HomeMy WebLinkAbout94-00930
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allO known u _illt' f'1/' A.-
Register of Wills of CUMBERLAND County, Pennsylvania
PETITION FOR GRANT OF LETTERS
No, 0<1 ... r:L1./J - q .3D
/ VI ).} (~";;{ /iJ;'J:1.!f.~_
f'f I Sfl"alvl _
_______ ..____._______.___....._......__._.___. DIC8U11d Social StcUnty No,~5 -1ft - tJ.trSI/
PtODCll"4r(I). wmOlL'i.i","a" Y"L" .~r.~;.~,.oii.f~-~~.~.{.-.lti.-.. ____.._.._4__.__n_.___.~__
~LE-re 'A' OR '6' BELOW:)
~ ~ A. Probal' and Granl oll.~t1"a TIIIRmenlary It'd """ 0111 PIlI1io<,",j., WIl'llhllrtoUt __nll11ed il ",'"t Wil of
"I Doo.dtn~ dI'-<l L_fl.7'.::-S".?-:"'_ .__. ard oodicJ~.) do'-<l__________
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EJOIDI u fonow., Decedenl did no1 ml'ry, w.. nol dlYOrted, Ind dd nol hi'" I cNld bo", or Idopled IIlIIr IrtetJOon 01 !hi doa.rnInll
0"1110 for probllW: Wit nol1l11 \lcOm of I "'ll1ng and wu nol'llldludcaled ""'m~.:l1:
o e, Granl 01 Lene,. 01 Mmlni,Ullion
..--.-.~i"t\iii-,-~hI:~~iL.;1.~G~ ml'O'lMl
PIlltionorjl)lho, I prope< .urth hul,"'" """I",,,,,d lhal Dooodenlleh no Wi1ll11d wu 1"""w<J by ~..'oIlowv1g IPOU" (It any)-.d
htirt:
NItN
Re!toonllup
Relrdonal
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(COMPlm IN illCASEST"Tuiti i.&ii.niJ....... d '*"Wi:---------
Otcedenl WII domiciled II dull1ln _C_I.l.JYLt~J:.--t.g.I'-cL . ______Counly, Pennl'ftvanil, wilh hi.",..lul fanily
01 principtlltlidenOlII__L5~ ~ __.t!!ct'1'- _ ~,-f,.__I~I~~.v~~M.I.J:f"'.s:1lA^-J(( 5 I.~l/;f:- P ii /7 a '7.!i' i.~(~t~t\.
(.'III1H1., f\um~ IJ'(j nunapaJrt)1
o-dtnl, hJn 0'5' ..._ Y.'" Drage, dod(X" 7, :Ii> ... ____, IG'I_IL. II ... . f1~_f!')Fl/ti lfrJ~f. Yd'X, PeL
1\..OtallOIlI '
Dec:.dent It duth owned pruportt Yfl.:h .'bllIlICld ""tUeI I. tol\owl
(II domOCllod", PAl An ponoll.1 propof1Y
(II nol dom",Ied" PAl f'",oMI "reporly In P""".ytvanll
(II nOI domicilod., I'A) 1'",,00&1 propony In Counly
Value 01 r,.1 .&talfJ W'l Pttnnaytv"'llol
1_....l0 (lO 0
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aillJ.t'-<lulolowa:
"""1..lore, Plliaonerjl) relpocduny ftlqt"'4'1 ~le p,ob.tot 01 ~1O lOll Will end Codi",1(1) prOloored wf1l1 Ihil Pellllon and \he gl'llllof
IanIrt il IhlopPftlprlalll Ion" '" UlU undulIlgllod
L~ S,u~lrJrC~==:=~.~===.:.=_~._~=-_=_-.~l~ 01 pnr.ll'd name and ,esloonc:e
/. -"~kt.: -lt~/- l.-'((lb~IJ5tJ!dci IJ/~'_J"lfc(j!.l
( f'"N"'C ,--1.",., J."'h_~// (..!,.,,~\ L<I.~ "....'n
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York.(ill. !71{~4
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1'13'1<;.
F"""aRW.' PlOt' oil
PI'p.&Il(I by Iht P'Mlyt~afll' Ihf AIl('l'_Ilt>.~\ lWl
REOISTER OF WILLS YORK COUNTY
, ,
OATH OF WITNESS TO WILL EXECUTED
, BY MARK
, (each)
codlcU
a lubscrlblna witness to the wlU presented herewith, (each) belna duly qualified accordlna to law,
depose(l) and say(s) lhat: leslat
was unable to Ilan h
name thereto; teltal
'I name was subscribed Ihereto In lestal
's presence; lestal
made h __ mark
Ihereon; testal
Rlld dependents(s) was (were) present when testal
's name was lubscrlbed
and whon testat made h
codicil
slaned the will wlil as wltncss(es).
Sworn to or affirmed' and subscribed
mark i and testat
was present when the underslaned
IN.fl
berore me this _
day of
1"'*""
19
IN...'
For the Register
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I!Y'I!143 E)( AFP 18.941_')
; COHttOfMAllH Of PEHJlSVlVAHIA
OEPAA1HEHl Of REVENUE
lUIlEAU OF IHOIVIOUAl lAXES
OEP1, 280601
IIARRIGIUIlO. PA 11121-060\
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 94-0930
ACN 95101081
DATE 01-17-95
TYPE OF ACCOUNT
~ SAVINGS
CHECKING
TRUST
CERTIFICATE
REHIT PAYHENT AHD FORHS TO.
REGISTER OF WILLS
DAUPHIN CO COURT HOUSE
HARRISBURG, PA 17101
\,
, II.'
R~:!
1..1
" I J i '.~
ESTATE OF BERTHA M STRAW
S.S. ND. 205-16-6659
DATE OF DEATH 10-26-94
COUNTY DAUPHIN
'95 l'i!IR-6
? 1 :1 B
CIUROBERT ESl',RlIwrl
CU~~~~~A~~Miit'~eAA~i 1QIili
1'1'/5 /-./UI( 1'--1)
YI!I~k: PI} 171(",-/
YORK FEDERAL S I lASS ha. provided the OIPartllllnt with thl InforutJon lilttd below which hll b..n UIIU In oalculatlng thl
pottntltl ttlC dUI. Thill' recordl Indicate that at thl death of the abovI dlcld,nt, you wtr. II joint owntr/bln,flohry of thll IIccount.
If you f..l thl, Infor..tlon J. Incorrlct, plla.. ohtaln wrlttDn oorr.otlon fro. tht flnanolel Inltltutlon, attach I copy to thl. for.
_"" r..lIr" It to tto. Il1nv" ..rlil'''''. ThJ. nt'':'?\'". Ie hl~:!':JIf\ J., .'''In'';l3nc' ".., ..." ll'''~rlt-:''''~f ~"W t.,.!:, \,{ tr... ':'....onl/~..lt.. rl r~'.-.,yl',I''''~
Qu,.tient .,y b. anlwlrod by call1nQ (7171 787.8321.
COMPLETE PART 1 BELOW . . . SEE REYERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account Ho, 010-060039 Dlh 11-10-71
Ettob1hhld
Account Beltncl 30.650.34
PtrOlnt Ttxtblo X ~ 0 . 000
A3IOunt SubJtot to TIX 15.325,17
TtX Rah X , 06
PohnUol TIX DUI 919,51
PART TAXPAYER RESPONSE
[!] I"AILURI TO II_SPOHlI WILL RESULT IHAN OllFICIALTAX ASSlSSHI!HT lASED OH THIS NOTtel1
A. 0 Th, about tnlorllllltlon and talC due Is corrlot.
1. You .ay choo.. to r..lt pay..nt to the Regllt.r of WJllt with two cople. of thl. notlCI to obtain
It dltcount or avoid Int.rut, or yOU .ay chick bOl( ",,'~' and r.turn this noUcl to the R'Qltt.r of
Will. ~nd an offlol.l ........nt will b, I.culd by the PA Depart.ent of Rlvenut.
B. ~ Th. above a..et he. bien or will be r.ported and talC paid with thl PlnntYlvanla Inherlt.nc. T.lC return
~ to bl filed by the dec.dent'. rlpre'lntatlu..
To In.url proper crftdlt to your account, two
(1.) cop Ie. of this notlcl IU.t .~co~any your
pay.ent to thl Rlglltlr of Willi, Hekl check
payabll tOI "Rlohttr of Wllls, Auntll.
HOTtl If t'l( pay..nt. art tad. within thr.e
(!I lonth. of tht dlcldent'. dati of death,
you lay dtduct a SX discount of tht talC du..
Any Inhlrltanol taM dut will b~coa. dlllnqu.nt
nlnt C9) Month. after the dtt. of d..th,
[CHECK ]
ONE
BLOCK
ONLY
c. c:J Th, abovt Infor..tlon I. Incorrtot and/or debt. and dlduotlon. wert paid by you.
You IU.t co.plltt PART [}] and/or PART ~ bllow.
If you InOloltl I dlfflrlnt hx rlh. plo..1 Itlto your
rl11tlonlhlp to dloldlnt,
. OFFICIAl.. .USE. ON LV 0 AAF!
PAD.EPARTHENTOFRElVENUE) I
PART
I!l
TAX HtiiuKh . CllNPlllllHClN OP
LINE 1. Dltl E,tlb1i,htd 1
2, Aooount Bl11nol 2
5. Plrotnt Tlxlb11 3 K
4. Anount Subjlot to lox 4
5, Dlbh and DlducHanl 5
6. Anount Ttxlb1t 6
7, TIX Rltt 7 K
a, TIX OUt a
fAX ON .JUUIUj'RUSl ACC;UUrHll
PART
[!]
DATE PAID
J
DEBTS AND
flAD
1
2
3
4
5
6
7
8
DEDUCTIONS CLAIMED
-
PAYEE
OESCRI PTION
AMOUNT PAID
1=
$
j=
TOTAL IEntlr on Llnl 5 of Tlx Conputltlonl
UnOlr ptnl1tltt of
z;~t. )::::
TAXPAYER SIGNATURE
perjury, I dlclar. that the fact. I hive reported aboye Ira tru., corract and
ny knowlodgt Ind blUlf. HOME ()/2...) ?(.L{- r Z2lr
Br~.,"l., Sh"...) {.vI,'er,tWORK ()17 1 7'1'/-/l3lr'.lt_~
TELEPHONE NUMBER
TVPE OF ACCOUNT
~ SAVINGS
CHECKING
TRUST
CF.RTIFICATE
REHIT PAVHENT AND FORHS TO.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
RIV-11143 IX AFP (8-94) '*
COHltONlIUlltI or PENNSVLVANIA
o.'~R'HENT Of RlVEHUlO
IURUU or INDIVIOUAl mEI
DEI'!, 210601
IIARRIUUMQ, flA 171Z1-0ltOI
/ (I. ({ <I V Ie'.
INFORMATION NOTICE
AND
TAX PAVER RESPONSE
t; q L~ I. U
ESTATE OF BERTHA M STRAW
5.5. NO. 205-16-6659
DATE Dr DEATH 10-26-94
COUNTY CUMBERLAND
BETTV L SHETRON
1508 MAIN ST
LX SBURN
MECHANICSBURG PA 17055
c!
FILE NO. 21 94-t",t ^y~,
ACN 95103867 U
DATE 02-16-95
-
PNC lANK hi' provided the Dlpart.lnt with the Infor...\1on lhtrd btlow which htlt bun u..d In calculating the
potlntlal tax dUI. Thtlr r.cord. Indlcat. that at the d..th of the above dlCldlnt, you wtr. a joint own,r/b,n,flctary of this account.
If you f..l thil tnfor...t1on II Incorrlct, pll..1 obtain written oorreotlon frol the financial In.tltutlon, aUrlch .. copy to thll for.
Ind r.turn It to thl above .ddr.... Thl, acoount J, taMable In aocordant. with tho JOh,rltlncl TaM law. of thl COllllonw'81th of P.nnwy\vanll.
IIu...\lonl IU)' u, IItl1lt.r.a ClY cllUng dl/) ,D/ ...,,,.
COMPLETE PART 1 BELOW
Aooount No. 5070072627
M M M SEE REVERSE SIDE FOR FILINU AND PAVMENT INSTRUCTIONS
Doh 06- 04-92
E.hblhhod
To Inlur. prop.r cr.dit to your account, two
(2:) copl.. of thlt nntte. .u.t aCl:ollpany your
pay..nt to the Righter of WUII, "eke ch.ck
payable tOI "~.gl.tAr of Willi, Aglnt..,
Aooount 81bnoo 7,817 . 01
Poroont Toxobb X 50 . 000
Aoount SUbjoot to To. 3 . 908 . 51
Toll Roto X ,15
Pohntlol To. Du. 586,28
PART TAXPAVER RESPONSE
CDIFAILUAI TO AISPOHD WILL RESULT IN AN OFFICIAL TAX ASSESSHENT BASID ON THIS HOTICE I
A,
HOTEl If t8M pay,.nt. are lad. within threl
(3) lonth. of thl dlced.nt'. dati of death,
YOU lay deduot a SY. dilcount of the t,M due.
Any Inh.rltanc. tllM dUI will bleo.. dellnquDnt
nlnl (9) "onthl aftlr th. dati of de.th.
[] The above Infor'8tlon and taM due I. corr.ot.
I, You ..y chao" to r..lt pay..nt to the R.gI.tor of Will. with two cop I.. of thl. notltl to obtain
a dllcount or ayoid lntlr..t, or you ".y chick bOM "A" and r.turn thl. not leI to thl Rlgllter of
Willi and on official .......ont will bl I.'ued by thl PA nlpartl.nt of Rlvenul,
[CHECK ]
ONE
BLOCK
ONLY
B, ~ The .bov. ....t has bl.n or ulll b. roported and taM paid wlth the P.nnlylvanl. Inh.rltanc. TaM r.turn
~ to bl fll.d by the dIC.d.nt', rlpr...ntatlvl,
C, ~ The above Inforl.tlon l~ncorr.ct andlor dlbtl and deduotlon. wlr. paid b~ you,
You IU.t cOlplet. PART ~ andlor PART [!] b.low,
If you indiooto 0 dlfforont to. rot.. pl.... otot. your
r.latlonlhlp to d.o.d.nt,
PART
~
TAl: IlETUllN - COHrUTf.TX!l~l
LINE 1. Dlt. E.tabll.h.d
2. Aooount 8.lono.
3. Plro.nt To.obl.
4. Aoount Subj.ot to To.
S. D.bt. ond D.Ouotlonl
6, Aoount TO.lbl.
1. To. Rot.
a. Tox au.
OF
1
2
5 X
4
S
6_
1 X
a
T.A1X O~! JO!t!"/Tn~eT ."~COl!~!TS
PAil
1_
2
3
4
5
6
1.
8
DEBTS AND DEDUCTIONS CLAIMED
PART
I!J
DATE PAID
PAVEE
DESCRIPTI ON
~
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t,) .... if) .,
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AMOUNT PAID
I I
TOTAL IEnt.r on Lln. S of To. Coaputotlonl .
Und.r p.nolU.. of porjurYl I doollr. t;'ot tho fooh I hovl r.porhd obovo Ir. Jruol oorr.ot end
OOllPl.t.. to tho b..t Of, , .kn~"bdl/l end boU.f. HOME ('7/7) 7 C. (. - .:2 [, !?C.' . , '
~.l'4 07': .JIlL l/ ~.n'v WORK () ') - JQ~' ys-
TA~AVER ,dGNATUa' TELEPHONE NUMBER ' D~
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CevJUt~ lilt. /? () 13
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CUrnbarl"nd Co., PA
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'0. DATU 0' DIATH Am. 12/31/91 CHICK HI"
INHERITANCE TAX RETURN ~o~::~ mOlT II CLAIMID []
RESI DENT DECEDENT,iLfNuMili---- _____u_______
COMMONWEAlTH Of PfNNmVANIA (TO BE FILED IN DUPLICATE' I -1~/-M3()
OE'A!'M!N! OF REVENUE ....
HARRllfJib, ~~o~1280601 WITH REGISTER OF WILLS) COUNTY CODE YE!lR_ ___ . NY_MBER
C5Ta~.;:/;~~~~HI'~D'''":1:lJ _.-n- -.-- - .]O!C~[~~O'f;W;~A~-'- LI5IJ/J~N __
IOC'A1IECU'"' NUM'" ----u-1Ai'O;DiAi.,----[OATlO,iiiiH--u----- 1'1(j(/frlAJICSI3vt2 (- PI! 17~!J".!J
;J.O!)" - I ~ - f~~1....___ _!..O_=~_~u'_~[<i... _I!...~~_~:!:._~L C~.,~(..i<!t1~~~!:AAJj2.._-.-___
I" "''''''"11''''''''0 "0":" "'" ".., .',,, "':_M~O:,,~~~,,"__ ~OC'A~.~~~~IY.N~.~I~~.___J:UN~:=~IVIO~U INIIRUC"ON~I
"'" 1. Orlglnol R.lurn ["J 2. Suppl.menlol R.lurn [-'13. R.molnder Rorurn
,.. .. n liar dor" 01 d.olh prior 10 12.13.821
[J 4. lImlled E.lol. [I 40. Fuluro Inlorell Compromh. [15. F.derol EllolI TOK R.rurn R.qulred
(lor dor" 01 d.olh "Iter 12.12.821
06. D"ed.nr DI.d T"lol. ["] 7. Docodonl Moll1lolned 0 Living Trull .Q.8, Tolol Number of Sole D.po.1I80Ktl
-- {Alloch copy of Willi U (Alloch copy of Trulll
. L CQII !SI'ONDINCI AND CONPlDllNTIAL TAlC IN'ORMATION IHC?ULD II ,DIII~CTlD ~ 0
_..EoBERT _?/ STt2Aw --...=:I- __ COMPL/~~A~~NO~7~~( R. a')
TIIE'HONE NUM'" Y y), I) JJ ( )Ip. IJ
7/ 7L 4~ 't.t1. g-'. ., ___- __ D,::-' r'I .7.,..,
111 _______._:.~n ..._________
I 2 I _ _______._.::-.:.____._____ n__."" :
13 I ________==-________ , ,
'I)'
(41--rl.'i{6~..;--i-o..~m-- )'.: ,
(51 ---I-.----n----
J.b' 105-:< 1 4S"
(61 -.---__Im___
171 ___ _-=__________
I q I _.EJ 4 :1.0 I 2 "/
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il~
1. Rool E1lole ISch.dule AI
2. Slack. ond Bond. ISch.dul. BI
3, Cloltly H.ld SlocklPorlnorshlp Inlero" (Sch.dulo q
4, Morlgog.. and NOli. Recelvoblo ISchedul. D)
5. Cash, Bonk D,polllI & Mhcellane(lus PerJonal Properly
(Schedule EI
6. Jnlntly Own.d P,ope"y (Schedule FI
7, T,ontler. ISch.dule 0) ISch.dul. II
8, Totol Grall A"." 110101 L1n.. 1.71
9. Fun.ral EKplnlll, Admlnhtratlv. COlli, Mllcellaneoul
hpeOlu ISch.dule HI
10. Deb". MO,lgog. lIoblllll... ll.OI ISchedulo II
11. Tolol D.ducllo" (10101 Lln.. q & 101
12, Nil Value 01 ellole ILlne 8 mlnUl line 111
13. Cho,lIoble ond Governm.nl"1 B.qullt. ISchodule JI
14, Nel Volue SubJ.ct 10 To, ILln. 12 mlnUl line 131
15, SpoUlol T,ansl.n lIar dol.. of d.olh oftor 6,30.q4)
5.. lnllructlonl for Applicable Percentage on RevlrI'
Side, Ilnclud. volulI ',om Schedule K ar Sch.dule M.I
16. Amounl 01 lIn. 14 laKobl. 01 6% role
{Include yolu.. !ram Schedul. K or 5ch.dulo M.I
17, Amounl of lIn. 14 laKobl. 01 15% ,ole
{Include yolu.. I,om Sch.dule K or Schedul. M,I
18, PrlnclpolloK duo {Add 10' I,om Llnll 15, 16 ond 17,1
19, Credl" SpoUlol Poverly Credit Prior Pay men" DI"ounl
+ ------ +-- --
6'~cj /./0.
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111) ?.,420 ,:l.'-j
112) . 37,96)" , 41
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1131 $7IQt2,41
{141
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I (I L__M ,06. :2,277t74
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M ,15 . -
(18) 2./')77,74
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Interell
1101__=
1151_____
1161 ~L_'t 6.:<.
1171
20, If lInelq I. greoler Ihon Line 18, enler Ih. dlllerence on Line 20. Thl. h Ih. OVERPAYMENT.
1110
21. If line 18 I. greoler Ihon Line 19. enler Ihe dlllerence on lln. 21. Thh "Ih. TAX DUE.
A, Enler the Inlerlll on Ihe bolonce due on Lln. 21 A.
B, Enllr th.lolol of line 21 ond 21A an Line 21B. Thl." Ihe BALANCE DUI,
Make Check Pavable 101 .egl.I.. .f Will., Age.I
(11\'r~ 1"'Il' II y'UII (lIt' Jt'qul'\llII!1 CI It.fulld 01 YOlll UVl'rlHlYllll'l11
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Under peno II" 0 perlury, I d" Oft I 011 aye uomlned Ihl. rei urn, Including accompanying "h.dul" ond "olemenl., ond 10 Ihe bOil 01 my knawl.dge ond bellel,
Ill, truI, corrlCt and compl"" I dlclar. thai all real ..tate has been report.d allrul market value, Declarallon of pr.porer other than ,hi plnanal "pr...ntatlv. I,
baltd on aJllnfo,",allon 0 which prepaft' ho. any knowlodg.. .
'IONATUIl~OP '.fIlSON /UPONSIIlt POll filING RETURN . AOORfSS. I. OAT!
f~ t;,..J~ I~/:-- ~ I\J, Vi'71~/Jl.tt, 1?l{()4 l..-~S-- 'IS"
SIGNAlURe Of PUPARU otHfR HtAN RfPIUSWJAllVf ADDU'S -------.{.:. ----- DAlf
"Y'I~::~~I~~NNIYlVANI^ LO'NTL Y~&~~~~)~OPERTyl
INHIRITANC! TAX mU,N
.I5IDINl DIC!D!NI
ISlATIO' -- - . - I FILE N.UMBER -
(3~((TI!..~ M:..i!!f1W __ _--.J 21-'14-_~'130 ____.
Join' 'e.o.'I'I.
NAME
ADDRESS
/f"W 1-1 J..~c. t<c!,
'/01<-1( I PA /7404
I!J-O'&' MtJ IN Sr. /-.tSBtJR,.tJ
H6cHI/AJ(C$!jlltZ6- ~~ 170,'i'~-
sotJ
RELATIONSHIP TO DECEDENT
A, f(.of;I3I~1 e, STll.~{;oj
II. 6E fry ~\ Sill: TioAl
()I'f U(rH TEll
C.
Jol.'ly-ow.ld pcoplrty.
--
LmER ,
ITlM 'OR DATI DESCRIPTION 0' PROPERTY TOTAL VALUE DECO'S DO
NUMBEI JOINT MADE OF ASSET % INT. DICE
TlNANT JOINT
--.
1. A %-~- CI).tI= 3So211Z (colla STliTes) 20/ D44 J.J. 50 I
:Zc 1'1 11-10-7/ S;tv, Acq; oIO-boIJ3'i (YkFf/l, 30) 6fJ7)j3- 50 15
.3, S. (,- o/-'Il C/(. riCe;' @ P,J C /Sir. 7, :}()9 !2-- 50 3
, ,
- .._~- -
TOTAL (AI.o enler on line 6, Rtcopllulollon) S
--- -----._-. --.
(/I mo,. .pOet II n..ded Insert oddiliono/.h..,. 0/ lame lire)
LLAR VALUE 0'
DENT'S INTEREST
DJ o:1..~, )..9
-} J:lS, 17
I 'OL/, 9r'
-
).~ C;S:2 ~ iff'
, ,
UVISll I" 11.1111
er::,ZTIfA
M,
1 SCHEDULE H J
fUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MI~~ELLANEO~S_ EXPENSES . PI. 01. Prlnl or TVp.
STfVt 1J._______~(~11t{ - 0930 ~__.___.
DESCRIPTION AMOUNT
.
COMMONWfAlIH Of P!NN$YlVANfA
INtlIRITANC! TAK ~!TURN
~!lID!Nl D!C!O!NI
ISfAlI OP
ITEM
NUMBER
A, Puneral Exp.nl'"
1.
6uY'l'eJ eX(J<-Yl)i's tV'''Vi'\. (,Jorl<'l'k.Jfl" ft.JI1~Vtl.1 Hml e
;213db 124
B,
1.
Admlnlll1'allv. COIIII
P."onol Reprelenlotlve Commllllon, .
Soclol Secvrlty Number of Perlon~1 Reprelenloll,vel _
, Yeor Commlulonl pold
I'
o
I
2,
Attorney Feel'
'0
3.
Fomlly Exemption
Clalmont
Addrell of Clolmonl 01 decedent's'deolh
Relatlonlhlp
o
Slreel Addrell
City ..J
4. Probale Feel
C. Mllelllanloul Explnlll'
1. . tjl'l1bUIf<..YlC.e,
2.
3,
41
5. "
" 6,
7.
8,
Slale Zip Code__
'4.tl i>
so,c'D
.
TOTAL IAho enter on line 9, Recopllulotlonl S ~) 4 ~() '^~
(If mall Ipac. II nlld.d, Inl.rt addlllonal Ih.." of lam. III..)
, ,
.
~COMMONWI"'arH Of PfNN,nW,NIA
I,..HUllANC. ''''It U'U...,
kltIO'NT OICIOI"'T
UV.UI1Utll.tJI
itATI 6,
IlIM
NUMIIII
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SCHEDULE I L
DEBTS OF DECEDENT" . .
MORTGAG' IIA,ILITI'SAND II.NS ... ,.... ,,'..<< "'-'_
~MIIII
_ ~1-9'f-D?30
11,
SilCltW
DISCIlIPTION
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IHHIIIIANCI IAK "'UIN
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_L
SCHEDULE J
BENEFICIARIES
1_
BE !tTH,lj
M. STfc'A W
fiLE NUMBER
~'-1~- D1'30
-.---. ._-----..__.._--_.__._._._.~-~--_..-.--_._-- ._-.......-----.
ITEM NAME AND ADDRESS Of BENEfiCIARY AMOUNT OR
NUMBER RELATIONSHIP SHARE Of ESTATE
~-_. ----~._------_._--- ---_.-~ ---
A, Tarable Blquul" fI
*
I. RLJ55EJ./... MW1 - Jti'1 S. fI1^I'1\ '5f, SON 4, 7'15, 30
Mtowolf rA J7347
~. r<Ay HIXJVEf<. - 51.71. TW/l.lfrHT W. 5DIJ 417'1.!J"'; 30 t
Yorl.t\ PI/ 171/0(,
3. C u,eTI S Nc()ve R _ 37-'1 (JiJL/" ~v, soN L/J 7l(!J'", Jo t
t)ov612 PIt !731..!>-
'1. 6-/JtQYS S1/~IIt/Sl3MvC-11 - YC{?)( (()1J1l1ry Ht>!1r. fJ!-1UC-ffT e K 4, 7'15< 30 *"
5'. BETTY SHETKoN - /50'if f1/J1IJ ST. LISdl" /)f)tJ{-H T 6 f<. 4/ 7,!SI 30 t
/...ftEClfIlMtS/Jl.Ill(r M nos!:.
6, (JMr~lce CJ..ItRt( - :ziS,!;- c;lIW~,6-E RV, (JAiJH{1ER. 41 it/S, ]0 *
'/oKfC',PII /7'1b:L 4, 7l(<;-, Jo *
f)GWR.e5 HItf<8D/.181 - 15''-10 !irk Ave OftvC-H1cf(,
7,
YDilr, PA 171{/):;J.. t
l~o{;l3tZT STtef/w - t5-I!J- 1.//..0(. ~p. SolJ 4) 74~1 30
8-.
YO(ZK/ fJl1 17t/oL{
T07HL SHItRe. BEFoie -1UI/E~~71tM.e Tllx t)ft)CJCr~
ITEM
NUMBER
NAMl AND ADORESS OP BENEfiCIARY
AMOUNT OR
SHARE Of ESTATE
B, Cho,lfoble ond Goyernmlnlol BequtllII
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AI.a enler on line 13. Rtcopllulallonl $
(If me.. 'p"ee II n..ded, In..,l addltlanallh.." .'Iaml lilt)
STATUS REPORT UNDER RULE 6.12
Name of Decedent I /3 e te t.f ~
Date of Deathl ltJ- ~(r all
, ~I
Will NO.~~ eN fat)
1\1. -S.J.i! Ii tV,
Admin, No. ~/~'~ - (:J ~8o
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estatel
1.
State~~hether administration of the estate is complete I
Yes~ No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
completel
3, If the answer to No, 1 is Yes, state the followingl
a, Did the personal representative file a final
account with the Court? Yes~_ No
b, The separate Orphans' Court No. (if any) for
the personal representative's account is:
(;/fP bee.f. Sfte A W
1 tpUS5'e-11 ~e i/V\
(f~ ee. vI, r -<<.
. c. Did the personal representative state an
account informally to the parties in interest? Yes-t<,- No
d, Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
,Cerk of the Orphans' Court and may be attached to this report.
~~.
... -pj?e--
S gnature
i(;fSt?/J a R.. I'M
Name (Please type or print)
111$ )J;"l/tJ Ir1/ /'l ~ -JJtJI.I ^' ~ f,
r~~J( fl/o/UD'I Add .ess Mt- ~11f: 14 17~ y?
I~/.~. "..,If iIH/JIt. ~?'J ~t,1, /(/ j '/
/'ilt, w.,p if,./?J'ItTel. No. .
o f2 f?.J1:1.---
CapacitYl J~t'ersonal Representative
Date 1.&---:"1!i.~
Counsel for personal
representative
(MAil I rmf/AM3)
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GENERAL INFORMATION
1. FAlLURE TO RES~OND WILL RESULT IN AN OFfICIAL TAM ASSESSHENT with .pplloobl. lntor..t b...d on Inforo.Uon
,ubllU,d by the fin.oat,l IntUtutlan,
2. InheritInG' till becOlltI deUnquenl nlllt .onthl IIft,r the deClde",I, dati of dillin,
J. A 101nt lOoount I" t'M~l. ,v.n though the dlc,dlnt', 0... WI' tddld II a ..tt.r of cony.nt.nol.
.. Accounh Unoludlng Iho.. held b.twt.n hu.b,nd Md will) which the dlle.dtnt put In joint n.... within on. y..r prior to
d..th Irl fully tlMlbll I' tranlflr..
5. Acoount. ..tlblhhed jointlY bltw..n hu,blNld Ind WUI flar. thin on. Vllr prior to d,.th IIr. not lutbl..
6, Acoount. hlld bv . dletdent "In trUlt for" Inoth.r or oth.r. ar. IRKlbl, fullv.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
I. BLOCK A - If thl Infor..tlon end c~t.tlon In thl notlcl Ir. corr.ct end dlductlonl ar. not bltn, cltt,.d, pilei an "W~
In block "A" of P,r1 1 of the "T.MPly.r A.,pon'l" Ilotlon. Sign 1.0 ~opll' end lub.lt th.. with your chick 'or thl ..aunt 0'
tu to the R.,Jtter of Willi of the ~ounh indlcettd. Th. PA Dlpart.lnt of RIYlnUI will luut ,n offlolal ........n1
(For. R!U~lS41 EX) upon rl~tlpt of the retlh'n froa thl R.ghter of Will,.
2. BLOCK II . If thl ....t lpeoifl.d on thll notlcl hu bun or wUI b. rlported and tal( paid with the Plnnlylvantl Inherltlnc.
TIM A.turn '111d bv thl dIe.d.nt', rIPr...ntatlvl, plac. an "Xrt In block "8" of Part I 0' thl ~TaMpav.r R..pon.l" 'Iotion. Sign on.
copv .nd r.turn to the PA atpert.lnt of R.Vlnul, Burllu of Individual TaM", D.pt 280601, ~llrrhburg, PA 11128.0601 In thll
InvIlope provJGtd.
S. 'LOCK C . If the no\lcl Infor'ltlon I. incorrect a~d/or d.ductlons Ir. b.lng clal..d, eh.ck block "e" and co.plvtl Parts 2 and S
oecnrdlng to thfl In.trucHon. bllow. Slgn two ctlpl.. and subelt thl. wIth your chick for thl ncunt of tax paVabl. to the Rlgitter
0' W1111 0' th41 county Indlelttd. nil PA Dlpart..nt 0' Rlvanul will l"uI an official uU..llnt (For. REV-IM8 EIO upon flCllpt
of the return 'rOIl the RIgllter 0' WUIt.
TAX RETURN. PART 2 TAX COMPUTATION
LINE
I. Ent.r the date thl account orlolnellv WI' .,tebll.h.d or tltl.d In the .enn.r 'MI.tlng et det. of de.th.
HOTEl For. dle.dent dvlng efter IUtz/ell AcecuMtt which the deeldlnt put In Joint n.... within orl' (1) y.ar of de.th are
tlMeal. 'ulIY I' tran,'.r,. How.ver, thlr. I. 'n 'Melu.lon not to .Mo..d 11,000 p.r trln,'.rel r.uardl,.. of the valu. ~f
tn. loeount or the nuabtr 0' lecount. h.ld.
11 . doubl. ..ttrllk In) app..,. b,'on veur first n... In the Iddr... portion of thlt notlc., the U,OOO 'lColullon
alr.ldY ha, b..n dt~et.d fro. the aoeount belano. al r.portld bv the flnaneial In'tltutlon.
2. Ent.r thl tot.1 blltno. 0' thl .oeount Including Intlr..t Iccruld to the date of dl..h.
S. The percln1 0' tht aocount that it hMlbla fer IIch lurlllyor It d'hraJn.d .. '0110\14.1
A. The p.ro.nt taMabl. for JoInt .."" IItablhhld .ore than one Yllr prior to the dlold.nt'. deathl
1 DIYIDED IV TDTAl HUMIER DF
JOINT OWNERS
El(aepl., A Joint ."It r.gl.t.red
DIYIDED IV TOTAL H\JHBER OF M 100 . PERCEMT lAMAILE
SURVIYINO JOINT OWHERS
In the n... 0' the d.ced.nt and two other p.r.on..
1 DIYIDEO IV S (JOINT OWHeRS) DIYIDED IV 2 (SURYIYDRS) . ,167 M 100 . 16,7% (TAMAllE FOR EACH SURYIYDR)
I. The p.rc.nt t'Mablo for ....t. ere.t.d within en. y.ar of the dlcld.nt'. d..th or account. own.d by the d.eadent but h.ld
In t~u.t 'or anoth.r IndJvldual(.) (tru.t b.nlfJclarl..)1
1 DIYIDED IV TDTAl HUYlER OF SURYIYINO JOIHT
OWNERS OR TRUST BENEFICIARIES
M 100 . PERCFHT TAM AilE
EM..,la' Joint .ceount r.gllt.r.d In the n... of the d.eld.nt and twu other per.on. and ..tebll.h.d within on. v..r 0' d..1h by
thl dee.dent,
I DIYIDEO IV 2 (SURYIVORS) . ,SO M 100 . SOX (TAMAllE FOR EACH SURYIVDR)
4, ThI MOUnt .ubjlot to taM <1lne 4) 1. deter.lnld bv .ultJpl'llng thl account bal.nel (lin. 2) by the Ptre."t tlMabl. (1In. 3).
5, ~nhr ttw tot.l 0' thl debtt and deduotlon. IIJt.d In Plrt 1.
.. The ..ount tlxabl, (UM 6) 1. d.ttr'ln.d by 'Ubtreotlfli the debt. and d.ouotlon. (ltn. ~) frol till Mount .ubj.ct 'Cu tl'" (Unl otJ,
7. Enter the appropriate taM ,,1. Uln. 7) .. d.terllnld bllow.
A, for dat,. 0' death occurring afttr 6/10/94, thl tll< rat.. for tran.,ire to .pcu... .re II 'ollowlI
1. Dlt., 0' d'.th on or .'1.r 111/94 Ind bl'er. 1/1/96 the r.t. I, lX.
2. glt., of death on or .f1.r 1/1/96 and bl'erl 1/1/97 thl rat. I. 2X.
S. Dat.. of death on or .,t.r 1/1/97 and blfor. 1/1/98 the rat. I. IX.
4. Olt.. of delth on or .,t.r 1/1/91 trln".r, to 'pou... will b. .Mlap1 froa taM.
Not., For dltl' 0' dllth prior to 111194 trln,flr. to .pou... ara tlMabla a1 6X.
I. Trln.,." to lln..l dt.etndtnt. including ,.thtr, lothtr, Ion, dlullht.r, grendehl1drtn, 10n'ln-Ilw,
dtuth1Ir~ln~l.w, ,tepchlld and thllr i'lUI Irl t'Mebl, at .IM p.rc.nt (h%l,
C, TrIO,,,,. to aU othtrl InaluclltlQ brother, tI.ter, unci., aunt, nlPht\14 and nllel ar. tlMablt et fift.." perclnt (15iO,
D, 1f you Chin" thl 11M rlt., pl.... ,plolfv your r.l.tlon.hlp to thl d.c.d.nt In the .r.a provld.d,
II The HOUnt of tlX due (lln. 8) It dater_Jn.d bv lultlplyJng th_ Hount taMabl_ (IIn. 6) by thl tlM rah (Un. 1),
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowabl. d.bt. and dtduo1lon. ar. dat.r.lntd I' follow'l
A, Vou I.plly Ire rupon,lbl. 'or p.v.."t, or thl fIItah ,ubjlc1 to IdIllnhtratlon bV I p.rlGo.1 repr".ntaUvI 11 In,uHicllnt
to plV the cftducUbl. It....
I, 'fau eotualb paid thl cftbtl I'ter d"th of the d.c.dlnt end 010 furnhh proof of plv..nt.
CI Debtl b.ln, Olalled IUlt be It..hld 'ully In Pert S. If addltlonll .peqe 11 n..dld, UII pllln piper a 112" Mil". Proo' of
p.~t .IV b. r.que.tld bv thl PA Depart,,"t e' R.v.nu..
< . ..... .............. .. TAXPAYER ASSISTANCE
IF YOU NEED FUIlTHEIlINFORHATIONORASSISTANCE, CONTACT ANY
'..'... > REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
'.,..ORCALl THE BUIlEAU OF INDIVIDUAL. TAXES TAXPAYER INQUIRY UNIT IN
HARRISBUReAT (717) 787-8327, TOO' (717) 772-2252 (HEARINO IMPAIRED ONLY)
GENERAL INFORMATION
1. FAILURe TO RESPOND WILL RUULT IN AN OFFICIAL TAM ASSeSS~eNT wllh .pplI.oblo Intmot b..od .h Inf"ootlcn
lUOIlltted bv thl flnancl.l In.Ututlon,
2. InheritInG' tlK blco... delJnquant nl~ ~nth. .ft.r the dlc.d.nt'. dlt, of d'lth,
5. A Joint IOCCunt II '....bl. Iv.n thOUgh tll. dle'eNnt', nu. w.. .dd," II . ..tt.r 0' conv.nl.not,
4. Acc~h (Includln~ tholl hlld bltw.,n hu.blnd .nd 'lUll which the dlCldlnt put In Joint n.... within on. YII' prior tu
dIIth .r. fullv t.Mabl. II tr'n~f.r..
5, Account. ..tlbll.hed jolntlv b.twI.n hu.btnd Ind wlf. .or. th'n on, YI.r prior to d..th Ir. not t'Mable.
6. Account. ~Id bV . o.cedsnt ftl" tru.t for" ~noth'r or oth.r. Ir. t.M.bl_ fully,
REPORTINO INSTRUCTIONS - PART 1 - TAXrAVER RESPONSE
1. IILOCK A ~ If the lnfer.ltlon It,d COllput,Uon In th. notlcl Ire corr.ot .nd deduction. art not b.lnu ol,IHd, pilei In "."
In block ..".. of rtrt I of the "TllCPIYIII' R..ponu" lIotlon. Slin two ooplu and lub.it th.. with your chick for the IIIOUnt of
tllC to the R,gllt.r of Will, of the county Indlc.tld. The PA Oln.rt..nt of ReVlnUI will II'u, In offlolll 11'~'I""t
(For. REV.1S46 E~) upon rlcllpt of thl rDturn frol thl R.glltlr of Willi.
Z. ILOC.'. Jf thl ~'llt IPlolflld on thlt not lei h.. blln or will bt rlportld Ind talC Plld with thl Plnnlylvlnl. Inhlrltlnc.
TIll Return flhd b~ thl dlCldl"t'l rIP,,"nt.t1VG, pltCt an "X" In block "&" of Plrt I of the "lOPIYIr Ruponll" lIotlon. SJon OM
copy and r.turn to thl PA DIPlrt.'nt of illv.nul, luruu of Indlvldull Till", DIPt 2110601, Illtrrhburg, PA 17121.0601 In thl
tnv.lope proyJdld.
5. IL~CK C - If thl notlcl Infor'ltlon JI Incorr.ct endlor dlductlcn. Ir' bllng Ollllld, chick block "C" end COaplltl Pert. l and 5
Iccordlng to thl In.tructlon. bllow. Sign ''"0 coplu and .ub.1t UI" with your e;h.ck for thl alount (It to plyaol' to the Righter
of Willi of tho county Indlcetld. Th. PA Dlpertllnt of RIYlnUI will 1"uI an offlclll 1111""lnt (For. REV-IS48 EX) upon rlcllpt
of the r.turn fro. thl RIol.t.r of Will..
TAX RETURN . PART 2 - TAX COMPUTATION
LINE
1. Ent" the dati thl Iccount orlglnll1Y H" uhblhhld or tltlld In thl tanner IIlI.tlng Itt date of doath.
HOTEl For I deo~nt dylnlil .ft" lUIUlll1 Account I which thl dlcldlnt put In Joint nal.. within ani (I) ylll of duth Ir'
tllllbll fully 'I trlnl'.r.. 1I0wlvlr, th.r. II an .~clullon nol to IllClld 13,000 plr tranlflrll rllillrdl... of thl v.lul 0'
thl account cr tM ~btr of !lCtiuntl held.
If I dcKlbit a,t.,hk (1Ul) Iflpur. blforl your flret nil. In the Iddrell portion of thb notlc., thl n,ooo exclullon
81rllay ha, b,ln dlduotld fro. thl QccGUOt balanc. I' r.portld by the flnlnclal In.tltutlon.
Z. Ent., the totll bllanc:1 of thl loCOunt Includlnglnt"..t ICcruld to th. d.ta nf d"th.
5, The peroent of thl Iccount th.t I. talllbll for Ilch .urylvor II dltlr.lnld al fallow'l
A. The perolnt "lllbll for Joint ....te utablhh.d 'nre thin ani vur prior to thl dle.d.nt'. d..thl
I DIVIDED IV TOTAL HUHBER OF
,IOINT O\lllERY
Elll~t'l A Joint a...t r'liIl.tlr.d
DIVIDED IV TOTAL NUHIER OF M 100 . PERCENT TAMULE
SURVIVINO JOINT ONNENS
In the na,. of ~h. d.cldlnt Ind two oth.r plr.on5.
I DIVIDED IV 3 (JOINT ONHERS) DIVIDED IV 2 (SURVIVORS) . ,161 M 100 . 16,7% (TAMABLE FOR EACH SURVIVOR)
I. The Plrcent tlxlbll for I...t. or'atld wlthJn ani Y.lr of thl dlc.dlnt'. dllth or account. ownld by thl dlo.dlnt but held
In tru.t for ._oother IrldlvJdualC,) (tru.t bln.flelarlu)l
,
I DIVIDED IV TOTAL NUMBER OF SURVIVIND JOINT M 100 . PERCENT TAMABLE
ORNERS DR TRUST BENEFICIARIES
Ex.-plll Joint Iccount rlgl.t.rld In th. nl.1 of thl dlc.d.nt end two oth.r p.r.un. and .,t.bll.hld ~Ithln ant yllr of delth by
thl dlc.dlnt.
1 DIVIDED IV Z UURYIVOA$) . .50 )( 100 . 50% lTA)(ABLE FOR EACH SURVIVOR)
4. The ~t .ubjlot to tall Olne 4) It dlhrelned bv lultJplylnlil th. Iccount balancl (lJn. Z) by thl percent texlbll (UM J).
5. Entar thl total of ttl. rl_ht. nr,d d.duotlonl U.ttrt In Ptrt ],
6, ThllIIOUI'It hlllbl. (line 6) h dlter.'nld bj lubtrftotlna thl dlbtl and dlduotlon. n'nl 5) 'rot the ..ount .ubjlot to tIll (lInt 4).
7. Entll' tht IPproprht. tu rah (line 7) II d.toreln.d bilow,
A. ~or dlt., of death occurring aft.r 6/30/94, th. till r.tl' for tr"n.f.r. to 'POU'II Irl I. follow'l
I. DI"I of d..th on or Ifter 111/94 and blfor. 1/1/96 the rata It 3:<.
Z. D.tu of delth on or "fter 1/1/96 and bl'er. 1/1/91 thl rat. it 2%.
3. Dati. of dl.th on or "ft.r 1/1/97 and b.for. 1/1/98 th. rat. JI 1%.
4. D.tll of d,lth on or .ft.r 1/1/9& tran.f.r, to ,POUII. will bl IMllpt frol tall.
Hot'l For dati. of dlath prior to 7/1/94 tr.n.f.r. to 'POUI" art t.lllbll at 6%.
I. Tn",f", to llM.t dUClnd.nt. Including fathlr, lothlr, .on, dlulilhter, grandchildren, lon.ln.law,
d.yth1Ir-ln-Ilw, It.pchlld ~nd th.lr I.,u. art tlllabl. It 1111 Plrolnt (6:<).
C. Tran.f"t to .11 oth.,. Inoludlng brother, .lthr, uncll, aunt, MPhlW snd nl.c&. er. tlMtbl1 .t flftltn Plrcent (lS:O.
D. If you ching. thl tall rlt., pl.... _plelfy your rllatlenlhlp to thl dlc.dlnt In the ar.. proYlded.
.. The ~t of till due (line 8J I. d.tlr.ln.d bv lultlplylnlil thl alcunt t'lCabl. (Ilnl 6) by th. talC rat. (1In. 7).
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowlbl. dRt. and dtduetlon. If. d.t"IJnld al fol1owlI
A. You llgllly Irl rllPonllbll for paY.lnt, or thl I.t.t. lubJ.et to Idllnl.tratlon by . plr.onll rlprl..ntltlvl II In.ufflol.nt
to ply the ~.ductJbll It.ll.
.. You lotuI1IY plld thl dlbt. Ift.r dl.th of thl dlOldwnt snd csn furnllh prcof of PIYI.nt.
C. D.bt. bllnlil ollllld IU.t bl It..lrld fully In Plrt 3. If Iddltlonnl Ipact I, neldld, UII pI,ln paplr 8 I/Z~ Mil". Proof of
plyttnt .IY be r,quI.tld by thl PA OIPlrt..nt of R.Ylnue.
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 IN~IVIDUAL TAXES, TAXPAVERINQUIRV UNIT. IN
,HARRISBURO AT (717) 787-8327. TOO' (717) 772-2252 (HEARINO IMPAIRED ONLY)