HomeMy WebLinkAbout95-00962
PETITION FOR PIWnATE llnd GRANT OF LETTERS
~/-q5-q(,~
No.
To:
Estate of Jnmns G. Thoobelei
also known as -...l..- Gaorr'o Thaobn 1<1
Reglstcr of Wills for Ih.
Deceased. CounlY of Cumberlnnrl In Ih.
Sodal Se,'urity No. 210-09-1751, Commonwenllh of "ennsylvanln
Thc petlllon of the underslgncd respeclfully reprcsenls lhat:
Your pelltloner(s), who ~/nre 18 yenrs of nge or older nn the exccutors
In the Inst will of thc nbov.~ dccedcnt, dnted AUf'ust )0
and codlcll(s) dnlcd NONE
named
, 19!15.-
(stCle rcle\'Bnt clrcllInllllncc5. e.,. renunclallon. death or cxC(ulor. etc.)
Decendenl was domicil cd nt dealh In Cumborlnnd 6 Coumy. Pennsylvnnia, with
I.is losl family or principal residence nt 2 05 Markat StrOAt
~amp H111 Borough
(list meet. number am) munclpalh)')
Decende}ll, then 76 years of ngc1,dled October 1 7 ,19 05
at 2005 Market Stroet. Cllmn Mill. PA .
Except as follows, decedent did not marry, was nOl dlvorccd and did not have a child born or ndoptcd
nftcr execution of 1ll5NE!1I offered for probnle; wns nOllhe victim of n killing and wos never ndjudicated
incompetem:
Decendent at denlh owncd property with estimated vnlucs as follows:
(If domiciled In Pn.) ^II personal propcrty S 7.500.00
(If not domiciled In Pa.) Personal property in Pcnnsylvania S
(I f not domiciled in Pa.) Personnl property in County S
Vnlue of real estnte in Pennsylvanin S
situnted os follows:
WHEREFORE, petitioncr(s) respectfullY rcqucst(s) thc probnte of the Inst will and codlcil(s)
presenled herewith and thc grant of lellers testamentary
(1e513JtlenIDrYi administration C.I.a.: administration d.b.n.c.t.Il.)
lheron.
I~ ~~~
c
.,0
~~ r;' It, ;~.tG. h/5u"-
~:) PreclIle M, B-ee~
;;
c
~
Vi
620 Runlev RrI,
cnm~011
::sr
400 Berkshire Rei.
!':eChaniCSburlt: PA 1 7055
~ I
---- -
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA }::IS
COUNTY OF CUI1Iberland
1.5 -: ,/,.-/?
The pelilioner(s) nbove.named swenr(s) or nffirm(s) thnt the statemems In Ihe foregoing petition are
truc nnd correCI to the best of the knowledgc nnd bclief of petltioner(s) and that os personal represen-
Intlve(s) of thc above decedem petitioner(s) will well Ud ~rulY administer t.~: estate according to law,
Sworn to ~r nffirme.d and S.ubSCribed... {.. tt~ ~, f!. ' ~ i'\l' "~T~ ~
before me thIS 26 dny of L - /J ~ ;//~ .: ~
J " 1)p7~b,~!f' ) .J9 CJ~ ..
/1111..1r,-I '/, "//' ('.1 ;,/. 1'1 / J'"'/iI7i~:' ~,! ~
Mary Ie. Lew16 Regisret , 0:;-
f / . ~
,-
: ~
!'-<
'-',.-,
..
I
.
"i
': ~ I':~~
'-'.
: "~I
,-,,'
,
;
"
Lust Will
of
.JAMES G. THEOBALI) A/K/A ,J. GEORGE THEOBALD
I. JAMES Q, TIIEOIIAl.Il AiK/^ J. OEOllliE TJIHlIlAW, n rcsidcnt ur ClIlllhcrlnnd CUIl111)',
Penl1s)'I\'lIl1in. dcclnre tlllll this is Ill)' will. I hcrchy rcvokc nil Ill)' prcl'iolls wills nllll codicils.
Article One
Jntrodlletor)' I)rll\'isillns
Section I. Mllritlll Stilt liS
n. I hn\'e no Iil'il1g children.
I nlll 110t currcntly Illnrricd,
Section 2. Children
AI.ticl~ TWII
AJlJl"intlll~nt III' My 1)~I'sllnlll 1{~JlI'~s~lItllti\'~s
S~~tillll I.
NlIllIilllltillll uf My P~I'Slllllll R~JlI'~s~ntllti\'Cs
luppoinl Ihe rollowing 10 he Ill)' Per~onal Repre~entulil'e:
NICIIOI.^S 0. DEI.I.^I\CII'ltETE ^ND
I'I\ECII.I.E M. BEEBE. Oil TilE StmVIVOI\ OE Tlm~t; TIIEN
1>^III'IIIN I>EI'OSIT B^NK & TI\UST CO~II'^NV
II' I()r un)' reu~onlhe Per~onul Repre~enluti\'C(~) nnllled ubol'e are unuble or unwilling tll ~er\'C.
Ihe lollowing ~ucee~~or Per~onul Repre~enlulil'e(~) shall ~erve unlil thc ~uccc~sor Pcr~onul
Rcprescnlulivc(s) on Ihe Ii~t hul'c heen cxhausled. Unlcss othcrwisc specilied if Co.Personul
Represenlulives ure serving, the ncxl I(lllowing nUlllcd ~ucee~sor Personal Reprcsenlulive ~hull
serve onl)' uller ull of Ihe Co-Per~onul Repre~entalive~ eeuse 10 aclus Personal Represenluti\'Cs.
Scetiun 2.
WlIi\'cl' III' Bund
No bond or undertuking shull he required of an)' Per~onul Represenlulive nOlllimlled in Ill)' will.
Section 3.
Genel'lIl PUWCI'S
r\'l)' Personal Rcpresentative ~hull hu\'C rull mllhority 10 mhllinisler illY e~late under Ihe law~ or
lhe Stule or Pennsylvaniu reluling 10 Ihe powers llr Iiducilll'ics. M)' Personal Repre~entutiw ',hull
hul'c the pllwer 10 mhllini~ter Ill)' eslute under the Indcpendent Adlllini~lrnlion of EstUlC Act.
2
A..tiele Th..ee
l>isposition of My ....ope..ty
Section 1.
DistJ'ihutiun to 1\1)' I{cvoellblc Livin~ Tl'Ilst
I give ull of my propcrly of whale vel' nalure anti kintl uml wherc\'cr localetl 10 my rc\'ocablc
living trusl of which I Uln 1I Trustor kuuwn as:
JAMES G. TIIEOIIAl.D A/KIA J. OEOIl<1E lIlEOIIAI.D. Trustcc, or his succcssors in
Irusl, untlcr the JAMES G. TIIEOIIALIl A1K/A J. GEORGE T1IEOIIAI.\J LIVING llHJST
t_ 1 " - -,., ", ~ ' .
daled J ."., ,,\. ie ,:) amI an)' umcmhnenls thcrclo
Section 2.
Alte..nntc Disposition
I I' my revocablc living trust is not in effecl lilr any rcason, I give 1111 of illY properl)' 10 111)'
I'crsonul Rcprcscnlative undcr this will us Trustee who shall holtl. udl11inister IIndtlistribute illY
propert)' as a tcstUll1entur)' trust, the provisions of which arc identicul 10 those of my revocllble
living Iruslon Ihc dale of excculion of my will.
A..ticle FOil..
Dellth TlIxes
Seetioll I.
Definition of Dellth TlIXcs
Thc lerl11 "death laxcs" liS usctl in my will shallmcan all inhcrilllncc. cslalc. succession amlolhcr
similur luxes Ihut 'ure puyuhle hy uny person on account of Ihul person's inlerest in Ihe cslule of
the tleccdent or by reason of lhc dcccdcnt's dealh including pcna\lics uml inleresl hut excluding
Ihc following:
u. . Any uddilion 10 Ihe fcdcral cslute lax for any "cxccss rctircment
accul1lUlution" under Inlernal Rcvcnue Code Seclion 4lJSOA.
b. Any IIdditiunullax tlllllmay be ussesscd under Inlernal Rcvcnue Code
Seclion 2032A.
3
"
.'
'.
Section 3.
Se\'Crnhility
Should un}' of Ihc provisiuns of Ill)' will he Ihr un)' rcuson dcclnrcd invulid such invnlidit)' shnll
not nlTect un}' of the uthcr provisions of this will. nllll nil invnlid provisiuns shnll he wholl)'
disregnrded in intcrprcting this will.
Section 4.
G()vernin~ Lllw
This will shnll hc conslrucd. regulutcd und guverned h}' nllll in nccordunce with the lull's of the
Stnte of l'euns)'lvunin,
I signed this. Ill)' lust will. on AUG 3 0 1995 ,
ESG'TIIE!I.I~I"^J'GEORG., IEO~ ~
5
,.
"
.'
The forcgoing Will wus, nnlhc dny und )'cur wrillcn uhn\'C. pnhlishcd nnd dcclnrcd h)' JAMES
G. TIIEOIlALD A/K/A J. CiEOIWE TIIEOJlAJ.D in nur prcsencc tn hc his Will. Wc, in hls
presence nnd ul his rClfucst, uml in Ihc prcscncc nf cuch \llhcr. hu\'e ullcstcd lhc SUIllC 1II1l1 hu\'c
signed our numcs us ullestinll witncsscs,
We declnre Ihul ul Ihe limc of our Ullcslulinn of this Will. JAMES O. TIIEOBAJ.D A/KIA J,
GEORGE TIIEOBALD \\'US, ucc\lnlinglo our hesl kn\lwlcdllC 1II1l1 hclicf, uf sound mind und
memory und under no undue durcss or conslruinl,
w4f,~
Addrcss:
a-P'I/ /~;9!
. .
'J.ress:
M~ / fJff
"
6
II
1'1,
I'.
-
n
'ci
:--!)
Ie--
i~
:\1'
, .
!\"'
,
In
Q,
\
~ 1")
-
I',
-
o
l I \ \ \
.
~
"',
. "'1
'd:l
-- ~
L:o
!@
..
....
III
:::I
....
f-< ..-l
..-l
'tl 0
r-I r-
III ..-l
.0'
0.... .
QlrJlo(
.c II<
f-<....
Ql ,
Ql.>c..-l
C,l......-l
... CUo.-4
0:E:Il
~1IlP.
os
. \0 III
I->NU
,
'.
~ ~. 0" .. -~ ,.'
-
-
-
\J
~ "
~ -
-
-
l -
~ -
~ rl\
....
0
~ l'... -
-........; -
~~ ""
~ ..... -
-
s:- 1
':i
.. "t
'k ~
(\..
~
l. ~
~ .....
~ l ~
V) 'V ,\.1 "
- ~ - ,
~~ '-
I... . ;\~
d .
--... c:..; I
",.
.....1'.
(
.o'
r 1.1 . ',\
. "~J
" ;J" ,I ,
L' ;.
-.
'''','' ..
'" . , ,
I ..
'i'-'" ....\
-' t
.. ,
I" I .'
" -.k
~. ,*
.: I
i'
".'
" 1
~
,-
I
I
I
___A
r~----
--:. --',.--':--"-'.-4_
_:.
... --...~...
. -. ,cO .. ~ ~
.. -- .- ~--- -- -~
,
;
,
- .--.-.--.--7"'"1;- -.--.
,:
._ c__"_. _____~_ .__._~ _ _.__ __ ~_._____
D AA 082501 COMMONWEALTH OF PENNSYLVANIA
NO. DEPARTMENT 0' REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
.'....116'11(1'...'
~..:,
,'So
., .
" .
RECEIVED fROM:
i
ACN
ASSESSMENT '='
CONTROL Iii.I
NUMBER
AMOUNT
I
,
J GEORGE THEOBALD TRUST
260:5 ill\RltET. STREET
---to 1
.64,:500000
CAMP HILL, PA 17011
- 'OION'"
ESTArE INfORMATION:
~ fiLE NUMBER
g 21-199:5-0962
~ NAME Of DECEOENr (LAST)
~ THEOBALD JAMES G
m DATE OF PAYMENT
EJ PosrMARK DAre
COUNTY
SSN 210-09-17:56
(fIRSr) (Mil
CUMBERLAND
DArE Of DEArH
REMARKS
J GEORGE THEOBALD TRUST
m TOTAL AMOUNT PAID
.64._:500.00
CW
SEAL
REGISTER OF WILLS
-'
( " J
RECEIVED BY ")n:ti./' ~ ('. . ;...j /--' j. '""
MARY C. 'L:E~~;'O~U;~'J-' 1Y--:'7-
REGISTER OF WILLS
CHECKII 0176
---- ----------- --- - - - -----_. ----_.--- ---.- -------.- ----.......-- - - ---
t'"
~_...,;,
,
,
,
.
----
.
_~_.__.-.---c-.~_JlcI.-_ J-r-
.."\'..
,
,
,;!. :.2;~! I. .. J
...
~
lj~~
w"u
,"00
u~~
11:'"
..
.;,~
...ill
~'"
~z
8~
12.
13.
I~.
15.
16.
17.
z
0
i= 18.
~
=> 19.
..
:II
'"
U
~ 20.
~
21.
'OA DAns 0' OIArH A"IA .2131191 CHICK HUI
If A SPOUSAL
. POVUrY CAID,r 15 CLAIMIO
'Ill NUM81A ~ I / ,-,. ',; .,-
T If E c :3,1 t. Cl lJ 1/ lit C:, I, .:'.-'~' (. c ..J ( " 'j j)I /I ~ /(; C r ~.,..-: ( ( r
:ioc:ii"\iC;".-iw..'"...ui'-"--'''- 'C""GICJIA.h. jo-,,-'fO:'--i,"TH' Clf fJ1" IfILL ,.-',J- /'1..'" - 'r"" j i
,-.~? .I"~~~_~~~)' I ~?",-. ~ (~'_~_~.I_.._.t(~.,'o",.,..!,.;;7r_;-,.~."I,~.,.,u'..~I'I!.' _~~ "~~.';I'..-o"-'C"""-'{I('-I""~'D 1f-1'~"""''''-U''''-'I,Do',,-, ____.__.____.__
' . ...., ' .',1. \..', , " , }.'.-, \I \ ....., ,.\' '0\' .'.'. .. il I .... .. .. " ~ .
IV /I~ : __III I
' ---. -----.-- ___".__L_._ _____ ..._ _.._,___ _______ __.._._.~.__..L
rX:I-O:;~~:C;'-R~turn -. 1 Suppl.menlol R'lurn
,
, C.. limited Euol.
,IS _ 71 :39.;...
,
(18) 7! .3 9;J.....
.
(19) t~ 7~
(20)
(21) ~ C,"7
(21") _ 0_
1218) ~ 1'...67
.
Cl.~' ~
It:'.,': ..(\
...... ~
15-' '7 I-I - '7
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
COUNTY CODE
c
<
(C~"'Otj"'f"I'.' (;' Plt"'\'l...tl'"
O(PAIl"'I"" (j' 1I[,plvl
Dl" :4C~(\'
._.....i1i11S.Uh.. PA "'1",)/')01
C((!OP. ~ "''''''I,,,~I ','\1 At.1 ... (Jr.,f
'j"i;
1:1(10",' \ u:'''''I(lf '0011\\
"EAR
~H.J"\3FQ
~
z
...
o
...
U
~
o
C-, 3
Ao fulur. InterllU Compromi,e
Ifo, dol, I 01 d.ath aher 12.12.92)
. 6 Decedent Di.d f.uol. X. 7 D.nd.nt Mointoin.d 0 liYlng fruI' ..L 9
! IAttach copy of Willi IAlloch copy of Trultl
i ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
N""', co""uu IolAlll"-O "OOIIU
I'IR~' Pf\'€CII-~C III deed,: 'fe'", hr:I?"->'liO~/!.
lfl(P"'OP-lrP-lvlolu'
4..'. . ..?ll~.J..
t~ 5.
8V~~,
R.moind., R"urn
(for do let of d.ath pr,o, 10 12.13.821
Fed.rol EI'ol. To. R.turn Required
Total Numb.r of 501. aepalil Bo.e,
It''/'
ft';
.d
-
I ." !lj;
"01,
,,, '- ,... ,I,J ^' , ( "
I. Real EUal. ISch.dul. A) (II
2. Stockl and Bond, {Sch.dul, Bl (2)
3. Clo"ly Held Stock/Pa,tn."hip Int.r"1 ISchedul. q (3 I
~. Morlgag'l and NOlet Receiyabl. (Schedul. 0) 1 ~ )
5, COlh, BanI.: D'pOlill & Milullon,oul P.nonol Property (5)
z IS,hldul. EI
0 6, Joinlly Own.d Property (Sch.dul. F) (61
i=
:5 7. T,on,I,,. (Sch.dul. G) (Sch.dul. Ll (7)
=>
t: 9. Total O,on Au.', (total Lin.. 1.7)
!:c
... 9. Funeral Ex~'n"I, Adm/niltro'iY. Co.... MI"ellan.ou. (9)
...
~ hp.nle. ( ch.dul. HJ
10. Oebl" Morlgag. liabilities, lI.nl (Sch,dule I) (10)
II. Tolol Deduction I (toloIUn.. 9 & 10)
-
I ~ 3~l
S- ..;l ~ .;2 76>.
/.:r (1.'5.~
,
1.:< C.S'7
. 1-
~
.J.-~;'.I
(8)
'-
~
\,.oJ
-
:..~
co
r...:)
o
.? I(~: (, 3.7-
\J},",
If lint 18 I, greol.r Ihon lIn. 19, enler the diHerence on lIn. 21. This I, the TAX DUE.
A. Ent., th. in,,,"t on Ih. bolonce due on Un. 21A.
B. Enle, ,h. 10101 0' L1n. 21 and 21A on L1n. 21B, Thh i,th. BALANCE DUE.
Malee Ch.cle Pavabl. tal R.gllt., of Will., Ag.nt
II lUll TO ANSWD ALL QUanoNS ON IIVIISI S1D1 AND TO IICHKK MATH
Under p.nalli.. of perjury, I d.c1ore thaI I ha.... 'lIomin,d this re'ur", including accompanying Ich,dul.. and Ilot.m.nh, and 10 th. be.. of my Ilnowl.dgt and b.U.f,
illl 'ru., corr.ct and compl.I.. I d.clore that all real ..tol. hat b..n reportelf 01 'tu. marh, 'Volu.. D.c1aralion of prepare, o'h,r than the p.nanol repr..,nlolive I,
bOI.d on all Information of which "po,.r halon)' knowl.dg..
lION" 0' PIlSON _UPONS.ILl '01 "UN IInUIN ADDIIUS .L o..t~
' ,.~ 'in. 0'0 .ue..j~i,.M.(7:( )/, ~~~ i}f ~ ~o.lj"h
AODIUS &- 1.~,(U '
(111
(12)
(13)
(141
N., Value of Eliot. (line 8 minuI line 11)
Charilabl. and Oo....rnm.nlol Sequel'l ISchedul. J)
N., Valu. Subjecl to TOAllin. 12 minu, lln. 13)
Spoulal Tron,f.n Ifor dolll of d.ath ah., 6.30.941
5.. In,lruetion, for Ar,plicoble Perc.ntcge on A,".n. (15)
Sid.. (Includ. volu.. tOm Sch.dul. K or Sch.dule M.)
Amount of Un, 14 loxabl. 01 6% rol,
Ilndud.. ....olu.. from Sch,dul. K Or Sch.dul. M.)
Amount of Lint 14 lox obi, at 15% rol.
(lnclud. values from Sch.dule K 0' Schedul. M.)
Principal '011 due (Add lOll from L1n.. IS, 16 and 17.)
Credill Spousal POYlrty Credit Prior Poymenll OilCounl Inllrtlt
- O~ + (,.t; 5110 + _~.:2VlS -':'"
If lIn. 19 il greater than lin. 18, .nl'r the diHer.nce on lIn, 20. Thll II the OVERPAYMENT.
aD
K.__
(161
K .06 _
(17)
~7:.j' '1"17--
I
Chccli hl'lc " you arc fcquc\,ing 0 ;cfund of Your ovcfpoymcnl.
-. -, ...... ... ....
,
Act #48 of 1994 provides for the reduction of the tax rat.. Imposed on the net value of transfers to or for
the use of the spouse. The rates as prescribed by the statute will be:
. 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
· 2% (.02) will be applicable for ellates of decedents dying on or after 1/1/96 and before 1/1/97
. 1 % (.01) will be applicable for ..totes of decedents dying on or after 1/1/97 and before 1/1/98
. Spousal transfers occurring on or after 1/1/98 will be exempt from Inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (,;) IN THE APPROPRIATE BLOCKS.
1, Old decedent make a Iransfer and:
a, retain the use or Income af the property transferred, ....,................................,................,
b. retain the right to designate wha shall use the property transferred ar ils Income, .,.............
c, retain a reversionary interest; or .......,..,........................................................................
d. receive the pramlse far life of either payments, benefits ar care' ................,......................
2. If death accurred an or befare December 12, 1982, did decedent within twa years preceding
dealh tranlfer praperty wlthaut receiving adequale canllderatlan' If dealh accurred aher
December 12, 1982, did decedent Iranlfer praperty within ane year af death wlthaul receiving
adequate consideration' ....... .......................... ...... ........ ........... ............ ....................... ......
I
3. Old decedent own an 'In trusl for' bank account at his ar her death'.....................,...............,
YES NO
( ~
I 1--
V
/ i .
I.....
1..-
I"
,..
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
,
,
l.va09llt,11Ul ~ J
-!.jj.
COMMOt4WU.UH Of PfNHnlVANIA
INH(lll'ANC[ 'I.. U1UIN
_Utp(NT DICIDlHT
SCHEDULE F
JOINTLY-OWNED PROPERTY
---_._~--~---_..-
FILE NUMBER
..:2/_ /'1'15 - o'lf.,.J...
ESTATE OF
c~ l"r"C
T;;'".,~b(lU...
-"
J.
~:~~~~:t~_ K~E.(:!":n(~r:_.':'7J,'~:''-4J?._" -{l~D~E~7J"tf.. i( . (,'e':-~f;~~6fiSHipTODEC:EDE'NT
A,
..U.OjJ- IJ/c,rkd Sr,
((.....If 11;1/, I'll (...."
S IS'Tf!/L
B e..TT~ II. c e TIII"&
8,
C.
Jolntlv.own.d prop.rlv.
ITEM LmER DATE
FOR
NUMBEI JOINT MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECD'S DOLLAR VALUE OF
TENANT JOINT OF ASSET % INT. DECEDENT'S INTEREST
1. A- .3/"3/&7
CD -fStc<< ~ I
.It d~lo0111.5"~~ /0, I,J.~ S<J'P ,5'0(,.;1..
,
If J/;J?>/K7 <:..1>-#-0;1./009/75(,-/ ;),5 ;1..93 t;-D 't I~, ,.1{(.,
1
If J/~/Y7 SI/'{II((.S #- o,;J./OO?I'lS'"7 ~ ,30 b 502 I (,,5~
, ,
TOTAL (Also enler on line 6, R.copiluloflon) S /'1. 3"
,
(/I mOfl .pace " n..d.d Inll,rl odd,Ilono' ,h..II 0' lome "n}
lUAU O' FILE NUMBER
.. :;: G<""'r ";1(el~ba.U... .:2(- 19'/,j--I}'Ic.:.J-
THII.SC..!lIOULl MUir BI COMPUTED AND FIUD IF THE ANSWIR TO ANY OF !HE QUISTlONS ON rHIRIVIISE SIDI OF THI COVII SHIIT IS YES.
ITlM OUCRIPflON Of PROPERlY fOIA'l VALUE DECO DOU.... YAlUE
.H~~'l~ !~~~ ~ 01"'. "0l'I1"''', n..., ,eloflQn'h.p 10 ,hUM"', dOl. 01"0"11., (JClU$IQN Of A55E' I;:'. O' ,DJflR~~~"S
'6
110 uL'D
I
I.
.;I,
a.
1-
5.
(.,
~
COMMONWr'..ttH Of PI,...N\l\"".W.I.
IHMI.".....c. 'AI .nUI"
.nIOlHT DeC.DlN'
SCHEDULE G
TRANSFERS
5i tlJI/~ f.',m,'/, ,II.. nil!., icr"h.l.d-
(I .;J(.'l'!..i /llllr,~r- .c;r-
OC'ru':f'i < I r:.""'f H.tl I '
('..",l,ul"H,l (l"~~l' ~""'( "''':''-:
7,1~ fIl/'I' ft'/?(F./. ,.',' .'I.;JI,t'.J.71..,tJl
1/..fC'-Ub 1I11U<~ .'tIs 9~o.
,
ilJl rl! ef' i:>!!l/rl/ vlIL/.<e r;S,I'I/J..,.rtrr-u
fl Y "r'I'~/"~t/L (re py /lrrtf<IIao)
~ll'" w/,-rtu- ~lt1o"'.$ . 0-
l1C'cr.t1- 'I,c ,o'f!t9OS- oc..~ (cePt t\f",~,,(l :
Pitt/If! W "- d(jE1Z..
t'/rrr II RF 3-{ ;J!r,J 1':' (c..(! G.tfo<'tJ.):
tf<fPEwlfElmrVL c:I.OfML fu./Jb
lleeT 1# 330 3~OOIr.946'f
i/;1I1R.6 ..5f1VltoICS J3rlll~ 301l~'" ~ t(1.
"
'J>.~~(I4,t.I DEfc~IT e.rlll1~ C/fCCt<,N(.
IlceT II- '11f~'f8>1i"
H-~t?({ IJ SAVINCS B/!. If .5"5oo.:z,3.;lI'f,
JA~/rfG5 IIcC~\JI\JT'
eE.1. "F/eliTE, of l:\t::fo,r,'r
&,
1-10 I../.S c. f/Ol-b Coo il5 Ft,I.(f{I~/II lies
,
^rvb Pe~sa"A" 8eLoN't:If.tCJ
'I.
~ill-Fe. bE:f~SIT' b~'1- cu4/,P..,r/S
~~,e. d I' 1H' /l-T'I V ft{.U. c eSOIltJi< s
ay It Pff(AIJlO'- (c~rr .. f't"ct...t)
1'7 K7 CIIe.,((o LfT cl1l'~'rE. - If bit SEM
I".
-0 -
-0.
_ 0_
_ co .
-0,
-0,
-0 -
-0 -
,;,-
3d 1~7 /O~
I
"lfASI P~INI o~ IYP(
100
~
lIt' ,I.'."
I
3d /,.2 7
.
.? '111 1M
, '
.3 Jfl9
/
" If''f
/
.s 'l()~
I
,f'fl
17.;J;l.
I
.31 I/- SI
/
p. DU-O
I
: ?3S-
17,00,
... ~_....._---_.
._---". ,-.--- ~
TOTI'/- L-
...",."'....,............
-0-
/If"1)
" '1'(
I
/1"1>
S'IOO
,
100
HI
IlrtJ
I 'I.}).
,
/ U6
.31 'f5/
,
/ <rtl
/:J. .uo
/
I L"V
'/.35'
1cr<J
10eD
,
II.
{; Qtl/Tff6LE.
/leer t4
TOTAL 1...110 ~l... an 11M 7. RlKopllwlaliOfll
'" mot. spoA ;. ttHded. MtNrl adGhottol.hH" 01 ,om4l JlI..'
of .zo wI} f}f</!VI)../ r{ ~ o. .3~ " 1'1
'1.:z. 700,;1'/.;1-'1'1'
,I/O
5
.3/, "'11
!! 5.;1.1, ,?l7fs,
l
I
II. '. 11. :h
ESTATE OF
ITEM
NUMBER
A.
.
~
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
i
I
J... . PI.a.. Print or Typ.
e ~7~E~-;-1:;~ ~-,,; ~ ~
AMOUNT
(O"oVOUWfAl1lt 01 '(W4!t't....ul1A
.~4t4I1I'''t4(f f,AI InUliN
IIf~~~I~I!_OI~!DIt_" .^_. u
1.1.
C.. c rJI!..
r/( ~ " b'l !.t..
DESCRIPTION
I.
Fun.ral EJCpenlll1
1'-) 1/' /::r( -'
\~ ".A - ./1
o G'K/lvt!
",/0
1'" ""1 t f.. r r - (I(I/''f /i; I,
of'/:";. N(;
fl/
Q
III Y CI! .s - /-III R lv' r: Ie:....
SS~vICE~'
7="" tv'l!.~/11. 1f.:J1I1c.
I
0/ CI'I.JI<-ET
C'A nil' 1(1t-L; fil
S",O{
I
B. Admlnl.trallv. Co.II,
4.
C.
I.
2.
3.
4,
5.
6.
7.
8.
1.
Personal Representative Commissions
Social SecurUy Number of Personal Repre,en'otl.e:
Year Commi..ion, paid 1'1 ? :5
1?9r.,.
Allorney Fee, 711 ty1 e.s 0;; m I Tit.... II Ll ~ 1<' 1/
,
d1./ :Jl.ro
8 1 50
,
:? Ol'{
,
2.
3.
Family Exemp'ion tv i,) N [;,
Claimant
Add,e.. of Cloimon' a' deceden", deo,h
S',eet Add,e"
Ci'y
5'o'e
Zip Code
Relotlon,hip
Probate Foe,
7,:}-'
Mlle.llan.oul Expensesl
.51. Ft:n-tlC'~ "f !1-ssj!.; ('{{v.rrh
,;> " () .
TOTAL (AI,o en'er on line 9, Recopi'ulatlon)
(II mar. .pac. I. n..d.d, In..rt additional .h..II 01 .am. .1...1
5 /:r 0.33
II..'."" r."
.~ J
lOM..()HwIAlht Of fI......."I.,.."
,fru...n.-.cl ,.. Inu'"
'U'OI..' ""101"" .
SCHEDULE J
BENEFICIARIES
ESTATE Of
C., , 'a ~ T-Ir' t' 0 b v. f.C
fiLE NUMBER
.~/- 1'1'/6-. or'(,.J..
C/.
ITEM
NUMBER
A. Ta.abl. Bequ....:
I. t1'/r( (l1,fo ;Iu.fc;/',"s,..n
~, d. { 1,.; k~ ? '",dl:trc. f'n?.t~
,j :0 l'" >1't.. 'Ml f {J,l!.
.4 Dtlr'l K n'ldf"r
5, /llr..... /11....,(, LlIr,( F~r'sr!..
c,. 1!1r-,..... (I Irs. F. IJ.,{Lt nl!. E >1 {.',~ I.P..
7. 11 {(S fr-/It /I-t!. Itl, au ht:..
g, Ld r ry r-. E. rot,
1. ::r Z, /. Y1 '0 u.C Ie... wQ.1 It',-
/0 111 ('5. II ((If'J'.4..rC r Il1c E wOo..,
RELATIONSH" AMOUNT OR
SHARI Of ISTATE
.
C!:'lI 1', n 10 ,-'.: c
I
I' J.. !) ,,~ 0
f ,.., t't-1 I
S O'} '..'
,
., ( b- e I..'i..'
I
.. ,;1. 0 l' IlL'
(
'" 0, l! l.l0
..
.. ""0 00 C
I
.. S 0.'0
I
" SO""
,
.. S, ,)OlJ
NAME AND ADDRESS Of BENEfiCIARY
ITEM
NUMIER
NAME AND ADDRESS Of IENEflCIARY
1.
8. Charitabl. and Gav.rnmlnlal 8equ....:
Co ve n t>.11 f !IOll ft.
t
3'1~ id;d 1711 Sf, ~V y,rI., AII'
,(.)(JI/. SdU ~
(1.2"- CrCtH Jr, Ilal'r,'!.'6"~", I'tl
/7 if IS
.,},
'fIU. S'Ilt..t//VncJl,/ AR.m y
I
.5.
l,rCH.u (IITE..13..e.s cJF- ~m€ttlc,~ tJF Cet<lTt2.tI'- PH
I
0'111.2 W'o.{,.,..d .>f, 1/,.,..,..-,SblArJ I Ill- 17t1,j
?>e..'rtf.eS'::'r+ ItISSIUI'/ r.d"Sa... 30'(( /Jae. f'4
, I I
'11Ds
4.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Aho .nlo< on lin. 13, RocopltulotiOflI
(If more .pac. I. n..d.d, InNrt additional ,h"'1 .f lame "Ie)
AMOUNT OR
SHARI O' ISfAn
10( 00,)
10lOOU
IOIOld
1'0, (JOD
S ~c.l ()OV
I.
.,r.
-.'
"
f',
1"
: ' .- ,.' }:; ;~.;" . 'r,\':'~.:;.{.~:.,.~,:""::..",..;,.~.,t,,,.',~,;,-,~:"~,"'.'.,".t'.'.c,,,(
Jf >,~~\:x~r " ';;.)-'-'-'--,---<-,-''-
.,..~_i" :~,r}~_ft'l , .i :,.',',' ,f'" - ;;.,-~ ~~
,;,;'Ii~"'f .,', ..
f'J~1$rf ,::,:'{ F'''::t;.~ r :"~'~'" S\'1'
.,~,'\t' 'I" i": ">:el
r ,<,,-.<\,. ' ,'.' >' '
,~. " C: L~"::' ::/~>
,,1 --. 1',1 _I,,~~ -~-N..-
. (F) -= (-,. "'~ '.
I' '-:: t' ;" ,:~;, ~'!,. ; >, :,;', : ".}i(
" .' ,"'-J t . ,- YJ,',.-:
L~, . ~'~~[" l ' ,.' "','" "..".,'J,,,a
.. l~f'~~ . ';'i:: -:" '. ,: . . '. ." ~.:,:c~t'
/:"lii\' W' == I" " ..-'-;,-.' .::' ' ;:,<:;:~{
K,'t, . ", 'r:: I.. :'>_. "'t>J:'.,. ":.::;.;''''~
",\,' '~'i<~""-'" -= [.'. ,,'....~ . ,'.', : >.",.,fl;or
]:\~ l~ >;..;~'f ~iH.. f'v-;~n. r; " ~. ~. - , '"i:. q.;,&'
,'IN. ._~ ",.:.~ol":'.':.\'~~"'" ":;;;':'~,:", ' .". '. ,,' ' ' ..;",'1: '.'~
1!iB~."!J, <";.'~!>.'.1...;./.<.".o.--.;:::"~ ',\ .- ,,' ,'" >o, ;,' .,' "'f.;"':'~': ''Si'<
~'~~.f~f ~~~f,.H;':~J;J:~r(:.!.~.i;'.;: of;;': ~. . '\":/-\',> ,:\':,I;~~';:I";:~~\'
,,~~'!';,,~[,'jj,\t<~l,!,,{.,\~,:'l"'-' ',','. .;:"....: :--,:..J ". 'f,. '""'''''>'\''\{
1... 'r.i...~."fA.i7;t-~~j;'::;' c~,,'~~\'i.' ~~r.~:;L "';_ :". " ,,~, - ~- - ". k', ':i-;"-:}:-~
'1 'Lt.,",,;;>...,:..;;; ~"'r'-""",' ,C,'..,'C\'<-- ~,' to>' _" ,.. " i h .,0. ,;<>",'1
;.:. -\1- '-"1 .".~ ....;;J.,..-'>11'.-"/'(J. ...,~., " ,__,~;~lI:'
"'ng"':'~'" ."",,,,,.'-'i',",,',,\, ,"'~' "'.. .,., ...".......
u,~... 1~.--:.. - .~1Jt-'r:~J~"~I.I. :~-~./~'" ~r (. ~': '!h ,<.~~.~I.~~y;~~~
>r,' 1 'FT::.tr~dJl -tV'<;1~'~""" L. - ; .., - -, .,'...~+'!i,-, "~
/, ' ,'_. "'"'''''' ..,' ," . ." .' - .
!.f:M ~~N ;,,~-.F:~~~';';I ":',7<, ~'_""'~ .'iOt ;:,: ~t,t-*>-/b;:-o<"
"t~~ ."'~>':rl?T r.::"ft' ~ '. 'j' .",'. ,...... \1:r-."1u""tI.....
1:i-3!ti r~ .x"~l'';';~,,?''''-1,.;;~..; .~t:;:J'~ '"':.;,' ) " ;- '-, .,t' '.'1 ,,\l.:'Jlp:'
'"'>F.: 1-1; '..,..'.. ".. ,,,.,, , .. ." ,.., .. ."
,,'< ...~" \>;;lI'~"'!;i:'.;: ::V1,',"'t' :,:'''.~ ;', "~" ',.'t.. ';; "~'"
w!,~~;".". ~".. . ,!,c;l"0';~ ~.}, ~-.';-,,;,,""" :': ;,[ J '''!,\l,'~'~''-':,
r, ~~,,<,,~..,tL ,_,'c" ..,.:,..,.;-<<t,;"'> "' ';.: '-",' . c.'.""; . ,'>.,: .,. "'ll
. i;~O,L" .'.".>.." ~J,;,"''J''r',''''' 4f""'::"',I'. . .... .."... ''''"'''''.,"
I~ii!;~t;;'~n;:":' ,'>" , ',F~f~
I. ~..., ,.~.' N' ' ',' ..,'0, ,,,,''''''.;.,.<'f,1 "
!~~i!&,;( ~ ' , :~f~!~~~r,
I"'''> \;,;;. '" ~ ' " ".,'.\ ' ,,!,'
1~1;K\~:;i;'~' ., i::' '1 ' ';ii~'!, '~!
r,":~!i ii' , S" ~, ;~"~"
~,~;t~', ' ~, "):,::)' :\,{;
lit .~f;j.~'~' ;'::.~', x .~, ", :.(,:~ '
\i;.~' 'oJ." "'" "",>.1.
II~~~;.~,:~<:~..~,~, . '~..,~\"
','. .,.~ - ..
'f ..... . ' ' , ~' "
~;>..~..~..: '~~..., ...<1:.,. ~':':;:'~,,;u
I~'::," ~ " '. " ::?". " y,,,,,,:, ""','
~ ;.~
.'~" ..,
l":'",., ''',,'~' ~ .\----
." .~\O.- , -
, . ". - - ,
, _! ' g:l
"
j
~
t'r-
","".'._ _I
.' ,"
"-; f" ;,,'~ !;
_'~-1
""!;::,'.?;',
<>
~-::-.- ;}
- ~,:.~~',_j< ~-f'
'.:' \. ~'-
..
,
"
",
, '.'~
(
t. ,
','
,. f
I "
.,
..
.1
'I " :f
.
"
<"
>
" /
..
" .
..... :.
C~LT" Of PENNSYLVANIA
DEPAAtHEH' Of REy[tU:
BUREAU Of INDIVIDUAL tAXEI
DEP'. IID6DI
HARtlISlURO, PA 11UI-06Dl
'*
INFORMATION NOTICE
ANO
TAXPAYER RESPONSE
"~I'_~CII'\'''~ (>-" r\.J.tu~",...1
EST, OF J G THEOBALD
5.5. NO. 210-09-1756
DATE OF DEATH 10'17-95
COUNTY CUMBERLANO
FILE NO. 21" q;j- '/'-''-'
ACN 95161679
DATE 12-28-95
TYPE DF ACCOUNT
[i] SAVINGS
o CHECKING
o TRUST
o CERTIF,
"',1141 II'"!'."I
BETTE R GETHING
2605 MARKET ST
CAMP HILL PA 17011
RENIT PAYNENT AND FORKS TO,
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
PSECU h.. provided the D8P.rhtent wUh the Infor..lIon lI.t.d b.low whleh hili bun u..d In calculating the
potentl.l t.lC due. Their racord. Indlcata that .t the da.th of the 8bov. d.c.dent, you ..ar. a Joint own.r/bena,lcl.ry of thh .ccount.
If YOU ,..1 thai In'or..tlon h Incorract, pl.... obtain written correction frOll the flMMeI.1 In.tltutlon, .ttKh a copy to thh fora
end r.turn It to the abov. addr.... Thi. account I. tallabl. In accordanc. with the Inherltanca lall L... 0' the Co~alth 0' Penn.ylvenla.
Qua.tlon. ..y be .".wered bw c.Ulng (717) 117-ISZ7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
A..O<.Wlt No. 0210091756-7 o.t. 03-23-87
Edabll.h.d
A..ount Bol...... 3.305,88
P.......t T..obl. X 50.000
A.ount Subj..t to T.. 1,652.94
T.. R.t. X .15
Pot.ntlol T.. au. 247.94
PART TAXPAYER RESPONSE
(!] I.. FAILUR!..:I"O. RI!SPOND: WILL.. RI!SUL ri IN AN Ol'ftICIALTAX . ASSI!SSNEHT .BASED. ON. THIS HOTIC!'1
A, 0 The 8bova Infor.atlon end tax due h corrlMlt.
1. You ..w chao.. to r_1t payMnt to t.M R-oht.r of WII1. with two copl.. of thll notice to obtain
a discount or .vold Int.r..t, or you ..y ch~k bolC "A" end r.turn thl. notlc. to the R-alst.r of
will. end ." o"lcl.1 ......-.nt will ba I..ued bw the PA Dapart-.nt 0' R.venue.
To Insura prop.r creellt to your KCount, hto
(Z) copl.. 0' thh notice ...,.t Kcoapany you,.
pay.."t to the R-aht.,. of WUII. .... check
p..,abl. tOI ""Reallt.,. 0' Wllh, Agent".
N01EI If talC p.yaent. .ra -.de within th,...
UJ .onth. 0' tha dK.dant'. data of death,
you ..y deduct a 5:t discount of the talC due.
AnW IntM,.1tanc:. t.lC dull wll1 bKo_ delinquent
nine (,) aonth. .,t.,. the data of death.
[CHECK ]
ONE
BLOCK
ONLY
B. ~ The abova ....t hili b..... 0,. wUI ba ,..pod.d end t.. paid with the PanntYlv."l. Inher1t.-.ea Tax r.turn
to be 'Uad by th8 decadant.. rapra"o"\lv..
c. D The abova Infor..tlon I";'ncorract and/o~llbt. end deduction. _ra paid b., you.
You .,.t capla'. PAR' l!J and/or PART l!J below.
If you Indlcata a dlff.~.nt tax ~.t., pl.... .t.ta you~
~.latlon.hlp to d.c.d.ntl
PART
~
TAX RETURN - COt1PUfAnuN
lINE 1. O.t. E.tobliah.d
2. Aceount a.lane.
s. P.~c."t Tu:abl.
4. A~t Subj.ct to T.x
S. Dabt. and D.ductlon.
6. Aaount T.~abl.
7. T.x R.t.
a. Tax Due
uF
1
2
3
4
5
6
7 X
8
TA~ uN JOiNT/TRUST ACCOUNTS .PAu
1
.2...
3
.4'
.5.
6
.7~
8
DEBTS AND DEDUCTIONS CLAIMED
.', OFFICIAL USE ONLY.O AAF!
PA DEPARTMENT OFRE~ENUE 1
i
'I
X
',.:'.
,.........,
~ :..'~'-':;..",~,,,,; .
',,;',
":;'1
'''1
PART
~
DATE
PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL IEnt.~ on Line S of T.x CoftPut.tlon)
I
.
pa~ju~y, I decl.~a th.t the
.1' ~~o...liadg. and...b.llaf..=-
'r/J.- U'G '
fM:t. I hav. ~.po~t" abCJv. .~. t~ue, ea~~Kt and
HOME ( l
WORK ( )
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AH OFFICIAL TAX ASSESSHENT tilth 1IPP1Iubl. Int.,.., bUM on lnlot..Uon
.....lttltd by thli flMnCla. InlUtutlon.
Z. Inhllrlhnu hll becOMI delinquent nine ~th. Ift.r the decedent', d.t. of ct.lth.
S. A Joint account I, t..able .v~ though the dlcaden", n... l01I" .oded al . ..tt., of convenience.
". ACCOU1h C InclUdlna tho,. held bet...." husband end IoIIU,) which the dlud.." put In Joint n.... ..lthln one vn, prior to
duth .r. fully "Mabla .. .t......,.,..
S. Account. .,tabll,hed Jolntlv b.tw..... husband end wlf. ear. t~ on. y..r prior to d..th .r. not t..abl..
6. Accounh htIld by . decedent "In truI' '0'" W\Othat or other. .r. tlllabl. fully.
REPORTING INSTRUCTIONS - PART 1
- TAXPAYER RESPONSE
1. BLOCK A - If the .n'or..tlon IInd cDllPUhtlon In the noUn ar. cornet And deduction. .r. not bllng clel"d, piKa WI "T"
In block "A" 0' Part I of the -t..pfty., R..pon.... .~tlon. Sign two copl.. end .~It tha. tilth your check far t~ .-aunt of
ta. to t~ Regl.tar of will. of t~ county Indlc.t.d. 1he PA o.p.rt..nt of A.v~ will I..u. ~ offlcl.1 ........nt
(Far. REV.15~' EX) upon r.c.lpt of t~ r.turn fr~ the Regl.t.r of Will..
I. ILOCK.O' If t~ ....t .p.clfl~ on thl. notle. ~. b.en o~ will ba reported and ta. paid with the Penn.rlv~la InherltlnC.
ra. Aaturn filed br the d.cedent'. r.pra.entatlva, pleca 8ft ~- In block -.- of P.rt I of the -Ta.oay.r A.~.a- .&ctlon. Sign one
capyand raturn to the PA D",arbant of Ravenue, Bur.." of Individual Ta..., Dapt 110601, flarrhburg, PA 17UI.UOl In the
anv.lap. provided,
3. ILOCJC C . If tha noUn Infor.atlon I. Incorrect Md/or deducUon. .r. baing cI.IHd, check block -c- and cOllPI.ta P.rtl I and 3
::('....~In~ '" .~ I.......u,..'''''. balow. 51.., t..o coPl.. and .uba" thaa ..lth your cheek far the MOUnt of t.. o.'W'abl. to tha A.ahtar
of Will. of the county Indlc.tad. The PA a.p.rt.ent of A.v.~ will I..ua an offlcl.l .......ant (far. AEV.I541 EX' upon rac.lpt
of the r.tvrn frOll thai A.,ht... of Willi.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. f.nt.r the d.t. the .ccount originally.... ..tabll.had or titled In ~ aannar a.l.tlna at d.ta of de.th.
HOTEl Far. decadent dying .ft.r 12llZllZ1 Account. which the dac.dant put In Joint n.... within ana I U yur of de.th .r.
t..abl. fully .. tran.far.. Uowavar, thar. h an ..clullon not to ..ceed n,ooo ptIr tran.f.r.. r.g.rdl... of tha v.lue of
tha account or the nu.bar of accountl held.
If . doubl. ..t.rllk (..) appear. bafor. your flr.t n... In the Dddr... portion of thl. notlc., the IS,OOO ..elu.lon
.Ir.ady h.. bean dMucted fraa the account bal..w:. .. rsported by the flnancl.1 In.tltutlon.
I. Ent.r tha total balanc. of the account Including Int.r..t accrued to the d.t. of d.ath.
3. Tha p.rcant of the account th.t I. t..abl. for aach .urvlvor I. d.t.ralned .. follow.,
A. The parcent t..abl. far Joint ....t. ..tabllahad .or. than on. v..r prior to the dec.dant'. d..thl
I DIVIDED IV TOTAL HUKlER OF
JOINT OWNERS
EMe.pI., A Joint ....t regl.tarad
DIVIDED BY TOTAL totlEA OF X laO . PCRa:NT TAXAILE
SURVIVING .JOINT OWNERS
In the n... of the dec.dent and two ather p.r.on..
I DIVIDED IV 3 lJOINT OWNERS) DIVIDED IV I lSURVlVORS) . .167 X 101 . 16.7% ITAXAIlE FDA EACH SURVIVOR)
I. The percent t..abl. far ....t. cr..tad within ana vaar of the decadent'. da.th or account. awnad br thl decadent but hald
In tru.t far another Individual I.) (tru.t banaflcl.rl.')1
1 DIVIDED IV TOUl If.JHIER Of' SURVIVING JOINt X IOD . PERCENT TAUBLE
OWNEAS DA tAUSt IENEFICIARIES
[xMPI.1 Joint acCCU'lt n,htared In tlMl n_. of thl dac:~t and two otlMlr p.r.on. and .stabllshed within DnII rur of d..th by
the d.cedent.
1 DIVID[D BY I ISlINIVORS) . .50 X IDO . 5IX CTAUILE FDA EACH SUAYIVDA)
4. the MOUnt .ubJ.ct to tax Ulna 4) II d.t.r.IMd by Mlltlphlng the 8Ccount balanc. Ill".. I) br thl "rc."t tuabl. Ulne 3).
5. Entar the tot.1 of tha d.bt. and d.ductlon. II.ted In P.rt S.
6. the ItIIOl.oW1t t..abla Illna 6) Is datar.lnad by .ubtrecUng tM dMl" and dHuc\lon. Ulna SI fro. the MO\.Vlt 'UbJect to tax (llna 41.
7. Ent.r the approprl.t. ta. rata Illn. II a. dat.r.ln.d b.low.
A. Far data. of d.ath occvrrlng .ftar 6/3D/94, the tax r.t.. far tran.f.r. to .pau... .r. .. follow.'
I. D.t.. of d.ath on or .ft.r 7/1/94 and bafor. 1/I/9S the rata I, 5~.
I. Data. of d..th on or aft.r 1/I19S tran,'.r. to .pou... will be t'Mld .t OX tax rat..
Hot.1 Far d.t.. of da.th prior to 1/1/94 tran,'.r. to 'POUI.. er. taxabl. at 6~.
I. Tran.f.r. to llne.1 d..cendant. Including fath.r, sathar, .on, daught.r, grandchildren, .on.ln-I..,
daught.rO'lnO'law, .t~lld and thalr I..ua .r. t..abl. .t .Ix percent C6~).
C. Tran.f.ra to .11 othar. Including brolhar, 'I.t.r, unci., aunt, nephew and nlac. .r. t.xabla .t fifteen parcant (15~).
D. If YOU change tha ta. r.t., pl.... .peclfy ~DUr r.l.tlonahlp to the dac.a.Rt In the ara. provided.
I. Tha -.aunt of t.. due (line I) I. d.taralned by Mlltlplrlng thl ..uunt ta.IbI. Cline 6) by tns tax r.ta (line 7).
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowabl. d.bt. and deduction. ar. d.t.r.lned .. follow'l
A. Vou ).galb ara r..pon.lbla far pnyaent, or the ..tat. .ubJ.ct to adalnlatraUon br a p.r.anal r",r"antaUv. II Insufficient
to pay thl deductlbl. It....
I. Vou actually paid the deb" .Uar de.th of the decadent and can furnish proof of p..,.."t.
C. Dabt. b.lng clalaad au.t be Ita.l~ad fullr In Part 3. If additional .paca I. naadad, u.. pl. In pap.r I Il,- )I 11-. Proof of
p.v..nt a.r be r.qua.t.d bV the PA Dap.rt""t of A.".,.,..
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. TOOl (717) 772-2252 (HEARING IMPAIRED ONLY)
CQHHOHWEALTH or P{NHSYlVAHIA
OCPARTHEHT Of' REVU&J[
BUREAU Of IHDIVIDUAl TAk[S
OEPT. 110601
HARRISBURG, PA 11UI.0601
*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21- 'I" "'".J.
95161677
12-28-95
TVPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
!Xl CERTtf,
In.1UIU.".,.".
EST. OF J G THEOBALD
5,5, NO, 210-09-1756
DATE Of DEATH 10-17'95
COUNTY CUHBfRI.AND
BETTE R GETHING
2605 HARKET ST
CAMP HILL PA 17011
REHIT PAYHENT AND fORKS TO.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
PSECU h.. provld.d the D.p.rt..,..t with the In'or..tlon Ilstlld b.low which h.. b.en Uled In uleul.Una the
pot."tI.1 t..: due. Theilr recorde Indlut. th.t .t the d..th of the above dft.dent, you ...r. . joint DWM.'/b.ndlcl.ry of thh ltCcount.
If you ,..1 thl. Infor..tlon Is Incorr.ct, pl.... obt.ln ..rltt.... corr.ctlon fro. the flnancl.l In.tltutlon, aUKh . copy to thh far.
end return It ta the sbov. ltddr.... 1hh 'CCCKM'1t .. t.nbl. In Iccardenc. with the InherltMC' 1.. l""e of thl Cu.onwellth of P."".ylvenll.
DuI.tlon. ..y be .".wered by cllllno (717) 111-IS21.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
Account No, 0210091756-2 o.t. 03-23-87
E.t.blhhad
AccOW1t e.l."c.
P.rcent T.><abl.
A.ount Subj.ct to
T.x R.t.
Potenti.1 T.x Du.
10,123.34
50.000
5.061. 67
.15
759.25
TAXPAYER RESPONSE
,FAILUIII!;To III!SPoND .,llILL ,'. RESUL r.. IN,.N OFFICIAL TAX ,ASSESSNEHT"BASI!D ,ON, ,TtlIS . NOTICI! '
To Inlur. pro~r credit to your ICcount, two
(2) cop I.. of this notlc. auet accoepeny your
p.y.."t to the R'alstsr of Wills. "skI check
peyabl. tal ""Re,ht.r of Wills, Agent".
x
x
NOTE. If te. psy.."te sra .... Illthln thr..
(1) .unth. of the dec.cllnt'. d.t. of death,
you .ey deduct a 5% dltcCU\t of thl tu dI.HI.
Any InharltMCe te. due 11111 bee... d.lInquent
nine (,) .unth. sft.r the det. of dleth.
T..
PART
ill
[CHECK ]
ONE
BLOCK
ON LV
A. 0 The above Infor.atlon and ta. due Is correct.
I. You .ey choo.. to r..lt payaent to the R.al.t.r of Willa with two co~l.s of thl. notice to obt.ln
e dl.count or avoid Int.r..t, or YDU ..y check bow -A- end r.turn thl. notle. to the R.alst.r of
Will. and an offlclel .....__t will be I..ued by the PA Dep.rtHnt of Revenue.
8. 0 The above ....t h.. b..n or will be reported end t.. plld with the Penneylv,,", Inherltanc. T.. return
to b. f Il.d by the decedent'. r.r"'"tltlv..
C. 0 Th. above Infar..tlon l,.....J.ncornct end.Io~ebt. end deduction. ware paid by you.
You au.' callPht. PART l!.J lndIor PART ~ belCMl.
If you indic.t. . different tax rate, pl.... .t.te your
ral.tion.hip to dec.dent.
OFFICIAL USE ONLY 0 AAF
. .PA IlEPARTHEltl"oF,!REVENUE
PART
~
TAX RETURN . COKPUIATION
LINE 1. Oat. E.tabli.h.d
2. Account aelane.
S. P.rc.nt T..ab1.
4. A.aunt Subj.ct to Tax
5. D.bt. and Deductiona
6. Aaount Tax.b1e
7. T.x Rat.
8. Ta)( Due
lAX UN JOINT;TRUST ACCOUniS
PART
~
DATE
DEBTS AND DEDUCTIONS
PAil
1
2'
3
4
5
6
,7
8
CLAIMED
..> ,..~, , .
,,:~,_... "-' - ;.
Or
1
2
3
4
5
6
7
8
K
';-'. "", ::~.,~(.:~~-- ': .
'; :>~>;. ~..,'
i
,
',:1
,
K
PAID
PAVEE
DESCRIPTION
AMOUNT PAID
I
TOTAL CEnt.r on Lin. 5 of Ta>< Co~utation)
I
.
Under Pal\ll1~ "ii.. of p.r~Y, _1 deal.r. that the
c.....l.t. to th. ~~.t 9frOlll Nl'i,dp. tnlH>eUllf.
.'" ~Lt.. 1.J.JJC.~1
TAXPAVER SIGNATURE
facta I
have r.port.d
HOME (
WORK (
TELEPHONE
above ar. t~, corr.ot and
OENERAL INFORMATION
1. 'AILUNE '0 "ElflOND Will REIULT IN AH O"ICIAL TAX ASSf.SSHENT ..Ith IIPPllcllble Inh'''' ba.~ on In'o....Uon
tubltUted b, U,. tlMMI.' In,"tuUM.
I. Int..,II~. h. hM.... ."1I",,*,, nine lNf1lhl lilt' 1M dececMnt't dl" Df datI'h.
I. A Join' _1:",.,1 II 1.....1. Iven tI_fIh Iho .I,ud""" n... .... IMkMd a.. ..tter of convent.nu.
~. Accowth I Inc Iud I", th.... h,l.. Ii,I"..,. h"tllwwe .td ,,"el which the doc-dent rut In Joint n_.. within OMI vu, prlo,. to
de.th .r. fullY ",IIbI. .. 1,.",1.".
.. Aeeount. ",,,,1 'litH Jolntl. h.t....n ,...."wwt .,.., wlf. Hr. 'hM one ,.... prior 10 d..th .r. not tuabl..
'0 Aceoun" hold b, . III"od.,,' "'n "utl I.'" 110O"'" or .Iho,. .r. ",.til. fulh.
REPORTINO INSTRUCTIONS - PART I
- TAXPAVER RESPONSE
I. .,OCIl A . If the In'.'..II.".... CHPUtlllDf1 In tt'l' nolln .r. cornct'" deduction. .r. not balno ctolaed, piKa..,....
In blDC~ "'" .f P"I I of the "I..p.,., ...pont." ..ctlon. Sign two cop I., end ,ubalt the. Mlth your check for t~ -.aunt 0'
h. ta the ...,lIh, a' Willi a' Ih. countw lnetlut.d. lhe PA Dep.rt""t 0' R.venue Mill ...UtI WI official ......Mnt
lrar. -.V..\U... upon nul,t of Ih. r.turn 'rDII lhe blht.r 0' 111111.
t. IIOCIl I . If Ih. ....1 sp.clfl'" an thh notlu has b.." or Mill be reported end t.. p.ld MUh the Penns,lv."l. Inher1t~.
fa. "Iurn flaed b., the decadent" r.pr..enl.llv., plH. IW1 '"X- In black ...- 0' P.rt 10' the "Tellp..,,, A..pan..- SHUon. Sign one
cop., end r.lurn 10 lhe PA nep.r'.ent af R.venue, lur..u of IndividUal J.Il.', Dept Z'D'DI, HarrisbUrg, PA 17IZ..06DI In the
env.lop. provided,
I. IIOCM C . If lhe nolle. In'ar..llon I. Incarr.ct endlor deduction. .r. b.lng clal-.d, check black -Coo end coapl.t. Plrt' Z and 5
.~~~.~I~ I. thl 1...t'I~llnn' helOM. Ilan two cOPI.. end lubalt thee Mlth your cheek for the ..ount of tall p.,~I. to the A-ul,t.r
of lilli, 0' the count., lnetlc.t.... 'he PA n.p.rl""t of A.venue Mill I.aua ." offlcl.1 ......eent (Fora REV.1S41 [X) upon rec.lpt
af the rltu,n fr.. lhe ...I.I.r a' 111111.
TAX RETURN - PART 2 - TAX COMPUTATION
"Il(
I. rnhr lhe d,l. lhe IIClcaunt arl,ln,lh Mil e.lllbll.h.d Dr Utled In 1M .lItVttIr a.hUnt at dill. 0' d..th.
NOll, rar. dec.-.nl drln, .'t.r 1"1"." Account. which the d.cedant pul In Joint n88.' Mlthln one II) .,e.r of de.th .r.
h....I. 'ulh .. Iren.f.r.. llawn.r, there II ., ..clullon not to ..c.ad .5,000 p.r Iran,fe,.. r~.rd"" 0' the vllue of
lhe HCIM'lI or the nuaber a' HCount, held.
I' . doubl. ..1.,1.. (..) ~..r. b.fo,. your flr.t n... In the .ad,... portion of thl, notlc., the '5,000 ..clu,lon
.lrtlMJ., h.. b.en deduGted fra lhe account b.lanc. .. repo,ted by the flnlnCl.1 In,Ulutlon.
I. 'nl.r lhe lot. I b.lanc. a' tho Hcounl Including lnt.r..t accrued to the d.t. 0' d..th.
J. thl percenl of 'hi aeC0U11 th.t I, t,..MlI. rar ..ch .urvlvor II d.hr.lned .. 'ollowlI
A. the p.rcant 1...MlI. for Jatnl ....t. ..Iabll,had aar. than one y..r prior to thl deCedent". da.thl
I DIVIDlD IV tOUl ~IU' Of'
JOINJ DWNrR'
(11..,1'1 A Joint ....t r.,I,t.red
DIVIDtD IY tD'Al NJttIDt OF )( lOO - PEACEHT TAXABLE
SURVIVING JOINT OWNERS
In the n... 0' the dKadent Ilnd tlfCl 01"., parson..
I DIYIOlD IY I CJOIN' OWHIRIJ DIVIDED IV Z CSURVIVORS) . .167 X loa . 16.7X CTAxaBlE FOR EACH SURVIVOR)
I. IhI p.rcent I..ebll fo" ...... cr..lad Mlthln one 'II.' of the dK~t". iM.th or accounh owned by thl ~t but held
In tru.t far .noltt.r Inetlvloo.II,1 "ruII beneflclarl"'1
I OIVlbrD IY totAL ~I[A or SURVIVING JOINT
OWNIRI DR tllUll I[H((ICIARI[I
h....l.. joint ItCcounl r'l..t.red In the n_. of the decadent and tlfCl ather patlon, end ..tablhhed Mlthln one y..r 0' de.th by
the d.udent.
I DIVIOlD IV , IIURY.VORI>> . ..0 M 100 . SOX CTAXAlLE FOR EACH SURVIVOR)
X IDa - PERCtHT TAX....lE
~. IhI...un1 .ubJecl to t.. (line ~I I. d.l.r.lned by aulllplylno thl .ccount b.lene. Clln. Z' by thl p.rcenl tax8bl. (line 5).
5. lnt.r th. 10111 of the debt, ..... deduction. Iht.d In Part 1.
A. ,he MOUnt t..abl. Cline ,) I' det".lned br .uatraetlng thl deb.. and cs.dUCtlon' I!IM ~, "CHI the MOUnt .ua)ICII to I'. lJ,lne ..,.
1. 'nl" the ..."oprllt. I.. ut. III". 'IJ II d.t.r.lned b.I....
A. ror det.. of d..th occurring aU.r 613D/94, the t.. ret.. '0" t,.".f.r. to .poun. .n .. lollDM'1
I. 0.1.. ., da.th on Dr .ft.r 1/1/'~ and b.'or. 1/1/95 the r.t. I. !X.
,. D.t.. a' d..th on Dr .fhr 111"5 tr.,,".,.. to .pous.. Mll1 ba tultd at n tu r.t..
Ho'., 'or d.t., 0' d..th prior to 7/1/94 tr.".f.r. to .pau... a,.. t..abl. .t 6~.
I. tun,f.r. to 11"..1 da.eand",t. Including ,.thllr, ..thar, .on, dMlghhr, grandchildren, .on.ln.l"',
dlUlhl.r.lnol"', .tepchlld and th.lr I.SUI '1'. t..abl. .t .1. pa,cent (6X).
C. 'ran,'.r. to .11 othlr. Including ~rDtha" .I.t.r, unci., eunt, nepheW and nlac. .,. t..abl. .t 'I't.-n parcant (15%).
D. I' you change thl t.. r.t., pl.... IP.cl'v your r.l.tlonshlp to the dlced",t In tha .re. provldad.
t. JhI.-aunt 0' II. duD Cline II I. d.t.ralned bv .ultlpl,lng the aaount t..lbl. (line 6) b, the t.. rat. Cll". 7).
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
AlIoM~I. debh If1d dlfUCUonl .1'. d.t".lned II 'OllOM'1
A. You l.g.II, '1'. r..pon.lbl. 'or p.yaent, nr the ..t.t. .ubJlClt to Ildalnlatntlon by . p.,..OI'\IIl repr....,..tlv. I, Insufficient
to p'V lhe deductlbl. It....
I. You ItCltu.lh paid the deb" .ft.r d..th of the decadent and un 'urnlsh prDO' of p.y..nt.
C. Debl, being cl.laId .u'1 be It..I.ed 'ully In P.rt 5. I' additional .pac' I. needed, u.. pl. In peper' Ill'" . 11-. P,oo' of
p.y.ent ..., b. r.qu..ted by t".. PA Dep.rl""t of R.v.,.."..
TAX PAVER ASSISTANCE ... "
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACTANV .
REGISTER OF WILLS. PA DEPARTMENT OF REVENUE, DISTRICT OFFICE.
OR CALL THE BUREAU OF INDIVIDUALTAXES,TAXPAVERINQUIRV UNITt".:. ,.:
HARRISBURG AT (717) 787-8327. TOOl (717)772-2252 (HEARINO<IMPAIREOONLV)
CDtttOHWE..lTtI Of' Pt:HHSYlVAHI"
DEP"ATttENT Of R[VOIlJ(
IUREAU OF INDIVIDUAL TAX[S
DEPT. UUIl
twtAISIlMG, P" UIIl~I6DI
'*
FILE
ACN
DATE
NO. 21 - '1:5- q ,', ~I
95161678
12-28-95
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
!Xl CERTIF,
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
m.IM''''''U."1
EST. OF J G THEOBALD
S.S. NO, 210-09-1756
DATE OF DEATH 10-17-95
COUNTY CUMBERLAND
BETTE R GETHING
2605 MARKET ST
CAMP HILL PA 17011
REMIT PAYMENT AND FORMS TO,
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
PSECU h.. pro"ld~ tM O~.rt.."t ..lth the In'orutlon lhted b.low which ha. be.., us.d In nlculaUng tM
potential t.. due. Th.lr record. Indlcat. th.t .t the d..th 0' the above decedent, YOU w.r. a Joint own.r/bene,lclary 0' thl. account.
If you ,..1 this In'or.aUon h Incorr.ct, pl.... ableln ..tltten correction 'roe the fl~I.. In.Ututlon, .tt.ch . copy to thh for.
ena r.turn 1t to the abov. .aan... Thh account Is t..IIbI. In accordenc. ..lth the Inherlt8nCe lex l.... of the C~lth a. P.,.,,,I,,..,la.
Que.tlon. .ay be an.wered by callIng (711) "'-1527_
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0210091756-1 Dot. 03-23-87
Edabl1ahed
Account Do1....c. 25.292.61
P.rc....t T..ob1. K 50.000
A.ount SubJ.ct to T.. 12,646.31
T.. Rot. X .15
Pot.nU.1 To. Du. 1.896.95
PART TAXPAYER RESPONSE
m I. FAILURI!.TO RI!.SPOND, ifILL., RESUL T.IN. ANOF.FICIAL.'TAX ASSESSMENT BASI!D. ON' .THI.S. .HOTICI!.. .1
... 0 The above In'orutlon end tax au. II correct.
1. You .ay choo.. to r..lt payeant to the A..J.t.r 0' Will. ..Ith two copl.. 0' thl, notlcl to Obtlln
. dhcount or avoid Intara.t, or you ..y check box ...... end raturn thh noUCI to the R....t.r a'
Will. and an offici.. .....s-.nt ..Ill be I..ued by the P" Depart.-nt of Revenue.
To In.ur. proper credit to your account, two
UJ copl.. 0' th" noUn "'t BCCOIIPany your
pa,...,t to the RaG I. tar 0' Will.. Hak. check
paYabla tal '"R....t.r 0' WUIs, Agent".
HOTEl If tlX payaent. ara ..a. ..Ithln thr..
(5) ""th. 0' the dec.clent', data of d..th,
you ..y IMduct a S:C dhcount 0' tM tu due.
Any IntMr1t8nCI tlX due ..Ill baco.a delinquent
nlna 19) aonth. a,tlr the datI of de.th.
[CHECK ]
ONE
BLOCK
ONLY
I. c:J Th. abo"l IS.lt he, blan or will be reported 8nd tax peld with the Pennsylvania Inherltancl Ta. rlturn
to be ,llad by the dlcadent-, reprl.entatlva.
C. 0 The abOVI In'ora.Uon J~neorrlCt endIoJ::-,dabts end deduction. were plld by you.
You lU,t CDl!Pht. PARr l!J and/or PART l!.J bal-*_
If you IndIcat. . dIff.rent t.x r.ta, ple..a .t.t. your
ral.tion,hlp to daced.ntl
OFFICIAl:: USE ONLY DAAF
PA DEPARTMENt"OF.,AEVENUE
. ." ... ","',', ...... ,
PART
~
TAX RErURN - COI1PU'IATIilN
LINE 1. Dot. E.tob11ah.d
2. Account Balanc.
S. P.rc.nt Taxable
4. Aaount Subject to Tax
S. Dabt. and Deduction.
6. Aaount T.xabl.
7. Tax R.t.
8. rax Dua
PART
~
DATE PAID
DEBTS AND DEDUCTIONS
l'AD.
.'.1'
2
3
4
."~.
:7,
8.'
CLAIMED
rAX ON JilINi,TRUST ACCOUnTS
01'
1
2
3 X
4
5
6
7 x
8
~ -: <.. , .:: ;-'. '
,. "'~'~'~,:I" ',:"
"'...-..:.,.:.,,':'
., '>~:;>:,;';~~':-,,~~~h~~?:
.',',,:, ',"(: 'm:;A~:'-{;?,,~;:,: ~::'", "
".-::
:::
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on LIn. 5 of Tax COMput.tIon)
I
.
Under panalti.. of parjury, I decl.re that the fact. I
coapl.t. to the b..t of .y knowledga and ball.f.
TAXPAYER SIG~HJ~R ~L (~ "
abov. ar. true, corract and
hay. rapart.d
HOME (
WORK (
TELEPHONE
GENERAL INFORMATIOIl
1. fAILU"E TO RES,.OHD WILL AESUL T IN AN OFFICIAL TAX ASSESS"ENT with ...UC8bla Int.....t b..ed on t"for_tlon
.ue-tUad b., 1M Un_I_1 In.tltutlon.
I, Inherlt~. ,.. beC~' d.llnquent nine .unth. .,t... the decedent", dl" 0' de,th.
), A Joint K(ount I. I'M~I. IV.n thouoh the dlcld.nt', na.. WI' added al . ..tt.r of conv.nlanCI.
.. AcclM.r'ltt I Including tho.. hIIld h.'...." hlJ,bend Bnd wlh) which 1M decedent put In Joint n.... within one v..r prior to
d..th .r. full., ,...bla II tt~.f.'"
\. Accoun" ..1_1 hhad Joln'lv betw.en hU.band and ..If. lor. than ~ y.... prior to d.ath ara not ,..abla.
.. Account, held by . decadent .In tru.t lor" anoth.r or other. ara t..abl_ fully.
REPORTING INSTRUCTIONS - PART
- TAXPAYER RESPONSE
1
.. alDCI A . If the In'or..tlon and cOIlPUlaUon In the noUu ara correct end deductlonl ara tlOt baing cta.aed, plKI an ""XW
In bloc'" "'" 01 P,rt I of the "'TIlI.pay., R..pon.... ..ctlon. Sign two coPl.. and ,\Ditt the. with your cMck far ttMI .-ount 0'
t.. to thl! R.,ht.r 0' Wllh 0' the countv lndlut.d. The PI o.p.rt..nt 0' RavWlUll ..UI 11Iu. en olllehl ...........t
1'0'. NEY'I'.. r.1 upon r.c.lpt 0' t~ r.turn 'roa the R.gI,t.r 0' Will'.
t. .lOC.' - If the ....t .p.cIfIMi on Ihll notlu h.. b.., Dr NUl b. r.portld and tax plld with the P..""ylvanl. Inhtrltlllnu
fl. M.lu,n flJMi by the dec.dent'. rllPrl,ent.Uv., plltel an "X" In blodl. "B" 0' P.rt I 0' the "TI.p.y.r R..pon.... .ecUon. Sign on.
copy ~ r.lur" 10 the PI Oep.rt...,t 0' R.venue, lurleu 0' Indlvldull Tlxl', O.pt 2'0601, H.rrl.burg, PA 17121.0601 In thl
env.lope provided.
I. "OCK C . I' lhe notle. In'or..tlon I. Incorrect andlor deduction. arl b.lng cl.l.ed, check block "C" Bnd co~llt. Part. Z and 5
~1,.U1..ln, I." ,... j....\fu"U...'U t~I~... s:~ ~;.;c :c;:!c. ..-t t':.'t'~tt ~"'''' .,It~ ynur r.~k for the INtOUnt 0' tax o,velll, to the Repht.r
of wllh of the county Indlut.d. ThI PA D.p.rtl..,t of R.venue will 111\11I WI offlcl.1 ........"t (far. Rty.15U EX) upon nCllpt
., the raturn fr~ thl R-ol.tlr 0' Will,.
TAX RETURN - PART 2
- TAX COMPUTATION
"10
I. fnhr
N01[,
the data the ICCount originallY w.. .,tBbII.h.d Dr titled In the aannar ..I.tlng .t d.t. of d.ath.
ror , dlCed...t dyln, ,ft.,. 11l11l'Z~ Accounh which the deced.nt put In Joint nlltH. within ona UI Y"" of d.ath .,..
ta.abla fully'. Iran.fl,." How.v.,., th.ra I. an a.clu.lon not to ..caad '5,000 p.,. tran.f.r.. r.gardl... of the v.lua of
the ItCcount Dr the ~r 0' KCDl.W1ts held.
I' . doubl. I.tarl.k (..1 appear. ba'orl your flr.t ~ In the addr... portion of thl. not lea, thl '5,000 Ixclu.lon
alraMY he. baen deducted 'roe the account balance II reported by the flnancl.1 In.titutlon.
t. fnlar the lot.l balanc. 0' the account Including lnt.r.at accrued to the date of dI.th.
I. 'he p.rcant of thl account that I. taxabla for .ach .urvlvor 1. det.r.lnad aa 'allow.'
A. the pareent t,.abll 'or Joint ....t. a.tabll~ aar. than one yaar prior to the dec.dant". d.ath.
DI\llo[D IV TOTAL NUttIER Of DIVIDED BY
JOINT OWNERS
h-.hl A Joint ....t ngllterM In thl nee. of
ToUL fUClER OF X loa . PERCENT U.AIlE
SURYIYIHC JOINT OWNERS
the decadent .-ld two other .,.r.on."
I 01\110[0 BV S (JOINT OWNERS) DIVIDED BV Z (SURY1YORS) . .167 X 100 .. 16.7% (TAXABLE FOR EACH SURVIVOR)
B. 'he parc.nt t,.abl. for ....t. cra.tad within one yaar 0' the dacadent'. d.ath or account. ownad by the dlC~t but held
In trult 'or Bl'lDthlr Indlvldualh) (tru.t banaf!clarl..h
I DIYIDED BY TOTAL NUttiER OF SURVIVINC JOINT
OWNERS DR TAUST BENEFICIARIES
K 100 . PERCtNT TAXAIILE
[x-.pla, Joint ItCcount r.glst.nd In the MIll" of the decadent .-ld two othor pu.on. and IItablbhad w1thln _ w-a,. of .s..th by
the d.cadent.
I 01\110[0 BV 1 (Sl,RVIVORSI . .50 X 100 . SO:C (fAXABLE FOR [Aat SQNIVORI
4. thl aaount .wjact to ta. (llna 41 .. d.ter'ln.d by aultlphlng the accOW'lt bahnc. Ulna ZI by the p.rcent taxabll Ulna :5).
, r~t.r t~ lotal nf the dabt. and daductlon. II.tad In P.rt 5.
.. thl .aount ta..ble (llna 6) II d.ter,ln.d by .ubtr.ctln, thl datah end daductlon. (lln. 5) fro, thl aeount .ubJltCt to t.x Ulna It).
7. [nllr the IPfIroprlat. II. nt. Ulna 7) a. dahreln.d balow.
A. For d.t.. of dalth occurring .,tar 6/50/94, the tax rat.. 'or trenl'ar. to .pou,.. ar. aa 'ollow'l
I. o.t.. 0' d.ath on Dr ,'t.r 7/1/94 and b.for. 1/1/95 thl rat. I. 5:C.
Z. D.t.. 0' d.ath on Dr .ft.r 1/1/95 tren.f.r. to .pou,.. will b. taxad at O:C tax rata.
Hotll For dat.. of d..th prior to 7/1194 tren.f.,.. to .pou,.. ara IIxabla at 6:C.
a. Tran,'.r. to Ilne.1 d..candant. Including fath.r, .other, 'Dn, daught.r, grandchlldr.n, .on.ln.lew,
daughtar.ln.I..., .tapchlld and thalr I..UI arl ta.abla at alx p.rcent (6leJ.
C. Tran,'ar. to .11 othara Including brothar, .I.tlr, uncll, .unt, nephew and nlaca .r. ta.abl. at fl't.en parcant (ISle).
O. I' you chang. thl t,x ratl, pl.a,a splclfY your r.l.tlon~lp to the decedent In the ar.. provided.
a. The aaount of tax due Ulna aJ h d.t.r.lned by aultlplylng the IIi8CQ1t ta.llbl. (llna 6) by the tax ratl (Una 71.
CLAIMED DEDUCTIONS - PART
DEBTS AND DEDUCTIONS CLAIMED
3
Allowabl. d.bt. and daductlon' ara datar.ln.d a. 'ollow'l
A. You hgaU>> ara rllpon.lbl. 'or p.yaent, or tha a.tatl .wjlct to adalnlstration by . par.onal rlpre,entatlvl II Insufficient
to P8Y the daductlbl. It....
B. You actuall>> Plld thl d~h a'tar d.ath of thl d,cldent and CM 'urnl~ proo' of paplnt.
C. Debts baing chl.ad lU.t ba It..llld 'ully In P.rt 5. If eddltlmal .pac. II n.aded, u.. pl. In papar . IIZ" x 11". Proof 0'
payaant .ay b. raqu..tad b>> the PI O,plrt..nt 0' R.vlnue.
TAXPAYER. ASSISTANCE..
..IF YOU NEED. FURTHER INFORMATION. OR: ASSISTANCE, CONTACT AllY
....: REGISTER OF WILLS; PA DEPARTMENT OF REIIENUE. DISTRICT OFFICE .....
OR CALL THE BUREAU OFINDIIIIDUALTAXES;TAXPAYER INQUIRY UNITlN
HARRISBURG AT (717) 787-8327; TOOl. (717)}72-2252. (HEARING IMPAIREDONLV)
1.5--- /<'/7
r.OHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
C/
BUREAU Of INDIVIDUAL TAMES
HllERUAHee TAX DIYISION
DEPT. Zlonl
HARRISBURG, PA 17IZ.~D'Dl
NOTICE Of INHERITANCE TAM
APPRAISENENT. ALLDWANCE DR DISALLOWANCE
Of DEDUCTIONS AND ASSESSNENT Of TAM
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
12-30-96
THEOBALD
10-17-95
21 95-0962
CUHBERlAND
101
PRECIllE H BEEBE
400 BERKSHIRE RD
MECIlANICSBURG
PA 17055
AMount R...I Uad
*'
'f..lhl II u. 111,'"
JAHES
G
HAKE CHECK PAYABLE AND REHIT PAYHENT TOI
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
iiE"v:is'4i-Eif-"j:p-n'2:ijl,-j"iicii''fcnWi-NHEififiitfCE-TAin,ppii7iisEifEN:r;-,UXciwANCE-b-R"---------------n
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF THEOBALD JAMES G FILE NO. 21 95-0962 ACN 101 DATE 12-30-96
APPROVED DEDUCTIONS AND EXEHPTIONS:
15.033.00
9. Funeral Expans../Ad... COlta/Hise. Expans.. (Schedule HI (9)
10. Dabts/Hodg.g. UabU1tl..!L1anl (Schedul. Il nO) 12.657.00
11. Total Daduct!ons 111)
12. H.t V.lu. of Tax R.turn (12)
13. Charitable/Gov.rn..nt.l Baqua.t. (Schedule J) (13)
1~. H.t V.lu. of Eat.t. Subject to Tax 11~)
NOTE: If an assessment was issued previously, lines 14, is and/or 1&, 17 and 18
reflect figures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. AMount of Line 14 at Spous.l rat. (15)
16. A.ount of Line 14 t.xabl. at Lin..l/CI... A rat. (16)
17. AMount of Line 14 t.~.bl. .t Coll.t.rel/Cl... B r.t. (17)
18. Principe! T.~ Due
TAX CREDITS:
PAYNENT
DATE
01-13-96
06-26-96
TAX RETURN WAS I I X I ACCEPTED AS fILEO
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Re.l E.t.te (Schedule AJ
2. Stock. and Bond. (Schedul. 8J
3. Clo..ly H.ld stock/P.rtn.r.hip Int.r..t (Sch.dul. CJ
4. Horta.a.'/Not.. R.c.iv.bl. (Sch.dul. DJ
s. C..h/Bank D.po.its/Hisc. Person.l Prop.rty (Sch.dul. EJ
6. JointlY Owned Prop.rty (Schedul. FJ
7. Tran.f.r. (Sch.dul. OJ
8. Tot.l Au.t.
RECEIPT
NUNBER
AA082501
AA1l2979
DISCOUNT 1+1
INTEREST (-I
3.394,74
,DO
. If PAID AfTER OATE INDICATED. SEE REVERSE
fOR CALCULATIDN Of ADDITIONAL INTEREST,
I CHANGED
III
121
131
(4)
151
161
17l
.00
,00
.00
,00
,00
19.361.00
524,276.00
181
NOTE I To In sur. prop.r
credit to your .ccount,
sub.it the upper portion
of this for. with your
t.~ p.y..ent.
543.637.00
?7.Ii.Qn nn
515.947.00
40.000,00
475.947.00
will
.00
.00
71.392.00
71.392,00
.00
,00
475.947.00
M .00.
M .06.
M ,15.
U81
71.561.74
169.74CR
.00
169.74CR
If TOTAL DUE IS LESS THAN .1. NO PAYNE NT IS REQUIRED,
If TOTAL DUE IS REFLECTEO AS A "CREOIT" ICRI, YOU NAY BE OUE
A REfUND, SEE REVERSE SlOE Of THIS fORN FDR INSTRUCTIDNS.1
ANOUNT PAID
64.500,00
3.667.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
RCG'.'r, ,I'
Ao"
i 01
.r'.;:1I5
'96 ole 3D fIlO :33
Clal, ,
Cumi.J<.'I;.
1'.irl
:1 eiJ, PA
RUERYAUOth [,..t.. of dludent. dwlng on or ba,ore Die""" U, 1.1l ..- If MY future Int....., In thl I"'" II tun,f,rred
In po.....lon or "'Jor~.nt to el... . (coll.",.l) b~flcl.rl.. 0' thl dlcld,"' I"'" thl ..plt.tlon 0' ~r ....t. 'or
11" or 'or y..t., thl Co.-onw..lth ~reby Ixpr"I.' r...tVI' thl right to appral.. ~ ...... tten,'.r r~rlt~. ,....
.t .hl IIM'ul Cl... I Ceollat'tall t.t. on eny luch future In'.r..t.
......... Of'
NOTlCEI To fulfill the ...qulr....,t. of S.ctlon 2.<<10 of thl Inh...ltenu and E'h'. hll Act, Act U of ."1. 7Z P.I.
Sectlon 2.ltO.
PAYHEHTa Dltach the top portion 0' thl. Hollcl end lubllt with your Ply...,t to thl RI,II"" of Will. prln'ld on thl t.v..... ,Id',
._"... check or MNMy ordu payable tal REGISTER OF MILLS, ADENT
All p.y.~t. rlcllvld .h.ll flr.t ba appllad to any Int.ra.t which ..y ba dua with ~y r...lnd.r appllad to tha t...
REfUND ICA)I A r.fund of at.. cr.dlt, which w.. not raqua.tad on tha I.. Raturn, .ay b. r.qua.tad by cOlplatlng an -Application
for bfund of P..",nlvttnla Inh.rltanc. and E.t.t. laM- IREV-UUI. Appllc.tlon. ara avaUabl. at th. Offlca
of the R.gl,t.r of Will., eny of tha ZS A.v.nue DI.trlct O"lc." or by c.lllng tha .p.cl.l Z4-haur
BR.w.rlng ..rvlc. nwbIrI 'or 'or.. ordsrlftGl In P.m.ylvanl. l-aOO-l6Z-U50, autlld. P.mnlvanla end
within local Itarrhburg ara. (711) 187"1094, IDa' 17111 77Z"ZZSZ Ol.arlng lap.lrad onlY).
OBJECIIONSI Any p.rty In Inter..t not .atl"I.d with thl appr.I....nt, .llowanca or dl..llowance 0' d.ductlon., or .......ent
of t.. Clncludlng dl.count or Int.r..tl ., .hown on thl. Hotlc. IU.t obJ.ct within .llI.ty (&0) d.y, of r.c.lpt 0'
thh Hotlca by!
"written prot..t to the PA D.part,."t 0' R,"'nu., Baird 0' App..lI, D.pt. zalOlI, Il.rrhburg, PA 17IZa-101I, OR
.-.I.ctlon to hav. the .attar d.t.r.ln.d .t audit of tha account 0' tha plr.on.1 rapr..antatlva, DR
.-app..l to tha Orphan.' Court.
AOftIN
ISIRATlV[
CORRECIIONSI
Factual arror. dl.cov.rad on thl. a.......nt .hoUld ba addr....d In writing tal PA Dlp.rta~nt of Rlv'nu.,
&ur..u of Indlvldu.1 Ta..., ATINI Po.t A.......nt R.vl.w Unit, Dept. laD601. lIarrhburg, PI 17UI-0601
Phona Cl11) '1'.'5D5. Sal pag. 5 of tha bookl.t -'n.tructlon. for Inharltancl I.. R.turn for a R.,ld.nt
O'Cldent- IRtV-15011 'or In ..plen.tlon 0' ad.lnl.lrallv.ly corrlctabla .rror..
DISCOUHr I
If any la. due I. p.ld wllhln thr.a Cl) c.landlr aonlh. a,tlr tha d.cldBnt.. d..th, a fllla p.rc.nt C5~) dl.count of
ttt. till. p.ld is .1I0...d.
P[NALTYI
Ttt. 151( t.. .-M.ty non.partlclp.tlon pen.lty Is cOlPUhd on thl tol.l of the "II. and Intar..t .......d, and not
p.ld before JllnUary la, I"', ttt. flr.t d.y .fI.r the .nd 01 the tall. .an"h par lad. Ihh non-p.rtlclp.tlon
panllty I. ~.Iabl. In the .... .enn.r and In IhI ttt. .... till p.rlod a. you ..ould .pp..1 tha ta. and Inl.r..t
th.t ha. ba." a.....ed a. Indlcat.d on this notlca.
INIEAUT.
Int.ra.t I. ch.rg.d b.glmlna with flr.t d.y of d.llnq~ancy, or nlna t'J eonlh. and one el) d.y fro. IhI d.t. of
d..th, to thl d.tl of p.y..nl. Ta.l. which b.c..a dallnqu.nt b,'or. Janu.ry I, I'll b..r Int.r..t .1 Ih. rata of
.1. (6~) p.rcent p.r ~ c.leulal.d at . delly r.ta of .0001'~. All t.... which bac... d.llnquent on end aft.r
Janu.ry 1, 1'12 will b..r Int.r..1 at . r.la which will v.ry fro. c.l.ndlr y..r 10 c.I.nd.r y.ar ..Ith Ih.t ral.
announced by Ih. PA nap.rtaenl of A.llanue. Th. .ppllCable Int.r..t r.I.. for 19.1 Ihrough 1'" .ral
'!!!! Inhr.,t R.t. D"lh Intar..t Fllctor ~ Inhra.1 A.t. n.llw Int.ra.1 F.etor
1982 ..~ . DOOS'" "11 .~ .000lU
l'U 16~ .DOOua l,ea-I991 11:C .OOOJOI
1914 II~ .ODnDI 1991 .~ ,0002'"
"IS U:C ,DOOU6 1991.199it ,. .0001'2
\... lU .00021" 1995-199' .~ .000lit1
"'Inler..t .. calcul'l.d a. folloMl'
INTEREST . BALANCE OF TAX UNPAID X NUHBER OF DAYB DELINQUENT X DAILY INTEREST FACTOR
"Any Notlca .uued .tt.r lhe la" baeo... d.lInquenl ..III raU.ct an Inlar..t calculation 10 f)ft.." USI d.y.
beyond IhI d.t. of the ........nl. II p.y.enl I, aad. .ftar Ih. Inl.r..t caapul.llon data .hown on IhI
Hotlc., IKIdltlon.1 Inlar..1 "".1 ba calcul.t~.
I~~-'N'i
BUREAU OF INOIVIDUAL TAXES
INHrRIlAHC[ TAll DlvnlOH
DlPT. 110.01
tlARRUllJlC, PI. 11UI'D6I1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
L/*
....,tllll"'1I1.6"
PRECILLE M BEEBE
400 BERKSHIRE RD
MECHANICS BURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-03-97
TltEOBALD
10-17-95
21 95-0962
CUMBERLAND
101
G
JAMES
A.aunt H..ttted
PA 17055
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE. PA 17013
HOTEl To lnlur. proper credit to your account, 8ub.lt the upper portion of lhi. for. with your t.. p.y~.nt.
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
ii'iy:ijjoTix-AFP-iiz-:9ijjOU---..ii-iiiifEliiTAiic'E-iAx-s'i'jifEii'iNi-oTA"c.ciiiiiif--ii..---------------------
ESTATE OF THEOBALD JAMES G FILE ND. 21 95-0962 ACN 101 DATE 03-03-97
THIS sTATENENT IS PRDVIDED TD ADVISE DF THE CURRENT STATUS DF THE STATED ACN IN THE NANED ESTATE. SHOWN BELOW
15 A sUHHARY DF THE PRINCIPAL TAX DUE. APPLICATION DF ALL PAYNENTs. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTEO INTEREST FICURE,
DATE OF LAST ASSESSMENT DR RECORD ADJUSTMENT. 12-23-96
PRINCIPAL TAX DUE.
71.392.00
-' -.---------..-----.-----
PAYMENTS (TAX CREDITS),
PAYMENT
DATE
01-13-96
06-26-96
02-11-97
RECEIPT
NUMBER
AAOB2501
AA112979
REFUND
DISCOUNT (+)
INTEREST (,)
3.394,74
.00
.00
64.500,00
3,667.00
169.74-
AMOUNT PAID
.</
" "M"
, -
. ~:
r~,
n.
,:; c..: ' -
a: !'" :: ;'1
'_H.)
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
71.392.00
.00
.00
.00
. IF PAID AFTER THIS DATE. SEE REVERSE
SIDE FDR CALCULATION DF ADDITIONAL INTEREST.
I IF TOTAL DUE 15 LESS THAN .1.
NO PAYNENT 15 REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI.
YOU NAY BE DUE A REFUND, SEE REVERSE SIDE DF THIS FORN FOR INSTRUCTIONS,
PAV,.:,KT .
oehch the top portion of thh Hotlu end .ubeit ..lth your pay..nt .adtI payable to thtl nM. end 8ddr."
prlnt.d on the r.v.r.. .Ida.
If RESIDENT DECEDENT .ake check or lIC)n.y order p.yable tOI REGISTER OF WILLS, AGENT.
If HOH'RESIDEHT DECEDENT .ak. ch.ck or .on.Y ord.r payable tOI COHMONWEALTH OF PENNSVLVANIA.
REF\lHlI lCAlI A '.f.... of . I.' c,.dll, .hlch ... nol ,........d on lho to. A.lu,n. ... ... ,......1... .. co..I.II.. ..
....llc.llon fo, A.f.... of p.....I...I. 1...,I'one. ond E.I.I. T... lREV'I.I.I. ..pllc.llon. .r. ...llob'. .1
the Dfflc. of the Ragl.t.r of Will., any of the ZS A.venu. DI.trlct Dfflc.' or fr~ tha Dapart.~t" Z4-hOUr
an.w.rlna ..rvlc. nuab.r. for for.' ord.rlngl In pennsylvanl. 1.800-S6Z-Z050, outside pennlylvanl,
and within local Harrl.bUrg ar.. (717) 787-60'4, TOO' (717) 77Z-ZZ5Z ~~.arlnD I.palr.d only).
All p.....I. ,.c.I.... ".'1 .. ....I.d fl,.1 10 ... In..,..1 ..Ich ... .. dUo .llh on. ,...Ind" ....I.d '0 Ih. I."
REPLY TO. .....lIon. ,..ordl.. ."0" conI. I"" on Ihlo nollc. .hoUld ... ...dr....d 10' PA O.p.,I_1 of AIV""" ...,....
0' Indlvldu.1 ,...., ATTNI po.t AI.....ant R.vl... Unit, Dept. Z80601, Harrl.bUrg, PA 171Z8-0601, phone
(717) 717-6505.
DISCOUNT I
If any t.. due I. plld within thr.' CS) cal.nd.r .onth. .ft.r the dlc.dant'. d..th, I flvl p.rcent C5X) dl.count
of the t.. paid I. allowed.
ThI I'X I.. .....1. non-p.,llclp.llon p.n.II' I. c..pul.d on tho tot.1 Df thl ... ond lnl.,..t .......... ond not
paid before January 18, 1996, the flr.t day ,ftar the and of the ta. ..na.ty p.rlod.
PENAL TVI
IHTEREST.
Int.,..t I. ch.,..d ...lnnl.. .Ith fl,.t d.. of d.'ln..one.. D' nln. 1.' ...th. ond ono III d.. f'o. Ih. d.l. of
d..lh. 'D IhI d.'. of p...onl. T.... ..Ich ..c... d.ll.....1 ..fD'. J....,. I. .... ..., Inl.,..t .1 Ih. ,.t. of
.1. C'X) parcent p.r annua calculltad at . dally rat. af .0001&4. All t.... which b.c..a d.llnquent on and ,ft.r
January 1, 1,8Z will baar Intar..t at . rata which ..Ill vary fro. cal.nd.r y..r to cal.ndar y.ar with that r.t.
.nnouncad by the PA OIPart..nt of Ravanu" Th. app1lcabl. Int~r..t rate. for 1,8Z through 1997 .r..
V.ar Int.r..t Rat. D.Uy Int.r..t fltCtar V.ar Int.r..t Rat. DaUV Int.r..t factor
I,at ,"X .ODOS48 1'87 .X .000U7
1'85 16X .DOOUe 1911.1991 IU .oaun
1984 IIX .OOUOI 199' .X .0002"7
1'85 UX .000156 1995-1994 71C .00019'
I'" lOX .aOal?" 1995.1997 .X .0aOl'"
...I"t.r..' I. c.lcul.t~ a. follOM.1
INTEREST . BALANCE OF TAX UNPAID X NUnSER DF DAYS DELINQUENT X DAlLY INTEREST FACTOR
.-Any NotSc. s..u.d aft.r t~ t.M b4Co... d.llnquent Mill r.fS.ct an Int.r.lt calcul.tSon to flft.an CIS) day'
beYond t~ data of the .I.....ant. If pavaant I. .ad. .ft.r the Int.r..t c~t.tlon data ahown on the
Notlc., ~ltlon.1 Int.,..t IIlJlt b. ulcul.tad.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: James G. Theobald
Date of Death: October 17. t995
Will No.
Admin. No. t995-00962
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 estate:
1. State whether administration of the estate is complete:
Yes X No
.
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court7 Yes No X' ,
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative sta~e an
account informally to the parties in interest? Yes X No
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.
Date:
1f!Jb /~ t
, I
J1 )!;, 9U1~l!A1M1i
Signa ture
I'l (). DE Lt,ll/? C I PIU r.&
Name (Please type or print)
t:zo RllfL,U/?il. tAmp JllLl.;?' 171) II
Address . ,
(7/7) ?t3' 9JOl,
Tel. No,
'_rj
- ~'\
Capacity:
X Personal Representative
.0
. ~~:
Counsel for personal
representative
(MAH: rmf/ AM3)