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"REV-AriS43 EX AFP (8-94) '*
CQHt<<)HWEALTH OJI' PfHNSYLVAHIA
DtPMTHVH OF R[VtHUE
BUR!AU OF IHDIVIDUAL TA.tS .
OEPT. ZU601
HARRIsaURa, PA 111:8-0601
CLARE M HALL
APT 8
1109 COLUM8US AVE
LEMOYNE PA 17043
NO, 21 - 'It; .. '1".(.,
95122505
05-25-95
TYPE OF ACCOUNT
~ ~:~~~HG
TRUST
CERTIFICATE
REHIT PAYHEHT AHD FDRHS TD.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
ESTATE OF DOROTHY ENGLISH
5.5. NO. 186-24-9651
DATE OF DEATH 03-22-95
COUNTY CUMBERLAND
DAUPHIN DEPOSIT ilK I T h.. provldMI the n.,.,.tunt with the In'aI"'QUon lhtM bellN Mhlch h.. b.-n u..d In c.lcuhtJnt tM
palMU.l tax du.. ~lr rMord. Indle.t. th.t .t the d..th 0' the "VI deced....t, :rou _n I Joint QWMr"/bw..,lol.ry of thh MC~t.
If )'OU ,..1 this Infer..Uon 1. Inca""Mt, pi.... obtain ..dUM oarr-MUon ,,.a the UnMell.l In.Ut1.Itlon, .ttech . COpy to thh fa,..
a:'Id ,..turn It to t:tr. nova ~,..... Thb ~t h ~"Ilhl. In ....,r~ with tf'\tI IMlIrl~ riM LWI of tn. eo.on....un of ...-.n.,lVWI1..
Du..Uonl -v b. ."....,ed by CIIUt"" (7171 7I1-8SZ7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account Ho. 0010141936 Doto 09-12-91
htablbhad
Account B.lane.
P....c.nt Taxabl.
Anount SUbj.ct to
Tax R.t.
Patanti.l Tax Du.
To Insure proper cracllt to your accOW"t, two
(Z) caple. of thh notle. ...t He~MY your
PI,..nt to the Rlol.tlr of Will.. "aka check
payable tal -Rlal.t.r of Will., Agent-,
PART
[!]
4,726.22
50.000
2.363.11
.15
354.47
TAXPAYER RESPONSE
;.. F!l-I"''''~l!.l'rrq~'~~~''!!i~''~~~~~'I\~:li%.''E!!ffi.'.9,1ffi.~;}!l,~:'JT'';;ASl'~H.Effii:1~~B:D.~.pN.:m%..$~~ncr;;i
K
MOTEl If telf PIY''''ts In ..dl within thr..
(5) aonthl of the dlced...,t's date of daalh,
you .ey deduct. 5% dhcount of thl ta. du..
Any I""'rltance tax dul Mill beeo.. d.Un...."t
nlM (9) eonth. Iftlr ttM Ate of duth.
Tox
K
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The MMtYI InforAtlon Md tax due b correat.
1. You .ay chOOSI to r..lt PI,.ent to thl R.alst.,. of Will. with two copl.1 of thl. not lei to obtlln
. dbcount or Ivold Intl"lt, or you "'I check bu -A- wld r.turn thb notlc. to thl Rotght.,. of
Will. ~ en off1cl.l ......-.nt will bl I.sued by thl PA D.~rtaent of R.venul.
a. ijJ ThI .bovI ....t h.. b..., or will b. reported and tax paid with the Pann'Vlnnl. Inh.rltanca Tn r.tum
to ba fllad by the decadent's r.,r..."tatlv..
c. 0 The 1boY. lnforaatlon I~nco,.,..ct andIo~'bt. _ dlductlon. _rl Plld by you.
You .ult coapl.t. PART L!J lndIor PART L!J below.
If yau indicate a di1far.nt t.x r.t., pl.... .tat. yaur
relatian.hip ta decedent I
PART
~
TAX R!TURN - COMPUTATION
LINE 1. Det. E.t,bli.hed
Z. Account aalance
5. Percent TaMable
4. Anount SUbject ta Tax
5. Debt. and Deduotion.
6. A.aunt Taxable
7. Tax R.t.
8. Tax Dua
l<l:I",~};i;j.~~'i'~OF.fiIl:tAm;USE'I(lIlt!.~j~ll11 .
1',.';hi"!::.;r~~'iI:tf.t'i;j.~"';' .,' I....:. i-.' ~".' .,.," '-';:10 '~,"'.!J;... ,.,~'l..-~,~,_ ,or ,_t:.:1i:I"T.l'"~~..
,.,., ",. <,~". Frlli' DEpA"nt!;~'r ;Or1,'RE\lENUE~' ",.,
~:1:)~':'~!~'~:;~::~, ':'"j :,;:"1 I"~ :,~~"l...~ . ,'[.":.. "~"'''''' ".1;';,..., " .", ~'., ~~~ ,~>..;.
M;!~,~:;r:;.:,:,;:': ::'., ",' :.'~ h,: ':,': "':.,' ': ~_:::',~~ .':"'~';~:' :,':" ';, ":..' ,_::;:
r(f)t:i~r::;I!~~~~lI"'~';:'~~'i~;'flf.&!'1"':f!~~~'V~!: ::""J )<I:~~'~"~#':~~'i:' F:;,1~?'I';o1'_~~.lti"~;(41
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!ii!.ti~1~?,~;.~;;,.tll" I.;'">,,',,!,~,, ~"'-' 7''''' l~ . ""J~:+.;'!." '-.IIo:)""~.! ~ ~dd ~~1
~J,I&:8t::<-'",::, :"/ .;:. :",;;; ~;' -:: ,:~' ", ~,:'::..~'::: I,,' :,-:",;:;~: ::.,:-::1. ,:
TAX ON JCINT/TRUGT ACCOUNTS
OF
1
2
3
4
5
,
7
a
.
.
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
PAYEE
I
.
I
TOTAL lEnt.r on Llne S 01 rax COMPut.tlan)
haYe raported abave ara trua, carr.at
HOME (7/7 1 ?:17' /.. <I J7 tJ
WORK ( 1
H I
and
AX
nder pan.lt!.. a1 perjury, I d.alara th.t tha fact. I
t. ta tha be.t of .y knowledge and b.lief.
./d ~ 117.
,NA
.
'.
GENERAL INFORMATION
1. 'AILU"e TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESS"EHT wl'h ....110...1. Int.....' b..... on l"'cr.atlon
,,-,,-itteel by the fln...ol.l Inttltution.
r. lntMlrlhftOl talc bMtMlel dellnqu.nt nine ..,\hl tft,,. the tIN......,.. dII" .f a.th.
S. A Jet"t .....,t a. taar_'" wen ~ tN deCI...",'. ~ "". added II . _tt.,. .f oonv..-.IMCI.
4. Account. (Includlnl those hlld bltve<en hulbllftd and "i,.l ..nlm ttt. dluel.", put In Joint ~. within on. y..r ."I.r to
dM;th .r. fully tanbt_ II ,"",f.,...
I. 'nount. .......UIhed Jolnt1>> blhllMn hulbMd Iftd w"o _n tt'IIIn .,. w-r ,rl.1" to dutn an not ta.MlI..
.. Mcountt Mid by . decl....' "In trutt fo,.. .,.the,. Dr atherl .r. taJI_.I futh.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. ILOCI(". If the In'.".Uon .-MI ~t.tlDn In tlta notlu .r. co,.,..., Md deduGtlont ara not tt.lnl ala.__. .1..1 Wi .....
In block ..,- of ,."t 1 of the .,.....y.,. lII..pon.... MGUon. Ilgn two .-.1.. encI .....U ~ tilth your Q\eck f.r tM MOUf'lt of
t.. to tt\lI Reela'." 0' WUh of tM oounty lndlutM. 1M PA o.ortMtlt of ..\lerNe .111 III". an oUlal.1 .........,t
(,.... RIV-ll4a DJ """ ,....l't of tN ntum ,,.011 tho h,I.,.,. of ....I..
Z. ILoa: I .. If tho ....t tpMlflllCl on thlt noUu !w. bMrl 0,. _111 1M r,,"'M .M tax ,.ld _Ith tN Pefwt.ylv..,l. 1ntt.,.It_.
T.. "oturn flbd by tho dKU..,t'. r.,,.....,'.'lv.. IIIH. M"'X"" In blOCk .... 0' P.,.t 1 0' the "'Tu,ovo,. Roapon.o. aactlon. Sign ona
cop," and ,.oturn t. tho PA o.po..t...,' of Ravanue. au...., of Individual T...., DatI, Zl060I, H.,...hbU,.., P' l71Z1-UOl In tM
anv.lotta ,,.ovlded.
5. ILDCX C .. If tho notle. Info....Uon It Incor,.Mt wwUa,. ......tlon. are belnt ohl..... ahack block "'C"" and 0.....'. Pe..h Z and 5
acnlMll,..~ to trnI In.tMIGtl..... balow. 111ft tw owlo. ..... __U u,.. _Ith your ..naok Idr U.. .......t 01 R. ,..ylbl. to tN _,,"'.r
.f VUlt af ttl. eounty ltMttcettd. Tho" D....,.t...,' of _avanua wUI I....,. an offlol.l .....lIIIWtt ('.r. ~.1l41 EXJ upon r".I"
of ttl. ,..tum 'roo tho "..lIta.. of Wi....
TAX RETURN - PART 2 - TAX COMPUTATION
LlHE
1. Ent.,. th. data tho "OeMont or I. In.'',, .... ..tablhhed .,. tlUed In tha aanne,. .d.ting at ut. of d..th.
NOTE I ,.,.. dOCM....t dJ'ln. dt.,. lZ/IZlIZI Accoun'. whiCh tho deeMMt put In Joint n.... _Ithln ana (1) 'I.." of d..th .r.
nx.,h fully.. t,..,lI.r.. Howev.'" th.ra II an ua1ualon not 'a ..ceeca U,OOO par t"8fJl..f,.,... ,....rdlt.. of tho v.lu. .,
tho acoount .r tho NIOb.,. of MClM'lt. held. '- 1 ~_J . :u
c: . 'n -, ;:,
If . double ..t.,.hk (_J .,.art bofor. your fir.' n__ In the metr... portion of thh notlc., th.'u,aoo exolualon
.1,...dy h.. baan dedUOtM f,... tN "count b.I8nC. .. repo,.t" by tho IIn....01.1 I".U tutton.
Z. [nt.r tho tanl IMIMeI. of ttl. MCOYtt IMlueUnt Into....t MGr-uad to tho dIIt. of death. ~
S, Tho ,."CW1t .f tho "OeMont th.t I. t...bl. far aach aurvlvo.. Ie dat.,...lnad .. follow.'
A. Tho pa,.oant t..iMllo for Joint ....t. ..tiMIllthad _n than ana .,..,. prlo" to the daeadon", de.th, ~)
1 DIVIDfD IY TDTAL NI.ItIOI a1 DIVIDED IY TOTAL tuCID DI' X 100 - POaHT YAXAIL!
..IOINT ONND'S UVIVING ..IOINT DWN[RS
~lor .. Joint ....t r..llttr... ln the neaa of tho dea.....t " bHI othor parton.,
I DIVIDED IV S (JOINT OWtCRSJ DIVIDED IV Z (SURVlVORSJ . .161 . 101 . 16.7% naulLE ". 9tH SURV~'4OAJ
I. Th. p.rcent nxabl_ '.r ....t. or..t.d within ana y..r of tho dtlcadant', d..th or Kcount. a.nad by thedacad..,t bUt MIld
In tN.t 'or another Indlvldu.U.1 (tN.t b.".f1chrl..l.
1 DIVIDED IV TOTAL frl,JttllR or SURVIVING JOINT
OWNERS OR TRUST ~ICI~lES
X 100 . POCOfT TAXAILE
b-.I.. Joint "count ....lIhr... In tho "... of tha daaadMt WId two ottMr par.an. snd ..hbllsnad within ana y..r of de.th by
tho dacladant.
1 DIVIDED IY Z (SURVlYORSJ . .Ia X 101 . 50% <TAXAIL! ,DA u.at SURVlVORJ
4. TM..aunt ~J..t to tax (l1n_ 4J It d.t.,..lned by .ultlphl". tho MCount b.hne. (ll"e Z) by tho pare."t twa.l. (11". SJ.
S. [nhr the total 0' tho debt. and deduotlon. Ilttad In P.rt 5.
6. Tha NOUnt toatOl. Ulna 61 it dat.,..lned by .ub1:r..U"1 the debts IInCI dadUotlon. Uln. SJ fro. tho .lIOUnt .uaj.ot to t'!' UI". ilIJ.
t. ton,.r tna appro"rl.'e taX rw'. UIII_ 7J e. eM'.ral"... below.
A. '0" dat.. a' d..th occurrlnl .ft.r 6150/9.. tho tax rete. 'a,. 'r",,'er. to .pou... .,.. .. followll
1. Dat.. of d..th on .,. ofhr 711/94 and bafor. 1/1/" the Mlt. Is S:t:.
Z. D.t.. of death on or ofhr 1/1/" and bafor. 1/1/91 tho ,..te It z:r:.
5. Dat.. of d..th on or .ft.r 111/91 and bafor. 111/91 tho ,..t. I. 1%.
4. O.t.. of d..th on a,. .ft.r 111/91 trlnef.r. to .pau... .,111 be ."....t 'roo tax.
Mot.. '.r det.. of death pdor to 7/1194 tr.....'.r. to spou... .,.. tu.ol. .t U.
.. T,.en.f.,.. to 11"..1 de.eendent. lnoluell", 'eth.,., 1IO''''r, 10ft, dWght.r. .randct'llld...." aon..ln..l.....
nughtor-In"l..., .twd'll1d tnd thalr luua .... '...,01. .t d. p.re."t (6%J.
c. y"",."r' to .U otharl InclUding brotha,., ,lIt.r, ...,.1., .."..t, napheIlil and nl..o .rt taxiMIle ., flfltW1 p.rcant U~J.
D. 11 yOU chan.. tho talc "t.. pl.... ,pacify you,. r...Uonttllp to tN d..ad....t In tho .r.. provldad.
.. Th. aaount of t.. duo Ulna IJ It det.ralned by .ultlphl,,- the aaount t...ol. <1lno 6J by tho t.x r.'. (l1n. 7).
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
AUowiMIlo dabt. and IMduotlon. .,., d.te,..lnad .. 'OUOllil.'
A. You Iq.11v sr. rtsoondbl. '0" p,y.."t, or tho ..t.t. 'ubJaat to ..1,....tnUon by . par.ond r...r..."tIUv. It Inaufflolant
ta p.y tho daductlbl. It....
I. You ..",.Ih p.ld tho debt. .It.r d..th of tho deead..,t and CM fu..nlth proof of p..,.."t.
C. a.bt. b,lng al.l.ad MI.t b. it..tud fulh In P.rt S. 11 IIddltlond ,p.ca It n..ded, u.. pl.ln p.per . 11:-- a 11". Praaf of
p.v-ant ..y b. r~.ted by thO PA Dop.r.....,t of ".venu..
TAXPAYE~' ASSISTANCE
",' IF: YOU NEED FURTHER INFDRHATIDNOR ASSISTANCE. CONTACT ANY
. .' .', REaISTER OF WILLS. PA DEPARTMENT..OF REVENUE. DISTRICT OFFICE ..i.'
.: . OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (717) 787-8327 . TOOt (7ln 772,2~SZ(HEARING IMPAIRED ONLV)"
~..'......-....-.-......
...-.-
.
DETACH AND RETAIN THIS PORTION FOR YOUR RECORDS
No.66111SI.l111lJ.
AJC NAME
J,'I'I;\!111H I,ll' JIll E'il.\H ..., lllWU1Hl' Il H4lil l!:H
0/'/16/95
AJC NO,
1~jO'-I-,rl"'10(Hj
D! :-;f 1"0
\ll' F ',-/
REMI" ANCE AMOUNT
INCOME PRINCIPAL
,~;J:jt.) 1:'1
FOR
1'., HIl;EfH'f.V~CI: 1;\>: ,','In 10
HP;H;IEH OF \HU.:;.
CUM\l!:RLi\tlll (:0 ,~OUl,
CM(LI'!~LX Pt'I 1?()jJ
i\G-FJ,jJ '
HounE
Pf,Y~lENT . TO IH1CIHVE r)l$COUNT
ON JLlINrLY QWNEDCHECI\1NG
"GN .'tlJ122505 FlLE: 21
EDTATt FILE 2~-95-0592
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REV-1543 EX AFP (8-941*
COHMOHW(ALfH Of' P[NNSYlYANIA
DEPARIKtNl Of REVENUE
IUA"AU Of INDIVIDUAL tAXES '
r.':Pt. zaonl
IIAHRUIUf'G, PA UIU-O'U
/,-,',/10' ;'.
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
NO.21 . yJ:: $I'~
95126223
06-13-95
TYPE OF ACCOUNT
~ SAVIHGS
CHECKIHG
TRUST
CERTIFICATE
REHIT PAYHEHT AHD FDRHS TD'
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FILE
ACN
DATE
ESTATE OF DOROTHY R ENGLISH
5,5, NO. 186-24-9651
DATE OF DEATH 03-22-95
COUNTY CUMBERLAND
CLARE M HALL
APT 8
110l)rCOLUMBUS
L EHOVNE .,
AVE
PA 17043
v:
PSECU ... h.. provided the Depa,.t..nt with ,he t"'or..Uon .htd balow which ha. b..n u.ed In ulcuS.tlng the
potantla. tax du.. thai, racord. Indica'. that at the d.ath of the above dacadant. you ..ar. . Joint ownar/beneflclary 0' thl. account.
I' you ,..1 thl, In'or..tlan I. Incorract, pl.... obtain written corractlon fro. the 'Inanclal In.tltutlon, attach. cnpy to thl. for.
Md return It to the abova IlIldt.... fhls account II ,...bl. In accordant. with the Inharitance ,.. l."'. of the Co..onw..1th of PaMsvlvanl..
...:~....!-~ :'.t~t :!..'!'..-.~.IJ..;. .tl1~i.,.,!':9...., :-:: _L:;.
COMPLUi! PART.)l BE..~Ij~. . . SEE REVERSE SIDE FOR
Account Ho. 0186249651-7 Doh 03-21-90
E.bblhhed
FILING AND PAYMENT INSTRUCTIONS
Account Balance
Percent Taxabl.
AMount Subject to
raM Rat.
Pot.ntl.1 Tax Dua
2,602.08
50.000
1,301.04
.15
195,16
TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT BASED ON THIS NOTICE
To In.ura prop.r credit to your account, two
(l) copt.. of thl, notlc. .us' 8cco~anw your
p.y..nt to the Rlgl,tar of Willi. Haka chack
payabla tal ~R.,I.t.r of Willi, Agant".
x
HOTEl If ta. pay.ent. .r. ..da within thr..
C3J lonthl of thl dlcadlnt"' data of death,
YOU ..., deduct. 5:C dhcount r.t thl tax dUI.
Any Inherlt~c' ta. due will blcu.. delinquent
nlna (,. ~th' a,tar the data of d..th.
To.
x
PART
ill
[CHECK ]
ONE
BLOCK
ONLY
A. IVI The above In'or.ation and taM ctu. II corrlet.
~ 1. You ..., ChOD" to ra.lt pI.,..nt to thl Ragll'ar of Will. with two copl.. of thl, natle. to obtain
. dl.count or avoid Intar..t, Dr you ..., chack box "A" end raturn thl. notlc. to the R.gl.t.r of
Will. and an offlcl.1 ........nt will b. I..u.d by the PA O~.rt..nt of R.v.nu..
a. E:J Thl .bov. ....t h.. b.an or will b. r.port.d and ta. paid with the P.nn'Ylvanla Inh.rltanc. T.. r.turn
to b. fll.d by the dlcadant.. r.pr...ntatlvI.
C. E:J Th. above Infor..tlon I~ncorr.ct snd/o~.bt. and dlductlona w.r. p.ld by you.
You .u.t co.pl.t. PART L!J and/or PART L!J b.low.
If you Indlcata a dlff.r.nt taM rat., pl.... .t.t. your
r.l.tlon.hlp to d.cadantl
OFFICIAL USE ONLY 0 AAF
PA DEPARTMENT OF REVENUE
PART
~
T^Y ~F.TIIP~ - r"!-!~I"'T.~T!C'~
LINE 1. Oat. e.tabli.hed
2. Account 8alanc.
3. P.rcant TaMabla
4. A~ount Subjact to TaM
5. D.bt. and Deduction.
,. A~ount TaMabl.
7. TaM Rat.
a. TaM Du.
('F Tl\~ ",.. ..In!HT.''''rRll!T ".~~"I_I~T9
.--...---.---........-...
PART
[!]
DATE
DEBTS AND DEDUCTIONS
f'.~n
1
2
3
4
5
6
7
8
CLAIMED
1
2
3 .
4
5
6
7-2L-
8
PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Ent.r on Llna 5 of raK Co~putatlo")
Under panaltla. of par jury, I declar. that the faat. I
CO.PI.t_/o the b..t of ~y k"OWled~. "end b.llaf.
C!., 124-u_ /7 /, /1 {~~' '-
TAXPAYER SIGNATURE
I
.
hay. raported abova
HOME ('/1 ') )
WORK ( 1
TELEPHONE NUMBER
ara tru., correat and
7 1 7 . C, <I ,'1' lJ
6 /h/<j,'
DAtE'
GENERAL INFORMATION
1. fAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAM ASSESSHEHT with appllubla lnt.,..t ba..d an Infur.ation
,ubalttad bw thl 'Inanclal In.\ltutlon.
Z. Inheritance tl. blea... delinquent nln. lonth. after thl dacld.nt', da'l of d..th.
S. A joint account .. 'a.,bl. Ivan though thl dleedant" n... wa. added II . ..tt.r of conv.nlenca.
4. Account. Clncludlng tho.. held batw..n husband and wlfa) which thl d.ced~t put In Joint n.... within anI y..r prior to
d..th .r. 'ully ,a..bl. a. trl"".'"
5. Account. I.'abll.had JointlY batwa.n hu.band and wlf. lor. th.o ona y..r prior to d..th .r. not ta.abla.
6. Account. held by . d.c.d~t Mln tru.t 'or" anoth.r or othar. .r. ,a..bl. fully.
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
1. BLOCK A _ If thl Infor..tlon and cD.putatlon In thl notlcl ar. corr.ct and d.ductlont .r. not b.lng cl.I..d, pl.c, an "."
In block "A" of P.rt I of the "t.~p.y.r R..pon.." ..ctlon. Sign two COP I.. .nd .ub.lt th.. with your ch.ck for the .a4unt of
t.. to the R.gl.t.r of will. of the county Indlc.t.d. the PA D.p.rt..nt of R.v.nu. will I..u. .n offlcl.1 ........nt
CFor. REV-1548 EM) upon r.c.lpt of the r.turn froe the R.gl.t.r of Will..
Z. BLOCK B . If the ....t .p.clfl.d on thl. not Ie. h.. b..n or will b. r.port.d and ta. p.ld with the P.nn.ylvanl. Inheritance
t.. R.turn fll.d by the d.c.dent'. r.pr..ent.tlv., plac. .n "X" In block "a" of P.rt I of the "ta.p.y.r R..pon.a" ..ctlon. Sign one
COpy and r.turn to the PA D.p.rt.ent of R.v.nu., Bur.au of Indlvldu.1 T...', D.pt Z80601, H.rrl.bUrg, PA 111~8.0601 In the
.nvelop. provldad.
S. BLOCK C _ If the not Ie. Infor..tlon I. Incorr.ct .nd/or daductlon. ara b.lng clal..d. ch.ck block "C" .nd co.pl.t. Part. Z and S
~ccordlng to the In.tructlon. b.low. Sian two cop I.. and .ub.lt th.. with your chack for tha ..ount of ta) p.y.bla to the Regl.t.r
0' Will. 0' the county Indicated. Th. PA Depart.ant 0' Rev.nua will I..ue an of'lclal .......ant CFor. REY-1548 EX) upon r.c.lpt
0' the r.turn 'roa the Regl.tar of Will..
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
I. Ent.r the d.t. the .ccount orlgln.lly w.. ..tabll.h.d or tltl.d In the ..nn.r a.l.tlng at d.t. 0' d..th.
HOTE' for a dac.d.nt dying .ftar lZ/IZ/8~1 Account. which the dac.d.nt put In Joint n.... within on. CI) ya.r of d.ath ar.
t..abl. 'ully .. tran.f.r', tlow.var, thar. ,. an a.clu.lon not to ..ca.d IS,OOD p.r tran.f.ra. rag.rdle.. 0' the valu. of
the .ccount or the nuab.r of account. hald.
I' . doubla ..tarl.k CMM) appe.r. b.for. your 'Ir.t na.. In the addre.. portion 0' thl. notlc., the IS,OOO ..clu.lon
alr.ady ha. b..n daduct.d 'roa tha .ccount b.lanca a. r.port.d by the financial In.tltutlon.
Z. Ent.r the tot.l balanca 0' tha account Including Int.ra.t accruad to the data of d..th.
S. Th. p.rcant 0' tha .ccount that I. ta.abla for aach .urvlvor I. d.t.ralnad a. follow"
A. Th. p.rc.nt ta.abla for Joint ....t. a.tabll.had aor. than on. y.ar prior to tha d.c.d.nt'. d.ath.
I DIVIDED BY TOTAL HUHBER Of
JOINT OWNERS
F..aaplel A Joint ....t ragl.tar.d
DIVIDED BY TOTAL HUHBER Of X 100 . PERCENT TAXABLE
SURVIVING JOINT OWNERS
In the na.. of the decadant and two othar par.on..
I DIVIDED BY 3 CJOINT OWNERS) DIVIDED BY Z CSURVIVORS) . .167 X 100 . 16.7X CTAXABLE fOR EACH SURVIVOR)
B. the p.rcant ta.abl. 'or ....t. cr.at.d within on. y..r 0' tha d.c.dant'. d.ath or account. ownad by the dac.d.nt but h.ld
In tru.t 'or anothar IndlvldualC.) Ctru.t b.n,'lclarla.),
I DIVIDED BY TOTAL HUHBER Of SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
E.aapl., Joint account ragl.t.rad In the n.a. of the d.cadant .nd two ot~ar per.on. and a.tabll.h.d within Dna yaer of d.ath by
the dec.dant.
I DIVIDED IY 2 CSURVIVORS) . .5D X 100 . SOX (TAXAaLE FOR EACH SURVIVOR)
4. Th. .aaunt ,ubJ.ot to t.. Cllna 4) I. d.tar.ln.d by Bultlplylng tha eccount ba1.nca (lln. ~) by tha p.rc.nt ta.abl. (1In. S).
5. [ntar the total of the dabt. and daductlon' II.tad In Pert S.
II. lna ...uuou ,...ol. lllna .., I. "a'...in.o UY .uDuacalll" U,. oaoC. .nd o.uu,"uunll lUll. ~, HU. U\. ..""'\1 ,uu,.C1: to l." tu.ne"J.
1. Entar the approprl.ta ta. reta (1In. 1) .. dat.ralnad ba10w.
A. For data. of d..th occurring aftar 6/30/94, tha taM rata. 'or tran.f.r. to .pou... er. a. follow"
I. Dat.. of d..th on or a,tar 1/1/94 end bafor. 1/1/96 the r.ta I. 3~.
2. Data. 0' d..th on or aft.r 1/1/96 .nd b.for. 1/1/97 the rat. I. ~X.
3. Dat.. of d.ath on or a,t.r 1/1/91 and bafor. 1/1/98 tha r.ta I. I~.
4. D.ta. of d..th on or aftar 1/1/98 tran.f.r. to .pou.a. will b. a...pt froa ta..
Notal for d.ta. of d.ath prior to 7/1/94 tran.f.r. to .pou... ara ta..bl. at 6X.
8. Tran,'.r. to Iln..l da.candant. Including fathar, aothar, .on, daught.r, grandchlldran. .on-In-law,
daughtar-In-taw, .tapchlld and th.lr I..ua .r. ta..bl. at .1. p.rcant C6X).
C. Tran.'ar' to all othar. IncludinG brothar, .I.tar, uncia, Dunt, n.ph'w and nl.c' ara ta.abla .t ,Ift.an parcant (15X).
D. If you chang. the ta. rata, plaa.. .p.clfY your ratatlon.hlp to tha dac.d.nt In tha araa provld.d.
8. Ttw POunt 0' ta. due Clln. 8) It dabr.lnad by M11tlplYlng tha ..aunt ta.abta Cllna 6) by the ta. rat. Ulna 7).
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable dabt. and d.ductlon' ara dat.r.lnad .. follow.'
A. You I.gally ara r..pon.lbl. 'or pav.ant, or the ..tata .ubJact to adalnlltratlon by a par.onal rapra..ntatlva I. In.ufflclant
to pay the d.ductlbl. It....
B. You actu.lly p.ld tha d.bt. after d.ath of the dacadant and c.n furnl.h proof of payaant.
C. Dabt. b.lng cl.l.ad au.t ba Itaalz.d fully In P.rt S. I' addltlon.1 .p.c' I. n..d.d, u.. plain pepar 8 1/2" . 11-. Proo' 0'
pay.ant aay b. raqua.tad by tha PA D.p.rt..nt 0' Ravanu..
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 (717) 787-8327. TDD' (717) 772-2252 (HEARING IMPAIRED ONLY)
;:;
REV-1543 EX AFP (8-941_
C~HWEAltH Of PENNSVlVANIA
?[~'NtH{N' OF REVENUE
BUREAU Of INDIVIDUAL 'AX[S
DEPf. 21U.Ol
IIARAISlUAG, PI l1lla-Dllot
FILE NO.
ACN
DATE
21 - '15 -'I~ (p
95126224
06-13-95
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
J,/~ CjS-'t~~
TVPE OF ACCOUNT
~ SAVIHGS
CHECKING
TRUST
CERTIFICATE
REHIT PAYHEHT AHD FDRHS TD.
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
ESTATE OF DOROTHY R ENGLISH
5.5, NO, 186-24-9651
DATE OF DEATH 03-22-95
COUNTY CUMBERLAND
CLARE M HALL
APT 8
1109 COLUMBUS
LEMOVNE
AVE
PA 17043
PSECU ha. prollldad the aaparhant with the Infor.atlon Ihhd balow Which ha. ba.n u..d In c:llculatlna the
pot'ntla. t.~ due. Thalr racord, Indlcat. that at the d.ath of the abova dacadant, you war. a Joint ownar/banaflcl.ry of thl. account.
J' YOU ,.,1 thl. Infor..tlon I, Incorract, pl.... obtaln written corractlon fro. the flnancla. Inttltutlon, attach. copy to thl, for.
and raturn It to the abava .ddr.... thl, account I' taMable In accordance with the Inherltanca Ta. LawI of the Coaaonw..lth of Pennsylvania.
""R~"U' l'~:" b- ,-:t::=~~:! b:: ==:1';"; n:1) '!~.,- :::':".
COMPLETE PART 1 BELOW .
Account Ho. 0186249651-5
. . SEE REVERSE SIDE FOR
D.t. 06-26-90
E.t.bli.h.d
FILING AND PAYMENT INSTRUCTIONS
To Insur. propar cradlt to your account, two
III copl.s of thl. not leI .u.t .cco~.ny your
pay..nt to tha A.glst.r of will.. ".k. ch.ck
payabla tOI "Ragl,t.r of Will., Agant".
Account a.l.nc. 1,238.18
Pa,.cant Tax.bl. )( 50 . 000
AMaunt Subj.ct to T.. 619 . 09
T.. R.t. K .15
Potanti.l T.x Dua 92.86
~~ TAXPAYER RESPONSE
[!]I FAILURE TO RESPOND WILL RESULT IN AN. OFFICIAL TAX ASSESSMENT BASED ON THIS NOTJCI!
i. 1Rl Thl abo\la Infor..Uon and t.. dUI 11 corrlct.
1. You ..y choo.a to raalt pay..nt to the Ragl.tar of Will. with two cop lIs of thl. notlca to obtain
. discount or .\lold Int.r..t. or YOU ..y ch.ck box "i. and r.turn thll not Ie. to tha A.gl.t.r of
wlIh and an official ........nt wll1 bl I..uad by the Pi Dlp.rt.ant of R.venua.
NOlEt If t.. p.yaant. .ra .ada within thraa
151 aonth. of the dac.dant'. data of d.ath,
you .ay d.duct . S~ discount of tha tax dua.
Any Inh.rlt.nca ta. dua will baco.a dallnquent
nlna 19) Iantha .ftar tha data of d..th.
[CHECK ]
ONE
BLOCK
ONLY
B. c:J Th. abova ....t h.. baan or will ba r.port.d and tn. paid with tha P~.ylv.nla lnharltanca Ta. raturn
to ba fllad by tha dacadant'. rapra.ant.tlva.
C. 0 The above Infor..tlon I~nc:orr.ct .nd/o~abh and d.ductlons w.ra paid by you.
You IU.t coaplata PART l!J and/or PART ~ balow.
If you indicata . diffa,.ant tax rat., pl.... .tata you,.
,.alation,hip to dacadant.
OFFICIAL USE ONLY 0 AAF
PA DEPARTMENT OF REVENUE
PART
~
T^~ R!TURM - CO~~UT^T!O~
LIHE 1, D.t. Eatab11ahad
2. Account aalanca
3. p.,.cant Taxabl.
4. Anount Subj.ct to Tax
5. Dabt, and D.duction.
6. AMount T..abl.
7. Tax Rat.
a. Tax Dua
OF
1
2
3
4
5
6
7
a
'!'^~ O~ J~!NT.'TRUST ~,CC~U~!T2
r-AC
PART
~
DATE
DEBTS AND DEDUCTIONS
1
2
3
4
5
6
7
8
CLAIMED
~
1..1\
~)~4
~.~ '
I,...,
1.11
. n?:'
.,., C)
x
C:.-,~
.
K
:-;
PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL CEnt.r on Lina S of Tax Co.put.tion)
I
.
Und.,. panaltia.
1,t. to tha b..t
/,,' )'J))-
of parju,.y, I dacl.,.. that tha fact. I
of .y knowledge .nd b.ll.f.
hava ,..po,.tad above
HOME '7, 7 1
WORK )
ar. t,.u., co,.,..ct
j,:?' 1.6 '/S(}
and
G {I_~- /h-
o TE,
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHEHT with appllcule Intarn' baud on Infor..Uon
.ubIIlttad by the flnancl_l Institution.
2. Inheritance t.. baco... delinquent nln8 eonth. aft.r the decadantOs data of d..th,
S. A Joint account I, t.lI.bl. avan though the decadant., n... w.. added .. . ..tt.r of convenience.
,. Account. Ilncludlng tho,. held batw..n hUlband and wl,.1 which the decadant put In Joint n.... wllhln on. y..r prior 10
dulh at. 'uth 'allabla .. trans fa".
S. Accoun" ..'abl hhad Jolntlv batw.'n husband ."d wlf. aor. Ih." an. V"" prior to dulh .r. not '8Mabl..
6. Account. hald b~ . decadant "In truI' for" anothar or olh.r. at. ta.,ble fully.
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
I. BLOCK A ~ If the In'or..tlon end co,putallon In Ih. notlc. .t. correct and d.ductlon. art not b.lng cl.I..d, plac. an "X"
In block "A" of P.rt I of the "Ta.pay.r Re.pon,e" ,ectlon. Sian two copla. and ,ub.lt th.~ with your check for thl aaount of
t.. to tha Real.t.r of Will. of thl county Indlc.t.d. 'h. PA D.partaant of R.venue will I..u. an official a.'....ant
Cfar. REY.15~' EX) upon rec.lpt of the r.turn frae the Aeal.t., of Will..
2. ILOCX I . If the ..,.t ,p.clf1.d on thl. notlc. h.. b..n or will b. r.port.d and taM paid wllh tha P.nn'Ylvanla Inh.rltanc.
T.. R.turn fllld by the d.cld.nt'. r.prl'.ntltlve, plac. an "X" In block "I" of Part 1 of the "Ta.ply.r R..pon'l" ..cllon. Slon ana
copy .nd return to the PA D.partelnt of Rlvlnul, lur.au of Indlvldu.1 T...., D.pt 2'80ftDl, It.rrhburg, PA 171Z1I.0601 In the
.nv.lap. provld.d.
5. BLOCK C . If the notice Infor.atlon I. Incorr.ct and/ar d.ductlan. ar. b.lna clal.ld, chick block "C" and coapl.ta Part. 2 and 5
arcordlnp to the In.tructlon. b.law. Slon two copl.. .nd .ub.lt thl. with your ch.ck for the ..ount of taM plyabl. to the Rlgl.tgr
of Will. of the county Indlcat.d, Thl PA D.part..nt of AIWlnu. will I..u. an official "'I.'..nt (for. REY.15~1 EX) upon racllpt
of thl r.turn fru. the R.gl.t., of will.,
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
J. Enter
NOTEI
the datI the account originallY wa. I.tabll'h.d or tltlld In the .ann.r e.l.tlng at date of d.ath.
far I d.c.dent dying eft.r IZ/12/1Z1 Account. which the decedent put In joint n.la, within ana (1) y.ar of d..th ar.
ta.abl. fully.. tr.n,f.r.. However, th.r. I. en I.clu.lon not to a.c.ed 'S,OOO plr tren.fer.. rag.rdl... of tha v.lu. of
the aCCount or the nu.bar of .ccount. h.ld.
If a doubl. ..tarl.k C~~) appear. b.fora your flr.t naa. In the addr... portion of thl. not lea, the IS,OOO ..clu'lon
alr..dy hi' blan deduct.d fro. the .ccount belanc. a. repartad by the financial In,tltutlon,
Z. Entar the total b.lanca of tha .ccount Including Inter..t accru'd to the date of dl.th.
S, Thl p.rc.nt of thl account that I. ta.abll for a.=h .urvlvor I. dlter.ln.d a. fallow'l
A. Th. percent tl..bl, for joint ....t. ..tabll.h.d .ar. than on. ye.r prior to the d.e.danto. d.athl
DIYIDED BY TOTAL HUHBER Of
JOINT OWNERS
E..apl'l 'joint ....t r.glstlr.d
DIVIDED IV TOTAl NUtl!ER OF X 100 . PERCENT TAXABLE
SURVIVING JOINT OWNERS
In th. na.1 of the d.c.dent and two oth.r p.r.on..
I DIVIDED BV S CJOINT OWNERS) DIYIDED IV 2 CSURVIYORS) . .161 X 100
16.7~ CTAMABlE fOR EACH SURVIVOR)
B. Th. perc.nt ta.able far ....t. cr.at.d within an. y.ar of the d.e.d.nt's d'ath or accounts awn.d by the d,cldent but h.ld
In tru.t for anothar IndlvldualCs) Ctrust b.n.flclarl'.)1
I DIYIDED BV TOTAL NUHBER Of SURVIVTNG JOINT
OWNERS OR TRUST BENEfICIARIES
X 100 . PERCENT TAMAllE
E.a.pl.1 Joint account r.gl.t.r.d In th. na.1 of the d.c.d.nt and two oth.r p.r.on. end I.tebll.h.d within an. y.ar of daeth by
the d.c.d.nt,
1 DIYIDED BV 2 CSURVIYORS) . .50 X 100 . 50~ CTAXAILE fOR EACH SURVIVOR)
.... Th. Haunt .UbJ.ct to te. Clln. 41 h d.ter.ln.d by .ultlplYlng the eccaunt balanc. Clln. 2) by thl p.rc.nt tuabl. ClIn. S).
5. Entsr th. total of the d.bt. end dsductlcn. ll.t.d In Pert S.
b. (h. a.ourn te.BbI. tlln. 6J h tl.urat".o by .uotracUng 'h. d.bt. .nd d'ductlon. Illn.!l1 tro. tn. a.aunt 'uoJ.ct to ,a... ClIn. ..,.
7. Ent.r th. approprlat. taM rat. Cllnl 7) a, d.t.r.ln.d bllow.
A. far dat., of d.ath occurring aft.r 6/S0/94, the taM rata. for tran'f.r. to ,pou.a. nre e. follow.t
1. Oat., of d..th an or aft'r 7/1/94 and b.far. 1/1/96 the rat. I. 3~.
2. Oat.. of daath on or eft.r 1/1/96 and b.far. 1/1/97 thl rete I. 2~.
3. Det.. of d.ath an or aft.r 1/1/97 and b.far. 1/1/91 the r.t. I. l~.
4. Oet.. of d.ath on or Ift.r 1/1/98 tren,fer' to .pou.., will b. 1.I.pt fro. ta.,
Natll for d.t.. of d.ath prior to 7/1/9... tran,f.r' to .pou... ar. taMabl. .t 6~,
a. Tran,f.r. to Iln.al d..c.ndent, Including fath.r, .athlr, Ion, daught.r, grendchlldran, ,on.ln.law,
deuQht.r-ln-Iewo ,t,pchlld and th.lr I.,u. .r. ta.abl. at 'Ix p.rcent (6~).
C, 'r.n.f.r. to all other. Including broth.r, .llt.r, unci., aunt, n.ph.w and nl.e. ar. ta.able at flft.en p.rcent CI5X).
D. If YOU chang. the te. rat., pl.... .p.clfy your r.latlon.hlp to the d,c.d.nt In the .r.. provldad.
I. Th. ..ount of tl. due Clln. I) I, d.t.r.ln.d by aultlplylng the e.uunt ta.abl. Clln. 6) by the tll. r.t. Clln. 71.
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowabl. d.bt. and d.ductlon. ar. d.t.r.lnad .. follaw.t
A, Vou I.gally ar' r..pon.lbl. for pay.ant, or the ..t.t. .ubJ.ct to ad.lnl.tratlon by . p.r.on.l r.pr..antatlv. I, In.ufflcl.nt
to pay the d.ductlbl. It....
I. You actually plld the dabt. aft'r d.eth of thl d.c.d.nt and can furnl.h proof of payeant.
C. D.bt, b.lng clal..d au.t b. Ite.lz.d fully In Part 5. If .ddltlonal .p.c. I. n..d.d, u.. plain pap.r 8 I/Z" . 11". Proof of
pay.ant .ay b. r.qu.,t.d by th. PA D.p.rteant of R.vIRu.,
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 (717) 787-8327. TOO' (717) 772-2252 (HEARING IMPAIRED ONLY)
REV-1543 EX AFP (80941_
t:O""ONWEALnI Of PENNSYLVANIA
OEPAATHEHT Of' R[V[MJ[
BUREAU Of INDIVIDUAL TAllES
DEPT. Z80601
ItAARISIIURG, flA l11za.0601
. 1/'1 ':1
15-"1&":'\
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO.
ACN
DATE
21-q5-l./~"
95126225
06-13-95
TYPE OF ACCOUNT
~ SAVIHGS
CHECKIHG
TRUST
CERTIFICATE
ESTATE OF DOUOTHY R ENGLISH
5.5, NO. 186-24-9651
DATE OF DEATH 03-22-95
COUNTY CUMBERLAND
CLARE M HALL
APT 8
1109 COLUMBUS
LEMOYNE
AVE
PA 17043
REHIT PAYHEHT AHD FDRHS TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU hu provided the DaparhMlnt with the In'or..Uon lIatad balow which hu bean u..d In ulculaUng the
potentia. taw due, Thalr racorda Indlcat. that at tha d..th of tha abo". dlcadant, you ..at. a Joint owner/benefIciary of thl. account.
I' you f..1 thl. Infur.atlon I. Incorract, pl.... obtain wrlttan correction frol the fl~l.l In,tltutlon, attach. copy to thl. for.
end return It to thl abov. .ddr.... Thll account II ta.abla In ~cordanc. with thl Inheritance r.. LI..I of thl C~..lth of penn.vlvanla.
t:~_~t1=n... /:I.., l.:. .;.r,h..r.::S t.~ :..:.l:':"i t~:.;": ';";;0 1::::-,
COMPLETE PART 1 BELOW .
Account Ho. 0186249651-2
. . SEE REVERSE SIDE FOR
D.t. 07-30-90
E.tabUahed
FILING AND PAYMENT INSTRUCTIONS
Account B.lanc. 2,457.64
Parcent Ta)Cabl. )( 50.000
AMount Subject to TaM 1,228.82
T.. R.ta H , 15
PotonU.l T.. Duo 184.32
PART TAXPAYER RESPONSE
COI FAILURE TO RESPOND MILL RESULT IN AN OFFICIAL TAX ASSESSN!HT BASED ON THIS NOTICE
A. ~ Tha abov. tnlor..Uon and talC due II carract.
1. You .ay ChoOI. to ,..It pay.ent to the Rag..ta, of Will. with two cop I.. of thl. notlc. to obtain
. discount or avoid Intar..t. or you ..y check bOM "AM and ratu,n thl. notle. to tha Raal.ts, of
Will, and an o'flclal ........nt will ba l'luad by tha PA Depart..nt 0' Rav.nue.
'0 Inlur. prop., cradlt to your account, two
(2) copl.. 0' thl, notlca auat accoap.ny your
pay.ant to tha Raallta, of Will.. Haka chack
payabla tal "Ragl.t., of Willa, Agent".
HOTEl If t.. pay.ant. .r. ..d. within thr..
(1) aantn. of tha dacad-nt', data of d..th,
YOU ..y daduct . S:C discount of tha t.. dua,
Any Inharltance taM due wlll becoae delinquent
nine 191 eonth. efhr the d.te of de.th.
[CHECK ]
ONE
BLOCK
ONLY
B. c:J The above ....t h.. been or will be reportad and t.w p.ld with the Penn.ylv~l. Inheritance T.. return
to be fllad by tha dacadant.a rapre.entatlve.
C. c:J Tha abova Infor.atlon I~ncorr.ct and/or dabt. and daductlon. wara paid by YOU.
You au.t coaplate PART l!J and/or PART [!] balow.
If ~ou indlcat. a different ta~ r.t., pl.... .t.t. ~our
r.l.tlon.hlp to dacadantl
OFFICIAL USE ONLY 0 AAF
PA DEPARTMENT OF REVENUE
PART
~
TA:W:
LIHE
P.~T'J'!" - COHP.'JT,^'!'!""
1. oat. Eat.bll.had
2. Account Dalanc.
3. Percent T.~abl.
4. AMount Subj.ct to T.~
5. Oabt. and Deductions
6. A_aunt Ta~.bl.
7. Te~ Rat.
a. T.~ Du.
T."~ (\~ ...IQ!NT.~'!'~ll!T ^r.r:."QI"~TS
0""
1
2
3
4
5
6
7 H
a
PART
[!]
DATE
DEBTS AND DEDUCTIONS
p,.,!J
1
2
3
4
5:
6
7
8
CLAIMED
......~.........._._-
H
PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL IEnt.r on Lina 5 of Ta. Co_put.tlon)
I
.
Under penaltla. of parjury, I daclare that tha
~o~~~ta to tha b..t of ~~ knowl.dg. and baliaf.
C {,6Li))J Ilt{l
TAXPAYER SIGNATU
f.ct. I hava r.portad abova era tru.,
HOME ('~ I '/ 1 7 iJ 'I
WORK ( ')
TELEPHO E NUMBER
corract and
G, 'I .v ('
fe, /1','/-1 "
linE'
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT Mlth IPpllubl. 1n'a"I' b...d on infor"Uon
aub_lttad by thl flnMeI.' Institution.
t. Inh.rltllnu tl. blea... dlll"qu..,' "1M lonthl .,t.r thl rtludenl" da'a of dnth.
). A Joint account Is t..abl, IVln though thl dlcldant's n... ..u added.. . ..tlat of (on",.nl",ol,
". Account. C Including thou held bat".." husband ~ IliIU,' which thl decltdant put In joint "_.. within on. yur prior to
d..th I" fullv tl.lbla .1 trans..t..
S. Accounts ..tHtlthad Jolnllv bat..I'" hulb."d and ..If. lor. than on. y..t prior to dnth .t. not ,...bl..
.. Account. held by . dlCld.nt "In trUlt for" .nothar or athtt. .t. t..able fully.
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
I. IlDCK A ~ If thl Inlor..tlon and coaputatlon In thl notln .t. correct end deduction. .t. not baing Clll..d, placl .. "X"
In block ..... of p.rt I of the "'..p..,.r R.,pon,." ,.cllon. SI," two cop I., .nd lubalt th.. with your ch.ck for the ..aunt of
t.. to tha Ra,ht.r of wllh .f t\'a county Indlcatad. Th. P. Olp.rt.."t of Rlvl~ will hlu.", official .......ent
(for. REVaU'" [Il) upon raulplt o;,thl r.turn frol tha RIglshr of Will..
I. BLOCK I . If tha ...el'PlcIUad on this notlc. h.. baan or will ba r.porhd and Is. paid with the Plnnnlv.nla Inharltanu
Tn R.turn fllld by Ihl daudlnt', rapr'l.ntaUva, pl.u an "X" In block "S" of Part 1 of tha "'a.p..,ar R..pon.... 'Icllon. IllIn ona
copy and ralurn to thl P. Dlpart..nt of Rav.nuI, luralu of Indlvldu.1 T'Ma., Dapt l8D601, Harrl'burll, P. 11118-0601 In the
anvalopa provldld.
5. ILOCK C a If the notlu Infor..IIOn Is Incorr.ct land/or daductlon. ara baing cl.laad, ch.ck block "c" end co_pl,t, Part. Z and !
accordlnll to the In.tructlon. balow. SllIn two copl.. and .ub.1t Ihl_ with .,our chack for the a_aunt of 1.1f payabla to Iha Reg II tat
of WUb of tha county Indlutad. Tha P. Dap.r'.ant of Ravanu. will I..ua .n official ....n..nt CFor. REYa15r.1 EXI upon raulpt
of tha r.turn fro. tha R.ghl.r of Willi.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
I. Enhr
NOTE.
the d.ta thl .ccount orlglnalh "" I.t.bllsh.d or tltlld In tha .annat niltlng .t data 0' dllth.
For. dlcldant dying af'ar IZ/IZ/8lr Account. which tha dacldant put In Joint n.... within on. III .,aar of da.th ara
hubla full., II tran.fat.. ItOWlvat, tha" h an I.chlllon not to a.caad n.ODD p.r tranlhr.a flgardl... of the v.lu. of
the .ccount or the nuab.r of .ccounts hlld.
11 . d04JbI. IItlrllk I") appaarl bafo'" you,. first na.. In the addr... par lion of this notln, thl n,DDD ..c:lullon
alnady h.. baan dldUctld fro thl ICCOunt b.lance .. rlporlad b., tha financial In.tttutlon.
Z. Entar the total balancl of the account Including Int.ra.t accrued to the datI of da.th.
!. Thl parcent of the account that I. t..abll for ..ch lurvlvo" I. datlralnad .. follow..
.. Th. perunt ta._la for Joint a...U ..tabU.had lor. thM ona yllr prior to tha dacadant'. dllthr
DIVIDED IY TOTAL NUttiER OF DIVIDED IY
JOINT OWNERS
E.aaplal . Joint ....t r'.latar.d In the n... of
TOTAL NUtlIER OF II 100 PERCENT TAIlABLE
SURVIVING JOINT OWHERS
tha d.ead.nt and two othar p.r.ona.
I DIVIDED IY S (JOINT OWNERS) DIVIDED IV Z (SURVIVORS) . .167 II 100 . 16.7% CUXAIUE FOR EACH SURVIVOR)
B. Th. pareent t..abl. 'or ....t. cr..t.d within ana .,I.r of the dlCldant'. d..th or .ccount. owned b., Ih. d.c.d.nt but h.ld
In tru.t for anoth.r IncUvlduaU.>> (tru.t b.naUclsrluJr
I DIVIDED IV TOUL NU"IEA OF SURVIVING JOINT
DWNfRS OR TRUST BENEFICIARIES
X IDD . PERCEN' TAXAllE
E...plar Joint .ccount r.al.t.r.d In the na.. of the decadant end two othlr par.ana and ..tabll.had within ana .,.ar of d..th by
tha d.c.d.nt.
I DIVIDED IY Z CSURVIVORS) . .SD X IDD . SOk nAMABLE fOR E.Ctt SURVIVDftI
~. Th. ..aunt .ubJect to tll. IIlna It) h dateralnad by aultlphlng tha account balanu (1lna 2) by the perClnt t...bla (lln. U.
S. Entar the tot.1 of the d.bt. and daductlon. ll.tad In P.rt S.
w. .,n. .."Wu ~tllIlllt.l.. (u,.. DJ h a.lar.lM" bv loutJ\I'actlllg \11' u.u,. mlU "soucHon. \l.ina !)J flU' In. II.UUfH subJ.ct to ta. Hlny If"
7. Ent.r the IIpproprlllt. t'M rat. Cllna 1) ., datar.lnad b.low.
A. For d.t.. of d..th oceur,.lna aftar 6/50/94, the tll. rat.. for trlln.fers 10 ,pou... IIr. II' foIlCJJi";
I. Oat.. of d..th on or IIft.r 711/9~ IJnd bafo,. 1/1/96 the rllt. h SiC. (;~.
2. Olt.. of da.th on or IIft.r 1I1/96 IInd befor. 1/1/91 the r.ta h ZX.
5. Ollt.. of d..th on Dr aft.r 1/1/97 and bafora 1/1/98 the rllta I. Ii(.
4. D.t.. of d..th on or IIft.r 1/1/'1 tran.f.r. to .pou... will ba ....pt fro. tllX.
Nat., For dat.. of d..th prior to 7/1/'_ tran.far. to .pou... ara tll.llbl. .t 6X.
I. TrlUl.hrs to lIn..1 d..undants Including fathlt, .athar, lon, d.ughter, arendchUdrln, .on.ln.l.w,
daughter-Inale", Itapchlld and th.ir luua ar. tll.abl. et .IM. p.rc.nt 16;(J. _.
C. Tr.n.h,. to .11 othar. Ineludlna broth.r, .ht.r, unda, lIunt, n.ph.., .nd nlaca ar. t..abl. lit Uft.." ffie.nt
D. If YOU changa tha taM rat., pl.... .p.elf)' your ral.tlon.hlp to the d.c.dant In the .r.. provldld.
\(.
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8. Tha alOunt of t.. due IIln. II Is d.hr.lnad by ItUlllphln. the ..ount t...bl. Clln. 6) by the hue rllta IIln. 1).
CLAIMED DEDUCTIONS
PART 3
DEBTS AND DEDUCTIONS CLAIMED,
.j ~
\.'::;
Allowabl. debt. end d.ductlon. Ir. d.t.reln.d aa follo.,.r
.. You II.alh .ra r..ponslbl. for p.vaant, or tha ..t.ta .ubJ.ct to edalnlltratlon by . p.r.on.1 raprll.ntaUva II In.ufflclent
to p.., the d.ductlbla It....
I. You actu.lI., pllld tha d.bt. .fhr dllth of thl d.e.dant and can furnish proof of p..,,,,,,t.
C. D.bts b.lng dale.d au.t b. It..lnd fully In P.rt S. If additional .pac. iI na.dad, u.a plain paper 8 Ill" . U... Proof of
pay.ent .av ba r.qu..I.d b., tha P. O.p.rtaant of R.venue.
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 (717) 787-8327. TDDI (717) 772-2252 (HEARING IMPAIRED ONLY)
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D AA 047888 COMMONWEALTH OF PENNSYLVANIA
NO, DIPARTMINT OF RIVINUI
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
RECEIVED FROM:
.1\t1l.2 u 1'."1
.
fJ
ACN
ASSESSMENT P:'I
CONTROL IiiI
NUMBER
AMOUNT
CLARE M HALL
9:51l?6224
.SS.22
1109 COLUMBUS AVENUE APT S
LEMOYNE PA 17043
'OtOHflf
ESTATE INFORMATION,
I!:'I FilE NUMBER
lIII 21-1993-0466
EJ NAME OF DECEDENT IIAST)
II DATE OF PAYMENT
EJ POSTMAR E
COUNTY
DATE Of DEATH
REMARKS
SEAL
SSN 1S6-24-9631
IFIRST) (MI)
CLARE M. HALL
m TOTAL AMOUNT PAID
.Se..Jre
SK
CHECKlI 2991
(' /., /;/
RECEIVED BY 'A'h", ( J I ,", ,~
IION'~ "v,,
.. / .-/,..4 ,:- /j.~.! ./
MARY C. LEWIS /'/ . , ,T
REGISTER OF WILLS /,' /., r
. ,
REGISTER OF WILLS
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D AA 047887 COMMONWEALTH OF PENNSYLVANIA
NO, DEPARTMENT 0' REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
~~
IIY-U.I..I....I
RECEIVED FROM,
&
ACN
ASSESSMENT I!I
CONTROL IiiI
NUMBER
AMOUNT
CLARE M HALL
951262ea
.185.40
1109 COLUMBUS AVENUE APT 8
LEMOVNE PA 17043
lOIOHflf
ESTATE INFORMATION,
EJ FilE NUMBER
21-1995-0466
EJ NAME Of DECEDENT (lAST)
II DATE Of PAYMENT
EJ POSTMAR
COUNTY
SSN lB6-24-</651
(fiRST) (Mil
DATE Of DEATH
REMARKS
m TOTAL AMOUNT PAID
.1S5~
CW
CLARE M. HALI_
SEAL
(j) / .y
RECEIVED BY / I/fll..;:. (i; j','t'U;/f,_
/1 510N...JURE'"- ~' '. . ,
'.' ./ I":.: ,. '"t.. . .
,/',. "'j'
CHECK" e990
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
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D A A 047907 COMMONWEALTH OF PENNSYLVANIA
NO, DEPARTMENT 0' REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
.
,
'1'1,11" U 14,"1
RECEIVED FROM.
i
ACN
ASSESSMENT P:'
CONTROL ~
NUMBER
AMOUNT
'jiJ---:.------- -----.---------""'"------.-.-~-..,.- ---..,.. ----- -- -- -,-~-~.-.--;--r-
"'1' ... -.\ ,
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DAUPHIN DEPOSIT DK & TR CO
POBOX 2961
Cl5/dqJ.!J05
...<)1
.336.70
HARRISBURG PA 1710~
ESTATE INfORMATION,
~ filE NUMBER
g 21-1990-0466
~ NAME Of DECEDENT IlAST)
~ ENGLISH DOROTHY R
II DATE Of PAYMENT
m POSTMARK DATE
COUNTY Q+q
CUMBERLAND
DATE Of DEATH
SSN 186-24-9601
IfIRST) IMI)
O::l/l?
REMARKS DAUPH I N DEPOS IT BK
ATTN ROBERT L KECK
CHECK" 661111)
m TOTAL AMOUNT PAID .336.70
, ;>>.
"""".;-1/fU,IJI ~
MARY C. LEW
REOISTER OF WILLS
& TR CO
SEAL
REGISTER OF WILLS
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********************************************************************************************************
* P.OI *
* TRANSACT! ON REPORT *
* OCT -06-95 FR 1 II: 05 *
* *
*. DATE START RECEIVER TK TIME PAGES TYPE NOTE M' *
* *
* OCT-02 09:06 99394042 1'20' 2 SENO OK *
* *
********************************************************************************************************
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FAX TRANSMITTAL
FAX # 1/1- 1i"3 -c. /~ l'
TO: ~Dp''hJIIYIDrvJ- $ ROAI~rnILD.
A'ITN:~ ~~
.
~~~~~4- 1,' fJ1j/A~L J LJ~
DATE: /O~ ~ - 9~
CAJ_L (71'1) 240.(j100 FOH ANY INQUlI!IES.
-,
FROM: .~-;-_(~_._
County of Cwnberland
One Courthouse Square
Carlisle, PA 17013-3387
FAX II (71 7) 240.,6490
PAGE ONE OF ~ i
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CDHHOHVULnt Of P[HHSYLYAMU
D(P,,"HVtf OF AEyOtUE
BUREAU Of tHDIVIDUAL f'I[S
KPf. ZlaUI
tlARRlSlURa, PA ITua-OUI
-
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
NO. 21 - tl:I".~ Illl'(.
95122505
05-25-95
FILE
ACN
DATE
CLARE M HALL
APT B
1109 COLUMBUS
LEMOYNE
AVE
PA 17043
TYPE OF ACCOUNT
~ SAVIHGS
CHECKIHG
TRUST
CERTIFICATE
REHIT PAYHEHT AHD FDRHS TD.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ESTATE OF DOROTHY ENGLISH
5,5, NO. 186-24-9651
DATE OF DEATH 03-22-95
COUNTY CUMBERLAND
DAUPHIN DEPOSIT IK I T "u lIrovlded the o.,.rteent .lth the Info....Uon lI.ted bel~ ~lch he. bHn u..ed In cIlcuhU"., the
patent..l tu duo. nwlr ncordl IncUeate that at tho de.th of thI Iibovo dKedant, yo.! were 0 Joint ownorlbeneflcllf"Y of thh KCCM.WIt.
If you feal thle lnfor..tlon II Inco,.r-.at, pl..... obt.ln .rltt.... correction froll ttM flrwnclll In.tlblUon, .ttach . COpy to Uti. fa,..
and nturon It to thiI ~ Mclnll_ Thla ~t .. t-.*'l. In H.""~ "Ith the Inhe,.lUn('e ,.. L..' of the eo-onwealm of Pw'nulv.,i
Questions .., H anrwrM! b, caUI"i (7171 787-an7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account Ho. 0010141936 D.to 09-12-91
Eshblhhed
Account Balanc. 4,726.22
p..c.nt T..obl. lC SO . 000
A..unt Subj.ct to Tn 2,363.11
T.. R.t. lC .15
Potantlal Tax Du. 354.47
PART TAXPAYER RESPONSE
m .., fI!'oI,"!-!"l!,;r~t!l~J'QJ~A;,I1~I.:,J:.%~IILT.t.IH~A!l~,~,IZ,t:.;..;:,I!\,",f'J"A.~.~A~~E,SSI,t~iM~~,),OH,~IS~~~Jc:!.ll
To InfUr. prop.r cr.dlt to your .ccount, two
(2) cop I.. of thl. notice ...t IICco.pen, your
p..,...,t to the Rlght.r of Wills. Hakl u..c:Jc.
plyabla tOI ""RIghtar of WUI., Agent".
NOTEI If ta. pay.entl Irl ..d. wlth1n th,.l.
CS) Mnthl of the dacldent's dlta of .s.a.th,
VO\I .., deduct. !i;( discount of thl tu du..
An, I,..,.dtenc. ta. dul will blcaee d.ll~..,t
nlna (9) .onth. aftar the data of death.
[CHECK ]
ONE
BLOCK
ONLY
A. 0 Th. Move infaruUon and tax due II corr.ct.
1. You e_v chao.. to ,...It pay.ant to tha A.gllter of Willi "Ith blo copl.. of this notice to obtain
. diaco...,t or .vald Inhra.t, or vou alY Check bole "A" and raturn thl. notic. to the RIght.r of
Willa land an official ......~t "UI be IliuM! b, the PA D....rgent of R.v..-NI.
I. IiJ th. .bav. ....t h.. b.en or will ba r.,pGrtad land talC pIIld with the panns.,lvanl. Inherlt".nca Tu ,..turn
to b. fll.d by the dlcadent's ,.epr....,bltiv..
c. 0 The Move lnfo""Uon 1,....J.ncarrect andJa~abtl and dactuction. ...ra paid by you.
You ...t c~l.t. PART l!J endIar PART l!.J below.
If yaU lndlcat. . dlff.rant t._ rat., pI.... .t.t. your
rel.tlan,hip t" d.cedent I
TAX ON JOINT/TRUST ACCOUNTS
OF.~ttAP~USE~ON~~i~~A~'
'tiE~~RTM9l:Tr1(iF.:!~EVEN~p~t;!..
,~~. ~~,~~,,~,.~1;~.~~1..:t:;~~J,;'.':11jt.~j>~:~;':;':(;'.~",~::J~!;~7:.:::~
~~~~~'~'f~':Ii:;:~';:C~~'~1'~~:~,j~'.:.~t.!~J:::'!:~K~;~t!:(i~...~:t;;~Ii~
,. ~~%~~t:t:~t(':\l!~~~;:t,;~~:,;.,~,:P;;t(:;!,~~',:i'X:~'~';1f~~.;:~~:~~:;~l:;J;.,j.:;; ;,
'~~~~~;;.a~;::~.:~:~~~';::;'1(~~:;;}W~~.l;:~:~;~~~:~~~:~i\;N-~:;~,~ '
l~r~~~~~~~~f;.:-~:::,:~~1:"~t~sfa;~!~1:{:4r~~;:[~;.~~.:-:~'.l~:f:ICi;~r.:::;_:.
~~..j:1"~"'" ~,":~i..i'~~n;.l' ':;:~~ "'~~'!(:!;'~:;~!-''''.'f:Jjf.':l.(~:'::i'~::''~''~{~/';
8'o".o\'tY.:-;:.:":"",>",'-~':'::',",.,':.,,,1O".'.'''''.''' ~T"",'l'V;';P':,,"""'-';"h..-,-
~f~' &{~~:1""'.".;,:r;) 'f;t"'''~l'''':'' ?)..~..-"~~ "'41;"'.;j'::.,l'.'~1~-': _......-l" ,
~f:~t;~;,;~.";~;~:::~:~:i':~~:!;;;i,:;i~~;~,;~~~'~~;;:;
PART
~
TAX R!TURH - COMPUTATION
LIHE 1, D.t. Est.bll.hod
z. Account Balance
5. Percent TaKable
4. A.ount Subject to Ta.
S. Debt. and Deduction.
6. A.ount Ta.able
7. T.. Rat.
8. T.. Due
OF
1
2
3
4
5
6
7
8
x
K
DEBTS AND DEDUCTIONS CLAIMED
PART
@]
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Entar an Lln_ 5 of T.. CoftPut.tian)
.
.nd
f.ct. t haye reparted above are true, corr.ct
HOME (7;1) ?.7 7. /.. 'I.J7tJ
WORK ( )
I HntlF NlIMR
.nd b.Uef.
1.>- ~_..,
nj),T~
~';:;
.
DETACH AND RETAIN THIS PORTION FOR YOUR RECORDS
Ale NAME
r.I'~i:UlfH\ !II
No,661118b111 B
11 'F ~ ':,~ \" ~,I ,':1' iJORlJlHY I? ENGl.l f,H
Ale NO,
t ;-;04'1 ',' ,'.h:!,'
Ob/16,.e;'~
D r ~:F'
rp'i
20
(
REMITTANCE AMOUNT
INCOME I PRINCIPAL
,,.j~16,
I
/ :\
.!....
FOR
P~\ [t\!HFH t 1'1',' K [' : ',~ I'r" (I. f I~
:., :.1", ;.j- !'I "J: i ,,' J'r::
il1U'j " n: "l "',J'.,;i,- l fliT,:.f
. ,I I . ~. l
1'...~~lI,',ll 1(1 RI,CEI'.'E II\SCOUI~T
0'" ,,11'11 N r L Y mINED CHf:('I\ ll'W
(\i':r~ 1~1,1~~~0~ fll.t~ 21
! ~'iTh ":. ,. tl, f; ~'.I:". 7:~'''O,;,I'/~'!
- . ~"''''u~-- _. --- -,- --. - -- - - - - _.- - --- - - -- - .-
" .4.......__._..to:t-._
ENI9
o Dauphin Deposit Bank
and Trust Company
--
. tIJt ;
....
.
.
.
.
.
.
.
.
. ..
U,S. POUAOI :,
P.O. BOX 2961
HARRISBURG. PENNSVLVANIA 17105.2961