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1. FAILURE TO RESPOND WILL RESULT IN AN OffICIAL TAX ASSESSHENT with appllCftbla Int.ra.t ba..d on In'or..tlon
lubalttad by the financlll Instltutlon.
Z. Inh.rltanc. tall b.co... d.llnquent nlnl lonths aft.r th. d.cldant', dft'a or da.th.
), A jolnt account I, ta.abla .van though the dacadent's na.a wa. addad al ft .atlar of convanlanc..
Ct. Acco...,h UnclUdlng tho.. hald balwnn hUlband and wlfll which tha dle.dant pul In Jolnl n..... wllhln Dna __aar prior 10
da.lh Ira fully ta.,bla .. tr.....fer..
5. Accounts ..tabl1.had JointlY b.lw.an hu.band and wlfa aora Ih3n Dna __.ar prior to da..th ara not la..bll.
6. Accounts h.ld by . dlcldant Mln tru.t for" anolher or olh.r. .r. la.abla fully.
GENERAL INFORMATION
REPORTING INSTRUCTIONS - PART
1
_ TAXPAYER RESPONSE
I. BLOCK A . If tha Infor..tlon and coaputallon In Iha notlc. ara corract and daduclion. ara not baing clalaad, pllcl an "X"
In block "A" of Part I of tha "Ta.pIYlr R..pon..M s.ctlon. Sign two cop I.. and subalt Ihaa wllh your ch.ck for thl a.ount of
t.1I to Ihl Raalltlr of willi o. tha county Indlcatld. Ih. PA D.part.ant of Rlw,nu. will I..u, an offlcl.l ........nt
CFor. REV.IS48 EX) upon r.celpt of tha return frol tha R.ghtar of wlUs.
2. BlQCK B . If tha a,ut ,p.cifl.d on this noUca hili b.en or wUI ba reportld and Ill. paid wllh Iha p.nnulvanla Inheritance
T.1l Return fll.d by tha dlcad.nt's rapre,.ntatlva, placl an "X" In block "I" of Part 1 of tha "Ia.pay.r Ra.pon.a" .actlon. Sign ana
COPY and raturn to tha PA Departaant of Revenua, lur.au of Individual TUII, Dlpt lB0601. tlarrlsburg, PA 171lS.0601 In tha
anvalopa provldad.
3. BlQCK C . If tha notiC' lnfonaUon Is Incorrect and/or d.ductlons erl bllng dala.d, chack block "C" and coaplata Partl 2 and 3
Iccordlng to tha In.tructlon. balow. Sian two cop la' and 'uball th.. with your chack for thl aaount of tall payabla to tha Raglst.,
of Will, of tha county Indlcatld. Tha PA Departaent of Rlvenua will I..ua an official al'llsaent (Fora REY.1S4S EX) upon racalpt
:~ t~: r~t~\"n f~:~ t~o; ~::l:~:~ :~ 'l!!.lt.
TAX RETURN - PART
2
TAX COMPUTATION
LINE
1. Entar tha data tha eccount orlglnal1y loOn e,tabllshed or tltl.d In the aannet allllting at date of death.
HOlE: For a dacldant dyIng aftar lUIUSi':1 Accounts which the decedant put In Joint na." within ani (I) ylllr of d..th ara
ta.abl. fullY al tran.fers. However, Ihere Is an IIl1cluslon not to a.ca.d '1,000 per transferea regard 111" of tha value of
tha eccount or the nuaber of accounts hald.
If a double e.terlsk (..) eppaer. bafore your flr.t nalla In the addrls' portion of this notlcl, the '3,000 a.cluslon
alralldy ha. baan daducted fro. the account balance liS reported by the financial In.titutlon.
2. Enter thl total balancl of the account Including lnterl,t accruad to the date of dlath.
3. Th. parcant of thl account that II ta.abla for aach .urvlvor II deteralnad al followll
A. The parcent tallable for Joint asslts e.tabll.had aor. than one year prior to thl decedent's d.ethl
I DIVIDED BY TDTAl HUHBER DF DIVIOED BY
JOINT OWNERS
Elleepll1 A Joint a".t reghterad In the na.. of
TOtal HUMBER DF X 100 . PERCENt TAXABLE
SURVIVING JDINT OWHERS
tha dac.dant and two other Plr.onS.
I. The perc.nt ta.abla for as,ets cr.ated within ana Ylar of tha deced.ntOs death or accounts owned by tha decldent but held
In trust for another IndlylduaUs) (trust blnlflclarln):
I DIVIDED BY 3 (JOINT QWHERSI DIVIDED BY 2 (SURVIVORS) . .167 )( 100
16.7X (TAXABLE FOR EACH SURVIVOR)
1 DIVIDED BY TOTAL NUMBER DF SURVIVINC JOINT
DWNERS OR TRUST BENEFICIARIES
X 100 . PERCENT TAXABlE
EIl..plal JoJnt .ccount registered Jn the ne.a of the decedent end two othar parsons and eltabll.hed within ana yllar of daath by
thl dacedent.
I DIVIDED IY 2 CSURVIVORS) . .50 )( 100 . ~OZ (IAXABlE FDR EACH SURVIYDR)
4. Tha a.ount subj.ct to tax Ulna 4) It dltaralned by .ultlphlng thl account balance elln. 21 by tha pereant tuabla Ulna 31.
5. Entar tha total of the debt' and daductlonl Illt.d In Part 3.
6. Tha aaount taxable Ulna 6) Is dateralned by subtracting the dabts and deductions Cllne ~) froa tha a.ount sUbjact to tall UJna 41.
7. Entlr tha approprlatl tax rata Cllna 7) al detaralnad below.
A. For date. of death occurring after 6/30/94, tha ta. rates for transfars to spou.a. ara a. followll
1. Det.. of dlath on or efter 7/1/94 and bll,ora 1I1/9~ tha ratl h 3X.
2. Det.. of d.ath on or aft.r 1/1/95 trans firs to spous.s will b. ta..d at ox tall ratl.
Nota: For dat.s of daath prior to 7/1/94 transflr' to SpOUSIS ar. ta.able at 6X.
B. Transf.r' to lineal dl.cenda"ts Including fathar, aoth.r, son, daughter, grandchlldr.n, son. In. law,
daught.,.ln.law, ltepchlld and thalr lllu. .re ta.abla at six percent (6X).
C. Tranlflrs to all othars Including brother, slst.r, uncle, nunt, nlphew and ni.ca ara tellabla at flfte.n Plrc.nt CI5XI.
D. If you changl tha tax rate, plaa.1 spaclfy your r.lationship to tha dacedlnt In thl arlla proYldad.
8. The a.ount of tall dua Cllna S) Is daleraln.d by .ultlplylng the a.ount ta.abla (Iinl 6) by tha tax rate 111na 7).
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable dabtl and dlductlons are dlt.,..lnld as followll
A. You llaelly era ra.ponslbl. for payaant, or tha Istatl subjact to adliniltretlon by a plrlonal raprl.ant.tlva Is In.ufflclant
to p.., tha daductlbl11 Ita.s.
B. You actually peld tha dabts aft., d.ath of the dlcedlnt end can furnish proof of pllyaent.
C. O.bt, baing clal..d lU,t bl Iteelzad fully In Part 3. If additional spllca ls nladad, uSI plain papar 8 1/2" . II". Proof of
pay.ant IllY b. raquasted by tha PA Depart.ant of Rlvanua.
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANV
REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES. TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (717) 787-8327. TDD' (717) 772-2252 (HEARING IMPAIRED ONLY)
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RECORO OF CERTIFICATE EARNINGS
CERT. NO. iCC-c;l\.;) r"/?J1
"
EARNINGS ADDI nONS OR WI T~DRA'NALS
BALANCE
DATE
I 225 1130'15 CAP
2 225 123195 CAP
3 225 012396 INT
4 225 012396 ~TH
59.69
510.07
57.51
52.02'1.3-
52.039.41
52.046.92
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CDMMOHW[Atltt Of P(HHSVLVANIA
I)[PAAlftENI OF Il[V(NlJ[
IURUU or INDIVIDUAL tAXU
')[PI. :!80nl
llARAlSBUAC, PI 111ll-01l01
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 - (1(.- '1~'/
96114538
04-29-96
1I'.IUII1'" .,.,,,
, I
EST. OF JENNIE M STINE
5.5. NO. 163-38-1593
DATE OF DEATH 12-29-95
COUNTY CUMBERLAND
TYPE OF ACCOUNT
IXl "AVIN;S
o CHECXING
o TRUST
o CERTIF.
"
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.
-
ARLEEN S BRILLHART
152 LANCASTER 6LVD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
HEllON PSFS hel provided the Depart.ent with It,. Inforeatlon I hhd below lllhlch has baan und In calcUlating the
pot.ntlal tax due. Their record. Indicate Ihat at the death of Ih. abov. d.ced.nt, you wera a joint ownu/b.neflc1ary of thh account.
If you faal thl. Infor..tlon I. Incorrect, plea.a obt.ln written correction fro. tha financial In.tltutlon, attach a copy to thl. far.
and r.turn It to the above .ddr..., Ihi. account I. taxabla in accordanc. with the Inheritanca lax taw. of tha Coaaonwealth of Pann.ylvanl..
aue.tlon. ..y ba an.werad by c.l1lng (117) 7.7-1327,
COHPLETE PA~T 1 Il::LOll ~ ~ N :lEE :tEVE~SE SUE FOR FILING :.:::: PAYMENT n:STnUCTICIIS
Account No. 00160-075095
Dat.
Establish.d
11-26-76
To In.ure proper credl t to your account, two
(ll cap I.. of thl. notlca .u.t accoapany your
pay..nt to tha Raghhr of Willi, Haka chack
payabla tal "Rallhtar of Wilh, Allent",
Account Balanc.
P.rc.nt T.xabl. X
Anount Subj.ct to T.x
Tax Rata X
Pot.ntial Tax Du.
2,964.60
50.000
1,482.30
.06
88.94
NOIE: If tax pay.ant. are aade within three
13) .anth. of the decedent's date of daath.
you .IlIY deduct a S% dhcOU\t of the tIll du..
Any Inherltanca tIll due will baco.. delinquent
nln. (9) aonth. aftar the dlllt. of d.eth,
PART
[!]
TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNENT BASED ON THIS NOTICE
[CHECK ]
ONE
BLOCK
ONLY
A. 0 Tha abova In'ora.Uon and hx dua 1. corr.ct.
I. You .IlIY chaos. to ra.it pay.ant to tha Ragi.ter of Will. with two caple. of thl. not lea to obtain
a dl.count or .vold Interest, or you lilY chack ball "Aft and raturn thl. notlc. to tha Ragl.tar of
Will. and an official .......ent will ba Issued by tha PA Oaplllrt.ant of Revenua.
B. 0 Tha above anat has baan or will be reported and hx PllIld with th. Penn,Ylvanla Inherltanca Tax return
to b. 'Ilad by tha dacedant'. rapra..nt.tlva.
C, fiJ Tha abova Infor.llItlon I. Incorract and/or dabt. and deduction. were plllld by you,
/ You .u.t co.phta PART 0 and/or PART ~ balow,
OFFICIAL USE ONLY 0 AAF
PA DEPARTMENT OF.REVENUE
PART
~
TAX RETURN - COMPUTATION OF
LINE " D~.~ F.,t~bli~h.d 1
,(J(i'l.lS 2. Account Balanc. 2
... 1. ,... ~1l.1
3. p.rc.nt Taxable 3
4. Anount Subject to T.~ 4
S. Dabts and Daductions S
6, AMount Tax.bla 6
7. Tax R.te 7
8, Tax Dua 8
If you indicat. a diff.rant tax r.t., pl.... st.t. your
r.lationship to d.c.dant:
x
ON JOINT/TRUST ACCOUNTS
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PART
[!]
DATE
DEBTS AND
PAD
1
2
3
4
5
6
7
c' 8
DEDUCTIONS CLAIMED
---__..___0- _~._.
TAX
x
(I C....
'.:itH
DESCRIPTION
-I
AMOUNT PAID
PAID PAYEE
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TOTAL CEnt.r on lin. 5 of T.x COftPut.tion)
,
HOME ,',. ')
WDRK ( )
TELEPHONE NUMBER
.re tru., corr.ct .nd
{~ (:'~. p- -:,):-~,:'; l
Und.r panaltia. of parjury, I declara that the
~lat. ~o the b.st.of n~,knoMladge ~nd b.l~.f,
i ~'\' ~ft) '. ..'{ ~'f
- ~ i' ~. - ~ '- .....'.-:.1 L p...(..<-
r XPA E S b ATUR
fact. I haya report.d above
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFfICIAL TAX ASSESSHENT with nppllcabla Inta,.ut b..ad on Infar..tlon
tUb_ltted by the financial InlUtutlon,
Z, tnher1t~. ta. baea... delinquent nln. aonth. .'t.,. the decedent's dll'. of dulh,
1, A Joint account J. t'.abl. Ivan though Ihe daCldlnt', n... w.. "ddad .1 a .att.,. of conv.nlanc..
~. Account. I Including tho.. hald batw.." hulband and wlf.. which the dacadant put In Joint na... within on. Y'." prior to
Matn an fully '....bl. .. "Mltafl.
S. Accounts ..tablhhlld Jointly batween hulbltnd and wUa aora than ana yu,. prior to dulh Ill" not luabla,
6. Account. hald by . dacadant "In tru.' 'or" another or other. ara la.able fully,
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
1, BLOCK' - If the Infor..tlon and co~t.tlon In the notlc. ar. corract and deductions a,.a not baing clat'.d, placa an .X.
In block -A" 01 Part 1 of the "fa.paver Re.pon.e" ..ctlon. Sign two cop I.. and .ub.lt tha. with your ch.ck far the a.aunt 0'
ta. to the R.gl.ter of Will. of tha county Indica tad. Th. PA Dapart'.nt of R.v.nu. will I..u. an of'lclal ........nt
(For. REV.IS~I EXJ upon rac.lpt of the r.turn fro. the R.gl.tar of Will.,
Z. ILOCk a - I' the a..at .paclfted an thl. notice hat b.an or will b. rapartad and t.. paid with tha P.nn.vlvanla Inh.rltanc.
Ta. Return filed bv the d.c.d.nt'. rapr..ant.tlv.. plac. an "X" In block "B" 0' Part 1 of the "T..p.v.r Ra.pon.." ..ctlon. Sign ana
copV end r.turn to the PA D.p.rtaant of R.vanue, Bur.au of Indlvldu.l Ta.... Dapt Z10601. tt.rrl'burg. PA 171Z8-a6al In the
anvalopa provided.
3, BLOCK C . I' tha notlc. Infor.atlon I. Incorract .nd/ar d.ductlon. ar. b.lng clal..d. ch.ck block "C" and co~l.t. P.rt. Z and 3
according to the In.tructlon. b.low. Sign two copl.. and .ubalt th.. with your ch.ck far the a.ount of t.. pavabl. to the R.gl.tar
of Will. of the county Indlcat.d. The PA D.partaant of R.v.nu. will I..u. an offlcl.1 ........nt (For. REV-IS~8 EX) upon r.c.lpt
at tn. r.turn troD the Hagt.t.r Ot WIll"
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
I, Enter
NOTE:
the d.t, the account originallY wa. ..tabllsh.d or tltlad In tha .ann.r ..I.tlng at data of d.ath.
For. d.c.dant dying after IZ/12/821 Account. which tha d.cadant put in joint n.... within ana Cl) y..r of d.ath .r.
t..abla fully .s tr.n.far.. How.v.r, thar. I. an ..clu.lon not to a.c.ad 13,000 par tran.far.e rag.rdla.. of tha v.lu. 0'
the account or tha nuab.r 0' .ccount. hald.
I' a double ..t.rlsk (~~) app..r. ba'ora your 'Ir.t na.. In the .ddre.. portion of thl. notlca, the 13,000 e.clu.lon
alr.ady h.. b.an d.duct.d froa tha account b.lanca a. raparted by tha Ilnanctal In.tltutlon,
Z. Ent.r the total balanca of the account InclUding Int.r..t accru.d to tha d.t. of d..th,
3. The p.rc'nt 0' tha account th.t I. t..abla for each survivor I. d.taralned .s lo110w'l
A. 'he p.rcant taxBbl. far joint a.sat. e.tabll'h.d .or, than ona y.ar prior to tha dacadant.. d.ath:
DIVIDED BV TOTAL HUHBER OF
JDINT miNERS
E.aaplal A joint ....t r.gl.tar.d
DIVIDED IV TOTAL NlfflB(R Dr x loa . PERCENT TAXAIILE
SURVIVINC JDIN' OWNERS
In the na.. of tha dacadent and two oth.r parson..
1 DIVIDED BV 3 (JDINT OWNERS) DIVIDED IV Z (SURVIVORS) . .167 X lOa
16,7~ (TAXAILE FOR EACH SURVIVDR)
8. The p.rcant t..able lor ....t. creat.d within one y..r 0' the dacedant.. daath or account. own.d by the daced.nt but hald
In tru.t lor anothar Indlvldu.l(.) (tru.t b.naflcl.rla.):
I DIVIDED BV TOTAL HOHlER DF SURVIVIHC JDINT
OWNERS OR 'RUST IENEFICIARIES
X lOa . PERCENT TAXABLE
E.aapl.1 Joint account r.gl.t.red In tha na.a 0' tha d.cedent and two oth.r per.on. and a.tabll.had within on. year of d.ath by
tha d.cad.nt.
1 DIVIDED BY 2 (SURVIVORS) . ,sa X 100 . sa~ (TAXAIlE fOR EACH SURVIVOR)
4, The aaaunt .ubj.ct to ta. Clln. 4) I. d.taraln.d by aultlplylng tha account balanc. Clln. Z) by the p.rcent ta.abla (.llna 3).
5. Entar the total of the debt. and deduction. ll.ted In Part 3.
6. Tha aaount ta.abla (lln. 6) I. d.ter'lned by subtracting the debt. and deduction. Cline S) fro. the aaaunt .ubj.ct to taK (1In. 4).
7. Entar the .pproprl.te ta. rata (lln. 7) a. d.ter.lned below.
A. For dat.. 0' d.ath occurring after 6/3a/9~, the t.. rate. for tr.n.far. to spou.e. ara a. lollow'l
1, Oat.. 0' d.ath on or a't.r 7/1/94 and before 1/1/95 the rat. I. ]~,
Z. D.ta. of da.th on or alt.r 1/1/95 tran.fer. to .pous.. will ba ta.ed at a~ ta. rat..
Hotel For dat.. of da.th prior to 7/1/9~ tran.far. to .pous.. .ra t..able at 6~.
8. Tren,'.rs to Iln.al dasc.ndant. Including fath.r, .other, son, d.ughter, grandchlldran, .on-ln-1aw,
daughtar-In-Iaw, .t.pchlld and th.lr I..ue ar. ta.abla at sl. percent t6~).
C. Tran,'ar. to all other. Including brothar, .I.tar, uncia, aunt, neph.w and nl.ce ar. ta.abl. at fl,t.an perc.nt (IS~).
D. I' YOU changa the ta. rate, plaa.. .peclfy your relationship to the deeedent In the araa provldad,
8, The aaount of tax due (line 8) I. dater.lned by aultlplylng tha a.ount ta.abl. (lln. 6) by the ta. rat. (llna 7),
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIDNS CLAIMED
Allowable d.bt. and d.ductlon. .ra datar.lned .. follow'l
A. Vou leg.lly ate r..ponslbl. for pay.ant. or the ..tate Subject to adalnlstratlon by a p.r.onal repre.ent.tlv. I. In.ufflclant
to pay the daductlb1. It...,
I. You actually paid the dabt. aft.r d..th 0' the daced.nt and can furnl.h proof of pay.ant.
C. Dabt. b.lng cl.I..d au.t b. It..lz.d fully In Part], I' additional spaca I. naad.d, usa plain pap.r 8 1/2" . 11". Proof 01
pay.ant ..y be raqua.tad by the PA Depart..nt of Rev.nue,
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY
REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (717) 787-8327. TDD' (717) 772-2252 (HEARING IMPAIRED ONLY)
@~Mellon Bank
( Savings Statemenf
---- ----- -- --
DIRECT INQUIRIES TU.
MELLOtl BANK tlA
COMMDN~IEAL TH REOIOtl
2 H MAIN ST
SHIREMANSTOHN PA 17011-6326
717-731-(,853
1...111...111....1.1..1.1..,11,.1.1..1.1.11...1.1..1
JENNIE M STINE OR
ARLEEtl S BRILLHART
152 LAtlCASTER BLVD
MECHANICSBURG PA 17055-3550
000069
0416
.-
00160-075095
PAGE 1
STATEMENT
FROM 12/01/95 TO 01/16/96
FIND OUT HOW TO CONSOLIDATE YOUR BILLS HITH A HOME EQUITY PERSONAL
CREDIT LINE. TO APPLY VISIT A MELLON OFFICE OR CALL MELLONDIRECT 24
AT 1 800 MELLON - 24.
STATEMENT SAVINGS ACCOUNT 00160-075095
~cci1uiit-sUMl!^RY -====-=_~-=~-.::==_-_=---=~~-==-=--=~:----=-:~-~--==--:_~-~== -- j
OPENING eAlANCE AS OF 12101195 2,959. b7
TOTAL DEPOSITS AND OTHER ADDITIONS INCLUDING INTEREST CREDITED THIS PERIOD +7.4B
TOTAL HITHDRAHALS TIllS PERIOD ItlCLUDING ANY APPLICADLE FEES -2,96 7.15
CLOSING BALANCE AS OF 01/16/96 .00
AVERAGE ACCOUIT BALANCE FOR TilE STATEIIENT PERIOD
INTEREST CREDITED FOR TilE STATEMENr PERIOD
INTEREST CREDITED YEAR TO DATE
DATE OF LAST TRANSACTION
2.961.36
7.48
2.31
01116/96
THIS STATEMENT REFLECTS ALL ACTIVITY FROlI 12/01/95 TIlROUGH 01/16/96. YOUR ANNUAL PERCENTAGE YIELD EARNED
FOR TillS PERIOD IS 2.03l.
[Ai:~ouiin'--CTIVfTY----~:_=~ --------:_-_=:~=__~~==:__===--=-=====-==:~:==-.::--- ----I
DEPOSITS
AND OTIlER
ADDITIONS
DATE
POSTED DESCRIPTION
12101195 OPENING BAlANCE
12131195 INTEREST CREDIT
01/16/96 INTEREST CREDIT
01116/96 HITHDRAHAL
01116/96 CLOSING BALANCE
DAILY
BAlANCE
2.959.67
HITIlDRAHALS
5.17
2.964.84
--":\
~.967.15 ) _
2,967.15
2.31
'-
--FINAL STATEMENT--
--ACCOUIT CLOSEO--
IF YOU HAVE QUESTIONS ABOUT THE INFORMATION CONTAINED IN THIS STATE-
MENT, PLEASE CALL THE MELLONDIRECT 24 CENTER FOR CUSTOMER SERVICE.
THE NUMBERS TO CALL ARE 1 800 222-9034 OR 222-9034.
.00
.DO
., IMUr.IlMAN MJ.:.MOIMI. WlHll(~:. INt:
2J..2!> Suuth Main Shppt
DOVtR, PENNSYLVANIA 17.11'j
III1
II
(I I) III1
, I'
'I '
3~O.i
(717) 292.2621
U~H:
.,,~y 11\, lfl'l(,
r.!ll:nl:o or .1tlllnl'! fl. r1t:1.no
~; !\r1.'JAII nr I) l.hnl:t-
1"" f.nuc:)fl't"l"'Il: 'f),v".
""~t"!l~I1i.~~h"I.", f!,\ ''''''',';
(;U,.f"",rI1Ullurnuo
':1: '.Il'~, .1f"!1\l\lr~ n.
,.Alrnrfllf)()U
". ~lnll'lhltlnll
VOA
phollf": (,'~7 -11: r,l
tEn.... "0t. l.r, "'~Y" npr.ln r.nmplol:1..o11
, QUANTITY
DEBOI;IIPTION. .
...~t/..:.:' ,<.~ ,~,':', ..
PRIOE.
AMOUNT
1.,~t:l:'.'J.".114 1:0 ',I" r.n'~lpl'!t('Jfl r01: .1"'l1n1(' '1. ~I: ltl!"'
(-tll'I';) in \.'n11o'" ('IHlrell (n!-. 1'01;"'1"(1 !Wl'
""1I1r<:h I.
~:., r. fl"
l
), ,...J
\0...' I I
'-\ '.1.
Thilnk you rOt' '!tvl.n'! t1iBth~ OPPOl:t.nnU:y 1:0 110
or: :'Hlr'lt'~p. tu Y\.)11.
"ECYClED PAPER
Conlentt: 40"1. p".Contumef. HI% Potl-contumef
~1illJt CYow!
ARLEEN S. BRILLHART
IS2 LANCASTER BLVD.
MECIIANICSBURO, PA 170SS
2470
J 60-82.'6
Dole G,!~ Irc, I6l::'9'>62
POYIOlh..d .m,' II/~ .II "II: /)' -<'"
Older of ~- ~"-V~-r~lU.o.~~~e' {:s -
@ ::,;~: .aAH5 -;:~,;."JI 'r,;-~ "~.~m":=
M,Il"llll.,,'.N.". 'W
C._..nhh........ II
nlt'klIo.... f_\ (""";). 0
MeIoo~~~ _ ~1\2\J~.fL&\!.Q-Cl-~tJ1o'
1:0 ~ ~ :1008 ~ ~I: u; ~III ~O 7111qbb ~II; ~.. 70
ARLEEN S. BRILLHART
152 LANCASTER BLVD.
MECHANICSBURG. PA 1705S
2302
-
.
II" '.19~
I
10-12
W18
iO ,.:...t-
.0 . ..._ .
o r I
@ ~,~.~~.:~nk ~. C
""""'---'" ~ J (;;:2 to
Memo(Jt..j.:') [~-h~...~...p 0! ""S' 5i ~! /11 eyfJ;:;t:. "
1:0:1 ~ :1008 ~ ~I: ~ b ~III ~O 711' q b b ~II' ~:l0 ~ ,1'0000005000.,1
Gciplc FI/Ilcral J/OIIIC, fllc.
!jJ MAIN STnct:T
GLCN ROCI<. PCNNSYLV^NI^ I7JZ1
(11 n 2J!j.OOi!2
OLcrm 1:. OCII'Ll: . supc.nvlson
!(): AI'lene S. Brillhnrt
152 Lnncanter Blvd.
Mechnnicoburg, PA 17055
!JAil: Janunry 16, 1996
III{MS: !let 60 Dayo
I()~ IUNL~^lI.X1'INSLS()r: Jennie l~. SUne on December 29, 1995-January 3, 1996
For Profeoeionnl Serviceo of Funeral Director and Staff
For ElnblllminB
~or Dreoaing nnd Caaketing
For Uoe of Facilities for ~Inerlll ServiceD
For Use of Vehicle for Removal From Place of Death
For Uoe of Hearoe
Far Use of Flower Car/Lead Vehicle
For Casket - Blltesville #S48 626 Vintage Bronze 20ga Steel
~'or Vault - llason/Dixon Standard Concro te Norwalk
For Acknowledgment Cards, Register Book, Memorial Foldero
TOTAL FOR SBRVICES MID MERCHANDISE SBLEC'EED
For Cemetery Chargeo - St. Peter's (Grave Open/Clooe)
For Certified CopieD of Death Certificato - 6 @ $2.00 Ilach
~'or Flowers - Double Spray
For Minister Honorarium - Rev. Gery Bowman
For 1I1lirdreooer
For Cometel'y Equipmellt
TOTAL FOR CASH ADVAIICES
TOTAL OF ALL CHARGES
$ 1190.00
$ 385.00
$ 125.00
* 370.00
$ 135.00
1; 135.00
$ 100.00
1; 1075.00
$ 650.00
$ ...Q.7.00
:I; 4232.00
:$ 410.00
1; 12.00
:$ 106.00
:$ 70.00
$ 30.00
$ 00.00
-----
$ 708.00
$ 4940.00
..1'1,- F)~X
1.:: I " "II ','I.",.' t: L IILI""L 1'11:1_11
','.',"
't';..':.
:':101,';' f'. '-'I
'r", I: :i 111" '!.l/ll :i1ll'~~l
'Ir~dhllllf;nlll.lI~I, Il^
!.lull! ".1$(,?/9((:: ,
111II1I11l!1 "'I"II'!'IIIIl,ltIlIlIlI/I:IIVIJI nlll!lIl..';{.
l
Ll/~!J~__ S, iJ.t:ild((t:t '
r'.U~I:
-Yt~(A..;;;Ie({lL':;'~/l
._-~-_.__.--.:._--_._-._...... ...J..'~... J.,__..
......-...--
'-...-..--
. .. .... ...... __a. ....__.___.. _~...'_.., __... .....__...
-------......------.... .-..-...-......-....-..
-------...... _. ...-.------... ..-.---......-....
-....------..-
-..-.-.--...-- -----.-----.. -.--.----...-.....
""11111I
,---.....
I'll., "",,"n :) Lp7~ -/3.?JEL
"hlllw JI1!) G!l/-UU!J ______
1'lIx ""UIIIJ J Tit 12'm - U'\'/I)
CU:
I h I U. ,
--.--.
IJ tltl/1)1I1
J\l.I'u/ YUill IIlvl,,1'I U lllllJly AMI'
tl "I~MO CUIIIIIIOII\
____.___.._h..___ ''''_.__.. ._____._.____
--"-"-.'--
i
I.
COKHONWLAI lit Of PI HHSVI VAHIA
O[PARTMEHI or Rt VI NUt
BUREAU or INDIVIDUAl TAIlI S
PlPI. lBObOt
liARRISBUNG, PA I1I:a-ObOI
*1
Ilt.lhl II "' II 'u !
;;' Ir '/ 'I.
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 - f/,-' <f .';/'
ACN 96115957
DATE 05-18-96
, 7
,
EST. OF JENNIE M STINE
S.S. NO. 163-38-1593
DATE OF DEATH 12-29-95
,COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
IX] CHECK ING
D TRUST
o CERTIF .
r: (
ARLEEN S BRILLHART
152 LANCASTER BLVD
MECHANICS BURG PA
C
17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
HELLON PSFS has provided the Oepllrt..nt toIlth the Inforeatlon 1Isllld belotol which hilI been uud In celculatlng the
potential taM due, Ihelr records Indicate that at the death of the Above decedent, you toIure II joint otolnur/beneflclary of this account.
If you fe.l thl. Infor_atlon I. Incorrect, please obtein toIrltten correction fro. the flnnncJftl Institution, attech a copy to this fore
and return It to the above address. This account Is ta.able In accordancu toIlth the Inheritance Ta. Laws of th. Coe.onwealth of Pennsylvania,
Questions .ay be answered by calling (1171 la7-8~ZI.
D.te
Esbblhhed
REVERSE SIDE FOR
11-26-76
FILING AND PAYMENT INSTRUCTIONS
COMPLETE PART 1 BELOW .
Account No. 162-107-5447
. . SEE
Account Balanc. 2,964,60
Parcant Taxabla )( 50,000
AMount Subj.ct to h. 1.482.30
Tax R.t. X .06
Potontl.l T.. Du. 88.94
PART TAXPAYER RESPONSE
COI FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNENT BASED ON THIS NOTICE
A. c=J Ihe above Infor.atlon and ta. due Is correct.
1, Vou eay chaos. to reelt payeent to the Register of wills toIlth two coplus of this notlc. to obtain
a discount or evold Interest, or you eay check bo. "Aft and return thl. notice to the Register of
Wills and an official assess.ent will b. Issued by the PA Depart.ent of Revenue.
10 Insure proper credit to your account, two
eZI caples of this notice eust accoepany your
payeent to the Register of will.. Make check
payable to: ftRegl,ter of Wills, Avent".
HOlE: If taM pay.ents ar. .ade within three
(~) eonths of the decedent's date of death,
you .ay deduct 8 S~ discount of the taM due.
Any Inherltanc. ta. due will becoee delinquent
nine (~) .onth. after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
B. r=J The above asset ha. been or will be reported and taM peld with the Pennsylvanle Inheritance laM return
to be filed by the decedent's representative.
C. -[;i,The above Infor.atlon Is Incorrect and/or debts Bnd deductions were paid by you.
i Vou .ust coeplete PART 0 nnd/or PARI [!) below.
PART If you indic.ta a diff.rant t.K)rat., ~l..~~ sta~e your
f21 ralatlon.hip to decadant: \ \} 1 I :.' I I l t' j
~ . '\
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRU~T ACCOUNTS
lINE 1. D.to Esbbllsh.d I i / - ;.:t ('."",;c..i.1 ^
2, Account Balanca 2_',. . .i : b. _' .'
3, Parc.nt Taxabl. 3 )( 6 tJ L~ = I. ("
4. Allount Subjact to Tax 4 : . /
5, Dabt. and Daductlons 5 . ,
, .........
6, Anount Tax.bl. 6 4..-..;.....;.....L.-:.:..-
7. Tax R.ta 7 X
8. Tax Dua 8
OFFICIAL USE ONLY 0 AAF
PA DEPARTMENT OF REVENUE
~..
PAD
1
2
3
4
5
6
7
8
CLAIMED
PART
[!]
DATE PAID PAVEE
", l." " (:1 ,. "tl,
"\ ~ "I' . d
'J
DEBTS AND DEDUCTIONS
DESCRIPTION
AMOUNT PAID
tt t"-
_. .....~... 1..1'
" ',. J ~
,>,
.- .
, ,
,..;,.
~
, ",
Lf ~I ,~ l,.
:'L
,
l"'~'
-,
I
TOTAL tEntar on Lin. 5 of Tax ConputationJ
,;
,
'~~2.:...__1.1
Undar penalti.. of perjury, I daclara that tha
cOllplata to the ba.t of ny knoNladg. and baliaf,
.1 ~; (~." \ ,:;~,. Id. .,-/
~AX~AVER SIG~AlU~~
facts I
have r.portad abova ar. trua,
HOME (./ '-I) L. ,-(;-
WORK (',.) ".
TELEPHONE NUMBER
corract and
. -~ -J ( I
1.'.. l
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable In'.rnt blind on Infor..tlon
lubIIlttad by 1M financial Institution,
Z, Inherltanc. tax blea..' delinquent nln. _onthl .fl.r thl dlcld.nt', datI of dlath.
1. A Joint account I. t..able IVln though thl dlcld.nt', n... ",a. added a. . ..tt.r of conVlnlencl.
~, Accounts (Including tho,. held bltw..n husband and wll.1 which thl dlcldent put In joint n.... within on. y..r prior to
d..th at. fully tallable 8. tran.f.rl,
S. Account. .,tabll,hld JointlY b.tw..n hu.band and wlf. lor. then one y..r prior to d.ath ar. not taxable,
6, Account. held by a dlcld.nt ~In tru.t forR anoth.r or oth.r. ar. taxabl_ fully.
REPORTING INSTRUCTIONS - PART 1
- TAXPAYER RESPONSE
1, BLDCK A . If thl Infor.atlon and (oaputatlon In thl notlcl are correct and deductions are not bllng elal..d, placl an "X.
In block "A" of Part 1 of tha ~T..payar Ra.pon.." .actlon, Sign two copl.. and .ub.lt the. with your chack for the a.ount of
tax to the Ragl.tar of Will. of tha county Indicated, Iha PA Dapart.ant of Ravenu. will I..u, an official .s......nt
(For. REV.15~a EX) upon rac.lpt of the r.turn froa the Ragl.tar of Will.,
Z, BLOCK I _ If the ....t .paclfl.d on thl. notlca ha. baan or will b. reportad and tax paid with tha Pannsylvanl. Inharltanc.
Tax Raturn fllad by tha dacadant.. rapra.ant.tlve, place an "X" In block "I" of Part 1 of the "T.xpayar R.spon.a" s.ctlon. SJgn on.
COpy and r.turn to the PA D.part.ant of Rav.nu., lur.au of Individual T...., D.pt Za0601. Harrisburg, PA 17IZa.0601 In the
anvalopa provJded.
5. BLDCK C _ If tha not Ie. Infor.atlon Is Incorr.ct andlor d.ductlons ar. b.lng clal..d, check block "C" and co.pl.t. Part. Z and 5
according to the In.tructlon. b.low, Sign two cop I.. and .ub.Jt tha. with your ch.ck for the a.ount of t.. payable to the RegJ.tar
of Will. of tha county IndJcat.d. Tha PA Dapart..nt of R.v.nu. will i..ua .n offlcl.l ........nt (For. REV.I5~a EX) upon r.c.ipt
of the raturn fro. the P.el,t.r nf W1111.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Entar tha data tha account originally wa. a.tablJshad Dr tltl.d In the .anner ..Jstlng at data of d..th,
HQTE: For. d.cadant dying aftar lZ/1Z/8Z1 Accounts which the d.cad.nt put In Joint n.... within on. CI) y.ar of d..th .ra
t..abl. fully .s transfar., Howev.r, thar. Is an e.clu.lon not to ..caad 13.000 p.r tran.f.raa r.g.rdl... of the valua of
tha .ccount or the nu.bar of account. hald,
If . double ..tarlsk Caa) app.ar. b.for. your flr.t na.. In the addras. portJon of this not lea, tha 13,000 ..clu.lon
.lra.dy ha. baan daductad froa tha account balanc. ., r.port.d by the financial In.tltutlon,
Z, Entar tha total balanca of the account Including Intar.,t accruad to tha data of d.ath.
3. Tha p.rcant of tha account that I, ta.abl. for aach survivor I' datar.ln.d .s follows:
A. Th. parcant taxable for Joint as..t. a.tabll.h.d .ora th.n on. yaar prior to tha d.cad.nt's daathl
1 DIVIDED BY TOTAL HOHlER OF
JOINT DWNERS
Ex..pl'l A JoJnt ..,at ragl.t.rad
DIVIOED BY tDTAL NUHBER DF X 100 . PERCENT TAXABLE
SURVIVING JOINT OWNERS
In tho na.a of the dacadant and two oth.r p.r,ons.
I DIVIDED BV 5 CJOINT OWNERS) OIVIDED BY Z (SURVIVORS) . .167 X laD . 16,7~ (TAXABLE FDR EACH SURVIVOR)
I, Tha parc.nt taxabla for a,..t. craatad within ono y..r of tha d.c.d.nt', d.ath or account. own.d by the d.cadant but h.ld
In trust for anothar IndlvlduaU.) (tru.t b.n.flelarlu):
1 DIVIOED BY TDTAl HUHBEA OF SURVIVING JOINT
OWNERS DR TRUST BENEFICIARIES
x lOa . PERCENT TAXAllE
Exa.plal Joint account r.gl.ter.d In tha n... of tho dacad.nt .nd two oth.r parsons and ast.bllshad within ana yaar of d.ath by
tha dac:ad.nt.
1 DIVIDED IY Z (SURVIVORS) . ,sa x 100 . 5D~ (TAXABLE FDR EACH SURVIVOR)
4. Tha aaount 'ubJact to tax (1lna 4) I, dataralnad by aultlplylng tha account b.lanca (llna Z) by tha parcant t.xabla (llna 5),
5, [nt.r the total of tha dabts and daductlon. 11.tad In Part 3.
6. The ..aunt ta.abl. (llna 6) I. datar.ln.d by ,ubtractlng tha dabt. and daductlon. (Ilna 5) fro. tha aaount subJact to tax (lJna 4),
7. Entar tha approprl.t. tax rata (llna 7) a. d.tar.lnad balow.
A, For data. of daath occurring aftar 6/30/94, the tax rat.. for tran.f.r' to IPOU..' ar. a. follow.:
1, Oat.. of d.ath on or aft.r 7/1/94 and b.for. 1/1/95 tha r.t. I. 3~,
Z. Oat.. of d.ath on or .ftar 1/1/95 tran,f.r. to spous.. wJll b. taxad .t D~ tax rat.,
Not.1 For dat.. of d.ath prior to 7/1/94 tran.f.r. to spou... ara taxabla at 6~.
I, Tran.f.r. to Iln..l d.lc.ndants Including fath.r. .oth.r, .on, daught.r, grandchlldr.n, son. In. law.
daught.r-In-Iaw. .tapchlld and th.lr l..u. ar. taxabl. at .Ix p.rc.nt (6~).
C, Tran.f.r. to all oth.r. Including broth.r, sl.tar, unci., aunt. n.phaw and nJ.c. ar. taMabla at flft.an p.rcant (15~).
D. If you chang. the tax rat., pl.as. ,p.clfy your r.latlon.hlp to the dac.dant In tha ar.a provld.d.
8, Th. a.ount of tax due (llna 8) Is d.t.r.ln.d by aultlplylng the a.ount taxabl. (1lna 6) by the t.M rat. (llna 7).
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
AIlowabl. d.bt. and deduction. are d.taraln.d a. followl:
A. You 1.gally ara r.spon.lbl. for pay.ant, or the ..tat. .ubJact to adalnl.tratlon by a p.r.onal r.pr...ntatlva I. In.ufflcl.nt
to pay the daductlbla It....
I, You .ctually paid the d.bt, aft.r d.ath of th. dacad.nt and can furnish proof of pay..nt,
C. Dabt. baing clal.ad aust ba It..lzad fully In Part 3. If additional spac. I. n.ad.d, us. plain pap.r 8 I/Z" x 11-, Proof of
pay..nt .ay b. r.qua,t.d by tha PA Dap.rt..nt of Rav.nuI.
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY
REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (717) 787-8327. TDD' (717) 772-2252 (HEARING IMPAIRED ONLY)
.~ Mellon Bank
PERSONAL BANKING STATEMENT
DIRECT IllQUIRIES TO. MELLotl MilK llA 1
COMMOllHEAL1H REOION
SHIREMAllSTOI.1tI
2 fl MAIIl ST
SHIREMAll5TOHll PA 17011-6326
717-731-4853
1".111",111""1.1,.1,\",\1..\.1,,1,1.11,,,1,\,,\,1.,...\11
JEtIllIE M STIllE
ARLEEll S BRILLHART
152 LAllCASTER BLVD
MECHANICSBURO PA 17055-3550
01931
CLS 0416
. ~:~~1~~~5:;''1
(--PAOE --I--0r 1
STATEMEIlT
FROM 11/22/95 THRU 01/23?96
FIND OUT HO\., TO CONSOLIDATE YOUR BILLS I'IITH A H0l1E EQUITY PERSONAL
CREDIT LINE. TO APPLY VISIT A MELLON OFFICE OR CALL MELLONDIRECT 24
AT 1 800 MELLON - 24.
RELATIONSHIP SUMMARY
DEPOSIT ACCOUNTS
PERSOllAl CIIECKltlG
TOTAL
BAlAllCE
0.00
0.00
lOAll ACCOUNTS
OUTSTAllDING
PERSONAL CHECKING ACCOUNT 162-107-5447
[AcCoutn SUMMARY
OPENIIIG BALANCE AS OF 11/22/95
TOTAL DEPOSITS AND OTHER ADDITIONS INClUOlIlG INTEREST CREDITED TillS PERIOD
TOTAL CIIECKS AND OTIIER HlTllDRAHAlS IIIClUDIflG FEES AlID CIIARGES TIllS PERIOD
CLOSING BALANCE AS OF 01/23/96
AVERAGE ACCOUNT BALANCE
!ACCOUln ACTIVITY
-1
19.90
+IB1.89
-201.7'
.00
65.48
DATE
POSTED DESCRIPTION
11/22/95 OPENING BALANCE
DEPOSITS
AND OTIIER
ADDITIotlS
CIIECKS
AND OTHER
HITlIDRAHAlS
DAILY
BALANCE
19.90
01/02/96
DEPOSIT . " 1) I(),',,-, \' 1""
REF ;COOOOOD5CCZOI4i .,. -. '.)
-~'.
l 181.89
20~ 7Q
01/16/%
01/23/96
CIIECK . 366 .
CLOSING BALANCE
, , . . , . ' , .
. . .
, . .
. 201. 7'
.00
.00
AIIOUlIT EFEREtlCE NO. CIIEC'
201 . 000000054177841
---"l
@KECK SUMMARY
CIECK.
66
CHECK'
AIIOlJtlT RErEREtlCE NO.
PLEASE USE THE ACCOUNT RECOtlCIlEMEIlT FORM lOCATED 011 TIlE BACK OF TillS
STATEHEIlT TO OAlAIlCE YOUR ACCOUlIT.
--...- - -'-' .-
RECORD OF CERTIFICATE EARNINGS
CERT. NO"IDO~ Odl;)112> .
RECORD OF CERTIFICATE EARNINGS
DATE EARNINGS AOOITlOIlS OR WITHORAWALS BALANCE OATE EARNINGS AOOITIONS OR WITHORAWALS
7
I 225 103195 CAP $15.7\ $3.151.1? I 225 113095 CAP $9.&9
2 225 113895 CAP S15.28 $3,1&&.40 2 225 123195 CAP $10.07
3 225 123195 CAP $15.87 $3.182.27 3 225 01239& INT $7.51
4 225 123195 PCI / sI0I.09- ! s3.ooo.38 4 225 012396 111ft $2.04&.92-
5 225 012396 INT SII.I& ( S3,01l.54
& 225 012396 11TH $3.011.54- $0.00
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---- ~_._._.- ..---------- -.-.-.. ._.. _.. .-.-.. .'--- ---.--.---. -...
01/16/96
12/29/95
TO: Arlene 5. Brillhart
152 Lanoaeter Blvd.
Meohanioeburg, PA 11055
Geip/e FI/IIC/'a/Hollle. f/le,
53 M^IN STReET
OLCN ROCI<. I'CNNSVLV^NI^ 17327
(7171 235.5022
OLCNU C, otlN.C . !iUPl:rlVISOn
Statement
Ml\'l(IUOI: IIUNO. \ '''''0 January
Jennie M. stine 4151 26. 1996
CI 'ARGIS CREDITS QAlANCE
For Funeral Expenaee $ 4940.00 $ 4940.00
Received an Account - Check #271911 - 1/25/96 :\; 4940.00 -0-
Arlene 5. Brillhart
Account Paid in Full
Thank you.
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..................................................................
COI"II"IDHWEAlIH or I'ENNSVlVANU
DEPARIHrHI Of AlVENUE
BUArAU or INDIVIDUAL lAMES
llEPI. Z80bOl
HARAISBUAC. PA 17IZe.ObOI
*'
.~
I ') II' 't' .)
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21- l!,. '15'/
96112488
04-15-96
'1'.lhl II II' It.'u I
r,'~"~
,
EST. OF JENNIE M STINE
S.S. NO. 163-38-1593
DATE OF DEATH 12-29-95
COUNTY CUMBERLAND
TVPE OF ACCOUNT
o SAVINGS
[J CHECKING
o TRUST
00 CERnF.
ROBERT E STINE
C/O 152 LANCASTER AVE
MECHANICSBURG PA 17055
REMIT PAYMENT AND FDRHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
YORK FEDERAL S & L ASS hili provided the Depart_ent ...ith the infor_allon I hied belo... ...hlch hili been used in calcullltlng the
potenttal tax du.. Th.ir r.cordl indlcat. that at the death of the above d.c.dent, y~u ....r. II Joint o...n.r/beneflclary of thll account.
If you f..l this Infor_ation Is Incorr.ct. pleas. obtain wrltt.n correction fro. the financial In.titutlon. attach a copy to thl. for.
and r.turn It to the above addr..., This account I. taxabl. in accordance with the Inherltanc. lax lawl of the Cossonw.alth of P.nnlylvanla,
Que.tlon. _ay b. answ.r.d by calling (111) 181-A3Z7.
eOMf'L~"'. PAl<l 1 ul:Luw ~ A A S~;; H..III:.H:iE :;.111;; ~DI< FILING AliD Pk"i';~~(, Iii,.. FlUe I S'jNS
Account No. 100-212773
Date
Establishad
12-04-92
To In sur. prOPllr cr.dlt to your account. two
(ZI copi.s of thl. notice SUit accospany YOur
pay_.nt to the Reglst.r of Wills, Hake ch.ck
payabl. to: ~A.gi't.r of Will., Ag.nt~,
Account ealanca
P.rcant Taxabla
Allount Subjact to Tax
Tax Rata
Potantial Tax Dua
x
3.181.25
50.000
1,590.63
.06
95.44
HOlE: If tax pay.ents ar. _ad. within thr..
(31 .onthl of the d.ced.nt's datil of death.
yoU say deduct a S% dl.count 0' the tax du..
Any Inh.ritanc. tax due will b.cos. d.llnqu.nt
nine (9) .onthl aft.r the date 0' de.th,
x
PART
CD
TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNENT BASED ON THIS NOTICE
[CHECK ]
ONE
BLOCK
ONLY
A. c=J The above Inforsatlon and tax dUll is correct.
1, You a.y choos. to r.sit pay.ent to the Aegist.r 0' will. with two copi.s 0' thl. notic. to obtain
Il discount or avoid Int.r.st, or you say check bo. ftAft and r.turn this notice to the A.gi.t.r of
will. and an official Il'Sllss..nt wlil b. issued by the PA Oepartsent 0' R.venu..
B, c:J Th. above asset hal b.en or will b. report.d and ta. paid with thll Pennsylvania Inh.rltanc. Tax r.turn
to be fll.d by the d.c.d.nt's r.pres.ntatlve.
C. ~Th. above Inforsatlon Is Incorrect and/or debts and deductions wer. paid by you.
You aust coapl.t. PART ~ and/or PART ~ below,
PART
~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LJN~ 1 Dot. Est.bl!chod 1..___-1.~- J:.~_l '::.:-
'!o-'l(,' 5,'1, 2. Account Bohne. 2 ". " 1 I c, /1
) '.A'P ,{....
. . . 3. Parcant Taxabl. 3 X
4. Anount Subjact to Tax 4
S. Dabts and Daductions 5
6, Anount Taxabl. 6
7, Tax Rata 7 X
8. Tax Dua 8
If you indicata a differ.nt ta~rata, plaasa stat. your
ralationship to dacadent: . ~ ('. //
OFFICIAL USE ONLY D AAF
PA DEPARTMENT OF REVENUE
I I,
, ,
, '
i. ..
" .
, .1
PAD
1
2
3
4
5
6
7
8
CLAIMED
PART
~
DATE PAID
-11./ ,", I q (" I -<"J "t" "
f '. I
I
I
DEBTS AND DEDUCTIONS
PAYEE
'j u .,
.,1
,
DESCRIPTION
Ir-.~,,,-.n-u,, '"l t,e,"-"I
I 1"'1 11j,'/-L"\'1-t- (tJt, l: ,
I ,/
I
TOTAL IEntar on Lina 5 of Tax Co~putation)
AMOUNT PAID
-1..JLr..'ULi,.ll.....
I
i: '.'
$
,
, .
Undar panal ti..
;~ata to, .,tha bast
, ',) /.
. - . ......1-.(...
daclar. that the facts I
bali.f.
hava raportad aboy. are trua, correct and
HOME (,;/1../) ~ -l 'j _ c;(.I ~ ~
WORK ( ).<;" A, 1(; I:'
L OA'l'E
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFfICIAL TA)c ASSESSHEHT with IIppllubl. 'nhrut bUDd on lnfor..t Ion
lub.ltlad by the 'In.nclal Inltltutlon.
Z. Inh.rltanca ta. baeo... delinquent nln. Monthl "flu Ih. tlacadent', tlllt. of Il..th.
J. " Joint account 11 ta..bl. ava" though the dacadant" "".. \If'" lidded IlII /I .."ar of conllanlanea.
..., Accaunta I Including tho.. hald betw..n hu.band "nd ..If.1 ..hlch the dacatJa"t put In Joint nun wllhln 0"8 'I.'" pdor 10
d..th .r. fullv ,...bl. II' trenl,.r..
S, Account. .11.bll,hld JointlY batw.." husbllnd and wlf. 80r. than ana 'I..' prior to d..th ",. nol t..able.
b, Account. held bv . dacadant -In truI' for" anolhar or othar. .r. '"."bla fully.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BLOCK A _ If the Infor..tlon and co.pulatlon In the notlca ar. correct and d.ductlon. are not b.lng clal..d, plac. an "M"
In block "A" of Part I 0' th. "Ia~pay.r R..~on,." ..ctlon. Sign two copi.. nnd ,ub.lt th.. with your ch.ck for th. a.ount of
ta. to the R.gl.t.r 0' Will. 0' th. county Indlcat.d. Th. PA Oepart.ant 01 R.vanua will I.,u' an o"lclal a.......nt
IFor. REV-1S48 EM) upon recalpt of the r.turn fro. the Regilter of Will..
Z. BLOCK a _ If the al.et specified on thl. notlc. ha. boon or will ba raport.d and ta. paid wIth the P.nnsylvanla Inh.rltanc.
Ta. R.turn filed bY the d.c.dent's repre..ntatlve, plac. an "K" In block "B" of Part I of tha "Ift~pay.r A..pon.." .ectlon. Sign one
copy and r.turn to tha PA Dapart.ant of Aevenue, BurOilu of Individual 10.... napt Z80&01. Itarrll.burg. PA 11118-0&01 In the
envelope provld.d,
], BLDCK C _ If the notice Infor.atlon Is Incorr.ct and/or daductions ar. b.lng clal.ad, chack block "C" And coaplet. Part. 1 and]
according to tha In.tructlon. below. Sign two copla. and sub.lt thea with your chack for the a.ount 0' ta. payable to the A.gl.t.r
of Will. of the county Indlcat.d. Ihe PA naparta.nt of Aovonua will I.su' an ol'lclal a....s..nt Irora REV-I~48 EM) upon recalpt
of t'~e roturn ."::1 :.1. ~"'lf'. \.' .... ..i 1.11,
TAX RETURN - PART
2
- TAX COMPUTATION
LIHE
1, Enter
HDIEI
the date the account originally was 'IItabllshad or tltlad In tha nannar e.I,tlng at data of d.ath.
For a dacedant dying aft.r 11/11/81: Account. which tha decadent put In JoInt na.a. within on. 111 yaar 0' death are
ta.able fully al tran.fers. tlowav.r. thare i. an .~clu.lon not to a.ca.d '],000 par tran"ara. ragardla.. 0' tha valu. 0'
tha account or tha nuabar of accounts hald.
If a doubla altarlsk (..) appaars bafora your flr.t naa. In the addra" portion 0' thl. notica, tha ,],000 ..clullon
alraady hal b.an daduct.d fro' tha account balanca as r.portad by tha financial Inltltutlon.
1, Entar tha total balanca of tha account Including Int.ra.t accruad to the data of d.ath.
3. Th. parc.nt of the account that I. ta.abla for .ach survivor ill d.t.r'lnad all followll
A. Tha parcant ta.abla for Joint a'l.t. alltabli.had .ora than ana y..r prior to the d.cadant's daath:
I DIVIDED BY TDTAL HUHBER OF
JOIHT DWNERS
E.a.pla: A Joint a.sat ragl.tar.d
DIVIDED BY TOTAL HUHBER OF M 100 . PERCENT IAKABLE
SURVIVINC JOINT DWNEAS
In tha na.. of tha d.c.dent and two oth.r p.rsons.
B. Th. p.rcent ta_abla for alsets craatad within ana y.ar of the dac.dant's daath or accountl ownad by th. d.ced.nt but hald
In tru.t far anothar Indlvldual(s) Itru.t b.n.ficiarl..I:
I DIVIDED BY 1 (JDIHT OWNERS) OIVIDED BY Z (SURVIVDRS) . ,161 X 100
16.1~ ITAMABLE FDR EACH SURVIVOR)
I DIVIDEO BY lOlAL NUHBER DF SURVIVINC JOINT
OWNERS DR TRUST BEHEFICIARIES
X lOa . PERCENT TAMABLE
E.a.plal Joint account r.glst.rad
tha dacad.n t.
1 DIVIDED BY 1 ISURVIVORS) . ,~O
in tha nn.a of tho d.c.dant and two oth.r parsonl and ..tabll.had within on. y.ar of daath by
M 100
~O~ ITAMABLE FDR EACH SURVIVOR)
4, Tha ..ount .ubj.ct to taM (1In. 4) il d.t.r.ln.d by .ultlplylng tha account balanc. tlin. 1) by the p.rcant ta.abl. (lin. ]).
S. Entar the total of tha dabtl and d.ductian. 11.tad In Part 1.
6, Tha a.ount ta.abla Illn. 6) I. detar~inad by sUbtracting tha d.bt. and deduction. Illna S) fro. tha aaount lubj.ct to taM (llna 4).
1. Entar tha approprlata ta. rat. (lin. 1) a. d.t.r'ln.d b.low.
A, For data. of d.ath occurring aft.r &/10/94, tha ta. rat., for tranlfers to IPouS.1 are ns follow.:
1, Datal of daath on or .,tar 1/1/94 and b.for. 1/1/9~ tho rata III ]~,
2. Oat.. of daath on or aftar l/l/9S transfar. to SPOUI.. wIll ba t.~.d at O~ ta~ rata.
Hote: For datal of daath prior to 1/1/94 tran.f.rs to Spoul" ara ta~able at 6~.
a, Iranlf.rl to llnaal d.sc.ndants Including fathar. .oth.r, .on, daughtar. grandchlldr.n, .on-In-Iaw.
daughtar-In-Iaw, .tapchlld and thair Is.ua ara ta~nbl. at sl~ p.reant (b~I,
C, Tran.far. to all othar. Including broth.r, .I.t.r, unci., aunt, naphaw and nlaca ara ta.abla at flft..n parcant CI~~).
D, If you changa the t.. rat.. pl.a.. IP.cify your r.lationshlp to thO d.cadant in tha nraa providad.
a, Iha a.ount of ta~ duO Ilina B) III d.t.r.ln.d by .ultlplYlng tho a.ount ta~abl. (11na 6) by tha ta. rate (lina 11.
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
AllOMabla d.bt. and daductlon. ara d.t.r.in.d a. follow.:
A. You 1.gally ara r.,pon.ibl. for pay.ant, or tha a.tata IUbjact to ad.lnlltratlon by a p.r.onal r.pra.ant.tlve I' Inlufflelant
to pay tha d.ductlbla Ita'II,
B. You actually paid tho dabtll aft.r d.ath of the dacad.nt and can furnl.h proof 0' pay..nt.
C. D.bt. baing clal.ed .ust ba It..I:ad fully In Part 1. If additional spaca is na.d.d. u.. plain papar B 1/2" . 11~, Proof of
pay.ant ..y b. r.quastad by the PA D.part..nt of Rav.nu..
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY
REGISTER OF WILLS, PA DEPARTMENT DF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES. TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (7171 787-8327. TDDI (7171 772-2252 (HEARING IMPAIRED ONLY)
~. ... ... ~
.'
RECORD OF CERTIFICATE EARNINGS
.
CERT.NO./D<KC3-13,lo .
"-
DATE
EARNINGS ADDITIONS OR WIT~ORAWA~S
BA~ANCE
1 225 103195 CAP
2 225 113095 CAP
3 225 123195 CAP
4 225 123195 PCI
5 225 0123% (NT
6 225 012396 UTH
,~ ,..~
Sl5.l~...~cl;~.~.P1 S3.151.1<
SI5.2il'0 r (., 1. -I D ,- J , s3.166.40
S15.87 ~ . S3.182.27
"\SI8.h3't-- . s3,ooo.38
Sll.16 S3.011.54
$3.011.54- SO.DO
~
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01/16/96
12/29/95
TO: Arlene S. Brillhart
152 Lancaeter Blvd.
Mechaniceburg, PA 17055
\lI\'ICIUOI:
Jennie M. Stine
Geip/e Fllllcra//iolllc, IIIC.
53 MAIN 5TREET
GLEN ROCK. PENNSVLVANIA t 73Z7
17\ 7) Z35.00Z2
GLCNN C. OCIPLC . SUPERVlson
Far Fwtere.l Expeneee l\ g;l.l...- ~. ..\..L.u<.C.
Received an Account - Check #277971 - 1/25/96
Arlene S. Brillhart
Account Paid in Full
Thank you.
-~ (
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~I~L-~~~~ - n'-aA c~, rJ~~d J
;t~ .......,h..fh.. ~ .U."'-.l)o\.(l
flUtiO,
4157
CH^RClS
$ 4940.00
Statement
I DAII:
January 26, 1996
CREDITS
BM^NCE
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$ 4940.00
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PURPOSE OF
NOTICEI
PAV":Hh
REFUND (CR)I
1('
N
',I
iC.
. -
.jc3
To fulfill the r.qulr...nt, of S.ctlon ZI40 of the Inh.rltanc. and E,tat. Tax Act,'Act ZI of 1991. e12 P,S.
S.ctlon ZI40).
O.tach the top portIon of thl, Hotlc. and ,ub.lt with your pay..nt to the R.gl,t.r of will. prlnt.d on the
r.v.ru .Id.,
.. "ak. ch.ck or .oney order payabl. tal REGISTER DF WillS, ACENT,
All pay..nt. r.c.lv.d .hall flr.t b. applied to any lnt.r..t which .ay ba du., with any r.aalnder appll.d to the ta.,
A refund of a tax credit, which wa. not r.qu..t.d on the ta. r.turn, .ay b. r.qua.t.d by co.pl.tlng an "Application
for A.fund of P.nnlYlvanla Inh.rltanc. and Eltat. Ta." IREV-15151, Application. ar. avallabl. at the Dfflce of
the A.gl.t.r of Will., any of the 21 Rev.nu. DI.trlct Offlc.. or by calling the ,peclal 24-hour an,werlng ,.rvlce
nu.ber. for for.. orderlngl In Penn,Ylvanla 1.100-16Z.Z0S0, out.ld. P.nnlylvanla and within local
Itarrhburg ar.a (111) 187-1094, IDD' (711) 712.Z2!;Z IHearlng I.paired Dnly).
DBJfCTIDNSI Any p.rty In Int.r..t not .atl,fl.d with the appral....nt. allowanc. or dl.allowanc. of d.ductlon. or a..e....nt
of tax (Including dl.count or lnter..t) a. .hown on thl, Notlca .ay Object within .Ixty 1601 day. of r.celpt of
this Notice by;
..wrltt.n prote.t to the PA Dep"rt.ent of Revenue, Board of App.al., Oept, Z81021, Harrisburg, PA 17IZ8.1021, OR
-.el.ctlng to have the .atter dol.r.lned at Ih. audit of the account of Ihe per.onal repr..entatlve, OR
.-app.al to Ih. Drph.n.' Court
ADHIN.
ISTAUIVE
COARECTIONS;
OISCDUHTI
P[NAUVI
INTEREST:
Factual .rror. dl.cover.d on thl. a.......nt should b. addra.,ed In writing tOI PA Oepart.ent of Revenue,
Bur.au of Individual Tau., ATTNI Po.t A"o....nt R.view Unit, DEPT. Z10601. ttarrhburg, Pi 11128.0601
Phon. (711) 781-6S0!;, Sa. page 5 of the booklet "In.tructlon. for Inh.rltanc. Tax A.turn for a A..ldont
D.ced.nt" (AEY.1501) for an e_planatlon of "delnl,tratlvoly correctable errors.
If any t.x due I. paid within three el) cal.ndar .onlh. .ft.r the dec.d.nt's de.th, a flv. p.rcent (!;~)
dl.count of the tax paid I. allowed,
Th. lS~ tax .8Me.ty non.partlclpatlon penalty I, co.put.d on Ih. total of the t.. .nd Int.r..t .......d, and not
peld b.fora January 18, 1996, the flr.t day aft.r the .nd of the tax a.n..ty p.rlod, Thl. non"partlclpatlon
penalty I, app.alabl. In the .... .anner and In the the .... tl.. period a. you would app.al the t.x and lnt.r..t
that h.. b..n .s...sad ., Indicated on thl. notlc..
Intera.t I. chargad beginning with flr.t day of d.llnqu.ncy, or nln. (9) .onth. and on. (I) day
fro. the date of d.ath, to the date of pay.ent, Ta.., which b.ca.. delinquent b.for. January 1, 198Z
bear Inter.st at the r.ta of ,I. 16~) percent per annU8 c.lculat.d at a dally rate of .000164,
All ta.o, whlch beca.. delinquent on or aftor January 1, 1982 will boar Int.r.st at a rat. which will vary 'r08
calendar yoar to cal.ndar y.ar with that rato announced by the PA Depart.ent of Revenuo. Th. appllcabl.
Int.r..t rat.. for 198Z through 1996 arol
Vear Intor.st Aat. Dally Intorest Factor
Vel!lr Intere.t Aat. Dally Int.rut ractor
llJ81 .. .000241
1988-1991 1I~ .000301
1992 .. ,000241
1991.199" ,. .000192
1995.1996 .. ,0002'"
1982
1985
1984
198!;
1986
ulnterut
20~
16i(
1l~
Ui(
ID~
I. cl!llcull!ll.d as
,OOO~48
,OOOU8
,000501
,D005S6
.00021"
follolllSI
INTEREST = BALANCE OF TAK UNPAID X NU"BER OF DAYS DELINQUENT K DAILY INTEREST FACTOR
..Any Notlco lssuod after the tax beco..' delinquent will r.'lect an Intor.st calculation to fl'teen (I~J day.
b.yond the data of the .'S.ls.ent. I' par.ent I. .ado a't.r the Int.re.t coaputatlon data .hown on the
Notlc., additional Inlere,t ~.t b. calculated,
/ jO, /1 \'1 0':1
REV-1548 EX AFP 112-951*
CD""ONWI A11l1 01 1'1 NN'iV' VAHU .
DlPIN'"IN' Of RrV1HIJl .
BUR(AU 01 INDIVlIlUAl lalli,S i', .
O[PI. ..lObO 1
IIARRISBuNe, PA 111:11-0601 ....
t---
NOTICE or INIIERITANCE TAX
APPRAISEHEIIT, ALLOHANCE OR DISAlLONANCE
or DEDUCTIONs, AND ASSESSMENT or TAX ON
JOINTLY IIELO OR TRUST ASSETS
DATE 09-23-96
ESTATE OF STINE
COUNTY
M DATE OF DEATll 12-29-95
JENNIE
CUMBERLAND
FILE NO. 21 96-0481
S.S/D.C. NO. 163-38-1593
ACN
96112489
ROBERT E STINE
C/O 152 LANCASTER AVE
MECHANICSBURG PA 17055
REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
Amount R..,tttod
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
R-Eii:is<ia-Ex--AFP--ii2-:9Si------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE OQ-23-96
ESTATE OF STINE
JENN!E
M DATE OF DEATH 12-29-95
COUNTY
CUMBERLAND
FILE NO. 21 96-0481
TAX RETURN WAS:
S.S/D.C. NO. 163-38-1593
IX) ACCEPTED AS FILED I ) CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
96112489
FINANCIAL INSTITUTION: YORK FEDERAL S & L ASSOC
ACCOUNT NO.
100-212737
TYPE OF ACCOUNT: () SAVINGS I ) CHECKING I ) TRUST I lO TIME CERTIFICATE
DATE ESTABLISHED 09-04-92
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
2.046.92
0.500
1,023.46
1.023.46
.00
.06
.00
NOTE, TO INSURE PROPER CREDIT TO
YOUR ACCOUNT. SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO,
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST (-)
AMOUNT PAID
TOTAL TAX CREDIT
IBALANCE OF TAX DUEl
INTEREST AND PEN.
I TOTAL DUE
. IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
I IF TOTAL DUE IS lESS THAN $1. NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REflECTED AS A "CREDIT" ( tRI. YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ,
.00
.00
.00
.00
PURPOSE DF
NDTICEI
PAYftEHTI
REFUHD (CAli
u
-,
'- )
II'
pJ
r_
I. l
rc
"' :J
OU
To fulfill tho r.qulr...nt. of Section ZI/tO of tho Inh.rltanu and Estat. Tall Act, Act ZZ of 1991. (7Z P.S.
S.ctlon 21401.
Dotach tho top portion of this Notlu and .ub.1t with your pay.ont to tho Roglst.r of Will. prlntad on tho
rovar.a .Ido,
-- Hake check or .onoy ardor payabl. tOJ REGISTER OF WILLS, AGENT,
All pay..nh roc.lvod .haU flr.t bo appll.d to any Intoro.t which .ay b. du., with any ro.alnd.r appll.d to tho tu.
A r.fund of a tall crodlt, which w.. not r.qu..tod on tho tax r.turn. oay b. r.qu..ted by coopl.tlng an wAppllc.tlon
for Rofund of P.m.ylvanla Inh.rltanc. and E.t.to T.xw CREV.13J3). Application. .r. av.Uabl. at tho Office of
tho Rogl.t.r of will., any of tho 21 R.vonu. DI.trlct Dfflc.. or by calling tho sp.clal 24-hour an.w.rlng .orvlco
~or. for for.. ord.rlngl In p.nn.ylv.nl. 1-800-362-2050, out.ld. P.nnsylvanl. and within 10c.l
Har,.lsburg ar.. (717) 181-e094. ,TDDI (7171 172-Z252 Ulurlng I.palr.d Dnly).
OBJECTIONS: Any party In Int.r..t not .atl.fl.d with tho app,.al....nt. allowanc. or dl.allowanco of d.ductlon. or a.s.....nt
of tax (Including dl.count or Int.r..t) a. shown on thl. Notlc. ~ay obJ.ct within .1xty C60J day. of ,..c.lpt of
this Notlc. bYI
--wrltt.n prote.t to tho PA D.part..nt of R.v.nu., Board of Appoals, O.pt, Z8lDU, Har,.hburg, Pi HU8-1021, OR
--.loctlng to have tho .attor d.t.r.ln.d at tho audit of tho account of tho porsonal repr.sentatlv., OR
--app.al to tho Orphan.. Court
ADKIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT I
PENALTY:
INTEREST I
Factual orrors dlscov.r.d on thl. a.......nt .hould bo addr....d In writing to: PA D.part..nt of R.v.nu..
Buroau of Individual Tax... ATTNI Post A....s..nt R.vl.w Unit, DEPT. 280601, Harrl.burg, PA 17128-0601
Phon. (717J 787-6505, S.. pago 1 of tho bookl.t wlnstructlon. for Inh.rltanco rax Roturn for a R..ldont
D.cod.ntM (REV-1S01) for an .xplanatlon of ad.lnl.tratlv.ly corr.ctabl. .rror.,
If any tax duo I. paid within thr.. C3J calondar .onth. aft.r tho d.cod.nt.. d.ath, a flvo p.rcont (5~)
dl.count of tho tax paid I. allow.d,
Tho 15% tax a~..ty "on-participation p.nalty I. co.put.d on tho total of tho tax and Int.r..t .......d, and not
p.ld boforo January 18. 1996, tho flr.t d.y aft.r tho .nd of tho tall aon..ty p.rlod, Thl. "on-p.,.tlclp.tlon
p.nal ty Is IIPp..l.bl. In tho .... .ann.r and In tho tho .... tI.o p.r lad a. you would app.al tho tu and Intl...st
th.t ha. b..n 1I......d a. Indlcatod on thl. notlc..
Intor..t I. charg.d b.glnnlng with first day of d.llnqu.ncy, or nino (91 .onth. and on. Cl1 d.y
fro. tho dato of d.ath, to tho d.t. of pay..nt. Tall.' which b.ca.. dollnqu.nt b.for. January I, 1982
b.ar Int.r..t at tho rata of .Ix C6~J porc.nt par ann~ calculat.d at a dally rat. of ,000164,
All ta... which b.c... d.llnqu.nt on or aft.r Janu.ry 1, 198Z will b.ar Int.r.st at a rate which wllt vary froo
cal.ndar y..r to calondar y.ar with that rato announc.d by tho PA D.part..nt of R.v.nu., Th. appllcablo
Int.ro.t rat.. for 198Z through 1996 ar.I
V.ar Int.r..t Rato OaUy Int.r..t Factor V.ar Interest Rat. Dally Int.r..t Facto,.
1982 >OX ,DDOSli8 1981 'X , DODZtt7
I.n 16~ .000"38 1988-1991 IU ,OOD301
1984 IU .00UOI 1992 'X ,OOGZ47
1985 U~ .ODUS6 1993-199" ]X .00019Z
'986 ID~ .OODZ1/t 1995-1996 'X .DOOl'"
ulnt.rnt I. calculat.d .. foUowlI
INTEREST = BALANCE OF TAX UNPAID X NU"BER OF OAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlco Inu.d aft.r tho tax b.co." d.lInqu.nt will raU.ct an lnt.r..t calculatlDn to flft..n US) days
boyond the dato af the a".s...nt. If pay.ont Is oad. IIft.r tho Int.rnt cooputatlon date shown on tho
Natlco, additional lnt.rnt ....t b. calculat.d,
PURpOSE DF
HDTICEI
PAYHENT I
REFUND (CA):
~ ,-
Ul
'r
('~
c_~
L, I
,
0-
'.:J
0u
To fulfill the require.ent. of Section 2140 of the Inherltanc. and E.tal. TaM Act, Act l2 of 1991. (7l P,S.
hctlon 2140),
Detach the top portion of thl. Notlc. and .ubalt with your pay.ant to the Ragl.ter of Will. prlntad on the
raver.a .Ide,
_. Hake chack or .on.y order payabl. tal RECISTER OF WILLS, ACENT.
All pay..nt. rec.lved .hall flr.t be appll.d to any Intare.t which .ay ba du., with any ra.alnd.r applied to the ta..
A r.fund of Ita. cr.dlt, which w.. not requ..ted on the taM r.turn, .ay ba requalted by co,platlng an "Application
for R.fund of Pann.ylvanl. Inh.rltanc. and E.tate Ta." (REV-ISIS), Application. ar. avallabla .t the Dfflca of
the Rlgl.tar of Willi, any of the 2S R.vanu. Dlltrlct Dfflc.. or by calling Ihe .paclal Z4.hour an.warlng ,lrvlcl
~barl for for.. orderlngl In Pann.ylvanla 1-80D.S6Z-Z0SD, out.ld. Pann.ylvanla and within local
Harrl.burg araa (717) 787-8094, TDDI (717) 77Z-Z2SZ (H.arlng I.palrad Only),
OBJECTIONS: Any party In Intlra.t not I.tl.flad with tha appral.a..nt, allowanc. or dl.allowanca of d.ductlonl or a.......nt
0' tl. I Including dl.count or Int.ra.tl a. .hown on thl. Notlc. .ay obJact within .i.ty (601 day. 0' rac.lpt of
this Notlc. byl
--written prota.t to the PA Dapartaant of Ravanua, Bo.rd of Appaall, Dept, lBIDZI, Harrl.burg, PA 17IZ8-IOZI,. OR
.-electlng to have tha ..tter dater.lnad at tha .udit of tha account of Ih. p.r.onal r.pt...ntatlv., OR
-.appe.l to tha Orphan.' Court
ADHIN.
ISTRATIVE
CORRECTIDHSI
DISCOUNT I
PENAL TYl
INTEREST:
Factu.1 arrorl dl.cov.r.d on thl_ ........nt .hould b. addte...d In writing to: PA Dap.rt..nt of R.v.nu.,
Bur..u of Indlvldu.l T..e., ATTHI po.t b......nt Ravla.. Unit, DEPT. Z8a6Dl, Uarrhburg, PA 171ZB-0601
Phon. (717) 1a7-6S0S. S.. page S of the booklet "In.tructlon. for Inh.rllanc. Ta_ R.turn for a R..ld.nt
O.c.dent" (REV-1S01) 'or an ..planatlon 0' ad.inl.tratlvely corr.ctabl. .rror..
If any ta. due I. paid within thr.e (31 cal.nd.r aonth. aftar the dec.d.nt'. d.alh, a flv. p.rc.nt (S~)
dl.count 0' the ta. paid I. allow.d.
Th. IS% ta. aan..ty non-participation penalty Is coaput.d on Ihe total of the ta. and Int.r..t .......d, and not
paid b.for. January la, 1996, the ,Irlt day aft.r tha .nd 0' the t.. .ane.ty p.rlod, Thl. non-participation
penalty I. appealable In the .a.. aann.r and In the the ...a tla. p.rlod a. you would appeal the ta. and Int.re.t
that ha. b..n .......d a. Indlcat.d on thl. notlc.,
Inter..t I. ch.rg.d b.glnnlng with flr.t day 0' delinquency, or nln. (9) eonth. and one el) day
fro. the date of d..th, to the d.t. of pay..nt, Ta... which b.ca.. d.llnquent bafor. January 1, 19a2
b..r Int.re.t at the r.ta of .1. e6%) p.rc.nt per annua calculat.d at a dally rate of ,000164,
All t.... which bec... delinquent on or .ft.r January I, 1982 will baar Inlerl.t at a rata which will vary fro.
calendar ya.r to calendar y.ar with that rat. announc.d by the PA O.parta.nt of R.v.nue, Tha applicable
Int.r..t r.te. for 19aZ through 1996 .r'l
y.ar Inter..t Rat. Oalh Int.r..t Factor Year Intlre.t Rat. Oalh Internt Factor
19at ZOX ,OOOSIo8 1981 'X .QODZIo7
1983 16% ,QOOOa 198a-I991 11% .0003Dl
1984 IlX .0D03DI 199Z 'X ,OOOllo7
1985 13% .00DSS6 1991-1994 7X ,OOOl9Z
1986 lOX ,DD0l7t, 1995-1996 'X .00Ol107
--Internt It calculated .. followlI
INTEREST = BALANCE OF TAK UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTDR
.-Any Hotlce I"ued aft.r the t.. baco... d.llnquant will r.fl.ct an Int.rest calcul.tlon to fl't..n liS) day.
beyond the dal. of the .......ent. If pay..nt I. .ad. aft.r IhI Int.r.st COlPUtellon dal. .hown on the
Notice, additional Int.r..t IU.t b. calculaled,
PURPOSE DF
HDTlCE:
PAV"EHTI
REFUND (CR):
'r.
, .
r:4
.J
,'4)U
To fulfill tho r.qulr...nt5 of S.ctlon 2140 of tho Inh.rltanc' nnd E.tat. la. Act, Act 22 of 1991. 112 P,S.
S.ctlon 2140),
D.tach the top portion of thl. Notlc. and .ubalt with your paya.nt to the R.gllt.r of willi prlntad on the
r.....r.. sid..
.. Haka ch.ck or aon.y ord.r payable tOI REGISTER OF WillS, ACENT,
All pay..ntl r.c.lv.d Ihall flr.t b. appll.d to Bny Int.r..t which aay b. du., with any r..alnd.r appll.d to the taM,
A r.fund of a taM cr.dlt, which wa. not r.qu..t.d on the taM r.turn, aay b. requ.st.d by co.pl.tlng an "Application
for R.fund of P.nn.ylvanla Inh.rltanc. and E.tat. Ta." CREV41113), Appllcatlonl are available at the Dfflcl of
tho Rlgl.t.r of Will., any of the 23 R.venu. Dlltrlct Office. or by calling tho .p.clal 24~hour an.w.rlng l.rvlcl
nuab.r. for for.. ord.rlng: In P.nn.ylvanla 1-800.162.20~a, out.ld. P.nnsylvanla and within local
Harrisburg ar.a (111) 181-8094, TDOI (111) 712-22S2 C11.arlng lapalr.d Only).
DBJECTIDNS: Any party In Int.r..t not latlsflad with thl appral....nt. allowanc. or dllal10wanc. of deduction. or ass.....nt
of taM (Including discount or Int.r..t) a. .hown on thl. Notlc. aay obJ.ct within .IMty (60J day. of r.c.lpt of
this Notice bYI
--wrltt.n prot.st to tho PA D.parta.nt of R.v.nu., Board of Appeal.. D.pt. 281021. Harrl.burg, PA 11128-1021, OR
.-.I.ctlng to have the .att.r d.t.r.ln.d at the audit of the account of the p.r.on.l r.pr..entatlv., OR
-.app.al to thl Drphan.' Court
AOHIN-
ISTRATlVE
CDRRECTIONS:
DISCOUNT I
PENAl TV:
IHTEREST:
Factual .rrorl dlscovar.d on thl. as......nt .hould b. addr....d in writing tal PA O.part..nt of R.v.nul,
Bur.au of Individual T...., ATTNI Post A.....a.nt R.viow Unit, oEPT, 280601, Harrl.burg, Pi 11128-0601
Phon. (111) 181-6~OS. See page 3 of the bookl.t "In.tructlon. for Inh.rltanc. Ta. A.turn for a A..ldlnt
O.c.d.nt" CREV-1S01) for nn ..planatlon of ad.lnl.tratlv.ly correctable .rrors,
If any tax duo I. paid within thr.. Cl) cal.ndar aonth. aftar the d.c.d.nt's d.ath, a flvl p.rc.nt (S~)
dl.count of the taM paid 11 allow.d,
Th. 15~ taM a.n..ty non-participation p.nalty Is coaputed on the total of the taM and Int.r..t a......d, and not
paid before January 18, 1996, the flr.t day aft.r the .nd of the tax aan..tv p.rlod, Thl. non-participation
p.naltv I. app.alabl. In the .aae .ann.r and In the the .... tla. p.rlod as you would app.al tho taM and Int.r..t
that has bIen assl.s.d a. Indlcat.d on thl. notlc.,
Int.re.t I. charg.d blglnnlng with flr.t day of delinquency, or nine C91 aonth. and on. (1) day
fro. tha data of d.ath, to tha data of pav..nt, Ta... which beca.. d.llnqu.nt b.fore January 1, 1982
b.ar Intar.st at tho rat. of SIM C6%) p.rc.nt per annu. calculat.d at a dally rat. of .000164,
All ta..1 which b.ca.e d.llnqu.nt on or aft.r January I. 1982 will b.ar Int.rast at a rat. which will vary fro.
cal.ndar y.ar to calandar y.ar with that ret. announc.d by the PA n.part..nt of R.v.nu., Th. applicable
Int.r..t rat.1 for 1982 through 1996 ar..
V.ar Int.rut Rat. Dallv Int.r..t Factor V.ar Int.r..t Rat. Dally Int.rut Factor
1982 20~ .000Sfta 1987 .~ .000241
'983 16:( ,00008 1988-1991 11:( ,000301
19B4 11% ,000301 1992 .~ ,000247
1985 13~ .00OS~6 1993.1994 lZ .000192
1986 10;( ,000274 1995-1996 .~ ,000247
ulnt.rut Is calculat.d AI follo,",1I
INTEREST = BALANCE OF TAX UNPAID K NUnDER OF DAYS DELINQUENT K DAILY INTEREST FACTOR
--Any Hotlc. ISlu.d aft.r the taM b.co." dallnquent will r.fl.ct en Int.r.st calculation to flft..n CIS) day.
b.yond tha date of the a,s'ls..nt, If pey..nt I. .ad. aft.r the Int.r..t co.putatlon data Ihown on the
Notlc., eddltlonal Int.r..t aust b. calculat.d.