HomeMy WebLinkAbout96-00752
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COMMONWEALTH OF PENNSYlVANIA' DEPARTMENT OF HEALTH' VITAL AtCOADS
CERTIFICATE OF DEATH
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PA DEPARTMENT OF I1EVENUE '!:B:S
ESTATE INFORMATION SHEET
FOR REGISl[l1'S OFFICE USE ONlY
ClllJlIly COllI!' Yllill \' Ill' NLlI1lIlI~1
R[V.)&8 [X l8'.m
152.
_J.._~'l___-_~__~2q ~
-----.-.--.-
DECEDENT INFORMATION: Enter data as It will appear on all documents submitted to tho department.
------------_..__._--~---_._. ..._......-_..-.~----
tMltlt11l1)
(11Hill
j
Namo (La.l)
'1)~: )
, . (-\1L fL-.
Docodont's Social Socullly Numbor
TYPE FILING:
tl1 n I(ll
Oal0 01 Doath loillll ot.i'" II
. ,,/., '/./~ I ,~) /,/. ,'--
" ' ,) ,) L ' (' )
Enter check (,...) mark to Indicate lhe nature 01 the return to be tiled with the department.
o Probate Relurn
OJoinl AssolS Only
ru~:o To< Only
C litigation PUfpOS05 (No Olho' ^",SOt5)
LETTERS GRANTED: Enter check (..-) mark to Indicate the nature 01 the proceedings at the Register 01 Wills
Olllce. (Allach addlllonal sheets II explanallon Is necessary.)
OT~5lamontary
o Administration
r.1//
~ No Loiters
DOther (Pleaso E)(plain)
ATTORNEY ICORRESPONDENT
INFORMATION:
Enter all data concerning lhe allorney or other Individual to receive all
tax Inlormallon and correspondence,
(Middlo) Supromo Court 1.0. ,
Namo (Last)
(Fllsll
SUeel Addross
Telephone Number
SlalO
ZIp CodO
Cily
Enter all data concerning the personal representallve(s) 01 the estate
authorized by the Register 01 Wills
PEnSON~L REPRESENTATIVE
INFORM A TION:
:yecutorl Administrator
(MlddIO)
Social Security Number
/t)~l /b 1,,3
(First)
I ) (i k.-t.' 'I II L I
f
11 rZ
C' (nYI) !J-,'LL
Co-Executorl Administrator
Namo (lasn
Telephone Number
Win 5 Dill
Zip Cado
/7(1
Sta'o
f'f)
70 )3/' YVe.O
City
(Middlo)
SocIal SCCUllly NumbN
Namo (Lasl)
(First)
_I
----------------
Slroet Add'osS
----.--
TelophOno Number
------
State
ZIp Codo
City
Co-Executorl Administrator
Social Security Number
(MIddle)
Namo (Last)
(Firsll
-1-_----1
--~-_.....__.._---_.._-_._-
Streot Addross
Telephone Number
--.------------
ZIp Codo
S'alo
CIty
Proparod By Ii. _ I! . r.~' 00'0;
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20. If line 19 is greoler than line 18, enler the difference on line 20. This js the OVERPAYMENT.
aD ."ir:r.lI~il>.lI'.I"'J:'I'.'I('."I'I'J''''II'I:.'.Enr:r:~.'l'J'I..rJ:I'.~'.II[.lil
21. II line 18 is 9reol.r thon line 19. enler the differenco on line 21. This is lhe TAX DUE.
A. Enler the inlerelt on the balonce due on line 21 A.
B. Ente, the total of Line 21 and 21A on line 218. This is Ihe BALANCE DUE.
Mob Check Payabl. '0: Regilt" 01 Wills. Agent
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH -<-<
U~der penohie, of perjury. I declare ,hall have examined 'h;, re'urn, including accompanying lthedulel and .totemenh, and 'a 'he be" of my ~nawledge and beli.I,
"IS Irue. carre" and complele. I declare Ihot all reole"ate ho. been rapar'ed a' true ma'~al valua. Oeclo,o,;., 01 p,epo'e, o'har 'han ,he pellonol rapr.'antative ;.
baled on 011 information of which preparer has any ~nowledg..
"G Iu.. O' ''''ON ""ON"", 'O","'NG "'U'N ADO"" .----------.--------______ o-.i,------- __.
~y;-fJ:..$.Vf,~L_'__c.41J'_<L!.L _J?~-, . CLf;2I./dtC7tL?_tJLL___
"GNAlU" O' "''''I' orH" IHAN "'''''NIAll'' ADO"" aAlI
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
COIolIo\ONW,.lI" 01 'III"'nVA".. (TO BE FILED IN DUPLICATE
o""b~WW~~\V'''Uf WITH REGISTER OF WILLS)
~~AIU!lIU.G. P~_ll"1_]~_0601 COUNrv COOl
O(CIOll.U.tIAMf IlA~'. fl.!lf. MWMIOOIf,.ltmu'lI OICIU1I4IHOM'IIU AOOlfU
Draen rary ,/ 1 Cll1mson Drive
''i'~ij'''l)'5NIM~91--- ---7AJl)'1/96 l"'27i2/05 C~~~b~;t~nlA 1'/011
,., """",r,.,.",,"" '''NI' '"~~'~: ""~=~~"_:'::~'-__I~O(IA':~"~'U:'~~:eou'."'er'''O-I'',Ii"iivel'o""
o 1. Original Retum '-I 2. Supplamenlol Relum r ) J. Rema;nder Relum
Ifor doles of deolh prior 10 12.'3.82)
04. lim;'ed ElIo'e 040. Futu,e Inlere.t Comp,omi.e [J 5. Federal ElIo'e To. Relum Required
I'or doles of dttalh aher 12. I 2.82)
o 6. Decedent Died Tellale ?CJ 7. Decedenl Moinlained a LiYing Trust
(Alloch copy of Will) (Allach copy of Trull)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
NAM' Doroth,v B. Garrick COMPl'f~'r~m~c;H Drive
Camp 11111 PA 17011
IUV.I.SOO (It 1,.QA,
J~'V
~~
r"~,? NUM'~)7-4460
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I. Real E"ale ISchedu'e A)
2. Slach and Band. (Schedule B)
3. Closel)' Held Slock/Patlnership Inlerest (Schedule C)
4. Morlgages and Notes Receiyable ISchedule 0)
5. COlh. Bonk Deposits & MilCellonoaus Personal Property
(Schedule E)
6. Joinll)' Owned Properly (Schedule F)
7. Tronr'"" (Schedule G) (Schedule I)
8. TOlol Gran Anets (tolal Lines 1.7)
9. Funeral Expenses, Administraliye COSh, MilCellaneouI
Expenses (Schedule HJ
10. Debll, Mortgage Liabilities, Liens (Schedule I)
11. Total Deduclions (Iotollines 9 & 10)
12. Nel Value of Eslote (line 8 minus Line 1 I)
13. Charilable and Goyernmenlal Bequests (Schedule J)
IA. Nel Volu. Subject 10 Tax (line 12 minus line 13)
15. Spousal Transfers lfor dales of deolh after 6-30.94)
See Insfructions for Ar.plicable Percentage on Reyerse
Side. (Indude yolues rom Schedule K or Schedule M.)
16. Amoun. of line 14 taxable 01 6% role
(Include values from Schedule K or Schedule M,)
17. Amount of line 1.4 taxable al 15% role
(Include values from Schedule K or Schedule M.)
18. Principal to.ll due (Add 10.11 from linos 15, 16 and 17.)
19. (redih Spousal Poyert)' Credit Prior Paymenll
+
--.._--_._~_._~----_....__._._-- -..-
\
/5-/2-7-/4
'OA DATU 0' DIATH A"IA 12/31/91 CHICK HIAI
If A SPOUSAL .
PDVlAn CAlPIT IS CLAtMID r I
f1U-NUMBiA . .. -- ---- ----
2./
qf.p
752
/'l.UMBER
YEAR
- 8. TOlal Number of Safe Deposil Boxes
N A
( 1 ) l!nZ7,684-;-51--
(2) -N/A
( J ) 'N7'!
(4 )11-0:-661.-56
15) .'1''''. .
N/A
(6). _
(7) filA
(9) $lie7H2e61:l
(B) $1)).)46.07
(10)
(11) $H,782.6tl
(12) h24~~9
(lJ)~A
(14) $124.56)e)9
(15) ___ x. _c N/A
124.56).)9 _ $7,47)eI:l0
(16)-~__________________x .06 _ .
(17) -------------.___X .15 =
Disc:ount
+-.---...-.----- -
(lB)
Inlerest
-----
(19)
(20) ______
$ 7 .47)e80
(21) _________._______
(2IA) _._ n_ _._____________
121B) _____ _______ ___ _____
- ---~---~--_..~-,,_..
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Act '48 of 1994 provide I for the reduction of tho taK ratollmpolod on the net value of tranlfe" to or for
the ule of the IpoUle. The ratel 01 prelcrlbed by the Itatute will be:
e 30/0 (.03) will be applicable for eltatel of decedents dying on or after 7/1/94 and before 1/1/96
e 20/0 (.02) will be applicable for eltatol of docedents dying on or of tor 1/1/96 and before 1/1/97
e 10/0 (.01) will be applicable for eltatel of decodents dying on or after 1/1/97 and before 1/1/98
e Spoulal transforl occurring on or after 1/1/98 will be oumpt from Inheritanco taK.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (vol IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a tranller and:
a. retain the ule ar inca me althe praperty tranderred, .......................................................
b. retain the right to delignate who Ihall ule the praperly tranllerred ar itl income, ...............
c. retain a reveuianary interelt; ar ..........................................................................,........
d. receive the pramile far Iile 01 either paymentl, benelitl or carei .......................................
,
,
,
,
,
,
\
;
I
\
\
\
2. II death occurred an ar belare December 12, 1982, did decedent within twa yeau preceding
death tranller properly withaut receiving adequate canlideratiani II death occurred alter
December 12. 1982, did decedenttraMler property within one year of death withaut receiving
adequate canlideratiani ....... ........ ....... ................ ........ .............. .................... ..... ..............
3. Did decedent awn on 'in trultlar' bonk account at hil or her deathi......................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESr
YOU MUST COMPLETE SCHEDULE G AND1fILE IT AS PART OF THE RETURN.
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W
COMMONWlAllH Of PfHN~YlVAHIA
INltllllANCf fAll IflU.H
IUIOINf DfCfD[Ht
"TATE 0'
IIV.IlOIIK + 1"61
SCHEDULE B
STOCKS AND BONDS
FiiENUMBlii -
mo..'j ~. 'Bro.'"
IAII prop"Iy lolnllv.ownld wllh Righi a' Survlvonhlp mUll bl dllClond an Sch.dull F.I
ITEM
NUMBER DESCRIPTION
l.
;..
3,
VALUE AT DATE
OF DEATH
FrMlldiN /1tmple/oN lA~/illt5
Ac:.c.f #. ,OIi".;J.-S-3.)-cr19
AA.;J \
I .;11/ SIi/ ~
, .
I-
;l'llS, ...3(, :JAcm e IIO,I$"
dffb"W",..r 5"r<.:k~ic. ,I",(!1k(,
11'1',:-141- 0/.3/ ~3' 0/5'1IJI
F""J -6:
,?,o;J.o'/;). sl-o @ ;I",. 7S
~ '(/~S9.Z!
Off'l..Mirur .51l<'-<<'O"t. ~"...l'. .FwJ - '8 :
;1c.d.:li- 0/.31 ;J.3/o0~077" '379r.n3 SMrtJ @11./.7J
II F',OJ,S. ~
'I.
fO(4i~ lA. s. <OlJ'Jl:fNJI4'olI- fj.,,J:
11 eel -JI:. 17 i"p..ra- ;l 1/9 7. (,8;. sAo..HJ
~
@ Cf.dO
! ~~ </79.!J
G.
rC<llN(j T n.d (LoJl<"'OIJ 5toc.lc-)
/~Qf/ s~~ @ ~7. 7~
i//,1I90. !!
~.
Of~tNkill''\t( Sf/e::l-t(ric. .I,.,(~
ficd :\\. .;l.60 (}'3o/t/Ot-/v 3
(/A.d ~ fl
,2 59 3. ~'S' 3 .:l'<"""" @ 1/. 7'/
J
.so
1;1.,'/1</. -
TOTAL (Aha enter an linl 2, RlCopllulotlon)
(II more space is need.el, in",' oclclj'jonal sh..ts 0' some sill.J
IIVIWlI,.' ifill
\_~_ "..~ ',"",lip'
FilE NUMBER
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
----..--------.
Tf\4st . O/J{ /J.JfJIHI1- :H." ('rtrli.lll, (IA JlO/3:
/ .
A cd =IF 'lOll 791
...
rcullltll
J 19-10. ~
c ~tc.1i'd -
;),
f,,-,..UJ ,~lt (5....,. "J t\bd~")
~ ~ 'FF/, E:
c."D -
;1cd 4l- (1ID Jt7'6
.---.-
TOTAL (A~er an line 5, Recapitulation) S ~ v(JI,.E:.
(Alloch odditionol 8Y," )( ".. ,hUh il mOl. 'pac. II n..ded 1
\ .~,,~ SCHEDULE H
.. "';" ~~ FUNERAL EXPENSES,
"".,," "".., "'" '" ",,,,,,,,AI'" I ADMINISTRATIVE COSTS AND
_. _ __ _ .._ "";\~::~'i:i',,"t(~~l:::'" _. _ . _ MISCElLANEOUS EXPENSES
nlAUOr--------....--..-....----- ..--- _.---
.._____ ('(\0..'/ ~. ~~(wJ
11\"""'1'"
ITEM
NUMBER
A.
1.
B,
1.
I. . ..P!oa.e P,lnt a, Type
HiUNUMiiER
I
---~.'_.._--_.._---- -..
DESCRIPTION
AMOUNT
Funeral Expon..s:
c'tJ"tJ l3,t1Il.n 1i.,~(f(.1 /J '~L ; (' N "J" ,PA
FlIlI...\ SfC'1
Gleovl. OP.DN""''lr
Glp-IX. (\'\o.(\(t(
3lA ffd
'r-.,?r;r. ~
lJI>
/cJ(,.-
~l1tJ.!e
qqtJ,~
lo3"l.1!
Admlnllhatlve Calls:
Personal Representative Commissions
Social SeclJfily Number of Personal Rep,eSp.nlolivc:
Yeor Commissions paid __ .,
2. Allornoy Feo.
3.
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
Family Exemption
Claimanl _.
Addre.. 01 Cloimanl at decedenl'. death
Streel Addre.. ___
Retatian.hip
City __._ _.._
_ Slale
lip Code.
Prabale Fe..
Mlscellaneoul Expen.."
l-t.~...1 NcJll/.L iv ., 14 bl'NiO [,,pl""/
~
47.
P"'fU.r. (w/::/l, fJA
,
.._+.... .-.----------
5 ?, 7FCl. g
-- .--.---.----.--..-..--....--.-
TOTAL (AI.o onle' an line 9, Recopitulalion)
(II ma.. space II noeded, Inle,I addlllonallheels allame II.e.)
I
REVOCADLE
TRUST AGREEMENT
MADE this 1'1.:e: day of :\nNLAn.Q' , 199.2.- by
and between MARY J. DREEN, an individual and r~ident of cumberland
county, pennsylvania, (hereinafter referred to as the "Settlor"),
and MARY J. BREEN, an individual and resident of cumberland county,
pennsylvania, as the Trustee (hereinafter collectively referred to
as the "Trustee").
WIT N E SSE T H:
ARTICLE ONE
(A) Establishment of Trust Estate: The settlor has
transferred and delivered to the Trustee that property more fully
described in schedule "A," attached hereto and made a part hereof
(the "property"). The Trustee shall hold and administer the
property, together with all other cash or property of any kind
which the Trustee at any time may acquire from the settlor or from
others by inter-vivos transfer or pursuant to beneficiary
designations by Last will and Testament or otherwise, including,
but not limited to, the residue and remainder of settlor's Estate
as provided for in settlor's Last Will and Testament ("Additions"),
together with the proceeds, investments and reinvestments with
respect thereto as a trust estate ("Trust Estate") on the terms and
conditions hereinafter set forth. Such property shall be held,
administered, and distributed for the benefit of the settlor of
this Trust.
The name of the Trust herein created shall be THE MARY J.
BREEN REVOCABLE TRUST.
(B) Distributions to settlor Durina settlor's Lifetime:
During the lifetime of the settlor, the Trustee shall pay to the
Settlor or expend for Settlor's benefit the entire net income
produced by the Trust Estate ("InCome") in convenient installments
or otherwise as settlor may from time to time direct, together with
such portion of the principal of said Trust Estate as settlor may
from time to time direct in writing or, if settlor gives no
directions, as the Trustee deem advisable to provide for the
health, welfare and comfortable support of the settlor, and to
continue settlor's accustomed pattern of giving to individuals and
organizations. Any unexpended Income shall be added to principal
and invested as such.
11
25. Authoritv to Siqn Documents: Any Trustee shall have the
power to execute individually any and all documents necessary
to carry out the powers, functions, and duties of the position
of Trustee. Such power shall include, but shall not be
limited to: the signing of checks, the opening of bank or
other financial accounts, the disbursement of Trust funds, the
execution of contracts, and other such financial transactions.
(8) Resiqnation of Trustee: Any Trustee may resign at any
time during Settlor's lifetimes by written notice to settlor.
After the death of the Settlor, a Trustee may resign at any time,
without stating cause, by notice to the remaining Trustee;
provided, however, that prior to the resignation of a sole
remaining individual Trustee, such Trustee's resignation shall not
become effective until after such Trustee has appointed a corporate
trustee as successor, and such corporate trustee has accepted such
appointment. Absent such appointment and acceptance, said
Trustee's resignation shall not become effective until said Trustee
has petitioned a court of competent jurisdiction to designate a
successor corporate trustee.
(C) Successor Trusteels): Upon the death, disability,
incapacity or resignation of any Trustee, during the lifetime of
the Settlor, the Settlor may appoint one or more successor Trustee.
Should the Settlor fail to appoint a Trustee, then upon the
death or incapacity of the Settlor, DOROTHY B. GARRICK, Settlor's
daughter, shall serve as Trustee. If DOROTHY B. GARRICK is unable
or unwilling to serve as Trustee, then EDNA J. LYNN, Settlor's
daughter, shall serve as Trustee. They are to serve without bond,
(D) Replacement of A Corporate Trustee: If at any time a
corporate trustee has been appointed during the lifetime of
Settlor, the Settlor may replace such corporate trustee by written
notice to said corporate trustee, and may, but shall not be
required to, designate a successor corporate trustee. Following
the death of the Settlor, the individual Trustee may replace a
corporate trustee by written notice thereto, and may, but shall not
be required to, designate a successor corporate trustee.
20
;"
4_
.
A LA TARTE
36 West High Slreel
CARLISLE. PENNSYLVANIA 17013
(717) 249.4055
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19~11l1l1lr:n IIIGIIW/\Y
C/\IlLlSLE.I'/\ 17013
17th May, 1996
.....nK orner:
QAnoru cny..A
'lIour 141.11H
pr"..&N'HI .Hnn"""" r."f
HOH.lte,"""""
Mrs. Dorothy B. Garrick
1 Clemson Odve
Camp ni11,P/\ 17011
Dear Mrs. Garrick:
We are pleased to acknowledge receipt. through our representative. of your signed applicalion
whieh provides protection as follows:
One Single Bronze Memorial for your mother Mary Jane Breen
$990.00
Down Payment: $990.00
Xerms: Cash - Paid in Full.
We operate solely for the interest of our lot owncrs amI you can be assured that the officers and
employees are anxious 10 assist you at all times on any problem that may arise. All of our
facilities lInd services will be available to you at any time.
We feel sure that you will have many occasions 10 express satisfaction with your selection ami
know you will recommend your Park to your friends.
4992
Cordially yours.
MARY J. BREEN
I CLEMSON OR,
CAMP HILL. PA 11011
19 '}~ '
60-012
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CUMBERLAND
V'J
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Fifty Forward I
a~lL/.; xY~
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P.S. please cor
to you in :
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FARMERS-
TI~UST-
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~ 04/06 10Z0002170006 PAYIIEIlT - TII~OUR PAYIIEtlT
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1)l1t Alh'I1U',IlIlc'hil\ l'ttdiU
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n,llm't feel. Alh,oct' tnn~ In l'triCltlk l'ltllil' lin~lllr(1ul't" f1a)lIItlllIJur r.....,nl.a. Ral.
"'- Utbil' Rale) .'......'lb"lhl...."
130.69 106.00 .00 130.69 106.00 .00 10.00 lS.1S?
l'tlitJllic C.ltrr'I."MIi1l8 11II141)1.C'\ In Whil.h ^1'Il1i1.:ahlr l'nfft\I.'llIliIl8
Rile ^nnuall'tn:tnl"~e rin4nct' tl\1f~e
Rail' llalan(('
_loUZ?' lS.lS0? PURCIIASES, AOVAtlCES. tltlAllCE CHARGES & FEES .00
.
SEtlO PAYNEIlT TO. FIRST CARO
4678 090 610 97Z
^tcounl Numhrf
P.O. BOX lS191 HILHlt~TOIl. OE 19886-5191
p,O. BOX ZOOB, ELGIIl, IL 601Z1-Z008
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.n KEVIN J. GARRICK 5916
, DORotHY B. GARRICK ;. .
.i} .1 CLEMSON DR. .' .. Q/ \
::.~ CAMP HILL. P'l".17~" :'h+ ,'' 19p.o"":;"'l .. ,.f:
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Apdl 1n, 96
CAIlLlSLE,I'A 11013 19_
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Doro thy nalT lclt
1 l]l('lnoon Urlv(' t:nrnp Jill 1, I'll. 1'10.11
SEYMOUR A, EWING
lIcensod Funeral Dlreclor
EWING BROTHERS drmf.l1atJ/ofTU?/
630 SOUTH HANOVER STREET
MEMBERS OF NAllotlAl rUtlERAl DIRECTORS ASSOCIATION
STEVEN A. EWING
lIcen!lcd funelill Director
WILLIAM M. EWtNG
L1censod funerol Dhector
March )1,
1996
Fun"rnl eXjJeonses 1'01' '.Iary Jane urccn.
Profesuional .:>crvices, fncllitieu, and Equil'mrmt.
:iolid t:oPPl'r t:f\sket
4l2,2B5.00
J,R15.00
----------
t:oncretc Vault (Ameoricnn)
lleath C~rtificat~s (6) \- (6)
lla.irdrE'sscr
,p6, 100 .00
850.0U
21~.01J
25.00
,p6,999'OO
'1'0 he r.ecei'led from t:umber.land \Jounty
(IHdow of Veteran)
.
100.00
--------------.
Ua1ance
;~6, 899 .00
lEGAL RAIE OF INTEREST AFTER THIRTY DAYS
MARY J, BREEN
" I CLEMSON DR.
, CAMP Hill. PA 17011 ... ))
t'. Jt7.1-19~t-.
PAY 10 1HE~ M A....~' Al. '- /., 1/_ "~I
ano'RaF_--;;'~'7.{I'JI.!..r..~ -t"f'L(,~/rh'--C-.J $ (" ~ 'i'9, ';:.--
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FARMT 'ERSG Fifty Forward!
RUST. /)
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':0:1 ~ :10 I.? ~Ol: 1111."'0 I.?q qlll ~.o_U_""'A,~IIIs:G...QJ:l.AA..~OOI"
4990
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THE SENTI NEL
P. O. BOX 130
CARLISLE, PA
IUVOleE uo
LEGAL
17013
DllllUO DAlE
83875
IIIDEIUnG IEI1""
ESTATE NOTICE In the esta
sum OA1[ ftlEM'OUE no
.
!, ,llt ~
r ,IIIIS ""'oUIII.... 47. 7 52. 4
Gross due after 06/20/96
VI~^!"'ASlrnCAnn r"YMElII orllotl Ofl nArK
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RECEIVED BY f,', (It,. '- ' , "j-" V
r /SIGHATURE ~ . -f
j 1 I If' \
MARV C. LEWIS .- ,'r': :,_J .'."" (,
REGISTER OF WILLS
.,
D NO. AA
146772 COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT O' REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
.
1....".111"..'1
ACN
ASSESSMENT 'it
CONTROL ~
NUMBER
AMOUNT
D
RECEIVED FROM:
101
$'/,103.1:10
DOROTHY B GARRICK
1 CLEMSON DRIVE
CAMP HILL, PA 17011
"
ESTATE INFORMATION,
~ filE NUMIER
Y 21-1996-0752
~ NAME Of DECEDENT (LAST)
~ BREEN MARY J
II DATE Of PAYMENT
II POSTMARK T
COUNTY
SSN 174-05-1591
(FIRST) (MI)
CUMBERLAND
DATE Of DEATH
m TOTAL AMOUNT PAID
$7,lI73.80
REMARKS
DOROTHV GARRICK
SEAL
CHECKIl 5000
REGISTER OF WILLS
'OlD HUI -
VZ
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IS- U i-It.!
COHHONWEALTH OF PENNSVLVANIA
DEPARTHENT OF REVENUE
BUREAU OF INOIVIOUAl TAXES
1"'UIfANC[ fail DIVISION
IXpr. n06Dl
HARAlSIURO, PI. 17111'0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DOROTIIV B GARRICK
1 CLEHSON DR
CAHP HILL PA 17011-0889
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
'j
12-30-96
BREEN
03-31-96
21 96'0752
CUHBERLAND
101
AMount Re..ltt.d
*'
In.IU' II'" IU.t..
HARV
J
HAKE CHECK PAVABLE AND REHIT PAVHENT TO:
REGISTER OF WILLS
CUHBERLAND CO CDURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LDWER PDRTION FOR YOUR RECORDS .....
iiEv:iSejj-EiCAj:,'p--nZ:96riioYicE--oF-YNHEiiifAifcE-YAx-jipPRjiisEHEiii'-,--iiLi:oiiANcE-oli--m---u--m--
DISALLDWANCE DF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF BREEN HARV J FILE NO. 21 96-0752 ACN 101 DATE 12-30-96
If an assessment was issued previously, lines 14, IS and/or 16, 17 and 18 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSHENT OF TAX:
IS. Anount of Lina 14 at Spousal rat. 115)
16. Anount of Lina 14 taxable at Lin..I/Clasl A rat. 116}
17. Anount of Lina 14 taxable at Collat.ral/CI... 8 rat. (17)
18. Prlnclpal Tax Due
TAX CREDITS:
PAYHENT
DATE
09-24'96
TAX RETURN WAS, I X I ACCEPTED AS FILED
RESERVATIDN CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rill Eltate ISchlduh Al III
2. Stock. and Bondi (Schedul. OJ (2)
3. Closely Hald stock/Partnership Interast (Schedule Cl (3)
4. Hortg.gas/Not.. Receivable (Schadule DJ (4)
5. Cash/Bank Deposits/Hisc. Parsonal Property (Schedule E) IS)
6. Jointly Owned Property (Schedule F) (6)
7. Transfars (Schedule G) (7)
8. Total As..t.
APPROVED DEDUCTIONS AND EXEHPTIDNS:
9. Funeral Expenses/Ad.. Costs/Hisc. Expense. (Schedule HJ (9)
10. Debts/Hortgage Liabilitie./Lian. (Schedula IJ (10)
11. Total Oaductions
12. Hat Valua of Tax Raturn
13. Charitable/GovernMental aaque.ts (Schadule J)
14. Net Value of Estat. Subject to Tax
NOTE:
RECEIPT
NUHBER
AA146772
DISCOUNT
INTEREST
I')
I-I
.00
I CHANGED
.00
127,684.51
.00
.00
5.661.56
.00
.00
IB)
8.782.68
.00
Illl
U2)
U31
1141
.00 X .00=
124,563.39 X .06=
.00 X .15=
U81
AHOUNT PAID
7.473.80
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
NOTE: To insure prop.r
credit to your account,
subMit the upper portion
of this forM with your
hlC paYMent.
133,346.07
A.7A? 6A
124,563.39
.00
124.563.39
.00
7,473.80
.00
7,473.80
7.473.80
.00
.00
.00
. IF PAID AFTER DATE INOICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN II. NO PAYHENT IS REQUIRED.
IF TOTAL OUE IS REFLECTED AS A "CREDIT" ICRI. YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS,I
Flee",
1'1
. "I
. \',S
'96 me 30 'llC :32
C\",
Cum\;
. ill
, PA
RESERVATION. Estat.. of dlcadent, dying on or bafor. D.c.~r 12, 1982 .- If any future lnt.r..t In the ..tat. I, tran,f.rrad
In pa.....lon Dr enJoy..nt to ct... . (collet.re.) bln.flcler... of the dlc.dlnt .,t.r thl IMPlratlon of any ..t,t. for
11', or for y..t., the Co..onw..lth hareby I.pr...lv t...tve. lhe right to appral.. and ...... tran,f.r Inherltancl 'aM"
at thl lawful ell'l . Ceoll.t.r,l) rat. on any such future Int.r..t.
PURPOSE OF
NOTICE I
To fulfill the r.qulr..ent. of S.ctlon Zl~O of thl Inh.rltance and E,t,t. TaK Act, Act Z2 of 1991. 72 P.S.
Slctlon 2140.
PAVJtENT.
Detach thl top portion of thl. Hotlel and ,ubalt with your pay..nt to the R.allt.r of Will, prlnt.d on the r.v.r.. ,Id..
.-"akl check or lIOnav order payabl. tOI REGISTER OF MILLS, AGENT
All pay..nt. r.c.lv.d .ha11 flr.t b. appll.d ta any Int.re.t which .ay be due with any r.ealnd.r appll.d ta the tax.
REFUND (CR) l
A r.fund of a tax cr.dlt, which wa. not r.qu..t.d on the T.. R.t~rn, ..y b. raqu..t.d by coapl.tlng an ~Appllcatlon
for R.fund of P.nn.ylvanla Inh.rltanc. and E.tat. T.M" (REY-11l1). Application. .r. .'1aI1ab1. .t the Off1c.
of tha R.gI.t.r af will., any of tha 23 RI'Ienu. Dl.trlct Office., or by calling the .p.cla1 Z~-hour
an.w.rlng ..rvlc. nuab.r. for for.. ord.rlng: In P.nn.ylv.nla 1-800-162-Z050, out.ld. penn.yl'l.nla and
within loc.1 Harrl.bUrg .r.. (711) 787-8094, TOOl (7l7J 772-Z25Z (H.arlng I.p.lr.d Only).
OBJECTIONSl Any p.rty In Int.re.t not .atl.fl.d with the .ppr.I....nt, allow.nc. or dl..llowance of daductlon., or a.......nt
of taM (Including discount or Int.r..t) a. .hown on this Notlcs au.t obJ.ct within .I.ty (60J d.ys of r.c.lpt of
this Notice bYI
.-wrlttsn prot..t to the PA O.put..nt of RSVlnue, Board of Appa.ls, Dept. 281021, Harrisburg, PA 17128-1021, OR
"sl.cUon to have the .att.r d.tar.ln.d at audit of the account of th. parsonal repreuntaUv., OR
--app... to the Orphans' Court.
AOtUN
IS1RATtYE
CORREtTtDNSI
Factual .rror. dlscov.red on thl. ........nt .hould b. address.d In writing to: PA O.part..nt of R.v.nue,
Bur.au of Indlvldu.l T...., AltN: Pa.t AII.....nt R.vl.w Unit, aapt. Z8060l, H.rrl.burg, PA 171Z8-0601
Phone (117J 717-6505. Sa. p.g. 5 of the bookl.t "In.tructlon. for Inh.rltanc. f.x R.turn for a R..ld.nt
D.c.d.nt" (REY-1501) for an .xplan.tlon of .d.lnl.tr.tlvely corr.ctabl. .rror..
DISCOUNT:
If any t.. due I. p.ld within thr.. (1) c.lend.r .onth. .ft.r the d.c.dent's dlath, a flv. p.rClnt (S~) discount of
the t.. paid ls .lIow.d.
PENAL TV:
The lSX t.. aanlsty non-p.rtlclpatlon p.na1ty 1. coaput.d on the total of the taM .nd Int.r.st .....s.d, and not
p.ld b.for. January 18, 1996, the flr.t day aft.r tha end of the tax aans.ty p.rlod, Thl. non-p.rtlclpatlon
p.na1ty I. .pp..labl. In the .... ..nn.r and In the the .... tl.. parlod .. you would appa.1 the t.. and Int.r..t
that ha. b..n ....s..d a. Indlcat.d on thl. notlca.
INTER[ST I
Int.r..t I. ch.rged b.glnnlng with first d.y of d.llnqu.ncy, or nln. 19) aonth. and on. 11) d.y fro. the data of
daath, to the dala of pay..nt. T.... which b.c... d.llnqu.nt bafore January 1, 198Z b.ar Int.r..t at the rat. of
.1. (6X) p.rcent p.r annua calcu1at.d at . d.lly r.t. of .000164. All t.x.. which b.ea.. dellnqu.nt on and aft.r
Janu.ry 1, 191Z will b.ar Inter..t at . r.t. which wIll vary fro. calandar y.ar ta cal.nd.r y.at wIth that rata
announc.d by the PA D'Plrl..nt of R''1anua. the appllcab1. Int.r.st rat.. for 1982 through 1997 .ra:
!!!! Int.r..t Rata Dally Inter..t Factor !!!r Intlrut Ral. aally Inl.re.t raclor
198Z ZO~ .0005'" 1987 'X .OODZU
1983 16X .ooo~sa 1988-1991 11;( .000301
198" IIX .000301 199Z .X .00al"7
1985 lSX . D001S6 1993-199" 7X .000192
1986 IOiC .000274 1995-1997 'X .000247
"'Int.r..t Is calcul.t.d as folloN':
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Hotlc. 1.lued .ftl~ the taM b.co... d.llnquent will r.fl.ct an Int.r..t calculation to flfl.an lIS) day.
beyond the dala of the ........nt. If pay..nt I. .ad. aft.r the Int.r..t eo.put.tlon date .hown on the
Notice, additional Int.rut IN" be calculated.