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PETITION FOR PROBATE and GRANT OF LETIERS
Estat~ of Iff Lt N :j rALI{ No, a I - I qCll.p - I a i
also known as To:
Rcgi~tcr of Wills for thc
. D~l'~a.f~d, Counly of in thc
SOl'Ial S~l'IIrit)' No, /7"1 - /0 - ,,13/t, Commonwcalth of I'ennsylvanla
Thc pClilion of Ihc undcrsigncd rc'pcclfully rcprc,cm, thai:
Your pClilioncr('J, who is/arc 18 ycars of agc Qfo1dcr anlhc cxccult.-;I
in Ihc last will oflhc ahol'c dcccdcnl, dalcd OCI/oN'l IS-
and codicill~) dalcd
named
, 19~
Nillt' rcl(,\i1nr ..:i''-'lIm\lanl'C'\. (',J.!. Il'nundaljon. dc;uh ur l'\((ulnr. tiC.)
()cccndcnl WllS domicilcd at dcath in (}.u ~1
It last famil 'or rinciPlll rcsidcncc III
I )~'~ A, 170,<:5
lli\1 \lIcet, lIumber luul IImlldJl.lIil)'1
Dcccndcnl, Ihcn ~ I ycars of agc, dicd .J I/.v t:>(. , 19 '/" ,
al_'i!!J_Y ...ifZtrT HaS/ztA/.. ';~c,'T ti/ll/vcW{:O ,Wf' .
EXCCpl Js follows, dcccdcnt did nol marry, was nOIl)il'orccd and did nol havc a child born or adopted
aftcr c\ccution of Ihc will r crcd for probatc: wa~ nOI thc I'iclim of a killing and was ncver adjudicaled
inCOml'Clcnl: ---1:'1
Dcccndcnl al dcalh owncd propcrty wilh cSlimalcd valucs a~ follows:
(If domicilcd in I'a,) All personal propcrly
(If not domicilcd in I'a,) I'crsonal property in I'cnnsylS'3nia
(If nol domicilcd inl'a,) I'cr~onal propcrty in Counly
Valuc or rcal e,latc in I'cnn,yJ\'ijnill/
,ilualcd a' follow,: NO IV v
S .',,71 17
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WHEREFORE, pClilioncr(,) rcspcclfully r'(ucSI(SI Ihc probaJ~ of Ihc lasl will and codicil(s)
prc,cmcd hcrcwilh and Ihc gram of Icllers--": - 'Tft;,1/ /llf/l!1 III- V
. Ih....lamC'nlary: admjnhlf\l~lln ":.1,.1.; adminhtrlllion d,h.n.c.t.a.)
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTII OJ: I>ENNSYLV ANIA } >l>l
COU1\in' OJ: _ CUl>IBERLAND
Thc I'Clilioncrl') abmc.n:uncd ",carl') or affinn(,) that Ihc 'laICmCnl' in thc forcgoing petition are
truc .mll corrCCllo Ihc hc,. of lllc ~nowlcllgc and hclief of pClilioncr(s) ,md Ihal as pcrsonal represen.
1,"h'cl') uf Ihc ahol'c dcccllcnl I,clilioncr(,j will wcll and truly adminislcr Ihc cstalc according 10 law,
Sworn hI or affirmcd lInd 'Uhscrihl'diqJ)LlJtI, f). bOLO ..!!l
hcfofl' mc Ihi, --2-tll_____ day of tr "
'-::lI\i.~~~l''-Ul)...pL~tiM.'LLJ' 1 ~
15-~Y-!i' MA'RY \:. L WIS Rl'~if/,'r' y.'l.'.J'J ~
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No. ~/-lqq~-I Z. V
Estate of
HELEN FALK
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW FEBRUARY 13 19--9.6.., in consideration of the petition on
Ihe reverse side hereof, sallsfactory proof having been presentcd before me,
IT IS DECREED thatlhe instrument(s) dated OCTORRR 1 Ii, 1 qq,
described therein be admitted 10 probate and filed of record as the lasl will of
HELRN FAr.K
TESTAMRNTARV
MARY K. BOLES
and Letters
are hereby granled 10
'-1r{slAl{C '~.IlA) .fJL~Ltr'fJ1,f)tU<-aJ
MARY C. LEWIS RcolWlII. /JJ.t~
FEES
Probate, Letters, EIC, ."".". S 25 .00
stiiR~li'iicales( ),."",." s--1:B.B-
Renunciation ,....,..."..", S
JCP S 5.00
TOTAL _ S 45.00'
Filed Ii'EBRUARY..13,. ..1996,....,....,
ATTORNEY (Sup, Cl, 1.0. No.)
ADDRESS
PHONE
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MAILED LETTERS TO EXECUOTR FEBRUARY 14. 1996
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STATUS REPORT UNDER RULE 6.12
Name of Decedent:.H~I.e" .s, Wi<
Date of Death:~qb
Will No. ~l. 9tp-IJ.% Admin. No.
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 ~hether administration of the estate is complete:
Yes V 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 Court? Yes V No ,
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c, Did the personal representative state an ,j ~I\JDN€)
account informally to the parties in interest? Yes 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:~o/18.- ~~1f~ ~~
ml\f!.f Kl1i OoL~~
Name (Please type or print)
Ii fJt>O uloo&. ~, IY\m~~'pA.
~ 17~-~771
iJ(7) l'lb-I( 7~
Te 1. No,
Capacity: ~personal Representative
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_____Counsel for personal
representative
(MAH:rmflAM3)
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LAST KILL AND TESTAMENT
OF
BELEN S. FALK
I, BELEN S. FALK of the Borough of Camp Hill, Cumberland
County, Pennsylvania, declare this to be my Last Will and
Testament, hereby revoking any will previously made by me.
I - I direct the payment of all my just debts and
funeral expenses out of my estate as soon as may be practical
after my death.
II - I devise and bequeath all of my estate of what-
ever nature and wherever situate unto my daughter, Mary K.
Boles, or her issue per stirpes.
III - I appoint Mary K. Boles, Executrix of this, my
Last Will and Testament. My personal representatives shall not
be required to post bond in this or any jurisdiction.
SAlOIS, GUIDO
" MASLAND
2109 Muk<l SIr<<!
Camp Hili, PA
IN WITNESS KHEREOF,
. ,,-
this, the. /j
I have hereunto set my hand and seal on
day of
-, J
((I r: .,;:.L"l .
'3
, 1992.
.;;
1l/--v1 ~ .j, J/iVtJ.
. Helen S. Fa1k
(SEAL)
Page I
.
. :.
.
Signed, sealed, published and declared by BELEN S. FALX, Testa-
trix therein named, on this and one (1) other sheet of paper as
and for her Last Will and Testament, in our presence, who, in
her presence, at her request, and in the presence of each other,
have hereunto subscribed our names as attesting witnesses.
~~
~/09 1lJenUI grJ ~ J/J; M
Address
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Address I '
~
Name
:j~ k.
SAlOIS, GUIDO
" MASLAND
2109 Market SIr...
Camp Hili. PA
Page 2
'.
COMMONWEALTH OF PENNSYLVANIA)
55.
COUNTY
OF
CUMBERLAND)
: WE, the undersigned, the testatrix and the witnesses,
irespectively, whose names are signed to the foregoing instru-
ment, being first duly sworn, do hereby declare to the under-
signed authority that the testatrix signed and executed the
instrument as her Last Will and Testament and that she signed
!willingly (or willingly directed another to sign for her), and
I that she executed it as her free will and voluntary act for the
: purposes therein expressed, and that each of the witnesses, in
, the presence and hearing of the testatrix signed the will as
Iwitnesses and that to the best of their knowledge the testatrix
: was at that time eighteen years of age or older, of sound mind,
and under no constraint or undue influence.
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Testatrix
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,lOIS, GUIOO
; MASLAND
09 Mltk.. Sir'"
:amp Hili, PA
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II Subscribed, sworn to and acknowledged before me by the testa-
i1trix, an~ubscribed an~w~before me by both witnesses,
! this /S day of CYe , 1992.
,
~~,CX:~
! Notary Public
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N01AA/.oIl SEAL
rnElMA 5, McCAUSLIN, tlOlary Public
Camp Hill, Cur.,tJer!and Counly
My Commissior. Expires July 3, 1996
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of
Will No.
Admin. No, / 9 '16 - a€) r d? 8'
To the Register:
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to
~Jle !pllow!ng beneficiaries of the above-captioned estate on
/1tLt/lJ 6, r F1 '-I< :
Name
IJ?A~V 1(fly fJt>tt5
Address
/1 f1JetJ)OD~L ilK. 1Ylfat(1i ~6~~,f,.
Notice has now been g ~De~~to all persons entitled thereto under
Rule 5.6(a) except IV~
Da'e, s~j'lf,
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Name /nfJ~V f(flJ! lJot~
Address II f:~{).)oocL tJt:.
!r/W 1/11 ~~ PI/-. In 'lG - .q 77/
Telephone <711) 7'1 b - II 7 ~
capacity:~ Personal Representative
Counsel for personal
representative
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RECEIVED FROM:
, '...'''~N~!lH'l'' ~""~~'~-,-''!\r''~''~,.'
1I'<!ii"'-~Nm, '.:VAN~j~~P.g'"'?~~~'Uo..'Y.\ ~,;i~~~.'"
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ACN
m ASSESSMENT I!' AMOUNT
II CONTROL I:iI
NUMBER
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MARY K BOL.ES
101
.000.00
14 EDGEWOOD DRIVE
MECHANJCSBURG, PA 17005
ESTAJE INFOlMATlON.
BIN R
EJ
II
EJ POSTMARK
COUNTY
.
SSN 172-10-2318
(fiRST) (Mil
-.
DATE OF DEATH
REMARKS
fa TOTAL AMOUNT PAID
.000.00
CW
MARY KAY BOLES
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RECEIVED BY /'It,-, A ,j I ,';( " ",' ",<
. /"ClNAf\JU " r
~~SrS~ERL6~I~IL~ /"U,'/ hY 'l,1
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SEAL
CHECKII 6
REGISTER OF WILLS
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I. Rtol Ella'o (S,hodulo AI ( 1)
2, S'od.. and Band. (Schodulo B) { 21
3, OOlOly Hold S'adJPortno"hlp Inloroll (5<hodulo q (31
A, Martgagll and No'" R"olvoblo (5<hodulo 01 ( A I
5, Co.h, Bank Dopa.". & MlKollanoou. Ponanal Proporty (51
(5<hodulo EI
6, Joln'ly Ownod Proporty (Schodulo FJ 16)
7, Tran.fo" ISchodulo GI(Schodulo II ( 7)
8, Tolal Gra.. A..o" ('0'01 Uno. 1,7)
9. Fun.ral EXpI"..., Administrative COlh, Mile,lIaneous ( 9 )
bpon... ISchodulo HI
10, Dob'., Mortgago Uobilillll, Uon. l5<hodulo II (10)
11, To'ol Dodudion, 1'0'01 Unll9 & 101
12, Not Valuo of E,'alo (Uno 8 minu. Uno III
13, CIIari'oblo and Govom...nlal BoqUOl" (5<hodulo J)
lA, Not Voluo Sub od '0 TaxlUno 12 minu. Uno 131
15. Spou,ol Tranofo.. (far dalll 01 dtolh alror 6-30,9AI
S.. Inllrudlo"1 for Appllcabl. Perc,ntag. on RIYln. (151
Sldo, Ilndudo valullfrom Schodulo K Of 5<hodulo M,)
16, Amoun' of Uno 1A laxablo 01 6'l4o ro'o (16)
Ilndudo va lUll fram Schodulo K or 5<hodulo M,)
17, Amaun' of Uno 1A laxablo 01 15'l4o ralo (17)
(lndudo volulI from 5<hodulo K or Schodulo M,)
18, Principal lax duo (Add lax from Unll 15, 16 and 17,)
19. C"diu Spoulal Poverty Credit Prior Poym.nlJ Dbeoun' Inlt'lI'
+ 550. + ?R Q'i _
20, II Uno 191. grOG'or Ihan Uno 18. onlor ,ho dlfforon.. on Uno 20. Thia I"ho OVERPAYMENT.
mlKJ
21. lllino 18 I. groalor Ihan Uno 19, on'or ,ho difforonco on Uno 21. Thl.fa ,ho TAX DUI,
A. En'" ,h,lnt"... on thl balanc. due on Un. 2tA.
B, Enlor ,ho 'alai of Uno 21 and 21A an Uno 21B. Thfa fa ,ho BALANCI DUI,
Mako Chock Payaklo '00 1..1110,./ Will., Agon'
~ i'.~31 ' F.lISUUTO ANSWQ AU: QUunONS ON lavus. SID. AND TO IICHICIC MAnt
Und.r JMftGh~. a. perjury, I dKfor. IhOl1 ho.... "o",ined 'hi, teNm, Including accompanying Kh.dvl.. and rtal'","U. and to Ih, b..t 0' my knowledge Dnd "l~f.
~~I true, corrld and compl,t.. I declar. fhal all rtal.lIolt hat been rlpontd allrvt mor\.' yalu.. Declaration of pr.par.r ath.r than th. p.nonal repr."nto,,.,.r,
uaMd Oft aU Inlormallon of which r.por.r hot on bowl.d..
I rou I IN ~., I ~ ,.;v~ 170~ :':: 8/Jf:J/'1f.
5010 'er1?J.-Su\€ \ll'j , S/28i'it,
i"'e 1AV\1CS\::x.,c-s I PA 1l0S"S'
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POIDATUO'DIATHAITIlI2121191 CHICXHIlI
.. A SPOUSAl.
POVIIlY CIIDIl It CLAIMID 0
flU HUM.I.
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
8
III
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COMMQHwr"'UH 0' '(NNSYLYANI...
O('....'M(NT 0' .IY(NUI
Dm, 2??oo,
H.....ISlu.O. PA. 17121-0601
N' NA#II ItA . "ll . AND MIDOI.r 'N' 11011
FALK, HELEN S.
~IAL UCUllfY NUMIII
335 WESLEY DRIVE A-426
MECHANICSBURG, PA 17055
CUMBERLAND
AMOUNt IICIIY 0 Isn INn.UCTIONS)
21
COUNTY COO!
96
Y!AR
0128
NUMIU
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1/6/96
4/12/14
172-10-2318
c
"AHUC;.lIU.IUI'm'1HQ tI'OuU" ....... """. "'U"'NO MIOOI"...,1.llI
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rn I. Original Rllurn
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o 2, Supplo...n'al Rllum
o Aa. FUNr. In'''''' Compromb.
(for dalll 01 dto,h alror 12,12,821
~ 6. D.Cld.n' Di.d r"'OI' 0 7. Dte.d.n' Malntoin.d 0 Uvln9 TN.'
IAnach copy af WillI IAnach copy 01 TMI)
ALL CORJWPONDEN~AHl),CONFIDENTIALTAlt INFORMAUON SHOULD BE DIUCTtD,TO
HAM COMrUtl MAlUM ADOIUS
o 3, Romalndor Rotvm
lfar datil of dOG,h prio, 1012.13,82)
o 5, Fodoral !,'a'o Tax Rolum Roqulrod
o A. limil.d E.fal.
_ B. TOlol Number 0' Safe D.poslt 80...
Scott M. Dinner, Esquire
1U'"ONI HUMIIII.
5010 Ritter Road - Suite 119
Mechanicsburg, PA 17055
z
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a:
4,186.13
,
7,471. 'i0
(81
3,301.4,
1111
(12)
(13)
(IA)
x.__
8,356.20 x.06 _
x ,15 .
lIB)
501.37
11,657.63
3,301.43
8,356.20
8,356.20
501. 37
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578.95
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(201
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Chr(~ hl"'" If vou or~ fcqul..'\hnq 0 ,l'fund or your ovc,poyml'nf. '
(21)
121AI
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COMMOI/wwnt Of P1HHIYLYANIA
IHHIIITAHCIIAX lITUIH
IIlIOIHT OICIOIHr
SCHEDULE F
JOINTLY.OWNED PROPERTY
HELEN S. FALK
PILI NUMIIER
21-1996-0128
mATI 0'
Join' 'onon'l.).
NAME
~ Mary Kay Boles
ADDRESS
14 Edgewood Drive
Mechanicsburg, PA 1705
RELATIONSHIP TO DECEDINT
Daughter
II.
C.
JoIntly-ownod proporty.
ITEM LETTER DATE
FOR TOTAL VALUE DECD'S DOLLAR VALUE OF
NUMBU JOINT MADE DESCRIPTION OF PROPERTY OF ASSET "'INT, DECEDENT'S INTEREST
TENANT JOINT
1. A 9/92 Nuveen Tax-Exempt (#58)
National Unit Inv. Trust $3,444.60 50% $1,722.30
2, A 9/92 Nuveen Tax-Exempt (#80)
National Unit Inv. Trust $3,014.~2 50% $1 ,507.26
3. A 9/92 PNC Bank checking acct.
# 50-8003-3111 $8,483.88 50% $4,241.94
TOTAL (Aho on'er on lino 6, Roeapi.ulo'!an) S 7,471.50
(II more 'pact ;s n..d.d ins.rt oddilionol shull 01 ,om, ,;ze}
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arv.un p. v...
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CQrMMONWIAUH 0' 'INNSYLVANIA
INHlllTANce TAX _UUIN
IUIDINT DICIDINT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
PleOM P,lnt 0' T e
HELEN S. FALK
2J-1996-0128
ITEM
NUMBER
A. Funeral Expen.e'l
B.
4,
C.
1.
2,
3,
4,
5,
6,
7,
8,
DESCRIPTION
1.
Neill Funeral Home, Inc. - cremation/death certs.
J. Bradley Funeral Home, Inc. -
headstone/services
minister
Admlnl.tratlve ColI.1
1,
Perianal Represenlotive Commission.
Social seeu,ity Numb.. 01 Perianal Rap,.senlative:
Vea, Commission. paid
2,
Allo'noy Fe..
Scott M. Dinner, Esq.
Family Exemplion
Claimant
Add,.ss 01 Claimant 01 decedenl'. death
sl,.et Address
City
slale
Zip Coda
3,
Relatlan.hlp
Probate Fe..
MI.cellan.au. Exp.n.e"
Pulmonary & Critical Care Med. Assoc. - med. care
HeaIthSouth Renova Center
Bell Atlantic - teIaphone expo
Register of Wills
Transportation/household expenses
H&R Block - income tax return prep.
AARP - ins. premium
Bethany Towers - Jan. rent
TOTAL (Also .nte, an line 9, Reeopllulallon)
(II more .pace I. need.d, In.ert additional .heet. of .ame .1...)
AMOUNT
$
735.00
758.50
50.00
300.00
85.82
14.88
30.00
45.00
695.33
65.00
34.50
487.40
5 3,301.43
15~~<I-?
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
BUREAU Of INDIVIDUAL TAXES
JlrHRITANC[ TAX CIVISIDN
O[PI. IIDnl
HARRISluaO, Pi .'lll'D,Dl
NDTICE Of INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
Of DEDUCTIONS AND ASSESSMENT Of TAX
SCOTT H DINNER ESQ
STE 119
!o010 RITTER RD
MECHANICSBURG PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
12-02-96
FALK
01-06-96
21 96-0128
CUMBERLAND
101
hount Ro.Htod
c.....
*
111'1'" IIIU.U,'"
HELEN
S
HAKE CHECK PAYABLE AND REHIT PAYHENT TOI
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE. PA 17013
CUT ALONO THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiilj:iii;;j-EX-AFP"i'o7":9iii-iiiificE--liTi"NHEiiii'ANCn'-"x-jipPRA-isEiiiiii'";",H,t'oiiAiiC!-o-Ii-------uumm
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF FALK HELEN S FILE NO. 21 96-0128 ACN 101 DATE 12-02-96
If an allall.ant wal illuad pravioullY, linal 14, IS and/or 16, 17 and 18 will
reflact figuraB that includa tha total of !bh raturnB aBBaBBad to data.
ASSESSMENT OF TAX:
15, Aoount of Llno 14 ot Spou.ol roto 1151
16, Aoount of Line 14 to.oblo ot Llnool/Clo.. A roto 1161
17, A.aunt of Llno 14 to.oblo ot Collotorol/Clo.. I roto 1171
18. PrincJpal TaM Due
TAX CREDITS I
PAYHENT
DATE
04-05-96
11-25-96
TAX RETURN WAS, I X I ACCEPTED AS fILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1, Rool E.toto ISchedulo Al III
2, Stocko and Bond. ISchodulo II 121
S. Clo..ly Hald stock/Partnerlhip Int.r..t (Schedule C) (3)
4. Hort.ogo./Noto. Rocolveblo ISchodulo DI 141
S. Cash/lank Deposita/Hisc. Parlonal Property (Schedul. E) (5)
6. Jointly Owned Proporty ISchedulo fl 16l
7, Tron.for. ISchodulo 01 171
8. Total A...t.
APPROVED DEDUCTIONS AND EXEMPTIONS I
9. funeral EMpen.../A~. COltl/HiIC. EMPan... (Schedule HI (,)
10. Debt./Hort.o.o Llobllltlo./Llon. ISchodulo II 1101
11, Totol Doductlon.
12. H.t Value of Tax R.turn
13. Charltabla/Govarn.ant.l Bequa.t. (Schedule J)
14, Not Voluo of E.toto Subjoct to To.
NOTE I
RECEIPT
NUHBER
AA112710
REFUND
DISCOUNT
INTEREST
It I
I-I
25,07
,00
l CHANGED
,DO
,00
,00
,00
4,186,13
7,471,50
,00
IBI
3.301. 43
.00
1111
1121
1131
1141
,00 X ,00.
8.356,20 X ,06.
,00 X ,15.
IlBI
AHOUNT PAID
550,00
73,70-
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. If PAID AfTER DATE INDICATED. SEE REVERSE
fOR CALCULATION OF ADDITIONAL INTEREST,
HOTEl To In.ure proper
credit to your eccount,
lub.lt the upper portion
of thl. for. with your
tex peYllent.
11.657.63
:'l.~n1 4~
8.356,20
,00
8.356,20
,00
501. 37
,00
501. 37
501,37
,00
,00
,00
1 IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED,
IF TOTAL DUE IS REfLECTED AS A "CREDIT" ICRI. YOU MAY BE DUE
A REfUND, SEE REVERSE SIDE Of THIS FORM FOR INSTRUCTIONS,l
"
, ,
I
r.,
L'~
_:J
UU
RESERVATION I [It_t.. of decedent. dying on or before Dece8ber II, .9., -- l' Iny lutur. lnt.r..t In the ..t.t. J. tranl'.rred
In po.....lon or enJo~t to CI,.. . (coll,t,r,l) beneflcl.r... of the decedent ,'t,r the ..plr.IJon of any ..t.t. 'or
11'. Dr 'or YI.t., thl C~.lth hereby ..pr...., r...rv.. the rlDht to appr'." and ...... tranl'.r InhlrltlnCl ,....
It tM .""ul CI... . (co11."",O nt. on My such future Inta,..t.
PI.IIPOU Of'
HOTICEI To fulfill the requlr..-ntl of Section Zl~O of the t~rltanc. and E,t,t, T.. Act, Act II 0' ."1. 72 P,S.
Section ZlU.
PAVttENTI DetHh the top portion of thh Notle. and I..m.lt with your PIYMnt to tN Reght,r of ""11 printed Dr'I the nv.rs. .lde.
u"", check or MlNy order Plvllbl, tal REGISTER OF MILLS, AGENT
All P.~t. recllvlMf shall first tt. applied to WI' Int.rut whIch ..y be dull with en, ,..Inder applied to the t...
RU\IaI (CAli A r.fund 0' . tl. credit, which .... not request.. on ttM T.. A.turn, .aw be r.quut.cl by COllPlatlng en "application
for A.fund of Pann'Wlvanla Inheritance and E.t.ta T.." (REV-ISIS). application. .r. avallabl. at the O"lc.
of the Aat..t.r 0' Will., eny 0' the ZS A.v~ DI.trlct O'flc.., or bw c.lllng the .peel.. 24-hour
answer I", ..rvlc. ~r' for 'or., orderlngl In Pann,wlvanl. 1-'DD-S6Z-Z0SD, out.lda Pann.wlvanl. and
within loc.! HarrIsburg ar.. e7171 7'7-'D94, TOO' (7111 77Z-ZZ52 (He.rlng 11Ip.lrad Onlwl.
OlJECTIOHSI Any p.rty In Int.r..t not ..tl.,lad with the appral...-nt, .11~anc' or dl.'llowanc. of deductIon., or ......eant
of tax (Including dl.count or lnt.r..tl .. ahown on thl. Notlc. au.t obJact within .I.ty C'D1 deW' 0' rac.lpt 0'
thl. Notlc. bWI
--wrlttan prot..t to the PA Dep.rt-.nt 0' A.v~, aoard 0' Appaal., Dapt. 2.ID21, Harrl.burg, PA 17121.1D21, OR
....lactlon to have the ..tt.r etat.r.lned at eudlt 0' the eccOWlt 0' the "'''01'\81 rapra..,tatlv., OR
.......1 to the Drphlln.' Court.
AllIIN
IITAATlVE
CClrRECTI OHS I
haM! .rrorl dlscovarad on this ..........t should be addr...ed In writing tal P" DapartMnt of A.venue,
lur.au of Indlvldu.l T...., ..TTHI Po.t .......-.nt A.vl.w unit, Dlpt. Z'D6DI, H.rrl.burg, PA 1712'-D601
Phone (717) 7'7-'515. S.. P'VI 5 0' thl bookl.t "In.tructlon. 'or Inherltanc. T.. A.turn for. A..ldant
Dacadant" CREV-ISOI) 'or an ..planatlon 0' ~Inl.tratlv.ly corr.ctabl. .rror..
DISCOUNT I
If any t.. due I_ p.ld within thr.. (Sl calend.r -.nth. ,'t.r the dacadent', de.th, . 'Iv. parcant (S~l dl.count 0'
the t.. paid I. .llowed.
PfMAlTVI
The IS~ t.. .-na.tw non-p.rtlclp.tlon paneltw I, coaputad on thl tot.1 0' thl t.. and Int.r..t ......ed. and not
p.ld before January II, I"', the flr.t d.W .ft.r the and of thl t.. .-na.ty parlod. Thl. non-p.rtlclp.tlon
PIN I h Is appe.labl. In thl .... .amar and In the thl .... tI.. p.rlOd .. you would appa.1 thl t.. and Int.r..t
that ha. bean ......acI .. Indlc.tad on this notlc..
IHTEREST.
Int.r." Is chargacl bellMlng with flr.t d.y 0' delinquency. or nlM e91 -.nth. and ana (11 day froa thl d.t. of
de.th, to the data of p.yaant. T.... which b.c... d.llnquent b,'or. Janu.ry I, 19.2 b..r Int.r..t .t thl r.t. of
.Ix C6Xl parcent par IIV'IW c.lculatacl .t . d.lly r.t. of .CDDI". All t.... which bacM' cMlInquant on and .fhr
January I. 19'2 will b..r Int.ra.t .t . r.t. which will v.rw fro. c.landar y..r to calendar y..r with that rat.
announced by the P" Depart.ant of A,venul. ThI appllcabl. Int.r..t rat.. 'or 19'2 through I'" ar'l
I!!! Intarllt Rat. D.llY Int.r'lt factor !!!! Int.r..t A.ta D.lly Int.r.st Factor
1911 lOX .DODS" t911 OX .DODZO
1915 UX .DODUI 1911-1991 \IX .DDnDt
t914 \IX .0DnOI 1992 'X .DODZO
1915 UX .DlnS6 I99S-19lM 7X .Goat9Z
1... lOX .DlDZ74 1995-1996 'X .DDDZO
--Int,rllt II calculatad .. fall..,sl
INTEREST . BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
."&nw Hotlc. l"Ulld .ftar the t.. becoa.. ct.llnquant wIll r.fl.ct an Int.r..t c.lculatlon to flft..., US) d.yl
beyond the det. of thl ........"t. 11 p.y.....t I. .acta .ftar the Int.rllt coaput,tlon d.t. mown on thl
Hotlc.. additional Int.ralt ault b. calculatad.
/:)-Y'/-'?
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
C-
*'
BUREAU Of INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DE:PT. 2106.1
HARAISIURG, Pi 17IZ.aD'Dl
.t'.III1I."'IIJ..U
SCOTT M DINNER
STE 119
5010 RITTER RD
MECHANICSBURG
ESQ
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-09-96
FAlK
01-06-96
21 96-0128
CUMBERLAND
101
AlIOUI\t R..ltted
HelEN
S
PA 17055
MAKE CHECK PAYABLE AND REMIT PAYMENT TOl
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
HOTE. To Inluro proper credit to your eocount, 1ub<<lt tho upper portion of thll faro with your tOM po~t.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
iiiWiiiijj.ix-AFji-nz:9;ii------iiiiii.iiiiiiliii"A'Nc!'.TAx.sTAfiH'E-riT.'iiF-A'ifcouiif--iiiii---......-------- ----
ESTATE OF FAlK HELEN S FILl! NO.21 96-0128 ACN 101 DATE 12-09-96
THIS STATEHENT IS ~ROVIOEO TO ADVISE Of THE CURRENT STATUS Of THE STATED ACN IN THE NANED ESTATE. SHOWN BELOW
IS A SUHHARY Of TNE ~RIHCI~AL TAX DUE, A~~LICATION Of ALL ~AYHENTS, THE CURRENT BALANCE, AND, If A~~LICABLE.
A ~ROJECTED INTEREST fIGURE,
DATE OF lAST ASSESSMENT OR RECORD ADJUSTMENT. 11-25-96
PRINCIPAL TAX DUE I 501. 37
PAYMENTS CTAX CREDITS).
PAYMENT RECEIPT
DATE NUMBER
04-05-96 AA112710
11-25-96 REFUND
'0
- :"f ~g;
oE,
tl):::: 6: ';: ..
')~ 0
.- .
~, ~.. ,...
~
'_' III ~
, ~ ';;.
...' , -,
o ,_~) oJ
Ow ,... -~
<DC: .; E
c: P' ~8
DISCOUNT C+)
INTEREST C-)
25,07
.00
AMOUNT PAID
550,00
73.70-
. If ~AID AfTER THIS DATE, SEE REVERSE
SIDE fOR CALCULATION Of ADDITIONAL INTEREST.
I If TOTAL DUE IS LESS THAN .1,
HO ~AYHENT IS REQUIRED.
If TOTAL DUE IS REfLECTED AS A "CREDIT" ICRJ,
YDU HAY BE DUE A REfUND, SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
TOTAL TAX CREDIT
BALANCE OF TAX DUI!
INTEREST AND PI!N.
TOTAL DUI!
501. 37
,00
,00
,00
PA'ntDIT1
DltMh the tOIl ,.rtlon of thh Hatlce ... s~1t ..lth your p.y""t ... p'YMlI. to the "... Met Nelr...
print_ on the rever.. .ldII.
If AEIIDOfT DrtEDEHT ... ehHk or lIOMy order p')'MlI. tal REGISTER OF WILLS, AGENT.
If NDN.RUIDrNT MaDDT uk. check or lIOMy order PI.I. tal CotltOHWEALTH Of PEMtSYLVAHIA.
All p~t. r..lnd _11 be ...,11_ first to MY Int.r..t which _I be due ..Ith MY r..lnder .."l1ed to the tax.
REf\III (aUI A ref\nl a' . te. cr_lt, which .... not rectUe.ted an the Tax .Iturn, .., be r....ted by capl.tlnt ..
"""lIutlon for R.hnd af P...,.)'lvenl. lmer Itence Met E.t.te T.... (R(V.UU). applications .r. avalllbl. at
the Dffl.. of the A..I.t.r af Willi, any of ~ Zl Aevenue DI.trlct Dfflc.. or 'r.. the Dep.rtoent.. Z4.hour
.....rlne ..rvlc. nu-bor. for 'ar.. ardllrlntl In Ponnsylv..l. 1.laa-S6Z.ZaSa, out. Ide Penn.ylvenl.
end ..Ithln lacel Horrllbur. .r.. (717) 717-la94, TOOl (717) 77Z.2ZSZ (Heerlnt 1.,.lrod onl,).
REPlY TDI Duo.tlon. r...rdlne .rrar. cont.lned an this notlc. should be addr...ed tar PA Dop.rtaont of Rovonuo, Bur.au
af Individual T...., ATTNI Po.t .....a.ont .Ivlew unit, Dept. 2la6al, Horrllburl, PA 17121.o,al, ~
17171 7'7-6IIS,
DISCDlIITI If 1ft)' tu.. It p.ld within thr.. (J) c.londer eanth. .ftlr the d1codlnt'. dHth, . flvl percent (n) dlsCCM'\t
af the tax Plld h .11.......
POIALTYI
The In tax ......ty "..,.portlclp.tlan penalty It cae,uted an the tat'l cf ~ tu end Int.,..t ......ed, Met not
pold bII'are Jonuory 11, 1"', the first d8Y .ftlr tho end af the t.. _.tv perlad.
INTDtEST I
Int.,..t It chIIrted boglmlnt ..Ith flr.t d8, a' delinquency, cr nino (,) -.nth. end ani (lJ d8)' fr.. the dIIt. af
dMth, ta th. dIIt. af P'YNnt. To... which bee... delinquent bo'ore Jonuor, I, 1'12 bur Int.,... .t the rat. af
IS. (~) ,.rcent por ..,.. c.lcul.ted It . dIIlh rot. a' .UOIM. All t.... which bee.. dollnquent an .. .ft.,
Jonuory 1, I'IZ ..Ill bo.r Int.r... It . r.tl which will v.r, 'r.. c.londer year to c.lendor ,ear ..lth ~t r.t.
MnOI.nCod by the PI Dop.rt.....t a' AevlnUl. Tho oppUclbl. Intlr..t r.t.. 'or 1'12 through 1"7 1'"
Yoor Int.....t A.t. DIlly Int.r..t Factor Y..r Int.ra" Altl D.II, Int.r..t Factor
191' Zll .OU541 1'17 9X .00020
191) 161 .0004)1 19"-1"1 III .001S01
1914 III .OOGSOI I"' 9X .00020
1915 III .OOOJM 1")-1'" n .UOItz
1916 lOX .000274 1"5.1"7 9X .000247
..Int.....t I. calcul.ted .. fall....,
IIlTEIlEIIT . IAWCE OF TAX VllPAIO X HUKlER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
..Any Notle. l.tuId "ter tho tax bee.... delinquent will r.,lect .. Intlr..t calculltlon to fifteen (15) day.
bayond tho d8t. a' tho ..........t. If p',""t II IIIdI .ft.r the Int.....t cOllPUtaUan cqt. shawn an the
Motlel, additional Int.r..t ou.t be c'lculated.