HomeMy WebLinkAbout96-00218
PETITION I:OR PROBATE and GRANT OF LETTERS
Ef/U,.' Ilf CbPP?~ ST19f-AtIf,i>/ No. -.OlJ- 9~ - OJI g
ul.to kll(l\l'lI us To:
Rcgislcr of Wills for Ihc
-. /J..c.'us,'''. CoullIy of (.~in lhc
Sociul S,'clI,i'y Nil. 170 - C!.L- J.~ )1. Commonwcallh of Pcnnsylvania
Thc Jlcliliuo of Ihc uodcrsigncd r"'Jlcclfully rCJlrcscllIs Ihm:
Your Jlclhioncr(sl, who is/arc IN )'cms of ngc or ol(~ lII'$\ccu'9/j(
in Ihc last will of Ihc nhovc dcc,'dcnt. dnlcd .- - - '1'-
and cudicil(s) dlllcd ui/-k:.
namcd
.19_
1\IoUe felc,anl drCllIlI\!tHl(C\, t".~. rl'lllIndatinn, dl'alh 01 L'\t'\.'Ulur. tiC.)
()cccndcnl wns dmnicilcd nl dcnlh in c! U m &1'"-1{' L /LA/.li_ CounlY. Pcnnsylvania, with
h1$_ lasl family or Jl~iJlal rcsidcncc al _-3 J t. t:':~~~ L ." b~ ''''~
~~ LU"" /~~. S#CJf.'t:.I!J,,/YftP~/vI p'/1 /701/
(11\1 \lrc('lrIlUI1lI~('r and l11uIIL'ipalil)') -~..:3
()cCCndCnl. Ihcn J.....LJ_l'cms of ngc. dicd I ~ r:,~ . 19 9' '" ,
at__r./~';( ~/I? ,r .N~/rAL .
E\ccJlI as I' uws. dcccdclll did nol mmry. was nul ~ivorccd and did nOI havc a child born or adOJllcd
aftcr C\CClllion of Ihc will offcrcd for Jlrobalc; was notthc viclim of a killing and was ncvcr adjudicalcd
incompt:lclll:
()cccndCIlI at dcalh owncd JlroJlcny whh cSlimatcd ,'alucs as follows:
(If domicilcd in Pa.) All Jlcrsonal JlroJlcny
(If nOI domicilcd in Pa.) Pcrsonal JlroJlcny in Pcnnsylvania
(If not domicilcd in Pa.) Pcrsonal JlroJlcny in Counly
Value of rC;11 .:\latc in Pcnn\)'lvnnia
situalcd as folio"':
$ - 8'.-<JCJt1(~ MY~
$
$
$
WHEREFORE. Jlclilioncr(s, rcsJlcclfully rcqucs!L') thc nrohmc of Ihc lasl will and codicil(s)
Jlrcsclllcd hcrcwith and Ihc gram of ICllcrs__JJ sTi1If1~NrnI2V
. IIC'I"ml'lll;u~'; ildmini\lriUi\1l1/I,il.; admini\lralion d.h.n.c.l.a.)
Ihcron.
,
-
"
c
~~
!.'::
:&:~
].g
~.=
~~
:;,
r.
.I:1ML!!m V. sr/i"ll'lIlh;!
__:=lL(~L~ L,hv.c0.4l.'e 7>~ _
_~:1I~~s7'f)~. 7fT77"I/
___ (_Zt.7)_U7:.~.?,g.,.___
~-'?1 ;?/,~a"'-/
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAI.TlI OF I'ENNSYI.VANIA I '>i
COUNT\' OF _~LI /11 8Ete I..Ii~b J IS
Thc Jlclitioncr(s) abovc'lUlIlIcd swcar(s) or .Iffirm(s) Ihat thc s""cmCllls in thc forcgoing Jlctitioll arc
Iruc and ,orrcct III Ihc hcst of thc ~nm'lcd~c and hclief of Jlelilioncr(s) and Ihal as Jlcrsonal rcprcscn-
lUti,'c(s) of thc ahovc dcccdclll Jlclitioucr(s) will well and Irnly administcr Ihc CSlalC according 10 law.
SWllCn It.' ur,alTirtllc<l ',md '"hscribed.l~,.W~"'1 i?1 &";;r~ '"
hcf,'rc m,' Ihi, __11_____ d,~ 91' _ ~.
If' 7/)~-v. ,IY~(~. I' !:
.LiliIU...'.C"_-':0..i...C!....;_c--(.. ,,'-'/'. 1// ~).:I'.J ~
MARY C. LEWIS N.'!!i.I'.>, ,!....-1_ ~
--'/
11I009In ltV If/tl
This II 10 certify Ihallhis is a lrue copy ulrhe record which is unlile in the Pennsylvania Division 01 Vital Recurds in accordance'
...Jlh ACl 66. 1'.1.. 304, approved by Ihe General Assc:mbly,june 29, 195~.
WARNING: 1111 lIIegllto duplicate thll copy by phololtat or photograph.
-
II
,--.0'
..-..
(J.J.II~
Charles Hardesrer
Slale Regislrar
Fee lur this certilicare. n~
3763622
No.
-
-.-
"IOIU'''''' ..,
..
,.
..
FFB 2 6 1996
(}ale
COMMONWEALTH 01 PINNlYLVAHIA . DIPARTM(HT 0' HULlH. VITAL MCOROl
CERTIFICATE OF DEATH
...
::::"0
..-:_.-::~-r
NlOJIIU$"'~
316 al..dal. Drl..
; .~
c::il.~O ..............0
-- ~-
....f......Care14
...--...--_.
/ldy.f/l'Rt"
-
" .. .
U "IlWO 't
...p .. 0
..-...-,.....
,.0-............. bower Allla ,...,.
'''''''-Penne,l,a&la-- =-
..,
---' tN.D~-=:':::..
f""'IWIl~"''''''''_~
,..
.at Hl11 Co..tar, rk. PA
~ ook11D FuDlral HO.I
_0
.
--.-......
.
t: _.._.............___....DI..._..._
\...,-_.._-
... 0 ,-)( _0 .; 0 .....
- - ...
CD'I....O'._~
"CUIt,"",,~~~C_"__"'''''''''_,,"_I'C'''_____U1
11.._...,..........._..............__.....-......... .............. .... '..... ...........................
....
I:
--
--.-..
.."""
.....
I
~
1
- J ,---
'" .
,..
'"
"'..,
. ......
=.1f"
o
CW l;WolWUl'l'
..-
... ......
........... \llllDMt Dl
-"'"'"
o
o
o
-
--
.... 0,-0
.
c#""""...__._-......
-....~-#04
-
,..-~--
c..IIl............
o
..... .
-,t7L~)-l.. . 2-
.uG ifOt~",",COWl. rm
'"~.r Po ~<A1="....&'JV1'6 , f,)
6MIifI G ~ 7""
..., "
rci74 \\4~~
. ~AHO~..........~_--...-.__-'""'"'._____
...........,............---"'..--.-....,.....-....................-...- .
-
"WOIC...u.~1l
011.......... ............ ....................IIIl.,................c-.4.... .......... ....,..... ........"'-1-...411....
.,.-"........................................................................................................
't/l~,' ,81
M
'"
..:,.'
, r
\1\1\llj"""\li\"",lF ' '
II 1\ \1 I ~ ' , I. . I . j I; I ' , 1 '
I II \'\,1\11;.\1\1;"\''\''
\ 11\'I,:H...., \., I',
\ 11 It lld'~ ,:l l" .
\11 \il!\Z1\:-196 ~: 218, .
'\1\\1\\111'1 ii',I',;::":I' ".';\:'"
'I I' . 1 .,
1\1\'lilil;;'<I, . .i'
1 l:j'!d'l';" l)l ,I
t 1\10'1; ,\" l. l~t ,t
ll\\I\I\\!\\I\l:j\i\!"1 :,::\;'I,I!' 'I: ~,,:< "
. 'fl I h,. I 1",1' .
\ l\' \ i l, ~ 1]1 f \ n", l~ 1 \ I l' (
\ 111,1111\\;\\'\:" II ,I ,1.',1,"
I \ l'lt i!'" ' , ,
\1 \1\\'I\\I\\\\:lll\1i\:\,II>' :i",>,',
t I'll II! 1 '.' "."
\ \ ,\,i\Hil'\'ii Idll, .,1;,; ."
,\,\\11\ iii, 1";i;'I:!' \", ;.; ,
\,1 11"I'!;:!\:"""'"
\ I' I., ;\\,\;\:::\',' ,I'
IILI \1\'1'''1'<1' 'I;',' ,
1\ ,,;.dq,l;n~ll l,' ,
'\\ 1\,\'\\i!\'jl';\1'i:'\!':\,', \1
\\\, q l,liil'tl'!il':::'l:';
II' \' P I.! II j ~ II . \ r, I
.\Il\; n;,', ;_]1 'I" I
, \ 1\.,1,,'. I '
\\ l\\\l\i\l\I\lli"liir'::";'i ',',,',,'
\ "Ill II ,l,;1 'HI ";
\ ,pl\ I \i -! \ d, I I ~ ; ,
ll\i '\'11 t!' lil'll II ~ 1 ': I, \ \ \ \' II:;,,": ,\ I I,
\ \' \"\11 ,'i,I'" ",': ' ,
. ' I\\ill ,,,;',,i'i' ,\'...., ' ".'
. \ I I <"II ',I, \' ,"ji' j 11
\ l\,1\! ~ !!:\ I i: i:., i: j' \: I, . d
, III \ll~ Il!\qj \ '!i,:P' ,Il' \;.:; i' ~
\ \ 1\1\\\ 1\ lldl"::'!ll, I' : "I';',' ,"
\\' \" ii\'lll'\i\iI'liipii'I,\\\ 'I' .
\ 11\ I" \,1\"1 ,iI'\"I!""" ,.! " ,
\ \ Iq qp II' 1 fit" ,1,. \,'
\ \' \\I!lI\.,II'll',il'I\';:"II:f'll ':, . """ ,.,
\ \ II{ I; '\'lli I'll 1 .... ,,' )1
I Iii! p' tJl '1!1" I,HI ,\ ,\ ~ I" l" ,.
I' \'\I\\IHili\i;\\\!\ii:;ii):' :1:\;, >!: ,,;;:: ,.
1\ I \' H\'DH:l!!l!qlldldl:~ '~;tll:.~;I: \ l'
I \ I l' '~\'1,11t!' ll.!q, II 'r l'
\ \ \ \1 \1'1' '\1\,\1::':1"\ ,\:,,:1\::1':::'\"
\ \l'\'\"'I"h:jI\1 iil,:::,'\ \;:~:> ,', I; ",;
I '\ \'\,!\\\I"\Il\II\,l\iL: ;,:!,;,,'I!'h ' .,,'
I \ I\\\i\' \\\.,\\\\11 :\Ij;';:" I':: ':.. " .
\ \ 1\ 1\1\\ it! \I:I\::lIj'\" 1;l1\'I:iI':,:'
I \"\'P"'" ", l' ,
1\1\1\\\ 11\111\ h\li\\:I::I\;\\;q"L\. i,". ,'"
I \ iI, I' " '" ,,' :liI" ,'j'" ':' , ....,
\ \ I '\\!\nll\'\iI!:>;l:lldi"I' I:, ,j , ,
\ I .,\jlll\ t;llil' \ t" ,l ;.
.\ Iii Ilnlq"I:'!",".' " ,
\ \\1\1 1\'\\:I\,j.\!\::' \i, ':,'.":"
Ltp \d!' I 'I 1:1 ~ I " I" :1
\'1\,,1\'::':":":: '
\i PILl,l !.,t~;: 1\'"
l \ \'hl\lll'I:I\i\~:.': :',iI':i ,li:: :,"
'II '1'"'''''' "
11..,11;1 Iii ::: \,"1':" )<
I I \\\il\\ii\(,',H:p:\:I:::,;;: ".,
\ III \1\'\\\\\iili:';:i;:\':I:;:'i"j':":("""
'\1 'I""" 'I '."" '.'.'" "
."1\" j .; ',,"
1\ \ \i\lll\i!'l\ii'\i\l!i:' I,: " ,,'
II 11\\'\11< .:01'." ",',>.',1,'
\ ll't .; !l1;',Q!ll:l,\\I;1 -';:
1, ll'll\'\\l\ilj,\i::'\h"'"'' ',p" ,
! I i.' jlh,l" \,tl,. " ! i
'\ 1\,1 \1\ "",'il'" I'"~ " ' 'i'
\1 \'1\ "1\\"1":":' "
\ \'1", 'I', "'i" ..
, Ill"!" " '1
, \'\ \1\1"\"" ,
'1\\ \,11:\\,11'1\:1: \: "
, III I' '\\1"
II !, \Ii'liil! ':;",'
1 \\'\"\\'\l!lIIH ,I,
1\ ,Iil\l\\\\\\\ \\\\\ Ii
, "
~ \
,':'
'J,; j
,;
""':, ,
li'1\"
'i
",:
'Il'
",
,.,,'
;\i "
;",
" ! ; : i H; ~ ~ \:\ t
""i!':!:,\/,!~\i:
\;i' . ,'\.i1iJ.,.",
~;~'Y~':'I\~;i',;t\
," ,,'" II j" ,.1"1"
, ,"::', i\\\t: \
,1 i"l';' i;
':: ' ':il~ ;,>.
,-1),\,"" .'
",:',I',;\\\;\\)!;;
!i'l:: i\ld!\iti:l\l
';"::,.:/!\;~;:\;!\
, 'I,!: ::1,,: :ldl\\\I\
\11, )iihi ,\\\I\!\I\\:
"LIJ\t.tl lit, !
':1."1;" 'jil('\"
,1l~ : ' I' ! h - ! : . ; ; ~ 'I! t!l (I
~.' "::i.i:'\\\l\:i
,f l~q., ; ,} HI
!' ~ d. ~. q;;.; "
. ":\.\\,i :\
'1" ;i\
"'i. p' 1.
i',\
'I:'
,',
l;
>i\,
:;"
,.
i;li
It':'
; " , ~ i .
; ~
""
.",
.i
!!
,:"
,\,
I:'
. \. ~. H:
.'
-. ,,',
. ,; ~,~~.; "
,( l~ I
,. ,.. '
,~~. '1' .
",;;;
;1,.'
::
:11
.....
j! I
. --" ~:;
"<1'"
\H i
i,l ;':
>), ~l ~\ j d
,>\. ,\, .d
::,;'1 n:
." \.,
'Hill'
,'i hi ,~,
;Hi
'f'" ;
"
q
n
:1
q
H
. i'
I,'
! ,\
! 1\
11\
, '\
\ i,
; Ii'
\ IIi
It
\ .1<
1(;
,.1>
i'l'
,! ,
, H\
L\
\ II'
1\1'.
I L
l,t.
\ \1:
, I'
I I ~
" .
I)!'
\'\1,
, '
"
I ,.i
It
11',1"
,. '
" ,
,11
14\
II!
\'\
lh
iii
HI
1\\
1\1
J
II,
II
\\,
"
B
ill
I'
II
It,
~ 1 i
"
\,
,I
,',
;,J.
, :jt :1;
.'1
"
"
l'
,
.' ,
"
WILL or CLAIR H. BTAYMAN
I, CLAIR H. STAYMAN, of Shiremanstown, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will
previously made by me.
ITEM I. I give all my automobiles, and all other articles of
personal or household use, together with all insurance relating
thereto, to my wife, MIRIAM V. STAYMAN, if she survives me by
thirty (30) days. If she does not so survive me, I give all such
property and insurance to my wife's children who so survive me, to
be divided among them as they may agree or, as my executor may
think appropriate.
ITEM II.
I give all the residue of my estate, real and
personal, to the trustee under my Revocable Trust Agreement signed
earlier today, IN TRUST, to treat it as an addition to the
principal subject to that trust agreement as it exists at my death.
ITEM III. I authorize my executor:
A. To retain and to invest in all forms of real and
personal property, regardless of (i) any limitations imposed by law
on investments by executors, (ii) any principle of law concerning
Page 1 of 5 Pages.
"
ii'
I' .
~ f ,
I
!\. .
! 0, .,.
i ~,~
; :
.'
,.
I'
, '
I. ....:-
'-.:.'
". '.
delegation of investment responsibility by executors or (iii) any
principle of law concerning investment diversification;
B. To compromise claims and to abandon any property
which, in my executor's opinion, is of little or no value;
C. To borrow from anyone, even if the lender is an
executor hereunder, and to pledge property as security for
repayment of the funds borrowed;
D. To sell at public or private sale, to exchange or
to lease for any period of time, any real or personal property, and
to give options for sales or leases;
E. To join in any merger, reorganization, voting- trust
plan or other concerted action of security holders, and to delegate
discretionary duties with respect thereto;
F. To allocate any property received or charge incurred
to principal or income or partly to each, without regard to any law
defining principal and income;
G. To distribute IN KIND and to allocate specific
assets among the beneficiaries (including any trust hereunder) in
"
.
Page 2 of 5 Pages.
" .
such proportions as my executor may think best, so long as the
total market value of any beneficiary's share is not affected by
such allocation.
H. To use administrative or other expenses of my estate
as income tax or estate tax deductions or both and to value my
estate for tax purposes by any optional method permitted by the law
in force when I die, without regard to whether they were paid from
principal or income, without requiring adjustments between
principal and income for any resulting effect on income or estate
taxes.
These authorities shall extend to all property at any
time held by my executor and shall continue in full force until the
actual distribution of all such property. All powers, authorities
and discretion granted by this will shall be in addition to those
granted by law and shall be exercisable without leave of court.
ITEM IV. I appoint my wife MIRIAM V. STAYMAN, executor under
this will. Should my wife, MIRIAM V. STAYMAN, fail to qualify or
cease to act as executor, I appoint my wife's son, MICHAEL D.
VOLLAND, executor under this will. Should my wife's son, MICHAEL
D. VOLLAND, fail to qualify or cease to act as executor, I appoint
my wife's daughter, DONNA S. DUDA, executor under this will.
Page 3 of 5 Pages.
,j.
I
"
I
I
I"
,
I.
,
'L~
,..",
.' .
ITEM V. I direct that any fiduciary acting hereunder shall
not be required to enter bond or other security in any court or
jurisdiction in which said fiduciary may be called upon to act.
Any corporate fiduciary shall receive compensation in accordance
with its standard schedule of fees in effect while services are
performed.
ITEM VI. The term "executor" and "trustee" or any pronoun
used to indicate the executor, trustee, any other fiduciary or any
beneficiary shall be deemed to apply to one or more than one person
or corporation and to the masculine, feminine or neuter gender as
the case may be.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this, my last will, this l(f~ day of March, 1994.
~JI,
(SEAL)
page 4 of 5 Pages.
."' ,.
COMMONWEALTH OF PENNSYLVANIA
(-, ,I".' J
COUNTY OF ororrPHIN
)
(
)
II
ss:
i
j". / '
i ,,' /
and
We,
\,/:/1,'1 -,
CLAIR
H.
STAYMAN,
I:' J I"",
the testator and witnasses,
respectively,
whose names are signed to the attached or foregoing instrument,
being first duly sworn do hereby declare to the undersigned
authority that the testator signed and executed the instrument as
his last will and that he had signed willingly and that he executed
it as his free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and
hearing of the testator, signed the will as witness and that to
the best of our knowledge, the testator was at that time eighteen
years of age or older, of sound mind and under no constraint or
undue influence.
(J~ W.~
CLAIR_H. STAYMANi ~
,'j" ) / " 'J /'
, J "
I /_____...-.-... ./ - /;-~.
( ,_ . i
witness
/)t..-.:JL
Witness .
SUBSCRIBED, sworn to or affirmed,
~..}~~
.../
and acknowledged
before me
by the above-named testator and by the witnesses whose names appear
above on ~t>R.c\'" \ S , 1994.
~Cl.W O.~c.~'
Notary public
\
CERTIPICATION OP NOTICE UNDER RULE 5.6(81
Name of Decedent: Clair H. Stavman i~ lS! :0:0
~8
_.~
:>. ' ~ !{La
Date of Death: Februarv 14. 1996 g:: ~'11
O.
c.., Jl. '\0
g") ....
File No. ~ ~ (~
00218-1996 ~ ~, = It>
a N Ins.
~~ e
\0
To the Regieter:
I certify that notice of beneficial interest required by Rule
5.6(a) of the orphans' Court Rules was served on or mailed to the
following beneficiaries of the above-captioned estate on March 29,
1996.
bIU
Address
~ir~am v~ s~avmi'ian: 316 Glendale Drive. Shiremanstown. PA 17011
Michael Q. vo _~ng. 3523 Blue Coat Road. Baltimore. MD 21236
D~~~; S. Dud~~ 1158 Sollenberaer Road. Latrobe. PA 15650
~~~~;e~'D~t:~r:~n:~V~~~:.l~rT:sU:e~. 3523 Blue Coat Road. Baltimore.
MD 21236
Notice has now been given to all persons entitled thereto under
Rule5.6(a) except
??~fi~'~~'lst:~~l?_' /
Executrix of the Estate of
Clair H. stayman
316 Glendale Drive
Shiremanstown, PA 17011
(717) 737-3232
I~~ ,1996
.
15. Spounl ftan,t". (10' dall' 01 d.ath aU" a-30-84). 5..
I",truction. tor App~tlbl. P,runulII on Plgl 2. (lnerudl
vAlun trom Seh.dull KOf 5eh.dul. M.I
18. Arnaunl of Uno 141axable at 11"4 ralo
(Include valuos from Schodulo K or Schodulo M,)
17. Arnaunl 01 Uno 141axablo al 15% ralo
(Include valuos hom Schodulo K or Schodulo M,)
TAX 18. Principal lax duo (Add lax Irom Uno. 15, 16 and 17.)
COMPUTA- 19. Crodlts Spousal Po","y Cr.dlt Prior Payments Discount Intorost
TlON + 0.00+ 1,769.17 - 0.00 (19)
20, If Uno 191. groalor than Uno 18, onlor tho dllloronco on Uno 20. Thl.I. Iho OVERPAVMENT. (20)
~ aiI.kh.... H You.... ..qlaUlIng .,.,..,d 01 your o..rpaymont. I
21. If Uno 18 Is groalor Ihan Uno 19, onlor Iho dilloroneo on Uno 21. Thl.I. Iho TAX DUE.
A, Enlor Iholnl..osl on tho balonco duo on Uno 21A,
B, Enlor lho 10lal 01 Uno 21 and 21A on Uno 21B, Thl.I.lho BALANCE DUE.
Mako Chock Pa ablolo: R alor 01 Willa. A nl
i"i::;;;!i!i'iill1ii'!!!i;liilir"i!ii",d!!,"i'I'H::iiln,..'I!Ii1"'8ESURE TO ANSWER ALl. QU:STI01lS ON PAGE 2 AND TO RECHECl< MATH'" ... ' "i i, " ", I,
n or pen 0 por ury, are t at avo ox no t roturn, U iog 8CCOrTl)Snymg schodules and statomonts, and to tho best ot my knowlodge
ond ballol,lf Is 1rU0, cornl<:Iond co~1010, I doclarolhat all roaloslalO has boOn roportod al uuo markol valuo. Doclaralion 01 proparor Olhor lhan lho porsonal
roprosonlattvols based on alllnlormaUon 01 which proparor h.. any knowlodgo.
SIGNATURE OF PERSON R PO LE FOR FILING RETURN ADDRESS
, . ltUV See SChedule attached
. ,uv..\lOO Ut"-"')
DECEDENT
CHECK
APPRO-
PRIAU!
BLOCKS
CORRES-
PONDENT
RECAPIT -
ULATlON
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
OEPT.2IO'O'
HARRISBURG, PA '''21.010'
/S-1CJ'CJ
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
L
N
FOR DATES OF OEATlt AFTER 12131/11
CHECK HERE IF A SPOUSAL
POVERTY CREDIT IS CLAIMED
FlU! NUMBER
1996
COUNTY CODE VEAR
OECEDENrS COMPLETE ADDRESS
316 Glerdale or.ive
ShirernanstoWn, PA 17011
02 14 96 07 17 1915 Coun OJmberlarrl 0JUn
SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
212-22-6399 45 487.15
2. SUpplomonlal RolUrn 3. Romalndor RolUrn
(lor dllu of dulh pllor 10 12.13-121
~5. Fodoral Eal"o Tax Rolurn Roqulrod
00218
NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
srAYMAN CI.AIR H.
SOCIAL SECURITY NUMBER
176-01-1219
(I VIVI
FIRST AND MID lE INITIALI
STAYMAN MIRIAM V.
1. Or1glnal RolUrn
o 4a. FuMO Inlorosl Co"1lroniso
(lor dalos 01 dealh ahor 12-12-82)
~ 6, Oocodent Dlod Toslalo HI 7, Decodonl Malnlalnod a UvIng Tru.t
(Ahach copy of WIll) (Ahaeh copy 01 Truat)
AUl'CORR!lIPClHOEIICE'ANO COIlFlDENTlAL TAX INFORMATlOllIlHOUUl Be: DIRECTED
NAME COMPLETE MAIUNG ADDR
'DOI1IS P. GACKI 105 I..OC1lsr smEEl'c I
TELEPHONE NUMBER HARRISBURG, PA 17101
717'-233-7576
1, Roal Eatalo (Schodulo A)
2. Slocka and Bond. (Schodulo B)
3, CIosoly Hold S1ock/Partnorahlp Inlorosl (Sch, C)
4. Mortgagos and NolOS RocoNablo (Schodulo D)
5. Cash, Bank Dopoalts & Mlscollanoou. Porsonal
Property (Schodulo E)
8, JolnUy Ownod Property (Schodulo F)
7, Transl... (Schodulo G) (Schodulo l)
8, TOlal Gross Assols (lola1 Unosl-7)
9. Funeral Expo....., Adninl.uattvo CoSIS,
MlscoIIanooua Expon... (Schodulo H)
10, DobIS, Mortgage UabniUos, lion. (Schodulol)
11. Tolal DoducUon. (Iolal Unos 9 & 10)
12. NOl Valuo 01 Ealalo (Uno 8 ninus Uno 11)
13, Charhablo and Govornmonlal BoquoslS (Schodulo J)
o 4, Unitod Ealalo
.Q... B, Tolal Numbor 01 Salo OOPOSII Boxo.
(1)
(2)
( 3)
(4 )
(5)
None
None
None
None
8,037.15
)
"'\J:.
):.~
G. .r~ ('l
t')
'.
5,'i u
"
'-<
--'
,l:Ia i
.' )
-u ';: "'w
VJ (jj Q.
':Ji
C7\
(8)
( 7)
None
651,131. 24
659,168.39
( 6)
(9 )
23,956.00
(10)
None
23,956.00
635,212.39
None
(11)
(12)
(13)
14)
635 212.39
0.00
(15)
45,487.15 x ,QQ.,. =
(16)
589,725.24 x
35,383.51
.06 .
(17)
O.OOx .15 .
0.00
(18)
35,383.51
1,769.17
(21)
(21A)
(21B)
33,614.34
0.00
33,614.34
ADDRESS
105 I..OC1lsr smEEl'
HARRISBURG, PA 17101
DATE
/L/ ~t /'/ft
loE { V.'I I c,~ ,
I
..~...- -'"
PA REV-lllOO EX (7-04) Poge 2
Act "48 0' 1lK14 provldea for tha reduction 0' tha lax rat.. Impoaed on thl nat valua 0' Iranal.r. to or 'or th. UII 0'
. th. Ipoua.. Th. m.. .. prescribed by tha ltatut. Will b.:
· 3% (.03) Will be Ipf)IIceble for ..tatea 0' deced.nt. dying on or an.r 7/1/84 and belor. 1/1/96
· 2% (.02) Will be appUcable for elllt.. 0' dICed.ntl dying on or an.r 1/1/96 and b,'or. 1/1/87
· 1% (.01) Will be appUcable for ..tat.. 0' dICedlnla dying on or anar 1/1/87 and balor. 111/98
· Spouul trana'era occurrlng on or anar 1/1198 Will ba axempt from Inherltanca tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (oJ) IN THE APPROPRIATE BLOCKS.
YES NO
1, Did deoedenlllllke IlrlNl... Il1d:
L retain Ihe U88 or Income 01 Ihe propllf1y lrlNlerred.. .".."."...".".,.".,.....,..",..,...".,..."..",.,..... x
b, retain Ihe r1ghl 10 doeIgl1lllwho ehlll U881he Propenylr.nsIerred or III Income" .,',...,.,."..".,.,."..,.,."..,...." x
c. retain I ~11IIY Irrtereo1; or.. ".., '..,..",. ,..., ,..".."..,..., ,.,.." "., .,..."..". ."..".." .. ,." " X
d. recoIve Ihe pro""" lor III 01 either p.ymen.., benelillorcere?.",."........"".."....,...,."..."..,."".,..., X
2. II delth occurred on or before December 12, 1982, did decedent within two years preceding deeth lrenofer propeny without receMng
ldequlla ool1llderlllon? II cleIth occurred Iher December 12, 1982, did decedent lrlnsler propeny within one year 01 de.th without
receMngldequlIlOOl1llderlllon?,.",.....".,..,.,..".",....,....",.",..".""..."..,.".".".....,.",. X
3. Dlddeoedentown ll1'nIlllIlIO~blnkICCOUnll'hIaorherdelth?"."..".""."..",.."".,..."..",."..,...".. X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
PA111OO2 HTFm.
Copyrlgh' FO'M.lolI..,.. Ofttr. 1....H.Ieo.lnco HHPA002
REV-1eo:l EX + (12-80)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAll RETURN
RESIDENT DECEDENT
brAn UI' FlU! NUMBER
aAIR H. Sl'AYMAN -1996-00218
(P.lp Irtt JolnlIV a'NMCI wllh Right of survtvonhIP mUll be dicta.... on llcheduIe F) All ,... ....Ie oIloUkI be reportacIallalr marlLal value
wlIIolIla dIIlMd..\he ptIoe at wlIIolI property would be..clIanOId be\W_ a willing bUy" and a wllllnllMlIor, nelthet....ng compalled
'" or both IIa NUOl\IIbIe of \he relevanllaa\a.
ITEM
NO,
SCHEDULE A
REAL ESTATE
VALUE AT DATE
OF DEATH
DESCRIPTION
NcIl9
TOTAL AIoo enter on Bne 1, R nulotlon
(II more apace II needed. IMOO oddl1lonll sheela 01 same size.)
$
0.00
PAl5021 NTF 1111
CoPyrllltlt For., 10t'wIt' Only, "'" NlIco,InCo N14PA021
~IY"I04IX'Il-"l
SCHEDULE C
CLOSELY HELD STOCK,
PARTNERSHIP AND PROPRIETORSHIP
PIe... PrInt or T e
FlU! NUMBER
-1996-00218
"'illl!!III1III',lIIl1iIIIllIIIHIIII il ~ ! Ii 1!11iI1!i! HIIIli'
VAWI! AT
DATI! OF Dl!ATll
ITI!M
NO.
, 'lllWNtOlIM
IlI!8CRIPTlON
"....lhiii Ii
Na'lB
TOTAL Alto enter on Uno 3, R ltulellon S
(If more sproce II noodod, lnoort eddl1lonal ohooll of ....... 1lz8.)
PA111041 NTF.213
CopyrigM Fo,,,,.lIollwarIOl'lty. ,.... NIlco,lnc. N"'P~'
0.00
ftly.tlOllX'I1-171
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
P1e_ PrInt or e
COMMONWEAl.'lH OF PENNSYl.VANIA
INHeIIITAHCe TAX IImJRN
IIUlIl!HT 1lECl!Df'1fT
ESTATI! OF
CIAIR H. Sl'A'iMAN
wl\IIlIte II
FILE NUMBER
-1996-00218
VALUI!AT
DATI! OF DI!A'OI
mil
NO.
llUCIIlPTION
1 1990 cm.vRJIEl' I.lHINA Al1lQoI:mIE
2 AMEX LIFE 1ISSURlINCE exHlANY - REFUND OF PREMIUI
7,500.00
537.15
TOTAL AJoo enter on 100 S. R ltulltlon S
(Attech edclltlonal81/'Z' x 11' lheeIa "more apece II needed,)
8 037.15
PAl_I NTF till
COP,,"I""'''''' aoltwu. Only, '.M Nllco,lnCo NMPAO"
.- ,. .,....,:._--''',.....~...-~ .~_.-.-.
\
~ -~~~:-;,-.._-
-'-
-".- ."-.~-
REV-lllOO EX . (12-11I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
mATEO!'
ClAIR H. srA'lM1IN
JolnI-'lI):
SCHEDULE F
JOINTLY-OWNED PROPERTY
i FlU! NUMBER
-1996-00218
NAMI!
ADllREBS
REL'nONSliIP TO DECEDENT
LETTER DATE DOUAR VALUE OF
ITEM FOR MADE DESCRIPTION O!' PROPERTY TOTAL VALUE DECO'S DECEDENT'S
110. JOINT OF ASSET "'INT.
TENANT JOINT INlEREST
Nooe
TOTAL IAllo onl81 on Uno e, Reclllllullllonl $ 0.00
JoInlI; owned prep Irtv:
(If moro apace Is noedod,lllSOlt IddlllonallhoolS of lame alzo.)
PA11lOOt NTF 12'""
Cop)'f'lght Fo'.... 80ftWlte Ofttt, tt14 Nlko,lnc. N...PAOI'
,(~-...".,,#.... ... ..... ...
REV-15l0 EX. (2-57)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAlC RE'TllRN
REIIIDl!HT IlECI!IlEHT
mAft Of
SCHEDULE G
TRANSFERS
~ PLEASE PRltlT OR TYPE
fl NUMIlER
ClAIR H. srA'iM1IN -1996-00218
nlls lICH. MUST Ill! ~ . FILED IF 'Illl! AHSWI!R TO Nfi OF THI! cul!snotlS ON Tlil! REVERS!! SID!! OF COVER SHEET IS Y1!S
DESCRIPTION OF PROPERTY DECD, DOllAR VALUE
ITEM Incluclo ....... at the Wonot..., their EXCLUSION TOTAL VALUE % OF DECEDENTS
NO. rela1loMhID to cIoo8cIont, da" 01 wonot., OF ASSET INT, INTEREST
1 Gift taxeS a\ gifts within 3 years 0.00
of death
2 ClAIR H. srA'iM1IN REIJOCABlE '1lllJSl' 651,131.24
umER 1.GREEHENl' DM'ED 03/15/94
TOTAL (Also enlOl on line 7. R8CaDltulatlonl $ 651 131.24
(It """e space II needed, lnoert additional ahoots at same size.)
PA11101 NTF "ITA
Copyright Foulls 80ttware Only. \114 H.lco,lnCo H14PA101
RIY-lIIUUCN7)
COMMONWEALlll OF PENNSYLVANIA
lHHEIIlTAHCZ TAX RmJIIN
R!lIDl!MT oeC!lll!HT
ESTAn OF
CIAIR H.
ITEM
MO.
STAYM1IN
IlAMl! AMIl ADDRESS OF BEHEFICIAIIY
RwnONSHIP
-1996-00218
AMOUNT OR
SHAIIE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS Alto entor on Uno 13, R ltulallon
(II more ...- .. nMded. InMrt IdcIllonaI ahNla of - IlzI)
A. Tillable BeqU_:
1 MIRI1IM V. STAYM1IN
316 GIEGLE IJUVE
SHIRI!M1lNSlOiN, PA 17011
2 MIQIA'EL D. VOU1IND
3523 BIDE CDAT Rll\D
~, K) 21236
3 DCtlNA S. 00D1\
1158 ~ Rll\D
IMRlBE, PA 15650
ITEM
MO.
B. chIrltable end GovemmenlAl Bequ_:
Na'le
PA11131 NTF 1Z20A
Coprr'ghlFor",. So.twar.OnIy. ,.M H.k:o.ltl~ N14PAn1
SCHEDULE J
BENEFICIARIES
FILE NUMBER
survivin;J spoose
45,487.15
b'l~
294,862.62
~
294,862.62
NAME AND ADlIRESS OF BEHEFICIAIIY
AMOUNT OR
SHAIIE OF ESTATE
s
0.00
REV.lll48 EX. (8185)
SCHEDULE 0
TRANSFERS TO SURVIVING SPOUSE
COMMONWEALTH OF
PENNSYLVANIA
INHERITANCE TAX REtURN
RUIDEMT DECEDENT
I!STATI! OF
RI. Number
CLAIR H. ~YMAN -1996-00218
PART A: Entor \he ~lIon and valu. olllllntorOlll, bolh IlXabIG and non-llXabIG, leglldloaa 01 Iocallon, (not 01 doducllons)
which p_1O \he doc:ldanfaaurvlvlng ""ou.. by wlM,Int8ltacy, oparallon 01 law, or othefWlto.
lion 01 homa Amount
1
1 POO~ DIsmIBUl'IOO m:M RESIOOARY ESl'ATE AND
REVOCABlE 'lWSl'.
37r450.00
537.15
2 Item 2 on SChedule E
3 Item 1 on Sd1edu1e E
7r500.00
Part A Total: Enler amount ahown on \he recapltulallon s_ln tho ~l IntonnaUon SaclIon., 45 487.15
Election To SubJect Property To Tax Under Section 2113(A) As A Taxabla Tranl'er By Thll DecedenL
Ila trulll or alrrillIlITangemont m001l the roqulromonll 01 SocI\on 2113(A), and:
a. Tho trulll or alrrilSllITangemonl1s Dated on Schedulo 0, snd
b, Tho valuo 01 \he trulll or aIlTillllllangomont Is onterod In whole or In pill" an ....t on Schodulo 0,
\hen \he translOlO(a per10nal reprosentallve may ""ocIf1ca11y ldontity the trusl (all or alracllonal portion or pOfconlagO) 10 bo Includod In tho
oIocIIon 10 havoauch trust or alrrillI property trostod .. a tlXabIG transfer In this oslato. II Ioaa thsn lho ontiro valuo ollho trust or oI",lar propony
Is Included .. a taxsbIG tr""er on Schedulo 0, the personal reprosenlsWo shall bo consldOfOd 10 havo mado the oIocllon only ..10 atrsellon 01
\he trulll or slmHlllllangemont Tho numorator 01 this traction Is oqual to the amounl 01 Iho trust or oI",llIlIIangmont Includod .. a tlXabIG ....1
on Schedulo 0, Tho dono"'nslor Is oqual to the tolll valuo ollho trust or al",llIlIIangomont
EU:CTION: Do you aIact undor SacUon 2113(A) \0 lroal oa alaXlbl. Iran"" In 1111. oala,. all or a porUon 01 .lIUal or almllar amngemanl
croated lor lha .... UH 01 1I11a doc:ldanfaauIVlvlng apouH dul1ng 111. aUIVlvlng apouH'a .nUralll.Um.?
YES 0 NO ~ Slgnatur. Dal.
No,.: II 111. aIacUon appll.. \0 mora lhan on.lIUal Of almllar l/TlI1gam.nl, 1I1.n a _ral. lorm mual be algoad and nlad.
Part B: Entor \he dooa1pllon and valuo 01 aIllnlOfosll, both laxablo snd non-taxabIG, regardless ollocallon, (not 01 doductions)
which p_ to \he docodonfa surviving spouse lor which s Socllon 2113 (A) oIoction Is boIng mado,
Amounl
Doscr1 lion 01 homa
1
None
Pill B Tolal 0.00
PA1M81 NTF '02'
Cop)'flgM FDrm.SoUwatl Only, 1In N,ICO,lne. "ISPA""
COMMONWlALTH 011 PINNSYLVANIA
COUNTY OF CUM.ULAND
}
III
Thomas p, Gacki, Esquire
b.lng duly sworn .ccordlng to I.w, d.po,., .nd '.y' th.t h. is the At torney
of the Est.t. of Clair H. Stayman
I.t. of Shirem~!1st~~.~_._...___ , Cumb.rland County, P.., d.ceu.d and that the
within I,an Inv.ntory m.d. by Thomas P. Gacki. Esquire ,th. ,.Id Attornev
of the .ntlr. .st.t. of uld d.c.dant, consl,tlng of .11 the ponon.1 prop.rty and r..1 ..tat., exc.pt r..1 ....t. outald.
the Commonw..lth of P.nnsylvanla, and th.t the flgur., opposlt. ..ch It.m of the Inventory r.pr.'.nt It's fair valu.
u of the date of d.codont's d..th,
.$Wo RI\.l
7)/!J!,~ /) I/v h/
, b..ut.. . M..'.IaKo'..
--
}::1'I'"rji' ,/
and ,ub,crlbod bofor. m.,
'f' h 11, '-)::
/1/
19rU,
till/!? -,tA/ .A)
105 Locust Street
NOlolia: 50nl
JacquelynA. Zolllemuyer, NotalY Public
liam<bulg, (Muphin County
My Commission F.):'tJlrtlS Jan. 20. 199~J
Montx:" Pelmvto/arlaA5scri..1lO1ot Nct:J:JlJ.i
14
Harrisburg, PA 17101
A~~....
February 1996
Oat. of D..th
Doy
M..th
Vur
INSTRUCTIONS
I. An Inventory must b. fII.d within thr.o month, aft., appointm.nt of p.non.1 r.pr...ntatlve.
2. A ,uppl.m.nt Inv.ntory must bo flI.d within thIrty d.y' 01 dl,covory 01 additional a...ts.
3. Additlonalsh..ts m.y b. .tt.chod u to p.rsonalty or ,.alty
4. S.. Artlcl. IV, Rduciarl., Act of 1949.
~ ~ ..;
-.. w l: ..
I"t\ .
~ lli S <1l l: ..
e :> ..
I ... >. 0 u ..
0 '" ..
~ w <1l ... Q III ..
~ '" w .. ..
j!; ... ... ., ... E
c-.... -' LL en l: iii
a
LL -' ~ 0 <1l ... :t:
I W 0 < . e i-
- > Z '" :x: QJ <
Z 0 Q \.< c
\.< '.-1 "
- '" z II
0 '" '.-1 ..c:
Z w < <1l Ul ....
... ...
.... c
U - ..
"t:
0 ..
... ... ...
.. E
- .. 0
.. " it 0
-' 0 ..
Inventory of the real and personal estate of
CLAIR H. STAYMAN.
deceased
1. 1990 CHEVROLET LUMINA AUTOMOBILE
2. AMEX LIFE ASSURANCE COMPANY - REFUND OF PREMIUM
$7,50 00
53 15
TOTAL
$8,03 15
-
- hi "5ct
o.!!1
~S v 0
D- O :
,'!...,., ~)
-
015 V ..C!_l
r
1.' - . ,j
'.
C):" ~ J ,-
e.rb g
o i..n ( ,,,
Uc:l ~ -ii:'C)
&!a: OlE
_::J
00
,
,
\
1
I
I
I
I r
I ;
! ~.,
\
i
I
t '
I
i
I'
. ,
; ~
~. j .
fl
i I
, I
.
\. ,
.. f!:,
i I'>'
I,'",
"~
-.1:',
'; .)'1
:1"" .
..., -. - ........'....
10- Cj().Cj
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
,I
~
*
BUREAU Of INDIVIDUAL TAXES
INHERllANCE "X DIVISION
O[Pl. ,"'Dl
HARRISIURG. P' 171Z'.D'DI
NOTICE OF INNERITANCE TAX
APPRAISENENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
lu.nd II iI' 1I1.tn
THOMAS P GACKI
105 LOCUST ST
HBG
ESQ
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-04-96
STAVMAN
02-14-96
21 96-0218
CUMBERLAND
101
CLAIR
H
A.ount Re..1Ued
PA 17101
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiiV:i54j-EX-AFji-roY:96T"iliificr-oF-YtiHERiTANCE-TAX-APPRAisEHEilf;-ALLowA"HcE-oli-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF STAVMAN CLAIR H FILE NO. 21 96-0218 ACN 101 DATE 11-04-96
TAX RETURN WAS' I X I ACCEPTED AS fILED
( I CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l E.t.t. Ischedul. AI III
2. stack. end Bond. Ischedul. BI 121
S. Clol.ly Neld Stock/P.rtner.hlp Int.r..t ISch.dul. CI 151
4. I1ort_oINot.. Rec.helll. ISchedul. DI I'll
S. C.ohIBenk lJepoo1bmhc. P.rlon.l Prop.rty ISchedul. EI 151
6. JointlY Owned Property ISchedul. FI 161
7. Tran.f.r. ISchedUl. QI 171
a. Tot.l A...t.
HOTE: To insure proper
credit to your accQU'\t,
.ubooH the upp.r portion
of thia for. with your
tex p._t.
,00
.00
,00
,00
8.037.15
,00
651.131.24
lal
659.168.39
23.956,00
.00
1111
1121
1151
1141
,~.qli~ nn
635.212.39
.00
635.212.39
APPROVED DEDUCTIONS AND EXEMPTIONS I
9. funeral EKPOnI.I/Ada. Coltl/Nllc. E_pan... ISChedul. HI 191
10. Qabt./l1ortgaga LleIlllltl../Llan. ISchedula II 1101
11. Total I)eduotlonl
12. Net Val... of Tex R.turn
IS. Charltelll./Qo..rnaantal Baqualt. ISchedula JI
14, Net Val... of Estat. Subject to Tex
If an a......ant wa. i..uad previou.lY, line. 14, IS and/or 16, 17 and 18 will
refl.ct figure. that include the total of ALL return. a..e.Bed to date.
ASSESSMENT OF TAXI
IS. Aaount of Line 14 at Spoulal rata 1151
16. Aaount of Line 14 texabla at Lln..l/Cla.. A r.t. 1161
17, Aaount of Line 14 texabla at Collat.ral/Cl... B rata 1171
18. Prlnol,.l Tex Duo
TAX CREDITS I
PAYNENT
OATE
05-15-96
NOTE I
,00
35.383.51
,00
35.383.51
45.487.15 x,OO.
589.725.24 x' 06.
.00 X ,IS.
1181
RECEIPT
NUll8ER
AA112841
DISCOUIlT
INTEREST
It I
1-)
.00
AttOUNT PAID
33.614.34
PAVMENT MUST BE MADE BV 11-15-96-.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
33.614,34
1.769.17
.00
1.769,17
. IF PAlO AfTER DATE INDICATED. SEE REVERSE
fOR CALCULATION OF ADDITIONAL INTEREST.
IF TDTAL DUE IS LESS THAH .1. NO PAYNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI. YOU NAY BE DUE
A REFUND, SEE REVERSE SIDE Of THIS FORM FOR INSTRUCTIONS. I
r-
.'
'__J
"i
I
":J
l
c...: y' :oJ
00
RESERVATlO.h Elt,t.. of decedenh dvlng on or bIIfor. Dee...,. 12, 1912 n If eny '...tur. lntar..t In the ..tat. is t"",".rr.cl
In po.....lon or ~jo~t to Cl... . (col1It.r.l) beneficl.rl.. of the decedent .ft.r the Ixplratlon of ~ I.tat. for
II'. or for ya.r., the C~.lth her~y ..pr...ly ,....rva. the right to ~r.l.. end ...... .,...".,. I~rlt~. T....
at the l~ful Cl... . (col1at.r.l) rat. on ."y .uch future 1nt.r..t.
PIJIIPOR IF
NOTICE. To fulfill the ,...,1,...."" of SecUon 2140 of the InherU.-.ca Md E.tlt, Tax Act, Act ZZ of 1991. 72 P.S.
Section 2140.
PAYMENT. DIll., the top porUon of this NoUel ... .ue-it with your PI)'MI'lt to the Regilt,,. of NUh prJ"t~ on the ,......,... .1..
--...... check or .,.y order PIIy~l. tal REGISTER OF MILLS, AOEHT
AU p.~t. reel.'" ahtI11 flrat be .,.1l~ to any lnter..t which "Y be due with eny r_lnder .,.U_ to the tax.
REF\ICD eeAh A r.hnd of . tax credit, ....Ich WIll not rllqUe.tMl on the Tax Raturn, -v be r.quuled by cOIIplaUng .. "ApplJc.tlon
far R.AnI a' flrIolI,I".,I. Im.rl~ MIl Elt.t. T.... (REY-1SIS). AppUc.tlonl .r. ..,.118111. .t U. DUlc.
0' U. A..llt.r of Willi, ." of ttMl Z3 A.v..... District Dfflc.., or by c.Ulng the l,.el.l Z4-hour
.,~rl", ..rvlce ~r. far fa,... or~rlngl In Pennlyl","l. 1-.ao-S6Z-lo5o, outll~ p~IYlvsnl. ~
tllthln 10CllI Hlrrbburl .r.. (717) 7.7....94, TDa, (717) nz-usz (....rlng 1..lr. Only).
OIJECTlDNSI My perb In Int.r.., not ..thfl.. ..Ith tn. eppr.beHrlt, .110W1nC. or dl..llOdnc. of cMduatlon., or ........,t
of t.. UnclucUng dhcCU'lt or Inter..u II IhowI on \hll Hotlc. .,.t obJltCt ..Ithln .lxty UO) da,. 0' rK.lpt 0'
thl, Notice byl
AIIIIIN
IITllATlIIt:
caARUTlDHII '."-1 "rora dhcowr.. on thh ........,t lhauld tM .:Idr..Md In ..rltlng to. PA Delp.r....t 0' R~,
Iur.... a' Indl"I"'. T....., ATTNI Po.t ,........t Aevl... lkllt, a.t. za060., Hlrrllbur., P' 17UI-06Gl
Phone (717) 717-6505. see P'" 5 of the bookl.t "In.tructlon. 'or Inhlrltenc. Tax A.tum for. A..ldent
Dlcedenr- (REV-IS01) far In .xpl~tlon a' .a.lnl.trltlv.I, corr8Gtlbl. .rrar..
If any tIx a,. is paid tllthln thr.. (S) calender ....th. 1ft.,. thl decedent". dMth, . flw percent (D) dhcount 0'
the tlX paid .. I11CM1d.
"'-wrltten prot..t to the PA DIp.r....t of R........., IoIrd of Appe.II, Dept. 2.1021, HIIrrhburg, PA 17UI-lOZl, DR
"-.I.tlon to hive the _tter dIIt.,..INd .t _It 0' the ICCOU'lt a' the "r~1 r..,,....,t.tlw, DR
........ to the a".,.,." Court.
DIIClllIlT.
PENAL TVI
The 15% tax ......t)' non-partlclp.tlon PINI. t)' I. c-..ut.. on the tot.. 0' the tlX ~ Int"..t ........, and not
p.ld bI'or, ......ry I', I"', the first day .ft.r the end 0' the t.x ..,..t)' period. Thh nan-p.rtlclp.tlon
PIftIlb I. .....11b1. In the ... -..r and In the the ... tI.. period II )'OU lfOUld .,..1 the tax MIl Int.rllt
thet hi. bien ........ II Indicated on thl. notlc..
1N'mtEITI
Int.rllt II chlrltlCl beIIlml". ..Ith first dey of dlUf'lqUInc)', or nine (9) ItOC'Ith. MIl ani (1) de, 'r~ the det. 0'
dHth, to the d8t. a' PI~t. Tu.. lfhlch bee.. dllInquw,t ~'or. JWlUllr)' I, 19IZ bar Int.r..t .t the ret. of
lbe (6%) percent Plr ....... c.lcul.t.. .t . ally ret. a' .DDol64. AU tlXII lfhlch bee-. delinquent un ~ .ft.r
......r)' I, .9IZ ..Ill belr Int.r..t .t . r.t. which ..Ill v.r, 'r~ eel"r ,..r to c.l"r y..r ..Ith thet r.t.
emouncld by the PA Dlper....t of A."..... The eppllc8b1. Int.rllt r.t.. for 1911 thrOUCllh 1996 ""
!!!! Inter.st A.t. 011111' Int.r..t Fector !!!r Intlrllt A.t. 0.1111' Inter..t FKtor
n.z ZOX . a00541 19.7 'X .aaOZ47
1915 16% .ooao. 19"0.991 IIX .0DDUl
19.. IIX .000SU I99Z 'X .00aZ47
1915 13% .000556 1995".994 7X .00019Z
I... lUX .000274 1995-1996 OX .000247
--Inter..t I. cllcul.tld .. 'ollow.,
IKTERElT . BALANCE OF TAX UNPAID X HUKBER OF OAYB DELINQUENT X DAILY INTEREST FACTOR
.-An, Notlc. 1.1UId .'t.r the t.. beeDle. delinquent will r.flect ~ Int.r..t c.lculltSon to fl'teen (15) day.
beyond the dat. 0' thl ........"t. If p.~t .. ... .ft.,. thl Inter..t CDIIPUt.Uon dat. shown on the
Notlc., .:Idltlonel Int.r..t .u.t be c.lcul.tld.
/5- '10- 9
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
BUREAU Of INOIVIOUAL TAXES
~~RllAHCt ~AX DIVISION
Dt.:'r. UD60:
HARAISIUAC, Pi 1712e-0601
THOMAS P GACKI
105 LOCUST ST
HBG
ESQ
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
PA 17101
u
11-18-96
STAYMAN
02-14-96
21 96-0218
CUMBERLAND
101
Anount Ra"tttad
,,\.~ .
frr-] ,
~.J"
....I\'IU." III.IU
CLAIR
H
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure prop.r credit to your account, sub,,!t the upper portion of this forn with your tax paynent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
iiiv:is9j-EiCAiip-iiiF96ynmii.-iiiHEiiifANCE-i'AX-iiECciiijj-Aijj-usi'iiENi'n..-nmmnmn-nn-nmn
ESTATE OF STAYMAN
CLAIR
H FILE NO. 21 96-0218
ADMINISTRATIVE CORRECTION
ADJUSTHENT BASED ON.
VALUE OF ESTATE:
1. Rool Eltolo ISchodulo A)
2. stock I and Bondi (Schedule 8)
S. Closely Hald Stock/P.rt~r.hlp Int.ra.t (Schedule CJ
4. Harteaga.IHota. Receivabl. (Schedule OJ
S. Ca.h/Benk Deposits/Hi.c. Parlonal Property (Schedul. E)
.. JoIntly o.nod Proporty (Schodulo fl
7. Tranlfar. (Schedule OJ
I, Totol Allotl
DEDUCTIONS AND EXEMPTIONS:
(1)
(21
(31
(41
(51
(.1
(71
9. Funeral Expen.../Adaini.trativa Co.t./
Hi.callanaou. Expan.a. (Schadula H) (9)
10, Dobll/Hortoooo LIabllltlol/Llonl (Schodulo 1) (10)
11. Totol DoductIonl
12. Nat Valua of T.~ Return
13. Charitabla/Gavern.ental Beque.t. (Schedule J)
14. Net Value of e.t.te Subject to Ta~
TAX:
15. AMOunt of Line 14 at Spou.al rata (15)
16. AMOUnt of Line 14 taxabla at Linaal/Cla.. A rata C16)
17. A.aunt of Lina 14 taxable at Collateral/Cla.. Brat. (17)
18. Principal Ta~ Due
TAX CREDITS:
PAYHENT
DATE
05-14-96
RECEIPT
NUHBER
AA112841
DISCOUNT (+ I
INTEREST (0)
1,769,18
ACN 101
.00
.00
,00
,00
8.037,15
.00
651.131,24
(II
23.956,00
.00
(111
1121
IUI
1141
45.487.15X,OO'
589 .725,24 x, 06 '
.00x.15'
nil
AHOUNT PAlD
33.614.34
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
DATE 11-18-96
659.168,39
23.956,00
635.212.39
.00
635.212,39
.00
35.383,51
.00
35.383.51
35 383,52
.0ICR
.00
.01CR
. If PAID AfTER DATE INDICATED. SEE REVERSE (If TDTAL DUE IS LESS THAN fl. NO PAYHENT IS REQUIRED.
fOR CALCULATION Of ADDITIONAL INTEREST. If TOTAL DUE IS REfLECTED AS A "CREDIT" ICRI. YOU HAY BE DUE
A REfUND. SEE REVERSE SIDE Of THIS fORH fOR INSTRUCTIONS.)
PAYftENTI
Detach the top portion 0' thl. Notlc. .nd .ubelt with your p.~t .ed. p'webl. to the n... ~ .ddr...
printed on the r.v.r.. .Id..
-- "eke check or ltOMy ord.r p.y.bl. tOI REGISTER OF WILLS, AGENT"
All pay-.nt. rec.lved .h.11 be applied ,Ir.t to eny Int.r..t which ..y b. due with any r..nlnd.r epplled to the t.x.
REFUND (CA)I A rl'und 0' . t.x credit, which w.. not r.que.tad on the Tlx Raturn, '.y ba rlqua.t.d by coapl.tlnt an
MAppllc.tlon 'or R.,und 0' Penn'Ylvanla Inh.rltanc. and E.t.t. T.x. (REY.1313). APPlication. .rl .vallabl. at
the Offlc. of the Ragl.tar 0' VIII., anw of the 21 Ravanu. DI.trlct D'flc.. or fro. the Departaent". 24-hour
an.warlng ..rvlc. nu.bera for for.. orderlngl In Penn'Ylvanl, l-aOO.36Z-Z050, out. Ide Penn.vlv.nl,
~ wIthin loca. Harrl.burg .r.. (717) 7a7.a094, TOOl (717) 77Z.!ZSZ CHearlng lapalred only).
IIfPLY
TO.
Oueltlon. r"'rdl", .rrors conhlMd on thh notlCI .hould be addra.." tOJ PA Dlpar...,.t of R.v.nue, luruu
0' Individual T.x.., ATTNI Po.t A""lIent R.vlew unit, D.pt. Za0601, Harrllburg, PA 1712'-0601, Phone
(717) 7I7-iS05.
DlstOLIUI
I' any t.x duI 1. Plld w1thln thr.. (3) c.landar ~th. aft.r the decedent". ~th, . 'Ive percant (5%) dl.count
of thl tax P.ld 1. .Ilowed.
PfHIL TVI
~ 15% tax -.na.ty non.p.rtlclpatlon penalty 1. c~t.d on thl tot.l 0' the t.x ~ Int.rl.t ......ad, and not
p.ld beforl Janu.ry II, 1996, thl 'Ir.t day .ft.r the ~ 0' the tax -.ne.ty periOd.
INT!RI:ST I
Interl.t h charlld baglml", with first d.y of dal1nquancy or "1M (9) aonth. and OM U J d.y frOll the data 0'
death to the dltl of Plyaent. 'IX" which bee... d.llnquent ba'or. January 1, 19.Z baar Int.r..t at the r.t. 0'
.1. (6%) percant p.r .,..,.. calcullt" .t a dally nt. of .000164. Al1 t.... which bee... delinquent on and Ift.r
January 1, 19a1 will ba.r Int.r..t It I rat. which will v.ry fr~ c.l.ndar ya.r to c.l.ndar y..r with that rat.
announced by thl PA Dtp.rtaent of A.venut. The eppllctbl. Int.ra.t rat.. 'or 1"2 through 1996 .rll
~ Intar..t R.t. D.lly Int.r..t Factor Va.r Int.r..t R.t. D.lly Int.r..t Factor
""Z Z'X .00054' 19'7 OX .IDOZ47
1'15 I6X .OOOU. 1"'-199. 11% ,...S.I
1914 IIX .000301 .992 9Z .000247
1'"5 ISX .000356 1993-1994 7Z .000192
1916 lOX .00027" 1995..9" OX .000247
-.lnt.r..t I. c.lculated a. fOllow.,
IIITEREaT . IALAMCE OF TAX UNPAIO X NUHIER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
..Any Hotlc. I..ued ,'t.r thl tax bacoae. d.llnquent will r.flact an Int.ra.t calcul.tlon to 'I,teen C151 dly.
beyond the date 0' the .......ant. If pa"",t It _eda aft.r the Int.rllt CCHlpUt.t1on data .hown on thl
Notlc., edcUtlon.1 Int.r..t IN.t be calculat.d.
I .""_._'
, ..
..V.IUI........
.
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWIALTH 0' PINNSYLVANIA
...,. DIPARTMINT 0' ReVINUI
IUIU.U 01' INDIVIDUAL TAXIS
om, 210601
HAlRIIIURO, PA 17121.Q601
I IDINT'S NAMI
/Ill NUMIIR
/
,'i
/
l
(/
/
AN
//-j/
SCHIDULI
ITIM
NO,
EXPLANAnON OF CHANOES
---.--.---.----.--------.------ .-- - --- -.--........--.-. . ... .--- ~-- ~- ....
, '
, '
,.
.(
--.-...-. -- ..--------..-.--.--- ._._-~-
- "
;/
-~._.- -- -. ..--. ..- --_..-~-----_._-_..~--_. --------
.~-_. _._..----_...---~
,
.. --.- .-.---.-------. .---.----
----_.._-_._----_.._--~~- .-..- --_._-'..~-' .--..--...-" ....--.-----.-
o...d.,.,J.tj...J!. :~_.
.-- -~._.. .._._~.. ------------------.--------
-----~._-_. .-. -. .... --.-.. ---~ -----_....-
___. _ ........ __ ___ .~. _ ,'M_ _._._ _. ..u"._..._._ .-..-~._--.---.- -..-.---------.--.--.
-------.------.----------..--.---...-..
. .-.- -.-.-. ..... -- -.- ...----- ----.-.-.----.---.---.---------.-------------
----- -----. ------- .-.- ..--.. -.. .-_., .-. ---- --. _.~---... .---.
.-.... -...--.-.- ~.__.. - .--.----.--.- ------
-----------_._----~. ---- -~_._---- ---.----..--- -- ---... ...-- --_.. ------... - .._._-------. .-. --. .._--------------._----~
_________.___________.._._..._.__ ...__ - _....__ ~__.__..__.._ - u_ ..__ .-. ... ..--- -..-. .--..--'- ---..--..-....--.---.. --.------..-----..-------
. .._.__ _______.___ .__..... .__n_.___ ____.._._______
-----.-------.-....--..-.. -----.--.----..-----.. _.- ------.- ,,-,
--------.+-.----.---.--------. .-.. .-----.---. '.'-"'-".'---'---. .-.-- -..--
- -- _.---'" --.------ --.--..------..---- --.--..
-+--_...._-.-- .._-- -------.---.
-------_.~--_._._~--+_. .-. ... ---- ----- ... _... --_.~._.... ..---. +- -... .-- -." ......
....-. .-.-- --- -- _._"-_._-_.__.~._- --...-
_._--_._.~--_..~--_. ~ .... -_._..~.. ...... -. ,.. - ..--_.._~.
-.-...--...----. ~ --.-----------
--.------...---- .--......--..---..- .-.
.-------.-. ---"._----._..~_._.._- -. _._--~_._._-----
.----..---..--......---.-..-. ..--..
-~--- .---..-.-..---.-.------.-----
. .--.--- .------- .----...-.,..-.-.-----
- .--._-- ._.._- ---- - -- ----_.~-~
I
1
'fAX-6XAMlNER:
/
/
,
.( /
/
.'
PAGE
,
r
"
~-
If),';"; h()IlAiJ,,:\J': 't'
i',.~rn
\.:"
00 \l"i :u
c: ._. :n n'
~, r'
" (J'. c~
q
cJ
C":l
I
UI
a
~ ,?j
.....j b
):; ;~ -
IS: CJ{)-q
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
C--
BUREAU Of INOIVIDUAL TAXES
'''~.llAN([ IAI DI~ISION
;.or..,. lion.
H....IIURO, PA ."'.'0"1
....UHII...'II.."
11-25-96
STAVHAN
02-14-96
21 96-0218
CUHBERLAND
101
CLAIR
THOHAS P GACKI
105 LOCUST ST
HBG
ESQ
DAT!
UTAT! OF
DAT! OF DEATH
FILE NUHBlR
COUNTY
ACN
'Mount R..ltt.d
PA 17101
HAKE CHECK PAVABLE AND REHIT PAVMENT TOI
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE. PA 17013
NOTE I To Inlur. prop.r cr.dlt to .our ...ount. lub.lt tho upp.r portion of thll for. with .our t.. p....nt.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiiv:iiiiij-EX-Aj:ji-nii':iiioT-----..ii-iilHEiiiTAHCi-fAX-S;'iiiiHitif-OF'-Accouiii---..-i.-_u-u_u-uu__uu
ESTATE OF STAVHAN CLAIR H FILE NO. 21 96-0218 ACN 101 DATE 11-25-96
THIS STATE"ENT IS PROVIOEO TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NANED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAY"ENTS. THE CURRENT BALANCE. AND. If APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT, 11-15-96
35.383.51
PRINCIPAL TAX DUE, ----"-'''''''''--''''
___.....____ _______w_..._._._..__ ..,.-.--""-' ..
PAVHENTS (TAX CREDITS),
AHOUNT PAID
DISCOUNT (+)
INTEREST (-)
1.769.18
33.614.34
PAVHENT
DATE
05-14-96
RECEIPT
NUHBER
AA112841
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
35.3B3.52
,OlCR
.00
.01CR
. IF PAID AFTER THIS DATE. SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN fl.
NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI,
YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIOHS. I
H
on
l': ;..
.')
L
..'j
PAMNTI
DetKh thl top porUon of thh Hotlc. and lutMlt with your PlY''''' aad. ply.tJl, to thl n... and addtf"
\J,
printed on the rlva,... tide.
If RtSJDENT D[C[D[NT ... cMck or .,ney order pIYH1. tOI REGISTER OF WILLS, AGENT.
If HQH-RUIlJ[Hl DEC[OI:HT IMI chick or ltOMy ora,. payabl. tOI CO""ONWEAL TH OF P!HHsVLVANtA.
All p.~t. r.cIIYld ~.11 b, ."llld 'Jr.t to eny Int.,...t which ..y bl due with ~y ,....Indt,. applied to the t...
REfUND eeA)t A ,.efund of It.. crldlt, which .... not r.que.tld on the TI. Return, ..y ba ,.aqua.tad by caaplatlng en
"application 'or A,fund 0' Pennlylvenl, Inherltlncl and Elt,tl T..- (REV-ISIS). application. .ra Ivellebl, at
the OfficIo' the A..lttl,. of Willi, eny of the IS Ravenue DI.trlct o"lc.. or fr~ the DIP.rt-.nt'. Z~.hour
Intverl", ..rvlel ~.r' for for.. orderlngl In ',nn,vlven., 1-100-56:-2050, out,ld. P.nn.vlvenl.
end within lOCal Harrl.burg ar.a Cl11) 111-10,., TOO' Cl11) 112-2252 CH..rlng lapalr.d only).
REPLY TOl
Due.tlon. r.gardlng .rror. contllned on thl. notlc. should b. .ddr....d tal PA O,plrteent of A.venue, lur..u
of Indlvldu.1 TIX", ATTHI Po.t A.....eent Alvl.w Unit, D.pt. 210601, Harrl.burg, PA 11121-0601, phone
17I71 787-6505.
DIscc.unl
If eny t.M dut I. paid within thraa CS) callndar aonth. If tar the d.c.dent'. da.th, . flv. p.rcent CSk) dl.count
of the t.. paid I, .llowed.
PlHALTYl
The 15X t.x aane.ty non-p.rtlclpatlon penaltv I. coaput.d on the tot.l of thl tax and Int.r..t .......d, end not
paid bafor. Jenuery 11, 1"6, the flr.t dav aftar thl end of the t.. aane.ty p.rlod,
INTEREST I
Int.r..t I. charged b.,lnnlng with flr.t day of d.llnquency, or nln. C') .onth. end one (1) day froe the dlta of
delth, to the dlta of P'Y'lnt. Tlx" which b.c... d.llnquent before Janu.rv 1, 1912 b..r Int.r..t at the rat. of
.1. C'X) percent p.r ~ calcul.tad .t a dal1v ratl of .00016~, All tIX.' which b.c... d.llnquent on end Ift.r
J~.ry 1, 1'12 will b.ar Int.r..t .t a r.t. which will v.ry froe calandar y..r to calandar y.ar with thlt r.t.
announced bv the p, a.p.rtlant of R.v~. The appllcab11 Int.r..t rat.. for 1912 through 199' ar.,
Va.r Intlr..t Rlt. a.lly Int.r..t Factor V..r Int.r..t A.t. Dally Inter..t factor
1912 ZOX ,000541 1911 9~ .OOO2~1
1913 IU .0aa~SI 1911-1991 11;( .00asOI
1'.~ m .000sal 1992 9~ .0002"
1915 In .OOOS" 1995"19M 7X ,OOU9Z
1916 lOX .00OZ1~ 1995-1996 9X .000241
....Int.r..t I. c.1culated ., foUow.1
INTEREST . BALAIlCE OF TAX UNPAIO X NUnBER OF OAYS OELINQUENT X OAILY INTEREST FACTOR
"-Any MoUe. IlIved .ft.r the t.. beCO'" ctallnquant wlll refl.ct an Inter..t calcul.tlon to flft.en liS) ~ay.
beVond the d.tl of thl ........nt. I' plyaa"t I. .ad. .,t.r the Int.r..t cOlPUtatlon dati .hown on the
Hotlc., additional Int.r..t au.t ba calculated.
..--_...
6- 90-1
IURlAU Of INDIVIOUAL TAlCES
IIHllIUMCI! TAll DIVIIIOIl
DlPT. 21"11
HAallllUR1. Pi 171"."'1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX lASED ON FEDERAL
ESTATE TAX RETURN
DATI
ISTATI OF
DATI OF DEATH
FILE NUHlER
COUNTY
ACN
THOHAS P GACKI ESQ
105 LOCUST ST
HBG PA 17101
1-
03-03-97
STAYHAN
02-14-96
21 96-0218
CUMBERLAND
201
_t RMIUod
*'
"'.... a IIJ IU.MI
CLAIR
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE. To lnouNl p.--r oredit to your 1lCl0ount, _it tM __r portion of thlo forti with your t... p._t.
CUT ALONCJ TttIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~
iiiy:4U-iic--AFi;"{U:.-96;--u-iii-jiiifici"oj:--liii'iRKiiiAiiON"ANIi-AssiiisHijiyU-"..---------u-----------
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ..
ESTATE OF STAYHAN
CLAIR
H FILE NO.21 96-0218
ESTATE TAX DETERMINATION
1. Cr.dit For st.t. D..th T.x.. .. V.rifi.d
2. P.nnsY1v.ni. Inh.rit.nc. T.x A......d
CExc1uding Di.count .nd/or Int.r..t)
3. Inh.ritanc. T.x A......d by Oth.r st.t..
or T.rritori.. of th. Unit.d Stat..
CExc1uding Di.count .nd/or Int.r..t)
4. Tot.1 Inh.ritancB T.x A......d
5. P.nnsY1v.ni. E.t.t. T.x DUB
TAX CREDITS I
PAYHENT RECEIPT
DATE NUHBER
N t::<(
of I/) ,u.
:1 0 "
.\ ,,):: ~- ,
~-:: 'S
0 )
-
" CI:
-=:
:.::
c..'
u r-- '"
Ql P' Qi ~.
a: _:J
UU
DISCOUNT C+)
INTEREST C-)
ACN 201
33.614.33
.00
AHOUNT PAID
DATI 03-03-97
151635.54
33.614.33
H
.00
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IIF TOTAL OUE IS LESS THAll n, NO PAYIIEIlT IS REQUIRED
IF TOTAL OUE 15 REFLECTED AS A "CREDIT"' ICRl, YOU IlAY IE
OUE A REr-UNO. SEE REVERSE SIDE OF THIS FO~ FOR INSTRUCTIONS.l
I Co;
'~"1
.,' -11 WIF PAID AFTER THIS DATE, SEE REVERSE SIDE
t. .\ FOR CALCULATIOIl OF ADOITIIlllAL IIlTEREST.
*......:'----_....__.,..-"'"._..~"...._.~--.........'---,. ., '.--'~
.
~..",..- -".
"'-II'
NOTICE. To fulfill the ,...,1.---tl of IeGUon 2141 (bJ af the Int."..... ... r.tat. Tax kt, Act ZZ of 1"1.
(71 P... Iootl.. 11411.
'AntENT. 0Itac1t the tap ,.rU.. of thl, MaUN .. MbIIU wIth rout' ~t to the A..l,tl" of .,IU, prlntad on the
nvv.. IldI.
.. Itl'" _ Ir _ _r _II tl' REGI.TER OF NILta, AIlEIIT.
All ......t. ,...1.,... "'11 be .,11., U"t to InV Into""t MhlClh .. be due Idth ." ,._1,.,. ."UIlII to tM taM.
IIEF\IaI (Cllh .. ref\n:l of . tax credit .., be .......t.. ~ ...oU,. WI ".Ucetlon far R.flnI o' Penn"l""l.
IMerltMoe ... r:.~t. T.... (II10-131U, Appllcationo.,. WIIJl.tllo ot the Offl_ .f tM .....t... of MUll,
MY .f the U .......... Dbtrlat Dfflo.. or fro. the o..rt.Mt'. 14"hour ......"1.... ..,.,,1_ ....... fer forlll .,.,.11'1I'
In Penn"I""I. ....0-362-Z050, aut,lell Penn"I""I. Ind withIn 10C11 ~rrl8bur1 area (717) 7.7-1094,
TIlD. (717) 771-WI (HoIrIIlO 1_1..... Onl.,.
OI.ECTIDNI. "". PWtw In 1nt.,...t not "Ulfl_ with U. .........t of ta II IhowI on thls notice .. obJeot within
_lxl:>> (&OJ _. of ,....,t of thh MaUa ".
--written ,rote.t to u. PI o.,.rtlllnt of RwenuI, IMnI of ......., Dept. U1UI, Her"1I0.,,,., PI 1711:1"'1121, a.
....leotl,. to hew the _tt.,. eIItor.!ned It IUdIt of the per...l npr..enbUve, OR
-.....-1 to the Orpfwt,' Court.
-
IIlUTM!
~lllItI'
'__I ...rar, dhoowe..... on thll 'IHI~t Ihould M edd,..... In wrlU,.. to. PA o..r'-'t 0' Aevwa.,
aur-. 0' Indlvl"l T..., ATTN. Pod AIH...,t Awl., Unit, Da,t. 21"11, Hllrrhburg, PI 17IU."I1,
Phone (nn 717.6515. lee,... 5 0' the bookl.t -In.truotlon. for lmIrJbnce TIX Ratwn 'or I A..ldlnt
DeoIdIrtt" UIEV-ISOU for ., ....l_Uan 0' _lnht,..UVlb oomoblll. .rror..
P!IIAL 1YI
ThlIU tmc _.b nan....rtlal,.tlon ,..lb II CGIIpUted an thI tot.l 0' thI tax MIl lnt.r..t ..H.IId, ... not
peld Mfore ......,. II, I"" the 'Int dey .ft.r thI end of the ta .....tv ,...lad. ThIl nan.,.rUal,.tlan
,enalb II ....1..1. In U. - ..... ... In the thI _ tl_ perIod I' )IOU IfOUld ....1 tha tu Ind Jnt.,...t
that ha. bien .....1Id .1 lndl_ted on thll noUce.
lIfIDDT.
'or dltal 0' ....th on or .fter 1'.).91, ......sylvanl. r.t.te Ta baNd on the ''',..1 E.bit. TIX
,..twn "'1 deU,...,t .t the uplrwUon of nl,. (09) ..,th. 'roe the data of death.
'ar dIIt.. 0' _th prior to 10.).'1, ......nlVW'll1 E.bit. TIX ba.... an the '...,..1 r.tat. Tax return
..... tIIl..,..t .t the ..lratlon of .1..t... UI) .with. f,. the ... of ....th.
Ta.. Wllch ..... .U......t before .....1"1 1, nlz bier Int.re" .t thI rwtl of .he (U) parcent Plr ....
_IOUl.ted .t I dI.b ,..t. of .1001604. All tax.. tlhlCih a.c- .1l~t on or .ft.r .......,. 1, IH' ..Ill bear
Inbred It . rIIt. tlhlCih Iflll ywy f.... OIlander ,..,. to 011...... raw ..Itt. that rwt. ........ by the PA
.....'-'t of....... ThI ...l1cebl. Int.,...t rat.. for 1HZ throuIh 1"7 .,...
YlOr Jnt.....t lata Dllb Int.,...t F.otor Y.... Int.,.ut bt. DIll' Int.....t FlOtor
1911 III ....- 1917 n ....Z47
IHJ 161 .1D141e 1911-1"1 111 .nulI
1_ 111 ."UIl 1"1 n .01.147
1_ 151 ."1156 1"'-lfM n ....191
I'" 1'1 .IIU74 1"1-19f7 n .001l47
--Inte....t 18 OIloul.ted .. fo11D1t..
IIlTERDT . IALAIICI! OF TAX UIlPAID X IlUIIBEIl OF DAI. DBLIICQ\IEIl't X OAILY IIlrEIlEIT FACTOI
....",., MoU.. lllUId 1ft.,. thI tu ........ deU"",,*,t ..111 ,..naat an Int.....t calculation to flft... (5) _I
bQond U. dlt. 0' the ........t. If,.,....t..... .ft.r the lnt.rut -..utlltlan dat. ....., on thI
Matl_, "'.U"'l lnt.....t .,.t be _loullted.
/5-Q(),'j
.U~IAU OF INDIVIDUAL TAXIS
.HHl~.,AO(I ". DIY.I."
1lI''', noUI
HAI_I'IUIO, P. "11.-"01
THOMAS P BACKI ESQ
105 LOCUST ST
HBG PA 17101
COMMONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF DETERHINATION AND
ASSESSHENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
CLOSING LITTlR
DATI
ISTAn OF
DATI OF DEATH
FILE NUMIIR
COUNTY
ACN
'*
c-
II""'" 'u Ill""
03-10-97
STAYMAN
02-14-96
21 96-0218
CUMBERLAND
202
CLAIR H
\
A"aunt R..Ut.d
HAKE CHECK PAYABLE AND REHIT PAYHENT TOI
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE. PA 17013
HOTE. To 1n.uro propor .rod1t to your o..ount, .ubo1t tho uppor port1on at th1. taro with your to. poy..nt.
CUT ALONO THIS LINE .. RETAIN LOWER PORTION FOR YOUR FILES ~
iiiV:,3ii-iX--AFP--fiZ:-96i-----ii.-HiOiic:i-OF--DET-iRHiiiAiiCiN-iiHD-AiisEsiiHEN;f-------.--.-----------------
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ..
ESTATE OF STAYHAN
CLAIR
H FILE NO.2l 96-0218
ACN 202
DATE 03-10-97
ESTATE TAX DETERMINATION
15.635.54
1, Cradit For Stata Daath Taxaa a. Vorifiod
33.614,33
2. Pann.ylv.nia Inh.ritanc. Tax A......d
(Excluding Di.count and/or Int.r..t)
.00
3. Inheritenca Tax A......d by Oth.r Stat..
or T.rritori.. of the Unit.d Stata.
(Excluding Di.count and/or Int.r..t)
33.614.33
4. Total Inh.ritanca Tax A......d
5. P.nn.ylvania E.tat. Tax Du.
6. Amount of Penn.ylvania E.tat. Tax Praviou.ly A......d
B...d on F.deral E.tat. Tax R.turn
7. Additional P.nn.ylvania E.tat. Tax Du.
TAX CREDITS I
PAYMENT
DATE
AMOUNT PAID
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE ,DO
oIF PAID AFTER THIS DATE, SEE REVERSE SIDE IIF TOTAL DUE IS LESS THAN II. NO PAY"ENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL IKTEREST, IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI. YDU ~Y BE
DUE A REFUND, SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS.)
.00
.00
.00
nn :uffil
Ciii ~
::1 -.
.- " n "
ii' Q
't ~ , ,',
-- '"
,- - .",
0 ,
l ,
;a ;b~'..'
Cl (Ii (l
:UC i~
"'~ -
C7\
NlPOSE 01'
IIOTla.
To fulfill the r.qulr..-nt. of Section 214S CbJ of the Inherlt~. .nd rlt,t, '1M Aot, Act IZ of 1"1. (72 P.I.
SMUon 1145).
PAYMOfT I
DelICh the top portion of thh HatlCI II'Id flAMIlt Mlth your ,IYHnt to thl ...hter of WUlI pr1ntlld on the
rey,r.. ,I..
... MMe check or IIONIY order plvllbh tOI REGISTER OF MILLS, AOEtfT.
AU PIVMfttl reellv" ahliU be applied first to WlY lnt.r..t which ..y be due ..1th WlY r...lnder ...,1111d to the tax.
REPlIID CCAlI " rehnt of . to orM! t ... be r.....tlld bV C0IIP1,Ung WI "AppllclUon for A,fund of P....,.vlvMt.
Inherltencl II'Id E,t,t, r.... (REY-ISJS), Application. .r. avalllbl, at the OfficI of the R..llt,r of WJ111,
~ of the 15 R,venue Dlltrlct Of'lCI' Dr fr~ the o.plrt-.nt"1 Z4-hour an'Wlrlng ..rvlcl nu.ber. far for.. orderlngl
In Pennlrlven!, 1-100-162-2050, out,lde PennlvlvWll1 end Mlthln locII Hlrrlsbur. .r.. (717) 7'7-1094,
TOOl (717) 77Z-ZZSZ CHeerlng 1.,.lred Onlv).
OI.IECUDHS. Any ,.rt)' In Int.r..t not ..thfled ..lth the ........"t of hx .. Ihown on thh notlc. ..v obJltCt ..Ithln
,Ixtv (60) dlv. of rltC.I,t of thl. Hotlc. byl
--..rltt," ,rot.,t to the PA o.p.rt.."t of Rev....., lo.rd of .....11, Dept. ZlI021, Hlirrhbur" PA 1712'-10ZI, OR
--.I"tI"I to have thl ..U.r d.hr.lned at Midlt of the JHlrlonIl r.pr...nt.tlv., OR
........1 to the OrphM\.. Court
_IN-
IITRATlVE
CORR!CTlOHSI
'lCluIl Itrorl dhcovered on thh ........"t Ihould bII ~r....d In wrlUno tal PA Depart.."t of Revenut,
lur.au of Individual T.x.., ATTHI Po.t A....aeent Review unit, Dept. Z80601, Harrl.bur" PA 171ZI-0601,
Phone (7171 78'-6505. Sea,... S of the bookl.t "In.tructlon. for Inherltenc. T.x R.turn for. A..ldent
Decadent" (REV-lS011 for an .xplan.tlon of Idalnl.tr.tlv.1V correctabl. .rror..
POIAlTV.
ThII ISJ t.x ....tv non"partlcl,.tlon penalty I. co.,uted on the tot.l of the hx and Int.r..t ........., Ind not
,.Id blfor. Jenuerv 1', 1996, the flr.t d.v .ft.r the and of the t.x eene.tv period. Thl, non"p.rtlcl,.tlon
,..,.1tv .. ....labl. In the ... unnIr WId In the the .... tI.. period II you MOUld ....1 the h. and Inhr..t
tMt hi. been ......Id .. Indlc.ted on thh notlc..
IHTER!IT.
Addltlonsl Pann.vlvlftl. E.t.t. T.x ......Id I' . r..ult of . change on the Flder.1 E.t.t. T.. clo.l",
l.tter bacoM. dlllnquent .t the ..,Iretlon of OM (1) aonth fra thl dlt. tI'M final notlca of thl lnerel..
In fader. I E.t.t. Tax I' recalved.
TUII which bee_ ctallnquant bIIfore Januarv 1, 1912 be.r Inter..t It thl r.ta of ... (6:n parc,"t per ~
c.lcul.tld .t . dlllv r.ta of .000164. All tu.. which bee_ delinquent on or .ftar Januarv 1, 198Z ..Ill be.r
lntan.t .t . r.ta which will vlrv fro. cllendar va.r to ulendlr v'" ..1th thet nt. lIWMI"M:ed bv tI'M 'I
Depart.ant of R.venul. The appllcabl. Int.r..t r.t.. for 198Z through 1997 .r'l
!!!! Int.r..t R.t. D.Ily Int.r..t Fector
!!.!!
Intanlt R.h
DIlly Int.r..t Factor
I'az
I'U
1'"
1911
1916
....Inter..t
ZOX .00054'
IIX .000'"
llX .000101
In .00OS56
lOX .000274
II cllcul.ted II fol1ow'l
1917
19"-1991
199Z
."'-1994
1991"1997
9X
llX
9X
n
,x
.OOOZ47
.ODOSO.
.00OZ47
.000192
,ODOZ47
INTEREST . BALANCE OF TAX UNPAIO X HVKIER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
..Any HaUc. I...... .ftar the tu bee... delinquent ..Ill raflect 1ft Int.ralt c.lcuhUon to f1ft.., USI day.
beyond the dIIt. of the ......-nt. If p.yHftt II Ada .ftar the Inter..t coepubUon data Ihowl on the
Hotlce, eddltlonal Int.r..t .u.t be calcul.ted.
,'......,..".>0- __'. ........ ''',' ~- ~
,,-
,.. ,-~ '
.
.
STATUS REPORT UNDER RULE 6.12
Name of Decedent I Clair H. Stayman
Date of Death:
Februarv 14. 1996
will No.
1996-00218
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 ;;hetho!.r a.:k,i,li3\.;.:atioll ot thlol estal:e 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 Court? Yes No X
b. The separate Orphans' Court No. (if any) for
'the personal representative's account iSI NtA
c. Did the personal representative state an
account informally to the parties in interest? Yes No X
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' C,ourt and may be attached to this report.
Date:,.,?/ (/;/A/I! /'f'f?J?'
~~,Z{ ~P'Tl.-/'
s'lgnature --.'
)
Miriam V. Stavman. Executrix
Name (Please typ'e or print)
316 Glendale Drive
Shiremanstown, PA 17011
Address
V'
\i"
'!:'j~
.,1:1
~1::': ~.l ';2 ~"'r.1 j""';,
( 711\ 737-3232
Tel. No.
Capacity: X rersonal Representative
__.counsel for personal
representative
(HAH: rmt/ AM3)
RW-27
:~
,~;
/'
I
:1
il
~ '.1
'~'
..'......
.Y-;i
..;\~~J~
';:::;<.'j'(.;,~
JRD/June 30, 1992/17858
REGISJ'ER OF WILI-'i
Cumberland County Courlhouse
One Courlhouse Squnre
Carlisle, PA 17013
NOTICE PURSUANI' TO RULE 6.12
PENNSYLVANIA SUPREME COURT ORPHANS' COURT RULFS
To: Personal Representative
Counsel :
MIRIAM V. STAYMAN
RE:
CLAIR H STAYMAN
I Deceased, ute of
Estate of
LOWER ALLEN TWP
Estate No.: 21-1996-0218
Date of Decedent's Death: 2 -14 _ 9(;
Pursuant to Rule 6.12, the above named personal representative or the above named attorney, if
applicable, within two (2) years of the decedent's death, and annually thereafter until administration is
completed, is required to file with the Register of Wills a Status Report as required by Rule 6.12, in
substantially the prescribed form, showing the date by which the personal representative, or attorney, as
applicable, reasonably believes administration will be completed, The purpose of this Notice is to advise
you that unless the requisite Status Report is filed with the Register of Wills or Clerk of the Orphans'
Court, as appropriate, within ten (10) calendar days after the date of this Notice that the Register of Wills
Is required to IIOtify the Orphans' Court Division, Court of Common Pleas of such delinquency and to
request that said Court conduct a hearing to determine whether sanctions should be imposed upon the
delinquent personal representative and the ~e1lnquent personal representative's counsel, if any.
Accordillgly, If the requisite Status Report Is not filed by 3-30 . 19_,9jbu are hereby
advised that a request will be submitted to the Court in accordance with Rule 6,12,
,--
Date: 3-17-98
Distribution to Estate File
"