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21-96-477
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CO....ONWEALtH Of PENNSYLVANIA' DEPARTMENT OF HEALlH' VitAL RiCORDS
CERTIFICATE OF DEATH
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CERTIFICATION Of NOnCE UNDEHJ!l!!.E 5.6(a}
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Name of Decedent: ALL It III ,J
Date of Death: flL'/ ,l -( ( ) C/....
Will No. t ~14(" ~( ,( 'f Admin. No.
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To the Register:
I certify that notice of beneficial interest required by
Rule 5.6(a) of the orphans' t:ourt Rules was served on or mailed to
the followin9 bene fie iar ies of Lhe above-captioned estate on
-:r t/ tfI t! ('( (t( tfy :
Address
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Notice has now been given to all persons entitled thereto under ./
Rule 5.6(a} except
Date:
S-t" I( Y 4\~
Signature
Name /17K!12 6...
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Address ..1'- t( 7 '''1;f..1I
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Capacity: personal Representative
~ Counsel fo:" personal
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rOA OATIS or OIATH AnlA 12/31/91 CHICK HIAI
IF A SPOUSAL .
POVI." CAlOnlS CLAIMIO IJ
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
21-%-1,77
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COMMONW(Allllor r('lUS'l'IVAUIA
mrARIM[NIOf A[YWU(
Dr,. 280001
flARRI5IURO,'o4 1~_118 0601
OI(lOItl 's ru.M( IIAST. tillS. AND MIOOII '''IH''II
HAY, Allan D., .Jr. 671, Lnllre1 Drive
iocl...f1((uiii,tiUMiii'-~----- -1;;iif.OfOr..iH----~--I;;i"Oiiiii"-~~ Boi linl\ Snrinl\s, I'A 170()7
1711-42-0522 5-13-96 7-22-1,9 c.,", ClIl'1berlnnrl
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l~ 1. Original Relurn LI 2. Supplemental Relur" 'J 3. Remainder A.'uIn
(lor dales of death prior to 12.13.82)
[J A. limited estate [~J .40. Future Inletlll Compromite [I S. Federal E,'ote Tax Relurn Required
('0' dn'e, 01 deoth olte, 12.12.B21
06. Decedenl Died Tellale 0 7. Dacede"1 Maintained 0 living TruI'
(Allach copy 01 Willi (Alloch copy 01 Tru"l
A L CORRESPONDENCE AND CONFIDENTIA TAX INFOR ATION SHO LD BE DIRECTED TO. . .
20. If line 19 I. greater than line 19, enler the difference on line 20. Thl, " ,he OVERPAYMENT.
aD
21. If line 18 II grealer ,hon Line 19, enler the difference on line 21. Thl.II th, TAX DUE.
A. Enler the lnteres' on the balance due on line 21A.
B, Enter ,he 10'01 01 lI,. 21 ond 21A on line 210, Thl, II ,he BALANCE DUE.
Malee Chick Payabl. 10: RIgllt., of Will., Aglnt
!,-. ',oj, ~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MAT -1(, -c: ,;;, ,\......,,'.
Under penchies of perfury. I declar. that I ha.... examined this relurn, Including accompanying schedules and Ilolements, and 10 the bell of my ~nowledg. and belief,
it I, true, correct and complete. I declar. thol 011 real O1lole hos been reported at true market yolue. Declaration of pre parer other Ihan Ihe personal represenloli.... 11
based on olllnformalion a' which preparer has any ~nowledge.
,~~' '. """; ;'.'~'il#""'"OO if' .a.:;;,~" 7 ,: '~:; d~:'i';r1v~:: """ "",in, 'on 1;',.;' 114 7
'f:;'t-J7i"': '// ~~Oiii~-__~-~---- PA 15068 DA2.(~' t:r'7
e i-Halters, '[II, ES'1l1ire 5/l East Ilain St., Ilechanicsburl~, PA 17055
YEAR
COUNTY ceDE
-OI(lVI'-.I:~ (OMPlf1( ~uv~;i~\
NUMBER
_ 8. Total Number of Sof. Deposi! Boxes
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121 -0-
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III, Es<]uire
COM'1(1l MAIIIIlG "DC~(!lS
54 East Main Street
Hechanicsbllrl\, I'A 17055
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1. Real E.'ote (Schedule AI
2, Stock. and Bond. (Schedule BI
3. Clolely Held Sloc~/Porlnership Inlerell (Schedule C)
... MO'lgages and Nolel Recei...able (Schedule 0)
5. Cash, Bank Deposils & MllCellaneous Personal Properly
(Schedule EI
6. 10lnlly Owned Prop.rly (Schedule FI
7. T,on.le.. (Schedule GllSchedule II
8. Tolol Grall Ane.. (Iota I lines 1.71
9. Fun.rol Exp.nses, Admlnistrati.... COlli, Mlsc.llon.ous
hpen.e. (Schedule HI
10. D.bll, Mortgag. 1I0bililles, liens (Sch.dul. IJ
11. Total D.ductionl (Iolollln.s 9 & 10)
12. Net Value a' 'Eslole (line 8 minus Line 11)
13. Charitable and Goy.rnm.nlal B.qu.slI (Schedule J)
lA. Net Volu. Subj.c1lo Tax (line 12 minus lIn. 131
15. Spousal Transfers (lor dal.s of d.alh after 6.30.9")
S.e Inslructions for Ar,plicable Percentage on R.....,..
Side. (lnclud. yolu., rom Sch.dul. K or Sch.dule M.)
16. Amounl of lIn. lA lallable 01 6% role
(Include values from Schedule K or Schedule M.I
17. Amounl of Line lA tall able at 15% rol.
(Include ...alues from Sch.dul. K or Schedule M.)
18. Principal lox due (Add 101. from Lines 15, 16 and 17,)
19. Credill Spousal Poverty Cr.dit Prior Poym.nll
+
+
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(91 7,694.71
(101 7,392.47
(BI ~967.77
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Chec~ heu~ if you are requasling a refund of your ovcrpaymcnl.
3,232.8/1
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Act '48 of 1994 provides for the reductIon of the tax rates Imposed on the net value of transfers to or for
the use of the spouse. The rates as prescribed by the statute will be:
e 3% (.03) will be applicable for estales of decedenls dying on or after 7/1/94 and before 1/1/96
· 2% (.02) will be applicable for eslales of decedenls dyIng on or after 1/1/96 and before 1/1/97
· 1% (.01) will be applicable for eslales of decedents dyIng on or afler 1/1/97 and before 1/1/98
· Spousal transfers occurring on or after 1/1/98 will be exempt from Inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (....) IN THE APPROPRIATE BLOCKS.
YES ~Q._
1. Old decedent make a Iransfer and:
a. retain the use or income of the property transferred, .......................................................
b. retain the right 10 designate who shall use the property transferred or its income, ...............
x
X
X
X
t. ..
c. re arn a rever~lonary rnterest; or ...................................................................................
d. receive the promise for life of either paymenls, benefits or care' .......................................
2. If death occurred on or before December 12, 1982, did decedent within Iwo years preceding
death Iransfer property without receiving adequate consideration' If death occurred after
December 12, 1982, did decedent transfer property within one year of death without receiving
adequate consideration'........... ............ ....... ...... .......... .................................. ...................
3. Did decedent own an 'in trust for' bank account at his or her death"-....................................
X
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_ IF<;JHE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESr
Ycftf~",uSI. COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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COMMONWlAUH of ,[HH5'flVAH1^
INHERitANCE ,,,... R(lURN
R(5ID[,Hll?[C[Dt~1
EstAtE OF
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SCHEDULE A
REAL ESTATE
\
fiLE NUMBER
21-96-1,77
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!"..bu~.or ..!~,~o.!!' ho.l"-9 _roa.onablo knowlodoo 01 Iho .olo.onl loci..
ITEM
NUMBER
Allan D. Ray, Jr.
VAlUE AT DATE
OF DEATH
DESCRIPlION
1. Real Estate situate in Honroe Township,
Cumberland County, pennsylvania, known and
numbered as 671, Laurel Drive, Boiling
Springs, PA
46,760.02
net sale nrice
-...---- .--
lOTAL (Aho enUH on line t. Recopitulation)
(II mo.o ,,.oe. i, ...d.d, io,.,1 oddilioool ,hee" 01 ,ome ,ire.)
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46,760.02
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COMMOHWEAUIt Of PfUNSY1V^,"A
IHllERIlANCf tAX REtuRN
RESIDENt O[((Onlt
j
SCHEDULE H \
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
~I~CE_LL~~EOUS EXPEN~ES_L-._ .l'leaso p.ln! _0' Type
_ -FiifNUMiiER
ESTATE OF
----
21-96-/177
Allan D. Ray, Jr.
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ITEM
NUMBER
-- -.-..--..---......
A. Fune.al Expen...:
1.
2.
Malpe?zi Funeral Home
3,250.00
560.00
Greenwood Mernor.inl - f\r.ave (J1lening
1.
B. Admlnlst.atlve co.ts.
Renounced
3. Family Exemption
Claimant ___--------------- Relnlian,hip --
Add.e" 01 Claim ani 01 decedenl" doalh
Slroet Addre"
2.
A.
C.
1.
2.
3.
A.
5.
6.
7.
8.
Personal ReproscntolivD Commission,
Social Security Number of Pmsonal Rcpl(~'icnlotivc:
Year Commissions paid -'. ..
Allarney Fee,
l1urrel R. Halters, lII, Esquire
3,450.00
..____4__ .._____
---.--.--.- ----.-
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City ._--------- ____Slale ---.- Zip Cade____
Prabale Feel 300.00
Miscellaneous Expenses:
Cumberland Law Journal - estate notice publication 60.00
Carlisle Sentinel - estate notice publication 74.71
TOTAL (Aha onter an line Q, Recapilulatian) S 7,694.71
(II mo.e spoce Is needed, Insert additional sheets 01 same size.)
IIV""'" 1""1 o,~(l_ \ SCHEDULE I
~ DEBTS OF DECEDENT,
COM~~::I'::'~'I~~'O::.':'::l,:\:"'" MORTGAGE lIABlITIES AND LIENS
InlOW I OfCIDlIl1
-- - ._..~--_.,._." - --" - -_.-
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fILE NUMBER
21-96-1177
ESTATE Of
___--- __ ___ .___._ _ __ __d_ .._ __u..d---------- ---- .___u.-----.. -----.-------
Allnn \). Rnv, .11:.
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AMOUNT
ITEM
NUMBER
DESCRIPTION
---~
-~--_._---_.__._---------_.
1. St. Margaret lIospitnl _ merlicnl 8.88
2. MasterCnrl! _ credit card hnlnnce 311.70
3. United Telephone 114.17
4. Sprint _ long dis tnnce telephone 17.89
5. Metropolitan gdison - electric 771.57
6. Kurt Stahlfeld, M.D. - medical 5.00
7. Ernest Coleman, M.D. - medicnl 11.25
8. Monroe TOImshill _ se\~er 150.13
9. Harv t1urrny, Tax Collector - school real estate tax 1,521.74
10. Mary Murra'l, Tax Collector - countv/t\~n. real estate 355.85
tax
11. \o1hite Rock Hater 67.38
12. lIarris Savings _ mortgnge 3,26n.O~
13. Vascular Associates - medicn1 11.00
14. Pinnacle Health Systems - medical 5.02
15. Lawn care 200.00
17. Carlisle Hospital _ medical 820.89
----
TOT AL (Also enter on line 10. Recapitulalion)
$7,392.47
---------------- -
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(If mo,e space is needr.d insert oddilionol sheeh of some sizo)
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FILENUMBER
SCHEDULE J
BENEFICIARIES
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COMMOUVwtAWIOI rftnUI\VAUIA
INIII_nANtf tAll IIrUIN
InlDINI DltfO'NI
H-96-1,77
ESTATE OF
Allan D. Rav. Jr.
,---~ ------- ---
--- ------_._-~--------_._-
AMOUNT OR
SHARE OF ESTATE
RELATIONSHIP
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
-----------
----.- -"_..~-------- - ------~ -. - -- ------ ---- .--.--.-----------.-
A. T olloble Beque'h:
Muther
101)7.
1.
Kathryn 1lU\~ard Ray
766 Caldwell Avenue
New Kinsington, PA 15068
----- -----------
--~~ --. ----
- ----------.-
AMOUNT OR
SHARE OF ESTATE
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
--------. ------ ----- --.---------.-------------.
8. Charitable and Gavernmenlal Beque,":
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AI.o .nl., on Hn. 13. Recapi.ulotion) S
(If mar. spac. Is n..d.d, Ins.rl addltlonalsh.... of same sl1l1
IU I-IA"RRIS
D SAVIN<;S BANK
1I.I11b ~.I\lIli~l HIU 1.11l1l1l"~ 'IIIII'I
li:b 1'\llltll t:~lh ~\1I1'1'1
1."IIIII\III'.I'\"IIII:.\I\.III1,II';IIU
ili i:1I 1110
'lli "/:11 !U~f~ 1'.1\
Janaury 30, 1997
~urrel R. walters, III
54 lliSt ~\:Iin street
~b:hanicsOOrg I I'll 17055
The inrorrlo.tion whieh :'0U !'eq\le~te,1 on the !'"ccounl(:;) of
.1r. l'State (Zodnl 5cr.urity \Iumbcr 174_4?_O'i??
IIllan D. Ray I
) is n5 [0110\015.
/.ccount !lumber< s)
18_02_132706
Cln%:s of IIccOlmt
S\vinrJs
---
2-15-96
-
Do.le Ope nee
Principo.l Do.lnnce
$1,483.43
12.69
Accrued !nterest
Dalo.nce nt
Do.te of Death
1,496.12
--
Irrlividll.ll
Account
uwncr5hip
tb rerord of n safe dLTmit In><.
lIame or Joint
Owner, if nny
-
Dnle Ownershi!,
\1."1:1 t.stnblinheu
2-15-96
1'1Q."l5C haw U", 1:X""'\1l:or of this I":state sign the enclosed \~-9 ronn
return it 1:0 1111 in UlC (lI"ovi,1cd cllwlq.c. 'l\13n1< pt.
hd~ilionnl ]nror-
malion RC'1uc<:te(1
5incerdy,
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GreldlCn I.. Clle
5r. Ilctail /ldninistration SerVices Rep.
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"IiDIiH"!. CHED''!' IIN'()N
S\lARE SAVINGS ACCOUNT: 2
Account Number/Suffix llli!dl~ {;{;!l27-00
Date Opel1ed 1I-21-l.L- tl.::l.J=B7
Principal Balance at Ilate of Ileath Sl570.H6 Sllt70.%
Accrued Interest to Dale of Ileath $ I. 77 SLn
Name of Joint Owner, If any Nunc * NUlw I\-
Date Joint Ownership Created N/A N/A
I
I C\lECKING ACCOUNT:
I Account Number/Suffix 15116-11
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;/ Date Opened 6-10-76
Principal Balance at Ilate of Ileath S69.I,2
Accrued Interest to Date of Ileath $0
Name of Joint Owner, if any NUIlC! if
Date Joint Ownership Created N/A
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix 1 5116-05
Date Opened 9-14-95
Principal Balance at Ilate of Ileath $3594.46
Accrued Interest to Date of Ileath $2.44
Name of Joint Owner, if any Nonl!
Ilate Joint Ownership Created N/A
INDIVIDUAL RETIIlEMENT ACCOUNT:
Account Number/Suffix 15116-10 44927-10
Date Opened 1-19-82 4-13-87
Principal Balance at Ilate of Ileath $4970.92 S909'i.02
Accrued Interest to Ilate of Ileath $6.64 ~10.53
Name of Beneficiary Nuncv J.'. Ruv Nuncv F. Rav
Estate of Allan Il. Ruy Jr
Dute of Death 5-13-96
Social SecurJty No. 174-42-0522
.Iuly 17, 1996
Ilate
Ins C)ufms Supervisor
Title
* SEE BACK
5275 Hast Trilllf/c !load · ".0. nox.iO · Mcchani<:shurg. I'cnl1s)'II':lIlia 17055 . (717) (,1)7.11(,1
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185157 COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
.
.rv.It620 l....q
RECEIVED FROM:
&
ACN
ASSESSMENT r;'I
CONTROL i:,I
NUMBER
AMOUNT
MURREL R WALTERS 111 ESQUIRE
101
t3,t!!E.84
S4 EAST MAIN STREET
MECHANICSBURO, PA 17055
lOlDH",
ESTATE INFORMATION:
!II FilE NUMBER
U 21-1996-'0477
!II NAME OF DECEDENT ILAST)
~ RAY ALLAN D .TR
~ DATE OF PAYMENT
Iii 02 0/97
m POSTMARK 114TE
COUNTY
SSN 174-42-0522
(FIRST) (MI)
CUMBERLAND
DATE OF DEATH
05/13/96
REMARKS KATHRYN H flAY
C/O MURREL R WALTERS III ESQ
SEAL CHECK II 104
m TOTAL AMOUNT PAID
$3,232.84
SK
RECEIVED BY j,:' I" / -'~
~GNAf.uIlE
MARY C. LEWIB ,/-1;
REGISTER OF WILLS
,.>I/IF.
'j
) /1./
REGISTER OF WILLS
- - - - -- ~--- -."- - .. "--. - --.- .-_. -- ---- ------ _. -
--- ------ _.... ----- ..-- --.- .---. ---- ..._- - - -- -
-----
----
....---.r..~. ~ _ [-... -,:.
. -. ... ~.
/5- /rJ y.. /3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
L
~*,
111-lh'II."III-'"
ALLAN
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 ~
'R-EV:i54"i"EiCAFP-niF9'fj-NOYicE--OF-i-NHEiiii;itiCE-YAX-jippjiiiisEHE'Nr-,--ALi:oiiANCE-Ori-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF RAY ALLAN D FILE NO. 21 96-0477 ACN 101 DATE 04-28-97
BUREAU OF INDIVIDUAL TAXES
INUERltANCE tall DIVISION
D[Pf. ZUIIOl
HARRISBURC, PA l71~a-ObOl
NOTICE OF INIIERlTANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
MURREL R WALTERS III ESQ
54 E MAIN ST
MECHANICSBURG PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-28-97
RAY
05-13-96
21 96-0477
CUMBERLAND
101
Anount Re..itted
TAX RETURN WAS. (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Ro.l E.t.t. (Sch.dul. A) (1)
2. stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Pertnership Interest (Schedule C) (3)
4. HortDaDes/Note. Receivable ISchedule D) (4)
5. Cash/Bank Deposlts/Hisc. Personal Property ISchedule E) IS)
6. Jointly Owned Property (Schedule f) (6)
7. Transfers (Schedule G) (7)
a. Total Assets
) CHANGED
o
NOTE: To insure proper
credit to your account,
sub. It the upper portion
of thIs forn with your
tax paynent.
If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of LIne 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/CI.II A r.te (16)
17. A.ount of Line 14 taxable ~t Collateral/Clasl B rete (17)
18. PrincIpel Tax Due
46.760.02
.00
.00
.00
22.207.75
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expanses/Ada. Costl/Hilc. Expense. ISchedule H) (9)
10. D.bt./Hoctgog. Llobllltl../LI.n. (Sch.dul. I) (10)
11. Total DeductIons
12. N.t Value of Tax R.turn
13. Charitable/Governllentel Bequests ISchedule J)
14. Net Value of Eat.t. Subject to Tax
7.694.71
7.392.47
(111
U21
CUI
(4)
NOTE:
.00 X .00=
53,880.59 x' 06=
.00 X .15=
UBI
TAX CREDITS:
PAYHENT
DATE
02-10-97
DISCOUNT 1'1
INTEREST/PEN PAID (-)
.00
AHOUNT PAID
3,232.84
RECEIPT
NUHBER
AA185157
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
68.967.77
1~.n87 18
53,880.59
.00
53.880.59
.00
3.232.84
.00
3,232.84
3,232.84
.00
.00
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN .1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS. I
RESERVATIONs
PUR90SE OF
NOTICE:
PA'mENT,
REFUHD (tA J:
OBJECTIONS I
i
.,
!
i
!
AOftIN
ISTRATlVE
CORRECTIONS I
DISCOUNT:
PENAlTVr
INTEREST:
nrJ
".. .-
- .
'i.'
-I
..,.,
--: ;:.
:..
'0)
,.::;
E.tat.. of d.c.dent. dying on or b.for. o.c..b.r 11, 1'82 -- I' any 'utur. Int.r..t In ~ ..t.t. i,~tran".rr.d"
In po.....lon or enJoy.ant to CI... I (coll.t.r.l) b.n.flcl.rl.. of the d.c.d.nt a't.r the .Mplr.tta~ of any ..tat. for
Ilf. or 'or y.ar., the C~onw..lth h.r.by .Mpr...ly r...rv.. the right to appral.. and ...... tran.f.r Inherltanc. TaM.'
.t tn. lawful CI... I (coll.t.r.l) r.t. an any such future Int.r..t.
To fulfill tn. r.qulr...nt. of Section 21'0 of the Inh.rltanc. and E.t.t. Ta. Act, Act 21 0' 1'95. (7Z P.S.
Sactlon 9140).
Detach the tap portion of this Not lea .nd .ubelt with your pay..nt to the R.gI.t.r of Will. printed on the r.v.r.. .Id..
""ak. check or 80MIy ard.r Plyabl. tor REGISTER OF MILLS, AGENT
A r.'und of . t.M cr.dlt, which wa. not r.qu..t.d an the T.. R.turn, .ay b. r.que.t.d by ca.pl.tlng an "Appllc.tlon
for R.fund of Penn.Ylvanla Inh.rltanc. and E.tat. TaM" (REV-llll). Appllc.tlan. ar. av.llabl. at the Offlc.
of the Regl.t.r of Will., eny of the Zl R.venu. DI.trlct Dfflc.., or by calling tha .p.cl.l Z'-hour
an.werlng ..rvlc. ~.r. for for.. ard.rlngs In P.nn.ylvanla 1-800-16Z-Z050, out.ld. P.nn.ylvanla and
within local Harrl.burg are. (717) 787-80'4, TOO' (117) 77Z-225Z (He.rlng I.palrad Only).
Any party In Int.r..t not satl.fl.d with tha .ppr.I...ent, allowane. or dl..llowanca of deduction., or ......eant
of ta. (Including dl.count or Int.re.tl .. .hawn on thl. Natle. lU.t obJ.ct within .IMty (60) d.y. of r.e.lpt of
thh Notice byr
.-wrltten prate.t to the PA Dep.rt.ant 0' Rev.nue, lo.rd of Appell., D.pt. 1810Z1, H.rrl.burg, PA
.-.lectlon to hay. the .att.r d.t.r.lned at audit 0' tha .ccount of the plr.on.1 r.pr..ant.tlve,
--appaal to the Orphan.' Court.
OR
17128.IOZl,
OR
F.ctual arror. dl.cov.r.d on thl. .......ant .hould ba .ddr....d In writing tal PA Dlp.rt..nt of R.v.nu.,
Bur.au of Individual T.M'., ATTN: Pa.t A.......nt Rlvl.w unit, O.pt. 280601, Harrl.burg, PA 17128-0601
~ (111) 731-6505. S.a p.g. 5 of the boakl.t "In.tructlon. for Inh.rltance T.. R.turn for a R..ldant
Dac.dent" (REV-ISOI) for an .Mplanatlon of ed.lnl.tratlv.ly corr.ctabl. .rror..
If any tax due I. paid within thr.. (1) cal.nd.r aonth. aft.r the d.c.d.nt.. d..th, a flva parc.nt (5X) dl.count of
the ta. paid I. allowed.
Th. 15X t.. aana.ty non-p.rtlclpatlon p.n.lty I. caaput.d on the tot.1 of the t.. and Int.r..t .......d, and not
paid b.for. January 18, 1996, the flr.t day .ft.r the .nd of the t.M aan..ty p.rlod. Thl. non-partlclp.tlon
p.n.lty I. appe.labl. In the .... .enn.r and In the the .... tl.. p.rlod .. you would app.al the ta. and Int.r..t
that h.. b.an ......Id .. Indlc.t.d on thl. notlc..
Int.r..t I. charged b.glnnlng with flr.t d.y of d.llnqu.ncy, or nine C') .onth. and on. (I) day fro. the date af
death, to the data af payeant. T.... which b.c... d.llnquent b,'or. January 1, 1'8Z b.ar Int.r..t at the rat. of
.1. (6X) p.rcent p.r annua calculatad .t a d.lly r.ta af .000164. All taM.' which bac... d.llnquent on end a't.r
January 1, 1'8Z will b.ar Int.r..t .t a rat. which will vary fro. cal.ndar y.ar to caland.r y..r with th.t rat.
announced by the PA D.part..nt of R.v.nu.. The .ppllcable Int.r..t r.t.. for 198Z through 1997 arar
!!!! Int.r..t Rat. o.Uy Inter..t Fector !!!! Int.,..t Rat. DeilY Inter.st Factar
198Z ZOX .00D5U 1987 'X .000Z41
19U I6X .000'1' 1'18-1991 IIX .OOUOI
1914 IIX .000!01 1992 'X .0DOZ41
1985 UX .00US6 1991-1994 n .ODOI9Z
1986 lOX .ooozn 1995-1997 'X .0DOZ41
.....Int.r..t 1a c.lculated .. foUOtil.1
INTEREST a BALANCE OF TAX UNPAID X NUnBER OF DAYS OELINqUENT X DAILY INTEREST FACTOR
..Any Notlc. I..ued .ft.r the t.M b.cDl.' d.llnquent will r.flect an Int.r..t celcul.tlon to fl't.an Cl51 day.
b.yond the data of the ......nnt. If p.yaant Is .ad. aft.r the Intlr..t coaputatlon d.t. .hown on t"-
Notlc., additional Int.re.t au.t b. calculated. . -0-
STATUS REPORT UNDER RULE 6.12
Date of Death:
Au c.\1
S'13 It,,
(J,
( ::l
~ II~!
.J /(
Name of Decedent:
Will No.
.J . <(-/7
Admin. No. (elV
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 wp?ther administration of the estate is complete:
Yes-! 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. I is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No Y .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes Y No
:~~rov~~s of~f~~malC~~i~~f~~m~~c:~~~~~,~~e~:~IS~:'7;fjf!,~1;nw::d:rr' s a~~e
Cerk of the Orphans' Court and may be a t~che t. is.' ort.
gt }/
. I- J& 'ij' .' L VI. ~
: Date: !6
U _.; -. Signat.ure
&!a: fR .0 ~' lit 'l-J,2CL t..',I . n:-t?.J
Uu
Name (Please type
~-.( L 1'/1/,111
or print)
~(t el.(l/ .it {~.J .-/2 c:
Address
( ,/ ( '/ ? cr "/ i( to ,,1)
Te I. No.
Capacity:
Personal Representative
J\
Counsel for personal
representative
(MAH: rmfl AM3)