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HomeMy WebLinkAbout95-00700 i,' :.:-.t:..' --'- -, ',":' ; REY.1500 EX+ 17.qAI * COMMONWEALTH Of P[NNSYlYANIA D[PARtMENT Of REYENUE Dfn 280601 HARRISBURG. PI. 11128.0601 DlClDWI'S HAMl IlASI. U"'. AND MIDDU IUIIIAII Hosband, Alvin K. 'Q(I~,;,~u~';;:"~';72 U.~':;D~~;~ _J~~~';:i;6 - I" ""\ICAIlIISUI'l'l'1'ING sPOUU.S,.,A....IIIAII. "111 ,U{D Io&llIOllllnllAll !.OClAl SICUIIIIY NUM'11l + + 20. If line 191s grealer than line 18, enler the difference an line 20. Thllls the OVERPAYMENT. DID 21. If line 18 Is grealer Ihan line 19, en I., Ih. differ.nc. an line 21. This Is the TAX DUE. A. Enter thelnler,sl an Ihe balance due on lIn. 21A. B. Enter the 10101 of line 21 and 21A an line 21B, This h the BALANCE DUE. Ma~. Chec~ Pavabl, '01 R.gII..r of Willi, Ag,n' i~'P5;":p,:::,:,,' - --BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH 1. . " f.l',," til'l't"\Il',~l;j Under penalll.. of perjury. I declare Ihall ha.... 'I(amlned this return. Including accompanying sch.dules and slalements. and 10 Ih. bllt of my knowledge and belief, It Il tru., correcl and complele. I declar. thai all real eslale has b.en nporl.d at Irue mark.t ...alu., o.daralion of preparer olh.r than th. personal r.pres.nlatl.... Is based on 0 formation of which "panr has an knowl.d . SIGNATUll f SONlIlS'ONSII,9fOllf II IIN AOOII S 611 B Street DA~" t 1,._ \ ,-,_ 1 Enola PA 17025 ~ A IH" AN' 109 South Carlisle Street OAI! \ ( el-l Rlnnmfi"'lrl, PII l.1J)liR ~1'&-1'tS l!! ..5" blf~ :0:09 ...~"' I:S-(;)7.,-~ INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) ffi lil III o fOR DATES Of DEATH AnER 12/31191 CHECK HEAl If A SPOUSAL 0 POVERTY CAlOIT IS CLAIMED fill NUMBER PlI COUNTY COOE OfCfDWI'S COMPUTl ADORlSS 611 B Street Enola, PA 17025 Co.,, Cumberland AMOUNtlllCllVlD ISll INSllUClIONSI 'If) YEAR 7,0 NUMBER Grace C. Hosband Entire Estate D 3. Remainder Return (far dollS 0' d.alh prior 10 12.13.92) o 5. federal Estal. Tax Relurn R.qulred 159-24-9164 ~ffi <Co <cz l'l~ [] 2. Supplem.ntal Relurn o Aa. Future Inlerelt Compromise (for dales of death aft.r 12.12.82) [K] 6. O.c.denl Died Teslal, 0 7. oec.dent Malnlaln.d 0 lI...ing Trusl (Attach copy of Will) (Attach copy of Trust) !ALL CORRESP.ONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED_TO.",. ",,'Ni>t:;l M (OMPUl( MAllINO AOOIIUS fX) 1. Original Relurn o A. Limited Eslale _ B. Tolal Numb., of Safe Deposit Balles William R. Bunt Es uire lUIPHONl NUMIU 109 South Carlisle Street New Bloomfie:(9pPA .17068:u z o ~ E ~ bl <c 1. Reol Estate (Schedul. AI 2. Sloc~s and Bonds (Sch.dul. 8J 3. Clo..ly Held Slock/Parlne,.hlp Inl"..1 15chedul. q A. Morlgag.. and Not.. Recel...able (Schedul. OJ S. Cash, Bank D.posill & Mllc.llon.aus Personal Prap.rly IS,hedule EI 6_ Jolnlly Own.d Property IS,hedule FI 7. T,an,fe.. IS,hedule GIIS,hedule l) 8. Tolal Grall Assets (10101 lines 1.7) 9. Funeral hpensll, Admlnlstrali...e COSIs, Mllc.llan.aul Expenses (Sch.dul. HI 10. Debls, Martgag. liabilities. liens (Schedul. I) 11. Tolal Deductions (Iotol LInes 9 & 10) 12. Net Value of Eslat. (line 8 minus lIn. 11) 13. Charitable and Go....rnm.nlal a.qulsls (Schedul. JI 14, N.I Value Sublecllo Tal( (llne 12 minus line 13) 15, Spousal Transf.,. (for doles of dealh alrer 6.30.9"1 See Inslrutllans 'or Applicable P.rcenlage on Rev.fle Side. (Include ...alu.. 'rom Schedule K or Schadule M.) 16. Amount of line IA lallable 01 6% ral. (Includ. valull from Schedule K or Schedule M,) 17. Amount of lIn. 1A tal(abl. 01 15% role (Include values from Sch.dul. K or Schadule M.I 18. Principal lax duelAdd 101( from lines 15, 16 and 17,) 19. Credits Spoulal Ponrty Cradil Prlar Paymants (I) 121 131- I A) (5) (6) (7) 40,064.04 1:1 ,-....) C_1 2 On....O.o ;..1 J' 39,Jl64.04 .:.:. 9,422.00 - (8) 191 (10) 9,422.00 30.642.04 Ill) (12) 1131 (IA) 30.642.04 0.00 30,642.04 )(,...Q...= 1151 (16) (171 )( .06 sa )( .15 1:1 z o S => ... :E o ... ~ ... (18) 0.00 ollcount Inl.relt (19) (201 ChNk huru if you a,u ruquusting a refund of your ovurpaymunl. 0.00 (21) (2IA) (2IBI ~ 1!i'a~.it 1~1il1 alt~ illl'!,htlltl'ltt I, ALVIIl K. 1I0SnANU, of East Penn,hurn TO'lIIshll>, CUlllberland COUllty, Pennsylvanh, do make, publish and declare this to be my Last Will alld Testament, hereby revoking and making void any and all fonner Wills by lIIe at any time hereto- fore made. \ i I 1 I 'I I I I I. J direct the payalCllt of my just debts and fUlleral expenses as soon after my decease as may be cOllvenlent to my Executrix hereinafter named. II. All the rest, residue alld remainder of my estate I give, devise and bequeath unto my wife, Grace C, 1I0sband, if she survives me. III. Should my wife, Grace C. Hosband, fall to sur'/ive me, I give, devise and bequeath the residue of my estate unto Oauphln Ueposit Trust Company, In trust, nevertheless, for the following uses and purposes: A. To convert assets Into cash at Its discretion as to time and mallner, and to Invest and rei livest the I.roceeds in securities suitable for trust Investmeats selected in Its discretion, and adlninlster the same In accordance with the Fiduciaries Act of Peansylvanla: 8, To pay over the Income from the fund, together with so much of the principal, If any, as the Trustee shall dee.. to be reasonably required for the support, maintenance, medical care and educatloll of my children to such person as shall have care, custody and control of my children until the younger shall have attained the age of 18 years, at which time to divide the fund, Including principal and all accumulated Income, Into two equal parts or shares, and to distribute one such part or share unto my daughter, Melissa 1I0sband, and retain tha other for the benefit of my son, Todd, ulltll he shall have arrived at the age of 22 years, at which time to distribute the sallie to him, and terminate the trust, The Trustee Is authorized and directed to pay for the bellefit of any child any extraordinary medical expenses or the cost 01 education appropriate to the child's aptitudes and desires even If the same shall create an Inequality of payment as between lIlY two children, and any child In whose favor such Inequal Ity may have been created by th clrcll11stances referred to shall not be charged with the same as an advancement on final distribution: C, Should a child become deceased during the tenn of the trust, the Trustee shall retain the Interest of the deceased child In the trust for the " bellefit of any l5sue such deceased chlld may leave to survive him during the minority of such l5sue, and 111 the event such chlld 15 not survived by l5sue, the share of the deceased chlld shall be added to the shore or the survivor, The Trustee shall have the same powers and duties with respect to the l5sua of a deceased beneficiary as with respect to one of my chlldrell, 0, IIeither the prfnclpal nor ll1come of any part of tha fUlld shall be llable to the antlc1paUolI, allenatlon, debts, or ellgagernents of any benefi- ciary. IV. If my wife, Grace C, IIosband, shall fall to survive me, I name, con- stitute aad appoint IIaoml Kernrer to be the Guardlall of the Person of any chlld who may be a minor at the time of my death, and In the event she shall for any reason be unable to serve, I appoint Louise Preston to be the Guardian of the Person In her stead. V. IlIame, constitute and appoint my wife, Grace C, IIosband, to be the Executrix of thfs, lIlY Wll1. Should she fall to survive me or fall for any reason to complete the admln15tratlon of lIlY estate, I name, constitute and appoint Dauphin Deposit Trust Company to be the Executor In her stead, and I appoint Dauphin Deposl Trust Company to be the Guardian of the Estate of any mll10r beneficiary with autho Ity to administer os such Guardian assets passing to the minor as the result of lIlY death otherwise than under the tems of this Will, to the extent provided by law, III WITNESS WHEREOF, I have hereunto set lIlY hand and seal thls,;l",~'aray of August, 1972. _, /;?2f.:... '_ A- ....14(-.tC . _ ~GEAL) Signed, sealed, published and declared by the above named Testator, ALVIN K, 1I0SDAND, as and for his Last Will and Testament, In the presence of us, who at his request, In hfs presence, and 111 the presence of each other, have here- unto subscribed our names as witnesses. /3) " _,/'7, ( /:A..~~---t-l--./: --;- ~ '.1'_ _~....t'... 'Il:,,~_ )1~<--, -2- __On.. .__ ~ __~.~__.. f UY.lSOIUt lJ-I'I -!j~ COMMONWfAUH Of PIHNSYlVANIA IHHIIIIANC' TAX .nUIH .UIDIH' DICIDINT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Ploa.o Print ar l' 0 FilE NUMBER ESTATE OF Alvin K. Hosband (All property lolntly.own.d wllh the Right .f Survlvonhlp mu.t b. ellul...d on Sch.dut. F. ITEM DESCRIPTION VALUE AT NUMBER DATE OF DEATH 1. 1981 Honda motorcycle 50.00 (See attached appraisal) 2. 1988 Wells utility trailer 0.00 (See attached appraisal) 3. 1980 utility trailer 100.00 (See attached appraisal) 4. 1973 Kawasaki motorcycle 50.00 (See attached appraisal) (Allam additional 8\0\'" )C II'" .h.... If mOil .pace I. n..d.d.) ~ J/ft' Clc. 't1LL<O~ ~"'~ - u.",.<:I(/"""7' 1 S.J~\.ry Public no, I -- CounlY mbOf 811u 198 \res Nov. 16. 19 ;/20/' pi t//I'I.U~ 7?f/!-"7 o Ra 0 a 0, NOliI)' U C Mid I.. p" Cumbe~.nd Counly MyComml.,'on Explra.Nov.16,1996 MCfT'bur, PaMSYIvariaAssodaI.ion 01_ " ,. .- ,- ,l. ~: riI'~l M \ilt~-;!,,:, "~I"fJ.uf~ti~~~'i~'p.:;;'''-':;i-;; ~" ~ ~,~ ~~~~ ~ml$'~m;r~r6'~Iffi1'~6'"Wl...W~m~1\'/J~PiT)"nl}?1Jm1~ol1i~romoo '~^~,('O~~Q"~~~.~~n~'\ < . <, ',lih -j; .-':"'I\',IIIII'I"!"".' ',"'" ' . . ,. ",' "..",,,\'1'1,,, 000 DEPARTMENT6~-T~-~~,~F:~RTATION 7'f0675102B06 56 CERTIFICATE OF TITLE'ro! A MotoR VEHICLE OR TRAILER I, II.. Secrelary v/ Traruportntlon ctrtlly thaf an aPI>l/cnt/on It,,'i /'~hh ;:'",Ie 10 -me. pllrsllallt tv III< Act 0/ AI>Til 29. 1959. 1'.1.. 5R a, amelldCl/./vr a Certificate v/ Titl. 10 t/.. n16tor .,.hltl.-br'iiiiiler clescribed '",uon. , ";". ,"1.; ,.,' 1,.I./h'.\\(.l,'\'...j';'/....rl I "/:.,,! ,,',,"'tl"I,,'I/1!!,;' " ,!:' ..: ,J("',t.t1!i;..j~i;I~I,r"'II'l,,';.. 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" '.,: I !. -1 I' It'''---.I1''' 4') : Ii "':':;1'1- :1 "':"'..1,' 'I, WilLIAM: PEN It1!i'j I)"j'-,'!; ,\:1J}""j1i '}:'-'," '1-', ,. , " ." "~-I _", I ,I" 'r r 1/" 11 I. 1'1' 1 ""1\ - 1-' I ". } .', ~rliIJ' ,~)' ,"I I II .,, I' ",!" .' fl. .;.' ., ~"''''''''' /.L 'I I i,.,..i:/i.r~,,, I .J.,.';';:'.I...Jrll'.....IA~Jlf J':;./" "d I' " j', ", 1 i t'I' SECOND IlNCUjllllll^NCF;llj""l,'J~' '1111""r--ll"7-tl/'I"\r"'~'11'\""'.J"'''!~'\!'i;I''''I'':'- JII ',", .. ': . _, J i _ _, '" IF I FAVOR 01'1" ,"'I'll "'}":-I/.";- ,",:' tl'llf'I,~u...l~A.!J_"llct.l,:, ''',-':!!,I,,_' !1'1]1~" 'N,J;UMIIIl^NCI'IIlF:l.l'^SJtIl~___ ' , I.' ~ , 1-,1 ,"" '14'" ~A~OUNl1l!r~ I "~l'l~"'~ . 1"III"'1~,U~I""hl>fl1 ".,(u~, . '.1 ~ '.' DATI: III',"".', , "1' ,:,"iJ'!\,"'I',:,: , . ',:_1,,:1,/,,'_,: ,"Jr . j 1,,"1111'1 " , I" ""'II,"\>I,"CI,-:fliNClJMDAANCIi-t1olDEFi " 'I' 'II"" ~ II" , I, '," :1'1/',11,1111'1 ,"J , ' - -, , , 'I I,'J - ; j '11111'\"" ,it \li.(I\!;ln'Y~-~-rur.;:---~ ______. ____~~_.. , "I "II "J:I ,1'11'1-' 'II 1\ .1I0RUEIJ 1IE1'1l8SENTATIVII ,I ,. "JI"J ,r , " , 'I:',., 1"11' '/'1" I I c/v /urtller cerll/y lllat I has" llsed rea,ona"', ,IIfIRellC'; III aicffl~lh- nll t.llet Itr or not II"/det' ,ta/.d ill said a/ll>/lca/lolI ~1 or TR~N.5' lor Ihl, Certi/icar. 01 Tltl. pre 'I;".,,' ~rll II,at I 1111I satb/I.d ,hal tI.. a/,pllcant b Ihe lalV/1I1 ,f,,<J.' ~oj>...' OlVntr 0/ tI,e IIIvlot f'd.lcle .or :ir~~..6:;_d~;crlb~11 h''Ieoll. or I, otllCr",b. clltitledlo I,."e the ~1. ...~ ,amrreRi'tered In lib naln.. _ , , ',',1, 1",",1, _ ' . i '1 Where/vre,1 ccrrl~y Ih<<<,l!!~-:!,isM('~ nanl.cI aPl>"cant ha, ',"ell dilly registered In the oilier 0/ the Pelln,yll'al1fa Del>Qrtllic,nl' ~t :Tran,/>ortallon a, Ih. lall'/1l1 Oll'lIer o/Ihe 1II0tor 'f,.hld. or trailer ddc.rlbctl h"<?ri,,'I.\:;.'::l!":--'.:.i~ . ' <;(,~A ~ Jj ~ .. \VltnCJ"n:~~?llf",'~,lta~Ht~,~mi-::;' ~~ ~.... - -....~(f:' . ., :"',. ", ~,"l::~lmU:';r-. Secretary of Tran,portatlon _ '"'1ttH or ,V~ ',1 'II~ IH .'.",. fLACr....AHl.A~T...-fllJ I",' ': ".,.UIII,,~OIDiTHI.:'nLl ' -':',1';' , ,J .; 'II!, II Ill' ,I I'. ' ' "1:1; 1'1",' i' 1"1; :'rl>l:i,_~: ,'I"l<!!i~I!:l!ld!-{"'il :',;i!:'I:,:iil/r'!,Wii -:1:'li'(,I'!(UIiIPd:l:~I::'::"': )" Ii ' , . .','_.' ~ 0 ~ 0 ~ hOG Ii ~,q ',) , ' ,- a ~ 0 0 _ 000 .. MO, M G ALVIN 611 n ENOLA K HOSOANO ST PA 17025 NUI,t(, .~' mon . MarinlJ. N I ~ e wp., Cunlbor d u ss/on Explros Nov.' ~o . Mombor. Pcmsytvania AsSOO.lljon 01 NOlilriO~l '!J1-" OJt,':LUO ~~.:I"'<x;'" ~~r,dr7 " lIIfY.ISIO 11+ 17.1:11 COMMONweAlTH 0' 'fNNIYlYANIA IHHflnANCI TAX UTUlti _!lIDINI DfCfOfHT SCHEDULE uG" TRANSFERS I ----------'iLI NUMiiiil ISTATI OP Alvin K. Hosband THIS SCHIDULI MUST II COMPLITID AND fILlD.. THI ANSWIR TO ANY Of THE QUESTIONS ON THI RIVEUI SIDI Of THI COVIR SHIIT IS VIS ITEM TOTAL VALUE DECD. DOLLAR VALUE DESCRIPTION Of PROPERTY EXCLUSION I~ Of DECEDENT'S NUMIER Of Assn INTEREST 1. Amer. Express Trust Co.-IRA acct. 3,189.42 773.345 shs. @ 4.098 (See attached letter) 2. American Express-IRA acct.-annuity 24,750.88 (See attached letter) 3. Delaware Group-IRA acct. 11,923.74 1,917 shs. @ $6.22 (See attached letter) TOTAL (Aha .nl., on Iln. 7, RlCoDllvlatlanl $ 39 864.04 (II more Ipace ,. ""ded In..rf addjtional lit.." a/.am. tile.} ~- . ~ III. 108 Ut. t1t1Utlll1c. Conlplny IDS Tower 10 Mh1l1e.poll., Mlnnplnl" 65440 AUG I 4 1995 FINANCIAL ADVISORS AUgU9t 9, 1995 William R Bunt 1'0 Box 336 109 South Corlialo St Now Bloomfiold PA 17068 9310-2164856-9 Groeo C 1I09band D09r Hr Bunt: Tho voluo of Policy 9310-2161.856-9 aR of Jnllo 2t, 1995 WAR $24,750,88, If you h9ve ony quo9tions, pInAao lot nR know, onel 149 071982 0612 6848 Insurance and annulll88 ara provided by IDS Lila InBu,anca Company. on Amarlcan exp'aas company_ '1~ _:.J .' . '. ALG - 2 1995 IE 11, NEWBOLD'S SON 1:.~TA/I/./HIC/lIRH .v./I, Nrwbu/d'. SIIII OM"'"I1( FIIIIIII"/lIrk & Co. IlIe, /0/5 Ml/llllllrI Huad lVorlll/r".bl/1!/. I'A /7043 (7/7) 763-8200 (800) 722-2294 f7/ 7) 763.( 765 FAX Mr",/,.,. o( All /'rille//llll Exrhallsr. August 1, 1995 William R. Bunt P.O. Box 336 109 s. Carlisle st. New Bloomfield, PA 1706B Dear Sir: I contacted the De1eware Group and received the following information regarding Mr. Hosband's account <#556000039304). The account balance as of close of business June 21, 1995, was 1917 shares valued at $6.22 per share. If you have an other question do not hesitate to contact me. . abersberger ice President Investments 1 ') fl' Y. (,'ZZ ~ \l')Z!..'14 l AH:tg .' . IIV"lIlt.I'"1 ESTATE OF ITEM NUMBER . SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Ploa.o Prlnl or TV 0 NUMBER COMMONWEAlTH Of PENNSYlVANIA INtU_UANeE fAX IlflUIIN IUIDEN'DECEDENt Alvin K. Hosband DESCRIPTION AMOUNT A, Funoral Expon..., B. 4. C. 1. 2. 3. 4. 5. 6. 7. B. 1. Sullivan Funeral lIome 4,057.30 1. Admlnl.tratlvo Ca.11l Porsanal Roprolonlall.o Camml..lanl Social 50eurlly Numbo, of Porsanal Rop,olonlall.o: Yoa, Camml..lanl paid 2. Alla'noy fool-William R. Bunt, Esquire 400.00 3, Family Exompllan ClalmanlGrace C. Hoshand- Rolallonlhlp Wife Acld,o.. of Clalmanl 01 doeodonl" doalh 3,500.00 5lroo' Acldro.. 611 B Street Clly Enola 51alu PA Zip Cado 17025 Probalo Fool Mlleollanoau. Expon..., Rite Aid-pharmaceutical supplies 120.00 Cowley Associates-medical account owed 100.00 Professional Home Health Care Agency-medical acct. 0 ed 44.70 Tamdot Homecare of Harrisburg-medical acct. owed 1,200.00 TOTAL (Alia onlo' on IIno 9. Roeapllulallan) (If mare .paco I. noodod, In.ort additional .hoot. of .amo .1'0,1 S 9,422.00 J C- o'/-.. v' REV-lS47 EX AFP (12-95* COMMONWEAl ftl or PENNSYlVANIA DEPARTMENT OF REVENUE BUREAU Of IHDIVIDUAl TAMES DEPT, n060a HARRISBURC, PA 111U-060l NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT Of TAX ACN 101 DATE 01-09-96 FILE ND. 06-21-95 CDUNTY CUMBERLAND HOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBHIT TIlE UPPER PORTION DF THIS FORH WITH YOUR TAX PAVHENT TO THE REGISTER OF WILLS, HAKE CHECK PAVABLE TO "REGISTER OF WILLS. AGEHT" REMIT PAYMENT TO: WIL LIAM R BUNT 109 S CARLISLE NEW BLOOMFIELD ESQ ST PA 1706B REGISTER OF WILLS CUMBERLAND CO COURT CARLISLE, PA 17013 HOUSE AMaunt Rellitt.d CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ iIEV=is;,-j-EX-AFii-nZ-:9ifj-iliificnWYNHEiiifi.NCE"TAinippiiiiisEHEiii'-;-AtrliwANCE-ifli--m---mnm- DISALLOWANCE OF DEDUCTIONS AND ASSESSM~NT OF TAX ESTATE OF HOSBAND ALVIN K FILE NO. 21 95-0700 ACN 101 DATE 01-09-96 TAX RETURN WAS, (XI ACCEPTED AS fILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Eat.i. (Schedule A) (1) 2. stock. and Bond. (Schedul. B) (2) 5. Clo..ly Held stock/Partner.hip Int.r..t (Schedul. C) (3) 4. Hortaag.I/Not.. Receivabl. (Schedull DJ (4) 5. C..h/Bank DIPollta'Hlla. Parlonal Property (Schedull E) (5) 6. ~ol"tly Owned Property (Sch.dul. FJ (6) 7. Tran.f.r. (Schedul. OJ (7) e, Tot.l A...t, J CHANGED .00 .00 .00 .00 200.00 .00 39,864.04 (BI 40.064.04 APPROVED DEDUCTIONS AND EXEHPTXDNSI 9,422.00 9. Funeral Expans../Ad.. Coat./H1eo. Expan... (Sc~dul. HJ (9) 10, Dabte/Hartg.ge Llabiliti../Ltana (Schedule IJ (10) .00 11, Total Deduction. ell) 12, Nat Valu. of Tax R.turn (12) IS. Charlt.bla/GoyernMent.1 Bequ..t. CSch~l. J) (15) 14. Kot V.lu. 01 E.t.t. Subj.ot to T.. (141 NOTEI I~.n ......m.nt w.. i..u.d prBviou.ly, lin.B 14/ 15 .nd,or 16, 17 .nd 18 r.~l.ct ~igur.. th.t includ. the tot.l o~ abb r.~urn. .......d to d.t.. ASSESSH!NT DF TAX: 15. A.aunt of Lina 14 at Spou..l 16. Aaount of Lina 14 taxable at 17. A.aunt of Lina 14 t.xabl. at 18. Principal Ta. Due TAX CREDITS: PAV"ENT DATE Q.4?? nn 30,642.04 .00 30.642.04 will rat. Lln..I/CI... A rat. Coll.taraI/CI... 8 rat. 1151 (161 117) 30,642.04 .00 .00 X . DO. X.06. X .15. IIBI ,00 .00 .00 .00 ... RECEIPT HUIIBER DISCOUNT I +1 INTEREST I-I AHOUHT PAID TOTAL TAX CREDIT BALANCE DF TAX DUE INTEREST TDTAL DUE ,00 ,00 .00 .00 . IF PAID AFTER DATE INDICATED. SEE REVERSE FDR CALCULATIDN OF ADDITIONAL INTEREST. If TOTAL DUE IS LESS THAN fl, NO PAVHENT IS REQUIRED. IF TOTAL DUE !S REFLECTED AS A "CREDIT" (CRI, yOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS fORH FOR INSTRUCTIONS,I i.L --.It) RESERVATIONI E.t.t.. 0' d.c.dent. d~lng on Dr b,'or. O.c.-b.r 12, 1912 ~. I' en~ future Int.r..t In the ..t.t. I. tr.naf.rrld In po.....lon or "'Jo~.ent to ell" . Icoll...r.U beneflchrl" of thl dlcedent .ft.r the .xplr.tlon of .n~ ..t.tl for 11ft or for ~.ar., the eo~.lth hlr.b~ 'ltpr..aIY r...r~a' the right to IPPr.I.. ~ ...... tran.f.r Jnherltanc. Tilt.. .t the lawful ell.a . leoll.t.r'll rat. on Dn~ .uch futura Int.r..t. P\JOP01EOI' HOTtCE. To fulfill thl r.qulr..ent. of S.ctlon 21'0 of the tnherltanc. end E.t.t. T'1t Act, Act Z2 of 1991. 71 P.S. s.ctlon 1140. Detach the top portion of this Hatlu end .ubllt with ~our p.~.nt to the Relht.r of Wllh prlntld on tM n~.u. lid., .~"IIk. check or IIOM~ ord.r p.~.11 to. REGISTER OF MILLS, AOENT All P'YMnt. r"llved .hlll flut bu -Wllld to ....w Intarllt which .., tM .... with .ny n..lndsr applied to the tl.. REFUND (CRII A refund of . t'lt credit, Which WII not requlltad on thl TIlt A.turn, .., tM requa.t.d b~ cOIfII..lng .... "AppllcaUon for Refund of PIM.~lvanl. tnhsrltancl Met E.t.t. TI.- IREIJ-UUI. ApplluUon. In .~.I"bl. .t the Offlc. of the A.ghbr of NUb, .n~ of tM ZS An."..,. District OffiCII, or b, ulllng the .p.cl.1 "-hour ,".w.rln, ..rvlc. nuab.r. far for.. ord.rlngl In P~.ylvanla l-aOO-162-20S0, autalde Penn'Ylvanl. ~ within local Hlrr"burg .r.. 17171 787-8094, TDDI (717) 77Z-ZZsr CHllrlng tap,lred OnlY). PAMHT. OIJECTlDHS. Any party In Intsr..t not ..thfl.d with the appral..unt, .lIo"lnc. or dl"UOWIWlCI 0' daductlon., or ......Mnt of t.. I Including dhcount or IntarllU II .ha"," an this HoUc. au.t obJ.ct within ahety 1601 da,. of racalpt of thh HaUc. by. .-"rlttan prota.t to the PA D.p.rt..nt of R.v.nu., lo.rd of App..I., D.pt. r810rt, Harrl.burg, PA 17121-1021, OR .....I.cUM to hava the .atter d.t.ralnad at .udlt 0' the .CColMt of the par.onal rapr...ntaUva, OR .-.,paa. to thl orphan.' Court. ADHIN tSTAATlIJE CDRRlCTIOHII DISCOUHh Faotua. Irrar. dl.Gov.r.d on thl. .......ant .hould ba addr....d In writing tal PA Dap.rt.ent of R.venua, Buraau of Indlvldu.1 Taltl., ATTNI po.t A.......nt Aavla" unit, Dlpt, 180601, Harrl.burg, PA .7128-0601 Phone 17171 717-650S. I.. patl 5 Df tha bookl.t "In.truatlon. for Inharltanca T.. Aaturn for a R..ldMt O.cldant.. IREV-ISDJ) 'or an axplanatlon of adlllnlltraUv.lw carrlctabll arror.. If any talt ctu. Is paid within thu. ISI calendar IMKIth. aftar tha d.cadent'. death, a flva parcent 15:U discount a' the tax paid I. .llowad. tHTERlST. Int.rllt Is chargad tM,lmlng with first da, 0' dtIl1nquency, or nine 191 aonthl ..s Dna (1) d.y frOll the data of de.th, to the d.ta of Plyaant. T.... which b.c... dallnqu.nt b.fora Januarw I, 1912 baar Intar..t at the rat. of .Ix (6XI parcent par .nnua calcuhtld .t . d.11v rata 0' .0001". All t.u. which bae..a d.lInquent on SInd Ift.r JInU.rw 1, .,er will be.r Intar..t at . rata which will varw fro. callandar v..r to calandar y..r with th.t ratl ~ad by tha PA D.part..,.t of R.venu., th. ,ppllcabla Intlr..t r.t.. for 1912 through 1"6 .ral '!!!! Intar..t A.ta D.lly Intar..t F.ctor !!!!' Int.rast A.t. D.lly Intar..t FlHltor 1912 ZOX .000S41 1987 'X .000247 1'15 lOX ,OOOUI 1981-.991 m .00as01 1914 m .OODSU 1992 OX .000247 1915 m .0003S6 1995-1'" 7X .000192 1986 lOX .ODD214 I99S-.996 OX .000247 uJntarllt h calculat.d II 'ollowlI INTEREST . BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR ..Anw Natlu IlIued aftlr the tilt b.c... d.lIn~t will rafllet an Intarllt uleullUon to ,ift..,. US) da,. b.yond thl d.ta of thl .......ant. J' p.yaent II .ada aft.r the Intlrl.t cu.put.tlon date ~ on tha Hotlea, addltlon.l Int.raU au.t be c.lculat.d.