HomeMy WebLinkAbout94-00131
WAriNING: IT IS ILLeGAL TO ALTER :;"i1S COpy Of!
TO OUPLICATE OY PHOTOSTAT OR ~HO'fOGRAI>lt.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTlt VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT.NO. 1921214
Octoh",,. 14.. 1 Q.9.3~
, ~"1I1l0i1iiiic7111l'1U11<)/1
... Name of Decedent
VIm.F.T
To
M'lldln
'l'IINr.F.MIIN
fir,'
Lalt
FpmRlp.
Social Security No. ~ 7 R
10
1ROR
Date of Death O"tnhp r 11.
Birthplace
Rlltlpr. PA
... Place of Death _ FnreRt PA rk He" 1 th Center.
. f.cllllyNamll. County
CllInberl "nd. Ca rli RJJres1nsvlvanla
Clly,lIoloullhor TOWIl.hlp .,
Race Whi h, Occupation Rpt. Snpprvi Rnr-RF>t;, i lArmed Forces? (Yes or No) Nn
Decedent's
Marital StatusM" rri Pr'l Mailing Address ?7?0 R itlle.L Hi nhw"y. C"rl i" 1 P. I'll 17011
Number 51r&d(.. Clly orlown Slatl
Informantnr. . Arthnr ,T. T"ngpm"n
N.ame and Address of
'Funeral Establishment Crpm"ti nn Sn".
Funeral Director
DRlp A. A\1P't"'-~l1pRl'"";!::nr
nf PA. 4100 ,TnnF>"tnwn Rr'l.. H"rriRhnrg.PA 1710Q
I nterval Between
Onset and Death
Part I: Immediate Cause
(a) N;:!tl1r~' ~Rl'I::,:::l!::;
(b) C,::s.rphr;:l1 VRc:.~I1'Rr A.~r.inpnt
1 mnc:.
(c) AT,..;;:!1 fin,...;' lRt'inn
(d)
Part 1I:0iher Significant Conditions
f!ypp.rh::ln~;nn:
Manner of Death:
Natural tx
Accident 0
. Suicide 0
Describe how injury occurred:
Homicide
Pending Investigation
Could not be Determined
o
o
o
Name and Title of Certifier
RnhF>rt ArtallF>n.
M.D.
(M.D., 0,0.: Coroner, M.E.)
C"rl;~_~7011
Address
R~O W" 1 nnt Bnttnm Rr'l. .
This is to cel1ify that the information here given
death duly filed with me as Local Registrar. The
Vital Records Office for permanent filing.
is correctly copied from an original cenificate of
original certificate will be forwarded to the State
--- .-. ~
i/I~~0 ...it..' _ 4~
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Octob~r 14. lqq1
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
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2720 RITNER HIGHWAY
CARLISLE PA 17013
c.,,, CUMBERLAND
o 3. Remolndor Relurn
(lor dole. 01 deolh prior 10 12.13.B21
o 5. Federal E,'ole Tax
Return Required
_ 8. Tala' Number or sore Oepo.1t BoxlI
,,~':~~:9~
.......,:i?'lho
COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
DEPT, 280601
HARRISBURG. PA 11na.Ollell
~
"
..
III
"
M .
TANGEMAN
IAS URI UM8 R
VIOLET L
.
F 0 ATH
DATE OF 81RTH
578-10-3808
~ 1. Original Reiurn
10/13/93 07/29/13
o 2. Supplemenlol Relurn
o 4. Limlled E,'o'e
~
'OR DATlIO.DIATHAmR 12/all9l CHICKHIRI
I' A IPOUIAL . . = . ,',
POVIRTY CItIDIT II CLAIMID ...... .
'ILI NUMBIR
2194-0131
COUNTY COOE YEAR NUMBER
o 4a. Future Interest Compromise
(ror dole. 01 deo,h ok.r 12.12.B2)
o 6. Decedent Died Teltale 0 7. D&c~dent Mainfained a Living Trus'
(AlIoch copy of Willi (AlIoch copy 01 T rU'I)
~LLCORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.,' '.
MPL M LN A
ARTHUR J TANGEMAN
Tf HONE NUMB
245-0531
2720 RITNER HIGHWAY
CARLISLE ~~ 17Q13
z
o
5
a
i:
~
..
62229
1. Real Elf 01. (Schedule AI ( I)
2. Slack. and Bond. (Schedule B) ( 2)
3. Clo.ely Held Slock/Pollne"hlp Inlere.' (Schedule C) (31
4. Mollgog.. and Nole. Receivable (Schedule D) ( 4).
5. Cosh, Bank Deposill & Milcellaneoui Perional Property( 5) .
{Schedule EI
6. Joinlly Owned Propelly (Schedule F)
7. Tron.fe" (Schedule G) (Schedule l)
8. Total Gron Anell (lotallines 1-7)
9. Funerol Expenles, Administrative CoslI, Miscellaneoul ( 9)
Expen.e. (Schedule H)
10. Oebl., MOllgoge lIobllilie., lien. (Schedule I)
11. Total Deduction. (10101 line. 9 & 10)
12. Net Value of E,'ole (Ii"e a minus line 11)
13. Chorllobl. and Governmenlol Beque.ts (Schedule J)
14. Net Value Sublect 10 Tax (line 12 minu.line 13)
15. Amount of lin. 14 taxable at 6% rate
(Indude value. from Schedule K or Schedulo M.)
16. Amount of line 1.4 taxable at 15% rate
(Indude volue. from Schedule K or Schedule M.)
17. Principal lox due (Add tax from line 15 and from line 16.)
18. Credits Spousal Poverty Credit Prior Palmlnti
2309 + 1155 +
19. If line 18 i'gr8oter thon line 17, enter ,hedifferente on lin. 19. This il the OVERPAYMENT.
aD
20. If lin. 17 II gr.aler t~a" line 18, enter the difference on line 20. Thi, is the TAX DUE.
A. Enter the inter..t on the balance due un line 20A.
B. Enter the tOlol of line 20 and 20A on line 20B. Thi. i. the BALANCE DUE.
Moke Chock Payable '0: Regl.ier 01 Will., Agent
. .. .... BI SUO TO ANSWEI ALL QUESTIONS ON RlVERSE SIDE AND TO RECHECK MATH.. ... ..., . ..~'jl
Under ~"ohj., of periury~ . dtdor.thol I hove IXomined this return, ind",ding accompanying ,cfl.dul.. and .lot.menh, and to the b.., of my Ir:~owl.dg. and beti<<,
it 'I tNt, Q)f't'ecf and complete. I d.dare that 011 r.ollstot. has b..n reported 01 Iru. morbi volu.. Decloration of prepar., olh" thon thf perlOnol repr...ntatlvel. .
.bo..d Oft 011 information of whichprtportt has ony knowl,dg..
NIL IlINGIfIU'N 2';;~'RitnerHWY CarlislePA17013 D'TE~A..P'
fiVE ADORUS DAT~ ~
II;J.qfq~'
( 6)
(7)
4499
(10)
(IS)
57730
(16)
Discount
Check h('fc if you arc Icqucsting Q refund of your overpayment.
.:'U
(..~;
I
~.0
( 8)
62229
(II)
(12)
(13)
(14)
4499
57730
57730
x .06 =
3464
x .15 =
(17)
Interest
(IB)
(19)
3464
(20)
(20A)
(20B)
-0-
-0-
<-
208 Burnt House Rd Carlisle PA 17013
~fY.l5l1U+ (;0.111
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If('
...
COMMONweAlTH Of P!NN$YlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEOENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Ploa.o Print or Typ.
eLl NUMBER
2194-0131
ESTATE Of
VIOLET L T~NGEM~N
ITEM
NUMBER
A, Funorol Expon...:
B.
4.
c.
1.
2.
3.
A.
5.
6.
7.
8.
DESCRIPTION
1.
CREM~TION (LESS 255 SSA REIMBURSEMENT)
CREMATION SOCIETY OF PA CREMATORY
4104 WALNUT STREET
HARRISBURG PA 17109
GRAVE MARKER
VANCEWALGROVE, MM'LE\'OX) CEl-IE:rERY, LAVERNE MN 16156
TRANSPORTATION ro MICHIGAN FOR BURIAL
l\R'IHUR J TANGElolAN, 2720 RI'rnER IIWY, CARLISLE PA 17013
Admlnl.tratlvo Ca.t.:
1. Personal Representative CommiSlions
Social Security Number 01 Personal Representative:
Vear Comml..lons paid
2. Anorney Fe..
3.
Family Exemption
Ciaimant l\R'IHUR J T~
Relationship SPOUSE
Addre.. 01 Claiment at decedenl's death
Street Addre.. ~720 RI'rnER HIGHWAY
City CARLISLE _State ~_ Zip Code 17013
Probate Fe..
LETTERS OF ADMINISTRATION AND SHORT CERTIFICATE
Mlleollanoau. Expon.o.:
ACCOUNTING FEES
LINDA C BENZON, BENZ ON & ASSOCIATES
TOTAL (Also enter on Ii... 9, ~apitulation)
(If more .po.' I. n.od.d, In..rt additional .htth or _ tI...)
AMOUNT
585
825
728
2000
76
285
$
4499
REV.1648 EX'{1.921 I
~~:?t. SCHEDULf N
!'lli7...... SPOUSAL POVERTY CREDIT
COMMONWEALTH OF PENNSYLANIA
INHERITANCE TAX DIVISION ~VAILABLE FOR DECEDENTS DYING AFTER 12/31191L
ESTATE OF --rrrLE NUMBER
VIOLET L TANGEMAN ~--2~4-0131
This schedule mU$1 be completed and filed if you checked Ihe spousal poverty credit box on the cover sheet.
PART I.. CALCULATION "OF GROSS ESTATE "- - "-'" ---" ,- -- - ,- - - - . --.. '-
,1. Taxabl. Ass.ls 10101 from lin. 8 (cav.r sh..tl.................................................................... 1.
62229
2. Insurance Proceeds on Life of Decedent .....,..........................",..",..."...."......................... 2.
3. R.lir.m.nl B.n.fils...,......Hoiise...H6'7lD711'..;;...tf:l9Hr......'......................... 3.
4. Jainl Ass." wilh Spaus....J?~.q...?~!l.~.._~9.<;:9.H!:\!;....l.H~,?I..?....7....1.I~.:H............. 4.
85661
5. PA la!l.ry Winnings .......................,..........,................................................................... 5.
60. Olh.r Nanlaxabl. Ass.ls: ListlAltach schedul. if n.c.ssary)," 60,
Burial payments from S5A
6b,
6c.
6d,
6. SUBTOTAL ILin.s 60, b, c, dl......................................................,.................................
6. 255
7. 148145
8. -0-
9.
7. Talal Grass Ass.ls IAdd lin.s 11hru 61..........................:..................................................
8. Talal Aclual liabilili.s . ............. ........ ..............,. ........ ......... ..........................,.... ......... ,"...
9. N.t Valu. of ESlal.(Sublroct Iin. 8 from lin. 7)............................................................."..
iF line 9 is greater than $200,000. STOP. The estoto is not eligible 10 cfaim the credit. If not, ('ontinue 10 Porl II,
148145
PART II. CALCULATION OF JOINT EXEMPTION INCOME. (Attach capi.s of Fcdcrallndividuollncam.
Tax' Relurns lor dcccqcnt.~nd sp~use.)
Income:
1. TAX YEAR, 1990
a. Spouse...................... 10.
b.O.c.d.nl...............".. lb.
28851
3946
32797
2. TAX YEAR, 1991
20. 29605
2b. 3506
2c. 33111
~d.
2.. 3068
_ 21. 36179
c. Joint"..........".."........ 1(.
d. Tax Exempt Income..". Id.
.. Oth.r Incam. nal 3001
listed obove ........." le.
. (non-taxable 55)
f. Talal."...... .."............ 11. 35798
4. Average Joint EKemption Income Calculation
40. Add Joint hemption Income from abo....e;
(11) 35798
+ 12f) __l6JY1!__.___ + (311
37485
~___I.~:.JL_.___
_ 36487
4b. Average Joint Exemption Income ...",.....",............,....................,..,....,.."....................,..... _ .____~.__
If lin. 4(bJ is gr.al.r than $40,000 . STOP. Th. e,tal. i, not .Iigible 10 claim Ih. credit, If not, cantinu. 10 Part ",.
PART III - CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT
ESTATES . ,
1. In.erl amount of taxable tranlfeu 10 spouso or S 100,000, whichever is leu",...............,......, 1.
57730
.04
-.. ~.-.__.. - --..-.-.--.--.-'---"-
2. Multiply by credil percentage 15ee instructions) ....... .................................
3. This is the amount of the Resident Spousal Poverty Credit. Include Inis ligure
in the calculation of total credih on l;ne 18 of the cover sneel. ..................... .
A. for Nonresidenh, enter the ratio of the decedent', gron e,tote in PA 10 tne value af the
deceden", gross eslote..................,.,..,...........".......,...................,,, "........................
S. MultIply line 3 by line 4 and enler the tolal here. This is the amount ollne Nonresident Spousol
Poverty Credit. Include this figure in the calculation of total uedih on line 1 B of the cover ,he!.
~t~
:t-
2309
..
Fo""
1040A
Step 1
Label
(Sot POP 14.)
U..1R8
label.
Othtrwile.
plene print
ort)'pl.
Step 2
Check your
filing status
(Chec:k only one,)
Step 3
Figure your
exemptions
(Se,_17.)
Jrmore lhaa 7
dependenta.
Nt p,.p 20.
Step 4
Fleure your
total Income
Altad> Copy~a or
your Forma W.2
&Ild w.2P be...
AltAlch chod< 01
mon., order on
...ofanyF.....
W.2orW.2P.
Step 5
Fleure your
adjusted
&roll
Income.
(
Humtllddr...lnumbtr Inchlrttt). tll)'OU have. P,O, boI....p&p lU
o A.ii:i&ilJR.. , it R;i)
t'lty.loWn OfpualUmc.. """. andZlPcode. (If)'OU hml fortlcn.dclmt. ..Plltl'"
c;.. -e'1G- s..d., i!.(.; f'- 1 '7 ~).. S~
Presidential Election Campaign Fund (see page 15) ~
Do you want $1 to go to this fund? . . . . . . . . . L:j Yea 0 No
Uiolntreturn,does}ourspousewant$1 to go to this fund? B'Ves 0 No
1 !~L/)IIlK;.' (Sce page 16 to find out if you can file as head ofhousehold.)
2 lJd'Married filing joint return (even if only one had income)
3 0 Married filing eeparate return. Enter spouse's social security number above
and spouse's full name here ~
4 0 Head ofhoueehold (with qualifying person). (See page 16.) If the qualifying person is your child
but not your dependent, enter this child's name here ~
6 0 Qualifying widow(er) with dependent child (year spouse died. 19 _). (See page 17.)
6a 0' Y ounelf lCyour parent (or IOmeone else) can claim you u a dependent on hi. or her tax } ~.:;:~: 2-
return, do not ChflCk box 6a. But be lure to check the bOI OD line lSb on page 2. o. and eb
6b 121 Spouoe
C Dependenta: 2.CheeJc 3.rr'~2orolder. <C. Dependent', S.No.ormol:ltha
. lIundlt &pendtnt.lOC'iaIllCUrity relatlonllllplO lived in your
1. Name (rant, InltlaJ.andlutn&mI) .2 number hOmlinl~
'.
~
Dtpe.rtmml Pl'lhtTtttlWy_'nttnw R,,,tnutlltrvltt
U.S. Individual
Income Tax Return (S)
1990
L
A
.
I
L
H
I
.
I
YIlW' rlnl MtIlI.n4lnlllal
.4R t I
Il. joint rtlurn.IPOWt'. nlll namt.nd Inltltl
....tllAmt
""'.....
.t; tV ~ /'viA ,J
.,.,/; 1\01 /lIV
Apl.no.
d If your child didn't live with you but is claimed as your dependent
under a pre-19B5 agreement, check here . . . . . . . . ~ 0
e Total number of exem tions claimed.
7 Wages, salariea, tips, etc. This should be ahown in Box 10 of your W-2
form I, AttachForm s W-2.
8a Tuable interest income (see page 23). (U over $400, also complete
and attach Schedule I Part I.
b Tax-exem t interest. DO NOT include on line Sa. Bb
9 Dividends. U over 400 also com lete snd attach Schedule 1 Part U.
lOa Total IRA 10b T6XlIble amount
distribu i lOa see e 24 .
l1a Total pensions l1b Taxable amount
and annuities. lla ) ':r"i 7 L: '- (see e 25).
tion (insurance) from Form(s) 1099-0.
13b Taxable amount
13a .iLl J-(,) (see e2B).
1Sa Your IRA deduction from a lU:able worksheet.
b Spouse's IRA deduction ~m applicable worksheet.
15b
c Add linea 158 and 15b. These are your total adjustments.
16 Subtnct line l5c from line 14. This is your adjusted IlrOl8 Income.
lfleu than $20 264 see "Earned income credit" on 38.)
OMBNo.I&4I.0Ga5
Your lOdaltocul'Uy ao.
'16ql,{, lFrs-o,.
SPCJIIM"1IOO1a1 MCUrit, DO.
S"78 i 10 l3flt)3
For Privacy Act
and Paperwork
Reduction Aot .
Notice, see palle 3,
Note: eheeki", 'y.,' wiU
not ehant. your rlJJC or
reduce your refund.
No.oryoUI'
cbJldrea on
6owbo;
. Oved
...Ull)'OU
. diu', live
with you due
todlvoroeol'
Nparat10A
(__al)_
No.ototlwr
!Iet>e.....tA1
l1aiecloa60 _
Add DUmbtn[2J
..teredo. 2.-
Ua.. above
7
61ck
lOb
lib
12
13b 1/ '
.I J- 797
.16 3;:.71
1990
Step 6
Figure your
standard
deduction,
exemption
amount, and
taxable
Income
Step 7
Figure your
tax,
credlu,
and
payments
If you waotlRS
10 f_your
tot see the
instructions for
line 22 00_
36.
. Step 8
Figure your
refund
or amount
you owe
Allach chock or
mone,. orderoD
IOpofronD(.)
W-2,et.c.oD
_I.
Step 9
Sign your
return
~a..pyor
tbil return ror
your raconIa.
Paid
preparer'.
UM only
Form 1040A
17 Enter the amount from line 16.
lSa Check {[;?'Y ou were 65 or older 0 Blind } Enter number of
if: S use was 65 or older 0 Blind boxes checked . ~18a
b If your paront (or someone elae) can claim you sa a dependent,
cheekhere. . . . . . . . . . . . . . . . . . . . . ; . ~18bbL
c If you are married ming eeparately and your spouse files Form
1040 and itemizes deductions, see page 34 and check here . . . ~ 18c 0
19 Enter your IlaDdard deduction. See page 311 tor tbe chart (or worksbeet)
that applies 10 you, Be lure 10 enter your llaDdard deduction bere.
20 Subtract line ]9 from line ]7. (Ifline 19 is more than line 17, enter .0-.
21 u i'-;-' I u x i Ii e .
22 SubtractIine 21 from line 20. (If line 21 is more than line 20, enter .0-,)
This is our taxable income. ~ 22
23
b Credit for the elderly or the disabled.
Com lete and attach Schedule 3. 24b
c Add lines 24& and 24b. These are your total credits,
25 Subtract line 24c from line 23. (Ifline 24c is more than line 23. enter -0..)
26 Advance earned income credit a ents from Form W.2.
p... I
17 3)... 7 91
19 ') 7 j-()
23
3J...gq
24c -~' )'.f9t
25
26
~ 27 3).89
30 Amount of line 29 you want refunded to you,
31 Amount of line 29 you want applied to your
1991 estimated tax, 31
32 If line 27 is more than line 28d, subtract line 28d from line 27. This is the
amount you owe. Attach check or money order for full amount payable to
"Internal Revenue Service." Write your name, address. social security
. number, daytime phone number, and "1990 Form 1040A' on it.
33 Estlmated tax penalty (see P81/e 42). 33 =:J
Undor=lJeI at ptljury,l cSeclarI that' have examined Lb.. ftIWm and .CCOIl:l~ ,ehedr.tla ed ltatc-mantl. and to tilt best or my ~
and tIwy... -. comet, and........... Declaralloo 01_ loll:or than tha .....",J 10 baled on all loformatloa 01_ \Iwo....,.,.....
"'1......
YClW'~ -") Dati YOW'occupaUon
27 Add lines 25 and 26. This is our total tax.
28a Total Federal income tax withheld. If any is
from Form(s) 1099, check here...) 28a 1. 3' 0
b ]990 estimated tax psyments and amount J /3
a lied from 1989 return. ((,
c Earned income credit, See page 38 to find
out if yOU can take this credit. 28c
d Add lines 28a. 28b. and 2&. These are our total a ments.
. 29 If line 28d is more than line 27, subtract line 27 from line 28d.
This is the amount ou ov sid.
Day Spouy', OCCUJ:I'Lion
0...
Cbocltil
001(....
No.
~
3 voJ
29
30
32
:;..8;;L
f'rwpuw'aooclll~...
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:~,~'. .
'~j;r~Hj
rJ
'1;'li
",'9<
'!~'I'
g.,,;
~~.~
:\~<;:,;:'
LN 7
LN8a
LN 8b
LN 9
LN 10a
L N 10b
LN 11a
LN 11b
LN 12
LN 13a
L N 13b
L N 14
Lf~ 15a'
LN 15b
LN 15c
WAGES
TAXABLE INTEREST.
TAX-EXEMPT INTEREST
DIVIDENDS
TOTAL IRA DISTRIBUTIONS
TAXABLE IRA DISTRIBUTIONS
TOTAL PENSIONS AND ANNUITIES
TAXABLE PENSIONS AND ANNUITIES
UNEMPLOYMENT COMPENSATION
TOTAL SOCIAL SECURITY BENEFITS I
TAXABLE SOCIAL SECURITY BENEFI TS I
TOTAL INCOME I
IRA DEDUCTION I
SPOUSE'S IRA DEDUCTION I
TorAL. 'AD.JUSTMs!iTS TO. INCOME.. . I
. -
PER RETURN
o
5.209
(8
o
(/J
l/J
26.844
26.844
l/J
4.126
1.058
33.111
o
(6
(/J
.
'V"
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'0' Tue. 19 JuJ 1994. 8:45 am
ih:,,""
.:~~C(':'
!/",f" RTFTP 469-16-8501 309112 R2 TANG SP SSN: 578-10-3808
~~; PER RETURN
LN 16 ADJUSTED GROSS INCOME I 33.111,37
LN 18b CLAIMED AS DEPNDNT BY ANOTHER TPI N
I
LN 22 TAXABLE INCOME" -".-'. I 21.811.37
LN 23 TENTATIVE TAX I 3.274.0l/J
I
LN 24a CHILD. CARE CREDIT ! 0,l/J0
LN 24b CREDIT fOR THE ELDERLY 0.00
LN 26 ADV~NCED EARNED INCOME 0,0(/J
LN 21 TOTAL TAX LIABILITY 3.214.00
2.532.00
700,lUI
0.00
3.732,00
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LN 28a FEDERAL WITHHOLDING
LN 28b ESTIMATED TAX PAYMENTS
LN 28c EARNED INCOME CREDIT
IN 28d TOTAL PAYMENTS
LN 30 REFUND AMOUNT
LN 31 APPLIED TO 1992 ESTIMATED TAX
LN 32 AMOUNT DUE
LN 33 ESrlMArED TAX PENALlY
5""""1,,....:.
" ,l/Jl/J
42,00
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d WlOU'ctikllili111......Ih\<lUbutlsdllmld..\<lU'dependaot"1dElrO"""1005agllllll1lenl,c:I1OO<l1lm ~ 0
. Total number of exem tlons clalmod. . . . . . .
7 Wagas, .alarl.s, lips, .Ic. Allach Form(s) W.2. . . .
Income .. Taxabll Inlar.stlncom.. M.ch Sch.dul. B II ov.r $400
Attach b Tax.lumpt Int.r.sllncom. ("'PUOl5),llONThUilali1ella ,
Copy B 01 your 8 Dlvld.nd Income. AIlach Sch.dula B II ov.r $400
Forml W.2,
W.2G, and 10 Taxablerufunds,cmdlls,aollsolsolstaleandlocallncom.taxaslromwol1<sheetonpage 15.
10DO.R h.... 11 Alimony r.calved . .' . . . . . . . . . . .
II you did not 12 Business Income or (loss). Mach Sch.dule C Or C,EZ. . . .
gel a W-2, see 13 Cepllal geln or (loss). AIl.ch Schedule D . . . . . . .. .
plige9. 14 C.pll.' gsln dlstrlbullons nol reporled on IIn. 13 (see p.ge 15) .
AIl.ch check or 15 Olher g.lns or (losses). Attsch Form 4797 . . . . . . . , , . . . .
mon.y order on 151 Tot.IIRA dlstrlbullons llil I b T.xable .mount (se. p.g. 16)
Flop or .wnY2 17 a Totalpensic:nslnl.....- lil!J. . . b T...ble .mount (s.. p.g. 16)
.arms -
. W.2G. or' 18 R.nts. royslll.s. p.rtn.rshlps. asl.tes, Irusls. elc, Allach Schedul. E, , , .
1099.R. 18 F.rm Income or (loSl). AIl.ch Sch.dula F. . . . . . . . . . . . . .
20 Unemploym.nt comp.ns.llon (see p.ge 17)
21a SOCI.'s.curlly benells. Iu!.J 4,282.' j b 'Te~e~le ~m~un't (~ee'p.~e ;7)'
22 Other Income. Ust t,pBlnlllmClll1l-oeeJl9l18
23 Add the amounls In th. f.r tlXlloo1nlorlnes 7 h22. ThIs Is totailncoml
24a Your IR'. dOOu::IbnttJmlljlplcable"""""","tonpago10a2O 240
Acl~ustm.nts bSpouse'slRA dedudilnttJm8A>lcable1Mllkshoot1llpage 10a2O . 24b
to ncome 25 On..h.lf 01 sell.employmanllax (s.. p.g. 20) . " 25
28 S.II.employ.d heallh Insur.nc. d.ducllon (s.e p.g. 20) 26
(Seepag.18.) 27 K.ogh r.llr.ment plan and ~SEPOOc1<tln 27
28 P.n.lly on early wllhd,.wal 01 IOvlngs . 26
2t Alimony paid, Roclplanl's SSN ~ I 28
30 M:li'leo.~ 2!l 1l1ooe.... lolalad ultmlnta ~ 30
39 Sl.Iblr.ctUne 30 from Une 23. This j'your.dJu.l.d Groo. 'ncom.. 11th"
Imount I' I.u Ih.n 122,310 and. Child IIVlJdWlth/OU. .tee Pllfl9 EtC.' to find ou, If
au can claim the "Earned Income CrttdW on Ime 5 . . . . . . . . . . , . 3 f
!1 04 0
Label
f~rucllons
on page 10.)
UII thl IRS
labol.
Oth.rwls.,
pl..s. print
or Iyp..
P..sld.nllal
Ellcllon c.mpalgn 110..
See . a 10. r
1
2
3
4
Filing Status
(See paga 10.'
Check only
one box.
exemptions
(Sae p.ge 11.)
If mar. Ih.n six
dapandants,
saa p.ga 12.
AdJulWd
Grolllncome
k ARTHUR J TANGEMAN
B It a Joint return. lpOUI&'Ihf'IimBan:li'tiiI Las' name
e
L VIOLET L TANGEMAN
H Home IOdr... (number and Itreat). If you have a P.O. box, 18. pege 10.
E 2720 RITNER HIGHWAY
R
E ClIy,lown or POlt Office. 111I1e, and ZIP code. If you hlilve 8 torolgn liIddrell, 18. page 10.
CARLISLE PA 17013
Do you want $1 10 go to this fund? . . . . . .
If. Joint ralurn, doas your spous. w.nl $1 Iogololhlsfund?
Slngla
X M.rrled llling joinl r.turn (.v.n If only ana h.d Income)
''emed fiilg ~!l.rekJm. En"'spousa~ sodaI security no. aIxMl and fur",""" hem. ~
H..d-O,-,;uusahOI0-(\IiIh~""",,"),(SaeI>l!l811.) II th. qualifying p.rson Is. child but not your
d.pandenl. ant., this chlld's n.m. har.. ~
5 au.llf In wldow.r wllh d. andent child a.r SOusa diad ~ 10
8 a !XI You r sa ". W IOU' plrent (orSCl11Oa1B else) can dain \W as . dependaot on tJs or "" tal<
relum. do nol c:I1OO<boicGa.Bu1be....bc:l1OO<lheboiconi1e3:lbonPU02
. Sea . a 11.
} No. 01 bOXes
checked on e.
. , . and6b ~
. , , No. of your
(5) fib. a' rmnt& c:hlldren on 8c
/'oohlOO' who:
taro h 11m
. liVid with you
. didn't IIvI with
y:ou due to
iUvorce or
siparatlon (HI
page 13)
No. 01 other
depend.nt. on 80_
Department of the Troasury-Internal Revenue Service e;'I
U.S. Individual Income Tax Return u
Fortho sorJan. 1.001J, 31,1992. Ofoawtal(
Your thai name and Inltlll
(@)92
Lalt name
ApI. no,
b !XI Sou.. .
C Olp.nd.nta:
(1) Name ~f1lt,I_.endlastro""')
. . . , . .
. . . . .
p.;::
I
(3) IfIlQO lor,*",.
dependent's Social
a8curll number
(4) Deoerdo-rs
relationship
to ou
8b
SpOUlt'1 loci.' IIcurlty number
578 10 3808
For Privacy Act and
Paperwork Rlductlon
Act Nolle., "" pagl 4.
NOh:Checkfng -Vea-
will not Change your tax
or reduce your refund.
Add.numb.r.
entered on
lines above ..
7
Sa
2
5 373.
i.l,l,
D
10
"
12
13
14
15
8b
7b
18
18
20
21b
22
~ 23
2.
-0-.
27 828.
1 672.
34 875.
'"
:'~i'f
,,:!~ "
rl:',i
34,875.
orm'4nUi
Form 1040 '1902\ ARTHUR J & VIOLET L TANGEMAN 46911618501 P.~e 2' .
32 Amount from IIn. 31 (sdJu,t.d gro.slncom.) 32 34 875.
Tax 330 Ch.ck If: IiaYou w.r. 65 or old.r,D 8l1nd; 1:&1 Spou.. was 6S or oldor,D 8l1nd, I l,},j't
Compu. Add tho numb.r of boxas ch.ck.d abova snd .ntor!tlll tolsl h.ro . . . .. 33a 2 '~\i~
tation b If your parent (or som.on. .1..) c.n claim you.s a dopend.nt, ch.ck h.r. .. 33b 0 .~'lf!:
~~~
(See page c If you Bre married filing soparatoly and ~our ~JUlJSU ilemlzes deducllons .1~
0 Ii.:;,l
22.) or you are 8 dUBI.statuG allen, see page 2 an check here . , . . . .. 33c ",(:\1';
Ent.r lIemlzod deductions tan -1\... 26. OR :~~\"
34 f~
Ih. Standard deduction shown below foryour filing ,talus, But II you checked .~ I,
larger any box on line 33a or b, gobpage22lofindyourslandard ~
01 de<1.diJ1. If you checkad box 33c, your standard daductioo Is ZSIO,
your: . Slng1.-$3,600 . H.ad of hous.hold-$6,250 34 7,400.
. Marrl.d filing Jointly or Qualifying wldow(.r)-$6,000 W
. Marrl.d filing s.paral.ly-$3,000 ..
35 Subtract IIn. 34 from IIn. 32 35 27 475.
36 If IIn. 32 Is $78,950 or I.s.. multiply $2,300 by th. tolal numb.r of .x.mpllon. clslm.d
on IIna 6e. If line 321s ov.r $78,950, s..the wor1<shool on page 23 for the amounl to .nt.r. 36 4,600.
If you want 37 hubl" incoJll"-Sublm~ line 36 from IIn. 35. If line 361s more than line 35, eolar.o... 37 22,875.
the IRS to 38 Enter tax. Chacklffrom a L&I TaxTabIe, b 0 Tex Rate Sch.dules, c 0 Sch.dul. O.
figure your or d o Faro 6615 (soo!XV'23). Amoont, If any, from Fonn(s) 8814 .. . L 38 3,431.
tax, soo page
23. 39 Addltlonallaxes (s.e page 23). Check If from a 0 Form 4970 b 0 Form 4072 30
40 Add IInas 36 and 30 .. 40 3,431.
41 Credit for child on:I~tcaeexpensas. Alta:hFam2441. 41 ,~~'I ;,. .
Credits 42 Credit for the eld.rly Dr th. disabled. Altach SdBiI>R. 42 l~J:{:
~)i.'"
(See page 43 Foreign tax credit, AlIach Form 1116 . 43 ;:~ll
\~',,~
23.) 44 Olher cradlts (.ee paga 24). Check If from a o Form 3800 1,t:.4/
b 0 Form 8396 c 0 Form 8801 d 0 F..m (.pecIfy) _ 44 ~~
45 Add lines 41 through 4~ . 45
45 Subtract tine 45 from line 40. If line 451s more than IIn. 40. ent.r .0,.. .. 46 3,431.
Other 47 Self.employmentt... AkIlSch3d...SEIlBo,......25. 47
Taxes 48 AIt.rnatlve minimum tax. Atlach Form 6251 . 4a
49 RocaptJraIaxes(seepage25),QlOd<WflOm a 0 Form 4255 b o Form 8611 c 0 Form 8a26 49
50 Soda! security ard Medl::are tax on tip i1ame notmpa1od b empia,oer. AIIacI1 Form 4137 50
51 Tax on quallfl.d retlrem.nt plans, Including IRA.. Atlach Form 5329 . 51
52 Advanced earned Income credit payments from Form W",2 52
53 Mlh:64611'mrl152. Thl.ls vour tolal tax . .. 53 3 431.
Payments 54 Fedemllra:metaxwlhheld. W""I'1s from Faro(.)10il9.dlOd<" liiI 54 2 328. ::;,,;,1
55 1992 esllmat.d lax payment. and amount applied from 1991rolJm 55 2 000. '!'!','
sa earned Income credit. AIta:h _ 8C 56 V:f~ ~:.
..,-~f.
Attach 57 Amount peld with Form 4868 (extension reque.l) 57 ;f,;'~~;
'.;',;,,",
Forms Wo2, . ,0 .~
58 Excess sodaI sacuiIy. Medi:31l. 300 RRTA tax_ (.... page 26) . 58 ,.,al
W-2G, and ;,~':?
1099-R on U Other payment. (.ee paoe 26). Check If from a 0 Form 2439 ~
the front. b 0 Form 4136 Sa 'il ~.
60 Add lines 54 throuoh 59. 1hase...v<utotal oavmonts .. 60 4 328.
Refund or 61 WhOOlsmonll1lr1h53,SlbIadIna53tan...OO, This Is the amount you OVERPAID .. 61 . 897,
Amount 62 Amount of line 61 you want REFUNDED TD YOU . . . . ~I. '1 . .. 62 0-.
Youo.w 63 M1cunl of 1na61 you \\\lrt APPLIED TO YOUR 1993 ESTIMATED TAX.. 63 897. ~
Attach mack or
=orderon 64 Wh53lsmonll1lr1h60.wbtactIi1eOOfltmina53.Thls Is the AMOUNT YOU OWE.
~ 0 Fam(s) ,6,\IacI1 d1ed< or money orderforfulllll1Oll1t payable 10 olntemal Raven"e SetvIce.o Wrm your
Ih;~(on 11Iml, ooaess, o:x:iaI sacuiIy I1U11ber. dayIine r/1OIlIl runber.lOld .1002 Faro 1040" on I ' 64
65 Esllmated tax oenallv (see Daoe 27\. Also include on II.. 64. T 65 ',. . S'l', \~. ,;'~ \-~.~-.-l
. Under penalties of perjury. I Cleclare that I have examined this return and accompanying ICheaulea ana statements. anlS to the
Sign best ot my knowledge and belief, (hey Are true, correct, Ind complete. Declaration of preparer (other than tlxpayer) II blled on
H alllnformaUon of which propsr.r hIS any knowledgs.
ere ~ Your gnatur Date Your GCcup.tlon
Keep a copy 1 /.
of this return I / l RETIRED
for your .... pOul8'lllgnatur, If Joint relu . BOTH must Ilgn. Dale Spouse', Gecup.llon
lecords. ,. ,(r. it1rJ: V',V',,,,e:SI',,,r..IZ 7k RETIRED
Prep.rer".... .J) O,te Check II Iti1 Pre parer's 10Clll ~no.
Paid slgnslure ,. C>1 V(l d~ (. 3 j () 'U se".em 10 ed "" 222 42 1500
~rep~elyr's Firm', nsms (or)WIlo.. LINDA C. BENZ N BENZON & ASSOCIATES HNo.25 1696047
58 ~n~e~'d:~~~Ored) "208 BURNT HOUSE ROAD CARLISLE PA ZIP cOd. 17013
Clllp$on CA. Corp.
Fonn
2'119
Sale of Your Home
It Atluh to Form t040 for ~"r of ..1..
O.p.rllTllnl Of lh, rr.lIury
In"rnIIR.venuIS,Met ~ S,. "plnt. In,tructlonl. . Pl.... print or typ..
Your fir.' name and InIUII. If. Joint r.lurn, 1110 glvI .pou.... nama Ind InlUIl, l.,' name
ARTHUR J & VIOLET L TANGEMAN
Fill In Vour Add".. Pr..onlodd".. (no.._....ap.no"nn1IOWl,orP'O.boxlll.rrroll~nol_"__)
Only" You A" FIling
Thlo Form by 1100"
and Not With Your
TI. R.turn
City. town or POI' oUlet, Itat., Ind ZIP cod.
1
2
3
4
5
8
7
8
8
D.t,
spou.... ,lgn.Me
~
OMB No. 1645-0072
~@92
Attachment
Sequonce No. 2 0
Your loclllucurtty number
469 16 8501
.pou.... IOcl.1 MOurlly numbtr
578 10 3808
16
17
10/01/92
2
-0-.
liII Y.s NO
. Dv.s IilINo
Oonorll Inlormlllon
Ost. your lorm.r msln home was sold (monlh, day, y.ar). . . . . . . . . . . . . . ~ 1
Fac. amount 01 any morlgag., not. (..g., sscond trust), or olh.r IInanclalln.trum.nt on which
you will g.t p.rlodlc paym.nls 01 principal or Inl.r.st Irom Ihlo oal. (0.. Inslrucllono). . .
Hav. you bough I or buill a n.w main ham.? . . . . . . . . . . . . . . . . .
Is or was an art of ..U:18r .maJnhom6-.tonled oul or used for business? If .Yes,- see Instructlons
Oaln on Sar. 00 nolinclude amounts ou deductss movln "ex enaes.
S.lIIng price 01 hom.. Do nollnclud. personal prop.rty lI.ms that you sold with your home.
Exp.na. 01 sel.. Includ. s.l.s commlsalons, adv.rllslng. I.gal, .tc.
Amount r.allzad. Subtract IIn. 6 Irom IIn. 5 .
Ba.ls 01 ham. sold (ue Inslrucllons). . . . . . . . . .
Olin on ilia. Subtract IIn. 6 Irom IIn. 7 . . . . . . . .
. IllIn. Gis z.ro or I.as, alop hara and .Uach this form to your return.
. If llna 3 la 'V.s.. you mu al go 10 Pari III or Pari IV, whlchav.r applleo. Olherwloe, go 10 IIn. 10.
10 If you hsv.n'l r.placed your ham.. do you plan 10 do so wllhln Ihe r.plac.m.nt p.rlod (see Instrucllona)?
. nllne 10 10 "Y..... atophate. allach Itio Icnn lOycllO' 18tum. and.... Addltlonll Filing Roqulramonto"'''' ilsCucions.
. If line 10 Is 'No' au mual 010 Perl III or P.rIIV whlch.ver 0 lies.
On..Tlm. Exclusion of Gain for PIO I. A . 55 or Older If au are not takln the exclusion,
11 Who was age 55 or old.r on det. 01 sal.? . . . . . . . . . . . . Vou DVour spouse
12 Old the person who was sge 55 or old.r own and us. the properly as his or her main home for a lolal 01 et
I.ast 3 y.ars (ex08p1lorshorlabs.nc.s) 01 the 5.y.ar p.rlod b.'or.th. sale? II 'No," go to Part IV now. . . DY.a DNo
13 IIl1no 12 II .YII,. do you alocl 10 Ilk a Iha ono.lIma axclualon? II "No," go to ParI IV now. . . Dy.s DNa
14 AI 11m. 01 sal., who own.d Iha home? . . . . . . . . . . . . . . . DVou DVouropouae DBoth of you
16 Social s.curlty number of spoua. .t lima 01 sal. if you had a dill.r.nl spouse from Ihe on.
above alllma 01 sal.. II you were nol marrl.d at lime 01 sal., .nt.r 'Nona" . . . . . . . . ~ 15
18 Exclullon, Enlar the Imlllar ollln. g or $125,000 ($62,500, if married IIl1ng s.parate r.turn).
Then, 0 to IIn. 17 . . . . . . . . . . . . . . . . . . . . . . . . .
Ad uslad Sal.. Prlca T,,"bla Olin Ind Ad uslad aasls of Now Homo
17 Sublracllln. 16 from IIn. G . . . . . . . . . . . . . . . . . . .
. IlIln. 17 Is z.ro. slop h.r. and aUach this lorm to yourraturn.
. l"ln. 3 Is .V.s.. go to IIn. 18 now.
, ". If you are reporllng this sale on the Installment method, slop here and see the line 2 instructions. ' ',;,'
· Alohn, atop hate and antor Iho amounllrom IIno17 on SChodula D,lIno 2 or IIna10.
18 Flxlng.up .xpens.s (s.. Instrucllons lor II,,!. IImlta). . . . . .
11 Add Iln.a 16 and 18. . . . . . . . .' . . . . . . . .
20 AdJullad 1.1.. prlca. Subtract IIna 19 Irom line 7 . . . . .
218 Oal. you mov.d Inlo new ham. (month, d.y, year) ~ 110/01/92 r b . C~st ~r ~.~ h~m~
22 Sublractlln. 21b Irom IIn. 20. lithe reaullls z.ro or I.as, .nt.r.o.
U Tlxabla glln. Ent.r tha Imlllar ollln. 17 or IIn. 22. . . . .
. if IIn. 23 Is zero, go to IIn. 24 and aUach thla lorm to your r.turn.
. · 'YOU 118 ~ IlIo sale 00118 _tmel1od. see'" line 21n5tu:bls and go tJ fnl24.
· Alohn,anlar Ihaltllounllrom IIna 23 on Schodula O,lIna 2 or IInal0. onlgotJfnl24.
24 Postponed gain. Subtracllln. 23 lrom IIn. 17 . . . . . . . . . . . 24 500.
25 Ad ualod bu.a 01 now homo. Sublrlctlln. 24 Irom IIn. 21b . . . . 25 84 837.
algn H.r. Und.r p.n.IUII or p.rlury, I d.cl.,. thlll hlv, lumln,d thll form, InCluding IUlehm,nll, Ind to 111. b'lt 0' my knowl.dg.
Onl)' .tyou Ind blll.r, 1111 truI, corrlct, Ind campl.ll,
Ar. flllno Your algnllur'
Thlo FOIll\ by
ltoo" and Hot
With Your Tu ...
R,turll ~ It I Joint r.tum, both mUlt algll.
For Paperwon R.dYCllon Acl Hollcl, I" ..p.nl. 'n'trucllon,.
Dl"
5
6
7
a
9
8 000.
8 000.
7 500.
500.
DY.s DNo
to Part IV now.
Both of you
500.
':"~(~'t:
'. ,,-. "'.. .f"'"
:, '~~'l'~.:.~~~ ,'::A;i"~.
j/;lr ,~t.:..1' .\.I,'''Ut'5j .
j',::\.;~" f~f:;~.~t
.' .
18
18
20
21b
22
23
8 000.
85 337.
-0-.
-0-.
::,y:~ ::'.' :,!J,:)lL;~".t,
I. .. ,,1,.___ .'I'.r.!I.'J.
,..' ,.".(..,,,:
,r. Ii' .':'1.'.; ::: ~~,; '" 'I';..
01'1
Form 2118 (tlSl)
Schedule ASB Form 1040 1002
. Nlm'fa) .hown on Form .0.0. 00 not Inl,r nlm. and aoclllllcurlly numb., It thown on oth.r ,Id..
ARTHUR J , VIOLET L TANGEMAN
Schedule B-Interest and Dividend Income
I Add the amounls on IIn. 5 . .....,..
7 Copllal gain dlllrlbullans. Enl.r h.r. and on Sch.dul. 0' 7
I Nonl8K8blodleHlutianB. (Saoth.lnll, for Form 1040. Uno g.). I
g Add un.o 7 and 8. . . . . . . . . . . . " ,...... 8
'0 Subtroctlln. 9 from IIn. 6. Enlor Ih. r.lull h.r. and on Form 1040, Un. 9.. ,"'0
'If you fec.lved c.plt., g./n dls/ributlan. buf do nol need Sch.dule 0 10 report .ny a/her gaIn. Of lassll,
so. fhelnBlruc/lan. for Form f040 IIn.. f3 and f4.
I' you hod ovor 5400 0' Inlorlll or dlvldondl OR hod 0 'orolgn Occounl or woro 0
,antor 01 or I trlo.f.ror to . foul n'rult ou mUlt com I.t. .hl. art.
"0 AI ony 11m. during 1902. did you hovo on Int.rlllln or 0 SignawarOlhllroulhonlyoveroflnonclol
account In I foreign country, luCh II . bank lecount, ..curUl.. Iccount, or olher financl.1
oceounl? Seo poge 8,2 for oxcopllonl Ind riling ~I:tFarm TDF9Cl-22.1
II II 'VII, ' onl.r Iho nom. of Ih. torolgn counlry ,.
'2 Woro you Ih. gronlar 01. or lronlforor 10. 0 forOlgn Irulllhol o',.lod during 1992. _0' not
au hive In beneflclallot.re'l In U? If .Ves. ou ma have to filii form 35~O 3f;'O.A, Of 926 X
Df. For '"erworlc RtCluclton Act Holtet, ". Fo,... t040 In.UNCtlon,. IChldul. 8 (For. 10.0) ".,
PorI I
Inlorool
Income
(S.o
p.g.a14
Ind B.I.)
Hot.: I' you
r,c.lv.d I Form
lOBO.INT, Form
1000-010.0'
lubamUI.
Ilal.m'nl 'rom
. brok.rag. 'Irm.
11.llh. flrm'l
nlme II the
Ply.r and .nler
lhelollllnl.rlll
.hown on thai
rorm.
Perl II
Olvldond
Incamo
(Soo
plgel IS
ond B.l.)
N01.: If you
r,cllvld a
. Form 1009.DIV
or lublmUI.
Itatem.nt'rom
I brok.rag.
firm. 11.1 Iho
firm', Mm. II
the payer Ind
.nt.r Ih. 1011,1
dlvld.nd,
'hown on that
form.
Perl III
Forolgn
Accounh
end
Forolgn
Trullo
(800
P.go B.2.)
OMB No, 1SCS-tlO74 Po I 2
Your IOCIII "curtly number
469 16 8501
AlIlehm.nt 08
Stquenoo No,
If you hod OVlr $400 In loxobll Inlt""llncamt OR oro clolmlng tho oxc/uslon of Inltrl.1 from IOrlll EE U,8.
oovlngl bondllnuod oltor '919, you mUll complololhlo port. L111 ALL Into"ll you rocllvod.1I you hod
OVlr 1400 In 'aubl. In'.r... Incom., you mUle 11.0 compl.t. Part III, I' you r,c'lv.d, I. a nomln", Inter...
thol ocluolly bolongo to onolhor potion, or you rocolvod or pold occruod Inloro.1 on ncurllloolronl'o"od
lIolwotn InlorOlI poymtnt dolt.. ..0 poOo s.,.
Inlere81 Income
, Llsl nom. 01 pay.'......1 ony Int.r.lllncomo 10 Iram 1.II.r'flnonc.d morlgoO.s,
I.. pooo 8.1 ond IIstlhll Inlo'.11 flrat ..
ADAMS COUNTY NATIONAL (WI
ADAMS COUNTY NATIONAL (HI
EQUITABLE LIFE (H)
CCNB.'(J)_ "_
CCNB (W)
FARMERS TRUST (HI
Amounl
,
1 313.
1 153.
37.
1 529.
1 264.
77.
2 Add th. amaunll on IIn. 1. . . . . . . . . . . . . . . . . " 2 5 373.
3 Excludablolnlo'ost on sorleo EE U.S. aovlnoe bonds 'Bluod ellor 1089 from Form
8815, IIn. 14. vou MUST aUoch Form 8815 10 Form 1040 . . . . . . " 3
4 Sublrocllln. 31ram IIn. 2. Enle' Ihe r.SUII h.,. and on Form 1040 IIn. Bo ,.It 4 5 373.
If you hod ovor $400 In oroll dlvldlndl ondlor olh" dlotrlbullonl on atock, you mUll complololhll port ond
Part Ill. I' ou r,cllv.d .1. nom In.. dlvld.ndl that Ictull! b.lon to Inothlr Irlon.1I I .8.1.
Olvldend Incam. Amounl
5 Llsl name of pay.r......nclud. on this IIn. capllal g.'n d'll"bullana, non lex obi.
dlelrlbullons, elc. ..
5
. . . , . . ,
I
Yoo No
'II'"
,',','
, ..
x
........-.-...
".rm4 6 84
OMB No. ,U5.0t77
Casualties and Thefts
· S.. up'"'' In.tructlon.. ~ ~ 9 2
D.p.rtm.nl 01 Ih. Tr...urv . Att.ch 10 your IIx ,.turn. AIl.ehm.nl
Inll/n.1 Rov.nu. S.rvl~. . UI' I II Int. Form UU for Ilch dlffuent cuullt or theft. S. uene.No. 26
Name(l) ahown on tax raturn Identltylng number
ARTHUR J & VIOLET L TANGEMAN 469 16 8501
SECTIONA.-Perlonal Un Property (Use this section to report casualties and thefts of properly not usedlnalrade
or business or for Income.produclng purposes.)
1 Deacrlptlon of prop.rUe. (.how kind, 10cIUon, 8nd dlle acquired for each):
Properly A 89 LINCOLN CAR AQUIRED 1989
Proparty B 91 ESCORT CAR AQUIRED 1991
Property C CONTENTS OF RESIDENCE 10 ZIEGLER MILL RD GETTYSBURG PA
Properly D
ACQ VARIOUS
Properties (Use a separate column for each property lost or
damagod from one casualty or theft.)
- A
2 co.t or other billa of each property 2 28.000.
3 In.urance or other relmburlement (whether or not
you .ubmltted I claim). See lnstrucUons . 3 12.418.
Note: If Ifn. 2/. mort thin Ifne 3, skip Ifne 4.
4 Gain from caaualty or then. It line 3 I. mort thin
line 2, ent.r lhe dlfferenc. here and skip IIn81 5
through 8 for that column. If line 3 Includ81 8n
amount that you dh:l nol rscolve, 188 Instructions 4
5 Fair market value b. fa fI casualty or theft. 5 12.418.
8 Fair market valul I ft. r casuIlly or thelt 6 -0-.
7 Sublract line 8 from line 5 7 12.418.
8 Enter the .mlller or line 2 or line 7 8 12.418.
0 Subtract IIn. 3 from line 8. If zero or II",
enler ~o- 8 -0-.
10 Casualty or then loss. Add tha emounts on line 9. Entor tha lotel
11 Enter Ihe .mounl from line 10 or $100, whlchevsr Is sm.ller
B
c
o
11.200.
50.000.
-0-.
50.000.
8.000.
-0-.
8.000.
8.000.
8.000.
12 Sublract line 11 from line 10. . . . . . . . . . .
Coullon: Uu only one Form 46B4 'or line. f3 through lB.
13 Add tha amounts on line 12 of all Forms 46B4 . .
14 Combine Iha amounts from line 4 of sll Forms 4664
1 5 e If line 14 Is more 1 h. n line 13, anter Ihe dlffersnce here end on Schedule O. Do not
campi. Ie the resl of Ihls 8Gcllon (see Inslrucllon.).
elfllne 14ls'e.. then IIna 13, anter .0. here snd conllnue wllh the form.
elfllne 141s .qu.1 10 line 13, enler -0- here. 00 not completelhe rest 01 this .actlon.
18 If line 141.I..e Ihen line 13, enlar Ihe dlfferencs , . . , , , .
18 7.900.
17 Enler 10% 01 your edjusled gross Income (Form 1040. line 32). Eslste. and 1rusts. seeilslrucllons
17 3.488.
18 Subtr.ct IIn. 17 from IIna 16, If zaro or leu. anls, .0.. ,0.1.0 anter r..ull on Schedule A (Form 1040).
line 17. Ellates and trusll, entor on the -Other deduclion.-Iine 01 our tax return
For Paperwork R.dueUon Act Nolle., ue p.g", t of ..puat. Inltrucllonl.
Ot81
18 4.412.
form ...... <<till I
j
'0;.
'.'1
~
10-8;).1- / 11-'
I REV-1547 EX AFP (12.94*
COMHONWEALTH OF PENNSYLVANIA
OfPARTKENT OF REVENUE
BUREAU OF INDIVIDUAL TA)lES
DEPT. 280601
HARRISBURG, PA 17123-0601
I~-I 'lq-/~
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
ACN 101
DATE 05-15-95
\;J~.J.- j .
S ATE OF FILE NO,
DATE OF DEATH 10-13-93 COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PDRTION OF THIS FORM WITH YOUR TAX
PAVMENT TO THE REGISTER OF WILLS. MAKE CHECK PAVABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
ARTHUR J TANGEMAN
2720 RITNER HWV
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
A.aunt Rallltt.d
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
REV:iS4i-Eif-AFP--n2:94Y~~~r[~g~-g~~IN~~R-t~~~g~;X~~-:-~:ii:I~~~-~~~~-?~W~~CE-~R-------~--------
ESTATE OF TANGEMAN VIOLET L FILE NO. 21 94-0131 ACN ,::101 Ul DAri'f~05-15-95
TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED :;;; : . ,~
~
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expens../Ad.. COlt.'Hisc. Expans.. (Schedule H) (9)
10. Debts/Hortgege Liebilities/Liens (Schedule II (10) .00
11. Totel Deduction. (11)
12. Net Velue of Tax R.turn (12)
15. Charitable/Govern.antal aequa.t. (Schedule J) (13)
l~. Net Vel"" of Estet. SubJoct to Tax 11~)
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will
reflect figures thet include the total of abb returns assessed to dete,
ASSESSMENT OF TAX:
1S. Mount of Line 14 at Spau..l tat. (15)
16. A.ount of Line 14 taxable at Line.l/Cla.s A rat. (16)
17. Aaount ~f lIne 14 taxable at Collat.ral/Cl... Brat. (17)
18. Principal Tax Due
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R.el e.tat. ISch.du1. A) (1)
2. Stockl and Bond. (Schedule B) (2)
S. Clo..ly H.ld Stock/Partnership Interest ISchedule C) (3)
4. Hortgaga./Not.. Rac.ivabl. (Schedul. D) (4)
S. Cash/Sank Deposits/Hisc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedul. F) (6)
, 7. Tran'.fers (Schedul. G) (7)
8. Total Als.t.
~
--.J
.00 ::1
~ 00 "J
\.1'- ..
)......::, 00 t.Jo,l
'"
.00
62.229.00
.00
.00
(81
4,499.00
.00
57,730.00
.00
X .00.
X .06.
X .15.
(18)
TAX CREDITS:
PAYMENT
DATE
10-13-93
07-13-94
RECEIPT
HUNIER
SPO SAL
MM886285
DISCOUNT (.)
INTEREST (-)
.00
.00
AMOUNT PAID
2,309.20
1,155.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCUlATION OF ADD1TIONAL INTEREST.
i);....
~,
62,229.00
ii.4QQ....DJL.
57,730.00
.00
57,730.00
.00
3.464.00
.00
3,464.00
3,464.20
.20CR
,00
.20eR
<< IF TOTAL DUE IS LESS THAN .1, NO PA~ENT IS REQUIRED.
IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICU, YOU HAY IE DUE
A REFUND. SEE REVERSE SIDE OF THIS FO~ FOR INSTRUCTIONS. I
JRD/JuDe 30, 1992/17858
REGISTER OF WILLS
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
NOTICE PURSUANT TO RULE 6.12
PENNSYLVANIA SUPREME COURT ORPHANS' COURT RULES
To: Peaonal Representative ARTHUR S TANGEMAN
Counsel:
BE: Estate or VIOLE.T TANGEMAN
\,;AHLJ.l;Lt:
, Deceosed, Late or
Estate No,: 21..94..131
Date or Decedent's Death: OCTOBER 13, 1993
Pursuant to Rule 6.12, the above named personal representative or the above nallled attorney, if
applicable, within two (1.) years of the decedent's death, and annually thereafter until administration is
completed, is required to file with the Register of Wills a Status Report as required by Rule 6.12, in
substantially the prescribed form, showing the date by which the personal representative, or attorney, as
applicable, reasonably believes administration will be completed. The purpose of this Notice is to advise
you that UDIess the requisite Status Report is filed with the Register of Wills or Clerk of the OrphlllS'
Court, as appropriate, within ten (10) calendar days after the date of this Notice that the Register of Wills
is required to DOtify the Orphans' Court Division, Court of Common Pleas of such delinquency and to
RqUest that said Court conduct a hearing to determine whether sanctions should be imposed upon the
delinqueDt persooal representative and the delinquent personal representative's counsel, if any.
Accordingly. if the requisite Status Report is not filed by 10..30 , 19.2..~ you are hereby
advised that a request will be submitted to the Court in accordillce with Rule 6.12.
Date: OCTOBER 13, 1995 ?n...oL.:... ewJ,O..
Deputy Register of Wills ~
Distribution to Estate File
(o-3:l7-.;l
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Violet Tangeman
Date of Death:
October 13. 1993
Will No.
Admin. No. ._~! .-(('11 -IS!
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes x: No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal re~resentative file a final
account with the Court? Yes No .
b, The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes NO~
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: CCT/6 It'f""-
.
~~/~~~~~
ignat,ure
Arthur J, Tangeman
c. Name (Please type or print)
2720 ilitner Highway. Carlisle, Pa.
'..{)
~-~
Address
(717 )245 - 0531
Te 1. No .
~~-'.
L-
i;l
-.
.:J
'ju
Personal Representative
Counsel for personal
representative
x
Capacity:
(MAHlrmf/AM3)
~