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HomeMy WebLinkAbout01-0703 REV-1500 EX 1&-00) J& -:2.J1e /0 REV-1500 i:}F:..:t:::,:i.L J5E':;r<JL'j *' COMMONWEALTH OF ,,' PENNSYLVANIA DEPARTMENT OF REVENUE , , DEPT 280601 HARRISBURG, PA 17128-0601 '" >- ::t;::!;cn u ,"< ",'"u ,,00 urt:...l "OJ '- << INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER .:z.L-O~ COUNTY CODE \'E4R --2Q,3- NUMBE.q ~ Z W o W U W o DECEDENT'S NAME (LAST, FiRST, AND MIDDLE INITIAL) Lois H. High OATE OF OEATH (MM-OO-VEAR) 02/10/2000 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS , SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER 168 24 2954 DATE OF BIRTH (MM-OO.YEAR) 01/28/1930 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST. FIRST. AND MIDDLE iNITIAL) 5C{ 1. Original Return o 4. limited Estate ~ 6. Decedent Died Testate (Attach cooy of Will) o 9. Litigation Proceeds Received D 3. Remainder Return {da(aoideathpllOrta 12.13-ll2) o 5. Federal Estate Tax Return Required ....Q... 8. Total Number of Safe Deposit Boxes D ~1. Election to tax unaer Sec. 9113(A) lAtlacnS~hO\ o 2. Supplemental Return o 4a. Future Interest Compromise (data 01 riealh arter'2.12-32\ o 7. Decedent Maintained a living Trust (Attach copy oiTrustl o 10. Spousal Poverty Credit (data ofdaath between 12.)1-91 and 1-1.95) >- Z '" o z o '" <n '" '" '" o u NAME Elizabeth P. Mullaugh I CQMPlE,E MAILING ADDRESS FiRM NAME ItfAppii<;>.tJ1el McNees, wallace TELEPHONE NUMBER (717) 237-5243 & Nurick 100 Pine Street P.O. Box 1166 Harrisburg, PA 17108-1166 1. Real Estate (Schedule A) {11 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Propnetorship (3) 4 Mortgages & Notes Receivable (Schedule OJ (4) z C 5. Casn, Do'-,,~ ::eGosits & Miscellaneous Personal Property (Sclledule E) (5) 11,339.25 16) o. Jointly Owned Property (Sclledule F) DseoaraleBiilinqRequested '- <r ::l l- e.. <( U W 0::: 7. inter-Vivos Transfers & MisceUa(leOUS Non-Probate Property '\Scheduie G or L) I}) 9. Funeral Expenses & Administrative Costs (Schedule H) iO. Debts 01 Decedent, Mongage liabilities, & liens (Schedule I) ',9) (10) (8) 9,041.41 4, 108.60 11,339.25 8. 70tal G(OSS Assets (lotal Lines ,.7) 11. Total Deductions (total lines 9 & 10) (11) 13,150.01 ( 1.810.76) 12. Net Value of Estate (Une 8 minus line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) , 14. Net Value Subject to Tax (Une 12 minus t.ine 13) 1,12) (13) (14) 0.00 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::l e.. :;; o u g 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.o_ (15) 0.00 x.O_ (16) 0.00 x .12 (17) 0.00 x .15 (18) 0.00 (19) 0.00 16. Amount of Line 14 taxable at lineal rate 17 Amount oi Une 14 taxable at sibling rate 18. Amount of line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYMENT Decedent's Complete Address: STREET ADD~ESS c 0 D'"~e C. Ka" ffmo~ 2100 East Coventry Lane CITY Enola I STATE PA I ZIP 17025 Tax Payments and Credits: 1. Tax Due (page 1 Line 19) (1) 2. Credits/payments A. Spousal poverty Credit 8. Prior Payments C. Discount 0.00 Total Credits (A + 8 + C ) (2) 0.00 3. InteresVpenally if applicable D.lnterest E. penally TotallnteresUpenally ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) (SA) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;................. 0 b. retain the right to designate who shall use the property transferred or its income; ........... ........ . 0 c. retain a reversionary interest; or............... ........................ ................. ................... .................... 0 d. receive the promise for life of either payments, benefits or care? ........................... ....... D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................. ........................ ................. ................... D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................................ .......................... D 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, No [JiI [JiI [iJ [iJ [JiI [JiI Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other lt1an the personal representative is based on all information of which preparer has any knowledge. (X{Cv;;,rL DATE (William R. Kauffman) '1- I L - 0) East Coventry SIGNATURE OF PRE THER THAN REPRESENTATIVE ~" PA 17025 p. ADDRESS 1 Pine Street, P.O. Box 1166, Harrisburg, PA 17108-1166 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (ill. 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 s1i11 applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(I.211. The tax rate imposed on the net value of Iransfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P,S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. '''''''M'''''''''''''* COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Lois H. High FILE NUMBER include the proceeds oi litigation and the date the proceeds were receive<i by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. iTEM NUMBER 1. DESCRIPTION PSECU checking account #0450113030 VALUE AT DATE ., OF DEATH ,c. 630.11 2. Allfirst checking account #09504-7927-0 in the name of William R. Kauffman, attorney-in-fact for decedent, f/b/o decedent 8,800.00 3. U.S. Income Tax refund 1,841.18 67.96 4. Refund from cable tv in decedent's former apartment TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additionai sheets of the same size) 10,088.07 REV.1511E)(.I1-97lII) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN i:<.ESIDENT DECEDENT ESTATE OF Lois H. High FILE NUMBER Debts of decedent must be reported on Schedule I. 'TEM I N~M8ER A. 2. 3. 8. 1. 2 4. 5 6. 7. DESCRIPTION FUNERAL EXPENSES. Stephenson's Flowers Rolling Green Cemetery Neill Funeral Home ADMINISTRATIVE COSTS: Personal Representative s Commissions Name of Personal Rep:esentaUve (s) Wil" iam R. Kauf fman Social Securny Numben:sl I EiN Number of Personal Rep,esentative(s) SlreeiAdoress 2100 East Coventry Lane Enola 17025 PA City State ZIP Year(s) CommiSSion Paid: ",y..,~, Family Exemption: (If decedent S addre~;:. ;~ 'n~ ~he same as claimant s. attach explanation) Diane C. Kauif~an Claimant 2100 East Coventry Lane Street Address Ena la 17025 PA Stale Zip ':ity qeiationship of Claimant to Decedent Llauenter Probate Fees Accountants Fees Tax Return Preparer s Fees TOTAL (Also enter on line 9. Recapitulation! $ (If more space is needed, Insert additional sneets of the same size) AMOUNT 178.71 2,515.00 2,347.70 500.00 3,500.00 (estate not sufficient to pay in full 9,041.41 '''''''''''''''"''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER 1. Surburban Cable 2. Bell Atlantic - PA 3. John Schiro, MD 4. Do Wray Mi Piano 5. PP&L Utilities DESCRIPTION 6. Buchanan Ingersoll Professional Corporation, Legal Fees for estate planning Pinnacle Health, medical services John Devorick, tax preparation Internal Revenue Service, income taxes for 1999 Pa Department of Revenue, income taxes for 1999 Orthopedic Institute of PA Central PA Surgical Assoc. AMOUNT 35.42 32.67 100. 00 206.70 23.06 472.50 96.70 150.00 2,273.45 464.00 169.10 85.00 7. 8. 9. 10. 11. 12. TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert addlttonal sheets of the same size) 4,108.60 REV-1513 EX+ (9-00) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT sa -.-I:"J BENEFICIARIES ESTATE OF NUMBER I FILE NUMBER 1. RELATIONSHIP TO OECEDENT NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Nol Li.IT.u.t..(.) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Diane C. Kauffman Daughter AMOUNT OR SHARE OF ESTATE 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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 (no assets after payment of family exemption amount) 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) . "'.c .~'h '.'''\' ".,r. fhis is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. /'tl'~~\1rOrpl,t~..~_._ "'~~~J',"" ~ ~~ . ~- /~~. ~\ ~~I .. - , I!:~ ~Ul . lit. .:b.$ '*\L' ".'""..... ,J*! \~ ~- - - /~l ~~ _//-$>./ -----',fl",fNT-~\ ~\:,',' ;;........;;,..#,##~,,,J1,,,,ljl f~al{~.~or1 Fee for this certiflcate, $2.00 P 6326136 r;; f',,), "L1~ /( atel 2000 H1U,..3A..2181 COMMONWEALTH Of PENNSYlVANIA. DEPARTMENT OF HEALTH. 'VITAL RECORDS CERTIFICATE OF DEATH TYPElPFIlNT . PEAIU.NENT IILACKt"lK ~ ~ ~ o ~ l z SlAJlf'l-l_R D~~~H,~,.t;:o..-;':;;;I-~- 4"'€.!i'ull ID Z CJ:L....J :=....10 - ~- _. 000 U 21. 21."""'1, E_lN diMa.........-.,.compIicaI.....___,t>e "".,h Cl<JACl.Oll..,t>emadeolltw'''II,wchl5o.,di.leoo,_aIOtya"_,OIlodo.,._,,. "",. .~ l......",.,...cauuon........... l=-"= '-^^^-J..L~-_J-.A9__--'---- ~'-"'~~__ ~""=-----J..- DUETD(OAASAC~t<<;EOFt~ i [ :~TD(OA~~~OOEOCE~ DUElOCOAAS..CONSEClU(NCEOF) . WERE"OlOPSYFI'IDINGS _NEAOFOEMH -.u8lE I'RIOA 10 COUPLETlOHCWCI.U$lE 0I'0EMH1 lO, .;lOCO PMTM: ou...ov-_--.gIO_.lIIII ....~.......~__inJWITI -. ~ [] o lIATEOflfUOAV (...........Oay.i'aall llwt:OflfiJlJAV 'tu)RVRWOf\K1 OlESCRlIll<H(lWIM.lUAVOCC\JAflED -- o [] o "'-"'CECWltiJORV''''_,_,_"ICIOfy.O~ Y. buikInv._.ISpooo""1 - _ 0 ....0 AcOode'" P....."II.......oigolion _0 ~D - CoukJ_beOO.."",,,,",, lOCRION(5Ir_Cly{lOwn.S-1 ..J a.. Dll. carJIflIEAI01_.....~."..1 .CEIITIf<V_PHVSlClAtlIPtl~"""<""""""<au...<:J"'''I",........""-,,,..,,,,.,,,,,,,,,h''''''~'''''''h''''''e,,,,,,,,.''''''''''''lJl To..._o,...,_..~.d.""occurnd_""'e"'''{oI_.....,n.,...fa1"",.. ~ 'PAOHOUHCIHG ANDCf-RTIF,...a ,,"'SICIAN IPtI_"", .""', ;>0"""""'''''' UN'" .."de",.I,,,,,, '0 c"""," oj ""~N TO__OI...,_~..d""'oce""-.d"""_''''''.._plK.,'''''d",'''",,"e'''''I'I''''''''''''''''''''I"'" "MEDICAL EXAU,NEAI(:ORONEA OnIf..be..."'..am;n.llonandlOlin...IIg.llan.mm'op'nian.d..lhoce........"h.U",.,d.lo,.ndplao..ondd".'alh.eo""l.land .....",..00...'..... '" ~O'SlA"A' SIONMORE""'ONv..BER / /Q,""tr -- V 1.21/1').IIIAI o n. 'I.' <;. 1."\. o.\" DJ\1EFIU;:OIMondl.Ooy,_, t.~~ t-\ILL ~ R-bR. Vll~ if / II 200<' , LAST WILL AND TESTAMENT OF LOIS HIGH I, LOIS HIGH, of Hampden Township, Pennsylvania, make this Will, hereby revoking all my former Wills and Codicils. ARTICLE ONE T ANGlBLE PERSONAL PROPERTY ~ 1.1 r bequeath all my tangible personal property, including by way of illustration but not by way of limitation, my household furniture and filrnishings, paintings, books, automobiles, jewelry and personal effects, exclusive of any such property used in a trade or business, to my daughter. DIANE KAUFFMAN ("My Daughter"), and my son, JAMES ADAM HIGH, ("My Son"), in as nearly equal shares as they agree, or to the survivor of them. Any items not so selected shall be sold and the proceeds shall pass as a part of my residuary estate. ~ 1.2 To the extent practicable in the Executor's sole discretion, r bequeath any policies of insurance on such property to the beneficiary entitled to such property. ~ 1.3 1 direct that the expenses of storing, packing, shipping, insuring and delivering any such property to the beneficiary entitled thereto shall be paid by the Executor as an administrative expense of my estate. AltnCLE TWO RESIDUE ~ 2.1 I devise and bequeath all the residue of my estate to My Daughter and My Son, in equal shares, or to the survivor of them. ARTICLE THREE APPOINTMENT OF FIDUCIARIES ~ 3.1 I appoint My Daughter's husband, WILLIAM KAUFMANN, as Executor of this Will. If he is unable or unwilling to act or continue to act, for any reason whatsoever, I appoint My Daughter as successor Executrix. All references herein to the "Executor" shall mean my originally appointed Executor or the successor Executrix, as the case may be. ~ 3.2 I appoint WILLIAM KAUFFMAN as Guardian of the estates of any minor beneficiaries under this Will, including the proceeds of any life insurance on my life payable to such minors and any other property, rights or claims with respect to which I am entitled to appoint a guardian and have not otherwise specifically done so. The Guardian shall have full authority to use such assets, both principal and income, in any manner the Guardian shall deem advisable for the best interests of the minor, including college and graduate education, and professional, vocational or technical training, without securing a court order. If WILLIAM KAUFFMAN is unable or unwilling to act or continue to act, for any reason whatsoever, I appoint My Daughter as such Guardian. -2- \,,.....',,'.._,,, .,.",~"~,,",",,..,,~,......'"~' rr '~'T ARTICLE FOUR POWERS OF FIDUCIARIES ~ 4.1 No fiduciary under this Will shall be required to give bond or other security for the faithful performance of the fiduciary's duties. law: ~ 4.2 Any such fiduciary shall have the following powers, in addition to those given by ~ 4.2.1 To invest in, accept and retain any real or personal property, including stock of a corporate fiduciary or its holding company, without restriction to legal investments; ~ 4.2.2 To sell, exchange, partition or lease for any period of time any real or personal property and to give options therefor for cash or credit, with or without security; ~ 4.2.3 To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; ~ 4.2.4 To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; ~ 4.2.5 To engage in litigation and compromise, arbitrate or abandon claims; ~ 4.2.6 To make distributions in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributees on a non-pro rata basis, and for such purposes to make reasonable determinations of current values; ~ 4.2.7 To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of any person affected thereby; ~ 4.2.8 To allocate, in the Executor's sole and absolute discretion, any portion of my exemption under Section 263 I (a) of the Internal Revenue Code -3- (which statutory exemption is presently $1,030,000), to any property as to which I am the transferor, including any property transferred by me during my lifetime as to which I did not make an allocation prior to my death; ~ 4.2.9 To disclaim any interest I may have in any estate if the Executor deems such disclaimer to be in the best interests of my estate and the beneficiaries thereof; and ARTICLE FIVE PROVISIONS FOR TAXES ~ 5.1 All estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature payable by reason of my death to any government or subdivision thereof upon or with respectto any property subject to any such tax, and any penalties thereon, shall be paid by the Executor out of the principal of that portion of my estate disposed of by Article Two of this Will. All interest with respect to any such taxes shall be paid by the Executor out of the income or principal or partly out of the income and partly out of the principal of such portion of my estate, in the absolute discretion of the Executor. My Executor shall not make apportionment among or seek reimbursement from the beneficiaries, recipients or owners of such property for any such taxes, penalties or interest. Notwithstanding any provision of this Article to the contrary, the Executor shall not pay any such taxes, penalties or interest attributable to any property included in my estate solely because of a power of appointment thereover which I possess but have not exercised or any qualified terminable interest property. -4- ARTICLE SIX PROVISIONS FOR DEBTS AND EXPENSES ~ 6.1 I direct that any of my legally enforceable debts, any expenses of my last illness, funeral and burial, and any of the administrative expenses of my estate, shall be paid from the principal of that portion of my estate disposed of by Article Two ofthis Will. ARTICLE SEVEN MISCELLANEOUS PROVISIONS ~ 7.1 As used in this Will, the term "Internal Revenue Code" shall mean the Internal Revenue Code of 1986, as amended from time to time, or the corresponding provision of subsequent law. ~ 7.2 If any person and I die under such circumstances that it is impossible to determine which of us survived, it shall be conclusively presumed and this Will shall be construed as if such person had predeceased me. ~ 7.3 An individual fiduciary shall be entitled to receive reasonable compensation for such fiduciary's services hereunder. ~ 7.4 Whenever a fiduciary is directed to distribute property to or for the benefit of any beneficiary who is under (a) twenty-one (21) years of age, or (b) a legal disability or otherwise suffers from an illness or mental or physical disability that would make distribution directly to such beneficiary inappropriate (as determined in such fiduciary's sole discretion exercised in good -5- r faith), the fiduciary may distribute such property to the person who has custody of such beneficiary, may apply such property for the benefit of such beneficiary, may distribute such property to a custodian for such beneficiary, whether then serving or selected and appointed by the fiduciary (including the fiduciary), under any applicable Uniform Transfers to Minors Act or Uniform Gifts to Minors Act, may distribute such property to the guardian of such beneficiary's estate, may distribute such property directly to such beneficiary's estate, or may distribute such property directly to such beneficiary (except if any of the conditions hereinbefore described in (b) apply), without liability on the part of the fiduciary to see to the application of such property. This provision shall not in any way operate to suspend such beneficiary's absolute ownership of such property or to prevent the absolute vesting thereof in such beneficiary. IN WITNESS WHEREOF, I have hereunto set my hand and seal this cJ.~ day of January, 2000. ~~~ Lois igh (SEAL) -6- Signed, sealed, published and declared by the above named LOIS HIGH, as and for her last Will, in the presence of us and each of us, who, at her request and in her presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto the day and year last above written. dL~ .d. LJ~Residingat Residing at c9/0<! h.ud- C~ ~~ C/l1~ . 'PA /7o~o , rJ lDa, E. (,/'JJenJ(j Iv<~ E-n6/C '7c j7W--.5- / ~-:tF:-? --.. Residing at z,~ t.h=~ ~ /<~"~A4 :f'A /H~ I . -7- --.~ COMMONWEALTH OF PENNSYL VANIA ss. COUNTY OF DAUPHIN We, LOIS HIGH, the testatrix, and ('JQJ('~ I.A +h rJeH-Rf ' CU(I<<rl/>,./Cil./)INi..J'N<) and AI?~/H-r.'..ut-lt...L~ the witnesses, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the Will as a witness and that to the best of his or her knowledge the testatrix was at that time 18 years of age or older, of sound mind and under no constraint or undue influence. =-::-- c-:=== ;e~f/ Ij 1/-. f2 Lois Higl3 . .=e-~_ _ ~,~(J 4)~ ;r;ss /3 Worn:" rM; :!J -"- On thi4aay of January, 2000, before me, a Notary Public, the undersigned officer, personally appeared ELIZABETH P. MULLAUGH, known to me to be a member of the Bar of the highest court of the Commonwealth of Pennsylvania and a subscribing witness to the within instrument, and certified that she was personally present when LOIS HIGH, AI~~ lA. '/-"'/t'Uif. 0-k-fo;T,>o!r <l AI, ""/W{) and whose names are subscribed to he within instrument, executed the same and acknowledged that they executed the same for the purposes therein contained. (SEAL) ~h(,A}"_- 0 C4W-f.';f N tary Public a My Commission Expires: Notarial Seal Kimberly A. Crostley, Notary Public Harrisburg. Dauphin County My Commission ExpIres Jan 4,2001 Member, Pennsylvania Association of Notaries -8- 218985-1; HOO1_General 01/19/00 12:07 PM /~_~y~-/O COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ELIZABETH P MULLAUGH MCNEES ETAL P.O. BOX 1166 HARRISBURG PA 1 ]':1:08...1166 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-03-2001 HIGH 02-10-2000 21 01-0703 CUMBERLAND 101 * REV-1547 EX AFP <12-DDl LOIS H Amount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=is4j-ix-AFP--ri'2-:ooi--NOT'ici--OF-'rtiHERiTANCi-T'AX-A-PPRAisEiiENT~--Aii-oWAtici-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HIGH LOIS H FILE NO. 21 01-0703 ACN 101 DATE 09-03-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED I~ an assessment was issued previoUSly, lines 14, 15 and/or 16, 17, 18 and 19 will r~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 1S. A.ount of Line 14 at Spousal rate (lS) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (S) (6) (7) .00 .00 .00 .00 11.339.25 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 9,041.41 4.108.60 (11) (12) (13) (14) NOTE: .00 X 00 = .00 X 06 = .00 X 00 = .00 X 15 NOTE: To insure proper credit to your account, subllit the upper portion of this forti with your tax paYllent. 11,339.25 ]3.150 01 1,810.76- .00 1,810.76- (19)= .00 .00 .00 .00 .00 TAX CREDITS: PAYMENT RECEI-'-T DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ..CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)