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To fulfill lho r~lr....l. of Stollon ZI40 of lho Inherll.... ond [.1.1. T.. Aol, Aol ZZ of Itll. C72 P,'.
Stollon 21401.
PA'IIIENT'
Polooh lho lop porllon of Ihlo Noll.. oncl .uboll .lIh ~our p._1 to lho RooloI.. of Willi prlnled on lho
rlVlrH .Ide.
... MIke oMotc or IIOMV order Plvlttl, tal RfOISTfA OF WILLS, AGENT I
All PI~tl r~.lved lhall flrlt be ~litd to anv Int.r..t whloh .,v b. duI, Nlth an~ r.-alndlr 1PP111d to thl tlX.
_CCRI.
A rlf~ of I tlx oredlt, whIch lif'l ~t r.qullted on thl tlX r.turn, IIV be f..,.,ttd by cMplttlnt In "Appllcltlon
for R,fund of Penn'Wlvtnl. l~rltlnC' end r,t.t. T.." CREV-l,lS), Appllo.tlon, ar. ,v.llabl. at thl Offlo, of
the RIII.t.r of Will., anv of the ZS R.v.nul Ol.trlct Of'ic., ~r bv cllll", the .,.clll t.~hour tn.warlnt l.rYlol
nuabtr. for fo,.. orderlnGl In Pennlwlvtnl. l~IOO~S6Z-ZDSO, out.l~ Penn.vlvanl. end within lOQII
Horrlollurl.... 17171 717-1094, TOO' (717) 77z-mz lHo..I.. 1...lr'" OnI~I.
OIJ!CTJOHII AnY p.rtv In Intarllt not .aU.f111d liflth thl IPPr.h......t, l11owlnolor d1c,Uowanoa 0' deduction. or .....Mlnt
0' tl'C <1nolucUnt dltoount or Int,rllt) .. thowrl on thl. Moth. IIV obj.at wUhln .hctv (60) dlV' of rtel.lp' 0'
Ihl. Noll.. b~o
--written prot,lt tothl PA o.,art.."t of Rav~, Iotrd af Appe,h, Dlpt. 211021, Hlrrltbur" PAI7UI"1021, OR
.".Ieatlnt to htvt the ..tter deter.lntd at the audit 0' thl 1C0ount 0' thl "rlOMI r.,rlltnt.U..." 0..
.........1 to thl Orphln.' C1Urt
Alll4IW-
IITIATlW
'COMIcnoNsl hotu.1 .rrart dlt.1OYlrld on thlt ........"t 'hOuld be tddre..ed In IifrlUng tal PA Dlpart.."t 0' RIYInUII,
lureau of Individual TIXI., ATTNI Po.t ...o....nt R....I... Unit, DEPT. 110'01, Hlrrilbur., PA 171"-0'01
PhonI (717) 717~'!l01. 1M Pili S of the bookl,t "In.truction. for ImarJt8M. TIK R.turn for. "..Idlnt
Dtclldlnt" (REY.UOI) for an .xpl""Uon of tdtlnlttrttlv.aw corrlOtabl. error..
DIICOUIfIO
If MV tlX dut It Plld within thrH (5) oaltndlr aonthl .fter tne Metdent', dtlth, . flva paroant (1)1')
dllOounlof lho I.. p.ld I. .110WId.
1HTD2.T I
Int.r..t II OMr,", bethwd", wUh flr.t dI., of dllInquenav, or "1M (,) wonth. end OM (1) dlv
fr. thlt dat. of delth, to the data of PIYMf1t. TlMII Ntlloh btQ.. dtllnqueftt befora JarM.rv I, 1911
bI.r Inter..t at thl rata af .1. C6X) paraent par annul a.l~ul.ttd .t , d.llv rlt. 0' .000164.
All tb.. Nhioh blta... delinquent on or .ftar Janulrv 1, 191' IifIU bur Interllt It I r.t. Nhloh wUI Ylr)' frot
ol.,,*r Vllr to Cllendlr VI.r ..lth tMt rata ~ed bv thl PA DatI.rt"",t of ".VIl"tUe. ThI IPP1Iotbl1
Int.rllt ratll for nil throuth 1"1 .rll '
'tilt l"t....1t Rat. D.lh, Inhr.U Factor
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.DIllv tntarut Feotor
1912
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III'I'IUIT . IALAlICI OF TAlI UNPAID II MUllIn OF DAYI DBLIMllI/EHT II DULY IHTBIUT FACTOB
"M~ Nolloo 111* .ft.. tho lox boo_I 01011_1 will rofllOl on Inl....1 oolo"I.llon 10 flfl_ CIII doVe
bo~ond lho dol. of lho ....._t. If .._I It _ .ft.. lho Inl....1 o_I.llon dolo .- on tho
Notto., eOdlttonal Int.r..t IUlt be a.loul,t...
RIV.l!l43 EX AFP (8.941_
COMMONWEALTH Of PENNSVlVANIA
Dt:PAAtHENT Of REVENUE
SUIlUV OF IHDIVIDUAl rAMES
DEPT. ZS0601
HA~IIIURQ, PA 111l1-06DI
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILl NO. 21" q'f~/(J 'I'
ACN 94151563
DATE 11-26-91,
ESTATE OF CHARLES W HARTZELL
5.S. NO. 178-16-5580
DATE OF DEATH 09-12-94
COUNTY CUMBERLAND
TYPE OF ACCOUNT
~ SAVINOS
CHECKINO
TRUST
CERTIfiCATE
REHIT PAYHENT AND fDRHS TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TERRY L HARTZElL
5m WEATZVIlLE ilD \?, 5 \ W u ",' ,ol('V j). ,,,(
&fI&t-A---, PA 17025 t'I\,Ll,llrlu' v " ,1)1\ I/J)!
DAUPHIN DtPOSlT BK I T hu provld.d the D,part...nt with thl Inferntlon Iht.d bllow which hll bl.n uud In c.lculltlng thl
potlntl.l till dUI, Thl1r r.cord. Indlclt. that at thl dulh of thl "bOY' dlc.dlnt, you WIr' . joint ownlr/b.n.flolary of thh ,DllOU.,t.
If YOU f..l \hl. Infurutlon I. Incorr.nt, pl.f1.. obtain wrlttln corrlctlon fro. thl ,lntlOolll In.\ltu\lon, attach II copy to thl. for.
"'Ill 1.\1.11" tl (0 tIl. lhU,VW llUU' In II , Till. J"Io(j"Il~ il IluCI,u." ir, C'l",,"lrUC'loc, 111111 \I,. ~,:.1lO1 itun.." i,,~. u( \',11 C"'lOfulll,QII~tll .,f rllll.tl\'Io.,i",
Qu..tlon. .ay bl an.wI,ld by calling (111) 781.eJ~7,
COMPLITE PART 1 BELOW. . . SEE REV~RSE SID~ FOR FILING AND PAYMENT INSTRUCTIONS
Aooount No. 0028792041 c.te 04-27-91
E.toblloh.d
Aocount e.hno. 3,036.39
P.roent To..bh M 50 . 000
AMount Subj.ot to To. 1, ~18. 20
To. R.te M .06
Pot.ntlol T.. Du. 91.09
PART TAXPAYER RESPONSE
CO~FAILURI TO RISFOND WILL RI8ULT IN AN OFFICIAL TAX A88188MIHT BASID ON THI8 NOTICII
A.
To In.ur. proplr cr.dlt to your account, two
III llopl.. of thl. not Ie. IU.t ac:ec.plny your
paY.lnt to the R.ghter 0' lUll., "Ikt chltk
payablt tOI "Rtghter 0' Wtlh, Ag.nt",
HOTEl If talC pay..ntl Ir. ..da within thrll
(3l lonth. of thl dlc.dlnt', dati of d.ath,
YOU ..y dtduct I 5% dl.count of thl talC dUI,
Any Inhtrltancl tllC dv. will bICO.I dlllnqu.nt
nlnl (9l lonthl afttr thl dati of dlath,
[CHECK ]
ONE
BLOCK
ONLY
o Thl above Infor..t1on and talC dUI II c:errlot.
1. 'Iou lay choo.. to rt.1t pay..nt to thl RIg!.hr of WUII with twn copl.. of thlt notlcl to obhln
I dlloount or avoid Int.r..t. or you uy chick belC "AIt and rlturn thlt notlco to thl Rlghtlr of
Will, and an offlolal aSlgl.l.nt will b. Ittu.d by the PA D.part'lnt of R.v.nuI.
a, [:J Thl abov~ al.lt hal bltn or will b. rlport.d ftnd talC paid with the r.nnlylv.nJa Inhlrltanc. TalC rtturn
to bl flhd by the dlc.d.nt', rlpr...ntlltlvl, :
C, c:J Thl aboYI Infer.atlon I~ncorrtct and/or dobt. and dlductlonl wtr. paid by you.
'Iou 'u.t coapl.tl PART L:J and/or PART CD bilow,
PART If ~ou Indlo.t. . dlff.r.nt t.. r.t., pl.... .t.t. your
~ r.l.tlon.hlp to d.o.d.nt.
TAX RETURN . COMPUTATION OF TAX ON JOINT/TRUST ACCOUN I'S
LINE 1. D.t. E.teblhh.d t '"\ -~, <j I
2. Aooount alhno. 2 .." 0 310 ~q
3. P.ro.nt To..blo 3 M ,"0 ,""
4. AMount Subj.ot to h. 4 \ ,<:;1'0 . 2'"
S. Dobto .nd D.duotlon. S - S\.J'1S. O~)
6. AMOunt T...bl. 6 v
7. To. R.te 1 M .Ob
B.To.Du. 80
OFFICIAl-USE. ONLY 0 AAF
PA DEPARTMENT OF REVENUE
PAD
1
2
3_""",-,
4
5
6
7
8_
-
-
PART
[!]
DATE PAID
I
DEBTS AND DEDUCTIONS CLAIMED
Ho o~qr
PAYEE
I-uM(41
DESCR I PTI ON
"'~1 h'~", I "'f"""
TOTAL lEnt.r on Lln. S of T..
C..put.tlon)
AMOUNT PAID
~""
.
.---- -~
f.ctl I h.vI reported .boy. Ire tru., corr.ct and
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GENERAL INFORMATION
1. FAILURI TO RISf'flHD WILL RESULT IN AN OFfICIAL TAM ASSESSHENT .lIh "",!lOlbl. Inl....1 b...d .. Inf....Il..
......111... b~ lho llnonol.l In.lllull...
2, Jnhlrlteno. t.. btco... delinquent nine .onth. .ft.r thl dlC,dentl1 dltl 0' dlath,
J, A Joint account I, t'NIbI. .ven thoulh thl dtoldentl, n... Iif" Idd.d II . I.tter of convenlanu..
4, Aouount. (InalUdknt t~'1 ~ld bttWltn hulbtnd and wlf,) whioh the dlo.dlnt put tn J~lnt n.... liflthln ana Vllr prior to
91th art fulh taMabl. II trlrll'.rl,
I. Acoountl a.ttbll.htd Jolntlv b'tlifttn hulbtnd .od wlf. .or. than 0"4 YI.r prIor to de~'h ftr' not tlMabl.,
" Account, held bv . dt<tdeht "In trUlt for" 'nother or other. Ir. tlMIbI, fullY,
REPORTING INSTRUCTIONS - PART 1
TAXPAYER RESPONSE
aLOCK A ~ I' th, Inforlatlon and oua~t.tl~n In the notlel 'rl corr.at Ind dtductJonl Ir. nct being olal..d, pl,ol In "~"
In bloak "A" 0' P.rt 1 of the "flMPIVlr Ruponll" '.UIUon, Sign two ct/pl.. and tub.1t thl. with your chick for the ..aunt c'
tll( to thl Rttlttlr of Will. of thl counh Indlc.t.d, Th' PA O'Plrt..nt of Rev.r.ut will 'nuI en offlol.1 .......ent
(Fa,. REV-IS4' EX' upon reollpt of the r.turn 'r~ th4 R,gilt,r of Willi.
BLOCK. - If the ....t .ploiflld on thh noUc. hll b..n or will bl rlPort.d ,nd talC p,ld liflth the Penn,ylvtnll Inh.ritanco
TIH Return filed bv th, d.o.dlnt'l rlpr...nt,tlv" placl In "X" In block "I" of Plrt 1 0' thl "TIICPlv,r R,.pon.l" 'Iotlon, Sl,n one
copy and r.turn to thl PA Dlplrt.lnt of RIVlnul, Burllu 0' Individual TIKI', O.pt 210601, H,rrl.burg, PA 17121~0601 In the
envllope provided,
BLOCK C ~ I' the notlcl in'or.etlon I. incorrtot andlor d.ductlonl Ir. b,lng olll'ld, chock block "C" and oo.,I,tl Plrt. Z and S
acoordlng to the InltructJon, b'~.Si," two copl.. end IUb,it th., liflth your chick f~r thl ~'ount of tlIC PIVlbl. to the RIgI.t,r
of WIU, of the CCMltv indicltld. The PA o.part..nt of Rlv.nul will ll1ut In offlclli 1I....II.nt (Fora REV-IS4I flU upon rlOIJpt
of the "turn frOll ttM Rlllttlr of Willi.
TAX RETURN "PART 2 - TAX COMPUTATION
LIlli:
1. Entar the dati the Iccount orllllnllh w.. IItabU..h.d or tithd In th, IINlh1r IIChUng at dltte of dllth.
NOTE I For I decldent dying .ft,r 12/12/121 Account. which the dlc.d.nt put In joint n.... within ~nl (I) y.er of d.eth Irl
t'lClbll 'ully .. trlnl'"" HOIifIVIr, thl" 11 .n 'Molu.lon not to IICcI.d n,ooo per tren,f".. reglrdl... of the v.lue 0'
ttM account or thl OI.r of accounts hlld.
I' , daubl. I'terl.k (lllC) Ippllr. b.fore your flr.t n.,. In thl Iddr... portion of thl. notlcl, tnl '1,000 IMclu.Jon
elrlldY hi, b..n dlductld fro. the ICCount bll.nce _I r,port.d by thl fJnlnoll1 In.tltutlon,
2. Entlr the totel blllnG. 0' thl .ccount Including intlr,.t ecoruad to the detl 0' dleth.
1, Tht "rolnt 0' the "Gaunt th.t II tllClbl. 'or lach lurvlvar Is dltertllm! .. followll
A, The plroent talCabll for joint ....t. .,tlbll.htd IGr. than on. YI.r prior to the dlotdtnt'~ d.,thl
I DIVIDED IV TOTAL NUHIER OF
JOINT OWNERS
E)lMpIII A joint IllIt ragiltar.d
DIVIDED IV TOm NUIIIER lit' X 100 . PERCENT U.AILE
SIJlVIVINQ JOINT DNIlERS
In the n... of thl dludtnt end tMO other plrlonl.
1 DIVIDED IV J lJOINT llNNERS) DIVIDED IV Z (SURVIVORS) . .167 . 100 . 16.1l (TAXAILE FOR EACH SURVIVOR)
I. The pe,cent tlxlbll for .I..t. or..tld within on. Y.lr of the dlcldent'l d..th or aocountl owned b~ the d.cldtnt but held
In tru.t for another IndJvldul1C.) (trult blnefloitri,,)I
I OIVIDED IV TOTAL NUHIER OF SURVIVINO JOINT
_RS OR TRUST IENEFICIAIlIES
. 100 . PERCENT TAXAILE
EIC...III Joint 'ClCOunt rlgl,tt.'td In thl na.. of the dlcldtnt .nd two oth.r p"lonl .nd IIt.blhh4d within on.. yllr of death bw
the deo.dent,
I DIVIDED IV Z (SURVIVORS) . .50 X 100 . 50% l!AXAlLE FOR EACH SVRVIVOfll
"" TIM ~t lubjlot to talC Ulnl it) It d.tertlnld by lultlphlng the account bllllncl Clln. 2) by the p.rclnt tlxlbl. (line 1),
$, Enhr th. total ul the dtbh ~nd d.:t.JoUon. llthd 11. Plrt 3.
6, The....,t '...bl, 01". 6) It dtttr.Jn.d by subtraotlna the dtbt. and dtducUon. (Une S) 'rol tht MOUnt lubjtot to tlx CUne 4).
7, rntlr the IPProprlltl t.x r,t. (IJnl 7) ,. dlt.r.ined b.low.
A, For dltll of dt'th OOClurrtnt ,ftar 6/10/M, thot tax rat.. for trans"l" to IPOUIII Ir' II followlI
I. O,t.. 0' d.ath on or after 1/1/94 and before 1/1/96 the ratl 'I 1~1
2, Oatil of cMlth on or 1ft" 111/" end ~forl 111197 thl ret. It 2X.
1, Data. 0' delth on or "t.r 1/1/97 end btfcrl 1/1/91 thl rlt. I. I~.
4, Dltll 0' dtath on or 'Iter 1/1191 tr"'lf.r. to .pou... wll1 b. CllCHpt frotl ttIC.
Not.1 'or dati. of dleth prior to 7/1/94 tr&,.f.r. to 'POUI., Ir, t'lCtbl. ,t 6Xl
.. Trani"" to lIn"l dllctndlllh Includlna fltMr, lather, Ion, dlUlht,r, grlndchl1drln, ..,n~ln.lIw,
dttuthter-ln"llW, ItlPohl1d tnd their IlIut ar. t'lCabla .t Ilx p.rc.nt (6Xl.
C, Trtn,ftr, to III "ther. InchJdlnll brother, .ltter, unci., aunt, n..,htw and nllOl "1 t'ICIbI, It flft.,n p.rotnt niX),
D, If you 0~1ntI the t.. rlt., pl.... .plol'y your r.l,tlon.hJp to the dlGldent In the .r., provided,
I. fhl MCMI1t of tlX due (lln. .) II detartloed bV IKIIUpblng the leount tlllabll (lIne 6) by the tu rlta CUnt 7),
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
AllDWM11, dtbh end dtduoUon. ar. dtt.,.lned .. 'allON.I
A. '10\1 ltgtl\v Ir. ,..,onlibl, for p,Ylant, or the ..tltl lubj.ot to Idtlnhtr,Uon by . p,r,on.1 rtpfllttnt.UV. It InlUfflollN1t
to PlY U,.t deductlbl. It'll.
I. You .ctualh pIAd the debts Iftlr d"th 0' tM deotdtnt tnd cen fu,nllh proo' of PIV'lnt.
C. Debt, btlng clllHdtu.t b. Itllllld fully In Pert 1, If IddltJonll .plel' It nteded, Uti plaJn paper I Ill" H \1". Proo' cf
P'VMnt "Y bl r.que.t.d bv the PA Olp,rt.."t of Rlvenul,
>) . ... ..........i.TAXPAYliIfA&sX$TAHCE.. ......i ..i..i.... .....
it ......lfll$tVfTUERI%I!I:xU~~Tt~"~l'fjpRAmAT~t~:T~~ \\VI:u~C:x'sf~l1!TACJFPIfcVEri" r..i...... .....
i>.aRCA~L .THE..UPlI!AUO~ INDIVI UAL'.TAXf,S. TAXPAVER INQUIIlV.UNIT IN ..................
<"ARRlS.UR$A1'(717)1I1.a~27."...TD ..... (.117).. 7h-2UZ... CHEAIUNGlHPAlREDaHt'lf.... .,
., ......'"" ...... '-::'.'-,><,...'......, ......", "...--.....,.,..,...., ,..'... ". .,-_...,.' .... ..".' . ';.'.-':.......,.'...".,....' ,-,,,..' ..-.,'...,...:-,.::..,:.,