HomeMy WebLinkAbout94-00826
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k~Vo1~43 EX AFP (8094),*
c_u nt OF PfNNSVlVAHU
DEPAIlTIEHl OF REVEIU
~AV 01' INDIVIDUAL TAXES
DEPT. 1I060l
HARlIIJURg. PA 17171-0101
/1) . .~~J,I I
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
(~)
FILl NO. 21 .q&i ~ Y'~,"
94139879
09-06-94
ACN
DATU
ESTATE OF HElM
5,5. NO. 190-18-1928
DATE OF DEATH 01-01-94
COUNTY CUMBERLAND
TVPE OF ACCOUNT
B ~ SAVIIWS
. CHECKING
TRU3T
CERTIFICATE
REHIT PAYHENT AND FORNS TO.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
HENRV
HElM
8 TERRACE PLACE
NEW CUMBERLAND
LOV R
PA 17070
HARRIS SAVINGS BANK has provided thl DepartHnt with thl In'oruUon IlItlel t.low Mhlch h.. been used In cllcul.Uno the
potenUal tlM due. ThIIlr recordl Indlct'e that It thl duth of thl above dlc.dent, ~ou wlr. I Joint owner/beneflollrY of thlt 'OtOWlt.
If you f.. 1 thll InfclI'uUon II Incorreot, plllll obtain written corr.otlon frol thl flnanel,1 In.Ututlon, ,Utch . oopy to thh for.
end r.turn It to the aboVI addr.... This Kc~t II taxable In Iccordancl with thl Inheritance fIX l"'l of the Co.-onw..1th of P""",vlvanh.
QuUUonl NV be ."Iw.red by allUnt .1717) 787-8lZ1.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
AccOWlt No. 07-66-231274 Cltl 11-21-92
E Itobl hh.d
Account hlonc. 42,742.29
Plrcont T..lbl. K 100 . 00
AlIOunt Subjlot to TI' 42,742,29
TI' R.t. ~ ,06
PcbnU.1 T.. Due 2,564.54
PAaT TAXPAYER RESPONSE
llJ I'AJLURI TO IlI1POND ifILL RESULT IN AN OFPICIALTAX A88188HeNT 1A8ID ON THI8 NOnCI I
A. 0 The above InforllUon and tu dul II corrl(jt.
1. You ..v choo.. to r..lt "~'i..nt to thl Righter 0' Willa with two copt.. 0' thlt notlcl too obh!"
. dhc~t or Ivoid Intlra,t, or you IIY chick bOle "A" IVld r.turn thh notlCt to the Rlgl'hr of
Willi end an off'ohl a.......nt NUl ba IlIutd by the PA Dt9trtHnt of RIVlno..
To tnlur. proper erect I t to your aoco~t I tNO
(z) cop!.. of thll notle. IUlt IlIccotplf\';' your
PIIYMnt to th4l Regllt.r of "'1111, Hekt cMck
payable tal "Righter of tflUI, Ag~t",
NOTE I If ttlx pay..,,', Ir. .ade within three
(5) ItOOthl of the dlCldent', d~tI of death,
yOU .ay deduct . S~ dhco1X'lt of tN tel( due.
Any IntMrHanu tlIC dot will b.tc:OH d,l1nquftnt
nln. (9) lonth. afhr thl dlt, of d..th.
[CHECK ]
ONE
BLOCK
ONLY
I. 0 Tht above ....t hu boen or NUl be r.porhd and tllle pftld with the P.nnlvlvwl!. Inherltanc. Tille r.turn
to be flied by the dec.d.nt'. repru.ntatlYI.
C. !Xl The Dba.... Infnr..t1on IMflcorr.ct endlor d.btl and dfituotlon. Wlr. Plld bv you.
"'OU MIlt c~ht. PART ~ and/or PART {!] belo'l,
If you Inulo.t. I dlfflr.nt t.X r.t."pllll~ .tltl yo~r
r.I.Uonohlp to doeodont, surv~v~nq spouse
OFFICIAL USE ONLY 0 A~F
PA DEPARTMENT OF REVENUE,.
PART
~
TAX RtTUnN - COMPUTATION
LINE 1. O.t. Eltoblllhod
2, Aooount B.l~o.
S. P.roont TI.obl.
4. A.ount Subjlot to TI.
S. Oobtl end O.duotlonl
6. A.ount T..obl.
7, TI. Rib
a. T.. Due
PART
[!]
DATE
- :
OF TAX ON JOINT/TRUST ACCOUMTS PAD
INovember 211 1992 1
2 $42,742.29 2
S K 100 3
4 42,742.29 Cl
5 11 . 5 1 8 . 71$
6 31,223.58 6
7 K .06 7 , ,
a 1.873.41 e
DEBTS AND DEDUCTIONS CLAIMED
PAID
PAVEE
DESCRIPTION
[ SBB ATTAC~'"
TOTAL IEnt.r on lln. 5 of TI. Co~tltlon)
AMOUNT PAID
[
.
-
-~-.
Undor pon.ltlll of plrjury, I doellr. thlt thl foct. I hlvl rlportod obov. Ir. true,
cDIIPI.t. to tM)~. It of .y knowlodlll ond b.lllf. H_OME ( 7] 7 ) 774 - 2 6 q 0
4;,), t, ".o/e:'I." WORK (--- ) --- ____
TAXPAYER SIGNATURE TELEPHONE NUMBER
oorrect and
It
D TE
') If
I
GENERAL INFORMATION
1. PAl LURE TO RUI'OIGl MILL RESULT IN AN OfFICIAL TAM ASSESSIIEHT _lIh ....11.0111. Inl.,..1 bo.ed on Info,oollon
oubollled by tho fl".,.ol.1 In.lllullon,
Z. Inhlrltlllnd tlM bMOM' dtllnquent "1ne MOnth. .ft,r the decedent" dltl of dnth.
S. Ii Joint ICICCMtt II tllC.11 Iven thoOlh the dMtdlntt, n.- WII Iddeci II · Ilthr of cooVtnllOC1.
4. AocOU\t. ClnolUl1lnt tho.. held betWHO hUIMld II1d wif,) which thl dludent put In joint MM' within one VI.r prior to
delth Ire fully 'I)lable II trlWl.fM",
S. AccOWtt. ..tlblhhed Jolntlv betwean hU.band WId WUI ItGr' thw\ OM VII' prior to dtlth .r. not tlMlblt.
6. 1.00000\. held by . decedftnt "In trult for" InOther or others Ir' tllCMll1 fully,
REPORTING INSTRUCTIONS - PART 1 - TAXPAVER RESPONSE
1. BLOC" A & If tht Infor.'Uon Ind COIlPut.tlon III thl noUtt fir' carr.et end ~t1on. .r. not b,lna allleld, piece In ")("
III block "A" of Pori I of tho "I.,p.,.' R..pon,," "0 \I on , SI"" t"O copl.. ond .ubolt ItIN _Ith ,ou' .hOCk lor tho .-.,1 of
tllC to the R'llttlr of Will. of the cotonty Indlclt.d. lh_ PA DIfI.rtnnt of M.v.nut will lllut Itl offlcl11 ......Mf',
(For. REY-1541 EX) upon reellpt of the rttu~n frol the R."ltt.r of Willi,
2, ILOCK I _ If lho ....1 .peolfled on Ihlo notl.. Ill' boon or _Ill be ...orlld on<! I.. p.ld _Ith tho pom.yl,onl. lnho,lIonc.
I.. R.lu,n flied by Ih. dococJont'. ,op,uonlltl'., plnc. on "K" In blu<k "I" of Pori I of tho .I.'p.,.' R..pon.." ..oll.n. II"" ono
'00' on<! ,.Iu,n I. lho PA D.Port_. of R."nu.. lu..... of Indl,ldu.1 I."., Dopl 210601, Ilorrhll<lrg, PA 11121-0601 In Ih.
l,wIlopt provlo.d.
5, ILOCK C _ If tho ncll.. Inlornllon I. Incor'IOI oneI/or d.duotlon. 0'. b.lng .Ioloed. chOCk block "C" oneI .oopl.l. P.,I' 2 ond 5
..co,dlng to lho In.I,ucll.n. b.low, Sign two .001.. oneI .uboll tho. _Ith you, .hOCk for tho --,I .f I.. p"..I. 10 tho Roglol.'
of Nllll of the COlSlt';' lodlclted, The PA DtPllr1.."t of R.II.nue will 11IIUI an offlcllll ......lIII\t (Fori AEV~1!i4a EX) l,Ipon rtcllpt
of thl rlturn frCMI the AlClhtlr of WIU..
TAX RETURN - PART 2 - TAX COMPUTATION
LlItE
1. Ent.r the d.t. the account originallY w.. utftblllhtd or HU.d In the .lrVMr .MI,tln" lit d.t. of delth,
HOlE I For I dec.d'!lt dying .ft.r 12112/IIZI Accountl which the d.c.dlnt put In joint n.... within on. (1) yllr of d..th .rl
taMable fullY" trlnlflr', tloNelllr, there II an .ltolullon not to IItcHd U,OOO per tr"'lfln.. rlglrdl... of thl v.lue of
thl accooot or the nullbtr of accountl hlld.
If I Ooublt ..tlrisk (1111) appl.rI beforl your flrlt n.... In thl Iddr.u portion of thll noUOI, the $1,000 .xch.lllon
,1rladY h81 been deducted frot the ICCGURt b.I~1 a. rlportld by thl flnanolal Inltltutlon.
Z. Ent.r thtJ totll b.lanc. of the acoount lnclucUng lnttr..t Iccrued to thl d.tl of duth.
S. ThI perunt of thl Icoouot thlt h tllCabll for IIch .urvlvor h dltl,.lned tt. followl'
A. TM perclnt tllCabl. for joint ....t. uttblhhld 110" thlln on. y..r pdor to thl d.Clldtnt'. dtlthl
I DIYIDeD IY IDIIL HUHIER Of
JOIHI DMR'J
ElC.-pltl A joint ....t regl.t.rld
I DIYlDf:D IV 5 (JD1HI _R'Jl DIYIDEO IV 2 (SURYIYDRtl . ,161 K 100 . 16,1~ tlAKAILE FDfl EACH SlJNIYDfll
DIVIDED IV 101ll HUMIER Of X 100 . PfRCEHI TAXAILE
Sl.<l'IlYlHO JOIHI DWMERS
In the nut of thl Meldlnt end two other perlon..
I. Tht parelnt tllCtbl1 for ....t. cr..tld within DOl y..r of thl dlc.dent'. d.lth or ICCountl owned by thl dlcld.nt bY' h.ld
In tru.t for \WlQthlr Indlvldu.U.J (tru.t btOtflchrlu)1
I DIYIDf:D IV IDIAL HUM&ER Of SUMV1YlIlO JD1HI
DW1lER'J DR IRUSI IEHEFIClIJUES
~ 100 . PERCENT 'AMAILE
ElClMIPIII Joint 1ICc:~t r.glttlrlt: In the nMe of thl dtctdtnt and two other plrton' end utablhhtd within on. y..r of d.ath bv
lho cIo<lodonl.
1 DIY1DED IV 2 (SURYIVDRtl . ,50 X 100 . 50X llAKAIlE FOR [ACII SURVIYDfll
~. The tIMKI"It tubjeet to tax (lInt 4) 11 det.ralned by lIUltlplylng thl IcCount b.lIanu (lIne 2) bv thl plre,"t talCabl, tllne 5).
S. Enter the totl\ of tht deb" and deduotlon. Ihted In P.tt 1,
If. The MOunt to;;abll (111'0.6) It d.tar.lned by lubtraCltl~ thl d.bt. end d.tkJct!onl 1\1". S) frol thl alount ,ubjlct to hli (11". 4),
7. Enttr thllPproprl.t. tilt rlto (lIne 1) u dettralned b.low.
A. For det.. of Math occurring .ft.r 6/30/M, thl talC rat.. for trenlf.rt to lpou'" Ire II followtl
I. Olt.. of dl.th on or .ftlr 7/1/~ Ind blfor' 1/1/96 thl rlt. I. !x.
2. D.t.. of death on or .ftlr 1/1/96 and blfor. 1/1/97 thl rat. I. lX.
S. O,t.. of death on or .ft.r 1/1/97 IMd b4for. 1/1/9' the rat. 1. IX.
4. Oat.. of delth on or after 1/1191 trlO.f.r. to 'POU'" will be .xUPt frOl talC.
Nettl For det.. of death prior to 1I1/9't tr""flrl to 'POU'" Irt tllCllbl. It 61/:.
I. Trlflliftr. to lIntll dt.OtnChlnt. IncllJcUna f,thlr, lother, IOfI, dlUQhtlr, grlOdchlldrlln, .on.ln~lltW,
dltUClht.r~ln.I"', Itepehl1d .nd thllr luue It. tllCbbll It Ill<< perc.nt (6:0,
C. Trln,flrI to .11 ot....r. Includlnt brothlr, .lIttr, unol., 8U'lt, nepheW and "110' ar. tll(tlbll at fift,," ptroent (I&:().
O. If you chane- the t'l( ratl, pl.... .ptOlfY your r.lltionthlp tu the IMctdtnt In thl .,11 provldld.
eo The IIIOU1t of telC due UII'II 'J 11 d.tlralntd by .u1tlphlnll thl MtOU'it t.lCtbl. OIM 6) by thl talC rat. Oln. 1).
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
AlIOtIItb11 debts n dtductlont Irt dtterllMd .. follow'l
A. You 11,llh ar. rllpontlbl. for PI)'MI\t, or thtl ut.tl s..mJtot to eo.lnhtrltlon by . "'''0(111 reprUtntlUVI It Insufflelllnt
to PlY thl deduotlbh "....
I. You actutllY p.ld the debts .ftar dt.th of the dlCtcMnt end CIn fur""h proof of paYlllflt.
c. Debt. b.lt" al.IHd tu.t bl "..IUd fullV In Pllrt S. If addltlonll .pee. II netdtd, UI' pl.ln peper a 112" lC 11". Proof of
rly.."t .aY b. rAqUl.tld by thl p"" n.pltrtMnt of R.venue.
TAXPAVER ASSISTANCE
IF VOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY
REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE
. OR CALL THE BUREAU OF INDIVIDUAL TAXES. TAXPAVER INQUIRY UNIT IN
HARRISBURG AT (717) 787"8327. TDDI (717) 772-22S2 (HEARING IMPAIRED OHLV)
. "
REV-1543 EX AFP 11-941,*
C_Al T1i Of P[NNSYlVAHll
IlEPAllIHEIfT Of REYEIU
IUlEAU Of INDIVIDUAL llXES
IlEPl. 110601
IWlIlIIWlG. PA nUI.om
t.
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 (ILI'~',~(..
ACN 94139691
DATI! 09-06-94
ESTATE OF HElM
S.S. NO. 190-18-1928
DATE OF DEATH 01-01-94
COUNTY CUMBERLAND
TYPE OF ACCOUNT
B ~ SAVINGS
CHECKIIfIl
TRUST
CERTIFICATE
REHIT PAYHENT AND FORH$ TOl
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
HENRY
HElM
8 TERRACE PLACE
NEW CUMBERLAND
LOY R
PA 17070
rENNSVLVANIA NATIONAL hit prolllo.d the o.p3rtunt with thl Jnfar..tJon IlItld baLow which hi' bHn ulld In cllc:uhtlng the
potentl.! tlM due. Their record, Indlut. that It thl d..th of thl above a<l~t, you wtr. I Joint owntr/blntflol.ry of thlt acCOl6\t.
If you fHI thh II1'or..tloo II Incorrtot, pl...1 obtain written corr.otlon 'rotl the flnancl,1 InlUtutlon, .Uach I OOf)V to thh for.
Ind r.turn It to the aboVI addr.... {till IeCOU'lt II "Mlbta In ncc:ord,ncl ",11/1 tM IrVl4irU..lCI rllC llWI of thl CO_OlltlIlUh 0' Pann.Y.ivllnh,
OuII\lonl ..y be ent.-rld by CIlllng (717) 787.aSl1.
COHPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Acccunt "c, 9600252091 D.h 05-06-92
E.hblhh.d
29,116.48
50,000
14,558,24
.15
2.183.74
~~ TAXPAYER RESPONSE
m I P'A~LUIl" TO 1118POf1D ifILL RISUL T IN AN OFFICIAL. TAX A88U8HIHT IASlD ON .THI8 HOT1CI
A. 0 The aboY, Infor..Uon end talC due II corroot.
1. You "V c:hoo.. to ,..It PIYHnt to the Righter 0' Will. with two copl.. 0' thh notlc. to obbln
/ It dltcoltlt Dr avoid Int.rut, or !too lIy check bole ".." and r.turn t~l. notice to 1he R.ghhr of
NIlIt and an offlchl I'!II.nMnt will b, luued by thl PA Depart..n' of R.v.~.
Acccunt B.lone.
P.rcant T..obl.
Aoount Subj.ct to T..
T.. ~.t.
Potantl.1 To. Duo
To Inlur. proper oredlt to your ICC:OI61', two
(2) copt.. of thlt notice Wit eccoapMY your
PlY"'" to the Reglshr of W11II. Make chick
Plylblt tal "Hltl.t.r 0' Willi, Aglnt".
K
HOTEl If taM PIVHf1" art ,Itdt within thr.'
(]) ~th. of thl dlo.o.ot'. de', of d..'h,
you .ay deduct I S~ dl.count of the talC due.
AnV InMrltencl taM due H1l1 btOOM dtllnqulnt
nine (9) tooth. aft.r thl de', of d,.th.
K
[CHECK J
ONE
BLOCK
ONLY -
a. 0 The \/0 ....t hu bien Of' will bt rlPOrttd end tax plld with the Pll'v'IIylvanl. Inhtrltanet TIlJIC r.turn
to . filed bV the dec.dent', r.pruenhtlvlI.
C.
TM Ibov. Infor..t1on I~ncorr.ct and/or d,btt and d,duc
You lU.t co~l.t. PART ~ and/or PART 0 b,lw.
If you Indlo.t. . dlff.rent t.. r.t., pl.... .t.t. your
r.l~tlon.hlp to d.c.dlnt,
OFflICIALUSEONL V 0 AAF!
PAIlEPARTHENT. OF REVENUE i
PART
I!I
TAX RETURN . COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. D.t. E.toblhhod I
2. Acccunt 8.lone. 2
5. P.rcant T..obl. 5 K
4. Aoount Subj..t tc Tox 4
S. Debt. and Ooductlon. 5
6, Aoount T..obl. 6
7. T.. Rot. 7 ~
a. T.. Du. a
PART
[!]
DATE
PAD
... ,1
, "'2
:5
.4
5
6
1_
8_
DEBTS AND DEDUCTIONS CLAIMED
-1 I
TOTAL IEnt.r on Line 5 of T.. COOl>Ut.tlcn) .
.-
Undor pan.ltl.. cf perjury, I docl.r. th.t tho f.ut. 1 h.v. r.pcrt.d obeY. .r. tru., oorr.ot and
~I,.h to tho bo.~t cf,.y kncdodll<l and b.lI.f. HOME (r~/:I ~I ) ',1 ~, II - ,;1, ,,'/ '"
<') /'I} YJ ( WORK ( _'_ ) :1/' r19
-mJI"AvtR S{IlNATUR' w,. TELEPH E NUMBER ' DA~E
PAID
J
PAYEE
DESCRIPTION
AMOUNT PAID
~
.
GENERAL INFORMATION
1. fAILURE TO R!SI'DND WILL REBUL T IN AN OFfICIAL TAlC WE'SIl!NT with "",,11011111 lnt....' bl"" on Inloreltlon
_Ittocl by 1110 /lnonolll In.tltutlon,
I. lm-r1tMe. tlX bee... delinquent nlM .,th. .ft.r the decedM,f, del. of de.th.
S. . Jotnt 100CM.l'lt 1. tlMlbl. IV," though tha deced....t'. f\IlM w.. Iddttd II . "Ulr of oonv...teno..
4. Aoo~tt (Jnoludl". thOH Mid bit...." hutbcnd It'ld wlf,) whloh the decedent put In Joint MM' wHhln one Yllr prlar to
dHth Ir. fulh 'IMlbl. II tr",,'.r..
It AI\GCMI'\tI ..tllblhhed Jointly b.tWNtt hulbend Ilnd wU. IIOr. tMn OM YI.r prior to dllth Ir. not taXlbl..
.. AooCMl"lh held bv . aude"t "In tru.t for" IOCIthlr or elMr, Ir. taxlb1. fulb.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. .LOCI( A .. If the 1"'OrAtlon 1M COIIPUtlUon In thl naUo. Ir. c:arreet .00 dedu<it1on. Ir. not bllng olftlHd, pllG. In """
In block ".'" 0' Pert 1 0' the "TIMp.y.r Rupon.." tecUon. Sign two cQflI.. BOd .ubllt thOll with your check for the MCMInt 0'
tlM to the R"llt,r of Willi nf the county Indicated. The PA DIP.rt-.nt 0' Revenue will 1..01 en 0"101.1 "I.I-..nt
(For. REV-U4I EIU ~ re<<l.lpt of tM r.turn frOll the R.gl.hr of Willi,
I. ILOCK I .. If thl "...t lpeOifltd on thh noUn h.1 bien or will be reportltd II'td talC p.ld with the Ptm'vlvltli, IriMrUIInO.
TuA'turn fl1td by thl decedent.. repr..."t,Uva, plec. In ")I" In block "I" of Pitt I of the "Tup.VIr A..pon.... IlOtlon. Sign one
oopy end r~turn to the PA Peplrt-.nt of R.venue, luralU of Individual TI~", o.pt Z10601, Kerrllburg, PA 17121-0601 In thl
env'lopt provided.
5. BLOCk C .. If thl noUc. Infer..tlon II Incorreot Ind/or deductlonl It. being ol.hIOd, check blodc "e" end oOllPI.t. Pith Z end ,
1C00rdlng to thl In.truotlon. below. Sign two copl" Ind lutMllt thee with vour check for thl IItOW'lt of tlIC paVabl, to thl RIght.r
of W1111 of thl comtv Indle.ted. TM PA Oeplttltll'1t of R.v.nut wUl luu. en offlolal ......Nnt (for. AE'J-154' [Jill upon rlC.lpt
of thl r.turn frOfl the Allht.r of WIU..
TAX RETURN . PART 2 - TAX COMPUTATION
LINE
1. Enter the dati thl IOClM'lt orl.ln.lIy WII ..tablbMd or tltl.d In thl IIIMIr .~btlng .t date of dI.th.
NOTE I For, Mcldlnt dvlng "ftlt 12112/121 ACCCMlt, which th4l dlced,"t put In Joint n.... within one (1) Yllr of death .rt
t.xable fullY 01 tren.fI". Ho...v", there b ." '~clu.lon not to IlCcNd U,OOO p.r trlnlf".. tllardl... of thtt v,lut of
thl IICOOWlt or the nu.btr of accounh held.
If a doubl. ..tGrlik (Mil) IIpPIItI before your flr.t MIM In thl ldetr... JlQrtlon of thh notlc., th41 n,ooo .~clullon
,1t1edY hili bltn deducted frot the M1cooot b.llnCl. II reportld by thl flnlMhl 'n.UtuUCH\,
Z. Ent.r the total b.llnGl of the IOCount lnoludlng Intlr..t IOcrUld to the dati of OI.th.
S. The percent uf thl ICCount th.t 1. tl~abl. for ..ch surv'vor I. dttlralned .1 follow. I
A. ThI peroent tllllbh for Joint 11l4tl ..tlblbhed ItGr. than ont yllr prior to thl deoedefltt. dellthl
I DIVIDED IV TDTAl """'IER Df DIYIDED IV TDTAl IUIIER Df X 100 . PERCEIlT TAKAIlE
JOINT DWNEAS SURVIYIHCl JOINT DWNEAll
E)lMplel A Joint 1..lt .'eght.rM In the nIM of thl dectdtnt Il'Id two othlr PItton..
I DIYIDED IV 5 (JOINT OIINERSl DIYIDED IV Z (SURVIYORS) . ,161 X IDO . 16,1X CTAXABLE FDA EACH SURYIYORl
I. ThI peroent t'lllbl. for ...,t. tr..t.d within on, yllr of thl dectdent'. dtath or eccO\.I\h 0lJI0td bV the decodtnt but held
In tru.t for- enothtr Indlvlctu.HI) (trust beneflcl"I..),
I DIVIDED IV TDTAl NUI1IER Df SIRIIVINll JOINT X 100 . PERCENT TAXABLe
OlINERS OR TRUST IEIEFICUJUES
EJCMpl.1 Joint ICCOW'lt reghterM In tM n... of the decldent 1M two other pe"on. and IitlblllMd within one Yllr of dteth by
tho Mudont.
1 DIVIDED IV 2 (SURVIVORS) . .so X 100 . SOX CTAXULE FOIl EACII SURYIVOIIl
4. The IlIOUI"It .ubJHt to tax (11M 4) II OIt"llned by IUltlplylng the ItCClCM.r1t blllnC. (lIne 2) by tM pereent ")llbl. (lIne S).
5. Entar tha tatel of the dMltI and deduOtlClflI Ihtao.t In Pitt 1.
.. The IIKI\I"lt tlUCtbl. (line 6) II dt1lralnld by lubtrectlng the IMbtl end dtduotlonl (I1ne G) frOll the ~t .ubJect to tlX Olne 4).
7. [lit" thl tpprDprl,ta tax ntl (lIne 1) .. d.tar,loed ~ICMt,
A. For dlt.. of death occurring Ifter 6150/94, thl tlK tit.. for tr."lf." to lPOU'" Itl .. followlI
I. Dat.. of dtlth on or .ft.r 7/1/94 Ind bafor. 1/1/96 thl r.t. I. 3X.
Z. Dlt.. of dtlth on or .ft.r 1/1/96 Ind blfor. 1/1/97 thl rat. I. 2X.
3. Oat'l of dt.th on or ,ft.r 1/1/97 and bifer. 1/1/9. thl r.t. I. l~.
4. o.tll of dtlth on or ,ft" 1/1191 trlnlf". to 'POUMI will be '~lIIPt fr. tax.
Notll For d.t.. of dtlth prior to 711/94 trln,fltl to tPOUMI Ire taxeb!. It 6;(.
I. Trln.f." to lInnl dt~endwlt. InchHflng f.thlr, IIOthlr, ,on, d.ught", grll'ldchlldren, lon-In-l.."
dtuthtlr-In-law, Itepchlld end their 1.lut art t.~abl. at IlK Plrt,"t (6;().
C. Trltl.fl" to aU otherl lnoludlrll brottMr, Ibt.r, unoi., loot, nepMw Ind nltcl are tlKebh .t flft"" perunt nUl.
D. If you chtntt tM tax rat", pl"M .peolh your r.l.ttonlhlp to the decedent In the ar.. provlDld.
I. The MOlI'\t of tllC due (lIne I) It detlr.lned by IUltlplylng tM IIIC)W\t tlXlC1. (11M 6) by thl tlX rltl (line n.
CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED
A1IOVlbll debt. end dtduotlon. ar. dttlr-.lned I' followl'
A. You l...lly ar. r.lponllbl. for p.~t, or thl Iltate '~JlCt to ~Inl.tr.tlon by . Plr.onel r~r..entltlv. II InlUfflolent
tC' ~ay thl deductlbll It....
I. You ectually paid the debt. .ft.r death of thl decedent and Oln furnl.h proof of p.v-ent.
C. Debtl b11lng clIIHd"".t ~ It..llld fullY In Part 3. If Iddltlonal SPIICI h nHdtd, u.. phln PlPlr . 112" K 11". Proof of
p'v.ent ..y be requa't.d bv thl PA o.p.rtllMt of A.venut.
\" ," ,,"i/'(;i:<<:..<., ... (..',',.,', .', '.. '..TAXPAYER,'ASSX STANCE, ....,..>.,.< .... ....." ,.,,'. ',,'.',. ... "(" .,....... ,. .,.,. ,..
:':.,:L:iRlt~tYS~E~E:'. :IUtLT~,I!Rpl'1fEOpR:RW~N~. OO~ .\YvWu\NClI)sfROXNJTWFFAfJE. .r
':'HARRlglu2aL~TT~'1 W'C~ _g~2J~Dr~~C~A~ 7 I~~E'72!~~~QYf~EI=mRlH~~I~EANij~N)>
~
..
.
Pennsylvania ~,Ban~~
Amount
Depo.lled
NM\O
NIIIIIl
Addltu
~
Henry B. Heim
Lay R. Heim
8 Terrace Place
New Cumberland, Pa.
,II ( ','~ ',';.
~ I"
17070
11125 20Q ~1I1
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CERTIFICATE OF DEPOSIT(.!' ,\' , , " ,
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"774-2690 ,', \.'
,"~ 'TIN .190-18-1928
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PtJIKIOSli OF
HOTlCEI
PAYlEHII
R!PUHD (CR).
"
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10 fulfill tho r.qulr...nl..f S.ollon 1110 of lho Innerll.... end E.I.t. I.. Aol, A'I II ,f'1991. (71 P...
"ollon ZlIOl. '
Dltlch thl top portion of thl, Hotlel and .unalt with vour Plv.ent to the RI,ltt,r of WIII.,prlnted on'thl
rev,r.. .1da.
.. Hake ohlck or lonlY order plvablt tal REgISTER OF WILLS, AGENT.
All Plv.ent. r.celvld thlll flr.t bt applltd to _nv Int.r..t whlch "V b, dUI, with .ny r~..tndtr ,ppll,d toth. tlX,
A r.fund of . tlM arldlt, which WI' not r'quI.tld on th_ tlM r.turn, ..y b, rlqul.tld by oOlpl,tlng In "~ppllo.tlon
far A,fund of Penn,ylvant, Inh,rlt,net end Eltete rlK" (REV-1SI]), Application, Ir. IVIII.blt at thl OffiCI of
the RI,I,t't of Willi, .ny of the 2S Revenul Dlltrlot OffiCI' Dr bv 01111ng the IPIOII. Z4-hour an,wlrlng .'rvlol
nuabtr. for for.. orderlngl In Plnn.vlvanl. 1~'00~]'2420S0, out'ldl Plnn.ylvanla and within 10cIl
Harrl.burg ar'l (717) 7'7~'094, TOO' (717) 772-2252 (Heerlng IlPllrld Only).
DeJECTIONS I Any plrtv In Int.rl.t not ,.tl.flld with thl Ippr.I,.-.nt, allowtnea or dl.allowana. af d.ductlont or ........nt
of t.~ (Including dl.count or IntarR.t) e. .hewn on thl. Hotla. alY ob~.ot within ,IMty (60) day. of r,ollpt of
thlt Hotlcl bVI .
~.wrltt.n prat'.t to thl PA D,p,rta,nt of RIV'nut, laird of Appell., DIPt. 281021, H.rr!.burg, PA 17121-1021, OR
...lactlnt to hlVI the ..tt.r dlt.relnld It thl audIt 0' the account of the p.r.onll rIPrl..ntltlvl, OR
"app..l to thl Drphan.' Court
ADIIIH-
ISIRATIVE
CIItlRECTlOHS.
DISCDUHI.
IHT!R!ST .
Faotull .rror. dl.covlrlrl on thl. a.......nt .hould b. .ddr....dln writing tOl PA nlPlrtllnt 01 RIVlnue,
Burllu of lndlvldunl TIM", ATtNI Po.t A.....Mnt R.vl.w Unit, DEPT. 280601, Horrltburg, PA 17128-0601
Phon. (711) 7a7~65DS. Sel P"I ] of the booklet "Inltruotlon. for Inherltlnce TIM Return for I He,ldent
Dtoedlnt" (P.EV~lSOl) fer .n 'Mpltnatlon of adtlnl.tratlvllY correatable Irror..
, If MY teM due 11 peld within thr.e (]) cellndar ""thl after the dlcld.nt'. dllth, a fly. perotnt (S~)
dltcount of the tlM Plld It 1110Wld.
Intere.t I. chargld blglnnlng with flr.t day of delinquency, or nine (9) .onth. and onl II) dlv
frOl the d.tl of death, to the dlta of p'vsent. TIM" whIch blca.. dallnqu.nt b,for. Jlnulry 1, 19.r
be.r Intar..t at thl ,.t. of 'Ix (6X) plrcent per InnuI calculltld at . dally rlta of .00016~.
All te~I' which blca.. d.llnquont on or .ft.r January 1, 1982 will b..r Int.r..t It . ratl which will y.ry frol
clllnda, Ylar to 411andlr y.ar with th.t rltl announced by the PA Dapartalnt of R.v.nuI. Thl .ppllclbl.
Intar..t r.tl. for 19a2 thrauyh 1995 arll
'tilt Int.rut Rat. O.ll~ Int.r..t Factor 'tilt Intlrut R.ta 0.11'1 Inter..t Flatar
1911 !OX .000548 1917 9X .ooom
1985 16X .000458 1988-1991 m .00~1OI
19" m .000501 199Z 9X .ooom
191. m .000356 1995-1994 n .000191
1916 lOX .000274 1995 9X .ooom
-.Inter..t I. caloul.tld a. followlI
INTEREIT . IALANCE OF TAX UNPAID X NUHIER OF DAYS DELINQUENT X DAILY INTEREIT FACTDR
..Anv Notlc. I..uld .ftlr the t.M b.o~. doll~nt will r.fl.et .n Jntlr..t c.lculltlon to fJft.ln CIS) dlV'
'b.yond the date of the ........nt. If PIYlent I' ..de .ftlr the Intlr..t ao.putatlon dlte .hown on the
NotlcI, additional Int""t llUlt be o.lcullted.
.~
PUllPDSE OF
NOTICE'
To fulfill thl r.qulrt..nt. of Stotlon 21~O 0' the Inherltlnol and [,tat, TnK Act, Act 22 of 1991. (12 P.'.
Stat Ion 2140).
PIVttEHT,
Dttlch the top portlcm of thlt NoUeI and .~1t with your PIYltnt to thl Atghttr 0' WUII printed on the
r,vuI. Ilde,
.- Mlkl chick or 10nlY ord.r ply,blt tal REOISTER OF WILLS, AOENT,
AU ply"ntl r.c.lved shall I1rtt bt IPpU,d to any Intlrut which "Y ba dUI, with any re..lnder IPpllld to tn. tiM,
REFUND (CRlI
A r.fund of . tlX crldlt, which wat not requI.tld on the tlM r.turn, .ay Lt r.quI.tld by COlpl,tlng an "Appllcltlon
for R,fund 0' Penn'vlva"t, Inherltancl and E,t.t, TIM" (REY-ISIS), Application. or. IVIII,bl, It the OfficI of
the Rlgllt'r uf Willi, Iny of the 23 R.vlnul Dlltrlct Offlc.. or by Dilling th, 'Plcl,1 24-hour anlw4rlng ..rvlel
~.r. for for.. ord.rlngl In Pannl~lvlnla 1.800.362-1050, outlld. P.nnlvlvanl_ nnd within 10cII
t1lrrhburg .r.. (717) 7a7.an9~, TOOl (7111 112.2252 (Hurlng IIpalrld Only),
OBJECTIONS I Anv partv In Int.r.lt not latllflld with tht .ppral....nt, allowanc. or dl.tltowanCI of dtduotlonl or ........nt
of taM (Inoludlng dl.oount or 1nt.r..t) a' thewn on thl. Notlc. .a~ obj.ot within .I~t~ (60) dlv, of r,cllpt of
thh Notle. bVI
-.wrlU.n prottlt to the PA DIPart.lnt of Rlvlnu., Board of APPuh, nlpt, 281021, Hllrrhburg, PA 11128-1021, OR
-.lllctlng to haVI th. ..ttar d.t.r.lnad It the IUdlt of the Icccunt of thtl p.r.onal r.prlllntaUu., OR
..Ipp.al to the Orphan,' Court
IDNIN-
ISTRATIVE
CORRECTIONS.
Fantu.1 .rror. dl.eou.r.d on thl. as..s...nt should b. addr....d In writing tOI PA O.p.rta.nt of R.ulnu.,
Bur..u of Individual lallls, ATTNI Post Au.....nt A.vllw Unit, DEPT. 280601, lIarrltburg, PA 17128.0601
Phone (717) 787-6505, S.. page ] of the booklet "Instruotlons for tnh.rltlnco TaM A.turn for a RIsldant
Dto.~t" (REY-1501) for an .xplanatlon of lo.lnlltrltJvllY ccrr.otabll .rror.,
DISCOUNT I
If any \Ix due h paid wlthtr, thr.. (3) callndar lonthl aftar the d.eldlnt'. dllth, a flvl p.,clnt C5:0
dlsoount of the taM paid Is allowld,
IHIEREST.
tnter..t II charg.d blglnnlng with flr.t dl~ of d.llnqulncy, or nine (9) Ianthe nnd ont (II day
fro. th. data of d.ath, to the dati of Plv..nt, TaMa. which blc,.. d.linqu.nt o.for. J.nulrv 1, 1982
balr Intlre.t It th, rat. of SIM (6~1 p.relnt par ennui calcul.tad at a dallv rlt. of .000164,
All tlMII which b.c... d.lInqu.nt on or aftar Januarv 1, 1982 will b.., Intlr..t at a r.t. whJch will Vlry fro.
c,llnd.r Y.lr to c.lan~ar v~.r wlt~ th~t rata announc.d bv the PA D.part..nt of Rtv.nu.. Tha appllcabll
Interlst rata. for 1982 through 1995 .rll
'tilt Intarut Alt. Olllv Int.r..t Flct3r lur Intarut Ret. Dallv Int.rut Factor
1982 10~ ,00054' 1987 9% ,000147
1905 1.~ .000451 19"'\991 ll~ .000301
\984 ll~ ,ooom \991 9~ .000147
IUS 15~ ,00015. 1995-\994 7~ .000191
I". 10~ ,000274 1995 9~ ,000247
ulnt"tlt le cllculattd ., followtl
INTEREST. BALANCE DF TAK UNPAID K NUNBER DF DAYS DELINqUENT K DAILY INTEREST FACTDR
..Anv Not Ie. I..utd eft.r thl ta~ blec... dallnquant will r.fl.ct an Int.ra.t cIlcul.tlon to flftatn (I~) diY'
b.yond tha data of the ........nt. If Plv.ent II ..de aftar the lnt.rlst coaput,tlon dltCI shown on thl
Notlcl, additional Intar..t ault b. calcul.ted,
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RI!V-1S48 EX AFP 020941*
COHHDNHEALTH DF PENNSVLVANIA
DEPARTMENT OF REVENUE
IUREAU OF I,,'IVIDUAL TAMES
DEPT, 1M'~1
t1IRRI/JURU, PI 17128'060\ I
ESTATE OF HElM
HENRV
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NDTICE OF INHERITANCE TAX
APPRAISEHENT1 ALLOMANCE OR DISALLOMANCE
OF DEDUCTION_, AND ASSESS"ENT OF TAX ON
JDINTLY NELD OR TRUST ASSETS
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OAT! 01,-03095
B DATE OF IlEATH 01-01-94
COUNTY
FILE NO. 21 94-0826
S.S/D.C. NO. 190-18-1928
ACN
LOV . R HElM
8 "ERRACE PLACE
NEW CUMBERLAND, PA 17070
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CUMBERLAND
94139879
RIHIT.PAVHI!NT TOI
REG.ISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
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REV"1607 IX AFP (12"94*
CDlIHOHIlEAITH DP PENNSVlVAHIA "NHER.TANCE TAX
DEPARTNENT DF REVENUE .. ..
BUREAU DF INDIVIDUAl TAKES STATEMENT OF ACCOUNT
DEPT. ZAGIOI
HARRISIURD. PA 1717A'0601
ACN 94139879
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DATI 04-17-95
DATI OF DEATH
HElM
01-01-94
HENRV
B
FILl NO. 21 94-0826
COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBHIT THE UPPER PORTIOH OF THIS FORH WITH YOUR TAR
PAYHENT TO THE ADDRESS SHOWN. HAKE CHECK PAYABLE AND REHIT PAYHENT TOI ,
LOV R HElM
8 TERRACE PLACE
NEW CUMBERLAND PA 17070
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
L A.ount R'.=::]
CUT ALONG THIS LINE ~ RE1'AIN LOWER PORTION FOR YOUR FILES ....
ifiv: ifili," iiiCAi:if"f 1 if: 94"j -- - - - -liiiii-iNHiiiiT'A'Ncii - TAiC iii''A"f iiik-tlf-jiri-Accouiff-" iili ii"m. ""- - - --... -" - - --
ISTATE OF HElM HENRV B FILE NO.21 94-0826 ACN 94139879 DATI! 04-17-95
THIS STATEHENT IS PRO~IOEO TO AD~ISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED
ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAR DUE, APPLICATION DP ALL PAYHENTS,
THE CURRENT BALANCE, AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT I 03-27-95
PRINCIPAL TAX DUE,
1,995.42
PAVMENTS (TAX CREDITS),
PAVMENT
DATE
09-28-94
04-01"95
RECEIPT
NUMBER
MM913010
AA023003
DISCOUNT (t)
INTEREST (-)
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4.79-
AMOUNT PAID
1,873.41
1'25.10
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TOTAL TAlC CREDIT
BALANCE OF TAX DUE
INTI!REST
TOTAL DUI
1,993.72
.30CR
.00
.30CR
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N IF PAID AFTER THIS DATE, SEE RE~ERSE
SIDE FOR CALCULATION DP ADDITIONAL INTEREST,
I IF TOTAL DUE IS LESS THAN II.
ND PAYHENT IS REQUIRED.
IF TOTAL DUE IS REPLECTED AS A "CREDIT" (CRI,
YOU HAY BE DUE A REFUND, SEe RE~ERSE SIDE OP THIS FORH FOR INSTRUCTIONS. I
PAVItENT,
Oltacn thl top portion of thll Hotlcl end IUblit with your pIV.."t ,td, plvlbll to thl n... ~ Iddr.,.
prlntlG on thl rev.r.. lid..
If RESIDENT DECEDENT ook. chock or 'on" ardor .o"blo too REGISTeR OF WILLS, AGENT.
If NDH-REIIDENT DECEOENT ooko ch.ck or o.n.. ardor ",obl. too CO""ONWEAL TN OF PENNSYLVANIA.
All Ply..nt. recelvld ,h'll bt Ipplltd flr~t to ,nv tnt.r..t which .IY b, dut with .ny r...lnder appllld to the t'M.
REFUND eCA)1 A r.fund of . tOK or,dlt, which wet not r.quI.tld on the TIM R.turn, "Y be rlque,tld by co.pl.tln~ In
"Appllo.tlc" for R,fund of PI"n'Vlvlnl. Inhtrlhnct Ind Eltlto Tell" (REV.UlS), Appllcltlonl Ir. Iv.llable .t
thl OfficIo' thl Rtll,',r of Willi, any of the l! Rlv.nut District O"lc.. or frol the O,p,rt..nt', Z.-hour
an'Wlrlng ..rvlel nUlblr. for for.. orderlngl In P,nn,ylvania l-aOO-36?-20Sn, outtlde Plnn,vlvlnl,
Ind within 10ell Herrlsburg eree (7l7) 7a7..094~ TODI (71/1 772.2252 (H.arlng Ilpalr.d only).
REPlV TOI QUIstlons r.glrdlng .rrar. contalnld en thl' not Ie. .hould b. addre,sed tOI PA Oepart..nt 0' AIV'nu., Bureeu
0' Individual taMil, ATTNI POlt A.......nt Rlvl.., Unit, D.pt. 280601, Hlrrllburg, PA 17l~a.0601, phone
(7l7l 717-6505,
DISCOUNT I
If any tlM dUI I. plld ~Ithln thr.e (5) cal.ndlr IOnthl If tar the d.c.dlntl. dlath, I flvl parclnt (5~) dl.oount
of thl tlM PI:d I. Illow.d.
INTEAt:IT'
lntlrl.t I, chergld b.glnnlng with flrtt dlY of d.llnquency, or nln. (9) ~th. Ind onl (I) day frol thl dl'l of
dlath, to thl dati of paV'lnt. YIMI. which ble... dll\nquent blforl J.nuAry 1, 1982 blar Inter.st .t the rat. 0'
.Ix (6~) perctnt plr annul calculat.d at a dally rat. of ,000144. All tUII which btc... dellnqutnt on and aUn
January 1, 19a2 will b.ar Int.r..t at " ratl ~Ieh ~ll1 v.ry frol eal,ndar y.lr to c.l,nd.r YI.r with thlt rete
announced by thl PA DIP.rt.lnt of Rev.nue. The appllcabl. Int.r..t r.t.. for 1982 through 1995 artl
Vttr Intullt R.t. Daily Inter..t Factor Vlllr Intlrllt Rate DIllv Int,rll.t Faotor
1911 20X ,000548 1987 9X ,000147
1m 16X ,000458 1981-1991 1IX ,000501
1911 lIX ,000501 1992 9X ,000117
1915 ISX ,000556 1995-1994 IX ,000192
1916 lOX ,000274 1995 9X ,000117
..lnt.rllt II cllcullt'd II followlI
IHTEREST ~ BALAHCE OF TAX UNPAID X NUNBEl or DAVS DELINQUENT X DAILV INTEREST FACTO.
..Any Hotlc. Ilsu.d Iftlr the t'M bucc... d.llnqu.nt will r.fllet In Int.re.t eslculltlon to flftlln (15) dlY.
bevond thl d." 0' thl ........nt. If plyJlltnt It .ad. Iftlr thl Int.rut oOlPut.Uon date shown on thl
NoHoI, ~dltlcnll Int.rut IU.t bl celculatld.