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01-1069
PETITION FOR PROBATE and GRANT OF LETTERS Estate of. Uir9i nii1 M. RrUY1ner No. -<1,-0/.. /I)~ Cj also known as To: Register of Wills f~~ t~e _ I . A . .IJAceased. County of Lum~r aag In the Social Security No. d 0..,- 03- 7~\.ft:J Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of ag~..?fler jp the executli~5 in the last will of the a~e decedent, dated ~ 'i and codicil(s) dated ~ Ilf*ed ,19__ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in h last family 01 principal residence at er (list street, number and muncipality) 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: ---nJ a $ '~q()('"n2! $ $ $ WHEREFORE, petitioner(s) respectfully equest(s) the probate of the last will and codicil(s) presented herewith and the grant of letters ritar theron. (testamentary; admi strati on c.I.a.; administration d.b.n.c.t.a.) ~ '" ~ <Ll U c: <Ll ~~ "'~ <Ll ... ~g -g.g cu'.o 3&:: <Ll'- a 0 ~ c: 00 Vi OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA J..ss COUNTY OF rl1mnerJ 6100 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 and truly administer the estate according to law. /7-~-2.. /3 ~ QQ' ::s ~ r: ~ ~ ~o. 21-2001-1069 Estate of VIRGINIA M. RRl1NNF.R , Deceased DECREE OF PROBATE A~D GRANT OF LETTERS AND NOW l\k)VFMRF.R 71 !':t:, _____ _ _ _ Jix.-20.0;Lin c,)!:sideraiion, - ,,: It':;'i,'r' '.1[1 the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated SEptember 9th, 1974 described therein be admitted to probate and filed of record as the last will of VIRGINIA M. BRUNNER and Letters TESTAMENTARY are hereby granted to KAREN LEE WORTHING'ION' AND SANDRA LEE TIMPLE'ION, NAA SANnAA LEE ~tSWEtt FEES Probate, Letters, Etc. ......... Short Certificates(5) . . . . . . . . . . Renunciation ................ x-PAGES (1) JCP $ 115.00 $ 1 c; 00 $ $ 3 .00 5.00 TOTAL _ $ .NOVEl'4BER .215t.,.2001. . .$138.00. . A TIORNEY (Sup. Ct. I.D. No.) ADDRESS Filed PHONE 00 ).I .-- =Ct' :S ::::L 0" <" (p d -" :o~ ron cC:~~ () Eo' c z ~ N -" ,_ C) ~:i,': l"~'i, .'''''1 I~.. <..) EXECUTRIXES WILL PICK DE, LETTERS 'IODAY I," -"'J I: )> ;::; ~ "'-" o o \0 o ..... }-': ns.sn:;; ;.;o,~y n/,Q(, This 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. ~ /?(~~- Local Registrar (1 Fee for this certificate, $2.00 p 7884379 NOV 1 9 2001 Date 21-2001-1069 S.l43Aev.2187 COMMONWEALTH OF PENNSYLVANIA 0 DEPARTMENT OF HEALTH 0 VITAL RECORDS CERTIFICATE OF DEATH '2. E--.. '2. 12'()"2l Pennsylvania CoIege (1'.01'5+1 MAAIT....STllI'us._ _M__ 0Iv0n:ed lSllecfy) ... Widowed ,,0.0......__.. 7498 SEX IIIRTHPI.AC6 (Oly """ Stale 01' Foreeon Country) 2. PlACE OF DEATH (Check onty 0rMt -..tntirlJCtlOnS on 0Ihef ~ HOSPlll'L OTHER: I..,...... 0 E~ 0 :::::=u 0 ~)o 79 Y... . COUHlY OF DEATH Cumberland 117 November Drive, Apt. 2 ... white DECEDENT'S usu.... 0CCIJl'jlTI()N (~...=:~"=.::~ Sales Clerk llb. Retail Clothing DECEDENT'S MAILING ADOAESS 1S1r.... CiIyIlOwn, _. z;p~, DECEDENT'S ACTUAL RESIDENCE (SeootlllNCll<lnS on other side) V\IlS DECEDENT EVER IN U.s. ARMED FORCES? ...0 NotilJ DECEDENT'S EDUCRlON SlJRVMNCl SPOUSE lit .... gIVe maiden IWf18) ... FRHER'S NAME IF... ModdIe.laIl) . . Bruce Garfield Snyder INFORMANTS NAME (Type/PrinI) Sandra L. Criswell METHOD OF DISPOSITION O 1Iuriol~ er_o _......_.0 Donotion 01.... _, . 'L SIGNATURE OF FU No.__ 17". wtINn.::cu.llimU 01 MOTHEA'S NAME (Fir,t Middle. Maiden Surnamet Lottie Mae Anderson llIcI - ""-In. _? ..... 117 November Drive, Apt. 2 Camp Hill, PA 17011 17.. &.Ie '1b. Cumberland Camp Hill _. ORE OF DlSI'OSITION (-.Day. -) o November 20, 2001 21&= OR PERSON ACT1NCl AS SUCH lICENSE NUMBER ~ 2211.FS 012 849 L "it the bell of my knowtedgll. ~ath occurred althe time. datil and pIaot Mated. (SignoIuro..... T"', ... INFORMANT'S MAlUHG AIlIlRESS _. CityI1Own, _. Zip ~I mL 4 Hampshire Court, Stafford, VA 22554 PlACE OF DISI'OSITION. Name oIComo1O/)', ~ LOCRION. c~, SIaIo. ZIp eo. '" 0Ih0r PIac:o 210.Mt. Olivet Cemetery NAME AND ADDRESS OF Fi\CIUlY 'Ie.P.O. Box 431, New lICENSE NUMBER 17070 .. i /Se/l5c 2 . V\IlS CASE REFERRED 10 MEDICAL EXAMINERICORONER? ...0 ..,Jf ... ,_ PART II: OIhor~__lO_.bul ; itUMlI....... noc reUling in 1M ~ C8UM given in PART I. I 0nMt and dMth I I I S TIME OF DERH Id: dV E DUE 10 (OR AS A CONSEQUENCE OF): DUE 10 (OR AS A CONSEQUENCE OF): WEllE AUlOPSY FINDINGS _LAlIl.E PRIOR 10 COMPLETtoN OF CAUSE OF llEMH? MANNER OF DEATH DREOF INJURV 1""""',Ooy,_) TIME OF INJUAY INJURY Ilr WORK? DESCRIBE HOW INJURY OCCURRED. Hat",.. ~ o o - P-..v_1on o o o PlACEOF'NJURY.A1_,.......'...,'actory,_ M. IKIiIclIng. .... ISpec4y1 _. ..... 0 NoD ...0 No~ -- - Could noI be det..",ined lOCImON IS..... CdyITown. SIal'" __ 2.... CERTIl'IER 1Ct>ool<.... enol .CERTtFYlNG PHYSICIAN (Physoan C8fbtying cause of death wn.t anoch. physician has pronounced death and comPleted lIem 23) To'" beelof"'yknowledglt, ..thoccurrecl...to....aUM(.).nd manner.....tec:II..................................................... ... o 'PRONOUNCING AND CERTlFYtHG PHYSICIAN (PhysiCian boltt pronounclf'lO death and certifying tocaustl 01 death) To the... 01 my kno...... death occurred" 1M lime, .... and pI..._. and due 10 the caUM(I) and manner.. _led.. . . . . . . . . . . . . . . . . . . . . . . . . 'MEDlCAL EXAMINER/CORONER on..... bule oIe.aminetlon and/or Inv..lIgatlon. In my opinion, deeth occuned It the time. date. and place. .nd due to the CIU""') and mann................................................................... Ow....................................... :th. REGISTRAR'S SIGNATURE AND NUMBER 70 '70 '. ~ IAST WILL AND TESTAMENT 21-2001-1069 OF VIRGINIA M. BRUNNER I, VIRGINIA M. BRUNNER, of Fairview Township, York County, Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking and making void any and all other wills by me at any time heretofore made. I. II I direct that my Coexecutrices hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. II. All the rest, residue and remainder of my estate, whether real, personal or mixed, and wheresoever situate, I hereby give, devise and bequeath as follows: A. One-half (1/2) unto my daughter, KAREN LEE WORTHINGTON. B. One-half (1/2) unto my daughter, SANDRA LEE TEMPLETON. III. My daughters shall divide among themselves my tangible personal property as they may agree. IV. I hereby nominate, constitute and appoint my two daughters, V. i I I I post I I I KAREN LEE WORTHINGTON and SANDRA LEE TEMPLETON, as Coexecutrices of this, my Last Will and Testament. No fiduciary acting under this Will shall be required to bond in this jurisdiction or in any jurisdiction in which he may act. IN WITNESS WHEREOF, I, Virginia M. Brunner, the Testatrix, have unto this, my Last Will and Testament, set my hand and seal this 1 tx day of September, A. D., 1974. LAW O"P'ICES 7Iy~)J1 ~u~(SFAL) Page one of two Pages JON F. L.AFAVER a,7 THIRD STREET NEW CUMBERLAND, PA. . !. II " . . SIGNED, SEALED, PUBLISHED and DECARED by Virginia M. Brunner, the above-named Testatrix, as and for her Last Will and Testament in the presence of us, who have hereunto subscribed our names as witnesses at her request, in the presence of the said Testatrix and of each other. ! ~ II I! II Ii I I I" II II I LAW O"P'ICES JON F. LAFAVER Page two of two Pages 31. 7 TK1RD STREE.T NEW CUMBERLAND, PA. REGISTER OF WILLS OF~ COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the test at , sign the same and that signed as a witness at the request of testat_ in h presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19_ (Name) (Address) Register (Name) (Address) 21-2001-1069 REGISTER OF WILLS OF CU~...\and COUNTY OATH OF NON-SUBSCRIBING WITNESS 5a~~ Cr;~we.I' We are ~arefl l2.e Wort.h'r\~n , qualified according to law, depose(s) and say(s) that familiar with the signature of Virqinia M. Brunner XBoticl will presented herewith and CHHicKxx believesxhe signature on the will is in the handwriting of testat rix of (~~ to) the that We Virginia M. Brunner to the best of our Sworn to or affirmed and sub:,:cribed before me this 21st day of November ~ 2001 -'~~ knowledge and belief. 9nn&a.&a-S;~.JJJ (Name) 4lbM.pn\re. cb S\-a~rd 0Q. ress ~::.\55'\ JPj' MELY URGENT t.XnnMU Y URGt.NJ EXTREMELY URGE.NT 1-X JRf.MU Y lJHt;ENl 1:A IH.t:M.t:U UHlo.t: Next Day Air UPS Next Day Air UPS N~xt Day Air UPS Next Day Air UPS He' ve~" ;AI Saver Saver Saver (1';!. BOXES Ele 2423 ( i'f,) j 502-2900 GTE '.;;0 8&5 wo,mSTOCK RD ROSWELL GA 30075 LTR 1 Of' 1 SHIP BUREAU OF INDIVIDUAL TAXE (770) 998-2772 TO: PENNSYLVANIA DEPT. OF REVENUE DEPT. 280601 INHERITANCE TAX DIVISION r HARRISBURG PA 17128.0601 .~.._.--.~---,..._...."'_._._---, .~. -, _._..~.~-_.. ........., .. ,-,~._-~._.. -,,- ..~'"___'_,.___~_.o___.__ PA 171 9-20 11111111111111111I :) l:;\~:!t'~i~'4ii' <:.~~. ~ t., '\ i..,," .~t ).~. ./1...."., \~:h 0 )' ~. .~\~.,. @ .~~~. ~( =' ..~~ '.^ .\ (N(V' ",,; ~. .'. 'I., ,," ;~'^ . I UPS NEXT DAY AIR SAVER 1~ TRACKING #: 1Z A63 5V0 13 1789 4535 ~~ .--------.... .-------..-.-----.---. " ~ ;.. -",. f l ,.. ):.- ;:~ BILLING: PIP . REF *12-; 02:"14=02 ........._._.__. '.h.. "_~__....______..~_ " ISH 3.30 E2442 16.0A 01/2002 ---- '...~....'''''''Il'ih_Nonc..Ca.~,.~~.:.''l''Y,':!..~IO~.r=-';..~~~~II==~~~~=....~,;; Sav d i"-l ,on rn CO . J ..;,:_~ f' ... ~ . J r fTn ~. .... .) ,/) . ::> ~ ~ II : ~ ~ '1.'='II~ "t' t~'I~', ...", :,} ~I .~;; I~~,,~':;~. ~~ .Il:r:~ , (~ r4 ~I I ~~ :.:~ j '~."-../ as .- C <0 > - U) - ~ Q) 0 C:CJ)X CC c::J~ 9 Q)C q;) a..Q)- ~ >lU ..... o<D-6 ~ a:.- ~ = - .~ '!t 'iiO"O~o:. .... _ co -- c;-co ... ~(I)-OOP c: co~ ~~~~~ E ~ ! a:e OQ)::SCU(Q oomo:z: ~~~ "iI,? ~ t; a: - U- 9 "".r r .. Ln N c.::J L.\.J L...... .I ,') CD cc N P ..1 ;- ;.;) :-: ..., ..J :;c; r..:l ll'l ~ ll'l~ ~ ..JO 0 ll'l..JuOt- HH ll'l.-l ;1:;1:0 r..:l Ur..:l ..J~ ll'lr< uO~5Ql >-~~i:~ ~ll'lfi~~ !iHI90..J ~~u:a ~t!U.-lU " COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 000888 WORTHINGTON KAREN LEE 525 AUTUMN WOOD CLOSE ROSWELL, GA 30075 ACN ASSESSMENT CONTROL NUMBER AMOUNT _n_____ fold 101 $4,330.09 ESTATE INFORMATION: SSN: 204-03-7498 FILE NUMBER: 2101-1069 DECEDENT NAME: BRUNNER VIRGINIA M DATE OF PAYMENT: 02/25/2002 POSTMARK DATE: 02/14/2002 COUNTY: CUMBERLAND DATE OF DEATH: 11/17/2001 TOTAL AMOUNT PAID: $4,330.09 REMARKS: KAREN L WORTHINGTON CHECK#1314 SEAL INITIALS: CW RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS s CERTIFCATION OF NOTICE UNDER RULE 5.6(A) Name ofDecedent: Yi 7..liJja. /I b/?d Date of Death: ./lI;v '/7 o!m/ , Will No.: ~/-rl()()/ -/~9 Admin No.: 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 I Of Name Address ~i~~4 .7,)S~MCk --~-Id/Q Jt7tj% ~~;'Y.&t: .r4t'1/ J;."e7~O~ .y;{6'1'"h{~a0~ Wz. ~ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except 16. Date: J.d& wI :'1 ro~1 0_ ~6 .4e.WmUWtk ~#,Qwg5' Address ...- I 0::: $ 77<1-?/~oZ'77ob Telephone p .,;~l .:..:s:: ,jJ. S ~~u Capacity: ~Personal Representative o Counsel for personal representative __. -v- C;;~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: 1J~7/1?1a. H Jfn~J1J1(,,/ Date of Death: / /- 17- cJO(} I Will No.: cm/-OIt?@9 Admin.No.:~ Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State wbe'fher administration of the estate is complete: Yes 0' No 0 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 rep~entative file a final account with the Court? Yes _ No uzr b. The sep~atA7JEhans' Court No. (if any) for the personal representative's account IS: I c. Did the personal repyesentative state an account informally to the parties in interest? Yes 0' No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report Date: Iqj;~ v: ~i 7K SIgna e )6~11 ot a Y;;~/J " Name t1 SdS ~vft;ml} !t};odClrt; ~~/Gu Address S427J 770 -9ff2.rl 77~ Telephone No. Capacity: ~rsona1 Representative o Counsel for personal representative Rtv- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 c - 13 W I- ~:$en oO::~ wa..o J:oo oO::...J a..lXl a.. c( z o . ~ ..J ~ !::: D.. <( o w 0::: FILE NUMBER .;tl-';l _ _ .J..L_ COUNTY CODE YEAR INHERITANCE TAX RETURN RESIDENT DECEDENT _~(LL'L NUMBER ~ Z W o W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 204 -03 - 7498 VIRGINIA M DATE OF BIRTH (MM-DD-YEAR) 3/29/22 BRUNNER DATE OF DEATH (MM-DD-YEAR) 11/17/01 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL) NA [iJ 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Willi o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (A\tach copy ofTrust) o 10. Spousal Poverty Credit Idate of death between 12-31-91 and 1-1-95) o 3. Remainder Return (date of death priorto 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) I- Z W Q Z o a.. en w 0:: 0:: o o NAME COMPLETE MAILING ADDRESS 525 AUTUMN CLOSE KAREN L. WORTHINGTON FIRM NAME (If Applicable) ROSWELL, GA 30075 TELEPHONE NUMBER 770/998-2772 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 1 1 2 382 . 39 -; (" ~ ~FFICIAL USE ONLY ;~'" 2 -.,. 3. Closely Held Corporation, Partnership or Sole-Proprietorship --'I f"'; C::J 4, Mortgages & Notes Receivable (Schedule D) 5, Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 1'\) U'j (6) .i.>.. (7) L- (8) 1 1 2 3 8 2 . 3 9 (9) 1 1 0 9 3 . 9 0 (10) (11) 11093.90 (12) 101288.49 (13) (14) 101288.49 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ~ D.. :!: o o ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15) x .0 45 (16) 4557.98 x .12 (17) x .15 (18) (19) 4557.98 16. Amount of Line 14 taxable at lineal rate 101288.49 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 REV-l508 EX . (1-97) ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERIT ANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER VIRGINIA M BRUNNER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 1 2 3 4 5 6 7 10 1 1 12 DESCRIPTION MEMBERS 1ST FCU, 5000 LOUISE DR. POBOX 40 MECHANICSBURG, PA 17055 ACCT # 11079-41 II 11079-47 II 11079-04 II 11079-11 " 11079-42 II 11079-45 II 11079-46 8 IRA ACCT 781517595, WAYPOINT BANK, 1300 CAMP HILL RD CAMP HILL, PA 17011 VALUE AT DATE OF DEATH $ 12044.05 22036.28 2001 .78 5940.08 10037.62 13047.01 5010.11 1733.57 52.98 8514.41 8334.00 9485.50 13000.00 1145.00 9 HARTFORD LIFE INS CO, PO BOX 5085, HARTFORD,CT 06104 A/C # 210273215 MEMBERS FIRST FCU, AS ABOVE, ACCT # AUTO--CHEVROLET MALIBU,2001(PURCHASED 4/1/01 BLUE BOOK VALUATION PERSONAL PROPERTY, FURNITURE, ETC TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) $112382.39 REV-1511 10;". ~?-9':i _ , '.:i.: ~..",,,,,W ~~tfilt"l\ .,~.;~:t..."~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I SCHEDULE H i I FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ITEM NUMBER A. VIRGINIA M BR~NNER I FILE NUMBER Debts of decedent must be reported on Schedule I. DESCRIPTION 1. FUNERAL EXPENSES: I BURIAL, CASKET & REL~TED FUNERAL EXPENSES ELECTRICAL BILLS OF bECEASED TRAVEL, MOTEL AND OUT OF POCKET FOR RELATIVES & LEGAL REPRESENTATIVEf TO COMPLETE ESTATE BUSINESS LAST MONTH'S RENT FO~ DECEASED AMOUNT $ 6902.90 168.20 2595.00 475.00 600.00 129.02 5 CPA FEE FOR FILING INHERITANCE TAX RETURN 6 CREDIT CARD & MISCELLANEOUS B. ADMINISTRATIVE COSTS: i 1. Personal Representative's Commissions ~ONE Name of Personal Representative(s) :KAREN WORTHINGTON & SANDRA CRISW LL Social Security Number(s)/EIN Number 0 Personal Representative(s} 2 3 4 Street Address City______ ROSWELL Stale~_Zip 30075 2_ Attorney Fees Year(s) Commission Paid: NONE 3. Family Exemption: (if decedent's address is not Ihe same as claimant's, attach explanation) 4. Claimant Street Address City_ State __ Zip Relationship of Claimant to Decedent 5_ Accountant's Fees Probate Fees & MISC FEES & CHARGES 6_ Tax Return Preparer's Fees 7_ AS ABOVE 228.78 (If more space Is needed, insert additional sheets of the same size) TOTAL (Also enter on line 9. Recapitulation) $ 1 1 093 . 90 r " ! I STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I, MARY C. LEWIS Register for the Probate of Wills and Granting Letters of Administration &c. in and for said County of CUMBERLAND do hereby certify that on the 21st day of November A.D., Two Thousand and One, Letters TESTAMENTARY in common form were granted by the Register of estate of BRUNNER VIRGINIA M (LAtiT, ,to'lKtiT, M1UULt.;) said County, on the I late of CAMP HILL BOROUGH in said county, deceased, to TEMPLETON SANDRA LEE NKA (LAti'l, ,to'lKtiT, M1UULt.;) WORTHINGTON KAREN LEE (LAtiT, ,to'lKtiT, M1UULt.;) CRISWELL SANDRA LEE (LAST, ,to'l KtiT , M1UULt.;) and and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 21st day of November A.D., Two Thousand and One. File No. PA File No. Date of Death S.S. # 2001-01069 21-01-1069 11/17/2001 204-03-7498 ~ c. x.....(~~~ Register NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL l} '. ,~7/1 ~\\ "'L.':'r':~t. '.~..1. ( . ,........ir.'.. ". ,." ~(... " . "~;; 2,~ .........' .~. ,.. .....).., ',""'" ~ .. ' ,", : /fl'::" S ~ '-, . t . .. · .~, ~ '; 4 .. I "'. ..' ~ F r. :: . <. .. ~ ;-:- ~ ,., ... ""... ' . a ~ Register of Wills of CUMBERLAND County, Pennsylvania Certificate of GranL of Letters No. 2001-01069 PA No. 21-01-1069 " ESTATE OF BRUNNER, VIRGINIA M (LA:::>'l, l' H<':::>T, Ml1J1JL~) .) ; .. " . ....." .' #. '*. .....,." .....,.o<#..j..t., /'., .# '. .oW. Late of CAMP HILL BOROUGH CUMB~.l{LAN1J CUU.NT::r:, WHEREAS, on the 21st jated September 9th 1974 Nas admitted to probate as Deceased Social Security No. 204-03-7498 day of November 2001 an instrument the last will of BRUNNER VIRGINIA M (LA:::>'l, 1"l.l{:::>T, Ml1J1JL~) late of CAMP HILL BOROUGH CUMBERLAND County, who died on the 17th day of November 2001 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LEWIS , Register of Wills in and for che County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to WORTHINGTON KAREN LEE and TEMPLETON SANDRA LEE NKA and CRISWELL SANDRA LEE who have duly qualified as Executor (rix) and have agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 21st day of November 2001. ~ C y I~ j/.._~ {/ ke~"'"~. * * NOTE * * ALL NAMES ABOVE APPEAR (LAST I FIRST I MIDDLE) 1 l....w o"'lcc.a .JON F. LAF.AVER 117 THIIlIO ST"CET NEW eUMIEIlILAND, ~.... lAST WILL AND TESTAMENT 21-2001-1069 OF VIRGINIA M. BRUNNER I~ VIRGINIA M. ~RUNNER, of Fairview Township, York County, Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament hereby revokin and making void any and all other wills by me at any time heretofore made. I. I direct that my Coexecutrices hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my.decease. II. All the rest, residue and remainder of my estate, whether real, personal or mixed, and wheresoever situate, I hereby give, devise and bequeath as follows: A. One-half (1/2) unto my daughter, KAREN LEE WORTHINGTON. B. One-half (1/2) unto my daughter, SANDRA LEE TEMPLETON. III. My daughters shall divide among themselves my tangible personal property as they may agree. IV. I hereby nominate, constitute and appoint my two daughters, KAREN LEE WORTHINGrON and SANDRA LEE TEMPLETON, as Coexecutrices of this, my Last Will and Testament. V. No fiduciary acting under this Will shall be required to pos bond in this jurisdiction or in any jurisdiction in which he may act. IN WITNESS WHEREOF, I, Virginia M. Brunner, the Testatrix, have unto this, my Last Will and Testament, set my hand and seal this <1 t;t day of September, A. D., 1974. rR; ~_~(SFAi Page one of two Pages J l -...-._-~.- - ---- .- .~--~ r ,SIGNED, SEALED, PUBLISHED and DECARED by Virginia M. Brunner, the above-named Testatrix, as ,and for her Last Will and Testament in the presence of us, who have hereunto subscribed our names as witnesses at her request, in the presence of the said Testatrix and of each other. / ;/~. ! I I tlO'i.BO-'" RF\' 'JrBe;. This is to certify that the information here given is correcrly copied from an original certificate of death duly filed with me as ,Local Ro:gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. f ",1f11jj7i7;;;;""",,_.. ,\,'I"~~\.1\\ OF PE,i'.-.-._ /\\#f;;--~J);""- $~*~ ... .. \~\. t_I<- \?.. , """I .... ;;z::~ ~ S\ -{~,' ::~~ ... \'. .' ~ "*':>; ._~" 'i*~ \~'" . --, ,~~/ '"'-~b~ .~\\ .".-----"!r4fENr~ 't.~'IIII'\ -"""'''''''''''#1/111/1111' ~ /J( q/;;:/z..t:-c/PV':>_- Local Registrar (J fec for this certificate. $2.00 P 7884382 N"'\' liv 1 9 2001 Date ::>.143Aev.2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH IIII<THPL'oCl! IC'v"" Stase oc FOl"8lQn CwnlJW ST,tJ'E FILE NUMBER SEX SOCIAL SECURITY NUMBER 2. F;male" 204 - 03 7498 PlACE OF DEATH (ChecM onty one ":J88 Il"1strUCliOtl!J on other 9ld81 HOSPITAL 1_'_ 0 ERiO......... 0 eo_ (1.401'5+) MARrTAL STATUS. Marr*f N.......MarrMld. W~ DiYo<cod IS""""") ,.. Widowed "0.0 .....__In :;'=....)0 RACE. Amencan tnlhR. SIeck. Whit.. etc. (5",""",) 79 y,.. Lemoyne. PA COUNTY OF DEATH Cumberland 117 November Drive. Apt. 2 OECEOEKT'S USUAL OCCUPIIIlON (~~Ii~~=:&~ . 11 Sales Clerk l1b. Retail Clothing DECEDENTS M..,UNO ADOAESS (SIt.... CtyfTown, Slate, r",code\ DECEDENT'S ACTUAL RESIDENCE (See IOSIruCbOnI on oIh8l" Sldel ......S DECEDENT EVER IN u.s. ARMED FORCES? YN 0 No blJ ,0. white Ie. SUAVtVING SPOUSE llf 'MI.. gtYe matder\ name) 117 November Drive. Apt. 2 Camp Hill. PA 17011 17.. Stili. 17b. Coun Cumberland No._..... 17.. wilNnKtwlUirnitJot MOTHER'S NAME (fitst. MtddIe. Maiden Surname) Lottie Mae Anderson Old - Min. lawnthip? ....... ... FATHER'S NAME (FirSl. Mic:JdIe. last) 1'. Bruce Garfield Snyder INFORMANT'S NAME (TypoIPrInI) _. Sandra L. Criswell METHQO OF DISPOSITION -BJ 0.........0 R_oIl_SIU.O 0lI1o< IS"""",,' Camp Hill cityltllofa. DATE OF DISPOSITION (Moo\ll. Ooy. _I o 21~ovember 20. 2001 E OR PERSON ACTING AS SUCH LICENSE NUMseR ~ 22b.FS 012 849 L 'b the beat of my know.... death occurred at the timtl. dala and ~ stated. (Signature and Title) 11. .NFORMAm'S MA'UNG ADOAeSS_. CilyIlOwn. _.lip~, . 4 Hampshire Court. Stafford, VA 22554 PlAce OF OISPOSmON. Name of ClfNlery. CrematcHy LOCA1lON. CityITown. Stat., Zip Code Of Othor PIooo 17070 2,o.Mt. Olivet Cemetery NAME AND AOIlAESS OF MC'UTY 220.P.O. l/seAse a3b. 23c. WOOS CASE REFERRED 10 MEDICAL EXAMINEAICORONeR? Ve'O ~ 21. ,___ PAIlT'I: OIhortignil\Canl___~"_,bu1 I inter4l~ not r-tauning in.. ~ c:auMgWen in PART I. : onMI and death I I s TIME OF OE.<rH 1,1 : dz) [ : ,. WERE AUlOPSY FINDINGS -.u.BLE PRIOR 10 COMPLETION OF CAUSE OF DEATH? DUE 10 lOR AS A CONSEOlJENCE OF): DUE 10 (OR AS A CDNSEOUENCE OF): MANNER OF DEATH DATE OF INJURY (Monlh. Day, Year) TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. -.... w o o Homicide Accident Pending ln~.ligation o o o PLACE OF INJURY. At home, farm. st,.." factory. otfice building. etc. ISpecdy) ..... ..... 0 NoD Natur" .....0 No~ .... .... Couki not be determined LOCATiON (Street. CIIyITO'o\'fl. SIale) ... 210. CERTtflEA (Check ant., one) "CERTIFYING PHYSICIAN (PhySlC68fI Cerlrtytng cause 01 dealh when another phYSICian has pronounced dea!l1 aoa completed Item 23) To \he beat 01 ",y kno.-ctge, death occu...-d due to th. cauM(a).nd manner.. atatlld. , , . . . . . . . . . . , . . . , . . . , . , . , . . . . , . 21. o .PAONOUHCUtG AHD CERTIF"tlNQ PHYSICIAN (PhVsiCllm bolh pronouncll"Q death and CE!f1ltyll"lg 10 cause 01 dealh) To the beet of m, knowledOl'. death occurred at the u.n., &lit., and plac.. and due to the cauae(a) and manna,.. s.ated... ., . . , ., , . . . . , . . . , . . . . . . .MEDICAL EXAMINER/CORONeR On the b8." of .JCam'natlon and/or Inv..tlgation. In my QIIlnlon, d..tl\ occurred at theUm., d.'e. and plac., and due to the cau..(a) .nd mann.,.. ...ted... .... .. . . ..... , .. . . " .. ..... ....... .. ..... ., ........ ..... ... .. , . ., . , . .. ........... . ... ..... .., ., 31.. REGISTRAR'S SIGNATURE AND HUMBER ,o~o COMMONWEALTH OF PENNSYLVANIA 'DEPARTMEfot'r OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-1069 01162443 12-28-2001 REV-1545 EX AFP (09-001 EST. OF VIRGINIA M BRUNNER S.S. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS lXJ CHECKING o TRUST o CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has providad tha Depart.ent with the inforntion listed below which has been used in calculating the potential taK 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 taKable in accordance with the Inheritance TaK Laws of the Co..onwealth of Pennsylvania. Questions .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 11079-11 Date 04-21-1994 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 5,940.08 16.667 990.03 .045 44.55 TAXPAYER RESPONSE 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". x NOTE: If taK pay.ents are .ade within three (3) .onths of the decedent.s date of death, you .ay deduct a 5% discount of the taK due. Any inheritance taK due will beco.e delinquent nine (9) .onths after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above infor.ation and taK 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 bOK "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. [] The above asset has been or will be reported and taK paid with the Pennsylvania Inheritance TaK return to be filed by the decedent.s representative. [] The above infor_ation is incorrect and/or debts and deductions were paid by you. You .ust co.plete 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 TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 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 ~OMMONWE~TH OF PENNSYLYANIA DEPARTMENT OF REYENUE BUREAU OF INDIYIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-1069 ACN 01162443 DATE 12-28-2001 REV-1545 EX AFP 1D9-DDI EST. OF VIRGINIA M BRUNNER S.S. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS iii CHECKING o TRUST o CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Depart.ent with the infor.aUon listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this infor.ation is incorrect, pleasa obtain written correction fro. the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of PennsYlvania. Question~ may be answered by calling (7171 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 11079-11 Date 04-21-1994 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 5,940.08 16.667 990.03 .045 44.55 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice .ust acco.pany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax pay.ents are .ade within three (3) .onths of tha decedent.s date of death, you .ay deduct a 5% discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] 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 may check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent.s representative. [] The above infor.ation is incorrect and/or debts and deductions were paid by you. You .ust 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 ~ 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 COMMONWEALTH OF PENNSYLVANIA DEPART~ENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-1069 01162445 12-28-2001 REV-15~5 EX AFP lUg-SUI EST. OF VIRGINIA M BRUNNER S.S. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT IX] SAVINGS o CHECKING o TRUST o CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answgrec1 by ceUin3 (71?> 7!l7-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 11079-04 Date 02-07-1974 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 2,001.78 16.667 333.64 .045 15.01 TAXPAYER RESPONSE To insure prDper 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 5X discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register Df Wills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has bean or will ba reported and tax paid with the Pannsylvania Inharitance Tax raturn to be filed by the decedent.s representative. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If you indicate a different 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 S. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 S 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line S 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 COMMON~EALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 - INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-1069 01162445 12-28-2001 REY-1543 EX AFP lD9-0DI EST. OF VIRGINIA M BRUNNER S.S. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT Iil SAVINGS D CHECKING D TRUST D CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 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 information is incorrect, please obtain written correction from 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. 11079-04 Date 02-07-1974 Established Account Balance Percent Taxable Anount Subject to Tax Rate Potential Tax Due x 2,001.78 16.667 333.64 .045 15.01 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) .onths of the decedent.s date of death, you may deduct a 5~ discount of the tax due. Any inheritance tax due will become delinquent nine (9) .onths after the date of death. Tax PART [I] A. [ CHECK ] ONE BLOCK B. ONLY c. [J The above information and tax due is correct. 1. Vou mey 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 may 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. [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. [J The above information is incorrect and/or debts and deductions were paid by you. Vou must complete 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 ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Anount Subject to Tax 5. 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 TOTAL (Enter on Line 5 of Tax Conputation) I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and conplete to the best of ny knowledge and belief. HOME ( WORK ( TElEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE --. FF;m"l : l.,Icw.th i ngtDIl F'HmJE ~~I]. 770 9'3:::: 1 el67 Jan. 24 2002 02: 15pr1 P2 COHHONWEALTH OF PENNSYLVANIA DEP~RTHENT OF REvENuE 8UR~AU OF INDIVIDUAL TAXES t1EPT. ZlI060 1 HARRIS8UR~, PA 17128.0601 '* INFORMATION NOTICe AND TAXPAYER RESPONSE FILE ACN DA rEo NO.21 01-1069 02100999 Ol-lB-2002 REY.I>~J H At. (U-~Ol EST. OF VIRGINIA M BRUNNER 5.S. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TVPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [i] CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL SA 30075 REMIT PAYMENT AND FORMS TO: RfGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEI1BERS 1St FE:P~RAl CREDIT UN /'189 provided tho D.Pllrt.....,t with tile ir1for...tion listed below whioh hu been u5&d in eel~ulatin9 tho pote~~lal tax duo. Tholl' recorQ, indioato that at tho d~oth of t~e above dOGode"t, ~ou WDrD a Sol"t own9r/banoflclar~ of this B~GOU"t. If ~ou f.. 1 this infor~at~on is inGorre~t, 'pIo.5a obtain writtan oorroction fro~ the financIal i",titution. attach ~ copy to t~i5 for.. and return it to the above eddre~~. This account ~s ~xable In accord~nco ~lth the Inhoritance Tax laws of the Cog~onN8olth ...- 'of "annsylv""i... Qu~~.bo. .1"1W'!',...e....ey~~-n'+'H..i'&~8:5~......__....._-----.__. ...... ........,.--.-..-.... -'-.-' .-.. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AN~ PAYMENT INSTRUCTIONS Account No. 11079-47 Date 04-24-2000 EshbliliiheCl Account Belal'\f:e Peratnt Taxal>le Amount Subject to Tax Hate Potential Tax Duo x 22,029.05 16 .667 3,671. 58 .045 165_22 TAXPAYER RESPONSE ~Q in~uro p~op9r eradit to your eceOU"t~ two (2) copios of thI~ notice mu~t accompany ~our p~y..ent to the ~e9i9tor of WillS. MQkD chock pe~eble to' "Re~lstor of Wills, AOO"~. ~ X NOTE; If tax PQY~.nt$ aro Gode wIth~n thrRO (3) 8onth5 of tho docedent's dota of death, you "DY doduot a 5Z diSCOUnt of the tax duB. Any inhorltanc. tv- dua will becone delinquent nine (9) .o~th~ aft9~ t~A d~tD O~ daath. Tlll)( -:- [CHECK ] ONE BLOCK ONLY A. 0 The Ol!:>\IVa infor..i>tlOI1 end t"", dUD is correct. 1. YOU ~QY C~OO$O to ro~it PBy~ent to the ~oaistor of Wills with two copies of thi~ notlce to obtain a di500unt ar ovald intere~t, or you mey choek box ~^" ~nd return this notic~ to the Register of Wil1~ and ~n offiaial asse.9~.nt will be 1~SUQd by the PA DQP~rtmOnt of Revenua. B. c:J Th8 ~boVQ eS50t h~s b.~n or will bo ~oPDrted &~d tax pAid with tho pgnn~ylva~la Inherit~ncG l~x rgturn to bD filed by tn. dDcodo~t's ra~resentative. c. c=J T~e ebova in~or..ation Is incorrect ~nd/or debts end deductions wore Deid by you. You NU7t co~plete PA~T [!J and/or PART ~ below_ PAYEE DESCRIPTION Li~ . .f T~ eo..pU~Lnl I -I If YQU SndSeate a different t.x ~ate, plesse $t.te your relatSon$~ip to deced8~t: PART I!J _TAX RETURN ~COHPUTATXON OF TAX ON JOXNT/TRUST ACCOUNTS _-__ ,,____....- _ &..- v..............._....,.......... . ,_ ..._ LINE 1. Date Establhhed 1 " --"--------...,~. 2. Account 'alene. 2 3. ~.re.nt Taxable 3 X ~. A~ount Subject to Tax 4 5. Debts and Deductions 5 6. A\lIount TaxlAbla . 7. Tax Rat. 7 X 8. Tax Du. , PAIn f!] DATE PAID DEBTS AND DEDUCTIONS ~ . TOTAL (IEnt.r el'\ AMOUNT I - c /'.-~ '-'-~ '''l....~.. ,I :-1 ~,. '._;.., -~,~";~ Under pen.lt1es o. pBrjur~. I daelare that the ~act$ f ~.v. r.port.~ abovB arB truB~ ~orr.ct and_, co~plete to the best of .y knowledge and b.lief. HOME . WORI( ( ( ) ) I " ""r"~r"..........I~ lUI....".,..."" Memberslsr FEDERAL CREDIT UNION 5000 LOUISE DRIVE, P. O. BOX 40 MECHANICSBURG, PA 17055 TELEPHONE NUMBER: 717.795.6049 LONG DISTANCE: 1.800.237-7288 HEARING IMPAIRED: 717-697-5312 DO NOT WRITE ABOVE LINE ' CERTIFICATE -WITHDRAWAL REQUEST Please Print ~ iA. ~ ['t'( ACCOUNT J ~ 0:1"':1 MEMBERS NAME: _ ( ,f'. Jj\J..(\~ NUMBER: _ I rl AOORESS:clo <.n,'1:\\Q CXiC;LWe\\ 1i W-Aiiv~h(e ci CITY: S\G:-((ifc1 STATE: ~ ZIP CODE: ~S54 HOME PHON~40)J::"\1\ L.l (0 --:;(7 WORK NUMBER: - j /'~YV - -....Y.:) NUMBER: DATE CERTIFICATE ISSUE: 10 3 WITHDRAW \\ld\ 01 CERTIFICATE NO.: CERTIFICATE CERTIFICATE CODE RATE TYPE Office Use Only _ Amount of Penalty Lll MATURITY DATE '-1/C8 $ Amount Disbursed $ ~,(J:!k;.;)'6 $ .'~ I HEREBY APPLY TO REDEEM MY CERTIFICATE AND: CHOOSE ONE: ACCOUNT NUMBER - DEPOSIT TO SAVINGS ACCOUNT - - DEPOSIT TO CHECKING ACCOUNT - - DEPOSIT TO INVESTMENT SAVINGS ACCOUNT - - DEPOSIT TO SUPPLEMENTAL SAVINGS ACCOUNT - - DEPOSIT TO ADD-ON CERTIFICATE - - APPLY TO LOAN ACCOUNT - - RECEIVE A CHECK - MEMBERS SIGNATURE: JA...L~ \16 ( A penalty will be imposed fe> arly withdrawal, for further details refer to the certificate disclosure you received when you purchased the certificate. ~'~ tia '- Ii / ' ,- EMPLOYEE N~~: ,:;r:I{~ - 'j ;' 'it j/- BRANCH: Cr'I(p DATE:~ DATE:) '/01161 MBi16 1: 58-21 Rev. 12/00 . Members 1ST FEDERAL CREDIT UNION CERTIFICATE' APPLICATION AND DISCLOSURE ~E~s::Jis"~AME: .Vi,., 'INI~ M. B. UNN~ 't' ADDRESS: III N oveMln~r Dl "\\1-(. A.,fhITY: (~rnr "dt HOME PHONE NUMBER: 1. 7' ,.... 'I t/ JOINT OWNER(S) NAME: rfN '0 jilPLEASE DEPOSIT S 2(){J(J'tA.) IN THE FOLLOWING MANNER Qi PLEASE TRANSFER sOl 0.000. vV' FROM ACCT. NO. II tJ 71'- MATURITY DATE: if!23!OZ- ACCOUNT # --J , 0"''' SOCIAL 7 Y"" P SECURITY # 204-- OJ.... '6- STATE: _PI... ZIP CODE: \., 0 \ l l!We hereby apply for a Members 1st Certificate in the" amount and term listed below. WORK NUMBER: S'tfNdN.... C r ~S tAU II SUFFIX (!)If...,) CERTIFICATE TERM 3 MONTH CERTIFICATE 6 MONTH CERTIFICATE 12 MONTH CERTIFICATE 18 MONTH CERTIFICATE 30 MONTH CERTIFICATE 3 YEAR CERTIFICATE 4 YEAR CERTIFICATE 4 YEAR BUMP UP CERTIFICATE 5 YEAR CERTIFICATE 9 MONTH CERTIFICATE $ AMOUNT ($500 Minimum) ($5,000111..) 3MO 26W 7 lYR 221*8 IBM 9 30M 10 3YR 14 4YR 15 848 25 5YR 11 9MO 26 .0 , f) * DiY. Paid al Maturity METHOD OF. DIVIDEND DISPOSITION PLEASE ACCOUNT CHOOSE NUMBER ONE SAME ACCOUNT . DEPOSIT BACK TO CERTIFICATE (1) - DEPOSIT TO SAVINGS ACCOUNT (2) - DEPOSIT TO CHECKING ACCOUNT (2) . DEPOSIT TO INVESTMENT SAVINGS ACCOUNT (2) . DEPOSIT TO SUPPLEMENTAL SAVINGS (2) - MAil ME A CHECK (3) MEMBERS SIGNATURE:>L--cd ('9-t.;'L-'-?~--'h1 d/i/c(.~' ..'/ ' / DATd It): - J- 3 -0 I This is to certify that the above named person(s} is (are) the owner(s} of a Certificate account at Members 1 st Federal Credit Union. The Certificate is in accorpance with the terms of the Membership and Account Agreement and the Credit Union's current Truth- in-Savings Rate and Fee Schedule which shall accompany the receipt of deposit for this Certificate and is incorporated by this reference. MBRS 1: 98-35 Rev. 05/01 'MefilberslST FEDERAL CREDIT UNION ~ --..-:at Your savings feeleraHy insured to $HtO.OOO NCUA P.O. Box 40 . Mechanicsburg, PA 17055-0040 (717) 697-1161 TOLL FREE (800) 283-2328 www.members1st.org NlllIonalCredlt UnlonAd~.U.s. GowmIMfttA..., ~------..;...o,-__ _.__.-.._,~~ . COMMONweALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-1069 ACN 01162441 DATE 12-28-2001 REV-1545 EX AFP lD9- DOl EST. OF VIRGINIA M BRUNNER S.S. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS D CHECKING D TRUST [X] CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEHBERS 1ST FCU has provided the Departllent with the inforllation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this inforllation is incorrect, please obtain written correction froll the financial institution, attach a copy to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COllmonwealth 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. 11079-41 Date 09-08-1997 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 12,035.24 16.667 2,005.91 .045 90.27 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice IIUSt accollpany your paYllent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax paYllents are lIade within three (3) lIonths of the decedent's date of death, you lIay deduct a 57. discount of the tax due. Any inheritance tax due will becolle delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You lIay choose to rellit paYllent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you lIay check box "A" and return this notice to the Register of Wills and an official assessllent will be issued by the PA Departllent of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent.s representative. [] The above information is incorrect and/or debts and deductions were paid by you. You IIUSt cOllplete 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 @] TAX RETURN - COMPUTATION OF lINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS x 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 I COMMONweALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-1069 ACN 01162441 DATE 12-28-2001 REY-15~S EX iFP <89- DUI EST. OF VIRGINIA M BRUNNER S.S. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST !Xl CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEHBERS 1ST FCU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 11079-41 Date 09-08-1997 Established Account Balance Percent Taxable A.ount Subject to Tax Rate Potential Tax Due x 12,035.24 16.667 2,005.91 .045 90.27 TAXPAYER RESPONSE 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. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART [3J TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. A.ount Subject to Tax 5. Debts and Deductions 6. A.ount 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.putationl I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and co.plete to the best of .y knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE . .. Members 1ST FEDERAL CREDIT UNION 5000 LOUISE DRIVE, P. O. BOX 40 MECHANICSBURG, PA 17055 TELEPHONE NUMBER: 717-795-6049 LONG DISTANCE: 1-800-237-7288 HEARING IMPAIRED: 717-697-5312 DO NOT WRITE ABOVE LINE CERTIFICATE-WITHDRAWAL REQUEST Please Print \ I, . '. ~ ) ACCOUNT \ t O\1n MEMBERS NAME: ~ \(3 · () C\. \ )fLAl \\e ( NUMBER: --U ' r-l ADDRESS:CP':iJJ0.ro.. c.f\3-0d\ L[ ~~:.hifP. ct . STATE: '111- ZIP CODE: ,~-3.e.s4 CITY: -s-\c[..fo( ~ ~~:~:::oN{"54()) ;(X)-41o ~ WORK NUMBER: CERTIFICATE NO.: CERTIFICATE CERTIFICATE CODE RATE TYPE Office Use Only Amount of Penalty 1 L8 MATURITY DATE 3J3, CB $ (0 63 . ~ .0ct $ I HEREBY APPLY TO REDEEM MY CERTIFICATE AND: CHOOSE ONE: ACCOUNT NUMBER - DEPOSIT TO SAVINGS ACCOUNT - - DEPOSIT TO CHECKING ACCOUNT - - DEPOSIT TO INVESTMENT SAVINGS ACCOUNT - - DEPOSIT TO SUPPLEMENTAL SAVINGS ACCOUNT - - DEPOSIT TO ADD-ON CERTIFICATE - - APPLY TO LOAN ACCOUNT - /' i /'i - REC~VE A CHECK - .' MEMBERS SIGNATURE:#j~'JA.vJ ~) . DATE: ~ A penalty will be imposed .~r 'S:"-rIY withdrawal, for further details refer to the certificate disclosure you received when you purchasedihe ",:rtmcate. . 1_. . I". EMPLOYEE NAM~~ 1 !rn~. l- DATE:~ BRANCH:G\(L, ') MSIilS 1: 58-21 Rev. 12/00 / \ Members 1ST FEDERAL CREDIT UNION CERTIFICATE APPLICATION AND DISCLOSURE DO NOT-WRITE ABOVE LINE ADDRESS: HOME PHONE NUMBER: JOINT OWNER(S) NAME: (J PLEA:sEDEPOSIT $ (J PLEASE TRANSFER $ MATURITY OAT I ACCOUNT # /0 SOCIAL ~{Efll11 SECURITY # .. '.. '.' ... .... . STATE' lliL if CODE, (];I] WORK NUMBER: N I .' .. . lIWe hereby apply for a Members 1 st Certificate in the amount and term listed below. FROM ACCT. NO. SUFFIX OFFICE USE ONLY CERTIFICATE TERM 3 MONTH CERTIFICATE 6 MONTH CERTIFICATE 12 MONtH CERTIFICATE 18 MONTH CERTIFICATE 30 MONTH CERTIFICATE HEAR CERTIFICATE 5 YEAR CERTIFICATE METHOD OF DIVIDEND DISPOSITION PLEASE ACCOUNT CHOOSE NUMBER ONE $ AMOUNT DESC. ACC ABBR. CODE 3MO . 6 26W 7 IYR . 8/22 IBM 9 30M 10 4YR 15 5YR 11 ANNUAL PERCENTAGE YIELD DIVIDEND RATE SUFFIX # . Diy. Paid at Maturity Branch: SAME ACCOUNT . OEPOSIT BACK TO CERTIFICATE (I) . DEPOSIT TO SAVINGS ACCOUNT (2) . DEPOSIT TO CHECKING ACCOUNT (21 . DEPOSIT TO INVESTMENT SAVINGS ACCOUNT (2) . MAIL ME.A CHECK (3) -"I MEMBERS SIGNATURE: '-{/)L{-'}'~~ rn ri!:Ju/t-)~ DATE: ~0-m j This is to certify that the above named person(s) are the owners of a Certificate account at Members 1 st Federal Credit Union. This certificate may be redeemed at maturity. The dividend rate and AnnualPercentage Yield are shown above. The Annual Percentage Yield and dividend rate assume that the dividend is added to the principal of the certificate. This account is subject to all terms and conditions stated in the Certificate Account Disclosure, as they may be amended from time to time, and incorporate the same by reference into this agreement. Dividends are based on the credit union's earnings at the end of a dividend period and cannot be guaranteed. EARLY WITHDRAWL PENALTIES: A substantial penalty will imposed for withdrawals prior to the maturity date that may result in invasion of principal. The forfeiture is calculated on the simple interest rate regardless of how long the funds have remained in the account. The penalty for certificates purchased or renewed with a term on one year or less will be equal to a forfeiture of an amount equal to 90 days' dividends, whether earned or not. The penalty for certificates purchased or renewed with a term of more than one year will be equal to a forfeiture of an amount equal to 180 days' dividends, whether earned or not. The credit union will give you at least 20 days notice prior to maturity. The certificate will automatically be renewed for another term at the close of business on the initial maturity date or maturity date of any renewal term unless it is redeemed within seven (7) calendar days. The rate of earnings for any renewal term shall be at the rate the credit union is paying at that time on new certificates of that term. In the event of the death of the certificate owner, the certificate will be surrendered without incurring the early withdrawal penalty. MBRS 1: 98-35 UNI Rev. 11/99 .MefilberslST J'EDERAL CREDIT UNION Your savings federaOy insured to $100,000 NCUA P.O. Box 40 . Mechanicsburg, PA 17055-0040 (717) 697-1161 (X9/,.LEI1EE,.{80P\.2~;3:2~28" .......'.'1".'.'.'. . .oO'.. . ,. bHDt:::: wW\lr.in'~i'nbM&1Sf:dr~ l, '.I I ".0" 1.:. r~ I,y:; " 'c'b ./ VI~) 1. t t~'j ":7 ::) ~,-. if- 1 %5 :.~ ,/ I) J: E'r:':i J t' J J t:~ ~\'l Nalloaal Crodil UnionAdminlstratlcn, _ us. Go...__AptlC1 :2: ~:J ~ '~f 1::.1'-'-( ,',t', i,' j .?(.,':\ 6 ..;0..' .__:. ri'<'ll! :j r, ;. ;,; I TO 1B f'1ONTH CErnIFIC}:HE BAt. : j ,:::, eUtlo. 'i.~IlZ1 E~'7" ~ '. l)OT ~ t?f9 /;6 V I RG I N H~ 1''1 BI1UNNSH 11.'7 NOVt:~f';'lBf~R DR APT ;:.~ CAMP HIL.L PLAZA APT8 CAMP HILL j:::'A 17t;iH 1--50Lt3 --..,."------~ _.__. ~~_._ ___n ~~ __"_. _ ____._.__.~___ "._._ __.. ____ _"_ ___"_....____. _..__ _._ ___.'___ _ COMMONW~ALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-1069 ACN 01162439 DATE 12-28-2001 REV-1545 EX AFP 109-001 EST. OF VIRGINIA M BRUNNER S.S. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [Xl CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Departllent with the inforllation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a cOpy to this for. and return it to the above eddress. This account is taxable in accordance with the Inheritance Tax Lews of the Com.onwealth of PennsYlvania. Questions .ay be answered b~ eBlling (7171 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 11 079-42 Date 10- 02-1997 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,030.39 16.667 1,671.77 .045 75.23 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice .ust accollpany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are .ade within three (3) months of tha dacedent's date of death, you may deduct a 57. discount of the tax due. Any inheritance tax due will become delinquent nine (9) .onths after the date of death. Tax PART ill A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Departllent of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent.s representative. [] The above 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 [!J 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 (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 , COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 01-1069 01162439 12-28-2001 REY-1543 EX AFP (09-001 EST. OF VIRGINIA M BRUNNER 5.5. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS D CHECKING D TRUST 00 CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEHBERS 1ST FCU has p..ovidad the Depa..t.ent with the info...aUon listed below which has been used in calculating the potential tax due. Thei.. ..eco..ds indicate that at the death of the above decedent, you we..e a joint owne../beneficia..y of this account. If you feel this info...ation is inco....ect, please obtain w..itten co....ection f..om the financial institution, attach a COpy to this fo..m and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answe..ed by calling (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 11079-42 Date 10-02-1997 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,030.39 16.667 1,671.77 .045 75.23 TAXPAYER RESPONSE To insu..e p..ope.. c..edit to you.. account, two (Z) copies of this notice must acco.pany you.. pay.ent to the Registe.. of Wills. Make check payable to: "Registe.. of Wills, Agent". x NOTE: If tax payments a..e made within th..ee (3) months of the decedent's date of death, you .ay deduct a 5% discount of the tax due. Any inhe..itance tax due will become delinquent nine (9) months afte.. the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [J The above info..mation and tax due is co....ect. 1. You may choose to ..e.it pay.ent to the Registe.. of Wills with two copies of this notice to obtain a discount 0.. avoid inte..est, 0.. you .ay check box "A" and ..etu..n this notice to the Registe.. of Wills and an official asses~ent will be issued by the PA Depa..tment of Revenua. [J The above asset has been 0.. will be ..epo..ted and tax paid with the Pennsylvania Inhe..itance Tax ..etu..n to be filed by the decedent.s ..ep..esentative. [J The above info...ation is inco....ect and/o.. debts and deductions we..e paid by you. You .ust co.plete PART ~ and/o.. 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 (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 .. Members 1ST FEDERAL CREDIT UNION 5000 LOUISE DRIVE, P. O. BOX 40 MECHANICSBURG, PA 17055 TELEPHONE NUMBER: 717-795-6049 LONG DISTANCE: 1-800-237-7288 HEARING IMPAIRED: 717-697-5312 DO NOT WRITE ABOVE LINE CERTIFICATE-WITHDRAWAL REQUEST Please Print ~ ' . '. x: ') ACCOUNT --.1J o1l9 MEMBERS NAME: \(5' () C\. )flAr \\e, NUMBER: ADDRESS:CP"IJJIJro.. CJ\<.Wd\ '-l ~~)::hi?? ct " STATE: '1A- ZIP CODE: ;:;)2t3~L/ CITY: 'S --\c[-tO( ~ ~~:~:~ON("S4{j) )(Xj-LJh:E WORK NUMBER: L.ld MATURITY DATE 3131 CB $ lO ()3 . ~ CERTIFICATE CERTIFICATE CODE R~ TYPE n CERTIFICATE BALANCE Office Use Only Amount of Penalty CERTIFICATE NO.: 1 f~ $ I HEREBY APPLY TO REDEEM MY CERTIFICATE AND: CHOOSE ONE: ACCOUNT NUMBER - DEPOSIT TO SAVINGS ACCOUNT - - DEPOSIT TO CHECKING ACCOUNT - - DEPOSIT TO INVESTMENT SAVINGS ACCOUNT - - DEPOSIT TO SUPPLEMENTAL SAVINGS ACCOUNT - - DEPOSIT TO ADD-ON CERTIFICATE - - APPLY TO LOAN ACCOUNT - - REC IVE A CHECK - MEMBERS SIGNATURE: DATE:~ A penalty will be imposed f~r rlywithdrawal, for further details refer to the certificate disclosure you received when you purchase the certificate. EMPLOYEE NAM~~ 1 /tfa L{'r- BRANCH:a-\~P _ I , DATE: It l:::ydo J MIiiI6 1 : 58-21 Rev. 12/00 MembersJ FEDERAL CREDIT UNION CERTIFICATE APPLICATION AND DISCLO~flE DO NOT WRITE ABOVE LINE. L( ~q. 6r I/We hereby apply for a Members 1st Certificate In the MATURITY DATE: - - -, amount and term listed below. ACCOUNT # J J 01- q ~ r{ 5 ; ~'l ^ 4. h f> {(.{ i1 "'-- '-' ~~g~~~TY # ,'( 0 (( -03 -1-1.[ 1 i ADDRESS: 1I+..N c) ve wd:J ~ ~ -IeITY: [a. /Vl'Vf /.J "- II STATE: fA-zIP CODE: f:;" 0 I} HOME PHONE NUMBER: :} 1"1- - '"}{O I - 3lJ t:j 4 WORK NUMBER: JOINT OWNER(S) NAME: }( CW ~ tJ ".t,.{.$,-,<....S k h I 5 a "''*' Ct W .;" w.~ Le 'Q"PLEASE DEPOSIT $ 6' 00 ; · tl · IN THE FOLLOWING MANNER o PLEASE TRANSFER $ FROM ACCT. NO. CDA Pleas. Print MEMBERS NAME: - SUFFIX OFFICE USE ONLY ANNUAL PERCENTAGE YIELD CERTIFICATE TERM 90 DAY CERTIFICATE 26 WEEK CERTIFICATE 12 MONTH CERTIFICATE 18 MONTH CERTIFICATE 30 MONTHCERTII=ICATE 4YEAR CERTIFICATE 5 YEAR CERTIFICATE METHOD OF DIVIDEND DISPOSITION PLEASE ACCOUNT CHOOSE NUMBER ONE DESC. ACC $ AMOUNT ABBR. CODE 3MO .6 26W 7 1YR · 8/22 IBM 9 30M 10 4YR 15 5YR 11 DIVIDEND RATE SUFFIX # elf- Employ,e hK.fl . Dlv. Paid at Maturity Branch: MEMBER~ SIGNATURE: . DEPOS\'T BACK TO CERTIFICATE (1) - DEPOSIT TO SAVINGS ACCOUNT (2) . DEPOSIT TO CHECKING ACCOUNT (2) . DEPOSIT TO INVESTMENT SAVINGS ACCOUNT (2) . MAIL ME A CHECK (3) >> 0A~-i..4~ or ~ / DATE: J (/) - ,7- - '17 . .. . 1 SAME ACCOUNT This is to certify that the above named person(s) are t~ 0 ners of a Certificate account at Members 1 st Federal Credit Union. This certificate may be redeemed at maturity. The dividend rate and Annual Percentage Yield are shown a ve. The Annual Percentage Yield and dividend rate assume that the dividend is added to the principal of the certificate. This account is subject to all terms and conditions stated in the Certificate Account Disclosure. as they may be amended from time to time, and incorporate the same by reference into this agreement. Dividends are based on the credit union's earnings at the end of a dividend period and cannot be guaranteed. A substantial penalty is imposed if certificate funds are withdrawn before maturity date. The penalty may result in invasion of principal when funds are withdrawn prior to the maturity date of the certificate. The penally for certificates purchased before January 1, 1995 will be: If the maturity of the certificate is one year or less, the penalty is a forfeiture of an amount equal to 90 days' dividends based on the dividend rate being paid on the certificate whether earned or not If the maturity of the certificate.is more than one year. the forfeiture is equal to 180 days dividend. based on the dividend rate being paid on the certificate whether earned or not. The forfeiture is calculated at the simple interest rate being paid on the certificate regardless of how long the funds have remained in the account The penalty for certificates purchasedaner December 31,1994 will be: If the certificate is one year or less. the penalty is a forfeiture of an amount equal to 90 days dividends. based on the dividend rate being paid on the certificate whether earned or not. The penalty for certificates with maturities of more than one year will equal the difference between the new dividend rate for the remaining period of time and the existing certificate dividend rate divided by 365 multiplied by the face value of the certificate and multiplied by the number of days remaining on the existing certificate. The minimum penalty will be the greater of this formula (as shown below) or $25.00. . Penalty = (New Rate. Existing Rate) X Certificate Face Value X Days Remaining 365 The credit union will give you at least 20 days notice prior to maturity. The certificate will automatically be renewed for another term at Ule close of business on the initial maturity date or maturi!}' date of any renewal term unless it is redeemed within seven (7) calendar days. The rate of earnings for any renewal term shall be at the rate the credit union is paying at that time on new certificates of that term. In the event of the death of the certificate owner. the certificate will be surrendered without incurring the early withdrawal penalty. MBRS 1: 98-35 Rev. 1/97 MefilberslST fEDERAL CREDIT UNION Your savings federaUy insured to $100.000 NCUA P.O. Box 40 . Mechanicsburg, PA 17055-0040 (717) 697-1161 TOLL FREE (800) 283-2328 www.members1st.org NallOllal Credll UIrion Administration, a u.s. Govemmenc Acency ------------------.----..-------..-..--..---.- . 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 01-1069 01162437 12-28-2001 REV-154! EX AFP 109-001 EST. OF VIRGINIA M BRUNNER S.S. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Department with the inforllation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent. you were a joint owner/beneficiary of this account. If you feel this inforllation is incorrect. please obtain written correction froll the financial institution. attach a copy to this form 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) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 11079-45 Date 01-17-1997 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 13,037.61 16.667 2,172.98 .045 97.78 TAXPAYER RESPONSE To insure proper credit to your account. two (2) copies of this notice IIUSt accompany your payment to the Register of Wills. Make check payable to: "Register of Wills. Agent". x NOTE: If tax paYllents are lIade within three (3) 1I0nths of the decedent.s date of death. you lIay deduct a 5% discount of the tax due. Any inheritance tax due will becolle delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [J The above information and tax due is correct. 1. You may 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 "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Department of Revenue. [J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent.s representative. [J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS lINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 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 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 01-1069 01162437 12-28-2001 REV-1543 EX AFP 109-00) EST. OF VIRGINIA M BRUNNER S.S. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS D CHECKING D TRUST [X] CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Department 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 information is incorrect, please obtain written correction froll the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may bs ans~erBd by calling (717) 781-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 11079-45 Date 01-17-1997 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 13,037.61 16.667 2,172.98 .045 97.78 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. [] The above inforllation is incorrect and/or debts and deductions were paid by you. You must cOllplete 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 @] 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 a. Tax Due OF 1 2 3 4 5 6 7 a 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 \ C W R Members 1ST FEDERAL CREDIT UNION 5000 LOUISE DRIVE, P. O. BOX 40 MECHANICSBURG, PA 17055 TELEPHONE NUMBER: 717.795.6049 LONG DISTANCE: 1.800.237.7288 HEARING IMPAIRED: 717.697.5312 DO NOT WRITE ABOVE LINE "" CERTIFJCATEWITHDRAWAL REQUEST Please Print ~' r.' A. \'j (~ ..,e( ACCOUNT \\O)jC] MEMBERS NAME: \ t '3 \ \\ ~ " ,l \.Af\\ . NUMBER: ADDRESSCP ::Oi'(\rC\.. C f(-;wd\ y~,(~ c-\- CITY: '"5\:A~C(~ STATE: ~ ZIP CODE: ~5~Y HOME PHON~O ) -r=Y\ 'dfo~ WORK NUMBER: / I ex...;' NUMBER: LIS CERTIFICATE CERTIFICATE CODE RATE ' TYPE G.(d) \~ff) CERTIFICATE BALANCE $ 13 ()Ll7.0 I Office Use Only . Amount of Penalty $$ Amount Disbursed $ I ~ 0'-17.01 DATE CERTIFICATE ISSUE' CERTIFICATE NO.: MATURITY DATE I HEREBY APPLY TO REDEEM MY CERTIFICATE AND: CHOOSE ONE: ACCOUNT NUMBER - DEPOSIT TO SAVINGS ACCOUNT - - DEPOSIT TO CHECKING ACCOUNT - - DEPOSIT TO INVESTMENT SAVINGS ACCOUNT - - DEPOSIT TO SUPPLEMENTAL SAVINGS ACCOUNT - - DEPOSIT TO ADD-ON CERTIFICATE - - APPLY TO LOAN ACCOUNT - - RECEIVE A CHECK - \ \0 MEMBERS SIGNATURE: DATE: /lId) I OJ A penalty will be imposed for e rly withdrawal, for further details refer to the certificate disclosure you received when you purchased the certificate. EMPLOYEE NAMC-~~'--/o/1 .)dJ/1;1- BRANCH: --LH 0 DATE: II hl/GL , , MIiIil6 1: 58-21 Rev, 12/00 ,,.........,-----.,.-"''''T'''''"I''.., '.".,fV,,"'f'!'V':-,'" "r .. ..b. . 1sT Memers. FEDERAL CREDIT UNION CERTIFICATE APPLICATION AND DISCLOSURE I/Wehereby apply for a Members 1 st Certificate in the' amount and term listed below. MATURITY DATE: 1/'1~Z ACCOUNT # /1()7 ~~g~~~TY # ~0l/-(}.3... 7ifW STATE: PA- ZIP CODE:17D II WORK NUMBER: S. (riswel' JOINT OWNER(S) NAME: o Pl.EASE DEPOSIT $. . ... . .. IN THE FOll . ING MANNER/I. () /) )4 PLEASE TRANSFER $13~ 00 FROM ACCT. NO. .. . . 77 SUFFIX ~~ CERTIFICATE TERM 3 MONTH CERTIFICATE 6 MONTH CERTIFICATE 12 MONTH CERTIFICATE 18 MONTH CERTIFICATE 30 MONTH CERTIFICATE 3 YEAR CERTIFICATE HEAR CERTIFICATE 5 YEAR CERTIFICAtE $ AMOUNT ($500 Minimum) 7 * 8/22 9 10 14 15 11 * DiY. Paid at Maturity METHOD OF DIVIDEND DISPOSITION PLEASE ACCOUNT CHOOSE NUMBER ONE SAME ACCOUNT - DEPOSIT BACK TO CERTIFICATE (1) - DEPOSITTO SAVINGS ACCOUNT (2) - DEPOSIT TO CHECKING ACCOUNT (2) - DEPOSIT TO INVESTMENT SAVINGS ACCOUNT (2) - DEPOSIT TO SUPPLEMENTAL SAVINGS (2) - MAil ME A CHEC~ ..~' i , ~ , / MEMBERS SIGNATURE: C4/L /; IA"'-"-":C hi ~k. (,[';/;rl,/1((/.../ / DATE: 1-- /..: ? / t / This is to certify that the above named person(s)is (are) the owner(s) of a Certificate account at Members 1 st Federal Credit Union. The Certificate is in accordance with the terms of the Membership and Account Agreement and the Credit Union's current Truth- in-Savings Rate and Fee Schedule which shall accompany the receipt of deposit for this Certificate and is incorporated by this reference. MBRS 1: 98-35 Rev. 08/00 . MetnberslST FEDERAL CREDIT UNION Your savings federaly insured to $UIO,OOO NCUA P.O. Box 40 . Mechanicsburg, PA 17055-0040 (717) 697-1161 TOLL FREE (800) 283-2328 www.members1 st.org NllCioaal Crutit UnlOllAdmlRistnlion,a us Go___ AFM)' 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 01-1069 01162435 12-28-2001 REY-15~5 EX AFP lD9-DDl EST. OF VIRGINIA M BRUNNER S.S. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS D CHECKING D TRUST OCI CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEHBERS 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 inforllation 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 COllmonwealth 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. 11079-46 Date 12-24-2000 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 5,008.09 50.000 2,504.05 .045 112.68 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice IIUSt accollpany your paYllent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax paYllents are lIade within three (3) 1I0nths of the decedent.s date of death, you lIay deduct a 57. discount of the tax due. Any inheritance tax due will becolle delinquent nine (9) .onths after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [J The above inforllation and tax due is correct. 1. You lIay choose to rellit paYllent 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 assessllent will be issued by the PA Department of Revenue. [J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent.s representative. [J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART ~ 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 (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 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-1069 ACN 01162435 DATE 12-28-2001 REY-1543 EX AFP lD9-DDI EST. OF VIRGINIA M BRUNNER 5.5. NO. 204-03-7498 DATE OF DEATH 11-17-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS o CHECKING D TRUST !X] CERTIF. KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 RE"IT PAY"ENT AND FOR"S TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 "E"BERS 1ST FCU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of PennsYlvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 11079-46 Date 12-24-2000 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 5.008.09 50.000 2.504.05 .045 112.68 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) months of the decedent.s date of death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] 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 assess.ent will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. [] The above information is incorrect and/or debts and deductions were paid by you. You must 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 [!] 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 I 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 Members 1ST FEDERAL CREDIT UNION 5000 LOUISE DRIVE, P. O. BOX 40 MECHANICSBURG, PA 17055 TELEPHONE NUMBER: 717.795.6049 LONG DISTANCE: 1-800-237-7288 HEARING IMPAIRED: 717-697.5312 DO NOT WRITE ABOVE LINE CERTIFICATE WITHDRAWAL REQUEST Please Print \ I ..' Cd .. \0 ( ACCOUNT \\ rrin MEMBERS NAME: ~ \ (~\!'(t\. \)((\..\.\\\ \:- NUMBER: v ,-, ADDRESS:c)Q ~'\0.\u" G \"'JJJc\\ ~I're. G1. CITY: 5-\Q.((cx-d STATE: ~ ZIP CODE: ~c::f5L/ ~~:~::ONE (540 )730- Ll0'Y; ~~~~ER: - DEPOSIT TO SAVINGS ACCOUNT - - DEPOSIT TO CHECKING ACCOUNT - - DEPOSIT TO INVESTMENT SAVINGS ACCOUNT - - DEPOSIT TO SUPPLEMENTAL SAVINGS ACCOUNT - - DEPOSIT TO ADD-ON CERTIFICATE - - APPLY TO LOAN ACCOUNT - I ' ... - RE~IVE A CHECK - MEMBERS SIGNATURE:jjf~\;I)U/\.i(W DATE:~ /, '\ , \ A penalty will be imposed f6r-~arly withdrawal, for further details refer to the certificate disclosure you received when you purchased the certificate. EMPLOYEE NAME'-1#YzJJ'-/tJ./lb/ri!.O- BRANCH: a\({> DATE CERTIFICATE ISSUED: CERTIFICATE NO.: CERTIFICATE CERTIFICATE CODE RAe. TY~w $ I HEREBY APPLY TO REDEEM MY CERTIFICATE AND: CHOOSE ONE: Office Use Only Amount of :enalt:g- Amount Disbursed $ '"50 0 . ACCOUNT NUMBER DATE:~ MIi&6 1: 58-21 Rev. 12/00 ~. 1\1:embers 1ST FEDERAL CREDIT UNION CERTIFICATE APPLICATION AND DISCLOSURE JOINT OWNER(S) NAME: o PLEASE DEPOSIT $ Q1S"LEASE TRANSFER $ MATURITY DATE: 0' '~.1fO ;)... ACCOUNT # '-1 (079 . Please Print \J .^ 0 IJ " SOCIAL 3 c.p MEMBERS NAME: I Q ~r1' ~ .AlI ~l\.lJ AJ1JEIl- .. SECURITY # o2ot( _ 0 -7q 'I\J . ADDRESS: J{f N O\J()~((" (. ftt, t ~.CITY: C''+'''f>thll STATE: a ZIP CODE: \ ,Oil HOME PHONE NUMBER: . . . '.' . 7 bt- 14 ,t(. WORK NUMBER: \Z'- !JJVf ""vtr I S ('r \ ~~ &() .. . IN THE FOLLOWING MANNER ~(J'}Ji),..... FROM ACCT. NO. 1'07'. lIWe hereby apply for a Members 1st Certificate in the" amount and term listed below. SUFFIX DC . CERTIFICATE TERM 3 MONTH CERTIFICATE 6 MONTH CERTIFICATe 12 MONTH CERTIFICATE 18 MONTH CERTIFICATE 30 MONTH CERTIFICATE 3YEAR CERTIFICATE HEAR CERTIFICATE 5 YEAR CERTIFICATE $ AMOUNT ($500 Minimum) 7 -- 8/22 9 10 14 15 11 * Div. Paid at Maturity METHOD OF DIVIDEND DISPOSITION PLEASE ACCOUNT CHOOSE NUMBER ONE SAME ACCOUNT - DEPOSIT BACK TO CERTIFICATE (1) - DEPOSIT TO SAVINGS ACCOUNT (2) -.DEPOSIT TO CHECKING ACCOUNT (2) - DEPOSIT TO INVESTMENT SAVINGS ACCOUNT (2) - DEPOSIT TO SUPPLEMENTAL SAVINGS (2) - MAIL ME A CHECK (3) ., "'} ~.. I".. ",/ / MEMBERS SIGNATURE: ( ,'t.A_,~ip~~.L,.;(. il? y;t.1'~<A'L~ eJf f "..., ').u (. ; DATE: /." ,:J) y. .. This is to certify that the above named person(s) is (are) the owner(s)of a Certificate account at Members 1 st Federal Credit Union. The Certificate is in accordance with the terms of the Membership and Account Agreement and the Credit Union's current Truth- in-Savings Rate and Fee Schedule which shall accompany the receipt of deposit for this Certificate and is incorporated by this reference. MBRS 1: 98-35 Rev. 08/00 --,---- _._.-..--------..~.-- ~.-.- MefilberslST FEDERAL CREDIT UNION Your savings federally insured to $1H.OOO NCUA P.O. Box 40 . Mechanicsburg, PA 17055-0040 (717) 697-1161 TOll FREE (800) 283-2328 www.members1st.org Natloll"CrtdIt u.uo.Adml~.. u.s.ao--nmentAaenr7 ~ PLEASE RETAIN THIS VOUCHER FOR YOUR RECORDS 997481813 11/21/01 000000000400713 $******1,733.57 CHECK MADE PAYABLE TO: ~NDA WORTHING~ Y-1Way~qi!'J PO BOX 1711 . HARRISBURG. PENNSYLVANIA 17105-1711 235 N. SECOND STREET. HARRISBURG. PENNSYLVANIA 17101 .717/236-4041 PLEASE RETAIN THIS VOUCHER FOR YOUR RECORDS 997481836 11/30/01 000000000400713 IRA DIFFERENCE $*********52.98 CHECK MADE PAYABLE TO: 'VI WayP8i!,~ LINDA WORTHINGTON LOOK FOR US. WE'LL GET YOU THERE. REBECCA J. OCHS Customer Sales Representative \ Waypolnt Bank 1300 Camp Hill Mall Camp Hill, PA 17011 717/737-2323 717/763-4530 fax Y-l WayR.<A N k- PO BOX 1711. HARRISBURG. PENNSYLVANIA 17105-1711 235 N. SECOND STREET. HARRISBURG. PENNSYLVANIA 17101 .717/236.4041 w-NW.waypoinlbank.com rebecCa.ochs@waypoInlbanl<.com ~IWayRoint BANK Look for us. We'll get you there. RECEIPT Acct# Ti :r # 3004 77Retire!llent TRANli 11 11/21/2001 Ledger Balance 781517595 1,733.57 Cioseout ON 11/23/2001 15:56:32 PM .00 Check and other items received for deposit are subject to the provisions of the Uniform Commercial Code. Certain deposits are subject to delays in availability according to Bank policy. TEL-009 (10100) THIS ISYOUR RECEIPT Member FDIC IF i .JAS:;<~: ,.'~" ",~,,:,),,,,"~~"'C2"'. .' " ..~.l " 'T~i:4~~.':.;.'-. ' .~~~~>~ ",t:. ~',.".;' tftr ~:&t;:/ ~~~~ii.,: ,; ";"~I"; \~I: ' . .'~7:h'~l !~~~::;l : ..~ . ',/X ~ ,,);~;~,?.,,'-.,,':~I. ...' ..(:.,.::,:......,~.... . .:.<"~\\ ~;~ ,J]1" . . ,,\:;' ..' ,..I'~1;~":,.~,:.,. ".;..':'" /5~~ " :. : ".. </j \:...." .... e" '.'.,c. 1,:::.:.:5 ' ./.; ~ ""'1 "W'A: " .. ",,'....."',. ~~}:~i;~. .n '} ,." - = .. ~ ..r t"- a- D" '"" .. t"- o o ..r t. ~ r.D II - ~ c.D tQ o o o I"U n.I o .. - ('f") M ex) M CIO ~ t- O') m ! ~ C( ;:) ~ ~ a:: w J: (.) :;) o > en ~ z ~ a: w ~ a: I:"- II'l M M t"" M ... ... .. ... .. .. 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BUy..;.;t;;'ti;N; Buy a lJ~car i Sen Y:bfJrQ:r I Moton;ydg 1 ..............~.......................................~ F1n~nQng I Il1surance :: L~mon Chede: I w~ntiE'5 ~ Accessories i c;;"R;;i;;';'~~ ~ar Pr~i~ ! OW$i1;)ft Guld@Sl ~: Advice ! .: '''At;~t'kbb'''! Kornel 10f2 wysiwyg:1 1 25/http://www.kbb.com/kb/ ki....;p&752;Chevrolet;2001 %20Malibu&1;CH;A1 NOTE PER DEALERSHIP: "A DIMUNITION IN VALUE OF $2500 OCCURS WHEN THE CAR LEAVES THE DEALERSHIP." Gift idea - u Click on the image above to visit this advertiser Blue Book Private Party Report ................."....., ................... ........................................................ .::;lm~:::t::WI~m~~r::~.~.;.:g99~'::~::::.,.::::.::'.:.:::.:,.::::.:..:::.:.:.:::.:::':.:.:::~::::::~:.:.~::~:.:~::::~:::::::::..~:::.'::.::~.:::~:~:...:::::.:.~::::,~:::~ ................................ ... ............. ...... ...... ............................. . ..................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . ...................... ..................... ..................-... ..... ................ ...................... .................... . ...................... . . . . . . . . . . . . . . . . . . . . . . ...................... ....................... ................... .. ................... ............................. .............................. <;M,L ~ _lIT PitKlJP:ms CARs'e~$.. t.tt~ TR~~ M:~ 2001 Chevrolet Malibu Sedan 40 Buva Used Car Financina Quote Insurance Quote Warrantv Quote Pre-Purchase Insoection Pavment Calculator Review of This Car Engine: V6 3.1 Liter Trans: Automatic Drive: Front Wheel Drive Mileage: 1,500 Equipment Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel Cruise Control AM/FM Stereo Cassette Compact Disc Premium Sound Dual Front Air Bags ABS (4-Wheel) Power Seat Premium Wheels Consumer Rated Condition: Excellent "Excellent" condition means that the vehicle looks great, is in excellent mechanical condition and needs no reconditioning. It should pass a smog inspection. The engine compartment should be clean, with no fluid leaks. The paint is glossy and the body and interior are free of any wear or visible defects. There is no rust. The tires are the proper size and match and are new or nearly new. A clean title history. This is an exceptional vehicle. Private Party Value $15,540 Private Party value represents what you might expect to pay for a used car when purchasing from a private party. It may also represent the value you might expect to receive when selling your own used car to another private party. 4B1:I,Ir~.ff!AfLW.::lf\Elli 11/18/0110:43 AM 993 STATEMENT OF PAYMENT Check No. 114295970 7 FOR: BENEFIT PROCEEDS FROM ACCOUNT NO. 210273215 FOR VIRGINIA BRUNNER To change your withholding on future distributions, please contact Hartford Life. Withholding too little may result in tax penalties. KAREN WORTHINGTON 525 AUTUMN WOOD CLOSE ROSWELL, GA 30075 01/08/2002 GROSS AMOUNT NET AMOUNT 8,514.41 8,514.41 Federal Taxable Amount 2,514.41 The Hartford Life Insurance Companies Attn: Individual Annuity Operations P.O. Box 5085 Hartford, CT 06104-5085 800-862-6668 Form ELC-21-0 No. - ~ i ',~ ~ ~ ~ (S) ~ ex> 0 c:r N . r- t;\ 0 a> In a') N '" '" .... . .. ... ... ~ ... \ 4/> .... to (/) J ~ l"- t"- 0 ...... 0"' ~ ....1"- ':I. ~ · a' ~ 80 Z ~ 8 "'1'00 rt'I ~l~ ... t"- >- 0 ~ m>\ 0 , .: . ffi j\\ == cD ~ t.D .. - c:O 0 c.D ,. c:O en 1\ 0 ~ 0 z '"" . ~ 0 :;: ~~w l'\J ~~ 1'\01 ~ M 0 .-I r- ~~ .. ~ 0 - Q .. \S ~ ~ ~ 0 ~ 0 z 0 1 a~ 0 ! 0 04) 0 ~; Q ~ 0 0 P. -l"I ~ .dO , .IJ MIlS .-I O~ 0 ;1 - .-I ~ C'4 - ~ .-I ~~ .-I , I 1 I II PAVl'ri.LH'l'x-'UNl:; THUUbANO t;J.GH'.n-~EVl::N ANl) 04/100 t)U.LLAH::i I 1"1, lOTHE ORDER OF L...........--.----- Member~ FEDERAl. CREDIT UNION P.O. Box 40 Mechanicsburg, Pennsylvania 17055 2313 PAYABLE THAOlJGH MID. ATLANTIC CORPORATE FEOERAL CREDIT UNION HAf'n:l1S8UM, PA 17111 60-8755 2313 :l.1/21/U1 002326 " THIS OOCUMlfNT HAS A WATERMARK, MICRO-PFlINT S/GNATUFlE l./NE AND HIGH RESOLUTION SOF/OER. ABSENCE OF THESE FEATURES WILL rNDICA'rE A COPY. $J1, (ltU,:'4 ~ANj)I-(A L CJ:U::;WI-.:l.L. OR KA!:{t-:N L WOl-<.TH1Nli'l'ON -~_... -'-'f"i"..,~,.~'JI 'h_~ &RIZEO SIGNATURE 'l)fn..n::~~_'~~::""_~~!1.:m;~J'r~'~:~~ ... ___._. ......: , 2:J .38 2 21. .qO? 211. Uln !!..nnnn ~ ~ ~ tl.l" _: 21.:1815501:111 Members~ FEDERAL CREDIT UNION P.D. Box 40 Mechanicsburg, Pennsylvania 17055 2313 PAYABLE THROUGH MID - ATLANTlC CORPORATE FEDERAL CREDIT UNION HARRISBURG, PA 17111 60-8755 2313 11./2.1/01 002326 THIS DOCUMENT HAS A WATERMARK, MICRO. PRINT SIGNATURE LINE AND HIGH RESOLUTION BOROER. ABSENCE OF THESE FEATURES WILL INDICATE A COPY. , l! I' I 'I PAY l'HLH'l'Y-UNI:: 'l'J-iUUbANL> t~JGH'.l't-SJ:~Vt:N i\NlJ b4/10U DULLAl-{::; $ ::l1 , 0 !:l"/ . ~ 4 TO THE ORDER OF \ ~ .: v-'"'.....--.-.."""'-..~'.... ,i>--- '-____ _,~"> ",!!_"",c ,--~~~~[~~ ::;ANUHA 1, CH1SWr.:l.L. OR KA!'<,r:N L WOH'1'H .LNG'l'ON 2 3 . 38 2 2 ~ . ~ 0 ? 211- LLl L ...... A_......_.-___:_ -".~._~________ !',A':;}, (:tH';CK/Cfl~Hi (i ,Iv l'J'l'.AKt:: 11/21/U1 11:4YAM 6~/ b 313 TMA HH:U6 1:1. {J'! ':'--00 BHUNNE!:'V\/U''(H N.l A f.'1 i....tlEl-'hi::> l::.f';L,~;.F~::>t: ~~Fl" DA'J'!:;:11/~1/1)1 CHt-~CK;;:> 1:{ELI::":A~t:; 600'2.:}'lb CASH HI::CVlJ: DOC, '1' 'f 111:::: U,H',:'~:l', HI-:TlIH:Nl:<;D: .00 'l.'U'l'l. H~;CVD: . 00 C:A::l H HI::'!'Vl:U'1I::n: ,00 31,O~).~4 TU: SANDRA L CH:1SW~LL UN TKAN ~,HW AJvlUUN'.l' ::;t'X ::11, oe'l. ~)1 0(1 BAl.,AL\lCl,:; 3;J,2tltl.4<:: ~H/~H/AP~ IN~/S ~MT :i 1 t U (1 '/ . !.:d: l-'~;E/ L'l'CG DU!:.: D'l' .00 5'1'1.) HI'!' \JON"!.' 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BUREAU OF INDIVIDUAL TAXES r''~ r~.; } ~`~~TAcE OF INHERITANCE TAX INHERITANCE TAX DIVISION ~~-PPRA~$,~M~NT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 ~~ ,_~~ ; C~F-~£~j~f'~.rONS, AND ASSESSMENT OF TAX ON HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS ?~~0 APR { ~ ~'~ f~~ 4$ C~.ER~C C~ ORPN~,~'~ Ct~t~RT SANDRA L CRISWE~~~ti~~~-~'_;n;, ,,y-, '~.`'^'., ~A, 4 HAMPSHIRE CT STAFFORD VA 22554 pennsylvania ~ DEPARTMENT OF REVENUE REV-1548 EX AFP C12-09) DATE 04-19-2010 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 01162434 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP C12-09~-------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER VIRGINIA M DATE OF DEATH:11-17-2001 FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 COUNTY:CUMBERLAND ACN: 01162434 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED FINANCIAL INSTITUTION: MEMBERS JOINT OR TRUST ASSET INFORMATION 1ST FCU ACCOUNT NO.: 11079-46 ( ~ CHECKING C )TRUST Cab TIME CERTIFICATE TYPE OF ACCOUNT: C SAVINGS DATE ESTABLISHED 12-24-2000 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,008.09 NOTE: X 0.500 2,504.05 - .00 2,504.05 Y .45 112.68 TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID INItREST I5 CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 112.68 INTEREST AND PEN. 50.23 TOTAL DUE 162.91 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~~ PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Anv party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may object within 60 days of the date of receipt of this notice by: A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from near to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501), the Pennsylvania Non-Resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2007 8% .000219 2008 7% .000192 2009 5% .000137 2010 4% .000110 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES' i_ , ~ `~._ ~.:' ~'~.r:~ ~bTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION - - ,'APP~R~p-iSEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 't'" i`.:_'+ '~OF ~HUCTIONS, AND ASSESSMENT OF TAX ON HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS Pennsylvania ~ DEPARTMENT OF REVENUE REV-1548 EX AFP (12-09) 2~~Q ~~~ ~ ~ ~~ ~2S ~,}$ DATE 04-19-2010 ESTATE OF BRUNNER VIRGINIA ~„R~,,,~~~ k..r'r QRPH~~''S ~J~~T [") t" (~ ` 1 ??, ~' ~ tit t i /', KAREN L WOR10r'f~N~ u'4' `'-' 525 AUTUMN CLOSE ROSWELL GA 30075 DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 01162435 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 M CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER VIRGINIA M DATE OF DEATH:11-17-2001 FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 ACN: 01162435 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 11079-46 TYPE OF ACCOUNT: C SAVINGS C ) CHECKING ( TRUST CX)TIME CERTIFICATE DATE ESTABLISHED 12-24-2000 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,008.09 X 0.500 2,504.05 - .00 2,504.05 x .45 112.68 NOTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 112.68 INTEREST AND PEN. 50.23 TOTAL DUE 162.91 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. COUN'TY:CUMBERLAND ~- PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may object within 60 days of the date of receipt of this notice by: A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, You must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from year to near with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501), the Pennsylvania Non-Resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Year Rate Factor 2007 8% .000219 2010 4% .000110 Interest is calculated as follows: Interest Daily Interest Daily Year Rate Factor Year Rate Factor 2008 7% .000192 2009 5% .000137 INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 SANDRA L CRISWELL 4 HAMPSHIRE CT 1.-..~,,;.~ - ~ ~ ,~.~ ,-~,n~ ~}}~ pennsylvania ~ < ~:::~IpT~,~ ~0#~-' ~HERITANCE TAX ~- ,, ., DEPARTMENT OF REVENUE d{~~~~I'~EN~,';A~~aWANCE OR DISALLOWANCE REV-1548 EX AFP C12-o9) OF DEDUCTIONS, AND ASSESSMENT OF TAX ON A ©©JOINTLY HELD OR TRUST ASSETS ~~~~ Fii~i~ € 6 P~ ~~` ~F~DATE 04-19-2010 ESTATE OF BRUNNER VIRGINIA M v~Ei~€\ ~r DATE OF DEATH 11-17 - 20 01 FILE NUMBER 21 01-1069 ~~~~~~~~~~~~~ COUNTY CUMBERLAND ~~~~~`'~~~~~`~~`~~' i~~' ~~; SSN/DC 204-03-7498 ACN 01162436 STAFFORD VA 22554 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE '~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER VIRGINIA M DATE OF DEATH:11-17-2001 FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 ACN: 01162436 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED FINANCIAL JOINT OR TRUST ASSET INFORMATION INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 11079-45 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST CX)TIME CERTIFICATE DATE ESTABLISHED 01-17-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 13,037.61 NOTE: X 0.166 2,172.98 - .00 2,172.98 X .45 _-__ 9 7.7 8 TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 97.78 INTEREST AND PEN. 43.58 TOTAL DUE 141.36 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. COUNTY:CUMBERLAND PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may ob]ect within 60 days of the date of receipt of this notice bv: A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; ar ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call C717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from near to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet CREV-1501), the Pennsylvania Non-Resident Instruction Booklet CREV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2007 8% .000219 2008 7% .000192 2009 5% .000137 2010 4% .000110 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. n~,r , ,~, ~.,: , ~~ pennsylvania ~ BUREAU OF INDIVIDUAL TAXES ~ ~ "-, ~-~M~YT~~O~t~TNHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION ~~~~I~a:~EM~N~T,~k ALLOWANCE OR DISALLOWANCE REV-1548 EX AFP (12-09) PO BOX 280601 ~ '~ ~~DI~G~~lON'S~,`- /KND ASSESSMENT OF TAX ON HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS ~~~~ ~~~ ~ ~j ~~ ~~: (}~ DATE 04-19-2010 ~~~~tE~ ~:'r :~~, 1~ti ~. ~ ([^'~~ RPM ~,~..t ~ ~t t_,~~;f~~j~f~ KAREN L WORTHINGTON ' 525 AUTUMN CLOSE ROSWELL GA 30075 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 01162437 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER VIRGINIA M DATE OF DEATH:11-17-2001 FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 ACN: 01162437 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 11079-45 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST CX)TIME CERTIFICATE DATE ESTABLISHED 01-17-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 13,037.61 X 0.166 2,172.98 - .00 2,172.98 Y .45 97.78 NOTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 97.78 INTEREST AND PEN. 43.58 TOTAL DUE 141.36 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. COUNTY:CUMBERLAND PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may object within 60 days of the date of receipt of this notice by A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from year to Year with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501), the Pennsylvania Non-Resident Instruction Booklet CREV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2007 8% .000219 2008 7% .000192 2009 5% .000137 2010 4% .000110 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. {-t~~t ~' +r+ 1~~~f-~~j~{'~~ }~-INHERITANCE TAX Pennsylvania ~ BUREAU OF INDIVIDUAL TAXES .^ ~ ~-J~ DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION --A-PPRAI-SEM,EI~'C, ~LOWANCE OR DISALLOWANCE PO BOX 280601 '~'-'aLpt~ 'DE~1Ut4T;Id,N`~,,;,~ AND ASSESSMENT OF TAX ON REV-x548 EX AFP (12-09) ~~ ~, HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS SANDRA L CRISWELL 4 HAMPSHIRE CT v~~~~\ OR~~(~,~~~ ~ ~~~RT .-. -,~-~ PA. CL~~y ~, !ter E ? ' ' , STAFFORD VA 22554 DATE 04-19-2010 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 01162438 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP C12-09)-------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER VIRGINIA M DATE OF DEATH:11-17-2001 FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 ACN: 01162438 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 11079-42 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST CX)TIME CERTIFICATE DATE ESTABLISHED 10-02-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: ~Q ~ ~ APR ~ ~ PM 12~ 48 10,030.39 X 0.166 1,671.77 - .00 1,671.77 x .45 75.23 NOTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 1NItKt51 15 GHAR6ED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 75.23 INTEREST AND PEN. 33.53 TOTAL DUE 108.76 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. COUNTY:CUMBERLAND ~~V' " PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may ob,7ect within 60 days of the date of receipt of this notice bv: A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty Period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet CREV-1501), the Pennsylvania Non-Resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2007 8% .000219 2008 7% .000192 2009 5% .000137 2010 4% .000110 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. ,; i t _~,~.- pennsy van~a ~ BUREAU OF INDIVIDUAL TAXES ,-;: f ~ . -N(~T~~CE~ OF INHERITANCE TAX d-PA~L'^sEME~f~ITr' ALLOWANCE OR DISALLOWANCE t'E~~~::'i~ DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION , REV-1548 EX AFP C12-09) PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON HARRISBURG PA 17128-0601 D OR TRUST ASSETS Y J ~~~~ ~~~ ~ ~ ~~ ~~~~ C~ ~~~ JT~ ;; n, f `f ~6 ~7 ORFr~~~~Y ~ ~,,{ ~: , KAREN L WORTHINGTON 525 AUTUMN CLOSE ROSWELL GA 30075 DATE 04-19-2010 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 01162439 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS <"~ ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER VIRGINIA M DATE OF DEATH:11-17-2001 FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 COUNTY:CUMBERLAND ACN: 01162439 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 11079-42 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST C)U TIME CERTIFICATE DATE ESTABLISHED 10-02-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 10,030.39 X 0.166 1,671.77 - .00 1,671.77 x.45 75.23 NOTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 75.23 INTEREST AND PEN. 33.53 TOTAL DUE 108.76 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. -f~ PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with Your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may ob,iect within 60 days of the date of receipt of this notice by A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501), the Pennsylvania Non-Resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Year Rate Factor 2007 8% .000219 2010 4% .000110 Interest is calculated as follows: Interest Daily Interest Daily Year Rate Factor Year Rate Factor 2008 7% .000192 2009 5% .000137 INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. ,-, r-.. , .-. ~- -•,. !-'t ;;,_.~-`~ ~ ~~= NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TA~Cfe"S ~ 1 ,_ °,,, + ~~ ,R,~ISEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION ~ _ PO BOX 280601 -i ~- b~ ~]~DUCTIONS, AND ASSESSMENT OF TAX ON HARRISBURG PA 17128-0601 ~ ~•- -~ 1 ~' `" ~ • ~ ~ ~ . JOINTLY HELD OR TRUST ASSETS a~~~-~~~#~ ~~~~~ SANDRA L CR~~I,.~°°` _,~;,:,~)~? n~ PA. 4 HAMPSHIRE CT STAFFORD VA 22554 Pennsylvania ~ DEPARTMENT OF REVENUE REV-1548 EX AFP C12-09) DATE 04-19-2010 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 01162440 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ""~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER VIRGINIA M DATE OF DEATH:11-17-2001 FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 ACN: 01162440 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 11079-41 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 09-08-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 12,035.24 NOTE: X 0.166 2,005.91 - .00 2,005.91 Y .45 90.27 TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF W:[LLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 90.27 INTEREST AND PEN. 40.24 TOTAL DUE 130.51 COUNTY:CUMBERLAND * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. n SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. <~,\ PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions ar assessment of tax (including discount or interest) as shown on this notice may object within 60 days of the date of receipt of this notice by A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue,* Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; ar B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty Period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from year to Year with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501), the Pennsylvania Non-Resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Year Rate Factor 2007 8% .000219 2010 4% .000110 Interest is calculated as follows: Interest Daily Interest Daily Year Rate Factor Year Rate Factor 2008 7% .000192 2009 5% .000137 INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Anv notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. ~r ~,;~,~~ ~~ ~~T ~ ~~3~ Pennsylvania ~ BUREAU OF INDIVIDUAL TAXES ~ `6~F INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION ~~~~~j,~'PRa--~SErM~~~,f ~iLLOWANCE OR DISALLOWANCE PO BOX 280601 ""'V~'~~~11'CTI~ONS,~AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-09) HARRISBURG PA 1~12B-o6o1 JOINTLY HELD OR TRUST ASSETS ~~{Q,~p~ ~ ~ ~~ ~~' ~#~ DATE 04-19-2010 CLEr~K ~~ QRF~~r~~`S ~~~,'~T KAREN L WORTHINGT 525 AUTUMN CLOSE ROSWELL GA 30075 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 01162441 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 _- ___ ESTATE OF:BRUNNER VIRGINIA M DATE OF DEATH:11-17-2001 FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 COUNTY:CUMBERLAND ACN: 01162441 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 11079-41 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST CX)TIME CERTIFICATE DATE ESTABLISHED 09-08-1997 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 12,035.24 NOTE: X 0.166 2,005.91 - .00 2,005.91 Y .45 90.27 TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT ~+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 90.27 INTEREST AND PEN. 40.24 TOTAL DUE 130.51 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. (jM/~ PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the tap portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Anv Party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may object within 60 days of the date of receipt of this notice bv: A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty Period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501), the Pennsylvania Non-Resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2007 8% .000219 2008 7% .000192 2009 5% .000137 2010 4% .000110 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINpUENT X DAILY INTEREST FACTOR Anv notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 SANDRA L CRISWELL 4 HAMPSHIRE CT r~rti_, E~ ~1, M_ f0~1JHERITANCE TAX ` d~PI~A~SEM~N '~4~'OWANCE OR DISALLOWANCE -;A'~~~EB4IC`T~I-0Q~"~~ ~~ID ASSESSMENT OF TAX ON t '~ -JOI~hTLY' H~L~D OR TRUST ASSETS 2~~0 APB l 6 P~ ~~~ 48 ~L~RK ~F 0~~~.~~r. Fly ~;~~r,~'R~''{^~j,}j1~ STAFFORD VA 22554 Pennsylvania ~ DEPARTMENT OF REVENUE REV-1548 EX AFP (12-09) DATE 04-19-2010 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 01162442 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS F"' ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 ACN: 01162442 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 11079-11 TYPE OF ACCOUNT: ( )SAVINGS CX) CHECKING C )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 04-21-1994 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TOX f~RFiITTS VIRGINIA M DATE OF DEATH:11-17-2001 5,940.08 NOTE: X 0.166 990.03 - .00 990.03 X .45 44.55 TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS.. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 44.55 INTEREST AND PEN. 19.86 TOTAL DUE 64.41 COUNTY:CUMBERLAND ~ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. (Y`\~ PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may ob]ect within 60 days of the date of receipt of this notice by A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.baardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501), the Pennsylvania Non-Resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Year Rate Factor 2007 8% .000219 2010 4% .000110 Interest is calculated as follows: Interest Daily Interest Daily Year Rate Factor Year Rate Factor 2008 7% .000192 2009 5% .000137 INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. ~.. .,~. f n.~ , BUREAU OF INDIVIDUAL TAXES ~ ~_- ..•~ '~~~"I~~ OF INHERITANCE TAX INHERITANCE TAX DIVISION ~• ,AP~!Ra~S~K~~~ ALLOWANCE OR DISALLOWANCE PO BOX 280601 s ..~.+ =©~~D~UC'1` d1V~, AND ASSESSMENT OF TAX ON HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS Pennsylvania ~ DEPARTMENT OF REVENUE REV-1548 EX AFP C12-09) ~~~~ ~~~ ~ ~ ~ ~~~ ~8 DATE 04-19-2010 Ct~~h ~C= t~RF`~1~~`S ~~,t~R~~ KAREN L WORTHINGW9~N`°"-~ 525 AUTUMN CLOSE ROSWELL GA 30075 ESTATE OF BRUNNER VIRGINIA DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 01162443 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 M CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER COUNTY:CUMBERLAND FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 ACN: 01162443 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 11079-11 TYPE OF ACCOUNT: C )SAVINGS CX) CHECKING C )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 04-21-1994 Account Balance 5,940.08 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.166 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 990.03 UPPER PORTION OF THIS NOTICE Debts and Deductions - •00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 990.03 REGISTER OF WILLS AT THE Tax Rate Y •45 ABOVE ADDRESS.. MAKE CHECK Tax Due 44.55 OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." TAX CRF1]TTS: PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM VIRGINIA M DATE OF DEATH:11-17-2001 TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 44.55 INTEREST AND PEN. 19.86 TOTAL DUE 64.41 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~~~~ PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions ar assessment of tax (including discount or interest) as shown on this notice may object within 60 days of the date of receipt of this notice by: A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501), the Pennsylvania Non-Resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Year Rate Factor 2007 8% .000219 2010 4% .000110 Interest is calculated as follows: Interest Daily Interest Daily Year Rate Factor Year Rate Factor 2008 7% .000192 2009 5% .000137 INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. ~,,, ~. ~, ."` r,. BUREAU OF INDIVIDUAL TAXES ~'; "'~"` ~~~~~` OF INHERITANCE TAX INHERITANCE TAX DIVISION ~„AR~-#ZAI;S6M.~N}Tti~ ALLOWANCE OR DISALLOWANCE PO BOX 280601 t ~`..~~~F' :b~DUCT2`UYJS, AND ASSESSMENT OF TAX ON HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS pennsylvania ~ DEPARTMENT OF REVENUE REV-1548 EX AFP C12-09) ~~~~ ~~~ ~ ~ ~ ~~: f}$ DATE 04-19-2010 ~~..~~~C ~~~~ ~'~ ~;~~)~F~ pFP~ , ,~~ ~ k_ ~. ,.-,-, r~. r, t SANDRA L CRISWELL C ~~4~~'=~ ~'~~ ~,' ' p 4 HAMPSHIRE CT STAFFORD VA 22554 ESTATE OF BRUNNER VIRGINIA DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 01162444 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 M CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER VIRGINIA M DATE OF DEATH:11-17-2001 COUNTY:CUMBERLAND FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 ACN: 01162444 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 11079-04 TYPE OF ACCOUNT: (X)SAVINGS C ) CHECKING ( )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 02-07-1974 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 2,001.78 NOTE: X 0.166 333.64 - .00 333.64 Y .45 15.01 TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 15.01 INTEREST AND PEN. 6.69 TOTAL DUE 21.70 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. _ SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~~ A PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may ob,7ect within 60 days of the date of receipt of this notice by: A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from near to near with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501), the Pennsylvania Non-Resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Year Rate Factor 2007 8% .000219 2010 4% .000110 Interest is calculated as follows: Interest Daily Interest Daily Year Rate Factor Year Rate Factor 2008 7% .000192 2009 5% .000137 INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Anv notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. ..,~~ ~.~--~, ,~;~~5~~,.~ ~~-- pennsylvania ~ BUREAU OF INDIVIDUAL TAXES ••' j• ~~~- - ~-k.~ OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION „<~ , , ~` ~P~iRAI;S~'~E~1~'', ALLOWANCE OR DISALLOWANCE PO BOX 280601 ' t`- -~~'~^ 0!F'~'D~EDUCTIQN'S, AND ASSESSMENT OF TAX ON REV-1548 EX AFP C12-09) HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS ~~~~, ~~~ ~ ~j ~ ~~~ ~}~ DATE 04-19-2010 d~F~,~~~~~ '.1 {~jit~~,-r KAREN L WORTH I NG'1`b1~ - `" 525 AUTUMN CLOSE ROSWELL GA 30075 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 01162445 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~"~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER VIRGINIA M DATE OF DEATH:11-17-2001 FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 COUNTY:CUMBERLAND ACN: 01162445 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED FINANCIAL INSTITUTION: MEMBERS TYPE OF ACCOUNT: ( ~ SAVINGS DATE ESTABLISHED 02-07-1974 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: JOINT OR TRUST ASSET INFORMATION 1ST FCU ACCOUNT NO.: 11079-04 C ) CHECKING C )TRUST C )TIME CERTIFICATE 2,001.78 NOTE: X 0.166 333.64 - .00 333.64 Y .45 15.01 TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 15.01 INTEREST AND PEN. 6.69 TOTAL DUE 21.70 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. Q~,~n PURPOSE OF NOTICE: Ta fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may object within 60 days of the date of receipt of this notice by A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call C717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet CREV-1501), the Pennsylvania Non-Resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2007 8% .000219 2008 7% .000192 2009 5% .000137 2010 4% .000110 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. `_ _. ~~~~ . !_~~~ ~~~#~~,~j~._~ ~~ pennsylvania ~ BUREAU OF INDIVIDUAL TAXES ~ .~..~ ~ iN~O~`~CE~~ OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION t4 `-;' ~APP~A~S~N~~IT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 ~ ~~" `'~`" "`~ REV-1548 EX AFP C12-09) OF `bEDUCT~IONS, AND ASSESSMENT OF TAX ON HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS ~~~~ ~~~ ~ ~ ~ ~~' ~$ DATE 04-19-2010 ~~~~~ ~' ~R~"~,r~~~~J ~~~~~T r SANDRA L CRISWELL 4 HAMPSHIRE CT STAFFORD VA 22554 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 02100998 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWEIR PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMIENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX OWN JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER VIRGINIA M DATE OF DEATH:11-17-2001 FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 COUNTY:CUMBERLAND ACN: 02100998 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FEDERAL CREDIT UN ACCOUNT NO.: 11079-47 TYPE OF ACCOUNT: ( )SAVINGS C ) CHECKING C )TRUST CX)TIME CERTIFICATE DATE ESTABLISHED 04-24-2000 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 22,029.03 X 0.166 X3,671.58 - .00 3,671.58 Y ~ .45 165.22 NOTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEI PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 165.22 INTEREST AND PEN. 73.64 TOTAL DUE 238.86 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YbU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may object within 60 days of the date of receipt of this notice by A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from near to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501), the Pennsylvania Non-Resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2007 8% .000219 2008 7% .000192 2009 5% .000137 2010 4% .000110 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. ...~_ ~,~ ~' ~ ~ `.• ~^ t "~ '~~M~T#~i+GE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES ~ ' INHERITANCE TAX DIVISION A~PiZAI.3~1~1~~1T, ALLOWANCE OR DISALLOWANCE PO BOX 280601 ~~~,T,~t,~t':~~~+',D'EDlICTf'ONS, AND ASSESSMENT OF TAX ON HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS pennsylvania ~ DEPARTMENT OF REVENUE REV-1548 EX AFP (12-09) ~~~~ ~~~ ~ ~ ~~ ~~+: ~.}~ DATE 04-19-2010 KAREN L WORTHIN'~'-' ~'•~`~`- °'~ 525 AUTUMN CLOSE ROSWELL GA 30075 ESTATE OF BRUNNER VIRGINIA DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 ACN 02100999 APPEAL BY DATE:06-18-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 M CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 04-19-2010 ESTATE OF:BRUNNER VIRGINIA M DATE OF DEATH:11-17-2001 FILE NO.: 21 01-1069 S.S/D.C. NO.: 204-03-7498 ACN: 02100999 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FEDERAL CREDIT UN ACCOUNT NO.: 11079-47 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING ( )TRUST ( ~ TIME CERTIFICATE DATE ESTABLISHED 04-24-2000 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 22,029.03 X 0.166 3,671.58 - .00 3,671.58 Y .45 165.22 NOTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS.. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 04-27-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 165.22 INTEREST AND PEN. 73.64 TOTAL DUE 238.86 COUNTY:CUMBERLAND * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the reverse side. Make check or money order payable to: Register of Wills, Agent. Failure to pay the tax, interest and penalty due may result in the filing of a lien in the appropriate county or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's Web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this notice may ob.7ect within 60 days of the date of receipt of this notice by A) Protest to the PA Department of Revenue, Board of Appeals by filing a protest online at www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Web site. You may also send a written protest to PA Department of Revenue, Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or B) Elect to have the matter determined at the audit of the personal representative account; or ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue. Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601 or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed and not paid before Jan. 18, 1996, the first day after the end of the tax amnesty Period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest 15 charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982, bear interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982 will bear interest at a rate which varies from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 2006 can be found in the Pennsylvania Resident Instruction Booklet CREV-1501), the Pennsylvania Non-Resident Instruction Booklet CREV-1736) or on the Department of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2007 through 2010 are: Interest Daily Year Rate Factor 2007 8% .000219 2010 4% .000110 Interest is calculated as follows: Interest Daily Interest Daily Year Rate Factor Year Rate Factor 2008 7% .000192 2009 5% .000137 INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. 1 Y ~,i ~, ~ ~~ ~L~~' ~ ~ August 3, :?07.0 Karen L. Wortr~in;?;ton 525 Autumn Wood Caose Roswell, G~~ 30075 Register of Wills 1 Courthouse Square Carlisle, PA 17013 This letter and attached Supplemental Return is in regards to f ourteen Inheritance Tax Li<<bility Delinquency Notifications recently received. Seven notifications were sent to me and seven to my sister Sandra Criswell. The notifications were f or the following ACN's. All are joint accounts. For Karen Worthington For Sandra Criswell ~, ~ ~,~ c-s a ~.:,.; , ,, 02100999 02100998 cv ~ ~= 01162435 01162434 ~_~?~c~~ ~ ti-~ ?l rn ~~, , 01162437 01162436 ~-' ~=~ ~ :•. ~ 01162439 01162438 ., ,-=,-, , - ~ `~ `~' - - =~ ~' ~: 01162441 01162440 ~ ~" _~ - - ,.~~ 01162443 01162442 , , ?=y _,, --- ' `~~' 01162445 01162444 `~A A tax return for these accounts and payment for all was sent on February 14, 2002. A Pennsylvania Inheritance and Estate Tax Official Receipt, NO. CD 000888 for $4330.09, shows payment received by Mary C. Lewis, Register of Wills, dated February 25, 2002. In an effort to determine why we received notifications for taxes owed, but believed paid ni~1e years ago I contacted the Inheritance Tax Enforcement division and was very fortunate to~ receive help from Todd Seidel (717-425-7711). Todd was able to locate the original tax return, and record of payment, but believed the problem we were having was with a lack of correct schedules being filed with the original return. It was also determined that we had actually over paid our tax obligation. He advised us to contact the Register of Wi11s office to determine if we needed to file a new return or a supplemental return. I was advised that a file for. the decedent, Virginia M. Brunner, File No. 2101-1069, was on record an that I should file a supplemental return. Attached is the supplemental return and related documentation. I have done the return myself this time, no CPA, and have endeavored to utilize the correct schedules. I hope this clears things up and I look forward to hearing from you regarding this matter. I have included a $15.00 check for the filing fee and a self addressed stamped envelope for a receipt copy of ithe return. If I can be of further help please contact me at the above address or at 770-998-2772. Tha for your help, ar orthi ~~ ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 • HARRISBURG, PA 17128-0601 ''~ RECEIVED FROM: WORTHINGTON KAREN LEE 525 AUTUMN WOOD CLOSE ROSWELL, GA 30075 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 000888 ACN ASSESSMENT AMOUNT CONTROL NUMBER I -------- fold ESTATE INFORMATION: SSN: 204-03-7498 FILE NUMBER: 2101-1069 DECEDENT NAME: BRUNNER VIRGINIA M DATE OF PAYMENT: 02/25/2002 POSTMARK DATE: 02/ 14/2002 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 / 17/ 2001 101 ~ $4,330.09 TOTAL AMOUNT PAID: REMARKS: KAREN L WORTHINGTON SEAL CHECK# 1314 INITIALS: CW RECEIVED BY: MARY C. LEWIS $4,330.09 REGISTER OF WILLS TAXPAYER I + 1505610101 REV-1500 Ex `°1.1°' enns lvania OFFICIAL USE ONLY PA Department of Revenue p Y County Code Year File Number ^EP~RTMENT OF REVENUE Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28o6oi ~ ~ fl ~ ~ C ~`~ Harrisburg, PA i~128-0601 RESIDENT DECEDENT l~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 204-03-7498 11 /17/2001 03/29/1922 Decedent's Last Name Suffix Decedent's First Name MI Brunner Virginia M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW O 1. Original Return p 4. Limited Estate O 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ~ 2. Supplemental Return p 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate lax Return Required U 8. Total Number of Safe Deposit Eioxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:. Name Daytime Telephone Number Karen L. Worthington (770) 998-2772 First line of address 525 Autumn Wood Close Second line of address City or Post Office Roswell Correspondent's a-mail address: karenwor@att.net State ZIP Code GA 30075 REGISTER O ILLS USE O~ ~ ~ c~ t )~ - 7- ~ +.~ ~ G'.l ~m ~' ~ I CTt r ~ _ ~, ~~~~ ~ T3 ..ir:: _ ._~ _ DATE { ED _ - _ t~,,a -~.. ~~ ,, r -; ..' ~;_) ._. Under penalties o 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 d compl .Declaration of preps er than the personal representative is based on all information of which preparer has any knowledge. T OF G TURN DATE 08/03/10 A RESS 525 A um Wood CI a swell, GA 30075 SIGNATURE OF PREPARER ER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 I r I' J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: Virginia M. Brunner 204-03-7498 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 0.00 2. ....................................... Stocks and Bonds (Schedule B) 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mort a es and Notes Receivable Schedule D 9 9 ( ) ........................... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 14,145.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 26,699.92 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 18,634.96 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 59,479.88 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 10,321.68 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 772.22 11. Total Deductions (total Lines 9 and 10) ................................. 11. 11,093.90 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 48,385.98 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 48,385.98 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0~ 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 45 16. 2,17'7.37 17. Amount of Line 14 taxable at sibling rate X .12 17, 0.00 18. Amount of Line 14 taxable at collateral rate X .15 1 g, 0.00 19. TAX DUE ......................................................... 19. 2,177.37 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 1505610105 1505610105 REV-1500 EX Page 3 Decedent's Complete Address: 4, 330.09 DECEDENTS NAME Virginia M. Brunner STREET ADDRESS 117 November Drive Apt. 2 CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments ____ B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. File Number (1) Total Credits (A + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. 2,177.37 4,330.09 2,157.72 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 :.......................................................................................... ^ Q 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? ...................................................................... ^ [x] 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ [X] 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ x^ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent (72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 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 percent [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 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling 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-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Virginia M. Brunner 2101-1069 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-15og EX+ (oi-1o) ~ .~: pennsylvan~a DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDt~LE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Vrigina M. Brunner 2101-1069 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A•~Karen L. Worthington 525 Autumn Wood Close Daughter Roswell, GA 30075 B' Sandra Crisswell 4 Hampshire Ct Daughter Stafford, VA 22554 C. ITEM NUMBER LFITER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTRUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR ]oINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % of DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST i. A. 02/07/74 Members 1st Federal Credit Union, Savings Acct. No. 11079-04 2,001.78 X6.667 333.64 2 A 04/21/94 Members 1st Federal Credit Union, Checking Acct. No.11079-11 5,940.08 (6.67 990.03 ' 3 A 09/08/97 Members 1st Federal Credit Union, Time Certificate Acct. No.11079-41 12,035.24 t6•66~ 2,005.91 4 A 10/02/97 Members 1st Federal Credit Union, Time Certificate Acct. No.11079-42 10,030.39 l6.6~7 1,671.77 5 A 01/17/97 Members 1st Federal Credit Union, Time Certificate Acct. No.11079~t5 13,037.61 16.661 2,172.98 ~ 6 A 12/24/00 Members 1st Federal Credit Union, Time Certificate Acct. No. 11079-46 5,008.09 So •0 2,504.05 ~ 7 A 04/24/00 Members 1st Federal Credit Union, Time Certificate Acct. No.11079-47 22,029.03 {6 •b67 3,671.58 ~ 8 B 02107/74 Members 1st Federal Credit Union, Savings Acct. No. 11079-04 2,001.78 16.667 333.64 ~ 9 B 04/21/94 Members 1st Federal Credit Union, Checking Acct. No.11079-11 5,940.08 16•dbl 990.03 10 B 09/08/97 Members 1st Federal Credit Union, Time Certificate Acct. No. 11079-41 12,035.24 ((,,667 2,005.91 11 B 10/02/97 Members 1st Federal Credit Union, Time Certificate Acct. No.11079-42 10,030.39 16.667 1,671.77 ~ 12 B 01/17/97 Members 1st Federal Credit Union, Time Certificate Acct. No.11079-45 13,037.61 16.667 2,172.98 13 B 12/24/00 Members 1st Federal Credit Union, Time Certificate Acct. No. 11079-46 5,008.09 $o. 0 2,504.05 c 14 B 04/24/00 Members 1st Federal Credit Union, Time Certificate Acct. No.11079-47 22,029.03 (6.67 3,671.58 JOINTLY OWNED PROPERTY: TOTAL (Also enter on Une 6, Recapitulation) I $ 26,699.92 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (08-09) ~ pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AHD INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Virginia M. Brunner 2101-1069 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE INCLUDE THE NAWE OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND NUMBER THE DATE OF TRANSFBt. ATTACH A COPY of THE D~ FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. Hartford Life Insurance Co. Annuity, Acct. No 210273215, Transfered 16,848.41 100 0.00 16,848,41 1108/2002 to daughters Karen L. Worthington & Sandra Criswell. 50% Each. 2 IRA Waypoint Bank Acct No. 781517595, Transfered 11/21/2001 to 1,786.55 100 0.00 1,786.55 Granddaughter Linda L. Worthington. TOTAL (Also enter on Line 7, Recapitulation) ~ I 18,634.96 If more space is needed, use additions! sheets of paper of the same size. REV-1511 EX+ (10-09) '. pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT City _Roswell _ State GA ZIp 30075 Year(s) Commission Paid: None __ ----- -- ESTATE OF FILE NUMBER Virginia M. E;runner 2101-1069 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Burial, Casket & related funeral expenses. 6,902.90 2 Travel, motel and out-of-pocket for relatives & legal representatives to complete estate business. 2,595.00 3 CPA fee for filing original inheritance tax retum. fi00.00 e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of personal Representative(s) Karen L. Worthington & Sandra Criswell street address 525 Autumn Wood Close 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address 4. 5. 6. 7. City _ _ State __ Relationship of Claimant to Decedent _ __ SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ZIP Probate Fees: Accountant Fees: Tax Return Preparer Fees: No preparer fees for supplemental retum. Fee for original return as noted above. TOTAL (Also enter on Line 9, Recapitulation) I ~ If more space is needed, use additional sheets of paper of the same size. 223.78 10,321.68 REV-1512 EX+ (12-08) - pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES St LIENS RESIDENT DECEDENT ESTATE OF PILE NUMBER Virginia M. Brunner 2101-1069 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. NOTICE OF INHERITANCE TAX r~.„~ 'a~P,~t~tT~NT, ALLOWANCE OR DISALLOWANCE BUREAU OF INDIVIDUAL TAXES i~~ INHERITANCE TAX DIV1S1oN ~', . ~~,,`~E~UCTIONS AND ASSESSMENT OF TAX PO BOX 280601 ~ ` ~ i F- ~ ~, ; , ~ _ HARRISBURG PA 17128-0601 ~ ~'°} X01 ~ N8Y - 8 P~ 2~ 3 4 ~I.ERI~ +?F (}~pHA~I'~ Cfl~JRT KAREN L WORTH~,~~;~.~`,~'''~ ~~'~' , ~'A 525 AUTUMN WOOD CLOSE ROSWELL GA 30075 tl) .00 t2) .00 t3) .00 t4) .00 t5) 14, 145.00 t6) 26, 699.92 t7) 18, 634.96 CUT ALONG THIS-LINE----- --~ R_ETA_IN LOWER POR_TION_ FOR YOUR RECORDS F'- _ ___________ _ REY-1547 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAI5EMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: BRUNNER VIRGINIA MFILE N0.:21 01-1069 ACN: 101 DATE: 11-01-2010 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED 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 tSchedule D) 5. Cash/Bank Deposits/Misc. Personal Property tSchedule E) 6. Jointly Owned Property tSchedule F) 7. Transfers tSchedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses tSchedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) pennsylvania DEPARTMENT OE REVENUE REV-1547 EX AFP t12-09) NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. t8) 59 , 479 .88 c9) 10 , 321.68 clo) 772.22 11. Total Deductions tll) 11,093.90 12. Net Value of Tax Return t12) 48,385.9$ 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts tSchedule J) t13) .0 0 14. Net Value of Estate Subject to Tax C14) 4$,385.9$ NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) .0 0 X 0 0 - .0 0 16. Amount of Line 14 taxable at Lineal/Class A rate t16) _ 48 .385.98 x 045 = 2, 177.37 17. Amount of Line 14 at Sibling rate t17) _ _0 0 X 12 = .0 0 18. Amount of Line 14 taxable at Collateral/Class B ra te t18) .0 0 X 15 = .0 0 19. Principal Tax Due t19)= 2, 177.37 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT t+) INTEREST/PEN PAID t-) AMOUNT PAID 02-14-2002 CD000888 108.87 4,330.09 TOTAL TAX PAYMENT 4,438.96 BALANCE OF TAX DUE 2,261.59CR INTEREST AND PEN. .00 TOTAL DUE 2,261.59CR * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" tCR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. DATE 11-01-2010 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 12-31-2010 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 ~~ BUREAU OF INDIVIDUAL TaxES ~ '~ ~ ' ~ /~I.NHERITANCE TAX INHERITANCE TAX DIVISION S TA'T E M E N T O F A C C O U N T PO BOX 280601 _ ' HARRISBURG PA 17128-0601 _, `"' `' ~- ., ;- ~~?~ 1~ ~ ~ ~1 r,/ t ^z -~ OAP ' ., ., ~ ~ ~, { ,F~. ~, ~ ~~ ,', 1 - .r ~ i KAREN L WORT~~~I~T~{~N '' i ~ ~; ti ~-,~ 525 AUTUMN WOOD CLOSE ROSWELL GA 30075 Pennsylvania ~ DEPARTMENT OF REVENUE ~~ REV-1607 EX AFP {12-09) DATE 11-15-2010 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP C12-09) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF:BRUNNER VIRGINIA M FILE N0.:21 01-1069 ACN: 101 DATE: 11-15-2010 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-25-2010 PRINCIPAL TAX DUE: 2,177.37 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 02-14-2002 CD000888 108.87 4,330.09 10-28-2010 REFUND .00 2,261.59- TOTAL TAX PAYMENT ~ 2,177.37 BALANCE OF TAX DUET .00 INTEREST AND PEN. ~ .00 TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. .00 C L~~ INHERITANCE TAX RECORD ADJUSTMENT pennsy vania JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION REV-1604 EX AFP (12-12) PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND KAREN L WORTHINGTON SSN/DC 204-03-7498 ACN 01162435 525 AUTUMN CLOSE Amount Remitted ROSWELL GA 30075 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE --I� RETAIN LOWER PORTION FOR YOUR RECORDS �--� REV-1604 EX AFP C12-12) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 01162435 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 11079-46 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING C ) TRUST ( X) TIME CERTIFICATE DATE ESTABLISHED 12-24-2000 Account Balance •00 NOTE: TO ENSURE2ROPER CMIT-0T9jYOUR Percent Taxable X 0.500 ACCOUNT, SpE§�T TH"PPOtRORTION Amount Subject to Tax •00 OF THIS NRI'Q CWITC�(OUj; TRX Debts and Deductions - •00 PAYMENT T0a'i�rRE6ISTERjWILLS Taxable Amount •00 AT THE ADiJjEX1;SJHOfi A=VP Tax Rate X .045 MAKE CHECCOR- R8NEY-,pRDJt!�AYABLE Tax Due •00 T0: "RE6 T t!�F ULLS,t "ENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID H CI) O DATE NUMBER INTEREST/PEN PAID C-) y, CT) -n TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. v PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the end of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan; 1, 1982 will bear interest at a rate which will vary from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 8% .000219 2001 9% .000247 2002 6% .000164 2003 5% .000137 2004 4Y, .000110 2005 5% .000137 2006 7Y. .000192 2007 8% .000219 2008 7% .000192 2009 5% .000137 2010 4% .000110 2011-2013 3Y, .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX RECORD ADJUSTMENT pennsy vania BUREAU OF INDIVIDUAL TAXES JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION REV-1604 EX AFP (12-12) PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 SANDRA L CRISWELL ACN 01162436 4 HAMPSHIRE CT Amount Remitted STAFFORD VA 22554 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS REV-1604 EX AFP C12-123 ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 01162436 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1sT FCU ACCOUNT NO. : 11079-45 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST ( X) TIME CERTIFICATg . DATE ESTABLISHED 01-17-1997 n c c © = M rrl Account Balance •00 NOTE: TO ENSURE "PER CVgDI1eTCb YOUR Percent Taxable X 0.166 ACCOUNT, gpRMIQs THf--UP"R;J-ORTION Amount Subject to Tax •00 OF THIS N0T4Eg4IT&Y06A X Debts and Deductions - •00 PAYMENT T.4 Th1E,79tEGISTE 0 WILLS Taxable Amount •00 AT THE AV§ktSSbSHOVN A V15. Tax Rate X .045 MAKE CHEC;g @ -MQNLR OROgR�PAYABLE Tax Due •00 TO: "REGIS3WR OF LLFh GENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) C7)AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE np IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address Printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the end of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, It 1982 will bear interest at a rate which will vary from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 By .000219 2001 9Y. .000247 2002 6% .000164 2003 5Y. .000137 2004 4Y. .000110 2005 5Y. .000137 2006 7Y. .000192 2007 By .000219 2008 7Y. .000192 2009 5Y. .000137 2010 4Y. .000110 2011-2013 3Y. .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX ennS lvania RECORD ADJUSTMENT P Y JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION REV-1604 IX AFP C12-12) PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 KAREN L WORTHINGTON ACN 01162437 525 AUTUMN CLOSE Amount Remitted ROSWELL GA 30075 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE 1� RETAIN LOWER PORTION FOR YOUR RECORDS +_ REV-1604 EX AFP (12-12) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 01162437 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1sT FCU ACCOUNT NO. : 11079-45 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST CX) TIME CERTIFICATE DATE ESTABLISHED 01-17-1997 Account Balance •00 NOTE: TO ENSURE PROPER .CREDIT TO YOUR Percent Taxable X 0.166 ACCOUNT, SUBMIT THE-_UPPER PORTION Amount Subject to Tax •00 OF THIS NOMICE WIT"OUEo7W4( Debts and Deductions - •00 PAYMENT TcgTm REGI*TER 5 o ILLS Taxable Amount •00 AT THE ADDREig SHO%*ABQRE�D Tax Rate X .045 MAKE CHECK)tIV'9iEY ORD" �41YABLE Tax Due •00 TO: "REGIPM qW W =LS;�A9tNT." TAX CREDITS: — I ° PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID =3 = 'xi DATE NUMBER INTEREST/PEN PAID C-) C F__A t7 N r- I)1 C" 3> CT) TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address Printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY T0: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the end of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, 1, 1982 will bear interest at a rate which will vary from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 By .000219 2001 9Y, .000247 2002 6Y, .000164 2003 5Y. .000137 2004 4Y, .000110 2005 5Y, .000137 2006 7Y. .000192 2007 By .000219 2008 7Y, .000192 2009 5Y, .000137 2010 4Y, .000110 2011-2013 3Y. .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX RECORD ADJUSTMENT pennsy vania JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION REV-1604 EX AFP (12-12) PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 SANDRA L CRISWELL ACN 01162438 4 HAMPSHIRE CT Amount Remitted STAFFORD VA 22554 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE --01 RETAIN LOWER PORTION FOR YOUR RECORDS +— REV-1604 EX AFP (12-12) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 01162438 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 11079-42 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING C ) TRUST ( X) TIME CERTIFICATE DATE ESTABLISHED 10-02-1997 Account Balance •00 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X 0.166 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax •00 OF THIS NATICE WITikYOUR ;Tj1X Debts and Deductions - •00 PAYMENT Tit BE REG`TtTE9CF WILLS Taxable Amount •00 AT THE ADOESS SHOj* AI@VgP. Tax Rate X .045 MAKE CHEC'1h g WNE1 OR#R6AYABLE Tax Due •00 TO: "REG;at!f(�pF NLL-ra PENT.•' TAX CREDITS: �? � o 0 C7) CD PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID - '*1 DATE NUMBER INTEREST/PEN PAID C-) n fJ -r) „ ~ r- M ry r- o TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE INTEREST AND PEN. 0 TOTAL DUE no * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address Printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY TO: questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call C717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the end of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, 1, 1982 will bear interest at a rate which will vary from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 BY .000219 2001 9Y, .000247 2002 6Y, .000164 2003 5Y. .000137 2004 4Y. .000110 2005 5Y, .000137 2006 7Y, .000192 2007 By .000219 2008 7Y. .000192 2009 57 .000137 2010 4Y. .000110 2011-2013 3Y, .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX RECORD ADJUSTMENT pennsylvarna JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION REV-1604 EX AFP C12-123 PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND KAREN L WORTHINGTON SSN/DC 204-03-7498 ACN 01162439 525 AUTUMN CLOSE •Amount Remitted ROSWELL GA 30075 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE --I� RETAIN LOWER PORTION FOR YOUR RECORDS +— REV-1,604 EX AFP (12-12) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 01162439 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1sT FCU ACCOUNT NO. : 11079-42 TYPE OF ACCOUNT: ( ) SAVINGS t } CHECKING t } TRUST ( X) TIME CERTIFICATE DATE ESTABLISHED 10-02-1997 Account Balance •00 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X 0.166 ACCOUNT, SUBMIT THE_UPPER PORTION Amount Subject to Tax •00 OF THIS NICE WITW.:YOUJ& RX Debts and Deductions •00 PAYMENT Ti TIDE REG�TENTIO�WILLS Taxable Amount •00 AT THE ADWS SHO A*Fv Tax Rate X .045 MAKE CHEC Ot MONEV ORDBRCPAYABLE Tax Due .00 TO: "REG T�tf;F WL-M QENT." TAX CREDITS: U: x C) PAYMENT RECEIPT DISCOUNT t+} AMOUNT PAID C? »� -� DATE NUMBER INTEREST/PEN PAID C-) C7 1 CV r— "C7 > CT) -71 TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE INTEREST AND PEN. up TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND (CR)s A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.rovenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering services 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY T0: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of.Individual Taxes, ATTN.- Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decadent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the end of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, 1, 1982 will bear interest at a rate which will vary from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.reyenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 8% .000219 2001 9% .000247 2002 6Y .000164 2003 5Y, .000137 2004 4Y, .000110 2005 5Y. .000137 2006 7% .000192 2007 a% .000219 2008 7Y. .000192 2009 5% .000137 2010 4% .000110 2011-2013 3Y, .000082 Interest is calculated as follows: INTEREST - BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX RECORD ADJUSTMENT pennsytvania JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION REV-1604 EX AFP (12-12) PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 SANDRA L CRISWELL ACN 01162440 4 HAMPSHIRE CT Amount Remitted STAFFORD VA 22554 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE --I� RETAIN LOWER PORTION FOR YOUR RECORDS REV-1604 EX AFP (12-12) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 01162440 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 11079-41 TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING C ) TRUST ( X) TIME CERTIFICATE DATE ESTABLISHED 09-08-1997 t"! w %O r n Account Balance •00 NOTE: TO ENSURE OVER CWIT TO5j OUR Percent Taxable X 0.166 ACCOUNT, S l4T THE PP6J1 RTION Amount Subject to Tax •00 OF THIS N013= gkTH YOUt T Debts and Deductions - .00 ATYTHETADD�S� , OWN BO��ILLS Taxable Amount .00 C> Tax Rate X .045 MAKE CHECK CORCNONEY DEjj;"YABLE Tax Due •00 TO: "REGIbg1EW_O� WALLS, yNT." TAX CREDITS: - o PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID +� Cn DATE NUMBER INTEREST/PEN PAID C-) TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, way be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the end of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, 1, 1982 will bear interest at a rate which will vary from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.reyenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 BY .000219 2001 97 .000247 2002 6Y, .000164 2003 5Y. .000137 2004 4Y, .000110 2005 5Y .000137 2006 7Y. .000192 2007 BY .000219 2008 7% .000192 2009 5Y. .000137 2010 4Y, .000110 2011-2013 3Y. .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX RECORD ADJUSTMENT pennsylvania BUREAU OF INDIVIDUAL TAXES JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION REV-1604 EX AFP (12-12) PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND KAREN L WORTHINGTON SSN/DC 204-03-7498 ACN 01162441 525 AUTUMN CLOSE Amount Remitted ROSWELL GA 30075 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS 4— REV-1604 EX AFP (12-12) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS e* DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 01162441 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 11079-41 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST ( )0 TIME CERTIFICATE DATE ESTABLISHED 09-08-1997 Account Balance •00 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X 0.166 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax •00 OF THIS NOTICE WITM- YOUR TAX Debts and Deductions - •00 PAYMENT W THE REG—Z—tTEpb R WILLS Taxable Amount •00 AT THE A SS SHQw A�V9. Tax Rate X .045 MAKE CHE iR MONE� OR AYABLE Tax Due •00 T0: "RE6 S,,IPOF WILL9i AGENT." TAX CREDITS: A = M cn C� e� PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) d h M O TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE INTEREST AND PEN. .0 TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY T0: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the end of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, 1, 1982 will bear interest at a rate which will vary from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 BY .000219 2001 9% .000247 2002 6Y, .000164 2003 5Y, .000137 2004 4% .000110 2005 5Y, .000137 2006 7Y. .000192 2007 BY .000219 2008 7Y. .000192 2009 5Y, .000137 2010 4Y. .000110 2011-2013 3% .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX RECORD ADJUSTMENT pennsy vania JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION REV-1604 EX AFP (12-12) PO BUX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 SANDRA L CRISWELL ACN 01162442 4 HAMPSHIRE CT Amount Remitted STAFFORD VA 22554 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE --I� RETAIN LOWER PORTION FOR YOUR RECORDS t--- REV-1604 EX AFP (12-12) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. ; 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 01162442 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS IST FCU ACCOUNT NO. : 11079-11 TYPE OF ACCOUNT: { ) SAVINGS (X) CHECKING { ) TRUST { 3 TIME CERTIFICATE DATE ESTABLISHED 04-21-1994 Account Balance .00 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X_ 0.166 ACCOUNT: SUBMIT THE UPPER PORTION Amount Subject to Tax .00 OF THIS NOTICE WITH YOUR TAX Debts and Deductions .00 PAYMENT TO THE REGISTER OF WILLS Taxable Amount .00 AT THE ADDRESS SHOWN ABOVE. Tax Rate X •045 MAKE CHECK OR MONF..; ORDER PAYABLE Tax Due .00 TO: "RE%;STER OF LL4a *ENT." Fn G7 TAX CREDITS: r. ° ? a PAYMENT RECEIPT DISCOUNT C+} -p AMOUNT PAI DATE NUMBER INTEREST/PEN PAID C-) D = C^) :7 C"- F'n C-n ;a ca C> C7) C) C-- r- rn -0 C7) ' Q�t TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE +� IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-B00-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN= Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the end of the tax amnesty period.) INTEREST: Interest is'charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, 1, 1982 will bear interest at a rate which will vary from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 By .000219 2001 9Y. .000247 2002 6Y, .000164 2003 5Y, .000137 2004 4Y. .000110 2005 5% .000137 2006 7Y. .000192 2007 8X .000219 2008 7X .000192 2009 5Y. .000137 2010 4Y. .000110 2011-2013 BY .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX RECORD ADJUSTMENT pennsylvania JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION REV-1604 EX AFP (12-12) PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND KAREN L WORTHINGTON SSN/DC 204-03-7498 ACN 01162443 525 AUTUMN CLOSE Amount Remitted ROSWELL GA 30075 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS 4 .. REV-1604 EX AFP (12-123 ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 01162443 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1sT FCU ACCOUNT NO. : 11079-11 TYPE OF ACCOUNT: C ) SAVINGS ( X) CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 04-21-1994 Account Balance •00 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X 0.166 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax •00 OF THIS NOTICE WITH YOUR TAX Debts and Deductions - •00 PAYMENT TO THE RE�TE� fg WILLS Taxable Amount •00 AT THE AMR&S SH6011 MMMS. Tax Rate X .045 MAKE CHE§ aR MON6ig- OR PAYABLE Tax Due •00 TO: "REQ=1kZ')-OF nLL 91GENT." TAX CREDITS: M cn I�,�. r-'." PAYMENT RECEIPT DISCOUNT O(+) CD DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID"' --tJ -'ri d C.) F m O TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 0 INTEREST AND PEN. TOTAL DUE nn * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, way be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the end of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, 1, 1982 will bear interest at a rate which will vary from year to year with the rate announced by the 'PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 By .000219 2001 9Y, .000247 2002 67 .000164 2003 5Y. .000137 2004 4Y. .000110 2005 5Y .000137 2006 7Y. .000192 2007 By .000219 2008 7Y. .000192 2009 5Y. .000137 2010 4% .000110 2011-2013 By .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX RECORD ADJUSTMENT pennsylvania BUREAU OF INDIVIDUAL TAXES JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION REV-1604 EX AFP (12-12) PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SANDRA L CRISWELL SSN/DC 204-03-7498 4 HAMPSHIRE CT ACN 01162444 STAFFORD VA 22554 Amount Remitt ed MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ---) RETAIN LOWER PORTION FOR YOUR RECORDS REV-1604 EX AFP (12-12) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S-S/D.C. NO. : 204-03-7498 ACN: 01162444 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1sT FCU ACCOUNT NO. : 11079-04 TYPE OF ACCOUNT: ( X) SAVINGS C ) CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 02-07-1974 Account Balance •00 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X 0.166 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax •00 OF THIS NOTICE WITR_YOUR TAX Debts and Deductions - •00 PAYMENT T^ THE REG TEQa g WILLS Taxable Amount 00 AT THE A RSS SHOhW A @VS. Tax Rate X .045 MAKE CHEC 1% MONEPORI;!%"AYABLE Tax Due •00 TO: "REG IGRP)F WILLS #ENT." TAX CREDITS: a = M cn c> o PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID d '-"C) -`n TI DATE NUMBER INTEREST/PEN PAID C-) C7 C7 —� C) r � c? C:: ~' E' r(i 'yr C3) TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .0 INTEREST AND PEN. .O TOTAL DUE all IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT-- (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the end of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, 1, 1982 will bear interest at a rate which will vary from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 By .000219 2001 9Y, .000247 2002 6Y. .000164 2003 5Y. .000137 2004 4Y. .000110 2005 5Y. .000137 2006 7% .000192 2007 By .000219 2008 7Y. .000192 2009 5Y. .000137 2010 4Y. .000110 2011-2013 3Y. .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX • RECORD ADJUSTMENT pennsy varna JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION REV-1604 EX AFP C12-127 PO BOX 2BO601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND KAREN L WORTHINGTON SSN/DC 204-03-7498 ACM 01162445 525 AUTUMN CLOSE Amount Remitted ROSWELL GA 30075 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS t--� REV-1604 EX AFP t12-123 ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 01162445 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 11079-04 TYPE OF ACCOUNT: (X) SAVINGS t ) CHECKING t ) TRUST t ? TIME CERTIFICATE DATE ESTABLISHED 02-07-1974 Account Balance .00 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X 0.166 ACCOUNT, SUBMIT TH"PPERORTION Amount Subject to Tax •04 OF THIS NOJICE WIT I -' OUW „ i Debts and Deductions - •00 PAYMENT TO=Tg RE6L*TER FPt,�WILLS Taxable Amount •00 AT THE ADD # SHOW�ABI &E;,P` Tax Rate X .045 MAKE CHECKrmtcMFNEY ORDF* F*YABLE Tax Due •00 TO: "REGIjffd$ Of WMLS,"'MARNT.” 7 Ca TAX CREDITS: PAYMENT RECEIPT DISCOUNT t+} AMOUNT PAID G7 1 _ Cl DATE NUMBER INTEREST/PEN PAID C-) C7 C'ri ...-4 C)r) TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the and of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, 1, 1982 will bear-interest at a rate which will vary from year to year with the rate announced by the PA Department-of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 By .000219 2001 9Y, .000247 2002 6% .000164 2003 5Y. .000137 2004 4Y, .000110 2005 5Y. .000137 2006 7Y. .000192 2007 8% .000219 2008 7Y. .000192 2009 5% .000137 2010 4Y, .000110 2011-2013 3Y. .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX RECORD ADJUSTMENT pennsytvania BUREAU OF INDIVIDUAL TAXES JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION REV-1604 EX AFP (12-12) PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SANDRA L CRISWELL SSN/DC 204-03-7498 ACN 02100998 4 HAMPSHIRE CT Amount Remitted STAFFORD VA 22554 - MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE --I� RETAIN LOWER PORTION FOR YOUR RECORDS +— REV-1604 EX AFP C12-12) *■ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 02100998 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FEDERAL CREDIT UN ACCOUNT NO. : 11079-47 TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING ( ) TRUST ( X) TIME CERTIFICATE DATE ESTABLISHED 04-24-2000 Account Balance .00 NOTE: TO ENSURE PROPER C,tEDIT TO YOUR Percent Taxable X 0.166 ACCOUNT, , IBMIT THFE-,UPP.ZR�ORTION Amount Subject to Tax •00 OF THIS tai�SE WIT Y0dR q-AX Debts and Deductions - •00 PAYMENT T aE REG TECOFO WILLS Taxable Amount .00 AT THE ADVRF= 'SHOWN AD WE Tax Rate X .045 MAKE CHEC?2* FWNE"RlWtAYABLE Tax Due •00 TO: --REGgP7%R�OF WILLSp XGENT.-- TAX CREDITS: ° n ca Z3 PAYMENT RECEIPT DISCOUNT DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID E._ TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE on * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. 0 PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address Printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the end of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the—date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, 1, 1982 will bear interest at a rate which will vary from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 BY .000219 2001 9Y. .000247 2002 6Y. .000164 2003 5% .000137 2004 4Y. .000110 2005 5Y. .000137 2006 7X .000192 2007 By .000219 2008 7Y. .000192 2009 5/. .000137 2010 4Y. .000110 2011-2013 BY .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX RECORD ADJUSTMENT pennsylvania BUREAU OF INDIVIDUAL TAXES JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION REV-1604 EX AFP (12-12) PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND KAREN L WORTHINGTON SSN/DC 204-03-7498 ACN 02100999 525 AUTUMN CLOSE Amount Remitted ROSWELL GA 30075 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE --bl RETAIN LOWER PORTION FOR YOUR RECORDS 4-- REV-1604 EX AFP (12-12) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 02100999 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FEDERAL CREDIT UN ACCOUNT NO. : 11079-47 TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST ( X) TIME CERTIFICATE DATE ESTABLISHED 04-24-2000 Account Balance •00 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X 0.166 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax •00 OF THIS FSTICE WIC Y0,8RrfFAX Debts and Deductions - •00 PAYMENT IN CHE REGGSTE j @ WILLS Taxable Amount •00 AT THE A t4S SHC" A 0. Tax Rate X .045 MAKE CHEC� OR *NEY ORF#"AYABLE Tax Due •00 TO: "RE6�lS'�Rt''UF 4flLLOY WGENT.-- TAX CREDITS: U)- PDATENT RNUMBER INTEREST/ PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, Cthe first day after the end of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of .death to the date of payment. Taxes.which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, 1, 1982 will bear interest at a rate which will vary from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 8X .000219 2001 9Y. .000247 2002 67 .000164 2003 57 .000137 2004 4Y, .000110 2005 5Y .000137 2006 7X .000192 2007 By .000219 2008 7Y. .000192 2009 5Y, .000137 2010 4% .000110 2011-2013 By .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shown on the notice, additional interest must be calculated. INHERITANCE TAX nnennS Y lvania RECORD ADJUSTMENT f`' JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES REV-1604 EX AFP (12-12) INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 DATE 10-23-2013 ESTATE OF BRUNNER VIRGINIA M DATE OF DEATH 11-17-2001 FILE NUMBER 21 01-1069 COUNTY CUMBERLAND SSN/DC 204-03-7498 SANDRA L CRISWELL ACN 01162434 4 HAMPSHIRE CT Amount Remitted STAFFORD VA 22554 -- MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE --i RETAIN LOWER PORTION FOR YOUR RECORDS t-- REV-1604 EX AFP (12-12) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE: 10-23-2013 ESTATE OF: BRUNNER VIRGINIA M DATE OF DEATH: 11-17-2001 COUNTY: CUMBERLAND FILE NO. : 21 01-1069 S.S/D.C. NO. : 204-03-7498 ACN: 01162434 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION rn , FINANCIAL INSTITUTION: MEMBERS 1sT FCU ACCOUNT NOO: 11079-i4 m C-> 00 cl cip TYPE OF ACCOUNT: C ) SAVINGS C } CHECKING t } TRUST CX) TIME CERTI 41- � � Ci-a DATE ESTABLISHED 12-24-2000 - Account Balance Q0 NOTE: TO ENSURE PROPM; IT�O T6UX Percent Taxable X 0.500 ACCOUNT, SUBMIbTXE UPP� P TTbN Amount Subject to Tax •00 OF THIS NOTICE:wrff i YOUI TA Debts and Deductions - •00 PAYMENT TO THE WEGISTER(W WILLS Taxable Amount •00 AT THE ADDRESS SHOWN ABOVE. Tax Rate X •045 MAKE CHECK OR MONEY ORDER PAYABLE Tax Due •00 TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE nn IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this notice and submit with your payment made payable to the name and address Printed on the reverse side. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lion of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the tax return, any be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from the Department's web site, www.royenue.state.p .us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call (717) 787-6505. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount of the tax paid is allowed. PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before Jan. 18, 1996, (the first day after the end of the tax amnesty period.) INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after Jan, 1, 1982 will bear interest at a rate which will very from year to year with the rate announced by the PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania Deptartment of Revenue Web site www.reyenue.state.pa.us. The applicable interest rates for 2000 through 2013 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 2000 8X .000219 2001 9% .000247 2002 6Y. .000164 2003 5Y, .000137 2004 4Y, .000110 2005 59 .000137 2006 7% .000192 2007 By .000219 2008 7X .000192 2009 5% .000137 2010 4X .000110 2011-2013 3Y. .000082 Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest computation date shorn on the notice, additional interest must be calculated.