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U.S. poslal Sorvice or CERTIFIED MAIL RECfljPT (DOIllllstw M,ll' Ollly, No ,"<;uwlll ft Cuvllr,U/fJ PfllVICtuc/J ~ ~~n.._.____ Po~lf1wk I Ho" I II', " ,',- "I ,\ ~ '~I 11 I I " " d' " ,I' ',",;'I \ .,1 I . 'r' . I .\ \1 , ...I . , .~ . I" \ ,0 . , , . " _________.--J ;;). II" U1 r'I Ul' ru CI CI CI CI .lI CI CI CI CI I'" f1o~lJlJO -.--------..---.-- Cllfl1t1odl"oo ..----.---- Aolurnflnr.eplFoo \EndOaemonlll!}(III'lIll.!1 A8~lrlCled Dolwery rOtI \[r.dOf.emo)nlll'<l{~!odl --.--- .--- TOI,I Po,t.g. &,... ~___~__ ,. " I " ," I " " " .. '...'" I ,. " /' "'" '" I' I, , I I' ,. :' ", " ",.. ,. .." ,.'.. ,.-..,' ., "J:,.,< '.~',......,_.._.. ,." - ,,""'I.~MII "',~~"~", . ~'" ,. " " ,I " ,. 'I, , " (. " ., IlII ~,' ',I ~,' , ,I' \ ,. r , 1,".1 ., . ',1 , ,I , , I~ , '~ I I I' i , _1f- ,~- TJr-.'\...'. " , I ~ PETITION .'OR (;RANT 0.' LETTERS 01<' ADMINISTRATION ES,lIue of ~..;;4!~'frf,---.l}~~U. ~o: h-.__d.I.:qy~.JjJ.l__ a/so know" as -=--.. .:;. _" . __c= 10, ___'m _.....h_,_._. Reglsler of Wills for Ihe . .__"_h., /)1'('('11.\('(/, Cauuty of .~~~BERLAN-'L- In Ihe Sol'la/ Sewr/ty No. -1.iZL.",-~J-"-.,,:J.t._~~,1.. Conunonwenlih of I'ennsylvnnlll The pelltlon of the underdgncd rcspeelflllly reprcscnts Ihul: Your PClliio~lCr(s), ~~o Is/~~c~~.~n:s of agC~lr,,~I~~e~~_~IPI_~::"::_::,~. fo~~ellers o~l~di~~I~::~~~I~~ (d.h.II,; pendente lile; ,hulIulc nh\Clllla: tlurulllll IIIhwrilUIC) the above decedent. Deeendent WIlS domiciled al dClllh In (~(JjjJJ_f(fj...!!_Iy.jL_..__ Coullly, I'ennsylvllnla, wllh h.j S last flll11l1y or principal residence III _1)., __".f1Jf'LJ.-':D-Y-_.Cd.",uc ..J:LEs:.M,,v Ie 5 [JUIf'C (Ihl Slrl'cl, IHlllIfu'r-lllld Il1Ullldplllll~') Deeendcnl, Ihen _~....::?_ ycars of IIge, died m___,_.,,,t,,_,,.~_A3___, 19 Cflf- .., lit '~J (J,e~,"-'b7 "G1...I,/_L..u...,(i.U'j_'tf.(lIV((J:L~L<'/,) C--___ Decendenlal death owned properlY willi eslillluled values as folllows; (If domiciled In I'll,) All pmonal propcrlY (If not domiciled In I'll,) Personal properlY in Pennsylvania (If not domiciled in I'a,) Personal properly In County Vlllue of real eslnle lu I'ennsylvllnla silualcd liS follows: ---------,_____u_.._ $1~.,~_, $----- $---,--- $ ..-...----------------,..... ------------. Pctilloner__ llftcr a propcr search ha___aseerllllned that deeedenllefl no will and was survived by the following spousc (If any) and heirs: Cf:t;t-J~~~P:= .. ..~ Residence .. ~"~ - - ~ OJ- G. Ii..;./. _ n__._.u~ .____~ -----.-.--- -----.--.---- ------- -------- - THEREFORE, pClltloner(s) respcetfully requcsl(s) the grnnt of lellers of lldmlnlstrntlon In thc approprlnte form 10 the underslgncd, ~ 6 'tl_ ~t 'tl.~ ~'e ~.. 'Ii. llO ~ Iii g;!:3!ffl~~y- 4~~-~~1'C:::~ / --I:2t-9-_I&.-e, r.u, t. U,Odl) , /'- L'dtf.lLS~1 ' 17 0 (g -------.---- =. 14 - C)()q.~ (( " ,H j.' I " I'" OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF' CUMBERLAND } ss The petltloner(s) above-named swear(s) or afflrm(s) that the statements In the foregoing pelltlon are true and correct to the best of the knowledge and belief of petltloner(s) and that as personal representatlvc(s) of the above decedent petltloner(s) will well and truly admlnlst~r the estate according to law, I,'. C(' ,.1 {. . No. _ 21 . 9~ - 411 (.1 'I iJ)U:' cr: ~."te o~ ( SYL VESTER E. CARBAUGH. SR. I Deceased .. _",.:1 Ul.) GRANT OF LETTERS OF ADMINISTRATION AND NOW MAY 4. 19~' In consideration of the petition on the reverse side hereof I satisfactory PI.oof hllYlo.g been IlleA~nt~d befme meJ IT IS DECREED that-- SYLVESIEK E. CI\KllI\UliH. JK anu JUANITA Y. CA~UGH Is/are entitled to Lelters of Admlniotratlon. and In accord with such Ondlng. Lelters of Administration are hereby granted to SYLVESTER E. CARBAUGH. JR. and JUANI1A Y. CAKB~UG~ SYLVESTER E. CARBAUGH, SR. --.-: In the estate of - FEES Lelters of Administration ,.,., $ 80.00 Short Certl (leates( 6) , .. .. .. .., $ 1 R no Renunciation ....,....",.,.. $ JCP _ $ 5 J).u- TOTAL _ $ 103.00 Flied .".~~y"~",.,.",,, A,D, 19JL M \ 1 d 1 d d J i v 5_4.PllP.NIl a e etters an or er to uan ta I. Carbaugh on 94 ATTORNIlY (SUP' CI, I,D, No,) AODRIlSS tH~"2Ilf"1I'1I11 tHE fOflttllfi tEfHtf~CA1[ pOOl WAlININ(i; II ,~; 1111 , ;AI I (I ~I 111\ IIII!; 1_' iI'V ,," TO DlJf't.IC(,11 1\ '( I"IIOIO!, I Al (Iii 1'110 I l>UIIAI'11. COMMONWE~I TlI OF PENNSVLVANIA oePARTMENT OF IIr~L TI1 VIT~lnrCOROB LOCAL Rt.GISTRAR'S CERTIFICATION OF DEATH CERT. NO.2 04119 7 -----(,.~M.~~;.lt,~t;;;!J.U-.n Name 01 Decedent _.~_.-Stttv~ttJt-E_~dCMbaugh (,;;";0.-..------..--...-------.-,,,'----.--..---- Sex ~__.._.Soclal Security No._ _ '&O-2.0-3~5q.- ,_ .__..._______Date 01 Death_ApUi.--ZJ.._1-9U-__ Date of Birth ~il--I'h-l#l--- Blrthplaco_ - Me(!hll>>'(c..\bu.\g,-,PJ.. ______.m_____n_n_.__.______.___._.__ Place of Death n 'U~~"A" I ~..-Cllmb"tand-Co _._,_Hampdl!.ll_JIIJ"~_____ ,_ ____PJlODBvlvanla ---g '.~I~mr~ (",,,"dr ,.. r,!ly.tt)r~lllllilJrrO',l"lHf' Race -~.ut--- Occupation ___._Supuv,u01l./Pakingllep.t. Armeel Forc~s? (Yes or No) _,___---'l.u_____~_ Decedent's Marital Status -(l.iVo.\(!ed---..- Mailing Address _ _._6331.&LtIIdtJ._Lane...1dechlU1{~MluAa.-.EA-JlQSL------- II ,ool,or .,t,,,,,l ell, or Fr.\II!l ~t&to Inlormant -J~i-t4-\l,.-~4.duWgh.---h--'n--- _ _ Funoml Dlroctol J, uLllAitll_CD_c.kUIl,_E.Q._______.~_______ Name and Address of Funeral Establishment __COCJ(LlN.fUAlERJ.LHQIJE O,iUAbUltQ.__ PA_11.019::0.4lA_______~-..------_-----_-. : Interval Between : Onset and Death , , (a) ___.~I.u4iw...cOJ/.ona.w-.MteJLlJ-- O~.6e.aAe____ m____._____.u_________._:__..____~___ I I I ---_.-,._--...-..__..~--_._-_._-_._------I--. , , , , I , I .-- Part I: Immediate Cause (b) (0).. (d) Part II: Other Significant Condlllons ,-..------- ----.-------. ..----_..__._---_.._--------_..~---_...-.. Manner of Death: Natural ~ Homlcldo 0 Accident 0 Pending Investigation 0 Suicide 0 Could not be Dolerminod [] Desoribo how injury ocourrod: __..____.___.u~__________ Namo and Title of Certlflor .__----IoUc.ha,q,l..L._N01l1l..I.4._C01I.OnelL.________,________ '--(M~D.~'D.D.:'-Coroner~MT) Address "O~FM'\'IIllUf--D.t. -MeGlaaM-4bwtg... PA--ll.0SL------.---., u___, ----,-. ---.-- --..------- This Is to certify that tho Information l)Oro glvon Is corroclly coplod from an original cnrtifioato of death duly filed with mo as Local Roglstrar. Tho original cortiflcalo will be forwardod to the Stato Vital Records Office for pormanont filing ~lal,:C(.C;_~_[!/4:~[?/..~ .__ __0:Zfj'~L I( ; ,," ," '10<,'''''' ,,' ",'" ,",'C,,,,,, .1.5"'" '".. __,.J."'} 1.2~._H9L 1((.. f//, ikCdj;:lA'1.r.:,it.Z_'I,{/:;.i..;~H,~,.l~ __jz.:~ If )11~'lllf ru.\llh'Il'Il'.I' ~;("~'f ,\ 11'!'1\ f:>I() 1111"11111 l"""UHf' STATUS REPORT UNDER RUl,E 6.12 Name of Decedentl S;'yC: I/t 7(fPP f -1~,(J~ P' Date of Deathl '7' Will NO.--.2./- el'-( - Iff! f))(UIJA~'b (h/(tAu9f! - v Admin. No. Pursuant to Rule 6.12 nf 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 X No , - 2. If the answer is No, state when the personal representative reasonably believes that the administration will be completer ]. If the answer to No, 1 is Yes / state the following I a. Did the persqnal re~resentative file a final account wJ.th the Court 7 Yes . No X., b. The separa te Grphans' Court No. (i f 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 I {, ~-:< ? - )(JcoO .<I' f', a,,-tu~ d, Signature ' F 5", E , e,</;('i5-1uc;ll JR I Name (Please type or print) / Lfo/ tfc c,;: "u(~,/ Lu mi).J' rliRai't. (.~ Address f (HAH IrmU AM]) (70) 0i() -(;2.<;1 Te 1, No, Capacity: ~personal Representative Counsel for personal representative \, " 'j " ,. , I ," " " Ii ..... ,-'" ~, , " I , , l'o~t,liJlI CorMOdFoo _4________ ..... '..... II01tltl,I'~ Hero '~ ~ Tal41 POU.". & FoOl $ --..-- :00---:---____". . .~I~::~nt.'/fl\~.C.<<.;'.'(t.~~,::':~~::"~.~:.'~::~:::,..,..,......"". . 'It'{ "'T'j PO fl,,, No> " Kf(~r::1 C,'j,,v' (1:""\?.......................... 'C;'''ti''('' iI.:t"'''1'rt,''" " .\4 ..\..,l,lI., J M 'LI'I ru Q Q Q Q ..IJ. Q Q Q Q "'. nlJturnllOC01nl Fil'l IEnuv'lltftll./rll'I0<11/Il0<l1 AUlflCled DoIIYo')' foo (E n(/ 0'" III en I II eq ~/oI 0<11 --.---- ---- , " Ii "1' 'I , ", 'I,i, I. ., .... ., \. " " " . 1.'1 " t_" ,. " ,,, 'P' " " " ., , " , '." , " " " " 'i, I, . o ;., ,I' <II. ,. , , ,. , ".. " '~ " , ,,. , .. : "'. '. , ~ d ; i~ , I , I' ",t- ,':, \ ,. ,; ",\ II I , 'I " ~ , '~ '. ~'~,~,., I" " , " " .. , 0', ,., i I ,., .,' '., I'; ~. 1" ' . ',' , 'r ,I .., I .. ., ", ~' , " .. . ~' " , ,"1 .'~' ~~' .. '11, / "" "~ .. I /, II' " , , ,. II," , , .7" ., '-....-"---.Dd'~' '.'4' ..._.._._'..'-..,.~d~lI,~_ " ....,..... ''''..ll' I ' Decedent's Complete Address: STREET ADDRESS G:J 3 i ~f)rJot,f) f L.o/ '. ~ 'M Ie h1 tVl C.5 rJe,n (- liP /1C 5" S' Tax Payments and Credits: 1, Tax Dlle (Page 1 Line 18) 2, CredllslPayments A, Spousal PovMy Credit _____ 6. Prior Paymenls C, Dlscounl (I) 3, InleresUPenalty If applicable 0, Interest E, Penalty Tolal Credits (A. 6. C) (2) , . , I, IS' 3 I\~ Total'nteresVPenally ( 0 + E) (3) 4, If line 21s grealer than line 1 + line 3, enter the d'fference, This Is the OVERPAYMENT, Check box on Peg. 1 Line 19 to r.qultte r.fund (4) 5, II line 1 . line 31s grealer than line 2, enter Ihe difference. This Is the TAX OUE. (5) __LJ_J]...M~ A. Enter the Inlerasl on the tax due. (5A) 6, Entar the lolal 01 Line 6' 5A. This Is the BALANCE DUE, (56) I. ( S J :/,1, Make Check Pa able to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1, Old decedent make a transfer and: Yes a, retain the use or Income ofthe property transfarred: """""""""""""".""""""",,,,,,,,,,,,,,,,,,0 b, retain the right to designate who shsll use the property transferred Ilr its Income; ",,,,,,,.,,,,,, 0 c, reteln a reverslonsry Interest; or"""".""""."""""""""""""""""""""."".".""".""""""."" 0 .' d, receive the promise for life of either payments, benefits or care? """""."".""""""".""""" 0 2, If death occurred an or bafore Decamber 12, 1962, did decedent within two years preceding deeth trallsfar property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? "",. """" "."" """"'" """,,,.,,., ".""."., .""."".". ",. """."."" '''' 0 3, Old decedent own an 'In trust for' or payab'e upon death bank account or security at his or her death? "'''''".,,,,,.,,,,,,,,,,,,,,,,,,,,,,,,,,,,.,,,,,,,,...,,,,,,,,,.,,..,,,,,,.,,,,,,,,,,,""".,.,,,,,,,,,,,,,.,,,,,,,0 4. Old decedent own an Individual retirement account, annuity, or other non,probate property? "" 0 No ~ W a--- rr EY IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN I .. - III I] .L I I - . .. 72 P,S, ~9116 (a) (1,1) (I) provided for the reduction of the tax rate Imposed on the net value of transfers to or for the use of the surviving spouse from 6% to 3% for dates of death on or eller July 1, 1994 and before January 1, 1995. 72 P,S, ~9116 (a) (1.1) (II) provided fnr the reduction of the rate Imposed on the net value of transfers to or for the use of the surviving epouee from 3% to 0% for dates of death on or after Janllary 1, 1995, The statute does not exempt a transfer to a surviving spouso from tax, and the statutory requirements for disclosure of assets and filing a tax return aro stili applicable even If the surviving epouse Ie the only beneficiary, FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995. Please answer the following question by placing an 'x'ln the epproprlete space, Old the decedent oreate a truat or almllar arrangement which la solely for the eurvlvlng spouse's benefit for hi, or her entire lifetime? Yes 0 No u;y If you answered yes to tha above question, the tax on the trust or similar arrangament 's postponed until the death of the sacond spouse, at which time it will be fully taxeble at the rate(s) applicable to the remainder beneficlary(les). Enler the value of the trust on Schedule J, Part II, In order to remove It from the calculation of the tax due In this estate, You may wish to file Schedule 0 In order to make the election available under Section 9113, If the election Is made, the trust or similar arrangement Is taxed In the estate of the flrst decedent spouse, lhe portion of the trust or similar arrangament which benefits the surviving spouoe Is taxed at the zero tax rate, and the remalndur Is taxed at the rate(s) applicable to the remainder beneficlary(les), If you choose to make the alectlon, you must aitsch Schedule 0 to a tlmely.flled tax return, along with Schedule(s) K andlor M In order to show the apportionment of the trust or similar arrangament between the surviving spouse and the remainder beneficlery(les), ., , ' , , 11'/01111". V411, ~ SCHEDULE H ~ti FUNERAL EXPENSES, COMMONWIAITH e. P1NNmVANIA ADMINISTRATIVE COSTS AND ItIHIAIlANCI TAX UlUIN MISCELLANEOUS EXPENSES 'UIDINT DICIDINT WtHip S 6- V r? /lIW't:./f S ITEM PESCRIPTION AMOUNT NUMBER A. Puntlal bplnl'" $. 'a I ~, 4 ^, 1. co-I.. I( IN' F(,II<I~f1 fl t.. HO.;rl P. 1. Ad",lnl'l~allvI Co.l" Plnenal Repr..lnlallve Commllllonl Social Security Number 01 PlnDnal Rlpr..lnlallvlI Vlar Commllllonl paid - B. , 2, AllorMY Feel 3, . Fomlly E~empl1on , Claimant' . -- Rllallonlhlp Addrell of Claimant 01 decedent'l death SIreet Addr... I I 1,,1 City State Zip Code I f2 a C". o'oJ' Prabale Feel (..CJttlIHnLn"'O OC:OC.""7 nee., C'I' ~/'-~/.s' MI'~llIaneou. ExplnlUl " ". TOTAL (AllO Inllr on IInl 1/, Rlcapllulallon) S S' C) ~ I, '1 ),. (If marelpacl II needed, lnllrt additional .hee" of .am' .111.) , , , ' . ' "~ll1ll"ll'''I. COMMOHW'AlfH Of ".INln"ANIA INHUIIANCI TAl lI'UIH "'IDIHIOICIOIN' SYt.. 1I~S'Tt!~ SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILIYlES AND LIENS PI, a.. Print or T p, J fiLE NUMBBR e CJqf?~/li/r;:..1I Sa ISTATI Of ITEM NUMBER 1. e!''- I1rlnA./itc- ~, C ,r; IMtvl< 3 C.I N /Jl9iY,c., 4 f/ 19,n,f, s' filiP' /1/(11/0101''''(. C' Nr.I?5'/O'Y /JeI1n~ II"C/~fiY Ct..v/.3 (.SM$Y"'NrtCI<r.{r) 1. I'fI i T"r/ H u~IlL.'o g. (tJlltt1nlJ 1Yl1C.$l' i C I.~~' !?,wfn'- J q. fJ IYI ~1(/ I CIIIV f.. t fJI) ~. .5:5' DESCRIPTION AMOUNT '117, 'ilS' :/.;,,3.1; /, '1.1.3. e; 5S'a,ac:>. 1,.5"'1/,00 s;aco co. ~ 7. 7 S' ~). S' 0<;' .' C'o (,,,,,0, 1)'0. ..0 17(fl.o '1 I), c. 13 " " 7'1/. " ~ '1 'I s: c;o. IC. /Jo/VtVlE. IIF.lo.J"rS 110M,? (ill!lI?WiL T/?IIIt.t:Y1 J II nc:.wnj . h t f~ 1-. IJ JOCIII'- Sf, C"M! RP. 1'(,l/'VlO I~ )T n flf ;::1/ /ltt1 IN J'Cd/19 Il/CIS ," ' " . TOTAL (Allo 'nllr on IInl 10, Rocapltula"on) I" mati 'patl i, nOldld, inlOr! addillona"hoo', 0/ ,ami Ii".) s ~,c; I. "/6. 06-26-2000 CARBAUGH 04-23-1994 21 94-0411 CUMBERLAND 101 ~__ AMount-R.Mlttod ~ MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .... iiEV: iilrj',.- Hie" "iiFP"i i '2:99Y'iioYici" 'oF' "fNHEifif AifcE-YAX" iiP'jiii'A i sEiiF.:ii'r;'iitr6wANCE' oR" - --" ,,-, --" - ,.., DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT O~ TAX SVLVESTER E FILE NO. 21 94-0411 ACN 101 If an aSlelllant was issued previously, linas 14, 15 and/or 16, 17 and 18 will reflsct figurel 'that include the total of ill returns alSessCJd to date. ASSESSMENT OF TAXI 15. AlIOunt of Lin. 14 .t Spou..l rot. 115) 16, AlIOunt of Line 14 to.obl. .t Lln..l/Cl... A r.t. 1}6) 17. AMount of Line 14 t..obl. .t Coll.t.r.l/Cl..s B r.t. (17) 11. Prinolpol T.. Duo TAX CREDITS I PAVNENT DATE / '1-.;( (,H/_ t. COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE (j BUREAU OF INDIVIDUAL TAKES llIlERIlAHCE U' DIVISIOIl Of PT. 180601 HARRJSI~G, PA 17128.1601 NOTICE OF INHERITANCE TAK APPRAISENENT, ALLOWANCE DR DISALLOWANCE UF DEDUCTIONS AND ASSESSHENT OF TAK 1\ l'~ ' DATE ESTATE OF DATE OF DEATH FILE NUMBER i I COUNTY ACN JUANITA V CARBAUGH 15D3 SWATARA ST HARRISBURG 'liD ,II ill J(J PA 1?Jl~,4 Cl:lli~ ESTATE OF CARBAUGH TAK RETURN WAS I I X) ACCEPTED AS FILED I 1 CHANGED I I RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN 1, R..l Estot. I Sch.dul. A I (1) 2, Stocko .nd Bonds ISohltckllo BI (2) 3, Cloo.ly Hold Stook/P.rtn.rshlp Int.rut ISoh.d"l. CI (3) 4, ""rtg.go./Not.. Roo.iv.bl. ISchedul. 01 141 5, Cuh/B.nk Dopodh/Nloc. P.rson.l Prop.rty ISohodulo E) IS) 6. Jointly OWn.d Proporty (Schedulo Fl 161 7, Tr.nohr. (Soh.dulo 01 171 I. Totol Au.to .00 ,00 ,00 ,00 34.806,05 ,00 ,00 IBI APPROVED DEDUCTIONS AND EXEMPTIONS I 9. Funeral E.pono.s/Adln. Co.to/Nilo. E.pons.. ISch.dul. HI 10. Dobts/Hortg.go Lioblliti../Llons ISohodul. I) 11. Totol Doduotlon. 12, N.t Volue of 7.. Rlturn 13, Chlrltobl.IOovlrnll.nt.1 Boquo.h) Non'.lIot.d 9113 Trustl 14, Not Value of E.t.t. Subjlol to T.. (9) 110 I 5,921.42 9.661,46 III ) 112) 113) 1141 I I: I Sch.dull J I NOTE I ,00 K ,00. 19,223.27 K ,06. .00 K .15. Ill) RECEIPT NUNDER DISCOUNT 1+) INTEREST/PEN PAID 1-) ANOUNT PAID INTEREST IS CHARGED THROUGH 07-11-2000 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, '* .tv.U,'.. '" lu.m SVLVESTER E DATE 06-26-2000 HOTEl To Inlur. proper credit to your .DOOunt, IUbllit the upp.r portion of thio forll with your to. pay.onl, 34,606,05 1 ~ . 582.78 19,223.27 ,00 19,223,27 ,00 1,153.22 ,00 1,153,22 .00 1, 153.22 539,17 1,692,39 I IF TOTAL DUE IS I.ESS THAH el, NO PAVNENT IS REllUIRED, IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU NAV BE DUE A REFUND, SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS,) RESERVATlOft I PURPOSE OF HOTlCE. PAYNEHT I REFlMlD (CR)I OBJECTIONS I AOftIH ISTRATlVE CORRECTIONS I DISCOUHT I PENAL TV, IHTERESTI E,t,t.. of dto~nt. dYing on or blfor. OIo..o.r 12, 1982 ~. If any future Int.r..t In thl I.t.t. S. trlO'f.rred 1n pOI..IIJon or enjoy.."t to CII.. I (00118terlll btneflcl.rl.. of the dlcldent .,t.r thl expiration of IOY ..tet. for 11f. or for y..fl, thl Co..anw.llth hereby Ixpr...ly r...rv.. thl right to .ppral,. end ...... trlOlf.r Inherltlnol l1KI' .t the l.wful Clo.. I (oollnt,r,.) r.t. on any .uch future Int.r.at. To fulfUl thl requlrl.onts of Slotlon %140 of the Inheritance and Eltate Tal< Act, Act 21 of 1995. (72 P.S. SloUon 9140), Detach tho top portion of thl_ Hotlol and lub.lt with your ply..nt to the Rlgl.t,r of Will, printed on the rlv.r.. 11dt. ....Hak. chick or lon.v order paYllbh tal REGISTER OF HILLS, AGENT A nfund of a talC cl,.dlt, which was not r.quIsted on thl TalC R,turn, lay be rlqu,st.d by co.plltlng an "APPUclltlon for R.fl.l\d of ~IMsvlvanla Inhlrltancl 8nd [statl TalC" ,REY-UU), Applications are avaUabl. at the Office of the Register of Wills, any of thl Z~ A,vlnue DIstrlot Off leIs, or by calling the splclal Z4-hour ~.werlng .orvlc. notb.r. for fori' ord.rlngl In Pennsylvania 1~&00-36Z-Z050, out.ld. Plnn,Ylvanla .nd within local Harrisburg are. (717) 767-8094, Servl~e. for thXpftYlrS with splclal hlarlng and ,plaking nlldsl 1-800-447-3020 (ll onh), Any party In Intlre.t not .atl'flld with thl appral....nt, allowancl or disallowance of deduotlon., or .".....nt of talC (lnoludlng dlsoount or lnte,.lst) a. shown on this Hotlcl lust objeo\ within sixty (60) days of rlc.lp\ of this Hotlcl bYI --Mrlttln prot"t to the PA Depart.lnt of Rlvenue, 80ard of Appeals, VIPt. 201021, Harrisburg, PA 1712&-1021, OR --Illation to havI the 'fltt.r dltlrllned at audit of the flccount of thll plrsonal rlPrulntatlvl, OR .-app.al to thl Orphans' CotJrt. Factual Irrors dlloovlrld on thl. flSslss..nt should be flddrn"ld In wrltlng tOI PA Depart'lnt of Rlvlnue, Bur.au of IndlvlduQl TalCIs, ATTHI Post A'~.'s.gnt Rlvl~w Unit, Dlpt. 2&0601, Harrlsburg, PA 1712&-0601 Phone (717) 1&7-6S0S. SI' pagl S of the book lit "Instr~tlons for Inhlrltance TIlC Rlturn for a RIsJdtnt Olcedent" (REY-ISOl) for an explanation of adelnlstratlvlly corrlctabl. 'rrors. If any talC due Is pald within thr.. (3) calendar .cnths after the dlCldlntls duth, a flvll perclnt 15:0 discount of the tax pald 11 aUowld. The l5i( talC HnI.t!.' noIl"partlolpatlon plnaltv Is co.puted on the total of tha talC alld lnternt ulllllad, Ind not paid bafora Januarv 1&. 1996, thl flrst day ftftar thu .nd of the talC aen.stv plriod. lhl. non-partlolp.tlon panlltv Is appealablt In thfl .... laMlr and In tho tha ....8 U.1l plriod as yoU would appeal thl talC and lntlrnt that has been a......d al Indlcatld on this notlcl. Inter.st Is charged blglnnlng with first day of dlllnquencv, or nlnl (9) tooths and anI (II dav frol thl date of death, to thl datI of paV'lnt. TalCIs which blcal. dellnquent before January 1. 19ft2 blar Intaralt at the rate of Ilx C6X) ptrclnt per annua oalculatld at a d.llv rltl of .000164. All talCIS which b.ca.. dllinqulnt on and aftl' J,,"yarv 1, 1982 w1l1 bollr Interllt at a rate which will varv frol calendar veal' to calendar yaar with th.t rate announcld by the PA DIPart"nt of Rlvlnue. Th. applicable Intarest rat.. for 1982 through 2000 arll '!!!!: Internt Rata DIUy Inter 1st Faotor X.!!! Intlre.t Rllt. DflllY Intare.t Factor 1982 20% ,000548 1988-1991 11% .000301 1983 16% .000438 1992 9% ,000247 19M 11% .ooom 1993-1994 7% .000191 1985 m .000356 1995-19911 9% ,000241 1986 10% .000274 1999 7% .000192 1987 9% .000247 2000 &X ,000219 RRlntar..t II calculatld IS follows, INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR nAny Hotlo. luued .ftlr thl ta)( blOOlltll delinquent will rafl.et afl Intarnt o.loulatJen to flft..n (1S) davs bevond thll data of till .....s..nt. If pay.,nt Is lada aftlr thl Intarnt cOlPutatlon dati .hown on the Hotlol, additional Interllt .Ult be calculated. r f ,',