HomeMy WebLinkAbout95-00704
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I)ETITION .FUR GI{ANT 01<' LETTERS O.....AI>MINISTHATION
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Estale 01 J::./'l1 m 14
also k I/O 11'1/ as
If LT()~
No, ___:? 1- 1's - 7...fLtJ_,
To:
I(egi,ter of Wills fur the
COllnl)' of __ In Ihe
COll1l11onwenllh of I'enmylvllnln
Dt'CI!as('tl.
Social SemrllY No, ~ - l4 - fl.3 q ~___
The petillDn Df Ihe nndersigned respectflllly'represenls Ihlll:
Your petilioner(s), who Is/are 18 years of age or older, llppL'("~_ for lellers of admlnlslrullon
on Ihe eslate of
(d.h.II.; pcndc:nll: lile:: LlUtanle oh":l1Ilo; lIUUII1Ie mlnuriuHc)
the ahove dc.:edenl,
Deeendent was domiciled al dealh III C.U 'M bt r- Lan ci Couniy,r. pen~~lrlap~th
II lOR. laS! family or principal residence al ~&fi}J" tc: J\.Il..MtJI7 ll\/,\ "
f~:tt PIC 'llliA'OI:lftIOlUmb'" Rnd lUnnldrR "11
D,J\~~ndent,lhen 16..-Ye:t.~tg~e~led AUGJJ&T-23 ,19 ~5" ,
atJ1nClDr: J:.SLa~p. _rJ\O\lId.<"n c.~~J:
Decendent at death owned properlY wilh eSlimated values as folllows:
(If domiciled In 1'0.) All personal property S
(If not domiciled In 1'0,) Personal properly In Pennsylvania S
(If not domiciled In Po,) Personal properlY in County S
Value of real estate In Pennsylvania S
siluated as follows:
Petilioner_ after a proper search h,,- nscertained that decedemleft no will and was survived by
the following spDuse (if any) and heirs:
Name Relallonshlp Residence
EMI
NGW ~\JT~?nu
l':f Sco -j"WlRI..1SfolP" Prt!l~.3b
J.1SB~<ot ' MI"=ha~lC.\b..!:'i '"'^, \]0>')"
_ .!l~;)ll~li\.L MCj~~Pl'\ l7o{!;-
--\l.iol\(r~r..
THEREFORE, petltloner(s) respeclfully request(s) the gram of lellers of administration in the
appropriate form to Ihe undersigned.
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OATH OF PERSONAL REI)RESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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The petItIDner(s) above-named sweaT(s) or affiTm(s) that the
statements In the foregDlng petition are true and cDrrectto the best
of the knowledge and belief of petItIDner(s) and that as persDnal
representatlve{s) Dr the above decedent petltloner(s) will well and
truly administer the estate according to law.
I.
SWDrn to or affirmed and subscribed f
before me this 1 Ii t:h day of
':11+, ~~_,Tt~~~'~A Cl.. p'~19S I
':. " " ' ,{:' Reg ter L
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No. 21-95-704
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Estate nf ::.
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EMMA ALTOFF
, Deceased
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GRANT OF LETTERS OF ADMINISTRATION
AND NOW SEPTEMBER 21 19....2.L. In consideration Df the petition Dn
the reveTse side hereof, satlsfactoTY proof having been pTesented before me,
IT IS DECREED that Char.lene Hlmelsbach
Is/aTe entitled tD Lellers of Administration, and In accoTd with such finding. Letters of AdmlnlstratlDn
are hereby granted to Char.I ene Illmelsbach
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In the estate of
EMMA ALTOFF
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o Relll,e, or WII(. '\
FEES
Lellers of AdmlnlstratlDn
ShDrl Certlflcates( ~ ' . , . . , . . . .
Renunciation ..............,.
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S 5.00
TOTAL _ SH on
Flied .. Sept,... 2.1.. ..... A.D. 19..9.5-
ATTORNEY tSup. Cl, 1.0, No,)
ADDRESS
PHONE
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21-95-704
RENUNCIA nON
In Re Estate Df
Emma A1toff
deceased.
To the Register Df Wills of
Cumberland
CDunty. Pennsylvania.
The undersigned Emily Kimball, Charles Altoff, Wnltor Altoff Df
the abDve decedent, hereby renouncc(s) the right to administer the C~lI"e IInd rcIJlC1:trully ask(s) that Lellers
of Administration
be Issued to
Charl~n~ Him~lRbach
WITNESS
hand thls..llltlu. day of Sout.
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CERTIFICATION OF NOTICE UNDER RULE 5.6/a)
Name of Decedent:
Emma Altoff
Date of Death:
Auq. 23. 1995
will No.
None
Admin. No. File No.# 1995-00704
To the Register:
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' ~olJrt Rules was served on'or mailed to
the following beneficiaries of the above-captioned estate on
.r"n. ] 9. ] 996
Name
Address
Ch"rleA E. Altorf Jr.
EmilY A. Kimball
3817
345
Lisburn Rd.
Thorley Rd.
Mechanicsburg Pa. 17055
New Cumberland Pa. 17070
Walter B. Altoff
938 Cedars Rd. Lewisberry, Penna. 17339
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except Nnnp
Date: 1/19/96
~ 0... ,.\~. ~ .~ O~'~....L
Signature
Name Charlene Himelsbach
Address 19 Scout Lane
Hummelstown. Pa. 17036
Telephone/71~ ~66-q649
Capacity: 'II'
Personal Representative
Counsel for personal
representative
COKHOHW[ALTH Of pnd:~VllJAHIA
O[PARIHtHT OF REVENUE
BUREAU Of INDIVIDUAL IAxts
[l[Pl. ..10601
. ;1& IAUIURr., PA U12I-0601
-
FILE NO. 21 95-0704
ACN 96144605
DATE 09-14-96
TVPE OF ACCOUNT
IX] SAVINGS
o CHECKING
o TRUST
o CERTiF.
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
.n-IUIII'" 1'.'"
EST. OF EMMA C ALTOFF
S.S. NO. 036-14-8394
DATE OF DEATH 08-23-95
COUNTY CUMBERLAND
CHARLENE HIMELSBACH
19 SCOUT LN
HUMMELSTOWN PA 17036
REHIT PAYHENT AND fOR"S TO.
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE. PA 17013
PNC BANK hu provided the Depart..nt with the Infar.aUan I hted b.lalil which hu b..n uud In ulculaUng thl
patantlal ta. due. Thllr rlcardl Indlca'a that at the death of tha abavI dlcldant, you wara a Joint awnar/ban.flclery a' thl. account.
tf you '.al thl. In'ar.atlan II Incarrlct, pl.... obtaIn wrlttan corr.ctlan frol the IlnlOclal In,tltutlon, attach. copy 10 Ihl. far.
-of ,..tllr" It t" th. ..tv.... ""14"".. Tto'" ",.,.'n....t II t...AhI. In ,"cordene. ",lth the Tnh.rltancl Ta. law. of the COI'l)nw.allh of P'M.ylvanla.
QU"llon. .ay b. an,war.d bv calling (717) 7.7.aS21.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
A..ount No. 5130130674 Doto 01-23-90
E.bblhhed
Account Oalance 4,029.57
Percent TaMabl. K 50.000
A.ount subJo.t to T.. 2. 014 . 79
Tox R.ta K .15
Potential TaM Du. 302.22
~~ TAXPAYER RESPONSE
COI FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNENT BASED ON THIS NOTICE
A. c=J Th. abova Inlor.atlon Ind t.. due I. carr.ct.
1. You .ay chao.. to r..lt pay..nt to the Regl'tar 0' Will. with two copla. of thlJ notlc. to obtain
a dl.count or avoid Intera.t, or you I.Y ch.ck bo. "A" and raturn thl. not Ie. to tha Ragl.tar of
Will, and .n official a..a....nt will ba I..uad by Iha PA Dapart..nt 01 Rav.nu..
To In.ur. prap.r cr.dlt to your account, two
121 cop II, of thl. not Ie. .u.t accoap.ny your
pay..nt to the R.gl.t.r of Will.. Hak. ch.ck
payabl. tal "Ragl.tar 0' will., Ag.nt".
NOTEI tf ta. ply..nt, ar. .,d. within thr..
IJI .onth. 0' tha d.c.d.nt., data of d.ath,
you ..y d.duct a 5X dl.count of the ta. du..
Any Inharltanc. t.. due will baco.. dallnquant
nln. 191 lonthl aft.r the data 0' daath.
[CHECK ]
ONE
BLOCK
ONLV
I. E:J Tha above ....t h.. baan or will b. raport.d and t.. paid with tha Pann.ylvanl. Inh.rlt.nca Ta. r.turn
to b. fllad by tha dacadant.. rapr.'_ntatlva.
c. f"iit Th. abova Infor..Uan I~ncorract IOd/o~abt. and daductlon. w.r. paid by you.
)P\You 'Ult coapla'a PART l!J and/or PAAT ~ b.low,
PART
~
1'..,(
LINE
If you Indl..t. . dlff.ront t"^U:~"~)AO" .tot. your
,..lation.hip to decedent I U"- G.ll1:..!;L!:S
~~IURH - ~~"~uiAI.uH
1. D.t. E.tabli.hed
2. Account Oelenc.
3. Percent Texeble
4. A.ount SUbject to TaM
5. Debt8~and Deduction8
6. AMou~~Taxabl.
7. Tax "f.
a, Tox ou.
';j
OFFICIAL USE ONLY 0 AAF
PA DEPARTMENT OF REVENUE
ur-
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2
3
4
5
6
7 K
a
T..,( ui. J~Ih'i,ikU~r A~CuUili'5 PAU
1/23/90 1
4.029.57 2
50.00 3
2.014.79 4
- 0- 5
2.014.79 6
.06 7
124.09 inc.$3.20 L te 8
DEBTS AND DEDUCTIONS CLAIMED
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DATE
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PAID ::-:
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PAVEE
DESCRIPTION
AMOUNT PAID
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TOTAL IEnte,. on Lin. 5 of Tax COMputation)
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Undar penalti.. of pe,.jury, I decla,.. that the
cOMPlat. to the b..t of MY knoNledg. and belt.f.
~~ATUR~~.....(..
fact. I have reported above ar. tru., correct and
HOME ( )
WORK (111 ) 19 C.. )~t j 311Y\
TELEPHONE NUMBER
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with apPllcabh Int.rut ba.ed on Inlor..tlon
lubalttad b~ the 'Inancl,. In"llutlon.
I. Inheritance tlM bICD... d.1Jnqu.~t nlna lonthl .tt,,. thl dlClalnt', data of d..th.
S. A Joint account I, t'.'bl, IVln though thl dlCldlnt', n... w.. Iddld '1 . I.lt.r of convenl.nc..
,. Account, Clncludlng tho.. held bltw..n husband and wlfl. which thl dlClnant put In Joint n.... within on. y..r Prior to
d..th .r. fully tl_Ibl, II tran,'.r,.
5. Account. ..t'blt,hld Jolntlv b.tw'.n hUlband Ind wi'. lor. then on. v,.,. prior to d..th .r. not t,..bl..
6. Account. hlld by . alCldlnt "In tru.t 'or" Inath.r or other. Ir. t'..bl, fully.
RiPDRTING INSTRUCTIONS - PART
1
- TAXPAVER RESPONSE
1. BLOCK A . If thl Infor.,tlon Ind coaputltlon In the notlc. .r. corract and d.ductlon, .ra not baing clalaad, placa an "X"
In block "A" of Part 1 of the "Taxpay.r Ra,pon,." eactlon. Sign two COP I., and 'ub.lt th.. with your ch.ck 'at the a.ount a'
t.x to tha Ragl,tar a' NIII, a' the county Indlc.t.d. Th. PA D,p.rt..nt a' R'v.nua will I"ua an o"lcl.1 a""".nt
(Far. REV.1541 EX) upon rac.lpt 0' the r.turn fro. the R.gl,t.r of NIII..
z. aLOCK a . If the .".t 'P.clfl'd an till, not Ie. h., b..n or will b. raport.d and t.x paid with the Pann.vlv.nl. Inh.rltanc.
T.x R.turn '11.d by the dlcld.nt', r.pr...ntatlva, plac. .n "K" In block "a" of P.rt I of the "T,xP.ver R"pon.e" ,.ctlan, Slon an.
copy and r.turn to the PA D,part.ant of R,v'nua, auraau of Indlvldu.1 Talla" D.pt lU601, Iflrrhburg, PA IlIZI-0601 In tha
.nV.lopa provld.d.
5. aLOCK C - If the notlc. Infor.atlon I, Incorr.ct .nd/or d'ductlon. .r. b.lng cl.la.d, ch'ck block "C" and co.pl.t. P.rt. Z and 5
:;:cctcHn; t: t~: h:t~c=tJ~r.: t:c1~". :::!iI\ t..c cw;:I~~ :.n~ ........1t tt,... "1t~. ,....t et...::. ret U.. ....Ioi..~.t ~r ta.. ....)..LI. t.. tll. ;:.lIht6.
0' NIII, of tha county Indlcatld. Th. PA D'P'tt'.nt 0' R.v.nu. will I..u. an of,lcl.1 ........nt CFor. REV-IS41 EX) Upon rac.lpt
0' the r.turn 'roe the R.gl.t.r 0' Will.,
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
I. Ent.r the d.t. tha 'ccount orlgln.llY wa. I,t.blt.h'd or tltl.d In the '.nn.r ,xl.tlng at data 0' d..th.
NOTE I For a d,c.d.nt dying aft.r IZ/IZ/aZ, Account. which the d.c.d'nt put In Joint n.... wlthJn on. el) y..r of d.ath ara
taxabl. 'ully a. tran".r.. Howav.r, thara I. .n axclu.lon nat to axe..d '3,000 per tran.far.. regardl." 0' tha valua 0'
the account or the nU~'r 0' account, hald.
If . daubl. a.tarl.k (MM) 'PPlar. b.fore your flr.t naaa In thl addra., portion 0' thl, notlc., tha '5,000 l.clu,lon
alraady ha. baan dlductad froa the account b'lanca a. r,portad by the 'Inancl.1 In.tltutlon.
Z. Entat tha total balanca of tha account Including Intara.t accru.d to the data of da.th.
5, Th. p.rc.nt of the ,ccount that I. taxabl. far e.ch .urvlvor I. d.t.r'lned a. fOllOW"
A. Tha p.rcant t..abl. for Joint ....t. ..t.bll.had aor. than on. y..r prior to tha d.c.d.nt'. d..thl
1 DIVIDED IY TOTAL HUMaER OF
JOINT OWNERS
EXlapl., A Joint ....t r.gl.t.r'd
DIVIDED ay TOTAL HUtlBER OF X IDO . PERCENT TAXABLE
SURVIVING JOINT OWNERS
In the n... of the d.c.dlnt .no two oth.r p.r.on..
1 DIVIDED BY 5 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) . .167 X 100 . 16.7X CTAXAaLE FD~ EACH SURVIVOR)
I. Th. p.rc.nt t.xabl. for ....t. cra.t'd within on. y..r 0' the d.c.d.nt-. d..th or account. own.d by the d,c'd.nt but hlld
In tru.t for anoth.r IndlvlduaIC.) (tru't b.n.flclarl..)1
I DIVIDED BY TOTAL HOHlER OF SURVIVING JOINT
OWNERS DR TRUST BENEFICIARIES
X 100 . PERCENT TAXABtE
Ex..pl., Joint account r.gl.tar.d In the na.. 0' the d.c.d.nt and two oth.r p.t'on, and ..t.bll'hld within an. y.ar 0' d'ath bV
th.- d.c.d.nt.
I DIVIDED BY Z CSURVIVORS) . .50 X 100 SOX (TAXABLE FOR EACH SURVIVOR)
4. The a.ount .ubS.ct to t.. Clln. 4) I. d.t.r'ln'd by aultlplvlng the account balanc. (IJn. Z) bV the percant ta.abl. Clln. 5),
S. Entar the total of the d.bh .nd deduction. U.ted In Part 3.
6. The ..ount t...bl. Clln. 6) I. dateraln'd by ,ubtractlng thl d.bt. and deduction. Clln. 5) froe the .aount 'UbS.ct to ta. (1In. 4).
7. Enter the approprJ.t. ta. rat. CIJn. 7) a. d.taraln.d b.low.
A. For dat.. of d'eth occurring aft.r 6/50/94, the t.x rat.. for tran.f.r. to IPOUI.. ar. a. follow.,
1. Dat.. of d..th on or aft.r 7/1/94 and b.for. 1/1/95 tha rat. I. 5%.
Z. Det.. of d'ath on Dr .'t.r 1/1/95 tren.f.r. to ,pou.a. will b. t..ad at O~ t.. rat..
Hot., For dat.. of de.th prior to 7/1/94 tr.n.f.r. to .pou... ar. taxabl. at 6~.
I. Tren.f.r. to JJnaal d"c.ndant. Including fathlr, aolh.r, 'on, daught.r, grandchlldr.n, .0r.Jn.law,
daught.r-In-I.w, .t,pchJld and th.lr I..u. .r. t..able .t ,J. p.rc.nt C6~J.
C. Tran.f.r. to .11 oth.r. Including brothar, .I.tar, uncI., .unt, n.ph.w end nl.c. .r. ta..bl. at flfta.n p.rcant
D. If YOU chan.. the t.. r.t., pl.al. .paclfy your r.l.tlon.hlp to the d'C'd.nt In the .r.. provldad.
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Th. ..aunt of t.. due (1In. a) I. d.t.raln.d by ~ltlplYlng the aaaunt t.xable Clln. 6) by the ta. ral. (1In. 7).
CLAIMED DEDUCTIONS - PART
N
CIt
3
DEBTS AND DEDUCTIONS CLAIMED
!;
Allow.bl. d.bt. and d.ductlon. .r. d.t.raln.d .. 'ollow.,
A.
I,
C.
-
-
You legallY ar. r'lpon.lbl. for pav"nt, or the ..tat. ,ubJ.ct to adalnJ.tratlon bv a par.onal r.pr...ntatlv. I. l~fflcl.nt
to p.y the d.ductlbl. It.... "'0-
You .ctr,allv p.ld the d.bt. .ftar duth of the d.c.d.nt and can furnhh proof of P'v..nt. ....
D.bt. b.lng cl.la.d au.t b. It..lz'd fullv In Part J. If .ddltlonal Ipac. I. n..d.d, u.. plain paper a 1/2" . 11". Proo' of
Plv..nt ,.y b. r.qu..tad bv tha PA o.part.'nt of Rav.nul,
TAXPAVER ASSISTANCE
IF VDU NEED FURTHER INFORMATION DR ASSISTANCE, CONTACT ANY
REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
DR CALL THE BUREAU OF INDIVIDUAL TAXES. TAXPAVER INQUIRV UNIT IN
HARRISBURG AT (717) 787-8327. TDD' (717) 772-2252 (HEARING IMPAIRED ONLV)
COHHOHWUlllt Of' PEHHSYlVANIA
DEPART"ENT Of REVENUE
BUREAU Of INDIVIDUAL TAXES
DEPT. Z~1'I6Dl
,IlARRUIURO, PA 171za.D601
*'
FILE NO. 21 95-0704
ACN 96144606
DATE 09-14-96
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
''''IU'I. "'II,ttl
EST, OF EMMA C ALTOFF
5,5, NO, 036-14-8394
DATE OF DEATH 08-23-95
COUNTY CUMBERLAND
TVPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
00 CERTIF,
CHARLENE HIMELSBACH
19 SCOUT LN
HUMMELSTDWN PA 17036
REHIT PAYHENT AND fORHS TO.
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
PNC 8ANK h.. provld.d the O.".rt..nt with the Infor..Uon I ht.d b.low which ha. baan uud In celculatlnll the
pot.ntlal tax du., Th.lr r.cord. Indlcat. that at the daath of the .bov. dac.d.nt, ~ou war. . Joint own.r/b.n.flcl.ry of this .ccount.
If ~ou f..1 thla Infor..tlon I. Incorr.ct, pl.... obtain wrltt.n corr.ctlon fro. the flnancl.l In.tltutlon, .tt.ch . cop~ to thl. for.
...'" ..e.".... 't t.. ..._ ,......,.. _.-tft.."c, Thh Iler:oun. Is hltabla In I'tccerltlllnca with tha Int\.rJtlllnc. Ta. llllw. nf the ro..anw'lIIlth of PaMlylva"la,
Qua.tlon. .ay b. answarad by call1nll (111) 187.85Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
Account No. 21001022341 D.h 04-12-90
E.bblhh.d
To Insura propar cradlt to your account, two
eZI capias of thl. not Ie. aust acco.pany your
pay.ant to the Ralllstar of Will., "aka chack
payabla tal "Ralllltar 0' Willi, Ag.nt",
Account a.l.nc. 6,539.50
P.rc.nt T.)C.bl. )( 50 . 000
A.ount subJ.ct to T.. 3,269.75
T.. R.t. K .15
Pot.nUd T.. Du. 490.46
PART TAXPAYER RESPONSE
CUI FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNENT BASED ON THISHDTICE
A, r=J Tha abova Infor.atlon and ta. due I. corract.
1. You .a~ choo.a to r..lt pay.ant to the Raglstar of Will. with two copl.s 0' thll notice to obtain
a discount or avoid Intar.st, or YOU .ay chack box "A" and raturn thl, not lea to tha Ragl.tar 0'
Wills and an official u......nt will be hSl;ad by tha PA napart..nt of Ravenua.
HOTEl If ta. pay.ants .ra ..d. within thraa
(S) .onths of the dacad.nt', data 0' death,
you ..y daduct a 5X dllcount of tha ta. dua.
Any Inharlt.ne. ta. due will baeo.a dallnquant
nlna e91 .onthl .ft.r tha data of da.th.
[CHECK ]
ONE
BLOCK
ON LV
8. c:J Tha above as..t has baan or will b. rapartad and t.. paid with the Pann.ylvanla Inharltanc. Ta. r.turn
to ba fllad by the daeedant., rapr,s'ntatlve,
C. ~ Tha above Infor..tlon I~neorraet andlor d.bts and daductlon. wara paid by you.
You au.t eo.pl.t. PART l!J and/ar PART [!] b.low.
If you indic.t. . diff.r.nt t.)C r.t., pl.... .t.t. your
"lotlon.hlp to d.c.d.ntl DMmHTIlR
OFFICIAL USE ONLV 0 AAF
PA DEPARTMENT OF REVENUE
pO
-':: ~~'
PART
~
TAli HI" URN - L;UMI'U I A l1UN
LINE 1, D.t. E.t.blJ,h.d
2, Account 8.lanc.
5, P.rceht T..abl.
4, A.ount Subj.ct to T.)C
S. D.bt, .nd D.duction,
6. A.ount" ....)C.bl.
7. T.)C A~\l.
8. Ta)C Du:a
IAII UN ~U!NI,rkU~r
4/12/90
6,539.50
K 50.00
3,269.75
- 0-
3,269.75
.06
PART
~
DATE
,.
DEBTS
IlCi.(lUNTiJ ..AU
1
2
3
4
5
6
7
inl"",t, In La e 8
AND DEDUCTIONS CLAIMED
U~
1
2
3
4
5
6
7
8
~p
-.
::1 c:i
.,
1....1
r:-;
1'.,1
-.J
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K
?nl
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PAID~ -
":~I
PAVEE
DESCRIPTION
AMOUNT PAID
I
TOTAL CEnt.r on Lin. S of T.x COMput.tion)
I
.
Under p.nalti., of p.rjury, I d.cl.r. th.t th.
coapl.t. to the b..t of MY knowl.dg. and b.li.f.
~.-;i~N~R~~
fact, I h.v. r.port.d .bov. .r. tru., corr.ct and
HOME ( )
WORK (1/1 )]~O'3Sto lllu
TELEPHONE NUMBER
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OfFICIAL TAM ASSESSHENT with applicable Intarnt baud an Infor..UoR
lubalttad b~ thl financial Institution.
Z. InheritAnce tlM blea... dlllnqulnt nln. lonthl aft.r the dlCldlnt.s data of d..th.
S. A joint account I, taMable Ivan though the dlced.nt', na.. wa. addld II . ..tt.r of convlntancl.
~. Account. (Including tho'l hald batw..n husband and wltal which thl dlcldant put In jalnt n.... wllhln on. y..t prior to
d..th .t. fullv t...bl. II transf.r..
S. Account. .,tablllhad Joint Iv batw..n husband and wlf. lor. than anI y..t prior to dlftth at. not ta..bla.
6. Account. hald by . dlCldlnt "In tru.t for" anoth.r or othar. at. t...bl. fully.
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
1. .LOC~' ~ If thl Infor..tlon and co.putatlon In the notlc. ere correct end deduction. er. not b.lng Clel.ed, pllce an "X"
In block "A" 0' p.rt I 0' the "T..p.yer R..pon.e" .ectlon. Sign two cop I.. end sub.lt the. with your ch.ck 'or the e.ount 0'
t.. to the Regl.t.r 0' Will. of the county I"dlcet.d. Th. PA nep.rl..nt 0' Rev.nu. will I..u. In official ........nt
(for. REY.15~a EXt upon rac.lpt 0' Ih. r.lurn 'rD. the R.gllter of WillI.
2. BlOC~ I . I' the ....t .pecl'l.d on thll nollce he. b.en or will be reported .nd I,M p.ld with the P.nn.ylvanl. Inh.rltance
T'M R.turn ,11.d by the d.cedent.. r.pr".ntetlva, pl.ce .n "X" In block "B" of Pert I 0' Ihe "T..p.yar Ra.pon.." .ectlon. Sian on.
copy end raturn 10 tha PA n.plrt.anl 0' Ravenue, Bur.au of Individual h.n, D.pt ZaOnl, Ilarrhburg, PA 1712e-0601 In thl
env.lop. provided,
S. BLOC~ C _ I' the notice In'or..tlon I. Incorr.ct and/or d.ductl~". .r. being clalaed, chack block "C" and coapl.t. Part. 2 and S
!t':':r~H~t I:) II':=. In:tr~:t1cnt b:)lcu. t!lIn tM: ,:cFh:: e..,~ =~=!t It:c~ ...1th :Jour =hC::~i ro,' th.a n:::....nt. .1 ta.. f'IU'~~. ~.. .1,. ft."...""
of Willi 0' the county Indlc.ted. The PA O.part..nt of R.venu. will I..u. en official ........nl Cfor. REY.15~a EX) upon rlcalpt
of the return fro. tha R.gl.tlr of WillI.
TAX RETURN - PART
- TAX COMPUTATION
2
LINE
I. Enlar
HOTEl
tha data thn account orlglnllly w.. a.t.bll.h.d or tltlad In the .ennar ..lltlng .t data of d..th.
for a d.c.dent dying .ft.r 12/12/a21 Accounts which the d.c.dant put In Joint n.... within on. (I) y.er of d..th ar.
t...ble fully e. tren.farl. tlow.var, thara It an uclullon not to a.c..d 'S,OOO par tr.n.f.r.a raaudla.. of tha valua of
the account or the nu.b.r of .ccounts h.ld.
If a doubl. a.tarl.k (MM) app.arl bafora your flr.t na.a In tha addrass portion of thl. notlca, tha 'S,OOO aMclu.lon
.lr'ldy h.. ba.n dlductad fro. thl account bel.ncI a. r.porl.d by tha flnancl.l Institution.
Z. Ent.r tna tot. I b.lenca of tha account Including Intara.t accruad to tha d.ta of daath.
S. Thl parcant of tha account th.t I. la..bla for aa~h survivor Is d.tlr.lnad as follow'l
A. Th. parcant t..abla for Joint as.at. ast.bll.h.d .ora than ana y..r prior to tha dacadant's daathl
DIYIDED BV TOTAL HOHlER Of
JOINT OWNERS
E.aaplal A Joint a..at r.glstarad
DIYIDED 1'1 TOUL NUHIER OF X 100 . PERCEHT UXABlE
SURVIVIHG JOIHT OWNERS
In tha na.a of the dacad.nt and two oth.r par.on..
1 DIYIDED BV ~ (JOINT OWHERS) DIVIDED BV 2 (SURVIYORS) . .161 X 100 . 16.1% (TAXABLE fOR EACIl SURYIYOR)
B. Tha parcant ta.abla for allat. craat.d within on. y.ar of tha d.cadant'l daath or accounts ownad by the decadant but hald
In tru.t for anoth.r Indhddu.lh) (tru.t banaHelarl..) 1
I DIVIDED BV TOTAL HUHBER OF SURYIYIHG JOIHT
OWNEAS DR TRUST BEHEFICIARIES
X 1 DO . PERCENT TAXABlE
..
S.
..
7,
EMe.plal Joint account ragl.t.rad In tha naaa 0' the dac.d.nt .nd tWD oth.r Plr.on. and astablllh.d within ana yaar of daath by
tha dand.n t.
I DIYIDED BY Z (SURYIYOASt . .50 X 100 . SOX (TAMABLE FOR EACH SURVIVOR)
Th. a.ount .ubj.ct to taM (1lna ~) I. d.taraln.d by aultlplylng tha account balanca (Ilna 2) by thl p.rc.nt ta.abla Cllna S).
Entar the tat'l of the dabts .nd d.ductlon. 11.lad In Part 3.
Tha eaount t..abla (1lna 6) I. datar.ln.d by lubtractlng tha dabt. and daductlon. Cline 5) 'roa the ..ount subJ.ct to tax (1lna 4).
Enter tha approprlata tax rata (1In. 1) a. datar.lnad balow.
A. For d.ta. of daath occurring aftar 6/S0/9~, tha taM rata. for tran.fars to spou... .ra e. follow.1
I. nata. of daeth on or .ftar 1/1/94 and bafora 1/1/95 the r.t. I. S%.
Z. Data. of dlath on or aftar 1/1/95 tr.n.f.r. to spou.a. will ba t..ad at OX t.M rata.
Hotal For datel of d~eth prior to 7/1/94 tran.far. to spousa. .ra ta.abla at 6%.
B. Tran.far. to Iln.al da.candant. Including fathar, aothar, son, d.ught.r, grandchlldran, .on.ln-Iaw,
daught.r-In.law, .tapchlld and thalr I..ue ara ta..bla .t .1. p.rcant (6%).
C. Tran.ferl 10 all othar. Including brother, .I.tar, unci., .unt, naph.w and nleca ara ta..bl. .t flft.an
D. If you changa tha tlM rata, pl.a.. Ipaclfy your ral.tlon.hlp to tha decadant In the .ra. provldad.
..
parcent .(ijI,!'
.....
~
""
cJ\
Tha a.ount 0' t'M dua (Ilna a) I. d.t.raln.d by .ultlplylng tha a.ount taxabla (1lna 6) by tha tax rata Illna 1).
CLAIMED DEDUCTIONS - PART
DEBTS AND DEDUCTIONS CLAIMED
3
Allowebla dabt. and d.ductlon. ara dat.r.lnad e. follow'l
~
,ubJact to ad.lnl.tratlon by a par.onal rapral.ntatlva I. In~lclant
-'
of payaant. ..
n.ad.d, usa plain p.par a 1/2" . II". ~Of o.
..
I.
e,
You lagally ara ralPon.lbla for payaant, or tha as lata
to pay the daductlbla It..s.
You .ctually paid tha d.bt. aftar d..th of tha dacadant and C8n furnl.h proof
Dabt. baing clal..d aUlt be It.alz.d fully In Part S. I' additional spaca Is
pay.ant .ay ba r.que.tad by the PA napert..nt 0' R.vanu..
TAXPAYER ASSISTANCE
IF VOU NEED FURTHER INFORMATION DR ASSISTANCE. CONTACT ANV
REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES. TAXPAVER INQUIRV UNIT IN
HARRISBURG AT (717) 787-8327. TOO' (717) 772-2252 (HEARING IMPAIRED ONLVl
- -. '.- --.. ..., >_.-,~.
-
- .~---- -.." , -- .--.- .'-"- ------ ,. -, ~- -,-- --- _..~' -..,. -" . .'---' .- --" ---- ---, ,--,'. -,~ -,-
.
I
'}~.-$?~l:t'?\~fi~R~'i%fUtcJ~~~lI:i!';:rJ:r~~i'~~:{f;VJ;:';i~:N::~~:t~~,"~~.-~;,S{;/jj':,:!,;,:.;t:r-?,'-';; {.~i';':; ,:~~;\i':' ::',';,~>i :":-' .-:~' ':~..t,t::':'::/\~"JS~::;";':~:!c~.;:::,~,!';~'- :J \,n "__; " '
,,;4~~I~i,~~~~~~~~~=:~~V~~I~;,~:,',it!~.': -.',\~,::".<.,;}t.. ,. " '.
lif..~f;.O'~Cl~L~IIPI:.'PIN,NSYLVANIAINHIR~NCI AND ISTATETAX \ !"",:) , ·
RECEIVED FROM:
D
ACN
ASSESSMENT I'!I
CONTROL iii
NUMBER
i
I'
i
AMOUNT
'161""606
..Wl.;:!'"
i
I
I
I
I
'DiDHf.,J
I
I
',I
CHARLENE HIMELSBACH
19 6COUT LANE
.,6144605
$124.09
HUMMELSTOWN, PA 17036
IOtOHflf
ESTATE INFORMATION,
let FILE NUMBER
U 21-1995-0704
!'I NAME OF DECEDENT (LAST)
~ AL TOFF EMMA
~ DATE OF PAYMENT
Iii 09/27/96
m POSTMARK DATE
COUNTY
SSN 036-14-8394
(FIRST) (Mil
REGISTER OF WILLS
fa TOTAL AMOUNT PAID
RECEIVED BY ~
MARY C. LEWI
REGISTER OF WILLS
.3e3.38
SK
,I
I
CUMBERLAND
DATE OF DEATH
OB/23/95
REMARKS CHARLENE HI MELSBACH
SEAL CHECK" 1241
,
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101"11111"11
Charlene Himelsbach
19 Scout Lane
Hummelstown, Penna. 17036
lip Code
A"_ntlon. TIC ~
PA DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT 280601 '
HARRISBURG PA 17128.0601
1.,.111."1,"11,.1,11"1,11,,..11,,11,,,,"11,1,.11
',\~~~""',,'h"""'d'Ui:'iS~~""'~A.'''-i'' 'Sl'~"'i_..iI\\A:.~'i'~'];]'
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONW'AllltQFPENN."'V,,"" (TO BE FILED IN DUPLICATE
D'P..,...tN,QF"V'NU' 21 1995
1....mg~~Uffi:,._t WITH REGISTER OF WILLS) COU OD Y
E~~~NrAit'~.ffR.",,"o"'DoL..m"l) '8rB"Ns~c:l"'.r~EJf1{'JY~, Apt 112
.OCIAL..CURflYNU...... OATEQFDEAnt DA1EOf.RIII Camp Hill, PA 17011
036.14.8394 08.23.95 c..." Cumberland
SOCIAL 8ECURITYNUMDER
REV.1600 EX t (1.0.4)
.
,.. . DATES OF DEATH AFTER lV31111 CHECK HERE
IPDUSAL
P,,~ERTY CREDIT IS CLAIMED
I!!
lSU
~I~
d
III
07047
UMBE
jIF N'f'l.ICIal) 1I.IMW<<J5I'OI.ISl'ltw.IE (lAST, ,msl NfJ...DOlE INtW.)
AMOUNT RECEtlftO (SEE tlS mUCTlONSJ
~ 2, Supplemenlal Rolurn
o 4, UmIlod E,I.'o 0 40, Fulurolnl....1 Compromlso
(for d.,.. 01 do.th oller 12.12.82)
o 8, OocodonIDlodT..tolo 0 7. DecodonlMalnlalnoda U'oingTru.'
(Attach copy 01 WillI (Atlach copy 01 Tru.l)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:-
NAME COMPLE'EMA"~OADDRUIS
Charlene Himmelsbach 19 Scout Lane
TELEPHOH.""....En Hummelstown, P~W036
C: ... <d
:1 ~ -.I
o 1,0riglnalRetum
o 3, Remainder Retum
(lord.,.. 01 death prior 10 12.13-82)
o 5, Fod..elEatotoTax
Rolum Required
_ 8, TotoINumborolSafoDopoalleo-
i1.".,:"',"',,\;'::.....;.-::
'1'1
.'J]/1I
,~ It
I
1, RoaI E.to18 (Schedulo A) ( 1)
2, SIocks and Bonda (Schedule B) ( 2)
3, Cloooly Hold SlocJo/Partn...hlp Inl....1 (Schodulo C) ( 3)
4, Mortgag.. and NoI.. Rocolvoblo (Schedulo 0) ( 4)
5, Cash. Bank OopoIlto & Mi.coIlanoou. P...onel property ( 5)
(Schedule E)
6, JolnUy OWned Propor1y (SchWulo F) ( 6)
7. Tran.'", (Schedule G)(Schodulo L) ( 7)
8, TotoI GIOIa AI.oto (lotoI Un.. 1.7)
9, Fun..oI Elcpon.... Admlnl.trou..... CooII. Mi.coIlanoou. (9)
Expon...(Schodulo H)
10, Dobll. Mortgago Uobllitlos. Uon. (Schedulol) (10)
11, TotoI Deduction. (1ol?i Unos 9 & lD)
12. NetValuool E.,olo (Uno 6 mlnu. Uno 11)
13, Charttablo and GCOYOmmonlal Boqu..1I (Schedulo J)
14, NoIVoIuoSubjoclloTax(Llno12 mlnu. Une13)
15, Spou.a1 T'81II1... (lor dol.. 01 dooth all.. 6-30-94)
S..ln.tructlon. lor Appllcablo Percentogo on ROVOfIO (15)
Sldo, (Includo vol.... ',an Schedulo K 01 Schedulo M,)
16, Amounl 01 Uno 141nxoblo a16% ,ole (16)
(Includo voIu.. Irom Schedule K or SChedulo M.)
17, Amounl 01 Uno 14lnxoblo a115% '010 (17)
(Includo voIu.. ',om Schedulo K or Schedule M.)
16, Prlnclpallaxduo (Add laxl,om Unos15, 16 and 17,)
19. C,edill Spou.a1 Poverty C,odit Prior Poyrnonl.
+
(19)
(20)
'T'
0 <u
""
0 -
67,000 -
10,285 'u
0 '1,1 (/.
.1> ;~. 'D
0
(8)
43,160
3,964
(11)
(12)
(13)
(14)
0 X,_ .
30,161 X.06 .
0 x.i5 .
(lB)
Discount Inl..osl
l,) n
,..
77,285
47,124
30,161
30,161
o
1,810
o
z
~
~
8
a
1,810
+
20, If Uno 191. groalerthon Uno lB. onlor lhedlfr..once on Uno 20, Thl. I. tho OVERPAYMENT.
[!}:JI Chock hare If you Ir. roquolUng 8 rofund of your oyorpayrnonL " 'I
21. If Uno 161e groaler than Uno 19. enlo, tho dilf..once on Une 21, Thl. I. the TAX DUE.
A. Enler thelntarosl on the balance duo on Uno 21A.
0, Enler tho 1ol?i 01 Uno 21 and 21A on Uno 21B, Thl. I. tho BALANCE DUE.
M.ko Chock Payablolo: Rog'.lo, 01 Will., Ao.n!
(21)
(21A)
(21B)
IL'':),.,..',~",''',;!,'. ".,...... BE SURE TO ANSWER ALL QUEsTIDN& ON REVERSE SIDE AND TO RECHECK MAT H...... ': .'0,...." ., I
Under ponoIlIos 01 potjuIY. I declare thai I hIM! """""nod Ihl, 'olum, Including occomponylng Ichedules and .18I0m0nto. and 10 the best 01 my knowledgo and belief.
1111 true. correct and complele, I declare thol all ,oaI osl.lo has boon reportod al troo market voIuo. Declarltlon 01 proparer other than tho personal reproson18lMt II
basod on a1llnlormatlon 01 which proparor has ony knoNledgo,
IVR P'R'DN 'PO!Ism~~,,: Eru I Aogr i\1 I~ Seoul. lanE \-\u ",~Lsl;:;;;-?~i03r.. ~/"/L)7
UlNA' PR'P'R" RES IV' Aoon".5403 Jonestown Rd, Hbg, PA DATE
"EV.IIW EX. CI2.a5)
.
SCHEDULE A
REAL ESTATE
COMMONWEAlntOF PENNln.VAN~
"'ERrrANCE TAX RETURH
RElOfNTDECEDf:NT
ESTATE OF
Emma Altoff
FILE NUMBER
21 95.0704
(Property Jolntiy-ownod wllh Righi 01 SurvlyolOhlp mUll bo dllclolod on Schodulo F) AU 10.' 011110 .hould bOlOportod 01 I,'r m.rkol y.luo
whIch I. donned lithO prlcl II which proporty would bo oxchangod bolwoon a willing buy or and. willing .aUor, nollhar baing compoUed
to b or IIU both hayln lOalonablo knowlad a oftho roloyanllact..
ITEM
NUMOER
1. None
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enlor on line 1, Reca Ilulallon $
(If mora Bpace Is needod, Insert oddlllonol shools o( somo Blze,)
ITF PM2021F.:I
\l\EV.tI5mEX.(4.)
..
CllMlIOHWEALnlOFPENNSI'LVAN"
fftllRITANCE TAXRE1\JRH
RUIDENTOeCEOINT
SCHEDULE B
STOCKS AND BONDS
ESTATE OF
Emma Altoff
FILE NUMBER
21 95.0704
(All property jelnlly-ownod wtth Righi 01 Survivorship mUll be disclosed on Schedule F.)
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. U S Savings Bonds - reported and all tax paid -
see attached reports
2 PNC Bank NA, reproted and all tax paid -
see attached reports
"
TOTAL (Also entor on line 2, Recapllulallon) $
(If mDro spoco Is noodod, Insort oddlUonol shools of somo slzo.)
JTF PM202IF."
<;'+,\:;~;'i:{t,,:;i't"~'J:,~'~'~~;~:~" ..
'REV.I&04 EX. p.e2J
SCHEDULE C
CLOSELY HELD STOCK,
PARTNERSHIP AND PROPRIETORSHIP
PIeBBe Prlnt or Type
FILE NUMBER
21 95.0704
.
COMMONWEAl1HOFPENNI'tI.VANIA
lHfllRlTAHCE TAX RETURN
REIIDENT DICIDINT
ESTATE OF
Emma Altoff
Schodule C.1 or C.2 mUlt be IUlched for elch bUllno'llntorolt of tho'docodont;othar thin a pro rlolotlhlp.~'},\'t.".1 i~~~~l\~ f",;~~;'::,nt-J.'..~jl
ITEM
NUMBER
VALUE AT
DATE OF DEATH
DESCRIPTION
1.
None
TOTAL (Also enter on Une 3, RecoplluloUon) $
(f( molO spoco Is noodod, Insort additional slloo/s 0' somo slzo.)
STFPA4202IF.5
'U:V.t505 EX. (3-'12)
.
SCHEDULE C-1
CLOSELY HELD CORPORATE STOCK
INFORMATION REPORT
COMMOHWEAl nl OF PENNln VAN~
filt[nlfANCE T..... RErunH
RESDENTDECEOtNr
ESTATE OF
Pie... Typo ot Prlnl
FILE NUM BER
Emma Altoff 21 95.0704
Tho'followln 'InfDrmatlDn must bosubmlltod with thls'schodulo:' ': : ,'~:' ,""',,i'.;,,., "'I,~,:(':"".'t""""':'r::', ,q,~"!\,fKW..~
A. DotalIod dOlcrlpllon IIlowIng tho mc\hod 01 ccmputlUon uUllzod In th. voIUIUon oIth. decodent'. Itock.
B. Comple1. copies 01 flnancl" .lltomenll ot comploto copl.. 01 tho Federel Tu Roturnl (Fod..e1 Form 112D) fot tho ~ 01 death end ~
pnlCodlng yeara,
C, Slat_t 01 dMdendI pald oach )'0". U,tthoo. doc/Oled end unpaid,
D. U.t nomea 01 0I11cero. ""arIes, bonu,.. end eny oIhor benefitl recelwd Iran Cotpct.Uon,
E, If tho COI1l>eny - reIIeslal., ,uoo" . 11'1 'haNIng tho complolo odd,o..'.. end esUmatod Felr Mari<ot V"u"'.. "Real E.IaIoAppr..'...
haw been 'ocurod, piau. .Ilach copies.
F. U.I ptIncIp.. Itocl<hold... el d.t. 01 dealh, number oIlhor.. held, and reI.Uonlhlp to decodenL
G, Arrt oIhor Information r...1Ivo to tho voIuaUon 01 tho decedenl'. Int",osL
1. Name 01 CotpctallonNone
Slalo oIlne.
Street Addr,,"
Dolo oIlnc,
Tel.. Number 01 Sharoholders
Clly
Stal.
ZIp Codo
2, Fed"II., 0, Number
(Same AI Fed.... Form 112D)
3. Typo 01 BUllno..
~,
BUllno.. RopcrtIng Year
to
Product
STOCK TYPE
TOTAL II SHARES
OUTSTANDING
II SHARES OWNED
BV DECEDENT
PAR VALUE
Canmon
Preferrad
ProYldo all rights and ro.lrlcUons portalnlng 10 oach cl... ol.tock.
5. Was decedenl employod by tho CotpctaUon? 0 Y.. 0 No
")'OS, PoslUon Annuli Salluy $ TIma Devoted 10 bUllnesl
a, Was tho CotpctoUon Indebted to th. decedent? 0 v.. 0 No
1f)'OS, pnMdo ernounl oIlndebledn,," $
7. Was ther.lllolnsurance peyebloto tho cotpctallon upon doath 01 decodent? 0 Yes 0 No
1f)'OS, C..h Surrender Valuo: $ Net Proceed. Payllblo: $
Owner 01 Pelley
a, Did tho decedent.oll ot Iran.f... .Iock oIthl. cOIllponyWllllln on. yeor p,lot 10 deoth If Ih. dato 01 death was on ot oner 12/13/82 ot Within
two yeara If the dato of dooth w.. prlot 10 12/13/82? 0 Ves 0 No
1f)'OS: 0 Tran.fer 0 Sele II of Shares Tronsferee ot Purch.....
Consldoratlon $
Attach 0 lep"ato .hoot rot eddiUonlllronsfers ondIot .....,
9. Old tho corporation havo on Inler..tln other cotpctollons ot partnerships? 0 Y.. 0 No
")'OS, report tho necesllll}llnformaUon on a .epOlato .heet, Including Schedulo 'C-l' ot '0.2' for each Int.....L
Data
10, Was thoro a wrlllen IhOlehelder'1 agreement In e"ectaltho time of tho decedent'. death?
")'OS. prcMdo a copy 01 tho agreemenL
11. W.. tho d_t'lItock .oId? 0 Y.. 0 No
")'OS, prcMdo. copy 0I1ho agreemenl oI.a1o, olc,
12, W.. tho corporation dl..oIwd ot Ilquldoled oner tho decodenl'. death? 0 Y.. 0 No
If yes, p~e 8 breakdONn 0( liqukfaUon distributions, etc. Attach 0 separate sheeL
o Y.. 0 No
ITF PM202IF.lS
,RfV.t5OG EX. (s.en
.
SCHEDULE C-2
PARTNERSHIP
INTEREST REPORT
Plea.. T)1><l or Print
FILE NUMBER
COMMONWEAl1lICW PENNS\1.YAHt4
I4ltERnAHCE TAX nE TURN
RElOENT DECEDtNT
ESTATE OF
Emma Altoff 21 95.0704
Tho follDwln InfonnatlDn must bo submltlod with Ihls 'schodulo:' " :', "~:,I., ;1,.;'..'.,:':. ;;"""'''<'''''';':0'.,
A. Detallod descrlptlon showing tho molhod of computotlon utlllzod In Iho voluatlon of Iho docedonl's Intotost,
B, Comploto coplos 01 nnonclal Btatomonls or comploto coplcs 01 Iho Fodorol Tax RoMns (Form 1065) lor Ihe yoar
01 doath and 4 preceding yoars, including a balanco sheet for tho yeat of death,
C, II the Cempany owned Real Estalo, furnIsh a IIsl showing tho complote address/os and oBtlmatod Fair Markel Value/s, II
Real Estato Appraisals havo been socured, plcase atlach coplcs,
0, Any other Infonnatlon relallvo 10 tho valuation 01 Iho docodonl's Inlerosl.
1. Nama 01 Pa~norsh1pNone
Fedorall, D. Numbot
(As por Fonn 1065)
Do to Buslnon Commenced
Addross
Business Activity
2, Decadent was aOGeneralO llmlled partner, II decedent was a r,,"I:3d partnor, provlda Inltlallnvestmenl $
3,
." OF DWNERSHIP
S~Y
cJ',~'i:'i:8~NT
PARTNER'S NAMES
% OF INCDME
A.
B,
C.
D.
4, Estlmatod Valua 01 docndent's Interest: $
5, Was Iha partnarshlp Indobted to Iho decedenl? 0 Yes 0 No
II yes, provlda amount of Indebtodness $
6, Was Ihoro nla Insurance payablo to Iho partnership upon Ihe doath of the decedent? 0 Yes 0 No
II yes, Cash Surrendor Valuo: $ Net proceedS payablo: $
Ownar 01 Policy:
?, Waa thore a Wlltlen partnership agreomentln ellect at the time ef the docedenl's death? 0 Yes 0 No
II yaB, allach copy 01 agreemant.
6, Old tho partnarshlp hava an Interest In any other partnerships or corporations? 0 Yes 0 No
II yes, report Ihe necessary Information en a separate sheel. Including Schedula 'C.l' or 'C.2' lor each Interest.
9, Old tho decedant'a Inlerestln the partnership change In the year belore dealh IIlhe dato of death was on or eftor 12/13/B2
or II death occurred prior to 12/13/62 In tho last two yams? 0 Yes 0 No
II yeB, exptaln:
10, Was the decedent related 10 eny 01 the other partners? 0 Yes 0 No
\I yes, explaIn:
11. Was Ihe partnership dissolved or liquidated altor decedent's death? 0 Yes 0 No
II yes, report en the related Informetlon, Including copleB of the SaleB Agreement end/or SeUlemenl Sheet,
12. Was Iha decedent's partnership Interost sold? 0 Yes 0 No
II yes, ptovlde a copy 01 the egreement of solo, etc,
ITFPMm1F.7
REV.I&01 EX tl'.)
.
SCHEDULE D
MORTGAGES AND NOTES
RECEIVABLE
PleaBa Print or Typa
FILE NUMBER
21 95.0704
DESCRIPTION
VALUE AT
DATE OF DEATH
67,000
67,000
COMMOHWl!AlntOF PENHIYlVAH~
IHHERlTANCI TAX RITURH
"!lIDlHTDlCfD!HT
ESTATE OF
Emma Altoff
(All property !olnlly-own.d wllh tha Right or Burvlvol1lhlp mUlt b. dl,clolld on Sch.dul. FI
ITEM
NUMBER
1.
L fe nsurance procees
see attached letter of
Counsel, Department of Revenue, Commonwealth of
Pennsylvania, fixing the survivors benefit
which is taxable to the Estate.
TOTAL (Also enter on line 4. RecapUulaUon) $
(If motu space Is noedod. Insort oddlllonol sheats of some size,)
ESTATE OF
Emma Altoff
IAII properly Jolnlly-ownod wllh Iho RIDhL 01 Survivorship mUll bo dllclolod on Schodulo FI
ITEM
NUMBER
Family Service Life Ins Co - prepayment arrange.
Personal property
Furniture
Wedding Band
Engagement Ring
Watch
Cash on Hand
Veterans Insurance Policy
Rent Refund
Veterans Insurance Policy
Rty.,SOI EX '11.'1
SCHEDULE E
CASH, BANK DEPOSITS AIlD
MISCELLANEOUS
PERSONAL PROPERTY
.
COMMONWEAl ntCW PENHlnVAHIA
IHlllftI'rAHCI TAX "Itu""
"IIIDINTOI!CIOIHT
DESCRIPTION
1
2
3
4
5
6
7
8
9
10
Please Print or Type
FILE NUMBER
21 95.0704
VALUE AT
DATE OF DEATH
6,317
750
1,000
50
250
75
75
1,537
100
131
IAlllchaddilionolSl12" X 11"lheets Irmorolpocoll nooded,)
TOTAL (Also enter on Une 5, Recapllulallon) $
10,285
ITFPM202tF,O
RfY.'&oIEX .112.ae1
COMMONWtAlnlOF PENNSYLVANIA
tntERITANCETAX RElURH
REsaENTDECEDENT
ESTATE OF
Emma Altoff
SCHEDULE F
JOINTL Y.OWNED PROPERTY
I FI~E NUMBER
21 95.0704
Jolnll.nlntfl):
NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. one
B.
C,
JolnLly-own.d property:
~ETTER
ITEM FOR DATE TOTA~ VA~UE DECD'S DO~LAR VALUE OF
NUMBER JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. .
.
TOT A~ (A1.o tiller on line e, Rec:apltul.Uon) $
(If mora spoco Is n_ i1.ort oddi/Iono/ shoo', of S/ltllO .Izo)
8lF PA4202tF.10
RlI/.lIlOU'12..n
.
COfoUrotONWEAL 11'01 p[NN.nVAH~
INHIRlTAHCI TAX RIYURN
"IImIHT DleIO_NT
SCHEDULE G
TRANSFERS
PLEASE PRINT OR TYPE
ESTATE OF
FILE NUMBER
Emma ALtoff
21 95.0704
H S F D V R I I C I
DECD, DOLLAR VALUE
ITEM DE6CRII'TION DF PRDPERTY EXCLUSION TDTAL VALUE II OF DECEDENTS
NUMBER hcMM name 01 Utt ItInJIerI., Ih,Jr "IIuonahlp fa decedent. 11'" of ifill"", DF ASSET INT, INTEREST
None
.
-
TOTAL (A1loenleton line 7, RecapllulaUon) $
(II mom opoco /& noodod. ho.1I oddiIlonolohoolo 010_ oil.,)
,
I:
ITF PM202IF. t,
RkV,l5lt EX' (1-68'
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EX ENSES
Pl.... Prlnt or T .
COMMDNWEALnl OF PENNSV\.VAH~
MIERnANCE TAX RE TURN
H
Emma Altoff
ITEM
NUMBER
21 95.0704
DESCRIPTION
AMOUNT
A.
Fun...1 Exp.n...:
parthemore Funeral Hone, New Cumberland, PA
Carpenter-Jenkins Funeral Home, Providence, RI
Parthemore Funeral Home, New Cumberland, PA
7,762
1,152
1,105
I.
2
3
B. Admlnl.lraUv. co.ts:
I. P.rsonal Repr.B.nlaUve Commissions 7,500
Social Security Number 01 Personal. R.pt.sentallve:
Year Commissions paid 1997
2. Allomey Fees 21,829
3. Family Exempllon
Clalmsnt RelaUonshlp
Address 01 Clalmanl at decedenl's dealh
Streel Address
City Slale Zip Code
~, Probale Fees
C. Miscellaneous Exp.nsea:
1. Office Supplies - see list 1,870
2, Lond Distance Phone Calls 239
3. Register of wills RI 34
~. Death Certificates 45
5. RI Scituate Records 25
6. CLergy, Luncheon, Transportation 319
7. Accounting Fees - Kelly Financial Svcs, Inc. NC 1,250
6. Tax Prep Fees - decedent 30
TOTAL (Also enler on line 9, Recapitulation) $ 43,160
(II moro spac. Is n..d.d, Insort addlUonal sh..ls 0' sam. slz..)
IlFPM202IF.'2
,'.,-. I
;',<=-"'" ;-". ,,",,~....!.i.ft.;\~:...~I.'1~i:',~;:~.;:"',:' .
Rly.,.t2Utlt.a)
SCHEDULE I
DEBTS OF DECEDENT I
MORTGAGE LIABILITIES AND LIENS
Pineo Print or
FILE NUMBER
21 95.0704
COIlMOHWEALnllW PEHNIYLVAIM
....lERffAHCI TAX Rl!tuRN
"ElDENT DlCEDENT
ESTATE OF
Emma Altoff
ITEM
NUMBER
DESCRIPTION
Federal Health Insurance - reimbursement
Blue Cross/Blue Shield - reimbursement
1,
2
TOTAl. (Also enter on Une 10, RecepnulatJon) $
(If molO space Is neodod, Insoll addltlonol shools 01 sarno size.)
e
AMOUNT
2,448
1,516
3,964
ITF PM202IF.IS
"-'~4.:'!t',. '. ,;j,'
,,"
r(ty.\t,,,IJCtl'-In
CQMMOHYt'lAlntCWPlHNIVlYNM
lNHllUTAHCI TAX "ItuRH
" .IUK"' UI:ClI:l.IIPII
SCHEDULE J
BENEFICIARIES
ESTATE OF
Emma Altoff
ITEM
NUMBER
FILE NUMBER
21 95.07046
NAME AND ADDREBS OF BENEFICIARY
RELATIONBHIP
AMOUNT OR
SHARE OF ESTATE
A. TIlCIbIe Bequests:
1. None
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B, Charllablo and G<MltI1Il1OI\loI Bequesls:
1.
TOTALCHARITADLEAND GOVERNMENTAL BEQUESTS (Allo enlor on line 13, Roeoflllulotlon) $
(II moro Ifll.o II nlldod, Inlort oddlUonll Iho.1I 01 I.mo ""0)
.l1PM2llZ1P.14
REV.,n. EX. ('044)
COMMONWEAL nlOf PENNSYLVANIA.
NIlCRrTANCE TAXRETURH
RUDENT DECEDENT
SCHEDULE K
LIFE ESTATE/ANNUITY/
TERM CERTAIN
ESTATE OF FILE NUM DER
Emma Altoff 21 9S. 0704
This schedule Is 10 be used lor eU single life, Jolnl or successlvo hfe oslotes end telTl1 certain celculallons, For deteB of death
after 12-31-111 and baforo 5-1-80. acluartal fottors fot single life calculations can be found In Revenue Booklet (REV.150IB). Fot
dotes of deolh on or after 5-1-80 ocluartal 'oclors con be found In IRS Publlcollon # 1457 Acluarlal Velues, Alpha Volume,
The Instrument craollng the lifa Inletostls e: (Please attach a copy of Instrumenll
o WID 0 Intervlvos Deed oITrusl 0 Olher
"'0'1'-, ,,," T,:'''' -,,,- ;:"". ",', LIFE ESTATE INTEREST CALCULATION ,..", p',;, "'", ,,,"". ;,""""("",1,.-,,:.,::
PresDnt Ago
Noaroal Dlrthda
Namola) of Lifo Tonlnlll)
Dllo 01 Dlrth
Tonn 01 Y.... Lifo Ellalo tl PIYlble
None
o Life OtO TelTl1 01 Years
o Life orO TelTl1 of Yea IS
o Life oro TelTl1 of Years
OllIe oro TelTl1 of Yea IS
1. Velue of Fund Itom which Lifo Estate(s) Is payable: ... ..... , , , ... .... .... ..... .. .. .. $
2, Acluartal Factot per appropriate Table............ , .. .., , ..... , ..' ...... , , , .. , ,.. .
Interesl Table rate. 0 3 1/2% 0 6% 0 10% 0 Variable Role . %
3. Value of Life Estate (Line 1 X Line 2) ........ .. .. , . .. . .. . . . , , . .. .. . .. , , , .. . . .. , .. $
"{'.,'1''-:'J ',c ~'J', ,~;';,JX~::,' '" ,~_"l' "j,,~:-:.~:,h'.)f" . :ANNUITY INTEREST' CALCUl:.ATION h;:\';"i',\', d~~:,_ :";i'.::.J.'4"'.;:ilt"-:::,;,,,l,--,~..,~li,,::~';;:.'
Namoll) 01 Annullanl(l) D.to 0' Dlrth Prolonl Ago Tonn 01 Ye... Annuity II payablo
(No.rosl Dlrthday)
o Life oro TelTl1 of YealS
o Lifo oro TelTl1 of Years
o Life orO TelTl1 of Years
o Life ero Totm olYeers
I, Value of Fund from which annully Is payable.. .. .. . . . .. .. . . , , , . , , .. . , .. , . .. . . , . .. . , $
2. Check appropriate block below and enler corresponding (number) In column, . , . , , . . . , . .
Frequency 01 payoul-O Weekly (52) 0 BI,weekly (26) 0 Monthly (12)
o Quarterly (4) oSem~Annually (2) OAnnually (1) OOlher ( )
3. Amount of payout per pertod , .. . , , .. .. . , .. .. .. , , .. .. .. . , , . . .. .. .. .. .. , . .. . .. .. . .
4. Aggregate Annual payment, Line 2 X Line 3 .. .. , .. . . .. , . . , . , , .. .. . , . , .. .. .. , .. . .. .
5. Annully Factor (see Instrucllons)
Inleresl Table role -031/2% 0 6% 0 10% 0 Variable Role %
6, Adjustment Factor (see instructions) ....,...,........,..""....."..........,...
7. Value 01 Annuily - II using 3 1/2%, 6%, 10% or If variable rale and period payoulls at end
of period, calculallon Is: LIne 4 X Line 5 X Line 6 .......,.".....""......,......
If using variable rate and pertod payout Is at beginning 01 period, calculallon Is:
(Line 4 X Line 5 X Line 6) + Line 3. . , .. .. , , .. . .. .. , .. .. , .
NOTE: The valuos of the funds which croate the abeve future Inleresls must be reporlod as part 0' the Estate Assets, Line 1
through Line 7. The Rosulllng Llfe/Annully Inlerost(s) should be reported allho approprlato tax rato on Lines 13, 15. 16
and 17 as roqulrod,
nEV.1&4IEKU.o2)
SCHEDULE N
SPOUSAL POVERTY CREDIT
(AVAILABLE FOR DECEDENTS DYING AFTER 12131/B1)
I FILE NUMUER
21 95.0704
COMMONW[AI. TII OF PEHNSYLANIA
INHEnlTANCE TAX DMSION
ESTATE OF
Emma Altoff
This schedule must be comploled end filod If vou checked the spousol poverty credil box on the cover s eo,
I PART I. CALCULATION OF GROSS ESTATE' ", ,\, ,,",',\ .' " .' ,.',':-;. '1
1. Taxablo Assols tolal Irom line 0 (cover shoel) .................................... 1. 0
2. Insurance ProceodB on Lire of Decedent ........................................ 2.
3. ReUrement Denoms ...............................,.,....................... 3.
4. Jolnl Assots with Spouso . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . 4,
5. PA Lottery Winnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . ~ . . . . . . . . . . . . . . . 5.
00. Olher Nonlaxable Assols: L1sl (Allllch Ichodulo If nocOSIll/Y) 00, ,. .,' '\;:i"~: '....t'i-.t:j.Ii-;:~ :},' ";".i~'\'l~,r:i
" ...".." ,1.'11""" ".,. .....'..I'j
Ob, ::::::,;:;,;;);ifjWf~(,\:~};.!;}:.~jF~},~j
Oc, . ," ,..,..,',.'1'...... ."!,.,,~,,,..,l
t ..- ' 'I, ;,. J : \ ,'.. " ;. ..' I. *.', , ,.':' 1 .' .~" "~ .
':"; "'t' \.," "...~ t t ',,' r' : { 't ,""'il
Od, j~:.:,: :;I~. ,;': :,:, ;"1 (, ::(H:' :.'!:, 1;: It "~~;.;::~:.J
o. SUDTOTAL (Llnos 00, b, c, d) ... . .... . ... ..... . .... ..... . . ..,.., , , ... . . ........ 0,
7. Tolal GtOSS Assots (Add lines 1 Ihru 0) ......................................... 7.
O. Tolal Actual LlablnUos . . . . . . . . . . , . . . . . . . . . . , . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0,
9. Nol Valuo of Estale (Sublract Ilno 0 from Iino 7) .................................. 9.
llin. P Is grr,'tr ,h,n UOO.OOO. STOP. The estate Is not rllQlble'o cI~/m rho Cfr<!,', "not. continue '0 p,,, II.
I PA,R\ II~, ~lIl.(~,Ut: ..Vi.... ",.... .',1 !UN INCOME. (Allach!lC)plolj,~f{~~orallnd,l~fdual 1,~~,:"m~1
h' . ' - . . , . - '"",.' ..' "" '" ' ."' : ~'
...... ....TaxRolurnsfDrdocDdonlandspouso. ' . ,.",' '.. P."" .....,'.., ,'..',,,.
Incomo: 1. TAX YEAR: 19 2. TAX YEAR: 19 3, TAX YEAR: 19
a. Spouso,....",." la, 20, 30.
b. Oecodont ......... lb, 2b, 3b,
c. Jolnl ............. lc, 2c, 3c.
d. Tax Exempllncomo ld. 2d, 3d,
0, Othor Incomo not
Iislod above .... 10, 20. 30,
I, Tolal...",.."" , 1f, 21. 3f,
h I
4. Averago Joint Exompllon Incomo Calculallon
40, Add Joint ExempUon Incomo from abovo:
(11)
+ (21)
+ (31)
=
(+3)
=
1. In sort om aunt of laxablo lransfors to spouso or $100,000, which over Is loss,..",..,. 1.
2. MulUply by crodlt porconlago (soo Inslrucllons) ,.....,......"....."....,....... 2,
3. This Is Iho amounl of Iho Rosldont Spousal Poverty Crodit. Includo this roguro
In Iho calculaUon of lotal crodlts on IIno 10 of Ihe covor shoel ,.".',..."".,.,..., 3,
4. For Nonrosldents. ontor tho rallo of Iho docedonl's gross oslalo In PA to the valuo of tho
decodonl's gross oSlalo.." , .. , . . .. , , .. , , , , , , , .. .. , , .. , .. ".. , , , ... , . . , , . , , .. 4.
5. Multiply Iino 3 by Iino 4 and enter tho tolal hero. This Is Iho amounl of tho Nonresident Spousal
Poverty Credit.lncludo this nguro In tho calculalion or tolal credits on IIno 18 of tho covot shoet. . 5,
SlT PM202tF,,1
Rllv.I649IJX+(819S)
SCHEDULE 0
TRANSFERS TO SURVIVING SPOUSE
COMMOHWEALlll Of PENNSYLVANIA
lHIlDITANCB TAX alnUllN
~lOf.Hf DEttODO'
ESTATt:OF
.'11, Number
I' AllT Al Entet Ibe description Dl\~ wlue of nlllnten:sts, bolh taxable Md nOlHllXIIb\c, regnnllcss of Iocallon, (neL of deduction,)
which to the decedent', 5Ol\'lvlng 5 use by wll~ Inteslocy, 0 mllon of law, or olherwlse.
Dcseri liDn of items Amounl
1
Port ^ Taint: Bnler the nmount !\hnwn on the n:cnf'lllUlnllon sheet In the Oerelle"t Information Stellnn.
Eleellon To Subject Properly To Tax Under Seellon 2113(A) As A Tuxoble Tronsfer By This Decedent,
If. IRlst or similar IllTlUIgcmenl meeLs the requlrcmenLs of Section 2113(A), on~:
0, TI,o IRlsl or sbnllnr IllTlUIgemellL Is Ilste~ on Sehe~ule 0, M~
b. TIle value of Ibe IRlsl or slmllnr IllTlUIgemcnt Is entcre~ In wholo or In (lOll lIS M llSSCI on Sehc~ulc 0,
then Ule trunsferor's pcrsonol representative may spcelOCIllly IdonlllYlhe tRlst (ull or 0 fmcllonol portion or pcrecnmge) 10 be Included In Ibe
elecllon'to hove such tRlsl or ,lmlLv propcrty lrenled lIS 0 laxoblo tmllsfer III Ihl, eslole. If Ics, than Ihe entire value of Ihe IRISL or ,lmllar
property Is Include~ lIS 0 laxoble tl1U1sfor on Sehc~lIlc 0, Iho pcrsonol n:prescnlollve sholl be consldere~ to hovo mode Ihe elocllon only AS to
o froctloll of Ihe IRlst or sh"lIar IllTlUIgemcnl, Tho numomlor of Ihl, fDlcllon Is cquol to Ihe M,ount of Ihe tRlst or similar IllTlUIgement
Include~ lIS 0 tllXllblc llSSCt on Sche~ule O. 11,e ~cnomlllnlor Is equal 10 Ihe 10101 voluo of Iho tnlst or similar omUlgement.
ELECTION: no )'ou tire. under Section ll1J(A) 10 trull. . Clllhle tran.rer Inlhl, rllllc all or I porlloa ora Irusl or limit., Irrlnccmrat
cnlltd (or the lair Ult orlhls deudent', ...nlvlng .pousc durlne lilt lurvMoIIPOUIt'. enllre Urrllmd
YES D NO D Slgnolure Vote
Nole: If the eleetlon applies to more thnn one trllsl or shnllnr nrran~el11enl, Ihen A separale rarm must be signed and OIed.
Part Dl Elller the description Md volue of 011 Interesls, bolh laxoble nn~ non.taxoble, regnnlleSS of Iocnllon, <nel of de~ucllonl) which
JlIISS to Ihe dec.:~enl's 5Ol\'lvlllg spouse for which 0 Seclloll 2113 (^) elecllon Is being mode.
Dcscri tiDn orilcms Amount
I
I'artII Tolol
aTFPM202IF,17
!i ~rrh~tl t;!!'L{I.!!!lli!::!!~!!'r
'rol VIUCP.IIT II, tltllllJf:M, I,'W,
OIlU old GLuno OIIUIHO
l'I'uvl.I,,"CU, III 0290l-7104
f'lIlltll CIIMII.f:lIP. M,'I'tWf' IIItU>lIilIflL'
^dmllllolrnLrlX of lho
P.ulolo o[ P.1II1On ^Ilolf
'I'ho UlUl01'sl'Jnod horoby nc:knuwlmIIJo(u) .'uvulpl or Lho rUlu!>> liS
Ilomlzod nllll nUlhudzoe., Lhu .lo,llIUllulI oC I/l Cur 1"'1nl C008 In
hnndll,uJ thin rnnttOl", pUL' uur llfJl'COlllOIll: nm) Lha lIonnnl chna:fJo8 u(
ntCmhul'B oC lho Ithotla lulnlll) nor ^unoolntlon illU. nluo tho payment.
o[ mudlcol bill. .. I~"nlzed,
I/Wo also llulho,'lzo lho .lclluC:lion nm) .1I1\'IIIOnl; or court couls DIUI
pL'cpnl'utlon expenDOD nO oct forth. _I/Wo nluo nulhul'ltu tho duduc-
lion ror upcelnl I"<jol wUlk no Iluled.
Il Is Cull)' lIlIdonlou,l lIl1ll lIl1u lu 0 C"II nlld (IliA' uoHIClnollt
and tho cnso can nove..' hu reoponed.
It Is CUlly umlcruLuOIJ lIh1t In tho ovant lhill lIuH'u nl'O nllY othor
unpaid bit 8 01.' uxpenDUD not Ilnted hulow, limn thoBO III 110 ur ex..
panoos L'cmnin Lho cllclILlo)1 ubi hJllLlon.
'fho net chock Dot rOl'Lh on Lhe bottom hlU'OOe In ncknowlclhJoll BS
[ulI nllll (\nol uolllolllOIlL,
1/1'111 rUl,l,Y U1l1l1lllll'MUIl 'I'U III 1lIl'I"I'I,llHp.U'r Mill M,!. 1Ip.lllle'I'! IlIIS,
SoltlDIODnt (prDuollt Vol"D"
^ltornoy'. FOD (1/] of preoonl villoo).
$ 200,000.00
$ 66,666.DO
!ll!!!!!!!llllil!!H!'J: _QL.!!!!'!"rh~l!!lli'U:!!!!l!!!
$ 150,00U,OU
$ 16,OOU.UO
$ 10,00D.00
~_H,.!!~2.!!!!
$ 205,0]9.00
Inltlnl I'nymont
12/lU/91
12nO/90
12/]U/99
'1'll'.'AI, II^yuu'r
1. IlIllI.1 PnYlllolIl.
$ 150,000.00
~-I~~~~t,.QH
$ 0],]34.00
2. Ilonn Altorlloytu 1'.001
J. 11080 Couto oml BXIHJIIIIOU
ll1uhll1llltJ lIIudlcal mcpurl:. ruvluwl
~___ll!50.J!!!.l
". 1l~'l' '1'0 el,) BU'I's
.I.
!!.2.l04.00
"1I1l l'I,^IIl'I'/Ff'S ('1'1111 1I1l/IIS-A'I'-I,^'" OF Ilt1l1^ ^!"I'(lf'~') 1I1l1lP.IIY MlIlEIl
^HU t'UI,J,Y UlIIlImS'I'MIU 'l'II^'I' OllllUr.u MIY UUI'MIl H1lIlIC^I, 1I11,I,S MIII/UII
1,IEIIS MUSil HI 'I'IIP. f'U'I'UIIII, S^1I1 IlII1'Mll tlP.IIH:M, 1I1I.I,S ^NU/DII
I,IP.NS WOUa.u IIIl "IIE IIIlSl'UIISI1IJI,/'I'Y Uf' 'L'IIP. l'I,^III'I'It.t'S ('I'1I1l IIIlJIIS-
^'L'- L^'" OF IlHn^ M,"Of'f'),
inTUIlSS
ciiiiiii,WIf7,l.iWTlI/ HIlLS1I^Cii;--
MII,llIlulrolrlx of lho
t:otnto of ~nllnll Altotf
DA'I'el>:
;;,':::-.!,~-_.
,"-~':~:?,~;L~0Z8:J:'"":'~'~' '~"~~"~~;>i~~,~.~~~;iZ'J1'~.~:"jl~~~,~:,:,~.:~~~~'.L:;i":'~1ift~, ~ '.
.........--
VINCENT
D.
l\tIORGERt\
n,.. 1'.k1.'IA,,,.. ."V,"""
:J'J.'N,w,.,lrr. :n'A",I.. .IU""I (11'.9(1,' -'''~
.I"/-.I.M'-,\,,.,.
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.
November 26, 1996
Mrs. Charlene IIimelsbach
19 Scout: Lane
lIummelstown, P^ 17036
Dear Charlene:
Enclosed herewi th you will find check' in t:he amount of $82,384.00
which is explained on the enclosed Settlement: ^greement. Please
sign the Settlement ^greement and have your signature witnessed.
Please date same, and return it to me in t:he enclosed, self-
addressed, stamped envelope.
If you have any questions, please do not: hesit:ate t:o contact
me at any time.
L'!'D.
VDM:EMW
\
,
Enclosures
via FEDER^L EXPRESS
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hi h i 1 i d ~I 1" d' 'L't'l" I' .I!r.: ..'~' m'rtl'1>l" ,!J..1.;t)!L;',Cj'....,.'...I...'f '
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December .17,
I,,' i
.' ,
1996
.JtJl-.I,f~'-(J,'C(J
.~'" .4(.'/-.J.'fI'-/'.r,J,r
"
Mrs. Charlene lIirnelsbach
19 Scout Lane
lIurnmelstown, Ph
17036
Dear
Charlone:
you, Jim,
New Year.
VDM:EMW
'"
Enclosurr.s
2.liT:rI,EMEN'r MREE~lEN'1'
'1'0: VI NCllN'I' D. MDnGlml\, I}I'D.
O"e old Sto"e Squnre
Provldc"c~, RI 02903-7104
FROM I CIIMLENE I\LTOFF IIIMELSDI\CI
I\dministratrix of the
Estate of Emma I\ltoff
'I'ho LIIl1lorsl<J"ccJ hcl'C~u}' acknowledge(s) I:eooipt or the funds as
II:cml?crl and .1uI,hor!?0Is) tho deductIon of 1/3 for legal fees in
hn"dll"g this 111,11:1;01.', [l~r our agreement a"d the normal charges of
lI1embel:s of the nhode Jnla"d nar I\ssoclation and also tho payment
of mcdlcal bills as Itcml?cd.
I/I~e n I no nuthol'l?e the cJClduct Ion and payment of court costs and
1'I'~(lal'al;lon C'XI'C"IlC'1l as fIel; forth. I/Wo also authorize the deduc-
tion for npocial logal work os listed.
II; is full}' U"IIf'!I.sl:ood l:hnt this III a full nnd [Inal settlement
",,.1 I:he cnsl'! en" nevcl' be rcopo"od.
II: Is fully ulIClcrstood thnt I" the ovont that there arc any other
unpnid bills or CXPC"SCS "ot listed below, then these bills or ex-
pcnlles l'cll1nin the clio"t(s)' obligation.
'I'ho "et chcck sot fOl.th 0" the bottom heroof is acknowledged as
full d"d final sottlemont.
I/WE f'UI,I,y UNDEnS'I'I\ND '1'111 S 5 E'I"rLEM EN'I' I\ND I\LL DEDUC'rIONS.
1. Settlement Check:
$ 12,000.00
$ (4,000.00)
$ 8,000.00
2. I\ttorney's Fee (1/3):
3. NE'I' ClmCK 'ro el,I EWI':
'I'IIE PI,1I1N'1'lFFS 1'I'IIE IIEIRS-II'I'-LIIW OF E~I~II\ IIL'I'OFF) IIEREBY IIGREE I\ND
FUI,LY UNDERS'l'lIND '1'1I11'l' 511001,0 IINY UNPI\ID MEDICI\L BILLS I\ND/OR LIENS
I\RISE IN 'rilE FU'I'URE, SI\ID UNPI\ID MEDICI\L DILLS AND/OR LIENS WOULD
DE 'rilE RESI'ONS1I311,I'I'Y OF 'rilE PLIIIN'1'IFFS (TilE IIEIRS-IIT-LI\W OF EMMI\
I\I/I'OFF) .
W1TNRSS
CIIIIIU,ENE IIL'I'OFF IIIMELSDI\CII,
Administratrix of the
Estate of Emma Altoff
UII'rlm:
.'
.
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--
" PAltTIlEMORE
Furlel'ol HOmef Il1c, '" '
.' '.
A Family TraLlition or Caring
August 30, 1995
The Estate of Emma C. Allorr
c/o Char lane Hlmelsbach
19 Scout Lane
Hummelstown, PA 17036
Dear Mrs. Hlmelsbach:
II's unfortunate we were unable to communicate our breakdown of charges
yesterday. Dad was quite concerned that this issue be sellled at once, given the
circumstances surrounding your mother's death. As has always been our polley,
we will do everything possible to meet & exceed your expectallons. In keeping
with this tradition, our embalming charge will be deducted,from Ihe lolal due from
Mrs. Alloffs final bill.
All of our funeral home's caskel, vault and services charges were guaranleed 10
be covered at the time of dealh, $540 was sel aside and Included in Ihe account
10 cover cash advance Items which are not our charges but are extended by us
on your behalf as a courlesy and to facllltale your arrangemenls, Below Is an
itemized list of cash advance charges,
Cash Advance Charges
Telephone 6.96
Death Cerls 65.00
Hairdresser 30.00
1..1.8, Air 207, HI
Flowers 127,20
Clergy 100.00
R.I. F.H. 660,00
Grave Open 600.00
tolal cash advances
Less previously funded
Difference
$2,016.37
$540,00
$1,476,37
. " I I
j,', \ I
!' Ii :, i' I ".
I : ,I, ," I': I , .
", ",; :'",,1
" ,
, '" . ~amily'ser'iide', Life, Ins. co.' (famlico) payment
. Aclual'prlce of funeral attoday's prices
Difference
, I
:
':. \'
"'$6,31'7.28
$7,762,37
$1,445.09
1'.0. Dux 4:11 . I:lll:l Bridgc Slrccl . Ncll' CUlllhcrllllld. I'^ 1707ll
(717) 774-7721 . (Fnx) 774.554Ci
Gilhcrl W. I'nrlhclllllrc. Supcrvi~l1I'
"r
,.
,.
."
We are required by PA state law to relurn any overage of funds earned on pre-
arranged funeral accounls. The overage on the accounl of Mrs. Emma C. Alloff
15 $31.28. (Ihe difference belween $1,476.37 less $1,445.09)
The hairdresser will be deducted due 10 Its Improper Inclusion on pre-
arrangement ($30) and although not required, we have also deducted $255 for
embalming.
Difference of cash advance charges less $540,00
Less overage of Insurance check
Less hairdresser
Less our embalming charges
$1,476.37
($31.28)
($30.00)
($255.00)
TOTAL DUE
~1, 1eo.O&
Being a small funeral home, we cannot afford to lose future business over
discrepancies such as this. If you have any further questions please feel free to
call. Thank you.
Sincerely,
~
Gilbert J. (Glb) Parthemore
.
,
,
,
"
[7'i:!,i""c
f........~l<<lIPI4
CarpentelloJenlts Funcral Home. ProvIdence
Qualtcr Lane Chapcl . West Worwlcll-
H. William Carpelller Sltl)hr.n E. Carpcnlcr
DIRECTORS
IIEIIORAIiDUI1
OF FUNERAL GOODS AND SERVICES I'URCIIASED
Servicee for: Emma Altott
Auguot 23, 1995
Parthemore FUlleral lIome Inc.
P.O. Dox'431
1303 Bridge St.
NeN cumberland, PA. 11010
SERVICES:
Embnlming
Securing papers/permits
Relllovinll tD Dur IlDmo
Transporting to airpDrt
Totnl Serviceo Selected
350.00
75.00
125.00
160.00
------------------
$ 710.00
HERCHANDISE:
Shipping container
Total Herchandise Selected
150.00
~-----------------
S 150.00
CASH ADVANCED:
Certified COp!DO (8)
U.S.Air Prov./Ilarrioburl1
Total Cash Advallced
85.00
201.19
------------------
Balance Due:
S 292.19
S 1152.19
===CU.ISlSC=
L.
" 659 Ellst Oreenwlch Avenue. West Warwick, Rhude Island 0289.3. (40J) 826.1600 --
J31 Elmwood Avenue. Providence, Rhode Island 02907 · (401) 421-4500
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED
Chargas aro only fDr lhoso Iloms that aro usad. II wo Dro roqultod by law to uso any Iloms, wo will oxplaln In writing
bolow.
II you SOIDClod a funoral which roqulrod ombalrnlng. such as a funorol wllh vlowlng, you may havo 10 pay IDr
ombalmlng. YDU do nDI havo to pay lor ombalmlng you did nDI apprDvo. II YDU solocliid arrangomonls such as a dlroct
cromatlon or Immedlalo butlal. II we chatgod lor ombalmlng, wo will oxplaln why bolow,
(NAME OF PERSON FOR WHOM
SERVICES WILL BE PROVIDEO)
'I . J
Funeral Provldor (, , /0.:,,, I~t/
Nama
/':,,"~-J"~
('
v) /'h'
r ./'f........',1~.I.l6',,~ ,'"
Addross
A. CHARGE FOR SERVICES SELECTED,
1. PROFESSIONAL SERVICES
Sorvlens 01 Funeral OhoclorlStall ~.... ~ . . ~ .
" ,-
$ t1.;u AI
$'""!OlSS AD
Embalming ...........................
Olher proparatlon of body
,. 1//,.1 ,.,JrJ', "IN:' I ,.". ~J..,tJ,~
'.I~ ,01. 0'" ,'\ ( .I'j~'....... ..N"G"
....................................
$~- A9
2, FACILITIES AND EOUIPMENT
U.o off.clllllo. for vlowlng7 ~ ~)J
(VI.II.llonlWako, ......;.,. I. :. . , . .. ..
Uso 01 faclllllos for funoral coromony . . . . . . . .
Usa of admlnlllratlvo aroas, rocepUon
are.s Gnd orrangomonl rooms . ~ . . . . . . . . .
$ I Y'.:rAI2
$I.,IS All
$,3/~ tJ A2D
$ (,";- A13
UIO of Propor811on room
Olhor uso of foclllllo.
$_A21
3. AUTOMOTIVE EOUIPMENT
Vehlclo to Iransfor romall1slo Funaral Homo
$ -Z:L AI4
$ t.:l,.C A I 5
Locol ..............................
Hoarse (Casket Conch)
Local............................. .
limousine
Local ........~.................~... $_A16
Family car
Local ,...................~........, $_A16
Flowor cor or flora' dlsposlll07 . .
L I I' d ; "'. ,d,"-;l1. All
oca .....,......... I.,...... r.... f.~_
Load car/clorgy car
Local.............................. $ 7$ Ale
Car for pallboarer.
Local..........,................... $_ A22
Oul of town lrnnsportallon .......,.'.." $ _ A22
$_ A22
$ _ A22
TOTAL OF PROFESSIONAL SERVICES, FACILITIES _
AND AUTOMOTIVE EQUIPMENT ............ $./ I J.:J
.;. -, .-
" I .. l" ...".
1'.1"3
':', t-
D.. ")("L. u.
City
;lI:, ~.1 ,..:'.... C
116 I ItJ It;
S'.'O.<I ~'I' r
B. CHARGE FOR MERCHANDISE SELECTED,
Co.ka' .olocted ( P.l'l'-I," (; ffl'..7 .. .. .... $ t..:Zt.S::
OoscrlP~1 1~',lr~J',u:r,.."
Molnl aougo _ Wood (.poc) _
Sholl slylo: Squaro L- Round _ Urn_
Extorlor color 7e...J., 1',~~t' ;.J,.,J.JJH,J, I '~(""-!
Intorlor MOlorlal _ volvot -X-- cropo
Inlo.fareolor I.r. .,-?("....
Outor Ourlnt C~l]talnor as Soloctod ~ ~ . . . . .. $ 2f{J
(Do scription) ~ ,//* ,'~ '",,I .J':
""'''7'' ~r..",,v....uAl.d ...\,-,.,."
Acknowlodgamonl cards ....... ~ . . . . . . . .
noglslar book(s) ......................
Momoryfoldors .. ,~.,...............
B
C
PrRyor carda ~............,...........
Tomporary gravo markor .....,..........
Cromatlon urn ...... ,I... .... .. . .. .....
(Oa&CIlpllon)
$_ J
$_ J
$~~J
$_ J
$_ H
$_ 0
OTHEn
$_ K
$_ K
$ K
$.,)S..Yi, (!
TOTAL MERCHANDISE SELECTED . . . . . . . . . .
C. SPECIAL CHARGES
Forwarding 01 romolns 10
$ _ A23
(Funoral Homo'
Immadleto Burlol ......................
Direct Cromatlon ......................
$_ M
$_ AI9
$_ AI9
$_ 0
$$70 I
$_ L
$_ L
$ L
$ .570
$ s..J.Lt/. I.!!.
Cromatlon ...........................
-_. C"n.Am TrB""1 ProtocUon ...............
Addlllonal Funds lor FUnolltl Sorvlcu
llama Not In 1 his Contract .l,,":'":.........
OTHER
J)f^1~ Cv<1. ,4120. M''''M..(~~i:)
(l'/Udll"1 t>I'.t1/I".I; ,r/f)..'.(/J'i:['/.1'i Etu1'" $'Tf'
. . .. ' .
TOTAL OF SPECIAL CHARGES
TOTAL OF ALL SELECTIONS
n.~~~I~~ ~~~ E.Mt?~.L~~~~ ;J""I :--,,/-1) /(/, "~J',1t'l
II any low. c'omotory. or cromatory roqulfomonls havo roqulred tho
purchallo 01 any Dr Iho Itoms IIstod abovo tho law or roqulromontls
Dxplalnod balow.
('.'.../1..,-,. .,h/ ,1 ?.:"d. -,;111./'; Jr/,.. ~,~,,)
, I
. .... <~~\ \ 'lid"
~
~ a~
- " --
, . .', "'.. .
. <{ihUlElR& W. lP'AJR&lllJlreMRrnRU&
,';.~1E~ lRllO!Rrill~ liNe.
^ Family Trudilionlll' Curing.
, '
MARKER ORDER & CHARGES FOR: Charlene Hlmelsbach
Statement date: 9/5/96
Marker will be ordered upon receipt of statemenltotal.
Please make check payable to Gilbert J. Parthemore. Thank Youl
Marker (Including placement & lellerlng) $666.00
Lllhochrome (10 darken lelterlng) 15.00
ShIpping 75.00
Cemetery charges to PQJJr base 14g.0.Q
Total charges
$1,105.00
Thank you I
Mosl sincerely,
.~~'-
! .i!bert J. Parth'3more
P.O. flnx 4.' I . I JlI,lllrillgc Sllwl . Ncll' (',nnhcrlllllll. P^ (7U7U
(717) 71-1-7721
WHEREAS, ALTOFF EMMA
\J."\~'J.', r Llt:)'l',
CUMBERLAND COUNTY , died
and
.---.. ..
'--,_."
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters of Administration
........~.....:
..,.. . .., ,," , ~ .............
...........)...~~... .... ,":' v:,..,..........
/:-i<~:..-(.~." .~~
.~ 0" :
- -.
No. 1995-00704 PA No. 2195-0704
ESTATE OF ALTOFF EMMA
~S'l~TRS'r,-r.rrnDL"E1
,';I
:. oj
~'.,
.-
'I,
. .
. .-
, '--~'~"':")j
" ":;J~...- '..
' :'.~.- ...~V
:'...--;.~
~ \,...
Late of
EAs'r PENNSBORO TOWNSIII P
CUMllER~nND-COUNTx,
,
Deceased
Social Security No. 036-14-8394
, late of EAST PENNSBORO TOWNSHIP
M.LUULC;;
on the 23rd day of
Auqust
1995;
WHEREAS, the grant of letters of administration
is required for the administration of the estate.
, Register of Wills
, in the
Letters of Administration___
THEREFORE, I, MARY C. LEWIS
In and for the County of CUMBERLAND
Commonwealth of Pennsylvania, have this day granted
to CHARLENE HIMELSBACIl
(L/\::;'l', r 11(::;'1', M.LUULt;;
of the estate
the estate according
at CUMBERLAND COUNTY
who has duly qualified as administrator(rlx)
of the above named decedent and has agreed to administer
to law, all of which fully appears of record in my Office
COURT HOUSE, CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office on the 21st day of Septomber 1995.
'-n?llll'd' C!.. :tL~ ral.p~
I(eg t:e '
...,-
REV-1548 EX AFP 112-95*
CDHH(JtIWCAllII or P[NNSYLVANIA ,
bfJ'A"IHtHf or RtytNU[
lUAU,U or IHDIVIDUAl lAkES I
PtPI. ,~a"l
IIARAUIUIIO, rA 11"1.0501 'It.
1I0ner. or 11I1Ir.RITAller. TAH
ArrRAISCIICIIT. ALI.OHAllec OR DIRALl,OHAllec
or DCDuenOIl.. ArID ASSr.SSIlr.IIT OF TAH 011
JDIIITLY IICLD DR TRUsT ASSCTS
DATE 10-07-96
ESTATE OF Al TDFF
EI1MA
C DATE OF DEATII 08-23-95
CUMBERlAIID
FILE 110. 21 95-0704
S.S/D.C. 110. 036-14-03P4
CIIARlEIIE IIlMElSBIICII
19 SCOUT lllllE
IIUMMElSTOWN PA 17036
COUll TV
ACII
96000112
REMIT PAVHENT TO.
REGISTER OF WillS
CUMBERll\tID CD COURT 1I0USE
CARLISLE, PA 17013
Altount Ra..iit;d--
- -w 13 5. ? i.:-
CUT ALONG THIS LINE ~ RETAIN lOWER PORTION FOR YOUR RECORDS --
RE-V:is4-a-E)f-AFP--iiir:9Sj------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY llELD OR TRUST ASSETS
DATE LO-07-96
ESTATE OF AlTDFF
EMMA
C DATE OF DEATII 00-23-95
COUll TV
CUMBERlAIID
ACN
96000112
FILE 110. 21 95-0704
TAX RETURII WAS.
S.S/D.C. lID. 036-14-0394
(X) ACCEPTED AS fILED ! I CIIANGEU
JOINT OR TRUST ASSET INFORHATION
FIIIAIICIAl IIISTITUTIDII. US SAVIIlGS 00110
ACCOUIIT 110.
TVPE OF ACCOUIIT I () SAVIIlGS ( ) CIIECKItIG ( I TRUST ( ) TIME CERTIFiCATE
DATE ESTADllSllED 12-01-91
Account Bolonco
Porcont Tnxoblo
Amount Subjoct to Tnx
Oobts nnd Doductions
Tnxoblo Amount
Tox Rnto
.Tox Duo
23,757.60
0.500
11,070.00
.00
11.070.00
.06
712.73
X
X
TAX CREDITS:
rAVME/H
DATE
DISCDuiir (f)
ItHEREST (-)
RECEIPT
IIUMBER
ItHEREST IS CII^RGED FROM 05"Z(,-96 TO 10-15"96
AT TilE RATES APPllCABlE AS DUTlllIED 011 TilE
o~'~PSE SIDE OF TillS FDPH
1I0TE. TD 111SURE PROPER CREDIT TO
VDUR ACCOUIIT, SUBMIT TilE
UPPER PORTIOII OF TillS 1I0TICE
WITh YOUR TAX PAVMEtlT TO TIlE
RFOISTER OF WILLS AT TIlE
ABOVE ADDRESS. MAKE CIIECK
DR MailEY ORDER PAVADlE TO.
"REGISTER OF WillS, AGEIIT."
AMOUIIT PAID
TOTAL TAX CREDIT
BALANCE OF T~UE
-iiiTEnEsr-iiiioPEii:-
TDTiiLliuE
':J1 ram ..Tn _. DAn . I Iltvt"'E TO~ CALCUlATION 0' ADD I iOiilLiiiIT~EST. .
,00
712.73-
25:53--
730.26
BUREAU OF INDIVIDUAL TAMES
U.IERUAHCI: t.M DIVlstOff
Dr:Pf. UUIl
I~AIS.URO, PA 17IZ'~"'1
COHHDNWEALTH OF PENNSYLVANI'
DEPARTHENT OF REVENUE
:tNHER:tTANCE TAX
STATEMENT OF ACCOUNT
*'
In.UII"fI'III.'"
CHARLENE IUMELSBACH
19 SCOUT LANE
HUHMELSTOWN PA 17036
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
C
10-28-96
ALTDFF
08-23-95
21 95-0704
CUMBERLAND
96000112
Anount Re.Ht.d
EMMA
MAKE CHECK PAYABLE AND REMIT PAYHENT TDI
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
NO~E' TD In lure ~rop.r credit to your account, .ubn!t the upper portion of thl. for. with your taN p.~n.nt.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
iiEV= iiliij-iX"iij:p-ioi-:96Y------iiiiii-iNH€JiiTANCif"fiix-sriifl1iiE'tif"iiF-iiifcoi:iiif--.-liii---------------- -----
ESTATE OF AL TOFF EMMA C FILE ND.21 95-0704 ACN 96000112 DATE 10-28-96
TillS STATEIIEHT IS PROVIDED TO ADVISE OF TilE CURRENT STATUS OF TilE STATED ACN IN TIlE NAilED ESTATE. slIOHN DELOH
IS A SUIINARY OF TIlE PRINCIPAL TAM DUE, APPLICATION OF ALL PAYNEHTS, TilE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 09-30-96
PRINCIPAL TAX DUE" 712.73
PAYMENTS CTAX CREDITS),
PAYMENT
DATE
10-08-96
RECEIPT
IlUMBER
AA146830
DISCOUNT 1+)
INTEREST C-)
24.29-
AMOUNT PAID
738.26
TOTAL TAX CREDIT
713.97
BALANCE OF TAX DUE
1. 24CR
INTEREST AND PEN.
.00
1,.. r.:!4CR
."
. IF PAID AFTER TillS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL IHTEREST.
I IF TDTAL DUE IS LESS TIIAH n,
HD PAYNENT IS REqUIRED.
IF TDTAL DUE IS REflECTED AS A ~REDIT" ICRI,
'~"_"'1."",,"'--,,7,''''"'' ',' "..,,', . ',< ...., "
TOTAL DUE
. ,'fe"~ , .~""",~m~~:M'f:'.,..,:,..,"n-,."j."..".. ','
,
I
~ ~,
'Y ~
~ ~,~-
oQ ~ ..~
i ru :I
. U r~L
m
(I)
r-
Z III ~.;;~
:> 'i =-~ III
0 ;:.. (i .J
~ ___ .J
....
~ _ 1Il3
E1 '" .. ':!iLL
ru ~. lIJO
i .J
Z ll:
~ Z-,,,, .lIJ
:> UI-
~~~~ ~ ~ III
~ 0 '" >....
ll:1!I
wo:> -' ~ <I 111
"'UZ
Iii ~ ~ t::l !:ll:
~ w
C '"
Z Z GI B
~ ~
~wl
Z:> <r
zi5 II:
(}o_ w
will:!: (I) i ~
ILo",Z m-
... - I ~
' 0 l!i :$ <r
:51~ ...
I
ol]
I. (I)
,~ Z 0
ol]
,.~~ ~ (I) (ij5" J:
0 U
J: r- UlE. <I
:, 0 . U ... III
~ Ii: <I III
en .J
iil III <I <r 111
8 ~ .J D- o !:
III III r- ....
I, !: Z . 0 J: <r
, '~ .... <I Z I <r
. ~ J: ..J :I III <I lIJ ru
U 0 (}o,:'!: 0 Z
~ (V) IE 111 5 I- (}o~!: Z lIJ .
00 Z III " \JJ <I .J :.!
0 III 0 .J I ..J cr U
?; CD .J U III Z ... LL rr <I III
""'=": rr III !: 0 ruz LL III J: J:
,. :i1 <I !: t w O~ 1Il U U
., ...- :t (}o ~ " 1-% I::z:
,,' 0 U J: !:! ..J~
t~1 '" ~. a~
... S!w " <Ill
~ '" %~ ~ L " l.'.l
, i w -" 0 ~ ~ ~ ~ S
~ ~ g I 0 0
d ,a w w " w '"
U ~ 2 8 ~
I w
z '" w ~ '"
1:1 GlGJlaml
"
'i
~ .'
.,-- ....... ..... . .... .-....
...---..-.
,1
~~, 1~
, Jlt. 244 -,
I CHARLENE B. HIMELSBACli
. ", 1"~I~~~~Jl~:~, PA I7030,U3ll ~..IQ/.719IL "li:m::i:l
" J)r.1f.~~r._ffg!:iIHliR_QF_W];L~S .,I\ClIiNT I $ 13B.~" '
"1f,...,~.._ .. L I 2i:JJ
i '_lo~ H~_T~~Jll_&t.~- L.l!Hl..:v~m=f
!' Membe..sllilW,
~~I~UI, UMnOIT UHIIIN ,
....-:..,'...... FIIe:tf.:U'lS".070'l--C II. \
~,Ag,L~"OOOIlJ.' ~.tl~!!
I: n 1:18 i! 21, ~I:o 21,1, 'I' 2 ~8 ~:l'1? ~ :lOu' I, I,
-
'.
. COf\HllUWUL 111 or II[llHSYlYAHIA
DLrllA'ttt.HI or RlV[tfU[
IUR(AU or IHDIVIDUAl laXLS
DtPI. uon.
IIARAISlURC. PA UUI.06G.
'*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 95-070"
961',"606
09-1"-96
..'.UII (I'" ".11I
EST. OF EMMA C ALTOFF
5.5. NO. 036-1"-039"
DATE OF DEATIl 00-23-95
COUNTY CUMBERLAND
TVPE OF ACCOUNT
o SAVIIIG'
o CIIECKIHG
o TRUST
!Xl CERTIF.
CIlARLENE 11IMELSBACIl
19 SCOUT LN
IlUMMELSTOWN PA 17036
REHIT rAYHENT AHD FDRHS TD'
REGISTER DF WILLS
CUMBERLAND CD COURT 1l0USE
CARLISLE, PA 17013
raid 9/10/96 ek# 1241
PHC BAtiK h.. provldld till D.p.,'"nt wllh the 1"'or,"l1o" I ht.d b.low whiCh II.. bun u..d In ulcuhUnll \h.
paten"" ,.. dul. 'h.lt ,.cord. Indlo.'. Ih.' .t Ih. d..th of the Ilbov. d.ndlnl, you ",.t. . Joint awnn/blndlel.r)' ., Ihlt ICCOunt.
If you ,.., \hll Infor-.Uon .. I"COrfut. pt.... obtain wrlttln cornell on froe thl ,llIlN..:l1I1 In.lItutlon, IUach . copy to Ih" 'or.
".... ,...tv.... It '" lh.. ~I"" Iddru., ,.,.. "fll;ounl .. tn","bl. In IICCortllll1CI with Ihl InttlrS'nllell 11111 tl... of tho Co..an.....lth of r.nl1,"~hbtll..
OU..Uon. ...y b. M....r.d bV uUlng (1111 't1.UZ7.
COMPLETE PART 1 BELOW " " " SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account Ho. 210010223ljl 0.1. 0"-12-90
E.bblhh.d
Account Bdanc.
Parc.nt Tu:ab1e
AMount Subject to
Tex R.t.
Potent1a1 Tax Du.
x
6,539.50
50.000
3,269.75
.15
"90."6
fa Inlurl prop., cr.dlt to your .ccount, two
(U cop I.. of thh noUe. ..u.t IIceOlpony yO\'"
Plly..nt to th. R.ahhr of Wills. Hak. check
pllvnbl. 101 ~R'al'l.r of NIII', Ag.n'"'
x
HOIEI If true pay.'n" a,. I'"d. within Iltr..
IS. I'onthl of 'h. decede"t., da" 0' dl.'h,
you ...y d,duct . 5~ dl.count 0' the taN due.
Anv Inhultnnca tnN dUI ..UI btlco.. dlUnqu.nl
nln. C'U 1II0llth. after the dot. 0' dlllt".
Tox
PART
1II.I=I\ILUI:lE,TO 'RI!SP.OHDi,~IL~
TAXPAVER RESPONSE
!lESULT'IN AN OFFICIAVTI\X:/lSSESSHENTD/lSED' ON.' TillS. .NDTICE'
[CHECK ]
ONE
BLOCK
ONLY
.. 0 It,e IlIbov. Inrur..Uon "nd t." due I. corr.ct.
I. You I'.V chao.. to re.1t PIlY""' to th. Aellhter 0' Wills wUh tvo copl.. or thh notice 10 obtain
. discount or .vold Int.,..t, Dr you ..ov ch.ck hOJ! "A" nnd r.lurn Ihll nollce 10 the R'lIht., or
WI1I1 IInd e" offlcl..1 .........n' will ba I..u.d by Ih. PA nar..""'" or Rnlnul.
I. 0 lhl "bovI ....t h.. bun or will be rerorted find talC pl'lld with 'h. P.,mlvlvnnl. InherU.nc. I.. r.turn
10 ba 'Uld by Ih. d.c.de"t', r.rr"''''lIlIv..
c. 0 Ih. ahov. In'orl'lIlIon Ir.=-.I1"corr.c' nnd/ah-!\t1bl' "nd d.ductlon. ...,. pllld by you.
Vou .u.' co..pl.'. PARI l!J nnd/or PARI ~ bllow.
If you Indlc.te a dlff.r.nt taK rata, pl.... st.t. your
relaHonshlp to docadont I nA tl(1I1'1' Po"
.'.
.........',DI'F1C1AL. USE .otlLV>OMFi
...PA llEPA~rMENr 0.1' REVEtlUE "
PART
~
'filII Ill! rUllff - CUMI'U I MI0"
LINE I. D.I. E.t.bll.h.d
2. Ar.count Dalanc.
S. rarcant T.~ab1a
4. AMount Subjact to Tax
S. Dabt. and Daductlon.
6. AMount TaKabla
7. T.~ Rat.
8. TalC Dua
x
lAJt ur; .JUlr;I/lICU~r l\"uuUrH5 'I'AU
4/12-90 1.
r, t;~'1 t;n .:..:2
<;0 00 {'J:.:;
1.7!';Q 7<; < (,Ij.'. ...
, ,.. ::.'.,:-.
- 0_.:.5'
1.7r,Q 7'i .......6...
or, '.;:'.1" ......
701 7Q In<, ~'i 10 Laco.8
DEBTS AND DEDUCTIONS CLAIMED
.;-::'",;., '. ,.',."
Ill'
I
2
3
4
5
6
7
8
x
.." i:~,;...
;,;'...'
:'.,.,
, .
rART
[!]
DATE
PAID
PAYEE
DESCRIPTION
AMOUIIT PAID
I
TotAL tEntar on Line 5 of TllC COMPutatlonJ
I
,
Under panaltl.. of parjury, I daclar. that tho fact. I hav. report.d abov. ar. tru., correct and
cOMpl.t. to the b..t of ny knowl.dge and b.ll.f.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU Of 1tl0lVIOUAL TAMES
....."1 UNCI lAX DIVIIIOft
DEP'.IID"I
IIAAAlnURo, t'. Illll.....
,*'
1I0TlCC or IIIIIERITAlICE'TAX
APPRAlscnEIIT. ALl.OHAIICE OR OISAI.LOHAIICC
or OCOUCTIOII.\ AIIO AsscssnEIIT or TAX 011
JOIIITLY tELO OR TRUST ASSETS
U,.U.......III.'..
CIIARLENE
19 SCOUT Ltl
IIUMMELSTOWN
IIIMELSBACII
PA 17036
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN"DC
ACN
11-19-96
ALTOFF
08-23-95
21 95-0704
CUMBERLAND
036-14-8394
96144606
Allount R..ltt.d
,
EMMA
C
HAKE CHECK PAYABLE AND REMIT PAYMEIlT TDI
REGISTER OF WILLS
CUMBERlAIID CD COURT IIDUSE
CARLISLE, PA 17013
CUT ALONG THIS LXNE ~ RETAIIl LOWER PORTION FOR YOUR RECORDS ......
hi!v:is4-a-EiC-AFii-r07-:96i------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 11-19-96
ESTATE OF ALTDFF
EMMA
C DATE OF DEATIl 00-23-95
COUIITY CUMBERLAND
ACN
96144606
FILE NO. 21 95-0704
TAX RETURN WAS.
S.S/D.C. NO. 036-14-8394
(X) ACCEPTED AS FILED () CIIANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION, PNC BANK
ACCOUNT NO.
21001022341
TYPE OF ArCOUNT, () SAVINGS ( ) CIIECKING ( ) TRUST (Xl TIME CERTIFICATE
DATE ESTABLISIIED 04-12-90
Account Bolanco
Percent Taxable X
Amount Suujuut to To~
Dobts and Doductions
Toxeble Amount
Tax Rate X
Tax Due
6,539.50
0,500
3,:!~9.75
.00
3,269.75
.06
196.19
TAX CREDITS:
PAYMENT
DATE
09-26-96
RECEIPT
NUMBER
AA146785
DISCDUIlT (t)
INTEREST (-)
6.11-
INTEREST IS CIIARGED FROM 09-27-96 TO 11-27-96
AT TilE RATES APPLICABLE AS OUTLIIlED 011 TIlE
REVERSE SIDE OF TillS FORM
IlDTE, TO INSURE PROPER CREDIT TO
YOUR ACCDUIlT, SUBMIT TilE
UPPeR PORTiOU OF illI~ lI~iiCE
WITH YOUR TAX PAYMENT TO TilE
REGISTER OF WILLS AT TIlE
ABOVE ADDRESS. MAKE CIIECK
OR HDNEV ORDER PAYABLE TO.
"REGISTER OF WILLS, AGENT."
AMOUNT PAID
201.29
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IIITfREsT. .
195.18
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DlPAATHEHI or R[vtNUE
IURCAU Of INOIYIDUAL IAXEI
DEPI. uual
I~AIIIURa, PA .,lrl."Ol
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 95- 0704
961'.4605
09-14-96
TVPE OF ACCOUNT
!Xl SAVIHOS
o CIIECKINO
o TRUST
o CERTlF.
..'.IIU ..." u.m
EST. OF EMMA C ALTDFF
5.5. NO. 036-14-0394
DATE OF DEATII 00-23-95
COUNTY CUMOERLAND
CIIARLENE IIIMElSBACII
19 SCOUT IN
IIUMMElSTOWN PA 17036
REIIIT rAYIIEHT ^HD FORIIS TO.
REGISTER OF WIllS
CUMBERLAND CD COURT 1I0USE
CARLISLE. PA 17013
Paid 9/10/96 Ck# 12~1
PHC BANK h.s pro...ld.d \11. D.put..nt wUh tll. In'orutlon l..lad b.low whlch 11.. b..n u..d In calculatlno \h.
potmtl.1 t.. du.. Th.lr ncords Indlcat. that .t th. duth 0' th. flbo.... d.ud.nt, you w.r. . Joint own.r/ban.flchlr\t 0' 'his "ccount.
If you ,..t this In'or..lIon Is Incorract, pl.... obt.ln wrlthn corrutlon 'ro. 'ha "",,"cl"" InsUtutlon, .U.eh It copy 10 Ih" 'or.
___ '''Iur" It '" th" ..~,. .ddr.... lhh oIccnOl" iii ",,,filii_ In ..scord..,c. ~Ilh \I.. IN,.rll,,"". 1... I.~c 0' tha Co...,,.,...,ol\to"' PjIt"f1.ylv,,"I..
Du.stlon, ..y b. answ.r.d by call1no 1717) 7.7..Srl.
COHPLETE PART 1 BELOW . . . SEE REVEnSE SIDE FOR FILING AND PAYHENT INSTRUCTIONS
Account No. 5130130674 Dal. 01-23-90
Eahblhh.d
Account O.l.nc.
Percant Taxable
AMount Subj.ct to
Tax R.t.
Potantl.1 Tax Du.
4.029.57
50.000
2.014.79
.15
302.22
TAXPAYER RESPONSE
F.!\l.LURI!, 'TO' R~Sp'oND'~~ILl\ 'l!!llIlL r~IlrAN . .oFFIClAl:',.AXASSESSHEHrxBASED> OH>THlS . NDYlCI!'.'
To Inlur. prop.' ct.dlt to your accounl, two
(21 copl.. of Ihh noUn ..u.t .cco.pany your
rOy...nt 10 t". A.olsl.r d. Willa. "n"'_ chuk
pnvnbl. tal ~A..I't.r of Willi, Ag.nt".
x
K
HOIEI .. tftM p.y...nt' .r. .nd. within thr..
IS) .anth. of th. d.cad.nt., det. of d..th,
you ..Y d.duct II 5X discount 0' th. 'OM du..
Any Inh.rlhtnea tall dUB will b.c". d.llnqu.nt
nln. (9) Months ....r U,. dat. of d..lh.
To.
rART
[!],
[ CIlECK ]
ONE
BLOCK
ONlV
.. 0 lh. ebo.... Infor..Uon and "'II dUB h corr.ct.
I. You ..\t choo" to ra.at pay...nt 10 th. As.lIhr of With with Iwo cDPI.. of thh nollea 10 obtain
. d"count Dr IIvold Intar..l, Dr you IIll1'y ch.ck bOI( "A" and rn'urn 'hh not Ic. tn th. A..lItar of
wills and an official PI.......nt will b. I..u.d by Ih. f1A a.pllrt...nt 0' Ra....nu..
e. 0 lh. IIboY. ....t hili bu" Dr will b. raporllld Ilnd till( paid wl'h UUI f1.,unyl....nl. Inharltanea hUI r.tutn
to b. "I.d by tll. d.ead.nt's r.pt...Il,.llv..
C. 0 )h. .bov. In.or..Uon IW,l1corr.cl IInd/or_dabls and daducllons w.r. "IIIld by you.
You Muat co.pht. rARI l!J IIInd/or PAAI [II b.law,
rART
~
lAX ~E1URH . COH~UlArlON
LINE I. Dal. E.I.bll.h.d
z. Account B.lance
S. Parcant Tax.bla
4. A.ount Subject to TaM
5. Dabt. and Daductlons
6. AMount TaMabl.
1. Tax Rat.
I. TaM Dua
OF
I
2
3
4
5
6
7
8
.. OFFICIAL ,USE DNlV' 0 AAF.
..,. PA DEPARTHEtlT' 'OF' REVENUE,:}' '
TAX UN JOIHT'/TIlU5 r IICCOUHT5 '::PAU;""" ."', " :'., >,' ,', ,;.1 :
1/23/90 i',
J1 . O?C). ~7 ..".,,::,.2.:.:...' ... :,;:,"",,",
',.',',:'",',.,'.. .'.,.
X 2. 0 i~ : ~g:n!ij;;~:':i;;;!;:;::>:,~,,:::,"
0- ;,::'::,:r 5?:'i::.;::::~::: ;::i':~:.~;;:; ;';'::';.\:::;,!,:.: ;':::'~;'~:':';:. ,,' ','.'.'. ,.,;;',.:. .'
2,014. 79 ,~6(i"" "., '
.06 . .',i
124.09 inc.$3.20 L t.e:s'
DEBTS AND DEDUCTIDHS ClAIHED
':..,' :.:..,....,
If you lndlcat. . different t.~r~f;le.se .t.te your
rel.Uonshlp to dacadent I DA G . ~
X
.".
PART
[!]
DIITE
PAID
PAYEE
DESCRIPTIOU
AHOUUT PAID
I
TOTAL tEntar on Llna S of T_x Conputatlon)
I
.
"',~'~'~_,''''''i''
.
., __'...4__.___......-_'.'.
.
CDHHDNWEALTIl OF PENNSYLVANII
DEPARTHENT OF REVENUE
*'
BUREAU OF INDIVIDUAL TAXES
UtIlRIUHC! U. DIVIIION
D[PI. u'''1
ICARR.IBUIlG, rA Inra.un
NOTICE OF INHERITANCE TAX
APPRAIBEnENT. AllOHANCE OR DIBAllDHAHCE
or DEDUCTlOH"l AND ABBESBnEHT or TAX 011
JOINTLY IELD OR TRUBT ASSETB
,
tn.'"'''''' ,,"UI
CIlARLENE
19 SCOUT LN
IlUHHELSTDWN
IIIMELSBACIl
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
SSN/DC
ACN
11-19-96
ALTDFF
08-23-95
21 95-070~
CUMBERLAND
D36-1~-039~
961~4605
"..ount Re.Hhd
.-
EMMA
C
PA 17036
HAKE CHECK PAYABLE AND REHIT PAYMENT TDI
REGISTER OF WILLS
CUMBERLAND CD COURT IlDUSE
CARLISLE, PA 17013
CUT ALONO THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
REii:is4-S-iif-AFii-{oir:96i------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE DR DISALLOWANCE OF
DEDUCTIDNS, AND ASSESSHENT OF TAX ON JOINTLY HELD DR TRUST ASSETS
DATE 11-19-96
ESTATE OF ALTOFF
EMMA
C DATE OF DEATlI 08-23-95
COUNTY
CUMOERLAND
FILE NO. 21 95-0704
TAX RETURN WAS.
S.S/D.C. NO. 036-14-8394
(X) ACCEPTED AS FILED () CtlANGED
JOINT DR TRUST ASSET INFORHATIDN
ACCDUNT NO.
ACN 961446D5
FINANCIAL INSTITUTION. PNe BANK
5130130674
TYPE OF ACCOUNT. (10 SAVINGS ( ) CIlECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE' ESTABLlSIlED 01-23-9D
Account Dolance
Parcont Taxablo X
Amount S"Lo;j...:t to Tb..
Dabts and Daductions
Taxablo Amount
Tax Rata ~
Tax Dua
4,029.57
0.500
:!,Ol'I.79
.00
2,014.79
.06
120.89
NOTE. TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT TilE
UrrER rORnou or TIll:; l:eTlC!:
WITIl YOUR TAX PAYMENT TO TilE
REGISTER OF WILLS AT TilE
ABOVE ADDRESS. MAKE CIlECK
DR MONEY ORDER PAYABLE TO.
"REGISTER OF WILLS, AGENT."
TAX CRED:tTS:
PAYMENT
DATE
09-26-96
RECEIPT
NUMBER
AA146785
DISCOUNT (+)
INTEREST (-)
3.76-
AMOUNT PAID
12',.09
INTEREST IS CIlARGED FROM 09-27-96 TO 11-27-96
AT TIlE RATES APPLICABLE AS OUTLINED ot! TIlE
REVERSE SIDE OF THIS FORH
CREDIT
DFFICE OF CIIIEF CDUNBEL
. OEPl, ~n,"ol
11AI1lIlfiIllJIIO.I'^ ITI~B"Unl
OMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
~
.; ,
February 21, 1997
1'1I0NE: 717.7B7.13B2
r^x: 71T.772,I~BO
Ms. Charlene lIirnelsbach
19 Scout Lane
lIununelstown, PA 17036
Rei Estate of Enuna Altoff
Dear Ms. lIirnelsbach:
I have reviewed the materials you have forwarded to this
office concerning the above-referenced estate, and have
subsequently spoken with your husband regarding our position and
an amicable resolution. Your allocation that you proposed in the
materials is acceptable. 1I0wever, we would require that the
portion allocated to the survival action be included in the
initial proceeds received. '1'he subsequent proceeds to be
received in 1997, 1998 and 1999 would be treated as part of the
wrongful death action. The following is a listing of the
/lllocation of the proceeds that would be acceptable to this
office.
Settlement by runica Mutual Insurance Company:
rnitial Payment
:12-30-97 '
12-30-98
12-30-99
$150,000
$ 16,000
$ 18,000
$ 21,039
$95,000
$16,000
$18,000
$21,039
$55,000
$0
$0
$0
Action
p.( l>.l " /7...I~b
Wrongful Death
Survival
pettlement by EMC Insurance Company:
Full Payment
$ 12,000
$12,000
The proceeds allocated to the survival action are fully
taxable for inheritance tax purposes. You are entitled to
allocate and deduct proportionate attorneys' fees and certain
estate expenses from the survival action proceeds in accordance
with the Inheritance and Estate '1'ax Act of 1992.
.
~Is. Charlene lIimelsbach
February 21, 1997
Pllge 'l'Wo
I have enclosed an inheritance I:ax fOJ:m and information
booklet to assist you in your filing. If you hllve lIny questions,
please do not hesital:e to contact me.
/" ) ),
Sincerely" /~<<'
, ,/ .,.. .-
"_. ,1/ ;:d /101'; '," .'
Thomas D. Kimmett
hssistant Counsel
Enclosures
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<Cumberland County Court House
Carlisle, Penna~ 17013,
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REV-1548 EX AFP (12-95*
CDHHOHVEALTH or PEHN$YLYAHIA
DEPARTHENT OF REVENUE
BUREAU OF INDIVIDUAL TAkES
DEP'. 28060'
HARRISBURa, Pi 171r'~06Dl
NOTICE OF INNERITANCE TAX
APPRAISE"ENT, ALLONANCE DR DISALLONANCE
OF DEDUCTION... AND ASSESS"ENT DF TAX ON
JOINTLY oELD OR TRUST ASSETS
DATE 10-07-96
ESTATE OF AL TDFF
EMMA
C DATE OF DEATH 08-23-95
COUNTV
CUM8ERLAND
FILE NO, 21 95-0704
S.S/D.C, NO. 036-14-8394
ACN
96000112
CHARLENE HIMELSBACH
19 SCOUT LANE
HUMMELSTDWN PA 17036
REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
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HARRI.IURD, PA17111.0'01
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLDWAHCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
CHARLENE HIHHELSBACH
19 SCOUT LN
HUMMELSTOWN PA 17036
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-03-97
ALTDFF
08-23-95
21 95-0704
CUMBERLAND
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COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
OUREAU OF INDIVIDUAL TAXES
01:1'T,280001
ttAnRISDUnO, PA 17120,0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RECEIVED FROM:
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ASSESSMENT ;
CONTROL _,._.....AMOVW, ,
NUMBER "
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CHARLENE B HUMELS8AC
19 SCOUT LANE
HUMMELSTOWN, PA 170 6
rOlDIlEfIE "'''-'...
ESTATE INF.ORMATION:
FILE NUMOER "'"
el-19Q~-O+05
NAME OF DECEDENT (~T)
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TOTAL AMOUNT PAID
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POSTMARK DATE
6/0~/Q7
COUNTV
-CU
DATE OF DEATH
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REMARKS CHARLENE B HUMELSBACH
RECEIVED BY
MARY C. LEWIS
SEA~HECK~ 117 REGISTER OF WILLS
Tt>is receipt 18 being replaced withl1~i~lrr466f' WILLS :
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HUMMELSTOWN, PA 17036
tolD"'"
ESTATE INFORMATION,
t:I filE MB
U el-199!5-0704
P:I NAME OF DECEDENT lLAST)
~ AL TOFF EMMA
II DAT! Of PAYMENT
B POSTMARK DATE
COUNTY
SSN 036-14-8394
(FIRST) (Mil
REMAkKS
CHARLENE B HIMELSBACH
m TOTAL AMOUNT PAID
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CW
CUMBERLAND
DATE OF DEATH
REGISTER OF WILLS
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RECEIVED BY II ), '~, /),'1/,..,11
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MARY C. LEW'S /..'.1;.;' ./,:(...4J<}.;
REGI8TER OF WILLS I '7,;
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COMMONWEALTU DF PENN~'fLVANIA
DEPARTMENT OF REVENUE
BUREAU DF INDIVIDUAL TAXED
DEPT.2D0601
HARRISBURG, PA 17126,0601
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NO. AA211406 .[v.".ml"''''
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RECEIVED FROM:
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ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
CHARLENE HIMELSBACH
19 SCOUT LANE
101
./00.415
HUMMELSTOWN, PA 17036
rOlOtlERE
rOlD "Em: ..
ESTATE INFORMATION:
FILE NUMBER
_R":tQh
NAME OF DECEDENT (LAST)
AI TnFF FMMA
DATE OF PAYMENT
hlOblen
POSTMARK DATE
1,105/97
COUNTY
(FIRST)
(Mil
TOTAL AMOUNT PAID
"60.3~
DATE OF DEATH
CW
REMARKS CHARLENF. B HI MELSBACH
,
RECEIVED BY ;t
MARY C. L
REGISTER
SEALCHECKII 117
This Receipt is replllcing M 21N99ISTER OF WILLS
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COMMONWEALTH OF PENH~YLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
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BUREAU OF INDIVIOUAL TAXES
INHERITANCE TAX DIVISIOH
DEPT. 210.01
HARRISIURO, Pi 171la-0601
."'16"" ", lit.".
CHARLENE
19 SCOUT LN
HUMMELSTOWN
HIMELSBACH
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-06-97
ALTOFF
08-23-95
21 95-0704
CUMBERLAND
96144606
A.aunt Rellltt.d
EMMA
C
PA 17036
MAKE CHECK PAYABLE AND REMIT PAYMENT TDI
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
NOTE I To in lure proper credit to your account, lub..it the upper portion of thla for. with your t.x pay..ant.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
iiifli: i61jj"EX""Fii"i'iz-:9iiiU""'..ii "iiliiiiiiYliili:E--TAiCiii' iiTEiiE"tWiiF'-;,ifcouiiTniiiii---...---..."n--___"
ESTATE OF ALTOFF EMMA C FILE NO. 21 95"0704 ACN 96144606 DATE 01"06-97
THIS STATENENT IS PROVIDED TD ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NANED ESTATE. SHDWN BELOW
IS A SUNNARY OF THE PRINCIPAL TAX DUE, APPLICATIOH OF ALL PAYNENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 11-12-96
PRINCIPAL TAX DUE,
196,19
PAVMENTS (TAX CREDITS),
PAVMENT
DATE
09-26-96
10-08-96
RECEIPT
NUMBER
AA146785
AA146830
DISCOUNT (+)
INTEREST (-)
6.11-
.00
AMOUNT PAID
201. 29
1.02
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
196.20
.01CR
.00
.01CR
. IF. PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADOITIONAL INTEREST.
( IF TDTAL DUE IS LESS THAN tl,
NO PAYNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI,
YDU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRN FDR INSTRUCTIONS. I
Rocore:"
Rop';""
:",,, of
, lilills
'97 JAN 17 All :48
CIOI~'
Cumbe:I'"ili.J
,.(Jun
(;0" PA
PA'ffl(HTI
D.tlCh thl top portion of thh Notlc. and lub.1t with your p.y..nt ..d. plyable to thl n... and Iddnll
prlntad on the t.v.r.. .Id..
If RESIDENT DECEDENT IUI chick 0,. .onlY order PIYlble tal REGISTER OF WILLS, AGENT.
If NON.RESIDENT DECEDENT ..ka chick or laney order PIYlbl. tOI COHMONWEALTH Of PENNSYLVANIA.
~
All p.y..nt. r,cllvld ,hall bl .ppllld flr.t to ~y Int.t..t which "Y b, due with .ny r...lnd.,. .ppll,d to t~ tl..
REFUND (eA), A r.fund of . tlM credit, which .... not ,..qul.tld on thl TI. A,turn, ..y bl r.qua.tld by cD.p.,tlng ~
-Application 'or A.fund of P~.ylvanl. Inheritance ~d E,t,t, TI.- (REY-ISIS). ApplIcation. .r. IVIIlabl, at
t~ OfficI of t~ AIgl,t,r of Willi, eny of thl IS R.venue 01.trlct Offlc.a or fro. the D,p'rt.~t'a 24-hour
anawerlng a.rvlc. ~.ra for far.a ard.rlngl In P.nnavlvanla 1-100-362-2050, outald. P~aYlvenl.
~ wIthin lac.1 H.rrlaburg araa (717) 717-'094, TDDI (717) 772-2252 IHaarlng lap.lrad only).
REPLY TDI
Quaatlona rag.rdlng .rrar. cont.ln.d an thl. natlc. .hould b. .ddr....d tOI PA D.p.rt..nt of R'Vlnu., Bur.au
of Indlvldu.1 T..... ATTNI Pa.t A......~t Rlvllw Unit, D.pt. te0601, H.rrl'burg, PA 17121-0601, phone
(717) 787-6505.
DISCOUNTI
If anv t.. due I. p.ld wlthln thr.. 131 c.l.nd.r .onth. aft.r the d.c.d.nt'. d..th, a flv. p.rc.nt 15X) dl.count
of th. t.. p.ld I, .Ilow.d.
PENALTY,
Th. 15X t.. .~..ty non.p.rtlclp.tlon p.n.lty I, coaput.d on th. tot.1 of th. ta. and Int.r..t .......d, end not
plld b.for. Janu.ry II, 1996, th. flr.t dlY Ift.r th. .nd of the ta. .~..tv p.rlod.
INTEREST I
Int.r..t I. ch.rg.d bag Inning with flr.t d.v of d.llnqUlncv, or nln. (9) .ontha .nd on. III day fro. th. dot. of
d..th, to the dlt, of p.ya'nt, Tlk" which b.ca., d,llnqu.nt blfor, Janu.ry I, 1912 b.,r Int.r..t at the rlt. of
,I. 16~) p.rc.nt p.r ~ Cllculat.d at I d.lly r.tl of .000164. All t.x.. which b,c... d.llnquent on and .ft.r
January 1, 1912 wll1 b..r Int.r..t It . rat' which will v.rv Iroa c.llndar yaar to clllnd.r VI.r with th.t r.t.
announc.d by thl PA D,p.rt..nt of A.v.nuI, Th' IPpllcabl. Intlr..t rat., for 1981 through 1997 .r'l
V..r Int.r..t Rat. Dlllv Int.r..t Flctor
Inter..t R...
D.lly Int.r..t F.ctor
Vur
nil ZO~ .000541 1917 .~ ,0002'"
1915 l'~ ,DOOUI 1911-1991 Il~ .00UDl
19'4 Il~ .DD03Dl 1992 .. ,000147
1915 U~ ,DDUS6 1993-1994 1~ .DDD19t
1916 LOX ,D00274 1995-1997 .. ,000247
.-Int.nlt II u1cullt.d .. followt'
INTEREST . BALANCE Dr TAX UNPAID X NUNBER or DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlc. I..u.d .ftar tha tax blCo", d.llnquent will r.fl.ct an Int.r..t c.lculatlon to fllt.an CIS) d.y.
b.yond th. d.t. of thl ........nt. If p.y'ant I. ..d. .ft.r the Int.r..t co.put.tlon d.t. .hown on the
Notlc., .ddltlon.1 Int.r..t .u.t b. cllcul.t.d,
....
IJ -5C,./I
BUREAU OF INDIVIDUAL TAMES
INHERITANCE TAX DIVISION
DEPT. 280601
IlAAAJSIUAG, PA 17UI-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
C/
*
NOTICE OF INHERITANCE TAM
APPRAISE"ENT, ALLOMANCE OR DISALLOMANCE
or DEDUCTION., AND ASSESS"ENT OF TAM ON
JOINTLY HELD DR TRUST ASSETS
CHARLENE
19 SCOUT LN
HUMMELSTDWN
HIMELSBACH
PA 17036
1I',lhlll An ..'.hl
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSNIDC
ACN
11-19-96
ALTOFF
08-23-95
21 95-0704
CUMBERLAND
036-14-8394
96144605
AMount R...ttt.d
C
EMMA
MAKE CHECK PAYABLE AND REMIT PAYMENT TDI
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ....
Rifv:i5ir8-EX--AFP--rO;~96i------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 11-19-96
ESTATE OF ALTDFF
EMMA
C DATE OF DEATH 08-23-95
COUNTY
CUMBERLAND
FILE NO. 21 95-0704
TAX RETURN WAS.
ACN
96144605
S.S/D.C. NO. 036-14-8394
(X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION. PNC BANK
ACCOUNT NO.
5130130674
TVPE OF ACCOUNT. (~SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 01-23-90
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
IF TOTAL DUE IS LESS THAN '1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" I CRI, yOU MAY BE DUE A REFUND,
SEE REVERSE SIDE OF THIS FORM FDR INSTRUCTIONS, I
Account hlance
Percent Tex.ble X
Amount Subject to Tax
Debt. and Deductions
Taxable Amount
Tax Rah X
Tax Due
4,029.57
0.500
2,014.79
.00
2,014.79
.06
120.89
TAX CREDITS:
PAVMENT
DATE
09-26-96
RECEIPT
NUMBER
AA146785
DISCOUNT (+)
INTEREST (-)
3.76-
INTEREST IS CHARGED FROM 09-27-96 TO 11-27-96
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
.
NOTE. TO INSURE PROPER CREDIT TO
VOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEV ORDER PAVABLE TO.
"REGISTER OF WILLS, AGENT,"
AMOUNT PAID
124.09
120.33
.56
.01
,57
I
'{, I,
'., ' I
i,J I
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,
VI
PURPOSE'"
NOTlCEI
To fulfill t~ r.qulr..-nt. of S.ctlon 2140 of the Inherlt~c. .nd E,t.t, ,.. Act, Act II 0' 1991. C7Z P.S,
Seotlon 2140).
PAMHT,
DataCh the top portion of thl, Hotlcl ~d suo-It with your Plyeent to thl RIDI"... of Willi prlntad on the
r."'''1 .Id..
.. HIlk. check or IMMMV ord.... p.yel. tal REOIITER Of WILLI, ACEHT.
All P.v.ent. rec.lv~ ah.l. flr.t b. applied to ~w 1n'.r..t which "V b. due, with ~v r,"lnda.. appll.d to tn. t...
RUlICD (CA)I
A r.fund 0' e tax credit, which WI' not ...qulllted on the hll r.turn, ..y ba ...qu..ted bv cHIII.t1ne WI "AppllC8t1on
'or R.fund of P.,.",,1Y..,11 InherltMCII IInd Eat... rlU- (REV-lSUJ. Applications .r. ''''IU.etI. at the Offlc. of
the Aegl.t.r 0' Will., any 0' the 2) R.vanua DI.trlot D"lc.. or by c.lllna the ~I.I 2.-hour an.~rlng ..rvle.
nuabar. for 'or.. ordering. In P~'Ylv8nl. I-IDD-)6l-2D50, out.ld. p~,Ylvanl. and within loc.1
twrrhburl.r.. (717) 717-1"0\, TDDI (717) 77Z-11SZ Utaarlng hlP.lred Dn!v).
OIJ!CTJOHII Any p.rty In Int.r..t not ..tl.,led with the appr.I...-nt, .llow~' or dl..llowanc. of deduction. or .......-nt
of tax (InclUding dl.count or Int.r..t) .. ahown on thl. Notlc. ..y obj..t within .Ixtv (60) day. 0' rec.lpt of
thl. NoUe. bYI
--written prot..t to the PA Dap.rt-.nt of A.vanua, loard of Appael., Dept. 2.10l1, H.rrl~rl, PA 17121-1021, OR
"-.l..tlng to Mol. the ..tt.r det.r.lned .t thl eudlt 0' tn. ..cou-tt 0' the personal rapr..entaUon, OR
-..appeal to tM Or,.,.,.' Court
ADMIN-
ISTRATIVE
CORRECTJDHlI F..tutll .rror. dheov.red on thl. ........"t thcMJld be addr...ad In writing tal PA Dap.rt..,t of A.venue,
lur.au of Individual T.x.., ATTHI Pa.t A.....eant A.vl.w unit, DEPT. 2.0601, twrrl~rl, P' 171ll-0601
Phone (717) 717-6505. S.. p... 5 of thl bookl.t -In.tructlon. for Inherltanc. Tax R.turn for, A..ldant
Decadent" (REV-1501) for an .xpl~tlon of .a.lnl.tr.tlv.ly correotabl. .rror..
DllCOl*TI
I' any tax due I. p.ld within thr.. ()) calendar ~th. .ft.r the decadent'. de.th, . 'Iv. parcent (IX)
dl,cCM'lt 0' tM t.x p.ld I. .1I0Wt1d.
PfHAL TVI
ThI 15X t.x ~.tv non"p.rtlclp.tlon p~alty I. c~ted on the tot.1 0' the t.x and Int.ra.t ......ad, and not
p.ld before Jenu.ry II, 1"', tha flr.t day aftar the and of the tlX ..,..ty p.rlod. Thll non-p.rtlclpatlon
peMlty Is .....Iabl. In the .... .annar WMI In the thl .... U.. p.rlod .. yOU would appa.1 the tlX wtd tnt.r..t
thIIt h.. bean ......ed .. Indlc.tad on this noUe..
lNTEREST I
Int.r..t II ch.rgad beginning with 'Ir.t d.y 0' d.llnquency, or nln. (9) aonth. and ana (I) d.y
'roe thl d.t. 0' de.th, to the dl" 0' P'YIIMt. 'IX" whldt bee... d.Unquant b.for. Januarw 1, 1911
bI.r Int.r..t .t the r.t. 0' .Ix e6X) parcant par ~ c.lcul.t.d .t a d.llv r.t. 0' .000164.
All tax.. whldt bee... d.llnquent on or "t.r Janu.rw 1, 1.12 wIll bI.r lnt.r..t It . r.t. which will vlr~ 'ro.
calilndlr w..r to uland.r w..r with thet rat. W'lnQUnCId bw thl PA a.,.rtMnt 0' RIVWIUII. The appllc.tJl.
Int.r..t r.t.. far 1.lr through 1996 .r..
Y.lr Int.r..t A.t. D.lb lntar..t Factor V..r lnt.ra.t A.t. D.lh lnt.r." Faator
1912 .ax .000548 1917 'X .000247
I.IS I6X .DDDUI 1911-1991 IlX .000SDl
1..0\ L1X .0OOSDl 1992 .X .0002.7
1911 UX .0DOSS6 1995-1994 7X .000Ul
I'" lOX .000274 1995-1'" OX .000247
....Int.r..t I. c.lcul.tad .. fOUON.1
INTEREST . BALANCE OF TAX UNPAID K NunBER OF DAYS DELINQUENT K DAILY INTEREST FACTOR
--Anw Notlc. I..uad .It.r the tax becOltll. d.lInquent will nfl.ct an Int.r..t c.lcul.tlon to ,1ft.an US) dQI
b.rand the d.t. of the ......Mnt. l' para~t 1. .~ .,tar the Int.r..t coaputatlon data ahown on the
Notlc., .dcUtlon.l Int.r..t suit be ulculltH.
15' / ~(,,' II
BUREAU OF INDIVIOUAL TAXES
INttEAITANCE TAX DIVISION
OEPT. UD601
IIAARISlURO, PA uua'DUI
COHHDNWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
C,.../
*
NOTICE OF INNERITANCE TAX
APPRAIBENENT. ALLOHANCE DR DISALLOXANCE
OF OEDUCT! ON.., AND ASSESSNENT OF TAX DN
JOINTLY oELD OR TRUST ASSETS
CHARLENE
19 SCOUT LN
HUMHELSTOWN
HIMELSDACH
PA 17036
In'I'" II u..u....
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
SSN.lDC
ACN
11-19-96
ALTDFF
08-23-95
21 95-0704
CUMBERLAND
036-14-8394
96144606
AMount R...ttt.d
C
EMMA
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
Rifv:i5iri-EX--AFii-ioi-:96j------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD DR TRUST ASSETS
DATE 11-19-96
ESTATE OF ALTOFF
EMMA
C DATE OF DEATH 08-23-95
COUNTY CUMBERLAND
FILE NO. 21 95-0704
TAX RETURN WAS.
ACN
96144606
S;S/D.C. NO. 036-14-8394
(X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORHATION
FINANCIAL INSTITUTION. PNC BANK
ACCOUNT NO.
21001022341
) CHECKING ( ) TRUST (Xl TIME CERTIFICATE
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
IF TOTAL DUE IS LESS THAN 81. NO PAYMEHT IS REQUIRED,
IF TOTAL DUE IS HEFLECTED AS Ii "CREDIT" I eR), YOU "AY BE DUE Ii REFUND.
SEE REUERsE SIDE OF THIS FORM FOR INSTRUCTIONS. I
TYPE OF ACCOUNT. () SAVINGS
DATE ESTABLISHED 04-12-90
Account Ba18nce
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
T axab 18 Amount
Tax Rate X
Tax Due
6,539.50
0.500
3,269.75
.00
3,269.75
.06
196.19
TAX CREDITS:
PAYMENT
DATE
09-26-96
RECEIPT
NUMBER
AA146785
DISCOUNT (+)
INTEREST (-)
6.1I-
INTEREST IS CHARGED FROM 09-27-96 TO 11-27-96
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
.
NOTE. TO INSURE PROPER CREDIT TO
VDUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
DR MDNEV ORDER PAYABLE TO.
"REGISTER OF WILLS, AGENT."
AMOUNT PAID
201.29
195.18
1. 01
.02
1. 03
on 'J~
c ;' " .~
,
.',;
!'-l
~
:..p (, ~
"
\.11
PURPOSE OF
NOTICE.
To 'ulflll the r.qulr..en.. of Sactlon 2140 of thl Inherltancl and E,t.t. Ta. Act, Act IZ of ."1. (72 P.S.
S.ctlon IUD).
)
I
I
"fl
J
j
PA\1tEHT, D.tach the top portion of thh Notlc. Bnd ,ub.1t with vour PlY"'" to the R.ght.r of Willi printed an the
r.v.,.,. .Id..
... "M' check or aontV ord.r p'vabl. tal REGISTER OF WILLS, ACENT.
All P'lnMf1t1 reea."" Ih.U flnt h .ppJl.~J to any Int.,...t Which ..)' b. du., with ....v ,...lncl.,. applJ.d to 'PM t'll.
REFUND (tA), A r.fund of . t.. cr.dlt, whIch WI' not requa.t.d on the t.. r.turn, ")' b. r.qu..t.d bv c~l.tlna an "Appllc.tlon
for R.fund of P..",.vlv....l. IntMirltMC. ..-HI hl.t. T.ll" CREY"tsU). AppUutlonl ar. 1",Uabl, It the OffiCI of
the R-al.tl,. of Will., any of thl ZJ R.y~. Dl,'rlct Df,lcI. or bV cIll1ng the ,peell. Z4-hou,. .....werlna ..,.vlel
~r' for 'or.. orderlngl In P~.vlvBnl. 1-100.56'-'050, out.l~ Pann'Vlv",l. ~ within loc.1
Harrl~rg .raa (717) 7.7-1094, TOO. (717) 77Z-I252 (Hearing 1"'lr.d Onlvl.
OIJl!:CTlDHII
Any p.rQ In Intar..t not ..thflMl with thl IlPPr.h.....t, .UOlIMnC. or dh.Uawww:. of d~tlon. or ...........t
of to Uncludlntl dhcount or Inura.U .. Ihown on thll Notlc. ..y object within .hty UO) dell" of ree.lpt of
thh MoUc. bYI
"-writ.." prot..t to the PA o.p.rt.....t of R.venue, loerd of App...., Dept. Zl1OI1, Hlrrhburl, PA 17UI-1OI1, OR
--.leeUng to heY. thl _tt.r det.ralned at the eudlt of th. KCount of the "r'0NI1 repr..",tatlv., OR
....."..1 to the Orphen," Court
ADKIN"
JlTAATlVE
CDRRfCTIOHSI
Fectuel .rror. dl.cov.red on thl. ......aent .hoUld b. addr....d In writing tOI PA Dlplrtsent 0' R.VInUl,
IurllU of Individual Tax.., ATTHI Po.t A.......,.t R.vl... Unit, DEPT. 210601, Harrlaburl, PA 17121-0601
Phone (7171 7.7-6505. S.. page 5 of the bookl.t -In.tructlon. for Inhlrlt~. Tlx R.turn far. R..ldent
Decedent" (REV-IS0l) for en .xpl~tlon of 1~lnl.tr.tlv.ly corractlbl. .rror..
DISCOUNT I
If LnV tax due I. Plld within thr.. (3) clllnd.r .onth. .ft.r the d.cldentt. death, a flv. pereent (5X)
dhclMl'1t 0' the t.x paid II aUowed.
PENALTY I
ThI 15~ taM .-na.tv non-partlelp.tlon panaltv I. cosputad on the tat.1 0' the taM ~ Int.r..t .......d, ~ not
plld blfors Janu.rv 11, 1996, thl flr.t dill' Ift.r the Met of thl tllC ..,..tv p.rlod. Thll non-p.rtlalpaUon
pensl tv II IaPp......I. In the .... ..,.,.r end In thl thl .... U.. p.rlod .. you would ~..I the; tlM end Int.rs.t
that he. been .......d .. Incflo.tMl on thh notlc..
INTEnEST I
Inter..t II chllrlMl bl8lnnlng with flr.t d.V 0' d.lInquancv, or nln. (9J lonth. end one OJ ct.v
frOl thl dlt. 0' d..th, to the dlt. 0' p.v.tnt. T.x.. which b.c... d.llnquant b.for. J~rv 1, 191Z
bI.r Intar..t at the rltl 0' .Ix (6XJ p.rcant p.r annua calcul.ted It I dlllV rlta of .000164.
All tIXI. which bee... delinquent on or .,t.r Janulrv 1, 1911 will b..r Int.r..t It . r.ta which will v.rv 'roe
clllndlr y..r to cII~r v..r with th.t rlt. announc.d by thl PA D.p.rt.ant 0' RlvlnUI. Th. IPpllolbl1
Inttr..t rst.. 'or 1911 through 1996 .r'l
Y..r lnttr..t R.t. OaUy lnt.r..t F.etor V.ar Inttr..t R.ta O.llv Inter..t F.otor
1912 ZDX .000541 1917 'X .000147
1911 lOX .OOOUI 1911-1991 IU .DODSOI
1914 llX .00OSOI 1991 'X .000l41
, 1915 UX .000356 1993-1994 7X .000191
I'" lOX .000174 1995-1996 'X .000147
...Int.....t I. ulcuhtMl .. foUo"'1
INTEREST . BALANCE OF TAX UNPAID X NUnBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Hotlct I..ued Ift_r the t.x bleo... d.llnquent will r.fl.ct en Int.r..t c.lcul.tlon to ,I,t.an (15) dlVt
btyond thl d.t. 0' the ........"t. If p.yeant II 'R' alter the Inttr..t eo.put.Uon d.t. .howl on th8
Notlca, Iddltl~.1 Intar..t .u.t ~ cllcul.ttd.
i5- 50 _/1
BUREAU DF INDIVIDUAL TAXES
IHH(A1TAHC[ TAX DIVISION
Of PT. zauoI
HARRISBURG. PA 111U.06111
CDHHDNWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
e---
.."HUll '" IU""
CHARLENE HIMELSBACH
19 SCOUT LANE
HUMHELSTOWN PA 17036
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
01-06-97
ALTOFF
08-23-95
21 95-0704
CUMBERLAND
96000112
AMount Reid t bd
EMHA
C
HAKE CHECK PAYABLE AND REHIT PAYHENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE I To Inaur. proper credit to your .ccount, aubMlt the upper portion of thl1 for. with your t.~ p.y....nt.
CUT ALONO THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-V:i60-j-Ej{-AFP--ri1i:96i-------...--iNifERiifANCif-TAj{-sriifEHE-NT-b-F-Ac:Couiff--.-..---------------------
ESTATE OF AL TOFF EMMA C FILE NO. 21 95-0704 ACN 96000112 DATE 01-06-97
TN IS STATEHENT IS PROVIDED TO ADVISE OF THE CURREHT STATUS OF THE STATED ACN IN THE HAHED ESTATE. SHDWH BELDW
IS A SUHHARY OF THE PRIHCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE,
DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT, 09-30-96
PRINCIPAL TAX DUE, 712.73
PAVMENTS (TAX CREDITS),
PAYMENT
DATE
10-08-96
RECEIPT
NUHBER
AA146830
DISCOUNT (+)
INTEREST (-)
24.29-
AMOUNT PAID
737.24
. IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN .1,
NO PAYHENT IS REQUIRED.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
712.95
.22CR
.00
.22CR
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (eR),
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
RocorOd ,
RO[jHr.. ,
i" 0 of
WIII$
'97 JIIN 17 1\11 :48
Cler" ' . . 'vodrl
Comb"",;j ,il (;0.. PA
PA'tHENTI
D.tach the top portion of thl, Hotlcl and .ubalt with your plw..nt ..da pIYlbla to thl n... and addr...
prlntad on the rlyer.. ,ldl.
If RUIDutT DECEDENT au. chick or .onay order paWlbh tal REOISTER Of WILLS, AGENT.
If NOH-RESIDENT DECEDENT .._ chick or lOftIly ardn plYlble tal COMMONWEALTH OF PENNSYLVANIA.
All p.~~t. r.calvld .hall be applied '.r,t to ~y Intar..t whIch '.y bl due with any r...lnda,. applied to thl t.w.
REfUND leA)1 A r.fund of Ita. cradlt, which WI' not ,..qulttad on t~ ,.. Aaturn, "V ba ,.aqua.tad by co~l.tlng ~
"Application for R.fund of P~.ylvanl. l~rlt~. and Eltat, 'IX" (REV-IIISJ. APplication. .r. IVIIIIbI, .t
the O"lcI of the R..llt,,. of Willi, any of thl ZS Aavenue DI.trlct O"lc.. or fro' the Depart.ent'. '4~hour
~.werlna ..rvlc. nuebar. for for.. ord.rlngl In P~.vIYenl. 1-.00-162-'050, out.ld. Pann.vly~11
end within 10c.1 H.rrl.burg ara. (717) 7'7-.09~, TOO' (717) 77'-"5Z (H..rlng lap.lr.d only).
REPLV TDI Due.tlon. r.g.rdlng .rror. contalnad on thl. not lea .hould ba .ddr....d tal PA D.parta.nt of R'v,nu., Bur.au
of Individual T...., ATTHI po.t A.......nt R.vlaw unit, O.pt. Z10601, Harrlaburg, PA 171'.-0'01, phone
(717) 717-6in.
DISCDt.U.
If anv t'M due I. paid within thraa (S) c.land.r aonth. .ft.r the d.c.dant'. d.ath, a flv. p.rc.nt (SX) dl.count
of the ta. p.ld I_ .llow.d.
PENAL TVI
Tha 15X ta. .-na.tv non~partlclp.tlon penal tv I. co.put.d on the tot.l of the t.. and Int.r..t .......d, and not
paid b.fora Janu.rv II, 1996, the flr.t d.v .ft.r the .nd of tha ta. aan..tv parlod.
IHTERnTI
Int.rl.t I. chargld bag Inning with flr.t dav of d.llnquancv, or nlna (,) aonth. end ani (1) dav fro. thl data of
daath, to thl d.t. 0' p.y..nt. T.... which b.c... d.llnqu.nt b.'or. Janu.rv I, I'.' b..r Int.r..t .t tha r.ta 0'
.1. (6X) p.rclnt p.r ~ c.lcul.t.d .t . d.lly r.t. 0' .OOOI6~. All t.... which baca.a dallnquant on and .'tar
Janu.rv I, 19.' will ba.r Int.ra.t .t . rata which will vary fro. calandar vaar to c.llnd.r va.r with that rata
announc.d bv thl PA Dapart..nt 0' R.venu.. Th. ,ppllClbla Int.r..t rat.. 'or I'" through 1997 .r.,
VI.r Int.r..t Rlt. ~.Ilv Int.r..t factor
V..r
Intarllt R.ta
Dallv Int.r..t f.otor
1'12 m .0005'" 1917 " .ODOZ~7
I9IS lOX .OOOUI 19.a-I991 m .0OOSOI
1914 m ,OOOSOI 199' " .oonu
1915 m .00OS56 1'91-199" .l .00019'
1916 lOX .OO0l7~ 1995-1997 " .oonu
.-Int.,..t It c.lculated .. fallow..
INTEREST . BALAHCE OF TAX UHPAIO X HUHBER OF DAYS OELIHQUEHT X DAILY IHTEREST FACTOR
--Anv Hotlc. I,.uld .ftar the ta. b.co... dallnqulnt will r.fllct an Int.r..t c.lcul.tlon to 'I,t..n (IS) day.
bavond the data of tha ........nt. I' ply..nt I. ..dl a,t.r the Int.r..t co.putatlon data .hawn on tha
Hotlc., addltlon.l Int.r..t au.t b. c.lcul.tad.
/s-.,s'{, - II
BUREAU OF IHOIVIDUAL TAMES
INHlRlf&HCE TAX DIVIIION
D[PT. 11060 I
HARRISIURa, PA 171'..0'01
,
c..
-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
.,,-aU'U"'III-'"
CHARLENE HIMELSBACH
19 SCOUT LANE
HUMMELSTOWN PA 17036
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-2B-96
ALTOFF
08-23-95
21 95-0704
CUMBERLAND
96000112
A~unt R..ltt.d
C
EMMA
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
NOTE I To Jnaure proper credit to your .ccount, .ub.lt the upper portion of thl. fora with your t.x pay..nt.
CUT ALONO THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iikV:ilibTiif-"Fjtuiiij-:9iii------iiiiii-iNiiiRil:iiiicE-i'iix--sTiiiEHEIWii,;-iicciiuiiiuiiiii-nmn-nn---- ----
ESTATE OF AL TOFF EMMA C FILE NO. 21 95-0704 ACN 96000112 DATE 10-28-96
TIllS STATEHEHT IS PROVIDED TO ADVISE OF THE CURREHT STATUS OF THE STATED ACH IH THE HAHEO ESTATE. SHOWH BELOW
IS A SUHHARY OF THE PRINCIPAL TAM DUE. APPLICATIOH OF ALL PAYHEHTS. THE CURREHT BALANCE. AHD. IF APPLICABLE.
A PROJECTED IHTEREST FIGURE.
OATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT. 09-30-96
PRINCIPAL TAX DUE .._.________________
712.73
PAYMENTS (TAX CREDITS),
PAYMENT
DATE
10-08-96
RECEIPT
NUMBER
AA146830
DISCOUNT (+)
INTEREST (-)
24.29-
AMOUNT PAID
738.26
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
713.97
1.24CR
.00
1. 24CR
. IF PAID AFTER THIS DATE. SEE REVERSE
SIDE FOR CALCULATIOH OF ADDITIOHAL IHTEREST.
IF TOTAL DUE IS LESS THAN .1.
NO PAYHEHT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI.
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE DF THIS FDRH FDR IHSTRUCTIDHS.
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PAYItDn'a DetKh the top porUDn of thh HoUel .-MI ___It wSth your Plv.ent elide PlY"'.' to the MMI IInd .setr...
prlntMl on the rewr.. .1....
11 REIIDOfT DECEDOn uk. check Dr .....y order PIY"'._ tal REGISTER OF WILLS, AGENT.
If HOH"RE:IIMHT De:CEDEHT Ak. check Dr ....y orar p.yabla tal COHttOHWEAL TH OF PENNSVLVANIA.
All p'~ts rH.lv~ 1M1l 1M 1IPP11~ fir.t to MY Intar..t which "V be ... with MY r...lnder ...lIed to the tax.
RU\IND (ath , refWMI of I tax creeUt, Mhlch .... not nque,tlMf 01'1 the TelC Aeturn, ..y be rlqutllted by CCNlPllUno .,
"Application far R,fund of P~.vlv.,l. Jnherlt~. ~ Eltat. TI." (REV-151JJ. Appl1cltlanl .r. .v.llllbl. at
the 0"101 of tM AI,I,t.r of Willi, MY of the 2S A.v~ DI.trlot O"lc.. or 'ru. thl DIp.rt-.ntt. 24.hour
anlWlrl"l ..rvlo. nuIbIr. 'or 'or.. ordlrl"-, In PInn'vlvanl. 1.100.S'Z.Z05D, out.ldI Penn.vlvanl'
~ within loc'l ",rrl.bur. .r.. (717) 717.1094, TOO' (717) 772-2252 CHI.rlna 1~.lrld onlv).
AfPLY TOI DUIIUon. rq.rdlna .rror. cant.IMd on thll noUc. .hould Mi addr....d tOI PA DIp.rt...,t of R.v...., Bur.....
0' Indlvl~1 T.x.., ATTHI Po.t A........,t R.vlew unit, Dept. 210601, H.rrl.burD, PA 17121-0'01, phonI
(17) 7.7-'505.
DISCDllfTI If anv tn dull .. p.ld within thr.. U) c.llndlr IIonth. .ft.r thl _edent". d..th, I flv. "rclnt UX) dhcOW\t
of the t.. p.ld I. .llowed.
PENALTYI The 15X tn ....tv non.p.rtlcJp.Uon fteMltV II COllpUtltd an thl totll of the to Md Intlrllt ......Id, Met not
plld b.for. JlhUlry II, 1996, the flr.t d.v .ft.r the end of the t.x .-nI.ty p.,lod.
IHTEREST.
Int.r..t I. ch.rged b.glnnlng with flr.t dlv of dlll~v, or nln. (9) lanth. Ind one 'II dav 'ru. thl d.t. of
de.th, to thl d.t. of PIV...,t. T.x.. which b.c... delinquent bI'cr. J~.rv 1, 19.2 Milr Int.r..t .t thl r.t. of
.Iw "X) p.rclnt p.r ~ c.lculat.d .t . d.IIY r.t. of .000164. All tl... which bac... d.llnquent on end Ift.r
Janu.rv 1, 19.2 will Miar Int.r..t .t . rat. which will vlrv 'rot c.llnd.r y..r to c.l.nd.r v..r with th.t r.t.
lnnCKnCed bV thl PA O....rt...,t 0' R.v..... ThI eppl1cabl. Int.r..t ntll 'or 1912 through 19" .r'l
V..r Int.r..t R.t. O.llv Int.r..t Factor Va.r Int.rllt R.ta DIUy Int.rllt Faator
1912 zax .000541 1917 'X .000247
ltaS 16% .0004Si 1'....1991 IIX .00UOl
I... llX .OOOSDI 199' 'X .00020
1915 ISX .DOU56 1995.1994 7X .00ll192
19.. I'X .000274 1995"1996 'X .DDDZO
--Int.rllt I. cllcul.tad .. 'OUOWII
INTEREST . BALANCE OF TAX UNPAID X "UKBER OF OAY8 OELI"qUEKr X DAILY IWfEREST FACTOR
.-Anv Notlc. 1..UId Ift.r thl t.. blcu.e. delinquent will r.fllCt an lnt.r..t c.lcul.tlon to fl'teen (15) dlY'
beyond thI data 0' thI ........"t. If P'Y8Int II .... .ftar thl Intlr..t COllPUtlUon data ahowl on thI
NoUu, additional Intarllt MItt ba calcul.tld.
I:;:'S" -1/
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
C--
*
BUREAU OF INOIVIOUAL TAXES
INHERITANCE TAlC OIVISION
DEPT. 110601
HARAIIIURQ, PA 17111-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR OISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
UN"'''''' UI-'"
CHARLENE HIMMELSBACH
19 SCOUT LN
HUMMELSTOWN PA 17036
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
EMMA
06-03-97
ALTOFF
08-23-95
21 95-0704
CUMBERLAND
101
A.aunt R..t t tad
MAKE CHECK PAYABLE AND REMIT PAYMENT TOl
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FGR YOUR RECORDS ~
iiEV=is4j-Eif-APji-io;;=m--tiiificEu0i1-i-N"HEiiii'AiicE-i:AX-A-PPRA-isEHEtiT-,--'iLroWANCE"iili------u---------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ALTOFF EMMA C FILE NO. 21 95-0704 ACN 101 DATE 06-03-97
TAX RETURN WAS. I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIOINAL RETURN
1. R..I eat.t. (Schedule A)
Z. stock. and Bonda (Schedule 8)
5. Clo..ly Hald stock/Partnership Int.r..t (Schedule C)
4. Horta.gas/Not.. Receivabl. (Schedule D)
5. Ca.h/Bank Deposlta/Hllc. Parsonal Property (Schedul. E)
6. Jointly Owned Property (Schedule F)
7. Transfara ISchedul. OJ
8. Tot.l Au.t.
I CHANGEO
.00
.00
.00
67.000.00
10.285.00
.00
.00
181
C
III
(21
(51
141
(SI
(61
171
HOTEl To Insure proper
credit to your account,
aub.it the upper portion
of this forM with your
tax pay..ant.
77 ,285.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
43,160.00
9. Fun.,.al Expan.../Adn. COlt./HIIC. Expan... (Sch.dul. H) (9)
10. Dabh/Hodgaga UabUltt../Llana (Schedule I) (10) 3.964.00
11. Total Deduction. Ill)
12. N.t Value of Tax R.turn (12)
13. Charitable/Govarnnental Bequa.t. (Schedul. J) (13)
14. N.t V.lu. of E.t.t. Subj.ct to T.. (141
NOTEl If an assesBment was iSBued previOUSly, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ahh returns assessed to date.
ASSESSMENT OF TAXI
15. Aaount of Llna lit at Spousal rat. US) .00 )( .00.
16. Anount of Lin. 14 taxabl. at Lin..l/Cb.. A rat. (16) 30,161 . 00 )(.06::1
17. Allount of Una 14 taxabl. at CoUat.r.lICI... B rat. un .00 )( .15.
18. Principal Tax Dua (18)
47.1'4 nn
30,161.00
.00
30,161.00
.00
1.810.00
.00
1,810.00
TAX CREDITS I
PAYHENT
OATE
11-26-96
04-10-97
RECEIPT
NUHBER
WRITEOFF
AA185378
DISCOUNT 1+1
INTEREST/PEN PAID (-I
.00
.00
AHOUNT PAID
83.60
1,810.00
BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-11-97
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
1,810.00
.00
60.35
60.35
. IF PAID AFTER DATE INDICATEO, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN '1, NO PAYHENT IS REQUIREO.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
A REFUNO. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.I
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E.t.t.. of decedent. dvSng on ar before Dec~r 11, 1'" .. Sf ~v future Snt.r..t Sn the ..t.t. J. tr~.f'rred
Sn pa.....Son or enJa~t ta Cl... I (coU.t.,.aU benIIfJaSlrJ.. of the decedent aft.,. the ..,S,..Uon of ~v ..t.t. fo,.
Uf.o,. fo" w..r., the C~1th h.,.ebv upr...b ,....n.. the rJliht to eppr.lI. end ...... t,.~.f.,. InhI,.Uence TD"
.t the lew'ul Cl... I (collata,.el) r.ta on ~v such future lnt.re.t.
p;
P\IIPOSl! '"
HOna.
To fulfill the r~lr.-.nt. of lectlon II~O 0' ~ Inhlrltenc, end E,tat, T.. 'ot, ADt II 0' 1"5. (71 P.I.
hctlon 9140).
PA\1EHT I
Detach the top porUon 0' thh HoUc. end lub.lt ..Ith your ,eYMnt to the Reglltl,. 0' MUll prJnted on the rlV,rN ,Ide.
ufWt. chick Dr ....v or.r p'vabl, tOI REGISTER OF MILLB, AaEHT
RUt.IID (CRh A r.,\ond 0' a t.. C,.MfU, lilhlch .... not reqwlted on thl TI. Rlturn, "V t>>. r.....ted bv cOllPl.Ung ~ "AppUc.Uon
for Re'und 0' Penn.vlvanl. Inherltanc. end E.tet. Tex. (REV.1S1S). Applle.tlon. e,.. av.llebl. .t the Of,lc.
0' the Rlgl.t.r 0' "111., InV 0' thl IS A.v~ DI.trlct D"lc.., or bv ceiling the spealel 14.hour
~.werlnt .ervlc. ~r. far 'or.. ordering, In P~'vlvanl. 1-IOO-S6Z-2050, out.lde Penn,vlv,"l. end
wIthin lacet Herrl.burg .re. (717) 717-1094, TOO' (717) 772-2252 (He.rlng lap.lr.d OnIV).
! !
j j
1
(
OIJECTIDHS, AnV p.rtv In Int.r..t not ..tl.fl.d with thl ~r.I''''"t, .llowlnC. or dl..llowenc. of deduction., or ......eent
of t.. (Including dllcount or Jnt.r..t) e. .hown on thl. Hotlc. .u.t Object within .IMtV (60) d.v. 0' r.c.lpt of
this Hotlc. bVI
AIlHIN
ISTA'lIVE
CORRECTlONSI
.-"rlUII'I prot..t to thl Pi DIP.rt.....t of A.vMUl, Bo.rd of Appe.h, Dept. 211021, H.rrhburg, PA 17UI-IU1, OR
--.l.etlon to h.v. the ..tt.r d.t.r.lned et audIt of thl account of thl Plr.onel repr......t.tlv., OR
..eppe.l to the Orphen'. Court.
factu.l .rror. dl.cov.rld on thl. ......lInt .hould t>>. Iddr....d In writing tOI P' D~.rtllRt 0' R.VInUl,
lur..u of Indlvldu.l T'M", ATTNI Po.t ......lInt A.vl.w unit, Dept. 210601, H.rrl.burg, PA 17121-0601
Phone (717) 71'-6505. S.. p.es 5 of the bookl.t "In.tructlon. fo~ Inherltanc. T'M A.turn for e A..ldlnt
Decedent.. (REV.1501) far an ..plen.tlon of adalnl.tr.tlv.lv correctlbl. .rror..
DISCOUfT,
If ~v t.. due 11 p.ld within thr.. U) cllllndllr IIonth. aft.r the decedent'. ..th, . flv. pere....t (I:U discount of
the t.. p.ld Is .llowed.
PENAL TV I
ThI lS~ t.M -.na.tv non-Plrtlelpstlon pen.ltv I. coaputld on thl tot.l nf thl taM and Int.r..t ......ed, ~ not
,.Id bafor. Januarv II, 1996, thl flr.t day .ft.r thl end of the t.M -.na.tv perlad. Thl_ non-p.rtlalp.tlon
.......Uv II 1ppI.llbl. In thl .... .W'lMr and In thl the ... U.. "rlad It you would eppa.l thl tex end Int.r,.t
thIIt h.. bien .......d .. Indlc.tad on thll notlc..
IHTERIEIT I
Int.r..t It chIrgld beglmlng ..lth first d.v of dellnquw\Cv, or nine (9J aonth. end one (1) d.V '1''' the d.t. of
death, to the dIIt. of P'VIII't. TIICIt whIch bee... cs.1J~t iMfor. J.....rv 1, 1911 ba.r Inter..t at thl r.t. of
ItM (U) percent per ....... c.lcul.ted at a dllh rat. of .000164. All tb.. which bee.. dell,....,..t on end aft.r
JanuerY 1, 1'" viiI be.r Int.r..t at . r.t. which viII varv froe c.lendar veal' to c.l~r va.r ..Ith thet rat.
ennouncad bv thl PA Dep.rt-.nt of A.venue. The appllclbl. Int.r..t r.t.. 'Dr 19.2 through 1997 '1"1
!!!r Int.rltt R.t. D.llv Inter..t Feetor !!!!' Inter." A.t. D.llv Int.r..t 'eetor
1911 lax .00054' 1.17 n .000247
1915 16% .00041' 1961-1991 11:C .OOOSO!
I'" In .00OSGl 1'" n .000247
1911 lSX .00OJS6 1995-1"" 7lC .000191
.... lOX .ooun 1995.1"7 n .000247
--lnt.r..t .II calculated II follow'l
INTEREST . IALAlfCE OF TAll UHPAID X IlUIlBER OF DAYI DELIHq1lEll1' X DAILY INTEREST FACTOR
--Anv Notlc. hlUld a'tlr thl tD Me.... dllI"..,t will uflact ~ Intarllt calculation to fifteen CIS) diva
bI)'Oftd the dlt. of the .........,t. If ,.pent II IIda .ft.r the Intarllt COlPUt.tlon dIIt. shown on 1M
Notice, Iddltlonel Int.ra.t "".t be calcul.ted.
.-.-.- --.......--...
,:),5(., -II
c,*,
COHHONWEALTH OF PENNSVLVANIA
DEPARTHENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
n'.lu,..",.II.III
'.
BUREAU OF INDIVIDUAL TAXES
IHHEAITAHCE TAX DIVIIION
DlPT. U0601
twtRlllURO, PA 171U"D'11
CHARLENE HIMMELSBACH
19 SCOUT LN
HUMMELSTOWN PA 17036
OAT!
!STAT! OF
OAT! OF DEATH
FILE NUMB!R
COUNTY
ACN
06-30-97
ALTOFF
08-23-95
21 95-0704
CUMBERLAND
101
A.ount RHi ttod
EMMA
MAKE CHECK PAYABLE AND REHIT PAYMENT TOI
REOISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE. PA 17013
HOTEl To lnlura propar cradlt to your ~count, lub_lt tha uppar portion of thll for_ with your t.. pay..nt.
CUT ALONO THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
ii"iv=Uiij-EX-"j:ji-io3:m----n-iiilil--iiiiiiR'i'fliiiciCi'Aic-si'A'fiHENi'-OF-ACciiiJiifniiiiimn----------n-n-
ESTATE OF ALTOFF EMMA C FILE NO.21 95-0704 ACN 101 DATE 06-30-97
THIS STATEHENT IS PROVIOED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELDW
IS A SUHHARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYHENTS. THE CURRENT BALANCE, AND. IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 05-27-97
PRINCIPAL TAX DUE,. 1.810.00
PAYMENTS (TAX CREDITS),
PAVMENT
DATE
11-26-96
04-10-97
06-05-97
RECEIPT
NUMBER
WRITEOFF
AA185378
AA211406
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
.00
60.35-
AMOUNT PAID
83.60
1.810.00
60.35
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
1,810.00
.00
.00
.00
. IF PAID AFTER THIS DATE. SEE REVERSE
SlOE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN .1,
HO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIOHS. I
C
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PAVlEHT I
D.t.ch the top po~tlon of thla Hotlea ~ .uo.lt with your pav.ent .ada plYabl' to the n..a ~ ~~a..
printed on the r.v.~.. aide.
If RfSlDfHT DECEDEHT nk. chaek o~ .onay ordar pavabla tal REGISTER OF WILLS, AGENT.
If NON-RfIIDEHT DECEDEHT .u.a ch.ck o~ aonev ord.r pavabl' tOI COHHDHWEAl TH OF PENNSVLVANIA.
REfUND ltA) I A r.fund of . talC c~edlt, which w.. not raqua.tad on the T.. Aaturn, ny b. r.qu..t.d bv cOllpht1ng M
RAppllcatlon for A.fund of Penn.vlvanl. Inh.rlt~. ~ E.t,t, Ta.R (REV-ISIS). Application. ar. .vallabl. .t
the Offic. of the A.gI.ta~ of Will., InV of tha 25 Aevenue DI.trlet Office. o~ fro. the Oapart-.nt'e 2'-hou~
M.werlng ..rvlc. nuabar. fo~ for.. ordarlngl In Penn.vlvanl. 1-100-562-2050, out. Ida Penn,vlvanl.
and within local H.~rl.burg ara. (717) 717-10'4, TOOl (717) 772-2252 (H..rlng I~.lr.d only).
REPLY TDI Dua.Uon. reg.rdlng .rror. conhln.d on thl. noUca .hould ba addr....d tOI PA D.p.rt.."t of R.vanue, lur.au
of Individual T...., ATTHI po.t A.......nt R.vl.w unit, D.pt. 280601, Hlr~l.burg, PA 17121-0601, phone
(717) 717-6505.
DISCOUHTI
If anv t.. due I, p.ld within thr.. e5J c.lander aonth. .ftar thl d.c.dant.. d..th, a flv. p.rcent (5X) dl.count
of thl t.. P.ld 1. .llowed.
PfNAL TVI
Th. 15X ta. aana.ty non-p.rtlclpatlon pan.ltv I. eoaput.d on the tot.1 of the ta. and Int.r..t .......d, and not
plld b.for. Janu.ry 18, 1996, the fl~.t dey .ft.r thl and of the t.lC .an..ty p.rlod.
IHTEREST I
Intar..t I. charged baglnnlng with flr.t day of dallnquancy, o~ nln. (,) .onth. ~ on. (1) d.y frOl tha data of
daath, to thl data of pay.ant. 'llCa. which bac... d.llnqu.nt b,'or. January 1, 1'82 b..r Int.r..t .t thl rat. Q'
.Ix C'X) ,.rcant p.r ~ c.lculat.d .t I d.lly r.ta of .000164. All tllC., which b.c... d.llnquent on and .,t.r
January 1, 198' will b..r Int.r..t at a r.t. which will v.ry frol cllandar v..r to c.l.nd.r y..r with th.t r.t.
announc.d by thl PA Dap.rt-.nt of A.venu.. Th. appllcabl. Int.r..t r.t.. for 1982 through 1997 ar'l
V." Int.r..t Aat. DIlly Intar..t F.ctor Va.r Intlrnt Rat. Dally Int.,..t F.otor
1.12 20X .0GaS'" 19117 OX .000247
l.n lOX .DGaUI 1918-1991 In .DODJOI
It" UX .DGaJDI 1992 'X .OGa2n
1915 ISX .00DJS6 1995-1994 n .000192
1916 lOX .000274 1995-1997 .X .000247
....Intar..t Is clllculat.d "" 'ol1owlI
INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
-~Any Hotlc. I..ued aft.r th. t.lC bacoa.. d.llnquant will r.fl.et an Int.r..t calculation to flftalO CIS) d.y.
bavond the d.t. of th. ........nt. If ply-.nt I. .ada .,t.r the Int.r..t coaput.tlon data .hown on thl
Notlc., 8ddltlon.1 Int.rut au.t b. caleul.tad.
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:-.-----...J_ , to. - , 1'.
I
-......-.......,
,
~lene Himelsbach
icout Lane
Ilelstown, Pa,
Zip 17036
...'
c_,;-
--_.'."'-
..
Cumberland County Court House
Register of Wills
1 Courthouse Square
Carlisle, Penna. 17013
'..
Y:
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1:,~~!!.!!.1!!~
_RCJ'U It..,.f
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- - - -- - -- - -.- ~- --- - -- - -- - - ...-. .~.. -~ -- -.-- -... -. -- - - -- -- - - -~- - -- --
(.' ."ir' , .' ~J'" f.V;.' .'.'I,..r.." ,r.:;~'J;' . t~,V i'" ;~V'~ yr,,',' t '::,' '.f, c~:,,' ii.;"":{ ,;-~.,~,~?/::; .',:: T';, i". t ~,_, .:~ '~~'t; r ;,:,- ..'- ',;:'< ~';. '. '<.;.~ -;'" ': /-::.
DfI1\(,~t;:';)I";!":1' ;1'6' .<'s<Y<.a'<'<<<O';CO;.wONWEALTH:OP' PENNSYLVANIA .
,.o;,\AA&.,"~ ' ," ,.",.,: ";."'\""'DIMlnMIHT. I... < ,.'., .,
f:!.;:;&tf[I\,:I';:'~~~'?;~~;'O"ICiAJ~ij~~~;~INNsYi.VAtirAf~-r:~~'c~~NDiSrAT~.TAX.
\1IIY>\1Q1J ",:",,~.-,.-...._-->-, -- ", ".. -'.'-", ,...... -- - ". ., . . ....,.. .
"..,..,'
-". '.-" ,,'. '--'. . "....
,;.'>'" .. .'.'. '-,
',- >;"'>~' .'" "',
,
RECEIVED FROM.
i
ACN
ASSESSMENT P:I
CONTROL 1:,1
NUMBER
AMOUNT
CHARLENE HIMELSBACH
19 SCOUT LANE
9600011e
.736.e6
HUMMELSTOWN, PA 17036
'OlD""f
ESTATE INFORMATION.
1:'1 FilE NUMBER
li1 el-1995-0704
EJ NAME OF DECEDENT (WiT)
II DATE OF PAYMENT
EJ POSTMARK T
COUNTY
SSN 036-111-6394
(FIRST) Mil
CUMBERLAND
DATE OF DEATH
REMARKS
m TOTAL AMOUNT PAID
SEAL
CHECK" e44
<.. '
RECEIVED BY
.736.e6
CW
CHARLENE HIMELSBACH
REGISTER OF WILLS
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REV-1S48 EX AFP (12-95_
COMMONWEAL tII OF PENNSYlVANIA
DEPARIMENT or REVENUE
BUREAU Of INDIVIDUAL JAMES .
DEPT. ll06D1
IIARAISIURa, PA 11lla.0601
NOTICE OF INHERITANCE TAX
APPRAISENENT1 ALLOWANCE OR OISALLOWAHCE
OF DEOUCTlOHs.. AND ASSESSNENT OF TAX ON
JOINTLY "ELO OR TRUST ASSETS
DATE 10-07-96
ESTATE OF ALTOFF
EMMA
C DATE OF DEATH 08-23-95
COUNTY
CUMBERLAND
FILE NO. 21 95-0704
S.S/D.C. NO. 036-14-8394
ACN
96000112
CHARLENE HIMELSBACH
19 SCOUT LANE
HUMMELSTOWN PA 17036
REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
b.ount R...Uhd
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
R-{v=isiii-EX--AFP--ii1f:9Si------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-07-96
ESTATE OF ALTOFF
EMMA
C DATE OF DEATH 08-23-95
COUNTY CUMBERLAND
EILE NO. 21 95-0704
TAX RETURN WAS,
S.S/D.C. NO. 036-14-8314
(X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
96000112
FINANCIAL INSTITUTION. US SAVINGS BOND
ACCOUNT NO.
TYPE OF ACCOUNT, () SAVINOS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 12-01-91
Account Balance
Par cent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxabla Amount
Tax Rata X
Tax Due
23,757.60
0.500
11,878.80
.00
11.878.80
.06
712.73
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."
TAX CREDITS:
PAYMENT
DATE
DISCOUNT (+)
INTEREST (-)
RECEIPT
NUMBER
AMOUNT PAID
.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
IF TOTAL DUE IS LESS THAN .1. NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" I CRI. yOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
.00
712.73
25.53
738.26
INTEREST IS CHARGED FROM 05-24-96 TO 10-15-96
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
PURPOSE OF
HOllC,EI
PAYHENTI
REFUND (CR) I
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To fulfill the r.qulree.nt. of S.ctlon 11~0 of the Inh.rltance and E.tate Ta. Act, Act 12 of 1991. C12 P.S.
S.cUon 2140).
a.t.ch the top portion of thl. Notlc. and .uo-It with your p.y.ant to the R.al.t.r of wills printed on the
r.v.r.e side.
__ "eke ch.ck or ~.y order psyabl. tal REGISTER OF WillS, ACENT.
All p.y.ents r.c.lved .h.11 flr.t b. appll.d to any Int.r..t which .IV be du., with any r..elnd.r appll.d to the t...
A r.'und of a tl. cr.dit, which WI' not r.qu.st.d on the taM r.turn, .IV b. r.qua.t.d bv coapl.tlna an "Appllc.tlon
for R.fund of P.nn.vlvanla Inh.rltanc. and Est.t. T.M" CREV-1515). Appllc.tlon. ar. .vellabl. .t tha Office of
the R.gl.t.r of willa, any of th. ZI R.venu. DI.trlct Dfflc.. or bV calling the .p.clal Z4.hour an.werlna .ervlc.
nuab.r. for fore. ordering, In Penn.ylv.nla 1-800-562-Z050, out. Ide P.nn.ylvanla .nd within loc.l
U.rrhbUra are. (17) 117-109., 100' (717) l1Z-USZ CU..rlna I.pllnd OnhJ.
OBJECTIONSI Any p.rtv In Int.r..t not ..tl.fl.d with the .ppr.I....nt, allowanc. or dl.allowanc. 0' d.ductlon. or a.......nt
of t.M Clncludlng dl.count or Int.r..tJ a. .hown on thl. Notlc. .ay obJ.ct within .I_ty C60J d.v. of rac.lpt of
this Notlce bVI
--wrlttan prot..t to the PA D.p.rt..nt of R.v.nue, Bo.rd of Appe.18, D.pt. :810:1, Harrl.burg, PA 17121-1021, DR
--.I.ctlna to h.v. th~ ..tt.r d.t.r.lned at the audit of the .ccount 0' thl p.r.onal repr..antatlva, OR
__app..1 to the Orphan.' Court
AOtUN-
IS1RAllVE
CORRECTIONS,
DISCOUNT I
PENALTY'
IN1EREST1
Factu.1 .rror. dl.cov.r.d on thl. ........nt .hould be .ddr....d In writing tOI PA D.p.rt..nt of R.v.nu.,
Bur.au of Indlvldu.1 1...', Al1NI pa.t A.......nt R.vl.w Unit, DEPT. 210601, H.rrl.burg, PA 171ZI.0601
Phon. C717J 787.6505. S.. p.g. 5 of the bookl.t "In.tructlon. for Inh.rltanc. T.. R.turn for a R..ld.nt
D.c.dent" CREV.1501J for an ..pl.natlon of ad.lnlstratlv.lY corr.ctabl. .rror..
If any tl. dUe I. paid within thr.. (5) c.l.ndar .onth. aftar the d.c.d.nt'. d.ath. a flv. p.rc.nt C5X)
dl.count 01 th. t.. plld Is allowld.
Thl ISk t.. .ene.ty non-plrtlclpatlon p.nllty I. co.pul.d on the total 01 the t.. and Int.re.t .......d, and not
p.ld b.for. J~arw II, 1996, th. flr.t d.V .ft.r the and of th. t.. .~..tv p.rlod. Thl. non.p.rtlclpltlon
p~.ltv I_ app.alabla In the .... .ann.r and In the the .... tl.. p.rlod a. you would epp..1 the taM and Inter..t
th.t h.. bien .......d a. Indlc.t.d on thl. notlc..
Int.ra.t I. ch.rg.d b.glnnlng with flr.t daw 0' d.llnqu.ney, or nln. (,J .onth. and an. (1) d.y
fro. the d.ta 0' d..th, to the dlt. of pay..nt. T.... which b.c..a d.llnqulnt be fora January 1, 198Z
bl.r Inter..t .t the r.t. of .1. (6XJ Plrcent per .nnua cllculat.d .t a dailY reta of .000164.
All tl.n which b.c..e d.lInqu.nt an or .tt.r Jenu.rw I, 1,8Z will bur lnt.r..t .t . r.t. which wUI vary 'ro.
cal.ndar v.ar to c.lendar y.ar with th.t r.t. ennounc.d bV the PA D.p.rt.ant of R.v_nul. The appllcabla
Intare.t rat.. for 1'1: through 1996 ar'l
~ Intarnt R.t. Dally Inter..t r.etor Vear Inter..t Rate D.lly Jnt.r..t F.ctor
19a: zoX .00050\1 1911 .X .0002"1
19as lOX .OOOUI 1981-1991 lJX .000SDl
1914 IU .000501 199: 'X .000247
1985 UX .000356 1995-1"" ]X .00019Z
19a6 lOX .000274 1995-1996 'X .00DZ"1
ulntara.t 11 c.lcubt.d O. follotl'l
INTEREST a BALANCE OF TAX UNPAID X NUNBER OF DAYB DELINQUENT X DAILY INTEREST FACTOR
--Anv Notlc. I.,ued .ft.r the taM b.eo.e. dellnquant will r.fl.et .n Int.r..t c.lculatlon to flft.an CIS) dlw'
b.yond the data of thl .""'.Int. If p.v.ant I_ .ad. .ft.r the Intere.t coeput.tlon date .hown on the
Hotlc., addltlonal Inter..t au.t b. calculat.d.
JRD/June 30, 1992/17858
-
-
REGISTER OF WILLS
Cumberland County Courlhnuse
One Courthouse Square
Carlisle, PA 17013
NOTICE pURSUANT TO RULE 6.12
PENNSYLVANIA SUPREME COURT ORPHANS' COURT RULES
To: Personal Representativc
Counsel:
CHARLENE HIMEI,SBACH
RE: Estate of EMMA ~L'l'OFF , Deceased, Lote of
EAS"l t'~NNb"Ul<U J.Wl"
Estate No,: 21-1995-704
Date of Decedent's Death: 8-23-95
Pursuant to Rule 6.12, the abovc named per~onal representative or the abovc named attorney, if
applicable, within two (2) years of the decedent's death, and annually thereafter until administration is
completed, is required to file with the Register of Wills a Status Report as required by Rule 6.12, in
sub5tantially the prescribed form, showing the date by which the personal representativc, or attorney, as
applicable, reasonably believes administration will be completed. The purpose of this Notlcc is to advise
you that unless the requisite Status Repon Is filed with the Register of Wills or Cleric of thc Orphans'
Coun, as appropriate, within ten (10) calendar days after thc date of this Notice that the Register of Wills
is required to notify the Orphans' Coun Division, Coun of Common Pleas of such delinquency and to
request that said Coun conduct a hearing to detennine whether sanclions should bc imposed upon the
delinquent persooal representative and the delinquent personal representative's counsel, if any.
Accordingly, if the requisite Status Repon Is not filed by 10 - 8 , 19:!...7 you are hereby
advised that a request will bc submitted to the Coun in accordmce with Rule 6.12.
Dale: 9-23-9'1
Distribution to Estate File
.. i.. ..
Ii
C
STATUS REPORT UNDER RULE 6,12
Name of Decedent I
Emmf!l r.. AIt:nFF
Date of Deathl
PA Fi~e #2195-070*
Fi~e #1995-0070*
Admin. No.
AUgURt: i::l,1'Uillii
Will No. N/A
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estatel
1, State whether administration of the estate is complete I
Yes \( No
2. If the answor is No, state when the personal
representative reasonably believes that the administration will be
complete I N/A
J. If the answer to No. 1 is Yes, state the followingl
a, Did the personal representative file a final
account with the Court? Yes No .A lina~ account wa4 li~ed with
the Ollice 01 Chiel Caunce~,State 8uneau al lnhenitance Tax,
b. The separate Orphans' tourt No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes x No
A~~ Hein4 01 the e4tate wene ~iven the appantunitv to examine aLL
in" d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
ALL State lnhenitance Taxe4 have 6een paid in lu~L, and hein4 havc
cd aLL account in, and pivcn capic4 il ne~ue4ted.
Date: n,...."h..,.. 7 1997
. Signature
~-?J. ~~J-
ChanLene 8, HimeL46ach
Name (Please type or print)
accaunt-
ne.vl,e.w-'
r'-I
','...
c::
19 Scout lane.HummeL4tawn,Pa. 170]6
Address
,--
I. .~
(7/7)566-96*9
Te I. No.
I..:
i"..
"
Capacity:
Personal Representative
,/ f1dmini4tnix
Counsel for personal
representative
, .
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O(j
(MAHlrmf/AMJ)