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j rOR DATES or DEAlII AnER 12131191 CHECK HERI
IF A SPOUSAL -
!,OVE~TY CRE!!!!}S CLAIMED I ]
flU NUMBER
.;:).\ CIS Lf'/3
COUNIY CODE YEAR NUMBER
lllClVlflf'50 COMrUIf AVORen
110 Wast Groan st.
ShJ.l'otnanS tmm, PI\.
Cl\Inhorlnnd
/5 - 3.1- CJ
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
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- AMuUtH RtCUVIO lui IU501RU(1l0N501
11 (DonU\ Jll't(!l0.!LW~~.~1
ttl I. O,lolnol Return r] 2. Su1'plementnl Relurn
o ... lImiled E.tale [1 410. rUIUfe Inl.r..' Cam1'romhe
(for dal" of d,alh oh.r 12.12.82)
[J 6. Of!cod,nt Dlod "','nlo rl 7. Decedent Maintained 0 lI"lnO Tru..
(Allach capy of Willi (Alloch copy a' Tru.tl
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO" " '
t~AMI COMf'llll MAUIUO AOOR[U
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J. 1l0bOl't :,tnuf'l'oL Att~",
ttU'HOtH tIU'-l'U
1 717 I 766-9673_
COMMOt~WfAlHt Of rIIHU'l'IVAUlA
D[PA.lM(NT (If IlIVWUI
Dl,.l. :180001
IIAUi!lIUIO.'A 11l?_8'0!'01
VIUUIU' 'IAM( (I'" . ,,1(50 ,AtlU MttlUilItWIA"
----EJS I mL ,_, fOOl'I~O :.-:,!_, UlI(llL.a 0 OI:Jg nZ_,-..J:!:.
!.OC.....l U(UII" f1UMIIIl DAn Of U(AIH DAn O. 1111It
203-10':'.:!-)Q.L_m____n_IJ1~~;~l~I!: .'_ ~~~otr::.~
t" ""tIC"'. 1,,,...,1111) IPOUII' ',"'''lll'''' "'\'lIIlf(' ""Nil I """",, !lOOAl !.(CUIUIY UIJMIlI
20. If LillO 191, g,eater than line 18, ent.r th. diffe,once aR line 20. Thl. I. ,h. OVERPAYMENT.
aD
21. If Uno 18 It grool"r Ihan lIno 19, onlor ,h, dlfforonu an line 21. Thl.l. the TAX DUE.
A. Enter Ih. Inl.r..1 an tho bolanco due on lIno 21A.
b. Enlor tho 10101 allln. 21 and 21A an line 218. Thill. ,he BALANCE DUE.
Mah Chock Payable tOI Roglal.r of Wills, Agent
L _ ,~ ~ BE SURETO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH,', ':>"",,",' ,,' I
Unuar Plnolll.. of 1'o'lulY, I d.dare Ihal I havo OIlOlllillOd thl. ,olur", including accamponr1ng IChedule. and .ralomonll, and 10 ,hit h." of my knowledge and b.li.f
it i. tru., (aHad and U'lllplelft. I ,1I,t1or. Ihal nil Iflol p"ulel"" beltn roperlod ul trUIt markol valuo. Doclarallon a' pr.pa,er oth", than Ih. pellanal repr...nlallve I;
baled on alllnformolitlll of which prOpalltr hot allY ~nowllldUIt.
'ION If 'rtl!lOHu!.r?NtuIUfc;}fIUtlOJl(lU~N AOD.U~lO \"lont Groon St DAn
l..L ,..:I--u-I~, ShireJnal1otOl-1n, PA' ] 70n t.lt.. /'lb-
fO' r IOIlH Itl rIU(H IVI ACIUPlU lIlt S 131d DAn . ,
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1. Reel Eslalo (Schedul. A)
2. Sta,ks and Bands (Schodule B)
3. Cla.ely tt.ld SlodtlPa,'ne,.hlp Inl.res' (Sch.dule C)
A. Martgag.. and Nal.s R.c.lvable (Sch.dull OJ
5. Ca.h. Bonk Depasits & MIIe.Uaneou. Personal Prop."ly
(S,hodulo EI
6. Jalr.lly Own.d Properly (Sth.dule f)
7. Tro,.lo.. (S,hodul. GI(S,hodulo I)
8. Tallll Gro.. A..... (Ialallin.. 1.7)
9. Funeral EkP.n.... Adminhtrallve Co.... Mlu.Uanoau.
Eapon... (Schedule U)
10. Debl', Mortgage liabilities, lion. (Schedul. I)
11. Talol Deductlan. (talallln.. 9 & 10)
12. Nol Value af E.lalo 11In. B mlnu. line II)
13. CharItable and Gavernmlnlal Seque," (Schedule J)
1,.. NIII Value Sublett 10 Tak (line 12 minus line 13)
15. Spco~"al Transfe" Ifar dat.s 0' deoth allor 6.30.9.t)
Sen In'trudlon. 'ar Ar,p!icable Porcenlage an Reve"o
Side. (Indude 'Value, ram Sthedule K ar Schedule M.)
16. Amounl olllno 14 toxobl, 01 6% role
(Indude 'Voln. from Sthedulo K or Schedule M.)
17. Am(,unl af Uno 14 la..nblo 01 15% rolo
Ilndude vulues 'rom Schedule K or Sch.dulo M.I
18. r,lndpallax dUll (Add laA from line, IS. 16 ond 17.1
19. C,edill Spaulal Paverly Credil Prior Paymenll
O. 00 + 0 . 00
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o 3. Remainder Relurn
(for date. af dealh prior to 12.13.82)
o 5. Fed'lfol E'tal. Tax Rolurn Required
JL 8. lolul Number of Sofe Deposit Bax..
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r" r, :..,)0,';, .;
(II
( 21
131
( 4)
(5) .
(6)
171
lIar!mt Squaro 131dg.
I,IochnnioobUl'g, PI\. :;'7055
0.00
0.00
0.00
0.00
77, 009.3~
0.00
0.00
(9)
(101
7,865.00
0.00
(81__
77,009.35
(11)
(12)
(13)
(141
(151 0.00 M._"
(16) _,__.....21~;35 M ,06 "
7,865.00
69,~.35
0.00
69,141+.35
0.00
4,148.66 _
0.00
L~,148.66
(171 __u,__,
0.00M,15.
(181
+
Dhcounl
0.00
Inter.s.
0.00
(191
(20)
0.00
0.00
Choc~ hOlo If yau Of 0 roqurstlng a refund of your ovorpaymont.
,
(211 _
(21AI
(2181
1~,1l~8.66
1 1-;00-
L1:1269.66
Act #48 of 1994 provldos for Ihe reductIon 01 ;he lax ralollmposed on Ihe nol valuo 01 Iranllors 10 arfor
Ih. u.. of Ih. spou.e. The role. as pro.crlbed by Ihe slalulo will b.l
. 3% (.e~1 will be applicable far eslale. of .Jocedonls dying on or aflor 7/1/94 and bolore 1/1/96
. 2% (.O~I will be appllcablo lor 0.1010. 01 docodenls dying on or aflor 1/1/96 and belor. 1/1/97
e 1% (.011 will bo applicable lor eslale. 01 decedents dying an or after 111/97 and b.fore 1/1/98
e Sp.u..1 Iran.fon occurrlny on or aflor 1/1/96 will bo oxompl from Inhorllanco lax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK ("..) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decodonl moko 0 trallsFer and:
a. relahl tho use or Incomo 01 the property transForred, ....................' .................................
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b. rotain tho right to doslgnato who sholl U,) tho property IransForred or lis income, ...............
c. relain 0 reversionary lntorest; or ............,......................................................................
d. receive the promise lor life of either payn'onts, beneFits or care9.......................................
2. II death occurred on or beForo Docomber "', 1962, did decedent within two years procoding
death IransFor proporty with".,t rocolving <Idoquate consldorallon9 If doath occurr~d after
Docember 12, 1982, did docodent IransFor I,roporty within one year of dO<lth withoul r~ceiving
adequcte consldoration9 ..... ,...... ..............., .... .......oo..................,.. I... ........................lO. H....
3. Did decodenl own an 'In trust For' bonk account at his or hor doath9......................................
IF THE ANSWER TO ANY ,)F THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDUI.E G AND FILE IT AS PA~F THE RETURN.
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Mellon Bank
MlIUlInllnnk,N.A.
MoUlin Unnk Contor
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I'hUlllMJlhlll,l'A 10101.1r,211
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Dear RetireMent Plan Client:
We have cOMpleted your request and enclosed the docuMent(s)
for your records.
Should you need any further ossistonce, feel free to contact.
us ot 215-553-8080 or 1-800-552-2621.
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12,063.32
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SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Ploa.o Point ar l' 0
fiLE NUMBER
COMMOI~WEAl1H OF PfNHSYIVA.NIA
INHUIlANC. 'AX UTUIH
aUIDIN' DICEDINt
ESTATE Of
GEORGE Z. FISHEL (aka) m~OlWE Z. Jo'ISlU~r" J11.
(AU prop.rty lalnlly--ownld with th. Right 01 S"rvlwonhlp mu.1 b. dlu.lo..d on Sch.dul. F)
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
1.
HELLOll BANK, H. A.. IllA Accuunt 110. 000000706$1.
J\l1ERICAH GEl./EIlAL LIl"E: IHSUHA11CE COHPAI1Y. Annuity
Account and Policy Ho. A10006$ll,OF.
ql 64,926.03
s 77 , 009 .35
tAtloch addillonal BVI" )( 11" ,h..III' more .pan It n..d.d.)
11'1-1111 lit ""1
EST TE OF
GEORGE
ITEM
NUMBER
A.
B.
2.
-!jJ.
COMMONWfAl1H 0' PfNNSYIVANIA
INHUtrANCf TAX REtURN
Itf~IOfN' D[CEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
F E
Ploa.o 'p'rlnl or Typo
OR
Z. PISIIJ;:L (aIm) GEOlWi<: :':. 1;'1 SIIEr., J11.
DESCRIPTION
1.
Funoral Expon.o..
IIYOl'S FunoI'nl llOlllO, Inc., 37 E. Ilain St., l1ochanics-
bUI'(l;, POlll1oylvnnin, 1'unoI'al oxpOllses.
1.
Admlnl.lrallvo Co.l..
Personal Reprolentotlve Commllllon.
Social Security Numbor of Porsanal Reprelonlallve:
Voar Cammllllanl paid
Allorney Fees J. TIobert Stau1'1'er, Esq., attorney's 1'ee.
3. family Exomptlon
ClalmanllCathorine 1'1. Fish01Relatlonlhlp Wi1'o
Addre.. of Clalmanl 01 decadent'. death
Stree' Addroll 110 l'lest Green St.
4.
C.
1.
2.
3.
4.
5.
6.
7.
O.
City ~hil"lAmnnr1t:nl.m
Slale P^ Zip Code 1 701 1
Probalo feel
MI.eellanoou. Expon.o..
HogistoI' 01' 1'lills, 1'iling Pennsylvania Inheritanoe
'fox TIoturn.
TOTAL (AlIa enlor on line 9. Recapitulation)
(If moro 'paeo I. noodod, InlOrl additional .hoo'. of .am. .1...)
AMOUNT
:1
I
5,770.00
80.00
15.00
s
'7,865.00
. .
v.Ullf" 11111
-tj~
CU.....UOtlWIAIIllOI'tll..\_'VAttlA
INHflnANC. rAlt 1111.11"
'nID'H'_~fCl.~~I~~ n._ .
SCHEDULE J
BENEFICIARIES
-
E~,\TEOF
FILE NUMBER
GEOJH.j]~ ~~. P:CSJtgr." Al=A nEonnE Z. }i':r::jI[]~[I, tTn.
ITEM
NUMBER
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
NAME AND ADDRESS OF BENEFICIARY
L
A. Toxablo 8ltflu"'hl
Kathori.na H. Pi.nhol
110 Wont aroon St.
Shirolllollo t0l1ll. PA 17011
\-li1'o
Bnt:lro goto.to
0.0 Dolo bono-
1'ioiary 01'
Annuity and
IDA o.ocount.
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
D. Charlloblo nnd Governmental Dequo,":
L
TOTAL CIlARITABLE AND GOVERNMENTAL BEQUE$TS (AlIa onte, on line 13, Recapitulation) S
(If more .pac. I. n..dl'd, In'lrt additional .h.... of lame ,'zl)
REV-1547 EX AFP 112094*1 ~
CO"HONWUllIl Of Il[NHSYI YANIA ACN 101
DrPAR1HfHI Dr R[VfNllE NOTICE OF INItERITANCE TAM
BUPEAU or IHDIYlllUAI IAk(S . APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
::~~~is~~:~~II'A 111_~"-OhOI la. ~_ OF DEDUCTIONS AND ASSESSMENT OF TAX. DATE 09-18-95
ESTATEOF"'TISilEl' .~GEORGE =z~-' M, ..". -- FILENO. . 21 95=0""3-
DATE OF DEATH Ot, -12-9'1 COUNTY CUMBERLAND
NOTE, TO INSURE PROPER CREDIT 10 YOUR ACCOUNT. SUBNIT TIlE UPPER "ORlIDN OF HilS FORN WITII YOUR TAX
PAYNENT TO TilE REDISTER OF WILLS. NAKE CIIECK PAYABLE TO "REGISTER OF WILLS. AGENT"
REMIT PAYMENT TO:
J ROBERT STAUFFER ATTY
MARKET SQUARE BlDG
MECHANICSBURG PA 17055
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
411Dunt R..1i tt.d
.X-, ? (). 'lr
CUT ALONG THIS LINE _ RETAIN lOWER PORTION FOR YOUR RECORDS _
iikV=is4';-Ex-AFP--n'2:94riiiil'-fcnij1-YNHEififiiNci-YAx-iippRA-isEH"€ii'i'-;-iiLDiiiiiiici-iili---------m--m
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF FISHEL GEORGE Z FILE NO. 21 95-0443 ACN 101 DATE 09-18-95
TAX RETURN WAS, I X) ACCEPTED AS FILED
l ClIANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l e.t.t. CSch.duh AJ ell
2. Stock. .nd Bonds (Schedule 8) 12)
3. Clos.ly tt_ld stock/Partnership Intereat ISch.dul. C) (3)
4. Hartgag../Not.. R.ceivabl. (Schedule D) Clt.
5. Cnh/Sank Oeposlh/Hhc. P.r,onal Prop.rty ISchedul. E) CS)
6. JoIntly Owned Prop.rty (Schedule f) 16)
7. Tnnsf.r. (Schedul. G) (7)
8. Total A.,ets
.00
.00
,00
.00
77. 009,35
,00
,00
18)
77 . 009,35
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fun.,.al E>cpen..,/Ad... Costs/Hhc. E)(pen,., ISchedul. to (9)
10. Debt,/Hortg.ge LlablUtle,/Lhn, (Schedule It 110)
11. Tbtal Deduction.
12. N.t Valua of rax Return
13. Ch."U.ble/Govern"l'ntal Bequ.sts CSchedule J)
14. Net Value of Est.te SUbject to JeK
7.865.00
,00
Ill)
112)
115)
1141
7.R~~ nn
69.1',4.35
.00
69.144.35
If an assessment was issuad previously, lines 14, 15 andl'cr 16, 17 ,,,,,.I 18 will
reflect figures that include the total of' ALL returns assessed to date.
ASSESSHENT OF TAX:
15. A"ount of Line 14 at Spou.el
16. AIIount of Line I', taKable at
17. Allaunt of Line 14 hubl. at
18. Principal Ta>c Dua
NOTE:
rat.
LIneel/Cla., A rat.
Coll.teraI/CI." D r.t.
.00
69.1'14.35
.00
.00
4 .1',S. 66
.00
4.148.66
X . DO.
X .06.
X .15.
118)
1151
1161
1l7l
TAX CREDITS I
PAYNEIIT
DATE
06-08-95
RECEIPT
NUNBER
AA047857
DISCOUNT (. I
INTEREST I-I
150.63-
AMOUNT PAID
',.Z69.66
INTEREST IS CHARGED FROM 06-09-95 TO 09-26-95
AT THE RATES APPLICABLE AS DUTlItlED ON TIlE
REVERSE SIDE OF THIS FORM
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
4.119.03
29.63
.81
30.44
, IF PAID AFTER OATE INDICATED. SEE REVERSE
FOR CALCULATION OF AODITIONAL INTEREST.
I IF TOTAL DUE IS LESS TIIAN $1. NO PAYNENT IS REQUIRED.
If TOTAL DUE IS REFLECTED ^S A "CREDIT" ICR), YOU HAY BE DUE
A REfUND. SEE REVERSE SIDE OF TillS FORN FOR INSTRUCTIONS. I
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Det.. tM top portion of thl. Notice 8M IUbltSt with yOUr paYMnt ... pantll. to tM "... Met edd,....
prInted on tM ravar.. side.
If MSIDDfT DECEDENT .... check or IIOMW order p.".tII, tal REGISTER OF WILLS, AGENT.
If NDH-RfSIDfHT DECfDefT .... chHk Dr' ...." or.,. p._l. tal CDtlttONWEALTH OF PENNSYLVANIA.
AU p.~h recalved .".11 be ..".11ee1 first to WI" l"ta,...t .....Ich "V H due with WlY ,....Inder ...lIH to the tlJl.
RUUND (CR) I A ,.,fund of . talC credit, which .... not reql.Mlted on thre TaM Rlturn, HW ba "..,..led by cOIIPlaU", nn
-Application for A.fund of P,""I"lv.,., InherJtinel Bnd Elt,.s Ta.- (REV"'.lIS). Application. .r. av.11MJI. .t
lM afflcl of the R-o.lt,,. 0' Willi, any of the ts A.v~ DI,trlct Offlc.. or 'ru. the u.p.rt.-nt', Z.-hour
en~rlng ..rvle. ~r. for fo~. ordering 1 In Pennl"lven.a 1-100-362-2050, out,lda Pennlvlv.nl.
Md within local H,,.,,llburg ,r.. (717) 717-1094, TOOl (717) 17Z.ZZSZ ("--rIng 1~.lr~ only).
REPLY TDI ou..Uon. r....rdlna arran cantalMd an th" noUn should be addr.... tal PA _.rt""t 0' A.v......, Bun..
of Indlvlw.1 Tu.., ATTNI Po.t A.....~t Aavl_ UnIt, Dept. 210601, llarrhburll, PA 17121-0601, phone
(717) 717-6505.
DJ:SCDUMTI If ....y t.. ckMI Is paId within thr.. (3) call1ndelr -.nth. .ft.r the decedent'. d..th, . flv. p.rc."t (5%) dhcaunt
of the tu paId Is allowed.
INTEREST I Int.r..t I. charged baglnnlng with 'Ir.t d.y a' delInquency, or nl~ (,) ..,th. and one (I) day 'roe the d.t. 0'
d..th, to the d.t. a' pay..nt. Ta.a. which bee... dell~t ba'or. January 1, 1912 b..r Int.r..t at the r.t. a'
.1" (6X) parc.nt par ennu. calcul.ted at a dally rat. a' .000164. All ta.a. Which bee... d.llnquant on and a,tar
January 1, .912 will ba.r Int.r..t at a rata which wIll vary froe calandar y.ar to cal~dar yaar with that rat.
BnnCK.ncad by the Pi _art""t a' Aevenue. TM appllcabla Intlrut rIIt.. for 1912 through .995 .r.,
Vaar Intara.t Rat. Dally Int.r..t Fector Vaar Intarut Aata DaUy Intar..t Fector
1912 ZDX .Oaa541 1917 'X .000247
1915 16X .000411 1911-1". IlX . GGUOl
19.. 11:,( .OOUDI 1"2 'X .000247
1915 13X .000556 199J-l'IM n .000192
1916 I'X .00aZ74 I'" OX .000247
-"Intar..t I. calculated .. follow'l
IHTEREST . BALANCE OF TAX UNPAID X NUWBER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
"-Anv Hatlca I..uad a,tar the ta. bacu... delInquent will r.,lect an Intar..t c.lculatlon to ,I'teen (IS) day.
bayond the data a' the ........,t. If PIVIIIf'lt h ..... aUa,. the Int.r..t coaputaUan d.ta .hown an the
Notlc., addltl~1 Intaraat auat ba calcul.ted.
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