HomeMy WebLinkAbout94-00926
PETITIONFOH I)H08ATE Ilnd GHANT 01' LETTERS
l';\'((I/(' oj ..li:cnunA" V..5.lf/Gi-e No. _u_.<i?'-~_<iIj_~..9~~___
111.\'0 kl/Oll'IIIIS _... _ , To:
u Reglsler of Wills for L1le
~~~:~:~:_-..:.. ,..", 'U'" "" _, f)('l'fqs.'d. COllnty of__glMBEfiblI1HL___ In the
Socilll S(,cl/I'lly Nil. J7 ~," (} ;.".Stjl3't"_:__, C'ommonwelllth of I'cnnsylYlInl1l
The pelltion (If Ihe nlldersiglled resll<'clflllly represenls thlll:
YOllr 11etilloller(s), who is/an' I K y,-ars of IIge or older IIl1lhe execut~/I\-_.._-_-I1I,~id
1IIIIw IlIsl will of Ilw IIhol'e dm-delll, dilled .Ft,_br.l!f?_I,'/-___I)_'l,-_____. , 19
, IIl1d codidl(s) dilled __ , u, _ _.___. .. _..___....._______________
bUlll' fdl'vanl dr.'HIIl,lUlll'l''', "'.I-!. rCl1ulldaliull, death of C'H'I,'ll\{H, ell'.)
Decelldellt was domiciled III delllh ill ._-----41c. _'!".berLtl.NJ.._'>.:'__ County, r nnsylYlIn II, wllh
IleA.._.... IlIst fllmily or princlpIII mid~nce 111,.;;0 "t .tolAf}JQ.......J.2R.,L./J'J' c-
, ---------Ul.pel?-i4-LJeAL TC'.wl>> ltf--m-------.---.--
(II.., ..1fl..'l'l, I1lIl11hl'f lInd IllUlldpalilY)
lit ~~cH~el~~I~pir;lCj;~p)'~?e'_I.IIC(~.0:~~~=:_j:'~r _--' 19 9'/ :
Except liS (ollows, dee,-delll did nOlmarry, \\'11\ 1101 divorced IIl1d 'dId lIot hllve II child born or lid opted
:~~~~II~~~~~:~: ~111 __o~IXlI )lt~'fered forp~o hale;.'l'as uot_!':" icl h:_ ~~'_~I~~II~lg llI~I~_W liS neyer lid] udlclIled
Deeelldelltlll delllh oWlled properlY wilh eSlimared I'alues liS follows:
(If domiciled ill I'll.) All persollal properly
(If 1101 domiciled illl'a.) i'l'rsoll,d properlY ill I'ellllsylyallin
(If nol domiciled in l'a.1 Personal properl)' in County
Vnllle of renl eslnle ill I'ennsyll'anin
siluuled us follows:
$tl.~ 000,00
$ ,
$
$
WI.IEREI'ORE, pelilioner(sl respeelfully I'equesl(s) lhe prohnle of Ihe 11111 will IInd eodlciI(s)
presenleu herewilh nnd Ihe grllnl of 1':tlers____...lESJ8MENJARY
(lc~IIIIllCnlUry; ;\(llI1illl~lralloll C.l,ll,; udmlnhlratloll d,b,n,c,l.a.)
theron.
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OATH 01<' I)I':RSONAL HEI)RESENTATIVE
COMMONWEALTII OJI l'ENI'IiSYLV ANIA I HH
COlJNTY O...n_n__ _CU~m.ERhI\.ND_...._n__. f ..
The 1"'lilioner(sl uhl1l'e-nnllled swenr(s) or nffirlll(s) Ihnl Ihe stnlemenls Inlhe foregoing pellllon lire
Irlle nnd corr"cl lolhe hesl of Ih,' knoll'ledge IIml helieI' of petitioner(s) nnd Ihnllls personal represen.
tnlil'e(s) of the nhol'e de"eueol p'-lilloner(s) will lI'ell nnd Irnly numlnlstcr Ihe eSlllte lIeeordlng to IIIW,
Sworn 10, ',II' IIf1'il'l1l<,'d ,nnd sUhserih,ed ~{!c., )LJLL.f'.,' '-, ,!)j:--tJl.I,-'~.1(~?J ~
hefol'l' m" Ihil._., .28TH. dnyof, _ T'~--~ ~
m~1-(!~~~,~Qtrjf1n, _' '~_n_:'~~._.":"_== ~
'''IM"Ai{J C. LEWIS III'~isll'r. 'n......______m____________ ~
II.{ - C)',{i..f - l.9
w_....
BE IT REMEMBERED THAT
I, EMMA V. SLAGLE, of the County of Cumberland and Commonwealth of
Pennsylvania, being of sound mind, memory and understanding, do make,
publish and declare this to bp. my LAST WILL and TESTAMENT, hereby revoking
and making null and void any and all Wills and Codicils, or writings in the
nature thsreof, at any tlme heretoforA made by me.
~: As my personal Representative, I nominate and appoint ~y
daughter, CONNIE G. QUESENllERRY, to be the ExecutrIx of this LAST WILL. In
the event CONNIE G. QUESENBERRY is unable or ceases to act for any reason
whatsoever, I nominate and appoint my daughter, MARY E. MOORE to aucceed as
Executrix of this LAST WILL.
SECOND: I direct that my debts and funeral expanses be paid as soon
after my death as is practicahle by my Personal Representative out of my
Astate.
THIRD: I direct that all estate, succesaion, legacy, inheritance or other
transfer taxes, however designated, that shall become payable by rea eon of my
death in respect of all property comprising my gross estate for death tax
purposea, whether or not such property passes under this LAST WILL, shall be
paid by my Peraunal Representative out of my Bstate.
FOURTH: I give and bequedth the sum of one ($1.00) dollar to my
daughter, PATRICIA A. JENKINS.
!!!::ill: All the rest, residue and remainder of my estate, both real
and personal, wherever situate, in which I may have any interest at the
time of my death, I give, devise and bequeath to those among my children,
WILLIAM L. SPANGLER, JOHN W. STOUFFER, MARY E. MOORE, JESSE J, SLAGl,E, JR.,
PEGGY LEE LAIDACKER, and CONNIE G. QUESENBERRY, who survive me in equal
shares. In the event none of these of my children survive me, then all to
those among my grandchildren who survive me, in equal shares.
SIXTHs If any part of my estate shall vest in a person who shall not
have attained the age of lnajority in the jurisdiction of that person's domicile,
my Personal Representative may, with absolute discretion deliver such part. or
any portion thereof, without bond, to the parent or legal guardian of such
person to be held for such person until he or she reaches his or her majority.
The receipt of such parent or guardian shall be a complete discharge and
acquittance of my Personal Representative and shall be final and bindil'g on all
persons in interest.
SEVENTHl If any legatee, beneficiary or devisee shall fail to survive
me by thirty (30) days, I direct that I shall. be deemed to have survived such
legatee, beneficiary or devisee and that this LAST WILL and all its provisions,
except where specifically stated otherwise, shall be construed on this
aosumption notwithstanding the provisions of any law establishing a contrary
presumption.
EIGHTHs I request my Personal Representative whenever legal counsel is
needed in the settlement of my ostate for the purposes expressed in my LAST
WILL, consult ALBERT Z. BOGERT, ESQUIRE, he having intimate knowledge of my
affairs, views and wishes in many matters that may arise in the settlement of
my estate.
IN WITNESS WHEREOF, I have subscribed my name and affixed my seal this
.19 day of A (/1" "~~J . 1984.
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FROM
JOHNSON, DUFFIE, STEWART & WEIDNER
Attorneys Ilt Law
P,O, Box 109
LEMOYNE, PA 17043
I
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TO
Register of Wills Office
Cumberland County Courthouse
.1 Courthouse Square
Carlisle, PA 17013~33a7
SUBJECT, Estate of Emna V. Slagle
FOLD .
21-94-0926
DATEr
7/13/95
Enclosed for filing in the above~captioned Estate are the fOllowingl,
1. OLiginal Inventory.
2. Original and copy of INheritance Tax Return.
3. Check in the ~nount of $729.99, Inheritance Tax payment.
4. Check in the amount of $25.00, filing charges.
PLEASE REPLY TO
.
SIGNED Edmund G. Myers
REPLY
DATE,
, SIGNED
horn' F270 OrIlVINC, P,O, Box 2944. HrlrUol'll, CT oe 104 .2044
r WhoeIor OtQt4l.Ire" 1982
THIS COpy f'OflI'Ln',ON AnnnCSSED
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D' )'''~;;.Q:O~78-' , ,COMMONW'ALT~O' PINNSYLVANIA , ,
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:!I~IIII'I~IH'" OPPlCIALRICII",. PlHNIYLVANIA/NHIRIJANCIANDIITAJI,rAX,
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ReCEIVED FROMl
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ASSESSMENT '='
CONTROL III
NUMBER
AMOUNT
&
EDMUND G MVERS ESQUJRE
301 MARKET STREET
POBOX 109
lEMOYt~ PA 17043
101
t789.99
-1010 HUI
( ESWE INFORMATION'_l
1ft FilE NUMBER
" 81-1994-0986 SON 1?8-01~~434
S NAME OF DECEbENT IIASTJ- IFlRST) (MI)
U: EMMA V
II DATE OF PAYMENT
g POSTMAR E
COUNTY 113r 9!:l
CUMBERLAND
DATE OF DEATH
-,
-
-
REMARKS
m TOTAL AMOUNT PAID
CONNJE G NEJD~RER
SEAL
CHEC/(ff ae9~
RECEIVED BY
REGISTER OF WILLS
MARY C. lEW S
REGJSTER OF WJllS
/L!-,:'IL/ V' C,
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWfAllN 01 PfNNbVIVANIA (TO BE FILED IN DUPLICATE
WARIMf'" Of R!VHW! 21 94
NARRllfJt6, ~~Qt'lb80601 WITH REGISTER OF WILLS) COUNIY(:O.o~ ,.,. "". __ YEAH
DEe D!NT' -NA",if(L.\s-:-;ifi~A~j.o'MlrIDlf- it/iIlA;l (IlCEDW1'S COMmu AODU~S
SL!\GLE, FH>IA V. 601 Wayne Drive
I !oc~~~~~~=~:~~~=~-u:: _ 10;1~~;~~~41 r:1'0"'''''_ ." CO""~::=__~~~~~~~______.~_
.-..:_ '"';I"C'iij:il"::~:U~'~~I,~,,'~\I,""'_"" """" '''''''''., !~C,,' !!C:~~_NUM"~ ,. _,._.__I::O:NI,R!C!'V!~I!!!~N~:C"::~_..
[]:1. Orlolnal R,'urn ['J 2, Suppl.m.nlal Rttuln r 1 3, R.molnd" R,'urn
(/or dnl., 01 d.ath pilar to 12.13.82)
[I 4, l'mlt.d Ellall I '1 40, fuluII Inl."ll Comproml.. LJ 5, f.d"al E.lnl. To, R.turn R.q",,,d
liar dalll 0/ d.ath nil" 12,12,B2}
lC.16, Decedent Di.d I.llat, ["I 7, Dec.denl Malnlalned n 1I,'ng Trult
IAllnch copy 01 Willi IAllach copy 01 Trultl
'A 'CO....POND.NC. AND CONPlDINTIAL TAlC INFORMATION SHOULD 81 DIRICTID TOr
COM'U ! MAHIN ADOII!
Wnl1rd G. Myers, Esq. Johnson, lXlffie, stewart , Weidner
lmiH6mNUl;i~--~-----_U __n "---.- - - - -- - - 301 t-Brl<.et St., P. o. Ibx 109
7l~-d__ 761:;},~_0~"c,'ccc,' .'....n-u--.','~,-l'~)7.~i~~Oc~~.=l_o --~f1'"
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RIV,1100 EX+ 11.9'1
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1. R.al Eliot. ISch.dul. AI
2, Slockl and Bond. ISchedule BI
3, Clollly H.ld StockIPo'tn",hlp Inl,,"t {Sch.dul. q
4, Morlgao" and Not., Rec.lvnbl. (Schedule 01
S, Cash, Bonk Oepo.11I & MllceUaneoul Perlonal Properly
(Sch.dul. EI
6, Jointly Owned Prop'r1y ISch.nul. f)
7, TranT/'" (Sch.du!. GIISch.dul. 1I
8, TOlal GIOII Alllllllololllnll 1.71
9. Funeral Exp.nlll, Admlnlllratlvo COlh, Mlscellaneoul
e.pen," {Schedul. HI
10, D.bll, Morloa,. lIabllllill, ll.nT (Schedulo II
11. Tolal D.ductlonT (Iotol llnll 9 & 101
12, N.t Value 01 E.tal. 11Ine B mlnul Llno III
13, Charllabl. and Go'"nmental B.qu.." {Sch.dul. JI
14, Nil Value Subjeello To, (line 12 mlnu.llne 131
15, Spou.al TranTf". liar datil a' d.ath aft" 6.30,94)
See Instrucllons for Applicable Percentage on Rev.rle
Sid., (Includ. ,aluOl !rom Sch.dul. K 0' Sch.dul. M,I
16, Amounl of line 14 la,abl. 01 6% ral.
Ilnclud. ,alu.. /rom Sch.dul. K or Sch.dul. M,I
17, Amounl a/line 14 la,obl. 01 15% '01.
IInclud. valu..lrom Sch.dul. K or Sch.dul. M,I
lB, Principal la, due (Add 10' from lInll 15, 16 and 17,1
19. Credlll Spousal Poverty Credit Prior Paymenh
______.____m_ u,,_ + ",,,___,_...__
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'OR DATil 0' DIATH AnlR 12/31191 CHICK HIRI
" A SPOUSAL
POVIRTY CRlDIT II CLAIMID 0, ,____
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0926
N.~MBE~
,,_ B, T olnl Number 01 Sofa D.po.11 Bo..,
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161 Ji,~n4~_._u____
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(B I _.25,225.00
(9 )
1101
.u 12., 929.45, __.________
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(III __13,O~2J...._____
1121 __12,l6.6.L!ll
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1141 ,12,166.57
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(161 .......t2,.:J,~6'_~1____________M ,06 ~
729.99
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Ol,,;ounl
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IIBI____.1.29_L!!L___
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Inlerel'
1191 '
{201
20, II line 19 I. greal" Ihan line I B, enl" Ih. dill""" on line 20, Thl. il ,h. OVERPA YMINT.
liD
21. II line 181. greal" than lln. 19, enl" Ih. dll/"en" on Line 21. Thit it Ih. TAX DUI.
A. Enl., the Inllfll' on the balance due on line 21 A.
8, Ent" Ih. 10101 01 line 21 and 21 A on LIne 218, Thll it Ih. BALANCE DUE,
Mak. Ch..k Pavabl. 101 R.gllt" 01 Will., Ag.nt
LJ ,,' ,,,ulno AN.WI. ALL QUlllIONS ON RIVI..UIDIAND TO IICHICK MATH _ ' '" ,I
Under Plnaltl., of perjury. I dlclar. Iholl av, examined Ihh ,elurn, Including accompanying Icheduhu and IlalenlfnU, and 10 lh, bill of my knowledgl an bll'l,
II h 'ru., correct and complet.. I dlclar. Ihol all real IUal. has been r.porled allrul mark.t value. Ooclorollon of preparer other than the penonal ,tprel.nlaHv. I
baled on alllnformallon of which ~"par.r hOI any knowledge.
NAM!, CO ,~~ ~ !PO:;~o:..""N "'~'W\-ADiiiE' ~~~l~~~k'-~~~-~;~~~---'--'-"----- 0-."7 (11 ( 9 (
l' ______m________n_____..__!ll._.'_m_____ ____ ....________u_,.,____ _________.. ___________.___
fl. " .00RlIL 301 Market St., P. O.1Dx 109 0'''_
_...... !<Un -----.------.ltmlyne,__.PA__lI0,43-Ql,QL______._________2fr l f/!.......__
. .'I.lQ.LO, ~.
(I11'(~ IH'''' " VOU (III' II'CIUI'\!lflH (I 1l"IJIUI of YUUJ OVl'lJHlYfllll1l1
1211 _____I~~_,-2.2._________
(21AI . ,___-:9.-:_____..______
121 B) .1~9 ..91!_,
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ITEM
NUMBER
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COMMONweAltH O. PINNSYlVANI....
INHU"ANCIIA~ mURN
RlIIOIN! OICIOINI
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Plla.1 Pllnt or T pi
-,
SLAGLE, EMMA V.
21-94-0926
DESCRIPTION
AMOUNT
A, Punlral bpln.."
1.
2.
3.
4.
I.
1.
2,
3.
4,
C,
1.
2,
3,
4.
$.
6,
7,
8,
Myers Funeral Home, Inc. - Funeral & Cemetery charges
Shultz'sDelicatessen - food for funeral lunch
Sears - hurial clothing purchased
Cumberland Valley Memorial Gardens - Bronze Memorial
6,012.20
116.00
51. 00
950.00
Admlnl.tratlvl Ca.t'l
Plrsonal Rlpr"lntotlvl Cornmllllon. Connie G. (QuesenbeLry) NeWerer
Social Security Number of Perlonal Roprollnta!lvOI
Vear Commllllonl paid 1995
1,000.00
A"ornlY Fe.. - Johnson, Duffie, Stewart & Weidner
2,500.00
Family Exemption
Claimant Jesse J. Slaqle, Jr. Relatlonahlp
Addrell of Claimant at deeedonl'. death
Street Addrtll 601 Wayne Driv,;,
City Mechanitsburq, Stote PA
Son
2,000.00
Zip Code-17055
Probatl FI.. - Register of Wills - Cumberland County
80.00
Mllelllanlou. bplnllli
Cumberland Law Journal ,. advertise letters 40.00
The Patriot-News Co. - advertise letters 35.25
Chuck Bricker - personal property appraisal 40.00
Register of Wills - file Inventory & Inheritance Tax Return 25.00
Register of Wills - photo copies 5.00
Reserve for close-out costs 75.00
TOTAL (Allo Inter on IInl 9, Recapltulatlonl S 12,929.45
(If more Ipael II nlldld, In)lrt additional Ihllt. 01 .aml 1111.)
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FILE NUMBER
21-94-0926
IlV,UI111l+IUlj
~ti
COM,lfONW'A.llIl 0' "NHin"A.NtA
lHHfllIAHCI tAlr IflUIN
IftIOIN,OIC,DINI
SCHEDULE J
BENEFICIARIES
ISfATE OF
SLAGLE, EMMA V.
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RelATIONSHIP
AMOUNT OR
SHARE OF ESTATE
A. Ta.abl. Boquo'llI
1. William L. Spangler Son One-Sixth
365 P1easantvi11e Dr., J~t 3224, Etters, PA 1731 Residue
2. John W. Stouffer Son One-Sixth
208 1/2 Reno St., New Cumberland, PA 17070 Residue
3. Mary E. !<bore Thomas One-Sixth
Address unknown Daughter Residue
4. Jesse J. Slagle. Jr.- 601 Wayne Drive Son One-Sixth
MechaniCRb\1rg, PA 17055 Residue
5. Peggy J~e Laidacker - 3445 Florence St., Apt. 2 Daughter One-Sixth
Harrishurg, PA 17110 Residue
6. Connie G. Quesenherry Neiderer Daughter One-Sixth
1806 S. York St., Mechanicshurg, PA 17055 Residue
7. Patrioia A. Jenkins adorn Daughter $1. 00
1411 Wanda Jane, Harrisburg, PA 17109
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Cha,lIabl. and Gav.rnmonlal Boqua.,,,
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS IAha onlor on IIn. 13, Ro,apllulatlan) S
(If marl .pa," I. n..d.d, Inll,1 addUlanal .h.... of .am. .11t)
COMMONWEALTH OF PENNSYLVANIA l
COUNTY OF CUMBERLAND J
:1/- qi- Cfa/o
1.--
(:'
511
Connie G. (Quesenberry) Neiderer
b.ln~ duly sworn .ccordlng to I.w, de pOI II ~nd UYI th.tS h. is Executrix
of the Esht. of Emma V. Slagle
I.t. of ____~r,..AllfUl,j'ownRhlp__ ,Cumberl.nd County, P." decttud end 1htt 1h.
within II.n Inv.ntory m.d. by Connie G. (OuesenberryDeiderer ,th. uld Executrj,x
of the .nti" IItlt. of IIld d.c.d.nt, conllstlng of ell the ptrlonll prop~rty Ind rill IIf.te, except reel IIht. ouhld.
the Commonwlllth 01 Pennlylvlnll, and thlt the figum oppollte each item of the Inventory "prellnt lt'l fair vllu.
II of the date of d.ced.nt'l dllth.
Sworn to
- -
Ind lublcrlbed before me,
. II ,0/1
---1:(}}1./X-<'c ..i).
I~ 19-22-_
NOTAAIA ~chanicsburg, PA 17055
DIANNE LENIG, Notary Public
Lemoyne Borough Cumberland Co, Add.."
My Commission Expires Dee, 21, WI'
o.t. of Ottth
13th
October
1994
O'Y
Month
Y..,
INSTRUCTIONS
I, An Inventory mUlt b. fII.d within thru month. afler .ppolntm.nt of perlonal repm.nhtlve.
2. A luppl.m.nt Inv.ntory mUlt b. lII.d within thirty days of dhcov.ry of Iddltlon.1 IIlIh.
3. Addltlonallhuh mlY b. IIt.ched II to personalty Dr realty
4. 5.. Artlcl. IV, Flduclarl'l Act of 1949.
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Inventory cf :he re,31 end cerSO;1al .Slale of
EM~IA V. SLAGLE
deceased
1. Household Goods - appJ':lised valulJ
2. ,Various Coins - appraised value
3. Dauphin ~positBank & Trust Canpany
Checking Account No. 007942534B
Date of death halance
1,015 00
65 50
BOl B6
4. Internal Revenue Servl-ce - refund - decedent's
1994 incare tax
45 00
5. Balance due. fran Connie G. NEliderer on the purchase
price of the real e3tate. located at 601 Wayne. Drive,
Upper Allen Township, Cumberland County, PA,
15,675 00
6. Prudential Insurance Co. - Policy No. 41-133130 -
benefits JA'lid to decedent I s Estate.
7. State Errployes I Retirerrent System - Hnal retirerrent
fund distribution
1,654 32
B. Myers ~llneral Home - Veteran's benefit paid.
142 94
100 00
9. Balance ,due on loan to Peggy Laidacker
700 00
Total
20 199 62
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V REV-1!I47 EX AFP (12-94_
COHMGHWEALT" Of PENNSVLYANIA
DEPAITHENT OF REYEHOE
IUREAU OF INDIYIDUA, TAKES
Dl!PT. 110101
HARRIIIURG, PA 17111.0101
1'1- .NY -?
~
ACN 101
HOTICE OF INHERITANCE TAX
APPRAISEHENT, AL,LOWANCE OR DISALLOWANCE
DF DEDUCTIONS AND ASSESSHENT OF TAM
DATI! 10-09-95
FILl! NO.
DATE OF DI!ATH 10-13-94 COUNTY CUMBERLAND
NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SU8HIT THE UPPER PORTION OF THIS fOR~ WITH YOUR TAX
pAYHENT TO THE REOISTER Of WILLS, HAKE CHECK pAYABLE TO "REGISTER Of WILLS, AGENT"
REMXT PAVMENT TO:
EDMUND G MYERS ESQ
JOHNSON ETAL
PO BOX 109
LEMOYNE PA 17043
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
I
A.o\H1t RI.I He<!
CUT ALONG THIS LINE .. RETAIN LOWER PORTION POR YOUR RECORDS .....
iie:V: isW. iX.AFP"f 12:94"1" - iiiiT"icr-cip."iNHiiii fANe!. T"Ail.A.PPRA i iii1'iiii' ~_. Ai. i:oiiAifc!. iili. ..-.. ...........
DISALLOWANCI! OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SLAGLE EMMA V PILE NO. 21 94-0926 ACN 101 DATI! 10-09-95
TAK RETURN WASI C X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSI!
APPRAISI!D VALUI! OF RI!TURN BASED ONI ORIGINAL RETURN
I, RI.I Elt.t. CSohldul. A)
2, stookl .nd Bondi CSoh.dull BI
5, Clol.ly H.ld Stook/p.rtn.r.hlp Intlr..t ISohldul. CI
4, Hort...../Not.. Rlo.I..bll (Soh.dul. DI
i, C..h/B.nk D.po.lt./HI.o, Plr.on.1 proPlrty CSoh.dul. EI
I. Jointly Olfl\.d Property CSohlck.l. FI
7. Tr.n.f.rl ISoh.dul. GI
B, Tot.1 A...t.
APPROVI!D DEDUCTIONS AND EXI!MPTIONSI
9. Pun.r.1 E.p.n.../A~, Co.t./Hloo, E.p.n... (Soh.dul. HI
10, Debt./Hort.... LI.bllltl../LI.nl ISohldul. II
II, Tot.1 D.duotlons
12, N.t V.lu. of T.. R.turn
IS. Ch.rlt.bl./Go..rn..nt.1 I.qua.t. CSoh.dul. J)
14. N.t V.lu. of E.t.t. Subj.ot to T..
( ) CHANGED
III
C21
m
(41
(SI
(6)
C71
.00
.00
.00
,00
18,3D2.36
6.923,44
.00
CIl
25,225,80
C91
1101
12,929,45
129.78
(UI
(121_
ClS)
114)
l~.OCiQ ,~
12,166,57
,00
12,166.57
NOTE I If.n ........nt w.. 1..u.d pr.v1ou.1Y, l1n.. 14, 15 .nd/or 16, 17 .nd 11 will
refl.ot figure. th.t 1nolud~ the tot.l of ~ r.turn. .......d to d.tl.
ASSESSMENT OF TAXI
Ii. AlROUIlt of L1n. 14 .t Spau..1 r.ta C 15 I
16, Aoount of Line 14 t...bl. .t Lln..l/tl... A r.t. CI61
17, A.ount of Lln. 14 t..obl. .t Call.tlr.I/CI.I. I r.tl CI71
II, prlnalp.1 T.. Du.
TAX CRI!OnSI
pAYHENT
DATE
o -13-95
RECEIpT
NuttIER
047996
-
DISCOUNT (+1
INTEREST Co)
,00
. If PAID APTER DATE INDICATED, SEE REVERSE
fOR CALCULATION OP ADDITIONAL INTEREST.
.00 X ,03.
12,166.57 X .06.
.00x.15.
III)
,00
729,99
,00
729,99
AHOUNT pAID
729,99
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
729,99
,00
,00
,00
( If TOTAL DUE IS LESS THAN ii, NO pAYHENT IS REQUIRED,
If TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU HAY BE DUE
A REfUND, SEE REVERSE SIDE Df THIS FOR" fOR INSTRUCTIONS,I
I"
.
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