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No. 21 - 94 - 430
Estate of
ADRlI HOpp~m CLARKIN
., Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
and Lellers
are hereby granted to
May 20, 94
AND NOW - _ 19_, In conslderntlon of the petltl.on on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the Instrument(s) dated March. 27. 1990
described therein be admitted to probate and riled of record as the lust will of
lIdra Hopper Clarkin
'l'estamentary
John E. Slike
Will Book N
Page _
1f1'
FEES
Probate, Lellers, Etc, """", $
Short Certl.Ocates(2 ) , , , , , , , , " $
Reny.nclatlon """""""" $
X-pages $
JCP, . .
TOTAL _ $
25.00
n.nn
John E. Slike, 06262
ATIORNEY (Sup, CI, I.D, No,)
Box 737, Camp Hill, PA 17001-0737
ADDRESS
Filed ,.... ,M~ Y . ~,q _ . J ,9.~4 , , , , , , , . . . . . . . .
12.00
5.W
4/1 nn
737-3405
PHONE
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Mailed letters and order to attorney on 5-20-94,
, , .
LAST WILL AND TESTAMENT
OF
ADRA HOPPER CLARKIN
I, ADRA HOPPER CLARKIN of the Borough of Camp Hill, Cumberland
county, Pennsylvania, declare this to be my Last will and Testament,
heroby revokJ.ng any will previously made by me.
I - I direct the payment of all my just debts and funeral expen'.
ses out of my estate as soon as may be practical after my death.
II - I bequeath certain items of my tangible personal property,
not including cash and securities, in accordance with a written list
made by me during my lifetime. I bequeath the remainder of my furniture
and household goods to my daughter, Sally M. Hayes. Any other articles
of tangible personal property not designated on a list or constituting
furniture or household goods, including jewelry, automobiles and per-
sonal effects, shall be distributed by my executor to my children in as
nearly equal shares as possible, and the remainder be sold and added to
the residue of my estate.
III - I direct the payment of $1,000 to my friend, Anna Cooper,
now of Camp Hill, Pennsylvania.
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ARNOLD" SLIKE, Al'IClRNf_n'Al'I.AW, Wl'l MARta.T HRH.l. (;^MI' 111I.1.. M 17011
"
IV - I devise and bequeath all the rest, residue and remainder
of my estate of whatever nature and wherever situate unto my son, John
D. Hopper, and my daughter, Sally M. Hayes. Should my son, John D.
Hopper, predecease me, his share shall be paid to his issue per stirpes.
Should my said daughter, Sally M. Hayes, predecease me, her share shall
be paid to her husband, Joseph Hayes. Should both Sally M. Hayes and
Joseph Hayes predecease me, then her share shall be paid unto Dauphin
Deposit Bank and Trust Company, Trustee, IN TRUST, nevertheless for the
following uses and pUrposeD and under the fallowing terms and condi-
tions:
1. The trust shall be held for the benefit of the
grandchildren of Sally M. Hayes in equal shares. The trust shall be
divided into as many shares as there shall be grandchildren then living
and grandchildren then dead represented by iDsue then living, and the
trustee shall:
(a) Distribute one Such share to the issue of
Such deceased grandchild per stirpes.
(b) Hold one such share as a separate trust for
the benefit of each of said grandchildren then living. Out of the
income derived by the trustee, trustee shall pay all the necessary costs
and expenses of the trust, inclUding reasonable compensation of trustee.
The trustee, at its sole and absolute discretion, may make expenditures
from the income or principal of the trust as it may deem necessary for
the support, maintenance and education of each beneficiary. As each of
the grandchildren attains the age of 25, his or her share shall be
distributed to him or her absolutely.
(c) If any grandchild for whose benefit the
trustee holds a separate trust dies before distribution of the entire
share held for the benefit of said grandchild, the principal and any
,
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COM ~~~A"r\~tw\\Oo'lJ/t.'illMANIA
HARRISR6~&,W'~\1I'0I0'
/if".;2/{J-'I
INHERITANCE TAX RETURN,
RESIDENT DECEDENT
(TO BE FILED IN DUPI.ICATE
WITH REGISTER OF WILLS
NUMBER
,
AEV~ UOOElC .(11~gIJ
(!...
POR DATESOF DEATH APTER 12/0' 1 CIlECKHERE
IF A ePDUBAL
POVERTY CREDIT Ie CLAIMED
FILE NUMBER
90CIAL SECURITY NUMBEA
180.01.3075
I X 1. Ollglnel Relurn
~ ~ 0 4, llmllod Eelalo
~ ~ ~ [R] e. Doeedent Dlod Te"slo
! (Msch copy 01 Will)
717 737.3405
1, Hoal E"SIO (Schedole A)
2, Slacks snd Bond, (Schedule B)
3, Closely Held Slock/Partnorehlp Inleresl (Schedule C)
4, Mortgagos snd Nolos Recelvablo (Schedulo 0)
6, Cash, Bank Deposlls & Mlscellanoous Personal Property
(Schedulo E)
e, JolnUy Owned Property (Schodulo F)
7, Transfele (Schedule G) (Schodule L)
a, Total Gross AssSI9(lolalllnes 1-7)
9, Funeral EKponses, Admlnlslratlve Cosls, Mlscollenoou.
EKpensos (Schedule H)
10. Debls, Mortgage Uabllltlos, Lions (Schedule I)
11. Tolal Deduction, (Iolal lines S & 10)
12. Nel Voluo 01 ESlala (line 0 mlnu, line 11)
13, Ch.,lIeblo snd Oovornmonlal Beque,'e (Schodule ,I)
14, NOI Velue Sub ecllo Tax IIno 12 mlnu, line 13
15, Amount olllno 141axeblo s16% rSle
(Include vsluo, 110m Schedule K or Schedule M,)
16. Amounl olllno 141axeblo s115% rsle
(Include veluo, from Schedule K or Schodulo M,)
17, Principal tax due (Add lax from IIno 15 snd Irom line 16,)
la, Credll'/Sp Poverty Prior Peymenl' Discount
+ 1,000,00 + 52,63
19. II line la " groelor Ihon IIno 17, onlor the dlfforonco on IIno 19, Thl,', tho OVERPAYMENT.
~ gm ~era" you Ira r"luutlng a rsfund 01 your OVllpAvmlnl.j
20, IIlIno 17 Ie groeler Ihen IIno la, orllor Iho dilloronco on IIno 20, Thl,'slhe TAX DUE,
A, Entor lho Inlor091 on Ihe balenco duo on IIno 2M,
B, Enler Iho 10101 01 II no 20 snd 2M on IIno 208, This Is Iho BALANCE DUE.
Mlka Check PI Bbl. to: Rs letsr 01 Will, A ent
,. ,. BE SURE TO ANSWER AU QUESTIONS ON PAGE 2 AND TO RECHECK MATH . ...
Undlt p.n.IlIU 01 PlrjUly, I d.cl'I.IIlU I hlv, .umln.d Ihll rlluln, including 'ccompanYlng .chululll and .1.I.m.nt., and 10 th. bul 01 my knowl.dg. and b.II.1, Ill' Iru.,
COlflcl.nd compllll. I d.cl.rl Ih.1 ,II flllul.11 h&l bltn f.pofl.rl.llfl.11 r 'fk.1 v.!ue. D.r.t.lrallon of pl'plfer olhlf Ihln 1h. pIUOnl! rtpltunllllve I, bl..d on .1IIn'Ofnl.llon
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2194.430
I
DECEDENT'S NAMl! (LAST, FIRST, AND MIDDLE INITIAL)
CLARKIN, ADRA HOPPER
COUNTY CODE
DECEOENT'S COMPLETE ADORES!)
3422 Trlnd1e Road
Comp Hill, PA 17011
YfAR
Cumberland
o 41. Fuluro Inloro,' Comproml'o
(lor dele' 01 dOSlh sher 12-12'02)
o 7. Decedenl Malnlalnod a Living Truet
(Atlaoh a copy 01 Truet)
3. Romalnder ROlurn
(for doloe of doalh prior 10 12-13-02)
Fodersl Eelole Tex
Rolurn Roqulred
TOlal Number 01 Sale Dopo," Bo.es
06.
....9..-a,
AU CORRESpONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME
John E, Sllke Es ulre
TEl.EPHONE NUMBER
COMPl.ETE M^ILING ADDRESS
R
E
C
A
P
I
T
U
L
A
T
o
N
(1)
(2)
(3)
(4)
(6)
Saldls, Guido, Shuff &
2109 Market Street
Cam Hl11 PA 17011
None
None
None
None
19,232.72
Mas1and
(6)
(7)
11,544.26
None
(6)
30,776.98
(8)
10,925.36
(10)
718.30
(11)
(12)
(13)_
14
11,643.66
19,133,32
None
19 133.32
1,088.00
(16)
18,133,32
K ,00.
T
A
X
C
o
M
P
U
~
b
N
1,000,00 X ,15.
(16)
150,00
(17)
1,238.00
Inlorosl
(16)
(19)
1,052.63
0.00
(20)
(20A)
(2llB)
185,37
0.00
185.37
SIGNATURE OF rEASON AEDPONSIOLE Fon FII.INQ nnURN AODAESD
DMt
P/~'
2i"69" i-ilil:ko't' St'I:~C't"""""""""""'." 0....
Cu'rop' iii i r: 'lii-:"i 7(iii............................
A(1DflESS
Saldls, Guido, Shuff & Has1and
2Y69' M~ii'ko't:' S't'l:~cto""""'"""""""., 0 0.0..
cuOnip" iiii r: . [iil' "i 7ciii.............. 0.............
tJ;/S-/9 T'
,
AE AAEAOTf~"A~"VE
DATE
,,,~~~zr.~
I foun .ollw.ft enly C,nl., PI'C' 80lt..,...rl, Inc,
REV - I!OIEX + 11-11)
COM~IRJ\l~4\W~ANIA
ESTATE OF
ADRA HOPPER CLARKIN SS~ 180-01-3075
SCHEDULE F
JOINTLY-OWNED PROPERTY
02/08/94
Pile NUMBER
2194-430
Joint tenlnl(l);
A.
NAME
John D. Hopper
ADDRESS
2304 Cheetnut St
Camp Hill, PA 17011
RELATIONSHIP TO DECEDENT
Son
II.
Sally M. Hayes
3422 Trindle Road
Camp Hill, PA 17011
Daughter
c.
Jolntlv-ownld property;
LETTER DATe
ITEM FOR MADE! DESCRIPTION OP PROPERTY TOTAL VALUE! DECO'S DOUAR VALUE! OP
NUMBER JOINT OP ASSET pECEDENTINTERE&T
TENANT JOINT "INT.
1 A&B 01/05/85 MFS Government Mtg Fund 34,632.78 33.33% 11, 544.26
,
.
,
,
TOTAL IN80 enler on line e, ROOaDnullUonl Is 11 544.26
(II more IplOlll needed, lnaert Iddltlonlllheeta of lame elze,)
CoPvrlghtlc)lUl form .allw,II only C.nt., PliO' eoftwltl, InD.
Form !BOO Sch.dul. P (R.v, 11-11)
REV- ""IX + (1-1')
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Print or T e
PILI! NUMBER
2194-430
COM\t\l\l~~'lf~WN'ANIA
I!S1'ATI! OP
ADRA HOPPER CLARKIN
ITEM
..JUMBER
A, Punerll EIlptn...:
SS~ 180-01-3075 02/08/94
DESCRIPTION
AMOUNT
1
2
Myers-Harner Funeral Home, Inc.
Rolling Green Cemetery - grave opening, memorial, etc,
5,195.00
1,637.36
B. AdmlnlllllUvl CoIIII
1. P8/'80nll Repreeentlllve Commlll8ions 1,000.00
Soclll Seourlty Number of Personal Reproeentltlve: 251-69.4606
Vlar Commlll8ions paid _
2. Attorney F888 1,000,00
3. Fan~ly Exsmpllon 2,000.00
Clllmant Sally Hayes Relstlonehlp Daullhter
Address of Clalmanllt decedent's delll1
Sueet Address 3422 Trindle Road
city Camp Hill State~ Zip Code 17011
4. Probate Fees 48,00.
C. MI_lIlnsouI I!xpenlll:
1 Register of Wills - filing fees 25:00
2 PNC Bank . check charge 20,00
TOTAL AI80 enter on line g Reo 1l11111Jon
(II morl IpI08I8 needed, In88ft Iddltlonallheel9 01 same size,)
CopyrlllM (el tll1 form .ottwa" only C,nter Pile. Softwl,..ln4.
. 10 925,36
FOIm 1100 S'h'd," H (ROY, 70111
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COMMONWIALTH OF PINNSYLVANIA
COUNTY OF CUMBERLAND
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III
John E. Slikfl
being duly __~~orn __ according to law, dopo... and laYI that h.
of tho Eltat. of Adra Hopper Clarkin
lat. of -- _,~,~,~~_~~.!.~.,_~,?,~ollg}~.. , Cumberland County, PI,. dtctUtd and that the
him executor
within Is an Inventory m.de by ._" the Illd
of the enllre OIteto of !lId docedent, conlllllng of .11 the perlon.1 prop'irty Ind rill eltalo. noept rOIl estate ouhldo
tho Commonwlllth of Ponnlylvanle, .nd that tho fl9urOl oppollte Qlch Item of the Inventory reprolent It'l fair value
as of the date of docedent'l death. '
is Executor
Sworn to
and lublcrlbed bofore me,
,
;:tJ.une 16, 94
.1 ~_19-;-
I ./ ?-x.al<...J Wln o.~_
2109 Market Street
NOTARIAL SEAL
THElMf. S McCAUSLIN, Nolary Public
r.aml,I1I1I, Cumberland Counly
Mv 1,,)'nm,:,lon Expires July 3,
Date of oe.iih"'--
Camp Hill, PA 17011
Add""
OIY
February
Month
1994
Y..,
INSTRUCTIONS
I. An Inventory mUlt be flied within thre. monthl .fter appointment of personal reprolOntatlvo.
2, A lupplement Inventory mUlt be flied within thirty daYI of dllcovery of additional alltll,
3. Addlllon.llheeh m.y be attaohod 41 to personalty or realty
4. Soe Article IV, Fiduciaries Act of 1949.
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ADRA BOPPIR O~IN, DICIABID
9 <I - tf..3 c>
Series "E" Bonde
u. S; Treasury - ,1993 tax refund
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TOTAL
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$17,62,7.72
1'. 60~. OQ
19,232.72
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NOTICE OF INHERITANCE TAM
APPRAISEHENT, ALLOWANCE OR OISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAK DATI 1l-01-94
FILE NO. 21 94-0430
DATE OF DEATH 02-08-94 COUNTY CUMBERLAND
NOTE, TO INRURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTIDN OF THIS FORH WITH YOUR TAK
PAVHENT TO THE REOISTER OF WILLS. HUE CHECK PAVABLE TO "REOISTER OF WILLS, AO~NT"
REMIT PAVMENT TOI
REV.1547 EX APP loa.94*
COHHOHWEAlIH OF PEHHSVlVANIA
DEPARTHENT OF REVEHUE
IOREAU OF INDIVIDUAL TAMEI
DEPT, UD60l
HARRUlORO, PA 17IZl'0601
ACN
101
-
JOHN E SLIKE ESQ
SAlOIS ETAL
2109 MARKET ST
CAMP HILL PA 17011
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
L
AMount ROMlttod
--
cur ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
ilEV: Iii;'''! - iie -AFji"f os": 94 T"iiii'r"ici' .OP'"iNHiiii;: AifC!" T AX'A iiiiii'A isiifiii r;'Ai.t"OWAifC! -,(ili'" - - -". - -......,
DISALLOWANCE OF D!DUCTIONS AND ASSESSHENT OF TAX
ESTATE OF CLARKIN ADRA H FILE NO. 21 94-0430 ACN 101 DATI 1l-0"-94
TAM RETURN WAS I I ) ACCEPTED AS FILED I x) CHAHOEb-) SEE ATTACHED' NOTICE
RESERVATION CCNCERNING FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL
1. Rool ERtOto lSohodulo A) 11)
2. Stooko ond Bond. ISohodulo B) 12)
S. Clo..1y Hold Stook/Portnor.hlp Inbr..t ISohodulo C) ISI
4. Hortgogo./Notoo Roool.oblo lSohodulo D) (4)
&. Co.h/B.nk Dopo.lt./HI.o. Por.onol P,oporty ISohodulo E) 15)
6. Jointly O.nod Proporty ISohodulo FI 16)
7. Tron.for. ISohodulo 0) 17)
.. Totol A..oto
.00
.QQ.
.00
.00
19,232.12
12,051.59
.00
II) .
31, 284,31
APPROVED DEDUCTIONS AND EXEMPTIONS I
9, Funorol E.pon.o./AdM. Co.h/Hilo, bpon.o. ISohodulo H) 191
10. DObh/Hortgogo Llobl1lti../Llon. ISohodulo Il 110) 718.30
11. Totll Dodo.tlon. 111)
12, Not Voluo .f To. Roturn (2)
15, Chlrltobll/Oo.ornMonhl Boqu..h ISohodulo J) US)
14. Not Voluo of Eltoto Subjoot to To. (4) 19,640,65
NOTE I If.n ......m.nt w.. i"u.d pr.viou.ly, lin.. 14, 15 .nd/or 16'; 17 .nd,U wUl
r.fl.ct figur.. th.t include the tot.l of ~ return. .......d to d.t..
ASSESSMENT OF T'AXI
1&. AMount of Llno 14 It Spou.ol rlto 11&1
16. AMount of Llnl 14 to.oblo ot LlnooI/Clo.. A roto (16)
17. A.ount of Linl 14 to.oblo ot CoUotorll/Cl... 8 rlto (7)
18. Prlnolpol To. Duo
TAX CREDITSJ
PAVHENT
DATE
05-05-94
06-16-94
10,925.36
11 . ~4~ /at.
19,640,65
,DO ",,'-"
.00 M .00.
18,640,65 M .06.-
1,000.00 M .15.
(8)
,00
1,118,44
150,00
1,268,44
RECEIPT
NUHBER
MM886048
MM886187
DISCDUNT 1+1
INTEREST I,)
52.63
.00
AHOUNT PAID
1,000.00
185,31
INTEREST IS CHARGED FROM 11-09-94 TO 11-15-94
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
1,238.00
30.44
.04
30.48
N IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
I IF TOTAL DUE IS LESS THAN 11, NO PAVNENT XS REquIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU HAV BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS,J
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RfIlHVATlOlll
P\IllPOtElIf'
NOTICE'
PAVHt:NT,
HEFI.lID (CHI'
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E.toto. .1 .........to d~ln. on .r bol.ro ..coobor IZ, ltiE -. If on~ luturo Intor..t In tho ..tOt. So tron.lorred
In POII.,.lon or .nJov.-nt to CI... . (coll,t,rl.) btn,flal,rl,. of thld.oldent .ft,r thl Ixplretlan of any ..te.e for
llf. or for y..r., the Co-.anw.llth hertby Ixpr.I.lv r..'rY'. thl right to .pprlt.. end ."... trln",r Inh,rltlnot TIXI.
.t tM l"'ful ClI.. . (ooUlt,r,.) rlh on any 'uch future Int,rllt.
To fulfill the r.qulr..."t. of S.~tlon 21'0 0' thl lnh.rltlnol end E,t't, rlx Aot, Act 22 of 1991. 72 P.I,
So.Uon !l\O,
INtech t~ top porHon ofthh Notice and tub,it with your PIY.."t to thl RIght,r of WUlI prInted on thl ,'IV,,,. licit.
'-Nol<o chock 0' oono~ o,d" P'~Oblo to, REGISTER OF HILLS, AGENT
All, Plv.,ntl rtc:elv,d .hlU Ur.. btl ."plled to .nv tnt.r..t which ..~ b, M with .n~ r'Nlnd.r .pplhd to the ttH.
A r.fund of . hH er~lt, which wt'. not r,quut.d on the TeH R.turn, 'I~ b. r.qu..ted by cDlp1ltlng In "AppllolUon
for R.fund of P.nn'Yl".nl. Inh'rltlnel .nd E.tlt. hue" (AEY"U15J. ' Appllc.Uon. Ir. e"a111b1l It thl Offlc.
of thl R'OI.t.r of WIll., any of thl 23 R.".nu. Dlltrlot Off lei', or bv o,lllng thl .p.ol,1 24~hour
,".w.rlng ..r"Io. nu.b.r. for for.' ordtrlnGI tn Plnnlvl"lnI, 1~IOO~S62~2050, ~ut.ldl P.nnlvl"lnll .nd
within looal Hlrrhburg 'rll (717) 781-8094, TOOl (717) 772~2252 (Hlldn; tlp.lrod Onlv),
OIJECTIOHSI Anv p.rtv In Int.r..t not .,tl.fl.d with thl .ppr.I....nt, Illo..lno. or dl.lllowlno. of d.duot.on., or ........nt
of tlM (IncludIng dl.oount or Int.r..t) 'I .hown on thl. Hotlot IU.t obj.ot within .Ixtv (60) dlv, 0' r,cllpt of
Ihlo Nollce b.,
ADNIN
IIlHATlI/!
C_C!lOllI.
DISCDlJN1'
INTERfST,
'I"~
~"wrltt.n prot..t to the PA D'Plrt..nt of R.IJ.nuI, ao.rd Q' APPIIlt, DEPT, 281021, H.rrhburg, PA 17UI-l021, OR
......oUon to hlv, th, ..tt.r d.hr.ln.d It audit of the lIooount of the p.r.onll r.pr...ntlt1v., OR
....."..1 to the Orph.n.' Court.
Factual .rror. dlloov.r.d on thlt ........nt .hould b. .ddr....d In wrltlnltol PA D.p,rt"nt of A'V'M,
Burltu of Indlvlduel TIX", ATTNI Po.t A.....~.nt R.vllw Unit, DEPT, 210401, H.rrI,burl, PA 1712..0601
Phone (711) 187,,6505. s.. p... S 0' thl book"t "In.truotlonl for Inh.rJtenol Tex Rlturn for I A..ld,"t
O.oedlnt" tAEY~IS01) for en explanation of ed.lnl.trltl"llv oorrletebl. .rror..
If any tlM due It Plld within thr.. (5) oal.nder lonth. after thl dlc.d.nt'. d.ath, I flvI peroant CS:O dhoount of'
the tlM P.Jd It l11ow.d,
Interelt h ehlrgld blglnnlnl with first d.y of d.Unqulnoy, or nlnl (9) _onth. Ind ani (1) d.v fro, thl d.tl of
dtlth, to the date 0' p.v..nt, T.kl' which b.el.. dllinquent blforl Jlnutrv I, 19'2 bl.r Int.r..t It the rlt, 0'
.Ix (6~) percent plr Innu. ollculettd It . dallv rltl of ,000164. All tax.. which blol.e dllinquent on and eft.r
Jlnulrv 1, 1912 will bier Inter..t .t I rttl whlch..111 vary froll o.llnd,r Vllr to clllnder Vllr with th.t ret.
announcld bv thl PA Dlperte.nt 0' A.vlnul, Th. appllolbl. Intlrl.t ratl' for 1982 through 1994 ar'l
'!!!!: Jnter..t Alt. OallY Int.r..t Faotor !!!r Intlr..t Aat. D.IIY Interllt Flotor
1912 lOX ,000&4' 1916 lOX ,0DDm
1911 16X ,000\11 1917 9X ,000241
191\ 1lX ,000101 1911-1991 1lX ,DOOm
I'U IlX ,000l&6 1992 9X ,Doom
1995-199\ 7X ,000192
"Inter..t I. o.loulltld ., folloWl1
INTERElT . SALANCE OF TAX UNPAIO X NU"IER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
"Any NoUOI IIIUId Ifter tht tllC HCOI" dll1nqu.nt ..Ul reUlot en Int.rllt ellculltlon to "1ftlln (!I)d.VI
bevond the dltl of thl ......eent, If plv..nt I. Ildl .ftlr the Int.rl.t oo,putetlon dlt. ,hown on thl,
NoUCI, addltlonl! Inter.., MIlt bl ethul'tH.
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REV,147HXIVtI
INHE~ITANCE TAX
EXPLANATION
OF CHANGES
... . . II
COMMONWEAL1ffOF PENNSYLVANIA
DEPARTMENT OF REVENUE
IURIAU OF INDIVIDUAL TAXII
DEPT, 28060 I
HARRISBURG, PA 17128-0601
DECEDENT'S NAME
--...,.....
FILE NUMBER
Adu. Clllrltin
2194-0430
ACN
'"
101
SCHIDULE
ITlM
NO,
EXPLANATION OF CHANGES
F
tncluded tlXlIb1e val uo of Dauphl n Depod t j 01 nt checking account in the
.~ount of $507.33.
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TIiX EXAMINER:
, I1nrch 9Uborllllln
PAGE
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PAVICHT I
R!PIIl1l (CRI,
R!PLV
TO,
OIlCO\lIIT,
IHTER!IT,
..
htlClh the top portion of thh ~Otlll' Dnd lub.1t w1th your ply..nt .,d, Plvabll to thl nu. end addr... prlnted
on thl r~v'r" ,Id..
All PIVHnh rlcalved 'hill first be .ppll'd to any lntlr..t which 'IY bt due with any r...lnd.r IPPlltd to the t'M,
A r.fund 0' . tlM or,dlt, whloh WI' not r,quI.ttd on thl TIM R.turn, ..y bt r.qulltld by co.pl.tl"g In
"Appllcltlon for R.fund of Plnnlvlva"la Inherltanc. end E,t,t, TaM" (REY~151]). Application. ar. IVIIIIbI. .t
thl OffiCIO' the A.ghter of Willi, Iny of thl 24 Rev,nul Olltrlot Offl"u, or by o,l111ng thl 'PIOlll Ztt~hour
InINtrlng ..rvlel nu.b.r, for for.. ordlrlngl NEW IN PENNSVLYANIA 1.800.362.Z050, out.l~. Plnn,vlvant.
and within thl 10011 Harrl'burg .rt. (117) 787.8094.
Outltlone r...rdlnG .rror. contalntd on thl. notlc. .hould b. addr....d tal PA O.p.rt..nt of R'v,nue, Bur.lu
of Indlvldull 1Ix.., ATTNI Po.t A.......nt A.vIIM Unit, DEPT. 210601, Hlrrl.burg, PA \71211-0601, phone
(7m 7'7.6105.
If InY tlx due I. Plld within thr'l (1) cII.ndlr lIonth. .ft,r the d.c.d.nt'. dlath, I flvl p.rclnt (S~) dlleount
of thl tl. paid II 1I11ow.d.
1nt.r..t II chlrgld big IMina with first dlY of dllinquenoy, or nln. (9) lonth. Ind one (1) day frow the d.tl nf
dt.th, to thl dlt. of P'1Hnt. TI.I' which b.o... d.llnqu.nt be fer. JlnulrY 1, 1912 bllr Intlr..t at thl r.t. of
.1. (6~) Plrclnt plr InnuI cllcul.tad It I dlllv r.te et .000164. All tIXI. which blo.', dtllnqulnt on .nd aftar
JInU.ry 1, 1912 will bl,r Intlr..t .t a rlt. whloh will varv frol ellend.r ye.r to oll.nd,r vear with thlt rlt.
Imounnd by thl PA o.p.rt.lnt of RIV.nul. Th. IPpllcabll Intlrllt rat.. fer 1912 throUllh 1994 artl
U!! Intlr..t Rlt. O,llv Int.r..t r.ctor X!!! Interllt R!t. DallY Intlrllt rlotor
1911 20X ,00054' 1916 lOX .000214
1915 16X .00045' I9IT 9X .ooom
1914 m .000301 1911-l991 llX .000501
1911 m ,000556 1992 9X .ooom
1995-1994 7X ,000192
--Inter..t I. caloullt.d ,. followlI
INTEREST . IALANCE OF TAX UNPAID X NU"IER DF DAYS DELINQUENT X DAILY INTEREST FACTOR
~.AnY Notlol I"uld aft.r th. tlX blooa.. dlllnqu.nt will rlfllot In Int.r..t calculltton to flfteln (11) dlY.
beyond thl d.te of thl ........nt. tf p(lyltnt It aldl after thl Intlrllt cOllputtUon d'tl shown on thl
Hotlcl, Iddltlonll Int.r..t IUlt bl c.lcul,t.d.
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STATUS REPORT UNDER RULE 6.12
Name of Decedent I /tdr?
Date of Deathl ,~ If) 11/
, , (
Will No.
/lo1/Jt'r (l/ClII€. (I;
_ Admin. No.. ,,;//,/77'1- Y'?o
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate I
1.
State wpether administration of the estat~ is complete I
Yes L No
2. If the answer J.s No, st.ate when the personal
representative reasonably believes that the administration will be
complete I
3. If the answer to No. I is Yes, state the following I
a. Did the personal representative file a final
account with the Court? Yes_____ NO~.
b. 'fhe separate Orphans' Court No. (if any) for
the personal representative's account iSI
c. Did the personal representative stat;e 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.
Datel 311:,'/f~
ture
)0/1111- tc)'JKe.
Name (Please type or print)
p () J3 6 X 7'37 (~i>"'1' 1-1; '/1 ;0.,.
Address 'I ' J 7 ' I
ou '0)
( ) / 3 '}, -'3 Y 0 j - 37
Te I, No,
I{)
Capacity I
Personal Representative
~Counsel for personal
representat. i ve
(MAHlrmf/AM3)