HomeMy WebLinkAbout94-01037
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III';TITION I,'OR IIROHATE Ilnd (;RANT OR<' LETTERS
/Mel/c' oj _9 LDonr\1.d .Il 1.0 l; z No, .. .~l -Et.f:-_I.QJ-7-. ---
"'SO kl/oll''' ".1'.. To:
_._..__.- Rcgislcr of Wills for Ihc
_.__.__. ._...... _. . ... ... .. _ _, /lc'l'C'(/.lI'tI, COllllly of .nG1E~Q(Jl'lnncl_ III thc
Sod,,1 S(,l'lIrlly No, 19~-16-4260 COlllll101lWClllih of I'cl1l1sylvlIl1lu
Thc pCllilol1 of thc ul1dcrsigllcd rcspcclfully rcprcscllts Ihlll:
Your pClliioncr(s), who is/llrc IN YCllrs of IIgc nr oldcr IIl1lhc CXCI'lII1''\':K._.._._.____.___IIUll1cd
illlhc lusl will of Ihc ubovc dcmlcllt, dlllcd _ ._.Q.cJLoJ.>ill'_12 '._n_..'__ , 19..26.._
IIl1d cmllcil(s) dlllcd .... ... n ...._ ....nn'_ ._._ _.._...___._._.__...._.__n__________
_..____~ __._.. _ .___._.. __ .n.__ __... ... ...~4. _ .__..._..____.~__
__.._____,__ ___.._~____.____._._~___.__n._...__._n__..__.____.________n._.___u
--.--.. ..--- ----------.." _.._._._._._---.~----_.__. --'-
(,tnlc rell'VIIIII drClll1l\lllllCl'\, c,~. rcnllllchllioll, dClIlh of C'(l'clIlnr, CIC,)
Dcccnd~nt \\'IIS domicilcJ ul dCllth ill__~~1:1hor'1 nnd ._ CounlY, Pcnnsylvanlu, with
h io ..__.llIsl flllllily or ~rllldPIII rcsidcncc III __5).Dl_..Eo)lgo..lioau+ On1'" i ,,'I ~'.A..
___._.L~g.ltJtLJ:!ic (ll!!t().JLfJ'Qy!nl~uuD__._ ---'--
(1l~1 ~lIccl, lIulI1hcr 11lHlmundpnlllY)
Dcccndcnl, lhclI_..._6C}_.... YCllrs of IIgC, died _1:oVe\1~'?'QR..E~____._, 19 94
lit ._..9.QLFo~g(LIl o (\.cl,__Car.lifll14-.bL-YIJ21.L-_.
Exccpt us follows, dcccdclll did nolmllrry, WIlS nol divorccd IInd did not hllvc II child born or IIdopted
aftcr cxecution of Ihc will offcrcd for prohlltc; WIIS nollhc victim of II killing nnd WIIS ncvcr lldjudlcatcd
Incolllpelcnt: ___m_.'___'_."_. ..-.---..--. .--
Dcccndcnlllt dC~lh owncd pn'pcrty wllh cSllmntcd vlllncs liS follows:
(If domlcllcd in I'll,) All pcrsonlll propcrty
(If not domlcllcd In I'll,) Pcrsonlll propcrty In PcnnsylvlInill
(If nol domlcilcd In I'll,) I'crsonul propcrty in CounlY
Valllc or rcul CSIIlIC In I'cnnsylvllnlll
sit 11I11 cd liS follows: _.._
$. 1~,OOO.OO
L_.
$
L
WHEREFORE, pctltloncr(s) rcspcclfully
prcscntcd hcrcwith IIndthc grunl of Icllers
thcron,
rcqucst(s) lhc prohlltc of thc last will und codlcil(s)
'Pnu.tlllUEUlt.n....y
(IcSlllOlClIllUYi IHlmlnl'lrllllUII c.t,n,i ndmlnlslrllllnn d.h.n.c.I.R.)
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Ii9_Eiii.t_.Lioburn_ll.o.acL_==
J3oWIl1lU10 dala.,_.l'1I.._..J.~/.D.Q[L_._
----------------------_..-.-------------- ...-----. .
----_._._.._---_._--~ --- ._.-_.------ -..-.---.-.--.-
OATH (lI<' PERSONAL REPRESENTATIVE
COMMONWEAI.TH 01<' "ENNsnv ANIA l
COUNTY ()Io' ....9Jl01'El1Jiii1U? _ J 1:18
Th'~ pClilionl'r(s) IIhOv'~.lIIl1ncd swcur(s) 01 IIffirm(s) Ihllllhc sllltcmcnls In Ihe forcgolng petlllon ure
Irllc 'lIId correCI to Ihc bcsl of Ihe kUOIvlcdgc IInd bcllcf of pClitloncr(s) und Ihlllus personul represen-
Ullivc(s) Ill' Ihe IIhOVl' dcccdem pelil:llllcr(s) will wcllllnd truly IIdminlslcr thc csllllc uccording to lu\\',
Sworn 10 III affirmcd ~nd suhscribed J fti~I~, ,;/. ~~ \I)
:;iti~'t~",("o~' ,,~lt:'f 1 ==::---'- -=== 1
fL'. P f) \!~f'~'t~ R<,~llfc'r __.n.____.______ .-. I:!.
L.
No. 21-94-1037
Estate of _
O. DCllAI.D DIBTZ
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW Deoember R 19~,ln consideration of the petition on
the reverse side hereof, satisfactory proof havJng been presented before lI1e,
IT IS DECREED that the InstrulI1ent(s) dated Ootober 12. 1992
described therein be adll1ltted to probate and filed of record as the lasl will of
G. Donald Dietz
Testmnontar;f
Sharon r,. Shipman
and Letters
are hereby granted to
'mil.,
('. 1. JJ J.;D ~~ {!/3 fJor,-:r-..
ROllllor of Will. ",
FEES
Probate, Letters, Etc, ""',',' $50.00
Short Certlflcates( 4} .. .. .. .... $ 1 2, 00
Renunciation .."..,..,'..", $
x-pages $ 6.00
JCP TOTAL _ $7j; XX
Filed""" ,Der:ember, ,8.,19,94""",
J. Robert Stauffer 06356
k A rrORN!!Y (SunSt,s 1.0, No,)
Bar et square tllug.
Neohaniosburg, l'A _ 17055
ADDR!!SS
717-766-9673
PHON!! '
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LAS!I.'\HLt AND TJ':STAl<lmWr OIP G. DONAW DIETZ
-
I, G. DONATJD DIETZ, of tho 'ro~mship of Sou1i11 lUddloton,
Oounty of OUlOberland fwd stute of Pennsylvania, being o,f sou..rld
and dlBpo~ in!!, mlnd, memory und undorstnnding, do make, publish
.and declnl'o thJ.s my T,aot \1111 /l nd 'l'en tnment I hOl'oby x'evolting and
malting void uny rmo all prior \'/1 11s by me (\ t any time heretofore
made.
1.
I dj,reot tho paymont o'f all my just debts and funeral
. expenses as soon after PlY. deooase as the /;lame oan be oonveniently
done.
2.
I give, devise and bequeath a11the root, residue and
remainder of my estnto ,real, personal nnd mixod, whu I;soever
nnd ~lhereBoever tho oame may bo oituate, to my foul' (!~) daughters,
hereillUfter named, to wit, PAT1UOIA A. t1ERHIS, SIIAHON L. SlIIPHAN,
KIl.ffililTILY IiI. OONKIrIN and DONNA JOLANg aHOOJoIE, shure and ohare
alike, per stirpes.
TJASTI,Y, I nomim.te, constitute and appoint my daup;htur I
SHAH ON TJo SHIPlilAN, tixocutx'ix 01' th:ts my TJust. lUll nnd Tootament,
and in the event thnt my onld daughter ohould prodcoeaoe me, or
should she be unahlo oX' llnwHlinr; to sorVf.l in such cnpnoity for
any reason, then in eithor Buch evont, I norrll.nato, constitute
-1-
Ill, ( I.:., I; 3
/ II I (' 'I
REV.IIOJlX/ P'''I 'OA DAIIS 0' DIATIt AnlR 12/31191 CHICK HIU
'S~\~j\ INHERITANCE TAX RETURN ~O~mn:~DIIIS ClAIMID II
COMMOIlW!MHI'" PlIlIllijVAtll^ (TO R::I~~~J I~Eg~~~~TA TE "Li NUMliR;21~9/;~1~3'1
IlEPARIMEt~1 ", MEVElH f
"^RmJ~tH~o\'!ll8 06'" WITH REGISTER OF WILLS) . COUfllY COUE 19%YfAR.()1937':(UM!~P
'~------~.m1&fiFrn~ijtti\t)ii~tA;Hi MliJiiit"i-iHfIAI," ~.~;:.;-._,.- ---- .--.--- ..... -.--. -; liffft'ifiPSu"jmmf/,oiiinr---------
IlU;'l'Z, n. j)ol1C11d <}O). lo'Ol'go Ho[\<1
I :~2~~~~~;,?~~~u:-u__.:.]Ui~!?~~(;I~~_.'~I"~~";;~;~;i;!~ c'""'( ()[\~~,~~~~i[\~~ 1'(013
___~.___ 1::"'~"~"::U""I/'o"ol/lI' "."~ '''"'~'" :"I/"'UUIII/II'"'' ..1:0(1"",",11, ~"M,," ~ 'Mouil; '~C:~.I~~i ~'::i~~~~l:~~~~~~~ =.~~~_-.
~ Iltll. Orloln,,1 K,'ur" r) 2. Supplem.nl'" Return ['1 J, R.molnder Relurn
I . Ifo, dol.. of d.alh prior 10 12.13,B21
~;lID [14. lI..lIod E,tnl. 1-140. rulure InIOlO" ComJHoml!e [) 5, Federal E.tol. To, R,'u,n Ro~ulred
u 9 1'0' dnto, 01 do",h 01,,, 12,12.B2)
r:1 6. Docedenl DI.d Tlllole 1 I 7. Oecedonl Molnlnlnocl 0 llvlno TfUII ..D_ 8. Totol Numbo, 01 Sol. Depo.lt Bo",
IAlIoch copy of Will) . (AIIClCh copy 01 hUl11
____n_..._ AlfeORIIESPONDINCe AND CONfiDENTIAL TAX INfORMATION SHOULD BE DIR_CT.!) TO, ,., ,,\ ':/" " ! '..... ,;, r- 1,', r".
ch WMT-----..-.--..-.~h_._-..-..-~------..-..--.-..--...--..-- C{ii:iPliIT.i,\^llIN(j-~fifiirH-.------------.
d ____J~._!(~b():\,t;_.:.l.I;~llrC()r, J\l;~.\~. IlUl'llwtl:Jl!jltn!'O Bldg. r.'
8~ "",1I0NI NUMIfR Hoo lun' 00 lurg, PA 170;.>?
--..- .~tl}1,b~,;Lg/~,,:,?{~73 '.__no........ n'"
1. R't/I E,'ote ISchedule A)
2, Slack. ond Bond, {Sch.dule BI
3. ClolOly Held Slock/Po,tne"hlp Inlor.II ISch.dule CI
4. Mo,'ooO" and Nol.. Recolvoble {Sclltdulo 01
5, Co.h, Dank 0'1'0"" & MI.celloneou. Po"onol P'oporly
ISchedul. EI
6, Jolnlly Ownod P'oplfly (Sc",c/ule FI
7, Trontlo" ISch.dule c.l{Sch.dulo LJ
B. Total 0'011 Au," 110/01 lln.. 1,71
9. Funeral hPlnllI, Administrative COlhl MIIClIlItlnlClUI
E'p.n.o. ISch.dule HI
10. Debit, Morloog. lloblllllll, ll.nI ISch.dule II
11. TOlol Dod"lIon. {Iolollln.. 9 & 101
12, Nel Value of EII.,. (line B ..I nUl line Ii)
13, C"o,lIoble and Oovernmontal 8tqutll! (Sch.dule JI
14, Nel Value Sub 'cllo To, 11In. 12 mlnUllln. 13)
15, SpoUtol Trond", {fa, dol.. of deolh 01", 6,30,941
5.. Inll/ucllo", la, Appllcobl. Perconlooe on Reve",
Side, Ilnclud. volu.. Irom Sch.dul. K or Schedule M.I
16, Amounl of lIn. i4 'o,obl. 016% rote
{Include volutl from Schedule K 0/ Sch.dul. M.I
17, Amounl of lIn. 14 lo,able 01 15% ral.
IInclud. volutl from Schedul. K ar Sch.dul. M,I
18, Principal 10' due {Add la, from Un.. IS, 16 and 17,1
19, Cr.dll. Spoutol Povlf'y Credll Pilar Poym.nlt DllCounl Inllll.'
..-____.J2L0.tL. + 0.00 _ L__Q...Q.fL _ 0.00
20. If lint 19 I. gftalt' Ihon line IB, enlt, Ihe difference on line 20, Thl." the OVlRfAYMINT,
I1[J_lh)l.~I'I"",.'&mmQllltll~
21. II line IB" o,o.ter Ihan line 19, enllf Ih. difference on lIn. 21. Thl! I! Ih. TAX DUE,
A. enllf Ihelnlm,l on Ihe bolonce due on lln. 21A.
B, Enllflhe t.,.1 of line 21 and 21A on llno 21B, Thl, 10 Iho BALANCE DUE,
___nO Mak~ Check Pavable ,.~ Regl,lor .f WIII'l_Agent _
~JI :1\ H ..~~;~'l~(:'~"'ONB T~'~N~~I~ ALL QUISTlONSO~ AMlll! SID~ ANlllor..Cll.Ck~j(TH:~tiflC\fffl~11~j1,},~~;,~,
Ulld" p.ntllll~. or f1orjury, I declare thai I hove lII(C1mlofldthll relufIl, Including {IccompClnylng IChedul" and Uatflmlnll, and 10 thl bill of my knowledge and bell.f
C I, Idlll corroel unli ,ulllfllel.. I doelor" Ihol au real nllnlft hal been rerorred ollrue mClrke' yolul. Oe.clarallon ", preparer olh., Ihan Ih. plnanal rtpre.entallv. I.
ii~::A o~~~~I;m~;~~IO~i~II;I~f~~'ij';r(1~ik~~_knOAb~~~~cTFn,:I\[IF' T:1,IJ b'ii-rnft o!iif.----- om n_:-
-(J!:..__..:5..1.. tlAd..I:.~l.ll.,l:1'..o._._ .._J}JL~ffil[\ll.o(ll!l.f.l..__jJ./\.-.l1.Q.QlL_ _ 7 ,. 1 if - 70
110 U "m Oz:R~~t""iIl'IA1Ivl A."OIlS J.InrlcoI; sr; lIuro Bldg. oA"
':u1/LU/T'='~' -.-_HechlllliAIJ.bur.g.._l'L_l7..o.~~______ ]=l1J,!;}-=-"
..
s
I
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. .--.--..._.._._._.___._n._.__.....___.
.. . .~._-_. ..__..... _._______._d___.._._______.
III ...... ..__O,QO_
( 2 ) ._ ..mm._.._11.QQ~ l OQ
I 3 1 -.. -..____.__._-.P.t.Qg.
(,1) ... ..... .... ..m___.~eQQ.
( 5 I......--.._9.l..J22_!.71
161 ... _._...._..__._.9_.00
171__..____....___9., 00
191 -.-.-____.J.l.?.2!J..! 12.
(10) -------.--.-.__'2Q2..31.
I B)
1l,276!1l
Ill)
112)
113) _
II~I
ll,5Q1Jb1
b1J3. 30
0.00
2,773.30
1151 _._________.___.Qe 00 M,___.
1161__.__h___~L7n!..3_Q,x ,06. _
1171.___________<2.'-00 M ,15.
.___--.12...QO
166 Jl9_
0.00
IIBI _
166 ./~o
0.09
119)
1201 -D..llQ
121) _______~~~~
121AI ---------.-lb6 :!~O'
121B) _._n_____ ..
1\.1 #41\ 011994 provide. for the reduction of the taK ralu.lmpoltd on the lIet value of tran.f.,. 10 or for
1:1' u.o JI Iho .pOUIt. Th. rat.. 01 pr..crlb.d by Ih. .Ialul. will bl!
" :1% (,/):!) will bll applicable for ..Ial.. of decedenl. dying on or after 7/1/94 and before 1/1/96
,- ~(% (,/)2) will b. applicable for ..tal.. of decedenl. dying on or alter 1/1/96 and b.fore 1/1197
. 1% (,0'1) will be applicable for e.tate. of decedenll dying "n or after 1/1/97 and before 1/1/98
Spou~\,! trnnafer~ occurring on or after 1/1/98 will bll eKempl from Inherllance taK.
PLEASE ANSWER THIl FOLLOWING QUESTIONS
r!.Y PLACING A CHECK MARK kl IN THE APPROPRIATE BLOCKS.
..!!. 'N~L
I, Old d,':odonl makll a trandM and:
(1. r" 1(/ln tho use or Income of the property transferredl "".........."........".............10.........."..
b, rt,olaln tho right to closlgnata who shall use Iho property translerred or lis Income, ..............,
v
~
c. 1'1l):.ln a reversionary Interost; or ,........,..,...............".............,.....,,,,,..............,,..,..........
,
d, r('Clilve Ihe promise for life of either payments, benelits or care9 ,,,,,,,,...."""" "".."..""..,,,
?" If dati!! occurred on or before December 12, 1982, did decedent wllhln two years preceding
dealh twnsler properly without receiving adequate consideration' If death occurred after
Dec'''.li.l~I' 12, 1982, did decedent transfer properly wllhln one yoar of dealh without receiving
tldat~\'ulu consldorallon?, ......"....,..",."",..,...",... ,,,., .....,.......,..... ............., to..,. .....".. ........
/
:1, Did cl,redont own an 'In trult for' bank account at his or her deathL.."..""".."........"....".." V
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RFTURN.
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COMMCJNWI~I"1 "f rrNN\ilV^,II~
INtlr"II~NC[ T~' HrrU!N
.. . 'USUlfNI OfrrtlHll . .
ESTATiHiji----.----- moo _n< - .__..______...__ _____ _._ "__',. .. _ .
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
0, DUlii\f.JJ ])11;;'1'%
.. . .. .... .. _PI'lll.P"nto~_Ty'f'.'.. u..
-ii'll! NUMBER ,~1-9~::i03;1-
1991~-0103'l
... .. .-. .- .- .--~_.-.. ..h._._.____ _._._ ._.
ITEM
NUMBER
--_.~._.--
A, Funn,al bp.n!eIT
B,
4,
c.
1.
2.
~:
5.
6.
z:
DESCRIPTION AMOUNT
.. .-. '.-'--'" -..._--- ..-_._~..-._--_.~_._---._~-~. -----.-.----------..--.-...
1.
Hyel'lJ Punol'n1 llOIllO, Ino., 3'1 Jo:. Haln St., Neohnnios-
burr., Pn., 1'\lnor[\1 oxp,onoeo. *
Ohestnut 11111 Uometol'Y AlIlJooiutlon, oponing find
olooinr: f/:l'nve.
lil15.oo
6,170.00
?.
3.
!1overond Hiohnx'd T.,. Bel'r:, oonduoting 1'unerl:\l
oel'vioe.
75.00
21.j..OO
l~ .
Hyers li'\l11ern1 llomo, Ino., DOl:\th Cel.tifiol:\tes.
I,
Admlnlltratlv. COlli I
Personal Roprosontailvo Commissions _
Social Socu,ily Numbor of Personal Roprosontatlvo: ___...__._
Yoa, Commissions paid ._....._........__. ____.__._._...
2,
Attarnoy Foos J, 110berl; Stauffer, maq., nttol'nay' a fee.
350.00
3,
Family Exempllon
Claimant ... "_m. .......________.._...__._ Relationship
Addross of Claimant 01 decedont's doath
Slroot Address - --...._._.._. .......-......-......._..__m______.__.___..
Cily ....m.. h_.._._ .....n____...._.. ._Slato hno__. Zip Code___._.__
P,obato Foos l1ogiotor of \'lillo of Cumbol'lund County,
Pennoy1vanla, Lattoro '1'ostulllontal'Y.
MI.c.llaneoul Expenl..,
Chuok 13rio1eol', AlIo tionoor, nppr'IULl L ng furniohingo
nnd tools.
PNC [lank, otorago opnoo rontal for Pebl'lIary, Nnroh
und APl'il 1995.
Ginlirich Hllmorin1s, Ino., ongrnvlnc; monument.
Robart C. Unix'nll, tnx cOlloctor, 1995 County and
T01mahip pOl' oapi I;a tux.
Oumberland LUI1 Joul'nnl, Eatn te Notioe.
The Sentinel, Eatate Notioe.
Ilegiatar of \'lilla, l'<'Jservad to filing Account.
Regiater of Hi 11s, i'Ul n/; 1'0111111;11 vania Inheritanoe
'fax !1etul'n.
73.00
60.00
75.00
96.00
16.00
40.00
62.12
9.3.00
15.00
-'W__""__m ..+.-- ._-.
---.-.. .-.. _..~-...._._ __u..
TOTAL IAlso onlor on line 9, ROlOpllulailon) $
'1 ,591~.12
._------------------_._-_.._._--_._-_..._--~~
(If moro Ipoce II noedod, Inlo,t oddltlonollhe... 0' lome 11z.)
-----.-
IIlVHIJ 141 IJ ~'I
.,a.,9~
'!~$
COMM'lIIWfAlllI 01 ,tlltl\lIVAWA,
INIl,.UAN(llMC IIIU.tj
ESTATE-OP.=...1"'/l:'~l~~I~I!'r.~"~~~,,,~~~-,,==~",,,,=~~,".~n~"~=' .- FiLE -NuMBeR -2i-I)I~-1 037
O. ])(lil1\1.]) DJE'l'Z 1991~-011)37
... ..........---...T----------...-. --.-------
RELATIONSHIP sH~~fg~t~lTE
SCHEDULE J
BENEFICIARIES
ITEM
NUMBIR
NAME AND ADDRESS OF BENEFICIARY
..... --..... ...- .-.._...-."---~--------_.--_._.
A. To.ubl. Doquo.",
1. PNrmO!A ^. Im!lIlW Daughtor Ono.fourth shal'
1071 W. ~lubuvn !load of Estate.
Oarl101o, I'A 1,/013
2. SHARON L. SlIT Ptt.Atl Daughter Ono-fourth ahar
119 m. I,ioburn !loud, BDI'Wlnno(lu1o, PA of Eatllte.
1'7000
3. ICrHumrlW 1'1. GOm:I,I1I DauRhtor One.rourth ahar
1 0101nona D1'1 VA, Apr. 13 of ]iJstate.
Dilloburg, Pat 17019
!~ . DONNA J. OROOHE Daughter Ono.fourth ohar
22 13111 Dugan Dr1 vo of Estate.
Etters, Pat 17319
ITlM
NUMBIR
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARI OF 8STATE
---.-----.------------
B, Charltablo and Gavornmonlol aoquollll
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Aha onlor on IIno 13, Rocopltulallon)
$
-------_..~._----------
(If mOl' .pa.. I. n..d.d, Inll.t addltlonal.h.." 0' .am. .1..)
v
/6,-,3-1-1
C'.
RIV"1547 I!X AFP (12.94*{
COHHOHWUlTH Of PENNSYLVANIA ACN 101
DEPARlltfNl Of REVENUE HOTlCE Of INHERITANCE TAX
IUAUU Of INDIYIDlJAl UWES APPRAISEHENT, .ALLOWANCE OR OISALLOWANCE
::mil~~~:1 PA 11118-0601 Of OEOUCTIONS ANO ASSESSHENT Of TAX DATI 10- 09 - 95
thAT! OF ]YElZ ~u~~==G= ~~,=~-==' - - FILl! NO. 4'103r---~~
DATE OF DEATH 11-25-94 COUNTY CUMBERLAND
HOTE, TO INSURE PROPER CREOIT TO YOUR ACCOUNT, SUIHIT THf. UPPER PORTION Of THIS fORH WITH YOUR TAX
PAVHENT TO THE REOISTER Of WILLS, HAXE CHECX PAVAILE TO "REOISTER Of WILLS, AO~NT"
REMIT PAVMENT TOl
J ROBERT STAUFFER ATTV
MARKET SQ BLDG
MECHANICSBURG PA 17055
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
r=" - A.ount Ro.lttod ~
CUT ALONG THIS LINE .. RETAIN LOWER PORnON FOR YOUR RI!CORDS ~
il!V: is'(.-i" iiC "A i:'ii. (i 2": 94 Y" Noi'-i Ii r"o F" i"NHiii i;: AN"O' i" fAX "'A"PPR Ai s iM !'Nr;' At rowA NO' E" iili - -....... - -. -""""
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ISTATI OF DIETZ G D FILE NO. 21 94-1037 ACN 101 DAT! 10-09,95
TAX RETURN WAS, I X) ACCEPTEO AS fILED
I I CHANOED
RESI!RVATIUN CONcifFijiING FUTURE INTEREST . SEE REVI!RSE
APPRAISED VALUE OF RETURN BASED aNI ORIGINAL RETURN
1, Roll E.toto (Sohodulo Al Il)
2, stook. ond lond. (Sohodulo II (21
S, Clo.oly Hold Stook/Portnor.hlp Inloroot (Sohodulo C) (3)
4, Hortgogo./Nolo. Rooolvoblo (Sohodulo DI (4)
5, Co.h/lonk Dopo.lt./HI.o, Por.onol Proporty ISo~odulo EI (5)
6, Jointly Ownod Proporty (Soh.dulo Fl C61
7, Tron.1or. (Sohodulo 01 171
a, Totol A...t.
,00
1,801,00
,00
,00
9,395,73
,00
.00
lal
11,276,73
APPROVED DEDUCTION8 AND EXEMPTIONS I
7,594,12
9, Fun.rol E.p.n.o./Ad., Co.t./HI.o, E.pon.o. ISoh.dulo H) 191
10, DObh/Hortgogo LloblllUu/Llon. ISohodulo II 1101 909,31
11, Totol Doduotlon. Ill)
12, Not Voluo of To. Roturn 1l2)
13, Chorltoblo/Oov.rn.ontol I.quo.t. ISohodulo J) (13)
14, Hat Vlluo of E.toto Subj.ot to To. 1l4)
NOTEI If.n ......mant w.. i..u.d previou.ly, lin.. 14, 15 end/Dr 1&, 17 and 18 will
r.flect figur.. th.t inclune the total of Abh r.turn. .......d to dat..
ASSESSMENT OF TAXI
15, AftOunt of Llno 14 ot Spou..l rot. (15)
16, AMount of Llno 14 t..oblo ot Lln.ol/Clo.. A roto (161
17, A.ount of Llno 14 t..oblo ot Collotorol/Cl... I roto (171
la, Prlnolpol T.. Duo
A.c;n~ 4~
2,773,30
,00
2,773,30
,00 X ,03.
2,773,30 X ,06.
,OOx,15.
(181_
,00
166,40
,00
166,40
TAX CREDITS I
PAVHENT
DATE
07"14"95
RECEIPT
HUHBF.R
AA04B003
DISCOUNT 1+)
INTEREST I')
,00
AIIOUNT PAID
166,40
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
166,40
,00
,00
,00
. IF PAID AfTER DATf. INDICATED, SEE REVERS'
FOR CALCULATION OF ADDITIONAL INTEREST,
IF TOTAL DUE IS LESS THAN .1, NO PAVHENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRl, YOU HAV IE DUE
A REFUND, SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS,)
,
,
Cl)('~
~ 11"
",
~d
~ .! i
J,1
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, "
(',
,..,
I
(h
fl',
REIERYAllONI E.,.". of dec.dent, dyln, on or blfor. O,o..o.r 12, 1912 -. if tnv 'ut~r. Int.r..' In thl I.,.t. II 'ran,flrred
In POI....10n or ."JoYI.nt to Cl.,. . (ooI1,'.r'1) ben.flcl,rl.. of thl dtcid,"t .ft" thl Ixplr.tlon 0' .ny ..t.t. for
lIf. or 'or ytlr., thl CollltOnwtlUh hlr'bY .Ilpr.lth r...rVII thl right to Iftpr.l" 1M ...... tran.t.r Inh.rUano. TIMII
It thl llNful el... a (col1,',r.l) rlt. on any such future lnt.r..t,
PURflOH Of'
HOTICEI To fulfill the r.qulr..,nt. 0' .Iotlon 2140 0' thl Inh.rltanc. .nd Elt't. Ta. Act, Act 22 0' 1"1. 7Z P.'.
'.at Ion Z140.
PAYHENTI Ottlch thl top porUon of thlt Hotlo. and 'ub.1t ..lth your pIV.."t to thl RI.hter 0' Willi prlnt.d on thl rIVIr.. .Ide.
'."oko chOck or .one, ordor ."oblo tOI REGISTER GF MILLS, AGEHT
All pautnt. r.o.lvld thlll flr.t bl JPplhd to IllV Interllt which .ev bl due with any rl..lndtr ""lied ta thti tlM.
ltffUHO ((.11)1 A r.fund of I tlM or.dlt, which w.. not requ..t.d on tM TIM Rlturn, "v b. rlqullted by co.pl.Ung In "APpllClltlon
for Rlfund of P.nn.vlvenll Inn,fltlnCl .nd ~tt.tl T.M" (AEY'15151. Appllcltlon. Ir. Iv.llabl. at the Of'lcI
of the R'II.t.r of Will., .ny of the 25 R.venu. DI.trlot Offlc.., or bv c.lllnl the .p.olel 2~-hour
an....rlng 'Irvlc. nulbtr. for for~' ord.rlnOI In Ptnn.ylvanl. 1-000'362-2050, out.ld. Plnn.ylvlnl. end
within looel Hlrrl.bur, erll (717) 717-'094, TOO. (717) 772-2252 tH.,rlng 1lPllr.d Onlv),
QIJECTIOHII Anv p.rtv In Int.r..t not 'Itl.fl,d with the .ppr.I....nt, .110.,no. or dl.,llowanc. of d.duotlon., ar ........nt
of tlM tlnoludlng dl.rount or Jntlr..tJ .. .hown on thll Hotle. lU.t obj.ot within .Ixtv (60) d.v, of rlellpt of
this NoUn bYl
-~lfrltt'" protllt to the PA DlptrtHf1t of AIV'nu., 10lrd of APpIII., D.pt. Zl1021, Htrrhbur" PIi 1112'-1021, OR
-'IIIO\i~ to hlv' \he ..ttlr d.tlr.lned .t .udlt of the .ccount of the p.r.on.1 r.prl..nt.tlvl, OR
utpp.II to thl Qrphtn.' Court,
ADIII"
IITRATlV!
CORRECTlOH'.I,
DIRCllUHI'
Ftctu.1 .rror. dl.cov.rld an thl. ......ft.nt .hould b. Iddr....d In writing tOI PA D.p,rt..nt of R'Vlnut,
lurtlu of Indlvldull Tin., ATTNI Pa.t A.......nt R.vl.w Unit, D.pt. 210601, Herrhburg, PA 1712'-0601
Phone (117) 717.6501. S.. p... 3 of th. book lit "In.trucUon. for Inherltlncl T4x Alturn for I RIIJdlnt
Decedent" (RfY-1S0l) for'" IllplenlUon of "Jnlttratlvllv corrtct.bh errorl.
If env tlM duI I. pll~ within thrll (5) oll.ndl' lonth. Ift.r the d.eldlnt'. dl,th, . flvl p.rolnt (I~) dl.count Df
the "M plld I. 1110Wld.
1"!EREIT 1
Inter..t It chlr..d bttlnnln, with first dlV of dllInqu.ncv, ar nln. (9) lonth. and one (1) dav frot thl dlt. of
dllth, to the dlt. of plv..nt. T.Il" which bIO,I, d.llnquent blforl Jlnulrv 1, 1912 b.lr Int.rl.t It thl rlt. of
.IM (6:0() PtrOlOt per annu. uloul.ttd at . d.lly rlt. of ,0001'-.. All hili' which ble... d.lInquent on Ineflfter
Jenulrv 1, 19.2 will bllr Intlr..t .t . rlt. which will vir V fro. o.llndlr y..r '0 olllndlr y.,r wl'h thlt rate
ennounctd bv 'hi PA D,plrtn.nt of Rlv.nut. Th. IPplletble Int.r..t r.tl. for 1912 through 19'5 Ir.,
'!.!!! Int.r..' A.t. Dltlv Intlr..t Fletnr :!!!r Interllt Aat. aally Intlrt.t F.ctor
1911 lOX , 0005~' 1917 91 .0002\7
1911 I'X ,OOO~II 191"1991 III ,000101
19M lIX ,000101 1991 91 ,OOOl~7
191' IU ,000116 1991,1", Ii ,000191
191' 101 ,OOOIH 199' 91 ,OOOl~1
..Int,,"t I. Olleulltld ft5 followlI
IHTERElT . IALAHCE GF TAX UNPAID X H~".ER OF GAVI DELIHQUENT X GAILV IHTEREIT FAOTGR
--Anv Notlcl I,.ued If'.r 'h. "M bleo." dlllnqulnt wJll r.fllo' an Int.r..t calculetlon to flftlln (11) dlY'
beYond th. dati of thl ....IINnt. If pl'IYHnt I. .Ide Ift.r tht Int.rllt eCMtPutltlon dlt. whown on 'hi
NoUCI, Iddltlonll Int.rllt lIU.t btI Clleullttel.