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' ". , ,~ , .,:.,:,1 .,' ,J, '/"" " " . i, ~ ..1,.,.'..-...".'...,.,....., .~ . i , . I . ' . ~.- -_._---"..---,..,- - -.-.-...' .-- ....----- ..,. .-.,..-.. -.-.... .-"- .....- -...- ..._-- -- -- --.......- ---... - ...-....- .1 '.' D ;""A' .':'0)'794 O. .... ';COMM.' ONWI~a.THO~PIN~SYLVANIA .NO. 1\ lIt. " . ,. . '. : DI'AIrlMINl 0' IlIYINUI' . ..~~i'.; ;.14'.~~_ . O,'ICIAL RICIIPT . PINNSYLVANIA INHIRITANCI AND ISTATI TAX .".w....::......... '. ',' . I. " .' ' .' , ' . ' . . , 'f,' I I, I" RECEIVED fROM: D ACN ASSESSMENT It' CONTROL iii NUM8ER I' AMOUNT DENNIS E HERMAN el41 BOBCAT ROAD -~51eIt73e .eo!l.'7l I ! \ '0,0 HilI I' --- CARlISLE PA 17013 _ '010 Hili ESTATE INFORMATION, 1ft fiLE NUMBER - iii 21-199:5-0492 II NAME Of DECEDENT {LAST) II DATE Of fAYMENT B POSTMAR E .' COUNTY 88N 191-18-3138 . (fiRST) IMI) DATE OF DEATH m TOTAL AMOUNT PAID .205.71 REGISTER OF WILLS /~<}- . ~() D ~ RECEIVED 8:(/1 . ' ' NA U MAR V C. LEW 8 REGISTER OF WIlLS REMARKS DENNIS [i Hf1:.RMAN SEAL CHECK" 238 ,\r.--.- _, -'---1'--"- ____ _._____ -;- "".--- ..-~....--. ......... .-' -,..... -..........., -~ -'- "C".- - -,,-'"'' ..-- -; ,'" ~ ,tt, ~ , \ :' I " , . . . ','-' ',I ......... If"""- " ,. -,;."...~ ."-"'--':'-1'I~'~M r1 ""\:.~.' ,........ l.r 4.'. .' I ! .' i oJ' ..'. ".....4t..... "_"., ~ , , ' , - - -,- '- --. ..__..4. ...e.,-_._ ...,;.,~..~ ..-l..._ "_4'.__ -., ~_ --, __,'.'" ~_, "7 ...~ ~......_ ,_.._ ..,.'~, ...l'~". ._. _,__' ."_ ..._. ....,. _..'__ ........_ ,.., ,_ ,__ _ .._~_._..~ . .. l' ,''','''", ',"" ~ ' 'l\" .... .t i " " ", .' ,'. ..;.. " ;\ \' ..:_ " . '1 ".Oji'AA\:O'4""Sj1 ',' co",MqNwIAtTH,Ofl PI..NN,SYLVANIA '.. ,.' !!~:. ". ", It.. II' " . DlM~I"'O'"IVI"UI ..' , "",. "",," " .. -""".. .. P.;'. .." -, " , ,I' . . .:.,i~I1.1 II I~'\'I : '. . OPPICIAUICII" "I"NIVLVANI~ INHllIlTANCIAND IITATUAX ......i ,. '-" ,;' '. 'il I, '.' .." .. 'f . . "., ----::;' RECEIVED FROM: & ACN ASSESSMENT f!I CONTROL iW NUMBER AMOUNT I : . . DENNIS E HERMAN e19 BODCAT ROAD '~1l!4'1!3 . t6'4.61 CARLISLE PA 17013 -.'OIDH'" 'OIDH"" ESTAte INFORMATION: l. !I IL NUM8ER - II a 1-199:5-04'12 SSN m NAME OF DECEDENT IlASTI IFIRSTI ~ HERMAN DOROTHY L II DATE OF PAYMENT EI POSTMAR~ DATE COUNTY 0/00/00 CUMBERLAND DATE 01 DEATH 191-19-3139 IMII !'I . m TOTAL AMOUNTPAID .674 .6~ ~n . 00/) .'" ~'fJ I '-7" RECEIVED 8~" / IA,. iJ.' A E REGISTER OF WILLS . R~~rS~ERL~~IWJLLe' REMARKS DENNIS E HERMAN SEAL CHECK. e3? 17;''''~,7;-,.--,.~~- -, --.- - -- ---., - '\:- - - ~~.-, ..,..._,._,~- -- -,. -.' -.- -- .,.... -_. .-- -- '-7' -- _.. - -..- ':::.- -. ". -:- 'r"C'" . , 'It, . ,ii, ',I , " J ". I .' , '....' ,,' ,4...._., 1Jf~ --'<I"" _...._.:-."1t~~.J.f1, __VH "~'.:'"I '-, ._- . .' ,I , '14 ." .. . /' - \, ~EV.1543 'ax ~r~ (8.941. C~HWEAl!H OF PEOHSYlYAHIA DEPARTHEN! OF REYEHOE 1/ BUREAU or INDIVIDUAL Tms DEPT. ZIObO! HARRISBURG, PA 1711a-0601 ,I', ,1/ , /.-', INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE '('I" NO. 21 - 15- If 1,..l..J 95124732 05-30-95 ESTATE OF DOROTHV L HERMAN S,S. NO, 191-18-3138 DATE OF DEATH 03-04-95 COUNTY CUMBERLAND TVPE OF ACCOUNT ~" ~:~~~~:Q TRUST CERTIFICATE RF."IT PAV"ENT AND FOR"S TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 DENNIS E HERMAN 219 BOBCAT RD CARLISLE PA 17013 DAUPHIN DEPOSIT BANK & hi' provldnd the Olpert',nt with thl Infor.dUon Ihtld nlow which hu bllKl uud In calculaUns thl JlQhnthl t:lll dw. Th,lt r.cordl Indlctt, th.t at thl duth of th. above dlced."t, Y(J Wit' I joint owner/beneficiary of thlt IccQtlnt. If y~u fnl this lnfor..tlon II lncorrlot, pl.... obhln wrlthn corr.ction frol the flnanr.hl In.tltutton, attlch . c::opy to this for. lIn~ return It tt' ttlt! 'l~I:'V. .dut.... Thl. DeleO""' I, t"."hl, 'n IU'lrnr,lent. '11th the Inh.rUanc. Tal( law", of 'hI COMonW"l'h of Plnn.~lv."l., Oul.tlon. ..y bl an.wlrtd b~ c~lllnG (7171 787~8~~}. COHPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAVHENT INSTRUCTIONS Account No, 0010451242 D.t. 07"06-93 E .t.bl hh.d Account S.I.ne. 7,942,21 P.rolnt T...blo K 50,000 A""unt Subj.ot to h. 3 ,971. 11 h. Rlt. K ,06 Pot.nUIl h. OUt 238, 27-- PART TAXPAYER RESPONSE m I 'AXLURI TO RI8POHD ifILL .AISUL'r IN AN OFFICIAL TAX ASSllS8NSHT IASlD ON THIS HOTICI I A, [J Thl IbQVt inforlltion Ind hI( dUI 15 torrlct. 1, You It 'I thou.. to r..lt pay..nt to thl Rtghtlr of willi Mith two copl.. of thit notlot to obtain a di.tount or avoid Inter'lt, or you .ay chick box "A" end rlturn thl_ notic. to the Rtgllt.r of Willi and an offlol'll u......nt will b. IUutd by thl PA o.pllrtHnt of R.vtn~. To Jnlur. propor credit to your IC"Ount, two (Z) copt.. of thh noticI lNat Icco.pany your pay..nt to th. Reghtlr of ~l1h. Hake ch.ck plyablt t01 "Rlallttr of Will.. Aglnt". HOTEl If tlX ply..nt_ Irll .ad. within thrll (3) ~th. of thl decldlnt'l date of dlath, YOU IIIV dtduot III 5:< dhcount of the hI( dUI. Any tnhtlr t tine I tl)( due w I II bloo" dtllnqu.nt nlnt (9) ItOnthl after thl dati of delth. [CHECK ] ONE BLOCK ONLY a. 0 Thl above Ullt hllll bltn Of will lI. r.pottld IIIIld tax plld with tht P.nn.vlvanl. Inhlrltanc:1 TI)( rtturn to bt fll.d b~ thl d.c.d.nt'l rIPr...ntttlvt. C, [Sa Till sbovI lnfor..tion I~ncorr.ct andlor dtbts and dflductionl wert ptld by you. vou IUlt CO~lttl PART l!J and '01' PART 0 bllow. If you indlclte . diff.rent tl~ r.t., pl.... .t.t. your rll.tien.hlp to d.eldlnt, PART ~ TAX R~rU~" . COHPUTATION LINE I, Olt. E.t.bli.~d 2. Account 811.nc. 3. P.re.nt Taxabl. 4, A~ount SUbjoet te T.. ~. Dlbt. ond Deduetien. 6, A..unt T..obll 7, To. Rat. a, TI. Duo OF i'Al: ON JOINT /TItUST ACCOUt~TS 1__..2. -0 (."'11 2 '7(ILJz..~1 3 )( cJ (', , (l C' 4 5 6. 7 K a . . OFFICIAlUSF. O~L'l' 0 MF PAIlEPARTHENTOF REVENUE PART ~ DATE PAID PAIl I 2 3 3'1'11, U II 5/.12 ,H- 5 .~ L.l ~ 'I, ' 4 c; 6 ,,()(,,_ 7 2:-().'~. 7 I 8 DEBTS AND DEDUCTIONS CLAIMED PAVEE ~ c:; ( ('. 1U TOTAL IEntlr en Linl 5 of DESCRIPTION .\-,\ n (' t1 (' O~- \ \. " . AMOUNT PAID To. Ce~put.tionl I . . - Undlr p.noltlo. of plrjury, I doel.rl thot thl flot. eoaplltl to thl bo.t knewlldgl ond bllilf, 1'1. ' t J. _-4 rl_/ (':/-lL,.' I nAVe report.d .bov. are tru., corrlct HOME (-; 1 7 )"' '-1. ') , '7 .3 I': 't WORK ("//?) :J,t.{(J - I.jL),' Ind i' r.~v" 'IS IlA GENERAL INFORMATION 1. FAILU~E TO ~ES~OND WILL RESULT IN AN DFFICIAL TAX ASSESSHENT .lIn ...II'ob1. 1n\.ru\ b...d on tn/,rullon saUted bv the 'Inll\ol,l Inltttutlon. z, InhtrltMClI tilt btcOllU d.lIn~,.nt nln. ItOnthl aflu th. dttud,nt', dl" of d,.th, 1. _ joint ACcount II t'M~lf ,vln though the dle.d.nt'. na.. WI' added a. a ~.tt.r of convlnl.ncl. 4, Account. (Including tho.. ~ld b.twlln hu,btnd and wl'tl which ~h. dlCldlnt put In joint n.... within on. Vllt prior to eMllth Ir. fullv tllClllJlt II trln,flr.. S, Aooount. ..teblllhld Jolntlv b.tw..n nu.blnd and wlf. lor. thin ani y..r prior to d"tn art not t.MIbII. 6. Aocount. held bV . diCldent "In trult for" anoth.r or other. ar. 'IM.bl_ fully, REPORTING INSTRUCTIONS - PART 1 TAXPAVER RESPONSE 1. BLOCK A . If thl Infor.otlon and cOllPuhtlon In thl notlcl Irl oorrflot and deduotlon. .r. not b,lng oll'eH, pilei In "IC" In block "A" of Part 1 of tha "TeMP.v.r ""pon.l" 'I(lUO". SI,," two (lopla. and .ub,,1t tllll with vour chack for thfl MOunt 0' taM to thl Rllltttr of Willi 0' thfl county Indto.htd. ThI Pi DlfltrtllMt of RIVlnyt will Inut an offlclll ......-.nt (fora REY~1Sd EX) upon rflltlpt of thl rtt'lrn frot the Rltl.t.r of "'1111. Z. aLOCK I ~ If thl ....t 'PlClfltd on thl. noUct h.. b..n or will b. rlPort.d Met tlM ~lld with thtl p.nnlVlvlnll InnerltlnCl '1M Rlturn fllld by thl dludlnt'. rlflr..tntaUvl, pile. an ")(" In block "a" of Part I of the ""MPIYlr R..pon.... lIatlon. 111'1 one copv and r.turn to tha PA Dlpl. t'lnt of RIVlnutI, lurllu of Individual 1IIMII, DIPt Z10601, HerrlllKlrg, Pi 17121.0601 In thl tnvIlope provided. 1. ILOCK C ~ If tht noUn Infor.aU!)n III Incorr.ot andlor dtduoUon. Irt' bllng ol.lttd, chick block "C" .nd cOlplett P.rt. Z end ] '''('Inrrtlna to tht IMtrVtltloM balow, Sign twa copllll and lubltlt tit". wlttl you.. i;htck tor ltttl MOlJfll of \Ile Plytblt to the HeglUlr of NUll of thl county Indl(llt.d. ThI P" DIP"t'lnt of RavlnUl will luut an offlolll ......unt (For. REV~1541 EX) ~ recllpt 0' thl return frol thl Raghter of WI\It. TAX RETURN . PART 2 - TAX COMPUTATION L1N!: 1. Ent.r thl dlta the tcoount orlgln.th' w.. IItlblhh.d or t1tl~ In thl ..nntr IMlttlnl.l at dlta of duth. HOTEl For I deotdtnt dying Ifter 121 I 1I8Z I Aeeronh whle:h thl tJI(lldlnt put In joint nUll wlthlnt'fitjl) Yllr uf dllth Ir. tawlbll fullv II tran.f.rll. Howtvar, th.r. It an IMolutlon not to tMoaad 13,000 p.r tranl~r",ragllrrJl'.. of the!P1ut of thai aceount or thl nuMJlr of accounts M.ld. ',-:: ~' ~l;: '-,-, ('" " Ii If . ~It ..tlrllk (n) IPPtlrl bafora yoyr flrlt ,.... In the addra.. portion of thll naile., thl 15,000 I"elu.lon Ilr,ady ~I' bttn deducted frol thl a~count blllnGa .. report.d bv thl flnlnalll InltltutJon. ( ~~, ~. Entar the total blllncl 0' tna ICCoUtt lnoludlnt lntarllt ICCrutd to the dltl of deatM, S. The parclnt of thl account thlt II t'MIbII for t.cn .urvlvor 11 detar.lntd II followll A. ThI plrcent t'Mlbll for Joint ....tl t.tabll'had lorl t~ ant v.er prior to thl dtctdent'. dllthl h.l OJ I DIVIDED IV TDTAl NUMIER OF DIVIDED IV TDTAl NUHSER Of X 100 . PERCENT TAXABLE JOINT lllIMERS S'IRYIVINll JOINT llWIiERS . EIe_11l A Jatnt ....t rlghtarld In the n... of thl dec~t and two othlr ptr.on.. (, , ~'.) ~I! <, I DIVIDED IV S (JOINT lllIMERSl DIVIDED IY I (SURVIVORSl . ,167 X 100 . 16,lX (TAXABLE FOR1ACH SllRVI~l I. ThI plrcent tllllbla for ....tll erllt.d within Me Vllr of ttMl d1c~tt. dQrth or accounts awntd bv thl dtee6lnt Ixlt held In trutt for anottwr IndlvlduIH.) Ctru.t btntfJcllrltl)1 1 DIVIDED IV TOTAL NUMI~R Of SllRVIVING JOINT OWNERS OR TRUST IENEFICI'RI~S Ele1lP111 Jotnt .ecomt rlglltlred In th, nHl of thl decldtnt and two oth.r p.rlOf1. tnd IItabllthld within one yur of ..th by thl daCldlnt. 1 DIYlDED av 2 (SURYIYORS) . .50 )( 100 . 50:< (lAIlAILE FOR EACH SURYIYOR) II 100 . PERCENT TAIlABLE ", The MOUnt lubjeot to tllM (line l\) it datar'ln.d by lulUpiYlnl the account bllanc. lUna U by thl plrcent t.weblt (lint 5>. 5. Ent.r thl total of thl debtt Ind dlductlon. lIlttd In Plrt 3. 6. ThI IMUnt tquolt 111M 6) 11 dlttraln.d by SUbtracting the dabtt and d.dUctlonl <llnl 5) frol thl HOUf'It .ubJlot to tlw (lIM "J. 7. Ent.r thl approprlttt tlM ratl (l1n. 7) .. dtttrtlntd bllON, A. For dlt.. 0' dMth occurring afttr 6130/''', thl tilt rlt.. fOl' tran.flr. to .pou... arl II follow. I 1. Dltl' 0' dI,th on or aftar 7/1/9" end bl'orl 1/1/96 the ra11 II 3~. 2. Dati' of dllth on or after 1/1/96 end b.forl 1/1/91 thl rlta II 2:<. 3. Dltl' of dI.th on or a' tar 1/1/97 end b.forl 1/1/91 thl rlt. 11 I~. 4. D.tll of dllth on or Iftar 1/1/91 trltn.ft" to 'POU'" will bl ')(lIIPt frOll taw. Hottl For chltll of delth prior to 7/119" trlN1.fl" to .pou... Irl tlltehl1 It 6:<. .. Tr.".flr. to Unt,l de.clndant. Inoludln~ flth", IlOther, Ion, dlUghtar, grandchildren, lon.'n~l..., dtughtar-ln-IMl, .tlPChlld and thllr Inu. art taMabl. .t 11M parQlnt (6:<), e. Trlt'll"r. to III Qthlr. InClludJng brother, Iiltlr, lmOl., aunt, nlPhtw end nltcl art tlwebll It 'Ift.en Plrcant (15:<), O. If you chino. th. tlW rat., pl.... .paolh your rllltlon.hl, to thl decadent In thl ".. provided. .. The llIlOU:rt of tlltl due Clint 'J It dlt.r'lntd by IllJIUplyJng tM Ir..\W1t t.wlblt UJna 6) by the tlW r.tl (IIna 7), CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED AlIawtbl, cflbt. .nd deduction. Ir. d.tarlln.d .. fol1o~1I A. VQU I.a.lb arl rllPontibl. for PIy..nt, or th. ..tltl .ulJJtct \0 Id'lnhtrttlon by I Pllrlon.1 rtpr...nt.tlvl It In.ufflolant to PlY thl deductlbll It.... I. You IctuIIIY p.Jd thl daht. eft.r ~Ith of the dlc.dant and can furnl,h proof c' pIY'lnt. C. Debt. bllng chi..d au.t b. Itllllld f~lh In P.rt). If IddIUan.1 SpIC' II Mld.d, u.. phln paplr 1 1/2" Ie 11". Proof of Plv-ent .IY b. rlqua.tld by th. PAD.plr'.lnt cf Rlvwnut. TAXPAYER ASSISTANCE IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANV REGISTER OF WILLS. PADEPARTHENT OF REVENUE DISTRICT OFFICE OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAVER INQUIRV UNIT IN HARRISBURG AT (717) 787-8327, TDD' <7(7) 77lt'l"~~52..(HEARING IHPAIREO ONLY) " ,ij ii,", .!,I -.1 , . , I 'I ~"'.".;. ", fl .. ~ ~....:. ro ('1')' n . lY .... ~, 'D 0-: '4 IV) .... - :..0 J .... - '... ~ o o . 00 o - .t,.~ '- II ~~ i:S '" ...s: t " U ... e6 C "'.~ :>.... ~ ~ ~ ~ I 'lI 'l) C'(' ~ ~ - ,- ...,.. ....J ...0 ,J ~ .iJ 'c 'v~-tr ~ Q.I 1Il (~ 1 tl ,,'.. '- ~ ~ .~ w (, ~ 4: ~ ~ ~ ~:f-('( _ r< ... ...... ~ ... ~ s 4 ..J ~ ~ Q.. t:.o c"6 ~ ~ ~ ~ ~ <t '~ be) " " , ''':,:~,,':).: ;1";, ' I ,. ,\ F ,r' ,. " " " :1' , ' , " , " " t"',, . " " I' ,r ,.' " ". " " 'I" " ,. .. ..' " " i. , " ,. " " :"( <II, '/1' ,.. " .},::" /. ;,1 I, .,. q ,. ,,;,. , ,'" ". " /, .',11 r ~! ,,1' ,. " "I,/';t ,\ ," ",I " . " 11,/.. FILE NO. 21.. q5- J/'1~ ACN 95124733 DATE 05-30-95 TVPE OF ACCOUNT ~ S.VIHOS CHECKIHG [ TRUST CERTIFICATE REHIT PAYHEHT AHD FORHS TO, REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ,1U!Y-1543 EX AFP (8-941,*, CO""OHWEAl Ttl Of PEHHSVLYAH1A ;' DEPARlHEHT Of REVENUE \ lUAEAU OF INDIVIDUAL TA'" I DEPT. 211601 HAARlSIURO, PA 171~a.0601 /', ,II /:; INFORMATION NOTICE AND TAXPAYER RESPONSE ESTATE OF DOROTHV L HERMAN 9,S, NO, 191-18-3138 DATE OF DEATH 03-04-95 COUNTY CUM8ERLAND DENNIS E HERMAN 219 80BCAT RD CARLISLE PA 11013 , DAUPHIN DEPOSIT BANK I hll provided the DIP,rt.ent with the Infa,..tlon IlIttd b.l~ which h.. be,n u..cI In calculating the potlntl.1 t.~ duI. Thllr r.cord_ Indict" that It thl d..th of the abovI dle.d.nt, you wit. I Joint ~wn.r/btn.flol.rv of thl. account. Jf you f.,1 thl. lnfer..tlon I, Incorr.ct, pl.... obtain written corrlctlon frOI thl fln&nQl.1 InltltutloR, attlch . copy to thl. f~r' end roturn It to tn. ebovI "del'.... Tnl" ,""tlnnt ill t"..bl. In Iccnrrllnc.. with thl Inhlrltenc. Tu Llw, of thl Co..onwu1th of PIMlylvanl.. QU.ltlonl .fty be InlWlr.d by cIlllng (111) 1d1-aSZ1. COMPLETE PART i BELOW . . . SEE REYERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS Acoount Ho, 5700229331 alto 07-06-93 Eltoblhhod Acoount 811onol 22,486,89 Plroant h.lbll K 50 , 000 -- AMount Subjoot to h. 11,243,45 h. Rlt. K ,06 PotonUIl T.. DUI 674 , 61 ~~ TAXPAYER RESPONSE [!] I FAlLURI TO RI8POHD WILL RllSUL T 1N AN. OFFICIAL TAX AS8188Hiit BASIl! OM THIS HOTtCI I A. ~ Th. Ibov. Infor..tlon end taM due II corr.ot. p 1. You..y choo.. to r..1t Plyant to thl RI"llttr uf willi with two copt.. of thla notlcl to obtain . dllcount or Ivold Intlr..t, or you ..y chick bOM "A" end r.turn thl, notlo. to the Ra"llt.r of Will. and en offtclll ......-.ot will b. II,uld by thl PA Dapart..nt of R.vlnu.. To In.ur. prop.r orldlt to your .~count, two (2) Cop I.. of thll notlc. IUlt Icco'plny your PIYltnt to the R.gI.tar of Willi. Kakl chick paYable tOI "Ragllhr of Willi, '".nt.". NOTE I If tal( paYI.ntl fir. nd. within thr.. OJ IIOnthl of the dlc.d.nt', dati of duth, you aay dldU<lt a 'ill: dllcoont of thl taM du.. "IY Inhtrlhoc. taM due will bloo" d.lInqu.nt nln4 (9) lonthl aftlr thl data of d.oth. [CHECK ] ONE BLOCK ON LV a. 0 Th. abovI a..at h.. bun or will be rt90rtld and tax paid with thl P.nn.ylvll'lle Inh.,.ltenc. TalC rlturn to b, flhd by thl dee.dlnt', r~rl..ntatlv.. C. ~ Thft IboVI Inforaatlon l~ncorrlOt .~d/or d.btl and d,ductlon. w.r. paid by you. You lu't co~l.tl PART L:J end/or PART 0 bllow. If you indiclt. I diff"'lnt t.x r.te, pl.... .tat. your r.l.tlon.hlp to dlold.nt, OFFICIAL USE ONLY 0 AAF.' PA DEPARTMENT OF REYENUE PART ~ TAX RETURN . CCiHPUTAT:.:Ofl LIHE I, alt. E.tlbll,h.d 2, Aooount 811onol 3. Plrcent rlxlbl. 4, AMount SubJlot to T.. S, Dlbh Ind Doduotlon. 6, AMount T..lbl. 7, TI. R.to a, T.. Du. OF TAl: OIl JOItlT/TI:USr ACCOU:m: I 2 5 X 4 S 6 7 X a PAD 1 2 3 II 5 6 7 8 DEBTS AND DEDUCTIONS CLAIMED PART ~ DATE PAID I PAVEE DESCRIPTION .. ~ TOTAL IEntor on Unl S of Tn. CO"putotlonl - , - AMOUNT PAID ~ . ,.- hlv. rlport.d .bov. Ir. tru., correct and ~OME (-IILJ ),1/1/ - -n't.y WORK (7/7) 'J..1~1l . '-{{:J. 'I :tf~(~" '/5 TELEPHONE NUMBER -- Undlr plnlltll. of porjury, I dlol.rl th.t thl foot. I oOMpl.tl to thl bl.t of MY knowl.dg. Ind b.ll.f, GENERAL INFORMATION 1, fAILURE TO RESPOND WILL R2SUL T IN AN OfFICIAL TAM ASSESSHENT with .ppll...11 In,,,..t b...d on In'"ullon lubtllUed bv thl 'Inanel.l Inltitutlon. 2. InhtrUeno. t..11 b,eo..' d.lJnqu.nt nln. .ont.", .Her thl dtucle"t', dst. oi dtlth. S. A Joint .ccount II tllllblt IVln though the dlctd.nt', n... w.. addtd III . ..ttlr of Clonv.nlencl. 4. Account. (Includlnt tho.. held b,twttn hu.blnd Ind wi',) which thl d.eldent put In joint n.... within on. v..r prior to dllth IrI fulh bobl, .. tran,f,rl. S. Account. IItlblhhtd Jolntlv bltw.." hulband and wlf. .or. thIn on. yur ~r Inr to dntn ar. not hublt, .. Accountl htld bV' d,e.dent "In HUlt 'or" anath.r or oth.r. ar. tlMable fully, REPORTING INSTRUCTIONS - PART 1 - TAXPAVER RESPONSE 1. .lOCI( A - If U\I InfarMtlon and co.puhtlon In thl notlcl art corrllJt Ind dtducUonl ar. not being Olli..d, plle. In ")(ft In blocfl "A" of Pert 1 of thl "TIllCplYlr RtlPonll" IIctlon, SllIn two cop I.. and lubelt thl. with your check 'or thl Hount of tllC tn thl RIgl.tlr of Willi 0' thl county Indlcltld, Thl PA OIPlrhlnt of RIYlnul wUl lllUI In offlolel ......Nnt (For. REY"IS~' ElO upon rlollpt of the rlturn frol 'hl R.ght.r 0' Willi. 2, ILOCI('" If thl ....t .peclfled on this nottOI hu b.." or will bt rlportld ,"d talC plld with thl Pennlylv.,,11 Inherltancl TIIC Rlturn flhd by thl dlclant'l rtpro.WltltlvI, pile. an ")(" In blook "I" 0' Part 1 of the "lIlCp.Ylr R..pon.... IMUon. Sign onl copy It'ld return to thl PA Deplrtltot 0' RIVenul, lurllu 0' Indlvldull TllCtI, nlpt 210601, tt.rrltburg, PA 17121-0601 In tht envllope provided, J. ILOCK C - If the notlcI In'oreltloo h Inoorrlot Ind/or deduction. .rl b.lng Ollllld, chICk block "e" and OOltPlltl Plrts Z and J Innnrftlno to thl InltruotIonl b.IC>>I. Ilgn two copl.. .r,d IlJb.1t thn wHh YOUI Ch'l;lk fOI \/.. IIIOWlt tit tlx Plvtble to thl Aeglstlr 0' WIUI 0' thl county Indicated. The PA DeplrtHnt of RIIIInUI will IIIUI on offlolll .....IHOt (Fori AEY"15~. EX) upon rlcllpt 0' thl return frOll thl RIght.r of 14111.. TAX RETURN - PART 2 - TAX COMPUTA1ION LINE I. Entlf HOTEl thl dlt. thl Iccount orlglnlllY WII IItablhhld or tltlld In the IIMlr IlChtlng at dltl 0' dele (j For I dtCldent dying Iftlt IUll/ll1 Accountl which thl dleld.nt put 1n joint n.... within on. tp"::.Yllr oflA-lth "t talCtlJII fully II trlnlflrl. tlowlvlr, th.,~t II In IICclullon not to olCcI.d 13,000 p.r trll1lflr.~'rlgllrdll..'~' tM vll~' thl Iccount or thl nullblr of accounts held, , . I: If I douhll lI.terhk (MM) Ipp..rt bI'orl your flrlt n_1 In thl Iddrtll portion 0' thlt nutlet, tM n,DO~ IMolul1on ..lr.ld~ hi' bltn ~tld fral the aco.)Ut\t bllanc:1 al r.port.d lJv thl Unlnc:dl1 In,tltutlotlo 2, Enter the totll bllancl of thl tclCowtt Indueling Int.rut ICcrued to thl dttl of liIoth. t-.." J. The peroent 0' the ~count thlt 11 \axebb 'or IIch ,urv1vor h d.ttr.lned II followl. (,'. A. ThI p.ratot tllCabll for Joint ....ts ..tlblllhed IIOrI thin on. ~."r prior to thl dlcedlnt'l claath. TOTAL HUMBER Of JOINT llWIERS EM"""lll A Joint ....t rlghtlred OIVIOf:O IV Tom HUNIER Of K 1" . PERCENT TAWLE SURVIVING JOINT OWNERS )1I' the dtctdtnt r.d two othtr ptrlonl. ;.> ...1 " "', 1 OIVIOf:O IV '.(l In thl n... of (}, 1 DIVIDED IV 5 (JOINT OWNERSl DIVIDED IV I (SURVIVDRtI . ,167 K 100 . 16,7~ (TAKAILE FOR EACH SURVIVORl I. ThI percent tllClbll for ...." crllt.d within one Yllr of thl dn,dtntll d..th or aecounts owned b~ the dectdtnt but held In tru.t 'or Inother lncUvlduIU') (trult beneflellrl..)I 1 DIVIDED IV TOTAL NlJNIER OF SURVIVINO JOIHT OWNERS OR TRUST IENEFlCIARIES K 100 . PERCEtIT TAKUlE Ex..ll' Joint ICOOunt r'Slhtlrld in the n... 0' the decldlnt and two othlr p.I'lon. tnd IItabU.had wUhln OM y..r 0' d..th by thl dec.dent. 1 DIVIDED IV Z (SURVIVORSl . ,50 K 100 . 50~ llAKAlLE FOR EACH SURVIVORl ft. ThllIIOU'1t .ubJlat to tlX (lint It) " detlrllMd by IlUltlplylng the &Ccount bllanol (11"1 2) by the Ptraent ttlllble Clint 51. S. Ent.r thl totll 0' thl dlbts and dtduotlon. lhted In Part 5. 6, ThI IIIOUnt tlllabll (Une 6) It dttlrtln~ by lubtrlotlng the detl and dlduoUonl Clln, S) frOll the MOUnt 'Ubjeot to tej( (Una 'l, 7. Entlr the tpproprlltl tax rltl Ulna 7) II dlter.lned bll'*. A. For det.. 0' cNlth occurring Ifter 6/50/94, the tlX "t.. 'or tran.fIrl to IpOU"" .rl II '011'*11 1. oat.. 0' dttth on or Iftar 7111'" Ind blforl 1/1/96 thl ra" II 5~, 2. Dat.. of d..th on or aftar 1/1/96 and b.farl 111/97 thl ratl It Z~, S. Dat.. of death on or Ifter 1/1/97 and blfart 1/1"1 thl ratl It 1j(, 4. Dlt.. of dtlth on or ,fter 1/1/91 tran.fI" to 'POUI" will bl IICIIPt frotl tolC. Hott. Far CStt.. 0' delth prior to 111/94 trtnlftrs to lpaull' I,. tlXlbl1 It 6:<. I, Tr."ftrt to l1nall d..cencl.....t. Including fathtr, lother, .on, daughter, grW\dchJldrtn, lon.ln~I..., ctIUIhttr"ln~lMf, .tlPchlld find tMlr I..ue IU, tlxabll It .Ix PtrClnt (u). C. Tr""I" to aU atMr. Inohxllnl brothrr, IIltlr, unci., aunt, nlPhtw and nllel arl talllbll at ,1ft.." Plrctnt (15:<), D. If you change thl taM r.te, pll'" IP.clh your r.IIUonlhlp to thl dlcldent In tt,1 tr.1 provldtd. t. ThI ..ount of ttlC dull UIM I) It det".IMd by IUlt1phl". tha IItOUnt tllCtbl. (Une 6) bv thl tllC rltl CI1M 71. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowabl. deb,. and dlduttlon. arl detlrelnld II folloWl1 A. You hgllh ar. rllPonllbh for ply..nt, or thl ..tetl lubJIClt to odllnhtrlUon by I Plrton.1 rtprl.lnhUIII It Inlufflallnt to Ply thl dlduotlblt H,.., I, You ICItull1y Plld thl dlbtl Ifttr d..th o~ thl dlctdent Ind un 'urnhh proa' of Ply..nt, C. Debt, being olel"d .Ult bl ltallud fully In Plrt 3. If IlIddltlonel IPIC' II nlldld, u.. phln PIflIr 1 In" IC 11". Proo' 0' PlYltnt .ey b'l rtqulltld by tilt: PA Dlpert..nt 0' AlVlnuI. TAXPAVER ASSISTANCE IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY REGISTER DF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE OR CALL THE BUREAU OF INDIVIDUAL TAXES. TAXPAYER INQUIRV UNIT IN HARRISBURG AT m71 787-8327. TOO' (717) 772.~25~.(HEARING IMPAIRED ONLY) " .c..." ~. \.'<~ , , '~r) }!" .In. If) 0, , ,) " ~~i~ L ,-() " ) ,. 1.0 .- ., , ~~I , " " , ~ ....r: .,\)" , (; , " ;\J l..l '" .. ~~, ad hi (j~ n: P\lIlPOtI!Of' MllTlt1!1 To fulfill IhO r..,lr_I. of seoUon 1I~0 of IhO lmorlt.... ond E.lol. To. Aol, Ao' ZZ of It'll. In P.I, ' StoUon 1I~0). ,'. Dtltoh IhO lop porUon 01 IhI. NoU.. ond _It lIlth V...r PIY_I '0 IhO R....'" DI Willi prln'''' on IhI river.. .Ide. " .._ Hlkl chHk or 110M" order p..,lbl, tal REgtSTER oF MUL., AOEHT. All PlyMM\tI rlCtlvK IhIU fint bt ."Ued to In" Int.rllt which MY H due, wUh In" ,_Inellr ."l1M to thl tlM. A nknl of . tll)( credit, lthlch MI' not requtltld on the tllX return, ..., tM requt.tld by ClOllPltUno an "ApftllctlUon for R"I.M of PInnI.,lv.,11 Inhlrltenol Ind Elt,t, TIX" (AEY"l51S). Applicltion. Ir. IVII1lbl1 It thl OfficI of UtI A..1tt,r of 'flUI, In" of thI ZS R.y~ Diltrlot O,flo.. or by olnl". thl IPNlll Z_-hour .,....rlnt ..rllloe nuIbIr. for far.' orderlngl In Penn''1lvenl, l..anO"S6t-ZOSO, out.\de P,""''11Vlnl, -nd within 100.1 Iltrrloburs .rn 17171 717-ao~, TOOl (717) 77z.l2S2 Illterl.. 1....lred Onlv), PAVlDT' RIl'\lHll lellll OUCTlIlMII An)t p.rtv In lnt.rllt no~ nU,'11d with tlw IPPrl1I..."t, .lloweno. or dlMUOWIMI of dNJOtlonl or .....lMnt 01 ,.. I \noludl.. dl.......I or In,,,..1I .. .-, on "'II NoU.. MV DbI..I _llhln lI.tv (601 dovo 01 r...lpl ql IIlI. NoU.. bV' . .~wrltt'" prot..t to tht PA oeplrt-.nt uf RIVInUI, 100rd of AppII1., Dept. Z110Z1, Hlrrl.burg, PA 171ZI-l021, OR ....lHtlnt to hlVI thl ".tt.,. det.r.IMd .t thl BUdIt of thl to(;~t of thl ~rlonll rlflr....,t.U"., alii ...sppeel to thl Orphanl' court AOIllH" IITllATlI'l! _CTlIlMI' FIGtul1 .rror. dl.cov.red on thl' ........nt Ihould be Iddr..1Id In wrltlnt tal PA Dlplrtlent of Rlvenue, lurllU of Individual Tax." ATTHI po.t A....ttent Rlvlew Unit, DEPT. Z10601, H.rrltbUr., PA 1712'.0601 Phone (711) 7'7-'501. I.. P'" 5 of the bOOkl.t "In.tructlon. for Inh1rltenc. t'M R.turn fo\' · Rllldlnt DIG.."t" (REY-UOn for IW'I IMp1tn1t1on of IdIln1ltreUv.1V carreatlb11 .rror.. ' If II1Y tel( due I. Plld w1thln thrH (5) clltndlr IKInthl .fter thl dMtdentl. a.th, I flvl Ptlfa.,t U~) dllooun' 01 'hi ,.. p.ld II 011-. Inl"'" II Dhor..... ""Iml.. _IIIl II.., do, DI dtll_, or nIno (,) _thl ond - (I) dov frM thl dltl of dllth, to thl IiItl of ply-.nt, TIMII which bee... dellnquentblfar. Jenutry 1, 1.1l btlr lnt.r..t It thl r.tl of .IM (6X) percent per ~ c.lcullted .t · dillY r.t. of .OOOl~. AU taxll which bttOlH d.Unqutnt on or Iftlr Jenutrv 1, lY'! .,Ul bur Intlrllt .t I "tl which NUl very fr.. cllandlr y..r to olltndlr y.ar with thlt rlt. announced by thl PA Dtp.rtlent of AI"enuI. The ."llclbll lnt.r..t rlt.. for I'll thrOUlh 1991 .rtl 011COlllT I 1Hmll!IT' 'till: lnt_nd A.tl peUv Int_,.lIt Factor XJII' tnt_fed Rltl D_llv Intt,...t Factar I'" 1911 19114 1915 1916 ."lnter"t lOX .00054S 16X .00041S IIX .000501 IIX ,000156 lax ,ooom It ollcuhttd I' followlI 1917 1'16-1991 1992 1991-1994 1995 'X IU 'X 7X 'X .000247 .000lGl .000247 .00Gl92 ,000247 ItmlUT . BALAMCE OF TAX IJ1QlUD X NUllDEI DF DAYS DELINQUENT K DULY INTEREST FACTOR --AnV MoUot i.tOId Ifttr the talC Moo'" delinquent will reUtat 111 Intere.t cllouleUon to flftlln nil dlV' bI~ond thl dlt. of tIM ISHllllnt. If Plvaent I. ... IIt.r thl Intarllt ooeputaUon detl IhcMI on thl Notlcl, Iddltlona1 Int.r..t eult be ol1cullted. I,' /1 I ~ I) J- 1 . RIY-1541 EX AFP (12-94* '_UTII rw PEHHSVlUHIA Df:PAlITIlEHI rw RE'lENUE IURUU 01' IIaIIVIDU.\L Tml DEPT, Zl0601 HARRlllURG. PA 17111'0601 DATI 08-14-95 COUNTY CUMBERLAND NOTICE or INNERITANCE TAX APPRAIIEHENT, ALLOMANCE OR DIIALLOMANCE or DEDUCTION I. AND ABSESIHENT or TAX ON JOINTLY nELD DR TRUIT AIIETI ESTATE OF HERMAN DOROTHV L DATE OF DEATH 03-04-95 FILE NO, 21 95-0492 S,S/D.C. NO. 191-18-3138 ACN 95124753 DENNIS E HERMAN 219 BOBCAT RD CARLISLE PA 17013 REMIT PAYMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 AlIOunt R..ltlad . CUT ALONO THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~ Riv: ii4's- ix -AF p' ('1'2-:94;---- - -- - ....- --..... -"--00'00- ...- - -... - -..oo- - _00- _00 -.. - ,-... -. .___oo__ - _... _ __ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-14-95 ESTATE OF HERMAN DOROTHV L DATE OF DEATH 03-04-95 COUNTY CUMBERLAND FILE NO. 21 95- 0492 TAX RETURN WAS, S,S/D,C, NO. 191-18-3138 (X) ACCF.PTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION, DAUPHIN DEPOSIT RANK & TR CO ACCOUNT NO, ACN 95124733 5700229331 TYPE OF ACCOUNT, (Xl SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 07-06-93 Account Ba18nce Percent Taxeble X Amount Subject to Tex Debt. and Deductione Taxllblll Amount TlIx RlIt. X Tax DUll 22.486,89 0,500 11.243,45 ,00 11,243,45 ,06 674,61 NOTE, TO INSURE PROPER CREOIT 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," TAX CREDITS I PAYMENT DATE 06-28-95 RECEIPT NUMBER AA047941 DISCOUNT (+) INTEREST (-) ,00 AMOUNT PAID 674,61 TOTAL TAX CREDIT BALANCE OF TAX DUE INTlRI8T TOTAL DUI · I~ PAID AFTER TNIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, . ( IF TDTAL DUE 18 LESS THAN II, NO PAV"ENT IS REQUIRED, IF TDTAL DUE IS REFLECTED AS A "CREDIT" ( C~.l.l VDU "AV SE DUE A RlFUND. SEE REVERIE SIDE OF THIS FOR" FOR INSTRUCTIOKI. I 674.61 ,00 ,00 .00 ~ ~(1f IIIITlClI, UVIlIlfI, _(CIlI, OUCTlOHI, AlIItIN- IITl1ATlI/! _CTlOHII DI_, INTPIITI ,. ,. .- 1",( ~&{ , .. .~'" " ,~l(t C1 .<J? " ()\ l_' C!!.' "r'j ~', ',\ \0 .., " ,- , !If ~~l: , ,. ~ J ',',I '~ ,., lrl C:( '/U (J~ P' r.r: To fulfill till .""'I'.....t. of I..llon ~140 of till IrIlt,ltonoo ond E.toto T.. Aot. Aot rr 0' !tt!, C!I P,I. hollon 11411. Dol.... tho tCltl po.llon 0' Ihlo Noll" ond .ubolt with '0'" .o.-.t to till RooIoI" 0' Will. p,lntocl on till rlVlrH IldI. ... ....,cheok or lIOMyorder plylbll tOI MOllTfR Of' WILLI, AGENT. All ....-.t. ,_hod oholl flrot be ,",lied to on. lnt"..t which ... be duo. wl\h on. ,_Indo, opplled to till t.., A r,f\nd of . taM credit, which "" not r.qullttd on thl tiN return, ..y be rlqUlltld by CNPI,Unt ." "AppUOltJon far R.~ of Pennlvlvenl1 Inhlrltencl ~ Elt,t, TIM" (REY.ISIS), Appllcltlon. .r. IVll1lbl, It thl Offlol of tho ""lItlr of NUll, .,y of thie U R.vllnUl Dlstrlot Offlc.. or by ~.l1lnt the 'PRill Z4-hour .,....rlnt lI,vloe ~r. for foral ordering, In Ptnn.vlv~l. l-100-162.Z010, out.lde Pennlylvenll Ind within loc.1 . ",rrlobu', ".. (m) 711-109<1. TOO' (717' nz-llSZ lHo,,11lI lop.lrod Dolv). Any "rtv In lntln.t not MtllUM with t.... IPflr.t....,t' ,UowtnClI or dlHllowlnC1 of dIduotlonl or .........,t of tal( Unoludlntl dhcCM.I1t or lnt.rut) " Ihown on thl. HoUOI HV obJlClt ..lthln Ihctv (60) dI~. of rtollpt of tI1h NoU.. "'" .~..rIU" prot."t to thl PA DeplrtlMlnt of A.vll"lUl, Ioftrd of Appt.lI, Dept. 2.1021, Hlrrhburg, PA 17UI.1021, OR -..llOtt.. to hi". thl IIU.r det.r.I'*' .t thl I\XtIt of thl ItCOCMllt of thl ptrlonll rlPru.,t.Uv., 0" .......1 to the Orphltl.' Court il i r \ I FIaMl .rrc.r. dhoo....rld on thh .....lIIIf'lt Ihould be tddr.ned In .rlUng tal PA o.trtMnt of ".VWIUI, lur..u af Indlvlduel Taxll, ATTNI POlt A.....eent Alvl... unit, DEPT. 2.0601, Hlrrllburl, PA 17121-0601 Phone (717) 717-6101. ... P'" J of tM booMllt ''In.truoUon. for InhtrlttnO. T.IC A.turn for. AIII'*tt OIGtdtnt" (REV-150l) for In .)(plInlUon of ..Inhtr.tt....lv corrlHltlbl. .rrorl. If MY tlM due II p.ld within thrH (J) c.lend1r IIOf'Ithl Ift.r thl dR.."t'l dllth, I five peroent (I~J dhoount of tho tox p.ld h 011_, Int.rllt II .reed btalmlng with flr.t dev of dellnquenov, or nlMl (9) Ionth. and OM (1) d1~ frH the det. of dMth, to the d.t, of PIIYMf\t. TIXI. which bee.. dllInquent blfor. Jlf1UIry 1, 191! bNr Intlrllt .t thl ntl of 11M (6XJ p.rc....t per ~ o.loulatect It . dlUv rltl of .OOOl~, All taxll Nt'l1ch beG.. ckIl1nquent on or ,ft.r J,"""ry 1, 1912 .,111 bur Int.rtlt It . r.tl which .,111 wry fr. ctltndtr vnr to c.llndtr yn, .,Uh that rlt. If'Il"ICMlCed by the PA DIfIlrtHnt of A.vtnUl. ThI -..11_1, Int.rtlt rtttl for 1912 thr~ 1"1 "" UK Inhr... Alh Dlllv Int.rut Factor " " , Il,tlr." Att. n,l111 tnt.r..t FlIGtftl' ~ 1"1 190 1111 IMI 1916 "'Int.rllt !OX IU IIX IU lOX 1. calloulltld II ,000147 ,00DlDI ,000147 ,000191 ,000147 9X m 9X 7ll 9X .000541 .000451 .000lDl .DDDlIf .000174 faUo"l1 1917 1911-1991 1991 1995-1994 1995 IIfTDIlIT a IALAMCll OF TAX UNPAID X NUIIIU OF DAY. DELINQIIIlHT X DAILY IN'rEIUT FACTa. --An. Notlo. luued .ft" till tOIl boG_o doll"""""t .111 ronoot on lnt"..t o.IOIIlollon to flit... nil ..... btvond thl det. of the ........"t. If PlY"'" It Mdt .It.r thl tnterut cotpUtlUon dati shown on the NoUN, eddUlonll Int.r..t .....t bI cllcullttd.