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HomeMy WebLinkAbout01-0574 Estate of =(' p '1' J also known as PETITION FOR PROBATE and GRANT OF LETTERS #} 1:;/~c.Jc!, Qr No. d.-l-O I -5'"11 To: Register of ~ills for the /J. , Deceased. County of Lo;nbl:'r-/o~ in the Social Security No. eX 0 -? - ~ '7 - _ <: / 5j/ Commonwealth of Pennsylvama The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executR Z k in the last will of the above decedent, dated :Tv 17 I B ( 19 B '" and codicil(s) dated njijped , 19~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in L vn7 her /q ....,/ County, PeQnsylvania, with h rS last family or principal residence at .~i/ ~ m;:;;:-o~ l'" ~"'/,;...J te- /11,.cL, P. /'" ~ ~L ~ { '<;7"'" , (list street, number and muncipality) V' Decendent then ~ 1M P ~ , -~.2(!:1c/ , at Except as follows, deced t 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: 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: . ,... / 'e pf"f: -F, -r-. $ y~. 00 $ $ ,o~ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters -t~ $....... _ ~ ~ ,.to;.... y ., ,(testamentary/administration c. La.; administration d. b.n.c.La.) theron. {g/~1 11-136. f{od<~,- D.-/I/__ 9~P~ , ~ '" u t: '" ~~ ~~ "'.... 1:>::'" t: -00 1:''= cd';:: 3~ '" '- 50 (is t: OIl Cii JZ,. n ~ r) r /...1. ~ II ~ 4 R" I?'~/t' OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSY~ANIA I ss COUNTY OF ~u M hp~ J-.4A/ . J The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well an truly administer the estate according to law. .r Register REGISTER OF WILLS Vl oQ' ::t I::l ..... ;::: ~ ~ No. 21-2001-5-74 Estate of FLOYD W. PACKER , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JUNE 19 th ~2 0 01, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated July 18 th, 1985 described therein be admitted to probate and filed of record as the last will of FLOYD W. PACKER and Letters TESTAMENTARY are hereby granted to JUNE D. KALINA. FEES Probate, Letters, Etc. .C c;A$!-I.l $ 25.00 Short Certificates( U . . . . . . . . .. $ 3 . 00 Renunciation ................ $ x-Pages (2) $ 6.00 JCP TOTAL _ $ 5 . 00 Filed . .JUNE .1.9th. 200.1..$.39..00. . AITORNEY (Sup. Ct. 1.0. No.) ADDRESS PHONE MAILED LETTERS AND ORDER TO EXECUTRIX uJ~ LEWI~ liu is to certit}, that the information here giver? is correcrly copi:d fro~ an original certificate of death dul~ tiled with I R '1'h,' ()riginal certificate will be forwarded to the State 'v Ital Records Office for permanent fillt1g. h;, ('gist rar. ~ me as WARNING: It is illegal to duplicate this copy by photostat or photograph. Fcc !1H rillS certificatc', $2.()() /~I/,Ii;lim;';;;;;.;;~ \\IIlit~\}"-_,~E! El-~~~. ,i'#/ ~..J::"'% .~'~I ""~\~';. lf~/ .~ - '\~% \~S\, ,{ii. i;;~ ','" - , _"'. ' x \"%.*~">'i*l \\ ~" /~~/ '(.", ~L>'''- ~/<..'f: .'' ~-_7ijI1;-'---- ~ ~"\, "" -----_ ,,, EN1 \\ """ ''''''''I#II,/#J P 7429776 N". 21-2001-574 ~ftZ~ LOlal Registrar JUN u ~ 20m Date 4J Rev. 2187 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECOROS CERTIFICATE OF DEATH NAME OF DECEDENT (FI'.. Maddie. lilll LFloyd W. Packer AGE Il... -Yl UNDER 1 YEAR -... Doyo SEX 2. Male UNDER , 0"" Hourw ! M~ P1..ACE OJ' DEATH (Cf\edI aNy 1)(\41 .... Itl",uct.oos on other ~ HOSPITAl., _~ E~ionIO :="Yl0 85 v.. COUNTY OF DEArH Dauphin DECEDENT'S USUAl OCCUMnOH ~_a1.:!':. "= ':::'.i:'l' wa~ouseman DECEDENT'S EOUCRION ~ lllJ'3f '2. STAlE FilE NUMBER SOCiAl SECURITY NUM8ER ..207 - 07 CoIogo (l."cw~...) ...... 1WlITAI. swus._ _.........w_ oo-cod (Spoc"Yl Divorced '7..IKI....__1n RACE'__._.-'.OIC:. 1~1 White SURVMNO SPOUSE tl..... QIW fNIdM,.... 245 Marlett Drive ,..Mechanicsburg, PA 17050 FAJHER'S NAME (Fir". MtdcIe. La..) 'I- Harr Packer 1Nf0000000'S NAME (TYJ*l'rinl) June Kalina METItOOOI' ION O - ~ c,..- 0 -.......51...0 ~ 0dI0r~1 I'.. Old - Min. Cumber land ........' 17..0 :...-=:=.. IotOTHER'S_ (f...._. _s........1 ~ Vivian Ruth Ensmin er 1NF000000T'S MAIUNO AOORESS{Slr...~. _. zc>"- 6141 Hocker Road Harrisbur PA 17111 I'lACI 01' 0tSI'0SlTI0H. _a1c-.v. c,_ lOCRlON. ~ _. ZIp otOdlor_ I~. 2001 2~t. L OFFlMW1Al~La _:r.J.c only wIlen....ilyWlg ~~ ill noI avaMbIe at bmlI of de.aftao --iiii.-ly-"_. .=_24-2I_bo_odby -=-'PMlDft.no ptOnOl.aneM dNth. ~-- dr/I MlUXATII CAUSe IFIW\al ~OIconc1ition _.-..IIing 11\ dMIl)--. cA /L(}( ifC OJ"c DUE 10 lOA ~ A CONSEOUfNCE Of): <l OUE 10 lOR ~ A CONSEOUfNCE llf), .. ...s t ~ld"N -=~..- . -.--.-- =:,*-, EnIer UNDUIlY1NQ ~__to.-"'_. l c ........... inlIIIed ~ ~...'-*'lI.._,lAST d. ';"WOSANAUlOPSV WEREAUlllPSYFINOINGS SPEAFOAMED? ~~~SE -= OF OERH' DUE 10 lOA ~ A CONSEOUENCE llf), ~ .ji UANHER Of' DEATH ........ ~ HomiCide 0 -.. "-_ion 0 - 0 Coukt noI M dM.fInlned 0 DATE OF INJURV t-. 00.._1 ... 0 No~ .....0 NoD - Olivet Cemetery PA 17070 NAUEAHIlAOORESSOFFIICllITY 1 0 .:tone&Murra FH408 3rd St New Cumberland PA lICENSE NUMBER DATE SIGNED _.llay.-I . . woe CASE REFERRED TO MEOICAl EXAMINERICOIIONEII' .....0 NoIB 21- I AppIoUMt. I iIUtWI between : 0AMt and dHth I I I PART H: 0dI0r",-_~__.", noI ~ in 1M ~ceuM QiYen in PNIT I. TIME Of' INJURY INJURV R WORK? DESCRIBE HOW INJUIlY OCClJRRED. Yoo 0 NoD II. II. PlACE OF INJURY. AI home. fafm. IUHI. tKtoty, omc. -.- Ole ,Spoc.Iv\ _. lOCATlONlSO'_~. s-. __ JIlL C81r....,~ only onoI -C8ITPYWG PHYIICIAN (Ph'f$lCloln <:"""''''9 cauM ~ dNIh whert anoIhftf ph'w'SIC.art hils plOI1OunC4ICI oed'\ ana COf'l'lt*l8d Item 231 Te............,know...........occuned..........c.uH(...ndm.nNf...............'............. ._.............................. ~ a -PfI()IlIC)tMtCINQ AND CUlITtFVING JlHYSK:tAH &Phvscan boIh jlI'OOOl.IOC,ng ae..".oo cef\ltylnQ 10 cause of de_I ~ To....bMI...y~......occurtecl..........date, anclpf.u, MdduetobUUM(.).ndm.nna'.....Ied.......................... ..iiiOi .::... ~==OIln.e"Ig"Ion, In my opinion, cle..h oc:CU,," ., u.ellm., de'e, .nd pia.., ond due 10 ,he .euOOC.'.nd manner.....'.......................................................................................,............ . .... -A-- --1... REGISTRAR'SSlGNATUREANDNUII8ER ~ ~ l'2jl I~I .II /2./-<./)/-6'71 LAST WILL OF FLOYD W. PACKER i; ,I il I, FLOYD W. PACKER, of the Borough of Mechanicsburg, County of !Cumberland, State of Pennsylvania, being in good bodily health and of sound ,I il and disposing mind and memory, and not acting under duress, menace, fraud or i ~ :i I undue influence of any person whomsoever, merely calling to mind the frailty lof human life, and being desirous of disposing of MY worldly goods while I have :1 !! the strength and capacity so to do, I do make, publish and declare this my i !I LAST WILL AND TESTAMHlNT. I hereby revoke, cancel and annul all my former !I 'I ilWillS and Testaments, including codicils thereto, by me at any time made, 'I :1 and declare this alone to be my LAST WILL AND TESTAMENT. I '! AS TO SUCH ESTATE AS IT HAS PLEASED GOD TO ENTRUST ME WITH IN THIS 1 I : LIFE, I DISPOSE OF THE SAME AS FOLLOWS, VIZ: ITEM 1. I direct that my executors hereinafter named pay and idischarge all of my just debts, funeral and testamentary expenses. ITEM 2. I direct that my bodily remains be buried in a lot which I 10wn, situate at the Mt. Olivet Cemetary, New Cumberland, Pennsylvania. 1 Ibequeath, absolutely i ~er stirpes. ,i 'i ~ ITEM 4. i~ Last Will. \1 ,I ,I 'I II I nominate and appoint JUNE D. KALINA as Executrix of this , i I , I JAMES M. BACH i ATTORNEY AND I COUNSELOR AT LAW i 352. 5. SPORTING HIL.L ROI' MECHANICSBURG, PENNA. 17055 TEL. (717) 737.2033 I I !!:J! ::;juh I I II - :i II ~ i Ii ii !I Ji 'i ITEM 5. I direct that my personal representatives, as well as : their successors, shall not be required to give bond for the faithful ! !! !performance of their duties in any jurisdiction. ITEM 6. I grant to my personal representatives herein named, in :iaddition to, but not in limitation of those powers vested by law, to be \j Ii exercised without prior application to or approval of any court, the power il I :! and authority to retain indefinitely any property, to invest and reinvest any q II ~ssets or the proceeds from the sale of assets, although said investments ilmay not be of the character prescribed by law, to sell, convey, assign, I; , ii transfer and encumber any property, to pay, settle or compromise all claims, ,i to make distribution or divisions in cash or in kind, and in general to i !exercise all powers in the management of any property hereunder which any individual could exercise in the management of similar property owned in his ;own right, and to execute and deliver any and all instruments and to do all :acts which may be deemed necessary and proper. I ! " I I I I d I 'I 'I ,I !I !I I I ! Ltt~~ i I II II JAMES M. BACH II I ATTORNEY AND COUNSELOR AT LAW 352 S. SPORTING HILL RD MECHANICSBURG. PENNA. 17055 TEL. (717) 737.2.033 1\ .T.umII H. BACH ATTORNEY AND COUHSnO'R AT LAW 107 aT. JONN'S CMUllCM MI. SUITI: ":1 CAM~ HILL. "'A. 1'70ft n:L. (717) 737-:1033 , ~ I' COMMONWEALTH OF PENNSYL V AN I A) i .. ) I! COUNTY OF CUMBERLAND ) I I I ------ -- ---.. ----------,--:-,c-;-'~.,"':~?MHiY.:,. ',j;~~: s~ I, FLOY!) W. PACKER Testator, whose name Is sIgned to the attached or foregoing Instrument, havIng been duly qualIfied according to law, do hereby acknowledge that I signed and executed the Instrument as my Last WII I; that I signed It willingly; and that I signed It as my free and voluntary act for the purpose therein expressed. Sworn or affIrmed to and acknowledged before me, by FLOYD W . PACKER the Testator, this ! R day of .:{uly , 1985. SONORA L. JON~ON. N'll"y r'uh\:c , Mv Co,nrnission Exc:"cs r ch ~ 7 1 ?&~ \~ec!1an;csburg (Hampden Twp), Pa. () d ,-,j",,,...~ y v.-. , /1 Notary Pub II c My Comm I ss Ion Exp i res ~ 2/27/89 f v !.- \'- ../ 1. -~-.. ~'-- The preceding Instrument consIsting of this and one (1) other typewritten page, Identified by the signature of the Testator, was on the date thereof signed, published and declared by FLOYD W. PACKER ,the Testator therein named as and for his Last WII I and Testament, In our presence of each other, have hereunto subscribed our names as witness. (~~ tl I (1~~ ;1/' ---1- .W~ ., ._-- I \ 11 I I I A~~? ResIdIng at 352 South Sporting Hill Road Mechanicsburg, =PA IV055 :1 .J, ," l;,~ ResIdfng at 214 South Sporting Hill Road Mechanic sburg , PA 17055 -A F F lLA.JI--LI COMMONWEALTH OF PENNSYLVANIA) ) ) 5S COUNTY OF CUMBERLAND We, James M. Bach and Christine M. Forti , the wit- nesses whose names are signed to the attached or foregoing Instrument, being duly qualified according to law, do depose and say that we were presen~ arid.: saw Testator sign and execute the instrument as his Last WII I; that he signed willingly and that he executed It as his free and voluntary act for the pli~:' pose therln expressed; that each of us In the hearing and sight of the Testa:- ator signed the wll I as witnesses; and that to the best of our knowledgetti~ Testator was at that time 18 or more years of age, of sound mind and uria~~:n~' constraint or undue Influence. :.:'.\r)'", Sworn or affirmed to and subscribed to before me by James M. Bach , \ r~ I t >,'1' .:l 1 + and jIhristine M. Forti '\ I ,I' . f. . , witnesses, this day of July . -, 19 85. . ,~ SONORA l. JONSON,. Noti~ry ~ubliC f'1 My Commission Exrllrcs Feb. 2L 19 (' Mechanicsburg (Hampden Twp), P~. . ; j , 'vL-d- ...."0... ,...., Notary Pub I I c nq"\Vj 1/ ~ '. My CommIssIon Expires: 2/27/89 of!" E: -- CERTIFCATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: r )"'f) 't J w Date of Death: V / (p /0 I P\\ hire fJO Will No.: ~ 1-0 I ....057'1 P ftc'"____K'e12, 55 ;}..o7-o7-~/S-( ft L-e fJo Admin No.: J. 0 C/ I ~ () c) ,~'1 Lf 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 cP/;rq/tJl : . Name Address XJ N -e.. ---p )(4 ,LIN 4-- &, / Y / HcJ cf'-eL 06{ t V "- II.6G 1# /)/ 1/ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except ,---- Date: !li.do ! ~~p~~ Si ature L J;; A}~ ]) b /--/~ /J- Name (p( tr/ Address No C K-P;2 'vA \ lie /#6 /d- /7/ r/ 7/7 -Sz;,/7t:: {7 (0 Telephone Capacity: ~ Personal Representative D Counsel for personal representative REV-1S00EX+(6-00j '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W (J W C W I- ::r.::~cn ,,"''' w~CJ ::1:,,9 "0.'" 0. '" z o i= <( ...J :J l- ii: <( (J W II:: z o i= ~ :J Q. ::!: o (J >< <( I- DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) PACKER, FLOYD W. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 06/06/2001 11/13/1915 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [R] 1. Original Return D 4. Limited Estate [R] 6. Decedent Died Testate (AlIach copy 01 Will) D g, litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date 01 death after 12-12-82) D 7. Decedent Maintained a living Trust (Attach copy ofTrust) o 10. Spousal Poverty Credit (dateofdealh between 12-31-91 and 1-1-95) I- Z W C Z C 0. Ul W '" '" o " THI$:$e~tION'MtJS'l':l!ll!J NAME CHARLES E. PETRIE FIRM NAME (If Applicable) I!lJ!iIiEiilHiALE~ ""~Ii~li!lil\filil',' .:I!IllitI' T'llll ; r Ii , COMPLETE MAILING ADDRESS 3528 BRISBAN STREET TELEPHONE NUMBER 717 561-1939 HARRISBURG 1, Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested (1) (2) (3) (4) (5) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent. Mortgage liabilities, & liens (Schedule I) (10) 11. Total Deductions (total lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election 10 tax has not been made (ScheduleJ) 14. Net Value Subject10 Tax (Line 12 minus Une 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X 0_(15) 73,329.62 X .045 (16) X .12 (17) X .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 110 _ 2F;Al1:'~ FilE NUMBER 2 -01 0574 Cl5UN'TY"COOE ---YEA~ - - "NUi:lBER-- c SOCIAL SECURITY NUMBER 207-07-5154 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 03. Remainder Return (dateofdeath prior to 12-13-82) o 5. Federal Estate Tax Return Required .2.... 8. Total Number of Safe Deposit Boxes o 11. Election 10 tax under Sec. 9113(A) {Attach SchO) PA 17111 OFFICIAL USE ONLY :0 (!) r: 80,512.87 7,183.25 73,329.62 73,329.62 3,299.83 3,299.83 Decedent's Complete ress: STREET AIlDRESS 245 MARLETT DRIVE CITY MECHANICSBURG I STATE PA I ZIP 17050 Add Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3,299.83 Total Credits (A + B + C) (2) 3. interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + E) (3) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) A. Enter the Interest on the tax due. (5A) B. Enter the total at Une 5 + 5A. This is the BALANCE DUE. (5B) Make Check to: REGISTER OF WILLS, AGENT 3,299.83 3,299.83 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ". ........................ ............................................... 0 [2g b retain the right to designate who shalt use the property transferred or its income; ............................... ........ D IZJ c retain a reversionary interest; or .............. ................. .............................. n. 0 ~ d. receive the promise for life of either payments, benefits or care? ......... ... .................. ..................... 0 [2S] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............. .... .................. ............................ ........................... 0 [2Q 3. Did decedent own an 'in trust for" or payabie upon death bank account orsecurity at his or her death? . ............... D ~ 4 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .... .................. ....................... ......................... ....... D ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare thai I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of pre parer oth han the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PE N RESPONS ~ ~~:N.- _ DATE ~y- - 1/22/02 61 HOCKER DRIVE H RRISBURG SIGNATURE OF PRE~~E~ER TH~EPRES~TIVE ~ c.A-"-L-;:/' ADDRESS 3528 BRISBAN STREET HARRISBURG ADDRESS PA 17111 DATE 1/22/02 PA 17111 """i!:;;1L,i ""'''''' ,""',,'" For dates of death on or after Juiy 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 PS. ~9116 la) (1.1) Iii] For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the chiid is 0% [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(111. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508EX+11-97J~_ . .~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF PACKER FLOYD W FILE NUMBER 21 01 0574 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 29 UNITED STATES SAVINGS BONDS 2,855.14 2. 1973 DETROITER MOBILE HOME 4,500.00 3. PATRIOT-NEWS REFUND 46.40 4. VERIZON REFUND 10.65 5 COM CAST REFUND 30.38 6. HOMETRENDS REFUND 70.40 7. TV GUIDE REFUND 27.45 8. STATE FARM INSURANCE REFUND 56.75 9. INCOME TAX REFUND 300.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets ot the same size) 7,897.17 REV-1509EX+11-g7)~_ . .~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF PACKER FLOYD W FILE NUMBER 21 01 0574 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. JUNE D. KALINA 6141 HOCKER DRIVE HARRISBURG, PA 17111 B c JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1- A 6/95 CERTIFICATE OF DEPOSIT AT FIRST UNION 7,037.79 50. 3,518.90 2. A. 6/95 CERTIFICATE OF DEPOSIT AT FIRST UNION 7,243.73 50. 3,621.87 3. A.. 11/93 CERTIFICATE OF DEPOSIT AT PNC BANK 4,004.21 50. 2,002.11 4. A. 4/99 CERTIFICATE OF DEPOSIT AT PNC BANK 6,629.08 50. 3,314.54 5. A. 3/95 CERTIFICATE OF DEPOSIT AT PNC BANK 10,743.59 50. 5,371.80 6. A. 6/66 SAVINGS ACCOUNT AT MEMBERS FIRST FCU 11,146.98 50. 5,573.49 7. A. 12/94 CERTIFICATE OF DEPOSIT AT MEMBERS FIRST FCU 6,175.70 50. 3,087.85 8. A. 12/94 CERTIFICATE OF DEPOSIT AT MEMBERS FIRST FCU 14,470.39 50. 7,235.20 9. A. 1/95 CERTIFICATE OF DEPOSIT AT MEMBERS FIRST FCU 10,976.83 50. 5,488.42 10. A. 3/99 CERTIFICATE OF DEPOSIT AT ALLFIRST FINANCIAL 11,056.54 50. 5,528.27 TOTAL (Also enter on line 6, Recapitulation) $ 72,615.70 (if more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent PACKER, FLOYD w. 21 01 0574 Paqe 1 Schedule F-2 - Jointly-Owned Property LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed forjoinUy-held real estate. VALUE OF ASSET INTEREST DECEDENfSINTEREST 11. A 1/99 CERTIFICATE OF DEPOSIT AT ALLFIRST FINANCIAL 10,182.24 50. 5,091.12 12. A 5/71 CHECKING ACCOUNT AT ALLFIRST FINANCIAL 3,884.28 50. 1,942.14 13. A 6/97 CERTIFICATE OF DEPOSIT AT WAYPOINT BANK 7,272.15 50. 3,636.08 14. A 11/97 CERTIFICATE OF DEPOSIT AT WAYPOINT BANK 3,60358 50. 1,801.79 15. A 5/98 CERTIFICATE OF DEPOSIT AT MEMBERS FIRST FCU 30,804.24 50. 15,402.12 SUBTOTAL SCHEDULE f.2 27,873.25 GRAND TOTAL SCHEDULE f.2 $ 72,615.70 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 01-0574 01148287 10-16-2001 REY-1545 EKAFP tD9-0DI EST. OF FLOYD W PACKER 5.5. NO. 207-07-5154 DATE OF DEATH 06-06-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS D CHECKING o TRUST IX] CERTIF. PA 17111 REHIT PAYHENT AND FDRHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 JUNE 6141 HBG D KALINA HOCKER DR AllFIRST FINANCIAL SERVICE has providad tha Department with tha information listed below which has baen used in celculating the potential tax due. Their records indicate that at the daath of the above dacedant~ YOU were a joint owner/baneficiary of this account. If you faBI this Information is incorrect~ pleasa obtain written corraction fro. the financial institution~ attach a copy to this for. and return it to the above address. This account is taxable in accordance with tha Inheritance Tax Laws of the Co..onwaalth Qf P&fins~lvania. Qu&stions aa~ b~ answar~d by oalling (711l 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR Account No. 80000002174086 Oat. 01-19-1999 Established FILING AND PAYMENT INSTRUCTIONS Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 10,182.24 50.000 5,091.12 .15 763.67 To insure proper cradit to your account~ two (Zl copies of this notice .ust acco.pany your pay.ent to the Register of Wills. Make check payable to: "Ragister of Wills~ Agent". x NOTE: If tax paYMents are made within three (3l months of the decadent's date of death~ you may deduct a 5~ discount of the tax due. Any inharitance tax due will beCOMe delinquent nine (9l months after the data of death. PART TAXPAYER RESPONSE [!]li!i!i!~~!~~.iiii.!i!._!iiir.\~~~~!~~.~i~i~li!!i.l!i.~~~.ii!i!~.I!!!II._!i!!.'!!!!.!!!i~~~lii~.~~IJ A. 0 The above information and tax due is correct. 1. You May choosa to reMit paYMant to the Register of Wills with two copies of this notice to obtain a discount or avoid interest~ or YOU May check box "AD and return this notice to the Registar of Wills and an official assessment will be issued by tha PA Department of Ravenue. [CHECK ] ONE BLOCK ONLY B. D The above asset has been or will ba reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the dacedent's representative. C. 0 The abova inforlllation is incorrect and/or dabts and deductions ware paid by YOU. You Must cOllpleta PART 0 and/or PART ~ below. PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate~ please state your r.latlonship to decedent: PART @] TAX RETURN - COMPUTATION lINE 1. Date Established 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 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on line 5 of Tax Co~utation) I $ Under penalties of perjury~ I declare that the facts I have reported above are true~ correct and co~lete to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with appliCable interest based on inforlllation sub.itted by the financial institution. Z. Inhedtance tax becomas delinqusnt nine .ooths after the decadent's date of death. 3. A joint account Is taxable evsn though the decedent.s name was added as a matter of convenience. 4. Accounts (including those held between husband and wifs) which the decedent put in joint nallles within one year prior to death arB fully taxable as transfers. 5. Accounts Bstablished jointly betwBen husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent din trost for'" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claldBd, place an "X" in block nAn of Part 1 of the nlaxpaYer Re$ponsen section. Sign two copies and submit the. with your check for the aMount of tax to thB Register of Wills of the county indicated. ThB PA Department of RevBnue will issue an official assess.ent (Farm REV-1548 EX) upon receipt of the return fro. the Register of wills. 2. BLOCK B - If the asset specified an this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent"s representative, place an "X" in block nB" of Part 1 of the "Taxpayer Response" section. Sign one COpy and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If tha notice infor.ation is incorrect and/or deductions are being clai.ed, check black "e" and cOllplete Parts 2 and 3 according to tha instructions below. Sign two copies and submit them with your check far thB a.ount of tax payable to the Register of Wills of the county indicated. The PA DepartMent of Revenue will issue an official asses~ent (For. REV-1548 EX) upon r&ceipt of the return frod the Register of Wills. TAX RETURN - PART z - TAX COMPUTATION LINE 1. Enter NOTE: the date the account originallY was established or titled in the .anner existing at date of dBath. For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) Year of death are taxable fully as transfars. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (..) appears before your first naMe in the address portion of this notice, the $3,000 exclusion already has been deductBd from the account balence as reported by the financial institution. 2. Entar the total balance of the account inclUding intarBst accrued to the date of death. 3. The percent of the account that is taxabla for each survIvor is determined as follows: A. The parcent taxable for joint assets astablished .orB than one yaar prior to the dacedant.s daath: 1 DIVIDED BY TOTAL NUMBER OF JOINT OWNERS ExaMpl.: A joint asset registerad DIVIDED BY TOTAL NUMBER OF X lOB = PERCENT TAXABLE SURVIVING JOINT OWNERS in the na~a of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7~ (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for 8ssats creatad within one year of the decedent's death or accounts owned by the decedent but held in trust far anothar individual{s) (trust beneficiarias); 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X laa PERCENT TAXABLE Exa.ple: Joint account registered the decQdant. 1 DIVIDED BY 2 (SURVIVORS) = .50 in the name of tha decBdant and two other persons and established within one year of death by X 100 sox (TAXABLE FOR EACH SURVIVOR) 4. The a.ount subject to tax Uine 4) is deterMined by lIUltiplying the account balance (line 2) by the percant taxable nine 3l. S. Enter the total of the debts and deductions listed in Part 3. 6. The 8110unt taxable (line 6) is deter.ined by subtracting thlil debts and deductions (line 5) frolll the BIIOUnt subjltCt to tax Ulne 4l. 7. Enter the appropriate tax rate (line 7) as deter.ined below. D.t. of De.th Spouse Lineal Sibling Coll.teral 07/81/9<i to 12/31/94 3Y. 6% 157. 157. 01/81/95 to 06/30/00 07. 6% 157. 157. 07/0l/00 io p....sent 07. 4.5%_ 127. 157. MThe ta~ rate 1.posad on the not valua Of transters troe a decaaselJ Chl1d-twenty-one years of age 0' y oUngBr lit death to or for the use of a natural parent, an adoptive parent, or a stepparent of" the child is ai:. The linaal class of heirs includas grandparents, parents, children, and lineal descendBnts. "Children" includes natural children whether or not they have been adopted by others, adOpted children and step chjl~ren. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents Bnd their dascendants and step-descendants. nSiblings" are defined as individuals who have at least ana parent in co.~on with the decedent, whether by blood or adoption. The "Collateraln class of hBirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined BS follows: A. You legally are responsible for paYMent, or the estate subject to ad.inistration b~ a personal reprBsentative is insufficient to pay the deductible ite.s. B. You actually paid the debts .fter death of the decedent and can furnish proof of pay.ent. C. Debts beinu claimed .ust be It8llized fUlly in Part 3. If additional space is needed, use plain paper 8 l/zn x II". Proof of paYMent May be requested by the PA Departeent of Ravenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEJIr. 280601 HARRISBURG~ PA 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0574 01140631 09-06-2001 REV-1SUEX AFP (09-00> EST. OF FLOYD W PACKER 5.5. NO. 207-07-5154 DATE OF DEATH 06-06-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT IX] SAVINGS o CNECKING o TRUST o CERTIF. PA 17111 REHIT PAYHENT AND FORKS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 JUNE 6141 HBG D KALINA HOCKER DR "E"BERS 1ST FCU has provided the Depart.ent with the inforllation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the,above decedent~ you were a joint owner/beneficiary of this account. If YOU feel this infor.ation is incorrect~ please obtain written correction from the financial institution~ attach a copy to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of ~ennsylvania. Questions lIay be answered by calling (717) 787-8527. COMPLETE PART 1 BELOW Account No. 8582-00 I( I( I( SEE Date Established REVERSE SIDE FOR 06-13-1966 FILING AND PAYMENT INSTRUCTIONS Account Balance Percent Taxable Amount Subjact to Tax Tax Rate Potential Tax Due x 11,146.98 50.000 5,573.49 .045 250.81 To insure proper credit to your account~ two (2) copies of this notice .ust aCCOlIPany your paYllent to the Register of Wills. Make check payable to: "Register of Wills~ Agent". x NOTE: If tax pay.ents are made within three (3) lIonths of the decedent's date of death~ you ~y deduct a ~ discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE [!]Jii~il~~~.li~~!ili~!!!II~~~~ili"~!'I!!~IIII!g!r,.~I~g:1::I~glll!.:~:~!.:!!~!!II.l!:I'~II:I!.~.11 A. 0 The above inforlllation and tax due is correct. 1. You .ay choose to re.it paYllent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Depart.ent of Revenue. [CHECK ] ONE BLOCK ONLY 8. 0 The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. 0 The above infor..ation is incorrect and/or debts and deductions were paid by you. You must co.plete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART !!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART I3J TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax S. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 4 5 6 7 8 x x PAYEE DESCRIPTION AMOUNT PAID , $ I TOTAL (Enter on Line 5 of Tax COMputation) Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of .y knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. z. Inheritance tax beco.es delinquent nine months after the decedent's date of death. 3. A joint account is taxable eYBn though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-IS48 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent.s representative, place an -X" in block ns" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C _ If the notice infor.ation is incorrect and/or deductions are being clai.ed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and sub.it the. with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessment (Form REV-1S48 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the date the account originally was established or titled in the manner existing at date of death. For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (..) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent.s death: 1 DIVIDED BV TOTAL NUMBER OF JOINT OWNERS Example: A joint asset registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) ~ .167 X 100 16.7Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent.s death or accounts owned by the decedent but held in trust for another individual(s} (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) z .50 X 100 = SOZ (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by mUltiplying the account balance (line 2) by the percent taxable (line 3). S. Enter the total of the debts and deductions listed in Part 3. 6. The aMount taxable (line 6) is determined by SUbtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 07.. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. wChildrenw includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendentsR includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse lineal Sibling Collateral 07/01/94 to 12131/94 3r. 6r. 15r. 15r. 01/01/95 to 06/30/00 Or. 6r. 15% 15% 07/01100 to present Or. 4.5%* 12r. 15r. _The tax rate J..posed on tne net value of transfers fro. a deceased chJ.ld twenty-one years of age 0' Y ounger at CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed IIUst be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/2w x 11". Proof of payment may be requested by the PA Department of Revenue. COHMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUR~U OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0574 01140629 09-06-2001 REV-l&45 EX .FI' (09-0U TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST !Xl CERTIF. TO: EST. OF FLOYD W PACKER S.S. NO. 207-07-5154 DATE OF DEATH 06-06-2001 COUNTY CUMBERLAND PA 17111 REHIT PAYHENT AND FORHS REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 JUNE 6141 HBG D KALINA HOCKER DR MEMBERS 1ST Feu has provided the Deparbllnt with the infor.ation listed below which has been used in calculating the potential tax due. Their records indicatll 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.llonwealth of Pennsylvania. Questions lIay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8582-44 Data 12-01-1994 Established To insure proper credit to your account, two (2) copies of this notice .ust acco.pany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Account Balance 6 , 175 . 7 0 Percent Taxable X 50.000 Amount Subject to Tax 3,087.85 Tax Rata X .045 Potential Tax Due 138.95 PART TAXPAYER RESPONSE [!].Q~.::il.il!~li~I~~~I~li~.~lil!'llllil.lili.~~~gillll~gl!II~."~!I..~!I.llllm~III~.~.l!I NOTE: If tax pay.ents are .ads within three (3) .onths of the decedent's date of death, YOU lIay deduct a 5X discount of the tax due. Any inheritance tax due will bec~e delinquent nine (9) 1I0nths after the date of death. [CHECK ] ONE BLOCK ONLY A. 0 The above inforllation and tax due is correct. 1. You .ay choose to r~it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or YOU ~y check box "A" and return this notice to the Register of Wills and an official assesSllent will be issued by the PA Depart.ent of Revenue. B. [J The above asset has been or will be reported and tax paid with ths Pennsylvania Inheritance Tax return to be filed by the decedent"s representativs. C. [J The above infor.ation is incorrect and/or debts and deductions were paid by you. You .ust co.plete PART ~ and/or PART ~ below. PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION lINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax S. Debts and Deductions 6. Anount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 X TAX ON JOINT/TRUST ACCOUNTS X PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on line S of Tax Comput.tion) Under penalties of perjury, I declare that the facts I have reported above are true, correct and COMplete to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information sub.itted by the financial institution. Z. Inheritance tax b8c~es delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's na.e was added as a .atter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint na.es within ona year prior to death are fully taxable as transfers. 5. Accounts established jointlY between husband and wife ~r8 than one year prior to death are not taxable. 6. Accounts held by a decedent ftin trust forft another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the infor.ation and co.putation in the notice are correct and deductions are not being claiMed, place an WXft in block WAft of Part 1 of the WTaxpayer Responsew section. Sign two copies and subMit the. with your check for the ~ount of tax to the Register of Wills of the county indicated. The PA DepartMent of Revenue will issue an official assesslllent (For. REV-1548 EX) upon receipt of the return frOM the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent.s representative, place an nxft in block WBw of Part 1 of the nTaxpayer Responseft section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice infor.ation is incorrect andlor deductions are being clai~d, check block ncw and co.plete Parts 2 and 3 according to the instructions below. Sign two copies and sub.it theM with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessaent (Form REV-1548 EX) upon receipt of the return frOM the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION lINE 1. Enter NOTE: the date the account originallY was established or titled in the .anner existing at date of death. For a decedent dying after 12/12182: Accounts which the decedent put in joint nallles within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the nUMber of accounts held. If a double asterisk (MM) appears before your first nallle in the address portion of this notice, the $3,000 exclusion already has been deducted frolll the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deter.ined as follows: A. The percent taxable for joint assets established More than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF JOINT OWNERS ExaMPle: A joint asset registered DIVIDED BY TOTAL NUHBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the nBllle of the decedent and two othsr persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.71. (TAXABLE FOR EACH SURVIVOR) B. The psrcent taxable for asssts created within one ysar of the dscedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Exa.ple: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 507. (TAXABLE FOR EACH SURVIVOR) 4. The aMount subject to tax (line 4) is determined by Multiplying the account balance (line 2) by the percent taxable (line 3). S. Enter the total of the debts and deductions listed in Part 3. 6. The a.ount taxable (line 6) is deter.ined by subtracting the debts and deductions (line 5) fro. the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deter.ined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3X 6X 15X 15X 01/01/95 to 06/30/00 OX 67. 157. 15X 07/01/00 to present OX 4.57.. 12X 15X MThe-tax rate I.posed on the not value of transfers from a deceased chlla twenty-one years of age Dr y ounger at 'death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 07.. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. ftChildrenn includes natural children whether or not they have been adopted by others, adopted children and step children. wlineal descendentsW includes all children of the naturel parents end their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. ftSiblingsW are defined as individuals who have at least one parent in COMMon with the decedent, whether by blood or adoption. The ftCollateralft class of heirs includes all other beneficiaries. " CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter.ined as follows: A. You legally are responsible for payment, or the estate Subject to adMinistration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being clai~d Must be itemized fully in Part 3. If additional space is needed, use plain paper 8 112ft x llw. Proof of payment may be requested by the PA Department of Revenue. COHHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPt. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-0574 ACN 01140635 DATE 09-06-2001 REV-1SUEX4FPl09_00> EST. OF FLOYD W PACKER 5.5. NO. 207-07-5154 DATE OF DEATH 06-06-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [j(] CERTIF. PA 17111 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 JUNE 6141 HBG D KALINA HOCKER DR "EMBERS 1ST FCU has provided the Iklpartllent with the inforllation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were l!l joint owner/beneficiary of this account. If you feel this inforaetion 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 eo.monwealth of Pennsylvania. Questions .ay be answered by calling (717) 7&7-8327. COMPLETE PART 1 BELOW Account No. 8582-45 )( )( )( SEE Oat. Established REVERSE SIDE FOR 12-12-1994 FILING AND PAYMENT INSTRUCTIONS Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 14,470.39 50.000 7,235.20 .045 325.58 To insure proper credit to your account, two (Z) copies of this notice .ust acc~pany your pay.ent to the Register of Wills. Hake check payable to: -Register of Wills, Agent-. x NOTE: If tax pay.ents are made within three (3) .onths of the decedent's date of death, YOU .ay deduct a 5~ discount of the tax due. Any inheritance tax due will bec~e delinquent nine (9) .onths after the date of death. PART TAXPAYER RESPONSE illli[[[~ri,\j~~'liiii~i!ii~ii[i~~~~iiiii_iiiii~li~[.i~.I,~l1iiii!~.!ii!I"'iiii"~j.ili!.~~[iii.~m-' A. D The above infor.ation and tax due is correct. 1. You .ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box -A- and return this notice to the Register of Wills and an official assessment will be issued by the PA Departllent of Revenue. [CHECK ] ONE BLOCK ONLY B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. [] The above infor.ation is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART @] TAX RETURN - COMPUTATION LINE 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 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I TOTAL CEnter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable intsrest based on infor_ation sub.itted by the financial institution. Z. Inheritance tax beco.as delinquent nine .onths after the decedent's date of death. 3. A joint account is taxable even though the decedent"s na.e was added as a _atter of convenience. 4. Accounts (including those held between husband and wifs) which the decedent put in joint n~es within one year prior to death are fully taxable as transfers. 5. Accounts established jointlY between husband and wife .ore then onB year prior to death are not taxable. 6. Accounts held by a decedent "in trust forR another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the infor.ation and co~utation in the notice are correct and deductions are not being claimed, place an "X- in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit theM with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official asseSSMent (Form REV-1548 EX) upon receipt of the return fro. the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept Z80601, Harrisburg, PA 17lZ8-0601 in the envelope provided. 3. BLOCK C - If the notice infor~tion is incorrect and/or deductions are being claimed, check block "e" and co.plete Parts 2 and 3 according to the instructions below. Sign two copies and sub.it th~ with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (For. REV-1548 EX) upon receipt of the return froM the Register of Wills. TAX RETURN PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the date the account originallY was established or titled in the manner existing at date of death. For a decedent dying after l2/1Z/82: Accounts which the decedent put in joint naMes within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (~~) appears before your first naMe in the address portion of this notice, the $3,000 exclusion already has been deducted frod the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: I DIVIDED BY TOTAL NUMBER OF JOINT OWNERS ExaMPle: A joint asset registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.77. (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered the decedent. 1 DIVIDED BY 2 (SURVIVORS) ~ .50 in the name of the decedent and two other persons and established within one year of death by X 100 507. (TAXABLE FOR EACH SURVIVOR) 4. The aMount subject to tax (line 4) is determined by Multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The aMOunt taxable (line 6) is determined by subtracting the debts and deductions (line 5) frOM the amount SUbject to tax (line 4). 7. Enter the appropriate tax rate (line 7) 8S determined below. g ounger at death to or for the use of a natural parent, an adoptive parent, or 8 stepparent of the child is 07.. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "ChildrenR includes natural children whether or not they have been adopted by others, adopted children and step children. "lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in co..on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%!lE 12% 15% MThe tax rate 1mposed on the ~t value of transfers from a deceased chlld twenty-one years of 8 e or Y CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment .ay be requested by the PA DepartMent of Revenue. COMHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BU~AU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0574 01140630 09-06-2001 REV-150EX AFP fG9.00) EST. OF FLOYD W PACKER S.S. NO. 207-07-5154 DATE OF DEATH 06-06-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. PA 17111 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 JUNE 6141 HBG D KALINA HOCKER DR MEMBERS 1ST Feu has provided the Depart.ent with the inforaation 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 Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8582-43 Oat. 01-09-1995 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, Agent". Account Balance 1 0 J 976 . 83 Percent Taxable X 50.000 Allount Subject to Tax 5 J 488 . 42 Tax Rat. X .045 Potential Tax Due 246.98 PART TAXPAYER RESPONSE [!]ltittii~I~~.tiji.ilil."iiti~~~~ititt_~iliti~lltlt.~i.~~~.tltli~.t!ti~."!I!!~ljlj.ltil.li~i.~.1 NOTE: If tax payments are made within three (3) .onths of the decedent"s date of death, you may deduct a 5X discount of the tax due. Any inheritance tax due will become delinquent nine (9) .onths after the date of death. [CHECK ] ONE BLOCK ONLY A. D The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Depart.ent of Revenue. B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. [] The above infor.ation is incorrect and/or debts and deductions were paid by you. You Rust co.plete PART ~ and/or PART ~ below. PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. D.bts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 X TAX ON JOINT/TRUST ACCOUNTS X PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and cOllplete to the best of IIY knOWledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforllation sub.itted by the financial institution. Z. Inheritance tax beco..s delinquent nine ~nths after the decedent"s date of death. 3. A joint account is taxable even though the decedent.s na.. was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint n~es within one year prior to death are fully taxable as transfers. 5. Accounts established jointlY between husband and wife lIore than onB year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the inforaation and co~utation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it them with your check for the ~ount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return fro. the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent.s representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice infor.ation is incorrect and/or deductions are being c1ai.ed, check block "e" and complete Parts 2 and 3 according to the instructions below. Sign two copies and sub.it thu. with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (For. REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN PART 2 c TAX COMPUTATION lINE 1. Enter NOTE: the date the account originally was established or titled in the manner existing at date of death. For a decedent dying after 12/12/82: Accounts which the decedent put in joint na.es within one (1) year of death are taxable fully as transfers. HOWQver, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the nullber of accounts held. If a double asterisk (**) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted fro. the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deter.ined as follows: A. The percent taxable for joint assets established .ore than one year prior to the decedent"s death: 1 DIVIDED BY TOTAL NUMBER OF JOINT OWNERS Example: A joint asset registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) E .167 X 100 l6.7X (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent.s death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Exa.ple: Joint account registered the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 in the name of the decedent and two other persons and established within one year of death by X 100 SOX (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is deter.ined by mUltiplying the account balance (line 2) by the percent taxable (line 3). S. Enter the total of the debts and deductions listed in Part 3. 6. The ~ount taxable (line 6) is deter.ined by SUbtracting the debts and deductions (line 5) fro. the amount SUbject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deter.ined below. death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OX. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. .Children- includes natural children whether or not they have been adopted by others, adopted children and step children. "lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. .Siblings" are defined as individuals who have at least one parent in co..on with the decedent, whether by blood or adoption. The .Col1atera1. class of heirs includes all other beneficiaries. Date of Death Spouse lineal Sibling Collateral 07/01/94 to 12131/94 3Z 6Z 15Z 15Z 01/01/95 to 06/30/00 0% 6% 15Z 15Z 07/01/00 to present OZ 4.5%M 12Z 15Z *ihi tax rate laposed on the net value of 'transfers 1'rOIl a deceased chIld 'twenty-one years 01' age or y ounger at CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for pay.ent, or the estate SUbject to administration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of pa~nt. C. Debts being clai.ed .ust be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x II". Proof of pay.ent .ay be requested by the PA Depart.ent of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BURE6U OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-D601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-0574 ACN 01148286 DATE 10-16-2001 REV-154S EXAFP U9.In EST. OF FLOYD W PACKER 5.5. NO. 207-07-5154 DATE OF DEATH 06-06-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS D CHECKING D TRUST IX] CERTIF. PA 17111 REHIT PAYHENT AND FDRHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 JUNE 6141 HBG D KALINA HOCKER DR ALLFIRST FINANCIAL SERVICE has provided the Departllent with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction froll the financial institution, attach a copy to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COllmonwealth of Pennsylvania. Questions may be answered by calling (717) 757-8327. COMPLETE PART 1 BELOW . . . SEE Account No. 80000002186142 Oat. Established REVERSE SIDE FOR 03-01-1999 FILING AND PAYMENT INSTRUCTIONS Account Balance 11,056.54 Percent Taxable X 50 . 000 Allouni Subjeci to Tax 5,528.27 Tax Rate X .15 Poieniial Tax Due 829.24 PART TAXPAYER RESPONSE [!]I:!I!I!~I~~.II!:I~IIII__I:I:I~~~I:IIII_~III:I~I:I:i.i:I:.~.liiiil~.ilil~.._:illl_llli~i:I:.~~:j:I_B1j:I:jl To insure proper credit to your account, two (2) copies of this notice must accompany your paYllent to the Register of Wills. Make check payable to: nRegister of Wills, Agentn. NOTE: If tax payments are made within three (3) months of the decedent"s date of death, you may deduct a 5X discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. [CHECK ] ONE BLOCK ONLY A. 0 The above information and tax due is correct. 1. You lIay choose to rellit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "An and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. B. 0 The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. 0 The above information is incorrect and/or debts and deductions wera paid by you. You must cOlllplete PART 0 and/or PART ~ below. TAX ON JOINT/TRUST ACCOUNTS If you indicate a different tax raie, please staie your relationship io decedeni: PART ~ TAX RETURN - COMPUTATION LINE 1. Dai. Established 2. Accouni Balance 3. Perceni Taxable 4. Allount Subject io Tax 5. Debis and Deductions 6. Allouni Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 x x PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on line 5 of Tax COllpuiation) I $ Under penalii.s of p.rjury, I declare that ihe facts I have repori.d above ar. tru., correci and cOBPlet. to tha basi of IIY knowledge and balief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT aith .ppli..blo Intor.st b...d on Infor..tlon subml tted by the fJnancial insti tution. 2. Inheritance tax b8CO~e$ delinquent nine months aftar the decedent.s date .of ~sth. 3. A joint aCCount is taxable Bven though the decedent"s n~8 was added as a Matter .of convenience. .. Accounts Clncludlng thos. h.'d b.ta..n husb.nd and alf.' ahlch tho d.c.d.nt put In joint n...s althln on. y..r prior to d8Bth ar. fully taxabla as transf$rs. 5. ACCounts established jointly betw8Bn husband and wifs .ore than .one year prior to death are nat taxable. 6. ACCOunts hrlil1d by a d8CliIdtilnt "in trust for" BRoths!' .or .others are taxable fully. GENERAL INFORMATION REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE I. BLOCK 0 - I' tho In.or..tlon .nd co.putotlon In tho notlc. .r. corr.ct .nd d.ductlon. .r. not b.lng .,.I..d, pl.c. .n 'X" In block "A' of P.rt I d' tho "T""p...r R.spons." s.otion. Sign taD copl.. .nd subolt th.. alth your .h.ck for tho ..ount of t.x to the R.gl.t.r of Wills of the DOunty Indlc.ted. Th. PA ....rt..nt of R.v.nu. alII lssus an of'I.,., .s'.'S..nt (For. REV-1548 EX) Upon receipt of the return frc. the Register .of Wills. l. BLOCK B - If tho .ss.t sp.cln.d on this notic. h.. b..n Dr alll b. r.port.d .nd tax p.ld alth tho P.nns.lv.nl. Inh.rlt.nc. T.x R.turn fllad by the ....dont.s repr...ntatlv., pl.c. an 'X' In blo.k "S" d. P.rt I of tho "T.Xpey.r R.spons." s..tlon. Sign on. coP' .nd r.turn to tho PO D.P.rt..nt of R.v.nu., Bur..u of Individual T.x.s, Dspt lBaOal, Harrisburg, PA 17128-aoal In the envelope provided. 3. 8LotX C - If the notl.. In'or..tlon Is Incorr..t .nd/or d.du.tlons ara b.lng c'al..O, chack block "C" .nd .o.p'at. Parts Z and 3 a.cordlng to tha instructions b.,ow. Sign two copl.s and s_it th... with your ch..k for tho "ount of tax pey.bh to tha ..glst.r of Will. of tho .ount. Indlc.t.d. Tha PO D.p.rt.ant of R.v.nua will Is.u. an offlcl.l .ssassoant (For. REV-'548 EX' upon r.c.'pt of the return fro. the Register of Wills. LINE 1. Enter NOTE: the date the account Originally Nas estabUshad or titled in the lIanner existing at data of death. For. dacBdant dYing ..t.r Il/ll/8l, "counts which the d.c.Oant put In joint n.... althln on. (I) .aar d. daath .r. ....bl. fully a. trans"rs. Howo..r, there Is an .x.'uslon not to axc..d $3,000 par trans'.r.a rag.rdlass of tho v.lu. d. the account or the ntIfIber of accounts hald. TAX RETURN - PART 2 TAX COMPUTATION If a doub" .starlsk CMM) spp.ars b.fora your flrst n... In the .ddr... portion of thIs notl.., tho $3,000 .xoluslon alrllll!ldy has been deducted from the BCcaunt belancli as reported by the financial insti tut.hm. 2. Enter the total bi!llance of the lltccount inCluding intsr8st eccrued to the d..te 0' daeth. 3. The percent of the lIIccount that is taxable for each survivor 15 dater.inad as follows: A. The percent taxillble for joint assets establIshed .Ore than one yesr prior to the deC8d&nt.s daath: 1 DIVIDED BY TDTAL HUKBER DF JOINT OWNERS Exe.Ple: A joint asset registered DIVIDED BY TOTAL NUHBER OF )( lOD PERCENT TAXABLE SURVIVING JOINT OWNERS in the nBlAllI of the decedent and two other persons. S. Tha p.r..nt "xabl. for ....ts cra.t.d within on. y.ar of tho d.c.d.nt"s daath Dr ..counts ooned by the dacedant but h.,d In trUst for another individual(s) (trust beneficiaries): 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) . .167 X laa 16.7i: (TAXABLE Fal<! EACH SUI<IVI\lQR) 1 DIVIDED BY TOTAL NUM8ER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES )( 100 PERCENT TAXABLE Ex~le: JoInt account registered the decedent. 1 DIVIDED BY Z (SURVIVORS) ,. .50 X 100 in the name of the decedent and two other persons and established within one year of death by 507. (T~XABLE FOR EACH SURVIVOR) .. The aoount subjact to tax [lln. " Is d.tar.ln.. by .ultlplYlng tho OC.ount b.'on.. (lln. Z' by tho parcant taxobla Clln. 3'. 5. Enter the total of the debts and dlllducUons listed in Part 3. O. The "ount taxBbl. [lln. 01 Is d.t.r.lnad b. subtra.tlng tho d.bts .nd d.ductlons [lln. S' 'ro. the a.ount subj.ct to tax Cllna .,. 7. Enter the approprJate tax rate (Jlne 7) 8S deter.ined below. Date 0" Death Spou" Lin..l Sibling Coll.tar-al 07/011'94 to 12/311'94 37. 67. 157. 157. 01/011'95 to 06/30/00 07. 67. 157. 157. 07/01/00 to present 07. 4.57.. 127. 157. IIflhs ta)( rao .lllfPosea on the n.t value of transfers ',:"0_ . deceaHo ch.ud 'tWBn'[y-one YSillrs OT ~glil or . death to or far thq usa of B naturel parent~ an adoptIve parent, or a stepparent of the child .IS ol. Th. lln.ol clos. of hair. Includ.s grand.ar.nts, paront., children, and lln.al das..ndants. "Chlldran" Includas n.tural children wh.....r or not th.. h.va b..n adopt.d b. oth.rs, .dopt.d childr.n and st.p childr.n. "L1n..l d.scand.nts" lnclud.. .ll chUdran of .... natur.l parents and th.lr d.s..nd.nts, ah.thar Dr notth.y h.va b..n .dopt.d b. oth.rs, .dopt.d d....nd.nt. .nd thalr .....ndsnts and stOP-d.sc.ndont.. "Siblings' .r. dafin.d .s Individual. aho hov. .t I..st on. porant In co..on with tho d.c.d.nt, Wh.th.r by blood or adoption. The "CQIIBteral~ class of heirs includes all other benefIcIaries. ounger at Allowable debts and deductions are determined as fOllows: O. You '.gal,. ar. r.spon.lbl. for P....nt, Dr the .stata subject to adolnlstr.tlon by . p.rson.l ropr.sant.tlv. is Insuf.lcl.nt to pay the deductible ite_s. B. You actually paid the debts after dea"th of the decedent und can furnish proof 0"" paY_nt. C. D.bts b.lng cl.i..d oust b. It..".d fUlly in Part 3. If addltlon.l sp... Is n.oded, uso plaIn pap.r 8 1/2" x II". Proof d. paY_8nt lIlay be requested by the PA Deparuen't 0" Ravenus. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUR~AU OF INDIVIDUAL TAXES DEPt. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-0574 ACN 01148287 DATE 10-16-2001 REV-1&'3EXAFPI09-DDl EST. OF FLOYD W PACKER 5.5. NO. 207-07-5154 DATE OF DEATH 06-06-2001 COUNTY CUMBERLAND TYPE DF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. PA 17111 REMIT PAYMENT AND FORMS TO, REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 JUNE 6141 HBG D KALINA HOCKER DR ALLFIRST FINANCIAL SERVICE hills providsd the Department with the information listed below which has been used in calculating the potential tax dUB. Their records indicate that at the dBsth of the above dacedent, YOU wsre l!I joint owner/beneficiary of this account. If you feel this infor.ation is incorrect, plBasB obtain written correction fro. ths 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 Commonwealth of Penn&ylvenia. Question~ saybo answered b3 ~allir.g (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE Account No. 80000002174086 Oat. Established REVERSE SIDE FOR 01-19-1999 FILING AND PAYMENT INSTRUCTIONS Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 10,182.24 50.000 5,091.12 .15 763.67 To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of WillS, Agent". x NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5~ discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE [!]~ilili~I~~.[![!.IIII_,~IIIII~~~lllli..I!!!I~I!!ll.![11.~1~.111~1!!1!1!."!1!1_!!l[.1!1!~1~1!!!!.~~11!!~ A. 0 The above information and tax due is correct. 1. You lIay choose to remit pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or yoU may check box "A" and return this notice to the Register of wills and an official assessment will be issued by the PA Department of Revenue. [CHECK ] ONE BLOCK ONLY B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. 0 The above information is incorrect and/or debts l!lnd deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate} please state your rel.tionship to decedent: PART ~ TAX RETURN - COMPUTATION LINE 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 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury} I declare that the facts I have reported above are true) correct end cOBPlete to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WrLL RESULT IN AN OFFICIAL TAX ASSESSI1ENT with applicable interest based on Inforlllstion $ub.itted by the financial institution. Z. Inheritance tax becomes delinquent nine .onths after the decedent's date of death. 3. A joint account is taxable even though the decedent"s nama was added as a matter of convenience. 4. Accounts (inCluding those held between husband and wife) which the decedent put in joint na.as within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife .ora than one year prior to death ara not taxable. 6. Accounts held by a decedent "in trust far" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAVER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claillad, place an "X" in block "A" of Part 1 of the "TaxpaYer Response" section. Sign two copies and submit the. with your check for the a.ount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assess.ent (Form REV-1548 EX) upon receipt of the return fro. the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent~s representative, place an "X" in block "Bn of Part 1 of the nTaxpayer Response" section. Sign one COpy and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice infer.ation is incQrrect and/or deductions are being claimed, check block "C" and co.phte Parts 2 and 3 according to the instructions balow. Sign two copies and sub.it them with your check for the amQunt of tax payable to the Register of Wills of the county indicated. The PA Department of Revanue will issua an official assessment eForm REV-1548 EX) upon recsipt of the raturn fro. the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the date the account originallY was established or titled in the mannsr existing at date of death. For a decsdent dying aftar 12/12/82: Accounts which the dacedant put in joint na.es within one [I) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee ragardless of the valua of the account or the number of accounts hald. If a doubla asterisk [..) appears before your first na.a in the addrass portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter tha total balanca of the account including intarest accrued to the date of death. 3. The percant of the account that is taxable far each survivor Is datenmined as follows: A. Tha percent taxable for joint assets established _ore than one yaar prior to the decedant.s death: I DIVIDED BY TOTAL NUMBER OF JOINT OWNERS Exa.ple: A joint asset registered DIVIDED BV TOTAL HUMBER OF X IOQ PERCENT TAXABLE SURVIVING JOINT OWNERS in the na.e of the decedent and two other persons. 1 DIVIDED BY 3 [JOINT OWNERS) DIVIDED BY 2 [SURVIVORS) = .167 X 100 l6.7~ (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts awned by the decedent but held in trust for another Individual[s) [trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X laD PERCENT TAXABLE Exa.ple: Joint account ragistered the decedent. 1 DIVIDED BY 2 (SURVIVORS) . .50 in the name of the decedant and two ather persons an~ established within one year Df death by X 100 50Z [TAXABLE FOR EACH SURVIVOR) 4. Tha a.ount Subject to tax (line 4) is datermined by lIultiplying the account balance [line 2) by the percent taxabla [lina 3). 5. Enter the total of the dabts and deductions listed in Part 3. 6. The BIIount taxable [11ne 6) is determined by subtracting the debts and deductions (line 51 fro. the aIIount subject to tax Cline 4). 7. Enter tha appropriate tax rate [line 7) as deter.ined below. Date of De.th Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3X 6X 15X 15% 01/01/95 to 06/30/00 OX 6% 15X 15% 07/01/00 to pr-esent 0% 4.57,- 12X 15% ./he tax rB'bi J.JIPOSBd on the not value of transfers fro. a deceased child twenty-one yaars of-age "' y ounger 1It death to or for the use of a natural parent, an adoptive parent, or a stepparllilnt of the child is ai:. The lineal class of heirs includes grandparents, parents, children, and lineal descllilndents. nChildren" includes natural chIldren whether Dr not thay hava been adoptad by others, adopted chIldren and stap children. nLineal descandentsn includes all children of the natural parents and their descendents, whether or not they have been adoptllild by others, adopted descendants and thair dascendants and step-dascendants. nSibllngs" are daflned as individuals Mho have at least one parent in common with the decedent, whethar by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable dabts and deductions are deter.inllild as follows: 4. You legally ere responsible for payment, or the astate subjaQt to administratIon by a personal representatIve is insufficient to pay the dlllductible ite.s. B. You actually paid the debts after desth of the decedent and can furnish proof of pay_ent. C. Dftbts being claimed .ust be it_bed fully in Part 3. If additional space is needllild, use plain paper 8 112" )( Un. Proof of pay.ant .ay be requested by the PA Depsrtment of Ravenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BU~AU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-0574 ACN 01148288 DATE 10-16-2001 REW-154S EXAFP U9-IU PA 17111 REMIT PAYMENT AND REGISTER OF WILLS CUMBERLAND CO CDURT CARLISLE, PA 17013 TYPE OF ACCOUNT D SAVINGS IX] CMECKING D TRUST D CERTIF. FORMS TO: EST. OF FLOYD W PACKER S.S. NO. 207-07-5154 DATE OF DEATH 06-06-2001 COUNTY CUMBERLAND JUNE 6141 HBG D KALINA HOCKER OR HOUSE ALLFIRST FINANCIAL SERVICE has provided the Depal"'tlllant with the infol"'lIIation listed below which has baan used in calculating the potantial tax due. Theil'" I"'acol"'ds indicate that at the death of tha above decedent~ you ware a joint ownal"'/beneficial"'Y of this account. If YOU feel this inforMation is incol"'l"'ect~ 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 accol"'danca with the Inharitance Tax Laws of tha COM~onwealth of P~ns~lvanie. Qu~~tlon5 way be answered b~ calling (71?) 787-8327. COMPLETE PART 1 BELOW Account No. 0067066569 J( J( J( SEE REVERSE SIDE FOR Oat. 05-28-1971 Established FILING AND PAYMENT INSTRUCTIONS Account Balance 3} 884.28 Percent Taxable X 50.000 Allount Subject to Tax 1 } 942 . 14 Tax Rate X .15 Potential Tax Due 291.32 PART TAXPAYER RESPONSE [!]lililil~~~~.lil!I!I!1!ili"!I!!I~~~!i!i!_~~!I~II!!lg!!!!.~~i~.~!I!~.!!!!."'~!!_!ili.I!lil!~I!I!I.~~!I!!!1 To insure propel'" credit to your account, two (2) copies of this notice MUst acco.pany your pay.ant to the Register of Wills. Make check payable to: "Ragister of WillS, Agent". NOTE: If tax payMents are lIIade within three (3) 1II0nths of the decedent's date of death~ you lIIay deduct a 5~ discount of the tax due. Any inheritance tax due will beCOMe delinquant nine (9) months after the date of death. [CHECK ] ONE BLOCK ONLY A. D The above infor.ation and tax due is corl"'act. 1. You .ay choose to remit paY.Bnt to the Register of Wills with two copies of this notica to obtain a discount or avoid intarBst~ 01'" YOU .ay check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revanue. B. D The abova assat has been or will be reported and tax paid with the Pennsylvania Inheritance Tax raturn to be filed by tha decadent.s representativa. c. D The above information is incorract and/or debts and daductions were paid by you. You .ust co.plate PART 0 and/or PART ~ balow. PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate} please state your rel.tionship to decedent: PART [!] TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. A.ount Subject to Tax 5. Debts and Deductions 6. AMount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax COllputation) I $ Under penalties of perjury} I declare that the fects I have reported above are true, correct and complete to the best of .y knowledge end belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with appliCable Intersst basad cn inferllation sub.itted by the financial institution. 2. Inheritance tax bacDll'B$ delinquent nine Months after the decedent's date of death. 3. A joint account is taxabls even though the decedent"s nBIIB was added as a matter of convenience. 4. Accounts (includIng thosB held between husband and wifa) which the decedent put in joint haMas within one year prior to death arB fully taxable as transfers. 5. Accounts established jointly betwBen husband and wife .ora than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" anothsr or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE I. BLOCK A - If the in#Or.ation and c~putatJon in the notice are correct and deductions are not being claimed, place an "X" in block "An of Part 1 of the "Taxpayer Response" SBction. Sign two copies and submit the. with your check for the a.ount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been o~ will be repo~ted and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent.s representative, place an "X" in bleck "8" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Departgent of Revenue, Bureau of Individual Taxes, Dept 280601, HarriSburg, PA 17128-0601 in the envelope p~ovidad. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Fon. REV-lS48 EX) upon rBceipt of the return frOB the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the date the account originallY Nas established or titled in the aanner existing at date of death. For a decedent dying after 12/12182: Accounts which the decedent put in joint na.es within one (1) year of taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless the account or the nu_ber of accounts held. death are of the value of If a double asterisk (MM) appears before your first name in the address portion of this notice, the $3,000 exclusion alrQady has been deducted fro. the account balltnCe as reported by the fimmcial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deter.ined as follows: A. The percent taxable for joint assets established ~ore than one year prior to the decedent's death: 1 DIVIDED BV TOTAL HUMBER OF JOINT OWNERS Example: A joint asset registered DIVIDED BV TOTAL NUMBER OF X 10D PERCENT TAXABLE SURVIVING JOINT OWNERS in the na.e of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) - .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) B. The pe~ent taxable for assets created within one year of the dscedent.s death or accounts DNned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUHBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 in the na.e of the decedent and two other persons and established within one year of death by X 100 SOX (TAXABLE FOR EACH SURVIVOR) 4. The aNount subject to tax (line ~) is determined by mUltiplying the account balance (line 2) by the percent taxable (lIne 3). S. Enter the total of the debts and deductions listed in Part 3. 6. The a.ount taxable (line 6) is deter_ined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deterllined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3X &% 1SX 1SX 01/01/9S to 06/30/00 OX &% 1SX 1SX 07/01/00 to p~.sent OX 4.5%- 12X 1SX MThe taw rate 1.posed on the net Value of transfers fro. a deceased child twenty-one years of age or y ounger at death to or for the use of a natural parent, an adoptive parent, o~ a stepparent of the child Js Q~. The lineal class of heirs includes grandparents, parents, Children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in com~on with the decedent, whether by blood or adoption. The "Collateral" class of heJrs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the dabts qfter death of the decedent and can furnish proof of payment. C. Debts being claimed must ba itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11", Proof of payment May be requested by tha PA Dapartment of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUR~U OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 * INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-0574 01152753 11-13-2001 REV-lSOEXAFP IU9-UD> PA 17111 REHIT PAYHENT AND REGISTER OF WILLS CUMBERLAND CD COURT CARLISLE, PA 17013 TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. FDRHS TD: EST. OF FLOYD PACKER S.S. NO. 207-07-5154 DATE OF DEATH 06-06-2001 COUNTY CUMBERLAND JUNE 6141 HBG KALINA HOCKER RD HOUSE WAYPOINT BANK has provided the Departllent with thlil inforllation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above dlilcedlilflt~ you were a joint owner/beneficiery of this account. If you feel this inforeation is incorrect~ please obtain written correction froll the financial institution~ attach II copy to this fore and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of Pennsylvania. ~estion5 lIay be answered by calling (7l7l r87-83i7. COMPLETE PART 1 BELOW Account No. 3355314545 . . . SEE REVERSE SIDE FOR Data 06-16-1997 Established FILING AND PAYMENT INSTRUCTIONS Account B.l.nce Percent Tax.ble Amount Subject to Tax Tax Rate Potential Tax Due 7,272.15 X 50.000 3,636.08 X .045 163.62 To insure proper credit to your account~ two (2) copies of this notice .ust aCCOMpany your pay.ent to the Register of Wills. Hake check payable to: "Register of Wills~ Agent". NOTE: If tax payeents are lIade within three (3) eonths of the decedent"s date of death~ you may deduct B 52 discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) eonths after the date of death. PART TAXPAYER RESPONSE L!lIJ!~ik~;t~~llliljm!ijl~_!i!il~i~l~il"~iij~iili~11!~.~~~b!I!I~I~~ili;__iiii_!~i.iml{~~li!i.~.iiiiil [CHECK ] ONE BLOCK ONLY A. D The above inforlllation and tax due is correct. 1. You .ay choose to re.it payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest~ or YOU may check box "An and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Depart.ant of Revenue. B. D The above asset has been or will be reported and tax paid with the Pennsylvanie Inheritance Tax return to be filed by the decedent's representative. c. D The above information is incorrect and/or debts and deductions were paid by you. You .ust co.plete PART ~ and/or PART ~ below. PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decadent: PART @] TAX RETURN - COMPUTATION LINE 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 1 2 3 4 5 6 7 8 X TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and COMplete to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information sub~lttBd by thB financial institution. 2. InharitancB tax beco.es delinquent nine months after the decedent.s date of death. 3. A joint account is taxable even though the decedent's naee was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint na.as within one year prior to dBsth are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by B decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and co.putation in the notice a~e co~~ect and deductions a~e not being clai.ed~ place an "X" in block "A" of Pa~t 1 of the "Taxpaye~ Responsen section. Sign two copies and submit the. with you~ check fo~ the amount of tax to the Registe~ of Wills of the county indicated. The PA Depa~t.ent of Revenue will issue an official assessment (Fo~. REV-ls48 EX) upon ~eceipt of the ~etu~n f~o. the Ragista~ of Wills. Z. BLOCK B - If the asset specified on this notice has been o~ will be ~epo~ted and tax paid with the Pennsylvania Inhe~itance Tax Return filed by the decedent's ~ep~esentative~ place an nx" in block nB" of Pa~t 1 of the "Taxpaye~ Response" section. Sign one COpy and ~etu~n to the PA Depa~tment of Revenue~ Bu~eau of Individual Taxes~ Dept Z80601~ Ha~~isbu~g~ PA 111Z8-0601 in the envelope p~ovided. 3. BLOCK C - If the notice info~ation is inco~~ect and/o~ deductions a~e being clai.ed~ check block "Cn and complete Pa~ts Z and 3 acco~ding to the inst~uctions below. Sign two copies and submit the. with you~ check fo~ the a.ount of tax payable to the Registe~ of wills of the county indicated. The PA Depa~tment of Revenue will issue an official assessment (Fo~m REV-1548 EX) upon ~eceipt of the ~etu~n f~o. the Registe~ of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Ente~ NOTE: the date the account o~iginallY was established o~ titled in the .anne~ existing at date of death. Fo~ a decedent dying afte~ IZ/12l8Z: Accounts which the decedent put in joint names within one (I) yea~ of death a~e taxable fully as t~ansfe~s. Howeve~~ the~e is an exclusion not to exceed $3~000 pe~ t~ansferee regardless of the value of the account or the number of accounts held. If a double asterisk (MM) appea~s befo~e your fi~st name in the address portion of this notice~ the $3~000 exclusion already has been deducted frOM the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest acc~ued to the date of death. 3. The percent of the account that is taxable for each survivo~ is dete~mined as follows: A. The percent taxable for joint assets established mo~e than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF JO INT OWNERS Exa.ple: A joint asset registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) - .167 X 100 16.7Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in t~ust fo~ anothe~ individual(s) (trust banaficia~ies): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 in the name of the decedent and two other persons and established within one year of death by X 100 50Z (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is dete~.ined by .ultiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is deter.ined by SUbtracting the debts and deductions (line 5) from the a.ount Subject to tax (line 4). 7. Enter the appropriate tax rate (line 1) as deter.ined below. D.tiil of Death Spouse Lineal Sibling Collat.r.1 07/01/94 to 12/31/94 3X 6X 15X 15% 01/01/95 to 06/30/00 OX 6X 15X 15X 07/01/00 to present OX 4.5%_ 12X 15% MThe tax rate i.posed on the not value o~ transfers frail a deceased chlld twenty-one years of age or . ounger at death to or for the use of a natural parent~ an adoptive pa~ent~ or a stepparent of the child is DZ. The lineal class of heirs includas grandparants~ parants~ childran~ and lin.al descandants. nChildrann includes natural childran whether o~ not they have been adopted by others~ adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents~ whethar or not they have baen adoptad by others~ adopted descandants and thei~ descandants and step-descendants. "Siblings" are defined as individuals who have at least one pa~ent in COllllon with the decedent~ whethe~ by blood or adoption. The "Collateraln class of heirs includes all othe~ beneficiaries. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for pay.ent~ or the estate subject to ad.inistration by a pe~sonal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of pay.snt. C. Debts being clailled must be itellized fully in PB~t 3. If additional space is needed~ use plain pape~ 8 I/Zn x 11". Proof of paYllant .ay be requested by the PA Depa~tment of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BU~AU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-0574 ACN 01152752 DATE 11-13-2001 REV-IU5EX AFP 109-DOl EST. OF FLOYD PACKER S.S. NO. 207-07-5154 DATE OF DEATH 06-06-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. PA 17111 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 JUNE 6141 HBG KALINA HOCKER RD WAYPOINT BANK has provided the Depart_nt with the infor.ation listed below which has been used in calculating the potential tax due. Their racords 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 corraction fr~ the financial institution~ attach a copy to this forll and raturn it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth ot Pennsylvania. Quastions .ay be answerad by calling (717) 187-8327. COMPLETE PART 1 BELOW Account No. 3058320963 I( I( I( SEE Date Established REVERSE SIDE FOR 11-12-1997 FILING AND PAYMENT INSTRUCTIONS Account Balance Percent Taxable Amount Subject to Tax Tex Rat. Potential Tax Due x 3,603.58 50.000 1,801. 79 .045 81.08 To insure proper credit to your account~ two (2) copias of this notice .ust acco.pany your pay.ant to the Registar of Wills. Maka chack payable to: "Register of Wills~ Agent". x NOTE: If tax pay.ents are .ade within threa (3) .onths of the dacadent's data of death~ you .ay deduct a 5~ discount of the tax due. Any inharitance tax due will beco.a delinquent nine (9) .onths after the date of death. PART TAXPAYER RESPONSE mliljl~~.~.lllli.!lli~_ijlll~~i!I!I!..~!~li~II~!.!i!i.~~~~I~II~.i~i__!i!i~_!ii~.ill!.~~I[li.~.I!llll A. D The above infor.ation and tax due is correct. 1. You .ay choose to remit pay.ent to the Register of Wills with two copias of this notica to obtain a discount or avoid intarest~ or you may check box "An and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Ravenue. [CHECK ] ONE BLOCK ONLY B. D The above asset has baen or will be raported and tax paid with tha Pennsylvania Inharitance Tax return to ba filed by the decedent"s representativa. c. D The abova infor.ation is incorrect and/or debts and deductions were paid by you. You IIUst complete PART 0 and/or PART 0 below. PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax S. Debts and Deductions 6. Amount Taxable 7. Tl!lx Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 4 5 6 7 8 x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line S of Tax Computation) I $ Under penl!llties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of .y knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interast based on infor_ation sub.ittBd by the financial institution. 2. Inheritance tax beca.es delinquent nine ~onths after the decedent's date of death. 3. A joint account is taxable Bven though the decedent's na.e was added as 8 matter of convenience, 4. Accounts (including those held betwesn husband and wife) which the decedent put in joint na.es within one year prior to death are fully tsxsbla as transfers. 5. Accounts Bstablished jointly betwBen husband and wife .ore than one year prior to death are not taxable. 6. Accounts held by a decedant "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS PART 1 - TAXPAVER RESPONSE 1. BLOCK A - If the infor.ation and cOllputation in the notice are correct and deductions are not being clahed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return frail the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent"s representative. place an "X" in block "B" of Part 1 of ths "Taxpaysr Response" section. Sign one COpy and return to the PA Department of Revenue, Bureau of Individual Taxes. Dept 280601. Harrisburg, PA 171Z8-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and COllplete Parts Z and 3 according to the instructions below. Sign two copies and subllit thell with your check for the allount of tex payable to the Registsr of Wills of the county indicated. The PA Department of Revenue will issue an official asses~ent (Forll REV-1548 EX) upon recsipt of the return from ths Register of Wills. TAX RETURN - PART z - TAX COMPUTATION LINE 1. Entsr NOTE: the dats the account originallY was establishsd or titled in the manner existing at date of death. For e decedent dying after 12/12/8Z: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferse regardlsss of the value of the account Dr the number of accounts held. If a double asterisk (MM) appears befors your first nalle in the address portion of this notice, the $3,000 exclusion already has bssn deducted frail the account balance as reported by the financial institution. Z. Enter the total balance of the account inclUding interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established lIore than one year prior to the decedent's deeth: 1 DIVIDED BV TOTAL NUMBER OF JOINT OWNERS Exallple: A joint assst registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the nalle of the decedent and two other persons. I DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7~ (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER DF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Exampls: Joint account registered the decedent. 1 DIVIDED BY Z (SURVIVORS) - .50 in the nalle of ths dscedent and two othsr persons and establishsd within one year of death by X 100 507. (TAXABLE FOR EACH SURVIVOR) 4. The amount sUbjsct to tax (line 4) is detsrllined by lIultiplying the account balancs (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The BIIount taxable (line 6) is deterllined by subtracting the debts and deductions (line 5) froll the allount SUbject to tax (line 4). 7. Enter the approprlats tax rate Uine 7) as determined below. death to or for the use of a natural parent, an adoptive parent. or a stepparent of the child is O~. The lineal class of heirs includes grandparents. parents. Children. and lineal dsscendents. "Children" includss natural children whether or not they have been adopted by others, adopted children and step chlldren. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not thay have been adopted by others, adopted dascendsnts and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in cOllman with the dscedent, whsther by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collat....al 07101/94 to 12/31/94 3X 6X 15X 15X 01/01/95 to 06/30/00 OX 6X 15X 15X 07101/00 to p....sent OX 'i.S%'- 12X lSX JiThe tax rate 111posed on 'tne not value of transfers 'tram a deceassd child~enty-one years o't age or y ounger at CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and daductions are detsrmined as follows: A. You legally are rssponslble for paYllant, or the estate subject to adllinistration by a personal representative is insufficient to pay the dsductible itellls. B. You actually paid the dsbts after dsath of the decedent and can furnish proof of pay.ent. C. Debts being clailled must be ite.ized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x II". Proof of paYllent may ba requested by the PA Department of Revsnue. 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 01-0574 01140634 09-06-2001 REV-15~S Ell iFP (09.00) EST. OF FLOYD W PACKER S.S. NO. 207-07-5154 DATE OF DEATH 06-06-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. PA 17111 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 JUNE 6141 HBG D KALINA HOCKER DR MEMBERS 1ST FCU has provided the Department with the inforlRltion listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a joint owner/beneficiary of this account. If YOU feel this information is incorrect, please obtain written correction frOM the financial institution, attach a copy to this forM and return it to the above address. This account is taxable in accordance with the Inheritance Tax taws of the Co_onwO-alth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW Account No. 8582-46 If If If SEE Date Esiab1ished REVERSE SIDE FOR 05-12-1998 FILING AND PAYMENT INSTRUCTIONS Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 30,804.24 50.000 15,402.12 .045 693.10 To insure proper credit to your account, two (2) copies of this notice Must acco~any your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5X discount of the tax due. Any inheritance tax due will beCOMe delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE [!]1!!!jll~~~.lljl.lii!~_il!~~!~llllll.~illli~I!111.iiii.~I~~~lilil~.i~i~~iiii"i~i.llli~~~llil.~.lilill A. 0 The above information and tax due is correct. 1. You May choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official asses~ent will be issued by the PA Department of Revenue. [CHECK ] ONE BLOCK ONLY B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You Must co.plete PART ~ and/or PART ~ below. PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART f3J TAX RETURN - COMPUTATION LINE 1. Date Established 2. Accouni Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amouni Taxable 7. Tax Reie 8. Tax Due OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on Line 5 of Tax Computaiion) Under penalties of perjury, I declare that the facts I have reported above ar. true, correct and co.pleie to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor_ation sub.itted by the financial institution. 2. Inheritance tax beeo.as delinquent nine .onths after the decedent"s date of death. 3. A joint account is taxable even though the decedent"s n~e was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly betwBen husband and wife wore than one year prior to death are not taxable. 6. Accounts held by a decedent nin trust forn another or others arB taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the infor~tion and co.putation in the notice are correct and deductions are not being clai.ed~ place an -XW in block WAR of Part I of the -Taxpayer ResponseR section. Sign two copies and submit the. with your check for the amount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (Form REV-1548 EX) upon receipt of the return fro. the Register of Wills. Z. BLOCK B - If thB asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decBdent's reprB5Bntative~ place an -XR in block wBw of Part 1 of the WTaxpayer Responsew section. Sign one copy and return to the PA Depart.ent of Revenue~ Bureau of Individual Taxes~ Dept Z80601~ Harrisburg~ PA 171Z8-060l in the envelope provided. 3. BLOCK C _ If the notice infor.ation is incorrect and/or deductions are being clai.ed~ check block RCW and complete Parts Z and 3 according to the instructions below. Sign two copies and sub.it the. with your check for the ~ount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessment (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. TAX RETURN PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the date the account originallY was established or titled in the .anner existing at date of death. For a decedent dying after lZ/1Z/8Z: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3~000 per transferee regardless of the value of the account or the n~ber of accounts held. If a double asterisk CMM) appears before your first na.e in the address portion of this notice, the $3,000 exclusion already has been deducted fro. the account balance as reported by the financial institution. Z. Enter the total balance of the account inCluding interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deter.ined as follows: A. The percent taxable for joint assets established ~re than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF JOINT OWNERS Exa.ple: A joint asset registered DIVIDED BY TOTAL NUHBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the na.e of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) ~ .167 X 100 l6.7Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered the decedent. 1 DIVIDED BY Z (SURVIVORS) - .50 in the name of the decedent and two other persons and established within one year of death by X 100 50~ (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is deter.ined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The ..ount taxable (line 6) is deter.ined by subtracting the debts and deductions (line 5) from the a.ount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deter.ined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 37- . 67- 157- 157- 01/01/95 to 06/30/00 07- 67- 157- 157- 07/01/00 to present 07- 4,S%- 127- 157- MThe tax rate lIrposed on the not value of transfers from a deceased Ch1ld twem:y-one years of age 0' Y ounger at I death to or for the use of a natural parent~ an adoptive parent, or a stepparent of the child is Oi:. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. -Childrenw includes natural children whether or not they have been adopted by others, adopted children and step children. wLineal descendents- includes all children of the natural parents and their descendents, whether or not they have been adopted by others~ adopted descendents and their descendants and step-descendants. -SiblingsW are defined as individuals who have at least one parent in co..on with the decedent~ whether by blood or adoption. The wCollateralw class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for pay.ent~ or the estate subject to ad.inistration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of pay~nt. C. Debts being clai~d .ust be itemized fully in Part 3. If additional space is needed~ use plain paper 8 l/Zw x 11-. Proof of payment ~ay be requested by the PA Depart.ent of Revenue. :w""".,,~'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF PACKER FILE NUMBER FLOYD W 21 01 0574 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. STONE-MURRAY FUNERAL HOME 5,820.00 2. JAMES GINGRICH MEMORIALS 75.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) WAIVED Social Security Number(s) I EIN Number of Personal Representative(s) Street Address Cily Stale Zip Year(s) Commission Paid: 2. Attorney Fees CHARLES E. PETRIE 350.00 3. Family Exemption: (If decedenfs address is no11he same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. ProbaleFees REGISTER OF WILLS AND PUBLICATION OF ESTATE NOTICE 175.98 5 Accountant's Fees 6. Tax Return Prepare~s Fees 7. LOT RENT 530.00 8. REAL ESTATE TAX 29.35 TOTAL (Also enter on line 9, Recapitulation) $ 6,980.33 (If more space IS needed, Insert additional sheets of the same size) REV-1512EX+11-971_~_ . .~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF PACKER FLOYD W. FILE NUMBER 21 01 0574 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. PA POWER & LIGHT 87.56 2. COMCAST CABLE TV 30.75 3. WATER BILL 30.87 4. VERIZON TELEPHONE 53.74 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, Insert additional sheets of the same size) 202.92 ."",;,m.,:"". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER PN~KFF FI nYD W ?1 01 0574 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 JUNE D. KALINA DAUGHTER 100% OF ESTATE 6141 HOCKER ROAD HARRISBURG, PA 17111 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) .. ''''~:;:;'O'.'. .co.,"P""""" .c;"'!"", 'l",.f,vi~,.,;.:: .... '':'4''!;'''-' .,-.....,. . " ":1","'" '-:':' :i .~:'."",~,;~\~~1~~;~'~~~:,~~~:' ~"'" Ii Ii ,I ',I 'I ii .' ill Cumberland, State of Pennsylvania, being in good bodily health and of Bound \ and disposing mind and memory, and not acting under duress, mena.ce, fraud or " ;\\undue influenoe of a:rry person whomsoever, , 'I: of human lif'e, and being desirous of disposing of ply worldly goods while I have (' the strength and capacity BO to do, 1 do make, publish and declare this JJJY I LAST WILL AND TESTAMENT. I hereby revoke, canoel and a.rmul all my former , \Wil1s and Testaments, including codicils thereto, by me at ~ time made, i and declare this alone to be my LAST WILL AND TESTAMENT. 21-2001-574 LAST WILL OF FLOYD W. PACKER I, ]'L(jfi) W. 'PACKER, of ~.the Borough of Mechaniceburg, County of merely oalling to mind the frailt,y 'I " i 'iLIFE. I DISPOSE OF TIlE SAME AS FOLLOWS, VIZ, I , , :!d1scharge all of my just debts, funeral and testamentary expenses. AS TO SUCR ESTATE AS IT RAS PLEASED GOD TO ENTRUST ME: WITH IN THIS 111!U. I direct that my executors hereinafter named pay and ~. I direct that my bodily remains 'be buried in a lijt which I !own, situate at the Mt. Olivet Cemetary, New Cumberland, Pennsylvania. I I rheresoever situate, and wha.tsoever it may consist of, I give, devise and ~eQUeath, absolutely and in fee, to my dearly beloved Daughter, .TUNE D. KALINA, ITm 3. All the rest, residue and remainder of 1II;:[ entire estate, "er stirpes. I i~Y I as Executrix of this ITEM 4. I nominate and appoint JUNE D. KALmA Las';; Will. ,. tl;;;! :;jut- JAMBS at, BACH ATTORNEY AND COUNaE\,.OR AT t....w ".2....0RT'NO'""LLR ..~C'"'..N'C..U..o. ..EN....... '''0'' TEL '''''')''3.,_iOU :.", h_~~,i~~~ :~~ ' ; ~:~~!,if~' :~~~~~~:;~i~ >,~,"f ITEM 5. I direct tblLt my personal representatives, as well as their suocessors, shall not be required to give bond .for the fai thf'ul i !. performance of their duties in any jurisdiction. i': , ~. I grant to my persona.l representatives herein named, in II addition to, but not in limitation of those powere vested by law, to be II exercised without prior application to or approval of any court, the power I and authority to retain indefinitely 8.lly property, to invest and reinvest any f:sets or the proceeds from the sale of assets, although said investments may not be of the character prescribed by law, to sell, convey, assign, I 'transfer and encumber a:ny property, to pay, settle or compromise all claims, ! : to make distribution or divisions in cash or in kind, and in general to j exercise all powers in the management of any property hereunder which any i:lindiVidUal could exercise in the management of similar property owed in his :own right, and to execute and deliver any and all instruments and to do all :acts which may be deemed necessary and proper. Ltt:~~ JANES M. BACH ATTORNEY AND Cou"a~l..o" "'T L.o.W :Uil...POJlTl/'olC"'I.LIlD MJCH..NIC$IIUIIO. PI...N... 1701ll1l TEL. (717)717.ilOI1ll ~~_ _"_~~ ." .. '( v' ~:~.'Y?;' ._~. I FLOYD W. PACKER Testator, whose name Is signed to the ettached,Or:",. foregotng Instrument, having been duly qualIfIed eccordlng to law, doher~bt. acknowledge thet I signed and executed the Instrument as my Last WIt I; that' I sIgned It wll I Ingly; and that I signed It as my free and voluntary 8Ct for the purpose thereTo expressed. if';,. :l ~5 ti ?ij i ~ ~ ;''1 ;",1 d~ '~~ ~;'1 ,! Sworn or affirmed to and acknowledged before me, by FLOYD \I. PACKER the Testator, thIs / R d.y oj , July . 1985. SONORA l. JONSON,. N",',vy P,uhl:r. M MvCommission Exprrcs r,b. ,7 1~ Mechanicsburg(Hampden Twp), Pa. .~Ofl"L...:L H_'~ {""" hd.. ,",.,0, .... Notary Pub I f c My Commission Expires,2/27!B9 ,',:',..',', The p;ecedlng Instrument consistIng of thIs and one (1) other type~rl~n page, IdentifIed by the sIgnature of the Testator, was on the date thereof "':f' signed, published and declared by FLOYDW. PACKER ,the Test~tor thereIn. named as and for hIs last WII I and Testament, In our presence of e~ch other, have hereunto subscrIbed our names as witness. ~4- .4- C ,.-('? Residing at 352 South Sporting Hill Road Mechanicsburg, -PA lvo55 ~/A-L,,~ ,$~ ____ ResIdIng at 214 South Sporting Hill Road Mechanicsburg, FA 17055 .-1l F F D A V I I ~:~i , I " \ COMMONWEALTH OF PENNSYLVANIA) ) ss COUNTY OF CUI'BERLANO ) if I ~!~ l_~:h We, James M. Bach and Christine M. Forti , the wIt::':'. nesses whose names are signed to the attached or foregoIng Instrument, belfig; duly qualified according to law, do depose and say that we were present lirid:/.' saw Testator sIgn and execute the Instrument as hIs last WII I; th~t he signed; willingly and that he executed It as hIs free and voluntary act for thepu-r.::t'" pose therfn expressed; that each of us In the hearIng and sight of the Tes+~:' atar signed the wll J as wItnesses; and that to the best of our knowledge tti~;": Testator was at that tIme 18 or more years of age, of sound mind ~nd unCfet.:..ind' constraInt or undue Influence. '~-il:./1.:~, Sworn or af firmed to and subscr I bed to before me by James M. Bach . .. ..:: .",~..." i , :,j ',{. ~!-:: ,t'" 8nd ~istine M. Forti , wItnesses, thIs I >?' day of JulY ; ~, ..,. Jums y. R&.cn 19 85. ~. ., '; ATTo....rr AND COUNmD" lIlT L.JlW 10''''. JOMM'. CMtrItCMIIO. SUIT': .:a SONORA L JONSON.. Notary ~\!hlic r~ My Comm;ss;O~ br\l'''s feb. "21~ 19 ,.. Mechanicsburg (Hampden Twp), P<I. I'" ,,",,~d.. .....-'1'1 Notary Pub II c _: n "'/i~ // ,.-' .>.,...." ~..~,.,\.\., PA. nOli r.~j!i Tn., "", 7".20111 ~: t My Commission Expires, 2/27/89 -. .,j,. , 1_ REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY , Deceased No. 2001 00574 Date of Death 06/06/2001 Social Security No. 207075154 Estate of PACKER, FLOYD W. also known as Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We verify that the statements made in this inventory are true and correct. l!We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney CHARLES E. PETRIE I.D. No. 29029 Address 3528 BRISBAN STREET HARRISBURG person,~1 Representative: /lu1<-€ p ~-f~ JU~ D. KALINA Dated 01/22/2002 PA 17111 Telephone: (717) 561-1939 Description 29 UNITED STATES SAVINGS BONDS Value 2,855.14 1973 DETROITER MOBILE HOME 4,500.00 PATRIOT-NEWS REFUND 46.40 VERIZON REFUND 10.65 COMCAST REFUND 30.38 qUU~J !,;'~') HOMETRENDS REFUND 70AO 8} Z d v- 83.:1 lO. Total (Attach Additional Sheets if necessary) /"8 7,897.17 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 i Continuation of Inventory PACKER, FLOYD W. 2001 00574 Paqe 1 Description of Inventory Description Value TV GUIDE REFUND 27.45 STATE FARM INSURANCE REFUND 56.75 INCOME TAX REFUND 300.00 Real Estate Subtotal $ Grand Total $ 384.20 7,897.17 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.2B0601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CHARLES E PETRIE ESQUIRE 3528 BRISBAN PAXTANG, PA 17111 __nun fold ESTATE INFORMATION: SSN: 207-07-5154 FILE NUMBER: 2101-0574 DECEDENT NAME: PACKER FLOYD W DATE OF PAYMENT: 02/04/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/06/2001 NO. CD 000827 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,299.83 I I I I I I I I TOTAL AMOUNT PAID: $3,299.83 REMARKS: JUNE 0 KALINA C/O CHARLES E PETRIE ESQUIRE CHECK# 281 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS MARY C. lEWIS REGISTER OF WillS / f) /, c PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 NAME OF DECEDENT: FLOYD W, PACKER DATE OF DEATH: June 6, 2001 WILL NO: ESTATE NO: 2001-00574 Pursuant to Rule 6,12 of the Supreme Court Orphan's 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 K... 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 representative file a final account with the Court? Yes No L b. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) c. Did the personal representative state an account informally to the parties in interest? Y es ~ No DATE: February 8, 2002 co d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~ ~.p_~ 2 4--0 SIGNATURE " L__ CHARLES E. PETRIE NAME (PLEASE TYPE OR PRINT) CO LLJ l.J... ("::;' '-l- p ..C: "j:: \.L~ ::. ,.,f'''''': ....- 3528 Brisban Street Harrisburg, PA 17111 ADDRESS (717) 561-1939 TELEPHONE NO. CAPACITY: _ Personal Representative X Counsel for Personal Representative \, / 6 - ,;:)3 'i- 2? BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-25-2002 PACKER 06-06-2001 21 01-0574 CUMBERLAND 101 CHARLES E PETRIE '02 f\P\<-1 3528 BRISBAN ST HBG \.:,~~ 17111 en;)C 7 :/3,8 '* REY-1547 EX AFP (01-02) FL OYD W Allount Rellitted CHANGED (1) (2) (3) (4) (.5) (6) (7) .00 .00 .00 .00 7.897.17 72,615.70 .00 (8) 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 __ ifEV =i5'4-j-E3f-i.FP--foY=02Y-Noi"-icE--OF-YNHEifiTAifce-YA'x-A-PPRAisEirENT-:--i.LLowAifce-oi-------------- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF PACKER FLOYD W FILE NO. 21 01-0574 ACN 101 DATE 03-25-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage 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 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. Hortgages/Notes Receivable (Schedule D) .5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (9) nO) 6,980.33 202.92 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 80,512.87 (11) (12) (13) (4) 7 .183 25 73,329.62 .00 73,329.62 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 ~ returns assessed to date. ASSESSMENT OF TAX: 1.5. Allount of Line 14 at Spousal rate (1.5) 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 73,329.62 X 045 = 3,299.83 .00 X 12 = .00 .00 X 15 = .00 (9)= 3,299.83 ~..._n. n____. . l+J AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 02-04-2002 CDOO0827 .00 3,299.83 TOTAL TAX CREDIT 3,299.83 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO 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.) RESERVATION: Estates Df decedents dying Dn Dr befDre Dece.ber 12, 1982 -- if any future interest in the estate is transferred in pDssessiDn Dr enjDy.ent tD Class B (cDllateral) beneficiaries Df the decedent after the expiratiDn Df any estate fDr life Dr fDr years, the CDmmDnwealth hereby expressly reserves the right tD appraise and assess transfer Inheritance Taxes at the lawful Class B (cDllateral) rate Dn any such future interest. PURPOSE OF NOTICE: TD fulfill the require.ents Df SectiDn 2140 Df the Inheritance and Estate Tax Act, Act 23 Df 2000. (72 P.S. SectiDn 9140). PAYMENT: Detach the tDP pDrtiDn Df this NDtice and sub.it with YDur pay.ent tD the Register Df Wills printed Dn the reverse side. --Make check Dr mDney Drder payable tD: REGISTER OF NILLS, AGENT REFUND (CR): A refund Df a tax credit, which was nDt requested Dn the Tax Return, may be requested by cD.pleting an "ApplicatiDn fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REV-1313). ApplicatiDns are available at the Office Df the Register Df Wills, any Df the 23 Revenue District Offices, Dr by calling the special 24-hDur answering service fDr fDr.s Drdering: 1-800-362-2050; services fDr taxpayers with special hearing and I Dr speaking needs: 1-800-447-3020 (TT Dnly). OBJECTIONS: Any party in interest nDt satisfied with the appraise.ent, allDwance, Dr disallDwance Df deductiDns, Dr assessment Df tax (including discDunt Dr interest) as shDwn Dn this NDtice must Dbject within sixty (60) days Df receipt Df this NDtice by: --written prDtest tD the PA Depart.ent Df Revenue, BDard Df Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electiDn tD have the .atter determined at audit Df the accDunt Df the persDnal representative, OR --appeal tD the Orphans' CDurt. ADMIN- ISTRATIVE CORRECTIONS: Factual errDrs discDvered Dn this assessment shDuld be addressed in writing tD: PA Depart.ent Df Revenue, Bureau Df Individual Taxes, ATTN: PDSt Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 PhDne (717) 787-6505. See page 5 Df the bDDklet "lnstructiDns fDr Inheritance Tax Return fDr a Resident Decedent" (REV-1501) fDr an explanatiDn Df administratively cDrrectable errDrs. DISCOUNT: If any tax due is paid within three (3) calendar mDnths after the decedent's death, a five percent (5%) discDunt Df the tax paid is allDwed. PENALTY: The 15% tax amnesty nDn-participatiDn penalty is cD.puted Dn the tDtal Df the tax and interest assessed, and nDt paid befDre January 18, 1996, the first day after the end Df the tax amnesty periDd. This nDn-participatiDn penalty is appealable in the sa.e manner and in the the same time periDd as YDU wDuld appeal the tax and interest that has been assessed as indicated Dn this nDtice. INTEREST: Interest is charged beginning with first day Df delinquency, Dr nine (9) mDnths and Dne (1) day frD. the date Df death, tD the date Df payment. Taxes which became delinquent befDre January 1, 1982 bear interest at the rate Df six (6%) percent per annum calculated at a daily rate Df .000164. All taxes which became delinquent Dn and after January 1, 1982 will bear interest at a rate which will vary frDm calendar year tD calendar year with that rate annDunced by the PA Department Df Revenue. The applicable interest rates fDr 1982 thrDugh 2002 are: Year Interest Rate Daily Interest FactDr Vear Interest Rate Daily Interest FactDr 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 fDllDws: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any NDtice issued after the tax becDmes delinquent will reflect an interest calculatiDn tD fifteen (15) days beYDnd the date Df the assessment. If payment is made after the interest cDmputatiDn date shDwn Dn the NDtice, additiDnal interest must be calculated.