HomeMy WebLinkAbout02-1051
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'*'" COMMONWEALTH OF
PENNSYLVANIA
. . .'ilIi!. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
n-\D3~ 02.-
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, ~ND MIDDLE INITIAL)
Otstot, Lorna M.
DATE OF DEATH (MM-DD.YE~R) DATE OF BIRTH (MM-DD-YEAR)
9-2-2002 11-11-1913
IX] 1. Original Return
o 4. Umited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Utigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (clate of death afler 12-1Z-82)
o 7. Decedent Maintained a Living Trust(/l.tt.achrop~CllTl\Is\l
o 10. Spousal Poverty Credit (date ofcleath between 12-31-91 and 1-1-95)
.
OFFICIAL USE ONLY
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
FILE NUMBER
2 1 -0 2 0 () \ D S ,
CQUNTYCODE YEAR - NUMBER- -- -
SOCI~L SECURITY NUMBER
172-01
- 8 8 0 4
x.o_ (15)
x.O~ (16)
X .12 (17)
X .15 (18)
(19)
19. Tax. Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
03. Remainder Return (date of death prior to 12.1,j il2j
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to lax under Sec. 9113(A) (AtlactlSctI0\
NAME
Andrew C. Sheel
FIRM NAME (If Applicable)
Es uire
(8)
33,737.83
COMPLETE MAILING ADDRESS
Andrew C. Sheely, Esquire
127 South Market Street
P.O. Box 95
Mechanicsburg, PA 17055
OFFIC-IAL USE' ONLY' --
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TELEPHONE NUMBER
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(11)
(12)
(13)
8,843.63
24,894.20
1. Real Estate (Schedule A)
2. Stoclr.s and Boods {Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
(1)
(2)
(3}
(4)
(5)
(14)
24,894.20
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4. Mortgages & Notes Receivable (Schedule DJ
5. Cash. Bank Deposits & Miscellaneous Persona! Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. InterNivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. lotal Gross Assets (total lines 1-7)
(7)
1,120.24
1,120.24
(6) 33,737.83
(9) 8,789.23
(10) 54.40
.
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 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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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
24,894.20
17. Amount 01 Une 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral rale
20.0
n~cedent's Complete Address:
STREET ADDRESS
1----
Lorna M. Otstot
4837 Trindle Road
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CITY
I STATE
PA
I ZIP 17050
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
1,120.24
1.061.28
"if! qF;
(2)
58.96
Total Credits (A + B + C)
3. InteresUPenally if applicable
D.lnterest
E. Penalty
TotallnteresUPenalty ( D + E ) (3)
1. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAVMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE.
1,061.28
A. Enter the interest on the tax due.
(5)
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Ves
a. retain the use or income of the property transferred;.......................................................................... ............... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or........... ..... ............... ........ ....... .................... ..,..... ..... ....... .................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ..... ........................... ,.,.. .............,......................., ,.............. ............,......, 0
3. Did decedent own an "in trust fo~' or payable upon death bank account or security at his or her death?.............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which
contains a beneficiary designation? .......... ..........,....................................... ............................................................. 0
No
Q9
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IX]
IX]
Q9
Q9
Q9
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
RETURN
Jack K. Otstot
P.O. Box 294
Under penalties of pe~ury, 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 repres ntat~v is ba d on all information of which preparer has any knowledge.
/1 r;.ATi_tJ2
November 11 2002
E DATE
C. Sheely, sq
. Nove er'
127 S. Market Street/P.O. Box 95
Mechanicsbura. PA 17055
lifl"' . ,-.-' - - ,.. --. .~~Iill,:'!i
For dates of death on or after July 1. 1 994 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 PS. ~9116 (a) (1.1) (i)J.
74~
Hessel, MI 49745
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ADDRESS
(. .
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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 (al (1.11 (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 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)(1)].
Tile 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
irlJividual who has at least one parent in common with the decedent, whether by blood or adoption.
REV.""'.""11""*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX REtuRN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
Lorna M. Otstot
FILE NUMBER
21-02-0
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO OECEDENl
A.
JACK K. OTSTOT
3410 West Cedar Street
Hessel, MI 4975
Son
B.
c.
JOINTLY -OWNED PROPERTY:
lETTER DATE DESCRIPTION OF PROPERTY %OF DAlE Of DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number O( similar Identifying numbel". Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deedforjoinUy-held realeslate. VALUE Of ASSET INTEREST DECEDENTS INTERES i
1. A.
A 3/18/9l New England Securities l /37,249.15 0% $18,624.58
Account No. 4VB-I05870
Date of Death Balance $37,249.15
Accrued Interest $0.00
Lorna M. Otstot/Jack K. Otstot
(See Attached Valuations)
2. A OI/28n Belco FCU 30,226.50 , 0% $15,113.25
Account No. 032050
Date of Death Balance $ 30,180.06
Accrued Interest $ 46.44
Lorna M. Otstot/Jack K. Otstot
(See Attached /Decedent Estate lnformatio )
TOTAL (Also enter on line 6, Recapitulation) $ $33,737.83
(if more space is needed, insert additional sheets of the same size)
2. Account number: C~~ rf~
3. Balance as of date of death: J~O;;Z
Balance Accrued Dividends
1.
Regular Savings:
Christmas Club:
Whatver Club:
Checking:
Money Market:
~
$
$
~
Certificates:
Balance
$
$
$
$
$
4. Date the account was initiated:
5. Name(s) in which Safe Deposit Box was held:
,.-
BD.OO
::c:.
Committed to Quality Service
DECEDENT ESTATE INFORMATION
+ f,-
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$ LJ ,7;7
$
$
$ -
$ 42.Cn
Accrued Dividends
Certficate Number
$
$
$
$
$
1~71
6. Date the box was initially rented:
7. Branch address at which the box is located:
8. Loan Information:
C. Mortgage Loans: $ $ $
$ $ $
$ $ $
9. MiSCf'l.laneousRo)U..)("~.f~ ()~. ;P'fim~ NX')(!l J- Jhis 0Im;{& J'f
rdtdn f.efe-llt o.dam.-'i __~d. J.JlfiS ~f1L 1(6' 0.._.-1 Q r:>tOf'rr")
BELCO MMUNITY CREDIT UNION
MAIN OFFICE
403 N. 2nd Street . P.O. B~::2Sit:: :::':~~;~::: 17108 . (717) 23-BELCO ~~~
A. Unsecured Loans:
B. Secured Loans:
Balance Accrued Interest Per Diem Int
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
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COMMONWEALTH OF PENNSYLVANIA
INHERHANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Lorna M. Otstot
FILE NUMBER 21-02-0
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1. HETRICK FUNERAL HOME, HARRI.SBURG, PA $ 6,541.20
RECEPTION 469.03
FLOWERS 235.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions JACK K. OTSTOT- EXECUTOR
Name of Personal Representative (5)
Social Security Number(s) I EIN Number of Personal Representative{s} $ 0.00
3410 W. CEDAR STREET
Street Address dlt",~r;L, PI1 4~"'..!S
City State Zip
Year(s) Commission Paid:
2. Attomey Fees ANDREW C. SHEELY, ESQUIRE, PER AGREEMENT $ 375.00
3. Family Exemp~on: (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 CUMBERLAND COUNTY REGISTER OF WILLS $ .00
INHERITANCE TAX RETURN FILING FEE $ 15.00
5, Accountanfs Fees
REIMBURSEMENTS TO JACK OTSTOT FOR MEALS " LODGING $ 1,154.00
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapituiation) $ $8,789.23
(If more space is needed, insert additional sheets of the same sile)
.
Estate Expenses / Jack K. Otstot, Executor
Trip from Michigan to Pennsylvania Sept 2 Fuel Cost $135.00
(825 miles) Lodging $65.00
Meals $73.00
Tolls $15.50
Post Viewing Reception $81.51
$21.62
Hetrick Funeral Home $6541.20
Flowers for Casket & Floor Spray $235.00
Women of Zion - Reception $250.00
Farewell/Remembrance Luncheon $85.83
$30.07
Return Trip to Michigan Sept 9 Fuel Cost $135.00
(825 miles) Lodging $65.00
Meals $73.00
Tolls $15.50
Trip from MI to PA to finalize Estate Sept. 29 Fuel Cost $135.00
(825 miles) Lodging $65.00
Meals $73.00
Tolls $15.50
Verizon Final Bill $48.40
Vascular Associates Bal Due $6.00
Return Trip to Michigan Fuel Cost $135.00
(825 miles) Lodging $65.00
Meals $73.00
Tolls $15.50
Sub Total $8453.63
Attorney Fees
Expenses for the Estate of Lorna M. Otstot $
HETRICK FUNERAL HOME, INC. .
3125 Walnut Street
Harrisburg, Pennsylvania 17109
(717) 545-3774
TO:
DATE:
Jack Otstot
3410 W. Cedar Street
Hessel, MI 49745
TERMS:
September 10, 2002
N/A
FOR FUNERAL EXPENSES OF:
Loma Otstot
Professional services, including facilities, equipment, and motor
equipment
Casket
Vault
Subtotal
Cash advances by funeral home:
Death certificates (10)
Clergy honorarium
Patriot News obituary charge
Subtotal
Final Total
Less amount received 9/6
Account paid in full - thanks
$ 3,935.00
1,525.00
900.00
6,360.00
20.00
100.00
61. 20
181. 20
$ 6,541.20
6,541.20
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REv 1512EX '(I-~i)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RES1DENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
EST ATE OF
LOMA M. OTSTOT
FILE NUMBER
21-02-
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
AMOUNT
Verizon - final bill
48.40
2 .
Vascular Associates
6.00
TOTAL (Also enter on line 10, Recapituiation) $ $ 54 . 40
(It more space is needed, insert additional sheets 01 the same size)
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Telep~tone: (717) 697-70,50
ANDREW C. SHEENY
- ATTORNEY AT L,AW -
127 South Mar~Zet Street
P.O. Box 95
Mechanicsburg, Pennsylvania 17055
Fix: (71.7) 097-7005
February 8, 2003
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
Dear Register of Wills:
RE: The Estate of Loma M. Otstot
No. 21-02-1051
Date of Death: September 2, 2002
Enclosed please find a check in the amount of $3.10 payable
to the Register of Wills, Agent. Kindly apply this payment to the
remaining amount due in this Estate. A copy of the Notice of
Assessment is enclosed for your reference.
Your time and consideration in this matter is greatly
appreciated.
Ver tr rs,
AND S y
ACS/bmk
Enclosures
c: Jack Otstot, Executor
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HAflRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 001880
SHEELY ANDREW C ESQUIRE
P O BOX 95
127 SOUTH MARKET ST
MECHANICSBURG, PA 17055
told
ESTATE INFORMATION: ssN: 172-oi-8804
FILE NUMBER: 2102-1051
DECEDENT NAME: OTSTOT LOMA M
DATE OF PAYMENT: 1 1 /22/2002
POSTMARK DATE: 00/00/OOOO
COUNTY: CUMBERLAND
DATE OF DEATH: 09/02/2002
ACN
ASSESSMENT
CONTROL
NUMBER
REV-1162 EX111-961
AMOUNT
101 ~ 51,061.28
TOTAL AMOUNT PAID:
REMARKS: JACK K OTSTOT
C/O ANDREW C SHEELY ESQUIRE
CHECK#1139
SEAL
INITIALS: DO
RECEIVED BY: MARY C_ I FwIS
51,061.28
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-601
ANDREW C SHEELY ESQ
127 S MARKET ST
PO BOX 95
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
MECHANICSBURG PA••1;7055-0318
REV-1547 E% ~FP (O1-OS)
DATE 01-13-2003
ESTATE OF OTSTOT LOMA M
DATE OF DEATH 09-02-2002
FILE NUMBER 21 02-1051
COUNTY CUMBERLAND
ACN 101
Amount Remitted
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 ~
------------------- -----------------------------------------------------
-- -- ---------
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF OTSTOT LOMA M FILE N0. 21 02-1051 ACN 101 DATE 01-13-2003
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) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion
4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fora with
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5.
Cash/Bank Deposits/Misc. Personal Property (Schedule E)
(5)
.00 y
ur
tax payment.
6. Jointly Owned Property (Schedule F) (6). 33,737.83
7. Transfers (Schedule G) (7) .00
8. Total Assets (g) 33, 737.83
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (q) 8,789.23
10. Debts/Mortgage Liabilities/Liens [Schedule I) (10) 54.40
11. Total Deductions
(11) 8.843.63
12. Net Value ofi Tax Return (12) 24,894.20
13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 24,894.20
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:
15 . Amount of L ine 14 at Spousal rate (15 ) . 0 0 X 0 0 _ , 0 0
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 24,894.20 X 045. 1,120.24
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 (lq). 1, 120.24
TOY f_RFi1TTC.
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
11-22-2002 CD001880 55.86 1,061.28
PAYMENT MUST BE MADE BY 06-02-2003*.
TOTAL TAX CREDIT 1,117.14
BALANCE OF TAX DUE 3.10
INTEREST AND PEN. .00
TOTAL DUE 3.10
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate far
life or far years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with Your payment to the Register of Wills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILLS, AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications era 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: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-SDD-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisesent, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice hy:
--written protest to the PA Department of Revenue, Board of Appeals, Dapt. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet ^Instructicns for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (37 calendar months after the decedent's death, a five percent CS%) discount of
the tax paid is allowed.
PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine C9l months and one C1l day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Veer Rate Factor Year Rate Factor Year Rate Factor
1982 2D% .000548 1987 9% .000247 1999 7% .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .000301 1992 9% .OOD247 2001 9% .000247
1985 13% .000356 1993-1994 7% .000192 2002 6% .000164
1986 10% .ODD274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown an the
Notice, additional interest must be calculated.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
N0. CD 002155
SHEELY ANDREW C ESQUIRE
P O BOX 95
127 SOUTH MARKET ST
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-- folA
ESTATE INFORMATION: SSN: X72-07-8804
FILE NUMBER: 2102-1051
DECEDENT NAME: OTSTOT LOMA M
DATE OF PAYMENT: 02/11/2003
POSTMARK DATE: 02/ 1 0/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 09/02/2002
101 ~ 53.10
TOTAL AMOUNT PAID:
REMARKS: ANDREW C SHEELY ESQUIRE
SEAL
CHECK# 1019
INITIALS: AC
RECEIVED BY: DONNA M. OTTO
53.10
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
/ I" //~ ~ J
!! L. C..
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX OIVISIDN
DEPT. 280601
HARRISBURG, PA 17128-0601
ANDREW C SHEELY
PO BOX 95
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX APP (01-33)
DATE 02-24-2003
ESTATE OF OTSTOT LOMA M
DATE OF DEATH 09-02-2002
FILE NUMBER 21 02-1051
- COUNTY CUMBERLAND
ACN 101
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-1607 EX AFP (01-03) *~(* INHERITANCE TAX STATEMENT OF ACCOUNT ***
ESTATE OF OTSTOT LOMA M FILE N0. 21 02-1051 ACN 101 DATE 02-24-2003
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-13-2003
PRINCIPAL TAX DUE:
PAYMENTS (TAX CREDITS):
1,120.24
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
11-22-2002 CD001880 55.86 1,061.28
02-10-2003 CD002155 .00 3.10
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
* IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
[ IF TOTAL DUE IS LESS THAN S1,
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. )
1,120.24
.00
.00
.00
PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA.
REFUND (CRI: A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
^Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
REPLY T0: questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280661, Harrisburg, PA 17128-0601, phone
C7177 787-6565.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%l discount
of the tax paid is allowed.
PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6%l percent per annum calculated at a daily rate of .OOD164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1987 9% .OD6247 1999 7% .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .060301 1992 9% .000247 2001 9% .000247
1985 13% .000356 1993-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (157 days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.