HomeMy WebLinkAbout94-00780
21 - 94 - 780
"
fOl' lnx PUI'POSUS, whulIlUl' 01' nol pnllslng undor lhls Will, Including ony
Inlol'ost 01' ponnlty Imposod In connucllon with such tax, shall bo consldored
us U pUl't of tho expense of the udministrutlon of my estule, and shall be
paid out of the pl'inclpal of my estato without apportionment or right of
re imbul'sement.
ITEM V: I appoint my daughter, June Louise Kemper, Execu-
trlx of this my Last Will and Testament. Should my said daughter fali to
qualify or cease to act as Exocutrlx, then I appoint my grandson, Kenneth
Scott l<emper, Executor of this my Last Will and Testament.
ITEM VI: 1 direct that my personal representatives shall not
be required to give bond for the faithful performance of their duties in
any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this
I ., -u.-
". day of
/11 "'/t~~/
I
, 1 071.
(A."..-d.--' 711~ 7?1.......'.r-lt-t.-.J'~,
CORA M. MIClIEALS
The preceding instrument, consisting of this and one other type-
written page, was on the date thereof signed, published .and declared by
CORA M. MICHEALS, the testatrix therein named, as and for her Last
Will, In the presence of us, who, at her request, In her presence and in
the presence of each other, have subscribed our names as witnesses hereto.
~.d.-~er r A.-?-....._M_~' Residing at
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21 - 94 - 780
REGISTER 01<' WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
.
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codicil .... /'
(each) a wbscrlblng witness 10 Ihe will presenled herewith. (each)belng duly qualined according 10
law, depose(s) and say(s) Ihal "'" / presenl and saw
"y
..... ....
Ihe leslpl , sign Ihe same and Ihal /" signed as a witness allhe
requesl of leslal_ In h presen7e and i6.he presence 'of,~ach olher) (In Ihe presence of Ihe
olher subscribing wltness(es)).
Sworn 10 O( arnr~ed, and subscribed bJfore
me Ihls" , day of
/19_
/
./ Reg/ster
(Address)
(Name)
(,..
,'....
,"
(Address)
ij(5
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
J \JJ1E L. 11& 11~f;JCR - /~N N r;i HI-.. Jr.E' M f'.FIX
(each) .a ~bscrlber herelo, (each) being duly quaUned according t~ !a~ depose(s) and say(s) I~al
We. 4 ~G" familiar wllh Ihe slgnalure or Co(-r',4. )1Ue. j?JI e;'z:.~
eHieil
will
leslat&L or (one or Ihe subscribing witnesses 10) Ihe
presenled herewilh and
cedicil
will Is Inlhe handwrlllng of
Ihal ale ReLlcf/e
believes Ihe slgnalure on lhe
eOt~;),.:.l##G' I?,}i d)LNIL.s'
10 Ihe besl of CI t) ''\ knowledge and belief, /I . V
Sworn 10 or arnrmed and subscribed berore (,//.//lW ~'--Ue./7fttlnA:t1 /
me Ihls 6TH day or {/ . (Nallle) ;I I f_ J2
EPTEMBER (!Jii/ 0 (~- /..../ /J S r: , 7 t:~(lll"('< It1 .
MARY C. LEWIS
~
'.
Id\'I~L'Q1ll4 111.'111 ('OADATESOfDEATHAnER 12/31/91 CHECKHERI
\-llV INHERITANCE TAX RETURN ~o'V:::?,ug~DITl5CLAIMED 0
fl,' iW';"r. RESIDENT DECEDENT flU NUMBER
COMMONW""HOIPrNNSVlVANIA (TO BE FILED IN DUPLICATE "I'te/ (11 7'0
DlP..I:t~~WJ.:\~V[NU[ WITH REGISTER OF WILLS) ...
.1.uRI!lIU~G.,.... ,!..ua.0601 _ .fOUN'Y_~ODE YEAR N_UMBI
A . I IAl M
'1"11" J.Le- GULA 1~.Ab .) ,QC: n...t.
.'1 " &:." U I n _ _ _ ._ ___ __ _ Ncchnnicd:urr I I'IJ 0 1'1055
wamrCUjlllY NUMII~IDi1f 6JJ!fAljl lOAlf P~iRItr-
201-1(,-0150 11/2<)/91. l/h 1<)OJ C L 1 d
Count \lm..e~ an
K,11. O,lginal R.'u,n 0 2, Supplemen'al Relu,n I] 3.
(J 4. limited E.tot. C140. fulur. Inle,.", Compromit. [J 5.
(10' da.e. of deo,h ohe, 12.12.92)
[] 6. Oecede"' Died TeUat. [] ]. Decedent Mainlained 0 Living TrUll
(Allo,h copy of Willi (Allach copy of T 'UII)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO)
AM M I MAlliN A R
June L. Kemper 1115 Cocklin St.
---------. -,,----- Mechflnicsbu1'[;, PElo 17055
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1. Real Ello'e (Schodul. A) I I) ~.
2. S.ack. and Bond. (Sch.dule B) ( 21 .~-40 1.?,1H. $1
3. Clolely Held SlocklPartne..hlp Inl.,e.. (Sch.dul. q (3). .._,_,...____.
4. M0r1g0g81 and Noles Recei....able (Schedule D) ( 4) _._.____~_______
S, COlh\ BQn~ DepolI" & Miscellaneous Penonal Properfy( 5) _ .____~__.___._ ~ ________
(SChedule E)
6. Jointly Owned Proper.)' (Schedule FI
7. T,ohlle.. (Schedule 01 (Schedule l)
e. Tolol Gron Ana's (tolallinos 1.7)
$12,)07.43
9. Funeral Expenses.. Administrative COlh, Mi\ColloneouI ( 91 . _ _." ..1..,.______.
Expenses (Schedule HI
10. Debts, MOr1gage liabilities, liens (Schedule I)
11. Tolol Deductions (Iolollinol 9 & 10)
12. Nel Value of Estate (line 8 minus line 11)
13. Charitable and Governmental Deques" (Schedule JI
14. Not Value Subject 10 Tax (line 12 minus line IJ)
IS. Amount of line 14 takable at 6% rolo
(Include value, from Schedule K or Schedule M.)
16, Amount of line 1.4 lakable at 15% role
(Include value. from Schedule K or Schedulo M.I
17. PrintlpollaM due (Add 10k from line' 5 and from line 16,1
lB. Credih Spousol Poverty Credil Prior Payments
+ ~_...._--- +..,
19. If line IB il groater Ihan line 17, enter the differ once on line 19. Thll Is Iho OVERPAYMENT.
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Remainder Relurn
(for dolel of death prior to 12.13.8~
federal eUale TOk
Return Required
Tolol Number of Safe Oepolil Bo...
~_.. _._---_.._.__......-.~--...... - ~--.~.- ._-~...._._-~-_..'"_.." --~--
".. ---._-~--_..._._~._- -.--.-- ----_.~----
-,1
( 6)
( 7)
':41,503.7J.,_____
( 91
~al 722.55
.. .. ... ,--..- .
(10)__...._____.___.____._,_
(15) _
(11)__!~_~,~07 .43_.
(12) _____.__
(131 _'_,______
_______J..141-- $_602. 4_.l5._o_E,
;;i69.,J.l5.1~____. ,06 = ~...4,lQ4091 .
(161
)( .15 =
(17)
Diuount
Inlorcll
Chock hero If you are requolllng a rofund of your overpayment.
(191
(19)
20. If line 1711 greater than line lB, enter the difference on line 20. Thil is Iho TAX DUE. (20)
A. Enlel .he interell on .he balance due on line 20A (20A)
B, Enler Ihe total of line 20 and 20A on line 20B. Thil il tho BALANCE DUE. (2081
Make Check Payable tor Regll'.' 0' Wilh, A~."t ______.__________..
.... BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH....
Und~, ,,""olliel 0' perjury, I declare that I hove uomined thil retuln, including occompanylng Iche'dule. and IIDlemenh, Clnd to Ihe be.t of my ~nowl.d90 ond belil,l
it il IIU. e,.'o.treel.nnd (0. mpleh~..1 declare thot 011 rool ollote hOl been,rhporled 01 "UO""Y':~t volue. ' .D..'.IDlotio.n o. f ".tepo.'..' olhor thon the pennnal ~e'p)lll.,.n.,
loti..... ,
~i~I,~tl~~~~!~~'~~~~;~~ij~j;t~ i~e:~~:~;~;t~~~ 1nowled!;~RT5i-.:l'!L~ / ..~ZJf~1tf:t_. (/- ..-. ..~.- ~--_._ - _____~_____ Wif CJ II.I!.f!l'l
.L.L.L) GOl'jrlln ..:.t 0 I ,..eCnl'niczi:uI"'C, 1'['. 17055
~iGti;.lUflfb'-rilIPAAnn)hiH, fHAN-R"ipiTnHfAIW(--'-AbDRn~--'- - -~_.__.._.- -- -- --~---"._.- -- ---. DAH
RIY.ISOl U; 1~.8bl
JJ\t.,~(\
-.~
COMMONWEALTH Of PfNt.U'flVANIA
INH(RIIANCf lAX RflURN
RISIOENT DECEDENT
SCHEDULE B
STOCKS AND BONDS
FILE NUMBER
ESTATE OF
CORA MAE MICHEALS
(All properly lalnlly.awned with Right a' Survl.."hlp mu.1 be dllCla.ed an Schedule F.)
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1.
2
3
4
5
6
7
8
9
e t an Bres 8
AM&I\lT~.CH Sharos IJB 41.875
u. S. West 76 Shares ~ 39.7d
Pacific Telesis 76 Shares ~33.eO
AT &T 197 Shares... 55.375
NYNbX 76 Shares I;d 31L 75
Bell South 85 Shares u 59 3/8
Southtwestern Bell 114 Shares... 41.875
Air Touch' Communiclltion 76 Shares \;J! 28 1/4
NO'fE: All Stocks are Common
Value At Time of Death Received From
Co!~ANY. 8/29/94
.
4690.'1
3030~5'
2508.00
101908./{8
<!945.00
5045.~
4773.75
2147.01
TOTAL (Allo enter on line 2, Recopltulallon
(I' more space is needed, ins.r' adcJilionolsheefs o( same size.)
S 40,218.81
11\1 '1~O'i II. P '~I
tOo,lo,lOtO,^,IA\1lI 01 'H.IHH\lAN"1o
IhllllllAt.Cl1U 'ITU'tl
'''IOtlll PICIOltll
SCHEDULE F
JOINTLY.OWNED PROPERTY
ESTATE OF
COhA MAE MICllbALS
~. +._----_.__..._.~------_.. -,_..._..~-_. -.
_ _u_.._ .___.. ___.....__..-__.__.. ---
FILE NUMBER
Jolnl 10no"I(')1
-----,--~_.__.~._---_._.._--_..__._._-_._---_.._.- ----------------~----~_..
_. NAME
A,JUN~ LOUISE KE~W~~
B,
C.
Jolntlv..owned propertVI
ADDRESS
---~._----
115 COCKLIN S'f.
\ECHANICS13UhG. PI.. 17055
___RELATIONSHIP TO DECEDENT_. '
DAUGIlT~H
ITEM LEnER DATE
FOR TOTAL VALUE DECD'S DOLLAR VALUE OF
NUMB'EI JOINT MADE DESCRIPTION OF PROPERTY
TENANT JOINT OF ASSET %INT, DECEDENT'S INTEREST
1. 10/80 Checking Account 2,.361.B~ 1/?' 1180.94
Dauphin Deposit Bank
Acct. ff 6002560.3 Checking
2 10/80 Harris Savings Bank 80,645.6C 1/2- 40,322.80
Money Market Acct.
Acct #1005001.309
,
TOTAL IAlio ontor on line 6, Recapitulation) S 1~1, 503.74-
, ~.._-------
(II more spaco is neoded insert addilionnt ,heels 01 same SilO)
llY-li" 11'17'"
,e.j;!.
COMMONWlALYH 0' .(NNSn......NI...
INHUI'...NCr ,.... UWIN
."IDrNt D(C(DINt
J
SCHEDULE H L_
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES . Plo".o Print or Tv~o .
CE NUMBER
bTATE OF
CLlIlA "lAE rr.ICllgALS
ITEM
NUMBER
DESCRIPTION
AMOUNT
A, Funorol bpon.o..
1.
2
3 Un
4
Neill Funeral Home
1.011in[; Grelln CcmetnJ'Y
(Plaqup Date foe
rnoath it. All (Gown)
Iron Kett10 (lunchron)
5,338,50
102.00
38.00
174.24
l"nrker)
I.
B. Admlnl.trotlvo CO.t'l
205
- 09
2,
3,
4,
C.
1,
2,
3,
4,
5,
6,
7,
0,
Perlonol RoprelOntatlve Commissions
Social Socurlly Numbor 01 Porsonal RoprelOntatlvo:
Voar Commissions paid
- 9706
Attarnev Fo..
1I0ne
Family Exomptlon ~2000. 00
Clalmanl June L. Kemper
2,000.00
Rolatlanshlp Daughter
Addro.. 01 Claimant at docodonl's do"lh
1115 Co~klin St.
Slreet Address
City Mp.~han:l cRllsurr
Slale Pn.
Zip Code J 70'i Ii
Prabale Fe..
~l1!l.oo
118.00
MI.eollonoou. Expon.o..
Certified Mail (Stock)
Stamps
Notary
Seidel Nemorial Hospital ~'or Cora Mal! Michoa1B
Aur:ust 2-29
~Btimntedk9Y4 Income Tax For Pa.
(Cora Mae MicheqlB)
22'.91
6.25
3.00
4,354.53
150.00
TOTAL IAlsa onlo' an IIno 9, Rocapllulatlan)
(If more .paco I. nooded. In.ort "ddl"anol .hoet. of .omo .lxe.)
S12,307.lr3
'.
... -. .- ... ... .. .
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I''''''~'!l:'~'~' , . '$i~' ~'~J:('''''lJ&';'''''Im;1(l!'''''t,.,''e''',1m;'~.''''IUI' rn~" ";~',:""d""l
-'. 'V:jl1:~I~~~ ;t~'+ -, ' , c' ',~~,~~ '<. 'tr'~~tfr~.:;o:~t;~:a;"tttr;J/kf:'-"'~r.. ,', .~'?f:~ " r-'''~- ,.,1;'$v. l'~;!'t'..l
F11[:/,' .,,),'rj~-ip"'''ii .h;"';.; COMMONWEALTH,OF.i.PENNSYLVAN'A,%:"'itV.I'i.~("\"f':i!,.rt:'",,~.?;r~1 ,-" 1'1' r~
O"M 9 .,"~ n83""H'~!i!i"\"t'!..,.",~,... ~h"<'." '". ..,........ ...~Ii'.l.'. >>., {.. " l'< ...hr..,. .""'1,,-., -". . ,4
_".:t.~ ' .';.a.~o_,\;I " !~;'-"f 'iJ~r""r1r.. ~~L:.;;;:'A!D'."A . INT:'.OP~.RIY'NUI.~~~'l::..."(\t,;t'~\~.~~,~t.,;? .~-'i'~'~:ff,:j::_i"\~~'::~~q-:~~.?~I~'{::'~' 'J
'. ~r''''J''t '~'w>"'c'.' ~...-;" _.,I,~.I\><l!J1:Ji:t.,..1;__,,.. ."!"i-i:7#<1.... r.c,'~-o,'~"..t"'~'.!!_bl'..,..-',~., "., ,.. "l,.:1--:.." ,Io-."t. ..,o;-,."t.,;..t;I<./~'"=,~i'<""'!_'i:'.:>i,!..
t'J.. ''(;'';\''',I.i'',",,-, .,.]
..~f:{J~i:i.ih{~iw..t;rf;9!~!~I~Y.ll~~~II1~;~N~~:r~Y~.N.I~',I~I;!E~Ir~.m;~ N~D. ESTATE;r~:;,;;f;f~::\'.:Jt~~\CV'i-,",,,,,~l;L;f)~
ACN
I:'J ASSESSMENT P:'I
II CONTROL Il;,I
NUMBER
RECEIVED FROM,
AMOUNT
JUNE LOUISE KEMPER
1115 COCKLIN ST
101
"<I. 9::16. 6'/
MECHANICSBURG PA 17035
1010 HI" IOl;D HilI """
ESTATE INfORMATION,
I M
81-1994-0760
D A
!3SN 201-16-0130
f
p", ME T
COUNT
cur1BER AND
o A
6/291<]
REMARKS
JUNE L.KEMPER
m
SEAL
CHECK" loa
REGISTER OF WILLS
-----------'-------------------~-----
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REV-lS43 EX AFP 18-941 *
CO""ONW[ Allll or P[NNSVL vaNIA
orPAAIHUH or REV[NUE ~
8UAUU or INDiviDUAL lAIlES i . . '"',
DEPt. Z80601 J
11ARAlSBUAG, Pi l7ltl-OUI II:
XNFORMATION NOTXCE
AND
TAXPAYER RESPONSE
FILE NO. 21 94-0780
ACN 94151630
DATE 11-29-94
JUNE L KEMPER
IllS COCKLIN ST
MECHANICSBURG PA 17055
TVPE OF ACCOUNT
~ SAVINGS
CHECKING
TRUST
CERTIFICATE
REHIT PAYHENT AND fORHS TO.
REGISTER OF WIllS
CUMBERLAND CD COURT HOUSE
CARLISLE. PA 17013
ESTATE OF CORA MICHEALS
5.5. NO. 201-16-0150
DATE OF DEATH 08-29-94
COUNTY CUMBERLAND
HARRIS SAVINGS BANK hu proylded th. Depart..nt with the Inlor..tlon I htad balow which hllll bun uled In ulcul.tlnQ the
potanUal In du.. I"alr racord. I"dluh that at Ut. duth of the above daeedsnt, yau war. . Joint owner/ban.flclar. of thlt account.
If YDU f.. I thlt Infor..tlon It Incorr.ct, pl.... obtain ..rlU." corr.ctlo" 'r08 the flnancla. Inltltutlon, attach. cop)' to thl. fon
:'On" ,..tvr" It to ,t,. """\0'1 .drt'.... lhl. /teenu"t II t...bl. In accfltdanc:. with ttl. Inherltanc. ISIl LawI of the Co.er)nw.alth of Pann.ylvanla.
;....ll"'IIJ .., b. Do:1:;I"l;rcl:! t:"1 crill",: 111'1 '~1'''\71
COHPLETE PART 1 BELOW. . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTION~
Account No. 10-05-001309 Ooto 03-07-83
Establishad
Account Salanc.
P.rcent Taxabla
AMOunt Subjact to
TalC Rat.
Potantlal TalC Du.
80.6ll,44
50.000
40.305.72
,15
6.045,86
'a in.ura prop.r cr.dlt to you,. account, two
(21 copla. of thil not lea ..u.t .cco.p.ny you,.
pay..ant to thll A.gl.tar of Will,. H.k. chllck
payabla tal "Aagh'a,. of Wills, Agan''',
K
NOt[1 If tu pnllanh ."a ..da within Ih,.aa
I,U 1I0nth. of tha daced.ntl. data of d..th,
YOU ..ay d.duct II S~ dl.count 0' tha ta. du..
Any Inha,.ltanca t.. dua will baco.a dallnquant
nln. 19J ..onth, II"." the d.ta of daath.
To.
x
PART TAXPAYER RESPONSE
COI FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNENT BASED ON THIS NOTICE
A, 0 'ha .bova In'or".tlon .nd ta. dUll 11 corrllct,
1. You 1111'1 chao.. to ra.1t pay.ant to tha Allallter of Will. wlth two copla. 0' 'hh notlca to obt.ln
. dl.count 0,. IIvold Int.ra.t, 0" yoU lIay chack bo. "A" ftnd ,.alurn thl. natlc. to tha Aaaht.,. a'
Will. IInd an offlcl.1 ........nl will b. I..uad by the PA D.pa,.tllant of Rev.nuII,
[CHECK ]
ONE
BLOCK
ONLY
"
B. i\:if'h. above ....t~!I. b..n 0" will be rapo,.tad and tllll paid with tha P.';n.Ylvanla Inhllrltance
~ to ba fllad by thalUitibantl. r.p,....nt.tlv..
C. [] lh. IIbov. In'o".atlon l~ncorr.ct nnd/or dllbt. and d.du:tlon. w.ra paid by you.
You ..u.t co..pl.t. PAR' L!J .nd/a,. PAR' ~ b.low,
'II. ,..turn
If you indicat. a diffarant t.. rat., pl.... .tat. YOUr
ralationship to dlcldantl
OFFICIAL USE ONLY 0 AAF
PA DEPARTMENT OF REVENUE
PART
~
Tr,l( RETURN . cnMPIITIITJON
LINE 1, Doto Eatobllahad
2. Account Dalanca
3, Parc.nt Taxabla
4. Anount Subjact to Tlx
5, Dabt. and Dlduction.
&, Anount Tlxabl.
7. TlX Ratl
8, Tlx DUI
TAX ON JOINT/TRUST ACCOUNTS
OF
I
2
3
4
5
.
7
8
x
PAD
1
2
3
4
5
6
7
8
CLAIHED
x
PART
~
DATE
DEBTS AND DEDUCTJONS
PAID
PAVEE
DESCRI PlIoN
AMOUNT PAID
I
I
I
TOTAL IEntar on Lina 5 of Tax Co,.pubUonJ
I
I
,
I
.
~, Unda,. panaltia. of pa,.jury, I dIe lara th.t thl
co,.pllt. to thl b~.t of ny knowlaj1ua and blli.f.
\"/;&;~/J} .:;z;i.tu;''--t. '-v/r)IA"'/ ~j
TA VE SIGNATURE
fach I
hav. rlPort.d abova .,.. t,.u., corraet .nd
HOME (~II 7) ;.1(' i;O
WORK (' - l ').J ;1' 'c t:; /..1. 1'/'(
TELEPHONE NUMBER DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT wUn applicable Int.r..t ba..d on In'or.ltlan
lubalthd by the fln,nclal In,tltutlon.
2. Inherltancl t.. blea... delinquent nlnl lIIenth. aft.r the dlcldant', dati of d..th.
5. A Joint account I. t..,bl, IVln though the dlcldant" n... WI' added I' . ..tt.t of convlnlencl.
~. Account. Ilncludlng tho" held batw..n husband and wi f.) which the dlCldant put In Joint n'~'1 within ana y..t prior to
d..th .t. fully ,...bla .. trln,'.r..
5. Accaunt. ..,.blt,had Jolntlv batw..n hu.band and wlf. 1II0r. than on. y..t prior to d.,th at. not ta..bl.,
b. Account. hald by . dlCldant "In trult for" anothar or othar. .t. t..abla fully.
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
1. BLOCK'. If thl Infor..tlon and co.putatlon In tha notlc. ara corract and daductlon. ara not baing clal.ad, placa an "X"
In block "A" of Part I of the "Taxpayar Ra.pon.a" .actlon. Sign two copla. and .ubalt tha. with your ch.ck for the a.ount of
t.x to the P.gl.t.r of Will_ of tha county Indlcatad. Th. PA D.part..nt of Pav.nu. will I..u. an official ........nt
CFor. REY.ISft. EX) upon racelpt of the r.turn fro. the p.ght.r of Willi.
Z. IILOCK II ~ 11 the ....t .p.clfl.d on this notice ha. bun or will b. r.ported and tax p.ld with the penn.Ylv.nla Inh.rltanc.
Tax Raturn fll.d by tha d.cad.nt'. r.pr...ntatlve, plac. an "X" In block "II" of P.rt I of the "TaMpayer Re.pon.." .actlon. Sign on.
copy and return to the PA Dapart.ant of R.v.nu., lIur.no of Individual TaMa., D.pt 280601, Harrllburg, PA 11128~0601 In the
envalop. provldad.
3. ILOCK C . If the not Ie. Infor.atlon I. Incorrect .nd/nr d.ductlon. ar. b.lng clal..d, chac~ block "C" and coapleta Part. Z and 3
according to tha Instruction. balow. LIgn two copla. and .ub.lt th8. with your chack for t~. aeount of taM pavable to the Regl.ter
", w111_ ft' tn. 't'o'.I"~~' I!'\dl.:et:d. Th. r& ::.pllrt~...L..., li"ytl1IU" ..III I..u. an 0,t1clal ..:"....nt CFor. REY.1541 E1C) upon racalpt
01 the r.turn 'roe the Regl.tar of Will..
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Ent.r
NOTEI
the d.ta the account originally w.. a.tabll.h.d or tltlad In the .ann.r e.l.tlng at data of d.ath.
For a dac.d.nt dying .ftar 12/12/1Z1 Account. which tha dac.d.nt put In joint n.... within on. Cl) yaar 0' daath are
t.xabl. 'ully a. tran.'.r.. Ho".v.r, th.r. I. an ..clu.lon not to .xcaad 11,000 p.r tranl'.r.. ragardla.. 0' the valua 0'
the account or tha nuab.t of account. hald.
t, a double a.t.rl.k C~.I appa.r. b.'or. your 'Ir.t na.. In tha addr... portion 0' thl, notlc., the 11,000 .xclu.lon
alr.ady has b.an daduct.d 'roe the account balanca a. raport.d by tha 'Inanclal In.tltutlon.
Z. Entar the total balanc. 0' tha account Including Int.ra.t accruad to tha d.ta 0' d.ath.
3. Th. perc.nt 0' tha account that I, taxable 'or aach .urvlvor I. d.t.ralnad a. '0110,,'1
A. Th. parcant ta.abl. 'or joint ....t. a.t.bll.h.d .or. than on. y.ar prior to tha d.cad.nt'. d..thl
DIYIDED IIV TOTAL HUHIIER OF
JOINT OWNERS
E..apl.: A Joint ....t r.gl.t.r.d
DIVIDED IV iOTAl HUH!lER OF K 100 . PERCENT TA1CABLE
SURVIYING JOINT OWNERS
In the nea. 0' the d.cadant end two othar p.r.on..
1 DIYIDED IIY 3 (JOINT OWNERS I DIVIDED IIY 2 CSURYIVORSI . .167 K 100 . 16.1~ tTA1CAIILE FOR EACH SURYIVOR)
a. Th. parcent taMabla 'or e..at, cr.at.d within on. yaar 0' tha d.c.dant'. daath or account. own.d by the d.c.dant but h.ld
In tru.t 'or anothlr lndlvldualt.) (tru.t b.na'lclarl..JI
1 DIVIDED IIY TOTAL HUHIIER OF SURYIYINC JOINT
OWNERS OR TRUST IIENEFICIARIES
X 100
PERCENT TAXABLE
E.aeple: Joint account raul.ter.d In the na.. 0' the d.c.d.nt and two oth.r par.on. and ..tabll.h.d within ana yaar 0' d.ath by
the d.cad.nt.
1 DIYIDED IIV Z (SURVIVORS) . .50 K 100 SO:< ITAKABLE FOR EACt! SURVIVOR)
~. Th. a.ount .ubj.ct to taM lllna 41 I. datar.ln.d by Multiplying the account balanc. Clln. Z) by the parc.nt tax.bl. Cllna 5).
5. Ent.r the total 0' tha dabts and d.ductlon. listed In Part 3.
6. Th. 1I.0unt hubla Clln. 6) Is d.t.ralned by .ubttactlnQ the d.bts and dllllltl.t:tlnn, I\lne SI 'rcn th:l Q:'Iou"t :Il.1tj...L t... t.... o It.. ..I.
7. [ntar tn. .p"roprlat. t.. tilt. clI". 7) II' d.t.r.ln.d balo".
A. For d.t.. 0' d.ath occurring .'t.r 6/30/9~, tha taM rata. 'or tr8".'.r. to .pou... ar. a. follow..
1. Oat.. 0' d.ath on or a'tar 7/1/9~ and b.'ore 1/1/96 tha rat. I. 5~.
2. O.ta. of d.ath on or a,t.r 1/1/96 and b.'or. 1/1/97 the rat. I. 2~.
5. Oete. 0' daeth on or aft.r 1/1/97 and ba'ore 1/1/91 the rat. I. l~.
~. Oat.. 0' d..th on or aft.r 1/1/98 tran,'ar. to IpOU..' will b. .M.apt fro. tax.
Hotal For deta. 0' dlath prior to 7/1/94 tran,'.r. to .pou... ara ta.able at 6~,
B. Tran.f.r. to lineal d..c.ndant. Including 'ath.r, eothar, .on, daught.r, grandchildren, .0"~ln~lew,
daulJhter~I"~law, .t.pchlld and th.lr luua ara taxabla at ... p.rc.nt (6X).
C. Tran,'ar. to all oth.r. Including broth.r, .I.tar, unci., aunt, n.ph.w and nl.c. are taMable at ,Iftean parc.nt (15~J.
D. I' you chang. the taM ret., plea.. ,p.cl'Y your r.latlon.hlp to the dlc.d.nt In tha ar.a provided.
.. Th. aeount of taM due tlln. 8J I. d.t.r.lnad by .ultlplying th~ aaount taMabla Cllna 61 by the taM rat. Clln. 1).
CLAIMED DEDUCTIONS - PART
3
DEBTS AND OEDUCTIONS CLAIMED
Allowabl. d.bt. and dlductlon. ar. det.r~ln.d a. follo".1
A. You lagally era ra.pon.lbla for pay.ent, or tha .Itat. .ubject to ad.lni.tratlon by a p.r.onal rapro..ntatlv. I. In.uf'lcla"t
to pay the daductlble It....
B. You actually paid the dabt. after daeth 0' the dlcld.nt and ca" furnllh proo' of paye.nt.
C. Dobl. being clal.ad .u.t ba 't.elzad fully In Part 3. l' additional .pace I' na.ded, u.. plain pap.r 8 1/2" M II". Proof 0'
pay..nt .ay ba raqu..t.d by the PA neparte.nt 0' Rav.nu..
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE. CONTACT ANY
REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES. TAXPAYER INQUIRY UNIT IN
HARRiSBURG AT (717) 787-8327. TOOl (717) 772-2252 (HEARING IMPAIRED ONLY)
REV-1543 EX AFP 18-941 *'
COH"OHWE1\ HI Of PEHHSVl VAHIA
OEP1AT"[HT or R[Y[NU[
BUREAU or INDIVIDUAL TAMES i . .
DEP1. 180bOl
1l1RRISBURC, PI l1UlI-0601 :c
FILE
ACN
DATE
NO. 21- ('\ . ,'1'1 r,t
94150210
11-14-94
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
JUNE L KEMPER
1115 COCKLIN ST
MECHANICSBURG PA 17055
TYPE OF ACCOUNT
~ SAVINGS
CHECKING
TRUST
CERTlf1.CATE
REHIT PAYHENT AND FDRHS TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
ESTATE OF CORA M MICHEALS
S,S, NO. 201-16-0150
DATE OF DEATH 08-29-94
COUNTY CUMBERLANO
DAUPHIN DEPOSIT BANK I has provided the Dapert..nt with the Infor.aUan llshd billow which h.1 b..n ulIld In celculatlnll the
potantlal tax due. Thalr r.cordl Indicate that at the d..th of the above dacadant, you ...r. II Joint owner/beneflcl.ry of thl_ lIeeDunt.
Jf you f.. 1 \hl. Infor..tlon I_ Incorrect, pl.... obtain wrlttan correction froll the financial In'tltutlon, attllch . copy to thl. for.
IInd r.turn It to the above addr.... This account I. ta.able In accordance with tha Inharltance TaM law. of tha Coeeonw.alth of P.nn,ylvanla.
Du..tlon. eay b. an.w.red by call In; (717) 187.83Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYHENT INSTRUCTIONS
Account No. 0060025603 D.t. 11-25-80
Established
Account aal.nca
P.rcant Ta~.bla
A~ount Subjact to
Ta. Rata
Potantial Ta~ Dua
To In.ur. prop.r cradlt to your account, two
(Z) cop Ie. of thl. not Ie. MU.t accoepany your
pay.ent to the R.gl.t.r of Will.. Haka ch.ck
payabla tal "A.ght.r of Wllh, Agent".
PART
m
2.363.48
50,000
1.181.74
.06
70,90
TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT BASED ON THIS
NOTICE
x
HOTEl If taM pay..nt. ara ..de within thr..
(3) eonth. of the decedent'. data of daath,
you eay d.duct a 5~ dl.count of the taM du..
Any Inh.rltance taM due will baco.. delinquent
nine (9) eonth. after the data of death.
To.
K
[CHECK ]
ONE
BLOCK
ONLY
A. c:J The above lnfor..tlon .nd t.M due l. correct.
1. You ..'1 choo.a to re.lt p.yeent to the A.gl.t.r of Will. with two caple. of thl. notice to obtain
a dhcount or avoid Inter..t, or you eay check bOM "An and r.turn thh notlc. to the Aeulst.r of
will. and an official ".......nt will b. I.suad by tha PA D.part.ant of A.v.nu..
B. c:J The above ....t ha. ba.n or will be raported and taM paid with the PennsYlvania Inheritance TaM return
to b. flied by the d.c.d.nt'. repr...ntative.
C, c:J Th. above 1nforeatlon l~ncorrect nnd/o~ebt. and deduction. w.r. p.ld by you.
You eust co.pl~t. PART ~ and/or PART ~ below.
If you indlcata a diffarant ta~ rata, pl.... .t.ta your
ral.tionship to dacadantl
OFFICIAL USE ONLY 0 AAF
PA DEPARTHENT OF REVENUE
PART
~
TAX RETURN - COMPUTATION
LINE 1. Data Est.blishad
2, Account aa1.nca
3. Percant Ta.abl.
4. A~ount Subjact to T.~
5, Dabt. and Daductions
6. Anount T.~Mbla
7. Tax Rata
8. Talt Dua
JOINT'TRUST ACCOUNTS
OF TAX ON
I
2
3 X
4
S
6
7 .
8
PAD
1
2
3
4
5
6
7
8
CLAIMED
PAR'"
@J
DATE
t.
DEBTS AND DEDUCTIONS
PAID
PAYEE
DESCRIPTION
AMOUtlT PAID
d...-,
'" .... <..
/1 l
t t'; ~
,.-0' 1,'
')
,J~
'",... C'-~;#J
..
.l ,i
JLI..!l.
cr..
:U:::"
/
TOTAL lEntar on Llna 5 of Tax Conput.tlon)
.
. Undar panaltia. of par jury, I daclara that tha
/}:oIlPlata to tha ba.t of illY knowladga and ball.f.
(,~I-'I.;' ,>-:2,1~t. ["':1. '/1 '.n:!.'!. '. /
TAXPAYER SIGNATURE
fact. I hava raportad abova ar. trua, cor~act ~nd
HOME (7/7) 7,: (. - .;/"c.; :,- {>
WORK ( ),<;4//'5"
TELEPHONE NUMBER
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFfICIAL TAX ASSESSMENT with appllUbl. lntuu' b...d on Infor..tlon
'ub.tthd by the flnancl.1 Inltltutlon.
2. InherltanCI tl. blea... dellnquant nln, lonth. .flat the dlc.dlnt', data of d..th.
3. A Joint account I, ',..ble IVln though thl dlc.dant', n... w.. added al . ..It.t of conv.nlenc..
~. Account. I Including tha.. held b.tw..n hu.band end wll.) which thl dlcldlnt put In joint n.... within on. v..t prior to
d..th .t. fullv ".abl. II trln,f.r.,
5. Account. ..'_bll,hld Jolntlv batw..n hu.band Ind wlf. lor. thin on. y..t prior to d..th .t. not t,.,ble.
6. Account. held by . dlCldlnt "In trult for" anolhar or olhar. .t. "..bl, fully,
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
J. BLOCK A . If the Infor..tlon .nd co.put.tlon In th. notlc. .r. corr.ct end d.ductlon. er. not b.lng cl.I..d, pl.c. an RXR
In block ~AR of Pert I of the "T..pIYlr R..pon.." ..ctlon. Sign two cop I.. end .ub.lt the. with your chIck for th. .IOunt of
te. to th. Rlgl.t.r 0' Will. of thl county Indlcetld. Th. PA D.pert..nt of R.~.nu. will 1,.uI .n offlcl.1 ........nt
Ifor. REV.IS~I EX' upon r.c.lpt of th. r.turn frol th, Rlgl.t.r of Will..
2. BLOCK B - If th. ...., .peclfl.d on thl. notlcl h.. blln or will b. r.port.d end t.. paid with th. P.nn.ylvlnll Inhlrltanc.
Te. R.turn fll.d by th. dec.dlnt', rIPr...ntetlv., pl.c. an "X" In block "B" of p.rt I of th. ~T..p.y.r Re.pon.." ..ctlon. Slln on.
copy and r.turn to th. PA D.p.rt..nt of Rev.nu., Bur..u of lndlvlduel T...., D.p' 210601, H.rrl.burl, PA 17121'0601 In th.
.nv.lop. provld.d.
S. BLOCK C - If the notlc. Infor..tlon I, Incorr.ct .nd/or d.ductlon. arl bllng cl.I..d, chIck block "C" and co.pl.t. Plrt. I end S
accordlno to the In.tructlon. b.low. Sign two copl.e and lub.lt th.. with your ch.ck for the ..ount of tl. Plylbl, to thl R'Dllter
..,0::::....: ~I,. .........t, 1r..:I..Q~.':. fl.. P;' D......(~oI.,,'~: r.......... ..::: h.~.... .."h.I..1 .IU.......... (r"". 5;;:0; :=0:'" c:a ,,_I '....:..l
of the rlturn fro. the RIgl.t.r of Will..
TAX RETURN - PART
- TAX COMPUTATION
2
LINE
I. Ent.r thl dltl th. .ccount orlgln.llv w.. I.tebll.h.d or tltl.d In the ..nner e.letlng .t d.t. of death.
NOTEs for. d.c.d.nt dying .ft.r l2/12/1Z1 Account. which the dlc.d.nt put In Joint n.... within one II) yeer of d..th .r.
te..bl, fulh .. tran.f.rl. tlow.~u, there h .n ..clutlon not to ..uld IS.OOO pu tranat.r.. "glrdl... of thl v.lu. of
the .ccount or the nu.b.r of Iccounte held.
If a doubl. ..t.rl.k 1M.) ,ppI.r, be for. your flr.t na., In the .ddre'l portion of thl, not Ie., the IS,OOO ..clu.lon
.Ir.ady h.. b..n d.duct.d fro. the .ccount bal.nc. .. r.port.d by the fln.ncl.1 In.tltutlon.
Z. Ent.r the tot.1 balanc. of the .ccount Including Int.r'lt .ccru.d to the d.te of d..th.
s. Th. p.rc.nt of the .ccount thlt I. t...bl. for each .urvlvor I. d.t.r.lned .. follow.,
A. Th. p.rc.nt t'.'bl. for Joint ....t. ..t.bll.h.d .or. th.n on. y..r prior to the a.c.d.nt'. de.th'
DIVIDED BY TOTAL HUHBER Of
JOINT OWNERS
E...pl.1 A Joint ....t r.gl.t.r.d
DIYIDED BY TOTAL NUHIER OF X laa . PERCENT TAXABLE
SURYIYING JOINT OWNERS
In the na.. of the dlc.d.nt .nd two oth.r p.r.on..
I DIYIDED IV 3 (JOINT OWNERS) DIYIDED BY Z (SURYIYDRS) . .167 X laa . 16.7~ ITAXABLE fOR EACH SURVIYOR'
I. Th. p.rc.nt t...bl. for ....t. cr..t.d within one year of the d.c.d.nt'. d.ath or .ccount. own.d by tha dlcad.nt but h.ld
In tru.t for .noth.r Indlvldu.II') (tru.t b.n.flclarl..).
I DIYIDED IY TOTAL HUHIER Of SURYIYING JOINT
OWNERS DR TRUST BENEFICIARIES
x laa . PERCENT TAXAllE
E...plas Joint account t.gl.t.rld In the n... of the d.cldlnt and two oth.r par.onl .nd .et.blt.h.d within on. y..r of d..th by
thl dlced.nt.
1 DIYIDED BY 2 ISURYIVORS' . .sa X laa . SO~ (TAXAILE fOR EACH SURYIVOR)
~. Th. ..ount ,ubJ.ct to t.x (1In. ~) 1. d.t.r.lnld by .ultlplvlng the .ccount b.l.nc. (lln. Z) bV the p.rclnt ta..ble Illne S).
5. Enter the tot.1 of the dlbt. .nd d.ductlon. II.ted In Part S.
6. Th. ..ount te.lbl. Illn. 6) I. dat.r.ln.d by .ub\ractlnB the d.bt. and daductlon. Illnl 51 fro. thl ..ount .ubJlct to t.. Illn. ~).
7. Entlr thl appropriate ta. rete (lln. 7) a. det.r.lnld b.low.
A. for dlt.. of dl.th occurring aft.r 6/3a/'~, the 'a. rat.. for tranlf.rG '0 IpOUI.. .r. a. follow'l
I. D.t.. of death on or .f'.r 7/1/'~ and blfora 1/1/'6 tha rat. I. S~.
Z. Dat.. of dea'h on or .ft.r 1/1/96 and b.forl 1/1/97 the r.t. I. Z~.
S. D.t.. of death on or .ft.r 1/1/91 .nd bafor. 1/1/9a the rat. I. I~.
~. Oat.. of daath on or aft.r 1/1/91 tren.f.r. to IpOUI.. will b. ....pt fro. ta.,
Notal For dat.. of dlath prior to 7/1/94 tran.f.r. to 'POUI.. ar. t..abl. et 6~,
B. Tran.far. to llne.l d.lc.ndent. Including f.ther, loth.r, .on, daughter. grandchlldr.n, .on-In-l.w,
d.ughter-In-Iaw, .tlpchlld .nd th.lr I..u. ar. ta..bl. at .1. p.rc.nt (6~1,
C. Tran.far. to all oth.r. Including brother, .I.t.r, unci., aunt, naph.w and nl.c. .r. ta.abl. at flft..n parc.nt 115~'.
D. If you chang. the tax r.t., pl.ae. .p.clfY your r.lltlon.hlp to the d.ced.nt In tha .r.. provldld.
a. Th. a.ount of tlx due (lln. a) I. d.t.r.ln.d by 'ultlplvlng the ..ount ta.abll Clln. 6' bv the ta. r.t. (1In. 7).
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowabl. dabt. and d.ductlon. ar. d.t.r.ln.d a. follow.1
A. You lagellv er. ra.pon.lbl. for pay..nt, or the e.tat. .ubJact to ad.lnl.tretlon by . p.reonal rlpr...nt.tlv. I. In.ufflcl.nt
to pav the d.ductlbl. It....
B. You actual Iv p.ld the d.bt. aft.r death of the dlcldlnt and can furnl.h proof of ply..nt.
C. Dabt. baing cl.I..d lU.t b. It..I~ld fullv In Part S. If additional .pac. I. n.ld.d, u.. pl.ln pap.r a 1/2" . 11". Proof of
p.y..nt .av b. r.qu..t.d by the PA D.p.rt..nt of R.vlnul.
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY
REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES. TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (717) 787-8327, TDDI (717) 772-2252 (HEARING IMPAIRED ONLY)
,
,
,,) ; 1/- {.
REV-lS47 EX AFP (OS-941*,
CO""OHwUt lit Of PDiHSnVAHU
O[PAA'"lNI or R[VntUr
IlUREAU or INDIVIDUAl TAkfS i ~.
DlPT, O'lObDI
t.APAISIlUAG, PA 11118-0601 -=
ESTATE OF ",n:mrrs-
DATE OF DEATH 08-29-94
C-
ACN 101
NOTICE Of INIlERITANCE TAX
APPRAISEHENT. ALLOWANCE OR DISALLOWANCE
Of DEDUCTIONS AND ASSESSHENT Of TAK
coR
DATE 12-19-94
FILE NO.
COUNTY
CUMBERLAND
NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION Of THIS fDRH WITIl YOUR TAX
PAYHENT TO TilE REGISTER Of WILLS, HAKE CHECK PAYABLE TO "REGISTER OF WILLS. AGENT"
REMIT PAYMENT TO:
JUNE L KEMPER
1115 COCKLIN ST
MECHANICSBURG PA 17055
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Allount Rellit hd
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV:iSi,-i-Ex-,mqiiii:94")~~~r[~~~~~~rN~~ii~~~~g~;~-~~-~-~~Rf~~~~~~~~-?~~~~-CE-~R-------:;'''-- - ---
ESTATE OF MICHAELS CORA M FILE NO. 21 94-0780 ACN 31'0-1 ::. DATt'~12-19-94
~~. ~.:. ~1
CHAHGED~' . ,) C ~~ G.
t., 1""""1 r- U
. , ~...
TAK RETURN WAS I (X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN SASED ON: ORIGINAL
1. Re.l Est.t. (Schedul. AJ
2. stock. and Bonds (Schedule BJ
3. Clos.ly Held stock/Partnership Intera.t (Schedule CJ
4. Hortaava./Hot.. R.ceivab1e (Schedul. DJ
S. Cash/Sank Deposita/Hilc. P.rlona1 Proparty CSchadu1e EJ
&. Jointly Ownad Property (Schedu1. FJ
7. Tranlferl (Schadul. GJ
a. Total Als.t.
APPROVED DEDUCTIONS AND EXEMPTIONS,
9. Funara1 Expansas/Ad... Costs/Hilc. Expanl.s (Schedule HJ (9J
10. Debt./Hortgage Liebilitie./Liens (Schedule IJ (10)
11. Total Deductions
12. Het Value of TaK R.turn
13. Charitable/Governllantal Sequests ISchadula JJ
14. Het Value of Eltate Subjact to TaK
If an assessment was issued previously, lines
reflect figures that include the total "f abh
ASSESSMENT OF TAX:
15. Allount of Line 14
1&. Allaunt of Line 14
17. Allount of Lina 14
18. Principal Tax Du.
TAX CREDITS:
PAYHENT
DATE
10-18-94
NOTEI
at Spous.l rat.
taxabla at Lina.l/Cle.. A rate
taxabl. at Co11atara1/C1.s. 8 rata
1151
llbl
1171
RECEIPT
NUHBER
MM913083
DISCOUNT (+1
INTEREST (- I
208.25
(1)
(2)
(3)
(4)
(5)
(61
(71
,
.
( j. t
t. ..!l.!L
40 , 218 <ill
~::OO
,DO
,DO
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69.415.12
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returns assessed to date.
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69.415.12 X .06.
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4.164,91
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AHOUHT PAID
3.956.67
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
. IF PAID AfTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
4,164,92
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,DO
,OICR
( IF TOTAL DUE IS LESS THAN '1. NO PAYHENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" fCRl, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE Of THIS FORH FOR INSTRUCTIONS.)
RESERYAfloHI CIt"t.. of d.ud.nt. dvlng an or b.far. D.t..b.r 11, I,., .. If .."V hlhH' Inhr..t I" the ..hl. Is IrM.f.rr.d
In pa.....lon or .nJav..nt to Cl... . (caU.t.raU h.n.flcl.rl.. of the d.ted.nl .fhr Ih. ..plr.llan o. any ..t.h for
Ilf. or far y..r., Ih. COllonw..llh h.r.bv ..pr...ly rl..r".. tI,. rlghl 10 "ppr.I.. .IId ...... 1r.,,,,.r ItlharlllWlu T....
.t the l.wful CI... B (call.t.,.I. r.le on .ny .uch 'utura Inl.,..I.
PURPOSE Dr
HOllCEI fa fulfill the r.qulr...nts of Section 11ltO 01 th. Inh.rHance and (shta f.. Acl. Acl " 0' '''1. " P.'.
S.ctian 11ltO.
PAVH{HT I
O.tach Ih. top portion of Ihll Holln and .ub_1I with YOUr tI,.,..nl to Ih. AIghlar 0' Willi .,rlnlad on Ih. "111.'" .Id.,
"Halt. ch.ck or Ion.., order p'ubl. tal REGISTER or MILLS, ADENT
All p..,..nt. r.nlv.d .hall flr.t b. .ppll.d 10 MY Inh"lt Whlth ..y II. dUI ..ith .any ,...Inder ."pllld 10 Ih. 1.11.
REfUND (CRh A r.fund 0' I t'lI cr.dlt, Which..,.. not "IIlI..I.d on th. T". R.tu'n. a.y ba uqullhd by co,pII'lnd.n "Application
'or R.'und of P.nn.vlvanla Inhlrll.nea and (1lah 'a." (fUV'UI1J, "I'I'llc.tlo". If. 1..,.II.hl. _, tha Office
of the Rlollter 0' Wllh, any of th. ZS FI.v.nuI DI.lrlct oUln., or by talllnlllh. .p.eI,1 ''''hour
an....rlno ..rvlu nuab.,. for '0'" ord.rlngl In rann'ylv.nl. l'IDO-U"lOtto, outside PeM,.,I".n., and
within loul Uerrllbu,g ar.. 1111) '.'..09". '00'11111 I1r."", III..rl"" IMp,lred Onlyl,
OBJECTloNSI Anv p.rh In Inllre.1 not ..11.'I.d wllh tha ""I'ltlll...a.nl, ,110_oIf1u at 1I1..1101rIWlt;a a' 1I.1I",'lon., or ........nl
of ta. (Including discount or Inl.r..1) a. .hown on Ihll Hotlu au.' obJllct within ,lIh IbDI III1Y' of r.ulpt of
Ihls Nollce bYI
....rUt.n protut to the PA ll.p.r'.."1 d' FI.v.nu., lo.rll of Appuh, 1111'1. PllOtl, tl.rrl.bu,g, P" 11111.1011. OR
...I.ctlon to h.v. th. .atllr d.teralnad .t lIt1dlt 0' "" "ccounl or Ih. ,'.rsun.1 r.II,..ant.tlv., OR
..appa.l to the Orphen." Court.
AD"IH
ISlRATlVE
CDRFlECTIDNSI
ftlctual .rrotl dl.cov.r.d on 'hll ........nl .hould II. 'utd'....d In ..rlllna tal I'A nll,,,.,I..nl ul A.v.nu.,
Buraau of Individual 'an., A"HI Po.t A.......nt A.vl.w IInlt, nll'1. lIaltOI. tt..,rhhurll, IIA 11111-0601
Phon. 11111 1I1'r.~D~. S.. pao. 1 of tha 1I001olal "In.lrucUo". lor Iflll.rll.nn ,.. Rat"rn lor. N..hl.nt
O.cld.nt" (REY-ISOI) 'or an .~"lan.tlon 0' "clalnl,lr.llvely turr.tt.hl. arrOrl,
OISCooHf,
If any II. due Is paid ..llhln 'hr.a U) eel.nll.r .unl". .".r Ih. lI.ud." I' , tlntlt, ,. rlv. ".,unl 1":0 dlscounl 0'
Ih. tall p.ld I. allow.d.
IHIERn' ,
Inhr..t I. ch.roed b.glmlno ..lth 'Irtt d.v 0' lIel hlllu.nCY. ur nlna 1'1 .onth. .ne' on. II>> day Irol th. d.,. of
d..'h, to th. dale of p.v.."t. 'a... Which baca.e dal!Jutulnt IIllo,a JINlu.ry I, "Ill II..,. Inh,..t ., the ntl of
.h 16;() p.run' per annUl c.lculat.d .1 II dally r.l. 01 .ODOIM. All In".. whll:h h.ea.. d.llnqu.nt on and ."ar
January I, 1911 will b..r Int.,.t' al a rat. which will v.ry 'rol clllaml., yair 10 callndar y.ar wllh that rat.
IInnoUllcad bv Ihl PA Il.pllrt..nt of Rennua, 'ha 1Il',llleahl. In'.,.,t "".. for ..'., Ihrough I""" IIr.1
~ Int.,...t Patl n.lh Inl.r..t ".ctor V.llr In"'''11 N.I. n.lly Inl.rut r.clor
IUl Zo:( .DOO!'''. 19" '" .000""
I'll IfI;( ,DOD"U 1981 .~ .000l'"
JU4 11;( ,DOUDI 1911-1"1 IIX .DODSOI
1915 UX .OOU\r. 1991 .~ .000l'"
Ins. I"" " .GDol"
I'" .~ ,oooru
"Int.,..t Is ealculal.d III 'ollnwlI
INTEREST . BALANCE or TAK UNPAIO K NU"BER or OAYB OELINQUENT K OAILY INTEREST rACTOR
"Any HoUc. lllu.d .".r thl t.1I b.co... d..IMlty.'1t will r.".et lit, Inll'..' ulcallatlon 10 'I".." 115) dllv'
bayond the dll. 0' the ........nt. If "I.,_ant I. ...,. _fler Ihe lul.,..I coapuhtlOlI d.l. lhow" on Ih.
Notln, additional Inter..1 ..u.t h. ulcl.ll.l.d.
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CERTIFICATION OF NOTICE UNDER RULE 5r6(a) ~ 0~,:
Name of Decedentl (~'O 1?,4 7>> 4 E 77? ':~C/~S~;~
-
Date of Death: J! U9 V',;;r-,~ '1/ ~'2-,C/
Will No. ,f( /t?~- tJ '7 ;( J Admin. NO.I7C;~ - CItY 7.To
J
To the RegisLerl
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' COllrtRules was served on or mailed to
the following beneficiaries of the above-captioned estate on
:
Name
-:J U;;; E
Address
/.. Otli~e /~/7J )J~~
/
/ (,,";',.5 -COc.KLI/7 Sr
/JJCc:h69' AfJ. / /&'..!.---s.-
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except
Date: J / ~ //99s--
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/J 1,-..4/
CiL/?,,7/ ~d-.-'./~.<'.(;'o/ ;;j~/.J1A./
~/. Signature '.
L Name:] U I? E /..otJ; s (3 A{.. Jlp?C7c....
Address// /6 -{! cJe/r"L III 5 r;
/J1ee4-/J-I1/ts. .Qt/)('f;; ~,/ 7C~-s
Telephone 1J1'l "7 ~ tf' - ~{j Td
capa~ Personal Representative
Counsel for personal
representative
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STATUS REPORT UNDER IIULI; 6. 12
Name of Decedent I Co IB4 7JJAC /:J?/(!/;eAt..S
Date of Death: q (..< ~.!l.!l.~
Will No, :2 I q4/ - (;? ;1 %' c.J Admin. No. / C;C?t/-O (J 7 %0
Pursuant to 11\110 6.12 of the Supremo Court Orphans'
Court Rules, 1 report the followLng with respect to completion of
the administration of tho obOVO-cllptLonmJ ostate.
1. Stato whother IIdminlstration of the estate is complete.
ves--K_ No_..____
2. If tho onllWOI' III No, nt.ot.o whon tho personal
representative reasonably IlOlIllVOfl that the administration
complete I
will be
3. If tho IIl1nWlJr t.o No.1 In Vos, state the following!
a. Old tho poroonlll reprosentative file a final
account with tho COllrt? Vnfl~_ No .
b. 'I'ho IIIIIl/II'l\to Orphllllll' CUllrt No. (if any) for
the personal reprOllolltlltlvn'1I IIcr:Ollnl. ISI
c. tHd t.ho plll'Honll1 roprosontative state an
account informally 1.0 tho pllrtlulI in intorest? Veil \ No
d. Coplon of rocolpts, releases, joinders and
approvals of formal 01: Informal accounts may be filed with the
Cerk of the Orphans' COIII:t IInd may be attached to this report.
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Name (Please type or' print)
)1 /.5-{.u(" ^ 'LII') .S ~-/.'~'c:~t~h0-_
Address /1-;.
(//7 ) 7/6 - '/ t?;;-()
Tel. No.
Datel
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Cumberland county - Register Of Wills
Hanover and High street
Carlisle, PA 17013
Phone I (717) 240-6345
~
Datel 8/16/1996
JUNE LOUISE KEMPER
1115 COCKLIN ST
MECHANICSBURG, PA 17055
RE: Estate of MICHEALS CORA MAE
File Number: 1994-00780
Dear Sir/Madam:
It has come to my attention that you have not filed the status Report
by Personal Representative (Rule 6.12) in the above captioned estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1,
1992, the personal representative or his counsel, within two (2) years of
the decedent's death, shall file with the Register of Wills a Status Report
of completed or uncompleted administration.
This filing becanle delinquent on..... 8/29/1996.
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
II' 0!tAl,"4U~L'1 P-0~\rr.aU({()
MARY C. LEWIS .. ''i!fp..'"-cL{
REGISTER OF WILLS
cc: File
Counsel
.Judge
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