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Home My WebLink About01-0542 PETITION FOR PROBATE and GRANT OF LETTERS Estate ofl?CJ~c- LI L.U A-AJ >1--( n-f/- also known as No. To: 21-01-542 Register of Wills for the County of (lU1il3ef? l.-/rflvO in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executoR 4!" in the last will of the above decedent, dated and codicil(s) dated C) Q Ie 8 E It. a 0 . / <) '1 p.t-uFO t=--x.c(lur-O/Q.- C!fI-'+~LJ;s: D t: ~i;'1I1 fJ, E 5 I d' , Deceased. Social Security No. II 9- :2<::J -. SLj" '7 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C () H 8c"/? i- .4-AI () County, Pennsylvania, with hEJ{ last family or principal residence at (,(134 WIL.LltrN i)fNvt:-. v.tt=--r-tfrtY/(!Sf)cJlhr t>A--. /7o~[J-"'c-Si , ffv'1NPlJc-t./ TcJ(J.),v<;ffIP , - , , (list street, number and muncipality) Decendent, then 91 years of age, died f1 A- Y ,;) ~ ..).0 <\J ( , .,.. d.()(J1, at M~<;;'I,,+I-I- Vi L.-L-'+6-t;. /'01..1 pI r tfLLc--N {)r/Iv't-- N cQtflt-J,'I(lS8{j~tr pd:-17asT Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: ,f/ C1 AJ ~ Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: ..7 ~ / a ~1 (') .. tJ(J $ $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters rc> r r1 M tnv 14 ~ Y theron. (testamentary; administration c.I.a.; administration d.b.n.c.l.a.) '" 'or u c: '" ~3 '" ~ 0::'" c: -00 c';:: ~..::: ~'" ~o.. '" '- :; 0 ~ c: Ol) CiS eX24p~. (! If .tflh E$ J.; s: N / T Ii- .J f( , 1003<1 (,(.J 11.-'-/ 14M /J /r It! ~ I.-It: elf ,f-j1/ I (! S 13 j) I? r;...- ,P;r 17 () ~tJ ..<& 6~ I OATH OF PERSONAL REPRESENTATIVE COMMONWEAL TH OF PENNSYLVANIA jl ss COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. C~ ~- ~~. affirmed and 5th V:l c}Q' ::s l::l .... ;:: ~ ~ No. 21-01-542 Estate of ROSE L SMITH , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JUNE 7 ~~, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 10-20-1972 described therein be admitted to probate and filed of record as the last will of ROSE L SMITH TESTAMENTARY CHARLES E SMITH JR and Letters are hereby granted to ~"'/ (l j1!:/'<!~~/-') A/ ~ . glster of WIlls FEES Probate, Letters, Etc. ......... Short Certificates( ).......... ieJ>JH?:ra~ion ................ JCP $ $ $ $ 5.00 TOTAL _ $ 77 .00 . . . . .J.WJ~. . .~ . . . . . . . . . . .4Q9~. . . . . . . 60.00 6.00 6.00 AITORNEY (Sup. Ct. I.D. No.) ADDRESS Filed PHONE Q1(\<;Q"" f.'F',' This is to certifY that the information here given is correctly copied from an original certificate of death duly filed with me as Local R~gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee r(H this certificate, $2.00 p 7386698 No. 21-01-542 r{~ ~~ Local Registrar r7 1Jf(;: .!l(,7 ;J t:' c1 I " ! Date Ht05.t43A.v.2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH TYPEJPRINT IN PERMANENT BLACK INK NAME Of DECEDENT (Ftral. Middle. LalIIl 1. Rose L. Smith SEX Female .. AGE (la. Birtnday) UNDER t YEAR -- ""'" UNDER 1 O.Q' HourI ! WInue_ BIRTHPlACE {Clly iUld PlACE OF OERH (Check only one see IflSlrucloOflSon other 9Ille1 Stale Of foreogn CCJ.Jf1uyl HOSPITAL: Bronx, New York Inp,.._ D 7. ... FACilITY NAME (II not ,nst,tuliOO. (JIve sll'eel and numtler) Mes,>,'1'J, ~ \J I LLA<'{. ~=It-tIO 91 v... .. COUNTY OF DERH Cumberland ... DECEDENT'S USUAL OCCUPATION (Giv. ~ot work dMedur~~ OI_....'\!ieW\'l:!fNilT<e~ 11.. llb. DECEDENT'S MAtUNG ADORESS($lrMI. C~ITo\Jm. Stal..l'lpCodeI 6034 William Drive Mechanicsburg, Pennsylvania 170 Own Home DECEDENT'S ACTUAL AESIOENCE tnstrUCIIOf1l other SIde) SWE FilE NUMBER SOCIAL SECURITY NUWBER .. 119 _ 20_ DAlE 'IF PEATIj;\4.oo'll. ll<< 1-' 5477.. May Lt!, LUU RACE -Amencan Indian, Bleck, WhiiI.. ecc (Spoc4y, White SURVIVING SPOUSE (II WIl.. g.ve mwaen fWJ'I81 wp. Cumberland Did -.. hin. township? 17d.D ~~=oI MOTHER'S NAUE (First, Middle. Maiden Surname) ony- Mary L. Odell ... "fORMANT'S ~~'WiYiFaIW'e~~tf~~burg, Pa. 17050 .... PlACE OF OtSPOSITIQH - Name of Cemelery. Crematory LOCATION. CiCyllOwn, Slat.. Zip Code 0<"'...."- St. John's Cemetery Camp Hill, Pennsylvania 17011 a w '" ::> .. < " < ... FJla'HER'S NAME (FIfSI, MiddIlt. las) 11. INFORMANT'S NAME (TYPfWPrintJ ... METHOD OF O4SPOS1T'2!l. D ...... L1' c,........ D 00natM)n 1Iy' 2t.. SlG 2tc. llCENSENUMBEA FD-014318-L 22b. urred at the 11m.. dal. and p1ac. slaled tlb. Caun John H. Bearens Charles E. Smith Jun 1, 2001 230. TIME OF DEATH ... I' ~ 2.5' A oM M 27. PART I; Enter the di......, tnjuriM Of etJmP'ICalions vwNch ~used lhe death Do nol anl..- th. mod. 01 !:tying, such as cardiac or rasptfalOfy arr8Sl, shock or h.art ,11I;....(. Lila only one cause on.ach Iin.. :J t. ~ ! : (, \ JL"",.....~ " y tv II./V3/1 ~ D""TO(OA!\S~ONSE. auE~on I J.s7l :?r::i;vI~ ":> DUElOtOAAS C EOU EOf): ~~ DUE ro {OR AS A. CONSEOUENCE OF}: WERE AUTOPSY FINDINGS A\AfLABlE PRIOR to COMPlETION Of CAUSE Of llERH1 MANNER OF DEATH DATE OF iNJURY (Month. Day. 'fear) D D o ..... 21d. NAME AND AOORESS OF FAQUTY Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, Pa 1705 22c. lICENSE NUMBER DATE SIGNED (Month. Day, Yur I 23b. 23c:. Wft.S CASE REFERRED TO :OAl EXAMINERlCOAONeR? No)Zt at. I Approxml.. PART II: Othef Signincan. COfldiIioN conllrlbYting 10 dII011Ch, but I inlefwI betWeen not ruuIIing in 1M Uftdertying C8UMI given in PART I : onMI and death I I TIME Of INJURY INJURY .v WORK? DESCRIBE HO'N INJURY fXCUARED. AccKMlm Pending InveslIQ.llion o o o PLACE OF INJURY - AI home. farm, alt... factory, ottic. building. Me_ {Sp<<,ly) >Do. M. 3Oc. ....w.. Homicide ...) lJ.J Yo'O ....0 Suicide Could 001 be del8fmlnud ~, o 2... 21b. ClRTlflEFI ,Check DOt.,. onel .CERTIFYING PHYSICIAN {PhY$lC1afl cer"IY1119 cause of dealtl ....her1 dnOlher ptIYSl(;ldn hdS pronounced otldlh ana <:ompl...'ltid Ilern 23) To.... bHl of my Ilnowledge, death DCC\Irred due1Q the cauH(.. and mlnMr I. It.ted. 21. z w :il ijl a ~ a w ~ < z .PRONOUNCING AND CERTIFYING PHYSiCIAN (PhYSICian bolt1 prOflOUllClll1J tledlh dud ':;e."lllylllg 10 .:;auslt of dt:dlh/ To the be.tot my kno"",a.dge, cte.thocc:ln,...t the 11m., date, and place, and du.lo ItMI cau"'I) Ind manner ill SlaiN ..,EOlCAL EX.....INER/CORONER On ttl. b..la 01 ...mlnatlon and/or In\l'..llgalion,ln my opinion, de.th occurred at the time, dal., and piece, and due to the causa('land mann.ru.tated........ _....,...... ....... _,....... .........., .,......"............ ..... ...... ,........,.."",. n.. REGIS l;Z, ( ,;), 11,-:21 ,.. [] ....D D o D ,.. .~ I';.) '~ ,>. ~ ~\, \ \< \ ~ \!. '<J II " ," 21-01-542 I I I , 2775 I of Bronx . . I, ROSE L. SMITH, married, residing at Kingsbridge Terrace in the Borough of Bronx, County L Il " i' City end State of New York, do hereby make, pUblish and de- clare this to be my Last ~ll and Testament 8S follows: FI~T: I hereby revoke all Wills and Codicils thereto heretofore made by m8. SECOND: I direct that my Executor, hereinafter named, pay my just debts and fnneral expenses as soon after if my death as Possible. THIRD: ProVided he survives me I give, devise I and bequeath oIl of the rest, residue and remainder of ~ estate, both real and personal, 'lheresoever situate, of which I moy be seized or possessed Or to#hich I am in any- ''1ise entitled at the time of my death to my hUSband, GHARLES E. S>IITH. FOURTH: In the event thet my husband prede- ceases me or de die in . cO~on disaster, I give, deVise Bnd bequeath all of the rest, residue .nd remRinder of ~ ..tote, both real .nd personal, .~er.soever situate, of '.Jhich I may be seized Or possessed or to "'hich I am in any- disH entitled at the time or my death to my son, CHARLES E. SHI'l'iI JR., reSiding at 6034- iiilliam Drive, Hechenicsburg, PennSYlvania. In the event that my said Son also predecease me, or we die in a common disaster, I give, devise and be- que.th all of the rest, residue 5nd remainder of ~ estate, I both real and personal, "heresoever Situate, of '.~hich I may be seized or nossessed or to '"hich I "m in anYliise entitled lt the time of my death to his '"ife, A'''~A I1AY SMITH. F'IFTH: I hereby nominate, consti tnt. and ap- 'I Point my hUSband, CHARLES, as Executor of this my Last qill , "nd Testamentmd I direct that he shall not be required to rile any bond to qualify and act in SUch capacity. In the r; 1/ that he shull not be required to file any bond to qualify I I event that my husband is unable Or un',;illing to act as E:xecu-I tor, I hereby nominate, constitute and appoint my son, CHARLESI, ','S Executor of this my Last Jill and Testament 'md I direct I I -2- also unable Or un~illing to Bct as E:xecutor, I hereby nomin_ and act in Such capacityo In the event that my said son is of this my Last Will and Testament and I direct that she ate, cOnstitute 8~d appoint his wife, ANNA '~Y, as Executrix in Such capacity. shall not be required to file any bond to qualify and act and of mine to him and carry the :full acquiescence and ap- ,1ill of my said hUsband is made pursuant to any agreement proval of the other of us, neither this Nill nor the said between us Whatsoever, and I do hereby reserve the right to simil~ prOVisions 2nd without reference to any lill of or ,:;greement \'li th the other of us. i " , IN :'iITNESS :'HEREOF I have hereunto set my hand I and seal at the end hereof and ;,ritten my name in the margin I of pages 1 and 3 for the purposes of identification and cert ification in the County of Bronx, City and State of NEw York ., 7t this ~( day of OctOber, 1972. c!t-~ _<:-- /) :~ '7/ __ / />J/J-pr~~, LOSO; I J,itnesses: ") . " ,,1 ,./ /L?L1~'7f//U..7' ~:/ccC ((~ . a/,,;-y ~~,<-/~ ;; Ii ~ ., . 'V ~ \ V ;' , K ":l.. Cj f<~ .' \ .".~ ,..,) ~. ''(. .".. II . .- -3- ;"/e, ':lhose names are hereunto subscribed, do hereby certify that the above named Test.:Jtrix, ROSE L. SIlITH,. (., in the County of Bronx, State of NeT;! York, on the ..>1 ~ dD.y of October, 1972, in our presence and in the presence of each other, signed, sealed, published and declared the foregoing instrument, consisting of three (3) sheets of paper inclusive !, hereof, each ':/ritten by type'ilriter and upon one side only, as and for her Last Jill and Testament and that we, on the said date and at the same time in her presence and at her request and in the presence of each other, have hereunto subscribed our names as the attesting '.'li tnesses hereof 2nd set opposite thereto our respective places of residence. II ~--. /1 ..2.d./c/~(UJ? ,J<,cC'-~'LireSiding J//? {,ti,.. /pjc~u.=- residin _il 21-01-54 " REGISTER OF WILLS OF CO OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to~ will presented herewit , (each) being duly qualified according to law, depose(s) and say(s) that present and saw Register signed as a witness at the nd (i~enCe of each other) (in the presence of the ~ " ~e) " " ~ (Address) " '", '''", "" , , " (Name) the testat , sign the same and that request of testat_ in h other subscribing witness(es)). Sworn to or affirmed and subscr' me this (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS cr tfv111 '- E S F. S ..\I / I t+ "../ P testatJ2 i X (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that J A- M familiar with the signature of Fro i>E /..... $' N I r;+ codicit @ presented herewith and ctxiietl. believetthe signature on the~ in the handwriting of of (one af the ~ubs\.:ribing willll;~~ the that I M /PL:SF L. 51/ i rr-l M'I ~~. (Name) . to the best of knowledge and belief. ~ Sworn to or affirmed and subs.:ribed before ~ me this 5th day of JUNE ~2001 '?rn'?'~~U+"~ZR)~ ' T Register (Address) (Name) (Address) 21-01-542 REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witn to the will presented herewith, (each) being duly ualified according to law, depose(s) and say(s) that present and saw signed as a witness at the ce of each other) (in the presence of the the testat , sign the same and that request of testat_ in h presence and other subscribing witness(es)). Sworn to or affirmed and subscribed before me this (Name) / /~ / (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS -11:tV /VA- 1v;.1 'I SlY i TH (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that / A-H familiar with the signature of /l CJ~ t: ~. S;y I r-ll codicil testatA/ J\. of (one of ..the g'lbscribing witnesses to) the ~ presented herewith and codicil that I believel the signature on the ~is in the handwriting of ;Q6)'t L, S~(.(rrfl- to the best of M Y knowledge and belief. ( Sworn to or affirmed and subscribed before [~~ . /;31/~ ( me this 6th day of /I-(Name) JUNE . ~2001 fT,,^ ""c... h S; ~; +~ '-,:;::::;:;~7 (77,/~J$/ A,o. , \Address) . /7 Register G 0.5 'f- Lv, I I, u... ~ /J f' ; J-{ (NtMttJ) hec~,^/c 5/0 l.^ ~ OJ", / 7 D S- () (Address) ~ CERTIFCATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: fj 0 <;.,E /-, <; 11/' rf/- Date of Death: NfJ-Y e2~, ;)(jc5Jl Will No.: ;L 0 d /-OcJS"'/-l- Admin No.: ;;;. /- CJ / --- () 5' r ;l-/ To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Name Address C!~Lt'-f E >H IrHJ fZ 10 ~ 5 f W I '-~ / It# OR /1):- H cc tI f IJ- /7o{o-6!t:j Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: -y J?. d /6 ! c~~~. Signature (I+} tti< L t-f" ~ ~ HI Tlf J f<- Name ~ () s 'f tAJ I LI-/ rt"1 j) R/llf: /vi i:C!. I-H't-tJ / ~<;. h u iY (r- P If- /70 ,f 0 - 4> (] S' / Address (7J7) 7t~-9S'/3 Telephone Capacity: [gJ Personal Representative o Counsel for personal representative r. SENDER: COMPLETE THIS SECTION · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. '~~~~~ (~. PR. ~ 'lDSl) 3. Se'):ice Type /i!l"'"Certified Mail o Registered o Insured Mail 705 . o Express Mail o Return Receipt for Merchandise o C.O.D. 4. Restricted Delivery? (Extra Fee) DYes 2. Article Number (Copy from service label) ~lXn <x.oo ~ t,EG\5' ~es- PS Form 3811, July 1999 Domestic Return Receipt 102595-00-M-0952 U S postal Service . . ED MAIL RECEIPT CERTIFI _ _ N I urance Coverage Provided) (Domestic Mall Only, 0 ns U1 I'- CJ ru U1 tr U1 r-1 Postage $ Certified Fee Postmark Here U1 ru CJ CJ Return Receipt Fee (Endorsement Required) Restncted DeliveryFee (Endorsement Required) CJ CJ CJ I'- CJ CJ ..JJ CJ JRD!June 30, 1992/1 7858 OCT 0 ~1 \ \ '~ In Re: Estate of Rose L. Smith Late of Hampden Township ORPHANS' COURT DNISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-01-542 NO. NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: Charles E. Smith Jr. Counsel for Personal Representative: Date of Grant of Original Letters: June 7, 2001 Date of Delinquency Notice: September 17,2001 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on August 24,2001, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: October 2, 2001 Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for ~n~i1"f k Jtl, pJ J at In Courtroom No.3. If the Certification of Notice is filed prior to the hearing date, the hearing will automatically be cancelled. Geor~ &K~:tQcCL. ~B-~-Ol. l ~t IUIAL UU~ ~~ L~~~ InAn ~~I nu rATncnl ~~ KC~~KCU. 'h. 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 reverse side. -- Make check or money of this Notice and submit with your payment to the Register of Wills printed on the order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-150l) 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 (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 2001 are: Year Interest Rate Daily Interest Factor Year Interest Rate DailY Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 --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. REV-1 500 --I :\ c.- ,~, COM~ION\VEALTH OF 1(0 - ;)37~ :3 Q.. ~ ~ PENNSYLVANIA --.'---... . - ~f):' DEPART~IENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER - , , . DEFT 2SCCU I ~~ HARRIS6URG. Pol 17I,S.CEul RESIDENT DECEDENT .;2 L-.Q~ 0051-/-:< CCl,J;Ill'f C:CE . y~~;l: .~.~~~" -- CECEDENrs NA~IE (L...ST. FiRS,. ANa 1o,ilCOL: INm~L) I S~~;A9SE':U~D ;~E' _ 5 'I 7 7 ~ 5 J-'flTI-/, R05 IE'" /..-. z w QArE. QF QE.~i'M \MM.CO.'1:'.::"Rl O;'Tc: OF SIRTH (MM-OO.YEAR) I Cl \ THIS RETURN MUST BE FILED IN OUPLlC), TE WITH THE W VS-;).~..;lOO/ o "j- 0'7-/909' REGISTER OF WillS U W (IF APPLICABLE) SURVIVING sr-CUSi:. S NAME \L.l.ST. F\RST. AND ,'-UDClE INIi1ALl \ SCCIAl Si:CUR1TY NUM8E~ Cl N/4 - - w ~ l. Ongmal Return o 2. Supplemental Return o J. R.emalnder Return (cbl.ol<:eJlIlgnQI!O lZ.lJ.aZl ... :!.. o 4, limited Estate o 4a. Future Interest Compromise \1>>.1lI oI4U1l'l a/tef 1'2.12~1l o S. Fede!'al ESiale Tax Return Required 0:'" .." 00 o 6. Decedent Died Testate (~c:::or 01 'NOli o 7. Decedent Maintained a Living Trust (AlUcnccoyolTIU$II 8. Total Numcet of Safe ae~Si\ BtI:t.es 0:-' .... - .. o 9. Litigation Proceeds Received o 10. SpoUSol Poverty Credit [~oIcle.1l/1a~ 1%.11.91 ~ 1.1.;51 0'11. E!ection 10 la;t under Sec. 911J(A) IAlU(:., SalOl '" ... THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ::: COMPLETE MAILING AQORESS w NAME CHI'rR.LffS ..JR. 0 12". S'1/71-+ jJt;(J tit: ::: ~()31- w/~/../I'tH 0 .. FlAM NAME \If~'l N/A .. '" H cCt/Itt.l/ c.s 8 c11?rr ht /'705o-~ fS/ 0: 0: TELEPHONE NUM6ER (']17) 0 H~-95 13 " 1. Real Estate (Schedule A) (1) /V/,4 Gel OfF!CIAL 111f ONLY , - - ,"" I \ ;.i/A - <C i ~ ~~ 2. Staas and Sonds {Schet\l.:le 'C) (1) '.:.'1 ::;.. r\ '9 ! j. Closely Held Corporation. Partnership or Sole.Proprietcrship (3) AI/A c.... "" /VIA = i 4. Mortgages & Notes Receivable {Schedule Ol (4) ~ 11 OJ;J, ~ :2 '8. olf .l>>o 5. Cash, Sank Deposits & Miscs!loneous Perscnal PropertY (5) (Schedule E) -0 Z J;{ if 9) 7! 8 S. 3? ~ 0 -""1 ~ 6. Jointly Owned Property (5c,e<lule F) (6) . N ~ o Separate Billing Requested v:J ...I (7) 1/ 1-91 9/ d. t,b ::J 7. Inter-Vivos Transfers & Miscel\aClecus. Nan.Probate. Prope~ !::: (Schedule G or L) /:I C- (8) 1 d::1, i ~~. Of, <l: 8. Total Gross Assets (total Lines 1.7) U 9. Funeral &'PeR... & AdmiNsl:?li'<e Co,", (St.,ed\lle H) (9\ , 9,';;39.9DJ. w c:: 10. Qebts of Decadei'll, Mortgage UabiDdes. & Liens (Schedule 1) (10) 1J/f1 11. Total Oeductions (total Lines 9 & 10) .(11) it 9) ;;139. 9,';l, 12 Net Value of alate (Line 8 minus Line tt) (12) ~ II 3J )3(p. IIf 13. Charitable and GQ\Iemmental eequestslse-: 9113 Trusts (or 'Nhic.'1 an eieaion to lax !\as not been (13) - made (Schedule J) 11 14. Net Value Subject to Tax (Line 12 mirrus Line 13) (14) II), I ~v. If SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCA6LE RATES Z 15. Amount of Une '4 taxable alltle spousal tax N/r4 0 - ~ ""e. or II'3ns1e.. under See. 9116('1(1.2) 1.0_ (15) 10 I!J) 3 71. ;) 9 x.o_ 116) 11 ..f,sl(,.'Ef ~ 16. Amount olUne 14 taxable it lil1eal rate , ::l ,JIll, - c.. 11. Amount of Une 14 taxatlle al sibling r.ate x .12 (17) ::!: / ~1 -g II. 85 .J;f 19t9-1. '1E 0 18. Amount of Une 14 taxable 31 ctllaceral race x 1S (181 . U If (p,Li3 t. ~;).. X (191 < 19. Tax Cue ~ Zo.O~::=:;:I.:::li:;a'4..llf.I;I::::l:I=.lil-;;"'flt\[~.~ > > BE SURE TO ANSWER All QUESilOIIS 011 REVERSE SIDE ANC RECHECK MATH < < Decedent's Complete Address: ~rRE.:.T ADQRESS MtSSI IrJl VIi.. L/T6--J;: , /0 () MT,4t..Le~ /JRlllt:: CITY I1€'CI-Irl'NI CS BuRCr I STATE PA- I ZIP /70SS . Tax Payments and Credits: 1. Tax Due (Page 1 Lme 19) 2. CreditsJPayments A. Spcusal Poverty Credit 8. Pr.or Payments C. Discount (1) o o o Tolal Credits (A + 6 ' C ) (2) o 3. Interest/Penalty if applicable a.lnterest E. Penally o o TOlallnteresUPenally ( 0 + E ) (3) 4. If Line 2 is greater than line 1 ... Line j, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) o <:> 5. If Une 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE. (5) IIt;.if3? 6:l... . o -# 1<'-13 '3. 6 2- . A. Enter the interest on the tax due. (SA) B. Enter the lolal of Line 5 + SA. Tnis is the BALANCE DUE. (56) ...... . .. __ . __ " ... M~_ke ~~e_~k Payable to: REGISTER OF WILLS, AGENT 1';'::~;;.1~"i.::0.::-::.:;:.-:''':!~'',*:::\'.:.l';2.:.i.:7:"~::,.:::~;.:7~;:;:";:~s.:!i[}~'L~G:;::"~;~::~,:~:.;::~~!.~3~1~I,-:._.~=:'::~.::(~ :.-:;;::.0:.;::::~:I:;;.~..E -:S~:'_';:='::~~:.~' _~;: ,~. .._ . .:1 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did deo::edent make a transfer and: Yes No a. retain the usa cr income of the property transferred;..... ................................................. .................. 0 ~ b. retain the rigr,t to cesignate who shall use the property tr.ansferred Qr its income: ..................... ................ 0 ~ C. retain a reversionary interest: or.............................................................................. ..................... ............ 0 !5{] d. receive the premise for life of either payments, benefits or care? ............:............ ............................ 0 IX! 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 !RJ 4. Did decedent own an Individual Retirement Acc~unt. annuity, or other non-probate property which contains a beneficarydesignanon? ........................................................................................................................ IRI 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. Uncler penalties a' pef\\lry. I declare l/'Iat I have examr:ed Ill.,; ~l\lm. inCuding ac::cmpan'f'll9 Sc....edules and statements. and to ltle besl of rfr( knowlee;! and !:Ilitf. it i:s true, eorTKt and ccrnple~. OedaralJCn 01 j:ll1!garer other ltlan ltle :::ersonal re:rl!!entallVe ts bas~ on a11lnformabon of 'lllliC1 orecarer lias any knowledge. SiGNATURE OF PERSON RE5PO~~G RET~RN ADDRESS (,031/- DATE WI J....L-I;'tH IJ 1(1 V E SIGNATURE OF PREPARER OTHER THAN REPRESENTATiVE II .;2 O. ~ PA- 1705'0- r,8'S,/ DATE ADDRESS .' ;:~~.;.r;.:.rr::~~:.;~"l:::::,--;:.~~::~ .~-.:-~:;_;2:~.i.:~~:5=~:.:i~i:!~.;:';2\~:.li;h=r~;:;-~~Z~"'!ri:~;,z:~~':.;~::.~.~"Ek~~;r,~.;:.&:::'Ql'::;~::;::;;::;:"i~3;:::.:~~~:...:;~:::.~....=::'i.:~~1 For dates of death on or after July 1. 1994 and before January 1. 199~, the tax rate imposed on the net value af transfers to or for the use of ;he sU(\living spouse is 3% [72 P.S. 9g116 (al (1.1)(i)l. . For dates of death on or after Januarj 1, 1995, the tax rate imposed an the net '1alue af transfe~ to or for the use of the sur/iving spouse is 0% [72 P.S. ~9116 (a) (1.1) (iijj. The statute does not Illxp.mot a transfer to a surviving s~ouse from t;:c. and the StGtulOry requirements for discosure of assets and filing a tax return are still ap~ticab!e e'/en If the surviving spouse is the only tene~carl For dates af death on or after July I. 2000: The tax rate imposed on the ne! 'falue of ttansfers frcm a decease'J 0..":110 rNemY"':lf1e years of age or younger al death to or far the use oi a natural parent. an acootlve ;:arent. or a st~parent of the child is 0% [72 FS. ~9ii6ial(1.2~]. The tax rate impOSed on the ne! '/alue -::f ~r<insiers to r:r :ar the use of :he decedent's lineal benefic:anes is 4, :~,~. exce?t as note!! in 72 p, S. ~g i 16( 1.2) (72 P.S. S91 iEial( 1 11 rne tax rate impOSed on the ne! '/alue af :ronsfers !o or for the use cf the dece-:1ent's siblings is 12% [72 P.S. ~9116ial(1.~)I. A sibling is de~ned. under Scc::cn 9102. as an inal'/ldual who has at least one parent In r;::mmon 'N1th ene de';ede~t. 'Nl'1e~er by btoca or adacnon. ~E~.'~H:t 'll?71 ~ r-. .'" ~ ~'~""n' -~l~r-: I';,~:.......-"" ~~ CCMMCNWE..1.LTH CF ;::=:",'lSY:"'J~NIA IrIHE;;:tr,:.N(E i..:.x ~=TUfiN ~E3:CE~IT CE::C'PI~ SCHEDULE E CASH, BANK DEPOSITS, & MISC, PERSONAL PROPERTY EST ATE OF rf(C9S'€ ).., S~/7'U FilE NUMEER 021- 0/- 00.,5 J-Ia lr.cJuce the prcceeds or litlgatlcn and l;:e date the ~,ccee~s 'Nere reCe!'le1:Jy the eState. All property jointly-owned with the right af survivorship must be disclosed an Sched'JI~;: ITEM NUMBER 1. DESCRIPTION \/.~LUE ,.IT C.':' i:: OF CE~,TH If. ;;':;'/fP :1.({,0,/ FlIPS, uAl/otV A.J!'rnOAl!l-L /3r4N/.!. /tIn,): ,4-<lC'ovw, Vcl'?/F/f!.tilolJ..s Po (0)( '/-OO;;2.!? rpo,4NoilE VA ;J.tfo;J.~-tJ3/3 Clt-f r:.t!t:;-C}L/Ntr IrQ.C(J()A! T 9 ~ ;JO~ ~ '11 oS' ~nT~1 ",___~.....~...::......::: ="r'"1r"1f!tl;;!lonl r ( ~:l,':li>.{)'i ~N' Reference 10: 185963 First Union National Bank Artn: Account Verifications POBox 40028 Roanoke VA 24022-7313 August 8, 2001 CHARLES E SMITH 6034 WILLIAM DRIVE MECHANICSBURG, PA 17050-6851 SUBJECT: Verification / Confirtl)ation of Account and Balance Information provided for: ROSE L SMITH (SSN# 119-20-5477) Date of Death: May 28, 2001 CERTIFICATE OF DEPOSIT 2474\205\ \93355 Deoosit Account Information Date of Death Average Date Maturity Interest Accrued YTD Date Balance Balance. Opened Date Rate Interest Interest Paid Closed $22,628.04 121611999 $61.32 $25,623.69 5/1512000 4/1312002 $76.15 $707.39 Account Account Type Number CAP CHECKING ACCOUNT 9620687105 LEGAL TITLE: ROSE L. SMITH LEGAL TITLE: ROSE L. SMITH ANNA M. SMITH . Due to system limitations. we can only provide a twelve month average balance on depository accounts. No Safe Deposit Box found for customer. . Date of death balance does not include accrued interest. . If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period. August 8, 2001 Date Drema Rubinoff Depository Representative abs; ag Servicenter Associate Title (540)563-7323 Phone Number 001032 , , . '(V.I,goq E~. In-1II1 C.,(~!1'V r.........:::;,'.\f' _.~:;..... SCHEDULE F JOINTLY-OWNED PROPERTY COMMONW!:;>.lTH c~ P~NNSYlvANI,.l, INHE~lf).NC: T,l.X ~eiU"N RESIQENt' oe"::':E,"l1 "RO$E )... SN ITtI \ fiLE NUMBER ;2.1-01- ooS'f~ ESTATE Of Joint tenent(s\: ------ ---- ----- -- I ADDRESS R.LATlONSHlPl'-b DECEDE~lT (i,()3'f G(JILL-Ir+"1 tJfi/llJe" so '-I I-fE(!!fItYI(' $ ~ C/IUr N+-- 1705"0-(, FS! (,03'/ W/Lur'l-M DRdl<' O,t-<J(rtfTf:t2--/1J-LltlAl HE"(!tfAI-IIC s 8utU,- f9t4 no~D~r" 'is' / NAME A. (>rfltfh F5. e. $ H 1 rlf V Q. B. ,f.v1Jf-l; /-1. >"or-f/ C. Join"y-o'Wned property: LETIER DATE ITEM FOR TOTAL VALUE DECD'S DOLLAR VALUE Of NUMBER JOINT MADE DESCRIPTION Of PROPERTY Of ASSET % \NT. DEC<DENT'S INTEREST TENANT JOlNT 1. A aa./a? /'17 fWr:eD 31i1.000 '1.56~0 111'7, O",iiJ, . If. SooJlo , 1l, .5;lI. O(J ;1.. A ,,/Jr!97 PAIl!.. ell ~/'i{)O/i!J f'8" ;j ',1'0.93 50"/., f3,i!J"go.Jf? 3. A 07'" 191 htc'l!/l 317 00/ "'i!J;J./~ J( I.s; 0;J. 3 .01 . 50% /I '7,51/ .51 -I. 1+ "t!II/'n, P.vc, eo 31;! OO) <17'170 J/ 5, 011/-. Golf .5 ~ ""0 " .2,507. ?, If 5. 1+ I;}./U/ao tiNe ell 31'/-00;1. 0' o"f'f Jl./~/'81. c." 5-% # &',390. 73 lo. A o r/al 111 PN~ CIUUJI';{,- 51'1- 01(,3"13 '1 II 1:l,555.79 .s'u% 1/(,,~7'.90 '7. A fJ3!.:J.:J./'I, F'ULr,1J ""Alii C!D JI~ 5~ '1. '17 5a% JI ,,?, 71'1. 3? ::25. ()o9 'i~ 'ffJ . '8. B 51<1'/00 r-,II.~T Villa"; '''It-T/OII''',- BItAlIc.. ~",..s; (,;),3 . C. 9 sef" IJ. I).; 8/1. "S- a/) .24 7Y}..;/o.$'1I9 'J.355' , I I I i ! TOTAL {A!<;o enler on \if"oe 6. Re-:cpin.llattonj I So 4'1J 335.3 (If more spac~ r~ 11J!~ded ln~ert addirranal ~hep.'= tJf ~omp. ~,zei 0. PNCBAN< Decedent Reporting Firstside Center 500 First Avenue, 4th Floor Pittsburgh, PA 15219-3128 SCP June 5, 2001 Charles E. Smith, Jr. 6034 William Drive Mechanicsburg, P A 17050 RE: Estate of Rose L. Smith, Deceased SSN: 119-20-5477 DOD: OS/28/2001 Dear Mr. Smith: Please find the date of death balances you have requested listed below. CERTIFICATE OF DEPOSIT #31200075620 Established 02/07/1997 ROSE SMITH CHARLES E SMITH JR DOD Balance: $17,000.00 + $42.16 accrued interest Interest earned from 01/01/2001 to OS/28/2001: $366.93 #31800108861 Established 11/15/1997 ROSE SMITH CHARLES E SMITH JR DOD Balance: $6,147.71 + $13.22 accrued interest Interest earned from 01/01/2001 to OS/28/2001: $151.30 Page 1 of2 A member of The PNC Financial Services Group PNC Bank NA Pittsburgh Pennsylvania 15265 ~ PNCBAN< #31700160216 Established 07/19/1999 ROSE SMITH CHARLES E SMITH JR DaD Balance: $15,000.00 + $23.01 accrued interest Interest earned from 011011200 I to OS/28/200 I: $388.44 #31200197470 Established 08/1111998 ROSE SMITH CHARLES E SMITH JR DaD Balance: $5,000.00 + $14.68 accrued interest Interest earned from 01101/2001 to OS/28/2001: $138.54 #31400206044 Established 12/30/2000 ROSE SMITH CHARLES E SMITH JR DaD Balance: $12,720.96 + $60.70 accrued interest Interest earned from 01101/2001 to OS/28/2001: $264.45 CHECKING ACCOUNT #5140163437 Established 04/0111981 ROSE SMITH CHARLES E SMITH JR DaD Balance: $12,549.76 + $6.03 accrued interest Interest earned from 0110112001 to OS/28/2001: $67.19 Our office only provides date of death balances for IRA's, CD's, Checking and Savings accounts. We do NO Financial Transactions or Statement Orders. For Further information please call1-800-4-BANKER or your local PNC Branch and ask to speak with a Financial Services Representative. Sincerely, ~4(~ 1-800-762-1775 Page 2 of2 A member of The PNC Financial Services Group PNC Bank N.A. Pittsburgh Pennsylvania 15265 COMMONWEALTH OF PENNSYLVANIA DEPARTMeNT OF REVENUE . BUREACI OF INDIVIDUAL TAXES DEPt. 280601 HARRISBURG, PA 17128-0601 '*' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0542 01138693 08-28-2001 REV-lSUEXAI'9la9-BG> EST. OF ROSE L SMITH S.S. NO. 119-20-5477 DATE OF DEATH 05-28-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG PA 17050 REHIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the Depart-ent with the infor.ation 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 infor.ation is incorrect, please obtain written correction fr~ the financial institution, attach a copy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of PennsylvanIa. Questions ~y be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW. Account No. 312000075620 . . SEE Date Established REVERSE SIDE FOR 02-07-1997 FILING AND PAYMENT INSTRUCTIONS Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 17,042.16 50.000 8,521.08 ,,' .045 '383.45 To insure proper credit to your account, two (2) copies of this notice .ust acco~any your pay.ant to the RegistBr of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax paywants are .ade within thrCKt (3) .onths of the decedent"s date of death, you uy deduct a 5% discount of the tax due. Any'Inheritance tax due Nll1 bilco.e cktliriquent nine (9) .onths after the date of death. PART TAXPAYER ,~ESPONSE ' , ',co', ' " ,', . m..~I.~!!!~!~~. ':"(..~,:"',':(-~ : ,~"""~,*,q')l...jYOU-UY)choo..to,,...lt P8YII8I1t,ttO :~tne, Il8llister,;;of 1Iills: lwithtwo Copi.s _ofthls 'notlce''to'obtaln ,T a discount or, avoid interest.. <',or~~ ,1IeY ::ch8ck ,'box ''':A",8ncf return ,:thIs' notice -to' the Reglster 'of Wills end an offIcial,!s'!.~Sll8nt w~ll:~~s~ by ~~,pA Def?.r~~~,()f.~~.'~ . 'I', .t., . '_"',l':',J, Itt~~f~r,' ','~" "~~-;~J~:-':T~'?'\':::,.},:<J:~,,"__:,"l ,,::,:(: L...l'\l"'"l B. D The above asset has btMn or will be reported and tax paId wIth' the Pennsylvania InherItance Tax return "to,.~e ,filed by,the__.cteceden~,:tlr..~~'t~.~~~l~e."I;i I,.' >0,'; q, .11;'~~~;::;:>~.'-:J""': ..,i,:,,'<..:. c. D The above infonation is Incorract"andJor debts.and deductions were.'peld b)"YDU.";ti': ~ ',; "'\').[;' You MIst coaplete ,PART ~ andIo~ ~;-PA~! [!] .bel~w. .,.." . . .. . ...." , 7 ._~ .'. "'~"'''''''''~;';l.:''.,,w,\. ,,',r_., .j '''4,~' '''.''',,~. ". ",' ;',,'t'~:'...;. J." a different tax rate) ple.se':stat. your ".' dec8Ctent: j ,-,L'l,\',~'b.',.l'i~/l:',":r",; ,..,' >1>" If you indicate relationship 'to [CHECK ] ONE BLOCK ONLY ,I;' PART [3J TAX RETURN - COMPUTATION LINE 1. D.t. E.toblish~d 2. Account Balance 3. Percent Taxable 4. A.ount 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 . ".-........~,,~'"-"..,,' ., TAX ON JOINT7TRUSTACCOUNTS ""'-'.'''-') " x x PART ~ DATE PAID DEBTS AND.DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL 'J,' ,.,'," I $ (Enter on Line 5 of Tax Comput.tion) Under penalties of perjury) I declare that the facts I have reported above are true) correct and co_plete to the best of .y knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE "BUREAU OF INDIVIDUAL TAXES DEPt. Z80601 HARRISBURG~ PA 171Z8-0601 '*' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0542 01138694 08-28-2001 REY-IS45EXAFPn9.00) EST. OF ROSE L SMITH S.S. NO. 119-20-5477 DATE OF DEATH 05-28-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IXI CERTIF. CHARLES E SMITH JR 6034 WILLIAM DR MECHANICS BURG PA 17050 REHIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the DepartlKlnt with the inforllation listed below which has been uSCld in calculating the potential tax due. Their records indicate that at the death of the above d8Cedent~ YOU were a joint owner/beneficiary of this account. If you feel this infor.ation is incorrect~ please obtain written correction froa the financial institution~ attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tex Laws of the Co..onwealth of Pennsylvania. Questions lIay be answered by calling (717) 787-83Z7. COMPLETE PART 1 BELOW . Account No. 31800108861 . . SEE REVERSE SIDE FOR Date 11-15-1997 Established FILING AND PAYMENT INSTRUCTIONS Account Balance Percent Taxable Amount Subject to Tax Tax Rat. Poten~ial Tax Due x 6,160.93 50.000 3,080.47 ..045 "'138.62 To insure proper credit to your account, two (Z) copies of this notice lIust accollpany your payaent to the Register of Wills. Make check payable to: "Register of Wills~ Agent". x HOTE: If tax p~ents are .&de within three (3) IIOnths of the decedent"s date of death~ you IHlY deduct a 5" discol6lt of the tax due. Any"inheritance texdu8 wIll becolle delinquent , nine (9) ~nths after the date' of death.' PART TAXPAYER;RESPOt:lSE . " [!]1f_~._UIlllll'_ a",. '" l~ .,' _ , ., . .~~ w"",-. .. . A. 0 The above Infor..tian and tax due 1. correct.,' ,'!.. ' ~, ~ 'f: ~ . ^ l t '.1',H",~":\l ;".F:"'H-',~",l\, ,1.'c~ You...y..choose._tora.It P1iYlIentf:t~_'.tha Rqlste..,:Qf W111s.,..IthtNo-copl.. ofthlsnotlce 'to-obtaln CHECK :i~~:c=t~r o::~~~a~n::::~i :~f~l -::. =~ b::;:':. :~ D~::~l:/'::~:U:~.~th. ~lIl.ter of [ B~~~K ] B. 0 The _YO a..ot has boon ::'~iii~lT'~rt:d :;~ .:. pa;~';~li\ti.:'~~n~lZ:I~\~;\t;~~:~~~I:o~rn ONL V \1:1'/; ~o ~l~~4td bY..'th~,. ~~"'t,~...~~~~~~~ll1.:.i .,,1: hi ..,,1.,..' ,,~Ii1..','U '.~1~j~t.~~Y;'~"~~8:'~:~i..i: c. D The above info....tlan is l'ncor~e~tL~)or debts and deductions were paid by y~;:.~~~ ~~~\ 'I tM ,~, You IlUst cOIIplet. PART 0 anello.. ,PART @J belo... . .......".~,_~,l,.", ,,'I("";~~/"'f.'''"'''''~'' '{' If you indicate. diff.rent tax rat., pl....'st.t. your'. < '\ rel.tionship 'tadecedent:., . .,~.. '.":iQ,:,Q- ,tilljii; ,~;r. r~'-~ ,.c::.; ,,'. PART [!J TAX RETURN - COMPUTATION lINE 1. Date Established 2. Account B.lance 3. Perc.nt Taxabl. 4. Amount Subject to Tax 5. D.bts and Deductions 6. Anount Taxabl. 7. Tax Rat. 8. Tax Du. OF TAX 1 2 ON JOINT/TRUST ACCOUNTS ..:'::.i~1i'~~_, 3 4 S 6 7 8 x x PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL ....<.:,;....,., ..",.,.;: I . (Enter on: Line S of Tax Co~utation) Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of ny knowledge and beli.f. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE COHHONWEAlTH OF PENNSYLVANIA DEPARTMENT OF REVENUE . BUREAt] OF INDIVIDUAL TAXES DEPt. Z8060l HARRISBURG, PA 171Z8-060l *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0542 01138695 08-28-2001 ItEY.154S EXAFP U'.DDl EST. OF ROSE L SMITH 5.5. NO. 119-20-5477 DATE OF DEATH 05-28-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [X] CERTIF. CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the Depart.ent with the infor.aUon 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 infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Co..onwealth of Pennsylvania. Questions .ay be answered by calling (717) 787-83Z7. COMPLETE PART 1 BELOW ~ ~ Account No. 31700160216 ~'SEE REVERSE SIDE FOR Oat. 07-19-1999 Establish.d FILING AND PAYMENT INSTRUCTIONS Account Balance P.rcent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 15,023.01 50.000 7,511.51 .045 338.02 To insure proper credit to your account, two (Z) copies of this notice .ust acco~any your pay.ent to the Register of Wills. Make check payable to: "Resister of Wills, Agent". x NOTE: If tax pay.enb are .ade within three (3) .onths of the decedent.s date of death, you ay deduct B 52 discount of the tax due. Any 'lnherltl!!lnceblx due ..ill bliCOlle delinquent nine (9) .onths after the date of death. PART . TAXPAYER 'RESPONSE . ", . ......,. ," ml_f.1Ell&"L'~.~~ A. D The above info,...Uon end tax dlJe.1s con-.ct..:' ',~~+ . ," .,' '. ....".., '.-r'.-I':.: .,~/,:,"",', ;J:~'" .I'i '".,~\" ,,~'l." You HYchoo.. to r_lt P8YII8r'1t:lto:the R8IJlsterofWiUs~'N1th,twocOp~.S:cOf,,'.th1s ,notice to obtain .-'. CHECK . discount or,avoid Int......t",or; ',~ou ~'checkbox,"A" imd ....turn~th1s'not1ce,to';theRegi.t.rof [ONE ] Will. end en official ~~~~~~~~?Wtl'.~ ~~~~ by ~,!.\~~r~:~n~);~!.~~;:::~;"~J'" is' e:.:!.i(~ ~'\G [ BLOCK B. D The above assat has been or ..ui~.,r~rted and tax paid ~11't~ ,P~Ql\;nia'i';h~r:~tance Tax return .ONL V . to,,~~,f!~~;~ ~}t~.,~,~'~!~~rt~l~~.~~~~.,r, ," .,'/';"".'<: 'tr.b"W1,,;L~:I;tc,'.~:,"~!~?i'f~t:)(. :U'-,\'1t':I~~ C.' D The above infor..t1~ is incor~~:~~r deb~S and deductions ..ere.,pald byyo~r~~-;'{'.ti <1,:~., ;'" You ....st cOllplete ,PART 0 enc;V~r~AR! @lb.low. . ,. . ,\' , .,' "."..;\ #..;1; ';...,1,' . "~ .. .' .. ",. '"~, ".. '.; ~ ,>, ". .~.; " ".._" ,.. '. _...;}C;i<,. If you indicate 8 different tax ratel pl.aseistat. your relationship to decedent: ',,,.',U.1;"t.(:.~"" /',.,' PART [!] TAX RETURN -,COMPUTATION OF TAX ON 'JOINT/TRUST ACCOUNTS LINE 1. Dat. Esttlblished 1 ..::~~:.'l;J...~_... 2. Account Balance 2 3. Percent Taxable 3 ~ 4. Amount Subject to Tax 4 S. Debts' and Deductions 5 6. AlIOunt Taxable 6 7. Tax Rat. 7 X 8. Tax Du. 8 PART l!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tex Computation) I . Under penalties of perjury I I declare that the facts I have reported above are truel correct and complete to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREA~ OF INDIVIDUAL TAXES DEPf. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0542 01138697 08-28-2001 REV-l!t45EXAFPU9_aD) EST. OF ROSE L SMITH S.S. NO. 119-20-5477 DATE OF DEATH 05-28-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CNECKING o TRUST [Xl CERTIF. CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the Depart.ent 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 8 joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction fr~ t~e 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 Comgonwealth of Pennsylvania. Questions .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW. ... SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31200197470 Data 08-11-1998 Established To insure proper credit to your account, two (2) copies of this notice .ust accompany your pay.ent to the Register of Wills. Make check payable to: -Register of Wills, AgAntK. [CHECK ] ONE BLOCK .oNLY Account Balance 5 , 014 . 68 Percent Taxable X 50.000 . NOTE: If tax p8~nts are made within three Allount Subject to Tex 2,507.34 (3) months of the decedent.s date of death, Tax Rate X .045 you .ay deduct a 5% disco...,t of the tax due. Any inheritance tax due .,i11 becOlle delinquent Potent,ial Tax Due ", 112.83 nine (9) .onths after tha date of death. PART . TAXPAYER 'RESPONSE ... "."'.. "", [!]I.t...~..~~ A. ,0 The above Inforut1on .... tax:due is corrlltCt. ,',' . :,' .: -" '::',' >" ',"', , ,', ,-i",' r ",,:.,.' ,":,,' ';;'1,' .,1. You uy,choose to ""l~~~t/_to-_'the Register ,of _Wills:;...lth'1:wo,copl~s of 'this ,notlc8"to"obtaln "I. e discount or avoid interes~i'_Qr'you II8Y checkbox''"AK andretum thl.-notlc8rto';theRegister,of Nllb and an offlclalassasnlM1t ..ill be issued by th8 PA nepar,tlHlntof,Revenue. '.:..' . .:) .i:,\^.:'(:',_f ,H1;1!~!!ra '~ ,\ ,_' ~.:~ J :;':.'1.' ;~.'.~,~' -l.:'i ,~j~,1!J,JiJ:I;"~n..~,,; ~L\'II :-;3in,yto , B. 0 The above asset hasbliKln or "lli"~ reported and tax ,paid '..it1.~th;:P.iln~'lV8l1i8 inh~~itance Tex return . tobeflledby.thedecedent',sr8Pr,s.entatlv8. ''', _". ..; >_ ...... '. ..".:_ .,"".. ,... ;,;" ~:' , '..' '- ,;,', .., ," " .". ',"'-1.'" . -~~.~,.~,~~~,.~\..,;.~;...\) ,;"t :'-,. ,'.".'.'- (ft.!:",... ,~.!'J1,"'..r'i'" . t~~~i~~;;"f,t;,\~ ..?.l' .,I!'l/. ,\ C. D The above inforntlon is incorrect and/or debts and. deductions .,ere:paid by"you'-"".~:j':j: ~!l :~qJ'.ill I You must COIIplete .~ART 0 andi~r,.':'PA~T;.0.b.IO". . ..., ' ,_. . ',- h";;l._..",,.,-.,l., " If you indicate a different tax rate, please '.tate your' .,.' ;1, I,) relationiship to 'decedent :" . '.! t-"';~,~.:-,~,,~x i"-,'" ,-'". x .,"r PART [3J TAX RETURN - COMPUTATION LINE 1. Oat. Established 2. Account Balance 3. Percent Taxable 4. AlIOunt Subject to Tax S. Debts and Deductions 6. haunt Taxable 7. Tax Rat. 8. Tax Due 'O~TAX ON 1 2 3 4 S 6 7 8 x :,-',.- PART l!J DATE PAID DEBTS AND .DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL ,,, t.~ i :', - I . :'- ,;:~.) , (Enter~n,Line 5 of Tax Computation) Under perull t le. of perjury, I declare that th8 complete to the best of ~ knowledge and belief. facts I have reported above are true, correct and TAXPAYER SIGNATURE HOME ( WORK ( TELEPHONE ) ) NUMBER DATE Charles E. & Anna May Smith 6034 William Drive Mechanicsburg P A 17050-6851 (717)766-9513 smittv9740lqJ,aol.com August 31, 2001 PA Department of Revenue Bureau of Individual Taxes Inheritance Tax Division Department 280601 Harrisburg PA 17128-0601 Certified Mail No. 7000 1670000796884234 Gentlemen: RE: File No. 2101-0542, ACN 01138692 I am returning the enclosed "Information Notice and Taxpayer Response" . document sent to me by your office with corrected information. As you will note from the enclosed Certificate of Deposit and correspondence from PNC Bank, the amount cited in the notice is incorrect; in addition, the account was co-owned by myself. I have consulted the local PNC office and have been assured that the information higWighted in their letter is correct. I would appreciate your correcting your file data and sendin~ me a revised Information Notice as soon as practicable. Should you have any questions, I would refer you to the PNC office cited in the enclosed letter. Thank you very much for your prompt attention to this matter. Yours truly, Q~P'~. CHARLES E. SMl;;: JR. V I ~unnVNN~A~ln ur ~tNN~f~VAM~A DEPARTHENT OF REVENUE BUREAU O~ INDIVIDUAL TAXES DEPT. 2:lS0(;01 HARRrSBURG? PA 1712:8-0601 * INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0542 01138692 08-28-2001 R.EY.l~4S EX l.ff (U'l-~') EST. OF ROSE L SMITH 5.5. NO. 119-20-5477 DATE OF DEATH 05-28-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [XJ CERTIF. ** CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the Department with the lnforllation listed below whieh has belln used in calcula~ing 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 form and return it to the above address. This account is taxable in accordance with the Inheritance lax ~aws of the CO.llonw.81th 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. 31400206044 Date 12-30-2000 Established K 9,781. 66 100.00 9,781.66 .045 440.17 TAXPAYER RESPONSE To insure proper credit to your account? two (2) copies of this notice lIust accollpanY your payment to the Register of Wills. Make check payable to: "Register of Wills, Agentw. Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x NOTE: If tax pa~nts are .ade within three (3) aGnths of the dacedant's date of death? you _ay deduct a 5~ di$Count of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after the date of death. Tax PART m j~111~~~.rJI'_~_~_~llllllill_m!g&~~_'_I: /&.. 0 The above info,..ation and tax due is correct." ' " "',, ,,;.,,- " ,,","< 1. You..y choose to r..it pay...,t_to ~Register of Wills ,with two copies of.-thlsnot!C8 to obbiin a discount or avoid interest.. or ~'OU ..y cMck box WAW .ms!,etuM'l~~b . JlQtlce 'to the Register of Wills and .., official aSSessaent wUl be' issued bY the PA nepart.ent of Reven..... [CHECK ] ONE BLOCK ONLY :'1._, ,'., _' ',,' T1/f(".;"..l' ", -,~ _"~~'t~'l_,,.~:IT I. 0 The. ebove essat has balm or ~v111 be report8cl and tax paid wIth the Pennsylvania Ime'r1tance Tax to be filed by the decedent.s represlU1tative. .. , ", ,", _ ,',"', ,',,' ," ,_,_ ;" '-_"';";"'1' \ .r, "...."' "'fl,~ t'.;: ":'.;"':I~";:i,"14.'t"(lotl:'\? C. ~ lhe~'.~~e"lnf~~..tlon i~ incor~~t'~/~'~ :d~tsand ~t1on"werepal~ ~~oti'~"~i~~"\~ .,,, You IlUSt complete PART 0 Bnd/or .PART[!] below. .,-:: ',' ".)~, .', .. '\-,,;-~'_":'.l." y' " If you 'indicate a different tax ratei please siate you~ relationship to d8c.dent~ return PART @ TAX LINE ~ETURN - ~O~PUTATIO~ 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TA~ ON ~OINT/TRUST 1 1? /30hooo 2 :I; 12.781.66 :::j 6. 190. 8 ~O 5 - 0 6=:J....2., 190.8"3 74 . .04'1 8_$ 287. <;9 DEBTS AND DEDUCTIONS CLAIMED PART @] DATE PAID PAYEE DESCRI PTI ON AMOUNT PAID I TOTAL (En~er on Line 5 of Tax COMputation) I $ declare that the facts I .lief. have reported above are true} HOME (717) 766-9'111 WORK ( ) N A T LEPHONE NUMBE correct and 8/11/2001 DATE '"-'Ie.& L.LI...I.""L'lI;; V.L .&ICl'U03.1.&. Account Verification , PNC Bank, National Association ROSE SMITH CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG PA 17050 Base Interest Rate 5.970% Package Points 0.250% FORM112991-Q300 ~ PI\JC~AN<. Certificate Number Reference Number 31400206044 2001001179 Purchase Date, Purchase Amount Dec. 30 2000 $12,720.96 Maturity Date Term Oct. 30. 2001 10 Month Annual Percentage Yield 6.40% Renewal Type Automatic Product Description 10 MONTHS FIXED RATE For Information, Call 1-800-537-2262 Int paid by: Transfer to Account 5140163437 Interest Rate 6.220% Effective Until Oct. 30, 2001 . CENTRAL PA Please see reverse side for Account Agreement Member FDIC COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUR&AU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0542 01138696 08-28-2001 REV-UUUAFPCD'Moa) EST. OF ROSE L SMITH 5.5. NO. 119-20-5477 DATE OF DEATH 05-28-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS !Xl CHECKING o TRUST o CERTIF. CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG PA 17050 REHIT PAYHENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has providgd 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 decadent, yoU were B joint owner/beneficiary of this account. If YOU feel this information is incorrect, please obtain written correction fro. the financial institution, attach a copy to this for. and return it to the above eddress. This account is taxable in accordBnce with the Inheritance Tax Laws of the Co..onw.alth of Pennsylvania. Questions ~y be answered by calling (717) 787-8327. Date Established REVERSE SIDE FOR 04-01-1981 FILING'AND PAYMENT INSTRUCTIONS COMPLETE PART 1 BELOW Account No. 5140163437 J( J( J( SEE Account Balance Percent Taxable Amount Subject to Tax Tax Rate Pot.n~ial Tax Due x 12,555.79 50.000 6,277.90 .045 282.51 To insure proper credit to your account, two (Z) copies of this notice lIust BCcollpany your paYll8nt to the Register of Wills. Make check payable to: -Register of Wills, Agent-. x NOTE: If tax pBYllents are lIade within three (3) lIonths of the dGcedant.s date of death, you lIay deduct a S;C discount of the tax due. "Any inheritance tax due will becon delinquent nine (9) -lIOf1ths after the date of death. . PART . , TAXPAYER.RESPONSE' . . ,. "'. f1ll_".....:...'....'.'........_....'...'.."."....'.....'liiiii;......'....'.'.'..,..'.'...........'.".........'.'........'...'......,..,.,...,......,.,........,......,."" ~ '" '" 'iiIl"-l'!:" , , " , . ~' , .-------, ., ,., . .,' ' . . :' . !!!iIi,,,,' . . .~. A. - 0 The'abov. info-~;;tion"~ tax 'dJ;":l;..~.;~.ct.: -'''-. -0':"--'1:':,_ .. '.';~ ' -':,: '::; ,-:-i ,; ,,'). ':'/'~: :, ,;: ': ... f'~,'" ::,'-':Ji . ~~.' ", t.:i \ ''''-~-;'1l:' " 1. ':'1 You '-.ychoose to r.1I1:t pallHl1~,,;tf):'i:the, Regist.r'ofIUllS, with 'twocop~1IS Of:'this'notice<.to' ~tliln .11 a dIscount or lIVOid Int.,.est,or'you.ny checlc bOx -A- 8nd r.turn'thisnotice-to:the Regtster 'of lUlls and an official assesSlMllntkill be 'issued b)' thePA DlIilpar'blent of IleV8l'lU8~ .... ." ' ~j ,!,;~"l ~,H4:'Ll:'\ ' ;""1 ..... ,'j-:;:+.,2.." '::(!i::.;(,1.',;~4:,1l4b:~!~.. ;,i'~l}{ ",1'1.r:~~.i,'.'P r .., ..':'--- '.' "'''f'''--:'f-:'P,t, Y"."';"f:~"": ----:,',,',':-- , B. D The above ass.t has been or ,dll .b.,_re~rted and tax paid ldth.:th.II!".~S)'~vani.lnherf:tanc.,Tax return '., to,b~ l,Uad, bY}he"dec~~.s",r::-e~~~~~~,i~e.-:',1 ,.... 1 "';";!',,,'i~:"A~ L~-mt~}',;;:l"l !\Il"_,,.-;-;,j( ~C':tl"t.,:;,',:t.."'.",~>',i C. 0 The above info~lIation i~ncorrec. .>t, ';m.'i'~.~Mebts. :and declU. ction. won ..;.d b)"Y~~ '.:i:;~;?~; \!~:rJra'4tJ:[ You !lUst colIPletg PART l!J and/or:PART, L!.J below. . . . . . .'. ...... .'. . ,., ~ ,.., 'I'",.d~,:....i-I'''l''''f(, :,t,.;:.~,-". '_,\ ,..-,:l.,""""~_",, ", ~",.,",,:.," "<:,,,j .:.~.~,"\'.;,"lt'" If you indicatll a dlfferer'lt tax' rate, please .ta~e3'our"" . relationship 'to decedent: -'.'''' ,~, ".~,j j,~: ~:... / , [CHECK ] ONE BLOCK ONLY. PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART ~ TAX RETURN - COMPUTATION LINE 1. Dat. Established 2. Account Balance 3. Percent Taxable' 4. A~unt Subject to Tax ~. Debts and Deductions 6. Allount Taxable 7. Tax Rate 8. Tax Due OF TAX ON ..JOINT/TRUST ACCOUNTS 1 . "......-.. 2 3 X 4 5 6 7 X 8 PAYEE DESCRIPTION AMOUNT PAID I $ Bre true, correct end Under penalties of co~let. to the best of I TOTAL (Enter onLine 5 of Tax Coaputation) perjury, X declare th8t the facts X have reported aboye IIY knowledge and belief. HOME ( ) WORK ( ) TELEPHONE NUMBER TAXPAYER SIGNATURE DATE fUL-Totl hf},J/.J.. C."I'JTICT10'; oP ,,+TE- of- @rA-Tff ~~l-ft-W~" aN ;ru";~LfI ~ool 13,/ ;?I? M (' If /VI /Tf'/ It (r- If {Q-- u;)..J 0 (l ftli. /..../ S" '- IE II f/. c- M-C~ rf/rN J co 5. B v~ 6- ,,1- /7()oO , ,,,0". o. ~~ :,:,51:'P:: x :;-04-93 :: :72.072319 + :72-07831Q "' 3ES- :: 0- 7:;_~c.2~-'~205 + O. 7 "~42:05205 x 67' ::: ['-~_.96,31j,~4873 + "~' 94:' 1 ~34e7?' + :,51::::-83 + .::,C31-,::,,~uc6u2 "'""" -- v~ efY\5S6'8.7?3! 5,/~/f)1 ('12(( It CUl1) (!d 'f f'; T It-TI 0'; 121.e7:: c- , ~o ~. Q' * 10- 2- -= 5- + 5' x 14.6 ::: 7" + 72- * 78' G* 5,512-83 + 49.943143 + ~8'77314~ 00 H H '":I Z ::c- >-3 o ::J Z Z >-3 trI 'Q -0 3:f--' >-3 >-3 ::8 ::8 (l- '- tJ 3:'< rt ::r:: ::c- 'D 'D 0 ::c- ~H Z 0 >-< >-< 0 0 0 ,CfJ o ::J 3: 3: 0 N '>-3 (]) >-3 >-3 0 >-3 (Jl II ::r:: I 11'0 0 II QJ 0 VcO \0 (]) CO '":I \0 N 0 0 >-3 0 >-3 >-3 H ::c- f--'O >-3 ""- II H) < H < H H ::>\ ::J 00 H 0 ~ QJ QJ QJ ::J \03 QJ (]) f-'- ::J ::J ::J rt C \0'0 ::J rt ::J [fJ [fJ [fJ H QJ 0 [fJ H H) QJ f--' (l C f-'- 0 0. 0. 0. ::J 0 ::J 0. (]) H QJ QJ QJ [fJ H 0.0. QJ -< 3 rt rt rt QJ (]) rt (]) QJI (]) (]) (]) (l rt (l (]) rt 0 (]) 0 f-'- >-3 0. 0. >-3 '":I 0 0 (]) (]) f-'- W ::J 0 (Jl 0 (Jl0 0 0 3 II ::r:: , W , W W ""- W ::c- (]) trI H (Jl '-- N '-- '-- '-- f--' X CfJ f--'N (JlN N \0 N '0 0 f-'- >-3 CON WN ""- W N ::r (]) rt ~ '-- '-- '-- 0 0 '-- QJ '0 trI COO WO \0 0 0 \0 0 10 Wf--' mo \0 f--' 010 0 N \0 '" ~~ (]) I 'D 'D '":I 0 3: H 0 'D '< '< '< >-3 '0 QJ [fJ (]) H >-3 3 3 ::8 rt [fJ '0 0 CfJ O\r 0 rt rt f-'- C C 0 0. 3: f-'- '":I 0 (]) ::J H (]) [fJ C H [fJ ""- 3: 0. 0. X rt f-'- f-'- (l >-3 '0 ' II ::c- QJ QJ (]) rt 0. rt rt ::r:: f--'''- 0 H rt rt 3 '0'< QJ ~ ~~ ~ Z (]) (]) '0 '< rtrt t" '":I rt 3 (])'< ::r::X:: :>: I rt '0 f--' f-'- (l (]) m f-'-S\ ::J >-3 0. H) [fJ 0. 0 0 0 H 0 0 rt 0 0 W W (]) W W 0 :>: H '-- '-- ..0 '-- '-- ~ H Z N N NN (]) '< >-3 N N N N >-3 ..0 ~ '-- '-- '-- '-- f--' C 0 0 0 o \0 0 W (]) f--' 0 f--' 0 N\O N m [fJ >-3 rt ~ 0 ~ ~ 0 0'":1 '":I IJ:J 0 C < QJ H QJ ::c- ~ 3: rt rt [fJ (l (]) [fJ t-' ~ H rt (]) ..0 f-'- t" CfJ 0 [fJ >-3 0 3 0 ~ f--' (]) H) (l ::c- O H 0 Z (Jl '0 0. CfJ -.l '":I >-3 H '< (]) m 0 ::J 3 II GJ 0 f-'- rt >-3 Z ::r:: rt 0 N H f-'- (Jl (Jl 0 cO 0 CfJ QJ , , m cO 0 >-3 N N rtOO '-- f--' 0 3: m (Jl (]) o 0 0 (]) 0 0 (Jl W 0.00 f--' H Z '-- 0 trI ""- W 0 0 0 0 ""- >-< -.l m >-< 0 0 -.l W f--' .~N' Reference ID: 185963 First Union National Bank Attn: Account Verifications POBox 40028 Roanoke VA 24022-7313 August 8, 2001 CHARLES E SMITH 6034 WILLIAM DRIVE MECHANlCSBURG, PA 17050-6851 SUBJECT: Verification / ConfUlIllltion of Account and Balance Information provided for: ROSE L SMITH (SSN# 119-20-5477) Date of Deatb: May 28, 2001 Account Type CAP CHECKING ACCOUNT LEGAL TITLE: ROSE L. SMITH Account Number Denosit Account Information Date of Death Average Date Maturity Interest Accrued YTD Date Balance Balance. Opened Date Rate Interest Interest Paid Closed $22,628.04 121611999 $61.32 $25,623.69 5/15/2000 4113/2002 $76.15 $707.39 9620687105 CERTIFICATE OF DEPOSIT 247412051193355 LEGAL TITLE: ROSE L SMITH ANNA M. SMITH . Due to system limitations. we can only provide a twelve month average balance on depository accounts. No Safe Deposit Box found for customer. ... Date of death balance does not include accrued interest. ... If date of death oecum on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period. August 8, 200 I Date Drema Rubinoff Depository Representative abs; ag Servicenter Associate Title (540)563-7323 Phone Number 001032 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '*' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0542 01146522 10-03-2001 REY-1543 EX AFP (I9-OIl EST. OF ROSE SMITH 5.5. NO. 119-20-5477 DATE OF DEATH 05-28-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [X] CERTIF. ANNA M SMITH 6034 WILLIAM DR MECHANICSBURG PA 17055 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 FIRST UNION NATIONAL BANK hl!!lS provided the Departllent with the inforution listed below which has been used in cl!!llculating 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 financil!!ll 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 Co..onwealth of Pennsylvania. Questions .ay be answered by ealling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR Account No. 247412051193355 Oat. 05-15-2000 Established FILING AND PAYMENT INSTRUCTIONS Account Balance Percent Tax.ble AIIo...,t Subject to Tax Rate Potential Tax Due x 25,623.69 50.000 12,811.85 ;15 1,921. 78 TAXPAYER;RESPONSE To insure proper credit to your account, two (2) copies of this notice IIUSt 8CCOIIpany your pay.ent to the Register of Wills. Make check payable to: nRegister of Wills, Agent-. x NOTE: If tax payllents are .ade within three (3) .onths of the decedent.s date of death, YOU IIl!!l)' deduct II S::C discount of the tax due. Any ,inheritance tax due will beea.e delinquent nin8(9) .onths after the date of death. - Tax PART [!] mr.~IMI_.~__IIIf~IIIIII~~~ffi_~.'::,:~:~:.':,., ;_~-r.o~,~~:~,?. ~~':::::':'::'::."::,"::~~:'i~:"":'.:~~:~'m;~:.~1_J':""""';':;' '.~ 0 The'!IboW info....tlon'~ tax dUe is cO~..:ect.~:i'~, ~, '~,-,'th~':""~:.:,:,),_ ';'_:::-',~', ""',',.,,: .",I.,t,You _y!choosa to ....it PIIYHOt~to:thll ,If:lIGist-!r:.of lUlls with,":two.copies of;this,notiC8ctocObtain' .~ . discCM.l'lt or avoid int.r.st, or YOU .ay' chItck bOx,,!".~, and r.turn :this notice >tottM RlIglster-' of Wills and an official as..s....twiU be Issued by the PA 08p11rtllent of Revenue. C,' '\';;; CiJF/, ~"'~ 1\l~fJt.t..i~.. r,~l;. l.i:l,i:r,",,-<0',~::<f,lffl'r.(.'i""H;;':;;'>l;,d:;: ts(:!L 'lil;:)t'ilit'tv,~.? r B. 0 The above asset has been or will be r-~~rted and tax paid~..1tT\'~-~~;Y~V1Sni8"~-nhel;'it..ceTIIX retu,rn t ~':,j t~ 1Ml:. fil~, ~~,.;~It,~:~~~~,~~, ~4!r~.~.:'t~(~:~,,~,~.,:). :~rtJ l"";"iif .!-l1'-r d' h.--l~'} d,,',;, Jt. ~1it,;'~Iil;>" '1 C. 0 The above inforsation is in~orr8Ct and/or debts and deductions were paid by )'ou. You !lUst cQIIPlete PART [!] and/or P.RT~ belo~. " '" ", . ,~. '. , . " , ~ ~ 1 . " ;1>:.....1'! ':",., [CHECK] ONE BOLN08~ 1 "",', PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate. different tax rate, pie.. state your~"," ,. ....l.tionshipto decedent: ' ~, " "'j;!, I!H" .' ,"': ';.~' " PART [!J TAX RETURN - COMPUTATION LINE 1. Oat. Established 2. Account Balence 3. Percent Taxable 4. Amount Subject to Tax S. Debts and Deductions 6. AlIOunt Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1" 2 3 X 4 5 6 7 X 8 PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line S of Tax Co~ut.tion) I $ Under penalties of perjury, I decla,.. that the facts I co~lete to the best of my knowledge and belief. Mye reported HOME ( WORK ( TELEPHONE aboye ere true} correct and ) ) NUMBER DATE TAXPAYER SIGNATURE .'~""~'I:'7). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBATE PROPERTY ESTATE OF ~OSJ: /.... !; M I TH FILE NUMBER .:I /- 0 J - 0 f)S 'I :L 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 %OF ITEM INCLUDETHENAAlEOFTHETRANSFEREE,THEIRREL/l.TIONSHIPTODECEDENTANDTHEDATEOFTRANSFER. DATE OF OEA TH DECD'S EXCLUSION TAXABLE VALUE ATIACHACOPYOFTHEOEEDFORREALESTATE. VALUE OF ASSET INTEREST IFAPPlICA8L-ei" NUMBER 1. rlU'l'l/l F't:.-IG.~E IS (l H 11th e-r: ~. ~MlrH..JR.. (~.N oF' Ot;-cc/t~cP) 6-Lcllt.~oO/t!. I-Ifc htV/J ItWlltJIT! ~Qi1PAtI,/ p.';. t3~x Cf;.J ~/~ P~LIrTJtI€" I IL {"O()9"-t.l~/:J.. 11/11A1tJl rj (JoAl Tf( It. T IV (J G-~ ')?l '4''10 1/'1" ?/),. ~j IDD 'YO - 111f, 9/).. t; . TOTAL (Also enter on line 7, Recapitulation) $ i-/9. 91:J.. ~{' J (If more space is needed, insert additional sheets of the same size) Glenbrook Life and Annuity Company P.O. Box 94212 Palatine, IL 60094-4212 GLENBROOK LIFE A Member of Allstate Financial Group June 15, 2001 Charles E. Smith Jr. 6034 William Drive Mechanicsburg, PA 17050-6851 Re: Contract Number: Claim Number: Rose L. Smith GA283840 GA12752 Dear Charles E. Smith Jr., We, at Glenbrook Life and Annuity Company, are sorry to hear of your loss and extend our sympathy. Enclosed please find a check in the amount of $50,041.47 for the proceeds payable under the referenced annuity This payment is computed as follows: Annuity Value as of 6/15/2001 Portion Payable to You: Federal Withholding: State Withholding: Total Net Proceeds: $50,041.47 $50,041.47 $0.00 $0.00 $50,041:47 , This annuity is subject to federal income taxes (on non-qualified annuities, only the interest earned is taxable). A 1099 tax statement reflecting $296.36 as your taxable income will be sent next January to assist you in preparing your tax return for 2001 . The annuity value on the date of death, OS/28/01 was $49,912.65, this may be necessary for estate purposes. If you have any questions or need further assistance, please contact me at 1-877-499-8418. Sincerely, Javier Salazar Life and Annuity Claims Enclosures ,~""~,,,gn.* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R.ESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ~oSE 1.. r;M ITH FILE NUMBER .;J /- 0/- OOS"l./.:L Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: iI d': J/ 9 9. 00 1. M'/J:R t rVNt?/UlI- /-fO'"'''- SelF t+rrttctlH~rJT FvJl/l:' If. A '- I.- v IV elf l!' oAl ./-I.1R 0 /wrr ~ R. ~- S '-""'1.1,," h-wi' 'eE" It-rrltrlf,., /:tJT 1/ 5o~. ';;;... Ft/"'I:.-~"'" '- ~ /N~It:.-,e. /3uFft::-r - fl+l 0 1"11. 0'" t:.- <;.rltr~ Y/ IIg,oo FUNC'I'I/H M~H l+<..r".1I.. "ct'"'Rl/cJQS TIPS <1-1 50.00 ;'1MM'r/fY Tifft';/<' Y'V (ltt-teOS 11 /J.5'o B ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Sodal Sacurity Numbe~s) I EIN Number of Pe"'onal Representative(s) Street Address Cily State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family E.empllon: (If decedents address is not Ille same as claimants, allach e.planation) Claimant Street Address . CiIy State Zip Relationship of Claimant to Decedent 4. Probate Fees (lot/AIry RI::.--(rI(Te/l2.oF w//-L.f,-UE47T/tfIfMe1'IT i/ (lVMB~RL.tJl/" '7 '7. Df) 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. TOTAL (Also enter on line 9, Recapijulallon) $ 9.~3 9. 9:J..... If more s ace is n i , p eeded, nsert additional sheets of the same Size) Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, Pa. 17055 Boyd L. Myers Jr., Supervisor (717) 766-3421 A STANDARD OF EXCELLENCE SINCE 1910 Friday, June 15, 2001 Mr. Charles E. Smith 6034 Wiliiam Drive Mechanicsburg, Pa. 17050 Dear Mr. Smith, Thank you for selecting our funeral home to provide services for your family during your bereavement. I hope that you found our services to be of the highest standards and that they met your needs and those of your family and friends. The following is a summary of the service charges as previously explained and provided in written form and herein indicated as PAID-IN-FULL. Rose L. Smith SUMMARY OF EXPENSES TOTAL OF SERVICE RENDERED LESS; Credits granted LESS; Total Payments CURRENT BALANCE $9,764.00 1,265.00 8,499.00 $0.00 Credits Granted: $1,265.0 Package Price Discount If there are any questions or concerns that remain unanswered, please call me. Sincerely, Christopher M. Williams -. - Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, Pa. 17055 Boyd L. Myers Jr., Supervisor (717) 766-3421 I STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED : Char~es. are ?~ly for thos~ items that you selected or that are required. If we. are re~uired by law or,by ~ ce':letery or crematory to use any items. we wil i explam In wntmg below. It 1;0':'- selected. a funeral that ~ay require embalmmg, sue as a fu~eral with vl~wmg..you may have to pay for embalming. Yo i do not have to pay for emba ffiJn\YOU dld not approve It you selected arrangements such as direct crematIOn or Immediate burial. Ifwe charge vou for a : embalming. we will explain why e1ow. ~ ~ ; For Savices of Rose L. Smith Date Of Death May 28. 2001 Date of Contract May 28. 200 I : Charge to Charles E. Smith 6034 William Drive Mechanicsburg. Pa. 17050 . ~ame Address Lit)' :)tate Zip - -. : A. CHARGE FOR SERVICES SELECTED: C. SPECIAL CHARGES l. PROFESSIONAL SERVICES Forwarding Remains to other Funeral Home $ Services of Funeral Director and Staff $ 1695.00 Receiving Remains form other Funeral Ho~ $---'- Embalming $ 895.00 - Immediate Burial $ Casketing. dressing, cosmetolog~~_ $ 195.00 Direct Cremation---~---- $.------- I Other Preparation of body $ 95.00 ------- $ Hairdresser / Barber $ - SUB-TOTAL OF SPECIAL CHARGES CS Autopsy Remains $ D. CASH ADVANCED $ Opening Grave/Crypt $ 500.00 SUB-TOTAL PROFESSIONAL SERVICES AIS 2.880.00 Newspaper Local $ 154.00 2. USE OF FACILITIES AND SERVICES Newspaper $ For visitation I wake service $ 425.00 Clergy I Mass Offering $ 100.00 For funeral ceremony $ 450.00 Certified Copies of Death Certificate 15 $ 30.00 For memorial service $ Family Flowers $ 125.00 Equipment & services for graveside serv~ $ 295.00 Organist $ 75.00 $ Marker $ 150.00 SUB-TOTAL FACILITIES AND EQUIPMENT A2 $ 1.170.00 Cemetery Equiptment $ 90.00 3. AUTOMOTIVE EQUIPMENT Rock Charge $ 250.00 Vehicle to transfer remains to Funeral Hom~ $ 350.00 SUB- TOTAL OF CASH ADVANCED D$ 1,474.00 Hearse (Casket Coach) $ 295.00 We charge you for our services in obtaining the following: Flower Car I Floral Dis~ibution $ lncl NONE Family Car $ Inc! Lead Car I Clergy Car $ 195.00 SUMMARY OF CHARGES Utility Car $ TOTAL ABOVE ITEMS (A.B.C.D) $ 9.764.00 Out of town transportation $ Sales Tax (if App) 1ft % $ 0.00 $ SUB-TOTAL AUTOMOTIVE EQUIPMENT A3 $ 840.00 TOTAL OF ALL SECTIONS $ 9,764.00 TOTAL SERVICES, FACILITIES, AUTOMOBILE A$ 4.890.00 LESS: Payment Made $ B. CHARGES FOR MERCHANDISE SELECTED LESS: Credits Pending $ Casket Cameo Rose 4506632 $ 2.050.00 LESS: Credits granted Package Price Discount $ 1.265.00 Other Receptacle $ BALANCE DUE by Jun 27. 2001 $ 8,499.00 Outer Burial Container Patrician $ 1350.00 A late charge of 1.5% per month on the outstanding balance (annual rate of 18%) i Acknowledgment Cards $ Incl will be added to the balance. I I Register Book $ IncI Memorial Folders $ IncI REASON FOR REQUIRED SERVICES OR MERCHANDISE Prayer Cards $ Reason for embalming family viewing , Temporary Grave Markers $ Cemetery requires outer burial container I Burial Clothing $ DISCLAIMER OF WARRANTIES Other Clothing $ Our funeral home makes no representations or warranties regarding casket~ Cremation urn $ or outer burial containers. The only warranties, expressed or implied, grantee $ in connection with goods sold with the funeral service are the express writte $ warranties, if any, extended by the manufacturer thereof, No other warrantie including the implied warranties of merchantability or fitness for particula TOTAL MERCHANDISE SELECTED B$ 3.400.00 purpose are extended by the seller. I agree that I have examined the items of goods and services selected above and found them to be correct and according to the arrangements I hay requested. I acknowledge receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds available f( ~a~ment of the cash price for the gOOdS and services selected. I also agree to make payment of $ 8499.00 within 30 days: I asree to be jointly and several ia Ie with anyone else who signs elow. A LATE CHARGE of 1.5% per month (18%Jer annum) will De applIed to the unpaid ba ance beglnnin~ 30 days afte the date of tliis contract. I will also pay the Funeral Director all reasonable costs pai bt the Funeral Director to collect amounts I owe under t is agreemen . Those costs mah include attorney fees and court costs. Any items requested after the da e of this agreement will be considered part of this agreement and w I be reflected on t e final bill. (Seal) May 28. 200 I Purchaser Contract Date (Soal) I Purchaser Christopher M. Williams Licensed Funeral Director ..c ..I.( ........'-L .::n::rvlI...~:. ~ --f1RSTUSA .-1-- CUSTOMER SERVICE 1-800.Z8.1-1%11 (INSIDE ITS) I-HI-Z48-!l61 (OUTSIDF. US) ..n .onect 1-883-446-3308 (en E'panol) www.nrstu.a.com () l i-f '-/'It/.,;;O Lnd--3 \- ,>-0 QYJ~t; f~d()1 BILLING INQUIRY P.O. BOX 8864 WILMINGTON, DE 198!I!J.8864 PAYMENT ADDRESS P.O. BOX 15153 WILMINGTON DE 19886-5153 ACCOUNT NUMBER TOTAL CASH ADVANCE AVAILABLE A V A1LABLE PORTION PAYMENT I ~LOSING CREDIT LINE CREDIT LINE t CREDIT FOR CASH ADVANCES DUE DATE DATE 4408 0399 98\3 4587 18,000 14,000 13,111 14,000 07/14/01 06/19/01 CARD MEMBER ACTIVITY SUMMARY TIL~NS. POST. REFERENCE NUMBER MERCIL\NT NAME OR ~NSACTION DESCRIPTION AMOUNT DATE DATE OS/21 OS/21 24455014D3ABP6W2Q TIlE BOOK HOUSE DILLSBURG PA ~2.26 OS/24 OS/24 24435654G034TNM IG MENDEI.SON,FOER8<IIARRlSON MECIL\NICSBURG PA /.72.00 OS/29 OS/29 2407]054N7QIDIJl.GV IL\RDING S CAMP HILL P A :r;o.oo OS/29 OS/29 24445004N9EQD5ZVG BARNES 8< NOBLE #20461L-\RRlSBURG PA 25.40 05/30 05/30 24418004P4QP4Y6ZZ OLD COUNTRY BUFFET #203 MECIL\N]CSBURG PA I, 27.32 06/0] 06/01 24071054S7QF4D81H IL\RDING S CAMP HILL P A ~52.42 06/01 06/01 74408034RO ]43A VlI7 PAYMENT. THANK YOU :245.89CR 06/08 06/08 24~10 17 34ZWGP5K8LX COUNTRY GIFTS 'N SUCH MECIL\NICSBURG PA .{,'53.64 116/13 116/13 24154.1455FA87E23S SOUTH STREET GRILL SLOA TSBURG NY rs2.07 06/19 06/19 PERlODIC RATE 'FINANCE CILAAGE' 56.40 PREVIOUS BALANCE + PURCIL\SES, FEES +CASII + FINANCE CHARGES - PAYMENTS NEW BALANCE AND ADJUSTMENTS ADVANCES AND CREDITS 4,151.63 815.11 0.00 56.40 245.89 4,777.Z5 CARDMEMBER NEWS CONVENIENCE CHECKS YOU RECEIVED BEFORE OCTOBER 2000 WILL NOT BE ACCEPTED AFTER JULY 16, 2001. PLEASE LOOK AT TIlE NmmERS AT TIlE BOTTOM LEFT OF YOUR ACCOUNT CHECKS. V AUD CHECKS WILL BEGIN WITH 044115511. PLEASE DESTROY CHECKS THAT BEGIN WITH ANY OTHER 9 DIGIT SEQUENCE. SUO H1D 4 f'll.,,si- ~:~~ x,. ~'0 rT'l ~ :=:d g-i'~'~ ~~;; :~*~ ~;:) ~ =: :::i;r::,.'!i: ::'1::' ;~f~~ '-. ~~~ :.t:,. ~if5m ,-n _.~ j::~,~ ,.=;, ~~ ~f6 ~ ._~ ':::> ~:r:, ;.~ 83 ;~1 ~!~ :c::'~. ~;~~ ...::::....',.;1:. ~~ ri~ '~~i f:~' :;r.o;: .'f;I~ ;r~ I"" IV::. 1'/1 ~ii f"~ j::tii .....1' .~, ~ ~I !--t: Iv\. !~ i~ '\.fJ -I " .=< r. 1- -1 ,-, ~ :I> r" -i,JJ I-~ ::;. i::r (1') 111 , .iyl' , .,. , \.) : (".1 ! ." t..) , .;;:.. G C ~.,) -lIT.! ~5!; 1-" .., ~;::: ~E (i):f.::"$ ; ~~:~ ~~: g2~ ~~~ -,J.' _" _"'. ,::=; ~~] ~::j . -, :~~6:!;~ .-,.,:' ,:.,., .-,.,:,.- '..c ,~. ."1',. "..-"",) ".'!".- : :i~: !::~;~ i~C :::: ~~~~~f~~~ ;~~ ~~ i~~ rn ~~ ;.'= ~~~1 .!fl- U1 ':::1 ~1...:: :::c ;=~ ..:g ~~ . ~~~ i:;,:."i ;~~.: ~''=' ... "~ ... "" ..~) ...".. ._,0" '-'-,"_.-:: '~'.' . ,:., '-,:~. -,. ~~ .;::;;. -~ ~~ it~%:; ,-.,;~, ,..!:~ ,~::::' : .:., ,~ ':."!'::--. :::::" c,,~ as ;>, ~5t ~~ ~c ~F.~ :~~ .0 n"' .,.~ ~~l~~ -:i "", ::--:2":;..' ~n ,,...~ :':,~: :1;;:':::; -':1 ~::;:J~ :", '.~:::~ ..>.:"'" . ..n .,. '..j i-I "';.~, ,.".', <.', '.." :::,;:: .. , RECEIPT FOR PAYMENT :========~========= Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Recetpt Date Recee.pt Time Recelpt No. 6/07/2001 11:13:53 1025840 SMITH ROSE L File Number 2001-00542 Remarks CHARLES E SMITH JR AC ------------------------ Distribution Of Receipt ------------------------ Transaction Description Payment Amount Payee Name PETITION FOR PROBA EXTRA PAGES SHORT CERTIFICATE JCP FEE 60.00 6.00 6.00 5.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D Check# 3937 Total Received.. ....... $77.00 $77.00 ,."""'~"~- '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT r . SCHEDULE J BENEFICIARIES ESTATE OF Rost= J... SM 11;+ FILE NUMBER .;( 1- 0 1 ~ ooS\f;)..- NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I . TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. (!H /T,qJ..E'S ~. s. f'/1 rrf J .J 1<.. I!> c:> 3 ..;. WI '- 1..111-1'1 fJ tV I V C H€C.rI-+1/IC'S.I$U(<&- PI'!- 17()S'O,t..'8~1 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) S" ,.j AMOUNT OR SHARE OF ESTATE 100 ~ II. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: \ A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN1ELECTION TO TAX IS'f.lOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needeo, insert additional sheets of the same size) ..~..7';1""'..~~~."..""~-~'~ -..- -"f' ,~ u.J CL t:) . a: t:) N >- a: '" Vl :::lLflo >- DClCOLfl .2: a.._(/')o-:::J 'IUr--D .0....-- ~ Vl Z Za: o a: a: :::l I -') U u.J E (Y) CXJ~ r-J, .Lfl UI~ ~g ~ - -\llI!!!!!!!!!Il -- -:: M a 1'- ---=s. ~ ~\\\ ~ ~ ~ ~ -:!! ~ -~ ~ ~ i .~ ~ ~ ~ ~ - - - - - - - - - - - ---. ~.> f" " a '" '" a t: s Ii~ fiJ~ ~~ ~!j Qq :>; E-i :z; ~ 0 u Ii:! ~ @ :3 <r: a H U2 ~ Ii:! Ii:! p::j U2 ~ P !:'-- 0 co u ::r:: C"'"\ E-i C"'"\ .@3 I U2 C"'"\ H 0 ....-1 H u 0 H !:'-- :s ....-1 M r:y ~ 0 Ii:! U2 p::; ~ ~ Ii:! .0 E-i ::r:: U2 U2 ;8 H H '@3 H 0 ~ Ii:! 0 <r: ~ u u ':1 ;::. "'~I~ :::; ~ "" '. . oJ .____ COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SMITH CHARLES E JR 6034 WILLIAM DRIVE MECHANICSBURG, PA 17050-6851 -------- fold ESTATE INFORMATION: SSN: 119-20-5477 FILE NUMBER: 21 - 2001 - 0542 DECEDENT NAME: SMITH ROSE L DATE OF PAYMENT: 01/14/2002 POSTMARK DATE: 01/11/2002 COUNTY: CUMBERLAND DATE OF DEATH: OS/28/2001 NO. CD 000744 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $6,438.62 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHARLES E SMITH CHECK# 5026 INITIALS: CW SEAL RECEIVED BY: $6,438.62 MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS , ~ 1(, -d5-7--3 BUREAU OF INOIVIDUAL 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 RGCC DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-26-2002 SMITH 05-28-2001 21 01-0542 CUMBERLAND 101 '02 ~IHR-1 f\11 .'") 3 ,I. -L CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG PA(~'d50 ( .UITi..", ~- REV-15~1 EX iFP (Dl-D2l ROSE L Allount Rellitted (1) (2) (3) (4) (S) (6) (7) .00 .00 .00 .00 22,628.04 49,885.37 49,912.65 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 ~ rfiy=is4j-E3f-AFP--COY=02Y-NoYicE-OF-YNHEifiTAirCE-YA'x-A-PPRA-isEi.fENT~--AL1-oWAifCE-(fR-------------- - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SMITH ROSE L FILE NO. 21 01-0542 ACN 101 DATE 02-26-2002 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE 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) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets 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/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax 9,239.92 .00 (11) (12) (13) (14) (9) nO) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. (8) 122,426.06 9.239 92 113,186.14 .00 113,186.14 NOTE: If an assessment was issued previously, 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: lS. Allount of Line 14 at Spousal rate (lS) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 113,186.14 X 045 = 5,093.38 .00 X 12 = .00 .00 X 15 = .00 (19)= 5,093.38 I"ATn~"1 K~l.;~.L1"1 l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 03-13-2002 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 5,093.38 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 10.86 TOTAL DUE 5,104.24 . 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" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERYATION: 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 for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIYE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF KILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REY-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice 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. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REY-15011 for an explanation of administratively correctable errors. 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. 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 is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 beer interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 n .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 n .000192 1986 10% .000Z74 ZOOO 8% .000Z19 1987 9% .000Z47 Zool 9% .000Z47 1988-1991 11% .000301 ZOOZ 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER 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. .. ..." REV-1470 EX (6-88) INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER REVIEWED BY ACN 2101-0542 101 SMITH, ROSE LARRY SZOLLOSY ITEM SCHEDULE NO. EXPLANATION OF CHANGES F 8 Lineal heirs are taxable at the rate of 4.5% for dates of death on or after 07-01-2000. ROW Page 1 BUREAU O~ ~D~~J T:~ INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT v,* REV-l401 EX AFP '01-021 Fie,;,~ R .02 i1Af~-1 DATE ESTATE OF DATE OF DEATH FILE NUMBER fIll :21 COUNTY ACN 02-25-2002 SMITH 05-28-2001 21 01-0542 CUMBERLAND 101 ROSE L CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG PA 170~I~b,_ Allount Rellitted 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, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV': i6oj-Ex-AFP--('oY:02Y------...-fNHERIi'-ANcE--TAx--si'jrfEME-tiT-OF"-Ac-CO[jtff--.-..------------------ --- ESTATE OF SMITH ROSE L FILE NO. 21 01-0542 ACN 101 DATE 02-25-2002 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: 02-26-2002 P R I NCI PAL TAX DU E : ........................................................................................................................................................................................................................... 5,093.38 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-11-2002 CDOO0744 .00 6,438.62 TOTAL TAX CREDIT 6,438.62 BALANCE OF TAX DUE 1,345.24CR INTEREST AND PEN. .00 If IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 1,345.24CR 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. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. If RESIDENT DECEDENT lIake check or money order payable to: REGISTER OF WILLS, AGENT, If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA, REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forlls ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar 1I0nths 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. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of paYllent. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annuli 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 2002 are: Year Interest Rate DailY Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 n .000192 1984 11% ,000301 1995-1998 9% .000247 1985 13% .000356 1999 n .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER 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 paYllent is made after the interest computation date shown on the Notice, additional interest must be calculated. /6'- c-;; ,,~3 7 ~_ ~;' CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS RE;... DATE ESTATE OF DATE OF DEATH FILE NUMBER '02 r'1F\f~ -8 P 1 :?~~~~~ ACN '* .. BUptAU OF INDIVIDUAL TAXES INH~ITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 REY-"O~ EX iFP <12-00l 02-27-2002 SMITH 05-28-2001 21 01-0542 CUMBERLAND 119-20-5477 01138693 ROSE L Allount Rellitted P A 17 0 5u:..;t)O 00 CUrti;, 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 ~ ---------------------------------------------------------------------------------------------------------------- REV-1604 EX AFP (12-00) -- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __ DATE 02-27-2002 ESTATE OF SMITH ROSE L DATE OF DEATH 05-28-2001 COUNTY CUMBERLAND FILE NO. 21 01-0542 ADJUSTMENT BASED ON: S.S/D.C. NO. 119-20-5477 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 01138693 FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 312000075620 TYPE OF ACCOUNT: () SAVINGS () CHECKING ( ) TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 02-07-1997 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.500 .00 .00 .00 .45 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE nn . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, Phone (717) 787-6505. 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. INTEREST: Interest is charged beginning with first day of delinquency or nine (9) months and one (1) day from the date of death to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) 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 2001 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 77. .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 77. .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER 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. , REV-1470 EX l-~8) INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME ROSE L SMITH FILE NUMBER Karen J. Appleby ACN 2101-0542 01138693 REVIEWED BY ITEM SCHEDULE NO. EXPLANATION OF CHANGES Above-referenced ACN is being adjusted to reflect zero tax due since it has been reported on the probate return. ACN 01138692 is suspended with no further activity. ROW Page 1 \. /6-C287--.:3 Y BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REY-16D7 EX iFP <Ol-D2) CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG '02 /-'1\')1''1, 12 D 1 'h? j J ~,_) '- DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-25-2002 SMITH 05-28-2001 21 01-0542 CUMBERLAND 101 ROSE L Allount Rellitted PAI.J!050 Cl 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, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV =i61fj-Ex-AFP--foY=o2Y------...--iNHERiYANc'E-TAx-sTAfEME-NT-'(fF'-Accouiif--.-..---------------- - - --- ESTATE OF SMITH ROSE L FILE NO.21 01-0542 ACN 101 DATE 03-25-2002 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-19-2002 P R I NCI PAL TAX DUE: ........................................................................................................................................................................................................................... 5,093.38 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-11-2002 CDOO0744 .00 6,438.62 03-08-2002 REFUND .00 1,345.24- TOTAL TAX CREDIT 5,093.38 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 If IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3). Applications are available at the Dffice of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLY TD: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCDUNT: 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. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) 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 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER 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. ,~- r , \. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 Telephone April 1 0,2002 717783-0972 PENNSYLVANIA DEPARTMENT OF REVENUE BOARD OF APPEALS DEPARTMENT 281061 HARRISBURG, PA 17128-1061 Dear Board of Appeals: Re: Estate of Rose L Smith File Number 2101-0542 County of Cumberland Date of Death05-28-2001 Pursuant to Section 9187 A(A)(1) of the Inheritance and Estate Tax Act of 1995, a protest is filed on behalf of the Commonwealth of Pennsylvania against the Notice of Appraisement of Assets, Allowance or Disallowance of Deductions and Assessment of Tax, dated 02-26-2002. On Schedule F, item 5, the estate proposed to tax a bank account established within one year of the decedent's death at 50% of the date of death value. The examiner accepted this value. Under Section 9107(1) and (c3) of the Inheritance and Estate Tax Act, any transfer of a bank account established within one year of the decedent's date of death is taxable at 100% of the date of death value less one $ 3,000.00 exclusion if not used with another asset. Review of the return shows that no exclusion was applied against any other asset. Both the estate's information on Schedule F and the information supplied by PNC Band confirms the date of establishment as 12-30-2000. Therefore the taxable value of item 5 of Schedule F should be $ 9,781.66 ($ 12,781.66 - $#3,000.00). The Department will issue a Notice on ACN # 01138692 noting that the bank account was reported on Schedule F of the estate's return and that any protest of adjustment of the taxability will occur on ACN 101. Sincerely, ......-..,-. ....J.... . ,- - _..~ o ~ J Paul Dibert Inheritance Tax Division cc: Charles R Smith, Jr. File Inheritance Tax Division --'" \.,c: --~~ /6~c23?- 3 BUREAU OF INDIVIDUAL TAXES ~ IW,:,iRITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' NOTICE OF INHERITANCE TAX APPRAISEKENTL ALLOWANCE OR DISALLOWANCE OF DEDUCTION~. AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP [01-02) CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG PA 17050 '02 f:I'Xi 1 Ci .t t. -' DATE ESTATE OF DATE OF DEATH FILE NUMBER CPlJNTY SSNI'DC ACN 04-22-2002 SMITH 05-28-2001 21 01-0542 CUMBERLAND 119-20-5477 01138692 Allount RBllittBd ROSE L \ ,J, .~ (", ," ~_..l ! 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 ~ RE-Y=is4-i-E)f-AFP--foi-:02j------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 04-22-2002 ESTATE OF SMITH ROSE L DATE OF DEATH 05-28-2001 COUNTY CUMBERLAND FILE NO. 21 01-0542 TAX RETURN WAS: S.S/D.C. NO. 119-20-5477 () ACCEPTED AS FILED (X) CHANGED SEE JOINT OR TRUST ASSET INFORMATION ACN 01138692 ATTACHED NOTICE FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 31400206044 TYPE OF ACCOUNT: DATE ESTABLISHED ( ) SAVINGS ( ) CHECKING ( ) TRUST ()() TIME CERTIFICATE 12-30-2000 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due X .00 1. 000 .00 .00 .00 .45 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS. AGENT." X TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 · IF PAID AFTER THIS DATE. 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" ( CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the top portion reverse side. -- Make check or money of this Notice and submit with your payment to the Register of Wills printed on the order payable to: REGISTER OF WILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering: l-BOO-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may 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 --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-150l) for an explanation of administratively correctable errors. 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. 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 is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or 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 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7"1. .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7"1. .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER 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. -. .----- I , . .- .. f"~V-1.7C "'-" (6-88) " . . * INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME ROSE L SMITH FILE NUMBER MICHAEL KODOSKY ACN 2101-0542 01138692 REVIEWED BY ITEM SCHEDULE NO. EXPLANATION OF CHANGES Above-referenced ACN(s) are being adjusted to reflect zero tax due since they have been reported on the probate return. ROW Page 1 e ....I c , N ~ ... C '" .. LIJ .. ~ (/) .. , 0 ~ '" .. ~ N ;€ CI CI Cllt\ N NCI I I I oo.:c CO.... ClI- NCI I 1-1 I It\ Xlt\.... .... CI (/) :\j CI ce .... H Z ce .... >111 ceo:: ....:) 1&.111111 >Z >< .... OAIQ (1)111 Z I&.~ Z> ce III ZIII .... X ~OZ> 1110:: .... lllcellllll~ a. III (I) 1&.1&. 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II') ~ ~ ~ 0 U3WII') .:>0 Wa:~ U30 W~< o:!<CL <:::::;c.O :J:-,cc: c:.J_::;) .3: CO U300:t"CI) ~aS2 ~<O~ :r:: cr: c:.J ~ u.J :iE J V\ ~. f-..... ~ M ~ <J ~ I() k, V\ .......... ~ "-u ~ I'i-\. VI :::::. f: h.-. '<. ~ ';::) ~ >-... h .~ ~ ~ \:j ~ .,~:: .-.J ~ ~ ~ .t .~ ~ lVI, " V f"'. ........... 't: ~ 'D ---J V1 ....... -J ~ ""- CJ .- - - - - - - - - .,.of "', I... \':' (.:. '. '. f') .,.., C) r'" .,00' r I ,'..\ ~! ~, ~.l.. ~~ ":..~ ~"~ jo',' ~. '~j ~.' x'' ~.:: ....-:-: ~... ~; .... *' >,;. .~ , COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SMITH CHARLES E JR 6034 WILLIAM DRIVE MECHANICSBURG, PA 17050-6851 ___n___ fold ESTATE INFORMATION: SSN: 119-20-5477 FILE NUMBER: 2101-0542 DECEDENT NAME: SMITH ROSE L DATE OF PAYMENT: OS/23/2002 POSTMARK DATE: OS/22/2002 COUNTY: CUMBERLAND DATE OF DEATH: OS/28/2001 NO. CD 001204 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $154.52 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHARLES E SMITH CHECK# 5093 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $154.52 MARY C. LEWIS REGISTER OF WILLS /~-~3 ?--3 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT 'v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 t CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG PA 17050 "LV 2/1 DATE ESTATE OF DATE OF DEATH FILE NUMBER COU~Y ACN 05-09-2002 SMITH 05-28-2001 21 01-0542 CUMBERLAND 101 Allount Rellitted L t~t '; *' REV-159S EX AFP <12-001 ROSE L 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, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ifiV"=is9-j-EX--AFP-fi'2:ooY-----.-.-iifHERYfANC-f-TA-i-RECORD-AD:.-uST;.ffNT--..-------------------------- --- ESTATE OF SMITH L FILE NO. 21 01-0542 ACN 101 ROSE ADJUSTMENT BASED ON: VALUE OF ESTATE: PROTEST BOARD DECISION 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 DEDUCTIONS AND EXEMPTIONS: .00 .00 .00 .00 22,628.04 53,276.20 49,912.65 (8) U) (2) (3) (4) (5) (6) (7) 9. Funeral Expenses/Adllinistrative Costs/ Miscellaneous Expenses (Schedule H) Debts/Mortgage Liabilities/Liens (Schedule I) Total Deductions Net Value of Tax Return Charitable/Governllental Bequests; Non-elected Net Value of Estate Subject to Tax (9) (10) 9,239.92 .00 (11) (12) (13) (14) 10. 11. 12. 13. 14. TAX: 15. Allount of Line 14 at Spousal rate 16. Allount of Line 14 taxable at Lineal/Class A rate 17. Allount of Line 14 at Sibling rate 18. Allount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: 9113 Trusts (Schedule J) .OOX 00 = 116.576.97X 045= .OOX 12 = .OOX 15 = (9) (5) (6) un (8) DATE 05-09-2002 125,816.89 9,239.92 116,576.97 .00 116,576.97 .00 5.245.96 .00 .00 5.245.97 I+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-11-2002 CDOO0744 .00 6,438.62 03-08-2002 REFUND .00 1,345.24- EREST IS CHARGED THROUGH 05-24-2002 TOTAL TAX CREDIT 5,093.38 THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 152.59 ERSE SIDE OF THIS FORM INTEREST AND PEN. 1.93 TOTAL DUE 154.52 INT AT REV . 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" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) PAYMENT: Detach the top portion of this Notice and submit with your pay.ent made payable to the na.e and address printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3). Applications are available at the Dffice of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, Phone (717) 787-6505. 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. INTEREST: Interest is charged beginning with first day of delinquency or nine (9) months and one (1) day froll the date of death to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% 1983 16% .000438 1993-1994 n 1984 11% .000301 1995-1998 9% 1985 13% .000356 1999 n 1986 10% .000274 2000 8% 1987 9% .000247 2001 9% 1988-1991 11% .000301 2002 6% .000247 .000192 .000247 .000192 .000219 .000247 .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax beco.es 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. BOARD OF APPEALS DEPT. 281021 HARRISBURG, PA 17128-1021 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE I COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG PA 17128-0601 CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG PA 17050 IN RE ESTATE OF: ROSE L SMITH DOCKET NO.: TAX TYPE: APPEAL TYPE FILE NUMBER: ACN: APPRAISEMENT: PETITION FILED: EXAMINER: MAILING DATE: DECISION AND ORDER 0208281 INHERITANCE PROTEST 2101-0542 101 02-26-02 04-1 0-02 LISA GARLAND DIAZ Direct Dial: (717) 772-3736 Fax: (717) 787-7270 Email: Idiaz@state.pa.us APR 3 0 aJD2 The Estate Representative agrees with the Commonwealth's Protest. Accordingly, it is hereby, Ordered that the Commonwealth's Protest is sustained. The Department is directed to issue an amended appraisement and assessment increasing the taxable value of Schedule F Item 5 to $9,781.66. FOR THE BOARD OF APPEALS 1P~ J A STATEMENT OF ACCOUNT WILL BE MAILED TO YOU BY THE BUREAU OF INDIVIDUAL TAXES. ANY APPEAL FROM THIS DECISION MUST BE FILED WITH THE ORPHANS' COURT WITHIN SIXTY (60) DAYS OF RECEIPT OF THIS DECISION. IF YOU REQUIRE THIS INFORMATION IN AN ALTERNATE FORMAT UNDER THE PROVISIONS OF AMERICANS WITH DISABILITIES ACT OF 1990, PLEASE CALL (717) 783-3664, OR FOR SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND SPEAKING NEEDS: 1-800-447-3020 (TT ONLY) Page. 1 of 1 \, / {.. c.:2 :,..-'J? -~"; BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * REY-1607 EX RFP '01-021 'O!~ ._iJL -1 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-24-2002 SMITH 05-28-2001 21 01-0542 CUMBERLAND 101 ROSE L CHARLES E SMITH JR 6034 WILLIAM DR MECHANICSBURG PA 17~~o, Allount Rellitted 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, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV: i6'ifj-Ex--AFP--foY=o'2Y------...-fNifERITANCE--TAX--SY]ffEME-NT-'ifF'-Ac-co[jtff--.-i.---------------- - - --- ESTATE OF SMITH ROSE L FILE NO. 21 01-0542 ACN 101 DATE 06-24-2002 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: 05-08-2002 PRINCIPAL TAX DUE: .mmmmmmmmmmmm 5,245.97 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-11-2002 CDOO0744 .00 6,438.62 03-08-2002 REFUND .00 1,345.24- 05-22-2002 CDOO1204 1. 88- 154.52 TOTAL TAX CREDIT 5,246.02 BALANCE OF TAX DUE .05CR INTEREST AND PEN. .00 It IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .OSCR 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. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. If RESIDENT DECEDENT make check or 1I0ney order payable to: REGISTER OF WILLS, AGENT. If NON-RESIDENT DECEDENT lIake check or money order payable to: C0l1110NWEAL TH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by cOllpleting 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 froll the Department's 24-hour answering service for forlls ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessllent Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. 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 cOllputed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which becalle delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which becalle 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 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 n .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 n .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER 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 cOllputation date shown on the Notice, additional interest must be calculated. , (Y / STATUS REPORT UNDER RULE 6.12 Name of Decedent: rf? () >' E ,J-. S M 17+1 Date of Death: ~? M Ity d:J OC) / Will No. ;;) / - 0 J . 0 & ~ Y c;l Admin. No. ..;)(!)e;j-Of9S':}::J 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 complete: Yes X No 2. If the answer is No, state when the personal 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 r~presentative file a final account with the Court? Ye~ No ~ . 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 d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: f/Jo/(j~ , -' C:~ ?Y. ~ l-r. . Signature ~ Qtflffh t:~ /c- S N /rt! V R . Name (Please type or ~rint) (, 0 ~ c.;. LV J L.LIIt+1 P/PIVt:= N l::otfrtNlcsBoRfJ"'" fA /?()S'o~t3S/ Address (7/'7) '16~-9.5'J3 Tel. No. Capacity: )( Personal Representative Counsel for personal representative (MAH:rmf/AM3) . 10 :s: el ... '" Ie ~~!c: ~-t lll....lTl :Ill .... III 1ft I S en ...,. I" !~;c: Ir- ~~~o 10 1ft 3 o-n .. e.r" 1'1 1% .. ... \G') rn o:t: -0 ........ -4 n va" ~ ~~ I 0 ::E:&',o ... l-t ,. r- ..... el.... \x ... ... ...c =' :z:~rn N ~~ I.... III 1-11-1 III "" \en c: nr- I ~c: Cl ~ lIlr-rn '" 0" Ir- ID Cl :Z:.- ~.... =1-1 ... 'tI c:,.1Il -4 1% ~ ,033 ~ \'" 0 'tI G) 1-1 ! ID c-l 1ft ~ ,o::E: 1/1 Cl c... ~ ID "'tl ,0 , Co . - ,. ... ... ..... ... -...I 0 0 " IC '" '" ~ 0 -t ,. ~ .... 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