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HomeMy WebLinkAbout01-0414 /(" -.;lc9.b -- 'f REV-1500 EX + (6-00) CAPB HpRL E pi 0 CRAC KOTK ES C P o 0 R N R 0 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 o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FiRST, AND MIDDLE INITIAL) Bo ar Mar uerite P. DATE OF DEATH (MM-DD-YEAR) COUNTY CODE YEAR SOCIAL SECURITY NUMBER 202-09-6809 THIS RETURN MUST BE ALED IN DUPUCATE WITH THE DATE OF BIRTH (MM-DD-YEAR) 01/26/2001 11/13/1917 (IF APPLICABLE SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) C!..- OFFICIAL USE ONLY 21-01-0414 NUMBER REGISTER OF WILLS SOCIAL SECURI Y 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 3. AemalnderAeturn ~r~~tO:f2e_ai~_82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes Copyright (c) 2000 form software only The Lackner Group, lnc {AttaCh copy of Will) (Attach copy of Trust) D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit D (date of death between 12-31-91 and 1 ~ 1 ~95) t:.!lIi!j!~~~~~~Iii!lij;Sj:!gii:l~P:J!!$elfl!i4:i.~+~~jlj~~~~lfi~~~!!l!l!'ljj.... ..~~_tf...... NAME COMPLETE MAILING ADDRESS Gre or K. Richards Es FIRM NAME (If Applicable) JAMES, SMITH, DURKIN & CONNELLY, LLP TELEPHONE NUMBER 134 Sipe Avenue Humme1stown, PA R E C A P I T U L A T I o N 3 -3 80 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 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) ::::Jlllllj?r& 17036 OFFICIAL USE ONLY (8) 118,691. 92 (11) 2,797.34 (12) 115,894.58 (13) (14) 115,894.58 (15) (16) (17) (18) (19) 0.00 5,215.26 0.00 0.00 5,215.26 (1) (2) (3) None NOne None (4) (5) None 660.00 (6) 15,533.42 102,498.50 2,797.34 None 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 115,894.58 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. X X X X X .0 0 .0 45 .12 .15 Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 1044 Walnut Street, Apt. 5 . CITY 1 STATE I ZIP Lemovne PA 17043 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,215.26 5,000.00 260.76 Total CredITs ( A + B + C) (2) 5,260.76 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. Thisjs_.the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 45.50 0.00 0.00 0.00 [![,,!ii[m~[ti~~~~[[~~~~~~ii!~~~i[~i~it[E~~~~~!!i~~!~i~~~~[~~m~yi!~t~~ili~i~ii~~! 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or. d. receive the promise for life of either payments, benefits or .care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. i!i!i!ii!i!iiii!WWiHi!!!!'tii[!i:!H" ii!i!ii:U:i!iiH'!, "ii.':!.!]: ,,:HHil1i,iij',W!ii!:Hi,1i:i:iiiii';i!'" "X"IN THE APPROPRIATEsL.OCKS ... . Yes No ~; D D ~ ~ D []] Under penalties of perjury, I declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, It is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. PERSON RESPONSlBLE FOR FILING RETURN Kathleen A. Milbrand DATE {(, }iIA,xlA\M"~J---~~~~a~i~-~~~~";~*ieei-i650--------------------- 7 HAN RE ESENTATIVE JAMES, SMITH, DURKIN & CONNELLY, LLP DATE _ _ _1.~~_ _5. ~pe_l~?"!,_,,'O~_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ __ Hummelstown, PA 17036 F dat eath 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. 9116 (a)(1.1)(i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(a)(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. 9116(a)(1.3)J. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1508EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Marguerite P. Bogar SS# 202-09-6809 01/26/2001 21-01-0414 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 Personalty - Miscellaneous furniture and furnishings, valued per daughter's opinion. VALUE AT DATE OF DEATH 660.00 TOTAL (Also enter on line 5, Recapitulation) $ 660.00 (It more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-15GB EX (Rev. 1-97) REV- 1509 EX + (1-97) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHEAITANCETAX RETURN RESIDENT DECEDENT ESTATE OF Marguerite P. Bogar SS# 202-09-6809 01/26/2001 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER 21-01-0414 A. SURVIVING JOINT TENANT(S) NAME Kathleen A. Milbrand ADDRESS 3875 Sullivan Street Mechanicsburg, PA 17050 B. Frederic D. Bogar 1947 Marthas Road Alexandria, VA 22307 c. -I JOINTLY-OWNED PROPERTY, LETTER ITEM FOR JOINT NUMBER TENANT 1 A DATE MADE JOINT 01/26/97 DESCRIPTION OF PROPERTY Include name of financlal Institution and bank account number or similar identifying number. Attach deed for Jointly-held real estate. Decedent's vehicle - 1989 Dodge Dynasty 4-door sedan with approximately 40,000 miles, titled jointly with decedent's daughter, valued per online services. DATE OF DEATH VALUE OF ASSET 725.00 2 09/15/97 Members 1st Federal Credit Union - Non-interest bearing checking account #170773-11, titled jointly with daughter, Kathleen A. Milbrand, principal balance valued per insurance products supervisor letter. 1,254.69 A RELATIONSHIP TO DECEDENT Daughter Son % OF DATE OF DEATH DECD'S VALUE OF INTEREST DECEDENT'S INTEREST 50.00% 362.50 50.00% 627.35 3 A 09/16/97 Members 1st Federal Credit 22,946.72 50.00% 11,473.36 Union - Investment savings account 1/170773 - 05, titled jointly with daughter, Kathleen A. Milbrand, principal balance plus accrued interest valued per insurance products supervisor letter. 4 A 09/15/97 Members 1st Federal Credit 965.00 50.00% 482.50 Union - Regular savings account Ifl70773 - 00, titled jointly with daughter, Tot 1 of Contim ation Schedule(s) TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. 2,587.71 15,533.42 Form REV-1509 EX (Rev. 1-97) Estate of: Marguerite P. Bogar Soc Sec #: 202-09-6809 Date of Death: 01/26/2001 Continuation of Schedule F (Jointly Owned Property) Item Ltr for # Jt Ten Date Joint Description of property Total Val of Asset Decds % Int Dollar Val of Decds Interest Kathleen A. Milbrand, principal balance plus accrued interest valued per insurance products supervisor letter. 5 05/12/99 Members 1st Federal Credit Union - Regular savings account #184076-00, titled jointly with daughter, Kathleen A. Milbrand, and son, Frederic D. Bogar, principal balance plus accrued interest valued per insurance products supervisor letter. A,B 7,763.14 33.33%_ 2,587.71 2,587.71 REV~ 1510 EX + (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCETJl.X RETURN RESIDENT DECEDENT ESTATE OF Marguerite P. Bogar 01/26/2001 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. SSlI 202-09-6809 ITEM NUMBER 1 DESCRIPTION OF PROPERTY RELA W8hMA'[~ t~b~~~B~WlAWJ~4~1flV~E6F t~~NRSFER. ATTACH A COPY OFTHE DEED FOR REAL ESTATE. Sullivan Funeral Home - Pre-paid funeral contract DATE OF DEATH VALUE OF ASSET 1,014.00 2 American Express Financial Advisors - Flexible savings certificate 118 0420 8367 8 001, gifted to daughter, Kathleen A. Mi1brand, less than one year prior to death. 26,182.52 3 American Express Financial Advisors - Certificate of deposit account 118 0419 8534 5 001, titled in decedent's name alone, transfer on death in equal shares to decedent's children, Kathleen A. Milbrand and Frederic D. Bogar, valued per death settlements processing team letter. % OF DECO'S INTEREST 100.00% EXCLUSION (IF APPLICABLE) 0.00 100.00% 52,115.44 100.00% 4 American Express Financial Advisors - Mutual Funds cash management account #11 3874 4666 6 002, titled in decedent's name alone, transfer on death in equal shares to decedent's children, Kathleen A. Mi1brand and Freneric D. Bogar, valued per death settlements processing team letter. 26,186.54 100.00% TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. 3,000.00 0.00 0.00 FILE NUMBER 21-01-0414 TAXABLE VALUE 1,014.00 23,182.52 52,115.44 26,186.54 102,498.50 Form REV-1510 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 Marguerite P. Bogar SSII 202-09-6809 FILE NUMBER 21-01-0414 01/26/2001 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. DESCRIPTION AMOUNT 1 FUNERAL EXPENSES, Funeral flowers 41. 79 2 Harry Trego - Fee for opening grave 75.00 3 Hoss's Steak & Sea House - Post-funeral luncheon for family and friends 238.55 Total of Continuation Schedule(s) 1,809.00 ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. 3. Attorney's Fees JAMES, SMITH, DURKIN & CONNELLY, LLP (If decedent's address is not the same as claimant's, attach explanation) 500.00 Family Exemption: Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Pre parer's Fees 68.00 7. 1 Other Administrative Costs Cumberland County Register of Wills - Filing fee for inheritance tax return 15.00 2 James, Smith, Durkin & Connelly, LLP - Reserved for closing costs 50.00 TOTAL (Also enter on line 9, Recapitulation) $ 2,797.34 (If more space is needed, insert additional sheets of the same size) Copyright Ie) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) Estate of: Marguerite P. Bogar Soc See #: 202-09-6809 Date of Death: 01/26/2001 Continuation of Schedule H-A (Funeral Expenses) Item # Description Amount 4 James R. Gingrich Memorials - Engraving on headstone 95.00 5 Rev. Keith Ensinger - Honorarium for clergy 200.00 6 St. Timothy's Lutheran Church - Donation to decedent's church 500.00 7 Sullivan Funeral Home - Funeral goods and services 1,014.00 1,809.00 Estate of: Marguerite P. Bogar Soc See II: 202-09-6809 Date of Death: 01/26/2001 Continuation of Schedule H-B2 (Attorney's Fees) Item 11 Description Amount 1 James, Smith, Durkin & Connelly, LLP - Attorney fees 500.00 500.00 Estate of: Marguerite P. Bogar Sac See #: 202-09-6809 Date of Death: 01/26/101 Continuation of Schedule H-B6 (Tax Return Preparer's Fees) Item # Description Amount 1 H&R Block - Fee for preparation of tax return 68.00 68.00 REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHER1TANCETA:X RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Marpuerite P. Bopar NUMBER I. SS11 202-09-6809 01/26/2001 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Frederic D. Bogar 1947 Marthas Road Alexandria, VA 22307 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Son Daughter FILE NUMBER 21-01-0414 AMOUNT OR SHARE OF ESTATE 1/2 personal property, 1/3 Members 1st account 11184076-00, 1/2 AmEx account 118041985345001 , & 1/2 AmEx account 11113874466660 Decedent 1 S vehicle, 1/2 personal property, 1/2 Members 1st account ENTER DOLLAR AMTS. FOR DISTRiBUTIONS SHOWN ABOVE ON LN. 15 THRU 1a, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON- TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEe. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 2 Kathleen A. Mi1brand 3875 Sullivan Street Mechanicsburg, PA 17050 TOTAL OF PART II - ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same sjze) Copyright Ie) 2000 form software only The Lackner Group,lnc. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 0.00 Form REV-1513 EX (Rev. 9-00) Estate of: Marguerite P. Bogar Soc Sec #: 202-09-6809 Date of Death: 01/26/2001 Continuation of Schedule J, Part I (Taxable Bequests) Item # Name and Address of Beneficiary Relationship Amount or Share of Estate 2 (continued) #170773 -11, 1/2 Members 1st account 11170773-5, 1/2 Members 1st account #170773-00, 1/3 Members 1st account #184076-00, 1/2 AmEx account 118041985345001 & 1/2 AmEx account #113874466660 ~ / t~:2~t-~7" BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-I'D7 EX AFP el2-DD) GREGORY K RICHARDS ESQ JAMES ETAl 134 SIPE AVE HUMMElSTOWN PA 17036 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-27-2001 BOGAR 01-26-2001 21 01-0414 CUMBERLAND 101 MARGUERIT P Amount Remi 'Hed MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WIllS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv=i6"O-j-Ex-AFP--ci"2-:o1fr------...--iNHERITANc"E--TAx-STATEtiENT-OF"-Accouiif--.i.--------------------- ESTATE OF BOGAR MARGUERIT P FILE NO. 21 01-0414 ACN 101 DATE 08-27-2001 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: 08-13-2001 P R I N C I PAL TAX DUE: ...._......................................._..._........._....._.._............_..._._..._..................._.._...........................................n..............................._.............. 5,215.26 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-25-2001 AA496512 260.76 5,000.00 08-13-2001 REFUND .00 45.50- TOTAL TAX CREDIT 5,215.26 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 ., IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) (J) m l> r :n 0 m )> S ;:;1 l> 0 :n 11 @ , 0 " m " )> r ,< ~/1 o o C Z -I ,-, -< :..~ ;:. -. f'- ::0 rn G) (j) -1 m JJ 0 11 ~ r r 0) :n -l m 0 0 -l m l> <: r );> ,..... m S ~( 0 0 OJ C '" -< Z -l \J l> is '-' ~~.~ ~ ,. , L. '< ""0 o (J) -I S )> . :n ".: ;A o '.~: ~ '.,'m "'.- 11 r= m z C s: ,- CD ,m :n ~ o :r: rn m ;IJ (J) rn --I ~ m z " o J) s: ~ 6 ~ z )> s: m o 11 o m (") m ,,' o I-"J m z ::~ -I :) ~; !'"'f-~ ......-' ~).} C': C --::n t. JJ .- ~ ('.' 'T\ i2 o ::r: m ;IJ m I I ,\ -" ..,r- i-':'-~ I :0 rn n rn <: m c ." :0 o ~ l> zogs COml> s~(J)o tJJ:n(J)z mos ::Or~ -I );> ~ o c Z -I X00300 )>mcmO :n""O:II"US: ::n-lm>:>s: cn~)>~o CDOCs:z COlOm~ :nS"zm o z-l)> ""0 ooC4 )> <I1X a:Do C~11 )>m""O ,zm -ICZ )>mZ x (/J m -< (/) r < )> z )> j f\) co 6 (J) S z 0 x. m ." :D ." =i - >"1J 0 Zm - OZ )> mZ r- >(1) z-< ::JJ C~ m m)> 0 (l)Z ~- m >> - ~ "'0 m -t ~ > >< Z 0 ~ )> ~ (.0 0") (}1 p '" :D rn \ ~ 0'> N rn x cb ~ / t .. -1 J I l " "7."""" . l.{? .- '/ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT I ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX GREGORY K RICHARDS ESQ JAMES ETAL 134 SIPE AVE HUMMELSTOWN PA 17036 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-20-2001 BOGAR 01-26-2001 21 01-0414 CUMBERLAND 101 .-.{ ) 'f c; REY-1547 EX AFP el2-00) MARGUERIT P Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLEI PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-Y-=is'4-j-ix--AFP-fi'2-.-ooi--NOTici--OF-.rNHEifiTAifcE-TAirAPPRA-isEiiENT~--Aii-oWANCE-ifR-----------_._--- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BOGAR MARGUERIT P FILE NO. 21 01-0414 ACN 101 DATE 08-20-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets Cl) (2) (3) (4) (S) (6) (7) .00 .00 .00 .00 660.00 15.533.42 102.498.50 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) ClO) 21797.34 .00 NOTE: To insure proper credit to your accountl submit the upper portion of this form with your tax payment. 1181691.92 Cll) (12) (13) (14) ?7Q7 54 1151894.58 .00 1151894.58 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total o~ ~ returns assessed to date. ASSESSMENT OF TAX: IS. Amount of Line 14 at Spousal 16. Amount of Line 14 taxable at 17. Amount of Line 14 at Sibling 18. Amount of Line 14 taxable at 19. Principal Tax Due TAX CREDITS: rat. ClS) .00 X 00 = .00 Lineal/Class A rat. Cl6) 1151894.58 X 045 = 51215.26 rat. Cl7) .00 X 12 = .00 Collateral/Class Brat. Cl8) .00 X 15 = .00 Cl9)= 51215.26 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-25-2001 AA496512 260.76 51000.00 08-13-2001 REFUND .00 45.50- TOTAL TAX CREDIT 51215.26 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 · IF PAID AFTER DATE INDICATED I SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)I YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)