HomeMy WebLinkAbout94-00243
N 21--94- 243
O.
Estate of
PAUL B. WIENER
, Deceased
DECREE OF PROUA TE AND GRANT OF LETI'ERS
AND NOW MARCH 11th 19-2L.in consideration of the petillon on
the reverse side hereof. satisfactory proof having been presented before me,
IT IS DECREED that the inllrurnent(s) dated May 7. 1986
described therein be admitted to probate and nted of record as the last will of PAUL B. WIENER
and Letters TESTAMENTARY
are hereby granted to EVELYN JF..AN WIENER
FEES
Probate, Letters, Etc. ........, 5 25.00
Short Cenincates(3) ...'""" 5 9.00
1U~..nwl( .X.,PGS..".",. 5 15.00
,lCP L 5.00
TOTAL _ 5 54.00
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. AliORNEY :S:: eX:,)
LAURI A. LAFOE, ESQUIRE 68143
SUITE 500, KELLON SANK BUILDING
HARRISBURO"'DDRESS PA 17101
717-236-9581
PHONE
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COMMONWEALTH OF PENNSYLVANIA' OEPAATMENT OF HEALTlt. VITAL AEoanos
CERTIFICATE OF DEATH
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_._--_._-------~_.......-
IDu,ut lWI ill u~~ ([tstttment
PAUL B. WIENER
,
I. PAUL B. WIENER, of 1921 Robinson Avsnue, Havertown.
Delaware County, Pennsylvania, declare this to be my last Will,
hereby reVOking all prior wills and codicils.
FIRST: The expenses of my last illness
--
and funeral shall be paid from my estate.
SECOND: I hereby give and bequeath,
absolutely and in fee simple. to my spouse, EVELYN JEAN WIENER,
all my household furniture and furniShings. books, pictures,
jewelry. silverware, automobiles. wearing apparel and all other
articles of household or personal use or adornment, provided that
if my spouse dies before the thirtieth (30th) day following the
day of my death. this gift shall lapse or be divested and I make
said bequest to my issue, per stirpes, living at the time of my
death. to b~ divided among them as they shall agrea. If they
cannot agree for any reason, my Executor shall make the decision
and its decision shall be final.
My Executor shall represent any minor child j,n any
division of such property and shall deliver to the person standing
in the place of a parent to such minor, without bond. such portion
of the minor'S share as my Executor, after considering the minor'S
wiShes. deems appropriate and shall sell the balance and hold the
proceeds for the benefit of said minor under Item FOURTH hereof.
THIRD: I give and devise the residue of
my estate, real and personal, to my spouse, EVELYN JEAN WIENER, if
she survives me. If she does not survive me, I make said bequest
Page 1
fBtJ
and devise to my children, 1,lNDA J. OLSEN, of nillsburg, York
County, Pennsylvania. and DONNA W. JORGENSEN, of Boyertown, Berks
Count~', Penney 1 vania. in equa 1 shares. If ei ther of my sa id
children is not living at my death. the share of said deceased
child shall be paid to the then living issue of said deceased
child, per stirpes. If either of my children dies without issue
surviving, that child's share shall be added to the share of my
other child or her issue, as the case may be.
If no issue of my children survive the survivor of my
said spouse and myself, the remaining undistributed principal and
accumulated income shall be divided into two equal shares and one
share shall be paid to my heirs who would be entitled thereto
under the Intestate Laws of Pennsylvania in effect at the death of
the survivor of myself and my SPOUllE'; and the other share shall be
paid to my spouse's heirs who wonld be entitled thereto under the
Intestate Laws of Pennsylvania in effect at the death of the
survivor of myself and my spouse as if my spouse had then died
Intestate.
FOURTH: I appoint my Executor as
Guardian to hold for minors all property payable by law to a
guardian appointed by my Will and use the same for the minor's
maintenance and education, either directly or by payment to any
person selected to disburse it, whose receipt shall be a complete
acqui t tance therefor. All. unexpended income and princi pa 1 shall
be paid to the minor at majority. For purposes of this Will,
majority shall be construed to be when the individual attains the
age of twenty-one (21) years.
FIFTH: No provision of this Will is
intended to exercise any power of appointment. including any power
of appointment granted me under my spouse's will.
Page 2
J/pL
SIXTH: All taxes, interest and
penalties thereon payable by reason of my death with respect to
property comprising my gross estate, whethsr or not passing under
this Will, shall be paid flom the principal of my residuary
estato. provided however, that funds of my Trust created herein
may be used to pay taxes, intorest and penalties attributed to
such trust assets. Taxes on future interests may be prepaid.
SEVENrH: No interest of any beneficiary
under this Will or any codicil hereto shall be subject to
anticipation or voluntary or involuntary alienation, and the
personal receipt of such beneficiary shall be the sufficient and
only discharge of my Executor unless otherwise provided herein.
EIGHTH: In addition to powers given
them by law, my Executor and and her successors and any guardian
acting hereunder shall have the following discretionary powers
applicable to all real and personal property held by them,
effective without court order and until actual distribution:
(a) To retain all property received by them including
the stock of any corporate fiduciary acting hereunder, provided
such property remains productive:
(b) To invest in all forms of property without
restriction to investments authorized to fiduciariesj so long as
such investments are productive:
(c) To compromise controversies;
(d) To hold investments in the name of a nominee; and
Paqe 3 ~I$ ~
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Tellt~lllent, in the presenoe of us, Who at his requElBt, in his
pr~8.no. and in the presence of each other, have hereunto
subscr.1bed our names as wi'tnesses:
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COM~m~~m'~"Jb~~~'tr1)'b~ANIA
HARAI9B~~~,V~ 17128-0801
/'-/-17'7- II
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS
COUNTY CODE
AEV ~ 1500 I::X tfllag1)
FOA OATES OF OEAlt( AFTER l~lJlftl CHECK HERE
IF"SPOUSAL 0
POVERTY CAEOlllSClAlMEO
FILE NUMBER
I
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ctc
K K
S
8 b
R N
R D
~ ~
COMPLETE MAILlNO ADDRESS
HETRICK ZALESKI ERNICO & PIERCE
10 S MARKET SQ., SUITE 500
HARRISBURG PA 1'1101
(1) Non,!!
(2) None
(3) None
(4) None
~) _ 1,100,00
DECEDENT'S NAME IlAST, FIRST, AND MIDDLE INITIAL)
WIENER, PAUL B.
orcEOENT'S COMPLETE ADDRESS
930 VALLEY STREET
ENOLA, PA 17025
SOClAlSECUAITYNUMBER
189-18-0250
X j, Original Rolurn
Courlly
CUMBERLAND
---03,
06,
04,
[]e.
041.
07.
Limited Eslate
Fulura Interost Compromlso
(for dalos 01 doalh altor 12-12-82)
DOClldonl Malntolnod a Living Tru'l
(Ahach a copy 01 Trusl)
Decedonl Dlod Tostate
(Anach copy of Will)
o e,
^LL COftRI!SPOHDI!NC! AND CONFIDI!NTlAL TAX INFORMATION SHOULD 81! DIRECT!D TO:
NAME
UURI A UFOE ES UIRE
R
E
C
A
P
I
T
U
L
A
T
6
N
TELEfiHONE NUMBEA
717 236-9581
1, Roal EOlato (S<:hodulo A)
2, Slocks and S<:nds (Schodulo B)
3, Closoly Hold Slock/PMnerohlp Inlerost (Schodulo C)
4, Mortgegss and Noles Recolvablo (Schedulo D)
6, Cash, Bank Doposlts & Mlscellanoous Poroonal Proporly
(Schedule E)
e, Jolnlty Ownod Proporly (Schodulo F)
7. Transfers (S<:hedulo G) (Schedulo L)
e, Total Gross ASSOls (tololllnos 1-7)
8, Funeral Exponoos, AdrnlnlstroUvo Cosls, Mlscolionoous
Expenses (S<:hodule H)
10, Dobts, Mortgage L1ablllllos, Liens (S<:hodule I)
11, Total Deducllons (Iotalllnos 9 & 10)
12, Net Valuo 01 Eslalo (II no 0 minus IIno 11)
13, Challlablo and Govommenlal Bequosts (Schodule J)
14, Not Valuo Subject 10 Tax (1lno 12 minus line 131
16, Amounl of line 14 taxable al 6% rolo
(Includo voluos from S<:hedule K or Sonodule M,)
1e, Amount 01llno14 taxable at 15% rato
(Inelud. valuo. from S<:hedulo K or Schodulo M,)
17. Principal I"" due (Add lax from line 15 and from II no 16,)
18. Crudlto/Sp Povorly Prior Paymenls Discount
Intoresl
(8)
(7)
None
-0'
(9)
4,082,00
800.00
(10)
219/,-0243
VEAR
NUMDER
Romalndor Roturn
(lor dalos of doath prior to 12-13-82)
Fodoral Eslalo Tax
ROlurn Requlrod
Tolal Number of Safo Doposll Bexos
(8)
1,100,00
(11)
(12)_
(13)
(14)
(J . 782 , 00) x ,06 .
4,882,00
(3.782,00)
None
(3 , 782 ,00)
0,00
(16)
~
(18)
0.00 X,15'
0.00
C
o
M
C
X
b
N
+
+
18, If IIno 181s groalor than IIno 17, onlur tho dllforonco on line 10, This Is tho OVERPAYMENT.
~ 0 IChlOk her. If you II' requu~ng I refund 01 your oVlfPlymln1.1
20, If IIno 17 Is groalor than IIno 16, onlor tho diNorunco on IIno 20, This Is Iho TAX DUE,
A. Enter tho Inlorest on tho bolanco duo on IIno 2M,
B, Entor Ihololal of IIno 20 and 20A or, IIno 206, This Is Iho BAlANCE DUE,
Mlkl Ch.ok Payable to: RllIlat" 01 Willi, Agenl
. . BE SURE TO ANSWER All QUESTIONS ON PAGE 2 AND TO RECHECK MATH 4 4
Und.r plnllll.. 01 ptrjurv, I dlel.,. thaI I hlVI ..,mln,d Iii,. '1luln, InCluding accompanying 'ch.dulu lnrl.llt.mantt, and to thl bOlt 01 my knnwltdg'lnd b,ll,f, III. IruI,
eorllct Ind compl't.. I tllclll'lhalllt lulllllll hu bun ,.pOtl.d I' "UI mlrk't ....luI. Utell'lllon 01 JH'p.'tI olh., thin thl pIIlon.! flprUlIlltllv.l. bind on IlIlnlormllion of
which pr.p.'" hutnv knowl.dgt.
SIGNATURE OF PEASON flESPONSIDLE FDA FII.INQ RETunN ADDRESS
(17)
0,00
(18)
(19)
0,00
0,00
(20)
(20A)
(20B)_
0,00
0,00
0,00
DATE
93'6 'ViiLi.f:Y' .sTilEF.T............. - - -............,. -..
kii6iX,' .,i;.....j 7ciis........ ...... -.... ........ -.....
. A~~)
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~,~, IO~~O"""O~IY~"'"P''''S~'''''
ADOflES9
7 I,s'" 4
. .
DATE
HETR'CK ZALESKI ERNICO & PIERCE
W~: ;1~~~~~ :~~':;: ~:l!!tj{ :~99:::::: :::::::::::::::
HARRISlIURG, PA 17101
7 Is /14
FOlm (Ah',Il'91)
I.
REV-1810 U + (HI)
COMWl\l\l~~{\~W~tN'AN'A
I!STAT1! OF
SCHEDULE G
TRANSFERS
Ploaso Print or T e
FIll! NUMBER
2194.0243
PAUL 8, WIENER SS# 189.18.0250 11/20/93
THIS SCHI!DllLI! MUST IE COMPLI!T1!D AND FILI!D IF THE ANSWER TO ANY OF THE QUESTIONS ON PAGE 2 IS YES.
ITEM DESCRIPTION OF PROPERlY EXCLUSION TOTAL VALUE DECO'S DOLLAR VALUE OF
NUMBER Includ, nlme of the t'lnlf".., th,i, OF ASSET %INT, DECEDENT INTEREST
,.rallon,hl;' -10 d.udlnt. dati on,.n.llr.
1 PSFS "IN TRUST FOR" ACCOUNT 400,00 0,00'
TODD R. OLSEN, Grandson
2 PSFS "IN TRUST FOR" ACCOUNT 1100,00
HARK D. JORGENSEN. Crandson
"
,
.
,
,
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,
,
TOTAL (Also enter on line 7, RoolUlltulaUonl 0.00
(II more epacels nooded, Insan addltlona' sheels 01 same size,)
COPyt'lllIht{ol 1111 form loflwarl only Clnt., PlICt Sollwlt., Inc,
Form '100 Schldule Q (RI", "111
SCHEDULE N J
SPOUSAL POVERTY CREDIT
COMMONWEAL TH OF PENN9VlVM!I'\
INNERI1ANCE TAX DMOION (AVAILABLE FOR DECEDENTS DYING AFTER 12131"11
ESTATE OF FILE NUMBER
PAUL B. WIENER SSII 189.18-02.50 ll/.?0/93 2194-0243
Thl9 schedulo mU9t bo complotud and filod II you chockod Iho opousal povorly crodlt box Dn tho cover ohool.
rPART I - OALCULATION OF GROSS ESTATE
REV-II" EXII-92)
J
1. Taxable A990tsIDI.llrDm IIno 8 (covor 9hool) , , , , , , , , ,
.."".' 1.
1 100,00
2. In9uranoo Procood9 on Lifo 01 Docodonl. , , , , , , , , , , , , , , , , , , , , , , , , , , " , , , , , , , , " 2.
0,00
3, Rollromont Bonoll19 , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , " 3,
0,00
4, Jolnl A990t9 wllh SpOU90 , , , , , , , , , , , , , , , , , , , , . , , : , , , , , , , , , , , , , , , , , , , , " 4.
0,00
8. P'" Lollory Winnings, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , " ,,','" 8.
0,00
Sa, Olhor Nonlaxablo A9so19: List (AIIach 9cho~ulo II noco9s91'/), , , , , , , , , , , " Sa,
0,00
Sb.
80,
Bd,
e. SUBTOTAL (Un09 8a, b, 0, d), , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , " 8.
0,00
7. TDlal Gr09s AS9019 (Add IIn09 1 thru 8), , , , ,
""""'" '.""""""'"
, , , , , , " 7,
1 100,00
I, Spouso""""""""""""
b. Docodsnt""""""""""",
o. Jolnt."",""""""""""
d. Tax Exsmpt Income, , , , , , , , , , , , , , , , , ,
I, Olhor Income nol1l910d above, , , , , , , , , , , , ,
I, TOlal"""""""""""
4. Averago Joint Exsmpllon Incomo C91culallon
oil, Add Joint Exompllon Income IrDm abovs:
(1f) 0,00
8. TOlal Actual Uablllllas , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , " ij,
I, Nat Value 01 Eslalo (Sublract IIno 81rom IIno 7) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
II line 1 Is grealor than $200,000 - STOP. Tho eslalals not ellglblo to claim tho crodll, II nOI, conllnuu to Part II, I. 1 , 100, 00
PART II - CALCULATION OF JOINT EXEMPTION INCOME - (Attach cople, of Federal Individual Income
Ta. Return, for dlCedent and, ute.
1. TAX YEAR: 1190 2.
11. 0,00 21,
lb, 0 ,00 21>,
10, O. 00 20.
la. 0 . 00 2d,
II. 0 ,00 21,
11, 0,00 :/1,
0,00
Income:
TAX YEAR: 1891
0,00 341.
0,00 3b.
o ,00 30.
O. 00 3d,
0,00 31,
0,00 31.
3.
TAX YEAR: 1192
0,00
0,00
0,00
0,00
0,00
0,00
.(~
0,00 +(3f)
0,00
.
0,00
~
0,00
4b. Avsrago .Iolnl Exampllon Income, , , , , , , , , , , , , " " , , , , , , , , , , , , , , , ,
IIlIno 4(b) Is grealor Ihan $40,000 - STOP, Tho 081alal9 nOI ollglblo to claim Iho crodll, II nOI, conllnUD to Part III,
I PART 1.11- CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT
. ESTATES
.
1. Insort amount 01 taxablo Iranslors to 9pOU80 or $100,000, whlchover Is109s, , , , , , , , , , , , , , , , , , , " 1.
0,00
2. Mulllply by crodl' porcenlago (aoolnslrucllons) , , , , , . , , , , , , , , , , , , , , , , , , , , , , , , , , , " 2.
3. This Islho "mounl 01 tho Rosldonl Spousal povmly Crodil. Includo thlsllgulo
In the calculallon ol1olal crodlla on IIno 18 Dltho covor ohool , , , , , , , , , , , , , , , , , , , , , , , , , , " 3,
4. Fo, Nonrosldonto, onlo' Iho ,olio Dllho docDdont'a grooo o'lalo In PA to Iho valuo 01 tho
decodont's groso ollalo, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , " ""'" 4.
8. Mulllply IIno 3 by IIno 4 and onlOl thu lolal hOlO, This 191ho amount 01 Iho Nonrosldonl Spousal
povorly C,odlt, Include Ihl911guro In Iho calculallon ollolal crodlts on IIno 18 01 tho covor 9hool. S.
Copyrlght\c) 111111 form .nflw""ollly C,lll., PI't. SolhUlt, Ino.
1,,00%
0,00
0,00
0,00
SChldul,N (A,v, 10021
\"
I
HAHHIt;BURU, I'I!NI'~Y~VANI" I/IUU
.-_. '.
,~ -
-
mast ltltt ill n~F aJ:ef.itmn:ent
PAUL B. WIENER
I. PAUL B. WIENER, of 1921 Robinson Avenue, Havertown,
Delaware County. Pennsylvania. declare this to be my last Will.
hereby revokinQ all prior wills and codicils.
.
FIRST:
The expenses of my last illness
and funeral shall be paid from my estate.
SECOND:
I hereby give and begueath,
absolutely and in fee simple, to my spouse, EVELYN JEAN WIENER,
all my household furniture and furniShings. books, pictures,
jewelry, silverware. automobiles, wearing apparel and all other
articles of household or personal use or adornment. provided that
if my spouse dies before the thirtieth (30th) day following the
day of my death, this gift shall lapse or be divested and I make
said bequest to my issue, per stirpes, living at the time of my
death. to be divided among them as they shall agree. If they
oannot agree for any reason, my Executor shall make tho decision
and its decision shall be final.
My Executor shall represent any minor ohild in any
division of such property and shall deliver to the person standing
in the place of'a parent to such minor, without bond. such portion
of the ,minor's share as my Exeoutor. after considering the minoris
wishes, deems appropriate and shall sell tho balance and hold the
proceeds for the benefit of said minor under Item FOURTH hereof,
."
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THIRD:
I give and devise the residue of
my estate, real nnd personal, to my spouse, EVELYN JEAN WIENER. if
she survivee me. If she does not survive me, I make said bequest
Page 1 few
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and devise to my children, LINDA J. OLSEN. of Dillsburg, York
County, Pennsylvania, and DONNA W. JORGENSEN, of Boyertown, Berks
County, Pennsylvania, in equal shares, If either of my said
children is not living at my death, the share of said deceased
child shall be paid to the then living issue of said deceased
child, per stirpes. If either of my children dies without issue
surviving, that child's share ehall be added to the share of my
other child or her issue, as tho case may be,
If no issue of my children survive the survivor of my
said spouse and myself, the remaining undistributed principal and
accumulated income shall be divided into two equal shares and one
share shall be paid to my heirs who would be entitled thereto
under the Intestate Laws of Pennsylvania in effect at the death of
the survivor of myself and my spouse; and the other share shall be
paid to my spouse's heirs who would be entitled thereto under the
Intestate Laws of Pennsylvania in effect at the death of the
survivor of myself and my spouse as if my spouse had then died
Intestate.
FOURTH:
I appoint my Executor as
Guardian to hold f.or minors all property payable by law to a
guardian appointed by my Will and use t.he Rame for the minor I s
maintenance and education, either directly or by payment to any
person selected to disburse it, whose receipt shall be a complete
acquittance therefor. All unexpended income and principal shall
be paid to the min~r at majority. For purposes of this Will,
majority shall be construed to be when the individual attains the
age of twenty-one (21) years.
FIFTH:
No provision of this will is
intended to exercise any power of appointment, inoluding any power
of. appoi ntment granted me under my spouse's wi 11.
Page 2
Pdw
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" " (e) To undertake any and all acta deemed necessary and
proper by it for the proper and advantageous administration and
settlement of my estal-e.
NINTH:
Any person, other than my
"
spouee, who shall have died within thirty (30) days of my death,
shaU"be deemed to have predeoeased me. If my epouse and I cUe
. . ,l '.' . "
's'imulta'neouIl1y, or under suoh oiroumatanoes that the order of our
deaths oannot be established by proof. my spouse shall be deemed
to have survived me. Any person (other than myself) who shall
have died at the same time as any then recipient of inoome or in
a oommon disaster with suoh benefioiary, or under suoh
oiroumstanoes that it is diffiou1t or impossible to determine who
died first, shall be deemed to have predeceased suoh
benefioiary.
TENTH:
I appoint my spouse, EVELYN
JEAN WIENER, as Executrix (herein referred to as my Exeoutor) of
this my Will. In the event my said spouse oannot aot or oontinue
to aot as Exeoutor for any reason, I appoint my daughters, LINDA
J. OLSEN and DONNA W. JORGENSEN, to aot together in her plaoe.
No fiduoiary aoting hereunder shall be required to post bond or
enter seourity in any jurisdiotion.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal, this 7~ day of V\I\ ^1- ' 19 J4~ to this
and the preoeding three (3) pages, and I have also pl~oed my
initials on eaoh preoeding page for better identifioation and
greater seourity.
fow-e B. ()J~
PAUL B. WIENER
, (SEAL)
SIGNED, SEALED. PUBLISHED and DECLARED by the above-
named Testator, PAUL B, WIENER. as and for his Laet Will and
" -""'"
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,...-..-.,................. ......_....,.."..."'.H~....... _.
Testament, in the presenoe of us, who at his request/ in his'
presenoe and in the presenoe of eaoh other, have hereunto
subscribed our names as witnesses:
~" J .J ..,;7. ~ ~....
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\ RIV-1547 IX AFP 101.94*
COIIlOIM:AL11IllF P(lMVLYAHII
DEPIIITllEKTllFM\'fHUE
IIJl!All 01' INDIYIDU.lL TAllII
DEPT. r,oul
HARRIIIURG, PI 171/'-0601
/1'/
t
NOTICE OF INHERITANCE TAM
APPRAISEMENT, ALLOWANCE OR OISALLOWANCE
OF DEDUCTXOHS AHll ASSESSMENT OF TAM
ACN 101
DATE 11-14-94
FILE NO.
DATI! OF DI!ATH 11-20-93 COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO YDUR ACCOUNT, SUJHIT THE UPFER PORTION OF THIS FORM ~ITH YOUR TAM
PAYliENT TO THE RESISTER OF WILLS. HAKE CHECK PAYABLE TO "RESISteR OF WILLS, ASENT"
REMIT PAYMENT TOI
LAURI A LAFOE ESQ
HETRICK ETAL
10 S HARKET SQ STE 50
HBG PA 17101
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
I
AlOunt R..lttld
J
CUT ALONO THIS LINI ... RETAIN LOWIR PORTION FOR YOUR RECORDS ~
REV: i5W-ix"AF P- i oe: 94"1" -NoTicE" "oF - YHHEiiiTAifcE" 'fAX" APPRA-i ;iilENr;-" n"owAifc E ",(ili""- - ""- on" - - - -..
DISALLOWANCE OF DEDUCTIONS AND ASSESSM!NT OF TAX
ESTATE OF WIENER PAUL B FILE NO. 21 94-0243 ACN 101 DATI! 11-14-94
TAX RETURN WAS I (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONC NINO FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE 0 RETURN BASED ONI ORIGINAL
1. RgIl Edatl ISohldull Al III
2. Stock. and Bond. (Sehadula BI (2)
S. Cle.lly Hald Stock/Plrtner.hlp Intarut (Sehadulo C) (5)
4. HodSlgal/Notl' Rlellvabla (Sehedula D) (4)
S. Cllh/Bonk Dapolito/Mho. Plr.enll Proplrty ISohedulo E) ISI
6. Jointly 0Wnad PrlltHlrty (Schedull FI 161
7. Tr....flrl (Sehlduh 01 171
a. Totll Alllto
.00
.00
.00
,00
1,100,00
,00
.00
la)
1,100.00
APPROVED DIDUCTIONS AND EXEHPTIONS,
9. Funarll Exp.".I./Ada. COlto/Mho. Ex...".I. ISchadull HI (9)
10. Dabto/Hortg_ LIIbIUUal/LIIl1. (Schedull Xl nOI
11. Totll Deduction.
12. Net Valua of Tlx hturn
15. Chlritabla/Go.lrMelltal BlqUllt. (Schedull J)
14. Net Valua of Elhta Subjocl to Tax
4,082.00
800,00
III I
112)
liS)
114)
4.A82 nn
3,782.00-
.00
3,782.00-
I
NOTEI
If an ....a...nt w.. 1..u.d pr.v1ou.ly, 11n.. 14. 15 .nd/or 1&, 17 .nd 11 will
refl.ot f1gur.. th.t include the tot.l of Akh r.turn. .......d to d.t..
ASSESSHINT OF TAXI
15. AIKMrlt of Line 14 It Spou.al rlta liS)
16. AlOUlt of L1n. 14 tlxabla at L1neallC1II. A rata 116)_
17. AIKMrlt of Line 14 taxabla at Cellataral/Ch.. 8 rltl 1171
la. Prlnolpll Tax Duo
TAX CREDITS I
PAYMENT
DATE
.00 X ,00.
.00 X ,06.
,00 M .15.
lIa)
.00
,00
,00
.00
RECEIPT
NUttiER
DISCOUNT (+)
INTEREST (-I
AHOUHT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DU!::
.00
,00
.00
.00
.
M IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN .1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YDU HAY BE DUE
A REFUND. SEE REVE~SE SIDE OF THIS FORH FOR INS"RUCTIONS.)
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IlIIRIl'/ATlIlM' E.t.tll of doG_to dVI", on a. llefo,. _. 11,'1..1 ., If ony Mo,. Int....t In tho ..ht. Ia tron.forrod
in po'Hulon or enJoYMnt to Ch.. . (oou_t'rIU bInIflot.rS.. of thl dec.....t .ftlr thl IKPlrlUon of WlV IItltl for
11f. or for VII"', thl C~lth herebv Ixprul1y "urve. the right to Ippr'''1 end IIMII trlnd,r Jnhlrltenol TIXI'
I' thl llW'ul el... . (ooll1tlnU nt. on .w IUCh future lnt.rllt.
P\IIPOSf: Ill'
NOTICE, To fUlfill tho ,_1,_10 of heUon 1140 of tho IrI1I'It.... and E.t.t. Tow Aot, Allt II of 1"1. 71 P.I.
heUon 1140.
PAVllENT' DetlCh tho top po.Uon of thll NoUo. and ,ulloolt with y"", p.v.ont to tho R..lato, of Willa p.lntod on lho ray.... .Ido.
,.Itolc. _ or -..y o,do, p.....,I. to' REOIlTER OF MILLS, AIlEHT
AU pIYHnh rlOllvlld 1h111 flr.t be 1Pf11I1d to WlY Int.rllt which NY bI dull with IOY rMlln61r .,UId to the '_Xt
RUlICD CCRlI A nfWMt of . tlJC crldlt, which .... not ,.qullted on thl Tax Rlturn, MV btI ,....,ted by a_Ie Una In "Applto.Uon
for .lhnI n' P"'"''thlnl, ImerH.-.ollnd Elt,tt TI." (REV-U1J), ApfIl1cltlont Ir. IVlI1lbll It thl OfficI,
of thl ....tt,r of Nll1t, InY of thl Z3 RIVWlUe DlItrlot Off1~.., or by cIUlne thl ,peal.. 24"hour
InlWrlng ul'Yloe nullbtrl fpr far'l orderlngl In PIm.vlv.nle 1-100-"2-2050, outllde PtMlVlvenle end
wlthl" 1...llIIrr1ob\l,. .,.. 17171 711.109<1. TOOl (m) 171'1251 (HII,t", 1_I,od Only).
OUCT1OH1I Any Plrty In Inter"lt not 'IU.flld with tM .,nJlMInt, .11ow~1 at dl..U~e of deduotlon., or ..H.....,'
of tax <lnaludlng dlHCKI1t or Inter..t) It ItW*n on thit Notloe ""It objtot within 11Mb (60) dlYI of rlQ.lpt of
thll Motlo. by,
....written prattlt to thl PA o.,lrtMnt of RIVMUe, laird of Appnlt, Dt'PT, 211021, H1rrbbur., PA 17121-1021, ON
....IIaUon to hlv. thl_ttlt dtai:lr.lnId It MIdSt of thl 1000unt of thit perlOMlI reprllentlUvl, OR
.........1 to the Orphln.' Court.
AllIUM
IlTUTlI/I
C_CTlIlIlI,
reaMI Irror. dllOOvlrld on thlt .......,t llwuld bllddrelled In wrlUng tal PA Dlplrt.."t of RIVIfM,
lur..... of Indlvlul Taxll, ATTN1 Past A.H.....,' R.vl...lWllt, DEPT. 210601, ...rrltbur., PA 17UI....Ol
Phone (717) 717,,6101. 1M p... S of ttlt bookll' "Inltruotlon. for IMirltenol Tax Alturn for I Rllietent
OIoldent" (REV-UDU for en IICPllf'lltlan of IdIIlnhtrlUVllv oort"tlbl. Irrorl.
1N1!R11T ,
If ony tow duo II p.ld within th,.. m oolondo. oonth, .ft., tho doG..,t.. _th, . fly. po....,t (~l dl.....,t a'
the tu plld I. ,Uowd,
Int.,..t I. chI'tod bIIl...l", with flrot doy of dlll_y, a' nino (9) oonth. and ana (I) doY f... tho dlt. of'
dM\h, to thl detl of pa~t. TUI. which __ dllI~t blfar. JWlUlrv 1, 1.11 bMr Intlnl' It the rltl of
lhe (6X) Plroent per .,.,.. clloulltld It I delly tltl of ,000164. All taIClI which becIM delinquent on end IUlr
JarMry ., ..er Mill belr Int.rlet .t . rlt. which will Vlty IrM olltndlr VNr to clllndtr Velr with thlt ra'.
IMCMftId by thrl PA o.,.rtMnt of RIV..,., The eppUclbl1 lnt.rllt tit.. for 1912 throuth 19M Irel
DIICCUIll t
'!!!r Intlrllt ftltl OIUY INt.r..t FlOtar !!!r Inter..t Alt. D111l~ tntlrtlt Fltotor
1911 lOX .nOMa 1916 IOl .mm
191' IU , Q004S1 1911 9X .ooom
19M IIX .00asOI 19"'1"1 IU ,000101
I'll ISX .OOOS" 1"1 9X .ooom
I"S"I99<l n .000191
....int.r..t I. cIlcul.tld I' followll
INTBIIIT . IALANCE OF TAX UNPAID X NUftIBl OF DAVI DELINQUENT X DAILY IHTEREST FACTO'
"Any NoUo. IIII.,od .fh' tho t.. boc_, doll_l wUI Nfl..t on I"t.'"t o.loul.llon to flftoon (II) daY.
bewond thl detl of thl ..H.....,t. If PIYNnt II IIdI Ift.r the Int.rtlt o~t.t1on dltl Ihown on the
~tICI, tddltlontl Inttrt.t aul' ,be Gllcullt~.