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HomeMy WebLinkAbout96-00690 llPf'l"RINl '" PEU'*'NfNl IlACKINK ~ , " " ('..~ ~ rX \r'.~ ~ ~ J 11)1, I" I ( I! 11\ I, oj ,Ii 1{('I'I',ll,11 .ill ..I,killl ,!tIll '1'1111"11('111 I dllll'. ! dcd '.'.' I! II lilt ,I~ ,11.1/1111' 1IIIlllll\,IIIIIIIIIII! )'1"'11 I'. "II"rl" i I hf Illlril).d 11'llilILI!( wdllH' !'I)\.\,iili,lll> 1111 II,. \'11 '1'1: '111,111 "111'111111111111' .Ii 1\1'llll ,I., {Jill<: I'll I "~i.1I 1 WARNING: It Is Illegal to dupllcato Ihls copy by photostat or photograph, h'l' f(ll lhi'; ({1(llil,H(, LIllO rlji;,/,'i'J~"F"'~ '->'_ ,i';ii~\.~\\H W Pf~.,'i:.", II' ~'/, '1'- "..I' ~,-' #.j,.~. .'....\........~?sJ ...", ., "" S ~' ,~ - :>.. * '., ...,-t ~, "i_cl1-;'f"/-:'~l l'.f/~iNt O\~~~".. N.'JJJJ1WJY 1/ I; NJt/XA........ 1\('gistLII (, ' W~U:..,. I~ Li)(,d I~\! &O~ ,~ 3757111 C'4, 0' .._t. Dale No, . HIIr.>IUfl., /'al OOMMONWEALTH OF PENNSYLVANiA. DEPARTMENT Of HEALTH. VITAL RECORDS . 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"m.~.I. .f\dptm 1111111 IlCENSfi7ijijGtfl U~I8:~~"1 - ""'~'.""QI<It.'" DAff Of iiE~jfil.;;;~ti,Ii:;;-;;;-;,-- .----. 4 ."",( J~T ~) , I~~t, tii;';.lfnM"'lb.~'~--'-' lI.Ir OFOC~fit'-----~~A tHtlm(iJri(;EOtJEA[i(I.l~i;;",;i'l . l'f'I<I""MP'O""~I>;'liIt"~ j. as'" -"'~---"-"'_____'_'''___ "'l._____LlL 1l00",!--.b.l.f[f,_~. U ,UlI I, ("fI' I~' "',..... "'I"''il1 0< '<WTVo<"""",,~ '"'.UIIY"" ""If" t>J """""'1'" "...,. ~l "'"'9 ..,~.. ,,',Joll'" 'iIll",.lo',."..,. II""" 0> ,....11....... 1,,,,,,,,"''''1''''0'''1<1,,,,. ~ii:fiffiiiii(&"iOiiii(iKm'T~~i,imrM YU ( ~I tw"'l Em Ir,WUllAl(tAUUd,.. ......",,,.J.l.< ,.~.""..',".H'I Af>f'lO......" ....lVllbtl".... OI\Hlllw.Jilf.lh ..j-.Q"",-" 1 -'''~I~~''''ON7f~,T'';'W:'- 1lOI1......""'...l/II.....,.,t,''IllIu...I/'<..'.......fHI ''S''l:,.n c ell c~~ t,,"I'lf-:I-rr' '..... .-.-. l1i'ifoiri;kiAn~lf.i it.ii_tli":: (~I .~:~r <t_;' 3 ~"l'>I""'.r'.' ,'...ol""1 ~ '''1 .''''''11 k' """t.kI" '.".. t",.,UNOIIlLYIkQ 'C.UUII'"''''''''''''I''' . 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In h () .~( I !:l- 1 J [ . 1.......1I~'''''.''''''lt6u. ...1I"'i.'"".4Ifjht1.m._d'I.,.Nl~I."..''<ld...."'''..~U(f).''''"'I,,''"..'11lI~ 11111,. .' .. . .,----.. ll~. i.. .. ,. . NAI.OEj,fjii'AlI('IUUOrrIHWNWWl:OIlPlf ItHl~lj' iOI nil"1 ....'tl.<:Alf.AMINtIlICt)flONI" l'I",,,,Ill,plOII'MI I-~. "<J. t~.. t1c'ol /' ~ ::' ::;::'~t:~:'i~'['''"''''"'''' """"""""~'''''''m. "" 'M_"'" '''"''i'~"I";'~::;''I::1 I I :''''A':6~;~l' ;,~ ;~~l"l:~j., . ~l-2-LC___ -'CJlI110r(A!~:;",'ii''',(It.;U/(lal' ll(j( t(l,(ti A~i A-';i,; lil '(~ ,(I,; '1 (iij \', \,. I' , fOR DATES OfDEA1HAmR 12/31/91CHECKHIRE .~,;~b'r. INHERITANCE TAX RETURN '~o~::~yugiDIT IS CLAIMED 'r;..~ RESIDENT DECEDENT !FILENUMBIR..... COMMOt~WfAllHOf PENt,lhYtVANIA (TO BE FILtD IN DUPLICATE I H::R~:31:1.';~;~:~:~~:, . . WITH REG;SrER OF WILLS) ,COU:T~CO~E YE~R() ...0['('i..0..";;.''''"' ,;;",,,,, """ """"""'...-=:;'-.--.-. --.--. '... '~. -. '--'~[)[(~f6Y;:-.'" """,,' ,,.,,, '6'~;;7~;,~,~~,~~~gg-W. ml;;/(6'!(;~6"'(~/~f~73 7 ..... (r:~O~~:lr~:<of~ 02 5 "'~::;~,:~~;:;::"~:" ''''''"d~:;;~~;~" ' ' J"f,wHRoM,~:,,","~ _ _ K}'.l. 01iglnal Return [] 2, Supplemental RO!lifn [J 3. RemaindIH Return (lor d\1tes of death prior to 12.13.82) [] 4. Limited Estale ~.l 40. Future InttlroU Compromise 0 5. fedarol Ellole Tal( Return Required (for dotos of deoth oftor 12-12.62) f] 6. Decedent Died TOIIOIO [J 7. Decodent Maintained 0 living Trull (Altoch copy of Will) (AHach copy of Trust) , ALL CORRESPONDENCE AND CONFIDENTIAL TAX'.INFORMATION SHOULD BE OIRECTED TO. -""AM!' IOMPlOf MAIliNG ADDRESS _JS.eiJJl~-13re.!lL1.QnE\I) /.__l';BgU.if~_.. _ _ 44 W. Mai n StrWu TElEPHONE NUMBf~ Mechunicsburg, \_~Pl\ 1'7055 _._.__ _,L-1.L7L~fi.9.2::Jl52~~==_.~=_-~~ _===_ -=- ~___-=,.c.=_-. IlfYI',OO Oi I'.(,>~) ~ Z W .. W '-' u' .. w ~ ......, ~~~ :cc:t9 ufca '" .. , ~ "'Z w," "''' "'z 8~ I. 2. 3. 4. 5. z c 6. i= :5 7 ::> ~ 0: 8. .. '-' Q. w '" 10, 11. 12. 13. 14. ---*-- 15. 16. 17. z c ~ 18. ~ IIQ if .. .. u ~ 20. ~ Real EUale (Schedule A) St~ckt and 8ond, (Schedule B) Closely Held Slack/Partnership lntorost (Schedule C) MOrlgages and Noles Receivable (Schedule OJ Cosh, 8ank Depo,ilS & Miscellaneous Personal PrlJperly IS,h.dul. EI Joinlly Owned Proporly (Schedulo f) Tronslors (Schedulo OJ (Schedule lJ Toto! Gran Auou (Iolnl lines 1.7J Funeral Ell;pensos, Administrative CasU, Miscellaneous Exponses (S~hedul& HI Dobts, Morrgage Uabilities, Lien~ (Schedule I) T otol Deductions (10101 lines 9 & 10) Net Yolue of Euolu (line 8 minus line III Charitable and Governmental BequesU (Schedule J) Net YCllue Su.?iecI 10 Tax (line 12 minus li~~__ Spoulol Transfeu (for dates of death after 6.30.Q4) See lnslrucllon' Inr Appllccble Percontage on Rever,e Sidfl. (Include values from Schedule K or Schedule M.) Amount of line 14 roxcble at 6% rale (Indude valulJs from Schedule K or Schedule M,l Amounl of Une 14 loxablfl 01 15% rale (Indude valu,,, from Schedule K or Schedule M,l Principal 10.... duo {Add lOll; from Unes 15, 16 clnd 17.} Credits Spousol Poverty Crodil Prior Poymon1S + E 06'JO NUMkER .0._ 8, Tolol Number of Sofo Deposit Bo....o\ (1)__21_O.QQJ.OlL ( 2 1 ._________.~_ ------ (31 ..__...._..__.________.__ (4) _._~_..____._.__.....m._ I 5 l~lj."ll6.~9_6. - - --.-. _.~.il.9_~_:.~3...__.._.. ~__ ---,=-<1..::.---..--- I " 'L' ( 6) ( 7) 18) ~_LMJ.98 (Q) ___~Jl1. 0 . 4 0 ___ 10,528.32 (10) (II) (12) (131 {l41 20, 33JL~72-_.~__ 1. 0..1....2.6..._____ .._ 1 03 ..2Ji. (IS) ___._~'O.l.2.fL___x.O"_. -0- {l61 _____.__._______X .06. (17) _..._._.._..____.___._..__..~." .15 . (IB) ..0- Dhcounl !n1fHost +..~ (lQ) (20) If Uno 19 is greater than line 18, onlor Iho dlflfHooce on line 20, m1i Thil II ,h. OVERPAYMENT, Chttdt hore I' you ore roquestlng a refund of YOUf overpayment. (211 (2IA) (2IB) 21 If linfl 18 is gre(ller thon lino 1r.). nnlor Iho diffe/cnc(I on Line 21 Thi1 is rhll TAX DUE. A Enler the inlorelt on tho bal{ln~e dun on LillO 21A :"0:'::.- 8, En!tH ,ho lolal 01 Lina 21 arId 21A on lino 21f\ Thii ii ,ho BALANCE DUE. M_~k~~~~~_~.p..~_'(~~_l. to: Reghter of Wills, Agent _m-'--';BE-SURETO ANSWER. ALL QUESTIONS ON REVERSeilDEANil TO RECHECK MATH ..(... __n. Undor penalliel of peqvly. I declortl !h(;;Th~~\-;~~~;~.~T!f:I.~--;-;;-urn.,-~-~~il~.;-~~~;~lPO~yin9-;-h;ldulnl oncJ ~Iotemont\. ond to rhe be\! 01 my knowledge OI'Id beliol. It I~ !ruo, corrncl nnd comploto I dncimo that nil rflnl flslCltn hm bfl(lrl Hlporlfd (It Irll(l mmkol vClI\lo_ Olldurolion 01 proporor other thon lho per\onol rOprtlSflntotlvfI 1\ baled on all IIllormo11on of wh,rh prflporflf hn~ orly ~llClwllldql' <;i(;~-IA-iLjii(;-'-~l-~ ~oi-i I.r ~ P( ,', ~-: .~ I r f ,,-~--i 1111/(;- ~ 11 liP', ., 1'1 J~ I '.', l'^ 17025 [)';':ff-- ,._,-- .~-.. II" /'/7 \...)" j,L_('~ IL.\_~,,' '\. {"lllIi I<i,,\ ~j(4'II'h~'~~;;f:~~'~~~'~'~=::_f '>I ',1.1 I ,I 101111X IIIl 11"011.<1 I{d., j';I<Olil, ,litl;PI',. tlli ~\I. ~Idill ~;trl'c~t r'h'('lldll i (.:-;j}UI'q I P^ 1705!, [)Al[' (./1/n Schedule F - Jointly Owned property Date of Death Bond No. Face Va.lll.~ Jeeue Ow Value (8/6/96) C73939885 $100.00 July 1984 113.08 C76574857 100.00 August 1984 113.08 C79169380 100.00 September 1984 110.84 C79175157 100.00 Ootober 1984 110.84 C81592524 100.00 November 1984 110.84 C81598527 100.00 Deoember 1984 110.84 C82771369 100.00 January 1985 110.84 C85852409 100.00 February 1985 110.84 C85857382 100.00 March 1985 108.68 C86960916 100.00 April 1985 108.68 C86966650 100.00 May 1985 108.68 C82656097 100.00 May 1985 108.68 C226745358 100.00 .January 1990 73.44 C226760697 100.00 February 1990 73.44 C226775861 100.00 Maroh 1990 71.32 C242897145 100.00 April 1990 71.32 C242912206 100.00 May 1990 71.32 C242927350 100.00 June 1990 71.32 C242943331 100.00 July 1990 71.32 C259465466 100.00 August 1990 71. 32 C26377B781 100.00 August 1990 71.32 C263797368 100.00 September 1990 69.24 C263819500 100.00 Ootober 1990 69.24 C263843741 100.00 November 1990 69.24 C276818793 100.00 Deoember 1990 69.24 C276843570 100.00 January 1991 69.24 C276869825 100.00 February 1991 69.24 C266947520 100.00 March 1991 67.20 C266972229 100.00 April 1991 67.20 C266996667 100.00 May 1991 67.20 C295247672 100.00 June 1991 67.20 C295278484 100.00 July 1991 67.20 C295289329 100.00 August 1991 67.20 C295320532 100.00 August 1991 67.20 C310346912 100.00 September 1991 64.56 C310370035 100.00 Ootober 1991 64.56 C310393733 100.00 November 1991 64.56 C330'777656 100.00 December 1991 64.56 C330797723 100.00 .Tanuary 1992 64.56 C330820343 100.00 February 1992 64.56 C330841262 100.00 March 1992 62.12 C342753242 100.00 April 1992 62.12 C342771810 100.00 May 1992 62.12 C342793479 100.00 June 1992 62.12 Sohedule F - Jointly Owned Property Date of Death Bond No. ~'ace Value Issue Date Y1!l.ue (8/6/96\ C360853704 100.00 July 1992 62.12 C360875720 100.00 July 1992 62.12 C360890641 100.00 August 1992 62.12 C360915584 100.00 September 1992 59.96 C367459763 100.00 Ootober 1992 59.96 C367485668 100.00 November 1992 59.96 C367510132 100.00 December 1992 59.96 C39462360B 100.00 January 1993 59.96 C394647413 100.00 February 1993 59.96 C394674006 100.00 March 1993 57.28 C410662455 100.00 April 1993 57.08 C410689272 100.00 May 1993 56.88 C410713683 100.00 June 1993 56.72 C410738232 100.00 July 1993 56.52 C425513097 100.00 July 1993 56.52 C425538646 100.00 August 1993 56.32 C425564488 100.00 September 1993 56.16 C437831550 100.00 October 1993 55.96 C437855922 100.00 November 1993 55.76 C437882473 100.00 December 1993 55.60 C437907458 100.00 January 1994 55.40 C437933344 100.00 February 1994 55.24 C437956014 100.00 March 1994 55.04 C437983482 100.00 April 1994 54.88 C467495841 100.00 May 1994 54.68 C467521043 100.00 June 1994 54.52 C467544703 100.00 July 1994 54.32 C467569368 100.00 July 1994 54.32 C467594370 100.00 August 1994 54.16 C485877282 100.00 September 1994 53.96 C485900717 100.00 Ootober 1994 53.80 C485927252 100.00 November 1994 53.60 C495169155 100.00 December 1994 53.44 C495195211 100.00 January 1995 53.24 C495220114 100.00 February 1995 53.08 C495245676 100.00 March 1995 52.92 C515406681 100.00 April 1995 52.72 C515432272 100.00 May 1995 52.52 C515455637 100.00 June 1995 52.52 C515479747 100.00 J'une 1995 52.52 C527319344 100.00 July 1995 52.52 Tota 1 : $5,790.04 Schedule G - Transfers Date of Death Bond No. Faoe Value Jssue Date Value (8/6/W C527344352 $100.00 August 1995 52.52 C527369107 100.00 September 1995 51. 32 C527.394113 100.00 October 1995 51. 32 C527418639 100.00 November 1995 51.. 20 C510563416 100.00 December 1995 51,20 C510587506 100.00 January 1996 51.20 C539956293 100.00 February 1996 51. 20 Total: $359.96 . .""UlI f.. f'.... ATE OF ~ SCHEDULE H FUNERAL EXPfNSES. ADMINISTRAnVE com AND MISCELLANEOUS EXPENSES CQMMONWfAIJH or 'fNNmVANIA INHfR"ANCI TAl< UTURN OI"OINI OICIOfNT .--" P1_ Print or T George h'. 13card 21 %-.0690 DESCRIPl'ION ITEM NUMBER A. Funeral expenlel' B. 4, C. 1. 2. 3. 4, S. 6. 7. e, ---- 1. Noil Funeral Ilome, Inc. 1. Admlniltratlve Colill Penonal Representatlvtt Commlvslonl N / A Sodal Security Number of Penonaf ReprelentatlVtlI Year Commiuions paid 2. Anorney Feel Snelbaker, Brenneman & Spilrc, P. C. 3. Family exemplion CaimanT Blanche M. Bpi'! ,-,1 Relationship Addre.. of Claimant at decedent'l death Street Addreu _.-Jl0 Beard Hnad Cty _ Eno1a State PII ZIp Cade 1711?r, ~DO\lF.B Probate Feel to Hegister of Wills, Cumberland County Mlleellaneoul ex"elllell Advertise Letters of Administration - The Patriot News Co. Advertise Letters of Administration - Cumberland Law Journal Heserve for filing fees, miscellaneous oosts of administration and notary fees AMOUNT . 5 ,130 . 00 1,500.00 2,000.00 57.00 63.40 60.00 1,000.00 TOTAL (AIIO enter on line 9, Recapltulationl Is 9,810.40 -- COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND II: Blanche M.Board being duly .__sw_orn _ according to law, do poses and says that she. is__tho Adm~n.i.stratrix of the Estate of _.G(;g;>r.g.\;lji-'-._~"IU::d..__ ._..~__ lalo of Silver Spring ~l'ownship _, Cumberland County, Pa" d.c....d and that th. within is an inv.ntory mado by. BIanchc _M. .Beard _~, the said.A.dminis..tJ;.iaJ::rtl< of the entiro .state of said dec.dent, conTisting of all th. personal prop.rty and real estate, exc.pt real .state outside the Commonwealth of P.nnsylvonia, and that th. figures opposite .ach it.m of the Inv.ntory represent It's fair value os of tho date of d.c.dent's death, Sworn to _ and subscribed before me, r" " ~ .!.~.\~,)-~,Oc}- ,_~l~\.(t <..:._\.-~~_ \_~~_JA_~.:!....r,j)..".. Executor. Admlnlltrltor _tb..i.P-1<:;( . _~ of ~_19_'t.7_ /j?.,;.- . () '-.! Ii <...~:. t:U/UA::}~ 4:L..*. ~"L<i_< k.) ~ Nolarlal Seal f'atrlCill J. n,omson, Notary PubIIe MOOlo~Ic.'lburg Bom, Cumbart8nd CountY My Commlssloo ExplrllS 000.81, TIlQ8 l_.~_~~ €itl1.__.^'1l9\Js:t: DIY Month 8 0 1>0.a 1;-,1 g.o-,~~L Enola, PA 17025 Add,." Dote of D.ath .__n_ __._19~.6 Vur INSTRUCTIONS I. An inventory must be filed within thrao months after appointm.nt of p.rsonal r.presentatlve, 2. A supplem.nt inv.ntory must be filed within thirty days of discov.ry of additional o..ets. 3, Additional sh..ts may b. attach.d eT to p.rsonalfy or realty 4, S.. Articl. IV, Fiduciari.s Act of 1949. P.. :a III ~ E-< ~ w ~ l::: -g i ~ 0 ~ ~ ..-1 ~ '" ~ H ~ ~ "- ~ \D 0 ~ P- C> 0 VI ll'l t- o w w Ul Q OJ i!: CT: .. I !Z "- u. . .; ... H E \D -' :s: H I:Q 0 u. .... ~ 0 OJ Cl. .~ rl W 0 <( "'I > f > CT: N Z ~ rl 0 Z 0 Q ~ '.-I . VI Z 0 Ul 13 .Q 0 CT: <( 1"1 ... .jJ Z w ... ~ ... ,., c OJ .. I ~ ... "t 0 ~ .Jl ... ... ~ E g 0+- C> ~ . it -' u '" is'' (B. /() COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DUREAU OF INOIVIOUAL TAXES IMlltRIIANCI: lAX BIVI!lION IIrPT, 260601 fl^~RISnlJRO, PA 17128.0601 NOTICE or INHERITANCE TAX API'RAISEMENT, ALLOWANCE OR OISALLOWANCE OF OEOUCTIOtls AND ASSESSMlNT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN KEITH 0 BRENNEMAN ESQ 4(1 W MAIN ST MECHANICSBURG PA 17055 09-29-97 BEARD 08-06-96 21 96-0690 CUMBERLAND 101 (' .~~ ~"tU~i 'fr:~,.\.;>gj: . ~ 'o)p!. .. ,t. IH l~'" tllH lel"l GEORGE W f --------------A.mounT Ra'i" i t -t 9d,-_u---'''--'j __~_______________ ____n_n.._...___..n____.___ :~_...:~..~----' ---'--_:_:_::_~~_::_:: '_:_---=~:----~~--=-~ 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; 1547 - Elf -iiFP-- f 0:3"-- 97Y - NOYlcE - -oF nINHEiiI i' AN-CE- TAX - iippjl'iii S EiofENT -; -iii.i.:OWAtfcE- OR- - - - --- - --- - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BEARD GEORGE W FILE NO. 21 96-0690 ACN 101 DATE 09"29-97 TAX RETURN WAS, I X) ACCEPTEtJ AS FILED - , ~ .--. RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE - ._--~-,-~_. APPRAIS~D VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real [statR lSch9dulo Al 2. stocks and Bonds (Sc:heduh B) 3, Closely Held stock/Partnership Interest (Schedule CI 4. Mortgages/Nohs RecBilJsbla (Schodllle D) 5. Ca5h/Bank Deposits/Misc. Personal Proper'ty (Schedule E) 6, Jointly Owned Property (Schedule f) /. Transfers iSchedule G) 8. 1'otal Assets APPROVED DEDUCTIONS AND EXEMPTIONS: q. Funeral F.xpenses/Adm, Costs/Mise, Expenses (Schedule H) 10. Debt s/Mortga98 L iabili ties/L iens (Schedule 1) 11, Total Deductions 12. Net Value of TIP': Retut'n 13, Char i tabh/Govor'nNtontal llequftsts (Schedule J 1 14, Not Value of Estate Subject to Tax If an assessment was issued previOUSly, lines reflect figures that include the total of ill ASSESSMENT OF TAX: 15, Amount of Line 14 16. Amo,mt 01 Line lf4 17, Amount of Line 14 18, Principal l'a>o: Due NOTE: at Spousal taxable ilt taxabh at rate Lineol/Class A rat. Collateral/Class 8 rat. TAX CREDITS: ~--------- PAYMENT DATE -...-".....--.--.--.. III 121 131 141 151 161 171 191 1101 1 CflANOED .l,OOO,OO ,00 ,00 ,00 15,546,96 2,895,02 ,00 181 9,810,40 10,528,32 1111 1121 1131 1141 NOTE: To insure proper credit to your account I submit ih. uppal' portion of this form with your tax payment. 20,441,98 20.338 72 103,26 ,00 103,26 14, 15 and/or 16, 17 and 18 ~ill returns assessed to date. 11E1 1161 1171 103,26 X ,00, .00 X,06, ,DO x ,15, 1181 .00 ,00 ,00 ,00 RECEIPT NUMBER I nn-orscoiiNT-i.;'" ......___._..n__.___.____ INTEREST/PEN PAID 1-) AMOUNT PAID , "".'''..' .,..._.._. .__......-..._.... u._~.___._____. ......____.~_..._____._..._.~..____,_...... TO!~~_~A_~CRE~-XIf=-~ ~ BtNVEN~~E~:O:A:~~~t~:~ I .......... w_n~~::~~i:=: IF TOTAL DUE IS LESS THAN II, NO PAYMENT IS REQUIRED, IF TOTAL DUE IS REFLECTED ^S A "CREon" ICRI, YOU HAY BE DUE A REFUNO, SEE RlVERSl SIDF OF TlUS FORM FOR INSTRUCTIONS,) . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, ,-'I 'I ,_.~ "j RESERVATION I Eltahu of decadents dying or\ 01" bl'l~c)r. DeoellibGr H, 1982 *R 11 rtny futurG interest In thlll athte Is transferred 1n poslelsion or enjoyment t~ Cla's 8 (oollateral) benefloJarl.s of the daoedant aft.r the expiration of any ..tate for life or for years, the CoMmonwealth hereby exprelll~ relerv.. the right to appraise enu ~".'s transfer InhGrltence Taxes at the lawful Clas. 8 (collaterall rate on any suoh future Intere.t. PURPOSE OF NOnCE\ PAVMENTI REFlIND CCR>1 OBJECTIONS I ADMIN ISTRATIlJE CORPECTIONS\ DISCOUNT I PENAL TV I INrERE9Tl To fulfill the requJrelllenh of Seotion 1140 of the Inheritance anti Estate Tnx AClt, Aot 21 of 1995. (72 P,S, Seotlon 9140), Dotach the top portion of this NotlQe and submit with your p8ymcmtto the Reglstor of 1011111 prlntod on the reverse sIde. --Make cheak or lIIanll~ ardor paYflblo lOI REGISTER OF' HILLS J AGENT A refund of 8 tex ct'edlt. whJchWa5 not r4lqululhd on thfl Tax Rohlfn, mllV be ("quested by completing IIn "App1Jo~tion for Refund of Pannsvlv8nh Inherltanco end Esttlte Tux" lREV-1313l, Applications orll llvllllable at the Offioe of the Ruglstlllr of WIlls, any of the 25 Revonue DIstrict OHlou, or by callJng the special 2'4"hour answer1n" service nUMbers for forms ordering I In Pennsy!v8n18 l-aOOR562-Z050, outside PennsYlv8ni~ end within looal Harrisburg llrAa (717) 767-8094, TOOl (7171 71?-ZZSZ (Heerlng IMpaired Only). Any party In Interest not satil~18d with tho 8ppraIsement, allowance or dlsallow8Me of dlld\Ictlons, or UUUment of t8~ (Including dlscount or Interost) flS shown on this NotIce mU$t objoct wIthIn slxtv (60) days of r.o~lpt of thls NotiCe! bYI --written protut to the PA Oel18rllllent of Rovllnue, Board of APPOllls, Oopt, 261021, Harrhburg, PA 17126-1021, OR ~-ol.otlon to have the metter dotmrlll1ned lit audit of the account of the personal represontlltIve, OR --appeal to tho Orphllns' Court. FactUlll errorl dIscovered on this assellment should bo llddrossed in writing tOI PA DoPftrtment of Revenue, Bureau of IndIvldulll T8)(0I, ATTNI Post h'C1ssmont Rovlew Vnlt, Oept. 280601, HarrIsburg, PA 17128-0601 Phone (717) 787-6505. Soo pllgy S of tho booklot "Instruotlons for Inhorltance Tal< Return for 8 ResJdlh"lt Oecadent" (REV-150ll for 6n explanatlon of l'Idftltnhtr!ltlvely torrClOtllble errors. If any t8l< due h fluid withIn thrfl8 (3) ollhmd~r IIIllnthll after the decedent's doath, 1I five percent (Sin dhoount of the tax patd Is allowed, The 15% hlx alllnuty non-partJoIplltlon penlllty Ii comfHlhld on tho totnl of the tax and Intorast lIuUI.,d/ and not patd before J8nuIlry 18/ 1996. the flrlt dfty 6ftor thfl end of tho hx Illllnutv per Jod, Thh non~P!lrtlclflatlon penal ty h l'Ippeolllbh 11'1 the Sflme manner end In the the 5811I0 t IIl1e per lod fII you would appelll the tnx lInd Interut that has bean ll..elled al Indlcllted on thIs notloa. rntara5t Is charged hoglrmlng ~dth flrgt dAY of dellnquencv, or nlna (91 month. and ona (ll day frail the dati of duth, to the date of pllyment. ToxllS which beC8IMe dellMlulllnt befol'a Jllnullrv 1; 1982 bur Intar..t at the rate of Ih< (6%) percont per "'nnull calculatfld lIt n dslly "atll af .000164, All tlIXI. whIch beC81l1a delinquent on and nfter Jan'J~ry I, 19&2101111 bear IntorlUt at 8 rftte whtch wtll vlIrv frQI\ cnlenclar yellr .to qalendar \lear with that rate announced b~ the PA Oepllrtlllont of RevenulI. lhe nppl tctlble Intorut rattu for 1982 through 1997 arll '!.!!! Inhtrest Rate Dolly Interest rllctor ~!!' Intorest RlIt~ Dally tntlrllt FlIGctor 1982 lOX .OO054e 1981 9% .000247 1983 16% .000458 1968-1991 11% .000301 1984 U% ,000301 1992 9% ,Oa0247 1985 13% ,000556 1993~ 1994 1% .000l9! 1986 10% ,000274 1995-1997 9% .000l41 --Interest h Clelculatad .. folloWl1 INTEREST = BALANCE DF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR .~An\l Notice luued 8fter the tftx be<loUt l1111nquent wHI reflect 8n Interlst calculfttlon to flf'.." (1S) daVI blvnnd the dah of the tll'llll5,"cmt. If paV"'Clnt Is llIf1de lIftar thl lntorut oOlllpuhtlon dat. ShOilln on the NOtlo.. addittonol IntGrlll MlIlt be lla!culatod, 1111, I, I" It'llth i1U( (hi,' IllllllllLlllllJI Ill"" .\',1'-'_'1' I', <(1111'\11\ "lill\'III!,'I1\ 11' "lli'III_'! ! (I, ,II !-"l'!',I,ll.ll. l'IIl' IHi!',l!l,d (l'llilil ,Ill' \', ili 1,(' (1111', Hlkd III 11,1' 'q.I!, \ It,d 1',-, "III, 11111<,11, 1111' 1111 d d",lill IliI\ 111,',1 '.'.1111 III 1',11\1.1111111 t1111\ WARNING: It Is II10gnl 10 duplloalo this copy by phnll"'lnt 0' pl\(Jto~Jfnph. hT !(II 11th L'('l'lilil"llt', ,:>,l,OO /) j) {' tli-d.; < rl LI1 ',c.(.1 tV~c_~ (..( -f,.,' 1.1)(,d IZq',I'ill,11 tt'/"/J ,"""''',-"", ,/<~\\ \I Of P/'i:'; ....$' 1'J';\ ;""~~''''' .;C-" Iii, "'I' <" \ I~'B:,.. ~f..', '!.'.~'..-.)) ~ II: ,'__,_. ..'C .,' 'i 'if I \ 'lb' . ~.F '. ~--- ~// ,.,>,:1"MfN\ ~,'(,\",/' ~!!{!!((1!JJ!J!!II- 4630396 ,l)" 1 Iji, c.("dlt,.U/ j D/ I ),Ht' No. Il'U~ ItJ H.. ~187 COMMONWeALTH Of PENNSYLVANIA' OEPA.RTMBIH O~ HEALTH' VITAL RECORDS CERTIFICATE OF DEAHl I , ~ ~ , 1'~lff~~~IIlI~A ".l,IlOfOi([Otii~-;:r.u.--:~--f--'-1!);- J-- - -jur~' Ii<A,~i'~t'lilli"~i;~-wili,,"---' :-'Fii€Of~r.;-",~.t:I"'''r" . -.- C_._ 0.0LAI''-f,!...._.-!'2c--_JlS.&L_.~-.l.------- - __n.' ,}.....~ IUc.Yj:L~f_~ :.::.'-2..8f2....~_.lj::_:...LLI1 .U~ll.I't1."'lI'l VliOfR1VEAA U"lotl\!OJlr O~'f.OI~llIlIf ~IRlur\JICf,~,,""1 P\""lrwr*~IIt""""!r'"" _"".,..",,\"'.....101 ~t f" ~If D.;t ~~'lww" I";~ I~:J~, t;:I~;f:,>;~';~,(" 1,~~~:I:<1 - t:=,""I; 1'- - ~l ;---I:=~~J- R."~P<<l~ ';r':I,'L~ ~(lI.JN:YOfIIl'A'H~ ~ n ~._. - ---dMOOf\{)(-\ fWl'orri(~hf--- r~tli(~~i.l.lt~'i';."~"((;-,:;;;'~-;..l ~,--;;(""~ ;;--- -_..._.I~:;~~;I?:,~S~:~=1i1 .-l=lm'j'~inlIl'"a."tWt\i. ..'. ..~':' ",'.1l~ "'......)) __.!LtA'tJ~~~ ~" J.... 80 m,eiltb 1~;Lt!r!"L~ I '~701.:2_ "'::'.':"_'~'::-' _1.. 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