HomeMy WebLinkAbout94-00837
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C10MMWIWIiAI.1I!tJI' 1'lJjNIIVI VMIIA
,f.\Ii"AlIIMlilll 01' IlIIVr.IIlJl'
IIUIIUU Of INOIVIUII^I, TANIR
III PI.'I\IJnClI
IIAI II II 1I11111 II I "A 111:111111101
PENNSYLVANIA
INHERITANce AND ESTATE TAX
OFFICIAL RECEIPT
'*
NO. AA 211 319 REv,"6' EX 1""6'
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nftCBIVBO rnOMI
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ACN
ASSESSMENT
CONlROL
NUMB~R
AMOUNT
PETEH .l IlEl~BLr"~
CIO M~lTE [VANG WOUDBIDE
3401 N FnONT DTAEET
HArm I f.lllUl~(l, I'll j'IIIO
101
.., .1i'91.~4
I 01/1 II\lU
FOt.DHEAE
t!1-I'i9/I"OIJ:n a IN029-,Ol,..OOE9.u__,._.._.
HAMI'1l1 IIITIiI)1.1I1 II AliI! , 'II'IIIAT! IMI)
FA1HDAlIlN
IIAII 01 "AVMrNI
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I'O!IIMAIIK I'~I!
MILUfU::
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,CUMJ:lE::f\LAND ". ",...__........._______
I"A'I (J1,;~~'~I!lIo.._-___.__
IIIMAIIKH DAV I)) W BHANNON RECEIVED BY
C/CI PE:THi J flIiU81.ER MARY C. l.EWIS
!JI'A,j.;HECKlI mlf.? .I,': _ U~.Ul..ll> Ll' .c........__~B I DTf::R OF W Il.LS
*11119 RF,Cl11PT WAA VOrnl'D lXIE 'm CXJo1MEI'(IfN-ili I'K,I('\fI"t;l'llvl!ll..u'iN~;I'JOO SEE Lm'ER or EXPtANATlOO
TOTAL A OUNT PAID
-'
.,...u....-/
'1,891.34
O/OQ/OO
CIlllfllV '
8K
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INHERITANCE TAX RETURN b~~8t~~~~~FDf~~M\;:ER 12/31/91
RESIDENT DECEDENT POVERTY CREDIT IS CLAIMEDO
COMMONWEAL1HOF PENNSVLVANIA (TO BE FILED IN DUPLICATE FILE NUMBER
OEPARTMEN' OF REVENUE 21 1994
HARR,"~~~k':~~~:".,,01 WITH REGISTER OF WILLS) COUNTY CODE YEAR
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS
Fairbairn, Mildred D. Leader Nursing Hare
SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH 940 Walnut Bottan Road, Carlisle, PA
DECEDENT 029-01-0029 07/07/94 03/26/1904 Coun C\.!n1.\:xlrland
II APPLlCAaLEI SURVIVING SPOUSE'S NAME ILAST, SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
~IRST ANO MIODtE INITIAL I
o 4a. Futuro Inloro~l CompromlsD
(la, dalos 01 doolh allaI12-12-82)
o 6 Docodonl Dlod Toslola 0 7, Dotodonl Molnl,lnod 0 Living TIll'1
(Moch copy 01 Will) (Allach copy 01 Tlusl)
ALL COAAl!SPON~HCe AND COHFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Peter J. Ressler 3401 North Front Street
TELEPHONE NUMBER P.O. Box 5950
717-232-5000 Harrisbur , PA 17110-0950
1, Roal E,lolO (Schodula A) ( 1 ) None
2, Stock. ond Bond. (Schodulo BI ( 2) 97,063,64
3, Clo.oly Hold S1ock/Po,tnorship Inlora.1 (Sch, C) ( 3 ) None
4, Mortgogo. ond Nolo. Roeolvablo (Schodulo D) ( 4 ) None
5, Co.h, Bonk D'po.lt. & MI.collonoou, Porsonol (5) 66,655, DO
Proparty (Schodulo E)
6, Jointly Ownod P'oporty (Schodulo F)
7, Tron.'OI' (Schodulo G) (Schodulo LI
8, Tolol G,oss AssOI' (Iolal L1no.1-7)
9, Funa,ol E'pon,o., Admlnl.I,otlvo Co,I.,
MI.collonoou, E'pon,o. (Schadulu H)
10, Dobt., Mo~g'go L1abllitla., Lion. (Schodulo I)
11, Total Doduclion, (101'1 L1no. 9 & 10)
12, Not Voluo 01 E.lolo (L1no 8 minus L1na 11)
13, Charltoblo ond Govornment,1 Boquasl. (Schodulo J)
14, Not Voluo Sub ocllo Tox (L!no 12 ",nu. L1no 13)
15. Spollul Transltr.\lof d.1,tu 01 dulh .Ihr 6-JO~941, Sill
InSltuClion,lof Appllc.sbla f'1I1l:ent"'QeonPaga 2.llncludl
valulJlromSchlduleKo,Schedul,M,)
18. Amounl 01 Uno 14laxablo a18% rato
(Includa voluashom Sclrodulo K a' Schodulo M,)
17, Armunt 01 L1no 14 taxablo 0115% 'ola
(Includo voluas from Schodulo K a' Schodulo M,)
['rlnclpol tax duo (Add lox ham Llno, 15, 16 ond 17,)
Crodits Spousal Pave/ly C"dll Prior Payments Discount
O,OO+_~!,OOO.OO+ 1,105,26-
20, If Line 191, gloolor Ilron L1no 18, onlo' liTO dlfforonco on L1no 20, Th!' I. tho OVERPAYMENT,
~ Cl1lGk h.... " YOIlI(' roqueatlng a rolund 01 your overpayment ,
21, If L1no 18 " g,oolo, 1I10n L1no 10, onlo' tho dllloronco on L1no 21, Th!, l'lho TAX DUE,
A, Enlollho Inlarosl on Iho bolanco duo on L1no 21A,
B, Enlor Iho lolal 01 L1no 21 ond 21A on L1no 21B, ThlS!s Iho BALANCE DUE,
Moke Check Payable 10: Rogl.ler 01 Wlffs, Agent
... ... BE SURE TO ANSweR ALL QueSTlONS ON PAGE 2 AN) TO RECHECK MATH" ..
!liiclOriionolllo, of porjllry, I doCliiio thOIII'ovo o,o",nod Ihl. rOlurn, Including occomponylng schodulo, and olalomonl', and to Ilro bo.1 01 my knowlodgo
ond bellol, It 1.lrllo, corroel and complolo, I doclo'o Ilral oil ro,1 0.1'10 ho. boon ropo~od olliuo markol voluo, Doclo,allon 01 proporor othor Ihonlho poraonol
reprosentallvo is basad on all information 01 which plOparor hos any kno'l.lodgo.
SIoNATGnE OF PER.10N RE~PONSIALE FOR FILING RETURN ADOflE~5 DATE
..j ;" ,\ ',(' I See Schedule attached \,\.tl~L,).(\ 1(1 (0
SIONi1URE OF PFl~P..A~E_ OT~~EA THAN AErn65ENTATlVE ADDIlESS, DAT~. \ I
I ,) i,; (' ~' ~(, t \ ~ 3401' North Front Streot., - It'> " 'I 7
1 F'" ,.. lIarrlflburg, PA 1"11]0-0950 I
NIJ4PAOOl
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PEY-ISOUEXtlHI41
lB 1. Ollglnol Rolurn
CHECK
APPRO-
PRIATE
BLOCKS
o 4, Llmilod E,lo'o
CORRES-
PONDENT
RECAPIT-
ULATION
TAX 18,
COMPlITA- 19,
TION
c.-
0837
NUMBER
Supplomenlol ROlu,n
3, Romolndor Rolurn
[IDrd~luoldulllprIDrIO 12-11-821
o 5, Fodolal E.tola Tox Rolllrn Roqulrod
8, Total Numbor 01 Solo Doposlt Boxo.
(8 ) None
(7 ) None
(8 )
(9 ) 4,404.44
(10) 3,336.86
(11)
(12)
(13)
(14)
163,718.64
7,741.30
155,977.34
None
155,977.34
(15)
K ,
(18)
o . DO K ,08 ,
0,00
(17)
155,977 .34 x
.15 :I
23,396.60
(18)
23,396,60
Inloro.t
(19)
(20)
22,105,26
(21)
(21A)
(21B)
1 , 291. 34
0,00
1,291,34
Eata~ Ofl Mildr!;1d D, Fairbairn
Sl.Jl101MY OF ALLOCA'l'IONS TO BEmF'ICIARIES
Class B
David and Vickie shannon
Constance Knudsen,
Patricia ,Shannon
Blorviie r-tlrse
Joshua Shannon
Jenn.1.fer Shannon
Jarc;xi Shannon
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31,195.47
15,597.73
7,798.87
31,195.46
31,195,47
31,195.47
155,977.34
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21-1994-0837
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Estate of:
Mildred D. Fairbairn
21-1994-0837
The follC1.'f.lng person(s) are s.1.gning the return as repj:esentfltlve(s) ,of th~ estate:'
David Shannon
4451 Saybrook Lane
Harrisburg, PA 17110
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COMMONWEAlTtl OF PErmsVLVANIA
INHfRITANcf TAK flETURN
AES1lJlNT D[CEU~NT
SCHEDULE B I
STOCKS AND ~ONDS~_
FILE NUMBER
AEVMI50:1 Ell t (4-88)
ESTATE OF
Mildred D, Fairbairn
(All property 10lnUv-owned with Right of Survlvorlhlp must be dlsclolld on Schedule F,)
ITEM
NO,
OF-SCRIPTION
1 180 shares of' 1\'1'&1' call1on stock
2 156 shares oE /l!reritech camon stock
3 104 shares of: Bell Atlantic Call1'On stock
4 1900 shares oE CIPRA, S.A, de C,V.
5 133 shares oE Call1'On\<K!alth Edison preferred stock
6 768 shares of Common\<K!alth Pederal Savings common stock
7 500 shares oE Conti.nental t<Edical Systems, Inc. canmon stock
8 2 shares of (111 common stock
9 8 shares of (111- EDS ccmron stock
10 300 shares of G1~ ccmron stock
11 104 shares of NynCX Call1'On stock
12 250 shares of Pennsylvania Power & Light common stock
13 700 shares of prirre Bancorp, Inc, common stock
14 465 shares of Reliable Finandal common stock
15 104 shares oE US West
16 11 shares of Viacom (Class A common voting)
17 11 shares of Viacom (Class B common non-voting)
TOTAL (Also onlor on IIno 2, Rooapllulallonl
(II mora spaco I. noodnd, In.ort addlllonal 8110018 01 sarno 8lzo,)
$
97/063.64
PAt&031 Nlf ""
, CopyrIght Form. 5011w.1I Only, llJ~" Nllco,lnc Ng"f'AOJl
REV-1!lI EK""'3J
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAK RETURN
RESIDENT OECEDENT
ESTATl! OF
Mildred D. Fairbairn
ITEM
NO.
1 Church of God Hare. Inc.
2 Carlisle Imaging
3 Holy Spirit Hospital
4 We~t Shore Anesthesia
SbHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LlABILlTIE!S AND LIENS
DESCRIPTION
PI.... P~nl or
FILE NUMBER
21-1994-0837
5 carlisle CCl11T\UI1ity Ambulance
6 Leader Nursing Hare
7 M:!tte, Evans & Woodside c services rendered prior to decedent's
date of death
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PAllIa' NTF 11I0
COPYlight Form. SollwlI' On Iv. Ilg~ N.lco, Inc, NI4PA12 I
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TOTAL Also enter on line 10, Rooa Ilulatlon
(II more .pace Is needed, Insort additional shools olsl101O size,)
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$
AMOUNT
507.00
20.00
45.39
61. 27
49.99
2, 077 . 06
576.15
"
3,336,86
"
(iv) Trustee may use principal from each child's
share under subparagraph (b)(1), (2), and (3) for
purposes of meeting necessaries needed for that
child, but only after all other sources available
for said purposes have been exhausted i provided,
however, that Trustee may use principal for the
secondary and higher education (including
graduate school) f rom each child I s share under
subparagraph (b)(l), (2), and (3) without the
necessity of exhausting other funds available for
said purpose.
4. Twenty percent (201,) of the residue shall be
distributed to CONSTANCE M. KNUDSEN, if living,
otherwise, said amount shall be divided among the
remaining shares created under this subparagraph
(b) in proportion to the remaining percentages
being distributed hereunder.
5, Ten percent (10%) of the residue shall be
distributed to PATRICIA SHANNON, if living,
otherwise, said amount shall be divided among the
remaining shares created under this subparagraph
(b) in proportion to the remaining percentages
being distributed hereunder.
6, Five percent (5%) of the residue shall be
distributed to BLONDIE MORSE, if living,
otherwise, said amount shall be divided among the
remaining shares created under this subparagraph
(b) in proportion to the remaining percentages
being distributed hereunder.
- 4 -
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7. Five percent (5'7.) of the residue shall be
distributed to DAVID SHANNON and VICKI SHANNON,
or the survivor of them, if living, otherwise,
said amount shall be divided among the remaining
shares created under this subparagraph (b) in
proportion to the remaining percentages being
distributed hereunder,
2, No interest of any beneficiary hereunder shall be
subject to anticipation or voluntary or involuntary alienation,
and the personal receipt of such beneficiary shall be the
sufficient and only discharge of Trustee, unless otherwise
provided herein,
3. Trustee may use any principal held hereunder for the
benefit of Grantor as Trustee deems necessary:
(a) To meet the expenses of any accident, illness or
disability befalling any of them;
(b) For maintenance, support I travel and other
reasonable recreation; and
(c) To pay funeral expenses including the cost of a
grave marker and perpetual care of the grave,
4. In the event that it ill determined that Grantor is
required to go into a nursing home with the likelihood of this
being her final residence for the remainder of her life,
Trustee shall have the special power of appointment to appoint
any of the principal of the Trust to the beneficiaries set
forth in Paragraph l(b) so long as the amount so appointed is
- 5 -
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,
,
in proportion to thel percentages set forth in said paragraph
1 (b),
5, 'l'rustee shall retain any income or principal payable
to a minor and use the same for the minor I s maintenance and
education, either directly or by payment to any person selected
to disburse it whose receipt shall be a complete acquittance
therefor. All unexpended income and principal shall be paid to
the minor at majority.
6. In addition to powers given them by law, Trustee and
Trustee's successors shall have the following discretionary
powers applicable to all real and personal property held by
them including property held for minors, effective without
court order and until actual distribution:
(a) To retain any property received by Trustee
inCluding the stocl<. of any Corporate Trustee, provided such
property remains productive;
(b) To invest in all forms of property
restriction to investments authorized for Trustee, so
such investments are prOductive;
wi thout
long as
(c) It shall not be necessary to segregate
investments as belonging to a partiCUlar share hereunder and
all interests may be held in undivided form in a single fund
from which proportionate distributions are made based on
current reappraisals;
(d) To
recapitalization,
join in any incorporation. partnership,
merger, reorganization or voting trust plan;
- 6 -
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incapable of receiving the same by reason of age, illness or
any infirmity or incapacity, or to pay the same to such person
as Trustee selects to disburse it, whose receipt shall be a
complete acquittance therefor, without the intervention of any
guardian:
(m) To assume continuance of the status of any
beneficiary with reference to marriage, divorce, illness,
incapacity or other change in the absence of information deemed
reliable without liability for disbursements made on such
assumption; and
(n) To undertake any and all acts in its judgment
deemed necessary or desirable for the proper and advantageous
management of the Trust.
7, Trustee may merge trust accounts established in this
Trust instrument with trust accounts established by Grantor 's
spouse I s Will and/or Trust instruments, ~7hen the terms of the
same are identical.
8. Any beneficiary
or under circumstances
impossible to determine
have predeceased Grantor,
who dies
wherein
who died
at the same time as Grantor
it shall be difficult or
first shall be presumed to
9, Grantor may add to the principal of this trust by
deed, will or otherwise. With the approval of Trustee, other
persons may make similar additions.
10, The situs of this Trust for all purposes shall be the
Commonwealth of Pennsylvania and its construction and validity
shall be governed by Pennsylvania law.
- 8 -
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09-09-97
FAIRBAIRN
07-07-94
21 94-0837
CUMBERLAND
101
._ AMount Ro.'!Hh!!._ j
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ....
REV: iS4?" EX "AF ii" i o:i: 97"j" iloT"i c r"o F" i"NHEifi TAifci" T"A' x" 'A"PPRii'i S EM Eili'~ - -A i:. row AN"C i" liFi"" -..""" - - -""""""
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
MILDRED 0 FILE NO. 21 94-0837 ACN 101
ILJ-lsf-)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAHES
IHlt[RIUHCE fA)( DIVISION
OEPf. 18060'
HARRIS.URO, PA 171~a'06DI
NOTICE OF INHERITANCE TAH
APPRAISEHENT, ALLOWANCE OR OISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAH
PETER J RESSLER
3401 N FRONT ST
PO BOX 5950
HBG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
PA 17110
ESTATE OF FAIRBAIRN
TAH RETURN WAS I (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST " SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. Rool Esl.to (Schodulo Al (11
2, stock. ond Bonds (Schooulo Bl (21
~, Closoly Hold Stock/Portn.rshlp Intoro.t (Schodulo Cl 151
4, Hortaogo./Notos Rocolyablo (Schodulo 01 (41
S. Cosh/Bonk Dopo.lts/Hlso. Porsonol Proporty (Schodulo EI (51
6. JointlY Ownod Proporty (Schodulo FI (61
7. Tronslors (Sohodulo 0) (7)
a, Tohl A..ols
APPROVED DEDUCTIONS AND EXEMPTIONSl
9. Funorol Ewpon.n/AdM. Co.Is/Hilc. Ewpon... (Soh.dulo HI (91
10, Dobls/Hortaoao LlobIlIU../Llons ISchodulo Il (10)
U. Tohl DoduoUon.
12, Not Voluo of TIM Roturn
15. Chorltoblo/OoyornMontol Boquosl. (Suhodulo JI
14, Nol Voluo of Estoh Subjoot to Tow
NOTEI
( I CHANGED
,00
97, 063.64
,00
.00
66,655,00
.00
.00
lal
4,404.44
3,336,86
(111
1121
1151
U41
.,
\..../
*
1I1-lhl II lit lit-III
MILDRED
D
DATE
09-09-97
NOTEI To in lure proplr
credit to your .oo~unt,
lubftlt the up~'r portion
of this forn with your
hx p.Ylllnt,
163,718,64
7.741 30
155,977,34
.00
155,977.~
If In allellmont was ilsued previoUlly, lines 14, 15 and/or 16, 17 and 18 will
reflsct figura, that include the total of Ahh returnl allelled to date.
ASSESSMENT OF TAXI
l~. AMount of L1no 14 ot SpoulIl rolo (151_,00 H' 03,
16. AMount of L1no 14 towoblo ot Llnool/Clo.. A roh (161 .00 H .06.
17. AMount of L1no 14 to..blo ot CoUohrol/Clo.. B roto (171 155,977~ H .15.
le, Prlnolpol Tow Duo (leI
TAX CREDITSl
PAYHENT
DATE
09-30-94
05-21-97
RECEIPT
NUHDER
MM913015
AA211321
DISCOUNT ('1
INTEREST/PEN PAID (-)
1,105.26
.00
BALANCE OF UNPAID INTEREST/PENALTY AS OF 05-22-97
AHOUNT PAID
21,000,00
1,291.34
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
,00
.00
23,396.60
23,396.60
23,396,60
,00
247.19
247.19
IF TOTAL DUE IS LESS THAN .1, NO PAYHENT IS RE~UIRED.
IF TOTAL DUE IS REFI.ECTED AS A "CREDIT" (CRl, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
RESERVll10N, E.t.I" of d.c.d.nt. d.lng on or b.lar. D.c..b.r 12. 1912 -- II .n. fulur. Inl.r..t In Ih. ..t.t. I. tr.n,'.rr.d
In .cllO"lcn or ."j....nt tc CI." I (coll.t.roll b.n.f1cl"l.. of tho dIC.d.nt .ft" Ih. ".Irotton 01 .n. ootot. 'or
Ilf. cr far ...r.. tho Ca.,on,..lth h.r.b. ...r...I' r...r..' Ih. rlghl 10 ...r.I" .nd ...... tr.n,'.r Inh.rll.nc. I.."
It thl lawful tll.. , (ca111"rall r.t. on any such future 1"tar..\.
') ,
, i
"
,.
lr,
C'...
, I
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, ( i
PIllI.OIE DF
NOTICE'
la fulfill tho roqulro..ntl .f Socllan 2140 of Ih. Inh"lton.. .nd E.I.t. 1" Ict. 1.1 21 01 1995, (12 .,1,
Slot Ion 9140),
D.t.ch tho tc. .crtlan of thl. Natla. .nd .ub.lt ,Ith ..ur .....nl 10 tho R.gI.I.r of NIII. .rlnt.d an tho r...r.. .Id.,
.""aka chick Dr 10nlY ordtr payable' tOI REGISTER OF tlILLS, ADENT
I r.fund of . I.' cr.dll. ,hl<h ... n.t r.qu..I.d .n Ih. T.' R.lurn, ... b. r.qu..t.d b. c...I.tlng dn "1..llc.llon
far R.lund of ..nn..I..nl. Inh.rll.n.. .nd E.t.l. T.," IRE.-1III). 1..II,.tl.n. .r. ...II.bl. .t Ih. Of lie.
of the AI,I,,'r of ~111., ,MY of the 25 Revlnul Dlltrlot OffiCI., or by cll11ng thl ,p.ela' Zit "hour
Inlw.rlng ..rvlel nu.b.r. for forM' ordlrlngl In PlonlYlvanta l-aOO-36Z"ZOSO, out.lde Plnn,vivanl. and
within loci' Harrisburg .r.. (7111 7al~a094, YOOI 11171 ?7Z.Z2S2 (H..rlng 1.p~lr.d Only),
In. ..rl. In Inl.r..1 not ..II.II.d .llh Ih. .p.r.I....nl, .lla..nc. cr dl.alla..nc. 01 d.ducll.n., or ........nt
.f I.. (In.ludlng dl.c.unt ., Inl.r..I) .. .h..n on Ihl. Hatlc. .u.1 abj..1 .Ithln .1.1. (601 d... of r.c.I.1 of
thh Notlcl bYl
...wrltttn prot..t to thl PA Dlpart.,nt of R.VlnUI, Board of App.al', n.pt. 281021, Harrl.burg, PA
....l.otlon to have the ..ttlr dtt.ralnld .t audlt of thl account of thl per,onal rlpr"l"t.tlv.,
'.app..l to thl tJrphan,' Court.
I7I2I-ID2I.
OR
OR
.IINENT.
REFUND (CRlI
DSJt:CTlQNS.
IlIItlN
IS1RI1IVE
COllRECTlDNS.
Faotual .rror. dlscovlrld on thlt IlIses...nt 'hould bt Iddrused In '4rltlng tOI PA Dtpartlltnt of R.v.nu.,
BureaU of IndlYldual Tltu., AllHI po.t h......nt R.vl.'4 Unit, D.pt. 280tiUl, tlarrl.burg, PA 11128-0601
PhOn' (717) 787.6505. s.. pagl S of the bookl.t "In.truotlon. for Inh.rltanc. Tft~ R.turn for a RI.ld.nt
Dlcld.nt" (REV.IS01) for an IMPlanatlon of adtlnl.tratlvllv corrlctabl. .rror..
If on. t.. duo I. ..Id .Ithln Ihr" III c.l.nrl.r ..nth' .11.r tho ..c.d.nl" d..th. · II.. ..rc.nt 15X) dl.c.u.1 of
the tlM Plld I. Illo'4ld.
Th. IIY. I.. ......1. nan-..rtlcl..tl.n ....11. I. c...ut.d an Ih. l.t.1 .1 tho t.. and Inl.r..1 .......d, end nal
..Id b.for. J.nu'" II, 1996, tho first rl.. .ft" Ih. .nd 01 Ih. tOM ..n..t. ...Iad, Thl. n.n-."Ilal..tton
..n.II' I. .....I.b1. In Ih' .... ..nn.' .nd In Ih. tho .... II.. ..rlod .. .cu ..uld .....1 Iho I.. .nd Int.r..1
that h.. b..n .......d a. indiclt.d on thl. notlc"
Inl.r..1 I. ch.r..d b.glnnlng .llh flr.1 d.. .1 d.llnq..na., or nln. (9) .onlh. .nd an. (ll d.. fr" Ih. d.t. 01
do.lh, 10 tho d.lo 01 ......t. T.... .hlch b..... d'lln....' b.for. J.nu'" I, 1912 b.., I.t.r..t .t Ih. r.l. of
.1. (6X) ..rc.nt ..r .nnu' c.lcul.l.d .1 . d.ll. ,.t. of ,ODDI64, III I.... .hlch b.c... d.llnqu.nt .. .nd .ft.r
Januarv I, 1982 wIll b..r Intlr..t at . rat. '4hlch '4111 varv fro. cal.ndar Vlar to c.l.ndar ~.ar '4lth that rDt,
Innouncld by thl PA Dlpart..nt of ReVlnul. The appllcablt lnt.r..t rat., for 1982 through 1~97 .rll
U!! lnt,,"t Rtta Dalh Int"..t Factor ~ ~ntlrllt Rat. DailY Int.".t Faotor
1912 20X ,000541 \917 9Y. .000247
19n 16X .D00411 1911-1991 llY. ,000101
1914 llX .000101 1992 9X .00D247
1915 llX ,000lS6 1991-1994 IX ,ODOI92
1916 lOX .000274 1991-1997 'X .C00247
.-lnt.'lIt I. c.louletld II '0110\11.1
IHTEREST . BALAHCE OF T~X UHPAIO X HUHBER OF DAYS DELIHQUEHT X DAILY IHTEREST FACTOR
.-AnY Hotlc. I..uld .ftlr the tl. blco'" u.llnqulnt '4111 r.fllct .n lntlr..t c.lculltlon to flftl,n (\S) dlVI
blvond the dltl of the ........nt. If ply..nt I. .ad. .ftlr thl Int.r..t co.putatlon dati .hown on the
HOtlCI, tddltlonll lnter..t lu.t bl c:elculltld.
DISCOUNT.
.ENIL TV'
IN1EREST.
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A f'HOf't8810NAL CORPORATION
ATlOHNi:Y& AT LAW
~401 NORTH rRONT BTRttT
rJO, 80)( aQUD
HARRI6PURO, PA 11110.0geO
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COMMONWEALTH OF PENNSYLVANIA
PEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
(/
V
*
BUREAU OF INDIVIDUAL TAMES
INHERITANCE TAK DIYISIOH
DEPT. ZI0601
HARRISIUIO, PA 17IZI'06VI
U'f-I..,nU'IIHU
DATE 03-26-2001
ESTATE OF FAIRBAIRN MILDRED D
DATE OF PEATH 07-07-1994
FILE NUMBER 21 94-0837
'I" ,COUNTY CUMBERLAND
PETER J RESSLER ACN 101
3401 N FRONT ST ~-- Allount R..Ht.d l
~O BDX 5950 I, - -
HBG PA 17110
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE I To inaur. proper or.dit to your lIOoount, Iubllit thl upplr portion of thil for. with your tl' p.y..nt.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiE'y:Uiiif-iic-AFii-ii1r:ooi"''''-liiii'--iNifiRi'TAHCI"fAif"9i'iifEiiifli;:-ii;;-iiifcoiJiif--i.-ili----------------.....
ESTATE OF FAIRBAIRN MILDRED D FILE NO.21 94-0837 ACN 101 DATE 03-26-2001
THIS STATEH~HT IS PROVIDED TO ADVISE OF '1HE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAM DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 09-08-2000
PRI~CIPAL TAX DUE, 23,396,60
PAVMENTS (TAX CREDITS),
PAYMENf
DATE
09 - 30-1994
05-21-1997
03- 02-2001
RECEIPT
NUMBER
MM913015
AA211321
AA478106
01 SCOUNT (+)
INTEREST/PEN PAID (-)
1,105.26
,00
247,19-
AMDUNT PAUl
21,000,00
1,291,34
247.19
. IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST,
( IF TOTAL DUE IS LESS THAN 61,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
YOU HAY BE DUE A REFUND. SEe REVERse SIDe OF THIS FORH FOR INSTRUCTIONS. J
TOTAL TAX CREPIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
2~,396.60
.00
.00
,00
'.
PAyltENT,
Dttlo~ the top portion of thh tr4oUOI and .ubllt with ~our plv..nt ..d, PDYlbll to the ntH and addr...
printed on the r.ver.. .Ide.
If RESIDENT DECEDENr .... .h..k .r .on.. .rdor pI.obl. t., REGISTER OF WILLS, AGENT,
If NOH-RESIDENT DECEDENT ..kl .h..k or ..no. .rd.r r....,I. t., COHHONWEALTtI OF PENNSYLVANIA,
REFUND (CR)! A r.fund of . talC orfldit, which Hal not request.d on the Tax Rtturn, uy ba r.qu..ted b~ co.phUng III
"ApplIcation fur R,fund of Ptno,Ylvanla Inheritance and Eltat. '1)(" (REV-1315J, Application. art Iv.lllbl. .t
the Offlol of the Reghtor of NUh, IIny of th_ 23 RIVlnU4t DlItrlct Offic.. Dr fr~. thl Dlp.rt..ntll 24-OOur
enllMdnll ..rvlol for for.. ord.rlngl 1-600-362-20501 ..rvle.. for ta)(Plyers with ,plc,tal huring end I or
,peaking n..dl1 1"800-447-3020 CTT only),
REPLY 101
"u..tlon. rlgardlng .rror. contained on this notioD thould be addraued tOI PA O.pllrtllent of A.v.nue, Burocu
of Indlvldulll TalCu, ATTHI POlt A......ent R.view Unit, Oept. 280601, Hf'lrrhburv, PA 17128-0601, phonl
17l11787-6S0S,
DISCOUNT I
If Iny talC due I~ paid within thr.e (3) cal.ndllr .onths aftor the deCldlnt'. d.ath, a fJv. plrc.nt (!iXI dl.eount
of the talC paid I. allow.d.
PENAL TY,
The ISX taM ..n..ty non-participation plnalty i, co.putld on the totel of the talC end Int.re.t .......d, end not
paid blfare January 18, 1996, the tlr.t day after the end of the talC a.n..tv period,
INTEREST,
Inter..t J. charged b.glnnJng with flr.t day of dllJnqu.nay, or nln. (9) 1I0nthl end on. (I) d~y fro. the dati of
d..th, to thl date of pay..nt. TalCe. whleh b.clIl. dlllnquent blfor. January 1, 1982 bear lnt.rllt at th. rete of
'llC (6X) p.rc.nt p.r annuli calculated at a dailY rate of .000164, All talCe. whlcM ble..e d.llnqulnt on aod eftlr
JNluary I, lCi82 will bur Inhre.t et a rata which wlll vary fro. eelender Ylar to eelender ye"r with thet rete
announcod by the PA Depart.lnt of Revlnue, Thl applicable Interllt rat.. for 198Z through ZOOl .rll
Vllr Inh,re.t Rat. Dally Interut Faotor Ve"r Inter..t Rat. Dally Inter..t Factor
1981 20X' ,000548 1992 9X ,000147
1983 16~ .000438 1993-1994 ]X ,000191
1984 11% ,000301 1995'1998 9~ ,000247
1985 13~ ,0003S6 1999 7% ,000191
1986 10~ ,000274 ZOOO 8~ ,000219
1987 9~ ,000247 2001 9~ ,000247
1988 '1991 1I~ ,000301
-.Int.rut II (alouletlrt III foUow.,
INTEREST' BALANCE OF TAX UNPAIO X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Hotlol IUUld afhr thl tllC beoolq. delinquent wUI r.fllot an Jnter..t cllloulatlon to flft..n USl d.y,
beyond the data of the a..e....nt. If pay..ot I. lade .ft.r thl Int.r.,t eOIPutntlon dllte .hown on the
Notlo., eddltlonlll Intaru.t .u.t b. Cielouhttd.