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It INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS COllNTYCO[J[::;" DECEDENT'. NAME (LAST, fiRST, AND MIDDLE INllJAL) DECEDENT'S COMPLETE AODNf,SS Elcho1bor or DDnald 219 Plaza Dr! vo SOCIALSECURI1YNu",eER DATE OF DEATH DATEOFOlntll Boiling Springe, PA 196-14.1348 02/08/1995 10/14/1925 17007 REV.!IOOEX.(7.t4) FUR DATES OF DEATH AFTER 11llUII CHECK HERE IF ASPOUSAl 0 l..k.RUllT IS CLAIMED FILE NUMBER 8 g NAME R ij RobboCII R. Hu hos ~ TELf,PHONE NUMBER 717.249.2353 1, Real E,'"e (Schedule A) , 2. Slack. and BondllSchedule B) (2) 3, Close~ Held SlockIPannership Inloresl (Schedule C) (3) 4, Mong.go. and NOles Receivable ISchedule D) (4) I, Cash, Bank Depo.n. & Mlscellaneou. Personal Proporty (Sch E) (5) e, Jolnl~ Owned Pr.porty (Schedule F) (6) 7, Tran"", (SChedule G) (Schedule l) (7) D. Tolol Gr055 A."els (I ole I Line. 1.71 I. Funeral Expenses, Administraliv8 CoslS, Miscellaneous Expenses (Schedule HI 10, Debls, Mortg.go llabllrtles, liens (SChedule Il 11, TOIaI Deduclions 110101 L1nos 9 & 10) 12, Nol Voluo 01 Eslol.ILlno 8 mnu. line 11) 13, Chern.blo end Go'''nmonloISequesls (Schedule J) 14, N.I Voluo SUbjoCllo To, (line 12 mnus line 131 15, Spousal Tronsl"s 1101 doles 01 d..,h oher 6.30.941 See Inslfuclions lor Appliceblo Porcenlage on page 2, Ilnclud. veluollrom Schodule K or Schedule M,) 16, Amounl 01 lin. 141.,obl. a16'/, ral. (Include v.lueshom Schedule K or Schodulo M,) 17, Amollnl 01 L1no 141a,able el IS'/, role (Includo valulShom Schedule K 01 Schedule M.) 11, Principal I.. duo (Add I.. ham llna 15, 16 and 17,) 18,CredRs/Sp Poverty Prior Paymenls Dlscounl Inleresl 0.00. 0.00 . 0.00 0.00 20, II line 19 is greal" Ihan Line la, enl" Ihe do'".nce on Line 20. This Is the OVERPAVMENT, ~ 0 ~k he,. " you ar. ,.qulltlng . ,.fund 01 your OY"Faym.nt,] 21, II lln. 181s grill" lhan lin. 19, Inl" lhe drlforonce on line 21. This Is Ihe TAX DUE, A, Enl" Iholnl"lSl on 'he balance due on Line 21A, B, Enl" lho 10lal 01 Line 21 and 21A on line 21B, This Is lho BALANCE DUE, M.k. Check P. abll to: R. Ilt.r 01 Willa, Aglnt , . . BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH . . "plnoIlI.. 0 per ury, dl(' 'fel all .v. ..,rrJned Ihll "I urn, Including .eC:OmplrJ'flnglCh.dultl .nd It&llmlInl', and 10 the bell 01 rr'rf knowlodi' .00 bllI,f, It lahUl, coutel.1'd complllll. dltcl'"1hll,1I ,..1111111 h" bttnffporltd Illr"" tl\Irk.l value, Oftlmllon of pI"p.I"r olhlf Ihan lh. ptllOMI "pt"Mnt.IUvt II hiNd on .lIlnlOfmlllon of which pI"p.l11I hn Iny knowltd~ll SI~N/ATUREJ~;;;O(N 7,SPONSrtE FOR F4Q RETURN X 1 (,;I'l:~ . )Jt-'rrf' ATUAE OF PREPAREA OTH[R iAN R~[SENTATlV[ .QQCl- ;, Copyrlghl (cj1ii4lolmlof ~u K ~ ~ COM ~F~mW\\ orFPFl\M:lI.1~ ANIA HAARlSmt,~i'l~\u.06<lI L/t3 NUMOEA Cumborland Count Rel1lllnder Rllurn lIar dales 01 dealh prior 10 1~.13.82) F.d"al ESlllo Tn Relurn Aequllld Tolal Numbor 01 Sale "eposn Bo... (IF N>rLICAeLEjSURVIVINQ SPOUSE'S NAMEllAsT,Frnsr AND MIDDLE INITlALI SOCIAL SECURITY NUMOEn AMOUNT RECEIVEO(S[E INstAUCTlONS) 0.00 ~pplemenlal Aelurn D 41. Fulul~ Inllr.sl Compromise (lor dalls 01 dlllh aher 12.12.821 []] 6, Dlcedonl Died T.slale 0 7. Decede,,' Mainlalne,j a living Tru.t (AllIch copy 01 Willi (Allach e copy 01 Trusll ALL CORRESPONDENCE AND CON~IOENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Xl, Origin.' Aoturn 4, Limltd Estalt 05, o e, COMPlETE MAlLINC AODR[!lS IRWIN, M"KNIGlff 6c HUGHf:S 60 Wost Pomfrot Stroot Cllr11nlo PA 17013 I I T U 1 N one Nono Nono Nono 945.99 Nono None (6) 945.99 (9) 3,583.10 (10) 161.05 (11) (12) (13) (14) 3,744.15 (2,798.16) None (2,798.16) (16) 0.00 0.00 X (16) o.og X ,06: 0.00 ~ (17) (2,798.16)( ,15: 0.00 c o c f N (18) 0.00 (18) (20) 0.00 0.00 (21) (21A) (21B) 0.00 0.00 0.00 409 Klluffman Stroot ilali iiiR'Si;ringa ;. Pi." mbY'.'....... ....... ... ~1~J. ~-- ~AT Vi )1 '{/I/ Form (, 7.t41 IRWIN, McKNIGHT 6c HUGHES 60' 'i/o's't' ~(;nitr(;t. S'treot:' 'Cr;~'l'i f; i~;'-' j'A" i lCll:i' ~\" L T':' j 1'; I '~' '," i , ":\ '-j "";j' '. '-, ,." ". , .~y;,,;, "'1 ;i ::'1' iy,~, 'i": ~; .'J-'j' ".' '",,' "1,1 !, .' :,:.;',:'\ ~ '48 of 104 pmvldn for IN rHuctlon of IN tax rltn Impolld on the nit vllu. of trlllll.ra 10 or for the UI. of the 'POU", The rlln a. prHcrlbtcl by the .lIlul. will be: 13% (.G3) will be Ippllcable lor n..... of dacadenta d~lng on or allar 7/f/M and belor. 1/1/88. In. (.CIa) will be Ippllcable lor Hlltn of dacadenta dlllng on or all... 1/1. and belor. 1/1/17 -1% (.01) will be Ippllcable lor n..... of dacadlnta d~lng on or Ill... 1/1/87 and belor. 1/1IM ISpouul IrIMI.,. occurring on or attar 1/1181 will be .xtmpt from Inhlrltanc. tax. PLWE ANSWER THE POLLOWING QUESTIONS BY PLACING A MARK (Xl IN THE APPROPRIATe BLOCKS. l; VII NO 1. Old dtctdtnlllllk.. lI.n,te, .nd: I',fllllnthlu..orlnconwotthtprOpertyttlnst'ntd" , , , , , , , , , , , ." , , , , " . , . ",.. , . , , , ., , x X II. 1t..1n II1t right 10 d.,lgntl. who ,lilY u..the properly tr.nsf.rred or ill Income, : . , , , , , . , , , , . , , . , : . . . 0. "..In. rlYlftlolllry Int,,,st; or , , , , . , , , , , , . ~ ' , , . . . . , , . , , , , , , , . , . , , '.. . ; . j . ',', , . X ~. rllCllvt the Plomil. 'or I". of .lIhtr ptymenll, benefill or CII.?, . . , , . , " , " , , , . , , , , , ,'. . . . , , . . x ~ .. "dulh occurred on or before D.c.rra.r 12, 1882, did dIC.d.nt wbhln Iwo Yllra prICedlng dlllh lI.nallI proptlrly wlthoul rec.lvlng .d.qu.1t consld"alion?" dtllh occurred .h.r Dac.mbtr 12, ' 1182, did dlC.dtnlll.nsl.r properly w*hIn one y"r of dtllh wlthoul rIC.lvlng ed.qU'I' cOlllIdt/llion? , , , . , , , , . , . , , , , , . , . , , , . , , , , , , , , , , , , , , . . , , . . . , , , . , , . . . , . . X . . S. Dlddtctd.nlownan.lnllll'tfor'b.nk.ccount.thltorhtrd.alh?""""",.",...,.,.,.",.. X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST CO~Lf:!TE SCHEDULE G AND FILE IT AS PART OF THE RETURN. " " ,. " ,'; i" H_, r; " ,,' "!, , , (, ' ,(.' , , " , , " , .1", ,I', 'ii' " " " ; " " ," "~I. " ", " . , , , I;" ,,1- , " . Ctwrlt~. (0) llt4 fonn ooUw... onI)I Cll'rol...., lno. , , "',m 1100 (Aw.7'''' , ftlV ,11011)(' 11.17) SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Plou. P,lnl br T . FILl NUMBER COfotllR,lWM_MhYAN'A ITATIOF Donald Q. Eioh~lberger SS# 196.14.1348 02/08/1995 {All "0""" joint -owned wHh RI hI 01 SYrvlvollhl ITEM NUMBER 1 Cash On Hand mUlt " dllclolld on SchNur. F) DESCRIPTION VALUE AT DATE OF DEATH 500.00 100.00 25.99 2 3 22 Rossi Pistol Nations8ank, Doneld,Q. Elohelbel'ger Trust, inoome 4 8011ing Spr.ings Assooiates, refund of seourity deposit 120.00 5 Sale of 1979 Chevrolet truok to Harvln P. Dymond. 200.00 " ,- 'I I',;.' , ' /" , , , , ,.( , " , " ',' " _I , ", 'j.; " I,' " .,1 , " " "il ,,' " I"~ " . ,i'. " '.i ", ,; TOTAL (Alsn .n111 on llna &, R.c. MIllon) , . , (AttAch .dd~lonaI8 112' x 11"11"11 N mo'lIpacIIs IlIld.d,) llof>ytlthl (c) 1114 101m ..IIWIII O!liy CPSyol_, '1'0, I I ,,,,. I I '. 945.99 '....1100 'chldulll (R.., 1,17) "'::-'.::;-r,';t'.u~"""""""""'''''''''n'-;j";-'''.,_~.;r~''_r; 'j I' . ~ '" ~ , .' , \. , , " " "F, , , " " , " ", " " "I "~ ~)'9. (i,ll"'(' ('>:I! '~ ,\ ' " n I, III \J :~'~~) .Ill Q:: 0:' " " " "I( " .,"" " 'I:," 1,' " " ..'(:t 'i' , \' ,Ii (: ".,1 " " " ". " , " I' \', 1',\1" ,~ , " !Xl' ;,I'CN ,~', " " ,f! ,j" " Hi ",':' " i ,I " ;,' \ " , 11'" , " 'I'. " " I' I),. I " '" '; I ~ ' Ii " " I " ,ill' I., " .... 1+. :~~'I" I',lil: , u "(/ " ir:) l.', ". 'il \1) .ili;~ ,c.> c:s t51 m-I'!""1"j"', "'~"'_'T_""'_"""""""'\''''''t_',~'L,' , ..'II "'I', '''';\ ,'1",' 1 '~I;~i.~,:",;~'i\1 if.:},:..!""" '.',;' .'11'1\ '\ '\'\t'.~'_');'F':I' ,:,', :' ..j.' ,; I -, ' " ',I " jJ'" \-,' " ,I' ",I', ," ,I" " ..' . , 'i ," ;' \ " ",1'" , ,,", ,'/: i." i'l. , " .:" '" " ,,, ,'I' " L ;, ,', " II ",,' " , " ';\', II , ' ,\1,: " , . ' '1Ij, " ,i," "I 1'1, ," ,I',. " ,I" 'loll I' " I'; '" 'i. , \'" .' 'li, I' " " ". " i"l "I " 1,':1,1 " ;, "\" " 1" " II. (., " , 'j',," "i' ",' "1. ':1_ +/! " , " " I' , " I' " /', " " ii' ,'j, I.!. " I "I i;'l' I,' 'I' , " i'.', ," " ,I "'j' '" , ,,' 'I, " " , 'I" Ii "'1> I'" \1,' (I" I' ',I \1 :." II- ':~' ':1,'4 f~, ",~t~~"t''';'",t''''':~/lI'IiIi~.~_~f~~'r;'"'~Ir''' ";".... ;:' \ ;- -,'- " ,~ I " ,J,I '. " ,," " ',-,I , " ,- .. - ,I' '-', '" ,". \'-, I', " Ih, , ,,-J ", "', "" "\' ., ,f' 'I' "X,,' " .' .,," d' ,i' " ,<I. ,1',-\\, '1"1 " " " 1'1' , 'I,' " ,I, " " , '" ,,;' " ('; .-, d 1 , , ',,1 " , " 1', ~ -.' \', ." " f_" :1" " " " I "1 , ," .. 'I, "',!l '1,',1 'I. I"", I." ",' I' " I' " , ,~ " " r ':'( "'j I" ,I! " ,,' "(' ,I " I,;', , ," .',' " ,iil\ 1\\1(. ,', " "i, ..1' ',', , ' " " '-j. ", " ",' " " " "1' .' l' '''i' '('- , '" " 1 , .. I" " i' "i, , " ,. I' ..' ,I' ,,1' 1\.., ;'" 01/ " I." ,;1 .. 1!, " I,' , ,,' , " , I' , "',,-_\. " OJ, ..' Ie " , ' ! ~ 'I,' 1\'1 ~ ',Ii' Ill. ',-. ". j'l' ',i " )'1; (, '" " ,.. " ,1" ;1' " " " " ;I " CO"'..W>>JMhYAN1A TATI Of' SCHeDULI! H fUNeRAL EXPI!NSES, ADMINISTRATIVI! COSTS AND MISCELLANEOUS l!XPeNSI!S PI.... 'rlnt or . PILI HUMIIR ftlV. ,1II1l( . (1.11) Donald mM HUM..II .. Eichelberger 550 196.14.1348 02/08/1995 DIICIIIPTION AMOUNT 1 '_III1,.nl..1 Hoffman-Roth Funeral Home 3,323.10 .. Admlnlllrlllv. COIIII ,. 'IIIOMI R.prlHNltlvl ConvriIllons 0.00 Social Slcurlly Number 01 PerloMI RlprtltNlllv" VII' Conmsllons plld WAIVED I. Allomey FIn IRWIN MCKNIGHT & HUGHES 250.00 t P.rrItt EXI~tlon 0.00 CLlI/IlInl NONE R.L1llonshlp Add'..1 of CIaIrt."'11 dlced.n!'1 d..lh SUtll Add".. City Stll. _ ZIpCodl_ .. Probll. FHI 0.00 C. MllcelllneoUI Ixplnl"' 1 Cumberland County Regieter 10.00 of Wille, filing fee TOTAL (Also lricer On Will t, Rtel Mulallonl . (" more 1,Icelt 1IMCIId. InHIl HdltlonlllhHll 01 111M 1111,) Doprrlthl ~I 11M 101m lOll",... only CPIyIt..., I""~ . 3 583.10 '....1100 Iclllot . , ;:.,.." '.11) i'" "IV .1111 1lC. (l.U) . COM~.,w.rAHIA " ,.. Donald Q. Eichelberger SSe 196.14-1340 02/08/1995 r;.'. \V'I ~!! ~_ij, " ,'$., \-<, ;~"''I' v:.. ',:'-.:\1 l:<~ 'ji~ (;l_; ;}5~' ;Wl; )J't, !~ ~\ rti: , ) lTIM NUMMR 1 DESCRIPTION AMOUNT 51.24 Metropolitan Ediscn Company, Aoct. #7343 39 0820 38, balance due 2 United of PA, Aoct. #717-258.8036. balance due 45,49 3 Matropo1itan Edison Company, Acct. #7343 3908 50 31, bslance due 64.32 ,. " , I' .-,! , , ),., ;, \ Ij " ." ;.1, .,1, " ,:,', I, " ,,_I',' ,'" , , " " ,,"1 " ,.' j". I,' " I: .,. './ , " " I' '\ " ~; ,.; , I" {, " , " I', .,. i'l, " ; ',;1' '! " i" ,.' " d, q , , '. , , ,. ." ~ d , , '" I; II,. Ii , " " , ", l't 'f, ;" " ,t':, !,,' " ,. (, ", " ,'; " 'j" , . - TOTAL Allo tmr on lint 10, RICI lullllon) , . (" morelplCl II _did, lnItll Iddllontllhttll oIl1mt lilt,) ~~I(o) 1114 IlIIm""l'IlItonl)l Cl'lrtl_, I... . 161. 05 POImllOOk_I(llov, I_II) <J.....,.~....,.....,._.., .,.'-0 '!",.' 1 ' I ftlV.16l11X + (1.111 , " COM.~.MbYAHIA ITATI 0' SCHEDULE" BI!NI!PICI les Donald ITEM NUMBER 02 08 1995 NAME AND ADDP.ESS OF BENEFICiAllY A, Tidbit a.qUIIlS: 1 Matthew W. Good 409 Kauffman Street Boiling Springs, PA 17007 2 William C. Good 409 Keuffman Street Boiling Springs, PA 17007 friend remllinder ITEM NUMBER NAME AND ADDRESS OF BENEFICiAllY B, CharllAbla and OoytrMW~1 a.qUIIIs: AMOUNT OR SHAIIE OF ESTATE ,,' TOTAL CHARITARLE AND GOVERNMENTAL BEQUESTS (AIIo Imr on1nl13, Riel kullllon) (K _I Iplcall naadld, Imllt add.lonal IhHts of llmelln,) Ctr/ftIhtCC) 1114 f"rlllloflw", cWl CPIy.tlml.'hC, . 0.00 ' ,""" 1100 _ J (1Iov,1.''/) " LAST WILL AND TESTAMENT, I, DONALD Q. EICHELBERGER, of Boiling Springs, Cumberland County, PeMsylvanla, declare this instrument to be my Last Will and Testament, hereby expressly revoklng any and all Wills heretofore made by me, ~: I direct my Executor or Executrix, as the case may be, to pay all of my debts, funeral and administrative expenses as soon as may be done convenlently after my decease, Furthennore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and all interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Executor or Executrix of my estate, nYQ: My Executor or Executrix, as the case may be, may, at his or her discretion, compromise claims, borrow money, retain property for such length of time as he or she may deem proper; lease and sell property for such prices, on such tenus, at public or private sales, as he or she may deem proper; and invest estate property Rnd income without restriction to legal investments unless otherwise provided hereunder, I authorize and empower my Executor or Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living, My Executor or Executrix . " All', I..I~\ ~!,:i;'l '/".'\1 il.; ;~.:i i" .;fj", ili ~' \i:" '''I' I',) "!~.l ~, , " \,',\ 11\, ", "IX.r \" \,,1 if ~ I ~~,' ",,' " Xf\,~ ; ',,{'j },(.,\ ;"{;.'_' li<.'\ :""1 IN WITNESS WHEREOF,l have hereunto sel my hand and aea1 this ,,,,,- day of 1anuary, 1995, Slsned, sealed, published and declared by DONALD Q. EICHELBERGER, the testator above named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the pl'esence of each other have subscribed our names as witne,ses hereto, 1< ~ " l', li, '" ;'/'. 7ll. ,,' , , , , -'I' " . I' .., \:"r , ' I' "j' " , , " I' "I'. I- " ,. .,' " " ." " , ,., , ' " tl .1 , , ,. I" ' , , , . \ , ..' . 3 I _~:, "..._~._.:\"t"ll"""''''''''''lfQ".....,\,.q'fI_~I.''''' ." 'I-i'~('. ,\';." i, i' . 1', ,I.. .. t/ /5-Y/~I'-I \ ~ REV-1!147 EX AFP 112-94)* CO"",,,,"€AlIII OF PfNHSVlVAN1A DEPAII1H€Nl OF REVENUE lUIlEAU OF INDIVIDUAl mES DEPT. 110601 ItAAAUIURO, PA l11Za-0601 ACN 101 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX DA TI 10" 02- 9 5 - -~PILE NO. 71 95-o49!--~ DATE OF DEATH 02-08-95 COUNTY CUMBERLAND NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT TNE UPPER PORTION OF THIS FORH WITH YOUR TAX PAVHENT TO THE REOISTER OF WILLS. HAKE CHECK PAVABLE TO "REGISTER DF WILLS, AGENT" REMIT PAYMENT TOI REBBECCA R HUGHES IRWIN ETAL 60 W POMFRET ST CARLISLE PA 17013 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 E:- -, AMOU!'-I,J~~ I CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~ i(! V: iS4"' "iie". it. j:p. [i 2":94"j. NOT i cr. ci F. i"NHiiii f ANeE "TAX -XpjiR'A- i S Ei,,"iil'f;. it. [,1 alii-NeE -'(jli..""."""....."... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ISTATE OF EICHELBERClER DONALD Q FILE NO. 21 95- 0493 ACN 101 DATE 10- 02-95 TAX RETURN WAS I I X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN 1. R.ol E.toto ISchodulo A) 2. Stocko ond Bond. I Schodul. B J S. Clo..h 1I00d Stock/Portnor.hlp Intoro.t ISchoduh C) 4. Hortgog../Noto. Rocolvoblo ISchodulo OJ 5, Co.h/Bonk D.po.lt./HI.c. Por.o"ol Prcporty ISchodulo E) ~. Jclntly Ownod Prcporty (Schodulo FJ 7. Tron.for. ISchodulo GJ B. Totol A..oh I I CHANGED .00 ,DO ,00 ,DO 945,99 .00 ,DO IB) 11) 121 (5) 14) 151_ (6) 171_ 945.99 APPROVED DEDUCTIONS AND EXEMPTIONS I 9, Funorol e.pon.oo/AdM, Cc.t./HI.c, E'Pln.o. ISchodull H) 10. Dobt./Hortgogo Llobllltlo./Llon. ISchodulo I) 11, Totol Doductlon. 12. Not Voluo of To. Roturn 15. Chorltoblo/GovornMontol Boou..t. ISchodulo J) 14, Not Volu. of E.toto Subjoct to To. (9) 110)_ 3,583.10 161,05 (11) 112J IISJ 114) 3. 74l,..I.S... 2,798.16- ,DO 2,798.16: If en al,ee.ment wae ilsued prBviou.1y, line. 14. 15 and/or 16, 17 and 18 will ref1act figurel that include the total of Abh return. a.lel.ed to date. A8DESSMENT OF TAXI IS. Atcunt of Llno 14 ot Spou..l roto liS) 16, Atcunt of L1no 14 to"blo ot 1,lnool/Clo.. A roto 116) 17, Atount of Llno 14 to.oblo ot Collotorol/Clo.. B roto 117) lB. Prlnclpol To. Duo NOTlI ,DO X .00, ,DO X ,06. . DO x ,15. liB) . DO ,DO .00 .00 TAX CREDITSl PAVHENT DATE DISCOUNT (+1 INTEREST (.) RECElrT NUHBER AHOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE ,DO .00 ,DO ,DO . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, IF TOTAL DUE IS LESS THAN .1, NO PAVMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAV BE DUE A REFUND, SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) .' " . ;".~_..~.",_.l."'l.' t, ,I- ( I, I ic PO ";i I.Ijl "1/ :u \i :~ !I) I' ., r.l II ~'\ Ii: t:~l r~ t .I 1,', "'rl " I /1' ,~ f' t. \J h U 1;- ~ ~; I =-:--J (', ! .1,., : i'. eu ( :~ R!SlAYATlO'h Elt,t., of declcMntJ dYing on or blfor. Dle...r' 12, 19'2 u If Inv future Intlrllt In the ..tit. 11 tran'f.rred In POI.I..lon or InJov..nt to CII.. . Coolltt.rll) bln.floltrl.. 0' the dlc.d.nt .ft.r the 'HPlr.tlon 0' Iny .."t. 'or II'. or for y"r., th, COMOnWulth hlr.bv IIIP""h r...rVII thl right to tPPI',I" 'nd a..l.. trln.f;r InhlrJtMO. TIlllI ,t the Ilw'ul CI... I (oollltlr,l' rete on anv .ueh 'uture Int.r..t. PtJRPQSE OF NOTICE' To 'ulflll the rlqulr...nt. of S.otlon 2140 of the Inherltlnol Ind Eltlt. Till Aot, Aot 22 0' 1991. 12 P.'. Stotlon 2UO. Detlch thl top portion 0' this Notlel Ind .ublllt with your PIY.lnt to the R.gh\tr of Willi prlnte, on the rever.. .Id.. ...".... oh.ok or oon.. ordor ......1. to, REOISTER OF MILLS, AOENT All plvatn\l r,cllved .hlll flrlt bl Ippllld to tnv Intlr..t which .av b, dul with anv rllllnd.r appll.d to the till, R!FUHD CCR)1 , r,'und of I t,x crldlt, which WI' not requl.t.d on the Tax Alturn, .av be rlqu..tod bv co.,l.tlnl en "Appllcltlon 'or RI'und of P.nnlvlvanl. Inh.rlbne. anI, E.tlt. Tlue" (REY"UISI. Applloatlon. ere aVlllabl. at thIO"I<l1 of the Alght.r 0' WUII, any of the 23 R.v.nut Dhtrlct OffiCII, or by Clllllng the .p.elll 24"hour tnlw.rlng ..rvle. ~Irl for for'l ord.rlngl In Plnnlvlv.nl. 1.100.362.2050, outlld. Plnn.vlvanl. Ind within 10011 Harrllburg llrea (111) 787.809lt. TOO. (711) 772"2252 (Hlarlng IIlPllred Onlv). PAY",,"T' OBJECTIONS' Anv party In Intlr..t not ..tllflld with thl Ipprlh...nt, IUOM'rlCI or dlllUOMlnCe 0' dIWcUon., or ......lIInt of tlJC (lnoludlng dlleount or Intlr.." .. .hown on thll NoUcl .u.t obJ.ot within ,hcty UO) d.y. of rto.lpt 0' thlt MoUc. b~l uwdU.n prot..t to the FA DIPlrt..nt of R,vlnut, Ba.rd 0' Apptlh, D.pt. 211021, Harrllburg. PA 11121.1021, OR ....I.otlon to have thl ..Uer d.ter.ln.d at lud!t 0' the account of tM parson.l rtpra..ntetlv., 0" ....rpp..l to the Orphan.' Court. AIlltIN IITRRTlvt' CORRI!CTlOIlt, FaotuII errors dltcav.rtd un thlt ........"t should bl ,ddreu.d In writing tal PA D.p.rt.."t of A.vanut, IlJr..u of Individual Till", AnNI Po.t A.......nt A.~l.w Unit, Olpt. 210601, Harrltburll, P' 11128.0601 Phon. (117) '.'.6505. Sa. page S of the bookl.t "In.tructlons for I~rlt.rlC' T.~ R.turn for I A.lld.nt Dtc.dent" (AEY.IS01) for an ellpllnltlon of adalnl.tr.tlvllv correct.bl. .rror.. OISCOIINT. If .nv tI~ due It Plld within th,.. ()) callndar 1I0nthl lI,hr tht cMoldent'. dlath, . flv. perc.nt (SX) dlloo,,"t of the tlJC pald 11 allowad. I"TEREST, Inte",t It chargld b.glMlnl with flr.t dlY of d'llnqu.noy, or ntne C9J .onthl end one UI dlY 'ro. the d,t. of !Hath, to the data of plv..nt. TIM" which blCI.. d.llnquent before Januarv I, 1982 b..r Inter..t at thl ret. of Ilx (6XJ p.rOI"t p.r ennui caloullt.d It a o.llv r.t. of ,OOOI6lt. All tllll. which blc... dlllnquent en Ind .ft.r Janulrv I, 1912 will bur Int.r..t It I retl which Mill VIrV fro. cahnder Yllr to cllendar yllf MUh th,t rlt. ~nt.d by thl PA D.p.rt..nt of Rlvlnu.. ThI appllcabl. Intlr..t r.t.. for 1982 through 1995 Irll !!!! Intarut Aat. Oallv Intlr..t flotor !!!r Inttrllt Rate .2!,!h Inter..t factor 1111 lOX ,QOom 1117 9% ,000247 1115 16~ .0000\18 1'11'1991 llX ,000501 1114 llX ,000101 I.,? ,~ ,000147 l'li ll~ ,OOO!56 1995-19'6 n .000192 1116 10~ ,000216 1991 ,~ .000147 ."Interllt II cllcualt.d a. followlI INTEREST . IALANCE OF TAX UNPAID U NUHIER OF DAYS DELINQUENT X DAILY INTEREST FACTOR ."Anv NoUe, IlIuld "tar the hie b.:OtI11 dellnqu.nt will rtfhct iN1 Inter..t cllcul.Uun to flft"n 0\) din blyond thl dltl of the ........nt. If ply..nt It ,Ide after tM lnter..t cOlIPutaUon dl''' .hown OIl the Notlol, Iddltlonl. Int.r..t _u.t bt e.leule'ed.