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PETITION FOR GUANT OF LETTEltS OF ADMINISTltATION
c../Ulr of V-(; r-:.r.' h l~ A, I"tl L ~(l-
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No, _d2l:_ql{ - 7.!f3
To:
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Soclul S"",trlty No, ( I)' ",...!(_~Jf.rO
Ilegl,ler of Will, I' oJ Ihe
CounlY uf (,1\~y~,J1!....- In Ihe
C011l11lunwenlth of I'enn'ylvnnln
The pelltlon of the uodel'lgued rV'peelfully relllV'enl> Ihlll:
Your pelltloner("" wlto IS/M<: 18 )'enrs of IIge III older, 1I1'1'1J~1':"'-.--- 1'11I \cllers of IId11llnimlllloll
on the eslllle of
(d.h.II.; 1lC'IIIJcllIc lill:; duranl\' nh~l'lltIll: durnnl.: mlnorllilll.')
the nhove deeedelll.
Deeendent wns domiciled nl delllh in l U,.,. (b/.~~/I"'(} CounlY, I'ennsylvunln, with
II ,r IlIsl fumlly or princlp"1 residence ul _':U:~l!<<LLIl"'C .Mu\/I"",c.rOlt,l..'" PA.,. ' -.- \
lli\t "1I\'1.'I.II\1l1\h.:r UIllIIllUukil1aIlI)') l~' I,,~V" Sp"" n~" ,...utfJ.
Dee21denl,Ihen c:: 0 yeurs of uge, died ~~ir..._;Je;> , 19'11(
Ul L ,()f\,J"" "C-:-f:...p^, r r~'.fflll)'- t f.1/,/\lJor f.B.
Deeendent UI delllh owned properlY with eSllmuled .'nlues us fol\low,:
(If domiciled in I'll,) All pelSonlll properlY
(If nOI dOlnlclled In Pn,) Personnl properlY in Pennsylvnnlu
(If nol domiciled In Pu.) PelSonlll properlY In CounlY
Vulue of reul eslUle In Pennsylvunlu
slluuled us follows:
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Pelltloner_ ufter u proper seureh hU-L-nseerlulned 111111 deeedenlleft no will und wus survived by
Ihe following spouse (if uny) und heirs:
Nume Relnllonshlp Residence
-;1:. l I ,'01>1(: _ ~fot'<~(lU,J IN~, !Y'({ffIl,J.u(J",lrr
nI\U(,-IITt'ft.
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THEREFORE, pelilloner('jf respeelfully request(s) Ihe grnl1l of leller' of udmlnlslrullou iu Ihe
upproprlute form 10 lhe undersigned,
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WAnNING: 11 IS ILLEnAI. 10 AI. HIl 111m COPY all
'ro DUI'U(;A'TE DV pliO'TOS1 AT 011 PliO fOGliAI'll,
CaMMONWEAlTU OF l'ENNSVlYANIA
DEPARTMENT OF UEAlTU VITAL f1ECOnOS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT, NO. 2327573
f' ..t-J- - ty
[l.l. 01 Iw..", III lh"C.II.llUI',Ofl
Informant
Name and Address 01
Funeral Establlshme
,fk--I~/-~---7{JZ"'~ ~<-L-Ilptl
Social Security No. .r 'J - j. ~ _ 1'0_.ti.. Date of D8JlJha7 ~~
/ 3d Birthplace {~~~::tz.
Place of Di7th/U1 "O""N_.Q I L;t.'-f'r-~~ yI~~/fj Pennsvlvanla
Race -.UJt..1Ii - Occupatio . _ ~~_t(.J~. d_ Armed Forces? (Yes or No)
II e dent's
. ~_ Mailing Addre"<: .
FU'~:~:I Dirac r ,,,-, _7-TO~." ~j
YL..3/~~~4u.;:i _ .___
, : Interval etween
: Onset and Death
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Name 01 Decedent
Sex /11
Date of'Blrthft
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Part I:
Immediat)ZSi; /
(a) "'--t1,a ./_
/~CJ
(b)
(c)
(d)
Part II: Other Significant COndltlO~
ManneroIDeuth:~
Natural ~ Homicide
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Describe how injury occurred:
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Could not be Delermlned 0
Nom, ,", T]W C,""'" ~L~d'j'
Address /It 1 J2.. U I --;;l(k.~f,L.~
Accident 0
Suicide 0
Pending Investigation
-
(M,D., 0,0.. Coroner. M.E.)
This Is to certify that the Information here given is correctly copied Irom an original certificate of
death duly flied wilh me as Local Registrar, T~~, .~rlglnal cerllflc?,;e will be forwarde9 to the Slate
Vilal Records Office for permanent filing. ( , '.c:../. :7"'11....)
. 22.222
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CERTIFICATION OF NOTICE UNDER RUI.E 5.6(01-
Name of Decedent: Kenneth A. Luckey
Date of Death: AUI.!lIst 20. 1994
Will No.
Admin. No.
1994-00749
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed (ll the following beneficiaries of the above-captioned estate on
9/19/94
~
Address
Penelope I. Luckey
2 Evergreen Lane Meclmnicsburg PA 17055
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Name
Date: 'i(lli{li(
Signature
Address P. 0, Box 963
Harrisburl,! PA 17108
Telephone ( 717) 238-4776
Capacity:
Personal Representative
xx
Counsel for Personal Representative
JOliN J, CONNElLY. JIt
JAMES It MID, JIt
JAMES p, srADR
LA WIENeR J, NBARY
JOliN p, LYONS
/.AwOmclU
CONNBUr, RBlO & SI'AOB
10B.l/l WALNUT STREET
P.O. BOX 963
IIARRISBURO. PENNSYLVANIA 17101
TIilDIIONR
(7I7jJJl4T71
TliI.IiCOrlBII
(7I7jJJ147JJ
FlUI NO.
February 20, 1995
940195
Cumberland County Register of Wills
CUMBERLAND COUNTY COURTHOUSE
1 Courthouse Square
Carlisle P A 17013
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RE:
Estate of Kenneth A. Luckey
No. 21.94.0749
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Dear Sir or Madam:
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Enclosed please find an original and four copies of the Pennsylvania Inheritance
Tax Return and Inventory for the above captioned Estate. Please return two stamped-
in copies of each document to me in the envelope enclosed for your convenience.
Also, enclosed please find two checks, one in the amount of $15.00, which
represents the filing fee for this action, and one in the amount of $130.09, which
represents the inheritance tax due.
Should you have any questions or problems, please do not hesitate to contact me.
Very truly yours,
/.y'f2".....:> 1:.. fe.';"l ~
James E. Reid, Jr.
JER/pr
Enclosures
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Curr;i,j ';,'.nr.. Co.. PA
FIRST CLASS
MAIL
'95 FEO 22 1111 :~i~)
LAW OFFICES
CONNELLY, REID & SPADE
108 .112 WALNUT STRH ,
P.O. Bo, 063
HARRIS DURO, PENNSYLVANIA 17' 01
TO:
CUHUERLAND COUNTY REGISTER OF WILLS
CU~IUERLAND COUNTY COURTIIOUSE
I COURTHOUSE SQUARE
CARLISI,Ii I'A 17013
FIRST CLASS MAIL
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",VI'Oor" III ?II 'I" .J,'iJ, IL' INH~INrAN~E;T~X '~~TURN rpU~~\f.<l'LIlMTIlAtttRt2IjtI9iCIlECKllER~/
"lrJi.;l POYlRTT CUDIT II CL~I~!>_q____~. J
'!.:'IW;;.!' RESIDENT DECEDENT rlU NUMBIR II'
COMMO"W''''"Of "''''''LVAI''A (TO BE FILED IN DUPLICATE
01 "RlMItI! O,""'''U[ 21 91\ 071\ 9
1l..",~J:b ~~m"o""l WITH REGISTER OF WILLS) coulm COD! YEAR NUMBER
liTrnmA1IAill(lA1r,IilIT;AmniiMll mlllllll -- Olcrumrn:m.il'lITlAlilillll'
t. Rool E,'olo (Schedule A) I 1)
2. Slack. and Bond. (Schodulo B) I 2)
3, Clouly Hold SlolklPollnonhlp Inlore.1 (Schedulo q I 31
~. Mor19090. and Nole. Rocol,oblo ISchodule D) ( ~I
5, COlh. Bonk Dopollll & Mllullonoou. Po"onol Proporly( 51
IScn,dul, EI
6. Jolnlly Ownod Properly (Schedul, F)
7, Tron"e" ISchedul, GI(Sch,dul, l)
9, Tolol Grall All 011 (Iolollinu 1.7)
9. Funeral EJCpenun, Admlnlstralive COlli, Mhcellaneoul I 9)
E.po",o. (Schedulo HI
10, Dobis, M011909' 1I0bllilles, lion. ISch.dulo I) (101
1 t. Tolol D.ducllon.(lololllne. 9 & 10)
12. Nel Value of E.lolellin. 9 mlnu.lln. 11)
13. Cholllobl. and Go,ornmonlol Boque.lI (Schodulo J)
1~. Nol Voluo Sub .tllo To. (lino 12 mlnu. line 13
15. Amount or line 1A IOJll;oble 01 6% rale
Ilndud. voluo. from Schodul. K or Schedule M,)
16, Amounl of IIn. I~ lo.oblo 01 15qb rol.
I'ndudo voluo. from Schodulo K or Schodulo M,I
17, Principal 10. duo (Add 10. from IIno 15 and from Iino 16,)
10. Crodill Spousal Poverty Crodil Prior Po)'monll Ohcounl Inlerol'
o 00 + O.....O1l + 0 00 _ 0.00
19. If IIno 10 II orooler Ihon line 17, onl.r Ih. dill.ronc. on IIn, 19, Thll II Ih. OVERPAYMENT.
aD
20. If lin. 17 II or.ol.r Ihon IIn. 10, .nlor Ih. dillor.nc. on IIn, 20, Thll II Ih. TAX DUE.
A. Enler Iho Inleresl on the balanco duo on lIno 20A.
B, Enl.r Iho 10101 of Iin. 20 and 20A on lino 20B. This II Ih. BALANCE DUE.
Mok, Chock Payabl, tal Regl..er of Will., Agen'
Io::jil~i.;.;\(~;~,,:ltit1:!t":I';";'-:',BEiSURE\lOlANSWIR!ALL'.I;lUE5TIONI(ONJflIVIRII'IIID.rAND~T.O; RICH.CK!MATHf:4II~~Qi.t.lI\fl\1ISl.~
Under penolllel of perlury. I dedore thaI I have uamin.d Ihll relurn, Including occompon}'lng tehedulel and IlolomenU, and 10 the belt of my knowledge and bell.',
It I Irue, corretl and complol.. I dodore Ihol all real flllale hOI bOlln reporled altrulI marhl vnlu.. O.c1arotlon 0' P"po,., olher thon Ihe penonal rerr.lenlative II
b. on a I' arm olio ~lch p .par,,' hat on owl.dge.
0( ~tt;(li ." ^
I, Lu key 2 Evergreen Lane, Mechanicsburg PA 17055
J.!!!-Y! lit t IV AU
c:I-8'o ,.~~___p; 0, Box 963 lIarrisburg PA 17108
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2 Evergreen 1,;:\110
Mechanicnburg PA
Cumberland
17055
I,uckev-, K()nneth
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8/20/91\ 12/14/33
o 2, Suppl"menlol Relurn
1B7-24-1B50
[}J I, Orlolnal R.lurn
o 3. Remainder Roturn
l'ar dolo. of deolh prlollo 12.13.0',
o 5, roderol E.lole To.
Relurn Required
_0, Tolol Numb.r of Sol. Dopodl Bo.o.
o Aa, Fuluro InlllrOl1 Compromho
(101 dol.. of doolh aliol 12.12.02)
o 6. D.cod.nl Dlod T..lol. 0 7, D.cod.nl Molnloln.d 0 1I,ln9 Tru'l
IAlloch copy of Will (Alloch co of Tru'l)
, L (cORRESPONDE CE A D:CONFIDENTfA~.TAX\INF.ORMATIONISHOULD.BE,DIRECTEDJTOII~WI' ~,IM..t j;:Oi\;J\~",.",;"""",::
M cOMFlhl MAIUrlO AOlJRtu
fJ ~. L"nhod Ellolo
James E. Reid. Jr.. Esquire
IHtfiiONI,iU;;;m-
717 238-4776
Connelly, Reid & Spade
P. 0, Box 963
Harr1sbu~' PA 17108
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0.00
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1B,987.44
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14,171.71
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33,159.15
7,417.49
21,405.28
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(12)
(13)
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2B,822.77
4,336.38
0.00
4,336.38
130.09
N/A
(15)
4,336.38
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130.09
(101
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130,09
Chock horo If yau ara roquostlno D rofund of ynu' t)vrrpnymon'.
139.09
0,00
130,09
(20)
(2M)
(20BI
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PLEASE ANSWER THE FOLLOWING QUEstiON'S BY ~LACING A CHECK MARK (,"'1 IN THE
APPROPRIATE BLOCKS. '
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1. Did decedent make a transfer and:
a, relaln the use or income of the properly transferred, ........................................
, '
b, retain the righl.to designate who shall use the property transferred ar ils income,
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c. rotoln a revorslonary Interast or ........................................I...~'.......................
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d, receive the promise for life of either paymOl'its, benefits ar care~ :......................
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2. If death occurred on or belore December 12, 1982, did decedent,.'wilhin two years
preceding deoth transfer property wilhout receiving adequate consideralion~ If death
occurred after December 12, 1982, did decedent transfer praperty within one year of
death without receiving adequate consideration~ ........................;..;.:...................
3, Did decedent own an 'in trust for' bank account at his or her death~......................
_.!-
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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COMMONW!A\III o. rrNNSYlVANIA
IHHUUANCI TAX .UUIH
--!.ISIDIHt DICIDINt
mATE OF
SCHEDULE G
TRANSFERS
PLEASE PRINT OR TVPE
-fiLE NUMBh
-- -_.---
Kenneth A. Luckey
21-94-0749
tHIS SCHEDULE MUST BE COMPLElED AND FILED IF THE ANSWER TO ANY OF THI QUIITIONS ON THI REVERSI SIDI OF THI COVER SHIET IS YIS.
IIfM DESCRIPTION Of PROPERTY TOTAL VALUE DECD, DOllAR YAun--
EXCLUSION 'K Of DECEDENI'S
NUMBER '"cluJ. nom. o( 'h,"on,'"", 'h." ,.latlon.htp 10 J,,,J.nl, JoI, at'tonl"', Of ASSET INT. INTEREST
1. IRA account with Members 1st
Credit Union I acct. 1133950-10 $14,171.71 IOOX $14/171,71
TOTAL (Allo .nl.r on IIn. 7. R.copllvlollon) 5 14.1"71
,,, mort .pac.l. nud.d, in.II' adJillonal ,hu', 01 .om. d,.,}
.'h'I."IIlI.., (1'''1
ESTATE OF
ITEM
NUMBER
~.b
COMMONW!ALTH 0' PfNNIYLYANIA
INHUlfANCf fA. UIURN
USIDINf DICfDfN'
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Kenneth 1\. Luckey
OISCRII'TION
1.
A. Fun.ral bp.nl.11
Hetrick Funeral Home
2,
Royer's Flowers
1.
B. Admlnlatrallv. COltu
2,
3,
4,
C.
1.
2.
3,
4,
5.
6,
7,
0,
Perianal Reprel.nloll.e Commllllons
S.clol SeeurUy Number of P.rlonol Repr.senloll.e,
Veor Commlsllons paid
AII.rney fe.s
James E. Reid, Jr., Esquire
family Exempllon
Clolmonl Penelope I. Luckev rtel/ll16l\\htll
Addr... of Claimant 01 d.cedenl'l dealh
Slr..1 Addrell 2 Everqreen Lane
CUy Mechanicsburq Slate PA Zip Code
Probol. f..s
Cumberland County Register of Wills
Mlse.llaneoul Expens.I'
cumberland Law Journal
The Sentinel
PI.al. Print or T p.
R
21-94-0749
'70<;<;
TOTAL (Aha enl.r on IIn. 9, ReeopUulollon)
(If mar. Ipaee :1 n..ded, Inserl addltlonallheetl of lam. II...)
AMOUNT
$3,595.15
$132.50
$0.00
$1,500.00
$2,000.00
$81.00
$40.00
$68.84
5$7,417.49
...VIlII...llflIW
COMMOHWrAUH 0' PlHHInVAHI4
IWIUI"HC. ..X IIIUu-t
UltOIHrDICIDfllJ
ESTATE OF
ITEM
NUMBER
I,
2.
3.
4.
5.
6.
7.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Plla.1 Print or T I
I FILE NUMBER
21-94-0749
Kenneth A, Luckey
DESCRIPTION
AMOUNT
$68.96
$16.11
$34.41
$23.30
$1,008.28
$54.48
$10.00
$5.00
Bell Atlantic - PA
PA American Water Co.
Sammons Communicatiolls
VA Medical Center
Visa
PP&L
Debra Weist - Tax Collector
8 .
School Taxes
9.
Mortgage with Leader Federal Bank (Joint -
$40,278.07)
$20,139.04
10.
Shortgage on escrow account with Leader Federal
Bank (Joint - $91.39)
$45.70
TOTAL (Allo onl.. on IIno 10, Rocopllulollon)
(If more .paco if n..d.el, in.lrf or:lclilional .h,.,. o( 10m. size,}
$
21 405,28
.JV.UU....,(1IFl
.
COMMOUWIAlm 0' ,INNi1\VAUtA
INHllnAtlClIU .I1UIN
IlIlDINtOICIDINI
SCHEDULE J
BENEFICIARIES
FILE NUMBER
ESTATE OF
21-94-0749
RELATIONSHIP
AMUUNT OR
SHARE OF ESTATl
Kenneth A. Lucke
N~T~'tER NAME AND ADDRESS OF BENEFICIARY
1.
A. Toxable Bequ..lll I"
I
Penelope I. Luckey
2 Evergreen Lane
Mechanicsburg PA 17055
Spouse
,
ITEM
NUMBER
NAME AND ADDlIISS 0' IINEFlCIARY
AMOUNT OR
SHARE OF ESTATE
B, Charllable and Gayernmenlal BequIIl1l
1. None
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AI.a enler an line 13, Recapllulallon)
(II mare .pace I. n..ded, In..,1 addlllanal .h..', 01 .ame .1..,
s
0.00
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
}
Ul
Penelope I. Luckey
bolng duly sworn according 10 low, dopo,o, ond ,oy' thot she is the Administratrix
of Iho E,lolo of Kenneth A. Luckey
1010 .f ~~c!..ani.!'.~~uEIL___._._,._____ , Cumb.rlond Counly, Po., d.c....d and thot Ihe
within" .n Iny.nl.ry m.do by Penelope L Luckey ., Ih. lold Administratrix
of Ihe ontlro 0"010 of IOld docodonl, con lilting of oil Iho p.rlonol prop.rly ond reol .,tel., exc.pt r.ol .stal. outsld.
Iho C.mmonw.olth of Ponnlylyonlo, ond Ihol Iho flgurol .1'1'0111. ooch Itom of the Iny.nlory r.p....nl 1t', folr y.luo
as of Ih. doto of docodont', doalh.
ond lub,crlbod b.f.r. m.,
Fe,bru.arLI ao
~
0tJl/]JJ-L'MIA R-.J
.;' II
19 1.1;-
tJOT"n!AL SE,\L
STACEY L FINK, NOllry Public
EJtI "'.IJr:chc.~'(:t Twp, Ycrk Co.
Mv Com~"'!2!F:. ~!.:!..x..,:'" 19. 1UOO
2 Evergreen Lane
Mechonicsburg pA 17055
Add,...
0010 of O..lh
20
Day
August
Mo"lh
1994
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INSTRUCTIONS
I. An Inyonlory mUlt b. flIod within throo monlh, oftor oppolnlmonl of porsonal ropr~~9.tIY~
2. A lupplomont Inyonlory must bo flI.d withIn Ihlrly daYI of dllcoyory of .ddltlonol 4"ots.
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3. Addltl.nol Ihoots m.y b. attach.d II t. porsonolly or roalty . l:B
4. S.o Artlclo IV, Flduclorlol Act of 1949. N
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D . AAO.22'S' .5' .5" COMMONWEALTH OF. PENNSYLVANIA
NO. . DEPARTMENT OF REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
,UV.II6JUI',"1
RECEIVED FROM,
i
ACN
ASSESSMENT I'l'
CONTROL ~
NUMBER
AMOUNT
REID JAMES E JR ESQUIRE
P.O. BOX 963
101
.1Scr.eq
HARRISBURG PA 17108
ESTATE INfORMATION,
1:'1 fiLE NUMBER
~ 21-1994-0749
Il'I NAME Of DECEDENT (LASTI
~ LUCKEY KENNETH A
I] DATE Of PAYMENT
EI POSTMARK DATE
COUNTY
SSN 187-24-18~0
IflRSTI (Mil
CUMBERLAND
DATE Of OEATH
REMARKS
PENELOPE I. LUCKEY
m
SEAL CHECK" 47<!6
REGISTER OF WillS
MARY C. LE IS
REGISTER OF WILLS
~----------------------~--------------------------
..... ,
~.~~ ,"
/
..
'----
..
---,_,__---;-_--..--.rtt.~.~...,:v ,,~-.:..
l--~
\
~EV-1547 EX AFP 112-94*
COHHQNW(ALTH Of PENNSYLVANIA
DEPARTHENT Of REVENUE
BUREAU OF INDIVIDUAL TAkES
DEPf. U06Dl
HARRISBURG, PA 171U-D601
I L/ d 3.J. - ,~
ACN 101
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AHD ASSESSHENT OF TAX
DATE 05-01-95
ESTATE OF FILE NO.
DATE OF DEATH 08-20-94 COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBMIT TIlE UPPER PORTION OF THIS FORM WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS, HAKE CHECK PAYABLE TO "REGISTER OF WILLS. AGENT"
REMIT PAYMENT TO:
JAMES E REID JR ESQ
CONNELLY ETAL
PO BOX 963
HBG PA 17108
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Allount R..ltt.d
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiEWis4'7-EX-AFP--ii'2:94rtliificE--ciF-YliilEifii'ANCn'-"x-jipPRjiisEj.jEiiT~--,m'-ciiiAifcnjR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LUCKEY
ACN 101 DATE 05-01-95
( ..1 CHANGED SEE ATTACHED NOTICE
nn -'1 :p
C r;"' \.d
cl ,:", .. (/
,..; ,00 , ,
,00 ="
:,.,
,00 ..<.
I
,00 V1
18,987.44
,00 -.
14 ,l~1. 71 ,".l VI r ~
. ,.. (el lJ1 33.159,15
KENNETH
A FILE NO. 21 94-0749
TAX RETURN WAS, (x. I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL
1. R..l Eat.i. (Schedule A) (1)
2. Stock. and Bonda (Schedule 8) (2)
5. Clo..ly Hald stock/P.rtnarship Int.,...t (Schedul. CJ (5)
4. Hortg.D.I/Not.. Receivabl. (Schedule DJ (4)
5. Cash/Bank Dapollta'Hllc. p.,.aonal Property (Schedule EJ eS)
6. Jointly Owned Property (Schedul. f) (6)
7. fran.fer. (Sch.dule 0) (7)
8. Totel A...t.
APPROVED DEDUCTIONS AND EXEMPTIONS I "
7 i'u 7.49
9. Fun.ral Exp.n.../Ad.. Co.t./Hi.c. Expan... ISchedule H) 19)
10. O.bt./Hartgag. LJabUlti../Lhn. ISch.dul. I) 110) 21.405.28
11. Total Daduction. 111)
12. H.t Value of Tax Raturn 112)
13. Charitabla/Govarn".ntal B.qua.h ISchadula ..J) 115)
14. Hat V.lu. of Eat.t. Subj.ct to Tax 114)
NOTEI If an assessment was issued previously. lines 14. 15 and/or 16. 17 and 1B will
reflect figures thst include the total of ALL returns assessed to date.
ASSESSMENT OF TAXI
15. Allount of Lina 14 at Spou..l rata 115)
16. Allount of Lina 14 taxabla .t Linaal/Cl... A rat. 116)
17. Allount of Lino 14 taxabla at Collat.ral/Cla.. Brat. (17)
18. Principal Tax Due
?8.8?? 77
4.336.38
.00
4,336.38
4.336.38
.00
,00
X .03_
X,06_
X .15_
Ilel
130,09
,00
.00
130.09
TAX CREDITS I
PAYMENT
DATE
02-20-95
RECEIPT
NUMBER
AA022855
DISCOUNT (+1
INTEREST (-I
.00
AMOUNT PAID
130.09
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
130.09
,00
.00
,00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATIOH OF ADDITIONAL INTEREST.
IF TOTAL DUE IS lESS THAN fl, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI. YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
00t- /
RESERVaTION I E.t.t.. 0' d.cedent. dYing an or,b,'or. O.c.-ber 1l, 1912 -- I' any 'utur. Int.r..t In the ..t.te I. tren,'.rred
In po.....lan or enJovaent to CI... 8 (coll.t.r.l) blne,lcl.rl.. 0' the decedent .,t.r the .xplr.tlon 0' any ..t.t. 'or
11', or 'or y..r., thl Coaaonw..lth hlr.by .xpr...ly r...rv.. thl right to appr.I.. and ...... tran.,.r Inherltanc. T.x..
.t the I,,'ul CI... . (coll.t.ral) r.t. on any .uch 'utur. Int.r..t.
PlJRP<lSE OF
NOTlCEI To 'ul,111 thl requlr..ent. 0' section 2140 0' the Inh.rltanc. end E.t.t. Tax Act, Act 2l 0' 1991. 7l P.I.
Section 2140.
PAYHEHTI D.t.ch thl top portIon 0' thl. Hotlc. end .ubelt with vour p.w-ant to the Ragl.t.r 0' Will. prlnt.d on the r.v.r.. .Id..
--KIk. check or .on.y ordlr p'Yable tal REGISTER OF MILLS, AGENT
All p.~t. r.c.lved shall 'Ir.t be appll.d to any Int.r..t which ..y be due with any raa.lndar applied to the t.x.
REfUND eCR)1 A r.'und 0' . tax credit, which wa. not r.~.t.d on the T.x Raturn, ..v b. raqu..t.d by coapl.tlng an "Appllc.tlon
'or R.,und 0' Penn.ylvanl. Inherltanc. and E.t.t. Tax" (REV-ISIS). Appllc.tlon. .r. Ivallabl. at the D"lc.
0' thl R.gl.t.r 0' Will., any 0' thl 2S Rlvenue DI.trlct O"lca., or by c.lllng the .p.cl.1 24-hour
an.w.rlng .arvlc. nuab.r. 'or 'or.. ordarlngl In pann.ylvanla l-100-S62-Z050, out.ld. Penn.ylvanl. and
within loc.l Harrl.burg .r.. (717) 717-.094, TOOt (717) 772-2252 (H..rlng lap.lrad Only).
OBJECTIONS I Any p.rty In Int.r..t nvt ..tl,'I.d with the appral'..ant, allowanc. or dl..llowancl u, d.ductlonl, or ........nt
of tax elncludlng dl.count or Int.r..tl .. .hown on thl. Hotlc. ault ObJlct within Ilxty e601 d.y. of r.c.lpt of
th.. HoUea bYI
--written prot..t to thl PA D.p.rt..nt of RIVlnu., Board of App.al., D.pt. 2.1021, Hlrrllburg, PA 1712.-1021, OR
-..I.ctlon to have the ..tt.r d.t.r.lnld at ludlt of the IcCount of the p.r.on.1 r.pr...nt.tlv., OR
--app..1 to the Orphanl' Court.
ADKIN
ISTRATlVE
CORMCTIDHSI
INTERESTI
Fectual .rror. dl.cov.rad on thl. ........nt should b. .ddr....d In writing tal PA D.p.rt.ent of R.venu.,
Bur.au 0' Individual T.MlI, ATTNI po.t A......ent Rlvl... Unit, D.pt. 210601, lIarrhburg, PA 17121.D601
Phon. (717) 787-6505. SII p.g. S of the boOkI.t "In.tructlon. for Inh.rltanc. TaM Aaturn 'or. A..ldant
Dec.dent" CREV-IS01) for an axplan.tlon of 1~lnl.tratlv'IY corr.ctabl. .rror..
If any taM due I. paid within thr.. (31 c.l.nd.r aonthl aft.r the dlc.dant'. daath, . flv. p.rcent C5Xl dl.count of
the tax p.ld I. .llow.d.
Int.r..t I. charg.d b.glnnlng with flrlt dav of d.llnquency, or nln. (9) lonth. and ana Cll day frol th. d.t. of
d..th, to the data of p.y.ant. Taxa. which bIe... dallnquent b,'or. JDnU'r~ 1, 19.2 b..r Intara.t .t the r.ta of
.Ix C6~) p.rcent p'r ~ c.lcul.t.d at . d.lly rat. of .000164. All t.x.. which b.c... d.llnquent on ~ .,t.r
January 1, 1'82 will b..r lnt.r..t .t a r.t. Which will varv fro' cal.ndsr y.sr to csllnd.r y.ar wIth th.t rat.
~cad by thl PA D.p.rt..nt of R.v.nu.. The appllcabl. Int.r..t r.t.. for 1982 through 1995 aral
DISCOUNT.
~ Inhr..t Ratlll D.lly Int.r..t Factor ~ Int.nlt R.t. Dally Int.r..t Flctor
1912 zn .000548 1987 'X .000247
1911 ..X .000431 1918-1991 U~ .000301
1914 IU .00OSOl 1992 'X .000247
1915 U~ .000356 199J-1994 7X .00019Z
1916 lOX .000274 I'" 'X .000247
--Inhr..t I. calculat.d .. foUo..,.
INTEREST. BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
_.Any Hot Ie. I..uad .ft.r the tax beco... d.llnquent will reflect an Int.r'lt cllculatlon to flft..., C151 dly.
b.vond the detl of tI.. ........nt. [f plY'ent It lad. ,fter the Inhr..t co.put.t1on dlt. .hown on the
Notlc., addltlon.1 Int.r..t IUlt b. cllculatad.