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HomeMy WebLinkAbout94-00935 1.- . . ~ I ' l' ,1 1:.111111' (~I _/'\. ..." r' aim kl/oll'l/ as. <) PETITION Hm 1)I(OnATE IInd (;I(ANT OF I,KI'TRRS 1,: >I,Mtt Nu, c21-:- 9~ -1~.s_..___._ 'I'll: R~glsll'l of Wills (m lhe l , !JI,('.'awtl, CUlIlIly of C'~1\J.I,Q,{...\'l\MC .. III Ihc So!'illl 81'('11/'11.1' No, r ['t'l Ci " IDOl I CU1I1111UIIWCllllh uf 1'~lIl1sylYIlIIIIl Tlil' ,,~lllioll III' IIIl' 1Il1llNsigl1l'd I~sp~~trlllly r~"lc;clIls lhul: YUill pI'llIlom'I(.S), \1'1111 h/ml' IH y~lIr.s of u~ (l! old~r UIIIIl!: ~~~III.R . on _.._....._.._lIamcd IlIlhl'llIsl will ollhl'ullo\'(' d~l'l'(klll, dulcd. ,'fuh\a lq-/ 1'1 ZlO... ___ .____.._.__, 19_ nlld ~lIdidl(s) dul~d ... __.._._._._._..________ 1II.lh'll'Il'\.tlIl ~'ir,'llIlhlatl\.'l", (",g. h'lI11udallllll, tl~'illh Oll'\l'I'U!tll, ell',) 1l~~~ld""1 wusdoluldll'd UI d~alh III (l.UA-{8.ERL~N'i). ,... ('u,lIll1r! PClIlIsyIYIIIIIII, with hER. 11I~/III1JiL\; \"J'l!,lli:.i"IrJ,.1;l.:,sk~;"~f al ifNJ~R.. hi 0 83,1 NG- mf'lf:.--- ,HJ106..n("I"...\\l: 1 .'S/, U1MC HIll., P;f>r.'7~/L--_- -- (Ii,[ 'lI"l'l, Illltllb\'l lInd 1ll\Jl1dp,thl~'1 I)~~'il\(k"ll::l.h;,"}j. 'lJy~ar\\IIU~~' dl~d, .~~G,,~~Jlvrr-lo-R"-" 19j!f'-'11 III uAPr.::\<" ("oPS, 0. /TOur::: f7D 0 f\lft1"'f\f;;'CSL C:nt"IS__ 11~..J.lll EX~I'l'las follolls, ,kmll'II1 did 1I;>llllarlY, lias 11111 dll'or~~d IIl1d did 1101 hlll'c a I'hlld born or IIdoJllcd IIIi~r I'XcI'lIlinllnf Ih~ willnllcled 1'", I'lnhal~; was IInllh~ I'klllllnf II klllillg IIl1d IYIIS ncycr adJndlcatcd in~nllll'~II'III: n. __.n____n___n.._._. IJc~~mkllllll dl'alh o\l'lIed prol'I'rty wllh csllllllIll'd l'lIll1~s as follnw,: (If dOlllidled III I'll,) All p~rsolllll proJ1~rty (11'1101 dOlllklkd III I'a,) l'~r.\l1l1al proPerty III Pcnnsyll'lInla (II' IInl dlllllklkd III I'a,) 1'~(sol1l1l propl'rty In COllllly ~:::::~~~;f;:~ail~;;::::,~hll'~N~y~~a . .. nn.____.__nn.____ $.!L,sr.zJJL_. $ $ L \\'11I;IU,FOI(E, p~lilll1l1cr(') re'p~~lfnlly [c(~I~SIV~ lhc R'(Ihlll~ of thc IIISI will and codlcl\(s) pr~s~lll"d h~rcwilh IIl1d Ih~ gllllll of kll~IS.m_ ._._J.~ _1'1JJ:lILI\L..n.____ (tC~llII1lClllIU>'; IHhnllll,lrllliol\ \",1.11.; utlmlnl,"ntlun d,h.fl.C.I,il.) Ihl'IlII1, ^ 1; h R I.C'JIA ~p . D. 3HUfcyY "g~Tt.1-IARvn 1,;, SHO [:, .,,0 ~~ 'fM~~~~~~~10~H ~ ~ ~ ", V) .n.~=.~~_ ~:..-.~--_.". ._.__._.._------_..~-_.:.._._- - OATIl OJ! ))EI{SONAI, I(IWRESENTATIVE COMMONWEALTII 01' I'ENNSYLVANIA L HH COli NT\' 01' CUMBERLAND f Th~ p"llllol1l'I(S) IIhll\"'II'"n~d Slll'M(" 01 IIlfinn(S1 lhal Ih~ sllllclllI'nls IlIlh~ for~golng Jlctltlon arc trll~ IIl1d WIIl'I'I 101h,' lIell IIllht' .lInwll'dg~ ami hdld of 1'~lilloll~r(s) IIl1d Ihllllls pcrsonlll rcprcscn. IlIlil'l'(s) ollh~ IIIHII'I' d''l't'dt'lIl I't'lllillll~I(s) will wdlalHllrllly adllllolsll'r Ihc C,IIIIC IIccordlllg 10 law, S.'WOIII In III alflll~'" alld Sllhl"III1('d~. J1;n~.uL _])"~. ..n.____. _ ~ Iwlnll' 1I11'11~s .'~~',ol 1(~E, nn.n._. Il ~. ((J(4r~'trv, \.- ~'~Ji ( '-hV1. ~- ' .... .----.-.-.- ii: '~'1f 0 2:t.1:.WL<l t ( . J \ n. _U' ^ ' 'n .. . ..m...__ ~ MA~J C. LEWIS /{1',t:i\lI'1 (; . ___.__.._ ~ .;.:>4.5- I No. 21 - 94 -, 935 Estate of MARY A FRAVEL I Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW NOVEMBER 7, 19~. In consideration of the petition on the reversc side hcreof, satlsfaclory proof haYing bcen prescllled before me, . IT IS DECREED that the Instrument(s) dated JUNE 19, 1980 described Iherein be admltled to probale and flied of rccord liS the last will of MARY A. FRAVEL TESTAMENTARY RICHARD E. SHUEY a/k/a RICHARD D. SHUEY and Lellers _ arc hereby gran led to FEES P b 40.00 ro ate, Letlers, Etc, """,', $ Shorl Cerllrtcates( 2) ""."", $ 6 .00 Rellunclation '..,'..".....,. $ X-pages , $6.00 JCP 5.00 TOTAL - $ 57,eO Flied "'" ~~,~~~~~,~, ?,', ,1,~?~,."""", .' '~~&J' Reglue, 01 Will. " 7/ ! MARY C. LEWIS ATTORNEY (Sup, Cl. I,D, No,) ADDRESS PHONB ':.j c. ,(- " , .... e ) ( 'i, ".. , I" .- (:"1 1.1I 1 ~ t u; I' t ~ .. :.1 00 Mailed letters.and order to Executor on 11.7.94. I, ~ \ ' (','.'" , '. ' i,~ ,"; , II /i'!', (. '1';",'("") ;,Ji ,,) 1\\'t.":" i( ;,', 11111.11,.,., 'V.l':', \ 'trILl,'i;,,', ," ." ",:,(tll':"/ F'.\ "i;"""\\ II"""".\. ~ I,: 'I. 'I I iI',',,;'," ", 1\ .'-\ HI' , 1 'ii '1.:1 ~; ';i;'/i''.: _ ~ ;.' ,11i li,[,,; ";,',i' ~;\ll"q;, l, il' \~i\ i i~ "':,' ',. l di' ,!1 1'\"" \, .'\, \. :l,:".!.,q,-.'11 :'," , ,:.jl<1I', ,I. 11 ' 'i'II"'I-' 1'\'-- \';I'H,' ,J [","dl\"'\,:'(. " Ili:',.,dl ".Iot'-.;" I::' I'.::. -', \ ,: . ",./.1 ,~ I, '.1 \,' I ',_I~,rl ,.\:'-1'1' \ 'I'~' . ,:.1.1,,' ,I.,' ,': '\ ;".1,1 \;1).' , ,. . , '" , ! _;;.:.'t:,,",' I :"11_" r f ~' i,! ':-il"l', \, ~!. I' . I " ~ \ 'I" ~ l ~-':_\~I.<,:..,:,. ,'c,,:I,;' ,1\ \' (J.,I ilL: :(11';,1'1.'1- ,I \1\,;", , ,'.::'Ii,;:. ',..j " " , " t." 'il .' ,"il "; ,I: ," , " I,i .'\, ,: .' .1' " \\ " " 'II', " :!' 11\'1\\ '1". . " \' " -",I ',Ii" " i, ',I',' ". ,II, " ," " , ' ',,' ,\1,' " 'I" t", ',1' 'I ',.1 "" ,'. , , I" i," " " ,., " . ", ,I' " i' ," ',' ", ,,' \" ,,' ,. , I. " ", 11\ l' . f","', i ,"' " .. " ," \' , I. I' .- " " " ,'p " .. , '" " , , , \, ., " ,,' I " ., " ",," .. , , <' ' ,.' , ,. ',' , " ,. . " i',' " ,. " " ...,. " .. " " " ,I ,I II " I. I' '" " ",' " 'I ,. , ': '1\1' \' , \'1 ", I " '., , " ,," I, ,.. Ii ,'j I \ I ~ \ , " ,'; I, It I" I' "'I' " ,. , . 'I' .' .' I, " '" :i , " ," I; , , ',. " .. PQ If! , ~l ," :O<tl " , ," 0' " i!1 , " . , i~) .1' lI," .,.... ! ,i'l .':~\ ,II .",-.1 " VI ,. \," 0". .' ffi ~' ~ ~ III .:S ~ l~ ~ ~ III~ Ii r !n\~ ~ . i in a J ~ l 'i, ., 10' " .. , " , l!11 1,1' ", ". ." ,,' " .,.. .1 " , " il. " il;.,( , ... .,., 't...... ''''.." 'L ',.1 I: -~- .-.... __.,.._ __ _......... _.........~._...~_._.____. ._.... ...-.., ~____ _..,.'. ..__.'..__ _...... .___ _.. ___ __... _._. _ ._ ~-o.-._~ ! . , , ' 'OIDH", , RECEIVED FROM: RICHARD E SHUEY l5O:5 WARREN 8T LEMOVNE PA 17043 . ISTAll EJ IJ II '. ""Y'lJ"'h: , 81-1991t-0'93S aSN'17i-l0-7071 ECEDENT (LAST) (FIRSTI IMlr L MAR'LlL & ACN ASSESSMENT PI' CONTROL 11.1 NUMBER AMOUNT --HH '-. $lISa.4a _.....,...--:r---.:....,,~ , .. -..-.---0_- II TOTAL AMOUNT PAID _'__ $423. 4a _____----i__ ----.- ~,_._...~_._~ ___ _____.___......._,__;0.----,-__ {-c-l,.," \. ;-,,"'.'/,' ,- " ,." --, . '. ",I"", ,I'- -' , 1 ,. 1;-' ,.'., " , . j .\' .' \ , "1.' ,f .\ . ,. " " OtO(l 6~/ae/.,4t REMARKS SEAL RJCHARD D. SHUEV CHECt<1I ItRO!5 ' REGISTER OF WILLS . .~ . . " , . ;' 'II' . ...-- 1 ,\ " ~'f .f,4 . : I ~" '" \ \. I 'i II'~ Y" ~ -:- ,.,,~ "7:. i ""1...,.* . .' . 'IV,!lOO IX+ 17.9'1 / if.. ~'18 ,- / 1. R.al Ellalo ISchodulo AI 2, Slack. and 80nd, (Schodulo BI 3, ClolOly H.ld Slock/Porln".hlp inl"o" (Sch.dul. C) 4, Morlgag.. and Nol" Rocol,ablo (Schodulo D) S. Ctuh, Bank Oepollll & Mlscellaneoul Perlonal Proptlr'y ISchodulo EI 6, Jolnlly Ownod Proporty ISchodulo F) 7, Tran,fo" (Schodulo GI (Schodulo LJ 8, Total Gran Allol' 110101 lln.. 1,7) Q 9, Funertll Expenlts, Admlnlllralivl Cotll, Mllcellaneoul (9) -2h.....7..!:C,,~f::J ExponlO' ISchodulo H) 10, Dobt., Martgago ll.blllll.., lion, ISchodulo II 11. Talal Doducllon. 110101 lln.. 9 & 101 12. Nol Valuo of E.lal. 11Ino 8 mlnu.lIno 11) 13, Charitablo and Go'ornmonlal BoqulIII ISchodulo JI U. N.I Valu~ Subloclto Tax ILlno 12 mlnu. llno 13) IS, Spou,al Tran""'IIor dot.. of d.alh aft" 6,30,94) Set Inllructlonl for Applicable Perc.ntage on Rev.,.. Sldo. (Includo ,alulllrom Schodulo K or Schodulo M,) 16, Amount 01 LIne 14 loxablo 016% rolo Ilncludo ,alue. from Schedulo K or Schodulo M,I 17, Amount 01 LIne 14 laxablo 01 15% ralo IInclude ,alu.. ham Schodulo K or Schodulo M,I 18, Principal tax duo (Add lax from llnll IS, 16 and 17,1 19. C"dilt Spousal Poverty Credit Prior Paymenh Dilcount ------ + --.-.-- +------ - 20, If lln. 19 I. groater Ihan line 18, en '" the dllf"enco an lln. 20. Thl.l. th. OV.RPAYMINT. 110 21. If lln. 181. groal" than line 19, onl" Iho dllf"enco on L1n. 21. ThI.1I Iho TAX DUI, A, Ent" the Inl"..1 on tho bola"" duo an LIne 21 A. 8. Enter Ihe lotal 01 lIno 21 and 21A on Line 21~. Thll II th. BALANCI DUI, Make Chock Pavable '01 Re,I.'er a' Will., A,en' 1'>:.':: ,,,c. ' " ")00 IllUllnO ANIWIULL QUUTIONI ON .IYI.IIIIDI AND TO IlICHIClC MA'" " l,"'/ Und.r penalll.. of perjury, I dicier. that I havI oKomlned lhl. r.turn, Including accompanying Ich.dul" and Ilolemenls, and 10 Ihe b.., af my .nowl.dg. and b.lI.f, It II lru., correct and comple,e. I d.clare Ihal all r.al ..Iale has b.en reporlea allrue mark.1 value. O.daratlon of pr'parer olh., Ihan the perlonal r.pres.nrallv, II bas.d on alllnformallon 0 which pr'par.r ha, any ~nowl'dg,.. _ SIONAlUII Of ""ON ""ONIIll! '0' ""NO lfl"'N A'D.IIS -? OA1I ' .--SO!;f4)...ililJUi..l//l zto!&~~WQ.tt;3__~ ~DORf$S ' (' , OAT! ! I ') I \J I " 'iPcb;! 11- c1Q. q (I tV rf: ~rTlS o. DIATH A"IM 12/31/91 CHICK HIR. INHERITANCE TAX RETURN Po~::?vumDIT IS CLAIMID 0 RESIDENT DECEDENT PILi HUMin COMMONWW1H or PlNHSIlYANIA (TO BE FILED IN DUPLICATE . ..., I C7 (I 01' ~ (_ DEPAllMINf 0' '\YINUI (..~ 0.;, HAnRllfJ/J. ~~onllQ0601 WITH REGISTER OF WILLS) COUNTY CODE VEAR NUMBER o CID!~f'IHAMI IIAlf."'lT;orOM~t'I'~-" '.- . OiC!DI!lfJtP";f.tIllI\l U R<!.~(i:. Ho Me. locl~~~--_jLJ-o'lf~'Ti'~' bA1I",.""", 'J&~ ~,4nrl:p. ,)7bll J.l7. ~ /n..:16 71.__ _Cf.:.. ~jr't 10 - 2 "(j 2. \. Co JI1 .. I .____ (I' A"II'AIUI IV~VIVltIO l'OVIU ~Ul1f 11.1.". 'IUI AlI(I MIOOlf ItllllAlI SOCIAL srCURtTV NUMIER AMOUNT UCEIV(O ISI INSTRUCTIONS/ .__ _L__ *", ' , . ~ ~ ill o l. Original R.lurn (J 4, lImilOd Ellal. fJ 3, Remalnd.r R.lurn - liar dol.. of d.alh prior 10 12.13.821 [I 5, Foderal htato Tax Relurn R.quired [1 2, SupplOloonlal Roturn i~ a~ [I 40, Futuro Inler1'I CompromllO .. Ifor dOl" 0 doath afror 12012.92) [l 6, Docedenl Died T"lal. [I 7, Docodonl Malntalnod a ll,lng Trull (Allach copy of WillI .. IAllach copy 01 Tru'll . · NDINCIAND NPlDlNTlALTAX INPOllMAnC)'UHOUlD 1ilollltlC11D To.~ ',j" :",<" 'i;!'.;)h. :r,a 1;) I' ~ u ~RS2 StiJlLi't C M "_b7S AOtJ~ R R 8J sT TIL!PH N~~ - _ - -.--- I ~An)l.'Y'ilE PP, 176<f-3 ~~~~ ~IV(VJV I . _ 0, '(alai Number of Safo Depo,lI Box.. z 5 I 111 -.-c---.-.-.--.---- 12) .___._______ 13) . (41._______.___ IS I --.fl'J.Z...&.:2 (61___.___ 17) (0 ) 973s,o'3 (10)______ 11I1--2.b7l.J., ~~ 1121 -2QS-2JS 113) . 1141 -.':ltJ.s7. } ~ 1151_____._",_.. 1161_7oS.Z Is___" ,06. _.!t.23!.Y3 s I 1171 ___ " ,IS. (181 _ Lj;z.3 l!.j?> Interlll a (19) . (201 (21) _._~ 2.3, If3 (21AI . (2181 ------q.2,3,'l-3 __ \. ~. ". 1''iUII u. 1'''11 . SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS F.XPENSES COMMONWfAl1H 0' "NN'VlVANIA INHIRIT'NCI lAX REtURN RI~IOINI OICIDINI ISTATI 0' _ffin ..f.MVE.L ITEM NUMBER A, Fun.ral Exp.n..., 1, Plio" Print or TypI 1: NUMBER DnCRIPTIO~1 HEt.:' FUNERAL.. HomE INC, R\ll<.;;A. BROTI\f?RS FLORIST KEN GIBso/'J'('fmETffl.y LfTTeRING 0,,", mAR~6R 1. B. Admlnl.tratlv. Co.hl Pellonal Repre.enlatlve Commllllons Soclol Security Number 01 Personol Reprusentatlvei Year Commissions pold ~ __ ~ 2, Attorney Foes 3, Family EXlmptlan Claimant Relatlonlhlp Addrell 01 Claimant 01 decedent's death Street Address City .4, Probate Fees C. MI.e.llanlou. bpln..., ,1. 2, 3, .4, 5. 6. ,/, 8, Stale __. Zip Code ' F~TlTi'o^' Po R SHo RI CERTt'FiC5\TE flL! ~ G- PEt:.. TOTAL (Also enter on line 9, Recopltulatlon) (If more .pae. I. nlldld, Inllrt additional .h.... of .am. .111.) , .i'_.---r:;....~~;~"';~-.~;~.......,~l.'. :.,'.....'... :;'r~'. ~"., i', .. AMOUNT aLf-77,7& qO,lo 35..00 57,00 15,00 s 2~ 7 If, ~ ~ I , . . J 1'''.''131'' ('.1l1 '* L~CHIDULE J COMMONWIAUH 0' tlHNsnVANIA BENEFICIARIES INHII11ANCI tAlC IUUIN IIIIDlNt DleIDltn ISfATI 0' PILI NUMBER -.fRflV.fL. ITEM NAME AND ADDRESS 0' BENEP1CIARY RELATIONSHIP AMOUNT OR NUMBER SHARE 0' ISfAY! A, Taxablo Boqllllll: '/0.. 1, PA u L.. R., 5 H UE: Y GRAI\JOSoru 50S WARREN sTREET LEinO "/ Nt: PA, no Ifj 1 JRfflES c . S/-IuEY (,f\ANOsof\) 'I~ 50S WARREN STR E ET L.EmO,,/NE \ PA, nO'If') , " ',' ITIM NUMBIR ' NAME AND ADDRESS 0' BENEPlCIARY AMOUNT OR SHARE OP 1ST A TI " ,B, Charltablo and Gavernmontal BoqulI'1: 1. " ; I' '" , , TOTAL CHARITABLE AND GOVeRNMENTAL BEQueSTS IAI.o on'" an 11"0 13, RlCapllulatlonl $ (If mort 'paco "n.odod, In,olf additional ,h.." of 'amo "ao' ~' I / 5,t1L\4 -\ ~V01!l47 EX AFP (12094'. V COHttOHWEAl HI Of PEHNSVlVA~I'" DEPAR1HfNl OF REYENUE lUAUU OF INDIYIDUAI. TAWES OEPl, 110601 . HARRISIURD. PA 11111'0601 NOTICE OF INHERITANCE TAM APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAM ACN 101 VI 6'(- Ill.JtIS-11 DATE 02-21-95 FILE NO. - 935 DATE OF DEATH 09-20-94 COUNTY CUMBERLAND NOTE. TD INSURE PROPER CREDIT TD YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YDUR TAX PAYMENT TO THE REGISTER OF WILLS, HAKE CHECK PAYABLE TO "REOISTER OF WILLS, ADENT" REMIT PAYMENT TOI RICHARD SHUEY 505 WARREN ST LEMOYNE PA 17043 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 f=.l!'ount ROMlt!!! CUT ALONG THIS LINI! .... RETAIN LOWER PORTION FOR YOUR RECORDS .... iiiV': iiwoiiC" AFP" i 12':941" -NoYi c r "OF" "iNHiiii;: ANCi" YAir A"p fiiiiiis iHENr; -A L'i."liwANCi" iili'" - - - -""..."""".." DISALLOWANCE OF DEDUCTIONS AND ASSI!SSMENT OF TAX ESTATE OF FRAVEL MARY A FILl! NO. 21 94-0935 ACN 101 DATI! 02-21-95 , TAX RETURN WAS I (X I ACCEPTED AS FILED ( I CHANGED RI!SI!RVATION CONCI!RNING FUTURI! INTI!REST 0 SI!I! REVI!RSI! APPRAISI!D VALUI! OF RI!TURN BASI!D ONI ORIGINAL 1, Ro.l E.toto lSohodulo AI 11) 2, Stooke ond Bond. (Schodulo B) (2) S, Clo.oly Hold Slock/Portnor.hlp Intoro.t lSchodulo C) (S) 4, Mortgogo./Noto. RlcolY.blo (Schodulo DI (4) I. Co.h/Bonk Dopc.lt./MIIC, Porlonol Prcporty (Sohodulo E) IS) 6, Jointly Ownod Proporty tSohodulo F) 16) 7, Tronl1or. (Schtdull 0) (1) a, Totol A..tto ,00 .00 ,00 ,00 9.732,03 ,.QJl., ,00 la) 9.732,03 APPROVI!D DI!DUCTIONS AND I!XI!MPTIONSI 2,674,88 9, Funorol E.ponl../AdM, COlh/Mho, E.ponl.. (Sohodulo HI (91 10, Dobh/Mortgogo Llobllltlooll,lonl lSchodult I) (10) ,00 11 , Totti Dtductlon. Ill) 12, Ntt Vtluo of T.. Rtturn (12) IS, Chtrlt.blt/GoytrnMtnttl Btqu..tl ISchtdul. J) (lSl 14, Not V.IUt cf E.tott Subjtot to T.. (14) NOTI!I If.n ......m.nt w.. i..u.d pr,Yiou.~y. lin.. 14, 15 and/or 16. 17 .nd 18 will r.fl.ct figur.. th.t includ. the total Df a1h r.turn. ......id to d.t.o AS91!88MI!NT OF TAXI 11, Aoount of Lint 14 ot Spoulol r.to Ill) 16, Anount of Lint ,4 to..blo ot Llnlll/Clo.. A r.t. 116) 17, AMount of Llno 14 to.obl. .t Coll.t.roI/CI... a rato 117) la, Prlnolpol T.. Du. TAX CRI!DITSI PAYMENT DATE 11-29-94 ',/"74 AA 7,057,15 ,00 7.057,15 ,00 K ,03. 7.057,15 X ,06. ,00 X ,15. Ila) ,00 423,43 ,00 423,43 RECEIPT NUMBER MM913228 DISCOUNT INTEREST (+ ) (-) 21.17 AMDUNT PAID 423,43 TOTAL TAX CRI!DIT BALANCl OF TAX DUE INTEREST TOTAL DUI! 444,60 21. 17CR ,00 21,17CR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, IF TOTAL DUE IS LESS THAN .1, NO PAYMENT IS REQUIRED, IF TOTAL DUE IS REFLECTED AS A "CREDIT" lCRI, YOU HAY BE DUE A REFUND, SEE REVERSE SIDE DF THIS FORM FOR INSTRUCTIONS,) ,. .," p~ g. " . (\l") .., j " 'j/ . _ I., t;!'1 l" " (') (I :,QC: ....;4 t'A, ~ ~ i!-:!l a .'..l r-.> :n::l:! l~~ ~ , ,.....(.1 n;' ("\; . ',: I'" .... :i;, :'.; ifi"~ ..... Rf.IRYATIOHI EI,.t'l of dlCldlnt. dvlng on or blfor. Dle'lb,r 12, 19.t .. I' tny future 'nt.r..t In thl ..tet. I, tr.n,'.rr.d tn pO....llon ur .nJoYI.nt to Cll.1 I (0011,t.rel) bln.fle).rl,. 0' thl dlCldlnt I't,r thl IMP'r.tlon of tnv I.t.t. 'or 11'. or for YI.r., t~ Co-.onw"lth hereby IMpr..,lv r'..r~'1 thl right to IPpral'l end I"'" trln",r Inherltlno,'t'M" It thl lawful ell.. I (col1.t,ral) rtt. on InV luch future Int.r..t. PlJAflOSE Of HOTlell To fulfill thl requlr...nt. of Station 21~O of thl Jnhtr't,ntl .nd E.t.t. TOM Aot, Act 22 of 1991. 72 P.'. Stotlon (!1~O. PAVHI!HTI D,tloh 'h, top parHaM of thh Hotlel and tub,it with your ply..nt to the Rftlllltlr of Willi printed on the rlva,.1 lid.. '-N... chock or .cn.. ord.r payabl. tCl REOISTER OF MILLS, AOENT All Ply"nt. rlcalvld .hlll flrlt b. appll.d to any lnt.rut which .ay b. dua with Iny ,,"lndar applt,d to the tllC. REFUND (CRll A r.fund 0' . tlM arldlt, which w.. not r.qul.tld on the TaM R.tyro, ..y b. r.quI.tld by coapl,tlng an "Ap~llcatlon 'ar RI'und 0' Plnn.Ylvanll Inhlrltancl .nd E.tltl Tlk~ (REV.1313), Appllcatlonl ar. IYlllabl1 ftt the Offlal of thl R'lIl.t.r of Willi, anv of thl 2] R,ytnUI DI.trlot Of'lc.., ar by cllllng thl .p.clll 24.hour tn.warln, .,rvlo. nUab.r. for 'ora. ord.rlngl In Pannlvlvanl. 1-800-]62-2050, uut.ld. P.nn,Vlvant, and within looal H.rrltburg .r.a (117) 787-8094, TOOl (717) 772.2252 (Hltrlng lapalr.d OnlY), OBJECTIONSI Any part~ In Int.r..t not .ltl.,I.d with the .ppr.I....nt, allowlnca or dlllllowlnol of d.ductiont, Or ........"t of tak (Inoludlng dl.count or tnt.r..t) I' .hown on thl. Natlcl IU.t abJ.ot within ItMtv (60) dlYI 0' rlo.lpt 0' thlt Notlo. bYI "wrltt.n prot"t to thl PA Olp.rt.."t 0' R.YInY., Board a' ApPIIlt, D.pt. 2UOZI, Herrllburg, PA 11128-1021, OR: --.llotlon ta h.vI the ..tt.r d.t.r.ln.d at audit of thl aacount af the p.r.onal r.pr...ntaUy., OR --"p.ll to the Orphan.' Court. ADIUM ISTRATlYE CORRECTlIlN1I 'Iotulltrror. dl.oov.r.d on thl. ........nt .hould be .ddr....d In wrltJno tal PA D'Plrtatnt of RtVtnut, Bur.eu of tndlvldull TIMI', ATTNl POlt A..llllent Revllw Unit. D.pt. 280601, H.rrl.burg, PA 17128-0601 Phone (111) 7.7-6505. S.. paDI ] 0' the book lit "Inltruetlan. for Inhlrit.ncl TIM R.turn 'er I R..ldlnt D.e.dent" (REV.1501) 'or an IMp'lnltion ef .~lnl.'ratlv.IY corr.etabll Irrara, If Iny tlX Out t. Plld within thraa (]) clllndlr IOn'h. aft.r tnl dla.d.nt.. dlath, I 'Iv. p.ralnt (S~) dlloount 0' tha hiM paid 11 allowed, DISCOUNT I INTERIITI Intlr'lt II chargld baDlnnlng with flr.t dlV of d.llnqu.ncv, or nlnl (9) .onth. .nd on. (11 day fro. tha dati of dilth, to tilt detl of plye.nt. TUII which bIa... dlllnqu.nt b.for. January I, 1982 bl.r Jnt,rllt at tht rlta of .Ik (6:<) p.rc.nt ptr .nnuI ellcuht.d It I dlUy ratl nf ,000164. All tlMII which blo... ~.Ilnqulnt en 'nd Ift.r J'hUWry 1, 19.2 will b,lr lnt.r..t at I r.t. which will vlry frol e.llnd.r VI.r to elllnd.r y.ar Mlth that r.tl announold bv thl PA OIPart..nt 0' RIv.nu., Th. .ppllclbl. Int.r..t rata. 'or 1982 through 1995 .r'l t!!r Intlrtlt Rat. ~tntlrllt Fllotor !!!r Int.rllt R.t. !!!h Int.,lIt raotor IUi! lOX ,OO054S I'll 9% ,OOOI~1 I'&! 16X ,000\11 1'''-1991 I1X ,000301 I'I~ 1lX ,000301 1991 'X ,ooom 1'15 1!X ,OU0l56 1993-199\ IX ,OOOl9Z I'" 10le ,ooom 1995 'X ,ooom ulnt.,l.t I. elleullt.d I' 'ollowlI INTEREST . IALANCE DF TAX UNPAID X NUHIER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notle. Iuuld .ftar the tlM bleo... dtllnctUtnt will nfl.et an lnt.rllt calculation to fllt.an ClI) din beyond tha d.tl of thl ........nt, If' p.vllnt It ft,d. nfter the Intlrllt OOllPlItltlon dati lhown on the HoUCI, 'dcUtlon,1 Intartlt .u.t bl e.leulattd,