounts in which the decedent's name appears: Account Type Account Number Account Title Opening Branch 0.0.0. Accrued Interest Balances (Includes Accr. Int.) $16,957.03 $.00 CHK 2673010373 OPENED 9/67 MABEL I DUNKLE ROBERT L DUNKLE 4319 2. Loans, Mortgages, or other obligations titled in the decedent's name Account Number Amount Owed Account Description NO Safe Deposit Box titled in the Decedent's name existed at our office. If you have any questions about the information provided, please contact our Records Department at (716) 635-40 I 0 or 1-800-724- 2440 outside of the Buffalo, NY calling area. Thank you. Sincerely, M&T BANK CORPORATION BY: cf}/i4~ ~~'--'/~,.~ Authorized Signature DATE: 0- I ,f - 02.- 08/22/2002 1"1 Way~qi!lKt LOOK FOR US. WHL GET YOU THERE. ~~~~UWOC~ AUG 23 2002 IRWIN MCKNIGHT & HUGHES 60 W POMFRET ST CARLISLEPA 17013 IRWIN, McKNIGHT & HUGHES The information which you requested on the account(s) of MABEL DUNKLE (Social Security Number 174-05-2807) is/are as follows: 1754286695 CERTIFICATE 04/24/96 30000.00 80.14 30080.14 Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership JTO Name of Joint ROBERT Owner, if any DUNKLE Date Ownership 04/24/96 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 1754286694 CERTIFICATE 04/24/96 30000.00 80.14 30080.14 JTO RALPH DUNKLE 04/24/96 PLEASE COMPLETE W-9 ZCerelY~ /J!itylio~ SENIOR SERVICES REP. P.O. Box 1711. HARRISBURG. PENNSYLVANIA 17105-1711 Toll Free I-B66-WAVPOINT (I-B66-929-7646) .IN YORK AREA 717/815-4500 . www.waypointbank.com COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 7 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 001788 ROGER B IRWIN ESQUIRE 60 W POMFRET STREET CARLISLE, PA 17013 fold ESTATE INFORMATION: ssN: 174-o5-2so7 FILE NUMBER: 2102-0974 DECEDENT NAME: DUNKLE MABEL I DATE OF PAYMENT: 10/30/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/31 /2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 52,485.05 TOTAL AMOUNT PAID: REMARKS: ROBERT L DUNKLE C/O ROGER B IRWIN ESQUIRE CHECK# 3015 SEAL INITIALS: CW MARY C. LEWIS RECEIVED BY REGISTER OF WILLS 52,485.05 REGISTER OF WILLS `~ ~' !/ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-0601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 E% AFP coi-oz~ DATE 12-16-2002 ESTATE OF DUNKLE MABEL I DATE OF DEATH 07-31-2002 FILE NUMBER 21 02-0974 COUNTY CUMBERLAND ROGER B IRWIN ACN 101 IRWIN ETAL Amount Remitted 60 W POMFRET ST CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1 ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF DUNKLE MABEL I FILE N0. 21 02-0974 ACN 101 DATE 12-16-2002 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 Al 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) .00 NOTE: To insure proper [2) ,00 credit to your account, [3) .00 submit the upper portion [4) .00 of this fora with your (5) 500.00 tax payment. (6) 59,496.88 (7) .00 (8) 59,996.88 APPROVED DEDUCTIONS AND EXEMPTIONS: 1,686.70 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 18 0.40 11. Total Deductions (11) 1.867.10 12. Net Value of Tax Return (12) 58,129.78 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 58, 129.78 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 00 00 00 15. Amount of Line 14 at Spousal rate (15) . = X . 16. Amount of Line 14 taxable at Lineal/Class A rate [16) 58,129.78 X 045. 2,615.84 17. Amount of Line 14 at Sibling rate (17) .00 X 12 .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 .00 19. Principal Tax Due (19). 2,615.84 1 f1A YRGYi 1 V DATE NUMBER + INTEREST/PEN PAID (-l AMOUNT PAID 10-30-2002 CD001788 130.79 2,485.05 TOTAL TAX CREDIT 2,615.84 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE e eccnun cFF REVERSE STDF OF TNIS FDRM FOR INSTRUCTIONS.)