HomeMy WebLinkAbout94-00941
,"
I'. Il
'if'
q'
"
"
.
.' '.I
'"
",
.'1
.
,!'
,;,'
,/....'....
,t/ililt,'"
,,'"
, '
, '.. I ,'~ I
"I
,',
.li,.I' ',,",(
';~.,,\, ,,' '>':, j. :,\.';,:_;:.,..;'.\,~j" d ~i:.' i
'J.'1"lol;,\o",,,;':',I'\J..::J.1.I~,,'tli-',J,~toi~'
,:1.
")1.'
t.-...
PETITION .'OR PROBA n: and <mANT 0.' LETTERS
Estate of ~lol~)tl~L~!~[)m'~~_____'_m..__ No, __oIU!{::...i!f I
also known a.l' _____._._._______.....__.._......_ To:
_________.__......__._...._...._. Register of Wills for the
._ ______., /)1'cru.\'('(I. County of ClUlllX'rli1ncl In lhe
Social Sel'llrlty No, . 194-22-G48B ___.____ Commonweallh of Pennsylvania
The petltloll of Ihe undersigned rcspectfnlly rcprescnts that:
Your petilloncr(s), who Is/arc IR ycars or agr or older anlhe execulRlX
In the last will of the above decedent. dated __.-,!~llY__2],,-_
and codlcll(s) dated ______
named
,19!i.!L-
(~lnIC rclc\'l\1ll clrC\llmlIIllCC~1 c,~. rClllll1chulon. llcl\lh (If executor, etc,)
Decendenl was domiciled at dealh In_~LUlllX'rliln~ County, Pennsylvania, with
It 81: last fqmily or prlnclr.ul reside/Ice III IJethi1ny..Yilli1Qc
J25 Wesley DnvQ, ~lccllilIllCsb\lrLJL. PA
(Iht meel. numher nnd 11l1l1lcipnllty)
Decendept, then lL_ years of agc, died.. OctolxT 8, 19 94
at flet.han'y' Vm'l99, [.o\',\Jr Allen 'townshi.p, C\ullbcrlmld County, PA .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
Incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled In Pa,) All personal pmperty
(If nol domiciled In PlI,) Persollal propcrty in Pennsylvania
(If not domicil cd In Pa,) Personal property In County
Value of real estate In Pennsylvania
situated as follows: .....l1~11IQ. Chilm!Y"-shllrg,
$ 60,000.00
$
$
$15,000.00
PA 17201
WHEREFORE, petltloner(s) respectfully request(!} ,he prob~le of the last will and eodleil(s)
presented herewith and the grant (If letters--2f I\clmllllst.l:atnx, c. t..il.
(1C'lamenlnr)': admlnlllrailon e,l.a,: admlnhlrailon d,b,n,e,I..,)
theron.
h
lij
-:I..
i's
J
/), ;:~t;'!t-"tl.. ,<"<,1,,/' /. T-
~ (/-{. If":''l'''-
/n/drt!.lj,,:. J;'kC:U;"
'J;1f (v, ,,'~r DI-c/~
-/)l"{').nll/~j-'- }J~ /'IMi'
(>YI-c>;"7/
OATH 0)<' PERSONAL REPRESENTATIVE
COMMONWI<:ALTH m' PENNSYLVANIA }' 88
COUNTY OF CUMBERLAND
The petltloner(s) above-named swear(s) or arrlrm(s) thatlhe statements in the foregoing pelition are
true and correct to Ihe best of the knowledge and belief of pelltloner(s) and th~t as personal rcpresen.
talive(s) of the above decedelll petitloner(s) will weil an,d, 1T\~IY,admlnl~~,.,the estate a~o.rdlng to law.
Sworn to or arrlrme~ fill subscribed. /;e i <<url. ,/). ,.....//.., ) '~l--. ~
before me this .6 day Of~_LlL.L.LD"i' /'f /"" I;t- ... '!S'
, ~, ' -iIJJ9 gq .-'l........-. Ii
.' ~LU_"^" ~JJ~. :i~ I
ARY C. LEWIS I ~R;';J;:;,: 1/4- ~
,I..J.- ~Jl/f)- '1
This is ((J l'l'rlif~' dwt lIll' illformatioll hut. ~iV(,11 ;:\ (t1l1'{'1 tly rilpit'd 110111 dll lIriglll,d It,t'liliralt' (If dl.,<llil dtll~' Illt.d with IIll' llS
tuelll (tl'gislrur, 'I'hl' OII.4ill;\1 ("('nUit-,IIl' will Ill' flllWill'dl'd tll lilt' .~I,Il(' "it,d [(('nll'do; ()!fin' fol' "l'! Illal\('lll fill11~.
WARNING: Ills Illegal to duplicate this copy by photostat Clr photagraph.
!I,'(' rc\r Ihls {('(llfkll"', $2,00
,) " ) /2 /) I
'-71<<C.,~,rt{.f;;~I~lchc:_~
2587559
~-__.___..._..__ _._._.. _.___... _...1.
No,
/(J.::a:,:: /"/f.,z_..__.
D,III'
"
i'
('..
.....'"7
CONMONWE!At.tH 0' P''''NSVLVANIA' OIPAnTMIiNT 0' HEALTH' VITAlAECOROS
OERTlFICATE OF DEATH
''''''..fo,l....~
~THY l~ DAVIS ____...0 - -- ..-_.-....--:i1;-.ma~. J~("\~~1~~~iA-:.. ~4a8 ~l1~~;~ll;'t'?-~~;-.
_.-- 1!k.;- ..-'J:, !.~.', ~\: ~i;'.WIlI< r+ UII,lS'\ ;','r;-,;;;I.- '~ll".I.i.i~r'~.":;-:;--.~~:'.~-.'~_.......~1 __r----.u._._..__~~_~L ~.~~.~-~..
...... Itvt"""'" .' . , """ ,,~ ,t """""., >O(lVIt-l, OIHf... . ,
74 v" JUOlJ 20, 1920 DQn/lld~on, Pd, ""'*.....11 .~.....(~ 001.(1 ~r{ "--41.1 1,:'..,1)
':;..:'~;~n";~:, Ti';;'~~'~'::~;Jr;~~:;=--'--"--T=K1'~~::-~=];Cr~:~t7' ~;"..,
1iiiTI'iii~;iin; "-k'l;iTI(;Ht~fjf.".~ tiIiOlHI t1t<<4or.1 ] l.Wll\l.l.tT"'llI1llhll~ - ~, \V'Mvffiwi;';--'"
..=t.=:'.a:r...:l:l'r - -----. U\lI'IVllO'(fi;'" 1~::"!J.::'::"'~J"IIt'~~:l-- ~~....~:~ ..-,"'.......'.......,
ltlch4r I Education II" 'n II "'1, 4 .""\,, t
WUCI.,... rw-l....b-'t~;;;:-;-.. -Elb~~"-. -lfl'WO ~pl)~;I\;iyanla _ ~_4_~.:' .. ----.;[l...;:;-~~~~~=-=~=~=.~~~~~-=:-=~~
1151 Scotll"d Ave. ~"::.~.... :::'
C~lIbtrlbu"91 PI, 1720J ...~....."" franklin -., ~............. Ch'IlI~!!',lblJ!q
-- .._.____.l~.'".'!I -.- _I' . 'u . --...--. .._.-.~
.........l~ 1MI1'..Il..IO....I',.....WrtiII"""~
Ha 1d E. R~~~_..._.__..~_____..._ H____ .-.-. ~~'tV.IAIn..IoW,HI~~'i;IO(''''''1
ttl J18 Wlster CIrcle Hechantubur Pa. 1105~ ._____.
01j.ijTi7i7"""~\ij.,,' - -- .-~I41tOfl1tI'O"lTOI,"-oIC_....c:'..._1 wr ~ ....;..~...r..c_
c...D .............[.1 "'....1..,..., ..t....."'-,
~":.."_:..-=-~ 111I_ O:t~_.I_ZI 199~ , III,. ..O~~4~~~~~_C.!.met8!.L.. _Utl. Oonald,on, Pa. _ .___.
";r...U..'......ll FK'~ fl-l\JU'lfl1 J~"'lIlflI.rorlU.'orIN:lf,'rv- JJJ ralllllQ Spring Rll
~ " :..."'"!:~. ___.. .1.", _ ro QIZlJ64. . _~ .__ .'" _'h_O:!"!\ L:.....-G,!lsel f.!!.~~41 H~ nc. [ha~~~~~h.r~~_.
-... =t~;;o>':.l,_.. ...",,,..,,, "'f, ......,,"..,.., E"'''...... :i.....
................. ............ ~. ~ ~ (., . ~.... .., f"l I
.......--...... LdlJll.l I'" I I ~).., ,< I) 't";ll'r ( I' ,']l
..............:.. t..- (l1l,~ ~-" )::Hi,.~~K-'t7('~7~;;:; ,-"~;,, 111 ffl' PF"'H~R'D1tJ:iiIIIAIofOJff I~ .-J__.__
'L__I __ ._ _ .,_ ._.1_. tl-__. .....~ ____
-... ..,............................~tI......""'.....~,Io...... ..'..,,,... ".. I"" ...,I" .1'............1...1..,....1..... ~........ ..IUK ~...........(fe.........-hftoq.._"""
l."",...IoIIIIiII"_~~ 1--"'_ ............."...............,...._"'''''11
1-...-
--~..... l
=~:="_ ._-----...\fl~_IJI~n:~.y:-: __moo _._.!-_._______.
Il..MIO...lf~'HU>'\lIH..t(ft 1
,
==-.... 11~--U-.DO..iJ~;,rAf~ri.r,i(Jiii;i.U,-- . .. ---..--t-- ---~.--
===~ '--tili.u~l;HiTriiiijO~..lljl.- ...-.._..-..~.._.-t---~
.. -':1:"-" ;..!;~ ' .'. .. , _... '.... 1_.
~~~J' ::""";' -... II '~:'.~~,~,~i:;i,";';"'i"; . '~";:":'~1-1""_" iiiM'nl""'IV/lY(li7.,.;,,- ---.....
.......... II .......r.q~..,., (I
... O,..,n< .. 0 .., n ...__ I-I (........,......._., r1 m(,'il';;ii'.il'-li;.:;;..,;.~;;.~...~_IDI'J:(('-~""(~___----~-.. - -._~--
~ ,...........j..f,\
_" tk . .
o-rl'tmll ----.-.-. _...~.- ~-...... - -. l.ItI_ --;HOiiiiii-.rCfii"rT)' ~ ....- -, .----
, ~~..(~Ie.a'""........"....It..,...lh..,"",..,I"""f..I'.......,'..'....,-' II (. /J"$"~'
.._.....,'-..........._IIf'IM_..tl4I~.tw_'''..II", U ~ I~.. .J.A.t(~_-'_"::~C -- __..___ _...___.
1(ii;i"Q " =t 1)1....''''.'''."
" ~NIIla,"lJ\"IIa,"'IIC~n.,"'''h'' ...".c<'l......._'j,..,........ ,,,.,j,,,,, fA l" A. ') O((~':;'I Y? ~ '" (1.~ 1-,/,. I.~_I._/_~_"I/
,..........,.............-............-.... ........ .....,,,,,..........II.........""""f'''... , " 1jJ,.;;{;.',~i;(#---;.--lJI.MiltfNl1.fl1(l~OIi/-(-mi -
1...~',l'''''.'tIII( 17,t(~(V(1 C (Affj',!
.lft...,~,...I,..u"n..flt""I.....,~I.',.....',I(,.......".'.tNl...tll.ltlIII [I iI/( tV 11 ! Sf f'l
Z' ::~.- .. . --.__._~. L4l/l."!l'...d~t.!L( '1O'L__.
r <1 ,., .. '"
.. "-L-..... u~~~~k'..!.." Y: ....d./LY...t'_____.___.....
"..
C""l.~d
:~~t:~:~7.;J}t~I;.~~~'-"~~..
~_..
. 5'l.\~~~\
CERTIFICATION OF NOTICE UNDER RULE5.6(al
Name of Decedent,
Date of Death,
Will No.
Dorothy I~. [),wis
October 8, 1994
Admin. No. 21-94-0941
To the Registerr
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to
the (allowing beneficiaries o( the above-captioned estate on
March 7, 1995 ,
N!!.!lli!
Mildred L, Shatzer
John C. Davis
Address
318 Wister Circle, Mechanicsburg, PA 11055
7545 Route 32, Columbia, MD 21044
Notice has now been given to all persons entitled thereto under
Ruie 5.6(a) except None
Date, March 7, 1995
\0 58:
.- ':'t
r.J -"1
~ (.J
':'r.~ C\.. ()
11-" 0
." ,.. .l
"
<; '..1 0
, ~ .J
'11 ~ "I
l') " ~ :.c:
l".. "
0 In .W
~&! ~ 'a
iii .
a: (3
~~~~///
~
Signature'
Name William A. I\ddams
Address 28 South Pitt St.reet
Carlisle, PA 17013
Telephone( 711 249-8300
Capacity:
Personal Representative
Counsel for personal
representative
x
I.
2, Supplemontal Return
U. FUluro Inlerest CoTf4)romloo
(lor dales 01 dealh after 12-12-82)
rn I, Decedenl Died Testale 0 7, Do<:odonl Maintained a Uvlng Truat
Attach co of Will Anach a co 01 Tru..,
8 P ALL CORRESPONDENCE .\ND CONFIDENTIAL TAX INFORMATtON SHOULD BE DtRECTeD TO:
R 0 NAME COMPLeTE MOILING ADDAESS
G ~ William A. Addams Fowler, Addams, Shughart & Rundle
S ~ TELEPHONE NUMaEA 28 South Pitt Streot
- T 717 249-8300 Carlisle PA 17013
1. Real Elllate (Schedulo A) (1)
2. Stor.ks and Bonds (Schodule B) (2)
3. Closely Held Stock/Pannorshlp Inlorost (Schedulo C) (3)
4. Mongag.. and Nolas Recolvablo (Schedule 0) (4)
5. Cash, Rank Deposits & MI8C9l1anoous Personal Proporty (Sch, E) (5)
I, Jolnlly OWnod Property (Schodulo F) (6)
7. Trensfers (Schodulo G) (Schedule L) (7)
I. Tolal Gross Assols (10101 Unea 1-7)
I. Funoral Exponses, Admlnl.lraUvo Cosls, Miscellaneous
Expens.. (Schodule H)
10. DeblS, Mongago UablllUos, Uens (Schodulo I)
11. Total Ooduc~ons (10101 Un.. 9 & 10)
12. Net Value 01 Estale (Une 9 minus Llno 11)
13. Ch8Iltable and Govornmonlal Boquests (Schedulo J)
14, Net Value Sub ectto Tax Uno 12 minus Une 13
15:. Spousal Tra~ers (Io'~~~ 01 dealh after 6-30-94)
,-se"lnstruc~ons lor Ap/ll6able percontage on page 2.
.... (h
(Incklde valu. from Sche~ulo K or Sohodule M,)
11. Amount 01 UI\614 taxable 016% ralo
llnclude val$l/ lrom Schodulo K or Schodula M,)
17. 'Amounl of Utw 14 taxOblo 0115% roto
(Include valJa Irom Schoqulo K or Schodule M,)
11. ~I~pal tax ~~e iAdd tax(~om Une 15,16 and 17,)
11'8!d4Us/Sp P~~rty PJIlIr:Baymonls Discount
+ ()() +
20. II Uno 191s gr.aler than Uno la, ontor tho dlfferonco on Une 20, This Is the OVERPAVMENT,
00 0 ~sre 11 you are roqueallng a relund 01 your ovarpaymenLI
21. II Uno 16 Is groalor Ihan Llno 19, ontor tho dlfferonco on Uno 21, This Is tho TAX DUE.
A. EnID! tho Inlerest on the balanco due on Llno 2M,
B, Enter tho tolal 01 Un. 21 and 21A on Line 21 B, This Is tho BALANCE DUE,
Make Check Pa abla to: Re later of Willa A nt
~ ~ BE SUIlE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH .. ..
Und.r pln.llI.. of Plrjury, I dicta,. lhall hlY. lIl.mln,d thl, "lurn, Including llCCOmpl"ylng loh,dulll.nd 1111.m.nh, Ind lG lh. but of my knowl.dg. Ind b.U.f, Ill.lru.,
corftct Ind compl.t., I d.cta,. lhlt ^""II..III. hu b..n "porl.d It"U' mlllt.l vIlu., O.cl&rllJan 01 pllpa,., alh.r lhln th. p.rlonlt IIp,...nllllv. la bl..d on IUlnfafmlllnn 01
which pr'pI'., hu any knowl.dg..
C A 8
~PL
c~g
K 0 K
P B
FOA OATES OF (JEAHI MTEA 12/31/;1 CUECK HEAE
IF A SPOUSAL
C C AI
FILE NUMBER
REV.. 1100 EX '('-'41
Jy- Jl!5'P'
INHERITANCE TAX R!:iURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS
Cmlf.'TY COOE
cOM~m~~W~'lf~:~lWIl'b~ANIA
HARRISB6~g,V~ 1,12..~eol
D
E
C
E
o
~
OECloENrs NAME (LAST, FIRST, AND MIDDLE INITIAL}
Davis Doroth M.
OECEOEfjT'[J COMPLETE AnDRESS
Bethany Villllgo
Mechanicsburg
SOCIAL SECURITYNUMOER
194-22-6488
CATE OF crATU
10/08/91.
CATE OF OIRTH
06/20/20
County Cumberland
(IF APPLlCABLEISURVIVINQ SPOUSE'S NAME ILAST.FtnST AND MIDOLE ItlITlAL) 80CIAl8ECUnITfNUMOEn
X 1. Orlglnal Roturn
4. Umi1.d ESlale
o 5.
o I,
R
E
C
A
p
I
T
U
L
t
o
N
1,908,07
17,519.04
(9)
10,133.90
(10)_
3,743,17
(15)
0.00 X
(16)
~
t'Ji
V
21-94-0941
'fEAR
NUMBER
AMOUNI RECEIVED{SEE INSTRUCTIONS'
Remainder Return
(lor dates of death prior 1012-13-82)
Forloral Eslate Tax Return Raqulred
Tolal Number 01 Safe Deposit BoXlII
(8)
98,898.69
(11)
(12)
(13)
14
13,877 ,07
85,021.62
85 021. 62
.
0.00
85,021,62 X .06.
5 , 101. 30
~
(17)
0,00 X ,15 .
0,00
c
o
M
C
I
!
N
Inlero.1
(18)
5,101. 30
(19)
(20)
0.00
0.00
0.00
5,101.30
0.00
5,101. 30
(21)
(21A)
(21B)
Mildred L, Shatzer
318 Wister Circle
it;"clia;{{~sb"ur-- - -PA" " "i7iis5........., "".."..."."..
Fowler, Addams, Shughart & Rundle
28 South Pitt Stroot
ci;ii i.i;i~:' 'PA" - -ijoi"3.......".."..."."."" -"..."...
OATe
.r,3j /91"
DATE
RIV-\I0IlX. 111-111
COMlIIllnftm4\Wr.ANIA
, E8TAT! Of PILE NUMBER
Dorothy M, Davia SS~ 194.22-6488 10/08/94 21-94-0941
(P,opt/1y Jolnl\Y-owned willi Righi of 8urvlvollh/p mu.t... df.clcHd on Schedul. 1') All ,..I ....t. .hculd.... reported It fllr IIIIIllII vllllt
which .. cIaflned u lit. prloa I' which PfOparly would'" ..ch.nged ...twaan I willing buy.r Ind I willing Hllar, nalIIttr ""Ilt oompalltd to
b or HIt bollt hlvln _nabl. kn of lit. ,Ill,vlnt flcla. .
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATli
1 Principal residence, 1751 Scotland Avenue . 78,918.40
Chamberaburg, FA, improved with single-
family dwelling houae, Value based on
aale price and aold by Executrix on 1/30/95,
SCHEDULE A
REAL ESTATE
,.
I'
"
, 1
"
"
"
','
" '
p'
, ','
, I'
,"
"
I-
I'
"
.'
"
j
, I'
, , "
.., "
" " " "
, 1 , ,
I.'
I'
. 1
"
I,
, ,
,/ ,
TOTAL AI80 .nl<< on Mill 1 Rill Ilulltlon
(II mort aplClla needed, II1IeI\ Iddltlonll.heel. ol.ame alte.)
..,~~~~~~~~,!~'~Jnl"',.~,f!",'~n'l\~"r~~..!.~..I". '\':"
." ',' '~I,' (1.'../.' \ '., ., ,. \ .',:'
"',' ','1,' }\!','," ' ." ,,' .
.
78 918.40
RIV -1I01lX + III-Ill
COMlIIll\l~~{\~W~~AN~
SCHEDULE F
JOINTLY-OWNED PROPERTY .
. ESTATI! OF
Dorothy M, Davis SS# 194-22.6488 10/08/94
Jolnt lInant(l)i
FIll! NUM8l!R
21.94-0941
A.
NAME
John C. Davis
ADDRESS
7545 Route 32
Columbia, MD 21044
RELATIONSHIP TO DECI!OI!NT
Son
8,
, c.
,
Jolntly-owned propertyl
- IJ!T1'ER ..
ITI!M DATE TOTAL VALUE DECO'S ~VALUeOF
FOR MADE DESCRIPTION OF PROPERTY
NUMBeR JOINT OF ASSET " INT. ceDENT INTEREST
TENANT JOINT
1 A 09/01/71 IValleybank, Checking 731,41 50.00t 365.71
,,"coount No. 001760214
~ccrued Interest 4.87 50.00t 2.44
2 A 09/01/92 Ivalleybank, Passbook 34,279,80 50.00t 17,139.90
Savings Account
No. {1600460278
.
~ccrued Interest 21. 98 50.00t 10.99
I
.
'0, , 0
" . "
,
, "
0
" ,
" ,
"
0 , 0
,
0 0' "
,
"
0 " '. "
.. I,
, ,
0
- TOTAL (AJao enter on Mne 8, ReclllKulallonl 17 519.04
(II more tpl108 II needed, IIlI8It addltJonallheetl of lame allo,)
I
'I
'I'
I!
"
,
,
I
. ~
t/
/ 'I ~ 115 .- "l
~/
RIV-1147 IX APP (12-941*
t_ALTH Of P1!NHlVLVAIIIA
IIlPUTItENT Of Ilt:VENUE
IUllUU Of IMlIYIDUAL TAXEI
IIlPT, 1~"OI
HAlllllllUMO. PA 1111A-D601
DTATI OP DAIIIS PILI NO.
DATI OP DIATH 10-08-94 COUNTY CUMBERLAND
MOTE. TO I",U~E P~OPE~ C~EDIT TO YOU~ ACCOUNT, SUlNIT THE UPPE~ PO~TION DF THIS FORM WITH YOU~ TAM
PAYNENT TO THE ~EOISTE~ OF WILLS. NAKE CHECK PAYAILE TO "REOISTE~ OF WILLS, ADENT"
REMIT PAYMENT TOI
NOTICE OF INHE~ITANCE TAM
APPRAISENENT, ALLOWANCE OR OISALLOWANCE
OF DEDUCTIONS AND ASSESSNENT OF TAM
ACN
101
DATI 07-24-95
WILLIAM A ADDAMS
FOWLER ETAL
28 S PITT ST
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAHD CO COURT HOUSE
CARLISLE, PA 17013
Aoount R..I U.d
l
:1
CUT ALONG YHIS LINE .. RITAIN LOWIR PORn ON FOR YOUR RECORDS ~
itiV: Ui;i'f"iif"AFP"f1z-:ilij'iloYici"o,.i"NHiiiiTANCi'YAil" APP AA"iiiiiiilr;.,m..owANci.oli----.............
DISALLOWANCE OF DIDUCTIONS AND ASSESSMENT OP TAX
IITATI OP DAVIS DOROTHY M FILE NO. 21 94-0941 ACN 101 DATI 07-24-95
TAM ~ETU~N WAS.. I X) ACCEPTED AS fUED I I CHAHOEU
RIIIRVATIOH CONCERNING FUTURE INTEREST . lEE REVERI.
APPRAIIED VALUE OF RITURN IAllr. ONI ORIGINAL RETURN
1, R.Ql Est.t. ISchadul. Al III
2. stock. and Dend. ISchadul. II 12)
I, Clo..L~ Held stock/P.rtner.hlp lnt.r..t ISoh.duL. C) II)
4. Hcrtllllllll./Hct.. ~ec.lyabla ISchadul. 01 14)
I. C.lhllenk Depo.lt./NI.c, P.r.anal Prop.rt~ ISchadul. EI II)
,. Jalntl~ Own.d Prop.rt~ ISchadul. F) 1'1
7, Tran.f.r. ISchadul. 01 (7)
I. Tot.l A...to
78.918.!Q..
553.18
,00
,DO
1.908.07
17,519.04
,00
II'
98,898,69
APPROVID DIDUCTIONS AND EXIMPTIONII
10,133,90
9. Funar.l EKp....../Adoo. Co.to/Nhc. Ex"""... (Schadula H) 19l
10. Dabto/Hcrtllllllll Llabllltl../LI.... ISch.dul. II (10) 3.743.17
11, Tot.l Daductlan. 111)
12. Hat V.lue of T.x ~.turn 1121
11, Charltabl./Qcy.rn.....t.l I__.to ISchadul. JI Ill)
\.4, Hat V.lue of Eotat. Subject to T.x 1141 85,021.62
NOTII If In ........nt w.. i..u.d pr.v!ou.1Y, lin.. 14, IS .nd/or 16, 17 .nd II will
r.fl.ct figur.. th.t includ. the tot.l of ~ r.~urn. .......d to d.t..
AISIIIMINT OP TAX'
11. Aooaunt of Line 14 .t Spau..l r.t. 11&) , 00 K' 03. ' 00
16, Aooaunt of Line 14 taxabl..t Llne.l/Cl... A r.t. 1161 85,021.62 M ,06. 5,101.30
17. Aooaunt of Line 14 toxabl. .t Coll.tar.l/Cl... I r.t. 1171 .00 M .15. .00
II, Prlnclp.l T.. Due 1111 5,101.30
TAX CRIDITII
PAYNENT
DATE
-95
1].A77 n7
85,021. 62
,00
~ECEIPT
HUNln
AA023042
DlSCOUHr
INTE~EST
AIlOUNT PAID
l+l
1-'
,00
5,101.30
TOTAL TAX CRIDIT
BALANCE OF TAX DUI
INTERIIT
T01'AL DUI
5,101.30
.00
,00
,00
. IF PAID AFTE~ DATE INDICATED, SEE ~EVE~SE
FD~ CA~CULATIOH Of ADDITIONAL INTE~EIT.
IF TOTAL DUE IS LESS THAN fl, NO PAYNENT II ~Equl~ED,
IF TOTAL DUE II ~EFLECTED AI A "C~EDIT" IC~I, YOU HAY IE DUE
A ~EFUND. SEE ~EVERlE SIDE OF THII fORM fO~ IHSTRUCTIQHI,I
,
",
pO" \". ~.
-ri,r'
"', ,/." ';1' -, L.
() .'(1 C'~ ','1
,I'
i . \ ," ~ (-;: '"
'Ii" ' C\
,
\0' "
N ..
" J
nA .,
'0' " ,",; "
,~ , 'I ,', I
~ 'I'; I,() :l;
, u; ,P" [~8
"
'1\ "I
, ,
, ,
RESERVATION' E.t.t.. 01 dootdon'. dvlnt on or bolor. DoG....r II, 1911 .. II any lu'ur. In'.r..' In tho ..,.t. I. tron.l.rrod
In po.tI.llon or ,"Jovwent to el,.. . (col1'\'t.l) btneftolar... bf the decedent .'t,r thl IMPlr.tlon of InV I.'a'a for
I1f. or tar ,yl.r., thl C~.lth hereby I.pr..tlv r".tv" thl right to .,pr,I.. and ...... tt~.f.r I~rlt.nc. TIM"
It thl .IW,ul ell.. . (coUI'lni) t.t. on any such ,utur. Int.r..t.
,
_lIl'
NOTICE'
To fulfill thl requlr...ntl of SHUon 21~O af thollnhlr1tInCl' end Estl" TIM Act, Aat 22 of 1991. 7t P.I.
l"Uon 1I~0.
ktlClh thl top portion of thh HoUOI Ind 1ub.1t wJth your "1YHf1t to ttM RI,lItu of '11111 prlntld on thl nver.. .Ide.
-'"14<. .hook or ....y orellr p.yobl. to, REaISTEll aF MILLS, AaENT
AU PIYHf\tI rlGllvld ,hill fir.t be epp1!ed to Iny tntlt..t which "V b, due with InY r...lndlr appl1ld to the tlW.
PAVlENT ,
RENfD (CRh
A r.ftN of . hit cr.dlt, Nhhh .... not r.....ted on the Tele R,turn, NV be rtqUl,ted bv CHPI,Unt In "AppllC1ltlon
for R,fund of PIM.whenl_ InheritInG' and Elt,tt TalC" (REY-Ul!), Appl1cIUon. I.lr. l"'IUabl, It thl Offlc.
o' the Rotls'." 0' Willi, MY of the ts Revenue DlItriot Offltlll, or b'i' nlUJnt the 'PM 111 Z.-hoYr
entwerlnt '.rvl~. nuIbIr. far far.. orderlhll In Penn'Ylv,"l, 1.'OO~J'Z-ZDSO, out,lde P,"",vly,"le and
'within 1...1 Hlrrl...... .r.. C711l111-'094, TOOl (1111 111-I15Z llll.rl", 1"".lrod Onhl.
OIJl!CTlOHI'
Any p.rtv In Int.r..t not ..tJ.'ltd with thl Ippr,l..-.nt, allowlnGl or dl.lllowlnCl 0' dtduotlon., or .......ent
of hM Clnoludlnt dhoN'lt or IntlrllU II lhown on thh NoUat lU.t object w!thln .hetv (60) diY_ 0' rlOllpt of
'hll IIotl.. bY' '
uMr1ttll"l pro tilt to the PA o.plrh..n1 of AIVtrM.HI, lo.rd 0' Appelll, Otpt. 2'1021, Hlrrhbur" PA 17121"1011, OR
.....l.otlon to hlv' thl ..tt.r det,relned It audit 0' thl I1Count of thl p.r.on.! rlPr..lntltlvl, OR
..."..1 to the Orptwn.' Court.
1DIt1"
IITRATIY!
C_CTlOHI,
INTEREIT,
FtCltUll .rrart dhoov.rtd on thh ..H...."t should ~ Iddr...td In wrlUng tal PA Dep.rtlllOt of "'VInYI,
lur.1U of Jndlvldull ,...., ATTNI Po., ~""'leOt ".vlew Unit, n.pt. 210601, Herrl.bur., PA 17121.0601
Phone (717) 717-6501, ,.. P'" J a. thl bnokllt "In.tructlon. for InheritInG' TI~ R,turn for I "1.ldlnt
Deatdlnt" (REV-ISOI) for," I.pllnttlon of tdllnl.trltlvlly correatDbI. .rror.,
I' ,"v tl. due I. plld within thr.. CJ) olltn6lr tonth. .ft" thl dtGtdent'. deeth, . flvl peraent (S~J dltoount of
thl tl. plld I. 1110Wtd.
Intor..' II .hlrtod botlnnl", with IIr.t cloy 01 dlll_y, or nino (9l _th. one! ono (II doY Ir.. tho dot. 01
dllth, to thl dlt' of Plveent. Tlx" which bta... delinquent before JlnUlrv 1, 198Z bllr Int.r..t It thl rltl, of
'Ix C'X) percent per ennui o,loullttd It I dlllv r.tl of .000144, All tIXI' which bto... delinquent on end Ift.r
Jlf'lUtrY I, 1912 will bit' Int"..t .t I rat. Mhtch will vlry 'rot cltend'r vllr to a.lend.,. Yllr with that rltl
ennounold by thl P' o.plrttent 0' RlvlnUI. The IPPllctbl. lnt.r..t r.t.. 'or 19.2 thrOUAh 1.95 .rll
DllICDUlfll
~ Int'r..t ".t, O.lly Int.r..t FlOtar !!!! Int"..t Rlt, O.lty Int.r..t flOtor
1911 lOX .ooml 1911 9X .00OZ~1
I91S 16X . DOOIH 19"-1991 m .000501
19" Il~ . ODOSOl 1991 9X .DOOI~1
1911 ISX .ODOSH 199J-1994 IX .000191
1914 UX ,ODOZ1~ 1991 9X ,000Z61
-.Int.,..t II c.laullttd 'I fDUOWII
INTERElT . IAtANCE aF TAX UNPAID M NUWlER OF OAYS DELIMQUENT X DAI.Y INTEREl1 FACTOR
"Any HoII.. 1..0Id .It.r lho t., bOo.... dlllnquont will r.ll..t on Int.r..t ..I<ul.tlon to III'... (Ill doy.
beyond tt. ut. 0' thl .....lIMnt. If PIVMnt II Mdt tft" tht Inttre.t cOlfKltlt1on dati lhotIn on thl
Notlct, tddltlonRl lntlrt.t IUlt be al~oul.ttd.