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HomeMy WebLinkAbout95-00781 ;" ~;.~!'~' "'.,- >~<-, O. :-;.. ..L:..:.... -' -, ..~ " '., -'. 'Z , ~ '. . ,.' "",~ i~;~~~ ._..,..;1< '~-(t ;;k,~~ _,~ ",:..,f~. I!' ;.- :<,. J.; ....1. , :';ii .~'~:.(r~ 't~ / j-I, / INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) IUY.l ~OO U. 17.Q41 , z 51 .. ~ E 2 c u ~ .. *' COMMONWfAlTH 0' PfNNSoVlVANIA OEPARTMENT 0' REVENUE DfP, 2'0601 HAUISlURO. PA 171"-0601 DECrDINr'. NAME (t...". flUT. AND MICOll: INIIIA'I .. ili III III CO MI ER KATIIRYN D. 10CIAL neURIll' NUMIU DAn or DUoTH 207-09-1735 07-20-95 I" "'t\1CA1UI IUI\'I'I'INQ 'POUlt', ,....IIILAII, ,.,.. AND MWOlllNll/Aij W l- . oe", tla:~ IoU~CI =..~ U...'" ... oe e9 I. Original ROlurn rol DAm 0' DIATH Ami 12131191 CHICK I " A SPOUSAL 0 POVllfT CIIDIT IS CLAIMID flU HUM." ~I COUNlY CODE o C DEN' C rt ADDUU J /qq5 YEAR lil NU.' 144 15th Strl!l!t New Cumbl!r1and, PA 17010 Co Cumberland AMOUNT UCfIYID (UIINII.UOIONI! DAfl or Illl" 04, 06, Umif,d eslal. o 2, Supplomonlal Rolum o 3. Romalndor Rolum lIar dOlo. of doalh prior 10 12.1: 0.5. F.d.ral ESlat. Tax R,'u,n Rlquir DAD. Futur. In',,.,, Comproml.. (far dOlO' of dealh aho, 12,12.821 Olcld,n, Di,d rl"al' 0 7. O.cld.n' Maintained a Uvlng Tru.t (Allach copy of WillI (Allach copy 01 Trusll ALL CORRESPONDENCE AND CONF/DENnAL TAX INFORMAnON.SHOUUJ:BE:DIRECrED TO, .. NAMe COMI'LUe #MIUNO ADO.US Stone LaFaver & StOOl! P.O. Box E er1and PA 1707 0101- ...ili "'co "z BIC z co S ~ III ... 1. Roal Ellalo (Schodulo AJ 2, Slack. and Band. (Schodulo al 3, Ca.oly Hold StackJPann."hlp Intoroll (Schodulo q 4, Mangago. and NOlo. Rocolvablo (Schodulo OJ 5. Cash. Bank D'polh. & Mile.llan,oul Plnona' Prop.rty (Schodulo EI 6, Jointly Ownod Praporty (Schodulo F) 7. T,an.lo" (Schodulo GJ (Schodulo II 8. Talal Grall Allol. (10101 Uno. 1.7) 9. Fun.ral Explnl", AdmfnlstrativI Co.t., MhClllan,oul Expon.o. (Schodulo H) 10, Dobl., Mangago Uabllitlo., Uon. (Schodulo IJ 11. Talal Ooducllan. (talal Uno. 9 & 10) 12. NOI Valuo of EllatolUno 8 mlnu.lIno I1J 13. Charllablo and Gavemmonlal aoquo," (Schodulo JJ 14. Nol Valuo Subfoct 10 Tax (lIno 12 mlnu.lIno 131 15. Spau.al Tran.fo" (far dOlO' of doalh ahor 6030.941 SI' '"Urudlon. lor Appllcabl. P,rc,ntag. on R.nrt. Sldo. (Indudo valuo. lram Schodulo K or Schodulo M,I 16. Amount of Un. 14 la.abl. 0' 6% rat. (Indudo ualuo. Iram Schodulo K or Schodulo M,I 17, Amaunl 01 lIno 14 raxablo at 15% raro Ilncludo valuo. from Schodulo K or Schodulo M,) 18, Prlndpallax duo (Add lax from lIn.. IS, 16 and 17.1 19. Crodlll Spau.al Pavori)' Crodll P,lar Paymonll _ 8. Tolal Numb., of Safe O.pcnil Be (11 (2 ) (31 (4 ) (51 (6) (7) ~ "t~??n ?n 40,616.17 + + 20. "Uno 191. groolor Ihan Uno 18, onlor Iho dlfforonce an lIno 20. Thl.l.,ho OVERPAYMENT. &! O."rr::r.I~t"lllolll_''''I'.'I.'''.''''I''<J.'II'h.f.(ilrrr:r:II'':'I.'J:'I''.tl'~"'.UJ..l'~11 21. "Uno 181. groalor than lIno 19, onlor Iho dlfforonco an Uno 21. ThI.I.,ho TAX DUE. A. En'., the In',re.' on the balanc. due on Un. 21A. a. Enlor Iho 10101 of lIno 21 and 21A an Uno 218. ThI.I. Iho BALANCE DUE. Mako Chock Payable 101 Rogloto, of Will., Avont >- BE SURE TO ANSWER ALL QUESTIONS ON RlVERSE:SIDf(ANIlTD. REOfECK MATH olI( nd., plneUI.. of p.rjury, I d.dor. that I hay. uomin.d ,hi. re'urn, Including accompanying .chedule. and Itot.men'., and 10 Ih. bll' of my .nowledge and b.li,' I II 'rue, correct and campl.r.. I d.c1ar. rha' all r.al ."ar. ho. blln r.pan.a at tru. market valu.. O.dararJon of pr'par.r orh.r than ,he p.nanal repr...nfall"'. alld on all information of which prepar.r hat any lenawl.dg.. laNA' II El' 'USON JlU'ONSI 1 '0. IILIN II IN ADORUS OArf 144 15th St., New Cumbl!rland, PA 17070 /() _( + "),' e;))l t;. tJe-./("",Q,~~. f'.A, "}~:ro 0"'0' I~,?f (91 (101 'nJ C;'1 nn (81 (ll) (12) (131 (lAJ (151 (161 (17) x.__ ~11. 1'1 17 )( .06. " .15. (18J DJacount $99.97 'n,.,..t (19) (20J (21J 121AI (2IB) ".':' . ....:. .' $101,R1fi 17 10.~11.00 33,323.37 33.323.37 1 QQQ 1.00 1.999.40 99.97 1,899.43 $1.899.43 Ad #48 of 1994 provide. for the redudlon of the tax rate. Impo.ed on the net value of tronde,. to or for the u.. of the .pou.e. The rate. a. pre.crlbed by the datut. will bel e 3% (,OS) will be appllcabl. for edate. of decedent. dying on or after 711/94 and before 111/96 e 2% (.12) will be applicable for e.tate. of decedent. dying on or after 111/96 and before 111/97 e 1% (,01) will be appllcabl. for e.tate. of decedenll dying on or after 111/97 and before 111/98 e 5,.___ tran.f.,. occurring on or after 1/1/98 will be exempt from Inherltanc. tax. PLEASE ANSWER THE FOLLOWING QUESTIONS 8Y PLACING A CHECK MARK (,..-) IN THE APPROPRIATE BLOCKS. YES NO 1. Old decedent make a transfer and: x a. retain the use or Income' of the property transferred, ....................................................... b. retain the right to designate who shall use th. property transferred or it. Incom., ............... x c. retaIn a revenionary Intere.t; or ................................................................................... d, receive th. promls. for life of either payments, b.nefits or care9....................................... 2. If c1...h occurred on or before December 12, 1982, did decedent within two y~ars preceding death transfer property without receiving ad.quate consld.ratlon9 If death occurr.d aft.r Dec.mber 12, 1982, did decedent transfer property within one y.or of death without receiving adequate. consIderatIon'..... II... I........... It_..... .,. II.. II... II' ... II .... ..... II.. ....,. II, II ... II ... ..... II.. II ....... x 3. Old dec.dent awn an""ln trust fort bonk account at his or h.r d.ath9.....,..........................,..... x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESr YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. (1- l-L. , ~ ." .,J -J (.)(, . SCHEDULE E CASH, BANK, DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTATE OF FILE NUMBER Kathryn D. Miller ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATII I. PNC BlI11k.BurlaJ Reserve Acxounl No. 1143280179508, Prine. $3,211.45. Inl. $8.75 $3.220.20 $3 220,20 SCHEDULE F JOINTLY-OWNED PROPERTY I nLENUMB'. ESTATE OF KATIIRYN D, MILLER JoIDl.......I(.) NAME ADDREllS IIEIATIONSIIIPTO DECEDENT A, Alice M, Kowo(ch 144 ISUI Stn:cl, New Cumberland, PA 17070 doughlcr B, C, JoIDlI1......... proptri7t LElTER ITEM fOR DATE DESCRIPTION OF PROPERTY TOfALVALUE DECD'8 DOLLAR VALUE OF NUMBER JOINT MADE OF ASSET 'MoINT. DECEDENT'8INTEREST TENANT JOINT I. A 01-01-78 PNC Bank-Inlezest ChcckJng No, S140043S74, Prine. $4S7.01, InL $ 4S7,48 SO% $, 228,74 $.47 2, A OS-12-92 PNC Bank-CCn. oCDcposit No. 1143270lS4182, Princ. $7,000.00, $ 7.081.89 SO% $ 3,S40,9S OS-04-94~ Inlczest $81.89 3. A PNC Bank-Ccn. oCDcposit No. 1143240179S06, Ptinc, $7,467.32, $ 7,486.62 SO% $ 3,743.31 1nlezest $19.30 4 A 10-18-94 .. PNC Bank-Cen. oCDcposil No. 1143270182038, Princ, $2,SOO.DO, $ 2.S01.34 SO% $ 1,2S0.67 Jnlczest $1.34 S. A 02-OS~4 All that cel1aln trnct oC land situate In the Borough oC Ncw Cumberland, County oC Cumberland, and Stale oC PcnnsyIvnnJa, being the same * Rollover pzemlscs whlcb KaUuyn D. Mi11cr, of CD 1143270154182 open widow, by her deed doted February more tha one y ar prior to death. S, 1964, and recorded February 7. 1964 in Cumberland County Deed Book C-21. Poge S24, grunted and conveyed unto KaUuyn D, Mi11cr and Alice E. Kowatcb, os Joint Tcnnnts wI the right oC survivorship lIDd not us Tenants in Common. The said Katluyn D. Mlllcr being the dcccdcnt herein. Assessed valuc timcs CLR 46S0 :< 13.70 $63 70S.00 SO% $31 8S2.S0 TOTAL (Alto enter on line 6, R<capilulalJon) $40,616,17 - ed ',;I.,." I'NC lIank, N,A, UI:'!C:'ulh.h'11iL.t. ('UIlI' 11iI1.I'A 17011 PNCBANK. August 8, 1995 To Whom It May Concern: As per your request for information on accounts the referenced decedent held with us, the information follows on the attached sheet(s), If I can be of any further assistancet please f.eel free to contact me at (717) 730-2321. Sincerel~_ . () L5tC:tt::. /..(. ,,,,aW-/ Edith Tancil Miscellaneous Services supervisor Bank operations ET/mky DECEDENT NAME: DATE OF DEATH: SOCIAL SECURITY NO.: Kathryn 0, Miller 07/20/95 207-09 1735 TYPE OF ACCOUNT: ACCOUNT NUMBER: NAME(S) ON ACCOUNT: Certificate of Deposit 1143270154182 Kathryn D. Miller Alice M, Kowatch DATE OPENED: DATE OF DEATH BALANCE: ACCRUED INTEREST: INTEREST PAID YEAR TO DATE: OTHER INFORMATION: 05/12/92 $7,000.00 $81,89 $211.74 TYPE OF ACCOUNT: ACCOUNT NUMBER: NAME(S) ON ACCOUNT: Certificate of Deposit 1143240179506 Alice M. Kowatch Kathryn D. Miller 05/04/94 $7,467.32 $19,30 $236,34 DATE OPENED: DATE OF DEATH BALANCE: ACCRUED INTEREST: INTEREST PAID YEAR TO DATE: OTHER INFORMATION: TYPE OF ACCOJi'JT: ACCOUNT NUMBER: NAME(S) ON ACCOUNT: Certificate of Deposit 1143280179508 Kathryn D. Miller Burial Reserve Account DATE OPENED: DATE OF DEATH BALANCE: ACCRUED INTEREST: INTEREST PAID YEAR TO DATE: OTHER INFORMATION: 05/04/94 $3,211.45 $8,75 $107,03 STOCK INFORMATION CAN BE OBTAINED FORM CHEMICAL BANK AT 1-800-982-7652 nOOK C. 21 rM;E ~21 .mt!i~ r ",~IHII'II.:rrrc~ or lHi 111 ~ tt\l';';~;: :;"fm !lubf t~f .5th day 01 February Lord one thou8and nine Imndred and sixty-four (J.964) ilftwffn KAnlRYN D. MILLER, Widow, 01' the Borough ot"New"Uuinberland, County 01' Cumberland and Btate 01' Pennsylvan1.a, ORantor. CUII~!.1 '..','.\' (I,UlIlr rEllin\tlw1llear 01 our A N D KA'lliRYN D. MILLER, Widow, 01' the Borough 01' Nelf Cumborland, County 01' Cumberl.and and Btate 01' Pennsylvania and ALICE E. KO'vTATaI 01' .Teet Chostor, Pennsylvania, as Joint Tenants with the right 01' surrlvorship and rot 8S Tenante in Col11mJn. .itnfllSft~, that in con8ideration o( One Dollar ________________________ -------------------------------($J..OO)___________________________________JDollars, in hand paid, the receipt whereo(is hereby acknowledl!ed; the said Gr,!ntor do. es heraby I!rant and convey to the said Grantee s their Hetrs and ,4s8ttnl, All that oer~in traot 01' land situate in the BoroUgh 01' Ne~r Cumberland ( 1'onnerly Lower Au.en Tounship), County 01' Cumber111lxl, and Btate 01' Pennsylvania, more partiouJ.arly bounded and desoribed as 1'ollo~ls, to Witl _ BEGINNING at a point on the South s1.de 01' Fifteenth Street, whioh point is six hundred sixty-six (666) feet from the southeast corner 01' Bridge Street and Fi1'teen_ th Street, at the corner 01' lot owned by Osoar Steger; thence eastwardly along F:1.fteenth Street, one hundred (J.OO) feet to a point. the property 01' George lofowrey; thence soutlmardly three hundred seventy (370) feet, more or J.ess, to land rmr as lots 01' W1llets Estate; thence westwardly aJ.ong said land one hundred (100) 1'eet, more or less, to said lot 01' Oscar Steger; thence nortlmardly along said lot three hundred sixty (:360) feet, Hlore or less, to Fifteenth Street, the place 01' BEGrmlIlIG. Improved ~r.l.th a -brc story brick house, ch:1.cken house and other outbuild:1.ngs. BEING the same l'rem1ses which RusseJ. B. Updegraff, singJ.e man, by Deed dated February 21, J.9Lf.J.., and recorded in Deed Boole ''HII, Vol. J.2, Page 131, granted and conveyed unto Jacob A. Brubaker and lUice B. Brubaker, h:1.s mfe. The said Alice B. Brubaker pro-deceased the sa1d Jacob A. Brubnker, who died April 23, 1948, having first made a Last Hill and Testament, now recorded in I"'ill Boole 4.5, Page 277, wherein he devised the above reaJ. estate to Kathryn D. Hiller, Grantor herein. '!HIS IS A TRAlISACTIOII betweon parent alx! ch.1.ld without conaideratton. "1111 the said Grantor JVill JVal'l'ant generaUy tlw property horeby conveyed In BIIII'II11 JlI~rrrnf, .9aid Grantor the day and year first abo/le written. has hereunto sot her hand and seal A/~: ,..- .Itl~ ....~;'thryn n. Hiller (--j "..-/ -"'-- --"--- QlllmmlllUU,.l1~ IIr ",nIIJullllllll G1l1llntUllr ommERLAND appeared 5th day 01 February .'1, I), Jl) 64 , lwloro 1110 a Notary Publio Iho IIIHlcrsll!lled uRloflr, /ler8ollall" Kathryn D. H1ller kllOWIl tu me or (8at/slaetorlly proven) to be the /lerBon whoBe lIame is BullBOrllJccl!o the lI'If,/II/lil/8t rltment, ami aoklwwledted that Bho oxeouted tho Bamo lor UlCll/lr1JUNC!8 thoroin eOlltallwd. III .'tnrJlJl.~rrrllr. I hereltltto Bot my llC11lf1 ami Offill al N ,ClI,~ . .." ""1(' . ......... ..... .......................'A: ,."-,,,:,. ttU. . .0.... \\ U " .11'. lOtI r I'r,' r' I' ", "I...~'I> .. ...' . , I .. I."',." '~, It. 't t'JG" ..., . . ' .;~s .... . .~." I ~, I.'.. it'...~" t. . () ...................,..I(j....'......'............\...''/;'.....'.....'....II"':.~ I. TIlle'of Offlcer' , "", -~[V. ~'~,"'~ ':':'11. ~ '1' ~ .. . \.,. :1 Vl... . , l<". ,.("~,, A' ...... t.. .. ., . \.- ...~ '. ., c. . - - (' , 0#1 . . J. .1',1 t. C. fl, ~. '~l '. ""'., ,.. .. J: ",,,," ....... ',' '. :;;"~' ',' '..... .,y. , .'t.... " . , ' On this, the I lIrrrbu G1rrUrU, thut the /lr(!oi,~e rflilid;flnc(J of tho G1'IIIltco . 144 F'l.:rteenth Street, llew Cumberland, Penns:/.I:va a. , .... .'. 11 ' , t ............... .................. .,t... .... I ~"i'f ."... ", ." t . I'. : -" "\ -...... . .~... . ,. .". Bon"" C. ~". .'lli.,ll ~...' I " ;," I l., .-" , " ~ ..'t..... j Go(., ~..-.:. 1l ~~ ~ ~ ~ts~~~ ~ ..... ~,~,,~ 2: m ISW.8 m~ffi~ OQ J , ,I><: f1 ~ r-l t:I I=l ra1 i '&:J ;;: I , I.: ... I).:) ~ 1'" '~ .;t Ie) l~i~J ~ f" :--,:. .("' ~ ;.' '!~ r..- ,. ,) 2: r~ : 11 o;aUl I.:. ~ ":> l'll o ~.) Ul.~ :";lce.., ~ C1I ~> a z G1l1llU1U1nm,.lt~ or 'rnMululntl } G1I1UntB of &.v.~ -."- ~ <- /J~.t JIll. '1ii -:::L~ Recorded on this '1 day 01 7'~ ,on .11. D, 19 ''I, in the Reoorder'B OjJ!oe 01 tho Baid COUllty inDeedBook I.;., Yolume .'2 I Pal!e 6 ::?~ Given under my hand and tho Beal 01 the Baid Ofl1.oe, the date above written. 800KQ.. 21 rAGE 525 ,..,/i._ P~.~.......Reoorder . SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES - I FILE NUMBER ESTATE OF Kallllyn D. Miller ITEM NUMBER A. DESCRIPTION AMOUNT Funeral Espenlel: Stonc &. Murray Oingrieh Memorials $4598.00 99.00 I.. 2. Admlnlstrallve Costs: B, Penonal Representative Commissions Social Security Number ofPelSOnaI Representative: Y car Commission paid 1. $2,191.00 Auomcy Fees Stone LaFaver &. Slone 2. Fnmlly Bxcmption 3, Clalmant Alice M. Kownteh Relationship dauehter Address of Clalmanl al decedent's dcntl1 Street Address 144 15lh Street City New Cumberlnnd Stale PA Zip Code 17070 $3,500.00 4. Probate Fees filing Inheritance Tax &. Inventory $ 25,00 C. Mlscellancous Espenses: $ 100,00 1. ResoIVC for closing expcnses 2. 3. 4. 5. 6, 7. 8, 9, TOTAL Also enler on line 9 Rcca ltuJation $10 513.00 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND O{/- r; 6 - '7.F/ I J u: being duly All ee N. KOWll teh sworn occordlng 10 low, depolel ond IOY' Ihat Mhe 1M till! of Ihe Ellale of Kllthryn IJ. Niller lale of __New. Cumbcrl.l!pd._ .. --.- -_.. , Cumberland County, Pa" docealed and that Ihe wilhin il on Invenlory made by. Alice N. Kowatch ., the lOid of the onllre ..Iato of laid decedent. conlllllng of oil Ihe pe..onol pro".,Iy and reel ..tate, except reel estote ouhide the Commonweallh of Pennlylvenio. ond Ihol the figure I oppollle eoch lIem of the InYentory repr..ent 11', foir yoluo .. of the dote of decedent'l dulh. 19 (~.:m 7z:.U/lhh" encutor . Aclmlnhtrator and ,ub,cribed befo,e me, 144 1 ~th Street New Cumberlllnd, PA 17070 Addr... Date of Death ?O DIY 07 Month 95 Yea, INSTRUCTIONS I. An inventory must be flied wilhin three monlh, after appolnlment of personal repreuntatlve. 2. A supplement Inventory must be filed within Ihirty daYI of dlscoyery of addillonal a..oh, 3. Additional sheeh may be attached as to personally or rulty 4, See Article IV, Flduciarl.. Act of 1949, ~ .,; W D M ~ '" I- .. w i:5 .. "" U D 0 .. 0 W 1I1 C '" '" '" w .. D I- :I: "" u. .,; "" E I- ,.J Z ,.J ~ 0 "" 0 u. =: w 0 -< :i- -< > Z '" Z 0 c: C " 1I1 Z 0 0 '" U z I w -< ... "" " c: .. I - -.: I 0 .. .0 d .. E " " - " ..!l .. ,.J U u: Inventory of the real and personal estate of Kathryn n. Mi 11 flY" deceased PERSONAL PROPERTY 1. PNC Bank-Burial Reserve Acct. 01143280179508, Principal $3,211.45, Interest $8.75 3,220 20 REAL PROPERTY NONE ',',. i' <,. \ !r.\ u~, :n -;:1 e- ' ,~ Q .' S -i' -' OJ:) c { , . " .~.. "C" B 0- ,. ;}... ;~;!-';; . ....~ ~.. " /5 - c,~;l - / (y~ .J RI!V-1547 I!X AFP (12-95* CO...OHWUL HI Of' POlfSnVAHIA O[PAATHE"' Of' RfVOIJt: IURfAU OF INDIVIDUAL TAXU DEPT. IID'Dl HARRIIIURO, PI 171"-.'01 ACN 101 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT DF TAX DATI! OZ-12-96 FILl! NO. DATE OF DIlATH 07-20-95 COUNTY CUMBERLAND HOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SU8llIT THE UPPER PORTION OF THIS FORN WITH YOUR TAlC PAYHENT TO THE REGISTER OF WILLS. KAME CHECX PAYABLE TD "REGISTER OF WILLS, AGENT" REMIT PAYMENT TOI DAVID H STONE 414 BRIDGE ST NEW CUMBERLAND REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PA 17070 -.nt R_lUMI CUT ALONO TMIS LINI! ... RI!TAIN LOWER PORTION FOR YOUR RECORDS ~ iiEY:i54'-ix-AFP--nz:95riliiiici--ciT"itl'HiiiifANcE-TAx-'jiPPRirisiHEili'-,--AL'LciiiANcE-oR'--------n------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX I!STATI! OF MILLER KATHRVN D FILE NO. ZI 95-0781 ACN 101 DATE OZ-IZ-96 TAlC RETURN WAS' I X I ACCEPTED AS FILED C I CHANGED RI!SI!RVATION CONCI!RNINO FUTURE INTI!REST - SEE REVERSE APPRAISI!D VALUI! OF RETURN BASED ONI ORIGINAL RETURN 1, R..l E.t.t. ISchedul. AI 111 2. steck. end Bond. ISchedul. al C21 5. Clo..ly Hald stock/Partnarahlp Int.r..t (Schedul. C) (5) 4. teartgavel/Kohl Receivable (Schedul_ D) (4) S. C..hlBank Dapollta/Hllc. Parlonal Property (Schedul. E) (5) 6, Jalntl~ Owned P~oP.~t~ ISchedul. FI C61 7. Tran.fara (Schedule g) (7) 8. Tot.l A...t. .00 ,00 .00 .00 3.ZZ0.20 40.616,17 .00 ISI 43,836.37 APPROVED DEDUCTIONS AND EXEMPTIONS, 10,513,00 9. Funeral ExPln.../Ada. Coat./Hilc. EMP~'" (Schedula Hl (,) 10, Debt.IHortG.O. Llebllltl../Llen. ISchedul. II CI01 .00 11. Tot.l DeductIon. 1111 12. Nat Valu. of TaM Raturn (12) 15, Ch.~lteblo/00ver".."bl aequ..h <<Schedule J) 1151 14, Het V.lue of E.t.t. Subjeot to T.x 1141 NOT I! I If an asaaasmant was isauad praViDua1Y, 1inas 14/ 15 and/or 16, 17 and 18 will raflact figuras that includa tha total of ALL ra~urns assasaad to data. ASSESSMENT OF TAXI 1S. Aaount of Line 14 .t $pou..1 rata (5) 16. Aaount of Lln. 14 t.Mab1a at Llnea1/Cl... A rat. (16) 17. Aaount of Line 14 taMab1a at Co1lat.ra1/Cla.. Brat. (17) 11. Principal TaM Due In,~L'I no 33,3Z3,37 .00 33,3Z3,37 ,00 X .00. 33,3Z3.37 X ,06. .00 x.ls" Clal .00 1 ,999,40 .00 1,999,40 TAX CRI!DITSI PAYHENT DATE 10-19-95 DISCOUNT I + I INTEREST C-I 99.97 RECEIPT NUHBER AAOBZ242 AIlOUHT PAID 1,899,43 TOTAL TAX CRI!DIT BALANCI! OF TAX DUE INTEREST TOTAL DUI! 1,999.40 ,00 ,00 ,00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN .1, HO PAYHENT IS REQUIRED, IF TOTAL DUE IS REFLECTED AS A "CREDIT" <<CRI, YOU HAY aE OUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I i J( AlSOYATlOMI E.tat.. of decedenh ctvlng on or befora ~r 12, 1HZ ... if MY future lntar..t In the ..tata h tren.,.rred .n po.....lon or enJo,...,t to Cia.. . (collataralt beneflclarl.. of the decedent aftar ~ a.,lrat.on of en, a.tata for ll'a or 'or ~a.r., the C~alth ~reb, akPra..I, ra..rv.. the r.ght to ."ral.. end ...... tran,'.r I~rlt~a T.... at ~ IINful C.... . (collat.r,lt rat. on any .uGh 'utura .nt.r.,t_ _Of NOnCEI To 'ulflll the r..,lrNant, 0' SecUon 2U. 0' ~ lmer.t-ne. .... Elt.t. T.. Act, Act U 0' 1"1. 7Z P.S. leatlon U40. PAMHTI DetKh the top portion of thh MoUc. and "'-It ..Ith your pa,...,t to the R....tar 0' "IUa pr.nted on tha r.v.r.. .Ide. "'"_a check or 110M' ordn p.V..... tOf REGISTER OF MILIJI, AD'EHT AU ,.panh rec.lvMt "'U f.nt be applied to .." Int.r..t Wh.ch NV he due ..Ith ."w r....ndar ...lIad to tha tlM. RUUHD CCRh A n'~ of I t.ll erMtIt, Mhlch .... not r....ted on ttMt TaM Raturn, .., be r.....ted b, CCMlPI.Ung .. ....lIcatlon 'or R"~ of PemnIVWI.' Inherltanca end E.tata hllOO CREV-UIJ). Application. .r. .vallabl. .t the Office of thl R'llItar 0' Wllh, ..,v 0' the IS R.venua DlItr.ct O".c.., or bW c.U.,., thl 'PHI.. 14.hour M....rlng ..rv.c. nullblin for 'or.. orderl,.,1 In Pann.vlvanla l-100"361-I05D, ouhlet. pann'Wlvan.a and ..lthln local Harrl~rl ara. (117) 111-1094, TDD' Cl11) 111.Z152 CHaarl.,. I.,..rad Onlvt. OBJECTIONS I AnV Plrt, In Intlra.t not ..th"ad ..lth U,. apprah..-nt, .11OManca or dh,UOManca 0' deduction., or .....nent of till (Including d..count or .nt.ra.t) a. ahown on th.. Notlea au.t object ..Ith." .llItv C'D) ct.v. of reca.pt 0' this Notle. bVI ......rltten prota.t to the PA o.parhent 0' R.".,."., Board of ~.h, Dept. 111111, "'rrlaburll, PA 11nl-IIU, OR --aIHtlon to hlYII the ..ttar detar..nad at IlUdIt 0' the account Df the pIIt10nal rapr..antaUv., OR ....,..1 to the Orphan.' Court. AOftI" IITRAnllE CORRECTIONSI I HTDtfIT I ,..tuel arrorl dheovlrad on thh .........,t Ihould be 1Idd,...~ In ..r.Una tOI PA Depart...t 0' Rev."",., Sur.1Y of Individual rail", ArTHI Po.t A........,t R.vlew un.t, Dept. l1D601, Herrl.burg, PA 17.ZI.060. Phona (117) 117-6105. 5.. p... S 0' thI bookl.t .In.tructlon. far Inheritanca ra_ R.turn 'or a R..ldent Oac~t. (REV..511) for an allplanet.on 0' ~.n..tr.tlv.lv corraotlb.a arror., If MV t._ due II paid ..Ithln thr" (,) cal",. Mintha aftar tt. dac...,t.. dMth, . flva parcent fiX) d.acou1t of the tax paid II ,"owed. Int"..t II dMIrgad bag.mlna ..lth flrlt da, of ct.lIf1qU1f'M:V, ar n.ne C') Hnth. .Mt ana U) dQ froe the Ata 0' death, ta tM ct.t. 0' pa,...,t. Tu" MII.ch bac_ delinquent bIIfa" J..." I, l'ez bear Inti,." at tha rat. of .11I (61) ~rcant par WW'IUI calcul.ted .t . daU~ ,.ata of .0101604. AU t.... which ~ delinquent on and .ftar Januarv 1, .911 ..... bur .ntar..t at . rat. Mhlch ..Ill vary fr. ca...r ,..,. to calandar VMr with that rata ..-need bw thl PA Depart..". 0' R.v...... Tha appllC8bl. .nta,.., rat.. 'or 191Z through 1"' .ral DISCOUNT I '!!!! Intlr..t R.ta D..lv Int.ra.t 'actor !.!!!' Int.,..t A.ta DIU, Intltl.t Factor 1911 ZDX .100141 1917 'X _ Glnu 1'15 lOX .0OOoUl 1911-19f1 lIX .101S0l 1t14 IlX .000301 .". 9X .aGUU .915 UX .000356 l"I-I9M n .aGOl'2 It.. lOX .DDDZ14 ."5.1'" 9X .DlnU ulntar..t .. c..cu..ted II fallCMilIl INTEREST . BALA"CE OF TAX UNPAID X HUKBER OF DAYB DELI"QUEnT X DAILY IHTEREST FACTOR ".Anw Hat.ca ...UId .,t.,. the taM baco.a. del.nquent ..III r.f.act In .ntar..t calculat.on to ,I,t.-n (15) day. beyond the dati of the .......-tt. If p.~t II ..... .ft., tM Intar..' .-puhtlon dlt. Ihowt on the Hotle., ~.tlonal Int.ra.t au.t be calcu..tad.