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Home My WebLink About01-0511 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG. PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT . No.AA 496657 R~-1162EX(11-96) RECEIVED FROM: r ACN ASSESSMENT CONTROL NUMBER AMOUNT WE I BLE JERRV A 126 E KING STREET &HIPPENSBURS, IDA 171m? 101 .hOIt..e #If FOlD HERE FOLD HER: ESTATE INFORMATION: FILE NUMBER 21-2001-0511 SSN e03-10-6001 NAME OF DECEDENT iLAST) HAWLEY JOHN T (FIRST) (MI) REMARKS ~. I .,/' . \ ,;. . . '~~... r y ,{ ;,,,, .,. '.'" , ' "'. \. .........., '. .t . " , .' , . I \ .... , '. , . -. '< \ I, ",' A',,, "! :: ....: .I I .'....' '\ ',.... \ t<'", ,,''"'. ~~ ..0 . 98 TOTAL AMO~NT,PAIP~ . ". J! ~ ' . .' "tOO (Z.I.". ,: ..~.Z " , .. <Ii .. .- DATE OF PAYMENT 5/30/2001 POSTMARK DATE 0/00/0000 COUNTY CUMBERLAND ~ \ DATE OF DEATH 3/30/2001 RECEIVED BY '~ MM. .~ .~" RE9I STEFt./ 'Wtl &.8" .' t ' I i f i"i l"\" ",);a..I!;:;; . I'pr .-IIt_________~_........_______.........~__~__._._._ -......4__~..._...__'f_.4'_ --.J"--.; ~ -...v_ _..........._ __ __.--....--... ~~_~ C/O JERRY A WE IOLE ESQU IRE CHECK. 3006 SEAL REGISTER OF WILLS \,/6-~.3~-~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE c;t c. V BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JERRY A WEIGLE WEIGLE ETAl 126 EKING ST SHIPPENSBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-09-2001 HAWLEY 03-30-2001 21 01-0511 CUMBERLAND 101 Amount Rellitted PA 11%57 *' REV-1547 EX AFP <12-00) JOHN T MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WIllS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=is4j-ix-"FP--fi"2=oOr-NOTici--OF-.rNHiifiTANCi-TAX-XPPRAisiMENT~--,,[l-oWANci-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HAWLEY JOHN T FILE NO. 21 01-0511 ACN 101 DATE 07-09-2001 TAX RETURN WAS: (Xl ACCEPTED AS FILED .c l CHANGED If an assessment was issued previouslYf lines 14, 15 and/or 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 16. AMount of Line 14 taxable at Lineal/Class A rate 17. AMount of Line 14 at Sibling rate 18. AMount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule Al 2. Stocks and Bonds (Schedule Bl . 3. Closely Held Stock/Partnership Interest (Schedule Cl 4. Mortgages/Notes Receivable (Schedule Dl 5. Cash/Bank Deposits/Misc. Personal Property (Schedule El 6. Jointly Owned Property (Schedule Fl 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 .00 .00 26.500.00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. 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) (10) 11,111.88 1.236.60 (11) (12) (13) (14) NOTE: (15l .00 X 00 = (16) 14,151.52 X 045 = (17) .00 X 12 = (18l .00 X 15 = (19)= NOTE: To insure proper credit to your account, subMit the upper portion of this form with your tax payment. 26,500.00 12.348 48 14,151.52 .00 14,151.52 .00 636.82 .00 .00 636.82 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-30-2001 AA496657 31.84 604.98 TOTAL TAX CREDIT 636.82 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ..CREDIT" (CRl, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) (2 REGISTER OF WILLS, CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 Name of Decedent: John T. Hawley Date of Death: March 30, 2001 Will No. 21-01-0511 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complet~: Yes X No Only asset was a Schedule G Transfer prior to date of death. PA Inheritance Tax Return was filed, and inheritance tax paid.Approved 2. I f the answer is No, state when the personal 7-9-01. representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No X d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with Cerk of the Orphans' Court and roa attached to this rep , QJ Date: August 16, 2001 Jerry A. Weigle, Esquire Name (Please type or WEIGLE, PERKINS & ASSOCIAT 126 East King Street Address Shippensburg, PA 17257 (717) 532-7388 Tel. No. Capacity: Personal Representative x Counsel for personal representative (MAH:rmf/AM3) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG I PA 11128-0601 *' 17 -CiJ(;;-c, INFORMATION NOTICE AND TAXPAYER RESPONSE REY-1545 EX AFP <09-00> v FILE NO. 21 02-0511 ACN 03111020 DATE 03-20-2003 EST. OF PAUL A POPIK S.S. NO. 161-40-0567 DATE OF DEATH 04-30-2002 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVING D CHECKI D TRUST [Xl CERTIF JOANN K POPIK 133 S CRESCENT DR HERMITAGE PA 16148 SKY BANK has provided the Depart.ent with the ir calculating the potential tax due. Their records indicate that at the death of 1 this account. If you feel this infor.ation is incorrectl please obtain written e to this fo~ and return it to the above address. This account is taxable in ace of Pennsylvania. Questions .ay be answered by calling (111) 181-8321. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR Account No. 3800788233 Date 06-04-1998 Established Account Balance Percent Taxable X A.ount Subject to Tax Tax Rate X Potential Tax Due A-C IV . (.~ .3 ide .:J.. t 34..780.89 5.000 1..739.04 .15 260.86 TAXPAYER RESPON REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE Tf1~ D /(T "1 ~S--)) ;)\-0 0' )7~ $0- 'lfP {2tAt~ 1\ L/J-J f th ( tion and tax due is correct. I to re.it pay.ent to the Register of Wills with two copies of this notice to obtain avoid interestl or you may check box "A" and return this notice to the Register of Ifficial assessment will be issued by the PA Department of Revenue. -5 been or will be reported and tax paid with the Pennsylvania Inheritance Tax return decedent's representative. ~lon is incorrect and/or debts and deductions were paid by you. 'ART 0 and/or PART ~ below. ~ate.. please state your 10, \r\b.~ IN JOINT/TRUST ACCOUNTS DESCRIPTION AMOUNT PAID .-1 $ have reported above are true.. correct and HOME (7 ill/-) ~ 'I- 7- 2. S 17 WORK ( ) /7- {, {;-{p c COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 02-0511 ACN 03111021 DATE 03-20-2003 REV-1545 EX AFP 109-00> EST. OF PAUL A POPIK S.S. NO. 161-40-0567 DATE OF DEATH 04-30-2002 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS D CHECKING D TRUST IX] CERTIF. PAUL A POPIK SR 133 S CRESCENT DR HERMITAGE PA 16148 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 SKY BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. " COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3800788233 Date 06-04-1998 Established Account Balance Percent Taxable A.ount Subject to Tax Rate Potential Tax Due x 34,780.89 5.000 1,739.04 .045 78.26 TAXPAYER RESPONSE To insure proper credit to your account, two (2l copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5~ discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. c=J The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or YOU may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. c=J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established I 2. Account Balance 2 3. Percent Taxable 3 X 4. A.ount Subject to Tax 4 5. Debts and Deductions 5 6. A.ount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART ~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID 'J '$ the facts I have reported above are true, correct and HOME (7024) J ~ 7. OL$"/7 WORK ( ) TELEPHONE NUMBER DATE COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' J 7 ~ f.p (p -b INFORMATION NOTICE AND TAXPAYER RESPONSE ~ FILE NO. 21 02-0511 ACN 03111022 DATE 03-20-2003 REY~lS43 EX AFP (D9~DD) EST. OF PAUL A POPIK S.S. NO. 161-40-0567 DATE OF DEATH 04-30-2002 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS o CHECKING D TRUST !Xl CERTIF . KEVIN M POPIK 133 S CRESCENT DR HERMITAGE PA 16148 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 SKY BANK has provided the Departllent with the inforllation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this inforllation is incorrect, please obtain written correction froll the financial institution, attach a copy to this fOrll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COllllonwealth of Pennsylvania. Questions lIa~ be answered by c;l11in9 U17) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3800788233 Date 06-04-1998 Established x 34~780.89 5.000 1~739.04 .15 260.86 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice !lUst aCCOllpany your paYllent to the Register of Wills. Make check payable to: ftRegister of Wills, Agentft. Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x NOTE: If tax payments are lIade within three (3) months of the decedent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will becolle delinquent nine (9) 1I0nths after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [J The abo~e inforllation and tax due is correct. 1. You lIay choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box ftAft and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. ~ The above information is incorrect and/or debts and deductions were paid by you. You lIust complete PART ~ and/or PART ~ below. PART ~ DATE PAID x . , t-- ,.~O 1.~~ DEBTS AND DEDUCTIONS If you indicate a different ta relationship to decedent: PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax S. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due TAX ON JOINT/TRUST ACCOUNTS OF 1 2 3 4 5 6 7 8 x / 7 -3 Cj, O~ PAYEE DESCRIPTION AMOUNT PAID I' $ facts I and HOME WORK TELE DATE , . ... , t COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 . /1- (,(p- ~ INFORMATION NdTICE AND TAXPAYER RESPONSE G REV-1543 EX AFP COg-DO) FILE NO. 21 02-0511 ACN 03111023 DATE 03-20-2003 EST. OF PAUL A POPIK 5.5. NO. 161-40-0567 DATE OF DEATH 04-30-2002 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS D CHECKING D TRUST [X] CERTIF. VICTOR M POPIK 1405 GRANIT SPRINGS DR CHULA VISTA CA 91915 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 SKY BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (7171 787-8~~7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 3800788233 Date 06-04-1998 Established Account Balance Percent Taxable AMount Subject to Tax Rate Potential Tax Due x 34~780.89 5.000 1~739.04 .15 260.86 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) .onths of the dWc8dent's date of death, yOU may deduct a 57. discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "An and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. ~ The above information is incorrect and/or debts and deductions were paid by you. ~ You must complete PART ~ and/or PART ~ below. If you indicate a different ta relationship to decedent: PART ~ DATE PAID x ' I "2- "Lr; DEBTS AND PART @] TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. AMount Subject to Tax S. Debts and Deductions 6. AMount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 S 6 7 8 x I 7.3 ct l) If TAX ON JOINT/TRUST ACCOUNTS PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line S of Tax COMPutation) [~ $ facts I have reported above are true, correct and HOME (7~+) dJ/-7"~S" I, W9RK ( ) TELEPHONE MBER DATE ~ '''11111 "1'1""11 U.S. POSTAGE PHlU HERMITAGE. PA 16148 APR 07.' 03 AMOUNT ceco $0.60 00030221-02 17013 \ ~ \i ..... ~ ~ ~ ~ " .. Q ~ Q '" 4 tU' \( ~ ----J. ~ V1 \lJ Cc -- 1--- \(j~ V"j ~ ~ ..... ~\j 00 -t ..... ~ 'S '.':. 'a.) <!. .'~ ~ ~~ ~ -%'t= ~ ~.~.~ ~.- 1S ;:, ~ ~ ...... -<u;::C ~u) 06 ~'. - - ::= - C'; p.. . - - - - - - ~ ~ f) f'J , f) '" o t ~ ,I>;::V-15DOEX (6-D1J1' w ,.., :::t:!;cn 0"'''' W"O :rOO 0"''''' ..Ill .. " COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 I- Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Hawley, John T. DATE OF DEATH (MM-DD-YEAR) 3/30/01 11.0 - d'3 0- "3 REV-1500 OFFICIAL IJSE ONLY FILE NUMBER ..2i --.D..i COUNTY CODE YEAR INHERITANCE TAX RETURN RESIDENT DECEDENT 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 Z (Schedule E) 0 6. Jointly Owned Property (Schedule F) 5 D Separate Billing Requested ~ 7. Inter-Vivos Transfers & Miscellaneous Non.Prohate Property I- (Schedule G or L) ii: c:r: 8. Total Gross Assets (total Lines 1-7) U 9. Funeral Expenses & Administrative Costs (Schedule H) W 0:: 1D. 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) __5_LL NUMBER SOCIAL SECURITY NUMBER 203 -- 10 - 6001 DATE OF BIRTH (MM-DD-YEAR) 10/24/19 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Hawley, Mary E. [KJ 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Altach oopy of Will) D 9. Litigation Proceeds Received 6964 D 2. Supplemental Return D 4a. Future Interest Compromise (date 01 death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach oopy alTrust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Altacl1 Sell 0) ,.., z w c z o .. ., w '" '" o o NAME COMPLETE MAILING ADDRESS 126 East King Street Shippensburg, PA 17257 Jerry A. Weigle, Esquire FIRM NAME (If ApplicableL , . we~gle, Perk~ns & Associates TELE R (717) 532-7388 (1) (2) (3) (4) (5) OFFICIAL USE ONLY (6) (7) 26,500.00 (B) 26,500.00 (9) (10) 11,111.88 1,236.60 (11) (12) (13) 12,348.48 14,151.52 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 14,151.52 z o < I- ~ Il. :i! o u ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 14,151.52 x.O_ (15) xO~ (16) x .12 (17) x .15 (18) (19) 636.82 636.82 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: .' STREET ADDRESS 330 East Fort Street CITY Shippensburg I STATE PA I ZIP 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 636.82 31. 84 Total Credits (A + 8 + C) (2) 31. 84 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is 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. 604.98 (5) (SA) (58) A. Enter the interest on the tax due. 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. 604.98 Make Check Payable to: REGISTER OF WILLS, AGENT 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;................ .................. ........................ .... D b. retain the right to designate who shall use the property transferred or its income; ..... ................... ......... 0 c. retain a reversionary interest; Of..................... .................................................... ............................................... 0 d. receive the promise for life of either payments, benefits or care? ................. ...................................... D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..................... .. .................................................... ................................ D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...... ....... ..... ....... ..... ....... ..... ..... ....... ..... ....... ..... ... .. ....... ....... ..... ..... ...... No IKJ IKJ IKJ IKJ IX] IX] IKJ ...0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of peijury, 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. ADDRESS 17257 sburg, PA SIGNATURE OF PREP ADDRESS es, 126 East King Street, Shippensburg, PA 17257 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. ~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 (aj (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 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)]. 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. REV150BEX+(2.B7! . 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 John T. Hawley (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F) ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ALL ASSETS JOINTLY OWNED WITH SPOUSE PA INHERITANCE TAX RETURN BEING FILED FOR INFORMATION PURPCSES TOTAL (Also enter on line 5, Recapitulation) $ (Attach additional BV2" x 11" sheefs if more space is needed.) ,,,,,,m.,,,,,.,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY FILE NUMBER John T. Hawley 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-1S00 COVER SHEET is yes. DESCRIPTION OF PROPERTY II~CLUDE TH~ NAME OF TkE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSfER ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %QF DEWS INTEREST Sarah E. Lake, Daughter 810 Mickeys Inn Lane, Chambersburg, PA 17201 Real Estate transferred 9/28/2000 325 East Burd Street, Borough of Shippensbur~, Cumberland County, PA Property previously owned by John T. Hawley and Mary E. Hawley, husband and wife - valued at $59,000.00 1/2 gifted by John T. Hawley = 1/2 x $59,000.00 29,500.00 liOO% TOTAL (Also enter on line 7, Recapitulation) $ (If more spaoe is needed, insert additional sheets of the same size) EXCLUSION IF APPLICABLE) TAXABLE VALUE 3,000.00 26,500.00 26,500.00 /' TaxParce/J.D.No. ~;l-33 -IFIi>7-U5? :2 (, ftr k., MADE THE Thousand (2000). THIS DEED )q'lfJday of b-t;;nf,f~'\ in the year of our Lord Two BETWEEN JOHN T. HAWLEY and MARY E. HAWLEY, husband and wife, of 330 East Fort Street, Shippensburg, Cumberland County, Pennsylvania, hereinafter referred to as Grantors, AND SARAH E. LAKE, of, 810 Mickeys Inn Lane, Chambersburg, Franklin County, Pennsylvania, hereinafter referred to as Grantee, WITNESSETH, that for and in consideration of the sum of ONE DOLLAR ($1.00), in hand paid, the receipt whereof is hereby acknowledged, the said Grantors do hereby grant and convey. in fee simple, to the said Grantee, her heirs and assigns, ALL that certain tract of real estate together with improvements erected thereon known as 325 East Burd Street, situate in the Borough of Shipp ens burg, Cumberland County, Pennsylvania. more fully bounded and described as follows: BEGINNING on the South by Burd Street; on the East by property now or formerly of Mr. Fortney; on the West by property now or formerly of Lydia Wonders; and on the North by an alley . CONTAINING thirty-two (32) feet in front on Burd Street, and in depth to the alley one hundred sixty (160) feet, more less. BEING THE SAME which Alice E. Gise. single woman. by deed dated June 18, 1965. and recorded June 22. 1965, in the Office ofthe Recorder of Deeds in and for Cumberland County. at Deed Book "Q", Volume 11. at Page 131, granted and conve)1CiI to John T. Hawley and Mary E. Hawley, his wife. Grantors herein. ~ c:> -< And the said Grantors hereby covenant and agree that they will warrant specially the property hereby conveyed. N -u THIS IS A TAX EXEMPT TRANSFER BETWEEN PARENT AND CHILD ::3 'c..:> <=> en r. ( fVJ/'J" f'.:' . ..c:;.u Ill:t 54 <,' ~ -~ ...~ " c; l:; .,' r ,- C) . . ~ ('l r~l <: -i' .-.- C" . r ~1 c...:VtJ :;": 11'1 \- -1 r~l ril -:CJ:;:J I (I) -0 l'- \'Vr:iC:;U~, Pr:,""I:'JS'. .\s::-,OCt~TCS ATTORNEYS AT L..:>.W l-.Cti l:/....ST hlNG STREET - SHIPPENS8URG, "'A 17257.1397 IN WITNESS WHEREOF, Grantors have hereunto set their hands and seals the day and year first above written. " -- Signed, Sealed and Delivered . i 'CL r ! ,/ ~Cc 1 / ) I J -,___ C( /l '- ? (J~ .J /~-t:w. fohn T. Hawley U , -- / ! ;'--/1 / C' " ';?j! tL'v../ d', Mary E. ~wley h/,;L(I.._~~_ ~j / COMMONWEAL TH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND r 17: On this. the '1 ~ day of h;h wJP) ,2000, before me. a Notary Public in and for said County and State, the undersigned officer, personally appeared JOHN T. HAWLEY and MARY E. HAWLEY, known to me (or satisfactorily proven) to be. the persons whose names are subscribed to the within instrument. and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereu 0 set my hand and official seal. (, ) ( 'L \. C~ r C,\.- :~I\;' ). ,,:', I _:.-' ,.., . ~.~~"r~~.""" ~ ~'-. \ I ,...' _,:\,,,"':' _ .... 4~?a .~".' '~'", : ...'.' . . .>'. - ," ....... tICrARJ."Lsr":. '"l..L ~~ .:19 ',-'" I Jerry h '/J81~, Ie' 'J rut'l c ': - :> - ".-. , ,-: ~ ,Stl~ppr-;n'"f.. Irr, r',\ (' '; l - r, t-r-L ..,'v ~ ~ "'~: :~,.::: ' ..... . ~': ---(-.:.:':!:...=-.__._::..'_'~-__'---._' :._._._~- , -J~:,:7~;.:~":;':~" ~ " ~r~n ~". ~Lu' ~~J ',IL.. 55 \:\IrIGL!_ PC.RKINS ,'~ ~S::;OC1ATES - />..TTORNEYS AT L..:>.W - 126 EAST KING STREET SHIPPC',SRURG, PA ,,:~~;, 1,',7 I do h=b, ~rtio/ltlmt th"'mPI~. office ~dress ?fthJ withl'n named . Grantee is 9,10 ~]~ \~/IM'" tL c~~td~\,!Uj Ih )20 J V 1 Q 17.- \);(t; f. ( "X ' 2000 . . ',. f-.-C.- &F~' 'Lu ! Art' ey fo .... ~U COMMONWEALTH OF PENNSYL VANIA SS. COUNTY OF CUMBERLAND RECORDED on this ;::) day of oj- in the Recorder's Office of said County, in Deed Book ::?~() , A.D. 2000, at Page <; Y ~.,...?- ecorder o ,-. /- ) '?- ,> , ~' '_,\.', ~ '., ..4. . :~~~~~\~~J:'f,l;. .'..... 1 ..,..,. -. -, .7. ...~' "'\-~.". '.,: --. .... ) ;.._.,.:' u_'-...,! ' ;~ ')\': '';': <.: ~~,,-~',>-;..l;j~_:~"~_. ,<< :/'.. 11' . ~'., .. ~_.;_.. .:'" . Cl:'.:~ ..-;~ ._I....-..J ~ , ~ ,l.;:~ ,;:~._I:\'-.\? - ~j 230 f~~~ 56 WEIGLC, PERKINS 6. ASSOCIATES - ATTORNEYS AT LAW - 126 EAST KING STRECT- SHIPPENSBURG, I-'A 17257 1397 , REV-1S11 EX+ (7-88) ESTATE OF ITEM NUMBER A. 1. B. 1. 2. ~~ COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Plea.e Print or Type FILE NUMBER John T. Hawley DESCRIPTION Funeral Expenses: Fogelsanger-Bricker Funeral Home Spring Hill Cemetery - grave opening Crider Meats, -Inc. - reception Helping Hand Ministry - reception David Porter & Debra Bender - house Administrative Costs: sitting during viewing & funeral Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid Attorney Fees Weigle, Perkins & Associates 3. Family Exemption Claimant 4. C. 1. 2. 3. 4. 5. 6. 7. 8. Mary E. Hawley Spouse Relationship Address of Claim~nt at decedent's death Street Address 330 East Fort Street City Shippensburg State PA Zip Code 17257 Probate Fees Miscellaneous Expenses: Register of Wills, Cumberland County - filing PA Inheritance Tax Return TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of same size.) AMOUNT 6,861.00 390.00 35.88 100.00 60.00 150.00 3,500.00 15.00 $ 11,111.88 " , REY.1512EX+(1.931 '*' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Please Print or Type I FILE NUMBER COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF John T. Hawley ITEM NUMBER DESCRIPTION AMOUNT 1. Teufel Orthotic Associates - shoes and inserts billing 350.00 2. The Broad Top Bulletin - newspaper subscription billing 27.00 3. GPU Energy - final billing 24.83 4. Penn Fuel Gas, Inc. - final billing 50.59 5. Comcast Cable - final billing 15.44 6. Cumberland Valley Tree Service - billing due at date of death 42.40 7. Timmons Oil, Inc. - final billing 115.29 8. Borough of Shippensburg - water and sewer final billing 229.61 9. Lisa L. Helm, Tax Collector - 3/1/01 real estate taxes 329.73 10. Lowe's - new locks on house 51.71 TOTAL (Also enter on line 10, Recapitulation) S 1,236.60 (If more space ;s needed, insert additional sheets of same size.) , , REV-"151JEX+12-S7) .. COMMONWEALTH Of P~NNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES FILE NUMBER ESTATE OF John T. Hawley ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE A. Taxable Bequests: 1. Not relevant asprobate estate is insolvent. ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: 1. TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recopitulotion) S (If more space is needed, insert additional sheets of same size)