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tOHHCNWEALTH OF PLNNSTLVANIA
I)[PAATttENT Of AevrlM:
IUR'AU OF INDIVIDUAL TA'el
tepl. IID6D1
HAMAtsIURfl, PA 171U-0601
ESTATE OF MESSINA
FILE NO. 21 95-0484
r /
/ ) .. J / ~ 'I
NOTICE OF INIIERITANCE TAX
APPRAISE"ENT1 ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONs, ANU ASSESSIIENT OF TAX ON
JOINTLY NELD OR TRUST ASSETS
DATI 08-07-95
BRIDGET M DATE OF DEATH 10-31-94
COUNTY
CUMBERLAND
S.S/D,C, NO, 172-18-3943
ACN
951<'6347
JANE A NAGODE
RR 2 80X 486
aROCKWAV PA 15824
REMIT PAYMENT TOl
REGISTER OF WIllS
CUMBERLAND CO COURT HDUSE
CARLISLE, PA 17013
r
AI.unt Rlnlthd
--- -
I
CUT ALONll THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ....
R IV: iSi.-i. iiC .AFp.. f 1'2.:94 Y.. U --. --............ ......... - -... -.. -.. - -.. --. -. -.. - -. -... 'u. -......... -......... -.
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLV HELD OR TRUST ASSETS
DATI 08-07'95
ESTATE DF MESSINA
FILE NO, 21 95- 0484
TAX RnURN WAS,
BRIDGET M DATE OF DEATH 10-31-94
COUNTY CUMBERLAND
S,S/D,C, NO. 172-18-3943
(X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
95126347
FINANCIAL INSTITUTION, FARMERS TRUST COMPANY
ACCOUNT NO,
11- 86299
TVPE DF ACCOUNT, () SAVINGS ( Xl CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 10'21-93
Account B.I.nce
Percent Texable X
Amount Subject to Tex
Debt. and Deduction.
Taxebla Amount
Tax Rata X
Tax Du.
TAX CREDITS I
PAVMENT
DATE
06-22-95
RECEIPT
NUMBER
AA047919
3,403,28
o ..ill...
567,22
,00
567.22
,15
85,08
NOTE, TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAVMENT TO THE
REGISTER OF WIllS AT THE
ABOVE ADDRESS, MAKE CHECK
OR MONEV ORDER PAVABlE TO,
"REGISTER OF WIllS, AGENT."
DISCOUNT (+)
INTEREST (-)
,00
AMOUNT ,PAID
85.08
TOTAL TAX CRIDIT 8s-:-iiif--
IALANCi- OF TAX DU.-----..--.-,..iio....
INTlRIIT '-.--."0- .,. :00-
TOTAL DUI ,00
IF PAID AFTa:R THIS DATE, seE REVERSE FOR CALCULATION OF ADDITIONAL iNTEREST. . - --.-- ..--- ,"H_'.
( IF TOTAL DUE IS LESS TNAN II, NO PAYHENT IS REQUIRED,
IF TOTAL DUE IS REFLF.CTED AS A "CREDIT" ( CRI.1 YOU "AY BE DUE A REFUND,
SEE REVERSE SIDE OF THIS ~ORH FOR INSTRUCTIONS, I
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NOTICE'
TD fulfill thl requlr.-.nt. of Slot Ion 2140 of the Inhlrltencl and E.tltl TI. Aot. Aot 22 of 1991. (72 P...
Seollon 21~O),
PAYltEN1'
o.tlCh thti top portion of thh NoUe. 1M .ubIllt with YQur pIYllnt to thl Relltter of W11l1 printed on thl
r.vlr.. .Ide.
... Hike check or .onlY order p.Ylbh tOI REGISTER OF WILLS. ACENT.
All PIY.."h recllv.d .h.ll flr.t bl .ppU.d to any Interllt ..hich .IY b, due, wUh .nv rt..lnder appllld to thl tAx,
REPl.llIl (CRlo
A refund of I hlC oredlt, whlch WII not reqUl.ted on thl tlx return, eay b. requllt.d bv co~l.Ung an "Applloatlon
'or Refund 0' PtM.vlv."l, Irmrltlnes and EttU. TIIC" (REV~13U). AppllcIUon. Irl IVIUlbll at thl OffiCI of
the RI,I.ter of WUlI, any of thl 2S R.vlnu. Dlstrlot Offlc.. or by cIUlnl the 'Plell1 14.hour tn.WlrlnG ..rvlcl
nutbert for far.. ordering I In Plnn.vlyanll 1-aOO.3U.2OSC, outtlde P.nn,vlvlnl. lod within 10cII
H.rrl.bur, Irla (717l 767-809., TOOl (717) 772-2252 (Htlrl~, t~llr.d Onlv).
OIJECTIONSI Anv Plrty In Intlr..t not .atl.fltd wJth the IPPr.l.e5Int, .llow~. or dl.lllo..lnc. of deduction. or ........nt
of hlC (InclucUng dllcOi.,t or InttrllU II ohown on thll Notlcl '.y Object wUhln .lxty (60) d.y. of r.nlpt of
thlt NotlCI bYI
-~wr1tt'" prot... to the PA Dlplrt.tnt of Atvenu., Board of ApPllh, O.pt. 211021, Hlrr1sbur" PA 17120-1021, OR
....l.otln. to haYI the "tter dtttrelntd .t the .udlt of tM account of tht Plrsonl1 rlflruentttlv., OR
~.Ippell to the Drphtn.' Court
AIlIlIN-
IITRATlYE
CDAtIt!ClIOHII
Faotul1 .rror. dJ.cov.rld 0" thl. a.......nt .hould be addr...td In writing tOI PA aePlrt.ent of RtYonut.
lur.1U of lndlvldull TIM", ATTNI Po.t A.....eent AlvJ.w unit, DEPT. 210601, Harrl.bur" PA 1712&.0601
Phone (717) 7'7~6505. See Pili S of thi bOGkllt "In.tructlon. for Inh.rJt.nel Tlx Aeturn for I R..IOtnt
Dlc.o.nt" (REY"1501l for an IxplanlUon cf IdlIlnhtrttlvllv corrtctlblt "rOrt,
OIlCCUlT I
If '"~ tlX due 11 p.ld within thrll (3) ~.ltndtr lonthl Iftlr th. dlcldlnt', dllth, . flvl p.rolnt U;o
discount of thl ttlC Plld I. IUowsd,
INTEREST ,
Intlr..t I. chlrged beginning with flr.t dlv of dlllnquencv, or nine (,) IOnth. end onl Cll d.v
frOM the det, of'dI.th, to the det. of Plyalnt. TaICI. which beel.. dlllnquent blfore Jenulrv I, 1912
beer Intlrllt It thl rat. of .lK (6iO plrclnt plr ~ cllcullt1d It I dlUy rat. of .OOOI6~.
All tlMII which btc... dlllnquent on or Ifter Jenutry 1, 1962 wll1 bltr Intlr..t lit . retl which will YlrV frOll
clltndtr v..r ta oal.nd.r y..r with thlt rlt. announced by thl PA nlPlrtelnt of Rlvenue. The appllcabll
Int.r..t r.t.. far 1912 through 1995 ar~l
Y.w Interllt Aat. Oallv Intare.t Flcter Y.w Intlrut Rat. n,llv Inter..t Flotor
1"1 IU ,00QlU 1961 9l ,000141
19U I'~ ,000031 1911-1991 m ,000101 Ji'
191~ III ,000301 1991 9l .nOOU7 .
1915 U~ ,000356 1991-1994 II ,000192
I'" IOl ,ooom 1995 9l ,000141
.~Jntlrllt I. clleul,t.d I' f~l1awlI
INTEREST a BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
~.Any Hotlee I..ued ,ft,r the t.x bleoel. dlllnquent will refltct an Int.re.t c.lculltJon to flft.1n (15) d.y.
beyond the d.tl of the ........nt. If p.~t I. tedt Ift.r thl Intlr'lt co~utltlon dltl .hown on tht
NotlcI, 'ddltlonal Intertlt .u.t bl ctleul.ttd.
~EV-1548 EX AFP (12.94.
COHMONWEALTH OF PENNSYLVANIA
DEPARTHENl OF REVENUE
BUREAU OF INDIVIDUAL TAMES
DEPT. Z80601
~'RRlSBURG, PA 11128.0601
/1) -1//- '-I
~
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONs, AND ASSESSHENT OF TAX ON
JOINTLY HELD DR TRUST ASSETS
DATE 08-01-95
COUNTY
CUMBERLAND
ESTATE O~ MESSINA
BRIDGET M DATE OF DEATH 10-31-94
FILE NO, 21 95-0484
S,S/O,C, NO, 172-18-3943
PATRICIA E REPINE
RR 2 BOX 486
BROCKWAY PA 15824
ACN
95116348
REMIT PAYMENT TOI
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 11013
Aoo~t '~~~~~~~~':J
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-v:i54-s.KX.-AFji-fi1f:94i-....-.......--------------------------.-------------.------..--...-......--...-..-.
NOTICE OF INHERITAN~E TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSET8
DA TI ...l!J.:U 7 " 9 5
ESTATE OF MESSINA BRIDGET M DATE OF DEATH 10-31-94 COUNTY CUMBERLAND
AON
9512U48
FILE NO, 21 95-04R4
TAX RETURN WAS,
S,S/D,C, NO. 112-18-3943
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION, FARMERS TRUST COMPANY
ACCOUNT NO,
11-86299
TYPE OF ACCOUNT, () SAVINGS (Xl CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 10-21-93
Account Balance
Percent Taxable 1-
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
3,403,28
0,166
561,22
,00
561.22
,15
85,08
TAX CREDITS:
PAYMENT
DATE
06-23-95
RECEIPT
NUMBER
AA041929
DISCOUNT (+)
INTEREST (-)
,00
NOTE, TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WIllS AT THE
ABOVE ADDRESS, MAKE CHECK
OR MONEY ORDER PAYABLE TO,
"REGISTER OF WillS, AGENT,"
AMOUNT PAID
85,08
TOTAL-fAXCREDXTT
8ALANOI OF TAiniul
-~----_.._._~---
INTlRUT
--'--'-'-'-'
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDlTiON~CfNTtiiEST:T ,..........1._
C IF TOTAL DUE IS LESS THAN fl, NO PAYHENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR I, YOU HAV BE DUE A RefUND,
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
.
85.08
,00
.00
,00
(")Q
~'(\l
:> ,.
"
,
.
\("1
",
:tJ
:T1({\
"'1:',
"
E: ,
Cd
I
(11
,
. (II
)" -'-
,
, I
(Ii (',
'':-:>
.~
PUIlPOSE 01'
NOTICE I
To 'Idflll the r.qulr...ntl of S.otlon 2140 of the Inh.rltancl and Eltat. Tax Act, Aat 22 of 199:1. ,<72 P,S.
S.otlon 2140),
PAlIlENT,
O.tleh thl top portion of thl, Hotlo. and .ubllt with your Plv..nt to the R.gl,t.r 0' Will, prlnt.d on the
r.v.r.. lid..
~. Mak. chick or .onlV ord.r payablt tal REGISTER OF WILLS, ADENT.
All ply..nt. rec.lv.d .h.l1 flr.t b. applied to any Int.r..' which .IY b. dUI, with any r...lnd.r appll.d to the t.M.
REFUND (CR II
A r.fund of . tllf crldlt, which WII not requllted on the till r.turn, laY b, r.qullt.d by cOMpl.tlng an "Appllolltlon
for R.fund of Plnnsvlvanla Inh.rltancl and E.t.t. TaM" IREY-1313), Application. art Ivftllabl, at the Offlo. of
thl Rlal.t.r of Willi, any of thl 2' Rav.nu. DI.trlct Dfflc.. or bv calling the 'Plclal 2~-hour enlwtrlng ..rvlcl
nueblrl for for.. ord.rlngl In Plnnavlvanl. 1-&00.362-2050, out,ldl Plnnlylvanl. and within 10cII
H.rrllburg ar.. (111) 711-1094, TOOl (717) 772-2252 CH.arlng IIPalr.d Onlv).
OIJECTlONSI Any p.rtv In Intlrut not utltflld with thl uPflrahantnt, allowancl or dlllllowlncl of dlduotlonl or a.......nt
of tWIe Clnoludlng dhcount or Intlrut) a. .hOWl on this Hotlcl .IV objlct within IIlety (60) diU of rlcllpt of
thll Motlol bYI
-.wrlttln prottlt to thl PA OIPartllnt of RIVenu., Board of App.als, DIPt. 2UOU, Harrllburg, PA 11128-10U, OR
-.lllotlng to havI thl ..tt.r dlt.r.lnld It the audit of thl aocount of thl plr.onll rIPrt.lntatlvl, OR
.-apPI.l to thl Or~hlnl' Court
ADMIN-
ISTRATlYE
CDflRECTlDHS.
Factual Irrar. dllcov.r.d on thl. ........nt .hould bl .ddr....d In writing tOI PA O'Plrt..nt 0' R.v.nuI,
Iur.., of Individual TIICII, ATTMI Po.t A"'II.ent Rlvlaw Unit, OEPT. 2'0601, Hlrrllburg, PA 17128-0601
Phont (711) 787-6505. SII p.gl 5 of thl bookllt "In'truotlen' for Inhtrlt,nc. TalC R,turn for I RI.ldent
Olcedlnt" (REV-ISOl) for an IlCplanatlon of ad.Jnlttratlv.ly corr.otlbl. ,rror..
DISCDIMT I
If any tllC due I. paid within thr'l (3) cal,nd,r .onthl Iftlr the dlc.dlnt's d'lth, a 'Iv. p.rn.nt (5X)
dl.~ount 0' the talC Plld II allowld.
INTER1!STI
Interllt 11 charg.d blglnnlng with first dlY of dlllnqulnoy, (lr nlnl (9) 101lth. and onl (1) dlY
frol thl dati 0' death, to thl d.tl 0' ply..nt. Tax., which b.oa.. d.llnqu'nt b.for. January I, 1982
bl.r Inter.,t at thl rate ef .IIC (6~) p.rclnt per ftnnu. cllculatld at . dallv rltl of .000164.
All telC" which b.ol" dlllnqulnt on or ,fter January 1, 1982 will blar Jntlr..t It . rltl which will vlry fro.
olllndar Ylar to caltndar Ylar with that rat. IMMounold by th. PA DIPart.ent of Rlvlnut. Thl applloabll
Jnter..t r.t.. for l,aZ through 1995 artl
'tur Intlrut Rltl Dill" Inter..t Faotor :r:ur IJlUr .u.L..BLII Olllv Interl.t Flctor
1912 m ,ODOS41 1917 9X ,OD0247
1913 16X ,OD!4!1 1911-1991 1IX ,ODOJDI
1916 lIX ,ODOJOI 1992 9X ,000267
I9IS lJX ,ODOJS6 199J.lm 7X ,000192
1916 lOX ,OD0274 1995 9X ,000247
"Inttrllt II cllcullt.d .. followlI
INTEREST . BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlel I,.uld after the tllC blCo", dtllnquent will rlfllot an Inttrl.t e.lculatlon to flft..n (IS) dlYI
blvond thl d.tl of the ,.......nt. If PIV.ent I, .I~' Ift.r thl Intlrl.t cQlPUt.tlon dati .hown on the
HoUCI, eddltJonll tntertlt _u.t be Cllcull~.d.
15 ~ '-/;-'1
\
V
RIV"1541 IX AFP (12"941*
' COHHOHlIUI TH OF PENNSYlvANIA
DEPARTHENT Of REVENUE
IUREAU OF INOlvlOUAl TAXES
DEPT, 110601
HARRISIURG, PA 17121-0601
NOTICE OF INNERITANCE TAK
APPRAISE"ENT, ALLOMANCE OR OISALLOMANCE
OF DEDUCTION , ANO ASSESSMENT OF TAK ON
JOINTLY HELD OR TRUST ASSETS
I DATI 08-07-95
ESTATE OF MESSINA
BRIDGET M DATE OF DEATH 10-31-94
COUNTY CUMBERLAND
FILE NO. 21 95- 0484
S,S/D.C. ND, 172-18-3943
ACN
95126349
JANE A NAG ODE
RR 2 BOX 486
BROCKWAV PA 15824
REMIT PAVMENT TOl
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 11013
Amollnt R..Utl.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...
ilIv: Hiltli-EX "AFji -iiz: 94"1" - - - - - - - -- - -- - - - - ---- - - - - - -- - - -- - - - - - - - - - - --.. - - - - -- - -- - - -- - - - - - ---- - - - - - -.. - -..., - - - --
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLV HELD OR ,RUST ASSETS
DATE 08-07-95_________
ESTATE OF MESSINA
BRIDGET M DATE OF DEATH 10-31-94
COUNTY CUMBERLAND
FILE NO, 21 95- 0484
TAX RETURN WAS,
S,S/D,C, NO, 172-18-3943
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
95126349
FIN~NCIAL INSTITUTION, FARMERS TRUST COMPANY
ACCOUNT NO,
12-14411
TYPE OF ACCOUNT I () SAVINGS (lO CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 09-15-94
Account Balance
Parcant Taxable X
Amount Subject to Tax
Debta and Daductiona ;
Taxable Amount
Tax Rata X
Tax Dua
4,021,39
0,500
2,010,.lQ....
,00
2,010,70
,15
301. 61
NOTE. TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAVMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS, MAKE CHECK
OR MONEV ORDER PAVABLE TO,
"REGISTER OF WILLS, AGENT,"
TAX CREDITS:
PAVMENT
DATE
06-22-95
DISCOUNT (+)
INTEREST (-)
,00
AMOUNT PAID
301,61
RECEIPT
NUMBER
AA047919
L
301. 61
,00
,00
,00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTlREST
TOTAL DUE
. IF PAID AFTER TNIS DATE, SEE REVERSE FOR CALCULATION OF ADDITioNAL INTEREST, ·
( IF TOTAL DUE IS lESS THRN 11, NO PAYKENT IS REqUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRI, YOU KAY SE DUE A REFUND,
SEE REVERSE SIDE OF TNIS FORK FOR INSTRUCTIONs, )
PURPOSE Of
NOTICE,
PAVItEHT,
REFUIID ICRI,
To fulfill thl requlr...nt. of SteUon 2140 of thl Inhtrlhnc. 'and Elt.t. rlx Aot, Act ~2 of 1991-. (72 P.S.
"ollon 214D),
Ottlch thl top portion of thlt Notlcl ,nd SUbMit with your Ply..nt to thl Rlgl,.,r of WII!I printed on the
I,.v.r.t .Id,.
-" Hike thick or .onlV ord.r Plv.blt tOI REGISTER OF WILLS, AGENT.
All PIV.."t. r.o.lvld 'hill flr.t bl appllld to any Int.r..t which .av bt dUI, with any r..alnder applied to thl tlM.
. r.fund of . 'IM orldlt, which wa. not r.quI.tld on thl taM r.turn, .ay bt r.qulttld bv oOlpletlng In "Appl1cltlon
for R'fund of Plonlvlvanla Inherltanol Ind Elt.t. raM" (REY.131~). Applloatlon. ar. Iv,llable at thl Offlc. of
thl RI,I.t,r of Will., any of the 23 ReVlnul 01.trlot Offlc..or b~ calling thl IPlolal Z4-hour anlwlrlng ..ryle.
nUlb.r. for forA' ord,ringl In Plnnl~lv.nla 1-800-362-2050, out,idl P.nnlvlvonla and within 10011
Htrrhburg .r.. (717) 717-8094, TOO' (717) 772-Z25Z (H..rlng r.palrad Only),
:0
:-:OW
C' ('l
;! ,
'I
(/J (,
OIJECTIONSl Any p.rtv tn Intlrllt not .ltl.f1td with thl apprat....nt, allowanCI or dl.allowanct of d.ductlon. cr a.......nt
of tllC (lnoludlng dltcount or Intlra.tJ II .hown fin thl. Notlcl .,~ objlot within .htv (60) dan of r,cllpt of
thlt Notlcl bYl
--written prot..t to thl PA Dlpart.lnt of R.vlnu., Board of APPllll, Dlpt, Zal02l, HarrhblJrg, PA nua-lOU, OR
--lllotlng to hlv, the .attlr d.tlr,ln*d at the audit of the Icecunt of the p.rlonnl rlpr...ntatlv., OR
--apP'II to the Orphln.' Court
ADHIH-
IITRA liVE
CORRECTlOfIS.
DlSCDUltT'
J'HTERfIT I
Factual .rror. dl.oov.rld on thl. I.......nt .hould b. .ddr....d In writing tOI PA Dlplrt,.nt of RIVlnu.,
lurllu of Indlvldull T.IC.., ATlNl Po.t A.......nt Rlvllw Unit, OEPf, 230601, Herrltburg, PA 17128'0601
Phone (717) 717-6505. SI' page S of the bock let "In.truotlon, for tnhlritancl TalC Rlturn for a R'lldGnt
Olo.dlnt" (REV-lSOl) for an IlCplln.tlon of ad.lnlatr.tlvllY corrlot3bl. ,rror.,
If InV tlIC du, II Plid Wlth!'l thr.. (3) callnd., tonth. IIft,r the dlCtdlntl. duth, a flv. perotnt UX)
dllcount of the talC Plld I. allow.d.
Intllrlll It chargld blglnnlng with first da~ of d,lInqutnc~~ or nlna (9) tonth. .nd on. (1) dav
frol the d.tt of d.ath, to the dltl of paVllnt. TaICI. which ~Ioall dlllnqulnt blforl Janulry 1, 1912
bl.r Int.rl.t at the rltl of Ilx (6%) ptrClnt p.r ennui oaloullted at . dailY rate of ,000164,
All tlk.. whloh blo... d.llnqulnt on or a'tlr January 1, 191Z will btar Intlr'lt .t I ratl which will varv fro.
elllnd.r v..r to olllndlr Ylar with that rat. announcld by thl PA OIPart.lnt of Rlvlnul. Th. appllelbll
tnt.r..t r.tl. for 1982 through 1995 arl'
Y.w Intlr..t ~Ih Dallv Intlrl.t Facter Xu! Inhrl.t Rltl Oallv Intlrllt Flater
1911 !OX ,ODDS48 1917 'X ,000247
I'U lU ,ODD438 1.81-1991 lIX ,000301
191\ llX ,000101 1992 9% ,000247
1.11 m ,00nS\ 1995.1991 7X ,0001'2
1916 lOX ,000274 1995 9% ,000241
ulnterut I. alloultt.d .. folloWl1
INTEREST . BALANCE OF TAN UNPAID N NUHBER OF DAYS DELINQUENT N DAILY INTEREST FACTOR
uAny Notlel IIIUld efter thl tu blcoe.. d.lInqulnt will refhot In Inter..t ClIloullUon to flftlln US) dlV'
b.yond- th, dltl of thl ..t.....nt. If Ply..nt It ..da Ifter the Inter..t COlput,Uen date .hown on thl
NoUel, Iddlt10ntl Internt IUlt bl oaloullhd,
..; ~. ,.. .... ~. ..., .... . - .~
......__.___ ____ _..... __._ ___._ ...._..... _.,;,. ~.h_____. ....._...._.._ __.._..___._......... .._~ __ _.. _._.__..~_._.___ ___.__ _ __.__
U" 'AA 047929 COMMONWEALTH OF PENNSVLVANIA
.No. ' , DI'AaTMINT 0' ..VINUI
"~1I'" ..,...., : OPPlCIAL IIICllfIl' . I'INNIYLYANIA INHIIUTANCI AND ISTAYI TAX
==---
'*
" .
,
RECEIVED FROM,
B
ACN
ASSESSMENT I'!'
CONTROL I.:iI
NUMBER
AMOUNT
PATRICIA E REPINE
RR e BO)( 4Bb
'10 1 I:!b;:l,+e
_"'::I. Uti
9!51 2b3!lO
U01.bl
BROCKWAY PA 1!5B24
'OIOHf~'
seN 172-19-3943
IFIRST) (Mil
REMARKS
m
__~3S6.b9
PATRICIA E REPINE
SEAL
CHECK4I b3 HI
REGISTER OF WILLS
MARY C. l.EWIS
REGISTER OF WIl.l.S
.--.......-.---......- ---.,- .--.--- -.'---,-" -.---- ..... ..- -. -- ..-.- ..-..- -----.-.-.- -...... ..- -.-........ -"'-r-,'--"-- - .
"
.\
"
,.,
.).
/
"
. ,-' '.
... - f _Ir~""""
-.-....... ---';,~"~.J.JII ~ -~f-"',:-'l,
I'
J,
'l' - ,
I
\
RI!Y-1543 I!X AFP (8-94) '*
COttHOHWEAl TH OF PEHHSVLYAHIA
DEPAR1HENl Of REVENUE
IllIlEAU Of INOIVIOIIAL TAXES
DEPl, 110'0 I
HARRISBURG, PA 171ze.a601
f',-- '/ / 'I
INFORMATION NOTICE
AND
TAXPAVER RESPONSE
FILl!
ACN
DATI!
NO. 21- 9r.
951263(,9
06-13-95
TVPE OF ACCOUNT
~ SAUINOS
CHECKIN~
TRUST
CERTIFILATE
ycff
ESTATE OF BRIOGET M MESSINA
5,5, NO. 172-18-3943
DATE OF DEATH 10-31-94
COUNTY CUMBF.R~AND
MM JANE A NAGODE
RR 2 BOX 486
BROCKWAV
PA 1587.4
RENIT PAVNENT AHD FORNS TO.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
fARMERS TRUST COMPANY hili provided thl Doped.,nt with the in'or..tlon lilted below which hit betn ul,d In cIlculltJng thl
potlntl.1 hllle dUI. Th.lr r.cord' Indlcat. thllt lit thl death of the above dlCldlnt, yoU wlr. a Joint owntr/bf,nlf!ohry of thlt ICCOunt.
If you '..1 thll Inlorlll1o" II Incorrlot, pin.. obhln wrltt.n corr.otlon frol thl f1nanchl In.tltutlon, "Uach . copy to thh for.
Ind r.turn It to thl ,bov, .ddr.... This Iccount 11 taXlblo In accordanol with thl InheritancI Tal( L,WI 0' thl CODllonw..lth of PIMlylvantl.
:'~.....~.lr._ ;.....~~.. ......~..;,!..~ ....1::,. (11;0: i':li' ~:',..',
COMPLETI! PART 1 BI!LOW M
Aooount No, 12-14411
M M SEE REVERS I! SIDI! FOR FILINQ AND PAVMENT INSTRUCTIONS
D.t. 09-15-94
E.tobllohod
To Inlurl prop.r cr.dlt to your account, two
(21 crpil' of thll noticl IUlt 'CCOIP.ny ~our
PIye.nt to the R.gllt.r of Will.. Hek. chick
pIyabl. tOI "Rlg!lt.r of Will., Ag.nt",
Account a.1anc.
P.rc.nt r.x.bla
Anount Subjlot to
Tax Rata
Potlnti.l TI. DUI
4,021,39
50,000
2,010,70
,15
301,61
--
TAXPAYER RESPONSE
FAILUAI TO RISPOND WILL RESULT XN AN OFFICIAL TAX ASSISSHIMT BASID ON THIS MOTICI
K
HOTEl If talC PI'II.ntl ar. .ed. within thr..
(3) .onths of the dlo.dlnt'l detl of dleth,
'IOU ley d.duot a S% d1scount of the tllC du..
Any Inh.rltenc. talC due w1ll blco.. delinqu.nt
nine (9) .onthl efter the d.t. of dllth.
T..
K
PART
m
[CHECK ]
ONE
BLOCK
ON LV
A. Th. abOVll Infor'IUon and talC due h oorrect.
'Iou "'I cho'J" to relit pay..nt to the R.ahhr of Willi wlttl two copl.. of thlt noUc. to obtain
. dllcount or avoid Int"ut, 01' YOU uy ohlck bOlC "A" and return thl, notloe to thl Rlllhtlr of
Will. and fin offiolal 11I.....nt wHI b. luuld by thl PA Dlpart..nt of Rlvlnue.
a. 0 Th. IIboVI allet hit bltn or will b, reported and till paid with thl PIMlylvanl, Inh"ltenCI Tu r.turn
to be fllld by thl dlc.dllnt', repr"lntatlv..
O no . -"
C. Thl abnv. Infor.atlon l~ncorrect and/or dlbt. end dlductllln, wer. pd, 6)' you. \ '. "1 ;-1'
'Iou IUlt cOIIPI.t" PART l!J and/or PART m bllow. . ' \ "
1
2
5 X
4
5
6
7 X
8
rAt
1
2
3
II
5~
,
7
8
DEBTS AND DI!DUCTIONS CLA~
OFFICIA~USE ONLY 0 AAF
FA DEPARTHERT OF REVENUE
~
-
If you Indlc.t. a ~iffar.nt t.x r.t., pl.... at.t. your
r.l.tion.hip to uloodont,_
PART
~
T~.;': P.!TU!!P-! .. ~O~~UT..'f'!'!t'~!
LINE 1, D.tl E.tobli.h.d
2. Acoount B.l.noa
3. Parc.nt Tlxable
4. Anount Subjlot to To.
5, Dlbt. .nd Plduotion.
6, Anount To.obll
7, fa. Rata
a. Tax Cu.
OF T.^.X Q~ JO!t-!T.'TnUST .^.c~~u~r!,g
::;{.
'..'
(," ,":"
-'" '
J,.;.+
~J.,
,''')
PART
f!]
DATE PAID
PAVEE
DESCRIPTION
AMOUNT PAID
I I
TOTAL IEntlr on L1nl 5 of T.. ConputaUonl .
Undlr p.n.l Un of plr jury, I dlolorl th.t the ,..to I
ooopllt. to the blot of .y knowl.dgl ond blli.f,
]6"P~VEftiGNATU(~Lf"' ~-
hlY. r.port.d abov. are truI, Darrlat .nd
HOME (717 l ,;Llt'S"r1/
WORK (71 7 ) ". Ie ;? r (0
TELEPHOflE NUMgER"
(. . u/";' 1-'
DATE
GENERAL INFORMATION
1, ~AILUNE TO NES~OMO WILL MESUl T 1M AN OfFICIAL TAX ASSESS"ENT with ....lI'.bl. Inl.,OII b.... on Inf"NUon
1\AHlltted by the flnlllOJ,l InltStutton.
2. Ihhlr1t~. 'IIC bICOM' deillnq"lnt nlnt I'mthl ,ft,r the dlClltdent'. dlt. 0' duth,
J. A Joint ICOount II taxablt Iven though tht dlcedlnt" n... ..II IckMd .. . ..tter 0' oonvenlence.
~, AoclMM1t, (lnoludlng thou hlld batlil"n hulbend end wlft) whteh thl dte.u.nt put In j01nt n.... within one V'" prior to
death Ir. 'l,IllY '1.lIbl, II tr.",fln.
.. Ar.cOl.W1\' IItlblhhed Jolntlv between hulb.oo w wlh.ore thin one yur prior to d,.th ar. not '.ubl,.
., Aooounll held hv I .fc*'lt "In trult for" Inother or othtre Ir. hubl, fully,
REPORTING INSTRUCTIONS - PART 1 - TAXPAVER RESPONSE
1. ILO(K A . If thl Infor..Uon and COlput,tlcn In thl tlotlCI ." oorrlo\ Wld deduotiona ,r, not being cl....d, plM' In "I("
In block "A" 0' Plrt I 01 thl "TIMP'YIr AIIP6nII" ..otlon. Sign two cClpl.. and IUb'" the. with your eh.ek for thlt MOUnt of
t'M to thl R..I.tllr of Will. of thl county Indh.:at.d, 'h. PA O.p.rt..nt of R.v.nu. Mill I..u. In offlol.1 .....Mlnt
(For. REV-1S4. EIU upon r'Cllpt 0' th. r.turn froll th. R.ght.r 0' Willi.
2. ILOCI( I . If th. ....t IPltCllfiad on thll natle. hu bun or will b. rlPort.d and tax Plld Mlth th. P.nnlylvllll"ll. Inhtrlttlne.
hM R.tlJrn fl1ld by th. dec.dll'lt'l rlprlllfltatlvl, pile. In "Kit In block "I" of P.rt 1 of ,he "flMP'VIr RIIPonll" ,ectlon. III." OM
copy and r.turn to th. PA Dapart..nt 0' ReYlnll" lur'lu of Indlv.ldull Tall", O.pt 210601. H.rrhburg, PA 17UI.0601 In thl
tnv.lope provided.
5. aLOCK C . If thl not It. Infor..tlon I, Ineorr.ct Ind/ar dtduot.lan. .rl b.ln~ tlll..d, chick bleck "C" end co.,I.,. P.rtl 2 .nd 5
Ilecordlf\lJ to th. In.trUCItlcl" blloN. Sign two copl.. Ind lub,lt th.. with vour chick for the ."ount of ttM p,vabl. to the RI,lIhr
of Willi of thl cnunh' Indl",.t.d. 'h. PA O.p,rt..." of R.v.nu. will Inu. In o"lcl_1 ........nt (for. REV-U~' EK) upon "Cllpt
of tht r.turn fra th. Alghtlr of HUll.
TAX RETURN . PART 2 . TAX COMPUTATION
LINE
I. Ent.r th. d,t. the account orlglnlllv WII .Iteblt.h.d or tltlld In th. lannlr t~l.tlnD at dat~ ef dtath.
HOTEl For I deo.dlnt dying Ift.r 12/IUUI f,eeounh which thl d.c.d.nt put In Joint n.... within ani (I) Vtllr "f d..,th Irl
tlMtbl1 fully II trln,"rl. How,vlr, thlr. It In uolullen not to 'Mcnd '3,000 plr t"n.ftr" ,.lglrdl..1 of thl vllul 04
thl tooount or th~ nuab.r e' Iceountl h.ld.
If, Wubll IIt'rllk (Mill) IPP"", b.forl vour lI,..t nl" In th. .ddr... portion of thll notlCI, thl n,ooo 'MolullDr'l
.Ir'td~ hi' b.tn d.duot.d 'rol th. Icecuot hllanc. It rlportld bv th. flnanetll In,tJtutlon.
2. Ent., thl tot.l b.hne. of thl Iccouot Including Inttrut aet-ruld to thl dlh of d.,th.
S. Tht ptrcent of \h. Iceount thlt 11 tlll'abl. for IIch .urvJvor II dtt.,.l.ln.d II follow.:
A. ThI ptrc.nt tlMebl. for joint IIlIt. IItllbllshtd lort thWl on. Vllr prior to tht d'lltdent'l d..thl
I DIYIll(D BY TOTAL ~BER OF
JOINT OWNERS
EM.,III A joint ....t rlGht.r~
OIYIll(D BY TOTAL ~BER OF , 100 - P€RCCNT TAMABLE
SURYIYINO JOINT OWHERS
In thti n... 0' thti dlClldlnt and two oth.,. p....onl.
I DIYIll(D BY ] (JOINT OWNERS) DIYIDEO BY 2 (SURYIYORS) - ,161 , 100 - 16,ll (TA'AILE FOR EACH SURYIYOR)
I. TM p.rclnt tlM,bll for ....t, Qr..ttd within on. vllr of the dle.d.nt'l dnth or accounts oNllld bV the dtctdtnt but held
In trult for another IndlvldulUI) (trUlt blnt'lcllrlll)1
I DIYIIlED BY TDTAL HUNIER Of SURYIYING JOINT '100 - PERCENT TA'AILE
OWNERS OR TRUST IEN€FICIARIES
EM..,III JoJ~t looount r.g.llt.rld .In thl n... c' thl dle,dent and tMO oth.r p.rlonl and 'Itlblllhed within one V.I" of d'lth b~
thl dteedent.
I DIYID€D BY 2 UURVIYORI) - ,50 , 100 - SOl (lA'ABLE FOR EACH SURVIVOR)
4. The MOl.W1t .ubjtot to tlX (ltn, 4) I. d.t,relnld bv .ultlpl~tng the Iccount bllancG (lInl Z) bv thl Plroent tlMabll UIM J),
S. Enter thl tot.1 of thl debtl Ind dtduotlonl IlIttd In Part S.
b. lhe ..aunt ttMIb!' IUne 01 II a.urlln.a bV .Ubtrlotlng tn. 0'0\1 ana dlOUelJetll UUII )1 trOll tOi.l allou"t lUOJKt to tu (liM 'U.
7. Entlr the IPProprht, tlM r.t. (Un. 7) II d.tlr.ln.d bllow.
A. For d.tl' of dtath ocourrlng I'"r 6/S0/94, tht tl~C ratu for trln.f.,.. to IpaUII. ara ,. fOUOMIl
1. Datu of dllth on or .ftlr 711194 .net b,fo,.. 1/1/96 th. rat. It 5%.
I. O.tll of dMth on or 1ft.,. 1/1/96 and b,fort 1/1/97 thl rat. II Z~.
S. Oltll of d.lth Ofl or I'ttr 1/1197 Mld b.fort 1/1/91 thl rat. II 1i(.
4. Dltll of dt,th on or Ift,r 1/1191 tr."lflrt to tpou", will b. IlC,npt frol t'M.
Hate I For datel of d"th prior to 711/94 trwlIft,.. to t~OU'" Ir' \aMabl. It 6:(.
.. TrlMlf.r' to lIn..l dllOlndtntl Inoludlng "thlr, lothtr, .on, dauohttr, DrtndehlldrfM'1, .on.ln~IMl,
deuthttr"ln-hw, ,tlpehlld and thllr luu. I" tnabl, ,t tlM p.ro,nt (6iO.
C. Trll"llflra to .11 othlrl Jncludl~ broth.r, Ihur, unci., 'lXIt, neflh.w and nl.e. I,.. \lI(IQII ,t flft,en PlrcfM'1t UU).
O. If vuu c:h8nOe thl hM rlt., pi.... IP'oHv veur r.Lntlon'hlp to th. dludent In thl er.. prevldtd.
.. TM ~t of tll( due (lIn, 11 It d.t.ralned bv IUlt1phlng tM NOunt tll(tbh (11M 6) bv the tlM rttl (11M 7).
CLAIMED DEDUCTIONS - PART 3
DEBTS ANO DEDUCTIONS CLAIMED
AlIowabl. debt, and deduction. Ire tt.ter'lned II 'allow. I
A. You I..alh .,.1 rllponllbll for p,)".nt, or thl utltl lubJlet to ed.linlttratlon bv . plrsonll r.prll."tlltlyCl II In.ufflClJlnt
to PIV the> dtductlb1t 1t.1I.
a. You .0tullIv PIJd th. debt, Ifter dllth of tht d.o.dlM'lt and c.n furnish proof of PIV...,t.
C. Debts btJng cllJHd ItUtt bt It..lud fulh In P.r' J. If IddJtlonl1 tPIC' .It ntttt.d, un ph In ptp.r I 1/2" M 11", Proof of
plvHnt .1)' bI r,ql.Mltld by thl PA O.pert..nt of R.vlOUl.
TAXPAVER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE. CONTACT ANV
REGISTER OF WILLS, fA DEPARTMENT OF REVENUE DISTRICT OFFICE
. OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAVER INQUIRV UNIT IN
HARRISBURG AT (717) 787-8:527, TDDI,<(717) 772-2252 (HEARING IMPAIRED ONLY)
,,":1: .
RIV-U43 IX AFP 18-941.
COHHOHWEAllH OF PfHHIVlVAHIA
Il[PAATHt:Nf Of REVl'HO<
IURfAU Of INDIVIDUAL IAMfl
Il[PT, 110601
UARAIIlUAQ, PA 1112'"0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATI
NO. 21- 9.5; t,/lftj
95126347
06-13-95
ESTATE OF BRIDGET M MESSINA
S,S, NO, 172-18-3943
DATE OF DEATH 10-31-94
COUNTY CUMBERLAND
TVPE OF ACCOUNT
~ SAVINGS
CHECKING
TRUOf
CERTIFICATE
RENIT PAVNEHT AHD FORNS TOI
REGISTF.R OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
JANE A NAGOD~
RR 2 BOX 486
BROCKWAV
PA 15824
FARHERS TRUST COHPANV hll provided the nlp.rt..nt with the Infor..Uon lllt,d helow whlr.h hili b..n ulld In cllculltlng the
pot.ntlll tlM due. Their rlcordl Indlca'e that It thl dl.th of thl above dlCldlnt, you wlr. . Joint owntr/blntflnlarv of thl_ Iccount.
If you f..l 'hll Inlar..tlon II incorrl<lt, pll'luI obtlllln written oorrlction frol the flnaflolal Inttltutlon, athch I copy to thll for.
Ind rill turn It to the tbovtl add,.... Thl. account I. talllbl, In Itccordancl with 1t1. Inhultnncl talC lllw. of tht t:'o'.~rl':.lttJ of ~'nnc~I":ln",
......j...... ....J w. ...,......,.J .., "loll ill. ,I." ",j J:.",.
COHPLETE PART 1 BELOW
Aoeount Ho, 11-86299
. .
. SEE REVERSE SIDE FOR FILING AND PAVHENT INSTRUCTIONS
Doh 10-21-93
E. lob I hhod
To Inlura proplr crldlt to ~our lecount, two
<l) copln of thll "OUCI IUlt aeco'plny your
paY.lnt to the RIgl,tar of Will'. Hnkl chick
payabl. tOI "R,gl,t,r of Willi, Aglnt"',
Aooount 80hneo 3.403,28
Poroont roXlblo X 16 , 667
AMount Subjlet to To. 567,22
To. Roto K ,15
PolonUol To. Duo 85,08
PART TAXPAYER RESPONSE
COI FAILURI TO RISPOND WILL RE8ULT IN AN OFFICIAL TAX AS8E8SNENT BAsKD ON THIS NOTICI
A,
NOTEI If talC ply..ntl ar. ..d, within thr.,
(]) IOnthl of the dlcldlnt', dltl of dl.th,
yoU I.y dlduct . SX dllcount of thl tl~ due.
Any Inhlrltencl tl~ due will bleOI. dlllnqulnt
nlnl <91 !tOnth. IftU the dltl of dutt!,
[CHECK ]
ONE
BLOCK
ON LV
-tZJ Thl abovG Inforl.tlon and till dutl It oorraot.
1~1, Vou lay choOI' to rl.it p.y.nnt to thl RIgl.ter 0' Will' with twn c~pl.. of thl. n~tlc. to obtain
I dl.r.ount or avoid Int.r..t, or YOU ..v ch.ck bow "A" and r.turn thl. notice to the Alol.t.r of
Will. and an offlclll ........nt will bl 1.luld by the PA Dlplrt.,nt of R.v.nu..
8, c=J Th. above ....t hI' bl.n or will b~ rlport.d ftnd taw paid with th. P.~~v~nla Inh.rltanc. TD~ r.turn
to bl f1hd by thl d.c.d.nt'. rtpr...ntIUVI. I"":, If; .,., ?
c, [~Th' abOVI Infor..tlon l~ncorract .nd/o~.bt. and d.ductlon. war. paid by YOU. Ji
'Iou IU.t ooaplata PART ~ nnd/or PART ~ balow, (
PART
~
If you indlclt. I dlfflrlnt tlX rlt., pl.... .t.t. your
rolotlon.hlp to dooldlnt,
T^~ nETUn~ . Ca~rUT^T!O~ or
LIHE I, Doto Eltobll.hod
2. Account ellance
3, Porolnt TI.oblo
4, AMount SUbjoot to TI'
L, Dobt. Ind Dlduotlon.
6, AMount To..blo
7, To. Rotl
e, Tox DUI
T:'.X
O~: .'O:!IT.'Tr'.'''T ,.,!'':'OUMT1>
. OFIlICIA~\lSE ONLY 0 AAF
PA DEPARTHtNt Oil REVENUE
rut":
."
PART
[!]
DATE PAID
~
DEBTS AND
1
2
3
"
5
6
7
8
DEDUCTIONS CLAIHED
'V'
.....' ,,'~
'~'
(')
" . ~.
c :.~
....-..--
I
2
3 X
4
5
6
7 X
8
..' "
PAVEE
DESCRIPTION
AMOUNT PAID
-
TOT AL
(Enter on line S of Tlx COftput.tian)
-'
.
Undo" plnllUol of porjury, I doolorl thot thl hob I
oooploto to thl bo.t of .y kno.lldgo and blllof,
(. ) t. II~ It' "".- " /r,."'<",l
/~~PAVER ! GNATURt ,1
~.va reported abov. ar. true, corrlct .nd
HOME C1' 7 ) ..n' ..,-n /
WORK (7')) 'Ife J'(I-lI ~tlL
TELEPHONE NUHBER u..rr--
GENERAL INFORMATION
1. FAILURE TO RF.SPONO HILL RESULT IN ioN OFFICIAL UK ASSESSHENT .Ith .ppllubl. Inlorool b...d on Inl.r"llon
.lJMIltttd by thl 'lnaochl In.tltuUon.
1. Inhtr!tGnClI t,lC blec... delinquent nlnt lonth. tfter thl dlCtdentl, d," of duth.
). . Joint IGcount II tulbh IVln thouyh thl dlCldlnt's n.... WII lNJd,d III . ..thr 0' conv.nl'MI.
4. AccountJ I Including tho., h,ld bltw..n hu.btnd and wlftl which the d.cldlnt put In Joint n.... wHhln ont yur prior to
deltll art fulh tllelbl, II trltnlflrl.
5. AClCOunh ..tlblhh~ Joln'lv b.tNun hu.blnd .nll wife Ion 'hen on. Ylar prior to dlllh 0," not tlMlblt,
6. Acccx,r,tI h,llj by . dec.dtnt "In tru.t for" anoth.r or athe" Irl tlMlbl, fullY.
REPORTING INSTRUCTIONS. rART ' - TAXPAVER RESPONSE
1. aLOCK' ~ If the Inlon.ticn Itnd coltPuhtlon In tht notlc. 1ft correct Ilnd deduction. art not bllng chlHd, pllu In "II"
In block ..... of Part 1 0' thl "fIMP'.,.lr A..pon.... ..otlon. Sign two copl.. and llub.1t th.. with your ehKk for the 'Runt of
tile to U'I Rllllttlr of Willi 0' thl CO\N1t~ IndlCltod. Thl PA o.p.rt..nt of Rlv.nul will I"\M .n offlclll ......Mnt
IFor. REY.ISU flO upon rlulpt of thl return 'rol thl Rlllhter of .,1111.
7. BLOCK.. (f thl ....t 'Plolfled on thh notlcl hu b.." or will be rlPorhd and tilt paid with the P'M'Vlvanle InhtrltlnOl
Telt R,turn fUld by the dloedent'. rlpre..ntltlve, phulll ")C" In block "B" of Part 1 of thl "hKpeYlr R..ponlt" IlCItlon. Sign OM
copy lOCI return to tilt PI DIIPart..nt of Rlvlnul, Burllu of Individual Tlue.., Dlpt za0601, ttlrrhburg, PA 17121.0601 In ttw
InvIIGpI provldl~.
!O. BLOCK C w If thl notlc. Infor..tlon ill lncorr.ot and/or d.tJuotlonl are u.lng chilld, ch.ck block "C" and c0ll(11etl Plrt. 2 Ind S
IttleGrctl"~ to thl lnttru:tlon. hllow. ~IQf1 hm r:('I~h.. end tl.lbult th.. with your ch,ck fer thl 1I1l0lmt of talC pdYlbl. to thl RIghter
of Willi of thl counh lndlutld, Thl PA napart..nt of R.v.ou. will I..ue an offlcl-.I lu......nt (For. REYwl5it8 EX) upon rlc.ipt
of the r.turn frol the A.gl.tlr of Willi.
TAX RETURN - PART 2 - TAX COMPUTATION
(INE
1. Ent... the dato th, ICcount originallY WII IItlblllhad or t1thd In thl lIannar IId,tlng at dati of duth,
HOTEl For a dlCldent dying after IUIUaZI Accounta which the dlcld.nt put In Joint n.... within ani (I) yur of d..th ar.
hubh fUlh .. trln,ftrs, IIowlyar, thlr. II an 'lIolu.lon not to a1Ccnd n,DOO par tran.fer.. rlgardi... of thl VIlua of
the ICCOunt or thl nu.ber of eccount. he'd.
1f a doubl. ..t"lIk (01) app.." hafora ~our flr.t nMI In th. eddrl" portion of thlt noUcl, the n,ooo .llolutlon
.1r.ldy hi' ba.n deduct.d frol tha account bll.nc. .. rlportld by th. financial In.tltutlon.
2, Entar thl totll bllanc. of thl IIJCOunt Including Irltarttt Kcru.d to th. data of duth,
S, Thl plrclnt of thl 'CCOlKlt thlt It tueblt for IIch lurvivor I. d.tar.ln.d III 'ol1ow'l
A. Th. perc.nt tllllbll for joint ...." ..t.blhhld lora th.n on. ynr prior to tha cecadant', dllthl
I DIVIDED ay TDIIL HtJIlaER DF
JOINT OWfERS
EM.-11l I Joint ....t raglttar.d
DIVIDED ay TOIIL HUltaER OF K 100 . PERCENT TAKAlLE
SlmVIVIHO JOINT DUIlERS
In the n... of the dt<;ldlnt and two othlr plrlonl,
I DIVIDED ay '(JOINT OIIIERSI DIVIDEO ay 1 (SURVIYORSI . ,161 K 100 . 16,1~ lTAKULE FOR EACH SURVIVlIfll
I. The p.rc.nt t.lllbl. for ....t. crlatld wlthln on. y..r of the dle.U.nt'. d.ath or Gec~unt, ownld by thl dlc.dent but held
In trult for 'nothlr JndlvldulH.1 (trult b.naflchrlttJl
I DIVIDED ay TDTIL HUHaER OF SDRVIYINU JOINT
OWNERS OR TRUST REHEF ICIARIES
K 100 . PERCENT TAKABLE
EMIIIPI.I Joint .ccount r.ghterad In thl n..e of tilt d.c.d.nt and two othlr plrson. and lltablllhed within Ont Yllr of d.ath b~
thl dlc:.dlnt,
I OIVlDEO ay ! (SlmYIVORSI . ,50 K 100 . 50~ lTmaLE fllfl EAC'1 SURVIYORI
~. The MOUnt .ubJlct to ~'ll Olne it) h d.tarllln.d by IUltlp1ylng the 1I000unt bellnol (1ln. Z) by the parcent taKlble (line 1).
S. Entar thl total of thl debta and d.duotJon. IlIt.d In Pllrt 1.
U. Tha ....,~ll \u...,l. dltt1l 01 U ale.,.Jmltl LJ:, .,UU(,IOonll \h" u.u" tlf.Q 0"0\101 Ion. U1nw ~J tr~ tn. l.ourn luoJaet to 1U U1M ....
7. Entar thl IPproprlltl tile rate (1lnl 7) II deter.lnld b.low,
A, For rat.. of ri..th oocurrlng eftar 6/30/9it, thl tu r.t.. for trln.far. to 'POUII. l!IrI II fol1owlI
1. D.t.. cf death on or aftar 111/94 and b.fore 111/96 the rata it 3:<.
2. Oat.. of death on or aftar 1/1/96 .nd bafore 1/1/91 the rata it 2%.
S. O,t.. cf d.ath on or aftar 1/1/91 and b.for' 1/1/98 the rata h 1%.
it. Dlt.. of d..th on or .ftar 1I1/9a tran."" to IpOU... wHI b. IIIl1pt frol till,
Hotal for datu of dlllh prior to 111/94 tran.flr. to IpOUIO. IIr. tlllllbl. at 6:<,
I, Trlnlfara to llnta1 dllc.ndllnt. Including f.thar/ .othelr, .on, dllughtar, grandchildren, .onwlnRItIl,
dwthtarwln-IMl, ItapohUd end th.lr luu. ara tall,bl. at .Ill parclnt 16:<).
C, Tran.far, to.ll othlra Including brother, 1I0tar, unol., duot, fllph.w Ind nllo, IIr. tlll.bll at flftlln Plrcent U,~),
D, If YOU c:hlrga tht tlM rlltl, pit... 'Plolf~ ~our relatlcn.hlp to thl d.o.dlnt In thl .r.. pro....ld.d.
I. The MOl.W1t of ta)! due I1lne 8) II d.tar.ln.d b~ IIUltlphlng the '.O\N1t t.lllbl. (line 6) b~ the tall rat. (line 7),
CLAIMED DEDUCTIOtlS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowabla d.bts ttld d'cIuotlon. era d.taraln.d .. follolll1
A, You l.gall~ Ir. rl,pon.lbl. for p'Ylant, or the I.t.to .ubJIOt to Ildtlnlltr.tlon b~ a p.r.onal r.pr...nt.tlvl J, In'1.Ifllc:llo\
to P'~ thl dlduotlbl. It....
S. You .ctUlllb paid the ..tabU aftar fI..th of the dlc.dlnt Inti can furnlth proof of pe~.."t,
C. Debts b.lng clth.d lUst ba Itlllud fully In Part 3, If IIddltlonll .pee. II nttdad, Uti pl.ln paper I 1/2" k 11", Proof of
pl~.ent 'II~ ba raqullted b~ tha PA DIPart.."t of R.vanu..
TAXPAVER 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 rAXF.S. TAXPAVER INQUIRV UNIT IN
HARRISBURll AT (717) 187-8527. TDP' pm 172-2252 (HEARINO IMPAIRED ONLY)
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D'" "'A' A' 0:47' 9' '19. . COMMO, NWEALTH Ofl PENNSYLVANIA
.. NO. "t , .' , DI'AIl'IMINT 0' IIIVINUI
,II~IIIJ I. ~"41 ' OPPICIAL RICI'''' . PINNSYLVANIA'NHIIII!A,NCI AND ISTATlTAX
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RECEIVED FROMI
ACN
ASSESSMENT '!'
CONTROL 1:.1
NUMBER
AMOUNT
i
JANE A NAGODE
'f:l1C!6;:1'47
.tl;).oa
421 LIMESTONE ROAD
eMU BLE PA 17013
9t51 l:l63'49
'301.61
ESTATE INfORMATION, ]
1ft flL UMBER
II el-1995-0494 BSN '172~la-3943
II NAME Of DECEDENT (lAST} (fiRST} IMI)
!!!L DR lOOEr M
II DATE Of PAYMeNT
.. B POSTMARP~il~ 19'
COUNTY lite!! I';:'
CIJf'1BERLAND
DATe Of DEATH
'ClO Hill
~
REMARKS
-
m TOTAL AMOUNT PAID ..
'3S".69
J~NE A NAGODE
SEAL
RECEIVED '~;/4,0.
MARY C. LEW S
REGISTER OF WILLS
CHECK" aeee
REQIST~R OF WILLS
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RI!V-11143 I!X AFP 18-94) '*
COHIlOIlWEAL IH Of PE....Yl VAHU
ll[PAAlIlEHI Of REYEIAJE
IUIlUU Of IHDIVIOUAl "...
IlEPT. lOUGI
HARRISBURG, PA 111z8.0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILl! NO. 21- ,/," - '/~"l
ACN 95126348
DATI! 06-13-95
ESTATE OF BRIDGET M MESSINA
5.S, NO, 172-18-3943
DATE OF DEATH 10-31-94
COUNTY CUMBERLAND
TVPE OF ACCOUNT
~ SAVINGS
CHECKIHG
TRUST
'- CF.RTJ.FICATE
REHIT PAYHENT AND FDRHS lU,
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PATRICIA E REPINE
RR 2 80X 486
BROCKWAV PA 15824
FARHElRS TRUST COHPANY hll pro...ld.d the Oep"tu"t with Ih, In'or..tlc," 1l,t..d below whlth h.. bl.n u..d 1M calculltlng the
potlntllL tlM dut. Th,lr r'oords Indlclt. thlt at the dllath of the abOVI dlc.dlnt, ~ou wlr. n Joint owner/beneficiary of this BOtOunt.
If you f..1 thlt In'or..tlon II Incorrlot, ph... obhl" wrltttn corr.otlon frOM the flnsnolnl lnltltutlon, .Uaeh II eopy to tnil for.
Ind "turn It In thl above .ddr.... 'hit BCeOU"t II t,)Coble In accordlncl with thl JMlrltlnc. Tile tlWI of thll Co..onwlllth of P'M.vlvanla.
;...... ~ :..r,,, 1-.., Lo.. .."......,... l., ....111. '... . i i ;', ,..,', nlll .
COMPLI!TE PART 1 BELOW
Aooount No, 11-86299
. . . SEE REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
D.te 10-21-93
E.hblloh.d
To In1urI prop.r cr.dlt to vour ttCcount, two
(2) copt.. of this notlc. DU't aCOlMlplnv your
plly..nt to the RIIII.ter of WIlIt. Mak. chIck
pl)tlbl. tOI "Register of Wllh, Aglnt".
Aooount Bohno. 3,403,28
P.ro.nt To..bl. K 16 , 667
A.ount Subj.ot to To. 567,22
Tox R.to K , 15
Pot.ntl.1 T.. Du. 85, 08
~~ TAX PAVER RESPONSE
COI FAILURI TO RISPOND WILL RI8ULT IN AN OPFICIAL TAX A9SISSHIHT, IASID ON THIS HOTICa I
A,
HOTEl If talC pnVllllnt. Ir. ..de wlthln thrn
(]) lonth. of the dlcldent', dati of d'lth,
vou ..y dIIducIt II 5:< dl.count of thl tlM dUI.
Any Inhtrlt.w. tlM du. ...111 baeo.a d.lInqulnt
nino (9) .onthl .fhr thl dlt, of duth.
[CHECK ]
ONE
BLOCK
ON LV
U1 Tho abo"', Infor..t1on and tu dut it cerr.ot.
l. You ..V choc'l to r..lt ply..nt to tho RIgl.tlr of Will. with two copl.. of thl. notlc. to obtain
I dl.count or avoid Intlr..~, or you ..y chock bolC "A" IInd r.turn thl, notlo. to the R.gl.tlr ef
Will. .nd .n offlcl.l ........nt will b. I..uld by the PA DIP.rt..nt of RIYlnu..
B. ~ Th. abo",. ....t hi' hl.n or ~Ill bl raport.d and talC paid ~Ith the P~'Ylvanl. Inherltanc. TalC rlturn
to b. fil.d bV thl dle.d.nt'. rIPrl.lntatlv..
C. [:] Thl aboy. Infor..tlon I~ncorrlot and/o~lbt. and dlduotlon. wlr. paid by ~ou.
You IIU.t eogplat. PART ~J and/or PlAT ~ b.law.
If you indlolt. I diff.r.nt tlX rite, pl.... .tlt. your
r.l.tlon.hlp to d.o.d.nt,
,OFFICIAL USE ONLY []~~
PADEPARTHENT OF REIIENUE
PART
[!J
'f'-.X
LINE
n~TunN - Cr.~~UTt.TIO~ Or-
1. D.h E,t.bl hhod 1
2, ADCOunt aallne. 2
3. P.rc.nt T...bl. 3 K
4, A.ount Subj.ot to T.. 4
S, D.bt. end Peduotlon. S
6, Aeount T...bl. 6
7, T.. Rlt. 7 K
e, T.. Du. 8
T.~~ Q~: JC:~IT/,.nUCT ACCOU~JTS
rAli _
1 "
2
3
4
5
6
7_
I e
DEBTS AND DEDUCTIONS C~AIHED
PART
L!J
DATE
PAID
j
PAVEE
DESCRiPTION
AMOUNT PAID
I
TOTAL IEnt.r on Lln. 5 of T.. Co"pu\.tlonl
I
.
-
Und.r, p.nd tI.. of p.r jury, I doolar. th.t the
0_1.'''/'0 the boot .f "~~nowhdg. .nd b.lI.f.
. (.. V I \.,~ ..--_
I .' ,rr ,.) !," \ -', .
TAXPA~E SIGNhURI: 7'
feoh I
hlv. report.d ebov. Ir. tru., Qorr.ot and
HOME _ ('~, 1/ ) \ II /,' I & ')
WORK ( )
TELEPHONE NUMBER
bAk
,./V\
GENERAL INFORMATION
1, fAILUR! TO RESPONO WILL R!lUL T IN AN OFFICIAL TAK ASIESSHENT with ...plI....I. Inl"ool b.... on Inl.r..IIM
lubIllUId by tM Ilnlnel'1 In.tltutlon.
Z. InheritInG' tiN benOltI dtltnquont nln, .onth. .It.r the dleldlnt', dltl of d,.th.
S. A Joint "count 11 hubl, 1..,ln thoouth thl dtC'ld4tntl, n... WI' IddM II . ..tt.r of conventlnu.
~. Aooount. (Inoludlnt tho,. held bltNteO hu.blnd nnd wlfl) which the dec~'t put In Jotnt n.... within Onl VI.r prior t.
d..th Ir. fulh tl.lbl, II tr."lf.rt.
.. Aocount. IItablhhed Jolnth b.t.,..n hUlbend..let wU, .or. thin OM VII' prior to d..th Ir. not tlMabll.
6. Acoount. Milt bV . dlc,d'n, "In trult for" lnother or oth.r. I" hilMI, fulh.
1 DIVIDED IV TOTAL NUIlIER OF
JOINT DNNERS
Ex...l.1 A Joint ....t r.aht.r....
REPORTING INSTRUCTIONS - PART 1 - TAXPAVER RESPON~E
1. aLOCk A ~ If the Infor..Ucn Ind co~ut.tlon In thl notlc. Ir. correot Ind dtduatlon' I" not b,lng oh....d, p18<1e WI ")l"
In block "A" 0' Plrt I 0' tha "flllPIVIr R..pon.... ..otlon, SIIIn two coplll end luhlt th.. with your cMok fur thl lMIOUnt n'
tlM to thv RI,lItlr of WUlI of thl oountv Indlcltld, The PA DtpertHnt of Relllnul wUI llIue In offlohl .....lMnt
(For. REY.lS4& EM) upon rlcllpt of thl return fro. the R.glet.r of Will..
2. BLOCM. B . If thl ....t Ip.oUl.d on thll notlc. hu b.en or will be reported and taM Plld with the (llon'Vll1."la Inhlrlhncl
TIM Rlturn fllld bJ thl decldlnt'l rIPr.lentltllle, pilei In "~.. In block ..... of Plrt I of thl "TIMP'Vlr R"Pon.l" I.otlon. Sign ant
copy Ind r.turn to thl PA Olp.rt..nt of R.lllnut, Bur.au of Indlllldu.i lall", O.pt 210601, Harrl'burg, PA 17121~O'01 In the
envelop. provided.
3, BLOCK C ~ If thl notlc. Infor'ltlon It Incorrect Indlor dlductlonl are btln~ chl.ad, chick block "C" and cOlplttt Pertt 2 and S
ulcordln{t to the tnlltrucUonl below. Sign two copJu and lubelt th.e with your chick for thl a.ount of tllM plyable to the R.oht.r
of WJIll of thl county IndJcltld. Th. PA Oop.rt.lnt of Rlvlnut will IIIUI an offlolal a'l",..nt (For. REY~IS~6 EM) upon rlollpt
of thl rtturn fro. thl R'ohter of Wllh,
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Enter the dltl thl KCount orlolntlly wu uteblhhld or tltlld In thl .annar IlCI,tlngat dati of dlath,
ijOTEI For a dloldent dvlng aftlr 12/12/121 Accountl which thl d,cldlnt put In Joint n.I" wlthJn on. (1) Ylar of dllth Ir.
tlMlble fully II tranlfllrt. HOWIlII", th",t it an IxolutJon not to 'Mc..d 1],000 p.r tr!lln.fer.. rlgardl... of thl VIlut 0'
thl 'OCOU"t or thl nueblr of IccOuntl held,
If I doubll ..t"hk (..) tlpp"rs blfor. your first "... In tht Iddr.., purtlon of thlt no~u:",1 thl U,OOO IMctullM
.trltcty h.1 bien dlduotld fro. thl account balancl lU r.portld b~ the flnanolll In.Ututlofti 'r, l.~; ..(./:n
\11 ((!
2. Enter thl tot.l b.llnol of the .eloount Including Intll,..t acoru.d to the d.tl of d..th,
S. Thl percIOt of thl ICOOunt thlt h taxlbll for ..ch .urvlvor II dehr.tOld II followl.
A. Thl PIt')lnt tllClbl_ far Joint ....tI ..t.blhhed ere th., OM Yllr prior to thl d'c'd.nt'l d'lthl
DIVIDED IV TOTAL IMlBER Of' K 100 . PERCENT TAKABLE
SURVIVING JOINT OWNERS
In thl n... of thl d'cI~nt and two oth.r plrlonl.
/'0-)
(1\
1 DIVIDED IV S (JOINT ONNERSl DIVIDF.D IV Z (SURVIVDllSl . ,167 K 100 . 16, n llmm fOR EACH SI)IWll'OAl
I. Thl perclnt t'MIbII f(lr ....h ar..tld within onl Yllr of the d'cldlnt'. clllth or accouoh own.d.b~ thll'~ClcMnt bYt~hlld
In tfl'.t for ..,ather IndlvlduaU.) {tru.t beneflolllrJU)1 .", .\
1 DIVIDED IV TOTAL NUllIER Of SURVIVING JOINT
DNNERS OR TRUST BENEfICIARIES
(. ,
X 100 . PERCENT TAXABLE
EM_III Joint IOcount regltt.r~ In thl n... of thl deeldtnt and two other perltlfll and lutablhhtd within ani ~aer of dllth by
thl alCtdtnt,
1 DIVIDED IV Z (SURVIVORS) . ,50 K 100 . SOX (TAKABLE fOR EACH SURVIVDRl
4, ThlllIIOOOt lubjlot to tlX Ulnl 4) II dlterllned by .u1tlphJng thl account baltncll (Unl t) bv tha pltre,"t hM1b11 (JIIlI S),
S, Enter thl totll of thl dRtt and deduction. lilted in P,rt 5.
6. 1M M4Wlt t'JICwl1 lime OJ i.. ol1lr.inld by lutnrtot!ng 1nl aeut; end u.duollon. uJnl S) trot tn. "oun\ lUUJ.,' Co 1Ill (Un.. If).
7. Entlr thl Ipproprt.te tax retl (Una 7) II dlter.tn.d balow.
A. For dltll of death Clcc:urrlng Iftlr 6/10/94, tht tllC rlt.. for tranlftrl to IpOUI.. Itl .. followlI
1. Dlt.. of d4t.th on or Iftlr 7/1/94 and beforl 111/% tM ratl It :!iX.
r. Dltu of death on or Ifter 111/96 ltnd before 1/1/91 thl reh It 2:<.
]. D.t.. of death on or Iftlr 111/91 and b.fore 1/119& the ret. Jt 1:<.
4. Oltll of de.th on or Ifter 1/1/91 tranlferl to 'POUI.. will bl IXHPt fro. tax.
Hotl. for dltl' of delth prior to 7/1/94 tran.f.rl to IPOU,.. Irl tlxabll at 6X.
I. Trunlftrt to l1n..1 delctndanh Including f.ther, lother, Ion, dlU(fhtar, nrtndchlldrtn, lon.ln.l.w,
dtlUthtar-ln-I..., IttpohUd and thlJr luut art tlobll .t .Ix perclnt (6X).
C. Tranlfer. to qU othflr. Including brother. IlItar, unCll, aunt, nlphlw and nllol art tillable It flfh." pare..,t niX).
O. If you chin" thl talC rata, pl.... lpeolfv your ral.tlonlhlp to thl d.cldlnt In thl .,.. provided.
I. TM MOU1t of t.M due tlln. U It dater.lnld bV aul tlpblng thl llIOunt t'Mlbll (11nl 6) bv thl tlM ratl (1Jnl 7),
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowabll debh Ind dlductlon. Ire datlr.lntd .. fOI1OVII
A. You I'D.lh Ira rIlPon.lbl. for Ply.."t, or thl ..tatl subjlot to .*Inhtriltlon b~ I p"lonal rIPr"."htlva 11 InlufflcJ'"'t
to pay thl d.duc'tlbll It....
B. You .otuIlh plld the d.bt, .fter death of the dteldMlt and can furnish proof of plyaent.
e, Debts being oltllld ault bl It.. I lid fulh In Part 1. If additional IplCO 11 n..cl.d, u.. plain p~1r & 1/2" M U", Proof of
Pl~""t ..y be rlquOIt.d bv the PA o.partnnt of R,"enu..
........ .. ........ . . ... .TAXPAVER ASSUTANCE
...... . . IF YOU NEED. f'UllTHBR INf'ORMATIONORASSISTANCE, CONTACT ANV
......... REGISTER OF .WILLS,PA DEPARTMEllTOF REVENUE DISTRICT OFFICE .
OR CALL THE BUflEAU OF INDIVIDUAl. TAXES TAX PAVER INQUIflV UNIT IN ...
HARRISBURG AT (7171 787-8327. TDIII".(717) 7t2-22/i2 (HEARING IMPAIRED ONLV.l
':'1"':""""":;'" , , ,
\
REV-l!143 EX AFP (8-941_
CllIlHON\IEAlIH Of PfHl<'YLVAHIA
Dl'PARlHENT Of REI'fNU[
lUIlUU Of INDIYIDUAL lA'E'
Dl'PT. 210601
!lARRtslllRO, PA 11Ua'0601
INFORMATION NOTICE
AND
TAXPAVER RESPONSE
FILl! NO. 21 -'ii) /;.1'11
ACN 95126350
DATE 06-13-95
ESTATE OF BRIDGET M MESSINA
S.S, NO, 172-18-3943
DATE OF DEATH 10-31-94
COUNTY CUMBERLAND
TYPE OF ACCOUNT
~ SAVINOS
C~ECKIHQ
TRUST
_ CERTIFICATE
REHIT PAVHEHT AHD FORHS TO,
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MM PATRICI E REPINE
nR 2 BOX 486
BROCKWAY PA 15824
FARHERS TRUST COHPANV hll prollidld the O.p.rt......' with the Inforll.tlon II,hd bllow which hll t-..n u..d In cIlelllatlng the
pohnUll tlM dUI, fhalr r.cordl Indlcat. that at thl d..th of the above dU'dant, you wire. Joint oWl'.r/ben,flchrY 0' thll account.
If you f..l thll In'cr..tlcn h Incorrect, pi.... obt.ln ..rltt.n correotion fro. the Iln,,"ell! Inltltutlon, .theh a ct)p~ to thl, 'or.
Ind r.turn it to the above .,ddr.u, this account I. t,ubl, In Iccord.ncl with the tnhlr I tane. Tu 1~. of the Co..onw..1th of PIM.v!....nl.,
:w....~I"".. ..I'~' ~;, .."..;~rl" :".' .....11:.." .11,:' j'i.; '0;'''''
COMPLETE PART 1 BELOW
Acccunt Ho, 12-14411
II II
II SEE Rl!VERSE SIDE FOR
D.to 09-1S-94
e.toblhh.d
FILING AND PAYMENT INSTRUCTIONS
Acccunt Hol.nc. 4,021 ,39
P.rc.nt T...bl. M 50,000
AMcunt SubJ.ct to To. 2, , 01 0 , 70
r.. R.to M , 15
PohnU.1 To. Du. 301. 61
PART TAXPAVER RESPONSE
m I FAZLURI TO RISPOHD lULL RIlSUL T IN AN OFFICIAL TAX ASSESSHENT lAUD ON THIS HOTICI
A, f\1l Thl aba.... Infar..tlon flnd tl)( due h c;orrlot,
~'LJ 1. ,,"ou .ay choo.. to r..1t plv...nt to the R.ghter ot Willi with two c:)pl.. of ttd. notlo. to obtain
a dl.count or avoid Intlr..t, or you ..y chick bOM "A" and rlturn thl. not Ie. to the RIgl.t.r of
Will. and an offlchl ........nt will b. ll1u.d by the ~'A DIPart..nt of ReYlnue.
To In.url proper crldl t to your account, two
(Zl copll' of thl. notlcl .u.t aoco.pany your
pay..nt to thl RIghtlr of Willi, Hlk, chick
pay.bl~ tol "R,gl.t.r 0' Will., AlIlnt",
NOTEI If tu p.y..nt. ar. ..d, wlthln thru
(3) lonth. of the dtc;.d.ntl, d.t, of dlath,
you IIY deductt a S:( dllcount of the tu dUI.
Any lnhlrltaocl tlM dUI will hleo.. d.llnqu.nt
nlnl f91 'onth. aft.r the dati of d.ath,
[CHECK ]
ONE
BLOCK
ONLY
8, 0 Thll above ..ut hll bun or will b. r.port'd llnd taM paid wltn thl P.mlyl...tnla Innlrltanc. Tu r.turn
to bl fll,d by thl dlc.d.nt'. r.pf....nt.UY..
C, ~ Th. aboy. Inforlatllln I~ncorr.ct .nd/o~lbtl and dlduotlon. w.rt ptld bV you,
You ault co.plltl PART ~ and/or PART L!J balow.
PART
~
If you Indlc.t. . dlff.r.nt t.. r.t., pl.... .t.t. ycur
r.htlun.hlp tc d.o.d.nt,__
OFFICIAL USE ONLY 0 AAf'
PA DEPARTMENT OF REVENUe
Tl~:-: RETum: - CCHrUTf,T::l~:
LIHE 1. Dato E.hblhh.d
2. Aorount alllnOI
5. Plrclnt TIXlbll
4. AMount Subj.ct to T..
S, D.bb .nd D.ducUon.
6, AMounl T...bl.
7, T.. R.t.
a. Tlx DUI
or TAX at: ':~:NT"'Tr.~:JT :.=:C:..!~:i:
I
2
3.....lL
4
S
6
7 M
8
roAD
~...
PART
[!]
DATI! PAID
!
2
3
4
5
6
7
8
DEBTS AND DEDUCTIONS CLAIHED
-
-
PAYEE
DESCRIPTION
AMOUNT PAID
i
.
_.---
.r. truI, corr'.ot .nd
t I
TOTAL IEntcr cn Lln. 5 cf T.. Cc.put.tlonJ
," Ur,d.r"p.n.IUII Qfp.rJClry, I d.clor. th.t tho hcb I h.v. r.pcrl.d .bov.
,'00""",(0 "th. b.~r of I.y,kncwlldg. .nd b.lI.f, HO~_ 1 )
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GENERAL INFORMATION
1. FAILUU TO R!lFOHD WILL RESULT IN AN OFFlCIAl TAX ASSESSNENT with '''''1I~1b1. Int....t bII.ed on lnfor..tlon
......Ilted b, tho flnonol.1 In.tltutlon,
Z. tnherttenol tllC He.., dtllnquent nl". lonth. Iftlr thl Mcledent', d,tl of eft,th.
S. · Joint HCOU1t h tllClbh Iven though thl Heldent'. n... Wal Idded I. I ..ttlr of convenJtnel.
~, Acoounts Oneludlnt tho.. held b.tween hutbind end WUI) ....Jd1 thl d.cldlnt put in joint n.... within one y..r prlcr tc
dtlth Ir, fulb tl14Ml. II trln.fer..
I. Accounts IItlbUIhed jointly bltw..n hu.b'nd and wU. IIOre thin onl Ylar prior to dll'h Irl not tlxlbl..
6. AccOWlh held by I dlcld."t "In tru.t for" IMt""r Qr athlrl Irt tlxlble fulh.
REPORTING INSTRUCTIONS - PART 1
- TAXPAYER RESPONSE
1. BLOCK'. If thl Infora,Uon tnd CCHlpUtltlon In thl netlcI Irt Clltroct and ~oUon. .r. not bllng cl,lnd, pLIOI In "X"
In bloot< "A" of Ptrt 1 of thl "lIMPIYlr R..pon.l" 1I0Uon. Sign two copt.. ancJ .ublJt thl, with Your chtok for the HOurlt of
tlx to the Rllhtllr of NUll cf the oounh tncUottld. The PA Depart"nt of R.vlnue wUI Juue In offtolll ......Nnt
(for. REY-U4. EX) upon recllpt (If thl rlturn frOll thl A"lIt.r of NUll.
Z. BLOCI('. If thl ....t 'Plalft.d on thh ""tlCI h.. LI.., or wUl bl repcrted Ind tile Plld with the P.M,y!v.,,11 Inherltancl
TIM Alturn fllld by thl dlcldant'. raprl.tnt.tlva, placl ." "X" In black "a" of Plrt 1 of the "TI.pay.r R.,pon.l" Iletlon. It an one
OOPY and rl'urn to the PA Dtp.rt.lnt of R.vtnUt, lurleu of Individual T'Ie", Dlpt 210601, H.rrl.burg, PA 17121-0601 In the
env.lope pravJded,
J. aLOCK C . If thl not1c. Info"lt1an I, Incorrlot Indlor dtduot1on. ". being clai.ad, clltck block "e" tnd COIIpI.t. P"h Z SOd J
.c,:orrlt"o t... th. 1".~rHMIMI b.,,,u. C;lpn tWQ CDPJ" and .utt.1t thl. with your chick for thl l'Ount of tllC PIyabl. to thl Righter
of Wllh of thl county Indlc.t.d. Th. PA Dep.rt.tnt of R,vlnul will luuI an offiall' ........"t (Fora REY-1541 EI() upon reo.lpt
of thl r.turn fr~ thl Rlgl.t.r of Will..
TAX RETURN - PART 2 - TAX COMPUTATION
lllE
I. Enter
HOTE.
the dltl thl Iccount ortgln.lh WI. ..tlblhh.d or HUld tn thl ..nner IMhUng at d.tl of dlath.
for I deaadent dYing Ifter lUIUI21 Acaoun" Nhtch thl dlo'dlnt put tn jotnt n.... within on. (1) Yllr of dlath .r.
t"obl. full. II trlll.for., HOWl"" th." II III I<olu.lon not to .....u 13,000 Ptr tr.n'lVt<J "gordl... of tho ~I... of
tho ...ount or tho nuobtr of ".oun\l hold, C i" \:; -J) 'i>
:'] ~ II . , . j
If I doubl. I.t.rt.k (IeM) 'PPI.r. blfor. Your flr.t n"l In the Iddr,.. portton of 'hi. notjcl, thl .3,000 .xolu.lon
'I reedy hIt bIen deductld frOll thl occount b.lencl .. rtpartld by th. flnancJal In.Utut1on. c.
r. Enter thl tot'l balanc. of thl .ccount lnotudlnt Intar..t Icarutd to thl data of d..th. F
S. The p,roent of thl ICCOunt thlt It taXublt for 'tch lurvivor h detlr.lnld .. fallowlI
A. The p.rcent t'lCabla for jotnt ....t. I.tlblllhtd IOrl than onl Yllr prior to thl dtctdtnt't de.th,
1 DIYIDED IV
N
r1\
TDTAl HlJltIER OF DIVIDED IV TOTAl HOlliER OF K 100 . PERCENT h~AlLE
JOINT OWNERS SURYIYING JOINT ONHERS . L1
ExMPltl A joint ....t rellhtlred In 'hi h_1 of thl dec'dent and two othlr Plrton.. 1.1
-L'" . .
1 DIYIDED IV 3 ~JOINT OWNERU DIYIDED IV ! CSlHlVIYOIlSl . .161 K 100 . 16, IX CTAKIILE FOR)1AC/l SlJRIIlY9'\'
B. The "ro,"t tnabl, 'Qr ....ta cr..tld w!thtn 0", y..r of the cltc'dlnt'. d.lth or ICONlta oNMd by the dfOtdent but hold
In tru.t fcr .nother lndtvtdualC.) (trult blnIUchrl..)I
1/1 (
1 DIYIDED IV TOTAL HlJltIER OF SURYIYING JOINT
OWIERS OR TRUST IEHEFlClIRIES
I( 100 . PERCENT TAKABLE
Ex..ll' Jotnt IClCount relhttred In thl n... of thl daoldlnt Ind two other person. and ..tabUlhld wlthtn one Yllr of death bit'
tho dtc.dtnt.
1 DIYIDED IV Z CllJRIIlYOIl11 . .50 K 100 . sn~ (TAKAllE FOR EACH SURYIYOR)
4. The MIOUnt lubjlOt to ta)l <111"1 ~) h- dltlrllntd by 1lU1Uplytng the ICQomt bllancl Ulnt 2) by the perOlnt tlxabl. (Une 3),
S. Entar the 1ot'l of the dHts Ind dtduCltton. Ihtld tn Part 5.
.. lilt Mount hleMJ11 US", .) 1. Ott.r.lneclll~ IUbtrtoUng 'hi "Ibtl and dlauctlon. \lInl !tl trOll thl nount .UbjlOt to taM (U'I" Itl.
7. Entar the apprOflrJlta tau rib (I1ne 7) I' dettr.tned bllow.
A. For det.. of dtlth ooourrtng If tar 6/30/94, thl talC rat.. far 'ren.ftrs to .pou... art II fOllow. I
1. D,t.. of de.th on or If"r 7/1/9" and beforl 1/1196 tha "It. It n.
I, Dlt.. of Hlth on or IIftar 1/1196 and before 1/1/97 the rlt. II 2:<.
S. Dlt.. of dllth on or Ifttr 111197 Ind btfor. 1/1/91 thl rate h lX.
4. D,t... of death on or Ifter 1/1191 trlMlf"t to ,pou,,, wUI ba IlCllpt frol tale.
Notll For det.. of dt.th prtar tc '111194 tranlf"l to ,pou,,, ar. tllCabll It 6X.
I. Tranlf,,, to lInetl de.Oendant. tnoludtng fathlr, IMther, 'on, deulhtlr, grandchlldr,", .on-In-I...,
dMflhtlr"ln"II." .tapchUd tnd thllr I..UI Ire tlMebl. It .h( perolnt (6;0.
C. Trtnlfl" to .U othlrs Including brothlr, tI.ter, lI'\Oll, tunt, n.phlw Ind nile. Ire "lllbl' at flftttn Ptrotnt (UX).
D. If YOU chant_ thl tll( rat., pl.... 'Plclh ~our rllltlon.hlp to tha dlcldent In the Inl provhMd.
I. ThI INICMMlt of tl.l due (Una I) It deter.lned by IUlt1phtng the IltOUnt tlleabll <lInt 6) by 'M talC rtta ClI". 7).
CLAIMED DEDUCTIONS . PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowabl. debtl IMd deduCltlon. Ira detar.IMet I' fallowlI
A, Vou 1...11> or. ro.pon.Jblt for PIY_t, or tho tltot. Iullj..t to ."'nlltrotlon b, . por.o..1 r.......toll.. I. In,ufflollllt
to PlY thl dlductJblt itH..
I, 'Iou ltGtullh paid the debts .ftar de.th of tht decedent tnd can furnlah proof of PIYllnt.
c. Dtbh b,tng chlNd Milt b. JtHired fully tn Pert S. If ICkHtJanll 'PIO. It nleMa, UII pl.ln PlPlr I 1/2" Ie 11". Proof of
PIYtllnt .Iy be rlqUtlted b~ the PA o.ptrtltnt of Rlv"lUI.
i.i ...i .i. .... ... ......... .............. .... .. .'tAXPAVERASSXSTANCE .. ... .. . ...... .... .
...i< IF YOU NEED FURTHER lNI'ORHATlONOR ASSlSTANCE. CONTACT ANY
i.. ...... REGISTER OF WU LS,PA DEl'ARTMEHl OF REVENUE DISTRICT OFFICE <.'i ."
<<ORCALL. THE. aUReAUOF INDIYIllUALTAXES TAXPAYERINQUIRYUNITIN.' < ............. .
. ..H~R~l$.URe AT(717~,.,..~S27.UU~;gH)772.2252(ItEARINO<lHPAIREII ONlY) ..,
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