HomeMy WebLinkAbout94-00480
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1. Roal Ellale ISchedule A) I 1)
2. Slock. and Band. (Schedule 8) ( 2)
3. Clo,ely Held Slack/Partnership Inlerell (Schedule q I 31
4. Mortgages and NOles Re"lvable ISchedule D) I 4)
5. Ca,h, Bank Depo,ill & Miscellaneou, Personal Property I 5)
ISchedule E)
6. Joinlly Owned Property (Schedule F)
7. Tran.for. ISchedule GI (Schedule l)
B. Talal Groll Auol.llalallines 1.7)
9. Funeral Expen.e.. Admini"'alive Call', Mlscelianeou. I 91
Expen.e. ISchedule H)
10, Debll, Mortgage liabllltie., lien, (Schedule II (10)
11. Talal Deduc1ian. 110101 line, 9 & 101
12. Nel Value of Ellale lline a minu.line 11)
13. Charilable and Gavernmenlal BequellllSchedule J)
14. Net Value Sublec1la Tax Iline 12 minulline 13)
15, Amaunl 01 line 14 loxable at 6% rate
(Include value. from Schedulo K or Schodule M.)
16. Amaunl of line 14 loxable 01 1.:l% role
Ilnclude value. from Schedule K or Schodulo M.I
17. Prlnclpal tax due (Add lax from line 15 and from line 16.1
lB. C"dlll Spau.al Poverty Credit Prior Paymenll Dlscounl
+ 2.800.00 + 147.37
19. If line lB il grealer than line 17, enler the dlHerence on line 19. This I. Ihe OVERPAYMENT.
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20. If line 17 il g"aler Ihan line lB, enler Ihe dlHerence an line 20, Thl. i. the TAX DUE.
A. En'er tho inlerell an Iho balance due an line 20A.
B. Enter Ihe 10101 01 line 20 and 20A an line 20B. Thi. Is Ihe BALANCE DUE.
Make Check Payable t., Rogl.ter .f Wlllo, Agent
.. BE SURI TO ANSWIR ALL QUESTlONS ON REVERSI SIDI AND TO RICHICK MATH....
Und.r p.nalll.. af p.rjury, I d.clar. that I have uamln.d Ihl. r.lurn, Including accampanylng lch,dul.. and lIal.m.nll, and 10 Ih. b.., of my knowl.dg. and b.lI.l,
111.tru., catr.ct and compl'I', I d.clar. Ihat all reall1lat. hat bltn r.par1ed allru. ""ark.t valu.. D.datallon of ~ftf'ar., olh.r Ihan Ih. p.nonal r.pr.l.nlatlv. il
bal.d on alllnfcumollan of whlc:h prtpar.r hal any knowl.dge.
A R NIL IUN R URN AD RUS 5ATf
,J'~ ".' I 1.820 llrIan Rd., Hechenicsburg, PA 17055
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A!V.Il00 IX+ 1'1.911
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
PO. DAn5 0' DIATH Am. 12/31/91 CHICK HIU
" A S!'OUSAL
POvnTY CUDtT IS CLAIMID 0
fill NUMII.
cou~ctDe ft - ~!~
M "OORUS
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COMMONwe....LTH 0' peNNSYLVANIA
ClPARTMeNT m ReVENue
OIPT, 280601
HAAAISlUAO. PA 111Je.0601
N NAM lLA . I . AN MI
IN A
Dorsch, Theodora
Hessiah Vlllage
Hechanicsburg, PA
17055
F.
ru Of oeATH A 0 81A H
I 2-26-1994 4-1-1905
o 2. Supplemenlal Rotu,n
lA'
UIU 'f NUM8
COllnly
eu berlm
o 3. Remainder ROMn
lIar dalll.1 doalh prior to 12.13.82)
05. Fedoral Ellate Tax
Rolu,n Required
_B. Talal Number 01 Safo Dopa,il Box..
218-34-0502
G 1. Original Roturn
o 40. FuMO Inloroll Compraml.e
(lor dale. 01 doath aftor 12.12.B21
o 6. Deceden' Dlod rollalo 0 7. Decedent Mainlained a Living TrUll
(AHach copy 01 Will) IAHach c.py 01 Trull}
ALL CORRESPONDENCE AND CONPIDENTlAL TAX INfORMAnON SHOULD BI DIRICTID TO.
NAM JCOMPten MAILING AODRUS
Robert G. Radebach .___ 105 ~. Front Street
" H N NJMe"-- I Harrisburg. PA 17101
234-5600 ..
o 4. limited Ellato
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55,199.58
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2.500.00
1 r I 'i7 Q7
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(121
(13) .
(14)
'i.1\'i7.97
49,541.61
NONE
49 .541.61
2.972.50
115)
49.541.61
lC .06.
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InlorOlI
11 B) 2.947.37
(19)_
Clw[k here if you (lfe Il1quc\tinfJ n re'unll ul your oVNflnymchl.
25.13
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120A)
(20BI
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l05 N. Front Street, Harrisburg, PA 17101
SCHEDULE "F"/JOINTLY.OWNED PROPERTY
. I ESTATE OF FILE NUMBER
I
Theodora F. Dorsoh SS# 218.34.0502 02/26/1994 I
. . ...... .. ....... ..,...... .. . ... . . . . ... . . ...... .. .. ....... . . ......... ,.... .,". .. ... . .. . .. . I
Joint tenant (s) : . I
NAME ADDRESS RELATIONSHIP TO DEC' 0 I
A.Dorothy M. Vlasek 4820 Brian Road Daughter I
Mechaniosburg; PA 17055 I
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Jointly-owned property:
ITEM LETTER DATE
I NUMBER JOINT MADE DESCRIPTION OF PPT'i TOTAL VAL DECO'S VALUE AT DATE
I TENANT JOINT OF ASSET \' INT OF DEATH
I 1 A 6/21/90 Money Market Savings Acoount 59,245.02 50.00\' 29,622.51
I #0806145672 in First Federal
I of Harrisburg in the
I principal amount of
I $59,120.79 plus accrued I
I interest of $124.23. I
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2 A + 1 Yr. Savings Account in York 51,154 ;15 50.00\' 25,577.07 I
Federal Savings & Loan I
Association in the principal I
I amount of $51,154.15,' I
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I TOTAL (Also enter ~n line 6, Reoapitulation) 55,199.58
.........................................................................................................................................................
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), York
~ !~~~al.
, ,': ': ASSOCIATION
To Whom It May Concern:
Tha balance of the savings account in the
names of Theodora M Dorsch and Dorpthy M
Vlasek as of February 26, ,1994 was
$51,154.15.
Kathy M MIller
customer Service
Camp HIll
763-7723
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101 South George Street. P,O, ,Box 1506B. York. Po. 17405.7068
(717) B46-8777 F,ox No, (717) B46.0913
SCHEDULE "I" IDEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS
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1 ESTATE OF
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ITheodora F. Dorsch SS# 21B.34.05D2 02/26/1994 I
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lITEM . ,,",' I
I NUMBER DESCRIPTION . .' . AMOUNT I
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.. .. .. .. .. ,,'.. '" .\. .. .. ~ .. .. .. .. .. .. .. .. .. .. .. .. .. .. ...1
I 1 Messiah Village, medical' ' . , ". 2,758.09 I
I bill I
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I 2 Messiah Village, medical 18.9B I
I bill '. . I
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I 3 Upper Allan Emergency 381.00 1
I Medical Services I medical I
1 bill '. 'I
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.1 ' TOTAL (Also enter on line 10, Recapitulation) 3,157.97 I
FILE 'NUMBER
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REV-1547 EX AFP 112-94*1
COMMONWEALTH OF PENNSVLVANIA
DEPARTHEHT OF REVENUE NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES APPRAISEHENT I ALLOWANCE OR OISAlLOWANCE
DEPI. 200601 01' DEDUCTIONS AND ASSESSHENT OF TAX DATE 05-08-95
ttARRlSBURO, PA 11lZa~0601
!STATE OF FILE ND. 21 94- 0480
DATE DF DEATH 02- 26 - 94 COUNTY CUMBERLAND
NOTE, TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTIUN OF THIS FORH WITH YOUR TAX
PAYHENT TO THE REGISTER or WILLS. HAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TOI
RG, &:~.L 1./3CJ I PS / - 3
~ /1..)/9'..1
N--J./3-- N
/
11/
ACN
ROBERT G RADEBACH
105 N FRONT ST
HBG PA 17101
B
t 011
V
101
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Anaunt Renltted
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FDR YOUR RECORDS .....
iiEV: i!14-j"EiCAFP"nF94Y"Niii'icE"-oF" iNHEifiii,N"CE" TAX' 'A -ppi!XiiiEMENr;-ALDiw;\N-CE"iiFimn....m....-
DISALLOWANCE DF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DORSCH THEODORE A FILE NO. 21 94-0480 ACN 101 DATE 05-08'95
APPROVED DEDUCTIDNS AND EXEMPTIONS: _
2.500.00
9. Funerol Exponoe./Ad.. Ca.t./Hleo. Expen.o. (Sahedule HI (9)
10. Debts/Hartgoge L10bllltlu/Llene ISohedulo II llO) 3,157.97
11. T.tol DoduoHan. (111
12. Net Veluo of Tox Roturn (12)
15. Cherltobh/Gavorn.entol Bequut. (Soheduh ,I) (15) _
14. Net Voluo of Eetoto SUbjeot t. ToN ll41
NOTEI If an assessment was issuad previously, lines 14. 15 and/or 16, 17 and 18 will
reflect figures that includa the total of 6h~ returns assessed to date.
ASSESSMENT OF TAXI
IS. A..unt .f Lln. 14 .t Spou.ol roto (151
16. A..unt .f L1no 14 toxeble ot Llnool/Ch.. A rote (161
17. A..unt .f Line 14 toxeblo ot Calloter.I/Clo.. B rete (17)
IS, Prln.lpel Tox Due
TAX RETURN WAS, (X) ACCEPTED AS FILED (I
RESERVATION CONCERNING ~UTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. Reol Eototo (Sohoduh Al III
2. Stook. ond B.nd. (Sohedulo B) (2)
3. Claooly Held St.ok/portn.r.hlp Intere.t (Sohedule Cl (31
4. HartGege./N.te. Reoolvoble (Sohodulo 01 (41
5. Ce.h/Bonk Dop.olt./HI.o, Por.anol Proporty (Soh.dule EI (51
6. J.lnt!y O"nod Praporty (Sohodulo FI (6)
7. Tren.for. (Sohedulo 01 (71
S. T.tol Auoh
CHANGEO
OD
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49,541.61 X .06.
.00 X .15.
llSI
TAX CREDITS I
PAYHENT
DATE
05-26-94
RECEIPT
NUHBER
MM886115
DISCOUNT (+)
INTEREST (-)
147,37
AHOUNT PAID
2.800.00
INTEREST IS CHARGED FROM 11-27-94 TO 05-16-95
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
TDTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TDTAL DUE
· IF PAID AFTER OATE INOICATED, SEE REVERSE
FOR CALCULATION OF AODITIDNAl INTEREST.
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55.199.58
~.657 97
49,541.61
,00
49.541. 61
.00
2,972.50
.00
2,972.50
2,947.37
25.13
1. 01
26.14
IF TDTAL DUE IS LESS THAN II, NO PAYHENT IS REqUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR). YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS,)
..-- -
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RESERVATION I Eltat.. of dlc.dlnt. d~lng on or b.,ar. D.c..b,r 12, 1982 .~ Jf eny future Int.r..t In thl ..tet. I, tran.f.rr.d
In Po.....Jon or .nJoy..nt to Cle.. a 10011e'.ral) b.n.flal.rl.. of the d.c.d.nt e't.r the Ixplratlon af eny ..t.t. far
'11'. or for v..r., th, CO'lonN.alth h.reby Ixpr..tlv r...rv.. the right to apprals. and a..... tran".r Inh.rl~.no. Tlx..
at tht lawful Clel. B (0011a"ra.) rat. on any such future Int.r..t.
PURPOSE OF
HOT ICE I To fulfill the r.qulr...nt. of S.otlon 2140 0' th. Inh.rltanc. and E.tat. rlx Aat, Act 22 of 1991. 72 P,S,
Section 2140.
PAV"ENTI O,tloh the top portion of thl, Hotle. and .~b'lt with ~our Ply..nt to the RIgt.ter 0' Wills printed on th, r.ver.. tide.
--Hlk. check or .onlY ard.r payeble ttll REDISTER OF HILLS, ACENT
All Ply..nt. r.celved Ihal1 fJr.t b. applied to any Int.r..t whl~h .ay bl due with any rl.alndlr appllld to the tax,
REFUND (CR}I A r.fund of a tax cr.dlt, whl~h waf not r.quI.tld an the Tax Rlturn, .ay b. r.quo.t.d by coaplltlng an "Application
for R.fund of P.nn.ylvanla Inh.rlt~nc, and E.tnt. Tax" (REV-1313), Applicaticn! art avallabl. at th.Offic.
of the Rlgl.t.r of Will., any of the 23 R.vlnu. Ol.trlot Offlc.., or by calling thl .p~ol.1 24-hour
an.w.rlng ..rvk. nuabar. for for.. ord.rlngl In P.nn.ylvanla 1.800-362.2050, out,id. P.nn'Ylvanla and
within local Herrisburg ar.a (717) 787-8094, TOO. (717) 172-2252 (H.arlng I.palrld Only),
OBJEr.TIOHSI Any party In Int.r.st not .stJ.fl.d with thl epprel....nt, allowlnc. or dlsallowanc. of dlductlon., or a.......nt
of tax (Inoludlng di.count or Int.r,.t) a. shown on thl. Hotlel lust obJlet wlthJn sixty (60) day. of rec,lpt of
thlt Notlol bYI
...wrltt.n prot..t to the PA OIPert.ont of RIIV.nul, Board of Appeals, D.pt. 281021, Herrltburg, PA 17128-1021, OR
.-.Iectlon to have the lett.r dot.r.ln.d at audit of thl account of the p,rlenel r.prelentatlv., OR
...pp.al to the Orphen.' Court.
AOHlH
ISlRATlIIE
CORRECTlOHS.
Factual .rror. dllllov.red en thll ........llt 'hould b. .ddr....d In writing tOI PA D.part..nt af A.v.nu.,
Bur.au of Individual Tex.., ATTNI Po.t A.......nt R.vl.w Unit, Dlpt, 2&0601, tlarrltburg, PA 17128.0601
Phon. (717) 787..6505. S'I page 3 of the baokllt "In.trJotlon. for Inhlrltanc. Tax R.turn for e R..ld.nt
Dlo.dent" (AEY-ISOI) far an Ixplan.tlon of aa.lnl.tretlv.ly earrect.bl, .rror..
OISCOUHT,
If eny t.x due 1. peld within thr.. (]) cal.nd.r tonths aftlr the dlcld.nt'. dleth, a flv. p.rc.nt (5X) di.eount of
thl tlx peld I. allowld.
IHTEREST.
Int.r..t 1. charg.d blglnnlng with flr.t doy of d.llnqu.ncy, ar nine (9) lonth. end Ont (1) day frol the det. of
d..th, to the date of ply..nt. Tnx.. which bIen" delinquent b.for. January I, 1982 b.er Int.r..t et the ret. of
.IM (6X) p.rclnt p.r annut c.lculetld at . delly rat. of .000164. All tax.. which blel.. d.linquent an and aft.r
Janulry 1, 1912 will b..r Int.r..t It e rat. which will vlry frol ~al.ndlr y.ar to calendar y.er with that ret.
1nnO~.d by the PA DIPartaent of R.v.nuI. Thl appllcabll Int.r..t r.t.. for 1912 through 1995 .r'l
'!!!!: Inttrllt A.t. DaBy Int.,..t Fector !!!! Int,,"t Rat. DailY Interllt Factar
1912 lOX .OOOS48 1987 9X .000/47
1981 16X .000438 I,U'l..1 IlX ,000101
1984 IlX .000501 1../ 9X .000/47
I'as UX .000356 1..5-1.94 7X .00019/
1986 lOX .000/74 I9n 9X .000147
".lnterllt II cllculatld _s follawtl
INTEREST . BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
-~.ny Hotlc. ..aUld aft.r thl tax b.~o..s d.llnqutnt wtll r.fllct en tntlrl.t celculat'on tc flft'.n (IS) dlVI
b.yond the dlt. of the ........nt. If Ply..nt J, ..d, eft.r the Int.r..t ca.putatlon dlt. .hqwn on thl
Hotlc., Iddl tlon.1 lnt""t ItUst b. calculat.ct.
'PAYltENTI
De,'" ~ top portion of this NotJel Bnd .ubIIlt with 'lour PIVMnt ... pIvlble to thl nHI Mld Add"..
prlnt.d on thl r.v.r.. .Id,.
If REflDEl4T DECEDENT lakl ehook er '..n,,, erdor .1'01010 tel NEllZSTBN OF IIILLS, AgENT.
If NOlI-RESIDENT DECEDENT lakl chock or ooone, erder .,,0101. 'C1 CClt1HClMWEALTH OF PENHlVLVAHIA.
All Plyant, reollvtd ,hill b. llPPlltd fir.t to anv Int.rllt whloh M" be rtue Hlth en., ".,Indtr 'PflUM to the 'IX,
REf'lJID (CR)1 A r.fund of . hx crldlt, which Nil net rtqw.tld on tM TIM Rlturn, "V be requelltd bv coa,l.Un, In
"AppUa.Uon for Refund of PtMlvll1ll'1hl lnhtrltlnol end E.tlt. TIK" (Rf,y.UU). Appllcltlon. Ir. IItIUebl, It
the Offlc' of thl RIgl,tu a' Willi, any a' thti U R.vtnUI DI.trlot OfficII or 'ra thl DeflartHnt" l4"hour
"I".rlng ..rvle. M1lber. far for.. ord.rlngl In P~lvlV1nl. 1"OO""Z.'O~O, oulll" Penn,ylvent.
and within 10Clll H.rrhburll .r.. (717) ,.7-IOM, TOOl (711) 7"-UIt Utlerlng 1.llrM only),
REPLY TOl QuI.tlon' r',lrdlng .rror. contelned on thl. notlcl should be tddr...td tOI PA Pepartlln' of RIVInUI, Bur.au
0' IndJvJdull Ta>l", ATlNI Pa.t A......."t R.vl.., Unit, Dept. 110'01, Il.rrhbur., PA 1712..0601, phone
(717) 717-6505,
DISCOUNTt If InV tl>l due I, p.ld within thr., (1) a.lend.r IOnt~. "ft.r the t~tdtntl. de.th, ~ flv. p.rcent (S~) dl,oount
af the t'>I p.ld I' allaw.d.
INTERESTt Int.r..t I. ch.rg.d bl,lnnln. with flr't dav of dtlln~v, or nlnl I'. tonth. Ind Onl el) dlV frOl thl dati af
dllth, ta the dlt, of ply...,t, TI>I.. which b.G.. d.llllflu.n' h.for. JIW'IlIIrV I, 1'" b..r Int.r..t .t the tit, of
lilt (6;0 p.rc.nt p.r ~ nllcullt.d .t I d,IIY rat. of .ODOI1l4, All 1'1111 whloh bin.. delinquent on and Ifter
Jenu.rv 1, 19IZ will bllr Int,rut at I rat, which will ",.ry 'rOIl ul.lIdlr v..r to cIlend,r Yllr with that rete
~~td bV the PA D,p,rt..nt of R.v.nue, ,he ~llctbll In tar.,' 'It,. for 1'" throuth I'" .r.t
Vllr Inter..t R.t. D.llv Int.rllt Fleltor V..r Inter..t Rite Dill, Int.rut Faatar
1982 m .ooml 19A1 ,~ .000141
1985 16l .0000' I'U-IIII IlX ,000101
191~ m ,000501 I'" ,~ .000141
1915 III .000lS6 I"l-I~ IX .Ooott!
1916 m .ooom I'ti n .000141
--Inter..t It cllcul.ttd II followlI
INTEREST . BALAHCE OF TAX UNPAID X NUHIER or OAVI DELINQUENT X DAILV INTEREST FACTOR
....Anv Notloe IlIutd .fter thl \,>1 blea.., ritllnquant Mill r.fIN' ., Int.ru' ClIICl"lltlon to flft,en (15) daYI
btvond the d.t. a' the ......Nnt. If PIVNnt It ,lOt .ft.r the Int.rut c~t.tlon elftl lhoM'lon thl
Notlel, additional Int.r..t lU.t be a.leullted,
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Earl Rlolinrd Blzweller
Roberl O. Rndebnoh
Keyln S, Ulnn/on
ETZWEILER ANI> RADEBACH
. ATIORNEYS-AT-LAW
105 N. FRONT STREET
HARRISBURG , PENNSYLVANIA .17101
. (717) 234-5600
HALIFAX LINE
(717) 896-3737
FAX LINE: (717) 234-5610
2 West MlIln Street
Ellzabelhvllle, PA 17023
(117) 362-8395
225 Markel' Streel
Mlllersliurg, PA t 1061
(111) 692.2519
May 12. 1995
Register of Wills
Cumberland County Courthouse
. One Courthouse Squnre
Carlisle. PA 17013
RE: THE ESTATE OF THEODORE A. DORSCH
Dear Sir or Madam: 3<'/ q;/ I! gO
. Enclosed plea~e tind a check in the amount of $26.14, which represents p~yment
. 10 full of the Inherttnnce Tax on the above Estnte, I have enclosed a Notice of
Inheritance Tax Appruisement for your records. If you should have any questions,
please call.
on t11 ''1:0
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NOTICF. OF INHERITANCE TAK
APPRAISE~ENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAK DATE 05-08-95
FI~E NO. 21 94-0480
02-26-94 COUNTY CUMBERLAND
TO INSURE PRDPER CREDIT TO YOUR ACCOUNT, SUB~IT THE UPPER PORTION OF THIS FORM WITH YOUR TAK
PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OP WILLS, AGENT"
REMIT PAVMENT TO:
"
REV-1S47 EX AFP (12"94'_
COMHONWEALTH OF PENNSVLVANIA
DEPART"EHT OF REVEHUE
IUREAU OF INDIVIDUAL TA~ES
OEPT, 280601
HARRlSaURO, PA 17121-0601
NOTE.
ROBERT G RADEBACH
105 N FRONT ST
HBG PA 17101
ACN
101
-
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLIS~E, PA 17013
L
~
A.ount Ro.itted
CUT A~ONG THIS ~INE .... RETAIN LOWER PORTION FOR YOUR RECDRDS ~
REii=is4-j-EX--AFP--fiz-:94i--NOiricE--OF-X-HHER"iTANC:E"Tiix-A-PPRA-isEH-iNT~--ALl-oWAN-CE"O-R------'----------
DISA~~OWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE DF DORSCH THEODORE A FI~E NO. 21 94-0480 ACN 101 DATE 05-08-95
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will
re1lect 11gures that include the total 01 ab1 returns assessed to date.
ASSESSMENT OF TAXI
15. A..unt of Lino 14 et So.usol rete (151
lb. A..unt of Lino 14 toxoblo et Llneol/Cloes A rote lIb)
17. A...unt of Uno 14 toxable ot Colletorol/Cle.. B roto 117l
lB. Prlnoipel Te. Duo
TAX CREDITS:
PAYMENT
DATE
05-26-94
TAK RETURN WAS' I X I ACCEPTED AS FILED
RESERVATI~N CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VA~UE OF RETURN BASED DNI ORIGINAL RETURN
1. Rool Estata (Sohedule Al III
2. St.cks end Bonds (Schodule B) 121
3. Cl.soly Held Staok/Partnorshio Intoro.t ISchedul. CI (31
4. Martgeges/N.to. RocDiveble ISchedule 01 (4)
5. Cash/Bank Deoosits/~i'c. Por.onel ProPlrty (Schedule E) 151
b. J.intly Owned Property ISch.dulo F) Ibl
7. Tren.for' (Sohedule G) (7)
B, T.hl A..ots
APPRDVED DEDUCTIDNS AND EXEMPTIONS:
9. Funeral Exp.ns../Ad~, COlls/Hise. Explnsl. (Schedull Hl (9)
10. Dobt./Martgege Llabllitios/Lien. (Schodulo I) (101
11. Tatol Deductions
12. Net Velue .f Ta. Roturn
13. Cheriteble/G.vorn.entel Boquo,t. (Schodule JI
14. Not Velue of E,teto Subjeot to To.
NOTEI
RECEIPT
NUMBER
MM886115
DISCOUNT I + I
IKTEREST l -)
147.37
( ) CtlANGF.O
.00
.00
.00
.00
.00
55.199.58
.00
(8)
55.199.58
2,500.00
3,157.97
(11)
(12)
(13)
(141
~.6~7 97
49,541.61
.00
49,541.61
.00
49,541.61
.00
K . DO,
K .06,
K .15.
(18)_
.00
2,972.50
.00
2,972.50
AMOUNT PAID
2;800.00
INTEREST IS CHARGED FROM 11-27-94 TO 05-16-95
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
TOTA~ TAX CREDIT
BA~ANCE OF TAX DUE
INTEREST
.TOTAL DUI
2,9(.7.37
25.13
1.01
'''i'
. If PAID AFTER DATE INDICATED. SEE REVERSE
FDR CALCULATIDN OF ADDITIDNAL INTEREST.
I IF TOTAL DUE IS LESS THAN U, NO PAYMENT IS REQUIRED.
IF TOTAl. DUE IS REFLECTED AS A "CREDIT" lCR), YDU MAY 8E DUE
A oFFlINn ~FF oFUFo~F STQ,E OF THIS FORM [qa,JHUR~CTlQ~S./
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