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OATil OF 1)lmSONAJ. HEPltESENTATIVE
COMMONWEALTII OF PENNSYJ.V ANIA
COUNTY OF . \ , . , .,.
J :iH
The pelltlonerN nhove'llllln<d ,w<mll) III allirllll') Ihal Ihe
MUlcmcnl!.ll1lhc furL'~nil1g (lclilinl1urc lUlL' Ulld \.'OIlC\.'IIU Ihe hL'!rI1
of Ihe knowled~e and helld of pelilioner,s) and 111111 '" per"lIl1ll
teptesentalll'C(s) of the above <I<<edenl pelilloner(sl will w<lI allll
rtuly adllllnlsaet the eslale accur<llnG In law, V . C
SWOtU 10 m affltlncd nnd suh,crlbcd J- ~faf/.-1!./-"t:.-b')(/'
befme lIIe Ihls 17th dny 01 1+
NOVEMIl,ER 19 95 .\
. ..f) ("I, I' ( . ':r.. , " ' ,,',. . Ii) II / .:( I. ,i l.(~.'
M1\RY ~C. ' Lkw 1 S ' HeR/sIt' ,( .
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No. ~, -lqqS -~ .2.3
Estate 01' 1\' ,\ ,. ,., '1,"-
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1"-,,,"/. 0'
, Deceused
,.
.
GI{ANT OF LETTEHS OF AI>MINISTHATION
ANIJ NOW -1;;EURUAR.Y-.2 19...L6_. In co",l<letllllon of Ihe pelltlon on
Ihe reverse ,ide hereof. sallsfnCllltl' proof havinG been prescnlcd before lIle,
IT IS IJECREEPllnu .'01,'" ,~""..,,'I'. ',,'
is/are elllltle<llo Lellers of AdllllnlsltlIlion. and In nccord with such I1n<llnG, l.ellers nt ,\dlllinIMrallon
arc hereby grurlled 10 ';'" Il,
.:~...s:.;_f..' I' -J '
i~__.
in Ihe eslnle of II ,_" , \ . I
, c. /' I,' .i l-,
FEES
Lellcrs of A<llIlinislrallon ..... S
Shorl Ccrllfieatcs(:~ . . . . . . . . .. S
Renuncialion ..........,..... S
1l0ND -deJ>- S
TO',:!,L _ S
Flied . f.1!!3.1!\ll\!lX... . .... A,IJ,
. - Ili'{' 'jcj\!j ,t;( .LJ;.~' ',.'> i/ ); "/){II/(I)
MARY C. LEWIS 1/'1',r" "r Wllh ''\}I/_/ITI/-
0aUJd cr ;; in flIV '
25.00
9.00
15.00
15.00
5.00rOTAl, 'I' :;. .:..",
19~ $69.00 ;i,..'I)',.
ArTOKNEY ISU~. CI. 1.ll. No.1
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MAILED LETTERS AND ORDER ~ro ADMINISTRATOR KKKKKNKXKXXXX FEBRUARY 5
1996 .
.,11 l/(/ ~J 'I" ,)
Gml)~orlilnd
Register of Wills of ~~~pounty, Pennsylvania
RENUNCIATION
Estate 01
N,wM L
Ii' J!. oS s-r..rS
"'/1#
No,
also known as
. Deceased
ThO undersigned.
7r1DMAS :r: [Zl>/Sli(t.TS SoN
IAelaUonship) (Capacity)
01
the above Decedent. hereby renounce Is I the righlto administer Iho oSlate end rospoctlullY ,oQue51(sl Ihal
Leuers"\' /\/),\...,.I1."..'-I:7/>'> be issued 10 P""I/J/.:r. /l.l>'/i1l.fS,.:rr.
Witness
t\l.:. 70 I~'" ~ D--
:> . - ay 01 ~'-7' .., ,19..E.
'I ~.>(; /;/Ii ...//~ t;->~
ISlgnalurOr I
&/
,,~ "I 50HO (:(')0& T" V, /t,-"m.JMtH
IAddressl
VA Z.3'fS'.S~
hand this
ISlgnaturel
.-.---
IAddrossl
ISignalurol
--.----
IAddross)
Sworn 10 Dr affirmod and subsc,ibed
'" ...-
uelult me this .:,,1 .-' day 01
C":K~~ . '9.::15-.
J ~
tf.iiiI~,,/ ,<, HI. c- '--'
Not.,v puhlln
My Cununlsslon eMpires:
My Comrnlstlon [lr,lr,.. I-!mh ~I I"'!'
.,........................,...--....... .
NOTE: RenunciAtion, uIJculad outside 1M Olllceol Rag'llar 01
Wills p,e required In 10"'0 cuunllol1u be nutufllad.
.................-....-". ..........
..~.._ ...,...,..,., ..-.._1
RW-" (Rvld 9/92)
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Register of Wills of &'lh~leounty, Pennsylvania
RENUNCIA TION
Estate 01
AlA~it1r ~, RtJ{J8IlTS
No.
also known as
. Deceased
The unde,slgncd,
DAVID :r. r~~a I!'/Z.TS , .., ON
IAclallOnshlp, tC.1"acliYI
III
tho above Decedent, hereby rcnounco(sl tho right 10 mhninis1uI tho csHltu an" fospuctfullV fOQuusllsl thai
Letle,s
be Issued 10
PI4Ul ..r, 1Z(J.3alZis. .:T'r.
W,tness 1"1 Y
hand this ') I 5"
"ayol ocT'ai3&1t
19'1'..
_~_ou~~ O. 'i?~
-~Sl~l
,,,,,-5' G-04F V IUAS DR/vII 'BoYNnN as+ct,l pI. 3)1(37
_ ~_.____....._._."~___.~L___
IAIIII,"ss,
ISiglliHuml
IAIIII"'..,
"--iS~II"itu~';-I- ,.,_. -.-..-.
IAUlllUss)
Sworn to or affirmed and,tuuscribcd
belo,e me this '11 ~ day 01
fL 19~..
"....., '''''''- MAr.,
~"T'i!!i;'..""..'HIM.''''''''.'''''''''' .. M"CtHlj' NOTE:
".~...~.!if.UWAQMl' * * E."... M~
* *'~I),\:..J..~l'!IO<f01~ ".. IJorKW by At.,
~ ~_"_ ._.01,,_ ~""'~ 800.......,.
~ .....~ -bJrANe
~ Or 11'" . 8CJO.aaaoll878
RnnuncillllOllli ttltnculud UUltiilJIl till! OlhctI ul RUUillln, ul
Wllh. lUU htllUUUtJ Ifl 11011111 COUlllltltO lu l.llJ nulllll/utJ,
RW-l) (R.sd 9/92)
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAK ASSESSMENT with "pplh:ltble Int.r..' bu.d on In,ot.IIUn"
,walttlld by thll f1n."cl.1 Inllltutloo.
r. lm.rlt."clI tn been... delinquent "lne eonlhl ..'t.r thll dec.uenl" dll'. of dllllth.
S. A Joint IICCount I. I._abl_ liven though thll declldent" "".. Wftl "dd.d ft. " .,,'1.' of cony.nlane..
It. Account. (Including tho'lI held bet".." hulbllftd Md wlf.. which thll dllelldent put In Joint ".... within on. y..r flrtor to
d..th .t. lully ,...bl_ .. ttftnlf.rl.
S. Account. lI.tabll,had Jolntlv b.tw..n hulbRnd ftnd wlf. liar. than on. ylI", prior to d..th .r. not '.."blll,
.. Account, held by .. deeedant "In trust for" another or oth.r. ..,.. ,...bl_ fullv,
REPORTING INSTRUCTIONS . PART
I
. TAXPAYER RESPDNSE
1. BLOCK A If the In,or..tlon An" co..,utatlon In the notln .,. cor,..d nnd d.ductlon. ar. not baing elal.ad. placa M "II"
In block .,~ of Part 1 o' tha "Ta.payar R..pon.." ..ctlon. SI~1 two copl.. "nd .ubalt the. with your ch.ck 'or the ..ount 0'
ta. to tha p.gt~tar of ~11I. of th. county Indlcatad. Tha PA D.part.ent at ~.v.nu. will I..ue an of'lclal .......ent
(For. PEV.l~~a lll) upon r.calpt at the r.turn fro. the R.gI.tar of Will..
t. BLOCK B _ Jf the ....t .p.clfl.d on thl. not Ie. h.. baan or wilt ba r.port.d and t.. p.ld with th. Pann.ylvanl' Inharltanca
Ta. Ha\urn fll.d by the c.cad.nt'. r.pr..ant.tl~a, pIAC' an "II" In block "B" of Part I of tha "T..pay.r R..pon.." ..ctlon. Sian one
COpy end return to tha Pit n.parta.nt of R.v.nut, Buraau of lndl~ldu.1 T...., D.pt 180601, Il.rrhburg, PA l1Ua-OUI In the
8nvalopt pro~ldGd.
s. alOCK C . If the notl~a l'Ifor..tlon I. Incorract andlor daductlon. .r. b.lng clel..d, chack block "C" and coapl.t. Part. 2 and S
Dt~crdh. :.. U'.. In:atl"u:Hcr.= t.:lcw. ell" h.c c:plc: :~d =:J~alt n..: IoOlth '1fJ'~~ :::nt.:: r~:" th: :::~.J:".t ~, ~:.:: ;::~'~l= t:a t~: !!:;;!:~:r
of Will. of the county Indlc.tad. Th. PA n'Part.ant of Ravano. will I..u. en o,flcl.1 .......ant tFor. REV-154a Ell) upon rac.lpt
Ilf the raturn fro. tha R-ulttar a. Will..
TAX RETURN . PART
2
. TAX COMPUTATION
UHE
I, Ent.r the data the .ccount orlgln.lly wa. ..t.bll.h.d or tltlad In tha .annar a.l.tlng .t data of daath.
NOTE, For. dacadent dying aftar 12/12/all Account. which the d.cadant put In Jotnt n.... within ana (I) y..r of death .r.
taubla hilly .t trttn.hrt. I~.v.r, there It an a.elutlon not to .Ilc.ad 15,000 par tran.f.ra. ragardl... of the ~.lut of
tha .ccount or thl nuaD.r of .ccount. hald.
I' . doUbla ..t.rl.k I..) app..r. bafora your flr.t n..a In the addr... portion a. thl. notlc.. the 'S,OOO ..clu.lon
.lreadY hu baen dedUCtad fr_ tM IM:count balanc. .. roportad by the flnancl.l In.titutlon.
2. Entar tht total b.lanc. of tha account Including lnt.ra.t ICcru.d to the d.t. of daath.
). Th. p.rcant of the ~count th.t I. ta.ebl. for .ach .urvlvor I, dat.r.lnad a. follow.1
A. TM parcent ta.abl. 'or Joint ....t. ..tebll&had eor. than one ya.r prior to the d.c.dent', d.athl
I DIVIDED av TOTAL ~BEA OF
JOJNT OWNERS
EM..,I" A Joint ....t reglstarad
DIVIDED av TOTAL tUtBER OF )( 100 . PfRC[NT TAIIABLE
SlIMV1VING JOINT OWNERS
In the na.. of the dac.dant and two othar p.r.on..
1 D1YlDED av S IJOJNT QWMERS) DIVIDED av 2 tSURVIVORS) . .167 X 100 . 16.7:C (TAXABLE FOR EACH SURVIVOR)
a. Th. p.rc.nt t..able for ....t. cra.t.d within ana y.ar of tha d.cad.nt'. da.th or account. awnad by tha dac.dent but hald
In tru.t for another IndlvlduaU.) Itru.t banaflclarlu)1
I DIYIOCD BY TOTAL HUMBER OF SURVIYING JOINT
OWNERS OR TRUST BENEFICJARICS
II 100 . PERCENT TAIIAalE
E..aplal Joint account r.gl.tar.d In tha na.a of the d.cad.nt and two othar p.r.on. end ..tabll.h.d within ana v..r of d..th by
the dacadent.
1 DIYJDED av 2 ISURVJYORS' . .50 X 100 . 50:C (TAMAlLE FOR EACII SURVIVOR)
Ii. Th. MOUnt .ubJ.ct to tu Illn. 4) It datar.lnad by .ultlpJylng the account balanca Clln. 2) by the parcent taxabl. Uln. SJ.
S. Entar t~ totel a. tha d.bts .nd dtductlon. II.t.d In Part 1.
6. Th. uCK6It ta.abla (IIna 6) Is dataralnad by ,ubtractlng the dabts and daduction' Clln. S) fro. the .aaunt .ubJ.ct to t.. Cllna 4).
7. Entar the approprlata ta. rat. (lln. 71 .. d.t.ralnad below.
A. For det.. of daath occurring .ftar 6/10/94, tha ta. rat.. far tran,'.r. to .pou... .r. a. falloM"
I. D.t.. of daath on or .ft.r 7/1/94 and b,'or. 1/1/95 the rat. I. S:C.
2. Oat.. of daath on or .ft.r 1/1/95 tran.far' to 'POU'" will ba ta.ad at ole ta. rat..
Not., For d.ta. of de.th prior tD 111/94 tran.f.r. to .pou... ara t.Mable .t 6:C.
a. Tr.".f.,. to Iln..l da.cMldant. Including f.thar, aoth.r, .on, daughhr, grendchlldren, .on-In-law,
deughhr-In-ltw, .tapchlld IIRd thalr I..ut ara ta.abl. .t dM pereant (6:C).
C. Trlll\.fa,. to all oth.r. Including brother, .htar, uncI., aunt, naphaw and nlac. .ra la.able at fllhen percent ClS:CI.
D, If you chang. the taM rat., pl.... .p~l'y your rel.tlon~lp to the dac.dant In the araa provided.
a. ThI ..ount of ta. due Illna al I. det.r.lnad by .ultlplylng the atOURt ta.abl. Cllna 6) by the ta. rat. Illna 7).
CLAIMED DEDUCTIONS . PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowabl. d.bt. IIRd dedUction. ara d.taralnad a. follow'l
A. You l.g.lly ar. ra.pan.lble for p.y-.nt, or thl a.t.t. .ubJect tn adalnl.tratlon bv a par.nnal rapr..antatlv. I. In.ufflclent
to p.y the daductlbl. It....
a. You actually paid the dabt. aft.r daath of tha dac.dent and can furnl.h proof of pay.ant.
C. D.bt. baing dal..d au.t ba It..bad fully In P.rt 1. If addltlon.l .pace 11 n.adad, u.a plain papar a 112" M 11". Proof o'
pay.ant .ay b. r.qu..ted by tha PA Dep.rteant of R.~anua.
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY
REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (717) 787-8327, TDD' (717) 772-2252 (HEARING IMPAIRED ONLY)
1lRU(IIlI~au,
AL.,Cr."'.. ftO,"'I"",..J"
l'foCl~"N
>>OUtRI.. c..um~
DAVID U DSNr'
,.hOt"'ll A DOClROW
llll....1II Itt A OOUOtt[Ah
.."Rvt'f'R1I IltMN.:AO
J......!!>l'Rlll
tnM;Cll5lJ IlMa..J1I
... .Jnn" J""OUt.f.AU
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OAVlD" "'IP"'~"
PI:AN""[l" l....ftOfo...U...I1't
ou.....',O...I...AI.11
McNEES, WALLACE & NURICK
ATTORNeyS AT LAW
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UA.1.It,GIl.\tf.!l!1oC...nulO
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HARRISBURG. PA 17108'1166
TntPttOft[1717IU18000
F"ll71712JHi300
or C(lUll"'l
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ROOf,"I.I, GCOJIO
January 26, 1996
Register of Wills Office
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Naomi Roberts
Our File No.: 17382-0001
Dear Sir/Madam:
Enclosed are the Administrator's Bond
Naomi Roberts and a check in the amount of
your fees for filing the Bond.
for the Estate of
$15.00 in payment of
Please proceed with the issuance of Letters of
Administration.
Very truly
yours,
XC'.~I}L~)
\ 0 Ln I
/). --rt\~t,. \ . ,,\ ,
. ,
;
Stephanie Kleinfelter
Estates and Trus..!;s.,Paralegal
-. .,- .1
SK/lmk
Enclosures
.,
t...
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&COt t ... OOULD
AOU[RI Q H........S
P"'-"N"n,lACI'l.&ON
OONAUJ P ......UtMAN
"'CHAtlA ItULl'
f'[1[R'-.~[t[
JAMta"" MUll
CA""l.ltC.f.4AAl()fj
I!i.ut()ftR PM'OO.I
CHU()f<fQH PH......
JON"'H"'''' H AvDD
ftIJuC[ R 6PlCtA
CAROI.A.,ft,"OUA
CA1H[AlNl r: W"'UtAS
OlJHttCM P. ....lLt...M50N
ill
HiE AE TNA CASUAL rf AND SURETY COMPANY
tlar1fo'd. Connecticut 06156
POWER OF ATIORNEY AND CERTIFICATE OF AUTHORITY OF ATIORNEVISHN.FACT
"'NOW'" L MINay Tll('l rRISINTS, THAT nil "[TN" CASUAL n ANDSURI TV COM'AN't, 'COlpof'tM)nnuly Ofg.n.,.d ...M,I 1I'l.I....' olttl.
5"1' 01 (o..",.,lo(ul. .nd hhl"\1'" p"""p.' O"'U 'I' lh, Crt, o'''''''o,d, COu"'... of H,,,lord 51'1' 01 (0"'11<10(1,11. "'lth ""d.. tOI'l.I'l.....d Ind
..,poml.d, ,nd dO" by It,... pr"'nl' "'.~.. (o....lllult .nd .ppo,nt
L(OH J. FEIHERMAN, PATRICIA PI(RCE .
01 IIARRI SBURG, PA . Itlllu' Ind It.'ul "nOI".,I.1 in JII(I, "...1" 'ullpo.U!.nd 'ulhO/lty h.',by co",,,,.d
10 ''\l". ..,e",1I ,nd "'"owl'rIg.. .1 ,,,., pl'u .....t,," lh. Un.t.d 51.1." 01. ., lh. 10no""1'I1l Un. W ',II,d 'n. ...,11',," th, .11. 11'1". dllig.
"...d . lh. following 1I'I'''um.nU.1
b,. 1'1,......" '01, "Gn'IUII ,nd 'ct. tn, '"d ,lIborwt.. l.cognl"N:n_ COIlI'.(t. o' Ind.".nlly, .nd Olh., ....!llmO. abl'O.la,.,. In III. n.luII of. bond.
rKognillnc:f, Of cond'hon.1 und.".kmg.nd .n., .nd.ll con..nll iN:ld.nlllh.lllo
not oxceeding tI,e sum ot FIFTY THOUSAND ($50,000,00) OOLLARS -
.nct to blnct THE: AITNA CASUALT\' AND 'URET\' COM,ANY, Ih.,.b,.. hili, ,nd to Ih. .."" ..I,nl ,.If 'M 11m. \11II"" .It"ldb, 'h. duty
.u'horl..doHlclf' oITH[ A(TNACASUALTY AND IUR(T\'COM'ANV..net .lllh. u1. 01,,1d Anofn.,I.I.I".'mpurlU,nllolh. .uthoftt, hlI.1n
""""" "'ifill, ,.UfI.d .nd contWmld.
'''II .t'r",..I......' i. ....(1. ...."'.. ...11 t-"l' .",...,Hlty rllh. '..11""""0 ..,.,,,t,.., Au..'"...,......, ",t t;c...J."""', "'''-:'' "'~C!..I,o;;r~ ... .~:.i It', '..~'I,HCI
.nd .HeeI,
VOtED Th.IU," ollh.lollo""",inO oH.",. Ch.i,m.n. VIC. Ch.i"".n, P,",II.nl. An... 1..cull,,' VIl. P"'leMnl, Art., G,oup [ncullV'. Anv ~.nIO'
VIC. ,,,.ld.nl. An.,VIC' p,.lId.nt. Any AUI.llnl Vie. PIt.Id.nt. Any SKltl.,.... An., A",".nl S'cIII'I\', m.., Irom Ilm.loUm. ,ppolnt f1..>d.nt
Vie. '"'Id,nl., RUld,nl A..III.nl S,u'"1'''. Allofn..,..ln.,.tt. .nd Ao.nll 10 .et 10' .nd on ~h.1l ollh. Comp.ny .nd m.., ot", .ny .UCh
.ppoonll' ,lICh .ulhoht... II hi. "".fiUlt af 'ulho"l., m.., P'"Cllb'IO ..gn Wllh Ih. Complny'. n.m"M ".1 """'llh Ih. Comp.n.,'. ...1 bond..
'rc.ognillnU'. COllltKII 01 ind.mnltv, .nd Olhll """"Iling' obhgllory In Ih. n,'UII 0" bond. IKooni,.n". or col'\di!ton,luNl"1Iklflg. .nd .n... 01
...KI offlC'" 01 Ih. Bo"d 01 O'"CIOII m.., .1 In., t,m. limo". .n., .uch 'Ppolnl.. .nd IIva..lh. power Ind 'uU'IOIII'y g,...n him Of h",
\Ion 0 Thll.n., bond, '''OQn,uf\C', conU'CI 01 ind.mnlly. 01 ...."I'nG obIIGllo,..,.~n I"" nllUII of. bond, IICognl""", Of condltlon.1 uncH",."ng
.h.1I bf .."Iod .nd blnd,...g upon Itll COl"p.n., ....h.n 1.1..on.d by Ih. Ch."m''''.lhl Vi" Ch'lIi'n.n. Ih. "lIid.nL.n (lIKUI..... Vie. ',IIKI.nt,'
GIO",p (lllull,,'. . '....iOf V.(I ',"idtnl, . VIU ',"id,nl. In A",".nl Vie. PIII,d'III or by. f1nid,nl VICI "nod'"l. pullu.nl 10 Ih. po"""'''
pllKrlb1d In I"" ur"'<'" of 'ulhOfll'y ol.u(h Anld'nl Viti P'n'd.nl. .nd dul., ."n1ld .nd .ul,d wilh Ih. Camp,n.,'. ...1 by. 5""1',.., 0'
"'Iill.nl SIC'"'"" Of by . AII,d.nl Ani.llnl SMullry. pul.u.nIIO Ih. powo" pIIU:'lb.d in Ih. (lnlrlC.1I 0' 'ulhO,.I., OI'IIlh AIIld.nl An,".nl
SKIll'",,; 0' Ibl dulr ,ucuttd lunder tI.l,.1 IIqUllld) b., Ont 0' mOil A"o,nlr..ln.Ftcl pu"u,nllO Ih. po.....' prnctlb.d In hi. Of Ih,1f (lnlrllll.
01 (I""ICIIII OI.ul"'Ofll'y.
Thl, '0"""''' 01 AnOfn., end C.ftlflc"l 01 AUlhOllty I. .IOn.d Ind 1I.I.d br '.ulmll. undlf .nd by .uthorlty ollh,'oUo".lno St.ndinG "..oluliOn
WOIK b...lh. Iolld 01 Di,Ktart of THE: AnNA CASUALTY AND SUflE:T\' COM' ANY .,..,hkh f1..oIu,lo" I, f'OW in holM 'OIC' IA4I ttfKt:
\lOTED. Th.llh, 'IGnlluII of tlch 011"" lollawing off".,,: Ch."m.n, VIC. Ch..,m.n. P'....,.III. My (."ull... Ve. PI..>dInt, Any G'lkip
[.ltu!t..... An., S.nlo, ViCl PII..d.nt. An., VIl. P'nid.nl. Anr A....I.nl Viu "n,d.nl, Anr S"""fy. Any AU,''''''I S'CIIII,.." .nd lhe .,.1 011""
Comp.n., m.., b, .H'lId by IK..mll'lo .n., ptWIo., ol.lIoll'l''!' 01 to .n., "nlltClI.III.ltng Ih""o 'PPOlnl'f'lg R",d.nl Vie. P,..id.nll. Rn"""1
A"I.I.nl S,CIII.,i.. 0' A110In'yI-in.F .e' 10' pu'po... only ollltcul,ng .nd .1I"lIno bOnd. .nd und.n"inljj' ,nd 01"'" ....""ng. obltg.IO,.., III I'"
nllUII Ihll.ol, .nd .n., ,uCh pow., o',nom.y 0' (I"lllC.I. b"""G .\lCh 11t.,m,1. 'lIil"IIUlt 0' ',ulm'" ...I.h.lltle....hd .nd binding upon Ih.
Comp,n., ,"d .ny .uch pow.,.o ""Ulld ,nd unll"d by .IIlh "(I,mll. .ign'h"" ,nd "(lim.l. ...I.h.1I bt ....lId.nd binding upon Ih. Comp.n.,
in Ih. lUlU" wllh '''plCI 10 .n., bond 01 und,n,'.ng 10 whICh it II ,nIChed
INWl1N1SSWHE:Alor. T"lAUN'" CASUALT\' AND sUI'nv COM''''NY hll"",..dlh.. in.lrum.nlla bt IlgntQb., ," Aul."nl Vk. ,,,lid.n!.
.ndlllco/PO'Il....llob.h".IO.f1I..dlnl. 30th d.., 01 July ,II 93
THE AUN , CA5U~r1 COM' ANT
(/.. 'f':; .,~ '
~., 0'0""'- Tho.,.~-~l-
Anld Yk."
1;111. 01 ("IIII'CI'(ul l
..
COllnt., 01 H.mo,d
".nlollf
Onlhl' 30th d.yol July .tt 93 ,btlo'om.pt,.on.n.,c.""QlDRQE:W.THOMl'SONlom.~n.....hO.
btlng b., 'fl' duly .....oln. d.d a,poII .nd 11'1' Ih.1 h...h'I' .....IsI.nl VkII ,,,.ldenl 01 THE: AnNA CASUALTY AND SURE.T\' COM'ANY, ItI.
COlportl.on d.lCllbod.n .nd ...."'Ilh .lIcul.d Ih, .bo~' Inlllllm.nl; I"'t! h....". kno""",.lh' ...1 01 ",d co/port~; Ih.1 I"" ...I.HI..d to 1"'0 ...d
inll'um.nl i. 'uch COrpoflll.tll. .nd Ihll h.:.h. .u,ul.d Ih. uod Inlllum.nl on b.h.11 Ollh. cO/PD"..on by .ulho,,1y 01 hll,'tIlf offlC' uNII
Ih. SI.ndlng f1nolul'Onl tll,"ol
..&'~ X~~'
...'c__.toOt'I..poo...........'I.'". ~'wOIoC
DOfolh,L.Manl
Cf.AnFICATE
1.lh. undll.iOn.d, 'Hf.I.ry 0' THE. AlTNA CASUAlTY AND IURE:TY COM' ANY. I .Iock cO,polllion ollh' 51111 of CanntC1tCul, DO H(REBY
aATlFY Inlllh. lottgolng 'nd ,nKh.d Po""",,, 01 Ano'",y .nd C.r1I,.ul, 01 AuthOllry ,.m"n. in lull fortt ,MI nit nol bI.n ,...-ok.d; 'nd
'u"hlfmoro, lh.1 Ih. Slandmg Anoluhon. or 1M Bo.,d 01 DIIKlo',. It MI'o"" In Ih. Co",fIu" 01 Authallty, ", now in 'oru.
Signed .nd S..led .11"0 Hom. OHIC. ollh. Camp.n....ln IhI C'ly or Hlnford. 51_'. 01 ConntctlCuI. O'led 1"'01
JANUARY ." 96
6th
d'" of
5.1121 FiMIIJ-"1
.,w~~
,^1IIlMlT,D~
s.c,,,.,.,
r
CERTIFICATION OF NOTICE UNDER RULE 5,6(a)
Name of Decedent. .AI.40ME E: ROSf!:~rs
Date of Death.
AVl:VS T O.-''Ns-"
Will tlo.
No",,,
Admin. No. Itf9S'-oa'l2.3
To the RegisLer:
I certify that notice of beneficial interest required by
Rule 5,6(a) of the Orphans' Court Rules was served on or mailed to
the following beneficiaries o[ the abovo-captioned estate on
rllt'III.'1 II.. '99" ·
Name
j)4V'O .:;: ;la"Ir/LO
Address
{,OZ:>"..IF lJ,tln brrvIL PO~"'/'IJN i1e...4. FL 341(J7
5'!3
Soho CouRT. VIIZGI/w4 fSl!'A-et, V4 23 ""0-
.
BuTfb"'WODD LA"'1ii ;:JO'r'N7DN O..-..t:If; (:'l. 33'131>
A....'rr STtZIS/;'" ME'IJ.JDfTII/ c.r 0{'45'0
j ~c IIrl..w
to all persons entitled thereto under
7Ho"'''$.:r. gODli'II.T'
M,4~"~h LOIW/Jt4-/Ulo
!-I;U4:,/.". V. SA.z NO
S <no po
Nntice has now been
Rule 5,6(a) except
." 'I'
.,3'-
given
,vDI/IE
Do te: I?t,", ,e.. 1'i9'
~.t Ii d /. .A- .I. .
5 19no3 t'r'~-r-
Name ?~" L :r. "?(J,JE~TS',.:rR,
Acidress 77" .;JQ~f'bINrr? f)1l",r
l?uR~"- V,4. 7.2.0/:'-
Telephone (70~) 7''(--<;oq z...
capacity:~ Personal Representative
Counsel for personal
t'opresen ta t 1 ve
-II "
REGISTER 01' WILLS OP CUMBERLAND COUNTY
REPORT 01' STATUS OP ADMINISTRATION
(Por Rcsldent Decedents Dying After July I, 1984)
ESTATE NO. 21_cI5_cl;n
./
Nome of Dcccdcnt:
5oclo1 Security Account
N40J-lI t: ;Zo(3gi!.r.s
lIo.:08Z-:1'.1.7"18'"
Date of Dcoth: A~
8"'. 1'1'1!J'
.
Nomc of Pcrsono\ Rcprcsentatlvc(s):
PAUl. .r. i'Z '>fleeTS. .:TR. ,
Capacl ty
(check one)
Executor
Administrator
".......
Administrator c.t.a.
Administrator d.b.n.
Is the administration of thc cstate complete?
Ycs
v
t'9C'
c: ,,: vi
3 I};
r
I,', Sf;
r -<
, ~
."...... 0
! ~,
.~
~
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).# .:~ ~
-J
:0
n!J,,,
r,.. (1
. t~;
If "ycs", how was the administration endcd? (check onc)
By court occountlng
By account stated to porties In Interest
Did thc partlcs rcleasc the
personal reprcscntatlve?
Othcr (cxplain)
'.,
..
vi 8.
Total amount paid to datc to crcditors ond for funcrol ond
admlnistrotlve cxpense
Total value of distributions to date to benerlclarlcs
$ 30 Ie
rr administration Is not complctc, estlmatcd value of assets
stili In administration
$
$
q) AUA'I.,H,/e.
NOTE: This stotus report Is duc no later than the due date for flUng the Pennsylvania
Inheritance Tax Return Dr, Ir no Inheritance Tax Return Is required, nlne (9) months
otter the date of death; Ir the administration or the estate has not becn ct'nc1uded,
a summary report shall be riled annually thereafter untllthe admlnlstratlon Is complete.
Oate:
'11t~ 7
, 19~
that the foregoing Information Is corrcct to the
and belief. ~ ~
~I . per~~presentative
-, ~ttgrRey (or CltdTn
I certify under penally of perjury
best of my knowlcdge, Informolion
This report must be signed by the personal representative, Dr one Dr them when more
than one, or by eounsel for the estate.
,:/-'15 - 'IJ..J
-
May 8, 1996
Register of Wills
I Court House Square
Carlisle, PA 17013-3387
As Ihe appointed admlnlstrntor of my mother's estate, lam forwarding two copies of
the documents listed helow along with two checks In the amount of $25 and $11 respecllvely
to pay the filing fee and the taxes due on Ihe estate, Docnments Include:
I-Inheritance Tax Relunl Resident Decedenl
2-Schedule B: Stock and Bonds
3-Schedule E: Cash, Bank Deposits and Mise, Personal Property
4-Schedule F: Jointly-Owned Property
5-Schedule H: Funeral Expenses, Administrallve Costs, and Mise, Expenses
6-Schedule I: Deb1s of Decedent
7-Schedule J: Beneficiaries
8-Inventory of the Personal Property and Relll Estllte of Naomi E, Roberts (one
original notllrized and one copy)
9-Report of Status of Administration
Receipt of these documents and checks close all known estate action, I CIIIl be
contacted by phone during the day at (202) 488-2407, home: (703) 764-9093 if there are any
quesllons,
Sincerely;
Itt.~;'m','''ml''
9716 Lakepolnte Drive
Burke VA 22015
Enclosures als
cc:
David Roberts
Marilyn Roberts
Thomas Roberts
...
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Recorderi C 11::.) of
Relll:;lcr "I v~IIIG
'96 MAY lOP 1 :02
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COMMONWEALTH Of PENNSYLVANIA
COUNTY Of CUMBERLAND
..:
.+: P,4Ul...T. RoCJIS/Z.TS..:r~
being duly :lUlAil.N attording to law, depo.e. a..d "Y' Ihal h. PAouL.r ii!da~IZ'tS..:Tn..
ADM'''' '.f T2 1\ 11) It- 01 th. E.IoI. 01 NAOH, tr. i2.oB67Z.LS
late 01 20 t" .1!!,.1V.Au~J~!:t I' ~"M P I;!!lUA no" , Cumberland Counly. P... d.t....d .nd Ihet tho
within is an in.enlory m.d. by P4ul.;r. RoBe:Il:'S',.T1C. , Ih. ..id A OJ-1'N/$'rlZ",f2j,,,,
olth. entire e.l.te 01 ..id detedent, ton.i.ting 01 .Ulh. pe"on.1 prop.rly and r..1 ..Iole. ..topt r..1 ..101. ouhide
Ih. Commonwe.lth 01 Penn.ylvania. .nd Ih.1 the ligure. oppo.it. e.th item 01 tho In.entory repre..nt 11'. I.lr valu.
a. 01 tho dal. 01 d.teden!'. dealh,
:)J1l'."
, /' \; -I \_ .\
.nd
f(!'
subscribed bofore me,
/ J //./; , /~
7' /hd/. ,'''',,1.. , J ,1
. /' hUlltor . A/mlnh'u'o,
'/1,..
,I I( f P'
'-.)}!.. /~ ' . .
;, ./(.,..c\U,
19 ')l,"
y)( [t .')'1; )(( ( j
;? "I'" j?-!(./j :' i' () tJ
q71 b L.A~PclNrli: DnlJ"-
fIU'/c1$ VA '2 :z.D'~-
Addr...
O.le 01 D..th .
.g
D.y
,4u'us j"
Month
I<jQS-
Y..,
INSTRUCTIONS
I. An invenlory mu.t b. filed within three monlh. alter .ppolnlment 01 pe"on.1 repre..nloti.e,
2, A .upplement In.enlory mud b. liI.d wilhln Ihlrty d.y. 01 dl..o..,y 01 .ddillon.la"eh,
], Additional .heeh may b. attath.d ,;. to pe"onalty or r.ally
4, See Arlitle IV, Fiduciarie. Att 011949,
r- r:'<(
'151" ~1 l~
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Inventory 01 the real anll personal cst ale 01
f\JAO~%: b. RoBGIZTS
deceased
!iff SI+4,z#tS csJ:' P<2...\I'I4 ro...,raE. 1 L''1t.r (,01'1......,.., STtJCr.
@ ~'l/$"ltaf'e. _ p+n~ DFt H.IZ. /)e4TH
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IffV.15oo u: + 1'.9" "
..*
COMMONWfAUH 0' 'fNNSYlVANIA
Df'AlffMfNf 0' ItfVfNUf
Dfn2'0001
HAUISlUIfO. 'A 1112'.0001
DECEDEN 'S NAME llA!. . '.1". AND MIDDlE INI IAII
R'H3t::rz.rs NAOI1J: ii"'
SOCIAl SlCU'''' NUMIU
l!!
..:5'"
Illg;~
=09
uE"
:ilffi
"'0
"'z
B~
z
o
5
g
III
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)/ 13
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
h
.01 OA'" o. OIA'H A"" 12/31/91 CHICK Hili
IP A SPOUSAL
POVIUT C"OIT IS CLAIMIO 0
PlU HUMa..
.;U
? :<1
q.s-
YfAR
....
ili
III
III
o
NUMln
082.."1.-2778
DAf( 0' IIIIH
Dill. I;, l.oS"
.'//+
~ I. Original Return
limited Eltate
o 2. Supplemental R,Jurn
o 3. Remainder Return
Ifor dol" 0' death prior 10 12,) 3.82)
o 5. Federol E.lol. Ta. Relurn Required
_ 8. Total Number of Safe D.po.lI Bolt..
o 40. future Inl.,,,t Compromise
[for dol.. of deolh after 12.12.82)
o 7. Deud,nl Malnlolned a living Trull
IAllach copy of Tru.l)
.A'T
Oec.denl Died Tellal.
(Anoch copy of Will)
RRISPO D CR 'AND C NP 01
PAUL :r. ~6ll'1l..15, :1",..
IUEPHON( NUMUI
7/,"-9093 . WI (:1.0 41ftr. 'J,'1();
1. Real E.tal. [Sch.dul. AI
2. Sloch and Bondi (Schedule B)
3. C1ol.ly H.ld Slock/Partner.hlp Inl.,,,t ISchedul. C)
4. Mor'gog.. and Nal.. Rec.lyabl. (Sch.dul. D)
5. Calh, Bank Depolil1 & MIIt.llan,oul Penonal Property
(Sch.dul. E)
6. Jointly Owned Properly ISchedule FI
7. ',on"." (Sch.dul. 0) (Sch.dul. I)
8. Tolol Gro.. A..eh (tololllne. 1.7)
9. Funeral e..p.n.... Admlnl'lrallve COlli. Mhcellan,oul
hp.n", (Schedule H) ,
10. O.bl1, Marlgog. lIobilitl'l, lien I (Sch.dule I)
11. Talal D.ductlons (tolollln'l 9 & 10)
12. N.I Valu. of Ellot'llIne 8 mlnulllne 111
13. Charitable and Gav.rnmenlol e.que'h ISch.dul. J)
14. N.t Value Subject 10 Talt Illn. 12 mlnul Un. 13)
15. Spou.al Trani"" Ifor dot" of dealh after 6.30.94)
5.. InUrucllon. 'or Appllcobl. p.,cenlage on R.yer" (151
Side. (Include yolu.. 'rom Sch.dul. K or Sch.dul. M.I
16. Amount of line 14 toxabl. 01 6% ral. (161
(Include valulI from Schedule K Or Sch.dul. M,I
17. Amount 01 line 14 laxable at 15% rot. (17)
(Includ. volulI from Sch.dul. K or Sch.dule M.I
18. Principaltalt duelAdd lax from lIn.. IS. 16 and 17.)
19. Credill Spaulal Poverly Credit Prior Paym.nh
(I) 95
(2) I a :1.&.
(3) (,6
(4) aJ
(5 ) loU,-
(6) .2 oS"~
(7) gS
;z.'13/ (8) _32.0;
(9)
(101 2.V!J7
(II) 3018
(12) 189
(13) as
(141 lrf'3
)(._- r6
)( .06 _ II
)( .15 ;I ~
(181 II
(19) r:t
(201 (1S
(21) II
(2IA) as
(21BI II
t;l5
1'89
gS
Dhcounl
Inler,,'
+ +
20. If Une 191. grealer Ihan lIn. 18, .nl., the dlff.renc. on Un. 20. Thllll the OVERPAYMENT.
m O."l"I'D":II.""I..I~'~';'.'II""""IIUI"IIIII'.'.llImmn_.~.1.1....III.u.u....IIII.1
21. If lIn. 18 II greoler than lIn. 19, enler Ih. differ.nce on Un. 21. Thh II the TAX DUE.
A. Enler th.lnl.,II' on th. balance due on lIn. 21A.
B. Enter Ih. tolol of Un. 21 and 21 A on line 21 B. This I. th. BALANCE DUE.
Mak. Check Payahl. tOI R.ght.r of Will., Age"t
'.(
7 /qq4,
, .
. "' -. ...~ .... .... ... .
'1011" 11.111
SCHEDULE E
CASH, BANK DEPOSITS AND
. MISCILLANIOUS
PIRSONAL PROPIRTY
'*
~.iiil~AN'A
! NAOM r a:. IZo 13 fItz.T.S .
I
I ,I....,.rtv 1e1_II_od whh tho ...hl of .u"'I....hl, ",u,1 ... dloclMod 0- .chodulo ')
j~~~ER DESCRIPTION
I
.sOP,+. 8t!.(
TOTAL Also .nl., on IIn. 5, Reco
(A""'" addl~onal 11\" II 11" ,,-,, K ...... 'P"'o 10 _"dod.)
VALUE AT
DATE Of DEATH
I ~!>-
s
/2G"
'911.11""1
~.~.~
. -~'J.ifIL,;.
COMMONWfALrH 0' 'INNSYLYAHIA
,NNUITANCe TAX IIIUIN
IUIDeNT DeCeDeNT
SCHEDULE F
JOINTLY-OWNED PROPERTY
.TE Of
N ~O f.A T. G'. fZ (J f3 Irfl. .,.,
I fiLE NUMBER
,nt lenanl[."
NAME
P~ul. .r. ~OIJ"Il,:TSf 3"r
ADDRESS
C/7/(" /.Ak'tJit'IHT6 Drtl/~
Bur leEr VA 2,2.0 ,:.-
RELATIONSHIP TO DECEDENT
SOA{
M"~ILV'" A, i6a/I'I.:rs
.\- HAil"'1'1 ~. Lo141 8",I.DD )
73/. BuTTb/olw,,",l> c..At-I...-
l3o'l'NrcN i3L4Ct4 PI. 33lt3,"
D4l)~HT/l'(l.
ntly-own.d prap.rty.
LmER DATE
M FOR TOTAL VALUE DECD'S DOLLAR VALUE OF
BEl JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT, DECEDENT'S INTEREST
TENANT JOINT
A-~ a hr '4,"0 $'AUIH~ ,4tcT" ~ ;10/-0'2-008 S SI!i?; 13 ~ 17/7
t1,r Foro ~ H. """')
. ,4ii3 ~.rl''''1l t:Jot..ct(', ftutr't!-S/YOC')3/.03 ~ 10~ ~ i 339
.' (, Pnll:. ANte)
TOTAL (Aho .nl.r on IIn. 6. R.capilulallonl S 2. (J IS/,
'*
(o....MOf'llWI."" 01 'IHHlnVAH....
IHHllrTAHCI 'AI 'INtH
'11IDtNt DlClDlHf
SCHEDULE J
BENEFICIARIES
rATI OP
PILI NUMBER
I\/AOMI
t5:', R. 0 BeRT.s
ITEM
NUMBER
NAME AND ADDRESS OP BENEPICIARY
RELATIONSHIP
AMOUNT OR
SHARE OP ESTATI
1.
A. Taxabl. Boqu..11l
P~uL. 3'. RDi3QJZ..~/ :J1t.
'11/(, U/l:flit'IWTli' Dr. utr
gLlr'K'R' VA ';22.0lS-
.
.JtHH 7' At: CDUl1'r
SON
'7,
~.4211'1" A. jZDiJtrt:I:S
(H~a.,,'f'" fl. t.o_04.lI.D4 0490.-l' ~II"" D"-fTJ
73" f3IJTrDNw~D t.ItNII'
E30'r'NT7>M l3c.t-Ctl / FL 33 Lf3p
.1D".T A t:CclU,4f
P4uCSH rct It
ITEM
lUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF EST A TI
8, Cha/itabl. and Gav.rnm.nlal BoqU"'1l
1.
TOTAL CHARITA8LE AND GOVERNMENTAL 8EQUESTS IAI.a .nlor an IIn. 13. R.capllulallan) S
(II more 'po<o I, n..d.d, 'n,.rt oddltlanol .h.... 01 .om. ....,
" ... ~.. .... ,~. -. .
-'-'- -- -.~-- ..-- -- -_.-
,
.,,1. "
g' . . .......AA.... "'1'1':'2'8""3"'0"',......'.cO.. .'MM....O.NWEALTHOF..PENNSY~VANIA
No... ..... . L ...:.; DI'AIll'MINT 0' RIVINUI '.
'';;'''61 n I'~~ " .' ,: OfFICIAL RICII...., . PENNSYLVANIA INHERITANCEAND ESTATETAX
'*'
RECEIVED FROMI
i
ACN
ASSESSMENT Ii'
CONTROL Iii
NUMBER
AMOUNT
PAUL J ROBERTS JR
101
.11.00
9716 LAKEPOINT DRIVE
BURKE, VA 22015
ESTATE INFORMATlONI
t::'I IlE NUMBER
~ 21-1995-0923 SGN 082-26-2778
II NAME OF DECEDENT (lAST) (fiRST) (Mil
m DATE OF PAYMENT
EJ POSTMARK
COUNTY
DATE OF DEATH
REMARKS
fa TOTAL AMOUNT PAID
"bL&9
PB
PAUL J ROBERTS,JR
SEAL
:" : j
RECEIVED BV
CHECK II Ib9G
l $IGNA'~IU,
REGISTER OF WILLS
MAR V C. LEWIS _i',iil)
REGISTER OF WILLS
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REV-lS47 EX AFP 112-9SI*, l:
COMMONW[AI HI or III NNSYIVANIA ACN
O[PART"rNI Of P[VINU[ NOTICE OF INttERITANCE TAM
ftUlflAU Of INDIVIDUAl IAkIS ~... APPRAISEMENT I ALLOWANCE OR DISALLOWANCE
~~:~is~~~~~'.lA I1Ii'a'O"~1 ~.. _ ___.~_ DEDU:TI~~S ~~__~~~_~ttENT OF ~~)(~ __~^TE ~_O_8"~~~~~._. .._._
ESTATE OF ROBERTS- tfAOHI- --E--=' --...-----------rnE" NO. ~-21-95-=0923"-- -,.. ...
DATE OF DEATH 08-08-95 COUNTY CUMBERLAND
t/
L /-.
101
NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUDHIT TIlE UPPER PDRTlON OF TltlS FORH WITH YeUR TAK
PAVHENT TO THE REGISTER OF WILLS. HAIeE CttEeIC PAYABLE TO "REGISTER OF WILLS J AGENT"
REMIT PAYMENT TO:
PAUL J ROBERTS JR
9716 LAKEPOINTE DR
BURKE VA 22015
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
AlI'lount Re,,1 t t.d
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
ifili: iS4"7"EX -,Uij; - ii'2=9ST - ileir Ifni" - i"NHEiil f ANCE-YIi x- iippilii IS EiiEil'r-; - .\i. i:ciwANcE -(iR--- _m_ --- - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ROBERTS NAOMI E FILE NO. 21 95-0923 ACN 101 DATE 08-05-96
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..l Esht. (Schedule AJ el)
2. Stock. and Bond. (Schedule OJ (2)
3. Clos.ly Held stock/Partnership Interest (Schedule C) (3)
4. Hortsages/Not.. Receivabl. CSchadule OJ (4)
5. Ca.h/Bank Oeposits/Hisc. Personal Proparty (Schedule E) (5)
6. 40intly Owned Property CSchedule F) (b)
7. Transfers (Schedule C) (7)
8. Total Auets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funaral E~pan..s/Adn. Costs/Hisc. Expensas (Schedule HJ 19'
10. Debts/Hortgaga Liabilitie./Liens CSchedule I) 110'
11. Total Deductions
12. Nat Valua of T.x Raturn
15. Charit.bla/Govarnnantal Baqua.t. ISchedule 4)
14. Net V.lua of E.t.te Subject to Tax
If an assessment was issued previously, lines
reflect figure9 that include the total of abh
ASSESSMENT OF TAX:
15. Anount of Lina 14
1&. Anount of Lina 14
17. Anount of Line 14
18. Principal TaK Due
NOTE:
at Spous.l rate
t.~able at Lin..l/CI... A rat.
ta~able at Collateral/Cla.s Brat.
1151
11&1
1171
TAX CREDITS:
PAYHENT
DATE
05-08-96
RECEIPT
NUHDER
AA1l2830
DISCOUNT (+)
INTEREST I-I
.00
I CHANGED
.00
1.026.00
.00
.00
125.00
2.056.00
.00
181
3.207.00
2,731.00
287.00
IllI
1121
1131
1141
3.018 00
189.00
.00
189.00
14. IS and/or 16, 17 and 18 will
returns assessed to date.
.00 x ,DO.
189.00X.06.
,DO X .15.
U81
.00
11. DO
.00
11. DO
AHDUNT PAID
11.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
11. DO
.00
.00
.00
. IF PAID AFTER DATE INDICATEO, SEE REVERSE
FOR CALCULATIDN OF ADDITIDHAL IHTEREST.
IF TOTAL DUE IS LESS THAN fl. NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCRJ, YOU HAV Bl
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR IHSTRUCTIONS
RES[RVAIIOHI
PURPOSE OF'
HOIICE,
PAVHl:NI I
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r~t.I.. of d.c.d.nl. ~ng on or b.for. O.c..b.r It, 19.' .. If ftn1 fulurl Inl.r..1 In the ..1_1. I. trln.f.rr.d
In po.....lon or ,nJoya,nl to Cl... I teoll,t.ral) bln.flelarl.. of the d.c.d.nt .ft.r Ih. I~plr.tlo~ of .~y ..t.t. far
Ilf. or for y..r., the Coaaanw.'lth h.r.by ..pr...ly r...rv.. the right to appral.. .nd ...... tr.n.f.r Inh.rlt.ne. I.~..
.t the I.wful CI"I I leoll.l.r.l) ral. an any .uch fulur. Int.r..t.
To fulfill the r.qulr.a.ntt of S.etlon tl~O of the Inh.rlt.ne. .nd [tl.t. I.. Act, Act II of 1991. 71 P,S,
S.ctlan II~D.
D.tach the top portion of thl. Hotle. and tubalt with your p.yaent 10 the R.gl.'.r 0' Will, prlnt.d on the r.v.r.. .Id..
uHa.. ch.ck or ..on.y ordar. p.y.bl. tal REGISTER or HfLU, AGENT
All p.y..nt. r.c.lv.d .h.ll flr.t b. .ppll.d to .ny Int.r.tt which .ay b. due wllh any r..elnd.r .ppll.d to the te..
REFUND (CR)I A r.fund of . ta. cr.dlt, which was not r.qu..t.d on Ih. 'a. R.turn, ...y b. r.qu..t.d by co.pl.llng .n "Application
for R.fund of P.nn.ylv.nl. Inh.rltanc. and [,lat. 'a." 'REY.IJ1S). Appllc.tlon. ar. .vall.bl. .t th.Offlc.
of the R.gl.t.r of Will., 'ny of the lJ R.v.nue District Offlc.l, or by c.lllng thl .p.elal t'.hour
an.w.rlng ..rvlc. nuab.r. far 'or.. ord.rlng. In p.nn.ylv.nla l.aOO.J6Z.ZD~D, out.ld. P.nn.ylvanla .nd
within local Harrisburg ar.. (717) 187.809<<', IDOl (111) UZ.ZZ5Z Hl.arlng I.palred Only).
OBJECTIONS I Any party In Jnt.r..t not .atl,'J.d with thl .ppr.I....nt, allow.nc. at dl.allowanc. of d.ductlonl, at ........nt
of t.. I Including dl.eount or Int.r..tl as .hown an thl. Notlc. au.t obJ.ct within .I.ty (60) d.ys of r.c.lpt of
this Notice bYI
ADHIN
IS'RAtlVE
CORRECtioNS I
DUCOUN' .
PENAl tv.
INtEREST.
"wrltt.n prot..t to th. P'" D.part..nt of R.".nu., BOllrd of App..ls, Dept, zaIDZI. lIarrltburg, PA 17lZa.lDll, OR
"al.ctlon to h.". the ..athr d.t.raln.d .t .udlt of the .ecount 0' the p.ttonal rapr...nt.tI...., OR
...pp..1 to the Orphan.. Court.
r.ctual .rror. dl.co....r.d on thl. ........nt .hould h. .ddr....d In writing tal PA D.p.rt..nt of R.vanu.,
Bureau of Indl...ldu.1 '.~n, Al1NI Po.t ..........nt R....I.w Unit, O.pt. Za06DI, IIl1rrl.burg, PA I7IU.0601
Phon. (117) lal.65D5. S.. pagl 3 of the book lot "In.tructlon. 'or Inh.rltllnc' la. R.turn for. R..ld'nt
D.c.d.nt" IR[Y.15DI) far .n a.pl.nallon of .d.lnl.tt.tlv.ly eorrectabla .rror..
If .ny t.. due I. paid within thr.. (J) e.landar aonth. aft.r the dac.d'nl.. d.ath, . fl"l p.rc.nt IS~) dl.count of
the tn. p.ld I. allow.d.
'h. 15~ ta. .an..ty non.partlelp.tlon p.n.lty I. eoapul.d on the total of the ta. and Int.r..t .......d, and not
p.ld b.for. Janu.ry la, 1996, the flr.t d.y aft.r the end of the t.~ a.n..ty period. 'hi. non.partlelpatlon
p.nalty I, appe.l.bl. In the .11.0 .ann.r .nd In the tha .... tl.. period .. you would app..1 the ta. and Int.r..t
th.t h.. b..n .......d .. Indle.ted an thl. nottc..
Int.r..t I. ch.rgad b.glnnlng with flr.t d.y of delinquency, or nln. (9) Gonth. and on. II) dey fro. the data of
d.ath, to the d.t. of pay..nt, ,.... which b.c... dallnqu.nt bafor. January I, 19a2 b.ar Inl.r..t .t the r.t. of
,I. 16X) p.rc.nt p.r .nnu. e.lcul.t.d .t . d.lly rata of .00016<<', "'11 t.... which b.c~. d.llnquant an and aft.r
J.nuary 1, 1982 will b..r Int.r..t .t . rat. which will v.ry fro. c.l.nd.r yeat to c.l.ndar y.at with that ral.
announc.d by the P'" O.part..nt of Rav.nu., Tha .ppllca~l. Intar..t rat.. lor 19aZ through 1996 .r'l
'!!!! 'ntar..t Jtat. DailY Intarnt ractor !!!! Intar..t Jtat. Dally Intar..t racto..
19a2 ZoiC .ODD5U 1981 9X ,DDOllt7
l,a3 16;( ,000"'31 19l1e-19?1 11;( .DDUDI
19a... II~ .DDUDI I'}<JZ 9X .DDDZ...7
I'as In .DDD356 1'}'J.5-1994 7X ,0001"
19a6 In .DDDU'" 1995.1996 9X .0001...,
uInt.,..t II calculat.d .. followtl
INTEREST = BALANCE OF TAX UNPAID X NU"~ER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
..Any Hotle. I..uad .ft... the t.~ b.eoa.. dallnqu.nt will r.'lact .n Int.r..t calculation to flft..n CISI day.
b.yond the d.t. of the ........nt. If pay..nt I. ..d. .ftar the Int.r..t co.put.tlon dat. .hown an the
Hotlc., .ddltlon.1 Int.r..t .utt b. c.lculat.d.