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Ta fulfill ~ requlr...ntt of Section 21'. of the Inherlt~. ~ Eltat. Tax Act, Act ZZ of ."1. (71 P.S.
SeclUon Zl40).
DetKh U. top portion of thl. Natlcai ..t sut.lt with your PIY8Wlt to the _..Iat.r of Wllh printed on the
rlv.r.. ....
..- .... chedl. or ~v order p~l. tot REelSTEA OF WILLS, AGENT.
All ,.penh rec.lv.d 1M11 flr.t btI ~l1M to MY Int.r..t which HV bIi ckM, with ...y r_lnder -wll-.:i to the tn.
.. refund of . tu cr...lt, which .... not r~.tlld on the talC nturn, My be r.qulllted by cOIIPlaUng ., oo&ppllutlon
for R.~ of Pennlylv.nl. Inherltenc. ~ E.t.t. Tax" (REV-IllS). application. ar. .v.ll.bla at the OfficI of
the R..htar of WIUI, My of ttMI ZJ R.venue Dhtrlct Dfflc.. or by ul1f,.. the special "-hour ....twer.,. ..,."Ice
nullber. far fa.... orderlngl In P......ylv.,l. 1-100-162-2050, out,l_ P.",lVlv.,l. WId .,Ithln lout
Herrlsbur. ar.. (717) 7.7-8094, TOOl (117) 712-Z152 ("--rlno 1~.lr~ Only).
DlJ[CTIDNSI Any party In Intar..t not .atl.,I8d with the 8PPr.I...-nt, allowanc. or dl..llowenc. of deduction. or .......-nt
of tex (Including dl.count or Int.r..t) .. ahoMn on thl. Notle. ..y object within .I.ty (60) day. of rec.lpt 0'
thll Notice by1
--written prot..t to the Pi Depert-.nt 0' R.venue, Bo.rd 0' Appeal., Dept. ZltOZI, Herrl&burg, PA 17IZI-IOZI, OR
--.Ieotl", to NYe the .ttar deta,..lned at the ...it of the KCGUnt of the per...1 r.,r.....t.tlWI, OR
.-.....1 to the 0,.".,.' Court
All'U.-
ISTlIaTlY!
CORR[CTJONS.
DISCOUNT I
POIAL TVI
INTOIEIT.
Fectulll .rron d"cov.r~ on thh .........,t Ihould btI eddra..tld In writing tOI PA DepertMnt a' R.venue,
lur.eu of Indlvl~1 Tax.., ATTNI Po.t A.....Mnt R.vleM unit, DEPT. ZI0601, Herrllburg, Pi 171ZI-0601
Phone (717) 7'7-6S05. See peae 5 of the bookl.t -In.tructlon. for Inherltenc. Ta. Return for. R..ldant
Dacadant- CREV-1S01) 'or en .xplanatlon 0' ~lnl.tratlv.ly correctable .rrorl.
If eny tex due II p.ld within thr.. (5) cal.....r .anlhl .ftar the _adent". death, . flva parc....t (5~)
dlacount of the tax paid I. allowed.
nw 15% tax ~.tv non-p.rtlolpatlon ,..1 tv II c.,.utad on the total of the tax and Int.r.st .....Iad, and not
,.Id bafora ........ry It, I"" the flnt day aftar the and of tM tex ....tv period. Thlt non-ptlrtlclptltlon
I*\81ty 11 .....Iabl. In the ... .....r and In the the ... tI.. period a. YOU MOUld IlPPMI the tu and Intar..t
that hII. bHn .....Iad .. Incllc.tact on thll notlc..
Inter..t II eM,.... begl,..,l", with flr.t .s.y 0' dltUnquency, or nine (9) __tha ... one U) day
'rOIl the data of dMth, to the data of ~t. T.... "'lch bee.- dellnquMt ba'or. .....ry 1, n.z
bear Inter..t at the rata 0' .1. (6%) percent par .... calcul.ted at a dalh rat. 0' .000164.
All t.... ..,Ich bacaaa delInquent on or a'tar Jenuery I. I,az will bear Intera.t at . rat. ..,Ich will Wiry frOll
calendar year to c.l.....r y.ar with that rat. MnCK.nC~ by the PA Depart...,t 0' R.v...... The 8PPlIcabl.
Int.r..t r.te. for I,az through I'" ara.
V... Int.r..t R.t. Deily Int.r..t Factor V... Int.r..t Rat. Dally Intar..t FlMltor
t..Z ZOX .000S4' '''7 OX .000247
I"S lAX .DOIU' 1'11-1"1 III .OOUOI
It.. IIX .DOIJOI ."Z OX . 000247
1915 IU .OOOS~ 1"5-1'" n .010191
ItM lOX .D00l74 1"5-'996 OX .DDOl47
--Int.r..t 11 calcuht~ .. 'ollaM"
IHTERElT . .ALANCE OF TAX UNPAID X NUKlEI OF DAYB DELINQUENT X DAILY IHTERElT FACTOR
__Any Motloa ....... after the tax ~. dallnquMt will r.Uaot an Intar..t ceIClUI.Uon to flftaan US) _.
beyond the data of the .....~t. If p.v-ant 11 ..... aft.r the Int.r..t COIIPUtatlon data IhowI on the
NoUc.. Mldltlonal Int.r..t .,.t bI calculat~.
,;
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PAMHTI
DetKlt the top portion of thl, Notlu ... ,ut.!t with vour p.ynnt .ede PIyIb1, to the n... .net Metre..
printed on the r.v.,.. .Ide.
-- ..... chKk or .,..y order p.vlttl._ tOI REGISTER OF WILLS, AGENT.
All p.,..,.." rec.Sved ilMll be 1IPP1led first to MY Inh,..' which ..y b, due ..llIl ."y ,...Inder 1IPP1I1d to thl ",c.
RUUHD (CAJI , r.fund of . t.. credit, which .... not r..,....d on the Tax .Iturn, ..y be ra..,tltd by cHIll, Una .,
-Application for R,fund of Pennlvl".,.a lnn-rltlnCl end f,t,t, T..- (R[Y61J1SJ. application. .r. evtllebl. It
the Ofllcl O. the ...11'" of Willi, .,y 0' the ZJ Ravenue DI.trlct Offlc,. or 'r~ the Depart-.ntt, Z.-hour
.,~rl", ..rvlel ~r. for for.. ordering I In Penn,YI".,., 1-100-]62-2050, out. Ide Pennlvl".,.,
end within lOCI. HarrlSbur. .r.. (717) 7.7-.094, TOO' (117) 17Z-ZtSZ (Hearing t.,.lrld only).
AfPlV TO.
Guu'lonl ,...rdlna .rror. cont.IMd on thl. notle. should be Mdt...1d tal Pi o.partMnt Qf .'venue, lur...
0' Indlvlduel T...., ATTNI Po.t A......ent A.vleM unit, D.,t. '10601, H.rrl.burg, Pi 171'1-0'01, Phone
(7171 787-6505,
DISCOUNT I
If eny t.x due I. p.ld within thr.. (S) c.I.ndIr ~th. .ft.r the d.c.dent'. d..th, . flv. p.rcent (SX) dl.count
of the t.. p.ld I. .IIDMed.
PlHAL "I
The lSX t.. .-ne.ty non-pertlclp.tlon pen.lty I. c~ted on the tot.1 of the tex end Inter..t ......ed, end not
,eld before JlnUlry II, 1996, the flr.t d.y eft.r the end of the tlX l8n8.ty period.
INTIII!IT I
Int.r..t I. cherged beginning with flr.t d.v of d.llnquencv or nine (., .onth. end one (1) dey 'r~ the d.t. of
delth to the dlt. of P.~t. T.x.. which bee... d'llnquent before Jenuery I, 191' be.r Int.r..t et the retl 01
.Ix (lX) ,.rcent ,.r ~ c.lcullt~ et e dellv r.t. 0' .000164. All tex.. which bee... delinquent on end Ift.r
Jenuery I, 1..2 will be.r Inter..t et . r.t. which will very 'roe Cllend.r y..r to c.lender y..r with that rete
ennouncld bv the Pi o.p.rteent of A.venue. The appllclbl. Int.r..t r.t.. 'or 19'Z through I'" .r'l
V..r Int.r..t A.tl D.II, Int.r..t Factor
V..r
Interllt R.t.
D.II, Int.r..t Feetor
1.12 zn .OOO"a I.., OX .OOUU
1985 .'X .UOU' 19"-1"1 \IX .GOUGl
1984 \IX .OUUI I99Z OX ,OOUU
1905 UX .OOOS56 I99S-I994 7X ,oaOl.Z
1916 lOX .OUZ74 1"5-1"' OX .oanu
....Int.r..t I. c.lcul_tld .. 'OU....I
IHTERElT . BALANCE OF.TAX UNPAID X HUNBER OF DAYS DELINQUENT X DAILY IIITEREBT FACTOR
....Any Hotlc. I..ued .'t.r the tex bee.... delinquent will r.fllCt In Int.r..t c.lcul.tlon to 'If teen (15) ~y.
beyond the dlt. 0' the """Mnt. If ")'Mnt II .Ide I'hr the Interllt Coeputltlon ~te .to.n on the
Hothe, Iddltlonel Int.rl.t .,.t be c.lculltld.
.
,."".+W.~~'f". 1"'''''V .m ,'~--"-
A ;trJ~~~;:,;5'
:il')lW' '1'\70 EX _I.
'COMMONWEAlTH OF PENNSYlVANIA
DEPARTMENT OF R1:vtNUE
IURIAU Of INDIVIOUAl. lAXEI
DEPl, 280601 ,
HARRtS8URG,PA171 B.0601
DECEDENl1 NAME
._---~'-'" t. ._'.c_,' ____~___- .~.
INHERITANCE TAX
EXPLANATION
OF CHANGES
SCHEDULE
ITIM
NO.
ACN
EXPLANAnON Of CHANQES
Deduetlone In the nmount of $~have been eredited to .the following
. ACNe95/.3~/9 Z
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PAGE
TAX EXAMINER: .'.
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PAMNTI
Detlch thl top portion of thl. Notlcl ~ lubllt with your p.y..nt .ldt pIYlblt to thl n... end Iddr...
printed on thl r.v.,.. ,Id',
If RESIDENT DECED[NT ... chick Dr lon'y order p.yabS, tOI RECISTER OF WILLS, AGENT.
If NON-RESIDENT [l[CED(HT ,akl chick or tonly order pIYlblt tal COHt10NWEALTH OF PENNSYLVANIA.
All p.~h r.ulvld shill b, 1IPP1led firs' to any Inte,ut which ..y bl due with any n..lnd.r IlPplllld to the t...
A[fUND (CAli A r.fund of . ... credit, which WI' not requeltad on thl TI. Return, ..y bl r.qul.tld by c~l.tl". an
"Appllcltlon for R,fund of Plnn.ylvant. tnherltlnCl end E,t.t, TI.- CREV..llS). Appllcltlont Ir. Iv,llabl, It
the Df'lcI 0' the Rlgll'" of Willi, eny of thl ZS R.venue Dlltrlct Offlc.. or 'rol the alp.rt,ent'. Z~.hour
~.>>erlng ..rvlcl ~'r' for 'or.. ord.rlngl In P.nn'Ylv~la 1-100-36Z-2050, out.ld. Penn.ylvanl.
and within 10c.1 Harrl.burg ar.. (717) 717-109~, TOO. (717) .772-2Z52 CH..rlng I.palr.d only).
RtPLV TOI
Qua.tlon. r.g.rdlng .rror. cont.ln.d on thl. notlc. .hould b. .ddr....d tOI PA D.partlent of A.v.nu., Bur.au
of Indlvldu.l T...., ATTNI Po.t A.......nt R.vl.w Unit, D.pt. 210601, H.rrl.burg, PA 17121-0601. phon.
(717) 717-6505.
DISCOUNT I
I' any t.. due I. p.ld within thr.. (3) c.l.ndar .onth. .ft.r the d.c.d~t'. d..th, a flv. p.reent (5~J dl.count
0' tha t.. p.ld I. allowed.
PENALTY I
Th. 15X t.. .ana.ty non"p.rtlelp.tlon p~alty I. co.put.d on the total of the t.. and Int.r..t .......d, Bnd not
paid b,'or. JInU.ry II, 1996, the 'Ir.t d.y "t.r the .nd of the ta. .en..ty p.rlod.
INTERESTI
Int.r..t I. ch.rg.d b.glnnlng with flr.t d.y of d.llnqu.ncy, or nln. (9) ~th. Bnd on. (I) day froe the d.t. 0'
death, to the data of p.y..nt. T.... which b.c... d.llnqu.nt b.for. Janu.ry I, 1912 b.ar Int.r..t .t the r.ta of
ai_ C6X) p.rclnt p.r annul calcul.t.d at . dallv r.t. of .00016~. All t.... which b.ca.. d.llnquent on and .'t.r
Janu.ry I, 1982 will b..r Int.r..t .t . r.t. which will v.ry fro. c.l.ndar y.,r to c.l.nd,r y.ar with th.t rat.
announc.d by the PA D.p.rta.nt of R.v.nu.. Th. .ppllc.bl. Int.r..t rat.. for 1912 through 1996 ar'l
,
,
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,
V..r
Int.r..t Rat. O.lly Int.r..t ractor
Int.rnt Rlt.
Dally Int.r..t rlctor
Y."
nlz m .000541 19.7 .~ .0002U
1911 16;( .000U8 1918-1991 IU .000301
19'" IIX .000301 1992 .~ .0002"7
1915 UX .000lS6 19'1-199' 7~ .000192
1916 10;( .00021' 1995-1996 .~ .OO02U
--Intar..t It calculat~ .. followlI
INTEREST . aALANCE OF TAX UNPAID X NUNBER DF DAYS DELINQUENT X DAILY INTEREST FACTOR
.-Any Hatlca I..ved Iftar the tax b.cOl4l. d.llnquent .,111 nfl.ct an Inlara.1 cllcu..tlon 10 flft,.., liS) d..,.
beyond the dlt. 0' the ........nt. If Ply..nt I. .Id. .,t.r Ih. Inl.r..1 coaput.tlon data .hown on the
Hotlca, addltlONll Intarnt MI.t b. cllcul.hd.
,
\
REV-1543 EX AFP (7-95),*
C~llTH or PENNSYLVANia
DEPAA1I'tEHT 01 AEYEJ<<J[
IURfAU Of INDIVIDUAL TAX[I
Dt:PT. Zlonl
HARA1SIUAG, PI 171l,.0601
,:i-(Y/~/
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
NO. 21 . q (. -1 ,
95136492
08-02-95
TYPE OF ACCOUNT
~ SAVINGS
eHECKIHG
TRUST
CERTIFICATE
REHIT PAYHENT ANO FORHS TO,
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
FILE
ACN
DATE
ESTATE OF ELIZABETH SHEPHERD
5.5. NO. 185-14-8728
DATE OF DEATH 04-09-95
COUNTY CUMBERLANO
.. BEVERLY G 8AKER
7814 E SUNSET DR
HBG PA 17112
HELLO" BANK NA hn provided tm. Dep,rteent with thl In'orllltlon Iltted hilI>>! which h"l bun U'I" In ulcullUng th.
potantS.. 'IX ~. '~Ir r.card. Indlce'. th.t It the d..th of the ~V. dlcedant, you wlr. I Julnt owner/beneficiary 0' thl. .ccount.
If you f..1 thl. Inlor..tlon 1. Incorrect, pl..i, obleln ~rltten correction fr~ the 'Inenelel Inltltutlon. .ttach I COpy to thl. 'or.
~ r.turn It to the ~V. addr.... lhi. ~count 1. 'IMable In Iccordencl with the Inherltenc. IBM l~.' or.the Co..onw..tth of Plnn.vlvanl..
au..Uon. ..y bl WI,werecl b)' uUUtg (11) 181-110.
COHPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 884-013-7569 D.ta 05-04-94
E.tablish.d
Account Bal....c. 1,929.66
P.rcent Ta.abla X 100 . 00
Aaount Subj.ot to Ta. 1. 929.66
Ta. R.t. X .06
PotenUal Ta. Quo 115.78
PART TAXPAYER RESPONSE
[01 FAILURE TO RESPOND MILL RESULT IN AN OFFICIAL TAX ASSESSHEHT BASED ON THIS NOTICE I
A. 0 Th. &bov. Infor..tlon end t.lC dutI h corr.ct.
1. You ..y choo.e to re.1t P'YHI'It to ttM R.ght.r of Wllh wlttl two copi.. of thh notln to obhln
. dl.count or Ivold Intere.t, or you eey chick bolC -,- end return thl. notice to the Regl.tlr of
Will. end en official .....~t will be I..ued by the P' Dep.rtaant of RlVenul.
a. ~ The above ..,.t h.. been ot will be reported and t.lC p.ld with the Penn,ylvenl. Inheritance TelC return
~ to be filed by the decedentO, repre.ent.tlve.
C. 0 ThI above Infor..tlon I~nc:orr'ct lind/or debts end dlductlon. Wltl p.ld by you.
You MI,t coaplltl PART ~ llndIor PART ~ b.le...
To in.ure prop.r credit to your ICcount, two
ell copl.. of this notlCI MI.t .CCOIlp8ny your
p.y..nt to the Rlgiltlr of Will.. "lkl check
Plylbl. tOI ~lgI.tlr of Will., Agent-.
MOTEl.' t.lC plyaent' .r. .Ide within thr..
()) aonth. 0' the dlCedento. d.t. of de.th,
you ..y deduct . 5% dl,count of the talC dutI.
Any Inheritance tile dull .111 ~~ delinquent
nIne (9) aonth. a't.r the d.ta 0' dl.th.
[CHECK ]
ONE
BLOCK
ONLY
If you indic.t. . diff.r.nt t.x r.t., pl.... .t.t. your
r.l.tionship to d.c.d.nt:
PART
~
TAX ~tTUR" - eOHFUTAi.Cn
LINE 1. O.t. E.tab11.h.d
20 Account a_Ianc.
3. P.rc.nt T.xable
~. Aoount Subj.ct to Ta.
5. D.bt. and Deduction.
6. Aaount Ta.abl.
7. T.lC R.t.
8. Tax Du.
T:'X ON JO:r:i"T::U~~ :':COUr~T~
FAIi
1
2
3
1\
5
6
7
8
DEBTS AND DEDUCTIONS CLAIMED
OFFICIAL USE ONLY 0 AAF
PA DEPARTHENT OF REVENUE
C'\(.'j
or-
1
Z
3 X
~
5
6
7 K
8
PART
[!J
~'i!!it:' "'" ~ """"""
~-:~~I~~I-~~~
TOTAL tEntar on Lina 5 of Tax Coaputation)
AMOUNT PAlO
I!~~y
.
Undar pan_Itia. of
~o tho ~"t of
{1:,~~
TA IGNATURE
p.rjury, I daclara that tha fact.
ay knowladga and baltef.
I haye reported above ara tr~e'JCorr.ct and
HOME (7/7 d.,)~- ~ I{ r./l . .
WORK () 11'l/~~
TELEPHONE NUMBER DATE
GENERAL INFORMATION
1. FAIlU'E TO RESI'OHII WIll ,nUlT IN AN OFFICIAL TAX AssnSNENT .lth ...11...1. In"'''' ..... on Inf.,..tlon
....lttecl by 'hi flMnClhl In.tltutlOl1.
r. IMerltMCI tIll .OM' dell".,."t nine IIOnthl aft.t the dec.....'.. dIIt, of death.
S. . Joint HCount I. '..lIbl, .y." though the dec.s.nt" neM WI' IldcMd II . ..U.r o' cortYMIMCI.
4. AceOWl" llnoludlne tho.. held between hu.lMnd Ilnd ..U.. which the decedent put In Jotnt n.... within one vur prior to
~~ .t. fully ,..lbl. .1 tr~.f.r..
5. Accoun" IIt_1l11hed Jalnth IMtween t.t.a.encI ~ .,1f, .on thWl DM VNr prior to d..th .t. not ,..lbl..
.. Account. held bv . dec~t Rln tru.t fa'. eno'hlt or other. .r. tllllbl, lullY,
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. aLOCI. - If thl! Infor..tlon Ilnd c.......t.tlon In the notice .r. correct 11M deduction. In not btlnt chlMd, piKa.., .....
In block WAW of Part 1 of the -'..p.v.r R'lpon.,- 'Htlon. Sign two capla. Ilnd .~It t~ .,Ith your check for the -.aunt 0'
t.. to the ...I.,ar of Will. of the county lndlc.t~. ThII PA o.,.rt-.nt of Ra..,enue .,111 I..u. en offlcl.1 ......-.nt
(For. REY-I54' [X) upon ree.lpt of ~ r.turn fr~ thl Aetl.t.r of Will..
2. IlOCK I . If the ....t .peclfl~ on thl. notlc. hi. been or .111 ~ r.ported ~ t.. p.ld .Ith t~ Penn.ylvlnl. Inherlt~.
T.. R.turn flied br the *ldInt". r.,,...,,htlv., pllC' In -X- In block -... of P.rt I 0' thlt "h.p.yet Rllpon.,- 'HUon. Sign OM
copy end r.turn to the PI Dep.rt.-nt of R.VInUl, .utllU of Individual T...., Dlpt 110'01, Harrl.burl, PI 17Il'-0'01 In thl
env.lope provided.
S. IlOCl C . If thl notlc' lnfor..tlon I. Incorrect ~/or dlductlon. .r. bllnt el.I.-d, check block "e" end e~l.t. P.rt. I end S
lOoordlng to the In,tNletl,..". .,.1"." $1.... two cOf!lI.. end ,ue-It t~ .lth your chick for thl.-ount of t.. p.y...l. to thl A..ht,r
of will. of the county Indlc.ttd. ThI PA Dtparteent of R.v~ .111 I.aut In offlcl.1 .....~t ('or. RtV-IS" [XI upon rec.lpt
of thII r.turn fra the R..htet of WlIlt.
TAX RETURN . PART 2 - TAX COMPUTATION
LINE
1. (nter the dll' thl ICCount orllllNllh ... ..tllblhhed or tlU~ In thl .emer ....tlng .t date of d__th.
NOrEl For. deetdlnt dying .ft,r 11I1Z/II. Account. which thl decedent put In Jalnt neII. .Ithln one (I' y..r of d..th .r.
taxllbl. fully.. tren.f.r,. ~v.r, thlr. It en ..clutlon not to ..clld 'S,OOO ~r trln.f.r.. r,.,rdl... of the v,lue of
the ICCount or the ,.".,.r of account, hlld.
If . daubl. .,t,,11k (n) ....". blfore your first n-. In thl tddr... portion of thh notlc., thl U,OOO ..clu.lon
.Irudy hi, bHn deducted fr~ thI ecCQW1t b,lenel .1 rlpOrttd by thl f1nMCl.1 In.tltutlon.
II Enter the tot.1 ~ltnC. 0' the eecount Including Int,,"t ICcrutd to thl d.t. of death.
J. TN Plrclnt of thl acCcutt thet It t..llbl. 'or ItCh IUrvlvor It cMt"llntd II follOMII
... fM perclnt t..MI. for Joint ...... ..tllbllthtd IOn thin OM Y"" prior to the dlCtdtnt'l dI.thl
I DIVIDED IY TOTAL tuclEA OIF
JOINT OWNERS
Ex.." I A Joint ....t rlllllllttd
DIVIDED IY TOUL tucKR Of X lOa . PERCENT UXAlLE
SlJI'VIVING JOINT (KHRS
In thII ftIM of thl dtc~t _ tNO other ptrlOn',
1 DIVIDtD IV J (JOINT CM€RS) DIVIDED I't' I (SURVIVORS' . .161 X lOa . 1'.7% CTAXAll[ FDA EACH SURVIVOR'
I. The perclnt ta.lbl. for ...... cr..ted IIIlthln one .,..r 0' thII decedlnt" duth or KCount. owned by thl He..,.t but hlld
In tru.t for tnOther IndlvldulU.' Uru.t blnlflclltlul,
1 DIVIDED IY TOTAL NUMlEA Of SURVIVING JOINT
OWNERS DA TAUST aENEfICURJES
X 100 . PERClNT TAXAILE
E....III Joint ICCCMont r..ht,nd In the n.. of thl decedent end two othlr plrson. end ..tllbllthtd .lthln one yur a' ct..th by
thl dtcldlnt.
I DIVIDED I't' I (SURVIVORS) . .50 X lOa . sox (lAXAlLE FDA [Aot SURVIVOR'
4. ThI MOUnt aubJlCt to t.. Cline U .. ct.tetllned by .ultlplYlng thl ecCOI.M'It bII1enc:. Cline I) by thl perclnt ...IIbI. Cline J).
5. Enter the tot.1 of thl debt. end Mductlon. lI,ted In P.rt J.
.. ThI...unt tIXIlbI. tllnt .. It Gu.r'InteI by tuattKUng tlM u.w,. ... ~U"l'" 'lll~ :.i ,,,,. U.. _., ......J_t lu I... Cline 4).
7. Ent.r the ""roprl." t.. tit. (lInt 71 .1 ct.ttr.lntd IMIOM.
A. For dlt.. of de.th occurring .ft., 6/S0/94, the t.. r.t., 'or trlft.f.r. to spou'" .r. .. follow'l t!)
1. D,t., of de.th on or ,ftlt 7/1/94 and t.fotl 1I1ltS thl nt. II n. (n
I. D.t.. of de.th on or .ftlt 1/1195 trlft,ftrs to .pout.' 11I111 t. ....d .t OX tn nt.. c-
Not'l For det.. of dI.th prlo,. to 7/119\ tr""ftrs to lPOU'" It. t.....I. .t 'X. ,,-
.. Tren."'" to lIne,1 da.ctndMt, InclucUng f.ther, ..thlr, .on, dlUght.,., or~l1dr.", ,on-In-I..., ~Z:
dtught.r.ln-IIW, .tepchlld end thllr IlfUI .r. t..abla .t ,I. PlrClnt (6XI. t\
C. Trln,'erl to all othllr. Including brother, .lIt.r, ~I., tunt, nephw and nlee. Ita t..llbl. .t flft.an perc.".-.dSXJ.
D. If you change thl t.. ,.t., pl.... .pecify ,our tll.tlonlhlp to lhI dlCtdlnt In the Itl. provldtd. -
10 The MCM1t of t.. duI Ulnt I' I, d.br.lnteI by ...ltJplYlng thl taOUI'It t..llbl. ell". 6) by the t.. tit. Clint 7'. ~,'?
CLAIMED DEDUCTIONS - PART 3
DEBTS AND OEDUCTIONS CLAIMED
C)
..
.:::-
.:::-
Allowlb" dtbtJ and deduction. It. d.t.,..lnad II follOWl1
A. You 1...lly Jr. raspan.lbl. for P.~t, or thl ..t.t. .ubJKt to tdllnl.tr.tlon bV . Plr.antl repr..."t.tlv. I. (ntu"lcllftt
to PIV thl dlduCtlbl. It....
I. You ICtuelh Plld the debt. .ft.r death of thl dJ.cldlnt end un 'urnlsh proof of P'YMnt.
C. o.bt. being c..l.... ....t 1M 1t..I,ad fulh In Pitt S. If additional .pac. II nMdtd, u.. pl. In PlPlr 1 1/l" . 11". Proo' of
p.,.."t ., bI r"",.ted by the PA OIIIert....t af R.vanua.
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORHATION OR ASSISTANCE, CONTACT ANY
REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR C~LL THE BUREAU OF INDIVIDUAL TAXES. TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (717) 787-8327. TDD' (717) 772-2252 (HEARING IHPAIRED ONLY)
,
----,.~~'_...
t
\
.------~----------------~-------------------------
.~!~;'!08~54I,.'~OMMONWEALTH OF PENNSYLVANIA.
,o~;';'";/''''''''''' " ;" .' ., DlPARTMINT 0' RIVINUI
'It'i&~r::h.;/::rj::>;'; O.'ICIAL RlCEI" . PENNSYLVANIA INHERITANCE AND ESTATE TAX
.
RECEIVED FROM:
fJ
ACN
ASSESSMENT P:'
CONTROL iiI
NUMBER
AMOUNT
BEVERLY G BAKER
7914 E SUNSET DRIVE
9~iJ6492
.8'.07
HARRISBURG, PA 17112
UTAT! INFORMATION,
!II Il NUMIER
Ii 21-1996-0077 SSN
!II NAME OF DECEDENT (lASTI (FIRSTI
~ SHEPHERD ELIZABETH
II DATE OF PAYMENT
EJ POSTMARK DATE
COUNTY
CUMBERLAND
DATE OF DEATH
IB~-14-B72B
(MI)
\ REMARKS
"
BAKER
m TOTAL AMOUNT PAID
.89.07
SK
\
\SEAL
CHECK' 3273
,.
RECEIVED BY/.
,~ ,'/'I.yj//
~GNAfUJ.E
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
v
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