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RIV-1543 IX AFP (1.911*
COMMONWEALTH OF PENNSVLVANIA
DEPAIITIlENT OF REVENUE
BUREAU OF INDIVIDUAL TAKES
DEPI. UD6Dl
HAIIIlISIURlI, PA 17111'0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILl NO, 21 - '1'\ _ (,/'>5 'I
ACN 94130834
DATI 07-26-94
ESTATE OF POLLOCK
5.5. NO. 174-34-3932
DATE OF DEATH 05-05-94
COUNTY CUMBERLAND
TVPE OF ACCOUNT
~ SAVIHIlS
CHECkIHIl
TRUST
CERTIFICATE
REHIT PAVHEHT AHD FORHS TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FRANCES
I.NETTLES MARV P
c:mUm~m~AM LA~~ 43952
FARHERS TRUST Cot1PANV hi' Ilrovldld thl DIP"te,n' with the InforllUon lhted below which hll bl.n Uled In aeloulttlne tilt
pottntl.1 tlM duI. Their rlcord, Indlc.', th.t It thl dlath of th_ abOVI dleedlnt, you wer, I Joint owntr/blneflclary of thl. lecount.
If yOU ,..t thl, l"forl.'lon I, Incorr.ct, pl.... ableln written corr.otlon frol th. Ilnenoltl In.tltutlon, attach. COpy to thi. for.
IntI r.'urn it to the ,1,0\11 Iddr III, Thlt ICr-om' 11 hM..,I. In It"l.'c.rdana. with the Inherltlno, hue law. of th41 COHonwulth of PtMIlIhlnl..
QUIIUonl HY be anlwlrld by c.lllno (111) 181"8127.
COMPLITE PART 1 BILOW . . . SEE REVERSE SIDE FOR FILINO AND PAVMENT INSTRUCTIONS
Accounl Hc. 1-104961C D.to 04-11-93
E.toblhh.d
Acccunl hi...... 20,044.05
P.ro.nl T...bl. k 50 , ODD
Aacunl Subj.cl 10 To. 10,022.03
T.. Roto k .06
Pclll11hl T.. Du. 601 ,32
PMT --- TAXPAYER RESPONSE
l~r-~AILURI~O RISPOHD WILL RISULT IH AN OPFICIAL TAX ASSISSHENTIASID ON THIS NOTICI
A, [] Thl above Infor..tlon and taM due I. corr.ot,
1. You .IV choo., to rl.lt ply..nt to thl Rlul.tur of Will., with two copl.. of thl. not lei to obtaIn
II dhcooot or avoid Intlrllt, or you ..y check bOM "A" And rlturn thl. notlu to thl Rlolltlr of
Will. and an official ft.......nt will b. 1..u.d bv thl PA Dapart.."t of Rtvenul.
To Inllirl prop.r cradlt to your .cco.....t, two
(2) coplt' of thl. notlc. .u.t .cco,plny vour
p.y..nt to th. R.gl.t.r of Willi, H-.. ch.ck
pavabl. t01 "RIol.ter of Willi, Alllnt",
HOTEl If taM pay..nt. ar. .adl wlthln thr..
(5) Ilonth. of the dlcldent's d.t. of dllth,
you IIV d.duot a 5;: dllc:ount of thl tal( due,
Any l",,-rltanc. talC due wUl beoOllI d.lInquant
nlnt (9) 'Clnthl after thl dati of d..th,
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[CHECK ]
ONE
BLOCK
ON LV
a, [] Th. aboVI all.t ha. beln or will bl rlportld and tllC paid with thl Plnn.vlv.nt. Inh.rltanc. raM r.turn
to b. filed bv the dlced.nt'. r.pr"lntatlv.,
C. [] The above InforaaUon I,.).ncorrlot and/CMlbtl Ind ~ctlon. war. paid by you.
You INst cOllPlltI PART ~ and/or PART ~ bilow,
If ycu Indlo.I. . dlff.r.nl t.. r.I., pl.... .1.1. your
r.I.Ilon.hlp 10 d.c.d.nll
OFFICI.IIL USE ON LV DAAF!
PA PEPART~~NT OF. REVENUE: ..
__ .,.... .... ~_,.~..._...,.., '.,l~.~.:.;,.c;,.,
PART
[!]
TAX RETUnN - COHI'UMTION OF T~.lC Ofl .J(I~f!T/T~l!9T M'('ntINT'
LIHE 1. D.t. E.tobU.h.d I 'I._ / /" '?-'
2. Account BIllnel 2 :..! (') L) ~/( I () ~-
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5 t Plrc.nt TIMlbl. 5~ 4" ( ) ... / /)
4. AIlQunt SUbject to TIM 4 J ('I f.,,) ..")~ l'JJ
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5. D.bl. .nd D.duollon. ~
6. Ancunl h..blo 6
7, T.. R.I. 7 M
8. TIl( DUI 8.
PART
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DATE
P.~!l
1
2
3
4
5
6
7
(, / .".) 8
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DEBTS AND DEDUCTIONS CLAIMED
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PAID
PAVEE
DESCRIPTION
AMOUNT PAID
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TOTAL
IEnt.r on Lln. 5 cf T.. Cc~pul.Ilcnl
f.cl. I h.v. roporl.d
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DIXU IMIIIl~'J~~
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COMMONWEALTH O' PENNSVLVANIA BUREAU O' INDIVIDUAL TAXES
DEPARTMENT 0' REVENU
Dear Register af W\1Is.
Enclosed you w\1l find. Ocheckls) Odocuments(s) which were received by the Department of Revenue In error,
These may be proce"ed according to normal procedures.
REMINDERI The POST MARK DATE on envelope attached to any checks enclosed must appear on your
OflJclal Receipt.
Thank you.
Sincerely /
John Murphy/Chief
Inheritance TaK Division
(717) 787,.6~01
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RIV"1!43 IX AFP 11.911*,
C_AlTH Of PEHHSVLVAHIA
IIEPAIITIEHT Of RfY(NUE
IUREAU Of INDIVIDUAL TAXES
IIEPT. fl0601
HAlIlUIIURlI. PA 11116-0601
)ll -;:.i.'~.-/l)
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
C!
FILl NO. 21 -qtj. -&.51
94130855
07-26-94
ACN
DATE
ESTATE OF POLLOCK
9,9, NO. 174-34-3932
DATE OF DEATH 05- 05-94
COUNTY CUMBERLAND
TYPE OF ACCllUNT
~ SAVINGS
CHECKINII
TItUST
CERTIFICATE
REHIT PAVHEtlT AND FORKS TO I
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FRANCES
POLLOCK
RR I BOX 147A
NeWPORT
I
WILLIAM 0
PA 17074
'FARHEns TMT COHPANV hi' ,provldld thl Dlp.rt.,"t with thl tnfor..Uun lllt,d bllow which hu b"n Uled In aBloul,Une thtl
pot..,UI' 'IX due. Thllr recordl..tndtClltl thl' a~ thl duth of thl aboVI deoldlnt, you wlr. II Jolnt owner/beneficiary of thlt IMlClount.
If YOU f..l thit Inforlltton II lnl'lorrlot, pl.... IIbllln wrltttn correotlon frol thl flnanolal Inltitutllll'l, .Ulch . copy to thl, 'or.
.nd r.turn it to thl above lad..".., lnll IICfoOUn\; Is tlxa.b1. In 'Cl~.ardanu wUII \11. inh..Il~""'1 i.l\: ~'N' of \fl" ";O.4IOM.,.Uh uf PWNllvlv."I..
euelUotll .IY tM WI'Wlrld by call1nll (717) 787-'527,
COHPLETI PART 1 BELOW . . . SEI REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
A..ount No. 1-101523C D.t. 03-03-93
E.tablhh.d
A..ount B.lIn.. 30,006.25
P.r..nt T..lIbl. K 50 . 000
AlIOUnt Subj..t to r.. 15 , 003 , 13
T.. R.t. K ,06
PotllRU.1 ra. Du. 900 . 19
PMT - TAXPAYER RESPONSE
L!J IpAXLURI TOR'SPOND ifILL RUlILT IN, AN OFFICIAL TAX ASSUS"INT 8A8I1I ON TNI.SHOTtCII
A, [1 Thl aboYI Infor..Uon and talC du. II corrlct,
1. You .av choa.. to r..it pav..nt to the Rlllhtlr of Willi, with two cop!.. of this noUcl ta obt,ln
a dhcount or avoid Intnrllt, or YOU aav check ball "A" and r.turn thh noUclI ta the R'lIht.r of
Willi and .n nHlclal ........nt will b. JUlMd by the PA DIP.rt..nt of RevM\Ul,
To Inlure proplr or,dlt to your .ecount, two
(2) copl" of thlt noUc. 'Ult acecaplnV your
payeent to thl Rllllltlr of Willi, Hlkl chick
p.y.bll tOI "R'lIllter of Will., AlIlnt",
HOTEl If talC PllYUnt. erl .ade within thrll
(3) eonthl of thl dlcldlnt'. date of dl'th,
you .IV d.duct a 51: dhcount af the tax dul,
My Inhlrltanet tlM due wlH bleOM delinquent
nine (9) tonthl Iftlr thl date of dl.th,
. [ C~W ]
BLOCK
ONLY
8, c:J Th. above alllt hat blln or will bt rlPorttd and tllX pIld with thl P.on,ylvanla InhtrJtanct TaM r.turn
to b, fll_d by thl dlcldlnt', rtprl,.ntatlvl,
c, ~ Thl eboVI Infcr..Uon IWncorreot and/Or-Albtt &Nt dtduatlon, wtrt p,ld by YOU,
You MI,t cQtlPltto PART l!J andlor PART L!J bilow,
If ~ou Indl..t. . dlff.r.nt t.. r.t., pl.... .t.t. ~our
r.latlon.hlp to d...d.nt,
OFFICIAL USE ONLY 0 AM.
PA DEPARr~ENTa~. REVE~UIl.:.il
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PART
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TAX RETURN . COHPU'l'AUON OF TAX ON ~OIN'r/TIlUST ACCOUNTS I'AD
LINE 1. D.t. E.tllblhh.d I J - j' ~ 'i Jl
2. A..ount &Ilona. 23 (I, ('J (l {., . OJ. 5.2
S. P.ro.nt TI..bl. S M ,. 5'0 3 '
4. A..unt Subj..t t. T.. 4 I:' (7 (1 ] . {j II. _
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DEBTS AND DEDUCTIONS CLAIMED
PANT
[!]
DATE PAID
PAYEE
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'ro{l ,~
DESCRIPTION
,
Ifl L.,
.... AMOUNT PAID
If' J V'
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TOTAL (En .r on lln. & of TIM C."",u . lonl
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Und.r pon.ltl.. .f p.rjur~, I d..l.r. th.t the f..t.
.o""l.t. to tho ....4l.~ kn..l.dll. .nd bell.f.
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I h.v. r.p.rt.d woov. .r. trua, ..rract and
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PURfIOIE lit'
NOTICE.
To MUll lhe "qull_I, 01 SloU... mo 01 tho 1"""11....0 ond E'loto TOM Aol. Aol If ., 1991, (72 P,I.
100U... mOl. '
PAMNT.
Ilol1lOh the I... POIU... 01 Ihh NoUoo ond ......11 wllh VOUI po~1 I. lhe Rothlor of Nllh pllnlod ... lhe
rlvtr'lI lIe11.
-- .... c'*'k or MMV orar PlVlbl, tOI RECUITEA OF WILLS, ADENT.
All ptvwent. ree,lvld thall flr.t b, .,,111d to any Int.r..t which ..v b, due, with any r"llndtr applied to thl tiM,
REfUND (CRI.
. I
A r.fund of . tlM crldlt, which WI' not reque.tld on thl tlM r.turn, "Y bl rlqUe'tld by cOIPlttlnl en "Applloatlon
for R.fund of Penn'vlvanta InheritInG' and E.t.t. TIM" (REY-15IS), Applloatlont .r. Ivallabl. It the 0"101 of
thl RIII.t,r of Will., InV 0' thl 2] RlvlnUI Dlltrlot 0"10" or by 0111101 thl 'PIOtt. 24-hour entwerlng .arvlol
nu.blr. 'or for.. ordtrlntl In Plnnlylvenll l-100-56Z-2050, out,lde Pennlvlv.nll ~ within locII
HOIII....,. oroo (1171111-1094, TOOl (l11l nz-a5Z lHotlllnt h..olrod Onhl.
OUCTlONSI MY p.rtv In Int.r..'t not IIthUIId with thtlPPr.hHtnt, 1I11onnc. or dh.UowlfWl. of deduoUon. or .....lHnt
of tlX (Including dl,cO\l1t or lnt"..t) II' shown on thh Natle. "Y object within .lIety (60) dtIy. of receipt of
thh HottCl bYI
4-wrJUen protllt to thl PA Dtp.rt-.nt of RlYtnUe, lard of App..lI, Dept. 211021, H.rrhburg, PA 17128"1021, OR
.41110tlnt to h.v. thl IIU" dtt.r,lned .t the MIdSt of thl ICCOU'lt of the Ptrlontll rlflru.ntltlvl, OR
ulPPlal ta the Orphln" Court
AIlNIN-
II",AlIY!
CORRECTlONII
Fllatutl .rrar. dl.cov.rld on thl. ......elht 'hould be addr.,.1Id In writing tal PA Dlplrt''"t of R4VInUI,
lurllU of IncUvldu.1 TIX", ATTHI Pa.t A.....Mnt R.vllw Unit, DEPT, 210601, tl4rrllburg, PA 17121-0601
Phone (717) 7.7"6505. S.. Pili S of the booMl,t "In.tructlon. for Inhlrlttno. Tlx Alturn far I RI.I~t
o.Gldent.. (MV"150t) far en Ilfpl."ltlon of tdIllnhh'ltlvllY corrlOtlbll "rort.
DIICllUNT I
If IRY tax au. I, Plld within thrll (5) e.llOdIr IOnthl .ft.r thl dtoedtnt'. dtlth, I flvl percent (IX)
dlloOWlt of tM tlX Plld It IUowd.
IMTERl!ITI
tntlrllt I. cherged ",Inning with flr.t dty of dtl1nqJ11M1Y, or nine (9) '""thl and one (I) dlv
'rQl thl dlt. of d'lth, to thl dllt, of PIYllnt. 1.... which ~ delinquent befare Janutry 1. 19.2
bMr Interut .t thl rlt. of .1Ie (6X) Plrcent Plr QMUII c.loul.tlld It II dillY rltl of ,000164.
All t.ICI. whl~h bee-. d.lInquent on or Ifter J6lnUlrv 1, 1982 will bllr Inter..t It . retl which will v.ry frot
elllndtr y..r to clltnd.r YI.r with th.t r.tl announcld by the PA D~lrt..,..t of R.venut. ThI appllclbl.
Intlr.'t r.t'l for 19.2 through 1'9S Irll
. I
~ In'.rllt Rat. D.uv Int.rllt Flctor ~ Inttrll' Rltl D.l1v Intlrll' F~tor
1912 lOX ,ODD"' 1917 91 ,DOOm
I9IS 16X ,00041' 1911"1991 iii ,000SOl
1914 IIX .000SOl I99Z 91 ,ooom
1911 ISX .000lSl I99S-I994 IX ,0U0!9Z
1916 lOX .000ZI~ 1991 91 .DOOm
"'Int.r..t I' olloulltld .. follow. I
INTEREST . BALANCE OF TAX UNPAID X HUWBER OF DAVB DELINqUENT X DAILV INTEREST FACTOR
~"AnY Notlol I,.ued .ft,r the 'IX bec~. dtltnquent will r,fllOt an Int.r..t ollcul.tlon to flft.en (11) d'VI
tMIvand thl eMIt. 0' thl ........It. It P'YMnt 10 ndt .fter the Interllt cOIlPUtlltlon d.tl thow1 on thl
Nattel, IddlUon.l Int.rllt ....t be CllcUlltld.
\,
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NOTICE OF DECEDENT
ACCOUNT STATUS
COMMONW{ AlIt! 01 PllHj~m,^,HA
OEPAllfM{tlf 01 ~1,'flllJt
aU..AU Of INOIVIlHJAt fAXU
(Hrr HOWl
==:.~_~~~~f.~~_~~~~:!.~,~2.:.1I.:.~~.l.:.--.:.._~..:.:.;.__:..:.~...:.:.;..;.~.:......;_;.-:.:._.:.:.:.;.:..:..=:.:~=~:;.:...,.____.,.
DECEDENT
INFORMATION
FINANCIAL
INSTITUTION
INFORMATION
ACCOUNT
INFORMATION
PLEASE ATTACH
COPY OF
SIGNATURE CARD
IF AVAILABLE
JOINT
SURVIVORI
BENEFICIARY
INFORMATION
JOINT
SURVIVORI
BENEFICIARY
INFORMATION
JOINT
SURVIVORI
BENEFICIARY
INFORMATION
JOINT
SURVIVORI
BENEFICIARY
ImORMATION
I ~L:::-/_1..:__~s L__u_______
--.'...---.---- --...:.;.;
.fW.Ir(Gilir-"-.----..-.----.--u_..---- IF"~ --. --.-- -iMidi!r.l;,illa
I'OI,I.OCK I,I~N^ " FR^NCES "
SOCfA~-::C~:~~:~ER - - ------..uu.---..uTAlC6n1AiH~~Qi;jr;ru~a;) -I~.:,)_
AbDRESS------------.--.----- ------.--u----Clly--.--. ---..-.----------coUflfi'--
M,lol^NCJo: 110m: 770 B, "^NOVEIl 91'. C^RI,IBI,r: CU~\[lmU,^ND
mE OF FINANCIALTmTllUlION
FM1~lIm:; 'l'IHl~;'I' COfll'^NY
ADDRESl--'- ---------- ----------Ciiyu.----.--------'--SlA'iE'----.u_.zIP COb-E---- -..
PO BOX no 1 I,. IIHiIl ~;'I'. CMUolSf.E, I'^ 17013
iIUpRoNHliTMB1r-------.-.----------.------._-----____
U Check block If name or add,... chang.
I -11-! I 20--)212
ER
rJ Join' SavIng. XI Joint Checkln" rl "ln T,vt' For" n Join' TIm' C11llfl,ah 10 _) ~ 1 5 1
liCCOUNf BALANCETlnilUcl. In'....' 10 dol. af d.olh) IR'OINAL DAlEf,CCOUNiWASESIABLISHEO
$0,7.55.51 7/22/89
ACCOUNITlTLE AS APPEAfinmS1GNAfURE CARD OR CEm ICAIE OFDEPl5Sl'----
FIl^NCE:; por,I,OCK on H^HY P. NE'I"l'J.ES
PlAC!-C1IECKfNliloci<lImiWTFACcOUNiWAS ESIAPLlSIlflillO;-ljiANSfER-OP-,UNDfFROM ANoTmRACCOUNffHAT'
WAS REGISTERED IN THE NAMES OF THE SAM! JOINT OWNERS AND ENIER THE DAlE ORIGINAllY ESTABLISHED.
() Rollo..." Account..Dat. Odglnally Eltablllh.d
" (Fhol)
NF.'r'I'LER H^RY
ADDRESS
P.
OFFICIAL USE
ONLY
PERCE I TA BlE
(~7')()
T^(tD
,"J 3 Y _~Lt1.nJll.I'-11 H " l
SIAIE
L c\ 'LL__
ZIP CODE
43902
-tltLKlilllliL.
CITY
S'I'EUDENVILI,E
RELATIONSHIP TO DECEDENT---
D^UGlI'rER SS#7.08-J2-J838
hll
Ollro
OFFICIAL USE
ONLY
PERCENT TAXABli
ADDRESS
wr------ STATE &31-~\ ~ \1--
-RFIAflciNiHiPT60ECEDENT--7J--'-~7" ----
(Ol.~- . (
" III' I I . nhla OFFICIAL USE
4 L (.6 -- .... ,:J= ONLY
:~''''==:=f'~" 6'Q,~-~'.t~'--~",o~~: .,,~~": :::,~" I
RElATlo.NSiiinooEcIDWr--------------..---r..- _m_____ 1
~
ZIP cooe-
TAX RATE--
'!lAME Ilo,'1
IFIIII)I'
OFFICIAL USE
ONLY
......--------.... -pflfc'ENnAXJ.oIl-
Ab-oRBs'
CITY
- ---STAtE-..-
... _..-------ifiicobr
RHtirioNSHipioDECEO-WI'
-......lAX RAfe"--'
I certify thut tho obovo Info,motlon Is truo, corroct ond complo'o,
-NAME OF PREPAReif:-p[iAliTRim------- -'-. -jT!1iPHOf.tTNUMO-ER....... -------l-OATE--..--.--]
YVE'I'1'I~ H. SlIUGII^Il'I' 717- 243-]212 5/94
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