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Home My WebLink About09-13-06 (2) ..J 15056051058 REV.1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-1)601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year IN~~~~:Nc;.E DT:E~~1~RN bll 610 File Number Date of Birth 175-48-4390 01/05/2006 11/15/1955 Decedent's Last Name SuffIX Decedent's First Name MI Bartoo Donald w <If Applicable) Enter Surviving Spouse's Infonnation Below Spouse's Last Name SuffIX Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 'S> 1. Original Return c::,:; 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c;:> c::::> 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c=J 10. Spousal Poverty Credit (date of death C:; 11. Election to tax under See, 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ...". .. .._____ ___ ---0 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8, Total Number of Safe Deposit Boxes 4. Limited Estate Cathy Bartoo Firm Name (If Applicable) (717) 802-1166 City or Post Office Mechanicsburg State ZIP Code 17055 REGISTERt:65 WILLS USE ~y ~ ,---:,. ~~:_~j t;.:;, 0') ; "':1 ~) --=d' n't C) r--' --) -,OJ ''::J in c:> CJ ~i) C-, rn (::J ")-1 First line of address 240 W. Simpson Street Second line of address PA .J;::- Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG R ER SIBLE Fa FILING RETURN o-;;2q o~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 ---I Q. --.J 15056052059 REV-1500 EX Decedent's Name: RECAPITULATION Donald W Bartoo 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . ., 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G)C::::::" Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 8. 175-48-4390 Decedent's Social Security Number 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 24,000.00 1,300.00 25,300.00 3,090.00 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . .. 11. 3,090.00 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . 12. 22,210.00 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . - . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .. . . . . . . . . . . . . . . . . . . . . . . 14. 22,210.00 _"_".W''''''''''_~''''"^""~NN''''''_'''''''''''''..~_,-,,,,,''''m,,",,'.w'''''~~''''',,''''~__''_'m,..."...,,-"."','-YN""'^'......~..._.."'-......".wm_"'^"""w~.,~..',.~,_"""""_.........._..._....,.v"........~......""'..............."".."..._.~wm'''^'''''''''''''''.,.,,..:''w,*,,'''''''>>>__~..,Wh''~..._N.."'.."'''w.w.....v.. TAX COMPUTATION. 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_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 22,210.00 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE.. ... . . . . .... .. .... . .. ..... .. .. ....... . _. .. . ... ..... .. .., 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L 15. 16. 17. 18. 15056052059 2,665.20 2,665.20 .....I REV-1500 EX Page 3 Decedent's Complete Address: I l! [ DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Donald W Bartoo 175-48-4390 STREET ADDRESS 240 W. Simpson Street CITY I STATE I ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 2,665.20 Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 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. (4) 6. Enter the total of Line 5 + 5A. This is the BALANCE' DUE. (5) (5A) (56) 2,665.20 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 2,665.20 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 Ii] c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 Ii] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 00 3. Did decedent own an "in trust for" or payable upon death bank account or seccrity at his or her death? .............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 Ii] 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (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 four and one-half (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 ofthe decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Donald W. Bartoo All real property owned solely or as a tenant in common must be reported at fair marf(et value. Fair marKet value is defined as the price at which property would be exchanged between a willing buyer and a willing seller. neither being compelled to buy or sell. both having reasonable knowledge of the relevant facts. Real property which is Jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM NUMBER 1. DESCRIPTION 240 W. Simpson Street Mechanicsbur, PA; parcel no. 20-23-0587-111; VALUE AT DATE OF DEATH 24,000.00 dimensions 66 x 100 x 50 x 106; 50% concurrent interest conveyed to decedent as heir to the estate of Betty Bartoo who at time of her death held title to the property in fee simple absolute; tenancy in common established with Cathy Bartoo. TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 24,000.00 REV-1503 EX. (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Donald W. Bartoo FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH none 0.00 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1504 EX+ (..... COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF Donald W. Bartoo FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. none 0.00 TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1507 ex. (6-98) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF Donald W. Bartoo FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH none 0.00 TOTAl. (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-,5(J8 EX+ (6-98) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Donald W. Bartoo FILE NUMBER 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. ITEM NUMBER DESCRIPTION Compact disc collection (quantity estimated at 500) VALUE AT DATE OF DEATH 600.00 Nutcracker collection 200.00 Clothing 500.00 TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,300.00 REV.I509 EX+ (..... COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOiNTlY-OWNED PROPERTY ESTATE OF Donald W. Bartoo FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A'none B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAllNSTlTUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VAlUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTlY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. none TOTAL (Also enter on line 6, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Donald W. Bartoo FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUOE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO OECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPUCABLE) VALUE 1. none I TOTAL (Also enter on line 7 Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX. (12-99)W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATM COSTS ESTATE OF Donald W. Bartoo FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: package discount price; funeral director and staff services, preparation of body, facility use, vehicle to transport body, clergy car, register book, newspaper obituary x2, clergy mass, certified copies of death certificate, flowers, coroner's authorization fee, crematory fee. 3,090.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address city State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Slate . Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,090.00 REV-1512 EX+ (12.03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABILITIES, & UENS ESTATE OF Donald W. Bartoo FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including un reimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. none TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 . 4113 ., .... . ::. . P-l"...T-W......~ -. _ ~ Aft" 1-"""""'" ,. .......--... JIoaJ7 .lW1, 1_. JMIau" p.. MADE THE 01 OUt' Lord. OM tAouaa~ ni1l8 hun4red tlCbi~ ~ r/' tBeeb, .'01 FJ/~ and seventy-two (1972).. , in t1&~ 'llear BETWEEN SOPHIE S. FRETZ, Widow, 01" Scottsdale, Arizone, party 01" the 1"lrst part, '~fttor . 'And MAX E~ BARTOO and :aETTY P. BARTOO, his wire, or the Borough 01" Mechanlcsburg, County 01" CUmberland and State 01" Pennsylvania, parties or the second part, G1'I1ntce s: WITNESSETH, tlult ift cOMideratiDn of the sum or Eighteen Thousand Fl ve Hundred- . . . ($18,500.00) Dol14,.. iA 1ul7I4 paid, thef'eceipt whereof.. lr.e1-eb, tJClmowledged, the said grantOf' do e3 hereby grant and convey to tke 84ill ~a..ntee s, 'their he Irs and as s 1 gns , ALL that certain House and Lot 01" Ground situate on the northeast corner 01" South York and West Simpson Streets, in the Fifth Ward 01" the Borough 01" Mechanicsburg, County 01" Cumberland and State of . Pennsylvania, bounded and described as follows, to wit: BEGINNING at a point in the curb line at, corner 01" South'York and West Simpson Streets; thenoe extending eastwardly along the curb line 01' sdd West Simpson Street, sixty-six (66) feet, more or less, to a point on said curb line at line 01" lot now or formerly 01" Lettie Long; thence northwardly along the line of said lot now or formerly 01" Lettie Long, one hundred (100) feet, more or less, to a point in a public alley; thence extending along said alley in a westwardly direction fifty (50) feet to a point on the curb line of South York Street, aforementioned; thenoe extending along said curb line of South York Street ina southerly direction one hundred six (106) feet to the point and piace 01" BEGINNING. HAVING thereon erected a two 'and one-haIr story frame dwelling numbered 240 West Simpson Street, Meohaniosburg, Pennsylvania. BEING the same premises which Thomas F. Basehore and wife, by their Deed dated May 1, 1948 and reoorded in the Cumberland County Recorder's Office In Deed Book "T", Volume 13, Page 5,1, granted and conveyed unto John C. Pretz and Sophie S. Pretz, his wife. The said John C. Pretz died on June 23, 1968, whereupon sole title In said premises vested in his said wife, Sophie S. Fretz, who is the grantor herein. TOGETHER with the rlgh~s and privileges granted in and aubject to the I reservati,ons contained in the following deeds: Deed of H. K. Spahr tl to Edwin R. Millar, dated Marcy 22, 1921 and recorded in the Cumberland , County Recorder's Oi'1"ice in Deed Boo~ "Gn, Volume 9, Page 367; and Deed of EdwinR. Millar and wire, to Lettie Long, dated January 14. 1926 . and recorded in the Cumberland County Recorder's Orfice In Deed Book I' "E", Volume 10, Page :288. ,;. ,0 I ) c, -/7' '// Jot'--' :\ ) {,-:::.Jt~:...4~e. . I L<. Uh1M'- ." / II ! ~ ....................d School Did. Cumbo Co.. P , Cumbo Co.. fa.. : I . -1'" ....1 f..... 'I'..",f.. T.. _ :.1 -1 'll. R..I bl.l. T...,I., T.. - ' ~" _ Sf.:l ~ 0 D.~!.-.IJ.:.-:-!;: Amf!:1'.~~ ').t. !.'.:~}:.~7.. Amt~:/.t .;. /' ! /-;;(L':<J.f',,/f~.. ,Jlt <"'( tn-I j/. .LA'" " t1 c-a.. c.. DI... c.I. Ail'. ~~K X ')A' ".. 130 e_It. c.. 0'''. Cotl. "9t. <~ "'oJ ",..1 PACE ! ' .' . . AND the saiG grantor will wamJnt Generally lureb1l C01IeMnt s aM aaree . 8 th4t she tI&e properly hereb1l conveyed. . j'r.r.. :.!;lJH~'f~l~ . '~I;:;;~~il:I~;~;.1 ii.il~1;:. ~.~1! ' lEi(,'V~~i~; m(~ ""~~..-,,,) . ~!J,.~f ~ ";.;,,,;/l1'. ~ . ~. -. ,\~: \r",;,~,~:~t . ". I U'I18U/,7,"i II II - , . '. ~~t~...~. Ll.'H .' ~-"'I :m'wr.1i.fj'{i[W11! :ii'ffl.~i:iifJ'i;fjlr W<~rf::;Tf"'ii(~{t:' :rf.~'''''. .. ~.~ "1"..:-1 - ::. ',,;~ -. .~. ,',. ' ~,~~.. ';.r~P"J~ ~ It _~"'~. :,~1:ttu;n"-f'~T'~.t,:ttu. '1:..,1' ":.1; "';i.:,,~~l"~' , " , l'Iij~~~;:'.I" '4', :., ,." r,-;, ~ ~(..(IJ,i..f,g~.~, .,u....{ ~'~/,,;..;\?-l'~.,. ,Ik,;.:... ';'. \' :~.~I "c.,lto-.- . .ff:~.......... _.,,~. .. '~'-." "., . ;. f~;g 1..:._..':" ~/1'~~;\9j2l I I ~~~ .:: . '-:~'<'.:..,~ .tf!~~~!ij , == <:.. ::>> ::.:::!- g ~ g ~ ",,~n2J """,0" ~;;:~j; -Cb.~' !; ;; ~ ~ rl S;::s;~ ~ ;:EQC"J"" =r: j;~~~ . -CUi..... -., :z: r-v. "' IN WITNESS WHEREOF, sa.id orantor the d4J1 AM !fear first alHwll writt~ hcI s hereunto set h4nd her aM 8eal J;iolll~. ';'.It. .~ Jltli.m. . is tJ,. 'ns_ .. . IJ ~ ;<) . -'~oPhie-1:~-...._.--.--.e ....--------... . .e -.-~.-..----.-.-.-----..-....-.--...-. e ....._--_.._._.__.._...__.__._...__..._._..__.._...~ Sto.te of Arizona }ss. do.1Jo{ '1[,......1, ...~ , 19 72, before me, Cwnty of 'In. tt..~ On this, the (,. ....~ the undcrBigftllcl officer, PCf'Bonallll appeir.red Sophie S. Pretz, Widow known to me (or 8a.tiBfactorilll pnnren) to be the per,on whose name is 8Ub8cribccl to the within iutrument, and acknowledged th.at . she ezecutecls/ltne for tM purposeB.thejfJin . conta.ined. . ....>~'~ OJ .... . . . /~ ~,'-".)' ] ~ J"v~. IN WITNESS WHEREOF, I herevnto set m~ 114nd /I~ seal. . ! ~ /;... "-? ~ ". . -~l.~!::....:.----_..:.._,~~...~~-~:~.r~;) c.. ..": l "J-' J I> \, .: ..:j ........u..Bo.t.lAr3...;...P.ub11.<L._.............c...;..u.....:..", ....~ My' CommiSsion Expires Jan. 3,1975 Title o{ OiJiteft.1 \ . \ .,\" My Commission Expires: My Commission Exnires}, 3 " an,. Z9l1t I do l&erebtl cerci!1I that the precise 1'68idence a.nd complete post office addre88 of the within Mmed t1f'G-ntee ~ 240 West Simpson St., Mechanicsburg, Fa. --~"t-~J~- At~ for ~~t.es 170SS ~. &OOK '^ 21 rAGE 131 l' r UifUDfLOOO l~:q( 10461107062006 ~LM6S6 7/Q'/2006 fll:2407835 CUMB CNTV TAX CLAIM CT1M8ERLlUm COUN':t'l' TAX ClAtM Bt1RSAO eNS COURTHOOSB SQUAU ~L!SLE p~ 17013 20-MECHAN~C$!URG ~OROUGH 216S0-MECHANXCSaURG ~EA S.D. STA'X'U'S C ttECE'IP'l' llA'1'B C01)~ DEBCRIln'ION' NO 01/1~/OS 200 CTV-MECHANXCS!URG 5 01/14/05 250 CLB-MSCBANlCSBURG S 01/14/0s 300 ~-MBCBANICS8URG 5 Ol/14/0~ .00 SCH-MECHANICSa~ 01/14/05 201 ~ILIRG ~EE 'dl/~3/os 202 POS~E aET & CLAIM O~/18/06 200 CTY-MSCHANlCSIURG 5 01j1a/06 250 ~LB-K!CHAN~CSBttRQ S 01/18/06 300 HUN-MSCHARICSSURG S 01/18/06 400 SCH-MSCHANICSBURG 01/18/06 201 P~LING PEE 02(Q8/06 202 POSTAGn liT & CLAIM TAX CLAI~ INQUIRY SITU8-~40 W SX~PSON S~RT & S ~ORK S'f~EI'I' J:lROP,ERTi'- DBSC -LAND -~esidential Building BOOXjPAGE 0024X OD130 LAND USE It ACUAG! .1JO Wl.Lt1& S 9. 930 VALTJ~ ~&G TAX 108.46 10.25 123.65 676.90 PEHJ1.LTY ;l,0.8S J,.C1:i 12-J7 G7.n INTERi:S'r 14.511 1.44 16.74 ~l.U CM1tGES 133.89 12.72 1!2 . 7G US.92 1:1.35.25\ 15.00 5.00 20.0~ J.155.29 137.42 12.33 152.76 878.94 1181.45 15.00 5.00 20.00 1201. 45 _ . ft _ _ _ _ _ M _ _ _ _ _ . " _ _ _ _ . ~ _ _ _ _ . . _ _ _ _ ~ . _ _ M!SC RelCEIP"tS 2004 TAX TOTAL ~004 ~EE TOTAl, ~~Rro~MS&~~ ES~AWCi DUE NEXT "0Imi 1.20.02 10.77 133.42 767.62 12.00 1. 08 13.34 76.76 5.40 .48 6.00 34.SG 2005 '1.'AX TOTAL 7.Q05 I!'BB TOTAL ~AR. T<Y.rALS & ElAUNCE ES'1'I~CE OUB NiX'!' MONTH Cr..AIM 'tOTALS ESTIMA'rED 'l:'OTAL DUE N~ MOln'H - - - - - - - - - - - - - - . . ~ ~JStL 74 PHONE 717 ~40-636G FAX 717 ~40~6354 REMARKS ~ERT M~XLyR/C 75141 Ci:RT MJl.7:L-SALB ~ NO 20-23-0567-111 t;lA~E5TS :e~E DUE .oo~ \.~ PAGE 01/01 PAGE.. 1 nTT ADDED nO! MO .Bi ..Q$ .93 S.Q~ .]...., 6.90 .90 ;08 1.00 S.76 .00 G01.~ 7.74 . . l20:g.19 " - - - - - - .. - .00 2356.14 3.4 . 6' 2371.:)8 .. " - - - - . . ,;.~' PROPERTY OWNER INFORMAL REVIEW ACCEPTANCE OR REJECTION FORM Cumberland"County Board of Assessment Appeals eAsof 5-/2,0-01 (date), I/we have requested an appeal of our assessment. e As of the above date, I/we have met with an official assessment representative to discuss my/our property assessment in question. · The parcel/account number of the subject property is as fo"ow~: 20 -23 ..O~07-/I/ Parcell Account Number · The current Market Value of this property is $ / jt/ ~ 5u " · The current Clean and Green v~lue (if applicable) of this property is $ Review Appraiser's Recommendation: lJev0 l)v\lur:' :7~830 ",. -,', - - - ,'. '.,':.::'-.'-';-.'-'.:.:-' Property Owrler's:~ision;;. ." ~-'" ' ,. o:<iU", -, <"' " I/we accept the recommendation ()fthe iJviewappraiser anq'q' . .' :< recommendatioC!" a fQrmar appei.tl,he~uing.win'nofbe ~cqe~~'aj1d" . appeal will b~,COnsidered to d ,'.. .dr~wn~;/ChecKin~;~hisbO~c()rnl~ ' asse-ssmenta'nd' awithdra\V;'.otthatBppeal:by my/<>fj!:a~Q~ptaf;i' understand thatiftheBoard;driesnotapprovettle recorot:nen " scheduled~ .' Ai . . .. - . ". ,.-,. ,.- _.- ,. - ',"-" -,- ,',--' '-. '_<_u ",U,' ". _ "'". "".. _', __'_",_' ....,0.,',.. ,,' 01/.. we reject the..:.re.c.o."....mmendatio.n..fbf..ttie..ri.. evie. w.'. ..'appt.a. ise'.an: fora formal': hearing by the ~pPeaj~atmne~.asstatedo , scheduled./' .' .... . . .. .... ... " ~' .' , :':;','-'::',,': ".,::,. ,,:' .,< :.--'-' :<-':":-' ':. ' .. - '-. ,,- -,:' ~';~,:;:;::, ":: :',',-,<" :,-,",-',::- ,:::- ",,-'~,-,.; , '. ...', -'--,,,',:, -'-',," '-..; ProperlyOwner(s) Si.gnatutEt(s):" 6,.. ..~~ ~ . . ' "",', ",.. .- '" -' -, ,-_.. . ':'-"_."> ",-, :~.'- "'-' :, '; :...-" ,"-:: - -," - ' :"<-"-' . '-'--' ., -. " ,- ),".- _:';,' -.: '.-, ":-':'-..: . . .." , :" .'-..., - " .., .-' .~.,,' - ~ - ,~ ' - - "- '- :' ;." --' ;,;', :- -,', :' -' ,." .,- ----'- - - " ~-,;'.'>' ':-'-' ,,~,-,:.,,< :---:,';:.-",,~', - -"', llwe ackrjowtedge'fec:$,ip{ofa;duplicate signe(j'C()p~()ftHis'~ Fonn 216 (v, 1.2)