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PETITION FOR GRANT OF LETfERS OF ADMINISTRATION
Eslalt o,1vJJ/JNr!~, t~(.Jf~;{e)tI)/'
also k no wn a.f
No. :V - ql. - 'J..~ 7
To:
Regi~ler of CI~/~or tlte "
Counly of _ nIJl/.!JJ',A/I) in the
Commonwealth of Pennsylvania
_, __ , Drr;tJ~.
SorlaIStellr/lyNn. 5It:!7-/fO_~' ~uCJ ,
The pelitlon of the under,igned fe\Jleclfully feJlrc~enl~ thai:
Your Jletilloner(~), who is/arc 18 years of age or older, aJlJlLL.i.5
for Icllers of administration
on the eSlate of
(d.h.n.i ('Iendrnlt' Iilr; durnnlt' ah\C'nlia: durAIlI!' lIlinllrililll')
the above decedenl.
Decedent was domiciled at death in
~ e ,? last family or principal re,idence at
,
Decedent at death owned property with estimated values as foilows:
(If domiciled in Pa.) Ail Jlcrsonal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(Ir not domiciled in Pa.) Personal Jlroperty in County
Value of real estate in peJ1usylvania
situated as follow~: AI /J'{j(! -
s J ?'tJO. 00
s
s
s 0
Petilioner_ after a proper search haL ascertained that decedentlefl no will and was survived by
the foilowing spouse (if any) and heirs:
Name Relationship Residence
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THEREFORE, Jletilioner(s) respectfuily reque~l(s) Ihe grant of lellers of adminislration in the
appropriale form to the undersigned.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
} 55
The petltloner(s) above-named swear(s) or arnrm(s) that the
statements In the foreaolna petlllon are true and correttto the best
of the knowledae and belief of petltIDner(s) and that as personal
rcpresentatlve(s) of Ihe above decedent petltloner(s) will well and
truly administer the estate ac:cordlnato law.
Sworn to or arrlrmed and
before me this 12th
/1JQIUO c.~~~~
~~.b. r\
subscribed r
day of
19-2.9-
Rqlsltr L
i
No. 21-96-227
Estate of
ROANNE C. BORJESON
J Deceased
GRANT OF LETIERS OF ADMINISTRATION
AND NOW MARCH 15 19~, In consideration of Ihe petition on
the reverse side hereof. satisfactory proof havina been presented before me,
IT IS DECREED that Diane M. Ruplch
Is/are entitled to Letters of Admlnlslratlon, and in accord with such findlna. Letlers of Administration
are hereby aranted to Diane M. RUpich
In the estate of ~anne'c:Bor:;eBon'-
)1100 Q.. Y;,,~. ,Q.. (J A 'J.~
Realsl" o~WiUJ
FEES
Letters of Administration ..... $ 2 Ii . 00
Shon CenifiCltes(i ) .... .. .... $ 1" n n
Renunciation ................ $ 1 Q n Q
JCP $ " nn
TOTAL _ $55 nO
Filed l:lAr.r-.ll. .15.,.19.96... A,D. 19_
..j)Mfi/e/~6?:P/~/ (rf- #7/f73
AlTORNEY (Sup. Ct. t.D. No.) oCJ
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. )ADDRESS
<./)i,t1 j,.,. ?k
PHONE(J/7 232-f/:2f
This is to ccrlify thul rhe in(urm,llion hl'fL' Hi\'l'u is (1lrrutlr nlpil.d lrom ;1I111ri~il1.d ll'fti(i(,lIl' o( dl'.lCh duly filed with me ;IS
LOl1l1 RcgistfJr. The Origillill (Crrifil-illl' will h<.' (orwilrlkd to till' SI.lll' Vil.1I Itnllnb Offill' fur pl'rll1;IIIt'1H filil1~.
WARNING: 1111 Illegal to duplicate this copy by photostat or photograph.
21-96-227
Fcc (Of thjll (t'nifjclH', $l,On
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CO....ONWEALTH OF PENNSVLlIANIA. OEPART"ENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
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Bor elon
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569-40- 3007
CW'Cl'ClIR"~"""'-..rt
. Declmber 28. 1995
L Female ..
I'U(.ICl'DlRHIO*.I
CUllberllod
Ealt Ploolba.a
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sYS1:S;;""Analyst Fa:l Gov't
........1rQOM..lSt_~..,.CooIf OIC&D1NTI
8 Marshsll Drive ~
oamp Hill, pa 17011 ~
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Leslie Oaks
~arol E. Allabach
Corinne?
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Dr., Scotts valley., Ca 950
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10.00 A. Decembl' 28. 1995
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CALIFORNIA ALL.PURPOSE ACKNOWLEDGMENT
State of O'tf.-.If!()~N)q
County of SIr/\! (/1 C(,...tfj{tf
onre6uu"f ~ /996 beforem~:)'tfld,"...i,~)[,,~''!.M1!~z' ~/a, ~
personally appeared S fop 1/ P ..'f Ii ' A (J ,.. V ~ r; 01")
Name oIS"T4^'J
[] personally known to me _ OR --Mproved to me on the basis of satisfactory evidence to be the person~
I' . whose name(\)ls/aHl subscribed to the within Inslrument
and acknowle~ged to me that he!ellailney executed the
same In hlslhefllhelr authorized capacitylieSl, and that by
hls~r{thelr slgnature(~on the Instrument the person(t\(,
or the entity upon behalf of which the person(~ acted,
executed the Instrument.
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MCHAB.ICNJRl'M
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I NoIart NlIID - - - ..
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WITNESS my hand and official seal.
rrVL A/gA~e'~~~~
S'Of'AlUfeolt ary ubi(; (J
OPTIONAL
Though tho In/anna/ion bolow Is not roquirod by law, It may provo valuablo 10 parsons rolying on tho documonl and could provonl
fraudufent removal and reattachment of this fonn to another documont.
Description of Attached Document
litle or Type of Document: ~(J/7"t1('1a.{.1I)'l Or /fsftrlt> or !<CIU/",. (, /i,t'Ti!'Jcv)
Document Date: :r,tfN, I fp. 119 fp Number of Pages: 711 r""@
I '
C^" OL. C', /fI,LIf8.'1c/t
Slgner~ Other Than Named Above: '"T" ~ _ fT
Capaclty(les) Claimed by Slgner(s)
Signer's Name: ~ -re V e 17 €, &r.1e So
~ Individual
I'J Corporate Officer
litle(s):
[] Partner -LJ Limited [] General
[] Attorney-in-Fact
[] Trustee
[] Guardian or Conservator
[] Other:
Signer Is Representing:
Top 01 .lbul11b hem
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o tR4 NtItlOf'lal Notl'" AllOC",llOf'l. 8236 Renvnel Ave, PO Do. 71~. Carooa Pal1l, CA 91:109-71&4
Signer's Name:
LI Individual
[] Corporate Officer
litle{s):
I J Partner - LJ Limited LJ General
[l Attorney-in.Fact
II Trustee
LJ Guardian or Conservator
I ] Other: Top o!thumb ""r.
RlGtlT THUI.1BPRlm
OF SIGNER
Signer Is Representing:
Plod No 5907
ReotdeI': ea' ToIl-Fr.. ,.800-876-6827
21-96-227
Register of Wills of Dauphin County, Pennsylvania
Estate of to A AI AI t!-
RENUNCIA TION
{!". f50 i?.:r e s (j)J
No,
also known as
. Deceased
Tha undersigned.
~~AjJ2.DI F ~('~U~o{.J
(Relationship) ICapacityl -
ot
tho abovo Decedent. hereby renouncelsl the right to administer the estate and respectfully ",qul!sllsl thai
Letlers be issued to J) /Q n P IYl . r.t:? U '?J r ~h} SSt3 '
hsnd this . 5' ~- day of 1J::l N.
/<.~~.~~ \l..
(Signaturel
Witness fY'-1
,192fa.
IAddressl
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NOTE: Renuncialion. IIUlculad uUllildo tho OlflCll 01 RtJUIslur 01
Will, are requned In lIomu cuunluu' 1u lJu llullllllOd.
RW-l' IRvsd 9/921
tmIaI Seal
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RECEIVED FROM:
ACN m
6 ASSESSMENT AMOUNT
CONTROL
NUMBER
"
lul .i:'U . ., II . 'f'f
DIANE M RUPICH
101 S SECOND ST
STE Ll
HARRISBURG, PA 17101
1CXD HIli
ESTATE IHIORlMTIOH,
!IIILNMER
III 21-1996-0227
!II NAME 0' DECEDENT (LAST)
~ BORJESON ROANNE C
II E Of PAYMENT
II POSTMARK DATE
COUNTY
SSN 569-40-3007
(fiRST) (MI)
CUMBERLAND
DATE Of DEATH
"
REMARKS
II TOTAL AMOUNT PAID
DIANE M RUPICH ESQUIRE
.20,977.44
CW
.'
SEAL
CHECK. 19
RECEIVED BY
REGISTER OF WILLS
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\~O. D"T15 0' DlATH An.. 12/31191 CHICK "I~
II A SPOUSAL [] :l-
pO.~"!_Y CI!IDIl II CLAIMID
PILI HUM."
2196 1996 0227
_ COUNlY..cODf" . ~,_ HUMll
01 ID N ., " AOOI
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'lUMMUN"'1 "IIH 01 'INHUIY...HI...
DI'''I1''''INIOf llYIHUr
Dirt nooCH
IlA'.'~\~l!~.~.:.'A J7121 0601
Ot IDIHI" HAMIIIA , ,", AHD MIDOtIIHI IAll
- ,
INHE~tf'ANt' TAX RETURN
RESIDENT DECEDENT
(TO BE FILllD IN DUPLICATE
WITH REGISTER OF WILLS)
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o 4. L1mit.d Ellotl 04.. futuro Int"... Comproml..
(10' da,...1 dealh oh., 12.12.821
[J 6. Oeude"t Di.d h'lale 0 7. Dec.d,n' Malntaln.d a living '''''I
(""och copy 01 WillI (""och copy 01 T ,u,'1
ALLCOiiiEsPONDENCE AND CONFIDENTIAL TAX INPORMAnON SHOULD BE DIRECTED TO.
H""'I ,U (MAiliNG AOOIIU
Diane M. RUpich, Esquire
W(IAl "CUlln HUM.II
DAn 01 OIA H
12-28-95
DAti Of III1H
5-12-34
8 Marshall Drive, H3
Camp Hill, PA 17011
c_ nand
A...OUHIIlCIIVIO l\llIH"'UC1IONll
\
I
I
, : ~ BE SURE to ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH
I' U;.;r.~p~nahiol 01 p.rjury. I d.c1or. that' ho.. uamin.d thh ,,'urn, Including occompanrlng "h.dul.. and "a.om.nll, and 10 .h. b.., 01 my knowl.dg. .nd blli,
t i "., tru., co"o" and complo'o, I d.c1o,. that all ,.01.,'0'. hat b"n ,.pall.cf a' trul marko' .olu.. Docloralian 01 propar.. a.her .han .h. portanol ropr...nlo'l..
llDUI n all informalion 01 w' prtpar., hat an ~nowl.d..
:rIG'" 0 UWH ll~roH I .01 flU t't ADDIUI DA'q -( q - '1 "
DAn
569-40-3007
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,J?~7 .. L 232-9724
1. R.al E1toll ISch.dull "I
2. S.ock. .nd Bond. (Schtdull BI
3. Clo.oly H.ld s.ociUpannl..hlp In..'''' (Sch.dul. q
4. Mallgog.. and 1'10'" Recel.obl. (Schedule 01
5. Coah, lonll Otpolit' & MilullanlOu, 'tnonol P,op.rty
(Sch.dul. EI
6. lalnoly Own.d P,ap.lly ISch.dull 'I
7. T,antl... ISch.dull G) (Schedull L)
8. To'ol G'OIl "".11 ('0'01 L1n.. 1.7J
9. funtrol bpt.n..,. Adminlstrativ. COil', Mlsullaneou'
Eapon'" ISch.dul. HI
10. D.bll, MOllgogl Liobili.i... Litn. (Schedul. I)
11. Talol D.dudion. ('0101 L1n.. 9 & \01
12. N.t Valul 01 E1.ot. IUn, 8 mlnu. Linl 1\1
13. Charltobl. and Ga..,n...ntol Boquo'"ISchedul. II
1.. N.I Valu. Sub.a to Taa {lIn. 12 mlnu, Unt 13
IS. Spou.ol T,anll... (lor do'.. 01 d.a.h oh., 6.30.94)
S.. InilruC1ion, for Applicablt 'eruntogt on Revtn.
Sid.. ('nclud. .alu.. I,om Schedull K a, Sch.dull 101.)
'b. Amount alllnt 1 A toxabl. at 6~ roll
{Indud. volu.. from Schtdult K or Sch.dul. M.I
'7. Amounl 01 lint 'A laxobl. 01 151Ma roll
(Incl,d. .alu.. I,am Schldull K or Schedull M.I
18. Principal lox dllt {Add loa from Un.. IS, 16 and 17.1
'Q. ("diU Spaulol Poverty Credil P,ior poylMn"
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Rtmoinder Rtlurn
liar do'.. 01 dlO,h p,lo, 1012.13.8
federal EIlal. To.. Rttu'" R.qulred
Total Number of ~ft Otpo,it lo..tl
(II
( 21
(3)
(4)
151
16)
(7)
101 South SecOnd 9treet,
I Harrisburg, PA 1'l:1~i
300,000.00
U
ste. L1
-:;
rfl
'U
~J
,-:J
o
5,000.00
71.700.98
o
o
17,163.40
..
"
( 81
376,700.98
(9)
(101
9,913.53
27,076.93
349,624.05
o
349,624.05
1111
(121
(131
1111
(15)
(16) 349,624.05
(17)
OilCount Inl"..t
.
..--
. ,06.
20,977.44
. .15 .
(181
20,977.44
(191
(20)
o
o
20. If line 19 ja Dr.alel than line 18. .nler Ih. diff.,.nct on Unt 20. Thia la the OVERPAYMENT.
a U."~"'I_II'_{""U.'II._I"('""~Uhl,_.-...~n...1'1"." ...I!l.!Jo....I.... .
20,977.44
(211
(21"1
(JIBI
,lU,~/I.44
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Ac' '48 0' 1994 prov/d.1 fo, ,he reduction 0' 'h. 'OIC ra'.1 /mpoI.d on ,he n.' volu. 0' 'rani"" to 0' '0'
'h. UIO 0' .... IpOUI.. Tho ra'OI 01 prelCliJled by the Itatut. will bo,
· 3% (.03) will be applicable for olta'.1 of decodontl dylnll on 0' aft., 711194 and be'ore 1/1196
,
,
, I
,
;'
!
o 2% (.02) will be appllcab/. fo, .atat.1 0' doced.nta dy/nll on 0' aft., 111196 and b.,oro 1/1197
· 1% (.81) will bo applicable fo, Oltatol 0' deced.nt. dYlnll on 0' aft., 111/97 alld bofore 111191
e Spoulal t,anl'.'1 occurrlnll on a, aft., 111191 will bo .1C.mpt ',om 'nh."'anc. talC.
PLEASE ANSWER THE FOLLOWING QUESTIONS
IY PLACING A CHECK MARK (~J IN THE APPROPRIATE BLOCKS.
J. Old dec.d.n, make a l,an.I., and,
YU NO
a. '.'aln Ih. UII or In com. of Ih. property I,analerred, .......................................................
b. r.taln the rlghlla dll'gnale who .hall ulllh. prop.rty Iranlftrred or II. income, ...............
c. ro'aln 0 rev.nion~ry Inlerlll; 0' ...................................................................................
d. recelv. Ih. promlll for lif. of .ilher pay""nla, ben.fil. or core' .......................................
2. If death occurr.d on or b.lor. D.cember 12, 1982, did d.c.d.n, within 'wo y.an pr.cedlng
death 'ransf.r prop.rty wlthou' r.c.lvlng od.qual. consid.ratlon' If d.ath occurred aft.r
D.c.mb.r 12, 1982, did dlCed.nt lron.fer property wllhln on. )'10' of d.ath wl,hou' r.c.lvlng
adequa'. consld.ra'/on'.......................................... .........................................................
3. Did dec.d.nt own an 'in tru.t 'or' bank account at hi. or h.r d.a'h"'....................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
'.
'.
UV.lSOII.. 1~.t6I
*
COMlolOHWIAllH O' IIHHIYlVAHIA
.HHIIITAHCIIA.I/'UIH
IU.DIHI DICID HI
IS An f
SCHEDULE B
STOCKS AND BONDS
fiLl MIIR
1996-00227
IlOANNE c. IlOOJ'E.SOO
(All p..,.rtl' folnlll'oOwn.d with RighI 01 Svrvlvo....lp mVIl b. dlICloltd on Sch.dvl. '.1
ITEM
NUMBER DESCRIPTION
1.
VALUE AT DATE
Of DEATH
rom
S
o
TOTAL AIlo .nlor an IIn. 2, RICO Itulallon
III mort .pa.. II n..d.d, inltrt addirional.h.." 0/ .am. lilt.)
ll'4-UOIlh "....
'*'
tQllMONWIAl1H Of PlHNIYlVANIA
tHHl~A~ IAllInUIH
l_liKtOIHT
ISTATI 0'
SCHEDULE D
MORTGAGES AND NOTES
RECEIVABLE
Plea,e Print or l' e
PILI NUMBIR
1996-00227
IAII...-.v ,",II. " ... wi....... RJekl .......1_.... ....1... oIlodeoH'" .......10 Pol
ROANNE C. ~
111M
NUMBER
DISCRIPTlON
VAWI AT
DATI 0' DIATH
Georgene Poticker
301 Walnut Lane
carlisle, PA 17013
personal loan
5,000.00
I" mo,. .poce ia n"dod. In..rt additional .hHh 01 .om' aI...)
'.
11'1110111.'''11
ESTATE OF
~ _ ~,'~1ft\\J~'~cr-;:';l!if~;-"c-';.'
. '
:. .:.....,.~...~,,'~:--~~
~:j~i}..
....'!!II".
COMMOHWUUH O' PlHNSYlY.AHLA
IHHllnANCI 'AX lnul"
1."DlNt DleIDIN'
SCHEDULE E
CASH, BANK DEPOSITS AND I
MISCELLANEOUS
PERSONAL PROPERTY
~Iea'e Print ar Type
FILE NUMBER
1996-00227
ROANNE C. ~
IAll p_rty .....d~..4 wllh ,... Rlthl 01 _........ ...., ... 41oc1oto4 ... SchetIulo ')
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
DESCRIPTION
VALUE AT
DATE OF DEATH
18,890.80
2,448.87
2,420.75
42,859.67
PNC Bank Acct. N 5140166945 - checking account
Members 1st Federal credit Union
savings account
National Life Insurance Cb.
Life Insurance Policy N 1635713
PeMsylvania Blue Shield - lReinbursements)
251.85
176.00
9.60
200.00
400.00
1968 Chevrolet sedan
Misc. Household furnishings
Rents collected: Real Estate
1660 McGregor Way
San Jose, CA
4,043.44
IAltodl addlllonoll.... . n. _If..... opau I. _ed.1
".
"~~"" p..... .
COMIo\ONWIAUIt 01 'IHHIYLYANI4
IHHUItAHCI tAX InUIH
IIl'DIHT DICIDIHT
SCHEDULE F
JOINTLY.OWNED PROPERTY
PILE NUMIIIR
1996-00227
EITATI OF
ROANNE c. ~
JoIn""nan'I')'
RELATIONSHIP TO DECEDENT
NAMI
ADDRESS
A.
NQIlE
B.
C.
Jaln,ly-awnld proporly,
.
ITEM LmER DATE DOLLAR VALUE OF
FOR TOTAL VALUE DECD'S
NUMIIER JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1.
NQIlE
TOTAL (AI.o onlor on I1nl 6, Rlcapltulallon) oS 0
(11 maro IpaCI i. nHdld in.or! additional IhHfo 01 saml .ill)
. '(':', u._ __,' _ ":"_'._' ::~:,;~:~tA\{;:,;t:
.' '~'~'#'~.~_l'J.."~"I:C~".:l"~..~~
IIY.IIIO n. 12"7)
~~
COMMONWfAl1H O' PfNNIYIYANIA
IHHlllt,AHCI'I'AX amlH
III/DINT DIC.DINT
i'STATfop
SCHEDULE G
TRANSFERS
J_
PfLE-ifuMBER
PLEASE PRINT OR TYPE
ROANNE c. ~
1996-00227
THIS SCHIDUU MUST BI COMPUTlD AND 'IUD IPTHI ANSWIUO ANY OPTHI QUlmONS ON THIRlVUSI SIDI OPTHI COVER SHIIT IS YD.
ITIM DUCRIPTlON O. PROPERTY TOTAL VALUE DECO. DOLLAR VALUE
EXCLUSION I~ O.DECEDENT'S
NUMIU Indudo.ome oIlhol""''''''', lhoit roIaIiomIUp fa _.1, dofo 01""".10,. 0' ASSET INTEUST
tam
.
TOTAL (AIIO .n'.r on IIn, 7, AecapihllallOll) S 0
(II mort Ipoc. it MflIeJ, in.." oadifionol thHh ol.ome Jilt,}
~.
I'VIIIIII. I'.'"
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Pl.al. Print ar Typ.
ILl NUMBER
1996-00227
~J~:~
_srJ>>f>
COMMONWIALTH orrINNI.LllANIA
IHH!llfANCe tAl UWIH
IISIDfH1 DtclOIHf
f
ROANNE c. IDloJESOO
ITEM
NUMBER
A. Fun.ral Expenl'"
DESCRIPTION
AMOUNT
1.
Sullivan Funeral Halle
1r171.00
.
B. Administrative Caltll
1. Penanal R,p,.l.nlallve Camml..lanl
Sadal SlCurlty Number al Penanal Rep"llnlall..,
V.ar Camml..lanl paid Waived None paid
2. Anarney ml
Diane M. Rupich, EsqUire 15,801.03
3. family exemptlan
Claimant R.lallanlhlp
Add,... al Claimant at d.c.d.nt'l d.ath OONE
St,..t Add,...
City Stat. Zip Cad.
... Prabat. Fell 55.00
C. Mlle.lIan.aul Exp.nl'" 9.00
1. CImtlerlarrl Law Journal
60.00
2, Carlisle Sentinel 67.37
3.
...
5.
6.
7.
8.
TOTAL (Alia .nler an line 9, Recapilulallan) S 17,163.40
(II mare Ipace II n..ded, Inllrt addlllanallheetl af lame Ilze.)
"~1J1!'''1''~ ..
COMMONWIAUH Of HNN''I\VlUflA
IHHllrlANCI WIIIUIH
.UlDIN' DtCIDlN1
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
PI.a.. PrInt ar T p'
i PILE NUMBER
1996-00227
ESTATE 0'
ROANNE c. BClIlJESOO
N~~ER DESCRIPTION
AMOUNT
1. SaIlmons o:mnunications
99.68
GI Card
5,516.91
Department of Revenue (1994 Assessrrent I
West Shore EMS
763.80
25.20
1,684.67
58.76
119.46
154.53
.
1,099.31
31 .38
359.83
Credit Bureau of Greater Harrisburg
OIS AIR Services
DFAS-DE/FYSA
Bell Atlantic
SUburban Cable
AT&T
East Pennsboro Ambulance
TOTAL (Aha .nlor on li.1 10, Rocapilulatlan)
(If mall 'poco ;, nmld. inllrt addilional.holh 01 .aml Ii...)
$ 9,913.53
. tIV.IIUJ" [U1l
'*'
COMMONWIAllH Of ,1,..,..",..."Ml"
INMIIt1ANC1 'AI tnUIN
....... "DIN'
SCHEDULE J
BENEFICIARIES
ROl\NNE c. BORJESON
FILE NUMBER
1996-00227
ISTATE Of
ITEM
NUMBER
NAME AND ADDRESS Of BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE Of ESTATE
A. Ta.abll BlqU1I11l
1.
Carol E. Allabach
125 N. Navarra Drive
Scotts Valley, CA 95066
Daughter
50%
steven Borjeson
550 N. 21st street
san Jose, CA 95122
son
50%
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE Of ESTATE
B. Charllabll and Gov.rnmlnlal BlqU1I11l
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Aha InlOr an linl 13, Rocapilulalion) ~ 0
(II mON 'PO.I I. no.dld, In.o" addltlanal .hOl" 01 .aml .1101
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AMENDED
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
.:;ij~
f'iI. '1\
-.. (QMMONW(ALlH o. 'INNr.nVANIA
OI'AUMfNl o. '(V[NUI
Of" U0601
H.....IUU.G, '." 111110601
OlelDIN 'l HAMill'" . ,. . ANO Ml INllAll
BORJESON, ROANNE
c.
.0. DAIlS O' DIAIHAnl. UI~I"1 CHICIlHUI
" A SPOUSAL
POVUn: ~I!.IDIIIS CLAIMID 0
fill HUMIIR
ON'
2196
c9UN1Y COpE
,at . Aooun
1996
YEAR
00227
NUMIU
03.
05.
Remainder R,rurn
I'or dart. of death prior 10 12.13.82)
Fed.ral ElIot. Toa Rei"'" Required
Chrdc hrrr if vnu nr!' ,rqlll.\tinl'J n ."fund of vnur ovrq'nymrnt
DAti Of 'IITH
8 Marsh~ll Drive, #3
Camp Ifill, Ph 17011 Curnbe 1 nd
COttM r a
AMOUNI 1"11'110 liIIIN$Uu(ltONII
o .c. Limir.d Ellar. 0 Aa. future lnl,,.,t Compromit,
1'0' do'., aI doa.h ah.r 12.12.82)
LJ 6. D,e,d,nt Died ...Iolt 0 7. O.ced.ft. Maintained Q Living Tnlll
(A"och copy a' WillI (A"och copy a' Trul"
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INPORMATION SHOULD BI DIRECTED TO.
NAMI U MAIliNG ADOIUI
Diane M. Rupich, Esquire 101 South Second ~t,
1I11'"ONI NUMa" Harrisburg, PA 17~ 01
71 232-9724
0-
ffi
o
...
u
...
..
WCI'" ueuI"'f NUMIII
569-40-3007
DAIl Of 0104'"
5-12-34
_ B. Tolal Number of Soft Oepatitlo...
Suite L1
:Il
\1-:
(1) 0 ,
, '
0 '-l
(21 0 I~
(3)
( 41 5,000.00
151 71,700.98
"
0 ' ,
161
(7) 0 76,700.98
17,163.40 (81
(91
9,913.53
liD) 27,076.93
(111
(121 49,624.05
(131 0
1141 49,624.05
(151
(161 49,624.05
(17)
Oitcaunt Inl.r..,
+
x._.
)( .06.
2,977.44
20. If line 19 i. qroal.r Ihnn line 18, .nl., th. diff.renc. on lint 20 Thi. ii the OVERPAYMENT.
gr2l
21. If line 18 it sreater than lint 19, .nler Ih. diH.,enc. on Un. 21. Thi.II Ih. TAX DUE.
A. Enl.r th. inter... on Ih. balonc. due on Un. 21.4.
B. fn'.r ,he '0'01 of lIn. 21 and 21A an lIn. 21 B. Thb I,.h. IALAHCE DUI.
Mok. Ch.ck 'ayable 'Ol R.gl,'er .f Will., Ag."'
~ ~ BE SURE TO ANSWER ALL QUUnONS ON RIVERSE SIDE AND TO RECHECK MATH -0( -0( .
I~dlf Plnolli.. of plri"')', I d.do,. Ihotl have ,.amin.d 'hit "Iurn, Induding accompanying .chldul.. and Ilollm.nlt. and 10 th. bllt of my knowledg, and belief,
. It IrUI, CO"lcl an.d compl.tl. I d. I Ihat all ,.01 '1latl hat b"n ,.porteer at true marhl valu.. a.daration of prepar., other than Ihl plnonal "preNntal," I.
.l.u.d 0 I infornlcuion of which p'. ore' hat an knowlldgl. I
,C.N...lu I N IUtO ~11l1 IN AODtln 00411
101 S. S:r:t:rrl st., ste. Ll, ~, m 17101
." ...",.........11 "',ht'lH(" "own. ......aol f1"". 'II" "... MiOOll""1Al1
rJ I. Original Rllurn
.0-
..Z
......
"0
"z
8f
z
..
~
=
0-
0::
c
u
...
..
I. Roal fSla'. (Sch.dul. A)
2. S'ac~' and Bondi (Sch.dul. 8)
3. Clollly H.ld Slod"'Porlnl"hlp Inter,,1 {Schedule CJ
4. Mor'gag," and No'" R."iyobl. (Schedul. D)
5. Calh, Bonk O'polih & Mlte.lIan,oul PertOnal Prop.rty
(Sch.dul. fl
6. Join,ly Own.d Prap.rty ISchedul. F)
7. Tran"... (Sch.dul. GI(Schodul. LI
8. Tolal Gran Anlll {Iolollin.. 1.71
9. funeral Eap.nlll, Admlnhtrativ. COltl, Mitc.llantoul
IIp.n.., (Sch.dul. HI
10. Deb... Martgog. 1I0bili.i... U.n. (Sch.dul. I)
11. T 0101 D.ductionl (Iotol Unts 9 & 10)
12. N.. Valu. of b'a..(lIn. 8 minu. Un. 111
13. Chari'obl. and GOYernmen.ol Boqu.... (Schedul. J)
.... N,t Volul Sub'eet 10 TOil lIn. 12 minvllin. 13
15. Spaulol T,an"." (far do'.. of d.a.h ah., 6.30-9.1
5.. Inllruction, for ACPllcobl. P.rcenlag. on R.v.,..
Sid.. (Includ. valu.. ,om Schodult K Of Schedul. M.I
16. Amount of linl 14 tOAabl. 01 611Ml rol.
(Includ. .,oluts from Schldul. K or Schedul. M.I
17. Amavnt of lint 14 101labl. 01 1511Ml rol.
(Includ. yalu.. from Schedul. K or Schedul. M.)
lB. P,incipolloA d"l (Add lOll from lints 15, 16 and 17.t
19. Cr.dill Spoulol PO.,erl)' C,.dil + 2~~0~~Gf:4~1
z
..
!i
0-
=
~
"
o
...
..
C
0-
AOO'US
)( .15 .
(181
2,977.44
(19)
(20)
20,977.44
18,000.00
(21)
(21.0)
(21BI
DAti
9)tiJ If .2).im?,
ATTORNEYS AT LAW
EXECUTIVE HOUSE
SUITE 1\
101 SOUTH SECOND STREET
HARRISBURG, PENNSYLVANIA 17101
PHONE: (717) 23308743
ARTHUR K. OILS
JOSEPH J. DIXON
DIANE M. RUPICH
September 19, 1996
Register of Wills
Cumberland County Court House
One Court House Square
Carlisle, PA 17013
RE: Estate of Roanne C. Borjeson
File No. 1996-0227
Dear Sir:
Enclosed is an original and two copies of an Inheritance Tax
Return, Schedules A through J, in connection with the above
captioned Estate. Also, enclosed is an Estate check in the
amount of $20,977.44 representing the inheritance tax due in
this matter.
Would you please clock-in the third copy of the Return enclosed
herewith and return it to me in the enclosed self addressed
stamped envelope.
Thank you for your cooperation and assistance in this matter.
DMR:kjm Il"l -....,.
'0 " R ~o~
Ene.,,::: ~ ,
,
a. ,
.-
-- <::>
N
~
.' Eb
" l~ ~
5 .~.::,
l.) Ll --
III a: ~ (JjE
a: u8
15'~/~3
CDMMDNWEALTH DF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
(l/
IUR!AU Of INDIVIDUAL TAXES
1."UlIAHtE U' DIYISION
IllPl. mIDI
HARAlllUItG. Pi 17UI."al
In.IUI U u. ",,,"
02-03-97
BORJESON
12-28-95
21 96-0227
CUHBERLAND
101
ROANNE
DIANE M RUPICH ESQ
STE Ll
101 SOUTH 2ND ST
HBG PA 17101
DATE
ESTATE OF
DATE OF DEATH
FIL! NUMBER
COUNTY
ACN
Aoaunt Rooltted
\
MAKE CHECK PAYABLE AND REMIT PAYMENT TDI
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE. PA 17013
HOTE' To Inouro propor .rodlt to your o..aunt. oub.lt tho uppor portion of this faro with your to. pOy.ont.
CUT ALDNG THIS LINE ~ RETAIN LOWER PORTION FDR YDUR RECORDS ....
iiiV:iiiiij-EX-AFP-nZ:9iii---"-iiiiiniiiiEiiiTANCi-fAX-STAiiHiHf-OF-Accciuiii--iiJiii---------------------
ESTATE OF BORJESON RDANNE C FILE NO.21 96-0227 ACN 101 DATE 02-03-97
THIS STATEHEHT 15 PRaVIOEO TO ADVISE aF THE CURREHT STATUS OF THE STATED ACN IH THE NAHED ESTATE. SHOWN IELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE. APPLICATIOH OF ALL PAYHENTS, THE CURREHT IALANCE, AND. IF APPLICABLE.
A PIlOJECTED IHTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 01-21-97
3,649.50
PRINCIPAL TAX DUE ,---,-----------'------'---.---------
PAYMENTS (TAX CREDITS),
AMOUNT PAID
DISCOUNT (+)
INTEREST (-)
.00
.00
20.977 .44
18.000.00-
PAYMENT
DATE
09-19-96
01-16-97
RECEIPT
NUMBER .
AA146765
REFUND
0$
.' I ~.::
lJ"\ t::<(
-
-; "
- 1--
2: .,
l""\
.....
0::
""
,,;:
,
;..
TDTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TDTAL DUE
2.977 .44
672.06
5.4B
677 . 54
...-) .'
<ll c.: '" .:
INTEREST lsatHARGED.FROMill~17-97 TD 02-18-97
AT THE RATES APPLICABLE ~~UTLINED ON THE
REVERSE SIDE OF THIS FORM.-
" IF PAID AFTER THIS DATE. SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE 15 LESS THAN .1.
NO PAYHENT 15 REQUIRED.
IF TOTAL DUE 15 REFLECTED AS A "CREDIT" ICRI.
YDU HAY IE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRH FOR IHSTRUCTIOHS. I
C
PA'ttIENTI
Deteeh tM top portion of thh Notlu end .ubIIlt wlth your pey.ent e.ele peyable to the n"l end eddrlll
prlntld on the revlr.1 .Ide.
If RESIDENT D€CEDENt 1.1 check or .oneY ordlr plyebll tOI REGISTER Of WILLS, AGENT.
If NOH-RESIDENt O[C[DENt .ake check or ..oney ordlr pnebll tOI COHtlONWEAL TH Of PENNSYLVANIA.
All p.".."" r..oIued ....11 .. _lied flrsl 10 on. Inl.r..I ""I.h ... .. .... .lIh on. r...lndar _Iled 10 IhO 10M,
IIU\INlI eCllll A r.fund of . to. ..edit. ""Ich ... nol r__.Ied on IhO T.. A.Iurn. ... b. r__.I" b. ._I.U... on
"AppII..Ilon for A.fund of penn..luonl. Inhlrllonc. ond E.I.I. T.." eREV-ISIS). Appll..Ilon. .r. .u.IIObI. .1
the OfficI of thl AIII.tlr of WillI, .ny of thl 21 RlvtnUI DI.trlct OffiCI' or fr~ thl Dtplrt.-nt'. Z~.hOUr
~....rlnt .lrvlcl ~rl for fori' orderInG I In Penn.ylv.nll l-100-16Z-Z050, out.lde ptnn.vlvenll
end within 10CII Hlrrllburl ,r.' (717) 717-10'4, TOOl (717) 77Z-ZZ5Z (He.rlno t.,.lr.el only).
REPLY TDI
Gut.tlon. reg.rdlng Irrors contllned on thll notlc. IhOUld b. .&tnnld tOI PA oep.rtnnt of RIVenue, IUr.....
of IndivIdual t..... ATtNI Po.t A......ent Rlvll" unit, Dept. Z10601, Hlrrl,burt, PA 171ZI-0601, phone
C717l 717-6SU.
DISCOUNT I
If on. I.. .... I. p.ld .Ithln Ihr.' eSl ..Iond.r .onlh' .fl.r IhO d....onl.. d..In, . flu. p.r.onl eSX) dl..ounl
of the tlx plld I. .Ilowed.
PDlAL TV I
The 15X t.x .-ne.ty non-plrtlolpltlon penlltv I. coeputed on thl totll of tM tlX end Int.r..t .,....ed' .nd not
p.ld b.for' J.nu,rv II, 1996, thl flrat dl'" Iftlr the end of thl tlX .-nt.ty plrlod.
tNtERfstl
Inl.r..I I. chlro.d boOlool... .IIh flr.I d.. of d.llnquon<.. Dr nln. (.1 DOnlh. ond one ell d.. froo IhO d.I. of
do.th, 10 IhO d.I. of p.".."I. T.... ""I.h b..... d.llnquonl b.fDr. Jonu.r. I, I.IZ ...r Inl.r..I .1 IhO r.I. of
.Ile (6X) ptrc.nt per ~ ulcullted It I dlUy retl of .aOO1f.~. All tI... which blea.. d.lInquent on end I".r
Jenuary 1, 1,IZ wIll bier Int.r..t et I rlt. which will Vlry froe cllender VIer to cllendar v.er with thet r.t.
~ed by the PA Depart...,t of R.venue. thl eppllcltbll Int.rllt retll for I,IZ through .997 erll
Vllr tnt.rllt Aete Deily tnt.r..t Feetor Vnr Int.r..t A.t, Oelh Intlrllt Flctor
I9IZ ZDX .GOGSU 1917 .X .OODZU
I9IS 16X .OOO~SI 1'''-1991 IlX .OOOSO.
I'" IlX .00OSOI 199Z 'X .00lU7
I9IS ISX .00OS56 199'-199'" 7X .000l9Z
1916 lOX .OODZ74 1995-1997 'X .OODZ47
--Int.r," I. cllcullted I' follow"
INTEREST . BALANCE OF TAX UNPAID X NUN8ER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
_.Any Hotlc. I.,ued .ftlr thl t.x blcoll. delinquent wIll rlflact en Intlre.t cllculltlon to fifteen (15) dlY'
beYond the detl of thl .......ent. If pay.",t II ... I",r thl Intlrllt CMPUtlUon dl" .heMIn on the
Notlel, ItdcUtlonll Interllt Milt bl ulcullttd.
Jr(,Cf/.J
IURIAU 0' INDiVIDUAL TAMES
11I01lAHC! lAX DIVIIIOIl
1lV'1. "'""
KAIIUIMMt. PA 11U.......
CDHHDNWEALTH DF PENNSVLVANIA
DEPARTHENT OF REVENUE
*'
(!....
~
NOTICE 0' INNERITANCI TAM
APPRAISENEHT, ALLOWANCE OR DISALLOWANCE
0' DEOUCTIOHS AHD ASSES,"EHT 0' TAM
"'.\11'"'" 111-'"
DIANE M RUPICH ESQ
101 S 2ND ST STE Ll
HARRISBURG PA 17101
DATE 01-13-97
ESTATE DF lIorjeson Rounne C.
DATE OF DEATH 12-28-96
FILE NUHBER 2196-0227
COUNTY Cumberland
ACN 101
Amount R..ltt.d
HAKE CHECK PAVABLE AND REHIT PAVHENT TO:
Register of Wills
Cumberland County Courthouse
Carlise, PA 17013
CUT ALONG THI:{ LINE ~ RETAIN LOWER PDRTION FOR VDUR RECORDS ~
REY:i54j-iX-"FP-ro'f:96Y-Ncii"ici--oji-YtiiliiiiTAiicE-YAx-APpiiAisiHENi'";-"i.LOiiAiicE-O.R-----~-----------
DISALLDWANCE OF DEDUCTIDNS AND ASSESSHENT OF TAX
ESTATE OF Borjeson Roanne C. FILE ND. 2196-0227 ACN 101 DATE 01-13-97
TAM RETURN WAS, ( I ACCEPTED AS FILED
(x I CNANCED See Attached Notice
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED DN: Original and Supplemental
1. R..l E.t.t. (ScheduI. Al (II
2. stack. and lond. (Schedul. II (21
S. Clo..ly Hald stock/p..tn..shlp Int....t (Sahadul. CI 151
4. Ka.t...../Hot.. R.a.lvabl. (Schedul. 01 141
5. Calhl8ank D.po.lt./Hl.a. P...on.l P.apa.ty (Sah.dul. EI (51
6. Jointly OWned P.apa.ty (Schedul. FI (61
7. T.an.f... (Schedul. CI (71
I. Tat.l A...t.
No. 01
HOTEl To insure proper
credit to your account,
sub. it the upper portion
of this for_ with your
tax pa)'llent.
nn
nn
.00
5.000.00
71. 700.98
.00
nn
lal
7(, 700.QR
APPROVED DEDUCTIONS AND EXEHPTIDNS:
,. Funa..l E.pan.../AdIo. Ca.t.lHha. !Mpan... ISch.dul. HI 1'1 5.962.37
10. Debt.lKortg_ Liabiliti../Llana (Schedul. I) nO) n n1'l c;,
.
11. Tat.l DeducUon. 1111 1" R7" Qn
12. Hat V.lue of TaM R.tu.... 1121 60 R?" OR
15. Ch..:tabla/Co...""anhl I.qu..t. (Sch.dul. JI 1151 .00
14. Hat V.lue of Eat.t. Subjaot to TaM 1141 60 R?" OR
NOTE: If an aSlessment was iSlued previouslY, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. Aaount of Lln. 14 .t Spou..l ..t. (151
16. Aaount of Line 14 taMable .t Lln..l/Cl... A ..t. 1161
17. Aaount of Lln. 14 taMable .t Coll.t...l/Cl... I ..t. (171
la. P.lnclp.l TaM Du.
TAX CREDITS:
PAYHEHT
DATE
.00 M.OO.
60 R?~ OR M.06.
.00M.15.
Ilal
.00
3.649.50
.00
" nb.O ~n
RECEIPT
H\Jl1IER
DISCOUNT 1+1
IHTEREST (-I
AHOUNT PAID
09-19-96
^A146765
.00
20,977 . 44
TDTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TDTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAH .1, NO PAYHEHT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY IE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. I
. -.--.....-.,-. -'-
,.
RESERYATIOHa E.t.t.. of decedentl dvlng on or before Dec..a.r lZ, 1,IZ -- If MY future Int.r..t In ~ ..t.t. I. trln.f.rred
In po.....lon or enJoVM"t to Cl... . (colht.r.U bInIflchrl.. of the dKed",t .n.r ~ IXplntlon of MV..t.t. far
11f. or far v..r., ~ C~lth hereby .wpr...1V r...rv.. the right to ."ral.. Ind ...... trln.f.r Inherltanc. Tax..
.t the I_ful Ch.. . (coll.t.~U nt. on InV tuCh future Inter..t.
PIJlPQSl! lII'
MOTlCEa To fulfill the r....lr...,t. of s.ctlon ZI40 of th4I Irhlrltlf'lCl end E.t.h Tu Act, Act ZZ of 1"1. 7Z P.I.
Section ZUD.
PAY1tEN1'a Dlhch the top portion of thh Motlca end IYtMIIt with your P'V-Wlt to tM Rqhhr of will. prlntlld on tM r..,.r.. side.
n"*e c:Mck or ..., order pQlbll toa REGISTER OF MILLS, AGENT
All P.v-ttl rlO.lvlld than flr.t be IIPPUed to MY Int.rllt ...,Ich AY be due with WlY r...lnder .".UIId to the to:.
REF\ICJ ((RJ. A r.fund of . tlX criedlt, ...,Ich .... not r.....tlld on tM Till Rdurn, HY be r.qullted by cMIII.Ung ., -....lIc:t1tlon
for Aafund of Penn.ylv.nl, tnhlrlt~1 Ind E.t.te Tax- (REY.l]I]). Appllc.tlon. .r. avelllbl1 .t tM Offlc.
0' tM A..hter of WIU., MY of thI n A.vll"IUI Dhtrlct OfficII, or by c.Ulng the ,,"hl Z4-hour
.......rl"8 ..,...,Ice """ra for fo~' orderln~U In PlMlYlv.,l. 1-.'0.]6Z.205', outtlde Pww'llYlnnl. Ind
..Ithln loc.1 HerrhbUr. ar.. (717) 7.7-..M, TOOl (717) nz-un (He.rlng IlPllred Dnh).
OIJECTIOMSa My p.rty In Intlrllt not ..tI.fllId ..Ith the .,r.lI..."t, .1lCMl~e or dhall~ 0' dlductlon., or .........,t
of tax Clncludlne dllClM'It or Intlrl.t} .. ahowl on thlt NoUcI .....t Object ..IUlln .btv (60) dlY' of receipt of
thlt Motlc. bya
.-..rltt.n prottlt to tM PI o.plrtHnt of A...,...., lo.rd 0' Apptd., Dept. ZI1.U, H.rrhburg, PA 17UI-IUI, OR
--lllOtlon to hllYI thI ..tt.r deterllntel It eudlt of the IeCOU'lt of thI perlontl repr..."taUvI, OR
.........1 to the Orphtn.' Court.
....IN
IST1IATlYE
CORRECTIONS. Fectulll .rror. dlllCOYerlld on thit ........"t should M tddre..Mt In ..rltlnt tal PA o.p.rt.....t 0' AIVIl"lUe,
Iur.-u of Individual Taxi', ATTNa POlt A.....llnt A.vl... unit, DlPt. ZI.'Ol, Harrl.burg, PA 171ZI.0601
Phont (717) 717-'5'5. s.. plV- 5 of the bOOk"t -In.tructlon. for InMirltence Tn A.turn for - Auldtnt
Decedent- (A[V.15.1) for en .wpltn1tlon of ~lnl.tratlv.1y correctabll .rrors.
DISCOlIfT.
If ...v tee due It p.ld ..Ithln thr.. (]) c.lender IIDnths .ftu thl dKldotnt's d..th, . flvI percWlt (5%) dltcount of
the tee Plld Is 1110M1d.
The 15% tax ......ty non-p.rUclpeUon ptnIl ty I_ coeputMt on the totel of the tu Ind Int.rut .....ud, end not
paid Mfore JInuIry II, 1"6, the flrlt dly .ft.r the end of the tllC ..,..ty period. Thlt non.PlrtlclplUon
panal tv Is tppUltble In the ... IIMIr .-d In thI tht ... tI_ p.r lad .. you MOUld .....1 tht taM ... Interest
that h.. bHn ......M .. Indlc.tlld on thh natlce.
PDlALna
INTIRUT.
Intere.t Is charged betlmlna ..Ith first day of dlllnquency, or nine (,) tonth. end OM (1) ca.y fr. the dltl of
dMth, to the dltl of Plv-tt. Tu" ...,Ich bee.. dtllnquw\t befar. J....ry I, 191Z MIIr Internt .t the ret. of
.b (6%) percent IMr ..... C4l1cuhtied at I dilly ret. af .000164. All t.... tIlhlch bee... delinquent on - after
J~ry I, 19.Z ..Ill belr Int.r..t It a r.tl which ..III v.ry 'roa c.l~r ye.r to cal~r y..r Nlth ~t r.ta
lIf'W'IQl.nCteS by thI PI o.partHnt of A.v..... The IPf1l1c~l. Intlrnt ret.. for 1'12 through I'" .nl
'!!!! Int.rut A.te a.llv tnt.r.st Factor !!!! Intlr..t A.tl DIUy tntlrllt FlCltor
I'az ZOX ..OOS41 1917 9X .OaOZ47
1915 lOX .00001 \911-1"1 11% .000301
I'" I\X ....SOI I"Z 9X .OaOl47
1915 I3X .00OSS6 1995-1994 n .10019Z
I'" lOX ....Z74 1995.1'" 9X ..aOl47
-.Int.rllt I. celtul.tld .. faUow.a
INTEREST . 8ALANCE OF TAX UNPAID X KURBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
....My Motlce luuteS .nlr the tu becoM. delinquent ..111 r.nKt In lnt.rllt c.lculltlon to '1ft.." US) dly.
beyond the dlt. 0: the .....~t. If Plv-nt Is lids .'tlr the Interut coeputttlon dltl IhoMn on the
Hotlca, tddltlonal Intlrl.t .u.t be celcullted.
-.-,...-.....-..-'... ---
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COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OP INDIVIDUAL TAXES
DEPT,280601
HARRISBURG. PA 17128.0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
'*
NO. AA 211460 REV.I1.m III.'"
RECEIVED FROM:
r
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
DIANE M RUPICH
101 8 SECOND ST
aTE Ll
HARRISBURG, PA 17101
ln1
aLoft 415
FOlJ) HERE -
'0l0 HERE
ESTATE INFORMATION:
FILE NUMaER
NAME OF OECEDENT (LAST)
(FIRST)
(MI)
DATE OF PAYMENT
POSTMARK DATE
COUNTY
TOTAL AMOUNT PAID
.698.45
DATE OF DEATH
,~
MARY C. LE '}// j~~i'l
REGISTER WILLS ~)~X/~A '1
REGISTER OF WILLS
i _,__------------------------------T---:--~--~
:i r' ;l 1
~ '
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J
"1
I
REMARKS DIANE M RUPICH ESQ
RECEIVED BY
SEALCHECI<II 1002
~" ...
~. .
~.
~
.f
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r~"
"-'---."--'-
-1l ~- -- ~ ..._.....
.-..-.--
I
r
.'
,5"- rl -J
COHHDNWEALTH DF PENNSYLVANIA
DEPARTHENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
v
*
BUREAU OF INDIVIDUAL TAXES
IHHE.AITAHCt TAX DIVISION
D[Pf. ZI"Dl
HARRISBURG, Pi 11121-0'01
le,.un II au Itl.t"
DIANE H RUPICH ESQ
STE Ll
101 SOUTH 2ND ST
HBG PA 17101
DATE
ESTATE DF
DATE DF DEATH
FILE NUHBER
COUNTY
ACN
07-21-97
BORJESDN
12-28-95
21 96-0227
CUHBERLAND
101
ROANNE
AMount R..itt.d
HAKE CHECK PAYABLE AND REHIT PAYHENT TDI
REGISTER OF WILLS
CUHBERLAND CO CDURT HOUSE
CARLISLE, PA 17013
NOTE: To inlure proper credit to your account, lub.it the upper portion of thil for. with your tax p.~t.
CUT ALDNO THIS LINE ~ RETAIN LDWER PORTIDN FDR YDUR RECORDS ~
REv:i6'iif"EX-AFji-i'oi-:9'rj------iiil.-iNHE"iiii"AiicE'-;:AX-STATEH'E-ti;:-OTACCOUN'T--iiliii---------------------
ESTATE DF BORJESON ROANNE C FILE ND.21 96-0227 ACN 101 DATE 07-21-97
TNIS STATEHENT IS PROVIDED 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 PAYHENTS. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSHENT OR RECDRD ADJUSTHENT, 06-09-97
PRINCIPAL TAX DUE, _,____________
3,649.50
PAYHENTS (TAX CREDITS),
PAYHENT
DATE
09-19-96
01-16-97
06-24-97
RECEIPT
NUHBER
AA146765
REFUND
AA211460
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
.00
26.39-
20.977 .44
18,000.00-
698.45
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE DF TAX DUE
INTEREST AND PEN.
TDTAL DUE
3,649.50
.00
.00
.00
. IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN '1,
NO PAYIIENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI.
YDU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS. I
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PA\1EHTI
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r/ii'; the
printed on
r- c:
p, .'~ :>
top potUoLlUhh HaUc. .. .utllllt wlth your P'YNnt ..... p.,lbb
1M n..,.r.. .leN.
to the n..e .-Nt IIddr...
-- If RESIDENT DECEDENT ..... chKk or Hnt, orete,. p.,lbh tOI REGISTER OF WILLS, AGENT.
.. If NOH-RESIDENT DECEDENT ... check or 110M, order PI,IbI' tal COtvtONWEALTH OF PENNSYLVANIA.
REFUND (a1h A rlfloftd of . tIX credit, which .... not r....tlel an the T.. A.turn, ..y tM r.qut.ted by CMp..Ung M
-Applleltlon for A,fund of Penn',lv,"l. l~rltlnC' ~ E.t.t. T..w (REV-ISIS). Appllc.tlon, .r. .v.lllbl. .t
tht Office of thI ...I.t't of Will., ~, of the 'S Aevanue 01.trlct Offlc,. or fr~ thI Oep.rtaent', '4-haur
Inewetlnt servlc. nuaber. 'or for., ordering I In Penn.,lvMI. 1-'00-56'-'050, out'lde Penn'Ylvanl.
and within loc'l H.rrl.bur. .r., (717) 7a7-ao~, TDO' (717) 77'-2'52 (H"rlnt lap,lred only).
REPLV TOI ou..tlon. rlOlrdlng .,.ro,.. cont.lned on thh noUc. .hould be addn..1d tOI PA o.p,tt.."t of A.v....., Bun..
0' Individual T...., ATTNI Po.t A......tnt A,vl... Unit, Dept. 210601, H.rrlabur., PA 1712'-0601, phone
17I71 717<6505.
DISCOUNTI
If tny tIX due I. p.ld ..Ithln thr.. (S) c.l~r aonth. ,ft.t thl dlcldlnt.. de.th, . flv. ,.rcent (~) dl,count
of the taM p.ld II .IIDNId.
PENALTYI
ThI 15" tIM --..lty non-p.rUc1p.tJon PMIIlty .. coaputld an the tot.l of thl ... Ind Int.,...t ......ed, Ind not
p.ld befar. "'lnUIty I', I"', thI fl,..t d., .ft.,. thI and 0' the t.. eMI.b period.
INTDOTI
Int.,...t II charged beglnnl,... ..lth fint dly of dellnquenc" 0,. nl.,. (9) aonth. IIr'ld one ct) lilt, fr~ the at. of
dNth, to the d,t. of p.,..,..t. T.... which 1Mc_ cMlInquent bIIfor. JlnWlr, 1, 1982 bear Int.,...t .t the ,..t. 0'
... (0) "rc~t per ..... c.lcul.tlel .t . dllh nt. of .00al". All t.... which _.. dllInquent on and .ft.r
JInuI,.y I, I"l will ~t Int.t..t .t . r.t. which ..Ill v.r, froe c.llnd'r y..t to c.lendar ".r ..Ith thlt r.t.
InnOUnCId by the PA Dep.rt-.nt a' R.v~. The ~llclbl. lnt.r..t r.t.. fot 19.2 through 1997 .r"
v.., Int.,...t R.t. D.ll, Int.t..t 'ICtO,. V.., Int.r..t R.t. D.llw Int.,...t Feeto,.
1911 'OX .000541 1917 'X .000247
I'" 162 .0I0Ut 1'11-1"1 IIX .aOOnl
1'14 IIX .GGOIOl I"' .. .000'47
1915 IU .000156 1"1-1994 n .0aOltz
UN lOX .010274 1995-1997 .. .000247
.-Int.t..t l, c.lculated a. follow.,
IIITERElIT . BALANCE OF TAX UNPAID X NVKIER OF DAYS DELIHQUEHT X DAILY IICTEIIEaT FACTOR
--Any Notlca ,.1UId .ft.r thI t.. ~. delinquent will r.fleet an Int.r..t c.lculatlon to '1ft"" (15) day.
blrond the dat. of thI .........t. If P'YNnt .. ... .ftar the Int.,...t cOllPUt.t1an dlta shown an the
Hotlc., IddltlDnll Int.t..t au.t be c.lculetld.