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",\",;':\:::c; . :'", II. i,,:,.:': ". -= ~ . .. .~;',i'> "" ... "'i~}".: ", C1J ',),,: . G) ,S' '. '., ~" '~:~> .; ".' . ....0 . ' '. .,r~.>,,;,:; ::~;~::'::.:; ,!,' 'i, .,<<' . ' .' ""::',>'Y'".. o ,'. ",:;..>;;, .".~:. :.' . .' . z . ~ - .~; ,e, '.. . ,':~ , " '~..' ";, ";.;;:~\ ;'."",:'y:::i;r.;.: :;,,': , ';:'" ',." 'C' '!}':"~;;: ~,~ . ;,il' :,~'," *: ,;:- I 't, . , ,'.' ,', I ~ - ,'l " . l _~! ;'~_.-- ~t~, f}-:i:, ',.J' ,-,:.; , .~ .'I'iBE'$URnO:ANSWERALL:QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH' Under plnaltlu 4i' perjury. I dedor. thai I have l.Ilomlned Ihlt '1Iur", Including occomponroing uh,dul.. and 11allmlnh, and 10 ,hi b." of my I,"owl.doe and b,li.f. II It truI, CO(...ct pnd compl.,.. I declor. thai 011 ,.01 .,latl has b..n repotled 01lfU8 moth' \lolul. Declaration of p"por., ath" thon the p."onol ,.p,..,nlall...1 I, balld on :lln rmallop;of which t.p hot an ~nowl.dg', ilONAlUI 01.11 . ~'o ( ., .lTu.t~ ACOIUS DAll , i ~~ 1552 Holly Pike, Cllrlisle, I~~ 171113 . J:t... :i. I '(l \ UII 0' If'A"1 HI tHAN ItIPlU ADO' US OAn V(,_.....' A.. ''7-0''--7 5 S. Hllllover St',~ll!llsle,JJi\ 17ll1:J )...<" AtV uoo II. l'lJ.1 ~ w:S"" ug:'" ~D9 ult"' "" I!.. I I I 1;1. ,,9.'~ ~A 'I, 6 . ~~ -> UP (OMMOI~WI"'IHI 01 '1IHIillV"'''IA 1I1P.U1MIUIOIIlI\lIHUI 1>1'1 1110bOI .j~'_.IU~~~,'A 111710601 V {IClIf~' t~A,",lllU II." Atlll ,",11)1111 Itll .AII 'OR DATlS 0' DIATII AnlR 12/31191 CHICK HIAI If A SPOUSAL . POVIRTY CAlDIIIS ClAIMID I 1 fill NUMBER d./ (OU,,'''' COOl OIUjj'fijT, (u,""iTTlA[)ll."\ INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) IQq.5 &lJ-~ l(AR UUMB(R I- if; lil u w c WEIIII,EY, CI,VIlE E. 15511 II oily Pike '0<12~":~;"~~'~;'~; ----~--I~~t':'~i~:;.~~;I;]-T~::r~:.;;;:;u26 CO"", Cllrl~:I~I;I::~II:I:(~I:J I" .......111 "..".." ",~" . ...;;"...,......,,-.;oi;;;-..~'."l -J.~li,,= [u".;. iiUiiii i. - -_,,-_ t"'j."i,~:' ~" ii, ."Ii, iiii."uif,6"-,,~- . (i( I. Oflginol R.IUfn [] 2 ~upplem.nlal R"ufn r J 3 Remainder R"urn I'of dal.. 01 d,alh pdOf 10 12.13.821 o A. lImil.d fllal. [] 040. fUIUft Inlef,.1 Compromh. r~] 5 F.defol fltol. Toa R.turn R.qulred If Of dot.. 01 death oft" 1'1.1'1.81) o 6. D.ud.nl Di,d Je.lal. IJ 7 D,c,d.n' Mainlain.d 0 Living Trutl (Attach copy of Willi (Attach copy 01 hUtl) 'ALL\CORRESPONDENCE AND CONFIDENnAL TAX INFORMATION SHOULO BE DIRECTED TO. .>'. "~';;''''','il>',F.'' "'~"i". eo',OIIIl MAiliNG ADO.ln 5 South HOllover Street Corllsle, 1'0 17013 _ 8 Tala I Numb.r of Safe D.potil BO"I :il15 "'c "'z fl~ Frey ond Tiley IlU'HON( NUMIU z c 5 E ~ u w '" 1. R.al Ella.. (S,h.dul. Al (1 I 2. Sta,k. and Bond. (Sch.dul. BI ( 21 3. Clo..ly Held StocklPortn.nhip Inl"..t (Sch.dule C) ( 3 ) A, MOfloag" and Not.. Recelvabl. (Sch,dule OJ (4 I 5. Ca.h, Bonk D.po.ih & Mhulloneoul Peuonal Property ( .5 I (Sch.dul. EI 6. Jointly Own.d Prap...y (Sch.dul. fl (61 7. Tran.I." ISch.dul. G)ISch.dul. II (71 B. Tolol Gran An." (Iolallln.. 1.7) 9. Funeral bp.n.... Admlnhlratlvl Com, Miu.llon.out (91 hp.n... ISch.dul. HI 10. D.b". MortgDg. lIobllili.., lI.n. (Sch.dul, II (101 11. Tolol D.ductlon. (torollln.. 9 & 10) 12. N., Volu. a' Ellot.lllne B mlnutUne 11) 13. Chorllabl. and Gov.rnm.ntol B.qu.." (Sch,dul, J) lA. N.I Valu. Sub.et 10 TOA lln. 12 mlnu. lIn. 131 15. Spousal Tron.'", (for dot.t of d.oth oft., 6.30.94) S.. Inlrrudlon. 'or Ar,pllcable Percentage on Rlv.n. (151 Sid.. (Indud. volu.. rom Sch.dul. K or Sch.dul, M.) 16. Amount of lIn. 1A 101lobl. 01 6% role (16) (Indud. valu.. hom Sch,dul. K or Sch.dul. M,I 17. Amount of line IA 10llobl, 01 15% role 1171 !lnclud. valu.. from Sch.dul. K or Sch.dul. M.I lB. Pflnclpal to.. duelAdd lox from Un.. 15, 16 and 17.) 19. Credit. SpolI.al Po....rty Credit P,lor Pcymen" Dhcounl Inl",.t 5,llOO.00 7.146.20 I B I 5.000.0ll 7,146.20 (2,146.2ll) (III (121 (131 (141 (2,146.20) 1(.__ K ,06 . K .15 a z c ~ .. 8 S (lBI (lql 120) + + 20. If lIn. 191, Oreoll' than lIn. 18, .nler the diff".nc. on lln. 20. Thl." the OVERPAYMENT. aD 21. If lIn. 18b greot.r Ihon lIn. 19, entlf the diff.,ence on line 21. Thi.II the TAX DUE. A. Enler ,he Inl.,.1I on the balance due on line 21 A. 8, Enler Ih. tolal of lIn. 21 and 21A on lIn. '118. Thl." Ih. BALANCE DUE. Make Ch.ck Payable tOI Regl.ter of Will., Agent Check helD if you 010 .equolling 0 refund of your ovC!.paymC!nl. (211 121AI 121BI ~.~r'~'7. ,"__,''W'7T :.&........~'::...-'..'..'.;-.: . ~ .~. tt . ~.:.....\ . , /i'/ \ " Act #48 of 1994 provides for the reduction of the tax rate I Impaled on the net value of tronolen to or for the use of the spoule. The ratel as prescribed by the statute will bel . 3% (.03) will be oppllcabl. for ellatel of decedenll dying on or oftor 7/1194 and before 111196 . 2% (.02) will be applicable for eltotes of decedents dying on or after 1/1196 and bofore 1/1197 . 1% (.01) will b. applicable for eltotes of decedenll dying an or after 1/1197 and before 1/1198 . Spousal tronlfers occurring on or after 1/1198 will be exempt from Inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK k) 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 the property transferred or Its Income, ....,.......... x X X c. retain 0 reversionary Interest; or .........................................................,......................... d. receIve the promise for life of either payments, benellts or care' ....................................... 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer f>roperty without receiving adequate consideration' If death occurred aher December 12, 1982, did decedont transfer property within one year of death without receiving adequate consideration'.,........ ......... ................ H.............................................................. x X X 3. Old decedent own an 'In trust for' bonk account at his or her death"'...........................,..,..... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~' ,. ItfY.UO:l U. ('-161 ~ COMMONW[AllH or P[NNSYlVANIA INItUIIANCl TA'll: .nUIlN '($ID[N' OlCIOIHI SCHEDULE B STOCKS AND BONDS ESTATE OF FILE NUMBER CLYDll E. WEIULEY (All p,op.rfy lolntly.own.d with RighI 0' Su,v/vorshlp mUll b. dl"lol.d on 5ch.dul. F.I ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 1 shBre Wykoff Run Campers Association, Inc. stock 5,000.00 TOTAL Allo ent.r on line 2, Reea Ilulotlon) (If more space i. ne.cI.el, inse,' oddif;onalsh..h o( Jome sfu.) S 5,000.00 .' .'YUII,.. 1'''1 ESTATE OF ITEM NUMBER A. 8. 2. 3. 4. C. 1. 2. 3. 4. 5. 6. 7. 8. ~:ifr. COMMONWUltH O' '(NN'n......W... INHUnAHCE tAX UIUIN IIUIO(Nf DfCrO[NI J SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES _ __ Ploa.. Print ar_~o ___,______1 FILE NUMBER CI,YDH H, IVmUI,HY DESCRIPTION AMOUNT 1. Funeral E.pon.... Hoffmon-Rolh Funorol 1101110 5,146.20 1. Admlnlltratlvl Calli' Porsanal Repro,en'ali.. Camml..lan, Social Secu,lty Number 01 Personal Reprollnlalivll Year Camml..lan, paid Attorney Fee. Family E.emplian Claimant Doris R. lVelbley Addro.. of Claim an' 01 decedenl" dealh Spouse 2,000.00 Relalian,hlp S'roel Addro.. 1550 Holly Pike Corllsle S'ale Pa. Zip Code 17013 City Proba'e Fe.. MII..llanoaul Expon.... TOTAL (Aha enlor on IIno 9, Recapltulolionl IIf mati Ipaco I. n..dod, Inll" additional .h.." 01 laml sI...) 7,146.20 s I; I -- l.'l, [, .J REV-1547 EX AFP 112-95* CO""OHWUl tit Of PENNSYlVANIA D[PARTHl:NT Of R[V[NlJ[ BURUU Of IHDIYID;JAl fAl([S D[Pf. lU60l It,lRRISlLRC, pa 171U-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIDNS AND ASSESSHENT OF TAX DATE 02-05-96 10-28-91 \. " ACN 101 FILE NO, COUNTY CUMBERLAND NOTE. TO INSURE PRDPER CREDIT TO YDUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAX PAYHENT TO THE REOISTER OF WILLS. HAKE CItECX PAYABLE TO "REOISTER OF WILLS, ACENT" REM:IT PAYMENT TO: FREY 8 TI LEV 5 S HAllOVER ST CARLISLE PA 17013 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 AMount Re.Ut.d CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~ i'iili:iSc,-j-E'lC"Fii-nZ:9rfj-iiii'ficE--ciF-YNHEiiii'ANCE-YA"X-iippiiiiisEHEii'r;-,U.i."ciiiANCE-oli----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WEIBLEV CLVDE E FILE NO. 21 95-0848 ACN 101 DATE 02-05-96 TAX RETURN WAS I (X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..I E at.t. (Schedule A) C 1) 2. Stocke and Bonde (Schedule 8) (2) 3. Clo..1~ Held stock/Partner.hip Int.r..t (Schedule C) 131 4. Hortg.g../Not.. Receivable (Schedule DJ (4) 5. C..h/Bank Depollta/Hllc. Parlonal Property ISchedule E) (5) 6. Jointly Owned Property (Schedul. fJ (6) 7. Tranafera (Schedule 0) (7) &. Tot.l A...t. APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Ewpen,../Ad.. COltl/Hiec. Expen... (Schedule H) (9) 10. D.bta/Hodg.g. llabiUti../Ll.n. (Sch.dul. 1) ClO. 11. Total Deduction. 12. H.t Valu. of TaM R.turn IS. Charit.bl./Gov.rnn.ntal Bequ..t. (Sch.dul. J) 14. H.t Va1u. of E.t.t. Subj.ct to T.M If an assessment was issued previDuslY, lines reflect figures that include the total of ALL ASSESSMENT OF TAX: 15. A.aunt of Lin. 14 .t Spou.a1 16. A~unt of line 14 takab1. at 17. Aaount of Lin. 14 takable .t 18. Principal TaM Du. NOTE: rat. Lin..l/Cla.. A r.t. Coll.t.r.1/Cl... Brat. USI U61 U71 TAX CREDITS: PAYHENT DATE RECEIPT NUHBER DISCOUNT (+) INTEREST I-I I CHANCED .00 5.000.00 .00 .00 ,00 ,00 .00 (BI 5.000.00 7,146.20 ,00 (111 CUI (131 U41 7,146 ?O 2,146.20- .00 2,146.20- 14, 15 and/or 16, 17 and 18 will returns assessed to date. .00 x,OO. .00 X .06. .00 X .15. UBI .00 .00 .00 .00 AHOUIIT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE .00 ,00 ,00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN Ii, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" leR., YOU HAY BE DUE A REFUND. SEE REVERSE SIDE DF THIS FORH FOR INSTRUCTIONS. I ... ~.. RESERVATIONI E.t.t.. 0' decedent. dvlng on or before Dec.~r II, I'll .. If any future lnt.r..t In the ..t.t. 1. tran.f.rr~ In po"....on or MJOV.....t to Cl... a (coUat.r.U __l1el.rl.. 0' tM McHent .ft.r the ..plr.Uon 0' anv ..ht, for II'. or for v..r., the Co..onw..lth h.r.bv ..pr."lv r...rv.. the right to tppr.I.. ~ ...... tran.f.r Jnharlt~. T.... .t the I~ful CI... . (coll.t.r.l) r.t. on any .uch future Int.r..t. PURPOSE OF NOTICE. To 'uIlUI the r.qulre.ant. 0' S.ctlon 21U of tM Inharltenc. 8nd Elt.t. T.1l Act, Act ZZ 0' 1991. 71 P.S. Sactlon ZI40. PAV~NTI D.tach the top portion 0' thl. Notlc. and .ubIlt ulth your p.v-.nt to thl R.gl.t.r 0' Will. printed on thl r.v.r.. .Ida. u"., ch.ck or IOMV ord.r p.vllba. to. REGISTER OF MILLS, AGENT All p.y,,"t. rae.aved .h.ll 'Ir.t b. appll.d to '"' Int.r..t which ..y be due with anv r...lnd.r ~llad to the t... REFUND CCR). A r.fund 0' at.. cr.dlt, which w.. not r.qu.st.d on the T.. R.turn, ..v be r.qu..ted by coaplatlng an Mlppllc.tlon for R.fund of Pannsvlvanla InhlrltBnCa and E.t.t. llAM CREV..)I)). Applications ar. avallabl. .t the offlc. of the R'lIht.r of WUI., any 0' the ZJ RIVInuI Dlt.rlct Office., or by c.Ulng the .paclal l~.hcMlr an.u.rlng ..rvlc. nuab.r. 'or fora. ord.rlno' In Penn.ylvenl, 1.100.16Z.Z0S0, out. Ide Penn.ylvanla ~ wlthln local Harrhburg ar.. C711) 781.aO'~, TDDI C711) 11Z.ZZ52 UI.arlnll 11Ip.lred Only). OBJECTIONS I Any p.rty In Int.r..t not .,tl.fl.d with the appr.I...ant, .alowanc. or dl..llowanc. 0' deduction., or .......ent 0' till Clncludlng dhcount or Intarllt) u .hown on thlt NotlcelU.t object ulthln .hty C6D) day. of rec.lpt of thlt Hot Ie. byl uwrltt~ prot..t to the PA D.part..nt of R.v,""" Bo...d of App..I., D.pt. lIIOIl, Htrrhburll, PA I1IZ6.1021, OR ...I.ctlon to hay. the ..tt.r d.tlraln.d at audit of thl ICCount of the p.r.onll rIPr...nt.tlv., OR ..app..l to the Orphan.' Court. ADHIN ISTRAlIVE CORRECTIONS I INTEREST. ractual .rror. dl.cov.r.d on thl. ........nt .hould b. addr....d In writing tal PA o.p.rta.,t of R.venue, Bureau of IncUvldual hu., AfTNI Po.t A......."t R.vl... Unit. D.pt. 260'01, ttarrl.burll, PA 171za.0601 Phone (111) 117.6505. S.. pq. 1 of the book..t "In.tructlon. for InharltMC' 'a. R.turn for a Rllldent DecedantM eREV"ISOl) for an ..pl.-lion of adllnhtratlv.tw correctabl. erro.... If any ta. dull It p.ld within thr.. (I) ul.ndar .onth. .'tlr the decadent'. dllth, . flv. p.rcent C5X) discount 0' the ta. p.ld .. allowed. Int.r..t I. charg.d beginning with flr.t day 0' delinquency, or nlne e'J BOn'h. ~ one Ct. day froe the data of d..th, to the data 0' pa,.ent. T.... which bee... dellnquent be for. January I, I,ez b.ar lnt.r..t at the rat. of .1Il .'X) p...unt p.r annua ulcul.t.d .t . d.lly ra.. of .oaOIM. All t.... which b.c... d.lInquent on Md .ft.r January 1, 19IZ will baar Int.....t at . r.t. .....Ich u111 vary fro' c.landar Yllr to calltftd.r y..r wlth thet r.t. announced by the PA D.part.ant of R.v~. The appllcabl. lnt.r..t rat.. 'or l'IZ through I'" .r.1 DtsCDUNTl ~ Int.rnt Rat. Oalh Intlrnt Factor ~ Int.r..t Rat. Dally Int.r..t Factor 1912 '"X .000541 1911 OX .000241 lIJU 16X .00001 l,el"IIJIJI II' .OOUOI IIJ8~ IlX .ooasol .". OX .000l41 19a5 IU .00055' l"I.I99~ l' .DOOI9Z 1966 lOX .00021~ 1"5.1'" OX .aaoz41 ulntlr..t I. calcul,ted a. follow.. INTEREST . BALANCE OF TAX UNPAID X NUnBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR .-Any Notlc. luu.d aftar the ta. b.ao... d.llnql*lt will r.flect an Int.rut calcul.tlon to flft.an US) day. b.yond the data of the .......ant. If pay...,t It .... a".r thl Intar..t COllpUt.tlon date shown on the Notlca, .ddltlonal Internt w.t ba calculal.d.