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Home My WebLink About95-00390 REY-1543 EX AFP (8-941 * . COHttOHWUl TH OF PENNSYLVANIA DEPARTHENT Of REVEHUE IUREAU Of INDIVIDUAL TAKES DEPT. 210601 ~JSIURO, Pi 111ZIpD6Dl FILE NO.21 95-0390 ACN 95131371 DATE 07-10-95 INFORMATION NOTICE AND TAXPAYER RESPONSE ARLENE H GONTZ 1929 RANDALL RD ENOLA PA 17025 TYPE OF ACCOUNT ~ SAVINGS CHECKING TRUST CERTIFICATE RENIT PAYNENT AND FDRNS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF MARGARET J BAIR 5.5. NO. 180-26-6752 DATE OF DEATH 04-27-95 COUNTY CUMBERLAND HARRIS SAVINGS BANK h.. prDvld.d .h. D.p.r.....t with ,h. InfDr..tlon Ih..d b.IDW whlDh h.. b..n und In c.IDu..tlno tho pot.nt',' ... du.. Th,'r r.cDrd. Ind'c," ,h.. .t .h. d",h DI .h. "DV' d.c.d...t. VDU w.r. . IDlnt owner/b....,I...rV DI .hl. 'CDount. If you f.. I thl. InIDr"'lon I. In'Drr..'. pl.... Db..ln wr"'''' 'Drr..tlon frD' tho Ilnancl.1 In.tltutlon. .tt..h . CDPV to thl. fDr. ond r.turn It 'D ,h. .bDW' .ddr.... Thl. .ccount I. ....... In ,ccDrdone' with tho 'nh.rl''''' T.. l.w. of ,h. CO..Dn...lth of pann.vlvonl.. ou..tJonl ..v bl enlN.red by calling (717) 111-1317. COMPL~TE PART 1 S~LOW M M M SEE REY~RSE SID~ FOR FILING AND PAYMENT INSTnUCTIOHS Account Ko. 09-00011644 D.t. 01-14-88 e.t.blbhed To Inlure proper credit to your account, two (2) copl.. of thl. notlc. .ust .cco~enY your ply.ent to t~ Rlalltar of Will.. "eka check payable tal ~R.Dl.t.r af Will., AD.nt~. PART ill 5.338.50 50.000 2.669.25 .15 400.39 TAXPAYER RESPONSE .' fAILURI!.',TOi RESPOND,"ILLRESULT: IN AM OfFICIAL. TAX. ASSESSNENT.'. lASED ON '.THIS' MOTtC!!.1 .,....,. . ",...,...,' .,..,.... ..-..... -. .."..'....'............ ....."... ".....-.'.. ".... "".....-,..... ..".. ."......."'.",, ,....," .'. Account aalanc. p.rc.nt Tax.bl. A.ount Subj.ct to Tax Rat. pot.ntial Tax Dua x HOTEl If t'K p.y.-nt. .re .ade within three IS) BORth. of the dec.dent'. date of d..th, you ..y deduCt e 5;( discount of the t8K due. Any lnherltence tlK due will beeoee delinquent nine (,) eonth' ,fter the dati of dl.th. T.. x [CHECK ] ONE BLOCK ONLY A. 0 Th. above Infor..Uon and tlK due is corrlct. 1. You .IY chao.e to r..lt Plyaent to the Regl.tlr of Will. with two copl.. of thl. notice to Obt.ln . dl.count or avoid Intlre.t, or you .,y check boK ~A~ end return thl. notlc. to the Regl.tlr of Will. and en offlcl.l .......ent will b. I..uld by the PA DIP.rt.ent of Rlv.nue. .. iTh. .bev' ....t h.. b..n or will b. "por..d end ... p.ld with .ho p"",,,'v,,,,l. 'nherltone' Tox "tum to be fllld by thl dlcedent'. rlP,,"ntet1ve. c. 0 Th. above Infor.,Uon Is Incorrect end/O~lbt. and dlductlon. ...re p.ld by you. You ...t coeplet. PART 0 and/or PART L.!J below. PART [!J TAX RETURN . COMPUTATION Of TAX ON LINE 1. D.t. Eat.b11ah.d 1 2. Account Oal.nca 2 3. Percent Taxabla 3 X 4. A.ount Subjact to Tax 4 5. D.bt. ~d D.duction. 5 6. A.ount Taxabla 6 7. Tax Rata 7 X 8. Tax Dua 8 . ...... ','OfFICIAL,USE:ONLYD~AF:i JOINT /TRUST ACCOUHTSPA~l'PA. .D~r~R:r~~~T\~:::~~VEN:E: "'1 21 3 .....'i 4 . ........ "j '5," ..... .. '; '..:e-!, ,.,," ,. '" ", . ... ....6'. ..... ,.... ....". .......... 7'.... ......"... .. ::8' DEBTS AND DEDUCTIONS CLAIMED If you indicata a diffar.nt tax rata, pl.... .tata your ral.tionship to d.cedanta .:'J ".:;\ PART I!I DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Entar on Lina 5 of Tax Coaputation) parjury, I declara that the fact. I nowladge and belief. . - -^ G. ~ v ~ _ ~Vtl.j 95 GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHEHT with .pUnbla lnt.r..' build on infonlUon suo-IUed by the flnMClal In.tltutlon. 2. .nherlt.nc:a ta. beCDH' delinquent nln. ItOI\thl ,ftar thl dlcedent', date of d..th. S. A Jalnt account 11 tlllabl. .....n though the decedent" n... wa. added al . ..Ua.. of corwenl.nc.. .... Account. lIncluding tho.. Mid b.t...." hUabMd ....d ..H.' which the decedent put In jotn' ".... within OM Y"" prior to d.ath .r. fullw h_lIble .1 tren...r.. 5. Account. ..tabllshed Jolntlv b.t...." huabend 8ftd wi'. lar' then one y..r prior to d..th .r. not ,..abla. 6. Account. held by . dlcadent ~In truI' for. another or other' .r. 'I.abl. fullv, REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BlOCX A _ If the Infor..tlon and c~t.tlon In thl! nolle. .r. corrlet lII\d deductions .r. not baing ela',ed, p'lel en "X. In block RAR of p.rt 1 of the -Ta.pay,r R..Pon.... ..ctlon. Sign two cop I.. and .uDalt tha. wlth your ch.ck for the .-aunt of t.. to the R.ol.t.r of Will. of the county lndlc.t.d. Th. PA D.p.rt.ent of R.venu. will l..u. an offlcl.l ......eent (For. REY.15~1 EX) upon r.c.lpt of the r.turn fro. tha R.gl.t.r of will.. 2. BLOCK 1 _ If the ....t .p.clfl.d on thl. notlc. he. b.en or will b. r.port.d end ta. p.ld with th. penn.ylvanla Inn.rltanct Tox R.turn flI" b. ,ho d.c..an.'. ropr..ont.tl.., pl... on -X" In blDCk "'" of Port I of ,ho "Tup.." ...pon..- ..ctlon. Sian'" cOPY and r.turn to the PA D.parta..,t of R.venut, Bur..u of IndlvldU.1 T...., Oapt 210601, H.rrl.bUrg, PA 17121-0601 In the env.lope provided. s. "OCK C _ If tho nDt'C' InIDr.."on I. IncDrr..' end/Dr d.dUct'on. .r. b.lno .1.1.... ch..k block .C" end CDOP"" p.r" Z end S .ccordlno to the In.tructlont b.low. sian two cop I.. and .~It tha. with your check for tht .eount of t.. p.y~l. to the R.glst.r of wlllt of the county Indlcat.d. Th. PA o.paru."t of R.venue will Is.ue WI offlcl.1 .........,t (Fora REV-aU DO upon rec.lpt of tna r.turn froe the R.ol.t.r of Will.. TAX RETURN - PART 2 - TAX COMPUTATION LItlE 1. Ent.r the d.t. the account orlgln.11Y w.. a.tabllahtd or tltl.d In the .ann.r ..I.tlng at d.t. of d.ath. NOTEI For a d.c.dent dying .ft.r 12JI2JIZI Account. which the d.c.dent put In Joint naea. within ona (1) ya.r of d.ath ar. ta.BbI. fully.' tran.f.ra. How.var, th.r. I. an a.clu.lon not to a.caad '1,000 p.r tran.f.raa ragardl... of tha v.lue of the account or the nuabar of account. Mid. If a double ..t.rl.k (aa) app.ar. bafora your flr.t n... In the addr.'. portion of thla notlc., the .1,000 a.clu.lon .lreadY hu ba.., d.ductad fro. the account balanc. a. r.portad by the financial In.tltutl~ () :0 c 7:: ',f' ~l' ,n Z. Ent.r the total b.lanc. of the .ccount Including Intar..t Kcruad to the d.t. of d.ath. S. Th. p.rcant of the account that la t..Bbl. for .ach .urvlvor I. d.tar.lned .a follaw.1 A. Th. parcant taxabla far joint ....t. a.tabllshad aar. than ona yaar prior to the dacadant" dealhl X 100 . PERCENT TAXABLE <.. c I lOTAL NUHIER OF SURVIYING JOINT oWNERS the eIK.dent end bla othar par.ont. DIVIDED BY lOTAL HOHlER OF JOINT oWNERS ~.eaplal A Joint ....t raglat.r.d r;: 1 DIYlDED BY In the n... of 1 DIVIDED IIY 1 (.JOINT OWNERS) DIVIDED IY z (SURVIYQRJ) . .167 X 100 . 16.7% (fAXABLE FOR EACH SURVI~J B. Tha p.rcant t..able far ....t. cra.t.d within ana yaar of the d.CRant'a d.llth or accounta owned by the deCadent but hald In truat for IInGther Indlvldu.U.) (truat IHInaflclarluU ~.",: - . . 1 DIVIDED IIY TOTAL tlJHBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 . pERCENT TAXABLE E~aapla1 Jalnt account r-ol.t.r.d In the n... of the dec.dent and two oth.r par.on. and ..tab11.hed within one y..r of da.th by the dec.dant. 1 DIVIDED IIY Z ($UNIYOR$) . .50 X 100 . SOX (fAXAlLE FOR EACH SURVIVOR) ". Tha eeount .ubject to t.. Ulne "J is det.r.lnad by ....ltlplYlng the .ccount be1IW'tCa Uln. ZJ by the parc..,t t..abl. (line ~). 5. Ent.r the tot.l of the dabt. and d.ductlonl II.t.d ln Part 5. 6. Tha eaaunt ta.abl. (llna 6) I. datar.lnad by .ubtractlng the dabt. end d.ductlon. (llna 5) froa tha .aount .ubJ.ct to t.. Cline ~J. 7. Ent.r the approprlata tax r.ta (lln. 7) a. d.tar.lnad b.low. A. Far d.t.. af death occurring aftar 6/50/~, tha ta. r.t.. for tran.ftra to .pOUI.' ar. a. follow.1 1. D.t.. of d..th on or .ftar 7/1/9" and bafar. 1/1/96 the rat. 1. ]~. Z. Oat.. of d..th on or .ftar 1/1/96 end bafore 1/1/97 the rata I. ZX. S. Oat.. of de.th on or .ft.r 1/1/97 end bafar. 1/1/9a tha rat. I. IX. ~. O.t.. af d..th on or .ftar 1/1/91 tren.f.rt to .pou... will b. a..apt froa tax. Hotal for d.t.. of ckath prior to 7/1/9" tren.fa,. to 'POU'" .ra t..BbI. at 6X. II. lran.f.rt ta llM.l dalcandllntt Including f.U.r, _th4Ir, .on, daught.r, grandchildren, .on~ln-l"', dllUQlht.r..ln-I.., stepchlld and thalr l..u. ar. taxabla at .he parcant (6X). C. Tran.fara to .11 othar. Including brothar, .I.t.r, uncia, eunt, n.ph.w and nlac. .r. ta.abla at flft.an parcant (15X). D. If yOU change the t.. r.ta, pl.... .paclfY your ral.tlonshlp to the dacadent In the ar.a provldad. a. 1M MCMrlt of tax due Ulne I) Is detaral".cl by ...Itlplvlno the uount t.xabl. Ulna 6) by the tax r.ta Ulna 7). CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowabla dabtt and dMkH:tlon. ara datar.lned a. fallatlll A. You legally ara re.pon.lbla for pa~t, or the a.t.ta subject to adalnl.tratlan by . par.~l repraaant.tlv. I. Inaufflclent ta p.y the dedUctlbla U.... I. You actuallY p.ld the dabta aft.r daath of the decadent and can furnish proof of P.yaant. c. Debts being dah.ed ....t be U..b.d fullY In P.rt S. If additional .pace It needed, u.a pl.ln papar · 1/Z" >>II 11". Proof of p.yHJI"It ..y be reque.tad by the PI Oapart..,t of R.venue. ,;:,:):;;,.:::'/}<::::": '..... ,::.::~_~"_,:,,,.":,' __',' . _ ...___. . ,o.:TAXPAVER:' ASSISTANCE:' ".,":IFYOU'NEED'FURTHERINFORHATlON'OR ASSISTANCE, CONTACT ANV .....}... REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE ",. ..i.:....' OR. CALL THE BUREAU. OF INDIVIDUAL TAXES, TAXPAYER INQUIRV UNIT IN H~RRISBURGAT (717) 7,87-8327 ;TDD' (717) 772-2252 (HEARING IMPAIRED ONLY) REY-1543 EX AFP (8-941 * . CD~EAlTH OF PEHHSVLVANJA DEPARTttEHT Of REVENUE BUREAU Of INDIVIDUAL TAXES DEPT. U0601 HARRISBURG, PA 17UI-D6al FILE NG. 21 95-0390 ACN 95131302 DATE 07-10-95 INFORMATION NOTICE AND TAXPAYER RESPONSE ARLENE H GONTZ 1969 RANDALL RD ENOLA PA 17025 TYPE OF ACCOUNT ~ SAVINGS CHECKING TRUST CERTIFICATE RENIT PAYNENT AND FORNS TOI REGISTER OF WILLS CUMOERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF MARGARET J UAIR 5.5. NO. 100-26-6752 DATE OF DEATH 04-27-95 COUNTY CUMOERLAND HARRIS SAVINGS BANK h.. prov.d.. .h. D.Por.....t with .h. 'nlor..tlDn Ih..d bol.. which h.. b.on u... 'n c,'cul.tlno .ho potontl.1 ... duo. Th.lr r..Drd. Indlc.', .h.' .. .h. d",h DI .h. .bDV' d.c.d.n', .ou ..r. . loin' ....r/bon.flcl.r. Df .hl. ..count. If .ou ,..1 .hl. Infor..tlon I. Incorr.c', pl.... Db','n .rlt.en corr,c'lon fro. .h. f.n....I.. In.tl.u.IDn, ....ch . CD" 'D .hl. for. end r,'urn 't 'D ,h. .bov. .ddr.... Thl. .ccount I. t....,. In ..CDrdonc. .I.h .h. Inh.rlt..... T.. I... of ,h. CD.......I.h of .onn..lvonl.. Qu..Uon, .., bIi an....r.d by calling (717) 717-1527. COMPLETE rART 1 BELGW ~ " M SEE REVER~~ SIDE FOR FILING AND PAYMENT II1STRUCTIONS Account No. 01-21-007614 o.t. 05-05-86 EatabUshed To Inlur. proper cr.dlt to your account, two (2) copl" of thl. notice .u.' 'CCD~enY your ply.ent to the Register of Will.. Hek. check p.yabl1 tal ~R.gl.t.r of Will., AgentM. PART ill 1,113.81 50.000 556.91 .15 83.54 TAXPAYER RESPONSE fAILUR!!.'TO RESPOND,lIILL RESUL Ti IN AN OffICIAL,TAX ASSESSNENT BASED, ON, 'l'HIS HOTICI!. I Account Balance Percent taxable Amount Subject to Tax Tax Rat. pot.ntl.1 Tax Due x HOTEl If tlX PlYlent. ar. ,Mia within three (]) ~th. of thl decedent" date of d..th, yOU "'1 d.mM:t . 5X dhcount of the tlX dul. Any l~rltene' t.. due will bICD" delinquent nine (,) .onthl .,tlr the dlta of d..th. x [CHECK ] ONE BLOCK ONLY .. 0 The abOVS Infor..Uon end ta. due h corract. 1. Vou IIY Choa,1 to raalt peyeent to tha Ragi.tar of will. with two copia. of this notica to obt.in . di.count or evoid Inter..t, or yOU "Y check box -A- and r.turn this notice to the Ragl.ter of willi end Bn official .......-nt will b. i..u.d by the PA Departaant of Ravenua. B. S" TM abova ....t has been or will be rapartad and tax F.ld with the p~.ylvBnl. Inhar!tBnCe Tax raturn to be fllad by tha decedent'. r.pre..ntatlve. C. 0 The abova lnfor.atlon l~nc:orract endJo~.bh end dlductlons wara pllid by you. You ""It c:o""lltl PART l!J and/or PART l!J balow. PART ~ TAX RETURN - COMPUTATIGN OF TAX GN LINE I. D.t. E.t.bll.h.d 1 2. Account Balanca 2 3. Percent Taxabl. 3 X 4. A.ount Subject to Tax 4 5. Debt. and Deduction. 5 6. A.ount Taxabl. 6 7. Tax Rat. 7 x a. Tax Due a :' \ OFFICIAL USE .ONLY 0 AAFj .JGINTlTRUST ACCOUNTS PAiI'P~: DE~~RTMENl OF'~,EYENUE' .; , '.: I'" 2 " 3 '4 . p5 .'. ',',' 6' pP .. :,.....,..... . ' ,"7" 8 DEBTS AND DEDUCTIONS CLAIMED If you indicat. a different tax rat., pl.... .t.t. your relation.hip to dlcedlntl """,,"j ,::J .~\ PART [!] DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (En er on Line 5 of Tax co_put.tion) Under plnaltia. of perjury, I dlclara that thl fact. I ClO.P1.t. to th. ~~Pt of :;;tno.lpda. ..d b.ll.f. ~_ nO .," 4-f. \n1:T; ~~ER SIGNAT~ r~ . HOME ( WORK ( TELEPHONE 1 1 NUMOER GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSES5HENT with applleabl. Int.,... ba.ed on Infar..Uan lubIIlttMl bV the UnMellat InlUtutJon. Z. Inheritance 'IX blea", delinquent nine ~th' .ft., the dlcedent', dl'_ of d..th. S. A Joint ICCount Ia tlMabl. IV." though thl dlcadent"' n... .... added .. . ..Ue,. of cDnvenlanc.. 'to Account. ClnchJdlng tho.. hald b.t...." hutbMd Ilnd wlta) which thl dlcadent put In Joint n.... within on. Y'" prlor to d..th .r. fully t..abl. .1 tren,'.r.. 5. Account. ..'abU,Met Jointly b.t...en hutbMld IIInd ..U. Hr. than on. Y"" prior to d..th .r. not 'aubl.. 6. Accounts held by . decedent "In truI' fa'" wtaU,"1'" or oth.,. .,. h_abl. fully. REPORTING INSTRUCTIONS - PART - TAXPAYER RESPONSE 1 1. BLOCK A _ If the Infar..Uon .".. co~htJon In thll notice .r. corract and deduction. .t. not baing d.I..d. placa .,. ")C1t In block "A- 0' Part 1 0' thll "T..payar R..pon.a- .actlon. Sign two copla. and .ubalt tha. wltn your chack for the .8OUnt of t.. to thl Ragl.t.r of Will. of the county Indlc.t~. Tha PA alp.rt.ent of R.v.nu. will I..ue an offlol.1 .......ent (for. REY.1S~' EX) upon r.c.lpt 0' the r.turn fro. the Rlgl.tar of Will,. Z. BLOCK I _ If the ....t .p.clflad on this notln h.. b.en or wll1 bl raportlld and tax plld with tha Plnnulvanla Inhlrltancl Ta. R.turn fll~ by the d.cedent', r.pra.entatlva, pl.c. en -X- In block "B- of Pert 1 of the "T.xp'Ylr R..pon..- .actlon. Sign ana copy and r.turn to thl PA aapartaent of R.v~, Bur.au of IndlvldUll Tax.., Dlpt Z8a6al, Harrl.bUrg, PA 17128-a6al In the envllope provided. S. BLOCK C _ If tha noUn Infor.atlon Is Incorract and/or d.dUctlon. ara baing chla.d, ch.ck block "C" end coaplat. p.rts Z and 5 accordlnv to the In.tructlon. bllow. Sign two cop I.. and .ub.lt thl. with your check fpr the ..aunt of taM p.yabla to the RIgl.t.r of Willa of the CCM'llY Indicated. Tha PA DaPlrt.aflt of R.v~ wll1 luue ., offlcl.l .........,t (For. REV-1S48 DC) upon r.c.lpt of tn. r.turn fro. tn. WI.l.t.r of Willi. TAX RETURN - PART - TAX COMPUTATION 00 S i:-- ~~1 ",~.J 2 LINE 1. Ent.r HOTEl the dlt. tha .ccount originally wa. a.tabll.hed or tltlad In the .ann.r 1.I.tlng at data of d.,th. for. d.cadent dying aft.r IZ/lZlaZI Account. which tha d.cadant put In Joint n.... within on. (I) ya.r of taxabl. fully.. ttan.f.r.. Hovev.r, th'ra I. an axclu.lon not to .MC.ld ss,aaa plr tran.faraa r.gardl... thl account or the nuab.r of account. hald. I d..th ar. of tha, v.lu. of If . daubl. ,.t.rlak (MM) appl.r. blfor. your flr.t naa. In the .ddr... portion of thl. notlc., the .~o IMclu.lon alr.ady ha. b.en d.duct.d fru. tha .ccount balanc. a. r.port.d by tha flnenel.1 In.tltutlon. Z. Ent.r tha total b.lanc. of the acCCM'lt Including Intar..t accrued to the data of d.ath. S. Th. plrcant of the .ccount that" taxabla for ..ch .u,.vlvor .. d.taralned a. 'allow.. A. Th. parcant taxabll '0,. Joint ....t. ..tabll.h.d lOr. than on. y.ar prior to the dlc.dant'. d~t~~ DIVIDED BY TOTAL tAJHBER OF DIVIDED BY JOINT OWNERS ~.aaplal A Joint ....t r.gl.t.r.d In the na.a 0' TOTAL HUHBER Of X laa . PERCENT TAXABLE SURVIVING JOINT OWNERS the d.cadant and two oth.r p.,..on.. I DIVIDED B" 5 (JOINT OWNERS) DIVIDED II" Z (SURVIVORS) . .167 X 100 . 16.r.( (TAXABlE FDA EACH SURVIVOR) II. Th. p.rcant t.xabl. for ....t. cra.ted within one y.ar 0' thl decadent'. delth Dr account. owned by the d.c.dent but h.ld In tru.t for enot".!" IncUvldual(.) (tru.t bWMIflclarl")1 I DIVIDED BY TOTAL HUH8ER OF SURVIVING JOIHT OWNERS DR TRUST IIENEFICIARIES X lOa . PERCENT TAXABLE E..apl.1 Joint account ragl.t.r.d In the n... of the dec.dant and two othlr p.r.on. and ..tabll.h.d within on. y.a~ of d..th by the d.c.dent. 1 DlvlDEa BY Z (SURVIVORSl . .sa X IDa . saiC (TAXABLE FOR EACH SURVIVOR) 4. The a.ount .ubj.ct to ta. (11M 4) II d.taraln.d by aultlpJylng the BCCount balllnCl Uln. Z) by the p.rc.nt taxabl. Ulne 5). 5. Ent.,. thl tot.1 of the dabts and deduction. llstad In p.rt S. 6. Th. ..ount taxabll Uln. 6) .. d.taralned by .ubtnotlng the debta and d.ductlon. Uln. 5) 'ratl the ..ount subJlMlt to t.. Ulnl 4). 7. Ent.,. the BfIproprlat. tft)( r... (Iln. 7) II d.taraln.d bllow. A. for d.t.. 0' d..th occu,.rlng a't.r 6/5a/94, the ta. rat.. fa,. tran.f.ra to spou... arl .. 'ollow'l I. O.ta. 0' death on 0,. Ift.r 1/1/94 and b.for. 1/1/96 the rat. la SiC. Z. Dat.a of d.ath on 0,. aft.r 1/1/96 and ba'or. 1/1/97 the ,..t. la ~. 5. Oat.. 0' d.ath on or .ft.r 1/1/97 and b.fo,.. 1/1/98 the r.t. I. liC. 4. D.ta. 0' d..th on or aftlr 1/1/9. tran.'.r. to .pau... will b. I.e.pt Iro. ta.. Hot'l fa,. dat.. of death prlo!" to 7/1/9~ t,.an.'.r. to .pou... .,.. te.abl. at 6iC. I. Tran.'ar. to lln.al d..cendant. Including f.ther, eoth.r, .on, daught.,., grandchildren, .on-In-Iaw, daught.r-In-I..., .tepchlld and their Issue .r. taxabl. .t .he pa,.cant (6;(l. C. T,.an.far. to .U oth.r. Including brothe~, ...tar, unci., INnt, naphsw end nhc. are ta.able at flltean p.rc.nt US~(). D. If you change the tlM rat., pl.... .paclfy your ral.tlon.hlp to the dacadent In thl ar.. provldad. I. The.-aunt of to due UlnII 8) II d.t.ralnacl by aultlphlng the uount taxabl. Ulna 6) by the tlM r.t. Ulna 7). CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED AJ1~able dabt, and deduction. ar. d.taralned .. 'ollowlI A. You l.g.lly .r. r..pon.lbl. 'or p.yeent, o~ the ..tat. .ubject to ~Inl.t,..tlon by . pa~.onal ,.ap,...ent,tlv. I, In.ufflclant to p.y the deductlbl. It.... I. 'Iou actu.lly paid the debt. .'t.r d..th of the decedent ~ can furnl.h proof of pa~t. C. o.bh baing clalMet au.t b. It..lnd 'uHy In P.,.t 5. If IIddltlonal .pac. Is n.edad, u.. ph In papar 8 112- . U". Proof of p.yaant ..y be ,.equ..ted by the PA aIP.rt.ant 0' R.vanua. , "" .TAXPAVERASSISTANCE IF YOU NEED FURTHER INFORMATION OR, ASSISTANCE, CONTACT ANY , ,> ,. REGISTER OF WILLS, PADEPARTMENT, Of REVENUE DISTRICT OFFICE' ...,., . ". .' OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN H~RRISBURGAT (7171787-8327.TDD' (7171,772-2252 (HEARING IMPAIRED ONLY) REV-1543 EX AFP (8-941 *' CDttHOHWfALTH Of PENNSYlVANIA D(PARTHEHT OF REYENUE BUREAU OF IHDIVIDUAl TAMES DEPT. ZlD6Dl HARRISBURG, PI. Hlze-0601 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 95-0390 ACN 95131383 DATE 07-10-95 ARLENE H GONTZ 1969 RANDALL RD ENOLA TYPE OF ACCOUNT ~ SAVINGS CHECKING TRUST CERTIFICATE RENIT PAYNEHT AND FORNS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF MARGARET J BAIR 5.5. NO. 180-26-6752 DATE OF DEATH 04-27-95 COUNTY CUMBERLAND PA 17025 HARRIS SAVINGS BANK hu provided the Caput.."l with the In,cr.atlon lhhd below which h.. b..., ulad In ulculaUng the pobnUal tax dull. 'hair racordl Indlcat. thlll at the d.ath af the above daudent, you ...r. 11 Joint owner/beneficiary of thll account. If you '..1 thl. Infor..tlon I, Incorract, ~1..'. obtain ~rltt.n corractlon frail the financial InstItutIon, .ttach . copy to th1. fora Bnd raturn It to the above addr.." Thl_ account I. taxable In accordance with the Inheritance Tax la... of the CO..onN..1th of Pannsylvanla. Que,tlon. ..y ba an.warad by c.l1In; (717) 7h1~er.21. CGHPLETE PART 1 BELOW M . M SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIGNS Account No. 01-16-093961 D.t. 00-29-06 E.t.blhhad Account Balanc. Percent Taxebl. A.aunt Subj.ct to Tax Te)( Rat. Potential Ta)( Dua To Insure prop.~ cr.dlt to your account, two (2) copl.. of thh notlu IIlJlt acco.peny your pav.ent to the R.gSltar of willi. "aka chack payabl. tOI "Ragl.t.~ of Willi, Agont". PART [!] 5.065.31 50.000 2,532.66 .15 379.90 TAXPAYER RESPONSE l' AI LURI!. ,TO.. RESPONDlIILL RESUL ,.INAN(I~F'ICIAL,TAXAS,SESSNE~TBJ\~I!DON,,.HIS.' NOTICE' x HOTEl If t.x pay..ntl ar. .ad. within thr.. (,) lanth. of the dac.dant'. dete of death, you .'V deduct a 5% dllcount of the tax du.. Any Inha~ltanc. tax duB wIll b.co.. d.llnquant nine (,) aonthl aftar the data of da.th. x [CHECK ] ONE BLOCK ONLY A. 0 Th. above Infor..tlon and talC duB h correct. 1. You .'V choo.. to r..lt pay..nt to the R.gllt.r of Willa with two cop I.. of thl, notlc. to obt.ln . dlacount o~ avoid Int'~.lt, o~ you .ay chack box "A" and r.turn thl, not Ie. to th. Regl.t.~ of Willa and an official ........"t will b. luu.d bv th. PA DItP.~hant of RavlN1U8. B. s1'he .bov. ...d h.1 bUn o~ .,111 b. nportad and tax plld with the pern.vlvanla Inharlt.nu Tax ~.turn to ba fUad by the d.c.dant'. r.pra..nt.tlva. C. 0 Tha abav. Infor.atlon I~ncornct and/o~.bh and dadUctlon. ...ra p.ld by you. You IUlt COllJllat. PART l!..J and/or PART l!J bllow. PART ~ TAX RETURN - COMPUTATION LINE 1. D.t. Eat.b11.had Z. Account Balanca 5. Parcant Ta)(abl. 4. A.ount Subjaot to Tax 5, Dabt. and Daduction. 6. Aaount Taxabla 1. Tax Rat. 8. T.x Du. ,,'OFFICIAL ',. USEO.NLYOM,Fj JOINT /TRUST ACCGUNTS#~;;','M:~~~AR!HENTOf REVENUE/'j "1" , , ' """'e'~ ,','""",2 '...~ ',:'3' ',. ::.:'..;,;.... .., ".:::~ :':':;:< '-'4:,"" ;';::::::.. .,', ,,,:",:..:,.' "'~ "",.5: .",' , ,,~ " ..." .",'""".,',.,..,",,',,',", """,;,.",.,.""""""""""."..."".',:: ;:."..6'..... , '..7.".."".'...""""""""""."""..',' ,'....'.'..'.'.. " '?1'S;'",.i DEBTS AND DEDUCTIONS CLAIMED If you indicata a diff.r.nt ta)( rata, pl.... .tat. your r.l.tion.hip to dacadantt OF TAX GN 1 2 3 X 4 5 6 7 X 8 PART [!] DATE PAID DESCRIPTION AMOUNT PAID PAYEE I . I TOTAL (Entar on Lin. 5 of r.x Co_put.tion) p.rjury, I daclar. that the fact. I wladga and b.li.f. OYl::t:: ~ hay. r_portad above a~. tru., corraot and ~~:~ ~ 7// ~ 7 ~ ;l. - ;;l !>- 0 e- TC' C ..n~c ~1I1i1i,!Jl -U{f ~h~- GENERAL INFORMATION 1. FAILURE TO RESPOND WILL ha:SUL T IN AN OFFICIAL TAX ASSESS"EHT .,lth 1lPP1Icabla Int.rut b...d on In'or..Uon luba1thd by the flnllnClat Inatitullan. Z. Inh.rlt~c. tax blea... dlllnqu.nt nln. lonthl aft... thl decedent'. data of d..th. J. A Joint ItCcount Is tlxabl. .ven though thl dlcedent'. n... .... ~dad .. . ..ttl" of convenience. ~. Account. (Including tha.. held batwlan hu.band .nd wl'al which the dlcadent put In Joint ".... within one y..r prior to d..th ar. fullY tuabh .1 \1"'.....,.1"'.. S. Account. ..tabll,hed Jolntlv b.t..l." hu,b8nd and wlf. ~r. then one y..r prior to d..th '1"" not taxabl.. 6. Account. held by . dlcadent "In trust far" anothl" or other. '1"" taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - I' the Infor..tlon end cD~t.tlon In thl not Ie. '1"" corrlet and deductions ar. not baing clal..d, plltCl an WX. In block RAW of Part 1 0' the -TaxpaYI.. R..pon,.- ..etlon. Sign two cop I.. and .ub.lt th.. with your ch.ck 'or the .-aunt a' t.x to the A.gl.t.r a' Will. 0' the county Indlc.t.d. 'h. PI O~.rt'ent a' A.v~. will I..u. an a"lcl.1 ......-.nt (Far. REV-IS41 EX) upon r.c.lpt a' the r.turn 'rot the R.gI.t.r a' Will.. Z. BLOCK 1 . If the ....t .p.clflld an this noUes h.. b.1I'I or will b. r.port.d and lu P.ld with Ih. P.rllllylvanl. Inh.rltane. T.x R.turn 'Il.d by t~ d'cedent'. repr..ant.tlv., pl.c. en -X- In black -I- a' P.rt I a' th. -T.xp.y.r R..pon..- I.etlan. Sign on. copy end r.turn 10 t~ PA O.p.rl.lftt a' R.v~, Bur.1V a' Indlvldu.1 T.x.., O.pt 210601, H.rrllburg, PA 17111.0601 In the env.1op. provided. 3. BLOCK C - If th. notlc. In'or..tlon I. Incorr.ct end/or d.ductlon. .r. b.lng cl.I..d, ch.ck block -C- end cosplet. P.rt. 1 and 3 lCeordlna to the In.truetlon. below. Sign two copl.. and .ub.lt Ih.. with your ch.ck 'Dr thl a.Qa, h. PllYtbl. to tlKJR.ghhr of W1111 of the county Indlut.d. Th. PA O.pert..nt a' A.v.nus will Is.u. en offlci.l .......en~:-(For. RE"-:.l~. [X) ~',"c.JPt of the "Iurn fro. thl RIght., of Willi. . - LINE 1.. Enter HOTEl , ,. thl d.t. the .ccount arlgln.lh .... nt.t)lhh.d or tltlsd In tM .tnntr ....tlng .t d.t. of d..th. r-~ For. d.csdsnt dying .fttr 121121121 Account. which th. d.esdsnt put In Joint n.... ..lthln on. (1) ye,,,,of d.lth I" t,xabl. fully.. tran,'.r.. HOWIv.r, ther. J. en .xclu.lon not to .xc..d 'S,OOO p.r tren,'.r.. r.g.rdl'll 0' the v.lu. of thl aCCOU"lt or the ~r of acCCKont. held. TAX RETURN - PART 2 - TAX COMPUTATION If. doubl. ..hrllk (..) tpp..n b,'or. your flnt nu. In the oddr... portion of thh notlc., the n.,quo .xciU.I~ Ilr.edy h.. b.1ft d.ducttd 'rot th. .ccCUlt b.ltnu II r~rtsd by th. UnMelal In.tltutlon.'" Z. Ent.r tht tat. I b.lence of thl account Including Int.r..t accrued to the d.t. 0' d..th. 3. Th. perCllnt of the accCKont th.t h t...bl. 'or ..ch lurvlvor h d.ter.lntel II' 'allow. I A. Th. p.rcant t...ble 'or Joint ....t. e.ttbll,hed lor. thll'l on. y'lIr prior to the d.c.dant'. d..th. 1 DIVIDED BY TOTAL NUttiER OF JD I NT OWNERS E..-pl" A Joint 1I...t r.gl.t.r.d DIVIDED BV TOTAL NUttIER OF X lUO . PERCENT TAXAIlE SURVIVINC JOINT OWNERS In the n... a' thl d.csdent and two othtr p.non.. I DIVIDED IY S (.JOINT OWNERS) DIVIDED BY 2 (SURVIVORS') . .167 X laG . 16.];( (fAXAllE FDR EACH SURVIVOR) I. The percent t..abl. for ....h crllt~ within ~ Yllr 0' the dlCed."t'. d..th or ItCcounh awn"Ct by thl dete.dent but htld In tru.t 'or anothar Jndlvldu.l(a) (truat ben.flcl.rl.I). 1 DIVIDED IY TOTAL HUHIER OF SURVIVINa JOINT OWNERS OR TAUST BENEFICIARIES E.llple. Joint etecount r.al.t.red In thl n... of thl d.ctelant tnd lwo ath.r p.r.on. end 'Itabll~ within ant y.ar 0' d..th by IhI dac.dant. 1 DIVIDED IY 2 (SURVIVORS) . .SO X taG . sn (TAXABlE FDR EActt SURVIVOR) X 100 . PERCENT TAXABLE 4. The lltOUMt .ubJect to taM (lIn. 1ft) Is daterlln.d by .ultlplylng the account b.lsnc. Cline I) by thl PIrClnt te..I. (11". S). 5. Ent.r the tntll af the d.bt. end dtductlon. llllld In P.rt S. 6. ThI BlOUnt taxable (1In. 6) I. d.l.relned by lubtr.ctlna the debt. and deductlonl Cllns 5) 'roe the BlOUnt .ubJect to t.. Cline 4). 7. Ent.r the .pproprl.te t.. r.l. Cline 7) a. deter.ln.d bllow. A. For d.t.. of d.ath occurrlna .ft.r 6/S0/94, the t.. rat.. 'or tren,'er. to lPOU'" ar. .. 'allow.. 1. D.t.. 0' d..th on or .'I.r-7/1/94 end before 1/1/96 the r.l. la S~. 2. Dat.. 0' d..th on or .'I.r 1/1/96 and be'orl 1/1/97 the r.t. I. lX. 3. D.t.. 0' d..th on or .ft.r 1/1/97 and b,'or. 1/1/9. Ih. rat. II 1~. 4. O.t.. 0' d..th on or a,t.r 1/1/9. trenl'.r. to 'POUI.I ..Ill bl ex.lpt 'rot t... Hoter Far dat.. of da.th prior to 7/1/94 trtnlf.r. to ,pouI.. .r. ta.abl. .t 6~. I. Trtn,'.n to IInt.l d..candtnta Includlno f.thlr, _ther, .on, deughter, grandchlldr..., .on-In-l..., dlUllht.r-ln-I..., .tepchlld end thllr hlUS ere t..liblt at a" percent (6il:). C. Trtn,'.r. to ell othera Includlna brother, .I.tar, unci., aunt, neph... end nl.c. ar. t..lble .t fifteen perc",t (15~). D. If ynu chang. th. t.. r.t., pIe... .pecl'y your r.l.tlon.hlp to the dlCed."t In thl .raa provided. I. ThI ~t of tIM dull ClI". I) h d.t.,.lntd bv IlUltlplyJng thl MIOUI'lt t...ble UI". 6) by the taM rete Oint 7). CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allawllble debt. end dtductlon. .re d.teralntel II 'ollow.. A. You 1.g.lly are r.~.lbl. 'or P.yaent, or ~ ..t.t. lubJ.ct to tdtlnl.tr.tlon by . persone1 r.pra.entltlv. I. In.ufflclent to p,_ the deductlbla It.... .. You ICtual1y peld thl dabt. after d..th 0' t~ d.cadent end cen furnish proof of p.v-ent. C. Dlbt. baing clelE.d .u.t bI Ite.lzad 'ully In P.rt S. If tddltlonal .pete. I. needed, u.. pl.ln paper. 1/Z- . 11-. Proof of p.pant .a_ be reque.ted by thl PA Dtpert.ent 0' A.vlf'lUl. ., TAXPAYER" A:lSI STANCE IF YOU NEED FURTHERINFORHATION OR ASSISTANCE"CONTACTANY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN HARRISBURG AT (717) 787-8327. TDD' (717)772-2252 (HEARINGIHPAIREDONLV) REV-1543 EX AFP (8-94) * . CDtUtONWfALTH OF PEHHS'tLVAHU DEPARtHEHT oF REVENUE BUREAU OF IHDIVIDUAL TAKES DEPT. i!106Dl HARRISBURG, PA l11ZI-0601 INFORMATXON NOTICE AND TAXPAYER RESPONSE FILE NO. 21 95-0390 ACN 95131384 DATE 07-10-95 ARLENE H GONTZ 1969 RANDALL RD ENOLA PA 17025 TYPE OF ACCOUNT ~SAVINGS CHECKINO TRUST CERTIFICATE RENIT PAYNENT AND FORNS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF MARGARET J BAIR 5.5. NO. 180-26-6752 DATE OF DEATH 04-27-95 COUNTY CUMBERLAND HARRIS SAVINGS BANK hu provld" tho D.Port....t with tho Inlorutlon It...d b.IDW which hu b_ u... 'n colculotlno tho pDtontl.. t.. du.. Th.lr r,cDrd. Indlc.t. th.t .t tho d..th Df tho obov. d.c.dent, .ou w.r. . JDlnt Dwn.r/b.nef'cl.r. DI thl. .ccount. If .ou ,..1 thl. InfDr..tlon I. IncDrr.ct. pl.... Dbt.ln written cDrr'DtlDn frD' tho flnonc'" In.tltutlon. .ttach . cop, to thl. IDr. ond "turn It tD tho obDV' .dd..n. Thh account 10 ....bl. In occordonc. with tho Inh.rltone. To. l.w, of tho CD..onwnlth 01 ponn..lvonl.. au..tlonl ..y bl .nlw.red by ceiling (717) 787-8527. COMPLETE PART 1 BELOW M M M SEE REV~RSE SID~ FOR FILINll AriD PAYMENT INSTRUCTIONS Account No. 09-66-229458 D.h 05-05-86 e.tabUahad 10 Inlur. prOP'~ credit to yaur lecount, two (2) cop... of thl' notlcl .usl ecco~enY your plvlant to the RIglat.r of Willi. Haka chick payable tal ~R'Dl.t.r of Wille, AD.nt~. PART ill 1,546.80 50.000 773.40 .15 116.01 TAXPAYER RESPONSE fAILU~I!./fO: ~ESpaNDlIILL.'!tESUL,\,IltAIl"C1f~ICIAL,TAX> ASSESSNI!NT ..IASED OH THIS"'. NO'TICI!.' Account Oalanc. Parcant Taxable A~ount Subject to T.~ Tax Rat. potential Tax Due HOTEl If tl. ply.ent. .r. aade within thr" (5) ~lh. of thl dlcadent" date of d.ath, you ..y daduCt . sX dhcount of tM t.. chM. Any Inhtlrltenca tllC due NUl beeo.' deUnquent nlna (9) .onth. .ft.r the dlle of d..th. x x [CHECK ] ONE 8LOCK ONLY .. 0 The above Infor..Uon end t.. dlM h corrltCt. I. Vou ... chOD" to r..lt p...ont to thO ..ol.t.r 01 Will. with tWD cop I.. of thl. nDtlc, to obt.ln a dhcQU'lt or avoid Interut, or )IOU e.y cheCk bo. "'."' end return thh noUn to the A.ghter of will. end en official .......ent will be I..usd by the P. Departe.nt of Aevenue. .. ~Th' .bDV' ....t h.. b_ Dr wll' be r.port" .... t.. p.ld wIth tho ponn..lvonl. Inherit..... T.' r.turn to be flied by the docedent.. rapre.entatlve. c. [:) The abova Inforeatlon l~ncorr.ct end/o~abt. and daductlon. war. paid by you. You IN.t co-.plata PART l!J and/or pART l!.J balow. If yOU indicat. a diff.rent t.x rat., pl.... atat. your relationship to d.c.dent, DEBTS AND " '.,,; , OFFICIAL USE O/'lLY 0 AAF'\ ',~~II~' PA~,~tA!tT~~N!>~F, ~EVEN~~, "I ",2 ' "J ""."'.,,.':6""" ,',",." '''11, :' :-',:", :;:>':'" ;,::::;::;.:~.;:::;:!:\: ::~:::>::::". ._ , ~:~JjJ .,7,' ' ' , . ,8' j DEDUCTIONS CLAIMED PART ~ TAX RETURN _ COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. D.t. Eot.b1Ioh.d 1 2. Account Balanc. 2 3. p.rc.nt Taxabl. 3 W 4. Amount Subj.ct to Tax 4 S. Dabt. and Oaduction. S 6. A.......t T.x.b1. 6 7. Tax Rat. 7 w 8. Tax Dua 8 PART I!l DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL tEnter on Line 5 of Tax Coaput.tio~) . Under p.nalti.a of y_Pl.h ,to t~. ,b.~ 0: , I'A~~ S'{tlIlATURE~ perjury, I daclare that the .y kRoWladg.and bell.f. .J \r" T1 -d feet. I h.v. r.port.d above HOME ( WORK ( TELEPHONE ./ .!> GENERAL INFORMATION I. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESsttENT with ."lIcllbl. Int.r..t bUM on Infor..tlon lutMllttH by the tlnMeI,. Inltttullan. Z. !nherUIlnCI ta. bee... cMllnquent nine .,.,tht .ft,,. the dluden", dl" of d....... S. A Jalnt ItCcount .. '1..1Ib.1 I."WI though U~ dlced."t', n... .... IMIdH .. . ..tt.r of convenience. 4. Account. (Including tho.. held between hu.b~ end .,.f.1 which t~ dlcedent put In Joint ~. within on. Y'" prior to de,th .r. futh 'anbll .. ',,,,".r.. 5. Accounts ,,'_lImed Jolnth btltMHl'l husband ~ ..If_ _n t"-' DnlI 'I"" prior to ..th .r. not hllllbla. 6. Account. held by . dec~."t "In 'rult for. ~th'r or other, ar. t....... fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. ILOCl A - If ttM an'or..tlon Md c~t.tlon In the; noUn Ira corrlct .1d dllductlont .r. not bllng c1aIHd, plKI en .X" In block "A" of Part 1 of the "'h.p.v.r H..pon.... ..ctlon. Sign \>>0 coP." Md .~.It tt-. with your check 'or the ~t 0' t.. to the Rlgl.t.r of Will. of the county Indlc.t.d. Th. PA D.p.rt'6nt of RevlnUe will I..ue .n af,I,I.1 .......-nt (Far. REV-IS" EX) upon r.ulpt of the r.turn frH the A.,ltt.r of Willi. 2. ILDCX I - I' the ....t .pecl'led on thl, notlc. h.. been or will b. r.parttd end tex p.ld with the Penn.vlvlnla Inherlt~. '.x Return 'lied bv the dec.dent'. r.,r..entetlv., plac. en~. In block -B- of P.rt I of the -'.xp.v.r Ae.pon..- .ectlon. Sign one copy end return ta the PA Dep.rtaant af AIVenue, Bur.au of Indlvldu'l T'.I', D.,t '10601, H.rrlsburg, PA 1711a-D6DI In the ~llape provided. I. BLOCK C _ If the notice Infar..tlon I. Incorrect ~or deductIon. .r. being cl.lled, cheek black -C. end caapl.tl P.rt. Z end I .ccardlna ta the In.tructlon. b.low. Sign two copl.. and .ubIIlt th_ with vour check far the uount of t.. p.yabl. ta the AlI8lstar of Will, of the county Indlc.t.d. The PA Dep.rt.ent af A.v~ will I..ue en offlcl.l ......aant (Far. REY-IS41 EX) upon recalpt of the r.turn fros the Ae,l.t.r of Will.. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Ent.r the d.t. thl account originallY w.. ..tebllahld or tit lid In the lannar ..I.tl~ .t dati of d..th. HOTEl Far. decedent dvlng .ft.r U/IZlIZI Account. which the d.c.dant put In Joint nus. within on. (1) v..r of death .ra taxabl. fully.. tran.f.r.. Haw.v.r, there I. an .~clu.lan not to e.c.ed ",000 p.r tran.f.r.. r.g.rdl... of the v.lue of the account or the nu-blr of account. hlld. 0 () If. dcMJl. ..t.rlak (....) .,p..,.. b.far. vour first n... In thl Mktra.. portion of this notTc'-;-thl n.,.daD ..dUM-if? .lready h.. been deducted fro. the ICCount b.lanc. .. r.ported by thl flnlll"lCl.1 In.tltutlon.: '. .1 ;.~ Z. Enter the tot.l b.lanc. of thl eccount Including Int.r..t accrued to the d'-, of dllth. J. Th. p.rcent of the account that h te..atl. for .Kh survivor" iNt.ralned .. follow" A. Th. percant texabl. 'or Joint ....t. e.tabllsh.d .or. than ani y..r prior to the dec.dent'. d..thl L r.- 1 DIVIDED IY TOTAL HUKlER OF JOINT OWNERS ~x.-pl'l A Joint ....t real.t.rod DIVIDED IY TDTAl NUHIlR OF X IGD . PERCEHT TAXULE SURVIVING JOINT OWNERS In the n... of thl decMMnt and two othar p.r.an.. I;-J -> I DIVIDED BY J (JOINT OWNERS) DIVIDED IY Z (SURVIVORSJ . .167 X IGD . I'.T.C (TAXAllE FOR EACH stlNlVORJ .u I. The parcant ta.abl. for ...... cr..ted within OM y..r of thl decMient'. d..th or accounts owned. by thl ~.."t but hild In tru.t for anothlr IncU"lcblU.J (tru.t beneflcl.rI..h I DIVIDED IY TOTAL HUttBEA OF SURVIVING JOINT OWNERS DR TRUST BENEfiCIARIES Ex...,I.. Joint account reglltarMi In thl ftIM 0' the decadant and two ather p.r.on. Itnd ..tablllheel within one v..r of dllth bV the cMcMMnt. I DIVIDED IV Z (SURVIVORS) . .50 X 100 . SD:c (TAXAaLE FDA EACH SURVlvnRJ X 100 . PERCENT TAXAlLE Ii 4. The uaunt .ubJICt to t.x Ulna 4J II d.t.ralned bv aultJplvlng thl account b.IIll"IC' Ulna ZJ by the percent taxabl. Ulna IJ. 5. Enter thl tot.1 of thl dlbts and dlduotlon. IlIt.d In P.rt J. 6. Th. "O\.W'It ta>>elbl. Ulna 6) II d.hralnad by .ubtrlOtlna the debt. end dlduotlon. Ulna 5J freM! thl MICK.W'lt .ubJlOt to tax Ulna 4J. 7. Ent.r thl appraprl.t. tax r.t. (line 7J .. d.t.r.lned b.low. A. Far d.t.. of death occurring .ft.r 6/10/94, the t.x r.te. 'or tran.fer. to .pou... .r. .. fallow'l I. D.t.. of d..th on or .ft.r 111/94 and b.for. 1/1/9' the rat. I. IX. 2. D.t.. a' dti.th an or' .ft.r Ill'" WKI b,'or. 111197 the nt. II U. 1. Oat.. of ~th an or .fter 1/1/97 WKI b.for. l'I"a the r.t. I. IX. 4. D.t.. of d..th an or .ft.r 1/1'9' tran.,.r. to 'POU". will be ....,t fros t... Natel Far d.t.. of de.th prJor to 7/1/94 tran.fer. to 'POU'.. .r. taxabl. at 6X. I. Tran.f.,. to llna.1 dlKend."h lnolucUna f.thllr, _thclr', .on, daught.r, IIrandchl1dran, .an-In.I..., daught.r-In-I..., .t-PChlld WKI thllr I.~ .r. taxable .t .1. parc."t C'XJ. C. Tran.f.r. to .11 athar. Including brot~r, .I.t.r, unci., aunt, nephew and nlac. .r. t..abl. .t fifteen parcent (IS~). D. If you c~ the taM r.t., pi.... .paclfY your r.l.tlonshlp to the decadent In the .r.. provldld. I. The.-aunt of tax QUI (1lna IJ I. dIIt.r.lned by aultJphl~ thl .-aunt taxllbl. Ulna" bv tha tax rat. Ulna n. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowabl. dlGt. and daduotlon. .re dat.r.l~ .. followlI A. Vou llfOIIlh are rllpanalbl. for p.v....t, or the ..t.t. aubJ"t to 8dalnhtr.Uon bv . Plraanlll raprllant.U". II InlUfflcl...t to P'V thl deducUbl. It.... I. You IOluaUy p.ld the ctet. .ftar dllth of the dlcadlnt and un furnish proaf of p.....,t. C. Debt. Hlne cl.11Id ",.t be It..bed fully In Part S. If additional aplCI II needed, UII pl.ln papar' I 1/r" Ie 11.. Proof of P'VHfIt IIV H r.....tlld bV thl PA D",Ir-taant of A.v.,.".. 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 INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT<IN H~RRISBURG AT (717) 787-8327. TDDI (717) 712-225<: (HEARING IMPAIRED ONLY) REV-1543 EX AFP (8-941* C~NW(ALTH or PENNSYLVANIA DEPART"UH or REVENUE BUREAU or INDIYIDUAL TAXES DEPT. lIOlO) IIARRISIURG, PA 11UI.D6DI INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO.21 95-0390 ACN 95131305 DATE 07-10-95 TYPE OF ACCOUNT ~ SAVINGS CHECKING TRUST CERTIFlCATf RENIT PAYNENT AND FORHS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 ESTATE OF MARGARET J BAIR 5.5. NO. 100-26-6752 DATE OF DEATH 04-27-95 COUNTY CUMBERLAND ARLENE H GONTZ 1969 RANDALL RD ENOLA PA 17025 HARRIS SAVINGS BANK hu provided the D.p.rtun' with the In'or..tlon 1 hted below which hu be'" ....~ In nlculeUng lh. potential tax du.. Thalr r.cordl Indlcat. that at the d.,th of the above dleldlnt, you w.r. I JoInt ownar/beneflclary of thl, account. If yOU f..1 thl, Infur..tlon I, Incorrect, pl.... obt_ln wrltt.n corr.ctlon frol the ,Inancl.l Institution, ettach . copy to thl, for. ~ r.turn It to the aboVI .ddr.... Thl' account I, tlxabl. In accordance with the Inherltanc' ,.. la"l of the Co..onw..lth of Pennsvlvanla. Qu..tlon. ..y ba an.w.r.~ by cIlllng (117) "7-8521. COMPLETE PART 1 BELOW M M M SEE REVERSE SIDE FGR FILING AND PAYMENT INSTRUCTIONS Account No. 01-00109623 D.t. 00-29-06 E -t.bU.had Account Belanc. 6,114.43 p.rc.nt Taxabl. )( 50.000 A.ount Subj.ct to T.. 3.057.22 T.. R.t. X .15 PotonUd T.. Du. 458.58 PART TAXPAYER RESPONSE [!] I' FAILURI!.TO RI!SPOND lIILL RESULT IHAM Ofl'tCIALTAX ASSESSNENT BAUD OHTHIS NOTICE A. E:J Th. above Infor.atlon and ta. due I, correct. 1. You .ay choo.a to r.,lt pay..nt to the R.gl,t'r of Will. with two cop I.. of thl, notlc. to obt.ln . dl,count or .vold Int.r..t, or you .ay cheek bo. -A- and r.turn thl, not lea to the R.gl,t.r of Will' end en offlcl.l ......eent will ba I,.u.d by tha PA O.part-.nt of R.venue. a. ~ha; abov. ....t has be." or will be r.pOrt.d ....d ta. paid with the Pannlylvenl. Inherltanca la. raturn to ba fll.d by the dac~ent', r.pr..entatlva. la Intura proptlr credit to your account, two (2) copl.. of this notle. .u.t .c~o~any your p.ya."t to the Ragl.tar of Will.. "aka ch.ck paYabl. tal -Aaol,tar of Will., Agent". HorEI If ta. payaant. ar. .~a within thr.a (51 .unth. of the decadant" data of daath, you aay 9duc:t . 5;( dhcount of thti t.. du.. Any Inherltanca h. dUa will becDM dallnquent nln. (91 aonth' .ft.r the data of d.ath. [CHECK ] ONE BLOCK ONLY c. 0 ThIi abava Infar..lIon I~ncornct and/or dabh and daductlon. lHIra paid by you. You ",.t co~lata PART l!J and/or PART [!] balow. If you indlcat. a diff.r.nt tax rat., pl.... .t.t. your ralationshlp to dacadentl "OFFICIALUSEONLV 0 MF,! ; ',', ~~DEPARTHENT OF R,EVENUE ' PART ~ TAX RETURN - COMPUTATION OF TAX LIN~ 1. Data E.t.bllshad 1 2. Account Balanc. 2 3. Parcant Taxabla 3 x 4. A.ount Subj.ct to Tax 4 5. Dabt. and D.ductlon. 5 6. Aoount T..~l. 6 7, Tax R.t. 7 x a. Tax Du. a ON JOINT/TRUST ACCOUNTS PART ~ DATE DEBTS AND PAD 1 ',2 3 , '4' S '::;6:;:';""'" "~, . DEDUCTIONS CLAIMED ....,.'i ',,','.':-'.' .; ;,.....;.-...::,::: PAID PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Entar on Lln. 5 of Tax COMPutation) I . p.rjury, I daclara that the fact. I k owladg. and b.llaf. hava raportad above ara true, correct and HOME (: ~): ~~ -07 .,~~~ / WORK (I '7 ~;Zfl1J-- TELE H E UM R GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAlC ASSESSNENT with ..pll...I. Intor..t bn.d on Infor..tlon tublllthd by the fln..,clt' institution. 2. InherU....C. tl. b.c~. delinquent nln, Iantha ....t thl Mudent', d.h 0' d..th. J. A jo1nt ~count ,_ t'M~l. Iven thoUgh thl dlcld.nt', n..' WI' addad .1 . ..ttar of canv.nl~', 4. Account. (Including tho" held batwI"" hUlbend end wlf.. whl~h thl dlcldlnt put 1n Joint n.... within onI y..t prior to Hath .t. full., '1IIIIbl. .. tr.......r.. 5. ACCOU1t. ..tllblbhed Jointly be'Mam hUlbllnd .nd wlf. Mr' th.... one y..t pdor to d..th .t' not ,..ebll. 6. Accountt hlIld by . dlcadent "1n trult for" another or other. .t' '1IIabl, fullY. REPORTING INSTRUCTIONS - PART 1 _ TAXPAYER RESPONSE 1. BLOCK A _ If thl In.or..tlon .nd c~t.tlon In thl notle. .t. corr.ct end d.ductlonl .t. not balna cl,I..d, pl8CI .... "X" In blDCk ... of P.rt I of tho .T..po.or ..,pon,." ..ctlon. Sian two coplo, end .ubPlt tho' with .our oheck 'Dr tho ooount of tlM to the Rlal.t.t of WillI of thl county indlcl,ad. 1~ PA Dlpartl..,t of A.venue wll1 I,.ue an official ......aent (Fora AEV-aU EX) upor\ recaipt of th. r.turn fro' th. R..ht.r of wills. 2. BLOCK I _ If t~ ....t .peelfl.d on thl. notlca ha. b..n or will b. r.ported and teM p.ld with th. Pann,Ylv.nla Inharltanc' T.. ..turn 111.d b. tho docodont'. ropro.ont.tl,., .,... on .X" In bIDO" -e" of p.rt I Df tho -To..o.or ."pDn... .octlon. Slon 0"" copy ~ r.turn to t~ PA O.p.rta.nt of A'v'nua, Bur.to of IndividUal Ta.'" D.pt Zaa6Dl, Harrl.burg, PA 1712a-06al In the anv.lope provid.d. .. elOOK C _ If tho notlc. InlDr.otlon I. IncDrroct end/Dr deduCtion. .ro b.lno cl.l.od, oheck blDCk -C- and cDoploto Port. Z .... · ocoDrdlno to tho In.tructlon. belDW. Sian two cDPI.o end .ub.lt the. .Ith .DUr chock 'Dr tho ooount Df to. po,o'lo to tho ..olotor of Will. of the county Indlcated. Th. PA D.p.rta.nt of A.venue will I..u, an offlci.1 ........nt (For. AEV-154a EX) upon racalpt of tha raturn frd the A..htar 0' Will.. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1.. Ent.r NOTEI P [! \.r', "7J the; data the ItCcount orll1lnallY was ..tablhh.d or tlU.d ln th. ......,.r ad.tlna at d.ta of'.da.th. ,- :-".--., For a deeadant dylng aft.r U/1Uel. Accounts whlch the; dac.dant put ln Joint n.... wlthlnon. (l) yuf'o' d..th-..r. ta..bl. fully a. tran.fsr', Hawav.r, thlr. I. an a.clu.lan not to ..c.sd ,s,aao par tran.f.r.' r...rdl... of th. value of th. account or the nu-blr of account. hsld. r. t. If . daubla a.tarl.k (MM) appear. bafora your flr.t n... In th. addr... portlon of thl. notlc., the .i:ooo axclu.lon .lraady ha. baan dadUctld fro' th. account balanc' .. r.portsd by the flnancl.l Inltltutlon. ~ j::" 2. Entlr th. total b.l~a of tha account Including Int.r..t accrued to the data of d..th. S. The p.rc,"t of the .ccount that h taxable for ..ch .urvlvor Is d...ralned a. folloWII A. Th. parcent taxDbl. for joint ....t. .atabllshad aor. than on. y..r prior to the dee.dant'. d.athl f.! 1 DIVIDED BV TOTAL NUM1EA OF JOINT OWNERS Ex.-pl.. A Joint ....t r'lIl.t.r.d DIVIDED BV tOTAL NUttBER OF K 100 . PERCENT i~~LE SURVIVING JOINt OWNERS In the n... of the deced.nt and two other p.rson.. 1 DIVIDED IV S (JOINT OWNERS) DIYIDED BV Z (SURVIYORS-) . .167 X 100 . 1'.n (TAXABlE FOR EACH SURVIYQA) B. Th. parc."t t.xllbla for ...... created within one :tllr of the deCadant'. d.ath or eccOlAlh owned by th41 dec.dant but h.ld In tru.t far anothar lndlvldu11U,) (tru.t ban.Uelarll1" K 100 . PERCEHT TAXABLE 1 DIVIDED BV TOTAL HUHBER OF SURYIVING JOINT OWNERS DR TRUST BENEFICIARIES Ex..,la. Joint account r'lIlat.r.d In the n... of t~ d.c.dant and two oth.r p.r.on. and ..tablla~ wlthln one y.ar of d..th by tM decadent. 1 DIYIDED BV 2 (SURVIVORS) . .50 K 100 . SOiC (fAXABLE FOR EACH SURYIVOR) ,.. The..ouRt .ubJ.ct to tax Clln' 4) h d.teraln.d by IlUltlplYlnll the account b.lanca Ulna Zl by the perc,"t taxatlla Cllna S). S. Entar the total of th. dabt. and deduction. listed In p.rt S. .. Tho ooount t..obl. (lIne ., I. dot.r.lned b. ,ubtr..tlno tho debt. end dodUctlon. (line SJ Iroo tho ooount .ubl.ct tD t.. (line ,). 7. Entar the approprlat. t.. r.t. (1In. 7) a. d.t.r.lnad balow. A. For dat.. of daath occurring .ft.r "SO/94, the tax rat.. for tran.f.rl to .poulaa .r. a. follow'l 1. D.ta. af d.ath on a~ aft.r 7/1/94 and b.for. 1/1/9' the rat. I. S~. Z. D.t.. of d..th on or .ftsr 1/1/9' end b.far' 1/1/97 the rat. I. ~. S. Oat.. of da.th on or .,t.r 1/1/97 Dnd bafara 1/1/9a the rat. I. 1~. 4. Dat.a of daath on or .ft.r l/I/9a transfar. to 'POU'" wl11 b. .x.apt froa tlX. Not.. For dat.. af dlath prior to 7/1/94 tran.far. to .pous.a .r. taxDbl. at ,~. B. Tranlf.,. ta lineal cHi.canci.,t. lncludlno fathar, IIGUlar, .an, daUGhter, IIranckhl1dran, .on.ln.l...., daughter-In-I..., .tapchlld and thalr hsue .ra taxable at .Ix parcant ('X). C. Tran.f.r' to .11 oth.r. Including brothar, .Iat.r, unci., eunt, n.ph.w and nlac. ar. ta.llbl. at flft"" parcent (ISX). D. If yOU change tha ta. rat., ph... .peclfW your ral.tlonlhlp to thai dec~t In tha .raa provided. e. Tha ~t of tax dUB Ulna G1 ~=' cHit.r.lned by ...,ltlplYlno tha MCM.A"It taxahl. Ulna 6) by t:ha tax rat. Ulna 7). CLAIMED DtDUCTIONS "PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowabla debta and daductlon. are dateralnac1 a. follovlI A. You lagalh ara rupanslbl. for pa~t, or tha ..tat. subJact to adalnlstutlon by . per.onal rapr......tat1". h lnsufflclent to pay thl deductible It.... B. Vou ItOtuallY paid the dabt. .ftar d.ath af the d.eR."t and can furnish proof of pa.,.."t. C. Debt. b.lno d.llIed ...,.t be It..lzad fully ln Part J. If additional spaca II nMdad, u.. plain p..r · I/Z" Ie 11". Proof of p.yaant ..y ba r~.tad by thai PA Depart..,t of nav.anue. , " " "'. ' . TAXPAYER 'ASSISTANCE' , .. "....'" .,>" IF VOU NEED "FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY ,,'>'. RE9ISTEROf WILLS. PA DEPARTMEtlT ,OF REVEtlUE DISTRICT OFFICE ,,<OR CALL THE BUREAU OF INDIVIDUAL TAXES. TAXPAYER INQUIRY UNIT IN IJARRISBURO. AT (717) 787"8327. ',TDDI. (717),772"2252" (HEARING IMPAIRED ONLVI REV-1543 EX AFP (8-941. CQHHONW(ALfH OF PENNSYLVANIA D(PAAfHt:HT OF REV[MJ( BUREAU OF INDIVIDUAL TAkEI Dt:P'. 'IUOl HARRISIURG, Pi 111ll-D'DI INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 95-0390 ACN 95131306 DATE 07-10-95 ARLENE H GONTZ 1969 RANDALL RD ENOLA TYPE OF ACCOUNT ~ SAVINGS CNECKING TRUST CERTIFICATE RENIT PAYNENT AND FORNS TO, REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF MARGARET J BAIR 5.5. NO. 100-26-6752 DATE OF DEATH 04-27-95 COUNTY CUMBERLAND PA 17025 HARRIS SAVINGS BANK hu provld~ tM Dep.rteent with tM Inlor..Uon listed aMlow which h.. bun u.ad In nlculeUna the potentia. tt. due. Thet,. r.cord. IncHee', thllt at ,,,. d..th of the above deced."t, you wer. _ Joint own.r/beneftc1.rr of thll IIccDUnI. If you f..1 this Infor..tlon I, Incor,.ect, pl.... obt.ln written corr.ctlon fro. the flnencl.. In.tltutlon, .ttleh . COpy to thl_ 'or. ~ r.turn It to the above .ddr.... Thl, account I. t..abl. In accordance with the Inh.rJt~. rt. Lt"l 01 the Co-.onwetlth of pannlvlven... auut10nt ..V tMi Mlw.red by nlllng (71n "'-IU7. COMPLETE PART 1 BELOW M M M SEE REVERS~ SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 09-66-237613 D.h 07-22-93 E.t.tolhh.d Account bl.nc. 3,054.37 P..cont T...bl. X 50.000 A.aunt Subj.ct to T.. 1,527.19 T.. R.t. X .15 PotonU.l T.. au. 229. DO PART TAXPAYER RESPONSE [!] I fAILURE TO RESPONDillILL RESULT IN AN OF,I'ICJAL.TAXASSI!SSNEHTBAS!D ON THIS NOTICI!. A. 0 The above In'or.eUon end t.x due Is correct. 1. You ..y choo.e to re.lt pey.ent to the R.gI.t.~ 0' Will. with tNO cop I.. 0' thl. notice to obteln . dl.count o~ .vold Int.~..t, o~ YOU ..V check bo~ -.- end r.turn thl. notlc. to the R.al.t.r of Will. and an o'flcl.l .......ent will b. l'lu~ bv the P. Depart.ent 0' R.venue. B. 0"The abo...e ....t h.. b.en or wUl ba reported and t.lC p.ld with the P.,..".y!vanl. Inherltanc. TalC r.turn to ba 'lIed bV the dec~ent.. rapr..entatl..... To Inlura proper cr~lt to your 8CCount, two (2) cop I.. of thl. notlc. .utt .cco~env YDU~ p.vaent to the Reght.r of Willa. "... check payabla tOI "R.glatu 0' WIUI, .g....t... HOTEl If tax pay.ent. ar. 88da within thr.. es, .onth. of the d.c~.nt.. d.t. of d..th, YOU .a., deduct a 5X dltcount of the talC due. Any Inherltanca to dua will b.co.. dallnquent nine e,. IIOnth. aftar the data of d..th. [CHECK ] ONE BLOCK ONLY c. 0 Th. above Infor.atlon I~ncorract Itnd/o~lbtt and dlductlon. .,.ra paid b., .,DU. You .ust coapleta PART l!.J MdIor PART l!J balow. If you Indlcat. a dlffa~ant taM rat., pl.... at.t. your ralaUonahlp to dec.dent I PART ~ TAX RETURN - COMPUTATION OF TAX GN JOINT~TRUST ACCOUNTS LINE 1. D.t. E.t.bll:h.d 1 2. AccoW'lt BalMe. 2 3. Parcant Taxabla 3 x it. A.ount Subjact to raM it 5. Dabt. and Daductions 5 6. Aaount raxabl. 6 7. raM Rat. 7 X 8. raM Du. 8 .:OFFICIAL USE ONLY 0 MFj '>flDEPARTNENTOF REVENUE ' PART ~ DATE PAD l' '2 3 , 4:'" ,{ i;<~:' CLAIMED '~,' '.,.' DEBTS AND DEDUCTIONS PAID PAVEE DESCRIPTION AMOUNT PAID I rOTAL CEnt.r on Lina 5 of Tax Co.putatlon) I . Undw~ pen.Hi.. o l.~ to the bast \.b .HI, of p.rju~y, I d.cl.~a that the fact. I of~.y knowladga and b.ll.f. ~=- . 't; .... ....... .... ... ..... ........... ~~ HOME (::~': =? ,':), ~ ~ .,- () ~ /' WORK (I -:{,fr" r .) TELEPH UM GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHEHT with IPPllcabl1 Int.rut b...d on lnfar..Uon lubIIltted by the flnllftCl.t InsUtutlon. Z. IntI.rUMeI hie bleD... deUnquent nln. lonthl ,ft,t the dlcedent', dl" 0' duth. 3. " Jalnt Iccount h tnabll I"un though thl dlc:.dent', n_' w.. Idded II . ..Un of convenl.ncl, ,. lecount. (InclUding tho.. held b.tw.en hU,bend and wlf.. which thl dlc.dent put In Joint n.... within one v..t prior to d..th .t. fulh ....bll .. 'tM,'.rs. 5. Account. "'abll,hld JolntlV bet..l." hu.b~ and wi'. .uti then one v..t prior to d.,th .t. not taMabl.. 6. Account. held by . dee_dent "In trult '0'" ~th.r Dr ather. .t. '1.lbl, fully, REPORTING INSTRUCTIONS - PART - TAXPAYER RESPONSE 1 1. BLOCK A - If the Intar..'Jon ~ c~t.tlon In thl notlcl .t. corr.et end deduction. It. not bllng cl.I.~. pl.ee 8n "X" In block "AM 0' Patt 1 of thl "TI.pay.r A..pon.a" 'Iatlon. Sign tNO cop I.. and .ubalt t~a with your ch.ck for thl ..aunt of ta. to the R.ght.r of WUts of the cOU'\ty Indlutld. Th. PA Dlparta."t of R,vII'IUI will Inus an offlci.1 .......ant (for. REY-1541 EXJ upon r.calpt of tha r.turn fro. the Rlgl.tlr of Will.. Z. ILOCK I . If the ....t .peclfled on thl. notlc. ha. b.-n or will b. r.port.d and tlM Plld with the p.nn.ylv.nle Inh.rltanc. TI. Rlturn fll.d by thl decadent'. rapr..ent.tlvl, plac. an "X" In block "I" of Plrt 1 of thl "T,.ply.r R..pon.." ..ctlon. Sign on. copy and raturn to the PA D.pert.."t of RIVenue, lureau of Indlvldu.1 T...., D.pt 2ID6al, Itarrhburg, PA 17UI..a601 In thl ~v.lop. provided. J. BLOCK C .. If the notlc. Infar'ltlon I. Incorr.ct .nd/or d.ductlon. .ra b.lng clalaad, chick block "C" and co."l.t. Plrt. Z and J according to thl In.tructlon. b.low. Sign tNO cop I.. and .ub.lt th.. with your chack for tha aaount of t.M plyabl. to thl R.gl.tar of will. of thl county Indlcatld. Tha PA Dap.rt.~t of R.v.nua will 1.lua an official ........"t (for. REV.1541 EXJ upon r.calpt of the raturn froe the Ragl.t.r of Will.. TAX RETURN - PART 2 - TAX COMPUTATION LINE I.. Ent.r NoTEI no c ;:---- \.~~ the data tha ICCount originally.... a.tabllsh.d or tlUad In the .anner a".Ung .t d.ta of de.th. '.;j for a daca<Mnt dying .fhr 12/12/1l1 Account. which tha dacadant put In Joint n.... ..lthln Dna (1) y.ar of duth .... taxabla fully.. tran.f.rl. Howevar, th.ra I. an ..clu.lon not to axc.act tS,aaa p.r tran.f.ra. ragardJ... of the valua of t~ acCO\.W'lt or the nuab.r of ecCCK.nh h.ld. t- ,- If . double I.tarl.k (xx) epp..r. bafor. your flr.t n... In the addra.. portion of thll notlca, the '~~Q axclu.lon .Ir.ady hat b.an d.duct.d frol the .CCOWlt b.lanca I' raporhd by tha flnanalal In.tltutlon. ~..... :n -.., -- Z. Entar the tot.1 balanca of the accOWlt Including Int.ra.t accrued to the data of da.th. J. The p.rcent of the .ccount that I. ta.abl. for aach .urvlvor I. d.t.r.lned a. faI10w.' A. Th. p.rcant t.xlbla for Joint ....t. a.tabll.h.d .ora than one v.sr prior to the dacldent's d.athl :u X 1DD . PERCENT UkAlLE c -'. TOTAL NUttiER OF .JOINT OWNERS Ex.-plal A joint ....t r.gllt.ract 1 DIVIDED IV TOTAL HUHIER OF SURVIVIHO JOINT OWNERS In the n.... of the decedent and two otMr parson.. DIVIDED IV G 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED IY Z (SURVIVORS)'. .167 X 100 . 16.7% (TAXAILE FOR EACH SURVIVORJ B. The p.rcant te:llIbla far ....h created ..lthln ~ )'." of the deced..,t'l d..th or eccDW1h owned by the decedent but held In trult for anotMr IndlvlduaUs) (trult banaflclarl.s" 1 DIVIDED BV TOTAL JAJHBER OF SURVIYING JOINT X 100 . PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Ex...I.. Joint accDUlt r.glltered In the n_a of the dacadent and bfo othlr pU.onl and ..teblhhad within ana ya.r of daath by the decedent. 1 DIVIDED IY Z (stlNIYORSJ . .50 X lOa . 50:C (TAXABLE FOR EACH SURVIVORJ 4. The aaount lubJ.ot to tlX (line 4) I. datlralnad by .ultlpl)'lna the account balanc. (line ZJ by the percent ta.~i. (line JJ. S. Entar the total of the d.bta and deductlonl ll.tad In Part 3. 6. Th. aaount taxabl. (ilne 6) i. datarained by subtracting the dabt. and daduction. (line S) froe the aaount .ubJ~t to ta. (line 4). 7. Entlr the approprlat. tlX rat. (lln. 7) I' d.t.r.lned b.law. A. For dat.1 of d..th occurring .ftar 6/30/94, tha tax r.t.. for tranlfarl to .pou..a Ir. .. follow" 1. D.ta. of da.th on or .ftlr'1/1/94 and b.for. 1/1/96 the rat. II S~. Z. O.t.. of da.th on or .ftar 1/1/9' and bafora 1/1/91 the rata II ~. 3. Oat.. of da.th on or .ft.r 1/1/97 and b.for. 1/1/'. the rat. II l~. 4. D.t'l of da.th on or .ftlr 1111.1 tran.farl to .pau... will b. axaapt froe tax. Nota. For da"l of death prior to 111194 tran.f." to .pau... ara taxable at 6le. I. Tran.fara to llneai da.cendants Including f.lMr, aother, .on, daught.r, grandchildren, lon-In-I..., daught.r-In-i"', stepchild and their I..ua .ra tsxabl. at .Ix perc..,t (6leJ. C. Tran.f.r. to all otherl Including brother, .lltlr, uncia, aunt, naphew ftnd nlaea .r. t.xabl. at flft.an percant (ISle'. D. If you change the tlX rat., ph... .pec11)' )'our r.I.Uonahlp to the dacadent In the .r.. provided. .. The MOUnt of tax We Ulna I) 11 detaralnad by IIUltlphlna tM aaount taxable Ulna 6) by the tax r.ta Uln. 7). CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowabl. debtl and deductions er. deteralnad n followl' A. You lag.ll)' ar. r..ponllbl. for payaant, or the ..tat. lubJact to edalnl.tratlon bv . parlonal rapr..antatlv. I. In.ufflclent to pay the deductlbl. It.... I. You actually p.ld the dabt. aftar de.th of the d.cactant and can furnish proof of pa)'lllf1t. C. Debt. b.lng c1alead .ult ba It....ad fulh In Part J. If IdcUtlontll .pac. .. needed, UII plein papar 1 IIZ. M 11-. Proof of p.y.ent ..y be r~.tad by the PA Dep.rt""t of R.vanua. . ..'.'. ,'."i ,.,. . 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 INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN HARRISBURG AT (7171787-8327. TDDI (7171 772-2252 CHEARINOIMPAIRED ONLY) REV-1543 EX AFP (8-941. CDHHDHWUlflt OF PENNSYLVANIa DlPARTHENT OF REVENUE IURfAU OF INDIVIDUAL TAXES DEPT. 210601 HARRISBURG, PA 17111-0601 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DAT! NO. 21 95-0390 95131387 07-10-95 ARLENE H GONTZ 1969 RANDALL RD ENOLA TYPE OF ACCOUNT ~ SAVINas CHECKINO TRUST CERTIFICATE RENIT PAYNENT AND FORNS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 ESTATE OF MARGARET J BAIR 5.5. NO. 180-26-6752 DATE OF DEATH 04-27-95 COUNTY CUMBERLAND PA 17025 HARRIS SAVINGS BANK h.. provided the Dep.rtHn' with thl Inlor..Uon IhtH bllow which h.. b..n u.ed In ulcultUnll the potantlal t.~ dUI. Thllr rlcardl Indlctt. that at t~ d..th of the abOVt dlcadent, you ...t. . Joint Dwn'r/b~'lcl.ty of thl. lecount. I' YOU f..l thl, 1nfor..tlon 1. Incorrlct, pl.... obtain wtltten corr.ctlon Irol thl 'Inancl.. Inltltutlon, attach. copy to thl, lor. ~ raturn It to thl ~ov. .ddr.... Thl, account I, tl.able In accordance with thl Inherltlnc. ,.. l.... of thl C~~....lth of PlnnlvJvan... Due'llon. ..y ba en....ted by calling 1711) 7"-11Z7. COMPLETE PART 1 BELOW M M M SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 01-16-096054 D.t. 10-10-86 eat.bl1ah.d To In.ur. propI' credit to wour lecount, two UJ copt" of 'hI. notice lIU.t acco~."V your ply...,t to thl RIgl,t" of Willi. Heke chick ply,bl, tor -Rlal.t,r of Will., Agent~. Account o.l..c. 2.454.66 P..c..t T...b1. X 50.000 bount Subj.ct to T.. 1. 227.33 Tn R.t. X .15 Pot.ntld T.. Du. 184.10 PART TAXPAYER RESPONSE m I FAILURI!. TO RESPOND ifILL RUUL T IN AN OfFICIAL TAX ASSI!SSNEHT,IASI!D ON THIS NOTICE A. 0 Thl abovI Inforlatlon and tl. due .. correct. 1. You "V chao.. to r..1t plly.."t to thl R.ah"r of Will, with two copl.. 0' thh notln to obl,ln . d..count or .vold Int.r..\, or you ..y chIck bOM -." and r.turn thl. not leI to the R.gl.tar of Will, end ~ offlcl,l ......aent will ba I..ued by thl Pi D~.rt"nt of R.v~. B. ~~he ebon ....t hll bewl or wU1 b, reported and taM "lid with the Pln,,.)'l,,.,,I, IntMrltanc:. IBM nturn to ba filed by thl dlced."t', rlpn...,t.t1v., NOtEI I' tl. ply.'nt. .r. lad, within thr.. (51 ~th. of thl dlcadent', datI 0' d,.th, you ..y deduct. 5X dl.count of thl ta. dul, Anv inheritance teM due will beeHe dellnqu.nt nln. ('I eonthl .ft.r the date of d..th. [CHECK ] ONE BLOCK ONLY c. 0 Ttt. above Infor..Uon l~ncDr,..ct and/o~.bh and d~Uonl ...ta p.ld bv you. You INlt cOllplata PART ~ W1d/ot PART ~ balow. If you indlcat. a differant t.x rat., pl.... .tat. your r.lation.hlp to dacadant. PART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE]. D.t. E.tablhhad 1_. .. . _. _.___.._____._... 2. Account Salanc. 2 3. Parcant Taxabl. 5 x 4. AMount SUbjeot to Tax 4 5. Debt. and D.duction. 5 ,. Aaount Taxabla , 7. Tax Rat. 7 X 8. Tax Du. a OFFICJAL USE ON LV DAAF ',..P" .' D,EPARTHENT OF. REVENUE PART ~ DATE PAD 1 2 3' " 0\ , 5 "'.6 7, 8' CLAIHED DEBTS AND DEDUCTIONS PAID PAYEE DESCRIPTION AMOUNT PAID ! (Ent.r I TOTAL on Lin. 5 of Tax COMput.tion) . of p.~jury, r daclar. that tha fact. of .y ~ow~adg. and baliaf. L. '" /1:&--, I haY. reported abova ara true, corraat and /_ HOME (~~'; ~ Q- - ~ r~~ :1 W~~~EP~ ~M 1< ~ '?l ~ GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESS"ENT with ~pllubh In''ru' b..ed on In'or..llon .uMltt,d bv the flnlWM:l,l In.Ututlon. Z. Inherlt~. t.. beco... delinquent nln. ~th. .'t,r the decedent" data of d..th. S. A Joint ecCDunt I, t'M~I. .~en thoUGh thl dlCldlnt's n... WI' .oded .. . ..tt.r of convenience. ~. Account. (Including tho,. hlld b.twI'" hu.b~ ~ wlf,) which the dlcadent put In Joint n.... within on. y..r prior to d..th .r. fullv hilMI_ .. I,.",f.r.. 5. Account. ..t,bllahld Jointly batwlen husband ~ wlf. lor. then ona y..r prior to d..th .r. not tl.abl.. 6. Account. held bv . dlcadent "In trult 'or" enother or other. .r. t..~l. fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. aLOCK A - If the In'or..Uun Bnd COllPUhtlon In IhI; noUn .t. corr.et IW1d deduction. .r. not bllng ohl.eeI, pllCI ." "X" In block "'" of p.rt 1 0' thl "YI.pIYlr R..pon.." .actlon. Sign two copla. and .ubalt thea with your chack for tha a~t 0' t.. to th. Ragl.t.r 0' Will. of the county Indlcatld. ,he PA nlp.rtaent 0' RIYlnul will I..u. .n o'flclal ........nt (fora REY-I541 EXJ upon rlc.lpt 0' tha rlturn fru. tha Rlgl.tlr 0' Will" 2. BLOCK I - I' tha ....t 'Plclfled on thl. notlc. ha. b.en or will b. rlport.d and t.. p.ld with tha Plnn.ylvanl. Inh.rltanca T.. Raturn fllad by the decadent". repr..ent.tlv., plac. en -X. In block -.. of Part 1 of the -T..p.yar R..pon... .actlon. Sign on. COpy and raturn to tha PA Dap.rt.ent of R.venue, .ur..u of IndividUal T...., D.pt 280601, H.rrl.burg, PA 17121-0601 In the envllop. provldad. ]. ILOCK C _ If the not Ie. In'or.atlon I. Incorract .nd/or deduction. ar. b.lng clal..d, ch.ck block .C. and coapl.t. Part. 2 and ] according to the In.tructlon. balow. Sign two copl.. and .ub.lt lh.. with your ch.ck far tha ..aunt 0' taM paYabl. ta tha Rlgl.t.r 0' Will. 0' the county Indlcatld. The PA n.part..nt 0' R.venue will I..ua en o'flclal .......ant (for. REV-I541 EX) upon r.c.lpt 0' the r.turn 'roa the Rlgl.t.r 0' Will., TAX RETURN - PART 2 - TAX COMPUTATION 11ft( I.. Ent.r tha d.ta the .ccount orlglnalh Wit astabll5hed or UtlH In the nnMr ad.Ung .t data of dnth. NOTEI For a dac.d.nt dvlng a,t.r 12/12/821 Account. which the d.c.dant put In Joint n.... within on. (I) y.ar of daath ara taxabla 'ullv a. tran,'.r.. Howav.r, thar. I. an a.clu.lon not to ..ca.d '],000 par tran,'ar.. r.a.rdl... of the valva of tha ltCcount or tha nuaber of account. hald, If a doubla ..t.rl.k (MMJ appe.r. bafor. your flr.t n... In the addr... portion 0' thl. no~h. .),OPO ..alu.l~ .lreMlv hn b.." dltduct.d froa the account b.lMe. as reportad by the Unenelal In.tltuUonc ; " \(", ..,.t j" . lJI . .. 2. Ent.r the total b.lanc. 0' the account Including Int.r..t accrued to tha d.t. of d..th, ). Tha p.rcent 0' the account that I. ta.abla 'or .ach .urvlvor I. d.t.ralned a. 'ollow'l A. Th. p.rcent ta.abl. 'or Joint ....t. a.t.oll.h.d aor. than on. v.ar prior to tha dac.dent'. d..thl ~ c. .- N J">o 1 DIVIDED IV TDrAL HUHIEA OF JOINT OWNERS E..apl., A Joint ....t r.gl.t.rad DIVIDED IY rOTAl tutaER OF X IDO . PERCENT TAXABLE StltvIVlHO JOINT OWNERS In the na.. of the d.c.d.nt ~ two other p.r.on., I DIYIDED IY ) (JOINT OWNERS) DIVIDED IV 2 (SURVIVORS) . .167 X 100 . 16.n lllXAllE fDA EACH SURVIVOR) I. The p.rcent ta.abl. for ....t. cr..t.d within ana y..r of tha dleHant'. d..th or .ccount. ~.b~ the dac~ant but h.ld In trult for another Incllvl~lC.) Uruat banallchrlasJI ,-, X 100 . PERCENT TAXAllE 1 DIVIDED BV lOTAl HUHBER Of SURVIVING JOINT OWNERS DR TRUST BENEFICIARIES E..-pla. Joint account r.glstarad In ~ n... of the d.cld.nt and two othar p.rsonl 8Md ..tabllshed within ana y..r of da.th bv the d.c.dant. I DIVIDED IV Z (SURVIYORS) . .50 X IDD . SDX (TAXAILE fOR EACH SURVIVOR) 4. The UDU1t lubJ.ct to tilt Uln. U II d.taraln.d by ....Itlphlnlll tM ac:COlA'1t b.1Mea Ulna ZJ by the ptIrcant tIM.tIl. Cllna l), 5. Ent.r the total 0' tha dabtl and deductions Illtad In P.rt l, 6. rh. a.uunt ta.abl. Ulna 6) .. d.tar.ln.d by .ubtractlng the d.bts and d.duatlon. Ulna 5) fru. the MtOUf1t .ubJect to t.. Ulna 4). 7, tnt.r the approprl.t. tl. r.tl (1lna 7) .. d.t.r.ln.d b.low. A. for dlt.. of d..th occurring .,t.r 6/]0/94, the t.. rlt.. far tranlf.r. to .pou... .ra .1 followl' 1. Oat.s 0' dl.th on or .ftlr 7/1/94 end ba'or. 1/1/96 the rata I. 3X. 2. Oat.s of d.ath on or .ft.r 1/1/96 end bafor. 1/1/97 the rat. II ZX. S. Oat.. of d'lth on or .ft.r 1/1/97 end b.fara 1/1/98 the rat. II IX. 4. Olt.. 0' d..th on or I,tlr 1/1/98 tran.f.r. to .pou... will b. ....pt fro. t.., Hot'l Far dat.. 0' de.th prior to 7/1/94 tranlf.r. to 'POU'" .r. t..abla .t 6X, I. Tran,'.rs to llna.l dalcendant. Including ,.ther, ItGther, Ion, daught.r, gr-*hUdran, .on.ln-I..., dMlGhtar.ln-l..., ,tapchlld and thalr I....,. er. t..abl. .t .he ptIrcant (6X). C. Tranl'.r. to all atharl Includlno brother, .llt.r, unci., aunt, nephaw and nl.c. .r. t..abla at flft.an parcent (15~). D. If YOU chang. the tall. rat., pl.... .peclfy your rel.tlonshlp to the dacadent In tha ern provided. e. TlM aaount of tu due ClIM IJ .. datar.ln~ by ....ltlphlng the MOunt t.ubl. UIM 6) bv the till. rat. Ulna 7>. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowllbl. dabts and deduction. ara d.taralned II 'ollow.. A. You legallv Ir. r..ponslbl. for p.yaent, or the .Itlt. .ubJact to adalnl.tratlan by a par.~l r,pr..~t.tlv. II Insufflclant to p.y the cMductlbl. It.... I. Vou actually paid the dabtl .ftar dnth of the dec.dant and can furnish proa' of p.~t. C, Dabtl baing cl.la.d au.t ba It.alr.d 'ullv In p.rt S. I' addltlon.l .p.ca I. n.eded, u.. pl. In papar e 1/2" . 11-. Proof of Plyaant a.v ba requa.tad by tha PA Dep.rtaant of R.Venul, "",.TAXPAyER ASSISTANCE IF YOU NEED FURTHERINFORHATION OR ASSISTANCE, CONTACT ANY ..',,'. ',' ",REGISTER ,OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE ' , '<OR CALL THE JlUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN HARRISBURG AT (717) 787-8327. JODI (717) 772-2252 (HEARING ,IHPAIRED"ONLV) REV-1543 EX AFP (B-941. 'CDHttOHWOLTIt OF PENNSYlVANIA DEPART"ENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 210601 tIARRUlUAG, PA 11121-0.01 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 95-0390 ACN 95131388 DATE 07-10-95 ARLENE H GONTZ 1969 RANDALL RD ENOLA TVPE OF ACCOUNT ~ SAVINGS CHECKING TRUST CERTIFICATE RENIT PAYNENT AND FORHS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 ESTATE OF MARGARET J BAIR 5.5. NO. 180-26-6752 DATE OF DEATH 04-27-95 COUNTY CUMBERLAND PA 17025 HARRIS SAVINGS BANK h.. provided thl Dlpart..nt with thl Infor..Uon listed bltow Which h.. b..n u'ld In ulcullUng thl potent II. tl. dUI. Their rlcordl Indlclt. thet at thl d..th of the above dlcedent, you "It. I Joint ownlr/beneflel.tv of thl, lecount. l' YOU '..1 thl. Infor.,tlon 1. Incorrect, pl.... abl.ln wtltt.n corr.ctlon frol thl flnanel,1 Inltltutlon, .ttlch . COpy to thl. far. and r.turn It to thl .bov. .ddr.... Thl. account I. tl.lbl, In accordance with thl Inheritance TI. LI.., of the Co..on....lth of p.nn.ylvenl.. Qu.'llon, ..y b, an....r.d by cll11ng (117) 7.,-81Z7. CGMPLETE PART 1 BELOW M M M SEE REVERSE SIDE FOR FILING AND PAYMENT U!STRUCTIOIIS Account No. 09-16-103571 o.t. 10-14-87 Eabblhhed Account Balance 3,006.93 P.rcllt1t T.....h X 50.000 bount Subj..t to T.. 1,503.47 Ta. R.t. X .15 Potenth1 T.. Du. 225.52 PART TAXPAYER RESPONSE III I,'. FAILURE TO, RI!SPOND llILL RESULT INAMOfF~CIAL,TAX . ASSI!SSMENt BASED ONTMIS NOTICE I .... 0 The abova Infor..lIon and tall due 11 corract. 1. Vou ..y choo.. to r..1t pay..nt to the Rlgl.tar of Will. with two cop I.. of thl. notlc. to obtain . discount or avoid Intar..t, or YOU ..y check bOil "...- and return thl. notlc. to the Rlglstar of WIll, and en o"lcl.l ........nt will ba I'.ued by the PA Depart..nt of R.v.~. B. ~Th. abova ....t hB. b.~ Dr wIll ba raportad and t.. paid with the Penn.ylv~l. Inheritance T8x raturn to ba 'llad by the dacadant'. rapr.lantatlv.. To In.ur. proper cradlt to your account, two (l) copl.. of thl. notlc. .utt accoapanv your pay.ant to the Ragl,tar of Will., "aka check payable tal "Raal.tar of Willi, Aaant", HOTEl If tax pay..nt. ara .ade within three (3) eanthl af the decedent'. date of de.th, you .ay deduct a 5~ dl.count of the taw due. Any Inheritance taw due will beco.e delinquent nln. (9) eonth. after the data of d..th. [CHECK ] ONE BLOCK ONLY c. c:J The above Infor.atlon I~ncorrect and/o~abt. and deduction. ware paid by YOU. You .u.t coepleta PART L!J andlor PART ~ below. If you indicat. a diff.r.nt taM rat., pl.... .t.t. your r.lation.hip to dacadantl PART ~ TAX RaTURN - COMPUTATION OF TAX ON JOINT/tRUST ACCOUNTS LINE 1. O.t. Eot.bl1oh.d I 2. Account Balanc. 2 3. Parc.nt Taxabla 3 X 4. A~ount Subj.ct to TaM 4 5. D.bt. and D.duction. 5 6. A~unt TaM.bl. 6 7. TaM Rata 7 X 8. TaM Dua 8 ",,/','OFFICIAlUSE ONlV',..OAAFi ", PA" DEPARTMENT, OF, REVENUE ',',: <,) "'"","'""",',.".."" ,..".", ,.,'." "',,'...1 :-.' ';',. PART [!] DATE PAD 1 u,2 3:' 4" ' 5, ::::'::::::::;6';'" .'. ,."..~.,'. CLAIMED '::"':;", .,. '...-,..":-,." " '.;:' , :""".;"., DEBTS AND DEDUCTIONS PAID 1 PAYEE DESCRIPTION AMOUNT PAID I TOTAL I . CEntar on Lina 5 of TaM COMPutation) Undar panaltia. of to tha bad of parjury, I daclara that tha .y ::zr~7dg. and baliaf. . (,yi:t fact. I haya raport.d above ar. tru., corr.ct and ~~:~ ~~:~: :3~ rc9 S7if4 TELEPH E UMB ..s .j - .."......' GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESS"ENT with appllCllOla Intara.t b..~ on Inforaallon .ubIIl tt.d by tha IIn.nclaa In.tI tullon. 2. I~rlt-nca ta. b.co... d.llnquent nln. ~th. Ift.r the d.c.dent'. dlta of d..th. 5. A Joint ~count I. ta.lbla aven though th. d'Cld~t". naaa w.. add.d a. , aatt.r of convenl~a. ~. Account. (InclUding tho.a h.ld bltwaen hu.bend and wlfaJ which tha d.cadant put In Joint ~. wlthln ~ yaar prior to da,th .r. fullY tallMlla a. tran.far.. 5. Account. a.tabll.had JointlY batwaen hu.bend and wlfa .or. than one YI.r prior to d.ath ar. not ta.abl.. 6. Account. h.ld by a d.cadant "In tru.t 'or" anoth.r or othar. It I tl.abla fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE I. BLOCK A . If tha In'or..tlon end co~tatlon In thl notlcl .r. cotract and d.dUctlon. Irl not bllno clslald, place an "X" In block "A" of Part I of thl "T,llplYlt R..pon'l" 'Ietlon. Sign two copl.. and .ubelt thaa with your ch.ck fat thl .-aunt of tl. to the Ragl.t.r 0' Will. of the county Indle.t.d. Tha PA D.partaant of R.venu. will 1"uI an offlcl.l ......aent CFora REY-1541 EX) upon rlcalpt of the raturn fro. thl Rlgl.t.r of Will.. l. BLOCK a - If th. ....t .paclfled on thl. notlc. h.. bien or will bl r.port.d and t.x p.ld with thl Plnn.ylvanl. Inhlrltanca T.x Raturn fllad by tha d,cldent'. rapt..ant.tlvl, placl an "X" In block "I" of P.tt I of thl "Ta.p.yat R..pon.." .actlon. Sign one copy and raturn to tha PA Dap.rtaant of R.venue, luraau of Individual Ta..., D.pt 210601, fl.rrl.burg, PA 17121.0601 In thl .nvllopl provld.d. 5. aLOCK C - If thl not lei Infor..tlon I. Incorract andlor dlductlon. .r. bllng cl.la.d, chick block "C" end co.pl.ta P.rt. Z Ind 5 eccordlno to the In.tructlon. bllow. Sign two copl.. and .ub.lt th.a with your ch.ck 'or the aaount of ta. p.yabla to thl R'II.t.t of Will. of the county Indlc.t.d. Th. PA Dep.rtaant of R.v.nu. will I..ue In offlcl,l ........nt CFot. REV.1541 EX' upon rlcllpt of the t.turn fro. tn. Rlgl.t.r of Will.. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1.. Entlr NOTE I 00 ~ ,. the d.t. the eccount orlgln.llY WI' ..tabllshld or tltl.d In the a,"".t .Ill.tlng .t dlte of dlath. Fot I dlcadent dying .ftar Il/lZll2, Account. which tha daCldant put In Joint n.... within one Cl) ya.r of da.th ara tlllabl, fullv I' tran.far.. Howavar, thara I. an a.clu.lon not to Illc..d '1,000 per tran,'.re. t.gl~I... of the.vslu. of the account Ot the hUlber of ec:count. held. 1- If a double e.t.rl.k (MM) app..r. b.for. your flr.t n..e In the .ddr... portion of thl. notlc., the ~llDOa ..clu.lon Ilr.ady ha. be.n d.ductld froa the ICCount b.lanc. .. r.portad by the 'Inanclal In.tltutlon. I.. ~d .on ?!? 2. Ent.r the total b.lanca of the account InclUdlna Int.r..t accrued to th. dlte of d..th. 5. Th. p.rcent of the account th.t I. tllllbl. 'Ot .Ich .utvlvot I. det.ralned .. 'olloM'1 A. Th. plrcent t.xabl. for Joint ....t. ..tabll.h.d lore then on. y..r prior to tha d.c.d.nt.. de.th, ""'1".- X lOD . PERCENT "'TAXABlE "- TOTAL HUHBER OF JOINT OWNERS EMaapl.1 A Joint ....t r.gl.t.r.d TOTAL NUHaER OF SURVIYINC JOINT OWNERS In the n... of the d~.dent and two oth.r par.on.. I DIVIDED BV DIVIDED BV I DIVIDED BV 1 CJOINT OWNERS) DIYIDED IV 2 (SURVIVORS)' . .167 X loa . 16.n CTAXAlLE FOR EACH SURVIVOR) I. ThI p.rcent tl.abl. for ....t. cr..tad within on. y..t of thl dlCadant'. d.ath Ot ec:count. owned by the dlCadant but held In tru.t for enath.r IndlvlduIU') (tru.t ban.llel.,I..)1 X 100 . PERCENT TAXABLE I DIVIDED IV TOTAL HOHBER or SURVIVING JOINT OWNERS OR TRUST IENEFICIARIES EXIIPI., Joint account tall.t.r.d In the n... of the d'c'~~nt and two oth.r p.r.on. and ..t.bll.hld within one Y.lr of de.th by the dec:adant. 1 DIVIDED IV 2 CSURYIVQRS) . .5a X 100 . 50X (TAXABLE FDA EACtt SURVIVOR) 4. Th. .lIOUI1t .ubJ.ct to talC Uln. ~J It d.t.ralnad by MJltlpIylno the account balllhCe UIIMI 2) by the pltc."t ta..bl. Oln. 5J. 5. Ent.r the tot.1 of the d.bt. end d.ductlon. II.t.d In p.rt 5. 6. The aaount t.llab). Clln. 6) II d.taraln.d by .Ubtractlno tha dabt. end deduction. Clln. 5) 'roe the alOUnt .ubJlct to tl. ClllM1 ~). 7. Ent.r the .pproprlate talC r.t. Clln. 7) I' d.t.rallMld balow. A. Fot d.t.. of d.ath occurrlno .ftar 6/50/94, the talC tat.. 'Ot tran.f.r. to .pou.e. .r. .. 'olloWII I. o.t.. of d.ath on or .ftlr7/1/94 end b,'or. 1/1/'6 the rata I. 5X. 2. D.t.. of ~.ath on or .ft.r 1/1/96 and be'or. 1/1/97 the r.t. I. Z:C. 5. Dlte. of de.th on or aft.r 1/1/97 and be for. 1/1/91 the rata I. IX. 4. Dati' of death on or .ft.r 1/1/91 tran.f.r. to .pou... will ba I..apt fro. tax. Not" For dat.. of de.th prlot to 7/1/'~ tran.f.r. to .pou... ar. t.lllbl. at 6:e. a. Tran,'.r. to llne.1 d..cendant. InclUding '.thar, IUthlr, .on, daught.r, grandchildren, .on-In-laM, daughter-in-IaM, .t.pchlld and thalr I..ue .re tall.bla .t .Ix p.reent C6:e). C. Tran.fe,. to .11 oth.,. Including broth.r, .lIt.r, ...-.cIa, aunt, nephlw and nleea .,. t'llabla at fUt..., patC~t U5X). D. If you chanal the tllC tata, pl.... .p.clfY your r.latlon.hlp to the dleedent In thl ar.. provided. I. The.-aunt of till ~ (line I) I. det.ralned by aultlplylno thl aaount t.llabl. Cline 6) by the tax tlta Cline 7). CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowabl. debt. and dadUctlon. arl d.t.rallMld .. follow" .. Vou I.gllly Ira r..pon.lbl. 'Dr p.vaant, or the ..t.ta .ubJlct to edalnl.tratlon by . par.anal r.pt..antatlv. I. In.ufflclant to p.y tM d~t1bl. It.... I. You .ctuallv p,ld the dabt. aft.r d..th of the d.c.dant and can furnlth proof of pIY'ant. C. Dabt. belno cl.iald au.t b. It..lzad fullV In P.rt 5. If addltlon.1 .peee I. needed, u.. plain paper I Ill" x II". Proof of plyaant .IV b. raqua.tad by the PA Dapartaant of R.venua. ". :..,i.'.":..i,,...i ".,. '. ' ,TAXPAYER ','ASSISTANCE.,i" .,,': If YOU NEED FURTHER'INFORMATION OR ASSISTANCE, CONTACT,ANV ',".,',". .,,' REGISTER OF WILLS, PA DEPARTMENT, Of REVENUE DISTRICT OFFICE ,'.....' '."'.. , , OR' CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAVER INQUIRY UNIT IN 'HARRISBURG AT ,(7171787-8327 .TDDI (7171, 772-2252 (HEARINO IMPAIRED ON LV V REV-1547 EX AFP (12-94* COHHOtMAl TIt OF' PO.dVLVAHIA D[PARfHEHT OF REVEtfJE BUREAU Of INDIVIDUAL lAMES DEPt. 11D60l UARRUIURG, PA 17U.~D'OI /:> )./. II \ (/ ACN 101 NOTICE OF INHERITANCE TAM APPRAISENENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAM DATE 11-20-95 FILE NO. 04-27-95 CGUNTY CUMBERLAND NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBNIT TNE UPPER PORTION OF THIS FOKN WITH YOUR TAM PAYNEHT TO THE REGISTER OF WILLS. NAKE CHECK PAYABLE TO "REGISTER OF WILLS. AGENT" REMIT PAYMENT TO: ALLEN D SMITH ESQ 51 S FRONT ST STEEL TON PA 17113 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 AlfOU'\t R."ltt.d CUT ALGNG THIS LINE ~ RETAIN LOWER PGRTION FOR YOUR RECORDS ~ iiEV:is'4TEX"iiiijoun'F94riioTicE--OF--INHEiiifAifcE-TAiC"iipjiRiiisEiiEiii'~uiii.LOWANCE-ijR------uumm" DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF BAIR MARGARET J FILE NO. 21 95-0390 ACN 101 DATE 11-20-95 TAM RETURN WAS. I X I ACCEPTED AS FILED RESERVATION CGNCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..I E.t.t. (Schedul. AJ (1) 2. Stock. and BondI C Schedule B) 12) 3. Clo..ly Hald stock/Partnar,hlp lnt.r..t (Schedule CJ IS) 4. Hortgav../Not.. Receivable (Sch.dul. DJ 14' S. C..h/Bank Dapollta'Hllc. Parlonal Property (Sch.dul. E) (5) 6. Jointly Owned Property (Sch.dul. FJ (6) 7. Tran.far. (Sch.dul. 0) (7) 8. Tot.l A...t. APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funaral Expan.../A.a.. COlt./HIIC. eMPen... (Schedull H) I') 10. Debta/Hortgaga Llabl11tt../Llanl (Sch_dule IJ (10) 11. Total Deduction. 12. Net Value of TaM Raturn 15. Charltabla/Gavlrn.ental Oequ..t. (Schedul. J) 14. N.t Valua of E.tat. Subj.ct to TaM If an assessment was issued previously, lines reflect figures that include the total of ALL ASSESSMENT OF TAX: 15. A.ount of Lln. 14 at Spou..l 16. A.ount of lln. 14 taMabl. at 17. AMount of Lin. 14 taMabl. .t 18. Prlncl~al TaM Du. NOTE: r.t. lln.al/CI... A r.t. Coll.t.r.I/CI... 8 rat. 1151 1161 117J TAX CREDITS: PAYNENT DATE 07-14-95 RECEIPT NUHBER AA048016 DISCOUNT I +I INTEREST I-I 577 .01 I CHANGED .00 .00 .00 .00 5.294.36 20.000.63 51. 653.00 ISI 85.755.99 0.714.50 .00 1111 1121 1131 1141 8.714 ~n 77.041. 49 .00 77.041.49 14, IS and/or 16, 17 and 18 will returns assessed to date. .00 M'OO. .00 X .06. 77.041.49 X .15. 11S1 .00 .00 11 .556.22 11.556.22 ANOUHT PAID 11,500.00 TOTAL TAX CREDIT BALANCE GF TAX DUE INTEREST TOTAL DUE . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL IHTEREST. 12,077 .01 521. 59CR .00 521.59CR IF TOTAL DUE IS LESS THAN 'I. NO PAYNEHT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI. YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. I '.JI r! ~.,I RESERVATION. E.t.t.. of dlcldent. dVlng on or before o.c.-blr II, I'll ~. If InV future Int.r..t In the ..t.t. I. trln.f.rrad In po.....lon or enJo~t to CI... . (coll.t.r.l) beneflcl.rl.. of ~ dlcedlnt .ft.r the 'Mplr.tlon of InV ..t.ta for Ilf. or for v..r., thl Coa.onwe.lth herebv 'Mpr...lv r...rv.. the right to ~r.I.. end ...... trln.f.r Inherltanc. ,.... .t the lewful CI... . (coll.t.r.l) r.t. on anv auch future Int.r..t_ PURPOSE Of NOTICE. To fulfIll thl requlr-..nt. of Section II~O of the Inherltanc. end E.t.t. T.. Act, Act 22 of 1991. 71 P.I. Sutlon 2140. DetlCh the top portion of this Hotlc. end .ubI" ..Ith your p'veent to tt. RIghter of "lIb prlntad on the r.ver.. std.. ~a"lka check or IIonIIY order p.ylbl. to. REGISTER OF HILLS, AOEIfT All p.v-ent. rec.lved shill flrlt b. applild to InY Int.r..t which ..y be due with any r"llnder applIed to the t.x. REnltD (CR}I A nfWld of I hM crldlt, which .... not r.qu.sted on thl 'n R.turn, MV bl r~..t.d bv coaplaUna In "Appllutlon for A.fund of Penn.ylveni. Inherltanc. end E.t.t. T.M" (R[VaISlS). applicatIons .r. Iv.llabl. .t the Offlc. of tt. Aegl.t.r of Will., InV of thl 2S R.v~ DI.trlct OffiCI., or by cllllna the .pacl.1 I~~hour In.warlna ..rvlc. nueber. for for.. ord.rlng. In Pann.yIVInI. 1-100-362-2050, out.lde Penn.ylvanl. end ..lthln loul Harrisburg .rs. (717) 717-1094, TOOl (717) 772-2252 CHa.rlng 11lP.lred OnIV). PAYHEHTI DlJECTlDHSI Anv partv In Int.r..t not ..tlsfled with the ...nl......t, aUOW8nC. or dlnllowanc. of daduc:tlon., or ......Mnt of tlX ClnclUdlnG dl.count or Int.r..t) .. ahown on thl. Hotlcl ault obJaat within .I.tv (60) dav. of racllpt of this HotlCI bv. --wrlttan proh.t to the PI. Dep.rtNnt of Ravenue, loard of A~..., aapt_ 281021, U.rrhburG, PI. 17121-1021, OR ...tactlon to tulv. thl ..tt.r dtItaralnad at audit of the ItCCOUlt of the "rsonal raprnent.Uv., OR .-app.al to thl Orphan.- Court. ADtUH ISTRAlIVE CORRECTIONSI 'utu.1 .rror. dl.cov.rad on thll ......eant ~Id b. Bddr...ed In writing tal PI. Dep.rtsent of R.VIMUl, Buraau of Indlvldu.1 T...., AnHI Po.t A.......,t a.vlew Unit, Dept. lI0601, tlarrhbura, PI. 171Z1a0601 Phon. C7171 787-6505. S.. peal 3 of the book lit "In.tructlon. for Inh.rltancl T.~ R.turn for a R..ldent D.c.dent" CREV-150IJ 'or In 'MPlan.tlon of edIIlnhtratlv'h corrlCltllbl. arrora. DISCOUNT I Jf anv t.~ due i. p.ld within thr.. (S) cllend.r .unlh. .,t.r thl decadent-. d..th, . flv. p.rcent CS~) dIscount of the t.~ p.ld II .llowed. Int.r..t I. ch.rged begInning with flr.t d.v of delinquency, or nine C') eonth. and ana (1) d.v 'roe thl d.t. of death, to the d.t. of p.raent. T.... which ~~ delInquent before Januarv 1, 1982 ba.r Int.r..t .t ~ r.t. of .1. C'~) p.rcent p.r annu. c.lculatld .t . dailY r.t. 0' .000164. All t.... which bee... delinquent on and .'t.r Janu.rv 1, 1"2 wIll b..r Int.r..t .t . r.t. which wlll v.rv froe c.lendar y.ar to calend.r v..r with that r.t. announcad bv the PI. Dep.rt.ent of R.v~. The appllcabl. Intar..t r.t.. for 1982 through 1995 .r'l JNTEREST. V.a,. Intar..t R.t. D.llv Intarllt f.ctor !2r Int.rut R.t. Dalh Intl".t factor 1912 20X .000548 1987 'X .0002"7 1'83 lOX .OOOUI 1981-1991 llX .000SOl ".. llX .OODSDI I.., 'X .000247 1985 l!X .00DSS6 l'U.l9'K n .000192 "16 lOX .00027" I... 'X .0002~7 ulntarllt h calcul.tad .. follow II INTEREST a BALANCE OF TAX UNPAID X NunBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR nAnv Hotlc. l..u.d aftar the t.. baca... d.lInquent wUl r.fleet en Int.ra.t calcul.tlon to flft.en CIS) d.n beyond the d.t. of thl .........,t. If p'v-ent I. aeda .ft.r ~ Int.ra.t coaput.tlon d.t. shown on the Hotlc., Mktl tlonal Intarnt .....t be ulcuhtld. 1;h':,i /:j.:J '/. /1 :...- REV-1607 EX AFP (12-94~ CDHMOHWEAlIH OF PlNHSVlYAHIA DEPAATHENT Of R[V(HU[ IURUU Of' INDIYIDUAl IAXU I)(Pt. UG6DI IlARRISlUAG. PA 11UI.O.oI ACN 101 XNHERITANCE TAX STATEMENT OF ACCOUNT DAn 12-11-95 BAIR MARGARET J FILE NO. 21 95-0390 04-27-95 COUNTY CUMBERLAND NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBNIT THE UPPER PORTION OF THIS FDRN WITH YOUR TAM PAYNENT TO THE ADDRESS SHOWN. NAKE CNECK PAYABLE AND RENIT PAYNENT TO. , ALLEN D SMITH ESQ 51 S FRONT ST STEEL TON PA 17113 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 A.ount R..ltted CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR FILES ~ i'iili:il.oTEif-Aiip-ii'Z:94y--_mli.ii-iNiiEii~YAiicr;:Aif-sTAfEiiEH;:-o"F"liifcouiffniiilin_-_nm_mm__n ESTATE OF BAIR MARGARET J FILE NO.21 95-0390 ACN 101 THIS STATENENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NANED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYNENTS, THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE. DATE 12-11-95 DATE GF LAST ASSESSMENT OR RECORD ADJUSTMENT. 11-13-95 PRINCIPAL TAX DUE I 11.556.22 PAYMENTS (TAX CREDITSI. PAYMENT DATE 07-14-95 11-22-95 RECEIPT NUMBER AA048016 REFUND DISCOUNT (+1 INTEREST (-) 577 .81 .00 11,500.00 521. 59- AMOUNT PAID \'...... TGTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE 11,556.22 .00 .00 .00 . IF PAID AFTER THIS DATE. SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN .1, NO PAYNENT IS REqUIRED. IF TOTAL DUE IS REFLECTED AS. A "CREDIT" ICRI. YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. ) , -t_- -.-, . PAYlENTI DetKh the top portion 0' thl. HoUel WId subIIlt with your PI,""' ... p.)'IIbla to tM ,... Met IIddr... printed on t~ rIYI"" .l~. If RESIDENT DEaDENT _.. chKk Dr .....V order p.)'IIb1. tal REGISTER OF WILLS, ACENT. 11 NOH-RESIDENT DECEDENT .... cheCk Dr 110M)' order plvllbb tal COtltONWEALTH OF PENNSVLVANIA. All plYMnh rHalved ...11 be ~l1ed Unt to .-tV In""'" which ..w be We with WlV ,._1,.,. ..-Ued to the to. REFUND (CA)I A refund 0' . tax credit, whIch .... not r....tect on the hx Return, MV be r.....tM bit C0IIP1,Ung WI "Appllcltlon for Refund of PennlvlvWll1 Inherlt~. Bnd E.t,t, Tax- tREV-1StS). application. Ira .v.llabl. .t the OffiCI of t~ Aeol.t.,. of Will., WI)' of the ZS A.venue DI.trlct Offlc.. or fr~ the o.plrtaent'. Z~-hour Wllwerlne ..rvlee ~r' for 'or.. Ordlrlngl In Pennlvlvants 1-800-562-2050, outside PennlvlvWlJa Bnd within locII Harrl,burg sr.. (717) 787-60", TOOl (717) 77Z-ZZ5Z (Helrlng l~.lred only). REPLV Tal Que,tlons rlglrdlng error I contained on this notlca ahould M MSdr...ed tal PA o.p.rt.."t of R.v...., lur.'" of Individual Taxa., ATTNI po.t A......ent R.vlaw Unit, Dapt. Za0601, Harrl.burg, PA 171Za~0601, ~ (717) 1I7~65QS. DISCO"'UI If IlnY tax due Is paid within thr.. CS) calendar IMM'Ith. attar the dac...,t'. dltath, a five parcent (SX) dlnount 0' tha tax paid I. alIDNld, INTERfSTI Intara.t II charged beglmlna with 'Ir.t day of dallnquency, or nlna C') ~th. end ona (1) day fro. the data 0' daath, to the data of p.y.-ot. Taxa. which bee... delinquent be'or. January 1, 1'8Z blar Int.ra.t at the rata of .Ix (61' parcent par ~ calcul.tad at a dally rata of .000164. All taxa. Nhlch bee... dall~t on and aft.r January 1, 1'8Z will baar Intara.t at a r.ta which will vary 'r" calendar yaar to cal~.r yaar with that rata announced by tha Pi D.part.ent a' Ravenue. The appllcabla lnt.ra.t r.ta. 'or .,a2 through ."5 ara, V.ar Int.r.at Rata DaUy Intaraat Factor Valr Int.ra.t Rat. Dalh Intar.at Factor 198Z 20X .DOOS41 1.17 'X .DDU47 1.13 16;( .0DO"S8 1'11-1991 llX .00nGl .... llX .000301 199' OX .000247 1915 lSX .000356 1995-1994 7X .00019Z .... lOX .000270\ 199' OX .000%47 --Intarnt la calculated .. 'ollOMII INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DULY INTEREST FAl:TOII --Any Hotlca la,uld .'t.r tha tax bacu.a. dallnquent will raflact an Intlra.t calculation to 'lft.en (15) daya beyond the data of the .......ent. If p.y.....t Is uda aftar the Intarnt c~tatlon data ahoNn on the Hotlcl, additional Intar..t .uat be calcul.ted. -1-:t:',J______~, ,_ . ' . ~ .J..J.uI p?af /tll,91J No. 21-95-390 , Deceased Estate of MARGARET JANE IIAIR DECREE OF PROBATE AND GRANT OF LETTERS AND NOW MAY 23 19..2L. In consldcratlon of the petition on Ihe reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the Instrument(s) dOled NOVEMBER 10. 1982 described therein be Bdmlued to probate and filed of record as the last will of MARGARET JANE BAIR TESTAMENTARY CARL GONTZ lInd Letlers lire hereby grBnted 10 'fr/(J.~ I' i1".;" r" (I fl. fJ~;: :,fUO;llJPu:1fJ Resister of Will. FEES Probate. Lellers, Ele. ......... S 40.00 ShortCertlficlltes( ).......... S 6.00 ~..X.,.l'AGES...... S 6.00 JCP S 5.00 TOTAL _ S 57 .00 Filed MAY. 23. .19.95.. . . . . . .. . . . . . . . . ." At"-- )). S',^",~-\1\ \ ,:\0'1.,,~ n ATTORNI!Y (Sup. Ct. 1.0. No.) .- "5"1 ",ou'l:f... ~(.......... St. 'i'.o,~.",=l.~t...... AOORI!5S > {.e~ ,....,.... , l?A, ":i \:t~ cp\' ~ le~ I I'HONI! CALLED ATTORNEY MAY 23. 1995 . l(rJtUJ.uj ()1.(J/.u.A ,r- ~ tt'J)dV" tJ.!J, j 'i f (j" """"" ",,'. 21-95-390 This i" 10'wliI)' lllill ,h" ;"(.....".lIio" '"...., gin." ""'""(11)' "'1'"'.1 11<"" ,'" ''''~''I,d "'II,li",",,,, dl'"d, dill)' (iI,'d wi,h nll',1S 1....." H"8i,"... Til,'o, illin"l n'IIili, al<' 1\ ill h,. I....w.o,ltd ,.. ,Ii.. ~'."I' Vn.d H."".I, 111111, I.... "1"11''''''''11I "Illig, WARNING: Ills IIlogollO dupllcnlo Ihls copy by pholoslnl or pholograph. Ft'l.j'or Ihi\ u'llII ir,llt', S!.uo --..+----.--.-..-_._____. ~_u.___ Nil. 2886512 a ~. ''''%'~-'~ I /.' '. ,;.';:: "~ <_ o r"y""'i'J,(.. '{:"~"'~--r I.ot. Hc.',I.(lstlur (j .----.. --.AP.I'l-Z-8-199S___ D.lle , , 1 , ,....... , ! COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH HI' IfotO U al_a.rei:."'dD':r~:'.I:r Ree.aurant Owner CiICI.DlNl.........MAOoN:..CSt....c.,tbon.liIIIe.IIlCWIt DfCl[)l:''''1 OCT"" 1969 Randall Road :.~~ .. Enola. Pa 17025 ~__ mtell"HN4'..IokUI,lNq Mellhanloebu ""'""-ACIjC.,- .... Sol'lttyl'K'['I1'. 00 y l"f'G.~,~....ItId~1 I"lACfOfDlRtllO.:'u .....--~(01~...... I1OUt1Al' _0 '""'--0 ,., fill""",,, If.. IOCULllCUf\lfyJrtJt.l1ll1l ., Female . 180 - 26 -6752 o.vIDfOlAJtI~D1, lINIl .. Aprll 27, 1995 H ....0 =r)D Health So n..StaN t.lAArlAlllAlUl.....,.... '"'~~~~ TIlvorDed u..m...................... IUAVIW<<III'OuIl (1.....0.."'-""'''-'-1 .. - ..... 'h1.Counr Cumberland .......' lP.D:i~~gI WO"IlA"H~IE(f." UuJe u........_, ..a 8 enna oro er 'UCH May 1. 1995 UCINSI HllUlIJ.R F. n. Ul1897-L .Jennle R 1NfOflM.t.NT"~Il.WQAOl:lR["lSlt"'.Clriboo\,'-lip I 19b9 Randall Rd. Enola. 1"\ACI000DlSPOtM ION.H_IlfC_...,.c.-.-y lOC,qIOt'l. ..0......... ~~..'::'/~--......I"'"..,"IfIlle"'"-.IIIf...",,...I.ltlfed , ROlling Oreen Hem Par NAUlNiOAoomllOflAOllry AUlllvan F.H 51 IltlHIlNUl,larA Ne Pa 17025 ".,..Z.Code N. oamp 11111. Pa Enola nr. Enola [WE'ION D 1101..., IHf.......1 ,.. WA.... Ilt:l(fUllD 0 r AI.. ~.[J " ...iY I '''''''l tIIII..Ihe--........OI~.,.l'IUlUNd__IItM" Po 1At.....,_l.AUM...Hdl.... ~I~J.CAU.I'~ ~ :::';~I':..~", ~ lOOASACc.>>r..r.Qu[II(;[ (1) HfI"-1I D""'" Ib!lIWe 0 AwdMi 0 '"'"""ubotll9AI"," 0 "" 0 No 0 .....,. 0 c:o..r..:tllOllbelltl",""," 0 l:"ACf:OfIItiJUft,.,.."""".,..,......"',IC""Yo"". u. hi I.. It ~'''~II "!'Ju~~PH~:at./l"hr'lO::_C~~fllldo.Ilh....,_..tI'JK.WI,..'f.(n.u"tIJ.............'"In'f-...J_ft,J, h.........f.,""'..........W.MCWNolI_.....~.)~"""'-..~."................................................. WlfllAUttwl'flHDlHOI ...."lIll!rmonro <:otUL1!f1ClHOftAuH Of'DlAfllf WAHNlAOFD[AlII [W10f1HJtJft'l' iIA.o"'I~'''''''1 ~u._. "'''''albM__ J""...,.....doMl'l I , , I I I , Jllol[ Of "'Nft'l' ""'11, OrIIef......oc_~__Ibi,tl"'G.....IIl.bu1 """-inQlIllllllllldt<l/"'llUlIIIII""tfllll,.unl c'A ~. I: OVI lOfUlAlACc.>>.s.tOUINCt Of. OUI TO f{>>I AS A COt1[QU( Net Of) 1P(JlJ1l'l'''' won", OISCfll8f.tlC"l'llHJUll'l'OCCLlNttO ....0..0 '~N40tI"''''l'>>lQ''tl'IlCLlHI'''''''_IdtIJII''''''''rv_'''d~''''',",,'''t.Ao'''gI''''''J ft......,.,.,.,........,.... ..""..... lilt.......... ....ptt.c............ .....-.c.J~ ""'_.................................. 'lII.tMCo\L IJ:AMlHCAlCOftOHlIt OIl...........f ..trIlInallon MdlOl'IrI,...lttllOll, '" ""opIfUoft.....lh .e."......lht 'NIt., ...1.. tlMlploc.. .11" du".1ht CIU"I',"'" JIL......,........................................................................................................... lJ Pa 10(/""<'/,/1 .., >.,'; '1';' I.,' , ,i " ,~ n.! ~. fz.t . O. ~~.. " ~ .,.~~, " '"i ~~' ~~ Eo< tIJ ~ " :; , 'l' , ',. + ,t. .:~ ',"- _ ,,>>::1'.~;L," j. " t',' t. ,. ~ LAST WILL AND TESTAMENT OF ~~RGARET JANE BAIR I, MARGARET JANE BAIR, of 201 Second Street, Summerdale, East Pennsboro Township, Cumberland County, Pennsylvania, being of sound mind. memory and understanding, hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all previous Wills and Codicils made by me. ARTICLE I I give and bequeath to STEPHANNE CLOUSER, who presently resides at 30 West High Street, New Bloomfield, Pennsylvania, if she survives me, by IDS Bond Fund, Inc., Account No. 0412-0800- 952-0. However, if the aforesaid STEPHANNIE CLOUSER does not, at the time my estate is to be distributed, have the power and capacity of an adult, then the aforesaid IDS Bond Fund, Inc., Account No. 0412-0800-952-0 shall instead be given and bequeathed to her grand- father, PIERCE L. 'CLOUSER or, if he is not then living, to CARL GaNTZ, with the request that PIERCE or CARL GONTZ so receiving the aforesaid IDS Bond Fund, Inc., Account No. 0412-0800-952-0 immediately make a gift of it to the aforesaid STEPHANNE CLOUSER under the Pennsylvania Uniform Gifts to Minors Act. If STEPHANNE CLOUSER shall predecease me, then this gift shall lapse. ~ ARTICLE II I give, devise and bequeath all the rest, residue and remainder of my estate to CARL GOlnZ and ARLENg GONTZ, both of whom preoently reside at 1969 Randall Road, Enola, Cumberland County, Pennsylvania, to be theirs absolutely, share and share alike. If CARL GONTZ and ARLENE GONTZ shall predecease me, then I give, devise and bequeath all the rest. residue and remainder of my estate to STEVEN GONTZ, CHERYL GONTZ, BRIAN GONTZ and MICHELLE GONTZ, all of whom presently reside at 1969 Randall Road, Enola, Cumberland County, Pennsylvania, to be theirs absolutely, share and share alike. ARTICLE III I appoint CARL GONTZ to be the Executor of my estate. If CARL GONTZ cannot serve, for whatever reason, then I appoint ARLENE GONTZ to serve as my Executrix. Any Executor/Executrix serving under this, my Will, shall serve without bond. IN WITNESS OF THIS. I have signed, sealed and published this Will on the 'O+~ day of November, 1982. This Will consists of three (3) pages. ~f~C.&--e-.-c~Y ~-~ 13a1-~ (SEAL) AR ~ JANE BA Testatrix -2- . " . . . " .... t On the lo"'~ day of November, 1982, MARGARET JANE BAIR declared to us that this instrument was her Last Will and Testament, and we were requeoted to act as witnesses to that declaration and to her signature. This Will was then signed in our presence, all of us being present oimultaneously. We now declare that she is, to the beot of our knowledge, of oound mind and we subscribe of 9L 1 f2L-1-- <;j.,....d 1'11- " of 5 JT II, 'J L. Ie". d E", l1"lo/f-' Sf~y!-J;m 17// ~ ., -3- 21-95-390 .j.,jul /lldJ' I", If' 9.5- REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (cach) B subscribing witness 10 lhe will prescnted hercwlth, (each) being duly qualified according 10 low, depose(s) and say(s) that presenl and SBW Ihe lestut , sign Ihe some and thnt signed as 0 witness Bllhe request of lesta' In It presence and (in the presence of cach other) (in the presence of Ihe other subscribing wllness(es)). Sworn 10 or affirmed Bnd subscribed before me Ihls dny of 19_ (Name) (Address) Reglsler (Name) (A ddress) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS A\\e.... y. ~~'til. d- s:~~NC^ C. Go~-i:-::t. (each) 0 subscriber herelo. (each) being duly qualified according 10 low, depose(s) and sny(s) Ihal -rh fBmlllnr with the slgnalUre of '/v"--d..,..:-r ;lC.".. il,o.:,t" . \ codicil leslBI~ of (one of the subscribing witnesses to) Ihe wlii Ihat ~\.,.-. , presented herewith Bnd codicil believes Ihe signature on Ihe will Is In Ihe handwriting of - \/,^-r,.<:~ c.....c""'( u C'''''c. ~<:....~ ( to Ihe besl of .oe\;...:../ knowledge and belief. A~,- c. h~ (Name) q(O.z9 11/. drll ~r- f(6('r- ~ W.e;;dress) Sworn 10 or affirmed and subscribed before me Ihls 16th day of MAY 1995 In;41 ~,fi. M h".L yv (. ~ fI ~ ~;~ '-Pu:/J.;.. Reglsler S') r (Name) t'"' ,;><>"rA. ':Fr......... ~+ (Address) s~ f.h.. fit i :j I iJ \-. ALLEN O. SMITH cI1Uo"'&y AI L..w (")0 ~a; \c.l :0 ::nn, Bl SOUTH ~"ONT ST"IIT v' .': ~: P. O. SOX 7BU t' nULTON. PENNSYLVANIA 17113 r:; TELEPHONE 17171113D'lnl ~ACSI"'1LE 1717111311'1DIIS - -.J ;:~': .-" ;........ &>.~ :ill .. July 14, 1995 . --, ~ 0'1 Mary C. Lewis Reigister of Wills Cumberland County Courthouae Carlisle, Pennsylvania 17013 Re: Estate of Margaret Jane Bair No. 1995-00390 Dear Mrs. Lewis: Enclosed pelase find a check in the amount of $11,500, which represents a payment of the inheritance taxes of the above referenced estate. Would you please forward a receipt to my office in the enclosed envelope. ADS:rmk Very truly yours, Encloaure ~ry Allen D. Smith. Esq. I " . I , . j I .~' , ~,'I'I W\l\ I i I I i I . i~ I I"J 1 Ilf if .~ f I t 1 j I . r I I . f i , I I , , :r ... i~ ~ 11 ~f .J < \ \ ~, 0:1) "- <a- ... ., l3 M # ~3 ..... ~ ~'. ..-_...._..._.~, -~"- M ..... "0 ...... "..... o .c ... '" .. ".... o = U .. :> .. >,.... .......>, .... c::.. .... "" en ~ 0 = -; U.. QI ~ ,.t'~ ~ ". ... tU.lU . QI...-If'"'"l t.J.&.J ... In ........ >>.... .c .... "'. bD a '" .. .. ;; .. ;l;l>:UU ".1:) t", :"11~) 9 [; I:V ,; I 1,')1' '.6. 'il !ll 1(>(lO !,')' P(!p~Ot.i H -.......,.. .- 0- .-. --.- ... . , '. '\1'1 .. ::-:1 :! ..~. ~....."",.... <J: (l. . , L:I ~ .. ti !:: .. < 1;;"'" i ..< ~r.!~ o..ro ",oz .....z So~ oLi II g Vi d .. 0- Il ....i...."-~.- ' -'-.~ f ..- '" I i i ! i I . - - - - I I I I I ell i ! i I I I I I I I , I I l I I ! ,. , , , ~ '. . , ~ I , ~ ";., ; .s \ "')11 ...t-," J" ,~. Jo. ,. f '\ ,.\ " I l". 'f ~ /r If""'~" , '''''''II "II '0. "". ~ ,I , '.l' . '.. ! ""1,,'..'I'~ ,#".\- !. i .~+~::.f\c i ,0 .. .:, " , ej"';' :> , -, .., " \, r . " , '. ..---' ~- .,..,..-. ~ AI^I"'~ ,: ' , ~.---..- . - -, ......~ -;-" _. -...-"- , ------------------------------~------------------- D AA048016 COMMONWEALTH OF PENNSYLVANIA NO. . , DEPARTMENT Of REVENUE , : ...,,,, IX '....1 OFFICIAL RECEIPT . PENNSVLVANIA INIo!ERITANCE AND ESTATE TAX . ACN ASSESSMENT P:I CONTROL ~ NUMBER RECEIVED FROM. fJ AMOUNT SMITH ALLEN 0 ESO 51 S FRONT ST Hl1 IftJJ,:3UU.UO STEEL TON PA 17113 ESTATE INFORMATION: ~ FilE NUMBER U 21-1995-0390 EJ NAME OF DECEOEN~ II DATE OF PAYMEN' fa POSTMARK OA E COUNTY SSN 180-e6-b752 (FIRS" (MI) NE !"l 1 DA'E OF DEATH m TOTAL AMOUNT PAID ~.~ / - C/ RECEIVED BY , NAl f MARY c. LEWh, REGISTER OF WILLS \.~,... REMARKS *11 .500.00 CW ARLENE GONTZ SEAL CHECK II 909 REGISTER OF WILLS , --- - -- ---- -"""'--"-;::-,7'.7'::-;:-"-:-,;-:---..,._:-- -,.-,.- _ -__ _~_ _,--0_-;-_ -;; _ _ _--:_~ _.. I ," . .., ,,, .. 1 p. . ' .f .' .. --' ..--.~ ..--., -~ --.- ..'.,.---..A. -- ." -'4:~." . ,...._'" , lOIOHfI'1 I I / I I I . / CERTIFICATION OF NOTICE UNDER RULE 5 6(8) Name of Decedenl: Margaret Jane Bair Date ofDealh: 4/27/95 Will No. 1995-00390 Admin. No. To the Register: I certifY that notice of beneficial inlerest required by Rule 5.6(a) oflhe Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-caplioned eslate on May 25. 1995 ~ Address Stephanne Rush nee 5teDhanne Clouser 30 West HiRh Street. New Bloomfield. PA 17068 Carl M. Gontz and ARlene H. Gontz 1969 Randall Road, Enola, PA 17025 Notice has now been given to all persons enlitled thereto under Rule 5.6(a) except Date: 8/1 dq J" . , Sign~?55f \0 - :; Name Allen D. Smith. Esq. Address 51 S. Front Street 5teelton, PA 17113 Telephone (717) 939-1891 Capacily: _ Personal Represenlalive .....1L Counsel for Personal Representative :) .!!], I': ;~t ~ . ,'C 0' I." =-:'1 ..-.:; ("" G, (I: a: l5; ;. i~ 1.1)::) UU . ~ R[Y.1.5oo EX + IMAI ~ J !.J~ 3'1-1/ j fOA DATU Of DIATH AnlR 12/31/91 CHICK HIRI INHERITANCE TAX RETURN ~o~::~W:~DITlSCLAIMID [-J RESIDENT DECEDENT 'Ill NUMBIA ------- ITO BE FILED IN DUPLICATE 3QO WITH REGISTER OF WILLS) COUt"TY CODE ~L YEAR CJ tr NUMBER OfClDIN '1 COMmTf A()OItU COMMONWEALTH Of p[NN'nVANIA DEPARTMENT Of A(V[NUE OfP' 280bOI HA.IUnURO, PA 11 21.0601 OEC(D(N"~ NAME I''''. In. AND MIDDlE INI 1"'11 Bair SOCIAL ,reUIUI, HUMIII 180-26-6752 Mar 'I!&=r-__Jllllll_- OAI( 0 DfAllt DAn Of '1llIIt 4/27/95 11/18/01 I" A'h.ICAlu,IUnl'lINU 'IOuU. N""" flUI. """ AND ""DOlt lNIIl'I/ SOCIA' ,rcuiii"iiNU'Mi11t 1969 Randall Road Enoln, I'A 17025 COllnl Cumbo r Innd "MOUN' ItfCllVIO IUt INSTRUCTlON'1 lXII. 04. Original R,tur" o 2. Supplemental Relurn Remainder R'lur" (for dat.. of death prior 1012.13.82) fed,rol ellat, TalC. R,lurn Requlrtd o .ca. Future Inl'''1I Compromh, (for dot.. of d,alh aft.r 12.12.82) lXJ 6. D.cedenl Di.d Testate 0 7. Ole. dent MalnlDlned 0 living TrUll (Attach copy of Will) IAllach copy of TrUll) UPOHDINClAND CONPlDINTlAL TAX INFORMATION SHOULD II D1RICTID TO,'; COMI'UH MAIlINQ ADDRU~ 51 S. Front Street Steelton, I'A 17113 ,-:rl 20. If lIn. 1911 greal.r Ihan line 18, enler the dlUerence on line 20. Thl,1J Ihe OVERPAYMENT. a []i .lIlTm."......_....I....... ......11.6'...',... ...nr.r..:t -..I......II...I...U!.j....',Iol,1 21. If line 18 II greal.r Ihan line 19, enler Ihe diUerence on line 21. ThiJ I, the TAX DUE. A. Enler Ihe Inlor8l1 on Ihe balance due on line 21 A. B. Enler Ih. 10101 0' line 21 Dnd 21A on Line 21B. Thl, I, the BALANCE DUE. Mob Ch.ck Pavabl. laJ R.gl.ter of Will., AD."t lImlt.d E,tat. 03. OS, _ 8. Talal Number of Saf. Oepo,lt BOIllI .:0 (1) 121 (3) (4 ) (SI 5.294.36 (6) 28,808.63 (71--21,.653.00 -" 'I i i Iii i ./ lil III .. I!! ..:5.. frllE~ "'''9 u~.. r!J1ii .... ..,., file Es " . ~ .:, " i.l (9) 8,714.50 (10) (B) 85,755.99 939-1891 ,., .. I: :5 E :. III .. 1. Real Ellalo (sch.dule Al 2. Slock, and Bondi (Sch.dul. OJ 3. Clollly Held Sloc~/Partneuhlp lnler..f (Sch.dule q A. Mortgag.. and Not.. R"elvable (Schedule 0) 5. Co.h, Bank D,pollu & MI."lIaneoul Pe"onal Property (sch.dule EI 6. Jolnlly Ownod Proporly (sch.dulo FI 7. Trani'''' (schedul. G) (soh.dule LJ 8. Tolal G.on An," (tolallln.. 1.7) 9. Fun.ral Exp.n.... Admlnlltrotlve Co.u, Mlltellaneoul Exp.nl" (Sch.dule H) 10. Debll, Mortgage L1abiliU... Uen. (Sch.dul. I) 11. T 0101 Deduction. (IDtaIUn.. 9 & 10) 12. N.t Value of E.late (line 8 minu. line l1J 13. Charilable and Governmental Bequest. (Schedule J) lA. N.t Valu. Sub eet 10 Tax (lIn. 12 mlnulUne 13) 15. Spoulol Tranl'e" Ifor dol.. of dealh oft" 6.30.94) 5.. In'lruetlon. for Ar,plicabl. Plleentag. on Reve,.e Side. (Include valu.. rom Schedule K or Schedule M.I 16. Amount of line 14 laxabl. at 6% ro'e (Include volu.. from Schedule I( or Sch.dule M.) 17. Amount of line 14 laxabl. at 15% rote (Include valu.. from Schedule K or Schl,dule M.J 18. Principal tax due (Add 'ax 'rom lIn.. 1S. 16 and 17.) 19. C"dill Spoulal Poverty C"dil Prior Paj'menll + 11,50u.00 (II) (12) (13) (14 8,714.50 77,041.49 77 .041.49 z S i! :0 .. .. .. u S (IS) (16) ______ (171 77 ,041.49 )(._- )( .06. )( .IS . 11 ,556.22 (18) OIICounl + 577.81 In'erest (19) (201 12.077 .81 521. 59 (21) (21AI (2IB) BE SURE TO ANSWER ALL QUmSTIONS ON REVERSE SIDE AND TO RECHECK MATH .__ Under penalU.. of perjury, I declare thaI I hove eltamlned Ihls return. Including accompanying IChedul.. and .Iatemenll, and to ,h. best of my knowledge and bell." It I. true, corred and complele. I declar. Ihol 011 r.al IIlate has been reporteo at Iru. market value. Declaration of prepa,er other than the pe"onalllpr...ntatlv. II balld on all Information of which pllporer ha. any knowledge. !lIGNAIU fPfR N S Slllf IllNGRflURN AOORU~ 1969 Randall Road DATE 0_/. . /. 'nola. PtL.ll02~ -.h/1f(9.s- 51 S l' 0'" r . ront Strllet ~'/ .d In,.. tllllltOll. PA 17113 ___I 7'L~~ . ADORUS -; \', Act .48 of 1994 provide. for the reductIon of the tOK rate.lmpo.ed on the net value of Iran.'er. to or for the u.e of the .pau.e. The rate. a. pre.crlbed by the .tatute will bel e 3% (.03) will be applicable 'or e.tate. of decedenll dying an or after 7/1/94 and before 1/1/96 e 2% (.02) will be applicable for e.tatu of decedenll dying on or after 1/1/96 and before 1/1/97 e 1% (.01) will be applicable 'or e.tate. of decedent. dying on or after 1/1/97 and before 1/1/98 e Spou.al tranaler. occurring on or after 1/1/98 will be exempt from Inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (....) IN THE APPROPRIATE BLOCKS. YES NO 1. Old decedent make a transfer and: x a. retain the use or Income of the property tronsferred. ....................................................... b. retoln the right to deslgnote who shall use the property transferred or its Income, ............... x c. retain a reversionary interest; or ................................................................................... x d. receive the promise lor life of ellher payments. benefits or care' ....................................... 2. If death occurred on or before December 12. 1982. did decedent within two years preceding death transfer property wllhout receiving ode quote consideration' If death occurred after December 12. 1982. did decBdent transfer property wllhln one YBar of death wllhout rocelvlng X adequale consideration'................ ......................... ...................................,........... ........... x x 3. Old decedent own an 'In trust for' bonk account ot his or her death"'.................................... x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESr YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. , _'Vl}OIlr.IJI1I .f~ SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Plea Ie Print or T e FILE NUMBER CQMMONWUUH o. ,rNN'YlVANIA INHlllfANCI fAX InUIN IUIDIN' DletDINT ESTATE OF Morgoret Jone Bolr CAll prop"'" lolntlYwOWn.d with ,h. Right .. Survlvonhlp mUll b. dltcl.l.d on Sch.dul. ft ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Account NumberlOOOO 0051 2080 0950 9 002 IDS Life Insuronce Compony - Dote of Deoth volue $5,094.36 2. Personol effects 200.00 TOTAL Allo enler on line 5. Reca lIulallon S 5,294.36 (Attach addUlo"al 8'nH )C 11" ,h..lllf mot. Ipoc.la n,.d.d.) 1I\1,UlJIIllt,lJlIl 9..,a,..~ W COMMONWU.UH Of '(NNlYlYANIA INHElutANCl ,.... RUURN RUIDfNl DfCfDfNT SCHEDULE F JOINTLY.OWNED PROPERTY ESTATE OF FILE NUMBER Margaret Jane Bair Jolnttenont(.l. NAME A. Arlene H. Gontz ADDRESS 1969 Randall Road Enola, PA 17025 RELATIONSHIP TO DECEDENT None B. C. Jolntlv-owned propertYI ITEM LmER DATE FOR TOTAL VALUE OECD'S OOLLAR VALUE OF NUMBER JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST TENANT JOINT 1. A 8/29/86 Harria Savinga Bank $6.114.43 50 $3,057.21 Acct. #01-00109623 2. A 8/29/86,Acct. #01-16-093961 5,065.31 50 2,532.65 3. A 0/10/86 Acct. #01-16-096054 2.454.66 50 1,227.33 4. A 5/05/86 Acct. 1101-21-087614 1,113.81 50 556.90 5. A 1/15/93 Acct. 1109-66-229458 1,546.80 50 773.40 6. A 0/14/87 Acct. #09-16-103571 3.006.93 50 1,503.46 7. A 7/22/93 Acct. #0966-237613 3,054.37 50 1.527.18 8. A 2/19/86 Acct. #09-66-246930 5,102.42 50 2,551.21 9. A 2/2/86 Acct. #09-66-246980 7,447.27 50 3.723.64 10. A 6/11/87 Accto #09-66-255796 17,372.79 50 8,686.40 11. A 1/14/88 Accto 1109-00011644 5.338.50 50 2,669.25 TOTAL (Also enter on line 6, Recapitulation) S 28.808.63 (II more space is needed insert oddilionol shee', 01 same size) t,.- .(Y.UIO(h 11.811 . .1 I i . COMMONW(Alltt Of 'ft~U!.'tlYAUIA INHUnANCI lAX .nU.N IIIIDIN' DfCIDIN' SCHEDULE G TRANSFERS I I PlEASE PRim OR TYPE FILE NUMOER ESTATE OF Margaret Jane Bair TNIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS QN TNE REVERSE SIDE OF THE COVER SHEET IS YES. I 'I DECO ' DOllAR VAlUE IIEM DESCRIPIION Of PROPERTY 'EXCLUSION 'OlAI VALUE .. Of DECEDENT'S NUMBER Includ. no",. o',h ',on,I.,.., Ih.i, ,.Iolron,hip'o d.c.d.nl. dol. 01 hum'.', . Of ASSET INT INTERES' 1. Property situate at 201 Second Street Summerdale, PA transferred from decedent to decedent and Carl M. Gontz and Arlene II. Gontz as joint tenants on July 15, 1994. Cumberland County assessed value 4,100.00 X Common Level Ratio Factor 13.33 yields fair market value of $54,653.00. 3,000 54,653.00 100 51,653.00 TOTAL (Allo .nle, on Iin. 7, Recopilulolionl S _ 51 t 653. 0.0 (I' mot. 'poco i, no.dod, in,." fJeld.lionDI ,h..h 0' '0",0 ,i,.., . . tHv,UlI ,.. I'll, ESTATE OF ~~~\~d" ...~1.1?:,.. COMMONW(AIIH Of PENN~YlVANIA INHfRITANC[ TAk REtURN Af~ID[NT Dl~[OrN' SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES_,_ _l__uu~lo~l!, Print or Tvpo ~UMBER Margaret Jane Bair L- I AMOUNT ITEM NUMBER A. Funoral Exponlo" B. 4. C. 1. 2. 3. 4. S. 6. 7. 8. DESCRIPTION 1. Sullivan Funeral Home $4,389.00 1. Admlnlltratlve COlt.. Penonol Reprelenloll.e Commlnionl Soclol Security Number of Personal Represenlollve, Year Comminlons paid 2. Allorney Foel - Allen D. Smith, Esq. 4,000.00 3. Family Exempllon Cloimonl Add,e.. of Claimant at decedent'l deolh Slreet Addre.. City Slole Zip Code Relallonshlp Probate FeOI 57.00 MllceUoneoul Expenle.. Advertising - Paxton Herald and Cumberland Law Journal 28.50 40.00 Reserve for contingencies 200.00 TOTAL (Also enler an line 9, Recapitulation) (If more Ipace II needed, Inlert additional Ihee" of lame Iln.) S 8,714.50 .' -'\I.15I:1UtIJ'1) 1_ " tjj. COMI,IONWUltH 01 rtHNtn"'AN14 INHII"ANCI ,All II'UIH IUIOINT DIClOINI SCHEDULE J BENEFICIARIES ESTATE OF Margaret Jane Dnir FILE NUMOER ITEM NUMBER RELATIONSHIP AMOUNT OR SHARE OF ESTATE NAME AND ADDRESS OF BENEFICIARY 1. A. To. obI. BtqU..hl Stephanne Rush, nee Stephanne Clouser 30 West High Street New Bloomfield, PA 17068 $5,094.36 None 2. Carl M. Gontz and Arlene H. Gontz 1969 Randall Road Enola, PA 17025 None Residue of estate. ITEM NUMBER NAME AND ADDRESS OF OENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Boque.hl 1. TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Ail. onter on IIno 13. Rocopltulollon) S (If more .pac. I. n..ded, Inll,t additional ,hee', of 10m. IlIe) ('/ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 1. J II: u ____GlIrl_~I._Gantz___ ________ _ __ ,_ _ _______ bolng duly _-"_\{9rn__ _ _ ___ according to low. dDpo,,, and ..y. thot h. is ___~he...EKe~~~.!'_r____________,_ ______ __u____ of tho Estoto of Narllaret Jane Bair lot. of ___ lIampden Township ________, Cumborlond County, Po., d.c....d and that the within I. en Inventory mado by .._u_~.uCurl.Jl.._Gol1tz____. ____ _'__'1 the uld IO:xerlltnr of tho onllro ..tato of .ald d.codon', con.lsllng of a/l tho p."onal prop'drty and rul ..tote, .xc.pt r.ol ..tat. ouhld. tho Commonwoalth of Ponn.ylvanla, and that the flgurD' opposlt. oach It.m of the Inv.ntory r.pr..entlt'. fair valu. as of tho dato of docodont'. doath. ,l.{- f..- 19 95 ?~///~~ Carl N. Gantz Eucutor . Admlnhtr,'or Sworn and .ub.crlbod bofor. m./ 1969 Randall Road F.noJa. Ph 1702, Add,... Oat. of D..th 27th April Month 1995 Vu, aey INSTRUCTIONS I. An In..ntory must bo fIIod within thr.o month. aft.r appolntmont of p."onal repr...ntatlv.. 2. A suppl.m.nt In.ontory mu.t b. fiI.d within thirty days of dlscovory of additional aueh. 3. Addlllonal sho." may b. ottach.d a. to po"onalty or roolty 4. Soo ArHclo IV, Flduclorl.. Act of 1949. ~ .,; w '" .. ~ ~ '" ... .c .. 0 w ~ ... Ul .. '" "- '" ~ U II M e 0 :il '" .. en ~ 0 w '" '" 0 C .. II 0 i!: "- u. I-< .; ... E I Z ... OJ 0 OIl U. ... ;1j 0 ~ r= ... ~ '" W 0 <( OJ .i- '" > Z '" ~ '1:1 - c Z 0 c ... ~ :0 VI Z OJ c.3 0 '" ... :c Z w <( '" - "- bD "0 ... c ;J - ~ 0 ~ .. I .a "0 ... I II E 0 I - :0 . 0 .. it ... u ... Inventory of the real and personal eslate of HARGARET JANE HAIR doceased 1. Account Number: 0000 0051 2080 0950 9 002 IDS Life Insurance Company 5,094 36 2. Personal effects 200 00 -; ~ l) :~? N ....1 ("''l . - t"~..~ "'(.1; i.l ,-" \D ~ ~'] .;::: . _Ll S l~ u8 , $-~ ~'-~ ~j) 0: a: p~ '- - ALLEN D. SMITH <:I1t/o""y at .J:..w , 81 80UTH 'RONT STRUT 1'. O. SOX 7BU STEELTON. 'ENNSYLVANIA '7113 TlLEI'HONE17I7I 838'1881 'ACSIMILEI7171 8U'188B August 15, 1995 Mary C. Lewis Register of Wills Cumberland County Courthouse Carlisle, Pennsylvania 17013 Re: Estate of Margaret Jane Bair 1995 - 00390 Dear Mrs. Lewis: Enclosed please find the original and the State's copy of the Inheritance Tax Return, Certification under Rule 5.6(a), Status Report under Rule 6.12, together with the Inventory for filing, in the above referenced estate. Also enclosed are copies of the summary page of the Inheritance Tax Return and the other documents. Would you please time-stamp and return these copies in the e.\closed envelope. Thank you for your attention to this matter. ADS: rmk Very truly yours, Enclosure Allen D. Smith, Esq. - o i1 "".-. ~ ':-1 c): ::>'~ t'~ .o;C .:-\0... '.' \0 - ~'B ..:':: " ',ua..: 0: ti-, P\ j I":: 68 n .i '.... --.....-.',-.... i I , 1;;~<; , " '. ~iA ( . ,tAl .' . \ " , , , . .. I .' \' I" ' . . \ \ , I \ \ \ ., 1 , I : /~i'\. ;.. cn\ \\;'; ~ ~ '<"","J}! ,/ .......-- .. ::l ii .., .... o "r-. ...... " o ..c: ... III ...... " " 8~ ~ t'.. " " . "" en r-t 0 41 .; i:'u". ., .,'" ,4.c=.. U Ill., . ........ U .... "41"'" i:'Bijtj ,I'l"''' III ;o:<uu . . j .... o ., ... .. .... llIl ., 0>: I I I \ J " I l'l ti ... :r - !: w' .. ~ '0: - ::E liiNz .... III "~g " . z'" . ~~z I c l I ""z Z x .w , ..0.. I 11/ " . . I oJ o"z , oJ .. 0 I c( - !:i I .. w w I Iii I i I I I ! I -.1 ~' , '''":' i -' -, , ,. ., ; '=~ !.; r I -, I ! I .' j . ,. ! ~ " , X f. i. . ! . ';-"1,j ,~ .~. ~ i. , ~~'. r'" "",p. , 1 I ,.\, 'f' . . .~ " '. .".t , : '. ~" :> L,: "'. . 'tt, .. r," } ., '. " ILl t ..,..\ . d", . . '. ' . . I . ,(" I ":,_-.-. I .;. I '; I , , . 't,. ., , ,) .t t!"' " " p. . . \, ' . , " )"---' r-- ., ...,-=-\<. -- -, I' .;.--:'.;,~ ~--,,--,,--'-""--~'-._~ _..~-. ~____~4_ _\~ , ,r-' . .-" - ...;~ "' n I I I, i I u ..~. ':") ('"1 ('" L_~l '.-- I I ! I I I j I ;;~ L- ll.: ';1 ;':;', cjO ! ;>~ " -'~_'"~"-_'..;,"...."._-"-".. ""'><"_'h'__",<:,"',__..,,-",,-;,'cc...' . - ...~_. . 'Y' ".. --~._" .,-,--_.~.- I 1:~:- . r , t.. 0 . , , ; i I , I I' , I I I " . I I .' l r I I I I \ I i I '. " ", w .;.. -s . ~ i- \. : ~~i "~' . j. '''.'' I .( , .' ...\, '(>'..1 ;. ~..,~,.. > " " '0. ':'. to .. . ,", '\1" ,'~ '.\ .,--. -"',\,,*. ....-'. - ,..' ." " I '... .~ .,- , I I , I I I I .1 :' ':. \' , '. .._-" -......4:0. ~.:......-.lI ~- , 40 .' ~ ~ I I , / '" . , . " ;:_; " " :.. 1;;5 ~= 5 ... ,. ;;j!o< a ~ . -e ~ ~ ~= ~ ~ If = a c o ~ = !o< ~~ !o< '''" -e y . .-..... -...... '" ~ , '- .\ , "t' I . " .' I' I f' ~'+ , I' , '. .. , '. 'I., t .. , . " ~ .~ , I P, . . -- .,..,-- -_..__ _-_'_:..............~.~ _'~~l' ~: - , ALLEN D. SMITH d1UolII.Y AI ..c..w 1I1110UTH ~RONT STRUT ... O. BOX 7BIIZ IITEELTON. PENNIIYLVANIA 17113 TELEPHONE 17171I13D'I1181 ~ACIIIMILE 17171 D3B'IDDII August 16, 1995 MBry C. Lewis, Register of Wills Attn: Cheryl Cumberland County Courthouse Carlisle, PA 17013 Dear Chl!ryl: Enclosed please find my check in the amount of $25.00 to cover fee for filing of Inheritance Tax Return snd Inventory. I must apologize for the oversight, however I thought the fee was collected at time of probate. ADS: rmk Very truly yours, Enclosure REV-1543 EX AFP (8-941 *' . ClJtmOHWt',uTH DF PENNSYlVAHIA DEPARTHENT OF AEYEHlJE BUREAU Of INDIVIDUAL TAXES DEPT. ZI0601 HARAISBURG, PA I7U.~06Dl y INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NG. 21 95-0390 ACN 95131327 DATE 07-10-95 ARLENE H GONTZ 1969 RANDALL RD ENOLA TYPE OF ACCOUNT ~ SAVINGS CHECKING TRUST CERTIFICATE RENIT PAYNENT AND FORNS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 ESTATE OF MARGARET J OAIR 5.5. NO. 100-26-6752 DATE OF DEATH 04-27-95 COUNTY CUMBERLAND PA 17025 HARRIS SAVINGS BANK h.. provldad tha Dapart.."t 1IIlth thl Infor..Uon Iht~ below which h.. bien used In ulculatJna thl potantlat tax dul. Thalr r.cord. lndlcat. that at the d..th of thl above dlcadent, you war. a JoInt owner/banallclary of thl. account. If you '..1 thl. Infor..tlon I. Incorr.ct, pl.... obtain lIItSttan corractlon fro. thl 'Inanclat Inltltutlon, attach. copy to thl. 'or. and r.turn It to the abave .ddr.... Thl. account I. ta..bl_ In .ccord~. with the Inheritance TI. law. 0' thl Co..an....lth 0' Pennsylvanl.. Questlona NY ba wuwuad by c.:.1Jlng (717) 7874:127. COMPLETE PART 1 BELGW M M M SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 09-66-255796 D.t. 06-11-07 E.bb1hh.d To Inaur. proper credit to your account, two eZI cop I.. of thl. not Ie. .u.t .cco~any your pay..nt to ~ Real.t.r of Will,. "aka ch.ck payable tor ""R.a....r of WU1., Agent-. Account Bd.nc. 17.372.79 Parcant Tll)(abl. JC 50.000 A.ount Subj.ct to T." 0.606.40 T." R.t. X .15 Pot.nU.1 T.. Du. 1 ,302.96 PART TAXPAYER RESPONSE [!] I.',.FAILURE "0., RESPONDlIILLRI!SULT IH.. A,.OI7!'ICIALTAX ASSESSHI!HT, BASI!.D,OHTHIS HOTICI!.:,I A. 0 Th. above Jnfor..Uon and hlC due 1. corr.ct. 1. You .ay choa.. to raalt pay.ent to the Ragl.t.r of Will. with two cap I.. of thl. notlc. to obt.ln . dl.count or avoid Int.r..t~ or YOU ..y check bolC -.- and r.turn thl. natlc. to the R.al.t.r of ~ Will. and an official .......ant will ba I..ued by the PA Dapart..nt of Rav~. II. lB"~ above ....t hu baan or will ba nported and tax p.ld 'lith the Pam.ylv....l. Inheritanc. Tu return to ba fUed by the dacact.nt's rapr..."htlva. HOfEr If talC pay.ants ara aada Nlthln thr.. (11 aonths of the dacad."t., data of daath, you .ay deduct a s;( discount of the talC dua. Any Inherltanea t.1C due 101111 baeo.. dallnquent nlna (91 aonth. aft.r tha data of daath. [CHECK ] ONE OLOCK ONLY c. 0 Th. abova InforaaUan l~ncDrr.ct and/o~ltb.. and daductlon. weta paid by YOU. You llU.t co..-lata PART l!.J 1IndJ'0r PARf t=J b.loN. If you JndJc.t~ p dJffarant taK r.t., pl.... .tat. your r.latJonahJp to d.c.d.nt, ":,'i," OFFICIAL' ,USE ONLY 0 AAF:i ""I'A DEPARTMENT, OF REVENUE', 'PAD~" ""':' " "'I ,,'2 .., 3>' .. of''''''''' 5' ".. 6 PART ~ TAX RETURN - COMPUTATION OF TAX ON LINE 1. U.t. e.tob11.h.d 1 2. Account O.lanc. 2 5. Parc.nt TaKabh 5 )( 4. A.ount Subj.ct to T.x 4 S. Dabt. and D.ductions 5 6. ADtOUnt T""lDb1. 6 7. TaK Rat. 7 )( 8. Tax Dua 8 JOINT/TRUST ACCGUNTS :,.: :,:i -,.': " :' '.'. ~:':' ' .; . :' ,.','. C,-.'.".:,::,: .'"'.....,. , , : ::.~ 1 "..' ., . " " .." :': ,,:' ':"::~: :::'.: ::.: .:,:: ::. .:.'. ;,:,:::,.",;. PART ~ DATE PAID DEBTS AND DEDUCTIONS : 1.'::~:" "':'. -" ~'~:'~:. :'8:~':;:' CLAIMED : i ~ . ~ PAYEE DESCRIPTION AMOUNT PAID I TOTAL CEnt.r on LJna 5 of Tax CoaputatJon) I . fact. I hava raported abov. .1". tru., correct HOME (717 173~ -,9 r)() WORK ( I ""d {: lllt~/p- GENERAL INFORMATION 1. fAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSES5HENT with lIppllCllbl. lnhr..t bu.d on IntonatIon autHlltt.d b', the financial Institution. Z. Inh.rltencll tllX bllea... delinquent nine eonth. lifter the decedent'. det. of d..th. S. A Joint account I, tax.bl. .w~ though the d.c.d~t'. n... .... added .. II ..tt.r of conv.nlenc.. ~. Account. Clncludlng tho.. held betw..n husband and wi'.) which the deced.nt put In Joint n.... within on. y..t prior to d..th .r. fully 'IIMable II' tran,'.r.. S. Account. ..tabllshed Jointly b.twllen husband and wlf. liar. then onll y..r prior to d..th ar. not 'lI.abl., 6. Account. held by II decedent "In trust for" another or oth.r. .r. 'IIMabl. fully, REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE I. BLOCK A ~ [f the tnlor..tlon and cQ8pUt.tlon In t~ notle. .r. corr.ct and deductions .r. not blllng cl.I..d, pl.c. en "X" In block "A" 0' P.rt 1 of the "l,xplyar Ra.pons." ..otlon. Sign two cop I.. and .uo-lt that with your chack for tha ~t 0' t.x to tha Aagl.tar 0' Will. of tha county Indlc.t.d. Th. PA D.p.rt..nt 0' R.v.nu. will l..ua en 0"101.1 ....ss.ant (For. REV.IS41 EX) upon r.c.lpt 0' the r.turn 'rot the A.gl.t.r of Willi. Z. BLOCK B . If tha ass.t .peclfl.d on thl. notlc. ha. b..n or will b. r.port.d and tax p.ld with the P.nn.ylvanla Inh.rltance Ta. Raturn 'llad by tha d.c.d.nt'. rapr..antatlv., placa an "X" In block "B" 0' P.rt I 0' the "laxp.y.r R.spon.." ..ctlon. Sign ana copy Bnd r.turn to the PA D.p.rtatnt of R.venu., Bur.au 0' IndlvldU.1 l...., D.pt 210601, H.rrl.bura, PA 17121~0601 In the anv.lop. provld.d. 5. BLOCK C . I' th. notlc. In'or..tlon la Incorr.ct end/or d.ductlon. .r. b.lng cl.I..d, th.ck black "e" .nd coapl.t. Part. 2 and 5 according to thl In.tructlon. b.low. Sign two cop I.. and .ub.lt th.a with your ch.ck for tha .aount a' ta. payabla to tha R.al.t.r of Will. a' the county Indlcat.d. Th. PA D.p.rt..nt a' A.venu. will I.su. In of,lcl.1 .....s..nt lFor. REV-1541 EX) upon r.calpt 0' the r.turn fro. thl R.glltar 0' Will.. n () :a c: -- ,d -'1,', TAX RETURN - PART 2 - TAX COMPUTATION ' , LINE I.. Entlr NDlEr tha date the eccount originallY w.. ..t.bllshad or tltlad In the tenn.r ..I.tlng .t d.t. a' d..th. '- L. For a d.c.dant dying .ftar IZlIZlI2r Account. which thl d.e.d.nt put In Joint n.... withIn on. (I) y..r 0' d.ath ar. t.xabl. 'ully .. tran.f.r.. How.v.r, th.r. I. an ..clu.lon not to a.c..d 15,000 p.r tran,'.r.. r.g.rd~.. of th. v.lu. 0' the account or thl rNIb.r of IICcounh h.ld.' " l' . duubl. a.t.rllk (MMJ appa.r. b.'or. your 'Ir.t n... In th. addr... portion 0' thl. notlc., the 15,000 ..clu.lon alr.ady ha. b.en daductad fro. thl acr.aunt balanc. a. r.port.d by the ,Inanci.l In.tltutlon. Z. 5. Ent.r thl total b.lanc. 0' tha account Including Int.r..t accru.d to thl data 0' d..th. The p.rcant of th. account th.t I. taxable for .ach .urvlvor I. d.t.r.ln.d .. follow'l A. Th. p.rcant taxabl. for Joint ....t. ..tabll.h.d aor. than on. y..r prior to the d.c.dant'. ", ): . d.athl DIVIDED BY TOTAL HUHBEA OF JOINT OWNERS Ex..l.1 A joInt e...t ragllt.r.d DIVIDED BY TOTAL NUttBER Of X 100 . PERCENT TAXAllE SURVIVINC JOINT DVNEAS In the n... a' the d.c.d.nt and two oth.r par.on.. I DIVIDED BY 5 (JOINT DNNERSJ DIVIDED BY Z <SURVIVDA$'J . .167 X 100 . 16.7X <TAXABlE FOR EACH SURVIVOR) B. Th. percent taxlbl. for ....t. cra.t.d within ~ y.ar 0' the dec.dant'. d.ath or account. owned by th. dIe.d.nt but h.ld In tru.t for DnOthar IndlvlduaUaJ (tru.t banliflc1arlaah I DIVIDED BY TOTAL NUMBER OF SURVIVINO JOINT OWNERS OR TRUST BENEFICIARIES Exaepl.1 JoInt accaunt r.al.t.rad In the ~ 0' thl d.cad.nt and two oth.t p.r.on. and ..tBbllsh.d within on. ya.r 0' daath by the dec.dant. I DIVIDED BY Z (SURVIVORS) . .50 X 100 . 50~ (TAXABLE FDA EACH SURVIVOR) X 100 . PERCENT TAXABLE ~. ThI a~unt ,ubJ.ot to tax (1In. 4) la d.tar.ln.d by aultlplylng tha account balanca (1In. 2) by the p.rcent ta.abl. (1In. 5). 5. Ent.r the total 0' the d.bt. and d.duotlon. II.t.d In Part 5. 6. Th. aaaunt ta.abla (1In. 6J i. d.tlr.lned by 'ubtraetlng the d.bt. and deduotlon. (1In. SJ fro. the ~t .ubJ.ot to t.x (line ~). 7. Ent.r tha approprlat. tax r.t. (11nD 7) a. d.t.r.ln.d b.low, A. For dat.. of de.th occurrina aft.r 6/50/94, the tax r.t.. for tran.f.r. to spou... .r. e. fallowsl 1. Oat.. of d.ath on or .ft.r 7/1/94 and ba'ar. 1/1/96 thl rata I. 3~. 2. Oat.. 0' d.ath on or .ft.r 1/1/96 and b.far. 1/1/97 tha rat. I. 2~. 5. O.t.. 0' d..th on or aft.r 1/1/97 and b.for. 1/1/9. thl rat. I. I~. 4. D.t.. 0' d.alh on or a,t.r 1/l/9a transf.r. to spou... will b. .x.apt froe tax. Not., For dat.. 0' da.th prior to 7/1/9~ tren.f.rs to .pou.a. .ra t..abl. at 6~. B. Tren,'.r. to llne.l ducand.".. including fathllr, tothlr, .on, dBUlhtar, arandchlldran, IOn-ln-I..., d8UQht.r-In-Iaw, at.pchlld and thalr Istua ar. taxabl. .t .ix pare~t (6~). C. Tran,'.ra to all oth.r. Includlna broth.r, .I.t.r, unci., aunt, neph.w and nlac. ar. taxabl. et flft.." parcent (lS~J. O. If YOU chang. the te. r.ta, pl.... spaci'y your r.l.tlon.hlp to thl d.cldlOt In thl ar.a provided. .. ThI aaount of tax due (line .) It dat.ralnad by aultlptylna thl aaount ta.abl. (JIM 6J by tM tlOC rata Uln. 7J. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowabl. debt. and deductIon. ar. d.t.r.lned a. 'allowsr A. You I.gally .r. r.spon.lbl. for payaant, or the ..tat. .ubJect to adalnl.tratlon by . p.r.on.l repra.antatlv. I. In.u'flolant to p.y thl daductlbla It.... I. You aolu8l1y p.ld the dabts aft.r d..th of thl d~.dant and can furnish proo' 0' plyaant. C. Dabt. b.lng cl.la.d .ult be It..lz.d fully In Part 5. I' additional 'PIC. II n.aded, u.. plaIn p~.r . 112M x 11". Proof a' p.yaant .ev be r.....ttd by the PA o.p.rtaant of R.vtnUII. .,". '..",',,'."..., <<..<'.',",.TAXPAYER,ASSISTANCE". ;"."",'... IF YOU<NEED,FURTHER,INFORHATION OR ASSISTANCE,' CONTACT ANY " REGISTER OF WILLS, PA DEPARTMEHTOF REVENUE DISTRICT · OFFICE ". ".",ORCALLTHE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN "HARRISBURGAT(717l 787-8327. TDDI(717) 772-2252 (HEARING IHPAIRED,ONLYI, REV-1543 EX AFP (8-941 * . CDttHONwblTH OF PENNSYLYANIA D[PlRTttENT OF REVENUE BUREAU OF INDIYIDUAL TAXES D[PT. zaO'Dl IQRRISIURO, PA 17128-0601 ARLENE H GONTZ 1969 RANDALL RD ENOLA PA 17025 FILE NG. 21 95-0390 ACN 95131369 DATE 07-10-95 TYPE OF ACCOUNT ~ SAVINGS CHECKING TRUST CERTIFICATE RENIT PAYNENT AND FORNS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 INFORMATION NOTICE AND TAXPAYER RESPONSE ESTATE OF MARGARET J OAIR 5.5. NO. 180-26-6752 DATE OF DEATH 04-27-95 COUNTY CUMBERLAND HARRIS SAVINGS BANK h.. provided thl D.p.'t...., with the Inlar..tian listad balow which hi' ba.n used In calculaUng thl potlntlal tlX dul. Thalr r.cordl Indlclt_ that at thl d..th 0' thl abovI dlcld.nt, ~ou "It. I joint owner/beneficiary of thl. ICCOunt. If ~ou ,..1 thl, Infor..tlon I, Incorr.ct, pl.... obtain wtlttan corr.ctlon frol thl financial In,tltutlon, .ttach . COpy to thl. 'or. and raturn It to thl abova .ddr.... Thl, account I. t.~.bl. In accordancl with thl Inherltancl '1M Law' of thl Co..anw'llth of Penn,vlvanl., Que.tlon. ..y bl en.wlred bll calling (717) ;-.'-8SZ1. COMPLETE PART 1 IELOW M M M SEE REVERSE SIDE FGR FILING AND PAYMENT INSTRUCTIONS Aocount No. 09-66-246930 D.to 12-19-86 Eot.blhh.d Account a8lanc. p.rc.nt TaKabl. AMount Subj.ct to Tax Tax Rata Pot.ntl.1 Tax Du. To In.ure pr~r cr.dlt to your account, two (2) cop II' of thl. notlcl .u.t acco.peny your plYlant to the Alal.tlr of Will.. "akl chIck plyable tal -Alal.tlr of Will., Agent-. PART [!] 5,102.42 50.000 2.551. 21 .15 382.68 TAXPAVER RESPONSE ;' FAILURI!.TO' RElIPGND}lIILL RI!SULT;, INAMClfI'ICIAL(1AXASSESSHI!HT BASEIl,O,.THIS . NOTlCI!. x HOTE. If tax p.y.~tl arl .edl within thrll (3) eonth. of thl dlcedent'l data of dlath, you .IY deduCt . SX dllcount of the tlX dUI. Any Inheritance hx due wlU blcoee d.llnquent nln. (9) aonth. .ftlr thl d.t. of dl.th. x [CHECK ] ONE BLOCK ONLY A. 0 The .bovl Infor..tlon end t.x d.... h correct. 1. You ..y choG.. to r..1t p.y.ent to the RIght.r of Wllh with two copl.. of thl, notlu to obt.ln . dl.count or avoid Inter..', or you ..V check box -A- and return thl. notlcl to thl Aegl.tlr of ~ Will. and .n offlclll .......ent will be I..u.d bv the PA D.plrteant of R.Venue. a. ~!he .bav. ....t h.. been or will be rlported and tlx plld with t~ penn.vlvanla Inherltancl Tlx return to be fll.d bv thl dlc.dlnt'. rIPr..."t.tlv.. C. 0 The abov. Infar..Uon l,.J,ncorrlct and/o~lbtl and dlductionl ...rl p.ld by you. You MIlt co.pl.te PART l!J and/or PART l!J b.law. PART I!J DATE PAID ,;~, ;OFFICI.AL ,USE ONLV' 0 AAFJ ", ",;".;-,::,' PII' DE,PI\RTHENT.',Of ;REVENUE ';" "';', JOINT/TRUST ACCOUNTS ,PAD" " ' p..'",..',' " , , '; ::,1." ',.'., ." ., ';:.~::.;:,:: . ':. .' ';' . .,'. .~,-" . "::1 ";,,;,,,;,.::2: ";.<'j 3 '" :4' ",,",'.' '..,' ','.. "p, ;,;,;...,', ,5 '....'::6: "'""" "".... 7" , .."",'.' ";..,;,."..,,,,,;,;'., .."....;, ' " '..,','8';';';""" ..'.......' .., ,'..' . ',':''.' , DEBTS AND DEDUCTIONS CLAIMED If you indicat. a diff.r.nt taK rata, pl.... .t.t. your ral.tlon.hlp to d.cad.nt. PART ~ TAX RETURN - COMPUTATION OF TAX ON LINE 1. D.t. E.tabli.h.d 1 2, Account Balanca 2 3. P.rc.nt TaK.bl. 3 M 4, AMount Subj.ct to Tax 4 S. D.bt. and Daduction. S--=- 6. AltOunt Taxabla 6 7. TaK Rata 7 x 8. Tax Dua 8 ,'.: , ::i ...."....;;":.;,;.;.."" : - :: ~ . ~ ::: ; , , ''-':1 ,'::::::;,;; AMOUNT PAID DESCRIPTION PAYEE \ . \ TOTAL CEntar on Lina 5 of T.M COMPutation) Und.r panaltla. of parjury, I daclar. that the fact. X (j""17t to th~br ~fJE;;d. ."d b.1I.,. ~T1,t~fThNA~RE d haya raported abova ar. trua, corract and ~~:~ ~~~: ~ .: : Ol - 62- S- 0 (~ h~" TELEPH NUM E Z~ y, GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AH OFfICIAL TAX ASSESSHENT with ...,Unbl. Int.r..t bued on Infor..tlon ,ubIIIU.d by tM flnllnCll.l In.UtutJon. Z. Inh.r1tWM:I tlM bICH.' d.lI~t nine nnthl .fl,,. thl decedent', data of d..th. 5. A Joint ecCDlont Is ,,,MIl. Iven though the dlClldent" n... .... Itdd.d II . ..th,. 0' convenience. 4. Accounts (Including thai' held batween husband and ..1'1. which thl dlcadent put In Joint n.... within ~ V"" prior to da.th .t. fullV' h_.tI11 '1 tren,f.n. S. Accountl ..t.tJllahed Jolntlv b.twlen hulband and ..If. ect. then DfMI Y"" prior to dtIlth .r. not tIllable. 6. Account. Mld by . decedent "'In 'ru,t 'or" IInOttt.t or other. .t. "Mabls fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If ttMI In'orntlon and cOllPUtat1on In ttMI notlc. .t. corr.et Met deduction. .t. not bel". clallled, pleca ." "X" In block Of'" of p"t 1 of thl "TaxpaYlr R..pon.... ..atlon. Sign bo copl.. Bnd lubIIlt ,hell with 'tIKI,. check for the 8HUMt of t.x to tha R.gI.t.r of Will. of the county lndlc.ted. Th. PA o.p.rtaent of A.venu. Mill I.~ ." offlcl.1 ........"t (For. REV-1541 EX) upon r.c.lpt of the r.turn froe the R.gl,t,r of Will,. 2. ILOCX I _ If the ....t IpHJfI~ on thh notln h.. been 0,. will b. ,..po,.t.d end tn p,ld with the PIMsvlv."l. Inh.dtene, T.x R,tu,.n fl1~ by the decedent" rep,.llent.tlv" pl.c. en ~. In block "I- of Pert 1 of the -Tlxplya,. R'lpon.," leetlon. Sian ani copy end r.tu,.n to thl PA Dlp.,.t,,"t of R.venue, Bur.eo of Indlvldu.l T...., n.pt "0601, H.rrl.burg, PA 17121-0'01 In thl env.lopl prov1ded. 3. BLOCX C - If thl noUn Inforl.tlon h Incorr.ct and/o,. d.ducUon. Ir. b.lng cllllld, chKk block "C" end cOllPI.t. P.rt. 2 end S ICcordlna to thl Instr-ucUon. below. SIIIf'l two copl.. end .utMllt th.. Mlth your chick fa" thl ..ount of till pllylbl. to thl R.ghter of WUla of the count)' lndlc.tttd. Thl PA a.part.....t of R.vlnUll Mill i..u. .., afflcl.l ........"t IFar. REV-lSU U) upon nnlpt of the ,..tu,.n frOll thl R.ght,,. of Willi. TAX RETURN - PART 2 - TAX COMPUTATION LINE I.. Ent.,. NOTEI thl d,t. thl ICCount a,.lgln.lly "'.. a.tlbll.had a,. tltlad In thl lanner .1I1.tlng .t d.t. af"',~, For I deelldent dying .ft.,. 121121121 Account. which ttMI d.cedent put In Joint n.... Mlthln~of*~tU )I'''r.of d..th .riI laxlbl. fully.. tr.".f.,... Howev.,., ttMIr. h In 'lIclullon not to a.c.1Id IS,ODO p.r tr.".'.,... n.er~l+" of ~ ".Iua of the account or thl nueba,. of ICCountl h.ld. ' . ; If a double ..t.,.hk e..) -w..n bafon you,. flret n... In thtl add,.... pa,.Uon of thh notlc., thl 11,000 ..elullon .Ir.ady h.. b..... d.duct.d fral the account balanca .. rapa,.t.d by tho flnlnClal Inltltutlon. I Z. Ent.,. the tot.1 balancl of thl IICCount Includlna Inter..t accru.d to the d.ta of dllth. f'.) 5. The perc....t of tha account that h t..lbl. for .ach lurvlvo,. .. dahr.lnId .. followu A. Th. pe,.cent t..abl. for Joint ....t. ..tlbllsh.d ~r' thin on. y..,. prlo" to the d.c.d....t'. d..thl DIVIDED IV X JaG . PERCENT TAXABLE I DIVIDED IV TOTAL IUfIEA OF JOINT OWNERS E..-pl'l A Joint ....t r.,I.t.,.ad TOTAL tutIER OF SURVIVING JOINT OWNERS In the n.... of the decad."t and two other p.rson.. :l! ...' - I DIVIDED IV 5 e.JOINT QWt€RS) DIVIDED IV Z (SURVIVOR"S) - .167 >>I lOG - 16.1% ITAnlLE fDA EACH stM"IVIII) I. The p.,.c."t hubl. for ....t. cr.. tad within ani )III" of thl dlcad."t'. d..th or KCCMoWth owned by the decadent but held In tr'U.t fo,. 8nO~r Indlvlduale.) et,.u.t blneflcla,.I..). X 100 - PERCENT TAXAlLE 1 DIVIDED IV TOTAL HUHlEA OF SURVIVING JOINT OWNERS DR TRUST BEHEFICIARIES E.IIPI'I Joint ICCCMoWtt ,..ghtarad In the nue of the dacadent ~ two ottMIr p.rson. w.t ..tlblllh4Ml within ani VI'" of de.th by the decadent. 1 DIVIDED IV Z eSUNIYDRS) - .sa X lOa . Sa:c ITAnlLE fOR EACt! SURVIVOR) 4. ThI.-ount .ubJ.ct to t.. (line 4) I. d.t.r.lnld by aultlpl)llng the 'CCCMoWtt belanc. (line ,) by the ~rcent tlll.bl. Illne I). S. Entar the total of the debt. and deduction. II.ted In P.rt S. 6. ThI .~t talllbl. Ulna') I. d.taralnad b)l IYbtractJn, ttMI debt. and d.ductlon. Cline 5) froa the .-GUnt sobJect to t.. II In. 4). 7. Ent.r tn. 8Pprop,.l.ta ta. ,..t. (1In. 7) ., det.raln.d bllow. A. Far d.t.. of de.th DCcur,.lna .ft.,. 6/50/94, the t.. ,..t.. fa,. t,.enlf.r. to .pou... .r. a. follow., I. O.t.. of death on 0,. .ft.r' 7/1/94 w.t b.fa,.. 1/1/9. the rat. 1. S~. 2. O.t.. of d..th on or .ft.,. 1/1196 end blfa,.. 111/97 the ,.at. II zx. S. D.t.. of d..th on 0,. .ft.,. 1/1/97 end b.for. 1/1/9. the ,.at. I. l~. 4. D.t.. of d..th on or .fh,. 1/1191 tran.f.,.. to .pau... will b. .lIopt fro. h.. Hot., Fa" d.t.. of de.th prior to 7/1/94 tran.f.r. to .pou." .r. tl.abl. .t 6~. I. Trendar. to lIne.1 de.candwlt. InclUding f.ther, aother, son, deught.,., ,rMdchlldran, .on-ln.I.... deughtar-In-law, .tapchlld w.t thllr I.SUI ar. tlllabl. It .1. pa,.cant (.~). C. Tr.".f.ra to all oth.r. lnoludlna b,.othe,., .1.t.r, uncI., .unt, nephew and nlac. .,.. t..abla .t fifteen percant C15XJ. D. If you chenga the t.. ,..t., pi.... .paclfw your ,..laUonllhlp to tn. dacldent In the ar.. provided. I. The.....t of tu due; Ulne .) 11 detaralned by IUltlplylng the MOUnt t..abl. Cllna " by the t.. rah Cline 7). CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED AlloMllbll debt. and dIduotlon. .,.. det.,..lned II followlI A. Vou legal IV a,.. r..pan,lbl. far p.~t, or the ..t.t. .ubJlCt to ~Inl.tr.tlon bw . personal r..r..ant.tlve I. In.ufflcl..,t to plW the cMductlbl. It.... I. You ecw.J1y p.ld the dabt. .fter d..th of the decedent and can furnish proof of p..,...,t. C. Debh Hlna cl.11Id IUlt ~ It..lud fuUy In P.rt S. If IIddltlon.1 .pac. h nHdad, u.. pl.ln P....,. . 1Ir"' II U-. PrODf of P'YMnt ..y ~ r~.hd b)' the PA o.pert...,t of R.v...... TAXPAVER "ASSISTANCE IF YOU NEED FURTHERINFORHATION OR ASSISTIINCE. CONTACT ANV .',,'.','.',..'... ..,' ",REElISTER,OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE C/,' OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN ,HARRISBURG AT (717) 7B7-B327,.TDDI, (717) 772-2252 (HEARINO IMPAIRED ONLVI REV-1543 EX AFP (8-941,* . COt,"OHWUL HI or PENNSn VANIA D[PAAlttEN' OF' REV[HUE IUR[AU or INDIVIDUAL TAXES DlPf. IU601 IlARAIIIURG, PI UU'~06Dl INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 95-0390 ACN 95131370 DATE 07-10-95 ARLENE H GONTZ 1969 RANDALL RD ENOLA TYPE OF ACCOUNT ~ SAVINGS CHECKING TRUST CERTIFICATE RENIT PAYNENT AND FORNS TO, REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ESTATE OF MARGARET J BAIR 5.5. NO. 100-26-6752 DATE OF DEATH 04-27-95 COUNTY CUMBERLAND PA 17025 HARRIS SAVINGS BANK hu provldad the O.",rt...,' .,lth the Inlonatlon listed below which hu b..., u..d In calculating the palMUI. 'IIC dUtI. Thai,. ncard. Indlut. thlt at thl d..th of the abovI dlCldlnt, you IiIlr. . Joint owner/blnaflcl.ry of thla lecount. I' you f..t thl. Infor..tlon I, Incorrlct, pl.... obt,ln wtltt... cornet Ion frol thl 'Inanel.. Inltltution, att.ch. copy to thl. for. and r.turn It to thl abovI .ddr.... This ICCO\.W\t II ,...bl, In accordance with thl Inhultanea talC la..,. of thl Coaonwulth of Pennlvlvenl.. au..llnn. ..y bl anlw.rad hy callInG (711J 7'7-a3Z7, COMPLETE PART 1 BEl. OW M M M SEE REVERSE SIDE FOR FILING AND PAYMEH'r INll rRUCTIONS Aocount No. 09-66-246900 Dot. 02-02-07 establhhed Account 8danca hrcent Ta)Cabla A.ount Subjact to ra)C Rata Potantl.l ra)C Du. fa Inlur. propar credit to your account, two U) copl.. of thl_ noUn .ult acco~""'Y your payaent to thel Real.ter of Wllh. Hake chuk paYabla tal ""Aegl_tar af Wl1h, Agent". PART ill 7.447.27 50.000 3.723.64 .15 558.55 TAXPAYER RESPONSE fAILURE TO RI!SPOND lIILL, /tUUL T,.' IN,.. AM ,OFFICIAL TAX .. ASSUSNENT~~I!.J) OHrttIS/tlO,TICE x HOTEl If talC plll~enh era .acte within thr.. (3) eonthl of thlll decedent'l data af d.ath, yOU ..y dedUct . s::c dlscOU1t of the telC due. Any Inherlt.,ca t:ax due will bec:o.e delinquent nln. (9) ""the aftar tho data of de.th. r.. x [CHECK ] ONE OLOCK ONLY A. 0 Tha abava Infar.aUon and talC duei h correct. 1. "'au .ay chao I. to n.1t pay.ent ta tho Raglster af willi with two caple. of thh natlca ta abhlr'l a discount or avoid Interelt, ar you an check balC ..",.. and return thl_ notice to the Register af Will. and an afflclel a"II...ent wUl be ISlued by the p", Dllpllrtaant of Aevenutl. B. OOThe Dbave e..IIt hili been or will ~ repartact end talC paid with the p.,.,.ylvenl. Irhlirltanc:e hlC return ta be fUed by the dlludent'. repre.entatlvII. C. 0 The Dbave lnfaraatlan l~ncorrKt andJa~abh and daductlanl wllrll pdld by you. You ""It C~..tll PART L!.J BndJar PART l!J below. If you Indlc.t. . dlff.rant ta)C r.t., pl.... .t.t. your r.latlon_hlp to d.cad.ntl '," "OF;I7:ICIAL'USEONLY': 0 AAF1 , , ,PAD~~II~TMENT OFREIIENUE 'i ,.. ,'0 0' ,,'. 0 0 0, ,',',', ~ -:" , o. _, _ 0 .' 0 .',' 0' ,'. 0 ':' 0':' 0 0:' .-0. ':': - _, 0 0 '0':': ': 0 0', 0 0,' 0 '0 0 0 _ 0 ,_ 0, 0 .: : ':, PART ~ TAX RETURN - COMPUTATION GF TAX ON LINE I, D.t. E.t8bU.had 1 2. Account Oal.ne. 2 3. Pare.nt raxable 3 X 4. A.ount Subject to Tax 4 5. Debt. and Deduction. 5 6. Aaount raxabl. 6 7. rax Rate 7 X a. Tax au. 8 JOINT~TRUST ACCOUNTS PART I!l DATE PAID DEBTS AND PAD 1 :..:- 2 3 ,'" 4, "',', ,',',' So, ._.. ".......-;',..,:_~':,o. ""6 ",.., ."'."!"!""'!"":>' 0'- '':;'":''''''' ,'1,' ," . .,'" ,.." 8 .:-::;:!:::~>:::::'::..-.' DEDUCTIONS CLAIMED '~ :.:,;.-,0'0' ..0.: , <i ":,:'.::,'::':-:0:'",. 1 , ,'j PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Ent.r on Lln. 5 of Tax Co.putatlon) I . Under panaltl.. of ~ to th. but of T ~AT~' p.rjury, I declar. th.t the .y knowl.dg. and b.lt.f. ~1(~ fach I have r.port.d above .,.. tru., correct and HOME (~'7 '~~.9 .r:J~'l) (Q W~~~EP~ONE N~M E GENERAL INFORMATION 1. FAILURE TO RESPOND WILt RESULT IN AN OfFICIAL TAM ASSES5HEHT with appllcllbll Int.t..t b..eeI on tnfor..Uon .ubIIltt~ br thl flnMCl.l In.titutlon. Z. InherltMCI ,.. beeD'" delinquent nln. eonthl .,tl,. thl dlcedlnt'. de', of d..th, :So A Joint account 11 t..ltbl. .ven though the dKIld....t.. "a.. wu edded II . ..th,. of convenl~.. 4. AccOI.W\t. (lncludlna tho.. held b.tw.... husbBnd end "lfe) which the dludWlt put In Joint ".... wUhln one V"" prior to de,lh er. fully t..able .. "IIn,'lrl. 5. Account. ..teblJahed JointlY bet"I'" husband Bnd wi'. ~r' th8n one y..r prior to d..th e... not ,...bl.. 6. Account. hlild by . decedent "In trull for" enothllr or other. '1"" ,..abl, fully, REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE I. aLOCK A . If the In'or..tlon end c~t.tlon In thli notlcl e... corrlet and dedUction. at. not being clll.-d, place en .X. In block "A" of Pitt I of thl "T..pIYI.. RI.pon..- Iletlon. Sian two cop I.. and .ubslt t~ with you~ check fa~ the .-aunt of t.. to the R.gl.t.~ of Will. of the county Indlc.t~. Th. PA U.p.rt..nt of R.v.nu. will I..ue en offlcl.1 .......ent (far. REV-154. EX) UPOn r.c..pt of the r.turn fras the R.gl.t.r of Will.. 2. ILOCK I _ If the ....t .p.clfl.d on thl. netic. has been or will b. r.port.d end ta. p.ld with the P.nn.ylvenl. Inh.rltenc. T.x R.turn filed by the decedent'. r.pr..ant.tlv., plac. ~ -X- In block ~I~ of Part I 0' the *T..p.ya~ R..pon..- .ectlon. Sign one capy and r.turn to the PA Dep.rtaent a' Revenue, Bur.au of Indlvl~1 T...., D.pt 2BO'01, H.rrl.burg, PA 17128-0'01 In the env.lope provided. 5. IlOCK C _ If the netic. lnfar.etlon I. Incorrect and/o~ daductlon. .ra b.lng cl.l.ad, check block -C~ end caapl.t. P.~t. 2 end S .ccardlng to the In,tructlon. b.low. Sign two capl" and ,ub.lt th.. with your ch.ck fa~ the ..aunt of t.x p.yabl. to the Ragl.t.r of Wilt. of the cnunty Indlc.t.d. Th. PI Depart..nt cf n,v~. will I.aua .~ otflcl.. ......-.ot (Fo~. qF.~-l~~' LX) upon r.~.Jpt of the return frOll the Reglst.r of WllI.. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Ent.r the d.t. the .ccount originallY w.. ..tabll.h.d or titled In the sann.r ..I.tlng .t d.t. of d..th. HOTEl Far. decedent dying .ft.r IZlIZl821 Account. which the dlc.d.nt put In Joint n.... within on. (1) y..r of d..th .~. taxabl. fully.. tran.f.r.. Howav.~, there I. en ..clu.lon not to ..c.ad 15,000 p.r tran,'.r.. r.g.rdl.'. of the y.lu. of the accawtt or the nuaIba~ of 'CCCKl"lt. held. If . daubl. ..terlsk (..) appe.r. bafor. your flr.t n... In the .ddr... portion 0' thl. netic., the 15,000 ..clullon .lr.adY h.. b.en deduct.d fro. the account balanc. .. rsparted by the flnlncl.l In.tltutlon. 2. Entlr the tat.l b.lance of the account InclucUng Inter..t ltecru.d to the data of duth. () 0 5. The percent of the acCCKl"lt that" t..able for .ach .urvlvor II d.t.r.l~ .. follow.. C i=-- A. The p.rcent t..abl. for Joint .,..t. ..tabll.had .ure thin one y..r prior to the dlc.dant'. daatht \.:; , , "" ;fJ TDTAl NJKIER Of' JOINT OWNERS Exsapl.r A Joint ....t ragl.t.r.d DIVIDED IY X 100 - PERCEKT TAXAIlE ~ L ,-- TDlAL MltIER Of' SURVIVING JOINT OWNERS In the npe of thl dacadent and two other parsDR'. r'-, I DIVIDED BY 5 (JOINT OWNERS) DIVIDED IY 2 (SURVIVORS) . .167 X IDO - 1'.7% (JOULE FOR EACH SURYIVORJ 1 DIVIDED IY I. The parcent ta.able for ....ts cn.ted ..lthln one y..r of the d.cedent'. d..th or ltCcount. owned by the dec.dant but held In tru.t for anoth.r Indlvldual(,1 (tru.t bana,lcl.rl..)1 1 DIVIDED IY TDTAl HOHlER OF SURVIVING JOINT OWNERS OR TRUST IEHEFICIARIES X 100 . PERCENT TAXABLE i.., E...,I'I Joint .ccount r.gllt.rad In the n... of the d.cadent end two othar per.on. and ..tBbll.hId ~Ithln one y..r 0' da.th by the d.cMlent. I DIVIDED IY 2 (SURVI~S) . .50 X 100 . 50X (TAXAILE FDA EACH SURVIVOR) 4. The aaaunt .ubJlct to tl. (line 4) II d.t.r.lned by aultJplylng the account b.lanc. Cline 2) by the parcent t..abl. Cline 5). 5. Ent.r the tot.l of the dabt. and dedUctlonl II.ted In Plrt 5. 6. Th. .lOURt t.xabl. Cline ,) I. d.t.r.lned b~ .ubtrlctlng the d.btl and d.ductlon. (lln. 5) fru. the aaount .ubJ.~t to t.. (1In. 41. 7. Ent.r the Ipproprl.te ta. rat. (1In. 7) .. d.tlr.ln.d bllow. A. For dlt., of d,.th occurring aft.r 6/50/94, thl t.. rata. fo~ tran,'.r. to ,pou... ar. .. (allow'1 1. O.t.. 0' d..th on or .ft.r 7/1/94 and b.for. 1/1/9' the r.t. I, 5~. 2. O.ta, of d..th on or .ft.r 1/1/96 and b.fare 1/1/97 the rata I. Z~. 5. O.t.. of de.th on or .,t.r 1/1/97"and bafare 1/1/98 the rat. I. 1%. 4. O.t.. of d..th DR or .ftar 1/1/98 tran,f.r' to .pou... will ba ...~t fro. t... Hatll For dlt.. of daath prior to 7/1/94 tran.f.r. to .pou... .r. t..abl. .t 'X. I. Transf.,.a to lIne.1 d..cendents Including father, ItDthllr, son, deught.r, grandchildren, .on-In-I..., daughter-In-law, stepchild and their lasua .r. taxabla .t ,I. parcent (6~). C. Tran.f.r. to .11 other. Including broth.r, 'Ist.r, unci., aunt, n.ph... Ind nlec. ar. t..abl. at flft.., parcent (1.~). D. If you cMnga the tax reta, pl.... ,peclfY your rel.tlonshlp to the dacMlent In the .,... provided. I. The.-aunt 0' tax due (line 8) I. d.t.r.l~ by aultlplylng ~ eaount taxBbI. (1In. ,) by the t.. r.t. (line 7). CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable dabt. end deductions .r. dlt~r.lnad a. follow. I A. You lagal1y are r..pon.lble for pa~t, or the ..t.t. lubJect to edalnl.tratlon by . parlonal rapr.,antatlve I, In.u'flclant to p.y the deductlbl. It.... I. You 1tew-lIy p.ld thl d.bts .fter d..th of the decedent end CW'l furnish proof of p.Y1Ient. C. Debt. b.lng c..lead lU.t ~ It.sl,Ml fully In P.rt 5. I' additional .pace I' needed, u.. plain p.,.r 8 Ill- . 11-. Proof a' paYltlf'lt ..y be raqu..tMl by the PA Dapertsant of R.vanua. ,Cd " ',', " ,', ' "d"TAXPAYER'ASSISTANCE , . ,,' IF VOUNEEDFURTHERINFORHATION OR ASSISTANCE, CONTACT ANY " " ",',," '....,,' ' REGISTER, OF WILLS. PA D:;;PARTHEIIT OF REVENUE DISTRICT, OFFICE > .,. ,'. ' OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRV UNIT IN ., ", HARRISBURG AT' (717) 787-8::127; TDDI (717)772-2252 (HEARING IMPAIRED ONLY)