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COMMONWEALTH OF PENNSY~HIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
1WoC0It:iUDlHf""-~
t. Fred C. Hers
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DWD/M,lrch 4. 1993/20148
ACKNOWLEI>GI\IENT
COMMONWEALTH OF PENNSYLVANIA
:ss:
COUNTY OF CUMBERLAND
I. FREDERICK C. MYERS. Testatur. whuse name is signed tu the furegoing instrument. having
been duly qualified accurding tu law. du herehy acknuwledge that I signed and executed the instrument as
my Last Will and Testament: that I signed it willingly: and that I signed it as my free and vuluntary act for
the purpuses therein expressed.
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Frederick C. Myer/
Swurn ur affirmed to and acknuwledged hefore me. hy Frederick C. Myers. the Testator. this Sf:1
day of II/au') . 1993.
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Register of Wills Office
Cunberland County Courthouse
1 Courthouse Square
FR()~I
Carlisle. PA 17013-3387
JOHNSON, DUFFIE, STEWART & WEIDNER
Attorneys at Law
P.O. Box 109
LEMOYNE. PA 17043
SUBJECT: Estate of Frederick C. Myers
FOLD +
21-96-0290
DATE: 10/1/96
Enclosed for filing in the above-captioned Estate are the following:
1. Original Inventory.
2. Original and Copy of Inheritance Tax Return.
3. Check in the amount of $25.00, filing charges.
4. Check in the amount of $1,644.79, Inheritance Tax balance.
PLEASE REPLY TO
.
SIGNED
David W. DeLuce
csh
REPLY
DATE:
SIGNED
RlIOtdel'"em .F210 Gta1Jrc. PO Do. 2')44, Hat1lOtd_ CT 06104 2'94.
"'GI.l"'.Pm""~US' THIS COPY FOR PERSON ADDRESSED
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lAW OffiCES
JOHNSON. DUFFIE. STEWART 61 WEIDNER
301 MARKET STREET
P. O. BOX 109
LEMOYNE. PENNSYLVANIA 17043'0109
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REGISTER OF WILLS OFFICE
CUMBERLAND COUNTY COURTHOUSE
1 COURTHOUSE SQUARE
CARLISLE PA 17013-3387
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STNI'E 01-' ~'I,OIl1 I>A
COUN'l'Y OF
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CIl<Jrlotte Allison ,mel .John All iHon
being duly S\\orn according 10 raw, depos.. and say. Ihal they, o1re Executrix ,mel
Expcutnr 01 tho Eslalo 01 FrL~lerick C. Myers d/k/d FrL'C! C. Myers
lalo 01 __Si I ver .!?nri!ill_:r~ship _ , Cumberland County, Pa., decoased and that tho
within Is an lnvenlory modo by ChdrIotte AI lison & John Allison , tho said Executrix & Executor
ollh.. entire estale 01 said decedont, consisting 01 all the personal prop.rty and real OItale, except real .stat. outside
tho Commonweallh or Pennsylvania, and that Iho ligur.s opposito oach itom 01 the Inventory r.pr.sent it's lair value
.s 01 the dale 01 decedont's dealh.
Sworn to
and subscribed belore mo,
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~ 1996
dl-t: A, / (/LC~."^:'
(/' Eucul'r_'~lU(
JaiN ALLISON
f.~ /df,- ,,:./, IIU,.;;""
C1IARL01"m ALI.!SON, EXECUTRIX
7864 Oak Porest I>rive, Plordl City, Plorida
..ddr... 34436
1/
MAR',f,;
...~v p,,~ MARGARET L.OENSMORE
'" A<:' COMMISSION - CC 395001
::: ~ EXPIRESAua 17,1990
~ ~ UONDEO l~RU
"(tJ! ~\.<.f AflANTtC BON01NGCO.IINC.
Date oi Death
2nd
April
Month
1996
O'Y
Yea,
INSTRUCTIONS
I. An inventory must be fIIod within throo months after appointment 01 personal representative.
2. A supplement inventory must bo filed within thirty days of discovery of additional assets.
3. Additional shoots may be attached as to personalty or realty
4. See Artiele IV, Fiduciarios Act 011'14'1.
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'lOR DAt1501 DIATH AnlR \213119\ CHICK IilRl
II A SPOUSAL
POYlRlT CRlDIlIS CLAIMID CJ
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'rILl NUMBlR
20. If line lq is greater than line 18. enler Ihe diHerence on line 20. This is the OVERPAYMENT.
aD
21. If line 18 is greater than line lq. enler Ihe diHerence on line 21. This is Ihe TAX DUE.
A. Enler the inler"t on the balance due on line 21 A.
It En"r th.tolal of line 21 and 21A on line 21B. This is lhe BALANCE DUE.
Make Check Payable to: Regls'e, of Willi, Agent
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH -<-<
Under penall;e, 01 peri"'Y, I declare .ha.l ha,e e,amined ,h;, re.u'n. ;ndud;ng oCtompany;ng "hedule, and "a.e",en... and '0 ,he b,,' 01 my Inawledge ond beliel,
it;, true, co"e" and comple.e.1 deda,e ,ho' all reol,,'ale ha, been repo'led a' true ",0,101 ,alue Deda,a.;an 01 p..pa... a'he' .han ,he pe"onal repre,en,a,,,e i,
based on 011 information of whIch prepare' has any knowledge.
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.......",;,: 1'"./(>, ,/{;. '.. FlOrdl City, Florid<l 34436 ;./,'- ^ f. 1....le.
'rz'O" ';,.. d'G :'"'' ";~~'";"'~1~~:"i^Slib4';:oY09""I09_ -= ";(- 1ft -=
. .I uce
INHERITANCE TAX RETURN
RESIDENT DECEDENT
cOMMO........llHO. .."..,"....'. (TO BE FILED IN DUPLICATE 2\
DVdY""fN1 o~ ~[VHjUf
H.",,~J:b ~~o~:"o"':. ._.' __~ITH REGISTER OF WIL~~I___ ,CQU,,'HQDE
lCEC"'NlI N'M' ,..., .,,,' .,.0.'00>1 .",1,.., ,"'''''' '" ;...." oe"""
MYERS, FREDEIUCK C. iJ/k/iJ MYEllS, FRlm c. 122 wU low Mill I'<lrk lloild
IOC'" "Cu"" ..U.'" \0'" o. 0"'. ML>ehanicsburg. I'^ 170.55
171-0.7-1592 c,.... ClJolllElU/lND
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96
0.290.
NUMH~
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vEA.R
c:: 2
Supplemental Return
3 Remainder Return
{lor dOl" of deolh prior to 12.\).,2\
Federal Eslate To.. A..lurn Requ;'.~
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~ 1. Original Return
o oS limiled E'lole G.sa Fulure In",.,1 ComprorTme
(for dOlllS of death ohllr 12.12.821
~ 6 Decedent Oied T"IOI, = 7 Decedent Maintained 0 lIving Tru,!
(Attach copy of Willl (Anock copy of Trusl)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECteD TO:
N,l,lol! \'CM'\lT( ..u,lllt<l.:i .loCC1l\J .
David W. DeLuce. Esquire I JohnSOn. OUtde, stewart & Weidner
",,,.0'" "u..., . 30.1 Market st., P. O. \lolC 10.9
761-4540. Leroyne, !'^ 170.43-0.10.9
I. Reol El.ate (S,hedule AI III _.2lr9DD.O'D,..------
2. Sloch and Bonds (Sci'\edule Bl 1'2 I
3. Clo,ely Held StoCk/Partnership Interest (Schedule C) ( 3 )
A. Mortgages and NotlS Receivable (Schedule 0) (.t )
s. Cosh, Bonk Deposits & Miscelloneoul Penenol Prop.rty I S I
(S,h.dule E)
6. Jointly Owned Property (Schedule f)
7. T,a"III' (S,h.dule C;) (S,htdul. II
8. Tolal Gron AnelS (total lines 1.7)
q. Funeral ElI.penses, Administrative Costs, Miscellaneous
Exptnses (Schedule H)
10. Debts. Mortgage liabilities. liens (Schedule I)
". Tolol Deductions (Iotal Lines q & 101
C::S
_ 8 TOlol Number of Safe Depos.t 150.1."
-.
34.681.50.
to)
(7)
(S I
87,681.50.
(Q)
11,966.59
1,591.78
(1I) 13,558.37
(12) 74.123.13
(13) -0.-
(l4) 74,123.13
X._= -o-
x .06 = -0.-
x .15 = 11,118.47
(IS) 11,118.47
(lQ) 9,473.68
(20)
121} 1,644.79
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(2181
(10)
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12. Net Value of Estote (lint 8 minus line 11)
13. Chorilable and Governmental Bequests (Schedule J)
14. Net Value Subject to Tall. (Line 12 minus line 13)
15. Spousal Transfers (for dales of dealh oher 6.30.Q41
See Instructions for Applicable Percentage on Revene
Side. (Include values from Schedule K or Schedule M.)
16. Amount of line 1.1 tall.cble at 6% role
(Include values from Schedule K or Schedule M.l
17. Amount of line 14 ta.able at '5~,b rote
(Include value, from Schedule K or Schedule M.l
lB. Principal tOll. due (Add tOll. from lines 15. 16 and 17.)
tQ. Credits Spousal PO'l'erty Credit Prior Payments
+ 9.0.0.0..0.0.
Di,count
+ 473.68
Intere,t
(IS)
(10)
(17) 74,123.13
. uv.f502 U. 11).151
*
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RUURN
R[SIDENT DICEDENT
SCHEDULE A
REAL ESTATE
FILE NUMBER
21-96-0290
ESTATE OF
MYERS, FREDERICK C. a/k/a MYERS, FRED C.
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\P,apotlv 'alnlly.awnod wllh Right a'Sur.l.a"hlp mu.t bo dlula..d on Schodulo Fl All ,,01 "Iato .hauld bo "pa,tod 0"01, markot .aluo
which I. doflnod a. tho price at which property would bo oxchangod botwttn a willing buyer and a willing ..lIer, nollher bolng campollod
t~l'~1' ~r.,!!I,-""."'-.~a~!~g ."a.anablo knawlodgoa'. tho "Io.ant 'ach.
ITEM
NUMBER
VALUE AT DATE
OF DEATH
DESCRIPTION
-.------.-.-. _._.~._.__....._.._-
1.
Real Estate - No. 122 Willow Mill Park Road, Silver
Spring Township, CUmberland County,
Pennsylvania.
(Deed Book "M" Volume 13, Page 159)
SALE PRICE
(Copy of Settlement Sheet attached)
$ 53,000.00
. .._._T~!~L_IAI.a. o.nl,,_ on l~n!.l..Rocapilu~alio~L.._ __
'If more space is ne&ded, inserl addifional sheels a( same size.J
mL~
53,000.00
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';tlllt 1.1' III 'jl^,1 1.11111
i. S[ftLcMcrnCIlAI1GE9 121{j'IG--------..-
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Fld. Cert. York
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itEMS nEQUIRED BY LEIIDEn TO OE PAID III ADVArICE
1,,101111,1 110m 08/2f796 lu08/TI796 \Is.
MOIIglIQO IrliUIlIllcn f'1fIf1l1WIl IIll IlIU In G E.
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1000 RESERVED DEPOSITED WI1ft LEflCEA FOn
1001 Ilnlnld III~U'nIICfl 1 Illl). 0 S.
IOO'} MOIIlJo1go IIlIUIOIICU 1 1110 0 S
00.1 Clly!fo'Ml 11Il r:lO 0 S
00.1 Counly lrtK 6 Inn 0 S
oos ^uonlntlnl'J 11I11 0 S.
1000 School Tax 2 11I0 01
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hOOll 1\agr1\djunt 11I0 Q S
fiioo llTlE cnAnoES
Bntate r'1urtg~ge
Bntilte r-tort1nqc
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Federal Silvillgn
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'101 SlIl1IfltlllllllOl CIoSIflU lonlo
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10) I,U""K.1l11illnlollll 10
110" 1,110 In~UI"nC8 blfldo' 10
I~ OOCUlnl'llll ploporo!JOIl 10
lIOf! Nolalrl"el 10
110' AlIolnlty'.lIlOl In
l,"cludl'll above Ileml No:)
110l! l,U,lnsUlnIlCo 10
(lficlodol nhovfl ilolllt No ,
1109 lMldnl'. cavlllaue S
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1100 OOVEnllMEHT RECOnDItlO ArlO tRA'ISFER CHAROE!!
:'OllloclIllltngloo!\. OnndS 23.50 f.lolltlaol'lS 35.50
';002 Cllyfcol.lnlyl.u,#lnmps Olllld S 530. OOMOlllI:1!11'l S
'201 51alnl.,./sI1llIlll'l 0""11 S 530. OUMml{J:1111'l S
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Cash
Jameo M. Baucll, Eoo.
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375.00
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50,300
53,OUO
Secure Law" Trallolero
JUO.O.1.710.BR
Secured Laud TrmlOters
Secured Land Trmu;[ern
467.00
",~~'?; ....t.,\ ,',',: .
'..:.' . ..".,:;. .'.' ;:/;:,:. ~:,; ''''.'. .
11.00
35.UU
f,"'.c$
59.00
530.00
53U.UO
100
""
""
,"',
''''.
'>os
h..oo tOTAL SETTLEMENT CHARGES ItlOtnl nn 10111I' IOJ .....J w'}. tncliOIl'lJtllld 1<1
ADDI1IOItAL SETTLEMENT CIfAROES
SUNIlV 10
fln~IIIi'lPOC"OIl 10
\~tr. Tat
, 96Sch.Tax
peotex
Johnson Lab
Debra B. Wleat
35.00
79.00
590.35
2199.86
4340.35
r."..., .!r..'"'' ~",.,,,,,,".'~I'l' !;..11I.....", "11""""""" 't. ....~, '''''''_.1.... 10""""".1 I.,..."".... "M'''' ....'h..III/l11 !;.ll_.~' !;I.I_". 1:.11........"'...l/"hll....I.' "'I~n..,
.--. "...."".. """'I",d ..., ..........,. .....,,11<1 ,... '''''~''''''''',,' .,.~ ""~'.'II"""''1I.'' ......1... .,........'" ..,...."l ...14..1.... ....11... ....'"' .~, ...,..... "" ."h.ot 'n II........ .....hl.' .'.."'..~.,
~"."r-..,....I................"...I.......'....
'nl\tIt!OI'I'"r"ccO\"'ll1rm"lnll~'IIII""Clion
..:$, jJ{ '-<<Mill I--rr;M.."
n...,.....lI...."_..r""'..t.....
11","'.11"......".."..-
0:...... ~ ~.,...!."..
...."". ~ ,.... .....I."~~" .,_.....
u_ ,.J. JJ.._"~"7'-I"'''' ",,"'r\~" .,.....,.. ,.... .,,~'""~ ,...", ""7'- .... :::...rt ."...11 .._...... If,. ,.....to I.. I.. .I..bt......ot.. .... '~.h..... .4'. lit.. .,'.....,....,
l'tl.lu...""L ( -' ift, /t(/ ' A y(.
,*,11ooo,tt",,,t/"ttI /1 II.'.
"'''mlllm hit........ ,It ./tn.....,.,. ....... h!tot ,...,.......... '..1.... "~....I ~~.,...." 1""", ..., "".4..1_ 1.....I...~ "I"''' I .~". I..... '... "".vtoo. ,......., ...,.._..... I... ot.u", U.
.."'..u,.c.:_r....I.....no'I.'..I~I....I010. l'II.,'........'.r.
I!VUOIlh fll1J
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Ploos. Print or Ty .
FILE NUMBER
21-96-0290
~:J~:~t\
-!fH~
COMMONWEAlTH Of 'ENNSYlVANIA
INHllnANCI fAX .nUIN
IUIDIN'DICIDIN'
ESTATE OF
MYERS, rnEDERICK C. a/k/a MYERS, rnED C.
(All prop.rt., lolntly..own.d with the Righi o. SurvivorshIp must b. dlsclos.d on Sch.dul. F)
ITEM
NUMBER
VALUE AT
DATE OF DEATH
DESCRIPTION
1.
2.
3.
4.
1990 Pontiac Grand Prix - sold at auction - sale price
1992 Topline Trailer - sold at auction - sale price
Household Goods - sold at auction
Dauphin Deposit Bank & Trust Company
Checking Account No. 33-39474-1 - date of death balance,
plus accrued interest.
Masonic Homes - refund
Suburban Propane - refund
Commonwealth of Pennsylvania - property tax rebate
Holy Spirit Hospital - refund
Physicians Alliance - refund
AllState - fire & liability coverage - refund
6,600.00
340.00
5,183.50
5.
22,210.81
50.00
72.86
111.05
12.00
25.28
76.00
6.
7.
8.
9.
10.
TOTAL (Also .ntor on lino 5, Roeo ilulotion) S
34.681.50
IAnoch additional 8VJ" )( 11" sh."s if mare spoce Is n..d,d.)
, ..
Ilvl)nt.. 1'"1
.
Il~'!~:~l\
--uo-
COMMONWU\1H 01 '(NN~nVA.NI'"
INHUITANCllAlll1UIN
.UIOEN'DECEDINT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
ESTATE OF
ITEM
NUMBER
Plea.. Print or Type
FILE NUMBER
21-96-0290
MYERS, FREDERICK C. a/k/a MYERS, FRED C.
DESCRIPTION
1.
A. Funoral Expens..:
1.
B. Administrative Casts:
2.
Personal Reprosenlal;ve Commissions
Social Security Number of Personal Represenlalive:
Vear Commissions paid
Allorney Fees - Johnson, Duffie, Stewart & Weidner
3. Family Exemption
Claimanl
.4.
C.
\,
2,
3.
.4.
5.
6.
7.
8.
Relationship
Address of Claimant 01 decedent's dealh
51reel Address
City
Slate
Zip Code
Probale Fees - Register of Wills - Cumberland County
Miscellaneous Expenses:
Cumberland Law Journal - advertising letters
The Patriot-News Co. - advertising letters
Register of Wills - short certificates
Register of Wills - file Inventory & Inheritance Tax Return
Keystone Oil - delivery 4/4/96
John & Charlotte Allison - reimbursement for airfare fran
Florida to PA and return - 4/3/96 - 4/8/96
John & Charlotte Allison - travel to and fran Tanpa Airport:
airport: parking - 4/3/96 - 4/8/96
Bell Atlantic-PA - final telephone service charges
(Sub-total fran additional sheet)
TOTAL (Also enler on line 9. Recapitulation)
(II more space Is noeded, Insert additional sheets 01 same size,)
AMOUNT
-0-
4,900.00
226.00
60.00
75.10
9.00
25.00
89.01
744.00
72.25
23.99
5,742.24
S 1l.966.59
...
'...--'
- ~- -...::'_-.---.-----....)14.11 t. _ T -r'oo-"
,
'.
SOIEOOLE H - aNl'INUED
Estate of: MYEIlS. ffiEDERICK C. alkla MYEIlS, ffiED C.
21-96-0290
c. MiscellaneOUS ExpenSeS, Continued:
9. John & Charlotte Allison - Mileage - driving fran
Florida to Mechanicsburg, PA and return - 4/26/96
and May 6, 1996 - 2,020 miles @ .31 per mile
(preparing real estate for sale and the household
goods for auction); motel charges - Canfort Inn West
5/1/96 to 5/4/96 after household goods were sold.
850.72
10. John & Charlotte Allison - reimbursement for postage -
mailings (Florida to PA): reimbursement for telephone
calls (Florida to pA).
185.39
11. Pennsylvania Power & Light - electric service -
3/14/96 to 8/23/96
61.47
12. AllState - fire & Liability coverage - 122 Willow Mill
Park Road
153.00
13. Debra Bashore Wiest. Tax Collector - real estate taxes
122 Willow Mill Park Road - County/Township
173.19
14. Real Estate Taxes - School - due fran 7/1/96 to
8/23/96, date property sold
15. Jack Gaughen, Realtor - commission - sale of 122 Willow
Mill Park Road property
78.47
3,180.00
5.00
35.00
16. Notary Fees - settlement documents
17. Se=ed Land Transfers - disbursement Fee
18. Gilbert T. Beamer - maintenance of the property. house
& mail before & after decedent's death until
the property was sold.
19. Recorder of Deeds - 1% transfer tax - sale of
122 willow Mill Park Road property
340.00
530.00
150.00
20. Reserve for close-out costs
sub-total
$
5,742.24
uv.lJUlhlUJI
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
PI.a.. PrInt or Typ.
FILE NUMBER
21-96-0290
CQM."'ONwl&~t" O' 'INN"W&NI&
IN"III'&H(I J,l,1 IlIUIN
IIIIOIN10lCI0INI
ESTATE OF
MYERS, mmERICK C. a/k/a MYERS, FRID C.
AMOUNT
ITEM
NUMBER DESCRIPTION
1. Internists of Central P/\ - decedent's account balance,
not covered by insurance
75.42
2. Robert L. Shindler, M.D. - decedent's account balance,
not covered by insurance
216.98
3. Masonic Homes - decedent's account balance - 8 days -
medication/telephone/dry cleaning
1.299.38
TOTAL (Aha enlOr on line 10, Recapitulation)
(II more spoce is needed, insert additional sheets of some size.)
$ 1,591.78
......
.1~llt1UI""1
146812 COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
ttk
o NO. AA
RECEIVED FROM: a
ACN
ASSESSMENT r:'I
CONTROL ~
NUMBER
AMOUNT
O"VIIl W DE LUCE ["QUinE
PO DOX 10'/
101
$1,6/14. 79
LEMOYNE. pn 17043
J_'OtDHflr
,
ESTATE INFORMATION:
!:II filE NUMBER
~ 21-1996-()290
m NAME Of DECEDENT (LAST]
~ MYERS FREDERICK C
II DATE Of PAYMENT
EJ POSTMARK DATE
COUNTY
SSN
(fIRSTI
171-07-159i!
(Mil
CUMBERLAND
DATE Of DEATH
I
m TOTAL AMOUNT PAID
SEAL
CHNlLOTTE ALL I SON ETAL
c/o DAVID W DE LUCE
CHECK!I 110
./-j
\ "
'I
RECEIVED BY ;' I ,',
$J ,61111.79
DO
REMARKS
REGISTER OF WILLS
,"
. alC~N",ullf
,
" .
MARY C. LEWIS ~~,
REGISTER OF WILLS
,. /
.......;
.. - .,......~
""'" -N.'" .--~.. v . ~:.
f,-. f/'., -- Ii)
,... ... ...
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INOIVIDUAL TAKES
.,.€RlTlHCE TAX DIVISION
DEPf. ZII0601
HAARlSIURC, PI 111Z8.06Dl
NOTICE OF INHERITANCE TAK
APPRAISEMENT, ALLOWANCE OR OISALLOWANCE
OF OEDUCTIONS AND ASSESSMENT OF TAX
DAVID W DELUCE
JOHNSON ET AL
PO BOX 109
LEMOYNE
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
ESQ
PA 17043
01-28-97
HYERS
04-02-96
21 96-0290
CUMBERLAND
101
A.aunt H..ttt.d
*
In.l..-'''''' ClI.".
FREDERICK C
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 ....
iiE'v:is'4TEiCAf'p--fIF96Y-NoTlcE--oF-YNHEifli'ANcE-"-AiniPPRA"isEHENi'-,--Aii.-owA'N-cri:iIi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MVERS FREDERICK C FILE NO. 21 96-0290 ACN 101 DATE 01-28-97
I~ an assessment was issued previously, lines 14, IS and/or 16, 17 and 18 will
reflect ~igures that include the total o~ abh returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Lin_ 14 .t Spousal ~.t. (15)
16. ADOunt of Lina 14 taxable .t Lin..I/CI... A rat. (16)
17. A.ount of Lina 14 taxable .t Collateral/CI... Brat. (17)
18. Principal rax Due
TAX CREDITS:
PAYMENT
DATE
06-20-96
10-01-96
TAX RETURN WAS: I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I Est.t. (Schedule A) (11
2. Stock. and Bond. ISchedule B) 121
3. Clos.ly Hald stock/Partnership Int.r.st (Schedule C) (3)
4. Hortgag..IHot.. Receivable (Schedule OJ (4)
S. Cash/Sank Deposits/Hisc. Parsonal Property (Schedule E) 15)
6. Jointly Owned Property ISchedule F) (6)
7. Transfers (Schedule G) (7)
8. Total AI.et.
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad.. COlts/HI.c. Expenses (Schedule H) (9)
10. Debts/Hortgage liabilitie./liens (Schedule I) (10)
11. Tot.l Deduction.
12. Net Value of Tax Return
13. Ch.ritable/Govern.ent.l Bequ..t. ISchedule J)
14. N.t Value of E.tate Subject to Tax
NOTE:
RECEIPT
NUHBER
AA112966
AA146812
DISCOUNT 1+1
INTEREST I-I
473.6B
.00
) CHANGED
53.000.00
.00
.00
.00
34 .681. 50
.00
.00
IB)
11,966.59
1.591.78
1111
1121
1131
1141
.00 X,OO=
.00 X .06=
74,123.13 X .15=
I1B)
AHOUNT PAID
9,000.00
1,644.79
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To In.ure proper
credit to your account,
.ub.lt the upp.r portion
of thl. for. with your
t.x pay.ent.
87,681.50
13.~~R 37
74,123.13
.00
74.123.13
.00
.00
11,118.47
l1,l1B.47
11,118,47
.00
.00
,00
I IF TOTAL DUE IS LESS TNAN .1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
,:'"''
,...,.
n
.,
I..
,:;
'91 J/\il 24 l' 1 :c 8
Ck.!
Cun
.
. I~
RESERVATION: E,t.t.. of dtcedent, dying on or before Dec.-ber IZ, 1982 ~~ If eny future Int.r..t In the I,'et. I, tren.flrred
In pa.....lon or enJov.-nt to el... II (cal1at,rell ben.flclar... of the dlc.o.nt a,t.r the IMp.retlon of eny ..tat. for
llf. or for y..t., the Co..onw..lth hat.by Ixpr.,.ly rll.rv.. thl rluht to appral'l and ...... tranl'.r Inheritance 'IMI.
at thl lawful el... II (coll,t.reD rat. on any such future Int.r..t.
PIJlI'OS€ Of
NOTIct: To fulf1l1 t.he ,",,It''''''1 of SKUon Z14D of the; Inhllr!tBnCI and Elt.t. Tax &ct, Act ZZ 0' 1991. 72 P.S.
StetSon ZIU.
PAVItEHT: a_tach tM top portJon 0' thl. NoUn and .ub,1t with YOUr' pay,."t to the; Rqllt.r of wllh printed on the t.v.r.. side.
.."8'" cheek or .oMy ord.r payable tal REGISTER OF HILLS, AGENT
All ply,."t. received shill flr.t bl ItPpUad to any Int.r..t which '.y b. dul with any r...l"r appU.d to the ta..
REF1.IaJ (CAh A r.fund of a taJC crecl1t, Nhlch w.. not ra~1t1Kl on the Ta. Raturn, ..y tMI requa.tlKl by c~lat1ng an "AppIlClltlan
far R.fund of Penn,ylvanla Inherltllf'lC. and E.tata Ta." (REV-UU). AppUcatlon. ara ItVIIllabh at tM Offlu
of tn. Ragl.ter of Willi, eny of the Z1 Revenue DI.trlct Off Ie.., or by call1na the apecl.1 Z'-hour
en....rlna ..rvlc. nuaber. far far.. ordering: In Pann.ylvenl. 1-100-S6Z-Z050, auttlde Pennlylv.,la I!lnd
within lacal Harrisburg ar.a (717) 7117.IOlM, TDD. (717) 71Z-ZZ5Z O".rlna llIp.lred Only).
OBJECTIONS: Any p.rty In Int.r..t not .atl.fl.d with the appr.I...ant, .llownnc. or dl..llowanc. of deductlonl, or .......ent
of taM Ilncludlng dl.count or Int.r..t) a. shown on thl. Notlc. ~.t obJ.ct within .I.ty (60) d.y. of r.c.lpt of
thlt Notlc. bYI
--written pratut to tM PA Depart...,t of R.VW1Ua, Bo.rd of App...., Dept. 211021, Harrisburg, PA 17128-1021, OR
-".IHtlon to have the ..tt.r det.ralnact .t audit of tM account of tM ~rsonal rapruantatlv., OR
--appeal to the Orph.,.' Court.
A[)tUN
ISlAATlYE
CORRECTIONS I
factuel .rror. dl.cov.red on thl. .........,t should be addr...ed In writing to: PA D.p.rtaent of R.v~,
Buraau of Indlvldu.l lax.., ATTNI Pa.t A.....eent R.vlew unit, Dept. Z80601, H.rrlsburg, PA 171Z8-0601
Phone (717) 187-6505. Sea P8Q8 5 of the bookl.t "In.tructlon. for Inherltanc. l.. R.turn far. R..ldant
Decadent" (REV-1501) far an .xplanatlon of adalnl.tratlv.lY carrHtabl. .rror..
DISCOUNTI
If any taM due I. p.ld within thr.. (]) c.lendar .unth. .ftar the decadent'. death, a flv. p.rcent (5%) discount of
the tax pald l. .llowed.
PENAL TV I
The 15% tax ..,..ty non-participation panalty It caputed on the tattl of the tax end Interut ......ed, end not
p.ld bafare January It, 1996, the flr.t d.y aftar the and of the tax ~.ty ~rlod. This non-participation
p.....lty Is app..labla In the .IMB .arner and In the the s... U.. p.rlod a. yau would appe.1 the taM end Int.re.t
th.t hu been ......ad .. Indicated on this notlu.
INTEREST I
Int.ra.t I. charged tMlQlnnlng with first day of d.llnquency, or nh_ (9) aonth. and 0fW n) day frOll the data of
death, to the det. of papant. TUII which bee... d.UnquMt baifar. JlltlUllry 1, 19IZ bear Int.rut at the rate of
.1M (6%) percent per IIfV1Ua calculated at a daily r.t. of .000164. All t.xu Nhlch beceM dellnqlJWlt on ... aftar
Janu.ry I, 198Z will b.ar Intara.t .t a rat. Nhlch will vary frOll calend.r y.ar to calendar y..r with that r.ta
announced by the PA o.partaant of R.venue. The appllcabl. Int.r..t rate. far 198Z through 1991 .ra.
'!!!! Int.rut Rat. D.l1y Intarut Fector !!!!! Int.r..t R.t. DailY Int.r..t Fector
198Z ZOX .000~8 1987 'X .0002'"
1911 lOX .OOOUII 19&8-1991 IIX .000301
19.. IIX .000101 ,... 'X .0002'"
1985 U% .000356 199]-1994 n .000192
I'" lOX .GOU7" 1995-1991 OX .OOOZ'"
--Intar..t Is calcul.ted .. fallow..
INTEREST ~ BALANCE Dr TAX UNPAID X HUKBER Dr DAYS DELINQUENT X DAILY INTEREST rACTOR
--Any Natlca I..ued aft.r the tax bacoaa. delinquent will r.flect ., Intarut calculaUon to flft"" CIS) days
b.yond the data of the .........t. If p..,.."t Is .acta afhr the Int.rut caput.Uon data shown on the
Hatln, additional Int.rut -..t be calculated.
...- -..-- ..-- .- -.. - - .-
---..,......-~-
.~lI62lXl....1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT O' REVENUE
OffiCIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
.b
UNO. AA 1'\ 2966
RECEIVED FROM:
i
ACN
ASSESSMENT IT!
CONTROL iii
NUMBER
AMOUNT
DAVID DELUCE ESQUIRE
1..)1
~.,.vvv.uO
POBOX 109
U:::NOYNE, F'A 170"~~
I
!. 1010 HUl 1010 HU'-
ESTATE INfORMATION:
1:1 filE NUMBER
~ 21-1996-0290
1:1 NAME Of DECEDENT (LAST)
~ MYERS FREDERICK C
II DATE Of PAYMEN~
m POSTMARK DATE
COUNTY
S5N 17 I-07-15r,t!
(fiRST) (Mil
CU~IElERLAND
DATE Of DEATH
REMARKS
JOHN ALLISON,CHARLOTTE ALLISON
C/O DAVID DELUCE ESQ
CHECK II 110
fa TOTAL AMO~I'lT PAID
\
\
$9,000.00
V2
REGISTER OF WI LLS
". '--/
RECEIVED BY' I. ;1..
" SIGNA'UR'~ ~
, I
MARY C. LEWIS '
REGISTER OF WILLS
.l .~
SEAL
j,
..---
..~..Jllf.~ "".-tnr....":.