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HomeMy WebLinkAbout02-1077 RE;'i.1500EX(E;.OO) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT UJ ,.., ",0<", ,,0:'" UJII." ,,00 ,,0:-' II."' II. 0< I- Z W o w o w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Corliss William K. I OFF!Cf/\L USE 01'H... \( I'/-/CJ </- A3 FILE NUMBER 1~-CJ 2. CQUNTY CODE YEAR -L012_ NUMBER DATE OF DEATH (MM-DD-YEAR) 09/08/2002 DATE OF BIRTH (MM-DD-YEAR) 12/18/1907 SOCIAL SECURITY NUMBER 019 - 01 - 0745 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ,.., z UJ " Z o II. '" UJ 0: 0: o " ~ 1. Original Return o 4. Limited Estate Q9 6. Decedent Died Testate (Attoeh copy of Will) o 9. Litigation Proceeds Received ~::- ~'~t . NAME Marlin R. McCaleb, Es uire FIRM NAME (If Applicabfej Law Offlces - Marlin R. McCaleb TELEPHONE NUMBER 717/691-7770 o 3. Remainder Return (date of deolh prior 10 12.13-82j o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) :}:g COMPLETE MAILING ADDRESS 219 East Main Street P.O. Box 230 Mechanicsburg, PA 17055 z o ~ :J l- e: <( o w c::: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Noles Receivable (Schedule D) 5. Cash, Bank Deposits & MiscellaneollS Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non~Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1~7) (7) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) o 2. Supplemental Return o 4a. Future Interest Compromise (d/lte ofdeolh/lfter 12.12-S2) ~ 7. Decedent Maintained a Living Trust (Attach copy ofTrusl) o 10. Spousal Poverty Credit (date ofdeall1 between 12.31-91 and 1-1-95) (1) (2) (3) (4) (5) (6) None OFFICIAL USE ONLY None None None 651. 79 590,175.00 1,043.36 x.o_ (15) 0.00 x.O~ (16) 26,087.96 x 12 (17) 0.00 x .15 (18) 0.00 (19) 26,087.96 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 mad< (Schedule J) (9) (10) 14. Net Value Subject to Tax (line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES z o ~ I-' :J a.. :i: o o X ~ 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 579,732.55 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rale 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT -; ';,~",~-, ,il",'.BJ;SURE. ToAN~~R:ACE_.QUES;J:j9NS' aN RElfF~SI;;-~P.g1AND ~ECHECK.MATH ., <'.;,+::<; "', .-:~" ',-:;~- 'A " !;\:;i<;;:~ (8) 5,335.60 6,802.00 (11) (12) (13) 591,870.15 12,137.60 579,732.55 (14) 579,732.55 Decedent's Complete Address: Corliss William K. STREET ADDRESS 100 Mt. Allen Drive CITY Mechanicsburg I STATE FA I ZIP 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) 26,087.96 0.00 24,783.56 1,304.40 3. InteresVPenalty if applicable D. Inlerest E. Penalty Total Credits (A + 8 + C ) (2) 26, 087.96 TotallnteresVPenalty ( D + E ) (3) 4. If Line 2 is greater Ihan Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 A. Enter the interest on the tax dUe. (5A) 0.00 0.00 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... IX] b. retain the rlghl to designate who shall use the property transferred or its income; ............................................ IX] c. retain a reversionary interest; or................... .....,.. ............ ....................................................................... ............ 0 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 for".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 [] IF THE ANSWEBJO-ANY OF THE ABOVE QUESTiONS is YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties oj petfury, I declare that I have examined this return, including accompanying scheduies and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration oj pfeparer other than the personal representative is based on all information of which preparer has any knowledge. IJRN No o o o IX] fKJ I&J A ADDRESS Community National Bank, Trustee DATE/ // /// ~ /5""--- a 100 Main Street Newport, VT 05855 Marlin R. McCaleb, Esquire DATE . - 20 .- 0 z.. ADDRESS 219 East Main Street Mechanicsburg, FA 17055 :'i~G~~[;::i.B,_:~~~,., -...,1~ ,"L_ _",-.u;4<ll"l ~ _,_ ....~l 'N~ ffi!1 ._..~' For dates of death on 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. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net vaiue of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stiH applicable even if the surviving spouse is the oniy 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. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use 01 the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. &9116(a)(1)). 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. 99116(a)(1.3)]. A sibiing is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 02/14/00 13:51 llauno. .onl. " llor.rO :un..l.u 11 IllY VlIII_.,OIrr"'"H'In lul1/1 ,,,qUIll. Ill. QS5I1 PEOPLES. 7176917772 HO. ! 11 P002/004 Cfll" WIt,) 61.::f1[;(J V11 r ~ t I J/;l. VIIAP !xuA,(. fWlA ttFt.e~ 0/ LASr WILL ~ TBSTAMI!Nl' OF WILLIAM 1<. CIlRLISS l<N::M ALL M!!1'l BY TflESI! FllESIIZl't'S that I, WilliMl 1<. CorU.., &1110 known as W. Kirkland Corliss, of tha '1Qm ot NorWield, O:lw;ty of Wallhingt:on and state of vermont, be.inq of llOurlC nUn1, 00 hereby 1lIeM, publish, and declue th1s my L1\ST WILL ~ TESTAMliNl', hareby revok.Ulq all other Wil18 lI.ld Codicils hsretof~. ~; AR'1'J:C'P" am JI.a I1QOI\ after my deoeall8 a8 my O:>-Exea.ltore IIhall deem COllIIIist:ent w:l.th good manaSell18Ot, I direct that they IIhall pay trcn the rea1due ot my estate, othe.r:will8 hsrl!l1naft:er d1IBpOEIed of, thl!I expctaes ot my 14st: illll8s8, funeral, and burial, all debts duly allowlild aga1nat my ..tate, the expenses of adnWUlltratl.CI1 of my estate, and all estate talru ~ other taxa and dut:.i.N OClClaSiDnlld by lIlY' death, wllet:har 1.J1t:m:nd with rupect to property pa'l!I1nt; under this Wlll, or othe1:lol1.se. AR'1'In".~ 'nIO I give and ~th all my tang1bJ.. per..xlAl ~ I I1IIlY own at: my death to my balCM!ld wU:l!I, Beatrice K. Clol:ll.lI, or it IIIUl be not then Uvinq equally to my tlu;Be children, sylvia C. Kini, l'axjari. CarU.s 0Ilnham, lI.ld Wlll1am K. COrliss, Jr. or tl18 s\lrV1vor of them. -1- 02/1.4/00 13:51 II...-p. llo.t. " fj~f.r_ e,ll;lItlQ'f..fElw .111.,..<#._.... I.. i!70 'llllfltlb.lll, aUu PEOPl.ES ~ 7176917772 f~O. 111 POO3/004 All of the rest, ruidue, lilI1d rEll!\l'lmer ot lll:i e.tate ot whal:8Vl!lr deilcription A!ld lIt\Qrever the eama may be J.cxlat:ecS, I <;ive, devise, am bequeath unto the Northfield SAvings flank, A Vemont banld.ng QOl:ilOration with its princi~le otfico 1n Nol:thfieJ4, V&m:lnt, IN 'm\]5'1' llIMlrthele.., un:ler the terms ot a CJBrt:4l.n trust agJ:~t ~tillq the ''will:l.llll1 1<. OcrU.. Living ~t" dated February 1S, 1976, and u ~ Febl:\lary 16, 1984 anti rabl:\w:y 15. 1991, to be hlt14, marusgea, an1 ,~Ib~t:ed in a~ with the te:rn\s of saict 'I'nl3t ~..__lt. l\R1'ICt.1: 'MllllI!i In the event that tl1II "\II111um K. 00r11.. Li~ 0rru.t" i. not in axisl:enos at the time ot my d8llth, then I give, devU&, and bequeath allot the rest. residue, and remaWer of my estate, ot whatever deec:riptian lilI1d wherever the same my be located, to my ~ wife, fleatrios R. CerUII.. if she 5UrV1vea me. In the event that my said wite, Beatr10e K. CerU.., ilhAll have predll'"e'l8lld l1lII, or in the llWIlt that ow lIhOIlld die W"dar c!rCUlllllWlCQ which do not ~t a l:I!lUOIlable datal:ml.natiCl1. IlIl to which ot l.Ul ~_M&:i the other, then 1:1 either event, I 9i.ve, ~ev1.,., and ~th ea.id residua in fIQIlAl lIhare. to my three children, Sylv:l.a Co X1ng l1CVI of 10619 ~ 56th street, Te1lple Terraoe, FL 33617, Hlu:jode OorU.. DuIIham l1CVI of 277 ~ Road S., Wqtport, cr 068801 W William K. COrliss, Jr. na</ ot 600 SO\Ith York. street, Mechan1~, PA 17055, their heir. an1 " AlIs19M forllVW. -2- 02/14/00 13:51 . I! t I PEOPLES ~ 7176917772 NO, 111 P004/004 "'lml' .onlt S: liufatb ~"\lUt_ .. ""' IWhlff (llJlN,""l'l 1a.':7G tr1~nr!., lh. "51l1\3 ARXt~,w. PCX.lB I hereby naII1nate, constitute, and appoint the Nclrlhtield Savirl9. Sank and Olristopher c. ~ now of 277 0:I'ap0 !laid S., w.atport, or 06880 to be Co-l'.:l<lIC\lton of thill, my r.ASr w:w:. AND~. In the event thet Olriato~ t\InhIIn IIhoold decl1n8 Aid trust, or fo:: IUlf nucn lIhwld fail to quality aa O>Executor, or having' qu&lit1ec!, IIhould resign or ot:hlu:w1.. VllCAta said oftioe, then I naninate !o!arjarie OorUea D.lr\MnI .a al1:erllate O:5-l!lx8c:utr1x . IN wnmss ~, I hElroIunto aubIIccibe my ~ thi. 25th day of March, 1 !l1I1 . ~~ d Co;! K. {~:.e ;.. ~ <- x. Oar ilia We, whoM MlIl8. are hereto 1lUbtI<::l:'ibl, 00 =";11">, that on the 25th day of March, 1 !llIl, William 1<. O:lI:U.., the tutator l1AI1lllCl aI:law, Il'JblCl:'1bed 111. name to this in8t:N'nent in our presence an:! in the pnaence ot each of US, am at the _ tUna, in our ~ an:! hearing, declared the _ to 0. his LAST WILL AND 'lE'3Tl1Mml', and ~ts1 u. lUld u.ch of Ull, to 8i!lfl cur rwna8 thereto .. witl1.-_ to the execution thenaf, whioll we do 1n the preS61loe of the tutator and of each other, on the day of the date of II&iI1 Will, and write opFOslte our ll!IlllU OJ%' n1spect.ive p1e- of resld8l108. .-.,/ ~. ~..,1. F, Y<.n<,( c, T.E, T ( l:'8II1di.ng.t IJof.1-IfJd, vi I d II;"~: I / I - r I ..."'" A~",s,'ff n181dirlq at (. ),.".L "9 '10-\ , - VI reeidinq at 1/rrJi! 'rI! d..{ vi' ~ I br"A<l~ </ ~'\.. TRUST AGREEMENT CREATING THE "WILLIAM K. CORLISS LIVING TRUST" THIS AGREEMENT, executed in duplicate on the date hereinafter set forth, between William K. Corliss, also known as W. Kirkland Corliss, of the Town of Nortbfield, County of Washington and State of Vermont, (SETTLOR) and the First Vermont Bank and Trust Company, a banking institution with an office in the City of Barre, County of Washington and State of Vermont, (TRUSTEE), WIT N E SSE T H 1. TRUST PROPERTY. For good and valuable consideration, the Settlor hereby transfers and delivers to the Trustee the property listed in Schedule A, annexed hereto, to have and to hold the same together with any cash, securities, or other property which the Trustee may pursuant to any of the provisions hereof at any time hereafter hold or acquire, all of such property being hereinafter referred to collectively as the trust estate for the uses and purposes and upon the terms and conditions herein set forth. 2. DISPOSITIVE PROVISIONS. The Trustee shall hold, manage, invest, and reinvest the trust estate, collect the income thereof, and dispose of the net income and principal as follows: (a) During the lifetime of the Settlor, the Trustee shall pay all of the net income of the trust estate to the Settlor, noLless frequently than quarterly. If at any time the Settlor should become incompetent or for any reaSon be unable to act in his own behalf, the Trustee may pay to or apply for the benefit of the Settlor, in addition to the payments hereinabove provided for him, such amounts from the principal of the trust estate, up to the whole thereof, as the Trustee may from time to time deem necessary or advisable for his use or benefit. The Trustee shall also pay such sums, from principal or income, as the Settlor may direct, orally or in writing, during his lifetime. BERNASCONI AND KOCH ATTORNEYS AT LAW P. O. BOX 892 BARRE, VERMONT 05641 (b) Upon the death of the Settlor, the Trustee shall payout of the assets of the trust, all of the Settlor's just debts then due, the expenses of his last illness and funeral, and all estate, inheritance, succession, and transfer taxes or death duties, which may be assessed or imposed by reason of the Settlor's death, upon his estate or any part thereof, whether the taxable property shall be held as an asset of this trust or not, or whether the same shall pass under the Settlor's Will, or otherwise; and such payment shall be made without apportionment or contribution by any beneficiary of the Settlor's estate, meaning hereby that this trust shall bear the full burden of taxes assessed against the Settlor's estate. (c) After the payments called for in subparagraph (b) above have been made, the Trus tee shall re tain all of the as.se ts of this Trus t in trust and shall pay all of the net income from the Trust to the Settlor's wife Beatrice K. Corliss, if she survives him, for and during the remainder of her life. The Trustee shall also have full power, in its absolute discretion, to invade the principal of the Trust for the benefit of the Settlor's wife, Beatrice K. Corliss, in order to provide for her proper care, maintenance, and support, and in this regard, the Trustee is instructed that it is the intention of the Settlor that the Trustee shall be liberal and generous in the exercise of its discretion to invade principal for this purpose. (d) After the death of the Settlor's wife Beatrice, the Truste shall retain all of the estate in trust and shall pay all of the net income from the trust estate to the surviving children of the Settlor, Sylvia Corliss King, Marjorie Corliss Dunham, and William K. Corliss, Jr., in equal shares during their respective lifetimes. (e) As each of the said chiidren of the Settlor shall die, the Trustee shall account for and determine the ,pro rata share of such deceased child immediately previous to his or her death and the Trustee shall then pay over such share, including a pro rata share of accrued but undistributed income, if any, to the issue of such deceased child, per stirpes, free of all trusts. BERNASCONI AND KOCH ATTORNEYS AT LAW P. O. BOX 892 BARRE. VERMONT O!lEl41 -2- 3. INVASION OF PRINCIPAL. In addition to the powers otherwise granted in this Trust Agreement, and not in lieu of such powers, the Trustee shall have full power, after the death of the Settlor and the Settlor's wife Beatrice, in the Trustee's absolute discretion, to invade the principal of the Trust for the benefit of any child or grandchild of the Settlor, for the purpose of providing for said grandchild's proper care, maintenance, support, and education, including college or graduate school in an accredited insti- tution; and such invasion of principal may be made without regard to the share or expectancy of a share which any such child or grandchild may have in the trust estate, and without regard to whether such child or grandchild is at the time of such invasion of principal entitled to receive any income from the trust estate. 4. TRUSTEE'S POWERS. In addition to the powers conferred by the common law or by statute, or by any other provisions hereof, the Trustee is empowered: (1) To hold, possess, manage, and control the trust estate for the uses and purposes herein set forth, and to pay all reasonable charges, taxes, or expenses appropriate to the management or preservation thereof. (2) To invest and reinvest all or any part of the trust estate in such corporate shares, bonds, securities, or other property, xeal or personal, as in its discretion it shall deem proper, without regard to sta- tutes, custom, or other rules limiting the property which Trustees may purchase. (3) To sell, transferm exchange, or otherwise dispose of any part of the trust estate, for cash or on terms, at public or private sale, and to pledge or encumber the Same. :BERNASCONI AND KOCH ATTORNEYS AT LAw P. o. BOX 892 aARRE, VERMONT O.!S641 -3- (4) To lease any real estate held thereunder for any term, notwithstanding the duration of this trust. (5) To execute and deliver any deeds, leases, assignments, or other instruments as may be necessary to carry out the provisions of this trust. (6) To exercise any subscription right in connection with any security held hereunder, and to consent to or participate in any reorganizatio , consolidation, or merger of any corporation, company, or association, the securities of which may be held hereunder. (7) To purchase securities or other property of any kind from any person, without responsibility or liability (except for fraud or gross negligence) for any loss resulting to the trust estate from any such purchase. (8) To make loans, secured or unsecured, to any person, without responsibility or liability (except for fraud or gross negligence) for any loss resulting to the trust estate from any such loan. (9) To retain, without liability for the loss or depreciation resulting from such retention, original property, real or personal, received from the Settlor's estate, for such time as it shall deem advisable, although such property may not be of the character prescribed by law for the investment of trust assets and although it represents a largo percentage or all of the trust estate, and such original property may accordingly be held as a permanent investment. (10) In its sole discretion, to apportion between principal and income any receipt or expenditure which in its opinion should be so apportioned; provided that whenever the principal, or any part thereof, of the trust estate is invested in securities purchased at a premium or at a dis- count, any such premium shall be charged against principal and any such discount shall be credited to principal; and provided further that share dividends and rights to purchase additional shares issued on securities held in trust shall be treated as principal and not as income. All other dividends, except liquidating distributions, shall be treated as income. BERNASCONI AND KOCH ATTORNEYS AT LAW P. o. sox 8112 l'JARRE, VERMONT 015641 -4- (11) To make any distribution hereunder either in kind or in money. Distribution in kind shall be made at the market value of the property distributed, and the Trustee may, in its discretion, cause the share to be transferred to any distributee to be composed of property like or different from that transferred to any other distributee. 5. ADDITIONAL PROPERTY. The Settlor reserves the right for himsel or any other person to increase the trust estate by delivering property to the Trustee, except that the duties and liabilities of the Trustee shall not be substantially increased or changed in nature, except with its written consen t. 6. SPENDTHRIFT PROVISION. No beneficial interest under this trust, whether in income or principal, shall be subject to anticipation, assignment, pledge, sale, or transfer in any manner, nor shall any beneficiary have the power to anticipate, encumber, or charge such interest, nor shall such interest, while in the possession of the Trustee, be liable for or subjec to the debts, contracts, obligations, liabilities, or torts of any beneficiary. 7. ACCOUNTING BY TRUSTEE. The Trustee shall keep accurate records and accounts of the trusts created herein, and annually, or more often if desired by the Settlor, but not more often than quarterly, shall render to the Settlor during his lifetime, statements of all receipts, disbursements, and investment transactions. After the death of the Settlor, the Trustee shall render, at least annually, to any adult beneficiary then entitled to income under the terms of this trust, a statement showing in detail receipts, dis- bursements, and distributions of both principal and income of the trust estate. 8. COMPENSATION OF TRUSTEE. The Trustee shall be entitled to a reasonable fee as compensation for its services hereunder. 9. RESIGNATION OF AND SUCCESSOR TRUSTEE. The Trustee may resign at any time upon written notice given to the Settlor if he is living, or, in BERNASCONI AND KOCH ATTORNEYS AT LAW the event of his death, upon written notice to the current income beneficiary P. O. BOX e92 BARRE. VERMONT 0!5541 -5- or beneficiaries hereunder. A successor Trustee may be appointed by the Settlor during his lifetime, or after his death, by agreement of all income beneficiaries or their legal guardians, or in the event of disagreement among such income beneficiaries, by any Court having jurisdiction over this trust. Any successor Trustee thus appointed, or, if the Trustee shall merge or be consolidated with another corporate fiduciary, then such corporate fiduciary, shall succeed to all the duties and to all the powers, including discretionary powers, herein granted to the Trustee. 10. MERGER OF TRUST. In the event that any time after the death of the Settlor and the Settlor's wife Beatrice, the Trustee shall be the rustee of substantially identical trusts created by the Settlor and the Settlor's wife Beatrice, then the Trustee, in its sole discretion, shall have full power and authority to merge said Trusts into one by paying over all of the assets from one trust into the other, or by such other method as the rustee shall deem advisable. In the event of such merger, separate records eed not be kept after the date of the merger, and the surviving trust shall or all purposes be considered as the only trust under the control of the rustee. 1. AMENDMENT, REVOCATION, AND WITHDRAWAL. The Settlor reserves he right, at any time, and from time to time, by instrument in writing elivered to the Trustee, to amend, modify, or revoke this Trust in whole or in art. After the death of the Settlor, this Trust shall not be subject to mendment or revocation, except by operation of law. The Settlor reserves the ight, at any time, and from time to time, by written instruction to the Trustee to withdraw any portion of the trust assets from the trust estate, and upon eceipt of such written information, the Trustee shall forthwith make payment o the Settlor in the manner which the Settlor directs. BERNASCONI AND KOCH ATTORNEYS AT LAW P. O. sox 892- BAR.RE. VERMONT 01:164\ -6- BERNASCONI AND KOCH ATTORNEYS AT LAW P. O. BOX 81i12 BARRE. VERMONT 08641 have executed this Trust IN WITNESS WHEREOF, the parties '.5--4J:-- /. day of Agreement this 7'~Vt<-<"'~l . / " / / ( ./ \..../ , 1.978. 17 //""1, /V (7 /. 1 'f/J_.{,,{ti':M1L '/r ,at/C?<j4'-" William K. Corliss, Settlor FIRST VERMONT BANK AND TRUST COMPANY / // -7- Schedule A The fOllowing described property has this date been delivered by the Settlor to the Trustee, IN TRUST, under the provisions of the foregoing Trust Agreement creating the "William K. Corliss Trust ". Savings Northfie;Ld Savings Bank check 65967 $12,500 Northfield Savings C of D 7fi% due 4/1/78 $5,000 Northfield Savings C of D 7~% due 1/1/79 $2,500 Northfield Savings C of D 7ft% due 7/1/80 $2,500 First Vermont .Bank a/c no. 55-59741-3 $3,500 First Vermont Bank a/c no. 55-59742-1 $10,000 First Vermont Bank Plat. 57-100877 due 7/27/81 $10,070 Howard Bank Savings Certificate No. 008517 $5,000 7 t% due 2/17/83 Stock 100 shs. Allied Research Associates, Inc. # C62134 500 800 84 79 50 ..:50 135 100 50 50 100 150 209 Warrants " Colonial Income Fund, Inc. # 5117 Current Income Shares, Inc. # NU 2643 and NU 12166 " " First Mortgage Investors # NB 19089 " Greater Jersey Bancorp. GJB 16909 " Mass. Mutual Corp. Investors, Inc. # BC41547 " Mony Mortgage Investors, # N93104 " N L Industries, Inc. # C777940 " Plaza Realty #NU 2510 REIT Income Fund # PKC 0014585 4 3/8% Cum. Pref. " " Revere Copper and Brass Incorporated #N133342 " S.S. Pierce Co. #26535 " Westinghouse Electric Corporation #NA 137715 Lord Abbett - Bond Debenture Fund * " 100 war. Cleveland Trust Realty Investors, #WCU 3519, Exp. 1/15/79 100 war. Plaza Realty Bonds $5,000 $5,000 #RB 1127 and RB 1128 Esterline Corporation 6t% Conv. Sub. Deb. due 4/1/95 The Howard Bank Series C 9% Sub. Cap. Note due 4/30/85 #253 .> AMENDMENT TO TRUST AGREEMENT CREATING THE "WILLIAM K. CORLISS LIVING TRUST" THIS AMENDMENT, made to one certain Trust Agreement dated February 15, 1978 is executed by William K. Corliss ("Settlor") of Northfield, Vermont and The First Vermont Bank and Trust Company ("Trustee") of Barre, Vermont, and WIT N E SSE T H WHEREAS, pursuant to Article 11 of the said Trust Agreement, the Settlor reserved the right at any time to amend, modify, or revoke said Trust; and WHEREAS, the tax laws of the United States have changed substantially since February 15, 1978; and WHEREAS, the Settlor's wife, Beatrice K. Corliss, intends this day to revoke a corresponding Trust created by her and to contribute the assets of that Trust to the Trust governed by this instrument; and WHEREAS, the Settlor and his wife, Beatrice, desire to revise the Dispositive provisions of this Trust, (including the elimination of "generation-skipping") and other provisions; NOW THEREFORE, the said Trust Agreement dated_February 15, 1978, is hereby amended as follows: 1. Article 2, DISPOSITIVE PROVISIONS is deleted in its entirety, and the following is inserted in lieu thereof: 2. DISPOSITIVE PROVISIONS. The Trustee shall hold, manage, invest, and reinvest the trust estate, collect the income thereof, and dispose of the net income and principal as follows: (a) During the lifetime of the Settlor and his wife, Beatrice K. Corliss, the Trustee shall pay all of the net income of the trust estate to the , ) Settlor and Beatrice, or the survivor of them, not less frequently than quarterly. If at any time either the 3ERNASCONJ & KOCH Settlor or Beatrice should become incompetent or for ATTORNEYS AT LAW BOX 892 IARRE. VERMONT 05641 any reason be unable to act in their own behalf, the Trustee may pay to or apply for their benefit, in addition to the payments hereinabove provided for them, such amounts from the principal of the trust estate, up to the whole thereof, as the Trustee may from time to time deem necessary or advisable for their use or benefit. The Trustee shall also pay such sums, from principal or income, as the Settlor (or after his death, Beatrice) may direct, orally or in writing. (b) Upon the death of the Settlor, the Trustee shall payout of the assets of the trust, all of the Settlor's just debts then due, the expenses of his last illness and funeral, and all estate, inheritance, succession, and transfer taxes or death duties, which may be assessed or imposed by reason of the Settlor's death, upon his estate or any part thereof, whether the taxable property shall be held as an asset of this trust or not, or whether the same shall pass under the Settlor's Will, or otherwise, and such payment shall be made without apportionment to or contribution from any beneficiary of the Settlor's estate, meaning hereby that this trust shall bear the full burden of taxes assessed against the Settlor's estate. Upon the death of Beatrice, whether occurring before or after the death of the Settlor, the Trustee shall pay the same type items, under the same conditions, for Beatrice as are provided in this paragraph for the Settlor. (c) After the death of both the Settlor and ATTORNEYS AT LAW BOX 892 BARRE. VERMONT 05641 Beatrice, and after all payments called for in paragraph (b) have been made, the Trustee shall render a final account and shall distribute all remaining assets of the Trust Estate, both principal and accrued but undistributed income, if any, to the children of the Settlor and Beatrice, Sylvia Corliss King, Marjorie Corliss Dunham, and William K. Corliss, Jr., in equal BERNASCONI & KOCH entirety. entirety. shares, the share of any deceased child passing to his or her descendants, per stirpes. 2. Article 3, INVASION OF PRINCIPAL, is deleted in its 3. Article 10, MERGER OF TRUST, is deleted in its affirmed. THE WILLIAM K. CORLISS LIVING TRUST, dated February 15, 1978 is 4. In all other respects, the TRUST AGREEMENT CREATING Dated I rfL, at City of Barre, Vermont this ~ day of February, 1984. BERNASCONI & KOCH ATTORNEYS AT LAW BOX 692 BARRE, VERMONT 05641 ~" .~." 7 " . I ./(Jf;/:l.-Mn- ~. ('~>64:~ William K. Corliss, Settlor FIRST VERMONT BANK AND TRUST COMPANY, TRUSTEE By: Ger Klop, Insurance $5,000 Travelers Insurance #1478445 * Physical possession of certificates at Moseley, Halgarten Done at Barre, Vermont this 15th day of February 1978. j),?/,'/ lb'?' ,. /J /(/;) . ti", f!r/ / .,' . / ,Y .' _ " 'r,;.//0( r>i .L'f>L/'( __j~t. Ld,~ William K. Corliss, Settlor ,.../ (/ '._-~ ~..., /',/ ~.:;, ,," /,1 / ,,' t.".") ,,,,~ ~ //7~"'".).-''''7'')'/ ... _,~ .v f I i ! i Trust Offic[er & Trust Co~ar i Michael H. Venuti, First Vermont Bank AMENDMENT OF TRUST Exercising the power reserved unto myself under Paragraph 11 of a certain revocable trust agreement created February 15, 1978 and as amended February 16, 1984 between myself as Settlor and First Vermont Bank and Trust Company, it's sucessors and assigns, as Trustee, I hereby remove the said First Vermont Bank and Trust Company and appoint the Northfield Savings Bank in substitution thereof and as Successor Trustee, 1--/ /0/9/ I Datetl ~ffi#~ % G-,ili~ Wi II iam K. Corl iss - Settlor Acknowledged: Northfleld SaVing; ~nk By: CJJ- 1 /UA-- Dated: 7../"~/c,1 First t~Ban;</~ By: UfiU~;;j~(d(L Dated: ~~/A/ Duly Authorized AMENDMENT OF TRUST AGREEMENT I, WILLIAM K. CORLISS, in exercise of the right to amend reserved in a certain Revocable Trust Agreement executed by me on February 15, 1978 with NORTHFIELD SAVINGS BANK as Trustee (the "Agreement"), hereby amend the Agreement as follows: 1 Section. I hereby remove NORTHFIELD SAVINGS BANK as Trustee, or Successor Trustee, under the Agreement and appoint COMMUNITY NATIONAL BANK, a national banking association, with a place of business in Derby, Vermont, to serve as Trustee, or Successor Trustee, as defined under the terms of the Agreement. 2 Section. I hereby ratifY and affirm the Agreement in all other respects. IN WITNESS WHEREOF, I have hereunto set my hand(s) this \ J..L day of A'f'<":'" \ 2000. ~OF: WI s 'K:"~\\-, \O..-C ~=t~~ C~~ Willi K. orhss, by Marjorie C. Dunham, his attorney-in-fact, pursuant to a power of attorney dated January 19,1995 STATE OF (1oVlVl~cA-; c_'_d~- ~ \ COUNTYOF'\="'O:\,,-~..\,Q SS 6\>..;~~~\- ...AI.-pR\ \, :;J..OO<> At ~),f'j, ~ c-....,-\- in said County and State, this "I ~ day of '^ 'f';a:, \ , 2000 personally appeared RJORIE C. DUNHAM and she acknowledged this mstrument, by her Signed, to be her free act apd deed, and her free act and deed on behalf of William K. Corliss, pursuant to a power of attorney dated \ \ \''1 \"11')"'. J ! I. L ,'~__ Before me, ~ - ~~7 -- - Notary Public CYN-, HI.. SW/\NSIGER NOTARY PUBLIC ACCEPTANCE OF TRUSTEESHIP MY COMMISSION EXPIRES AUG. 31,2003 I, W~~A ;fy{Jh. duly authorized representative of Community National Bank, a na'tional banking association, with a principal place of business in Derby, Vermont, hereby accept appointment as Trustee or Successor Trustee under the terms of the Trust Agreement dated February 15, 1978. Dated ay;Lr.fl,;2~ ~ ' this 3.,:' day of 4ud/C , 2000. ~iONAL BANK 4422 REV.\S06EX-+ \1_67} .. SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or Type FILE NUMBER COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF William K. Corliss SS# 019-01-0745 09/08/2002 (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F) ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Commonwealth of Massachusetts - Medicare Part B premium refund. 532.15 2 Commonwealth of Massachusetts - group health insurance premium refund. 119.64 TOTAL (Also enter on line 5, Recapitulation) $ 651.79 (Attach additional 8Y2" X 11" sheets if more space is needed.) REIJ-1&l9 EX. + (\-97) '*' SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF william K. Corliss FILE NUMBER SS# 019-01-0745 09/08/2002 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 DECEDENT A. William K. Corliss, Jr. 600 South York Street Mechanicsburg, PA 17055 Son B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MAOE Include name offinancial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate, VAlUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 12/23/ 9 Checking Acct. #6100628159, 2,086.71 50.00% 1,043.36 - Citizens Bank, Mechanicsburg, opened 12/23/99 in joint names of Decedent and his son, William K. Corliss, Jr. , principal balance as of D.O.D. : TOTAL (Also enter on line 6, Recapitulation) $ 1,043.36 (If more space is needed, insert additional sheets of the same size) .: CITIZENS BANK 525 William Penn Place Suite 153-2510 Pittsburgh, PA 15219 October 31, 2002 Marlin R McCaleb 219 E Main St PO Box 230 Mechanicsburg, P A 17055 Estate of WILLIAM K CORLISS SR Date of Death: Sep 08, 2002 SSN: 019-01-0745 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-537-5591. For all other inquiries, please call 412.867.2299. Sincerely, .7~~~ Philip Lynch Operations Services $ GOG olls:)mluI Gl.A lL.980Z$ GOG JO su :):)uulus: luno:):)v $ GOG Ol ~uHsOd lSU'1 uuoJ lS:)l:)lUI lL.980Z$ GOGJo su :):)uulus: lud~:)U~ld ~u~))::):)qJ :)dAl. luno:):)v 6661hZ/Zl p:)U:)dO :)WG (IS SSI'11IOJ)I WVI'1'1IM. (IO (If SSI'11IOJ)I WVI'1'1IM. :)llH luno:):)v 6~18Z90019 l:)qmnN luno:):)v -- )lNVH SNtlZI.LI:J ~t REV.1510EX+(1.97) '*' SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DEC DENT ESTATE OF William K. Corliss SS# 019-01-0745 09/08/2002 FILE NUMBER ITEM NUMBER 1. This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY INC1.-IJDETHENAMECFTrlEiRANSFEREE,lliElRRELATlONSHIPTODECEDENiANDTrlE DATE OF TRANSFER AITACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET 590,175.00 William K. Corliss Living Trust, - inter vivos Trust created by Decedent on 02/15/78, amended 02/16/84, 02/15/91 and 04/07/00, with Community National Bank, of Vermont, as Trustee. See attached letter dated 09/27/02 and Trustee's Summary and Schedule. Principal balance as of 0.0.0.: $582,847.00; Interest accrued to 0.0.0.: $7,328.00; Total Value: %OF DECO'S INTEREST 100% EXCLUSION IFAPF'LICABLE\ TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) TAXABLE VALUE 590,175.00 590,175.00 I COMMUNITY FINANCIAL SERVICES GROUP The Trust & Investment Management Affiliate oj Community National Bank CFSG September 27,2002 Marlon McCalab, Esq. P.O. Box 230 Mechanicsburg, PAl 7055 Re: TlU/A William Corliss Dear Mr. McCalab: Enclosed are the following for preparation of the Pennsylvania Estate Tax Return on behalf ofthe Corliss estate: . Copy of the William Corliss Revocable Trust document . Tabulation of trust assets with date of death values indicated under column marked "market value" . Notation next to each security for Income in Respect of Decedent totaling $7,328. Please call if we can be of further assistance. "" V erytruly yours, i/ ";71!~ C Michael H. 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M "' ,., ~ ~ o '" '" " is '" '" ~ o 0. '" o U '" 11 U Z H >< '" H o o '" "' " Z o '" " '" " H '" "' '" H '" H o o '" ~ '" ~ ~ o '" ~ o '" N '" N ,., RfV-1511EX+(1-97) . ., . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF William K. Corliss FILE NUMBER 88#019-01-0745 09/08/2002 Debts of decedent must be reported on Schedule I. ITEM NUM8ER A. 1. 2. 3. 4. 5. 6. 7. B. 1. 2. 3. 4. 5. 6. 7. DESCRIPTION AMOUNT 120.50 FUNERALEXP~NSES' Gordon s Florist & Greenhouses, Ipswich, MA - flowers for memorial service. Myers Funeral Home, Mechanicsburg, PA - funeral expense. R.S. Lane Company, Gloucester, MA - grave opening. Rev. Charles R. Burgard - funeral expense, bedside funeral service at Messiah Village, Mechanicsburg, PA. Rev. Wendy Fitting - funeral expense, memorial service in Gloucester, MA. Gloucester House Restaurant - funeral expense, memorial service luncheon, Gloucester, MA. Mt. Pleasant Memorials, Gloucester, MA - funeral expense, cleaning and engraving marker. ADMINISTRATIVE COSTS: Personal Representative's Commissions 1,796.10 300.00 100.00 165.00 396.00 545.00 Name of Personal Representative (s) Social Security Numbe~s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney Fees Law Offices - Marlin R. McCaleb 1,500.00 Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip Probate Fees Accountants Fees Tax Return Preparer's Fees 1. Other Administrative Costs Community Financial Services Group - pro-rated Trustee's fee for 08/21/2002 - 09/08/2002. 298.00 2. Larry A. Murphy - preparation of Decedentls final income tax returns. 115.00 TOTAL (Also enteron line 9, Recapitulation) $ 5,335.60 (If more space IS needed, Insert additional sheets of the same size) '. . RE\I.1512 EX' (1-971 '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF William K. Corliss SS# 019-01-0745 09/08/2002 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 2. Pharrnerica - account payable, prescription medications. 6,657.25 144.75 1. Messiah Village - account payable, room, board and medical care TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6,802.00 . . REV-15!3EX+(1-97) '*' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF William K. Corliss SS# 019-01-0745 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. William K. Corliss, Jr. 600 S. York Street Mechanicsburg, PA 17055 2. Marjorie Jean Dunham 277 S. Compo Road Westport, CT 06880 3. Sylvia King 10619 N. 56th Street Temple Terrace, FL 33617 FILE NUMBER RELA TtONSHIP TO DECEDENT Do Not List Trustee(s) Son Daughter Daughter AMOUNT OR SHARE OF ESTATE $ 193,939.75 192,896.40 192,896.40 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTtONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRtBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (tf more space is needed, insert additional sheets of the same size) 0.00 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EX111-96) BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 001904 MC CALEB MARLIN R 219 E MAIN STREET MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssrv: ors-of-o~45 FILE NUMBER: 2102-1077 DECEDENT NAME: CORLISS WILLIAM KIRKLAND DATE OF PAYMENT: 12/02/2002 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 09/08/2002 101 ~ 524,783.56 TOTAL AMOUNT PAID: REMARKS: MARLIN R MCCALEB ESQUIRE CHECK# 200397 INITIALS: AC SEAL RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS 524,783.56 REGISTER OF WILLS ~'~ ioy ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 E% ~FP (O1-OS) DATE 01-28-2003 ESTATE OF CORLISS WILLIAM K DATE OF DEATH 09-08-2002 FILE NUMBER 21 02-1077 COUNTY CUMBERLAND MARLIN R MI:CALEB ~ ACN 101 219 E MAIN ST Amount Remitted MECHANICSBIJRG PA 17055 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 CORLISS WILLIAM K FILE N0. 21 02-1077 ACN 101 DATE 01-28-2003 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 Bands (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .0 0 submit the upper portion 4. Mortgages/Not:es Receivable (Schedule D) (4l .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 651.79 tax payment. 6. Jointly Owned Property (Schedule F) (6) 1 , 043.36 7. Transfers (Schedule G) (7) 590,175.00 8. Total Assets (g) 591,870.15 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 5,335.60 (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 6,802.00 11. Total Deductions (11) 7 _? . 1 37.60 12. Net Value of Tax Return (12) 579,732.55 13. Charitable/Governmental Bequests; Nonelected 9113 Trus ts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 579,732.55 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 Line 14 at Spousal rate (15) .00 X 00 __ .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 579,732.55 X 045= 26,087.96 17. Amount of Line 14 at Sibling rate (17) .00 X 12 - .00 18. Amount of Lime 14 taxable at Collateral/Class B rate (18) •00 X 15 - .00 19. Principal Tax Due (lq)= 26,087.96 TAY f'DCTITTC. - - DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 12-02-2002 I:D001904 1,304.40 24,783.56 TOTAL TAX CREDIT 26,087.96 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 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 for 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 an 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 ar money order payable to: REGISTER OF WILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested an 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 by calling the spacial 24-hour answering service for forms ordering: 1-800-362-2050; services far taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, ar assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 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 C717) 787-6505. See page 5 of the booklet "Instructions 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 (3) calendar months after the decedent's death, a five percent (5%) 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 C9) 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 C6%7 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 Year Rate Factor Vear Rate Factor Year Rate Factor 1982 20% .000548 1987 9% .000247 1999 7% .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9% .000247 2001 9% .000247 1985 13% .000356 1993-1994 7% .OOD192 2002 6% .000164 1986 10% .000274 1995-1998 9% .000247 2003 5% .OOD137 --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 on the Notice, additional interest must be calculated.