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IJETITION FOR IJROIJATE and GRANT (lI<' LETTERS
21-94 .. 4/n1.
[,\1111(' I!l FLORJ!NCE, E. I,OIIMAN
III.HI kllOll'lI liS.
No,
To:
Rcgisll'r or Wills 1'01' Ihe
,.. '. /)"('1'/1,1'/'11, ('OOllly or CUKIIIlRLAND...... , ill thc
Sodol S('('I//,;Iy No. . ,175-03-0169 ('ollllllollwealth or pClIlIsylvaaia
Th,' petltioll 01 Ihe IIl1,kl.siglled Il'Slll'l'll'lIl1~' 1'<'11Ie,Sell" that:
Your pl'thiollcr((), whols/lllllH year,s or age or (Ilder alllhe e,,"elllr1x. nn. ..n.. lIamcd
~~~ \\il~=lho:ib\I~'I'X~llIj~U~ JIt~c WuWi.tm b~ 'TlIE. DEdKAsRiinANfi:~{~.:=
,. EXEcfmJa IN TIlE WIll. PREDECEASED illS WIFE,ONJAN1JMY31.J.92L , h.__
hldh' ll'k\'UlIll'irl'!Illblltlh\'\, ('.)'. Il'Il11lhliIIIPll, dl'i1lh illl'\l'l'lllor, ~'ll:.)
Ilcl','mil'11I was dOlllkill'd al dl'lIlh ill
h,. er., .. lasl I'alllill' 01 ptilll'ipallelhkllC'<' III
.mS()uth Middleton Township.,
Cumberland .. , . ('oumy, Pellllsyl\'allia, with
20 K,enwood ~vemleLC!!!:H~J.!!.LI'A. ."..._
(II'.I ," l'l'l , 1l11l11hl'r alld 1l1ll11dPillil\'J
DCl'eudl'UI,lhell .74. yea" 01 age, died March ,,2.5,..... ,.-.......--......1 19, ~~..__.,
al ,C~J:Usle Hospital. Carlisle, PA .. . H ..._.. ....n..._,,,...._......H......._.
EXl'eplas I'l>III1\\',S, del'elklll did aot allllry, was 1101 di\'OI'l'ed alld did 1101 ha\'c a l'hlld born or adoptcd
after ,'xel'alioll or the will ol'fered I'or proball'; WIIS lIollhe \'klilll or a killillg alld \\'as lIever adjudkalCd
illl'OlIIllCll'lIl: . "_.H .._..H.H.._....__H... ., ....."...._
lJel'emil'lItal dealh oWlled properly wllh eslilllall'd values as I'ollows:
(If dOlllidll'd ill I'a,) All persollal proPl'rty
(II' uol dOlllidlcd ill I'll,) I'ersllllal prol'l'r1y ill 1'l'lIl1syl\'allia
(If 1101 dOlllkill'd ill I'a,) I'ersolllll properly ill ('ollllly
Value or rellll'slale ill I'l'IIII",lvllllill
sllullled as I'ollows: 20 Kenwood.AlIenu'1, Carlisl!!. .1'1.. ,_.... u.....
lllJ.uthHiddlllt,on Township
5.....57..000.00___
$----....----.
$ ..---...,..-.------
$ _.65..000.00_..__
WIIEIWI;ORI;, pelitioller(s) respeell'ully reqllcsl(s) Ihe probate of the lasl will "ud l'odlcll(s)
presellled herewilh alld ihe gram (>1' il'1Il'rs...,,'r!l.!I.t:!!ID!l.!IJ./noy..._.__________
(lc,llllIIl'lllary; IIdmlnl\lrullull C.l.u.; ullrnlnhlrallon (I,h,n.c,I,U,)
Iheroll,
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H.HAaOMl'tl'l'.t. 1111.'1" ...
'.."jjj~()LDKiJ.L . ROAD
CjAAI.ISI.Il.....PAJ 70J3
. 7 7D.~_3 S.7(r~.
.... ____._..__~~_______h____.__~_~__~
..-.-.~-._,.._,,-- --.---,--.------
OATIl ()Ii' I'EI{SONAL ImJlRESENTATIVE
COMMONWEA.L.T1.I. 0.1" I'.I<:NNS\'LV ANIA .} Hli
COUNT\' OF <:UKBERLANQ 'u_
Thl' Iwtllilllle!'(s) UI1I1I'l'.nallll'd Sll'l'al(s) III afllnn(s) Ihallhe "lllIellleIlI.S illlh,' foregoing petition arc
Irlle IIlId l'OITCl'l In Ihe hest 01 Ihl' ~lIl1l1'll'dge alld 11I'Iiel' III' pelilioller(s) ulld Ihllllls personill reprcsclI-
tlllil'e(s, or IIiL' a11l1l'e del'edl'lIl pl'lililllll'I(S) will \l'dl und IItlly admillisler Ihe csllllC 1Il'l'llrdillg to III\\"
S\I'llIt1 III 01 arrinlkl~L alld stlhlclilwd I }) (({ ~ft:. u.. .. .LL.'. :t~).J!L~~.--_-..... c~
helllrl' tin' I~j>. (~TH da~ III . '.'\fGAREr:i.. ,,!'ItXV...... n ... ... "
111illl,f (. Jl:L~~~ fl' (, In}).'ttt;,f~~~l .... "..--.--- ~
(' ,I1ARY C. LEWIS Ii,'gill'" -[(1' U ~
J ~I --' rOlll ." I ~.).
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No.
21-94 ~ 417
Estate of
FLORENCE E. LOHMAN
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW MAY 5, 19.1L. In consideration of the petition on
the reverse side hereof. satlsfaclory proo[ having been presented be[ore me,
IT IS DECREED that the Instrument(s) dated October 18, 1914
described therein be admitted to probate and flied of record as the 11Ist will of FLORENCE E.
LOHMAN
arid Letters Testsmentary
are hereby granted to Margaret ]. Fry
1&~
RORer B. Lrwin. Esquire ID No 06282
A11'ORNEY (Stlp, Cl, I,D, No,)
$
TOTAL _ $
MAY 5. 1994
.'..."...."",.".,..",.,...,... ,
60 West Pomfret Street, Carlinle, PA 17013
ADDRESS
(717) 249-2353
Flied
PHONE
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lust mtll aub mtl1tamtnt
I, FLORENCE E. LOHMAN, of 20 Kenwood Avenue, Carlisle, Cumberland
County. Pennsylvania, do make and publish this as and for my last will
and testament, hereby revoking any and all wills heretofore made by me
1. I direct my executor to pay all of my debts. funeral and
administrative expenses as soon as convenient after my decease.
2. I authorize and empower my executor to sell any realty and/or
personalty owned by me at my death. at either public or private sale
or sales and to give good and sufficient deeds and/or bills of sale
therefor. in fee simple, as I could do if living. My executor is
authorized and empowered to continue to engage in any business in
which I may be engaged at my death. for such periOd as seems expedient
to said executor.
3. All the rest, I'esidue and remainder of my property, real and
personal, I give, devise and bequeath to my husband, John A. Lohman.
Jr.
4. Ii' ,John A. Lohman, Jr. should not survive me for a period of
60 days, then I give. devise and bequeath all my property, real and
personal. to my children, share and share alike.
5. I nominate and appoint John A. LOhrnan. Jr. to be the executor
of this my last will and testament without the filing of any bond.
Should he die before my death, renounce or refuse to serve for any
reason or die leaVing any of my estate unadministered, I nominate and
appoint my oldest living ohild as substitute executor, with the same
powers as are given herein to my executor, and also without the filin
of any bond.
6. I suggest that my personal representative retain the service
of Irwin. Irwin & Irwin, CarliSle. Pennsylvania, as attorneys in the
settlement of my estate.
seal this /3~day of Octpber, 1974.
'1,1 , /
. ~L{.~ -"e: Lo C:,' ~:ii ft7l1 r ~.v
FLORENCE E. LOHMAN
Signed, sealed. published and declared by the within named
testatrix as and for her last will and testament, in our presence, wh
at her request, and in her presence and in t5tpresence of each other,
have hereunto set our llameB~~As~bscribin~ wi sses. "
_ ~. ~,,\.{' ,{ ..2 .' W"\-."-'"
{h (1,', " I ...3' i!Jrccrd'
WITNESS my hand and
(SEAL)
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CERTIFICATION OF NOT)CE UNDER !l..!'LE S.li/lll
Name of Decedent I JIlorollex 1::. JOIUII1IJI
Date of Death I 03-25-94
Will No. Admin. No. 21-94 - tft7
To the Registerl
I certify that notice of beneficial interest required by
Rule S.li(a) of the Orphans' Court ~ules was served on or mailed to
the following beneficiaries of the above-captioned estate on
I
~ Address
Margarot J, I'ry 333 old Mill Hoad, Cilr11olo, P^ 17013
Edna MJrrCM 1506 Ibll~ Avonuo, Cildin10, PA 17013
Richard Lohman 1008 r.ynnhilvoll Pky, Virqinin Boadl, V^ 23452
John R. It:lhman
374 SOllnut lllUrL, IobmlClIl, l'A 17042
Notice has now been given to all persons entitled thereto under
Rule S.li(a) except___
Datel
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/,/---//1 ('3 ~
(~, ,
::::atur~,} Irwin, Esquire
Address 60 Wast Pomfret Street
Carlisle, PA 17013
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Telephone/ n~ 249-2353
CllpacitYI
Personal Representative
Counsel for personal
representative
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/'1-, {o'l. /,).
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
fOR DAns OF DIATH A"1l 12/31/91 CHICK HIRI
II A SPOUSAL
'OVIAn CRlDIT IS CLAIMID 0
fill NUMBIR
j 21
COUNTY CODE
M I A
!EV,I!OO IX. 1",911
I I ~., fvlult Inl""1 Comproml..
I'or dolll 0' d.olh oller 12,12,821
[XI 6, O"odonl Ol.d 1o,Inlo II 7, Ooeodonl Malnlaln.d a living Irvll
____ __,l~l!u,h e?.I'Y "'. Willi .'.... _ .. .jAI'?.'h'o~r 01 Trvlll
ALL COUIIPONDINCI AND CONPlDINTlAL YAK INfORMATION SHOULD BE DIRECTED YO.
~ I ::~IN, JIl~JN /, Md~NlliI\'I: n'-_'---j:PT~~;;III;~~;:~; STREET
U~ U"'III'HH IIIIM'" - .. u_nn CARLISLE, PA 17013
0("\
____ L 711 l/l(I..~:I'I'1 . ,.._
1. Ro,,1 f""lol~,h.dlllo AI ( 11 _--pltQOO.OO
2, &Iolk. "nd Rill,," 1~"lOdvlo '1 I 21.
3, (I.,oly 110ld &llIlkll'lIl1nOl.hll' Inl"o,IIS,hodvlo C) (31
~, MII,IUIIUII 1II,,11~lIlo' AOlolvllhl, IS,h,dul. DI I ~I
~, e",h, RI/nk 1I'l'n,llI'" MI"ollnn,nu, P,"o,.1 Propo~yl 5),_~1 ,026.!,99
(~,hOI ,,10 tI
6, Jlllnlly Ownod 1''''I'O'ly (&,h,dulo fl
7, lrell1""' I~(h.dllll' 0115[h,d,lo II
8. 1"11110...,, "",11 (Inllllllnll 1,71
9, "vno,"11 'I"n,", IId.,lnl,l/ollvo Co,l" Mh,olla.oov. ( 91
fop.'UO' IS[h"lul, III
10, 001,11, MlIlIuouo lIol,lllllo" II.., (5eh,dulo II (101
II, IOlolll.d"rUIIIII (1IIIIdllno, 9 & 101
12, Nol Vol"o III '"1110 IlIno 8 mlnv, 11.0 III
13, Chll/llolllo ",,,I Ollvo,nmon'ol hquol" IS,hodul. J)
t~. N.I Volllo S,hl"lllI Ill. IlIno 121111'~~_1In' 13)
IS, Amounl of Ilno I~ III.ohlo 016% '01.
(Incivdo ",Ivo, 1'lIm S,hodvl. K or Seh,dul. M,I
16, Amllunl"llino I~ 10.01110 01 150/0 101.
(Incivd. voh",lrom &,h.dul. K or S,h.dul. M,I
17, Pllnell'ollo. d". (Add 10. Irom Iln. 15 and '/om IIn. 16,)
1& eltdlll &pOlllol Poverty C"dll Prior Paym.nll
. 'u, + +
19, If lino 18 h oroa", Iholl lin. 17, .nl" Ih. dlll".nco on lin. 19, Thl, Is Ih. OVERPAYMENT.
11:1
20. If IIno 17 h gftol" Ihal/ lin. 18, .n'" Ih. dlll".nco on IIn. 20, Ihh II th. YAX DUE,
A, fnlo/ Ih. InlO/O'1 on Ih. b.lanco duo on lin. 20A,
B. fnlll Ih. 10101 of IIn. 20 and 20A on IIn. 20B, Ihl. I. Ih. BALANCE DUE,
Ma~o Ch...~.Pa~abl. 'o',.llogl,t" of Will., Agonf
.'. riESURE YO ANSWER ALL QUESTIONS ON REVERSE SIDE AND YO RECHECK MATH..
U~dll"I.nnlU~i '~f'lIllj'lI y. I d~(I,;r-;-'h;i-i-t1av. uamlnid thl. ,.Iurn, Including uccompanylng Ichlldulel Chid .falemenll, and to ,he bill of my ~nowl.dge and blll,f,
It h !fUI, (tHfffl and Ctln'pl.'n I d.dtllfllhal all r,al .11010 hea bien r.por1.d allru' mar~el value, Declaration 01 preparer olh., than Ih. penonal ,.pr..tntall.... II
tHII.rl nn nlllnlarmnllon nf which I"'pnr.' hOI any knowledge,
IIMu.11111 (]I HUt'l" 1I11{1"I'~ir lb. lii/,iGuru!.. A..RESI OAII
'I) " , Id 'III ',/1') j, I ( I . 333 Old Mill Rd, Carlisle, PA 17013 06-27-94
If!1,iAYllrr ~{ hH/". OIl/till/Xii w1rfrNl.'lvl-AOOR!\1 OAII
, (I. (I () ? (1.1"'''. 8H~1 60 W. Pomfret St, Carli"le, PA 17013 06-27-94
I!!
~~~
xt
Utili
oil
I
g
20 KENWOOD AVENUE
CARLI SLE, PA
SOUTH MIDDLETON TOWNSHIP
c'""!L.CmlBERLAND
o 3, R.malnder hlurn
lIar datil of d.olh prior 10 12,13,82)
o 5, F.deral Ellol. To.
R.lvrn R.qul"d
_ 8, Tolal Nvmber of Safe D.po.lt Ba...
I
'(
"v:Ii-,)'V~
{~'\:~'.;;"
COMMONWEAl1H 01 PENNSYlVANIA
DEPAllTM!NT 01 REV(NU(
OfPT. 280601
HARRISBURG,'A 11128,0601
ID!CIDIN1'!'NAM! IIAII, "'1':ANDM'-Dwif'lITri.1j'~-'----~-'~'
LOHMAN, FLORENCE I':,
IAnIClrftffmT",m'" ..,
!XI 1. Original R.lu,n
Li ~, llmllod F ""10
1I'.IIl (]I hI.III
1l:l-2~i-9/1
, . . .
I I 2, &vppl.m.nlal R.lv/n
17 5-03-0169
'!bAlfOfiIAlti....-
09-21-1919
. - .------.
i
( 6),
( 71
I 8)
12,389.47
1.490.97
(11)
(12)
(13)
(1 AI
(151
112.146.55
~ ,06..
116)
~ ,15..
117)
DllCounl
5%
Inleres'
(181_
(19)
ClUltk h.,o II you me ...qu4uling CI rofund of your ()vorpDvmcnl.
(20)
(2011)
(206)
94
YEAR
417
NUMBER
i)
126,026.99
13,880.44
112,i46.55
112,146.55
6.728.79
336.44
6,392.35
6,392.35
UV,UII".. P'''I
ISfATI OF
ITEM
NUMBER
A.
B.
4,
C.
1.
2,
3,
4,
5,
6,
7.
8.
9.
,..... P,lnt 0' T .
liMIt.
21-94-417
~:j~
COMMONWEAlTH Of PENNIVLVANIA
INHERITANCE ,.. RETURN
RIIIDENT DrCEDEN!
SCHEDULI H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPINSIS
FLORENCE E. LOHMAN
DESCRIPTION
1.
Fun.ral Exp.nl'lI
Hoffman-Roth Funeral Home,.,...",.,."".,..........""......,
Hoye Greenhouse - Flowers,...",...",.,..,..,...,..."."...,..
Middlesex United Methodist Church - Ladies Aid..................
Grave Opening..,....,.,..,...".. I .",.......,.. .,.,.".,.., .."
Carlisle Memorial Services. Inc. - Inscription......,..,....""
1.
Admlnlltratlv. COlli I
P.rlonol R.prellntatlve CommllllDnl
Social Security Number 01 Perlonal Reprelentatlvel
Year Commllllonl paid
2,
Attorney Fel. Irwin. Irwin & McKnight.....,.,.."..,.............,.,
3.
Fe<mlly Exemption
ClalmantN I A
Addrell 01 Claimant at decedln"s death
Street Addrell
Relationship
City
State
Zip Cod.
Probate Fell Letters Testamentary
Mlscellan,oul Exp.nl'"
Spahr's Antiques-peraonal property appraisal....................
Register of Wills - Filing Fee.. .."""..,.............."....,
Notary Fee - Roger B. Irwin....""."",.....,...,....."...."
ERA Garman Realty- Real Estate Appraisal.,....,...,...,..".....
Hoffman Roth Funeral Home-Grave opening (4) Death Certificates..
The Sentinel-Advertising $16.93; $16.93; $18.71.................
The Cumberland Law Journal-Advertise Letters Testamentary.......
Donated items to Middleaex United Methodist Church..............
The Sentinel-Advertise Letters Testamentary..."...,...,.",.."
TOTAL lAlla .nter on IIn. 9, R.copltulatlon)
(II mall IPOC' Is n..d.d, Inll" additional Ih..tl 0' lam. III'.)
AMOUNT
4,495.00
185.50
84.56
150.00
8S.00
6,500.00
261. 00
60.00
25.00
24.00
150.00
158.00
52.57
40.00
50.00
68.84
S 12,389.47
uv.uu I.. 11"'1
"
~~
COMMONWIAI1H 0' 'INtHnvANIA
INHUlfANCl1AIl'InUIN
IIIIDIN!OICIDIN'
I
SCHEDULE J I
BENEFICIARIES .-1
ESTAifOf
FLORENCE E. LOHHAN
fiLE NUMBER
21-94-417
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
NUMBER SHARE Of ESTATE
A, Ta.abl. 8.qullh:
1. Margaret .1. Fry Daughter 1/4 Residuary
333 Old Mill Road
Carlisle, PA 17013
2. Edna Morrow Dsughter 1/4 Residuary
1506 Hemlock Avenue
Carlisle, PA 17013
3. Richard Lohman Son 1/4 Residuary
1008 Lynnhaven Pky
Virginia Beach. VA 23452 1/4 Residuary
4. John R. Lohman Son
374 Summit Court
Lebanon. PA 17042
ITIM
NUMBER
NAME AND ADDRESS Of BENEfiCIARY
AMOUNT OR
, SHARE Of ESTATE
8, Charllabl. and Gov.rnmental 8equlltll
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Aha en1er an line 13, Recapitulation) S
(1/ more 'pace I, needed, Inlllt addltlonol,he... o',ame 'II"
,. .t
COMMONWEALTH OF PENNSYLVANIA l
COUNTY OF CUMBERLAND J
PI
MARGARET J. FRY
beIng duly Dworn ,_____ eccordlng to lew, deposes end SlYS thlt she iR ths executrix
-_____.._,______ 01 the Estete of Florence E. Lohman
I.t. 01 _~911t.LMidd,let'!1l..Tl1wn~h!l'u.. --., '__, Cumberl.nd County, P.., d.cused .nd thlt the
within Is .n Inventory made by ....lllltiUllJ. F':y ,_ _, " the s.Id exocutrix
cl the entIre est.te 01 Slid decedent, consisting 01 ,II the personal property .nd r..1 estlt., .xc.pt r..1 estet. outsld.
the Commonwealth 01 Pennsylvania, and that the "guros opposite each It.m 01 the Inventory r.presentlt', f.lr v.lu.
U 01 the deto 01 decodont's death.
Sworn and sublcrlbed belore me,
'u
l- , , 19.1.L-
J C~_
,
e....ti,ix
Margaret . Fry
333 Old M 11 Road
Carlisle, PA 17013
Add"n
"
Dat. cl Death -_...2S___
D.y
03
Month
94
VOl'
INSTRUCTION$
I. An Inventory must be lIIed within three months after appointment cf person II r.preslntltlv..
2. A suppl.ment Inventory must be lIIed within thirty deys 01 discovery of .ddltlonll IU'Is,
3. Additional sheets may b. attached u to personalty or reelty
4. See Article IV, FIduciaries Act 011949.
:a
~ 1 ~
~ ~ ~
.. B
~ I:l "
~ m ~
,.., 0 ~ .~ jj
..... ~ ..
." W i QJ Q I:l f.o
I j; g: :tJ .
." -' u.. :. 'S ~ ~
Cl\ u.. -' ~ 0 'll
I ~ 0 iJ
..... 0 ~ ~ ...l {: ...0(
N o Q . .l:I
1<1 " . t-<
- ffi ~ .. ~ I'l
0 ~
Z 1<1 0 tit .
... u lJ) -0 ~ ~
.~ c QJ
" 00
... "l: cil
~I 0 J ...
'1 ...
3 E 8
'P I d if ..
REYol!147 EX AFP (08094*
COl4ltONWEAlltlOF PENNmVANIA
OEPIRltlENI Of' REV~NUE
BUREAU Of' IHOllJlDUAl 'AlCEI
om. 1I060 I
HARRISBURG, PA 17111-0601
E.-
::207
NOTICE OF INHERITANCE TAM
APPRAIS~HENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAK
ACN 101
DAT! 11-01-94
DAT! OF DEATH 03-25-94 ~~b~T~O. CUMBERLAND
HOTEl TO INSURE PROPER CREDIT 10 YOUR ACCOUNT. SUBHIT THE UPPER PDRTION OF THIS FORH WITH YOUR TAK
PAYHENT TO THE REgISTER OF WILLS, HAKE CHECK PAYABLE TO "REgiSTER OF WILLS. AgENT"
REMIT PAYMENT TOI
IRWIN ETAL
60 W POMFRET ST
CARLISLE PA 11013
REGISTER OF WILLS
CUM8ERLAND CO COURT HOUSE
CARLISLE. PA 17013
I AMount R..ltt.d I
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ...
iliV: IAlit-iie",\ F P"COS":94 T" NOT i or -OF" iiiiiiii i;: AiicE"TAX -A"PPRA i iiEM KNT ~.. Ai. i:owANci 0 'tift -... -.""""".....
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTAT! OF LOHMAN FLORENCE E FILE NO. 21 94-0417 ACN 101 DATE 11-07-94
If .n ......M.nt w.. i..u.d pr.viou.ly, lin.. 14, 15 .nd/or 1&, 17 .nd 18 will
r.fl.ct figur.. th.t includ. the tot.l of abk r.turn. .......d to d.t..
ASSESSHENT OF TAXI
1&. AMount 01 Lln. 14 .t SpauIII rat. 115)
16, AMount 01 L1n. 14 taNabla .t L1naal/Ch.. A rah 11~)
17, A.aunt 01 Lln. 14 taNabla .t Callatar.l/Clall Brat. (17)
18, Prlnalpal Tax Dua
TAX CREDITS I
PAYHENT
DATE
06-24-94
TAM RETURN WAS, I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST 0 SEE REYERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL
1, R..l E.tata ISah.dula Al
2, Stookl and Bonda ISchadula BI
S. Clal.ly Hald Staok/Partnarlhlp Int.r,"t ISahadul. CI
4. Hartgagal/Natl1 R.aalvabl. (Soh.dula D)
5, Calh/Bank Dlpalltl/Hlla. P.rlon.1 Prap.rty ISahadul1 EI
6, Jointly Ownld Praplrty ISahldula F)
7, Tronllara ISahaduh 0)
8, Tahl Aluto
APPROYED DEDUCTIONS AND EXEHPTIONSI
9. FUnlral Exp.nl.I/Ad.. Caltl/Hlla, Expanlal ISohadul. HI
10. D.btI/Hartglg. Lllbllltlal/Lllnl ISohadula Il
11, Tahl Daduotlonl
12, Hat Valu. 01 TaN Raturn
IS, Charltabll/govlrn.antal Blquftltl ISchadula J)
14, N.t Valua 01 Elhta Subjlct to Tax
NOTEI
RECEIPT
NUliBER
HH886228
DISCOUNT I +l
INTEREST 1-)
336.44
. IF PAID AFTER DATE INDICATED, SEE REYERSE
FOR CALCULATIDN OF ADDITIONAL INTEREST,
I I CHANgED
II)
(2)-
IS)
141
15)_
16)
171,
65,000,00
,00
,00
.00
61,026.99
.00
,.0.0..
18)
l26,02~
(9)
110)
12.389.47
1.490,97
111 )
1121
(15)
1141
13,880 44
112.146,55
,00
112.146.51
.00 K' 00.
112,146,55 M.06.
,UO M .15.
118)
.00
6,728,79
,00
6.728,79
AHOUNT PAID
6,392.35
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUI!
6,728.79
,00
.00
,00
IF TOTAL DUE IS LESS THAN el. NO PAYHENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI. YOU !lAY BE DUE
A REFUND, SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
Rl!IIRVATlONI
PtJIllIO$! Of
HilllCII
PAVItEHTI
llEPl.9IO (CRII
~".I
:(
,1,1,
"
,',
'I'
r"1
I,
",
,I
I'i
, :~)
Ul)
Elite". of dlo.de'nt. dvln. on or blfar. DIC'R.r 12, 1912 ... if ."y future Int,,", In the ...tlt. r. trlnlf,rr.d
In po.tlnlaR I.Ir .nJoy..nt to el... . halllt,ral) blntfJol.rt.. 0' thl dlc.d,nt IU,r the uplrlUon of Iny utat. for
Uf. or for v..r., the Co..onwo.1tn horeby 'lCpr'"b r'..rll.. the right to ,pprlll. Ind ...... tran.flr Im.rU.nel TlMII
at the lawful Cl,.. . (0011.t,rll) rlt, on I"Y .ueh tuture Int.r..t.
To fulfill thl rlqulrl.,ntl of Slotlon ZlitO 0' the Inh.rltlnc. and EltltI Tlx Act, Act 22 of 1991. 72 1'.5,
Slotlon U~O.
D.tlch th, top portlon of thll Hotio. 1M tub,it wUh your Ply..nt to thl RIght.r of Wllh printed on the rlv.r.. IlcI4.
- -Hike chick cr .cnl. ordor PI.lbll to I REGISTER OF HILLS I AGENT
All Ply.ent. r.cetvld Ih,l1 flr.t b. appU.d ta Iny lnt.r..t which 'IIY b. dut with IIny rllllndtr IPPllld to the tlM.
A r.fund of I hx crtdit, which WII not rlqulltld on tha TalC R.turn, "IY bl rlqutlhd by celpllUna In "AppllclUon
for Alfund of PlnnUlvlnl. InhlrHanc. and Eltah TalC" (REY-1]l!). Appllcation. are aVllhbl1 It the Offlc.
of the Righter of Will., .ny of thl 23 Rlv.nUI District OffiCII, or by calling the .p.elal Z4-hour
an'wlrlng ..rvlcl nUlbgr. for far.. ord.rlngl In P.nn.ylvanla 1-800-362-l0S0, out.ldl P,nn.ylvlnl. and
within 100.1 H.rrhburg artll (111) 787-8094, TnD' (717) 71l-ZZS2 IHI.rlng bp.Jr.d Onh),
OIJECTlOHSI Any party ln Int.rut not ..thUld with thl appral....nt, allowoool or dh,l1cw.nc. of dlductiona, or ........nt
of tlM <lnctudlng dhoo\lnt or Interllt) II .hown on thll HoticI IIU.t obJlct within .hcty 160J diY' of rtcllpt of
thll Hotlcl bYI
ADHIH
IITRATlI/t
CDRtlfCTIONSI
DISCOUHT I
IHTIRUTI
--wrHten prot..t to the PA Dlpart.lnt of R.v.nuI, Board of APPllh, DEPT, 281021, ttlrrltburg, PA 17128-1021, OR
--llIotlon to h.v. the .,tter d,tertln.d at audit of the account of the p.r.anal r.pr'..ntattv., OR '
--.pp..l to th. Orphln.' Ccurt,
Flctu.1 errart dhoov.r.d on thil ......II.nt .hould bl addre"ld in wr I tlng tOI PA Dlpartllnt of R.Vlnul,
Iurllu of Indlvld\111 hlC", ATTHI Po.t h.......nt Rlvl.w Unit, DEPT, Z80601, Harrisburg, PA 171ZI-0601
Phonl (711) 181-6505, Sit plgl 5 of thl bookllt "In.tructlon. far lnh.rit.nc. talC Return for a FlI.ld.nt
Olcldlnt" (REV-ISOI) for In IlCptanatlon of adttnl.trattv,IY corrl~t,bl, .rror.,
If any ttIC dul It p'ld within thrl. (3) cII.ndar .onth. aftlr the dlCtdlnt" dllth, , fivI plrolnt (S;() dltaaunt of
thl tlM p,ld It allowed.
Inter..t It cherg.d b'QJnnlng with first dav of d.lInquenav, or nln. (9) Monthl and on. (1) day frail thl dltl of
dltth, to thl d,t. of pa~..nt. TlIC" which b.oa.. d.lInqu.nt b.for. January I J 1982 blar lnt,,"t at the rat. of
lhe (6:./) p.rclnt par annUl calcul,tld at a dallY r.t. of ,000164, All tlM" whlah b.c... dlllnquent on Ind ,ltlr
Januarv 1, 1912 wtll bur lnt.rllt at a rete whIch wUI vary fral c,lIndar vur to calendlr yur with thlt rtta
announcld b~ thl PA O.p,rt..nt of Rlvlnul. Thl appllclble Internt rat.. for 198Z through 1994 artt
Vllr Intortlt Ratl 2!Jh Intlrtlt Factor ~ Intlrllt Rat, Dally Intar..t Factor
......
1912 lOX ,000541 1916 lOX ,000274
1.15 16X ,OO04!1 1.17 9X ,000147
1.14 IIX ,000301 1911-19.1 IIX ,000301
1.15 IlX ,000556 1991 'X ,000247
1993.199/, IX .000l91
....Int.r...t I. e'lculat,d a. fOllow',
INTBREST . SALANOE OF TAX UNPAID X NUnlER OF DAVS DELINQUENT X OAILV INTEREST FACTOR
--Any Notlo. I..u.d aftlr thl taM baco.l, d.1Jnqutnt will rafllct ~n Intlr..t calculation to flft,.n (IS1 dlV'
btvond thl d.t. of the ........nt. If "'Vllnt h ..Idl after thl lnter"t oa19ut,Uon d't. .hown on tht
NottCI, 'ddltlon,1 Int,r..t 'Ult b. calculat.d,
91
.. l..'-. ,..'t'
, 1''"'1'--;.'.:
'~,"'.~-41