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~. ' FOR DATES OF DEATH AnER 12131/91 CHECK HERE
~""~ ~l' INHERITANCE TAX RETURN !~o"v:;fyUi:iDITISCLAIMED [I
..".. . RESIDENT DECEDENT : i1i'i NUMSiC -, - __H' nu,
(OM;~::~~~fi5~;~1~:~~:"'A i ,(~!r.~~;~~~T~~~!P~~t;)E ,., S?I!~)CODE __'' l~~~ &
IOfCEO~NT'S NAME ll,.l,ST FIR.S1 AtW MIODlf IIH11AlI '-~~'-'~-'-'----_._'--"--'-IDtCfD7tjfJ COMPlETE ADORF.5S .-
I loll LL ,_ _ '" . 49{)l) 'prindle! Hoad
~ I~~~~~~'~;U;~'; T\lWL _Jt~-~7:~H~']~A;~'JIJ';;f~I)!- (",,~0.C~~~~;~~:~~~~' PA 17055
~ I"~ ;:;,,;,;;;;,, I"";;;;C;;;oOili=",,,7,;-i1,;;; ~~o;;;;-;;;;;;;;-'-F()ClAi. i,ct"iiNuMOi-'-' ,,- '--i"O\ilifii-'WV'O il'ITlNTIiur.iio'I$1
--;--r~ ~ 0"9'"01 Rel~-;-;- 0 2 6::-;;;;'IR'~u~;;----~---' 0 3. Remo",der Relurn
:.::$ v.I (for dales of death prior 10 12. \ 3.82)
u g: ij fI 4 Limited EUole r..:J 40 Future Interost Cl:lmprOIl1lSo 0 5, Fedftrol Estate Tax Return Roqulred
~~9 .-J (for doles of dealh aher 12.12.821
w~~ ~~
Q", ~.-J 0, Decodent DitJd Toslote Ll 7, Decedent Maintained a living TrUSI _ g, Total Number of Safe Deposit Boxes
<<{Allo,hcopyoIWilll [Allo,hcopyoIT""1 closed prior to deatl.
~--I'AU."CORRESPONDENCE AND CONfiDENTIAL TAX INfORMATION.SHOULD BE DIRECTED. TOI '" ..":~;h""';::Z--
th ~ NAME rOMI'UTe'MAitiNO ADDRE!$
::J~~Wion. Zul1 j & Sr" hArt 109 [,ocustoi,>..~reet '"
tl:t "'''HO''' "UM'" Harrisburg'; ,'PA .1,7101'
____ 7-p,r,-Q,nl .
r- ~.-
I I. Rltal Euate (Schedule Al
Srocks and Bonds (Schedule 8)
Closely Hltld Slock/Porlnershlp lnleres' (Schedule q
Mortgages and Notes Receivobl" (Schedule OJ
Cosh, Bonk Deposirs & M(scellaneou~ P~rsonol Praporty
{Schedule EI
Jointly Owned Property (Schedule F)
Trons/ors (Schedllle OJ (Schedule L}
TO'lol Gran Assets (lotol Line, 1.7}
Funeral EXPMses, Adminislralive Costs, Miscellaneous
Expenllu (Schedule H)
Debls, Mortgago Liabililios, Lions (Schodule I)
Totol Deducllons (10101 Lines 9 &. 10}
Rf'I-1 ,~I)O f ,(. 1/'''4)
2.
3.
J.
5.
"
co 6.
;::
~ 7.
;:.
!'i 8.
u Q.
w
a:
10.
II.
12.
113.
__---'-14.
115.
I
116.
I
117
I
118.
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Net Value 01 Estale (Lino 8 minus Line II)
Chr.nilable and Governmenlal Bequests (Schedule J)
Nel Value Sub(edto Toll. (Line 12 minus Line 131
Spou~al Tronsfers (for dotes of deoth aker 6.30.94)
See InslrVClions for Applicoble Percenlage on Reverse
Sid.,. (lncludtt voluos from Schedule K or 5chedulo M.l
Amount of Line 14 taxable at 6% role
(Include values from Schedule K or S(hedule M.l
Amoun! of Line 14 toxoble at 15% rare
(Include values from Scheduio K or Schedultl M,)
Princioollox due (Add tux /rom Lines 15, 16 ond 17_)
Credit~ Spousal Pov~rty Credll Prior Payments
------~_..- +
I :) 1/ J I
(prig
_...._NlJ_^!!'E~
{II ________
[21
[31_,
{J 1________,
( 51._,,__~___
d
I
'j;
~-..,
161 1AL.!!.lJL 6 0
{ 7}
I Q I 8,465.12
{IDI 841.97
L"i
18 )
148,418.60
9,307.09
139,111.51
-0-
139,111.51
[II)
112)
(131
1141
[151
X._D
1161 '
139,111.51
x .06=
8.346.69
[171__.,_.
x ,15 ::I
{181
8,346.69
+
Discount
417.33
IIQ)
1201 -
417.33
Inrnre,1
If Line 191s greoler Ihl"1n Line 18, IInler the dlHlIrencll on lInfl 20. This i, the OVERPAYMENT.
DO
21. If Line 18 is gr8aler Ihon Lint'! 19, enter lhe difforence on Line 21. This is tho TAX DUE. (21) 7 , 929 . 36
A. Enter the inlenut on Ihll balance due on lint! 21 A. (2IA)
8. Enter the 10101 of Line 21 ond 21 A on Lino 21 B. This il Iht! BALANCE DUE. (2\ B) _._--1...t...9.J~...lL____
M~_k. Check Pa.ya~_l. 10: _~.gl.t.r o~_ wm~_~ A_~_.n.1 _ ._
~ >. B~ SURE TO AN5~ERALL QUESm:lN's ClN.REVERSE:5IDE AND\TOIRECfIECl(.MATHIilt.~.~.j
.U~der penallie, 01 p,equry, I declorlllhOl I hove eXflmined Ihis return, including accompanying schedules and stotements, and 10 Ihft btUl of my knowledge and bellel.
It IS Irue, cerr",t and ~omplllle. I declCHtI !hor <111 refl! lulnlo hello boon ,'oported at !rUA markel volult. Declaralion 01 preparer olher Ihon the pSr10nal representalive is
based on all infnrmalion 0/ which prllpOffH hOl any ~nQwll!ldgl!l.
~ru~ orTei'.o" ""ON'l8lE ,o.iiliNG.,liiiN"--,iiDiE)> l-;. - '];2 - 010.:) _. .
__i?1,J..J....l..~:...... .iL ,fil.-'i-i.. // .~ -1. '/.\n <.!~IUlOlJ.'V~_Il.','/ <'''' <'.1. /(/~("
~j(,NA!l/IIE Of 'IlEP II OTH l;4AN HfMENIMIVE '---~~~~' ... .-. I --) I J DAte '.. _ . t
\:,-+4c:-~ " . < It 'i' I" ,,'( .iL-.l!:,L /l,.", " )J..-Jii.~U( Ii: _ ..!.,4.') / ,..Ii<
" ~J....c..tk.a. /II '-;'-1 . I , ,,'
20.
C cck here if you pre roquvstin 0 rofunq of your overpayment.
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C.JMMONWEALTH OF PENNSYLVANIA
1~IHERlrAN<:e rAX UTURN
_..~ESIOENT OE<:EOet.rr
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
~
ESTATE OF
Averil I. Shearer
ITEM
NUMBER
DESCRIPTION
A. Funerol Expense"
B.
4.
C.
1.
2.
3.
4.
5.
6.
7.
a.
L
Myers Harner Funeral home
Charlene Myers Caterer- Funeral luncheon
2.
3.
4.
Rolling Green Cemetary - Burial
Floral Spray - Funeral Flowers
Administrative Cost"
L
Personal RepresentCllivo Commissions
Social Security t'-Iumber of Personal Represenlallve:
Year Commissions paid.
2.
Allorney Fee, WiQn, Zulli & Seibert
3. Family Exempllon
Claimant
Addre.. 0' Claimant at decedent', deolh
SIr.et Addr.ss
City
Relotion,hlp
5101. ___ Zip Code
Probate Fees
I
I
I Ploas. Print or Type
I FILE NUMBER -
I
AMOUNT
Miscellaneous Expense"
Wion, Zulli & Seibert - Copies, overnight mail
Register of Wills - File Inh. tax return
5,540.00
457.37
695.00
237.75
1,500.00
20.00
15.00
TOTAL IAlso entet on Iln. 9. ReccPitulatlonlT ~6 5.12
(II mar. spac. is n..d.d, Ins.rt additional .h..,s of .am. "...)
~fv. I ~ 11 !~. (1,'1J)
~..
. ,l!l::'I
':,X:. .~
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
(OMMONwt.l.lfH Of P!NN5YlVANIA
,/'m~mA~I(e f"~ ~HUIIN
USIO!Hf Ot(fP~Nr
iSTAT, OF
Averil I.
PI.a.. Print 0'. Typ.
J FILE NUMBER
Shearer
4.---...:...._______~~~___._._ _.~__~___.
~-_._-,---
ITEM I
NUMBER I
I.
2.
3.
4.
5.
6 .
"-
DESCRIPTION
Wasserotts - Oxygen
Health Force - Nurses
Mrs. Paul Gelhouses - Nurse
Kelly Assisted Living - Nurses
Nurse Finders - Nurses
Amy Betts - Nurse
TOTAL IAllo onto, on lin. 10, Rocopitulatlonl
(If mo", space is n".d,d/ insert QrJrJifionol sheets of sam. siztt,)
I ~~-
AMOUNT
49.97
336.00
192,00
96.00
118.00
50.00
J $
..llL.li
.r IFlJ ;j
,)- ., I . 'I
RUREAU OF INOIVIDUAl TAXtS
[N~!lR I r ANer !o\x [) I V I S I ON
flirT. ,'Mi.01
IIAlHl I SIHJRtl , PA 111<'f1...0iIO!
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE Of INIIERITANCE lAM
APPRAISEMENT, ALLOWANCE OR OISALlOWANCE
OF DEDUCTIONS AND ASSISStlENT Of rAX
DATE
ESTATE OF
DA TE OF DEAHl
FILE NUMBER
COUNTY
ACN
f~:----=~~:~:_-A,~~~-~I:~_~~_It:I~;~~_~~-=~
I
e_____________..__ ..._.__~__....J
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
eUMBERI.AND CO eOURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE . RETAIN LOWER PORTION FOR YOUR RECORDS ~
ifE" V: iS4-j" E if -A f: ii - f 0;-'-96 Y"NO 'r" i c F." -0 t? - YNHEifi f ANC E - 'fAx "iip P R A-is E MEN 'r -, - -A L 'i. ii w ii NeE - OR - - -" -" -- -" - - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
AVERIL I FILE NO. 21 96-0698 ACN 101
WION ETAl.
109 L oeUST ST
HBG
PA 17101
ESTATE OF
SHEARER
TAX RETURN WAS: I X) ACCEPTED AS FilED
- -
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R.al Estate (Schedule Al
2. Stocks and Bonds (Schedule B)
3, Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Note, Receivabl. (Schedule 0)
5. CQsh/Oank Deposits/Misc, Personal Property (Schedule El
&. Joint ly Owned f'r.operty (SchedulOl F)
7, Transfers (Schedule G)
8, Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9, Funerel Exp.ns8s/Ad~, Costs/Misc. E~penses (Schedul. HI
10, Oebts/Hortgaye liabiliti.~/li.ns (Schedule II
11, Total Dedllctions
12, N.t Value of Tax Rehlrn
13, Ch5rit.ble/Government.l Bequests (Sehadule J)
14, Net Value of Est.te Subject to T.~
If an assessment was
reflect figures that
ASSESSMENT OF TAX:
15, ","aunt of line 14
16, "mount of Une 14
17, Amount of Lina 14
18, Principel Ta~ Dy.
NOTE:
12-02-96
SHEAReR
06-13-96
21 96-0698
CUMBERLAND
101
) CHANGED
11 )_
12 )
13)
14)
15)
16)
171
.00
.00
,00
,00
.00
148,418.60
.00
18)
(1/
~;I~'~
~fr:J.\ "4:~~'
'.iip~., .. - ~t.~
19)
110)_
8,465,12
841.91
1111
112)
113 )
114)
ll~-I\.I q IH In! hi
AVE,n L
I
DATE
12-02-96
NOTE: To insure pr'oper
credit to YQur aocount,
submit the upper portion
of this form with your
tax p8ymant,
148,418.60
9.307 09
139,111.51
,00
139,111.51
issued previously, lines 14, 15 and/or 1&, 17 and 18 will
include the total of &!..b. returns assessed to date.
at Spo\lsal
taxable at
taxable at
rat. (15)
li"..l/C18ss A rat. n&l
Collateral/Class 8 rete (17)
TAX CREDITS:
.PAYMENTi-----RECE!PT ..
DATE NUMSER
---------OcFoF96--- AA146698
. 00 X . 00,
139,111.51, X .06,
. DO X .15,
118)
.00
8,346.69
.00
8,346.69
~--~~~.__._.._--~..-.. ._.._._.._-~--_._~
DISCOUNT 1+) I AMOUNT PAID
INTEREST 1-)
41 7 ~33- ---~----?;929~-36
liir~r:~;:r ~:~':tJJ~=--., "':: j
I-~-----....... .-.,..---~-----l
[INTEREST AND PEN. I .00
---TOTAL DUE....r-------:Oo-1
___~'_'''",._ _" _. '........ ...._______1... ..,. ..".._..~____._______.._,,_I
~____L_____
, IF P~ID AFTER D~TE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF TIllS FORM FOR INSTRUCTIONS. I
.'
I"
I
"
,.
(l(.-j
RESf.RVIITtON, Estat.. of dlOldlntl dyinG on or b.fore Olo..blt 12, 1982 -- If tiny futurA lnt.rut In the utah 11 trllnlfarr.d
In Po.....ton or enjoy..nt to Cia.. 8 ((loUateraU bln.Holarlu of the dloed.nt aft.r lhe '1IlplrllUon of IIny IItltl for
llf. or for Ylar., the COlllMonwealth hlreby IlCpr...ly rnarY.. thl "IAht to appral.. IInd IUllItS tran,flr Inherltancl TUIll
at thl lawful Clan B (collat,rftl) rate on IUW Sl./Qh future Interut.
PURPOSE OF
NOTICE r
To fulfill the r.qulr..."t. of Slot Ion 2140 of the Inheritance ~lrId Elt&t_ T8x ^tt, Act Zi? of 1991. 72 P.S.
Section 2140.
PAVMENT:
Oatach the top portion of thl.. NotlclI and sub.it with your pl'lyltent to thll Righter' of Wilts printed on the rl"lr.. sid.,
--Makll chIck or ~or:.y order peyebh tOI REGISTER OF HILLS, ADENT
All paYJlllnt. recell"ed .hall first bl 8pplhd to llny Interut whloh ,"ftY be dUI with MY rllfll8indlr appllld to tho tax.
REFUND (CR)I A rllfund of a tu crlldJt, whloh 10111 not requutlld on thl Tall R.turn, lIay bt requested by cOllpletlng an "AppllQatJon
for Refund of Pannsy)vania Inhlrltence tlnd Estete 11'1l1" (REV.1313), AppllQntlonl tlrl aVllllable at thlOffiol
of thl Rlgl.tlr of Will', any of thl 23 Rlvonuo District Officii, or by Qalling thl IPeQI.1 Z4.hour
answlring .ervlcl nUllblr. for forI' ordlr!ngl In Pennsylvania 1-800-362-2050, outside penn'Ylvania Ilnd
within local Harrllburg arlUI (117) 787-8094,10011 (7l7l 772-ZZSZ (fllar!lIg IlIpalrld Onh),
OBJECTIONS I Any party in Interut not sat Isf ild with thl tlpp"a I....nt, allowancl or d IlIllloWllntll of dlduc t Jon., or 1l1I.....nt
of tall (Including dhQount or Interllt) II' 'hown on thls NoticI IIIU.t obj.ct within sixty (60) day. of rOOllpt of
this NoticI bYI
--written protut to thl PA O.partlllent of R,vlnul, Board of Applals, Olpt, 281021, Harrl'burg, PA 17128.1021, OR
...110tlon to hllVI thl MUe,. dlhrlllined nt audit of thl ftQcount of thl plr.onal reprl..ntetJvt, OR
uepplal to the Orphan.' Court.
ADMIN
ISTRATIVE
CORRECTIONSI
Factual errart dhooYlred on thh tl....."'.nt .hould bl tldclrll'lld In wr,tlng tal PA Department of R.v.nuI,
Burlau of Individual Tal<lI, ATT~I Po.t AUllu",ent RIylew Unit, Dlpt. 280601, Harrisburg, PA 17128-0601
Phon. (717) 787-6505. S.. pagl 5 of the booklet "Instruction. for Inhlrltancl 18)( Rlturn for a Ruldent
Olol(1lnt" (REV-1S0l) for nn I)(plantltlon 01 tld.inl.tratIYlh corrlchble Irrors.
DISCOUNT:
If any hll dUI 11 paId wlthJn three (3) eallndllr lIIonthl filter the dlc.dent's death, II flvD plrelnt (SiD dhcount of
thl tall Ptlld I, allow.d,
PENAL IV I
The 15% tall IIW1nutv non~partjclptltlon pen!llt~ Is eOWlputed on thl totnl of thl hl< !md Interllt u.....d, and not
paid blforl Janutlry 18, 1996, the flrlt day lifter thl Gnd of the tall a.nllty periOd. Ih1l non.partiQlplltlan
penal tv I. llpplalabll In the Il'IlIIe '"tlrmer and In the the ItlWlI t hit por lad III you would IIppnl the tall and inter..t
that has blln PlI"lIed u Itldl('lshd on thil notice.
HHERESTI
Intere.t II charged beginning with flrlt dfty of dellnqu.noy, Dr nine (l)) lIlonths tlnd on. (I) day froWl tht date of
dlath, to the data of plIYWlent. h.lIlI! which bloilOftllle dellnqu.nt blforl January 1, 1982 bur Interut at thl rate of
IllI (6%) p.rclnt per annuIII calcultlted ot II dlllly rate of ,000164. A11 tllllll which btctlJlt dtllnqulnt on and nftlr
January 1, 1982 will bur Interllt tit tl rlltl which will vllry fro", clllendllr Ylar to cal.ndar year with thtlt rate
announcld by the PA nepartment of RIyanUI, Thl appllcnble InterlSt rat.. for 1982 through 1996 lIf.1
'!!!! Interut Rat. Oaily Intet'ut Fllctor !!!r Internt Rllte Dally Interut rllotor
1982 20% .000548 1987 9% ,000247
1985 16% .000438 1988-1991 11% ,000301
1984 11% .000301 1992 9% .000247
1985 13% .OQ03S6 1993-1994 7% .000192
1986 10% ,000274 1995-1996 9% .000241
ulnterllt 11 calculated .. folloWfll
INTEREST. BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
.-Any Hotlcl IlIuld after the hI< bAcom.. delinquent will rllfllot (In !nter'lt cIlloulatlon to fifteen (1S) day.
bayond tt11! (Int. of th'III....lIl.nt. If pllVlllent I. "'fide "Hlr thl Interout cOlllPuttltlCln date shown on thll
Notlcl, addltlonfll lnter..t must he celcuJllted,