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HomeMy WebLinkAbout94-00229 No. 21-94 -0229 Estate of HELEN McELHANEY [,OOK , Deceased DECREE 01<' PROBATE AND GRANT OF LETTERS AND NOW March 10th 19---2..i, In consideration oflhe pelltlon on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED Ihatlhe Inslrumenl(s) daled June 22. 1988 described therein be admitted 10 probate and riled of record as the last will of _ Helen McElhaney Look and Letters _ Testament.il.ry are hereb'y granted to Janet L. Siciak /}Y}. ] $' . 11: ~ lJ/7.;;' Iltllhyf./ '-I.7:::~/J, ( -. "-1'(/ R,~I!l of Will. FEES Probate; Letters. Ete. ......... s..2.Q..Jl.Q._ Short CerlIflcates(l ) . . . . , . . , .. S 3. 00 lRlIlIUIl'C~Kot<< , " . aon.e" "" $ 15 .00 JCP S 5.00 TOTAL _ $ 73.00 Filed.. .~1I,l;'9il. ),0.,.. ;t.~~A......,.,... AifORNev (Sup. Ct. t,D. No.) ADDRess PHONe ." j!1 (\1 .lJ,J.: CC Ln "11.1: l;C,' .-- I C1. ' co .. " I (.~ ..~ :r_ " ,'./. ~.l ,l) [; PI :I 6u .' '('.; .'!] , \.... .. j ,ft , ,I" '.1' . , . :'1,1 " " .. " , "," '. ,.' " :' I !', , ' )11.'i' I' \ ,. :: , . ,. '.'. ' ",I "j ",0, ., , .., "1 ' /)Jr.a;LtL, U Il..ff.(,-.12~? d-/,;J..ff' tll(l!.II2nEVI.6Il l,ee fOA THI9 CffHlFICAU U OOt WAIINING: n I!; IllEGAL 'U Al.lEII IIII~; COpy "II TO DlJPLll:ATI' BY P!lOTO!;'1 AT Oil PliO ICHOIIAI'II. COMMONWEAL TII OF PF.NNSVLVANIA OEPARTMENT OF HEAL TH VITAL RECOROS CERT, NO, 2166222 J .- ) - 'II -'~iitii1ll1ueo'lhltC.'lltlr"'tkm N.m.,' 000'''''___ 'XLtL~-,jklifltw;.Li--'~ ~__ SeK 1- ~~Ial SIlC.l~~y No.,.ADJ :jJ-~-4,z~4- t__,~ato of Death..jJ;!id~~rttj Om. " Blrthlk;4LUL BI"he""__ _ . ..ft]". t~.__.___ ____.____________ Place of Death I {J ~'-1- /J rJ1~p~...id~.1JL___u&(d'_ u,~_~_(~_~4!~_F~_,___penn_!!Y.lv.(!,nLll. Race I{)id~ .'~~~':~~tion ---t:! _ (1"LL,L;: Armod For~:~;.;~'~:' ~';'~:) ~_.i{(L___ , . { /; Deced}l l's I - f1.~ " LA fA . '-7/' Marital Stat IS ~'--;r::llir(q Adless !.t.,j]_~ -d-,--1.t?l:~,:i_<~_&"L.L!...UJ~_1tL ' ",",,'" ''''''''~ J 7r- c.t, ," ,,,.. i~ I,'mm." ,.' ,-, '""',,' DI,,,'m . "~'f:!:,~" ~4~,.~ ~~~e~aa s~~11~~S~~~t jCtt>> }-ltf-----3..-l./JI._l~<y-,;jL---- _,,==;(;__ __,____ . f/, I nterval Between It~_,__J7~,______i. On~et and Death Part I; Immedia~ C'luse ::: l t-(t.L~ , , , .._---_.-.-._-----~ I , I ...._-_._---_._--~ I , I , (C) (d) Part II: Other Significant Conditions Manner of De~ Natural E( Homicide 0 Accident 0 Pending Investigation 0 Suicide 0 Could not be Determined 0 N.m..od T111~ 1 C"""'~ (JjkLK_(!j4--r:'jJJ,,/i ~,__ _____~ AddreSs-3jU=~-Llt!.dl7jJ..1-___,u.lu,~j~__ ._, ,___(~:~~'~~~~ ~ner~~~.) This Is to certify that the information horo glvon is corroctly coplod from an original certificate of death duly flied with me as Local Roglstrar. Tho original cortlflcate will bo forwardod to lho Slale Vital Records Office for permanent filing. "L,....F~vJ 22.~' " Descrlhe how injury occurred: ..--.---...----.----.-.-.----.-- . 3 -) - 9( 2(',.~:1 1_., - l';;-~;i H,~,,",i, ,;:;iv;il,"lll',;,r J.,-.... . .- ---- ~-',);,~iTtTr;.---_. -1i:li"-n;(~;'-;;!j".;T,7;lji;;;-I;!~;i..' .. . -~; i ;",1 ,I, '01 to; ,\- - . (:,il~'li,;l';';ui,-' i I~;"--;,"r,~'r;..-~~" ~ ~.. ...,..., J' .,.. POWER OF ATTORNEY 1Irr<'ltIl'lIloll'l 1I0:-in Nll.ll- /(1/011' 11II ML'/1 ".I' nlt'.R' P/'t'.\'L'IIt.\1 I,~ j:; 2 ~ 1 0 'I h,lI lhi\ JlU\\l'1 (II :\ttorlll') I' not \.11111 Of III l'Ill'l't Ilnk~\ all,Il'lH.'11 to tilL' hond \\hirh It ,lllthllrill" C\l'l'Ulcd, hilI 1ll,1}" Ill' tktadlcd hr llll' llPIHo\'in~ OIlIL'L'r Ii' lk,ucd ThaI \\\'~h'rll SUrl'l) {'lIlllp.lU~, ,I ~'(lrl'(lr,llillll. tlll~' hcrchj rna~c. l'lllhllllltl' Mid llppoilll 1111~ followillll ~FUr:N _[ 11 ,11Ilholl/cd 111llilidtr.lh - ,Iiiri'il iR I i I i)l~llii'ifjf~\Ts---------'-- ------ --,WITmw I fiJf~~1l1 l'filll.11 S'- ._'_._'~--'_.'---"-_._"----- ---. -~~.._-_._._._.-... ....__..~........_--------.,..,------~--------:._- DAVID W HOPCRAFT RICHARD W HOORE JEFFREY V8RINTDN KATHY J HIMES CYNTHIAH SHfAfF8~ ' JEFFREY LInGETT SCOTT KATHY L SNYDER' . ,..I III 110, (Ill ol,_.c.AIl.USLL_ .Slal' or ____-"_EtJN5..\'.LlI.ANll-____,1I'111o Ilmll,d alllloll1l1l. lis Irll' /11111 lawful ,'\lIorlll')hllll till'! \Iilh filII pOl\l'r !Iud aUlhoril) hl'rch~ l'(llllclfl'd. III "Ill!. C\cl'IHe. adntl\\klllll' lInd delivcr for nnd on Ih helml!' U~ Surcl~, tllle of tilL' fClII()I\ill/ol hUlul, ~=_~\~ ,~.!RErr;~:\I.,.!I~!!~'.!. ~~~~~.U~L~alut~'. ~~~.l:!~(11 (~~rl ~~_~~~~:!.!l::~J~~__~__~__.___.___ (\1 \Il\lI\I'UI \llIlt HII/ HII 1\ 1'\1(11110\ 1 \1 t I.IOH (0\1\11"10\1 I( 10 'III HI \1 1'1 \11 1'/1('(1\ \1 III I'IU " \ 1,\11\ I 1111 "ll (Ill HI ( 11\ II( - 11l1I.1I1~IU'IIl'\ II \\'ltullulllIUII1lr1 III (11'\1(111\\011'10\11'111\1 (11(\101( ( 0"111\ ,\101( III 1\( 0\11'1 II \11/"\'11(\ \ III (0\1'11111101 I\f (1\11'111 \I '\11 III HI \1 III( 1'1 1('0\ \1 1'1101'1 I( I' - \~hen lhl. WIIII',I") 1i,I\ 1111,1111\ Inll hlltlcl 111 IIlll'lI il j, d \t'I1MJrt l'l'l1llIUIMl'IIUIIIIII,llIII II/IInrlh"r\..kunh. MAXIMUM I'EN""IY , ,llll,nnn III 10'10\ \1'1" \I II \{II 111\(,01'1 \ 1'1 \\11\.'1\\,\\'1'1 R'IIII \\011(,1 \11\\111 01 ,\JI'llll\II\11 , In,llnn , ,n.nnn , IUll.nnn , 1n.nlll) , 1.nnn -------- , 1"nnn 1111 {II \NIlI \\ III "1\oN Oil 10\\1 H\ \IIIN (II \1l\OIl ~I- \111 \N,-i'iIIil"l---~-----ImTi\IH-h.I-:>;t.;I:~I~'-;;I~~--.- 1'1111I11 (III Ie 1\1 ,\"/11111'1.111' 11l1'111 ('1",I.lIll"III,lI ~ 11(111 I 1iit-rr\i\ili~~\I' ..UIII" \I"IIJ' ,\ 1",;'~~~I~;;'~;;-;:~-'-------' II h~1'1 I-I(III,IIIIIII~ , ___._~~:'!~~I__':'.~~.':.'.:r.!..~~~'-~ll~I.!i:!.b.':MlIL'2iI.'~:..............~_. III 11l1"1 \\III'III\IIII\fII'IIW\Il'\\IIIII/llt1I',llIll"\II'fll \\'JltII \ \ II III It \1 \1,1\(\.lIIe \'1\111'1111 011111,11 '--'--------l--j---'- "1.\\1 II( I \" 1\\III'IIHIII ~ lu HI""\II1~fOUR 4 t'o'lah ,II,' 1II11"IIU,1 \,Ii:r~ II:~ ,1.1I~ pi A~~~~~~~~~N l~D APPRE ~~'~,~'~~~'~~~'~',"""~;'~;~'~c~'~'~.. LIQUOR ......................................... AUCTION COMPANY AND AUCTION HOUSE .............. PRIVATE DETECTIVE .............................. ................................................. ................................................. , 10.lIno Hrl "'1 (1\1 1I11 I \l K' , MOO 'IMI'OWI,INII 1101\ 110111' 11111\1 I". filII-ii III Iod'''[I' III, 1I111ll'1l1'1i In fill' hUllllulul II 1111I'1 h,' 11ll' '1111I1' dalt' 11\ till' IWIIII. Im--,\Tllii\ililU--r\fir\TW" rl""dl.l lI;':~I7.fi;:til,', 1'.,"~,-;T\t!;'~-\~i;ti,~I:iiil"I,I) III III: 101111 "I' .In 'I\d"'l~ii':lil, WICI III ICIC/wlI\ II,nc.1 1>', II,.' \:I'I,r l'I'!:I''''1I111f Illli;n l',.t:r"tlllnol (Iltl,," I'lc".knl \1,: I'ri,!.I:III\t\,I'lIIl \,,1 1'10<1:,,( 'c,r:llI~, 11:I'IlIet "r AIII1I,lTI1 \.:':lel'I'\ III \'CI1trn SIIf.'11 (1'1"1.111" ,)...."11,,11, .IIJlI.'ilI!IJI, II> ~\~':lill<'II 1"1 ,,,'lilfll'..lIl"lI <,( !II: n:,(".II~ "1111(n ,"'11111'111), plOI~ '"111.1.-1 ""r Iln,loII/lllnj J(I\UlmCIl! JI '. .11l.:t!.~l!.!.!.llql,llill''''ill1lll.l'.1.11 _ Non R\lPPA.~UH'Ni C1R OI'I,S 1'1 ~HI ". Ill{ "I\Y [lusUS fl\" \1'1'1 \1 OK OlI"K,\SIU 01 Jlll(i\U\1 IIR 11"" 110'111\ 01( f'tlS.,II\l1( Tlo~ litH ilK {'n~IIl^,'1 nO~ns OK 1I(l~IlS HIK 11111 ~Il\"" fll( 1'11111 Y 1I11'mll 1I0~'ll'i Illl '"1 l\lI'KO\'I\IP,1 1f(I~W' ,\1(1 ~ol AliTIlOKIII:!lIlY 1I11~ I'OWI,K or ^lfllll~1 \', ,,<<,I f"'I'l"'" 'fl ~<""" lill WF.SI Ht;-; SIR' ,. UJ\ft''''' (llllli~r ~'~rllrl~~ th.ll tllc fllllll\\in.r I' ,I truc ,11\\1 ""Id ~'llPi III SWillrl ? of Ihc 1I).ln", uf Wc,tcrn SlIrclr ('lIllll"'ll)". dill)' ,lduJllcllllnd 1111\1. III ((,r(c. IO'~\11 'Sc.'llllll 1, ..\11 nlllHh, f'l,II\I~\, 1IIHlcn,llilllh, l'o\\Cr, of "ltl1rl\C), or ollicr llhlIM.IIIHIl\ llf lht' l'oqlilr.uion sh.11I be e\Cfllled in Ihc l'nrp\lr.ltc tl,IIllC of Ihc ('olllr.lIlj h)' tIle PrC,"lelll. Sc.'rc1M" ;rll) :\"i,t,llll Sc~rC1iln. h~'d\IIfCI. Of ,Ill) \'k~' I'rC\illcnt. (II b)' slIcl1 olhu (l(ficer~ lIS Ihe lIo.trd or DiIC(101' 111.1; ;llIlh"lf/C The Prc\lllcm, ,'II, \'I.'C l';c\lllcl\t, ScoelillL ,lll} 1\\il~l,lIll S~'ncIM;, pr IIlc 'hc,l\llrcr 111.\) .IPI..oint AllllfnCj'l in Fnellll A8cnt~ wlw ,hill! hll\C .unhOfH)' tllli\IJe NIIHk pf,ll~'IC', or IIlhlcrl,llll1lh 11I1lie n,UllC pi lli~' ('IlIlW.Ill). Hc ~'ilrf'l'l.ltc s".11 i\ not nC~ChM.I (ollhc \',Iltdll) III' lIIl)' hUIHh. plllidc\, uncJcnll~irr~~, I'o"cr, ll( ,\lIurllc\ air llcr (Ihliu' .111l 1\' III' tltC (lI(pnr,tlioJl IItc "1~11.'llIrC or ,Ill) \IIdl (lffi~'l'r ,11I11 1111.' CMplll,lIc 'clII Illil) hI.' primcd 11,' (a~,.,jmilc,' . II' I S 'I I' R:-i S lJ R E '1 Y (' 0 Sl I' AN\' IIIICIllh" 1\lh l:,II II' 111I<1,111. 1'1'11 , II~ ~ A ~ AITf''i''____,_,_._ . ____ ,\...I::.AL\r:,~ ..\\\1\111111 SCl'U'lllf) SlAlbOI'\llIdlll).\WI,1 I (lllJ~n III \!I~~III.\II.\ I" On tllIl 1\111 d,1\ "I lll'ull\. 1'1/1 1'.'loil,' II"; II 1\1,11 ltl~ UII.r:II:j'II.1 ,Hhcr, r<'1"ql,lli\ 11'1....,"~.r JOI 1'1\11-11 \'11 lOll \\tl" ,10\1'" kd~c" IeHIl(lHI III ~(Itlc l'lclllleot JrlJ ,\\\.\1 iii! ~al\'1I'I). !~ll"",II\d), "t \\~,II'1Il '1I1~1l ("lllp,lr.\, ,I ,oIIP""IIII>II, ,llld Lhll 11'1',. ,h jll,h ,,'II,'~I' j,~in~ ,IIlIlWII/(lllo ,In I.'. (le,LIlt,1 Hie Ir(V,1I ~ III\lrllll'~nl f",lhc fiulf'''''(I HIUclll \",nl,lIII"1. '\' lrll:"I,I If;: I'~I"" ,,' Itl, \L'll"IIIII"II', Ih~III,~hll 11,,,,11 1,llr,'(r. ~ 1r1.llllr,\"hclc,'111'''I\'IIPII''I:IJII',h,IIIoJIl',lr'ill''llI,ll ~lr l'umml"lnll"\l,hl'\ In _.. N""O",b.']~___,u_______uu'n_'__ . 2111111 ---M--- .. ~u IH) Puhllc, SUl/IIl n"~lIl. I (he illl,t~ftl~Ii~J 11111.,1 (,r ~\"I~il\ \L"~I, ("111,1'1. I ,10 ,l "rl'''llll''ll ,I II c ~lllC 0 ~o 11Ih 11\1.. II Iln tICI~~, ~(11111 IIII HI~ 1111.11:,1 I', \\0 (I ,\Il"'I\C) II 111 11111 (1I1\( I!hl elrC,1 111.1 1\ 11f(" Ol,Jbl, 11~IIIIIlI,f"I r, III! \ .11 " "I II, 11,.11'" 0' II, ,t 1111'111) 1.1,'(! 1111 IIllh~ 1', \\~t I ( \111 Ill:, ~{;n'r.'I,i /111_ /J l j )(")nt/ 11'(('11"',"1', "1;<,',1 I t 11,111\11111 '\Cllll 111.1" IlI:.,II,t II' \\,'I:'\~II"I. ("lIfl"ll!, ~dl'" II/lHC ( _1--- _'L'L"!- \\'IS1'W~ ('OMP,IN',. III CJ--- - PWI SIIlI. III FOI'mO!l'^'I.fI4 "'........ - ..-. if ~H'~ II ,':11''. ' j". P j I. 'i' I . 'I i,I"", "~ I }"j ,........ .....'.,. ........... 1-, , " " . ~ Ii . '. ;0', \'j. '., ,\ " " .. '. ." ,. .. , " i' " .j I, I' I', i , '. i . ' " ~ , 1~~~~i.~!\,~!o/rl,!I~'o)\\.!tt'i'f"!~~:f!)hi~i''i'~''~h1J-ftt1ll-~NN)1\"rf1~~M#'~.\~~('~W'~~f~~I'W!(~~~}1~~~"'i~tYA1ftt1~)I"'~\JtII"'~~I'W'1...~,ll'~I-tfel~:'l"Jk-~t-~~ aelO ~INO.LSall\l Nl:l3b "ay' w a'Va6~ ' )IVIOI JJ1NVr 1 lV 011 SPFLD 11H 20.18 1t.\,1' ,_""~'" .-:',', t'~ L {j~"'.., " l \ . '1.\ .....~~' " (,',. F' ~I " \ i O:j/liJ7/95 #2 "j' I,"'" Roc!)":' :ri ~"i: or 'I~('iil :1;11 ':, \ i1lls ~c-C;/.5Tt?? OF (..V(?t-S " ' '9') 11nR,lU Hll :;W CC-iI-76i'i:;-;d..t.-A-RP co c..C?~,Ilr Ifa?<~e- ~IOII\"" '. _"'." Liu~t/) cPl~tal:.cll..s? 6' 1'K"d'? , ' ,,/ /7t?r :> " , , 1111 '1!''''I"III'IIl1,II"IIlllflll,II,I,llll,',I'I,fII , ' , 04"~'_'_''''''_'~''"'''~''''~~~'''IIIi......,....,...........t''-'-~'''''.~.'''f'''-~''''''''''''''''''__I " ',-~\ 1.-'....1""'- I .41 '" ,. , , ,: ". " . , . 1', I, ,I, .:' '" .""{. .. ,~.' I ,;.....'. ~ 1~.,'.4 ,\, " ','r t. ' , 'I,' . I '"t, J >~ " ,. i: (; ',-: " 141~': (I' ,ii, "I' ," " I, I'," , " ,. " ' I ~ '! ., , ~, t,'" l . ',:Ij', I', ,I 'j' , i. .", :01 '," jt, . I~t) ':ll, '/ Ii ,(,' . , ~ ".j. II' 'ii ',,(, ,\ " , , ".; " '-j, . " " ., !' .1 , " ,t. '(, :~ ' . ,i _' ~ . ,. " .." I'.. ,,, .\' i ~II" ..' - ,,' ",',," " . ft' .~~.. ".~ .' .................-1 .':\ ''ll'''' -......." , ,. " " 1/ ..- t STATUS REPORT UNDER RULE 6.12 Name of Decadent I /..00 j-,. , J'I E L e.-L/ He... F..c../~ A;U e-- y Date of Deathl I-1-1Rc- /-I _2 I ~7"'Y ( Will No. /7"'/1/.-- /!/}2 .2 Y Admin. NO.2/?..,.-_ c;>2..:?2 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 estatel 1. State whether administration of the estate is completel Yes ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be completel ___________ 3. If the answer to No. I is Yes, state the followingl a. Did the personal representative file a final account with the Court? Yes No ,....-- . b. The separate Orphans' Court No. (if any) for the personal representative's account iSI c. Did the personal representative state an account informally to the parties in interest? Yes I../" No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans I Court and may be a ttached to this report. Datel 111tJ.(I'1~ \ ~JJ/'" ~ICu_QL Signat.ure JA1JET (.... SI CI AI::" \ Name (Please type or print) 3 ((1 6A U~ fYl7lJ. f2.D i Aaaress 'a-t,lJAtt'Sll1'r~ J ,,,44-- (413) bLff:1f/-( I Tel. No. J CapacitYI 1/ Personal Representative ______Counsel for personal representative (MAHtrmf/AM3) '" ,.' to,;' , ,.:.. 'r'l rf\ . ':'["1.. / c; - /1'(,; -' II INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) "- RCV.llOO 1.+ 111'.'1 l!! ~~~ 02.- ",Cll '" <( ~~ ::ll!: o z u~ z o i z o ~ S ~ g 'OA OATIS O' DIATH AmA 12131/91 CHICK HI.I " A SPOUSAL POVUTY CAlDIT IS CLAIMID 0 PILI NUMBU / r:' II ,J (), q COUNTY CODE 02 YE~R r; r- IWMBE~ N' M l A fa'>-'?-/) A~(..t=,.w CoAtE ;('~'AC> /1ec..I,/A"v,c> t?k,<2~ f'/l.. .s;.,jL"L~~~t:) o 3. R.malndor R.lurn (far dalll of d.alh prior 10 12.13-821 05. F.deral E,lal. Tax R.lurn n.qulred .1... 8. Talal Numbor a' sn'. D.pooIl80x., ~ ~ Q COMMONweAlTH 0' P!NNSVlVANIA D!PAIUMlNr 01 R!V!NUE om, 210601 HAUllIURO. PA 1112e.o601 lceD~NT'S NAM! (LAST, flUT, AND Mloo,e INITIAlI C' .:J"f'1' 6'A~ t:7 hr......, 6'.e",a. M -4,R. P.S' ,= A....J" 0.2'3 '(: ,e...f, ,vA. C1L1./< ~~- 9? 71" 1. R.ol E'lal.(sch.dul. A) ( 1) 2. Slack! and 80nd, (Sch.dul. 6) ( 2) 3. Cla..ly H.ld slackIPartn."hlp Inler.,' (sch.dul. C) (3) 4. Mortgogll and Nal.. R.ctl,abl. (sch.dul. 0) ( 4) 5. Ca,h, 60nk D.pa,'" & MI".lIan.au. P."onal Prop.rty( 51 (Sch.dul. EI 6. Jolnlly Own.d Prap.rty (sch.dul. F) 7. Tran,',,, (sch.dul. G) (schldul. l) 8. Talal Grall All'" (Ialalllnll 1.7) 9. Fun.ral Exp.nlll, Admlnlltrati,. Ca,ll, MI".lIan.au. ( 9) Exp.n... (sch.dul. HI 10. D.bl', Mortgag. lIablllll.., lI.n, (s,h.dul. I) (10) 11. T 0101 D.ductlan. (10101 IIn.. 9 & 10) 12. N.I Valu. a' E,lal. (IIn. 8 mlnu,lIn. 111 13. Charllobl. and Governmonlal 6.quIII' (schldul. J) 14. N.I Valu. SubJ.ct 10 Tax (line 12 mlnu,lIn. 13) - -- - I? '77 (61 717.33.0/.::' ( 71-- /~, ..:J-'~'" . ()~ - COU"'Y o 40. Fulur. Inllrlll Compro~.I.. (for dol.. of d.alh ahor 12-12.82) 1J1"6. D...d.nl DI.d To.lal. 0 7. D...d.nl Malnloln.d a lI,lng Trull (Atrach copy of Will) (Attach copy a' Tru"1 ALL CORRESPONDENCE AND CONfiDENTIAL TAX INfORMATION SHOULD BE DIRECTED TO. NA.M M UTE MAILING AOOA!SS (151 1J7. 1.2~. j t , 15. Amaunl of IIn. 14 taxabl. 016% ral. (Includ. valu.. 'rom sch.dul. K or sch.dul. M.I 16. Amaunl of IIn. 14 laxabl. 0115% ral. (Includ. valu.. from Sch.dul. K or Sch.dul. M.I 17. Principal lax duo (Add laK from IIn. 15 and from IIn. 16.1 18. Cr.dll, Spou,al Pa"~y Cr.dll Prior Paym.nl. Dllcounl Inler.II + + ---- 19. If IIn. 10 I, gr.al.r Ihan IIn. 17, .nler Ih. diU",nc. on IIn. 19. Thl"'lh. OVBRPAYMBNT. aD 20. If IIn. 171, greal.r Ihan IIn. 18, .nl.r Ih. dlUer.nce an IIn. 1.0. Thll II Ih. TAX DUE. A. Enlor Ih. In'.r.,' an Ih. balance duo on IIn. 20A. B. Enler Ih. 10101 of /In. 20 and 20A on IIn. 206. Thl, 1,lh. BALANCE DUE. Mak. Ch.ck Payabl. to. R.gllter of WIII" Ag.nt (1~) - Clll'(~ here if you me rNlue..'ing 0 f(.luncl 01 your oVL'fpnyltlp.nt. (81 ~ "71 tt? I.f tt:' (11) -j-f:;(. , ()~ (121 17. J t- (131 (141 --L'. x .06. x .15. (17) s '-( '7. "t. (18) (19) 8 '-t 7. .., t (20, (20A) (206) _J.. 7' 7. ~ t,. .. BI SURI TO ANSWER ALL QUUTIONS ON REVERSI SIDI AND TO RECHECK MATH." Und.r p.nahl.. of p"lury, I d.clor. Ihat I ha.... .JIlamln.d ,hi. r.lurn, IncludIng accompunylng Ich.dul.. and lIal.m.nll. and 10 Ih. b.1I of my knawl.dg. and b.ll.f, It I. Hu., corr.ct and compl.I', I d.clar. rhal 011 r.al .1101. hal b..n r'port.d allru. mark., ...alu.. D.dllrallon of pr'par.r olh" than Ih. p'rlonal rtprll.nlal/v. II ba..d on alllnlormallon of which rlpar.r hot any knowl.dg.. ::~~: Z;;'~';~~ "~'~IN ~ ~i:~<<~k_~rN ~d t9~~&-~';~:;ZrD-f ~0o~;- I... " .."'ltOtU.III.tvl '* COMMONWIALTH 0' 'INNIVLVANIA INHUITANCI TAX IITUIN 1!lIDINT DICIDlllT ISTATI 0' --.luf.LE;V J.ln' '.n_n'(')1 SCHEDULE F JOINTLY.OWNED PROPERTY t1..eL. ~A voFl' NAMI A. ' ,J A 4.1 If :11.:::.. f .&1 /d!- B. c. J.ln~y..wn.d property. J.f:Jt:1~ , "., -.;..... .~ PILI NUMBIR ADDU" RlLAT10NSHIP TO DICIDINT 3'19 tlAt. P ,.."r,A/ ~"" R,4u~f'(,e-;e" Dtie.v ".,A.f?$ rc:J~ H;lt. ./ ~)I :3 :J 7 ITIM LmlR DATI POR NUMB.' JOINT MADI DISCR1PTION 0' PROPIRTY TOTAL VALUI DICD'S DOLLAR VALUI 0' TINANT JOINT 0' ASm % INT. DICIDINT'S INTlRIST I. ~.e- c. () 11..>'(:;> lof? 11 .3 '? (Of I.;t.. r;- J'"~ ..!.-C'P~ .>-e:;> IV 1'(, ,. . (I 1/ CII II.:>""&' 1.2'8'.;!.. t:',!>- .1-/ ~C' .>'?? ( 1.!?t!J, cZ> ~, I J. II it C f? II ~(:J 1,,2. r,,2. () '7 ;1,.>0e:::> ,J.-O t .:z..>e::J, tf't!) ) , '1. II N CP I(~P 1'>- ,2.1'...3f"' -7 I f)P Iff 0 ~ P~"o. 00 5: ~ If fA t1w~ <!J~/JP.!J <;>>~1.:J1 .> ~..:l T. '1':r ..!>-t) .:;. , ';', ,2:z. , (I f $.4f/(-v~.Jo <5'130 ':Jt71"7.Jr 1; r-rt.. .,. ~ ,:,-<D '?' 'i' ",~,.2..2.- 7 (I '( .a H~fl'lt1i ..h 'r'C'~ .J rr3 '? ~~.o?I"'. rf !i'&J II} J,'or;. q to /;Uc; PA/l/I< se>W r If c.~p'rI(.4? , / R.4 . TOTAL 101.1,0 .nlt, on IIn. 6, Rl<opll,lollon) S 27 "~'2 1,(1")' / III more 'poco /, n..cI.cI /nllrt acld/llonal,h.." 0/ ,om. "..) " . UV.UUihll.UI BTAl! 0' ITIM NUMIIIR A. 1. Plio I. Prln' or Type J FiLl NUMBIR ,zt..- '1 t(-<t',:.l 5' AMOUNT ~:l~'~1I ..W COMMONWUlIH O. '!NNSYlVANIA INH!IIIANCt TAX mUIN 1!lIDINT DeceDeNT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ,i/ /Y"" E.::. IIA..A--' cy I- """/.<::.. DISCRIPTIOtl Fun"olbplnllll ,V1r/'- I"'v.v1!;E!4J-. 1i'.c?/7t: ~ ~4n~~~ ce~~A~Y .:> ~tI,Il.. ()14 (I- 'Y e,.€ ~o 'i I?~ I?D~ Pe-Ii!4;P--,4.. ... ..5PN',.S II. Admlnlltratlvl Cal'll 1. Penanal ReproSlnlatlvl Camml..laRl Social Slcurlly Number of Personal Repr"lntatlvll Ylar Cammlulonl paid 2. AllarnlY Fu. 3. 4. C. 1, 2, 3. 4. 5. 6. 7. 8. 'i' ~ Family EXlmptlon Claimant .7'/'1"", /:'7 5' ~ Rllatlon.hlp PAutt:" 1I'7,ffO Add,," of Clalmanl 01 dlcldlnt'l dlolh Strul Addre.. 3'1'7 &A~P U'f"'" I<cI.. Clly B6/.2.A/.rI.eP.s r-O#1./ .Stall.t:!&.. Zip Code C::?/..? S 7 Probatl Fu. Mllcellanlaul bplnll'l /#coAf?(t</ Dr:: c:..e~7'R4~ ""t!:',y,,</ /,~,A/"c..J P<t'c...>e:f2. V 4/(;'(+7 ~t"t.'- e:?p ~eA./~",/ ~-(-;- .!!q + IfJf,31 .;2~,~? ..,. 13. :TO fI"tY .sP/.e/ r 1-10$o'p "~"j/.'9H PIJ./. /~ fr'~-t?rc;.4L- 1/:it.'Y ct.! ,vIe;.. hTi'P c.c:-~ C"'''I'Ir',tpI{I1-4 /-fC/'fe- H ,"A...,.# ~K.~ "'t,+, Jlt?,I:....... 7' I"} ,.Ie /I...:r~ &/-.-1:;i!.t;'A- H~JDI2. ,net7 1-"_"'''''- C./.AII't n f.4n /"10""_0;. c.&,#.."r&.olf/!.-'fC.-o<fT""t'C;J;V C-4p~e- TOTA~ (AI.a onlor on IInl 9, Rlcapllulatlonl (If mall IpaCI II nl.dld, Inllrt addltlonallh..h of ,ami II...) ?~ -~ c'ZJ S5~; 0<:, :JtrCJ~ '1'7'" 1~7- Q 0 ~p~ a~ '7;J~ cc) I r-C1, 0'" .2.lt~;J1 'I&J,~" . 't?, ce> 'ff~. ,,21 .sa .2-e,' tiT, I~ (0. (70 .ya. ~ ( " ~f 5 /1 S'lt,&J , ' ~lUt~'.'J,~f,*":I",~"",_",,.,~..;~._~......,~'f<'Iotif-'w~\W!H;tN;4;-W{l{~TII~'.W.l,6tl~tH'f4...~:t"l,'"'' \.".,n'~~':"'7.--;';I'r~~~~~n_",,~~,-""""'-'::~'~:""""';""'rr--I. , ., ", ., ..j," ,.1 ,,-, 1\",' ' . /:-.. .' ',', " i{bt.' ,'I . ,,'.'; ", ":..' - '-, ..:' ," ('.,,;'.~: '" ~\" . \ .~~r ~ ,I' \ I' "4' , .' ...... ... ,~'''''''''''-#' """-'" .. ~.... I' " " , .. " , ". ;/ .,1' . / -'. .I " ", " ,. " 'ii' ill 1 .,. I,.' ,!, , 'Ii <II j,;' ;,}. ", 'i' ,. " /;' ,t, " I' ," j!' ,,, , 'I " .. I' Ii ,I' ,. .' , '"j ,'" ~ .' ' , e '_ ",' , ,_, I" ,"I ., ,,\~!<..,trl!,~t\~;y,\lJ~(it.'R''f\'y11\~,~\!~'j;~'pr(t!ii!'",'Vf''J'Ji\.,(,-iN_,'\wtJYJ.l~ K~fr":~})ittm"""''''-~;'''''',:", ",j "",-'~ , h... ' , ," , 'i"" " ,..."",.<;.,'.,;' .i" 11'....., "'f AL & JANET SIOIAK 8!&!~,LO MTN. AD. BER.--,..... aM 01337 ;-:;r Jl' '-I - ;;l,~~T . ' I I,H~ \1 i'. !):. , I , .~. ,. .' " / . 12,/(;I2r'!;l4.'JI.L.. r;f" ,-_ ' ',' . :,' . " I: ..,.."," "-. 011S;PFI~D l'lA 22',09 \ /r.. (~(\ ,-.::.:-" - I<t:G/.5ret2 C <f)Cr"v T f .:;C? Fe {" I? (9!if"e ~A.<./t? c o~12 r f(e.'&~..s eo I' O'F u ( ?v-~ 'I" . Ii \1'" :\-,' COO i",,1I , id ,j'II.' "I c A /2. t. ( ,$'/"- e:; /3 A; ( '701;; 1"(/ c:: . , );'T7p( Cf(t:;e y,- " II " , . I' '" ,I';, ,. ,',.. I,' I "'r.. It'..t \ ",'tf " . ,. , ,it I. \, " ., . " i'-.-;, I. " " ',," " .'" " ,. " I ~ ;' A. , ,,-i-' , ,. . 'i ,. ii 4' ,I'" 01' ,. I " . , " .I' " '. .~ ' , ' i" . , ,. ,II, ,. "., I,' '-'," .-_. ._~ . ..-..... r--"-' ~-.., i'" ..~~.~. (',;)~" ,;' ,,,,~_4" . I" ._",;;.j,Jt*'~1 ., J \i.,... r. '..~ '.'Il ,......, '" 0/ " , ! I," l-o! I i I I r " , \ , ~. I / , " '\--)" ." ,', 1 ( .\ ..",...f..,..,"'.,..."......, .. '''''., .. ....... 'II " , " ",' I' ,ij," " . " i. Jt" (.' I. :',1 , Ii " " " " ,. .I' , " " I' )\ . \1 .], .' . ~ . i 0'\ " , . I,! {"--I'd,i,'" ,. .~ . , 41 ,1".- NOTICE OF INHERITANCf, TAK APPRAISEHEHTI,^~~QH4NCE OR OISALLOWANCE d 'O~'bEDtJC'ntiHi WMlJASSESSHENT OF TAK DATI 02-15-95 , ! ,~ FILE NO, DATE OF DEATH 03-02-94 COUNTY CUMBERLAND NOTE I TO INSURE PROPER CREOIT TO YOUR ACqq~TI\~UB~~ ~~.I U~ PORTION OF THIS FOR" WITH YOUR TAK PAYHENT TO THE REGISTER OF WILLS. MAKE ~~ECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT TOI AON 101 JANET SICIAK 349 BALD MTN RD BERNARDSTON t~IW\ 1 (I ~ 'I I , .!~iOfj ," ,1(0)atl REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MA 01337 A.ount R..ttt.d (i 7 .:3.?:> ,CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS .. . <~~M-\l-~.:'=":"~"~'~~ ~ ~ :",~:/~-:,_,:,,:,,,,,;,,:..,:,,;;~. \' ;~~.~.;,l"\..,_~;:.';,7.1 :~,~"~J~;~;~~!-:\:,~~~:':7J;~~-"'" .,,~~.~ .......... ~ !:....:o:' ':". ":':'".!'.,,:~. --: r.....--.~ ':":':'"............. .7"".T'.,7..~~. "'- ",,\ ~':.."1" .r';' I I I' ! ,~ I \ \ i ._\i " , . . t\ " .\ . I ~ " ll'~ \\ ~ ' "~. ,1' '11 ~~: " ":. '. f. , r.o ',I \ , I I' I " ,,;.. " I I ',Ii . , ",I ",r I' ; "\ . I; -,'-' I., I t .t '.\ ",tf t. , " " , . " , (,.,' ,"II, . ,,' Ji " ." " j' , " ,,I' \.: ,r , , ""'. .,' " " 'j' i I , I ,I .' jl " \\ .,. .. I' t . " ',' ; , 1",\ " ,. d' ". ,,' ", j; ,.' 'I ,. " j' .,j ,I " ' , , 'f'" ",' ,:,. ....,4 "...,:". r----. . r ~ "'7~f:,.t~~'- , ' I, " ' .J " ''l\' n"" '. ...j.. ..,....n_~' . . I 1,,1 'f: .--::~',' ..,.:'t..~ . j'-' ,Il"'''lf~~j:t~: II.'J ' " - "H ~ .' . . t /;,I'~ (1),,'-/1 REV.1547 EX AFP 112'94*1 i eOHHOHNEAlTU OF PENNSVLVANIA ACN 101 (OERARTHEHI OF REVENUE NOTICE OF INHERITANCE TAK BURF,AU Of INDIVIDUAL mE' ~PPRAISEHENT' ALLOWANCE OR DISAI.LONANCE 2:~S:~~~l~A 1111~:0601 --===r,--'- _ O::~:,~ION~:=SHEN~ OF TAK ~TE 02-15: urATE uF LOOI( MITI: FHE NO. 21 94-02,,~ DATE OF DEATH 03-02-94 COUNTY CUMBERLAND NOTE I TD INSURE 'ROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PDRTlON OF THIS FORH WITII VOUR TAK PAYHENT TO THE REOISTER OF WILLS. HAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAVMENT TOI = JANET SICIAK 349 BAL D MTN RD BERNARDS TON MA 01337 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 r=-====- AMount ROMlttod ~ CUT ALONG THIS LINE .... RETAIN LOWER PORTION FOR YOUR RECORDS ~ R 'EV: i5'4"; " i'lf"Aj:ji "( 1'2"-"94 "i"ileif iCE" "0 F"YNH iiii f AN"OE" 'fAx' ifP' PRA"i 8 EHEilr;" AL.1."OWANO Ii "iiri"""""""..""""""""" DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LOOK HELEN M FILE NO. 21 94-0229 ACN 101 DATE 02-15-95 TAK RETURN WAS, I ) ACcEPTF.D AS FILED ( X) CHANGED SEE ATTACHED NOTICE RiiiRVATION CONCERNING FUTURE INTEREST . SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL 1. Rool E.toto ISohodulo A) ll) 2. Stock. Ind Bondi ISch.dul. 8) (2) 3. Clo.oly Hold Stook/Portnor.hlp Intoroot ISohodulo CI (3) 4. Hortgogo./Noto. Rooolv.bl. (Suh.dulo D) (4) 5, C..h/Bonk D.po.lt./HI.o, P.rlonll Proporty lSohodul. EI (5) 6, Jointly O.nod Proporty (Soh.dulo F I (6) 7. Trln.for. (Soh.dul. 01 (7) a. Totol Au.h .00 .00 .00 .00 1.977,00 23.733. 40 .00 lal 25,710.40 APPROVED DEDUCTIONS AND EXEMPTIONS I 9,586,04 9, Funlrll Expln.I./Ado, Co.h/Hho, Exp.nl.. ISohldul1 H) (9) 10. Dlbh/Hortglgl L1lblll tI../Llln. lSohldul. I) llO) . 00 11. Totol Dlduotlon. 1111 12. Not Volu. of Tox Roturn (121 U, Chlrltlb11/GovornMontl1 a.qu..h (Soh.du1. J) ll3) 14. Not Volu. of E.totl Subj.ot to Tox ll41 NOTEI If an ..Iellment wee ilsued previously, linel 14, 15 .nd/or 16, 17 end 18 will reflect figuru that include the tot.l of M.h returns .lIeued to dat.. ASSESSMENT OF TAXI 15. Alount of L1n. 14 It Spou..1 rlto (15) 16. AMount of Lln. 14 tlx.b11 .t Llnll1/C11.. A r.tl (16) 17, AMount of L1nl 14 loxlb11 It CollotlrlllClou a rltl ll7) 1a. Prlnolpll Tlx Du. TAX CREDITS I PAVHENT DATE -rr:'16 - 94 q.I1A~ n4 16,124.36 .00 16.124.36 .00 16,124.36 .00 K .00, K ,06, K ,15, (lS) .00 967,46 .00 967.46 RECEIPT NUHBER MM913213 nISCOUNT (+) INTEREST I') .00 AHOUNT PAID 862.46 INTEREST IS CHARGED FROM 12-03-94 TO 02-23-95 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE 862,46 105.00 1. 99 106.99 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN H, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I REIERYATIlMII PURPOIE OF HOTlCE. "! .. " '. " " ,," t;.tlt.. of dlc.d.nb dvlng on or blfar. D.cllbtr 12, 1912 u If .ny future Int.r..t In the ..tat. h tr.n.ferrld tn pOI.,..lun or .nJoY~.nt to CI... B (0011I'.r.l) bln.flol.rl.. of the d.c.dtnt aft.r the 'Mplr.tlon of tny"",,;'or IU. or for vI.r., the Co..onwtllth h.r.by .Ilpr'..h r"trYIII the right to IIppr.l.. and ...... tr.",'" Inh.ritancI TalC.. .t the IIH'ul ell.. a (0011",ral) r.t. on any luoh future lnt.r..t. To fulfJl1 the r.qulr.".nh of Stotlon 21400' the InherJtanc. and Elt." hl( Aot, Aot 22 of 1991. 12 P.S. S.otlon 2140. PAVHF.HTI Dlboh th, top portion of thl. Notlc. and tUb.1t with your Plly..nt to the R,ght.r 0' WUII prlnt.d on the r'VIrIl lid.. -'Heke chICk or ..ne. order ,,,'b1e tOI REGISTER OF HILLS, AGENT All ply..nt. rlc.lv.d .h.ll flrlt be applJld to any Int.r'lt which eay bl due with any rl.llndlr appllld to thl tlM. REFUND (eR)1 A r.'und of a hM orldJt,whlch WII not rlqullhd on thl TaM Alturn, lIay b. rlqu.ltld by cOlplltlng an llApplloatlon for Refund of P'MIylvlnh Innlrltlnol and Eltat, TaM:ll (REV.1513). Appllcatlonl arl avallabll It the OfficI of the RIglltlr of Willi, In'lof the 25 Alvlnul Olltdot OfficII, or by call1nA thl IPlohl Zit-hour .nlwlrlng ..rvlcl nu.b.rl for for.. ordlrln~l In Plnn'vlvanlfl 1-800.362-2050, ouhlnl Plnlllylvlnla and withIn localllarrhburg ar.. (717) 7e7"1I09~; TOOl (717) 172-2252 (HI.rlng IIpllrld Only). ,OBJECTIONSI Anv party In Intlr..l not ..thflld NUh thl appr.I....nt, allowancl Dr dhal10wancI of dlducUonl, or .......ent of tlM (Including discount cr Jntlr..t) .. thown on thl. Notlcl lurt objl~t within tlMtV (60) days of r.c.lpt of thh Notlcl bYI uwrltt.n protllt to thl PA aIP.rt..nt of A'V.nul, Board of Appea1t, alpt. 2111021, Harrisburg, PA 1712b.1021, OR ....I.ctlon to havI the t.ttlr d.hrlltlnld at audit of thl account of the plrtonll rlpr...ntaUvlI, OR ulpPlal to thl Orphan.' Court. AIlIlIH IITRATlI'E CORRECTIONS I Factual .rror. dl.cov.rld on thl. a.......nt Ihould b. addr,.t.d In writing tOI PA D.part..nt of R.v.nue, Burnu of Individual TaM:u, ATTNI Po.t A.......nt R.vllw Unit, Dlpt. 210601, Harrllburg, PA 17121"0601 Phone (7171 787-6505. S.. p.gl 3 cf the bookl.t "In.truotlon. for tnh,rlta.,o, Ta)( Return for. 'Ruld.nt Dlcldlnt" (Af,V"1501) for an l)Cplanatlon of ,dllnl.trltJv.IY ccrr.ctabl. Irror.. OIlCOUHT. IHTEREST. If any tllC due h p.ld within thr.. Ul oallndlr lonth. aftlr thl d.eldent', dllth, a flvl plrclnt (5iO dltcount, of the taM plld t. alJowld. Jnter..t I. chara.d b.gJnnlng with flr.t dflY 0' d.llnqu.ncy, or nJn. (9) tonth. and on. (11 dlY frot the datI cf duth, to the dltl of plV"nt. TaMil whIch ble"1 dellnqulnt blfor. Janulry 1, 1982 blar Int.r..t It the rat. of .Ix <6iO p.rclnt plr Innu. cIlculated at a dallY rat. 0' .00016~, All to)('.. which b.oa'l dlllnqulnt on and after J.nulrY 1, 1982 will bear Intlrl.t It a ratl which will vary fro. callndar Ylar to cal.ndar Ylar with that ratl announcld bv thl PA D.pnrtllnt of Rlv.nu.. The appllcabll Int.r..t rat., for 1912 through 1995 .r., '!m Inter..t Ratl ~nt.r..t Factor !!!or Intlr..t Rlltl DailY tnt.re.t Factor 191Z m .00054A 1987 9% ,000:!47 19S! 16~ .000438 1988-1991 IIX .000501 1984 l1X ,000101 1997 9X .000747 1985 m .000IS. 1991'1994 IX .000197 19U lOX .000774 1995 9X ,000747 ..tnter..t 11 caloulat.d .. 'ollow., INTEREST' BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTERErT FACTGR ."Any Notlcl IlIuld Ifllr thl tlM b.cot.. dlllnquent will r.U.ot an int.rut caloul,tioll tc flftHn (1S) d'y, b.yond the d.t. of thl "'.I".lnt. If paY.lnt ,. .,de "ftlr thl Intlr.,t cOlputatlon d.t. 'hown on the HoHn, addltlon'l Int.r..t I\l.t be calcul.tld. ,',I, '. , 'I I II" i ,I \ I I ! \ \ I II ;1 Ii /&1.1 .~.- fJ;Q,[iJ/.-. 6('(; ,/1':1'( / (' AON 101 " L1/ II / 'RlVo1607 IX AFP (12094* COHltONlIEALTH OF PENlISVLYIHIA DEPIRTHEHT OF REVEHUE ~ IUREIU Df IHDIVIDUAL TAME I DEPT. 110601 HARRISBURD. PI 17111-0601 / .' ! I /~ 1/ XNHIlIUTANCII TAX STATIMIINT OF ACCOUNT DATI 0~-27-95 LOOK DATI OF DIATH 03-02-94 HOTEl TO INSURE PROPER CREDIT TO YOUR ACCOUNT. IUIHIT THI UPPIR PORTION OF THII FOR" WITN YOUR TAM PAVHENT TO THE ADDRESS SHOlIN, MAKI CHECK PAVAILI AND AI"IT PAVNINT TOI , HELEN M S~b~T~O. ~OMZ~Rm JANET SICIAK 349 BALD MTN RO BERNARDSTON MA 01337 REGISTER OF WILLS CUMBERLANO CD COURT HOUSE CARLISLE, I'A 17013 t_.~-A..lHirRHiIT'd 1 CUT ALONO TH:t8 LlNI ... RITAIN LOIIIR !lORTlON I'OR YOUR I'ILII ... R iV: Hilij - iic -Ai: p -r 1'2':94 Y - - -".. ii ~ii - f llifirU YAilai- -fA j(" iTA "f iHi"Nf - '0-" - Aifci6uN'T"' iiiil".... 0 ...... -. - 0 0" - 0 ISTATE OF LOOK HELEN M I'ILI NO. 21 94-0229 ACN 101 THIS STATEMENT IS PROVIDED TO ADVIIE OF THE CURRENT ITATUI 0' THE ITATED AcN IN THE NAHED ESTATE. SHOWN BELOW IS A SUMHARV OF THE PRINCIPAL TAK DUE, APPLICATION OF ALL PAV"ENTI. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJE~ICD INTERIIT FIOURE, DATI 03-27-95 DATE OF LAST ASSESSMENT DR RECORD ADJUSTMENT, 02-06-95 PRINCIPAL TAX DUE, 967.46 PAVMENTS (TAX CREDITS), PAVMENT DATE 11-16-94 03-07-95 RECEIPT ,-, -_u""iifsCOUNT 1+1--' NUMBER INTEREST (-, ._--~ ----......,.---"---. MM913213 ,00 AA022922 2,30' AMOUNT PAID 86~ro .' :o:I1 loii, '0 \n 11" (.' I';: ~-: " " , , ; ~. ;, \, \ I" .' :..':t " ~. ~ v;- (,1 'U" t \ ):';:1 ..;. , J H IF PAID AFTER THII DATI. III RIVERIE SIDE FOR CALCULATION OF ADDITIONAL INTIRIIT, I IF TOTAL DUI II LIII THAN II, NO PAVMENT II REQUIRED, IF TOTAL DUE II REflECTED AI A "CRIDIT" ICRI, YOU HAV IE DUI A RIFUND. 1r.1 RIVIRII IIDE OF THII FORN FDR INITRUCTION.. I TOTAL TAX CRIDIT .ALANO' OF TAX DUE INTlRBIT TCTAL DUll 967.46 .00 .00 .00 ,i :_~: i " . .,-J -"iil " 1 ,:,1 !-,I 1_" '.""1 }.""I ( I I .1 PAYItI!Nh 'i, " . .' .1 ,I. ,. 'DtllOh the top portion 01 thh Hotlol ond .ubolt with "." ply_t 10<10 Plyobl. I. lhe 'n_,ond tdcf".. prJn'~ on thl r.v.r.. Ildl. .. II RESIlIENT DECEDENT lokl .hICk or ..no crdor PIYlbl1 tal REGISTER OF WILLS, AGENT. -. If HOI/-RESIIlEHT DECEDENT lokl .h.ak or oonoy ardor P'Y"" 101 COltltONWEALTH OF PENNSYLVANIA. AU plw..nt. ,.calvld .hell b, ",pllld fir It to any lnt.r..t which '.y bt M with any r...Ind4r 'Pplltd to thl tllC. REFUND (CA)1 A r.fund of . tile crldlt, which WI' not r.qul.tld on thl Tlx Rlturn, "Y b, rlquelttd by cOlplttlng In "Applloltlon for Rlfund of PIMlvlvlnl1 Inh.rltlnCo 1M Elt.t. Tlx" (REY.UU), ApplJclUonl Ir. Iv.Ulbh It the OfflcI of tne A,gllbr of NUll, tny of the 23 R'vlnut DhtrJct OfUcII or 'rol thl Dlp,rt.,nt', 24.~r .,,1.,.r1"8 ..rll101 ~'rI for foru orderlngl In PenneYlvante 1-800-362-20S0, outalde Ptnn.yhan', and within 10cll H,rrt.burg .r.. (717) 117.10~, TDD' (717) 77Z~Z252 (Hearing I~alr.d only), REPLY TOI DISCOUNT I INTEREST I Ou..tlon. regarding error. cont.tn.d on thl. nottc. Ihould bt eddrl..1d tOI PA Deplrteent of Rtvenut, lur.au of Inefly'dual TaK", A1TNI Po.t AI......"t Aevl." ~It, Dlpt. 280601, Hurltburg, PA 17128.0601, phont f1I11 111'6505. If .nv tlx due 11 p.td within three (]) cellndar eonthe eft.r the d'Cldent'. d..th, . 'Iv. p,rc,nt UlO dlleo""t of ttMI tlX p,ld II IUowetl. Inter..t II chlrged beginning with tlr.t dey ef dlllnquencv, or nln. (,) eonth. end one (1) dlY fro, thl dat. of dI.th, to thl dlte of ply,.nt. TIXI, which btc... d.llt~nt before Janutrv 1, 1982 b.lr tnt.r..t It thl rlt. of .IM (6X) p.rc.nt plr annUl cllculated It a dillY rat. of ,000164. All t'XI. which bee... d.llnquent on and .ft,r JlI'IUlry 1, 1912 wUl bltr Int.r..t et . rate Nhlch wUI vary frol otlenetlr YII, to ellan., YIU with that rlt. lnnOunotd by thiPA o.p.rt..nt of A.vlnul, The ftPPllcabll Int.r..t ret.. for 1982 throuJh 1995 .rll Vllr Int.,...t Alt. Oath Intlr..t Faater VI.r Intultt R.t. D.llY Intlr..t F.oter 1911 ZOX .0005\1 1911 9X .OOOI~1 1911 IU .000\11 19"'1991 IIX .000301 191\ m .000101 1992 'X ,000241 1915 UX .000156 1991'1~ 1X .000192 1916 lOX .000114 1995 'X .0001\1 ulntlr..t I, calculatld a. follew'l INTEREST . IALANCE OF TAX UNPAID X NUNIF.I OF DAYS DELINQUENT X DAILY INTEREIT FA~DA ..Any Notice It.uld ,ftar the tex bleo... d.llnquent will reU.ct an Intarllt ellcullUon to flftttn UI) dI~, blyond thl dlte of thl ........nt. 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