HomeMy WebLinkAbout96-00795
l() c:t
C'" tC
0
I '-'
~ ..... ~
(J 0
q: ill
~
G)
r{, ;:::,
.... ~
. 0 :t
0 ...:J
... '7 -"
-,
'" \J 1.,,:,,
Z r.i
u.I l\J U
;M ~
,.>
~
,.rvl',(lOI(tl"I,11
I' I 1'1
INHtRlf ANCE fA)( RU tHIN
RESIl)ENl ()ECH>ENf
(TO BE F II. Ell IN llUl'UCA TE
WITH REGISTER or. WillS)
~~ii&
(OMMONW[AllH 01 l'fNmil ~ AillA
orPARTMrNI 01 IHYUHJf
fJEPI1lWWl
~1^R~ISIIURo,tA 1/1'JO-Of,Ol
=~.;.- 0- eEDEN-T-'-S ~j^MCflA~'(lT~f,i A,tj(,~il(lli{llql ;~Ij
"'
....
",,""
uiE~
~a19
ut",
"
:ilffi
....
"x
fllC
I.
2
3,
4,
5,
~ 6,
7,
~ 6
hl 9,
..
10
II.
12,
13
14,
-..--,.-----..-
15,
16,
17
x
c:>
~ 16
~ 19
:1/
c:>
U
l1 70
....
N/A
p<] l. Origlocll Rotul!1
(] 4. limIted F.~tutfl 4(1 I PhH" Ihhl/f11t C!I/npU'lIIiHI
llll! !llih" ill IIIIfllh ollflf I'J 1/',112)
!XJ 6. OecIHJof\t Dilld lfHlol1I I I IllIllIdflHt Mlllrl/(dl\ud II liv1tllllrtut .0<08. TOlol Number of Safe Deposit Boxes
lAttach copy III Will) 1^lIf1'.h I ClPt {t huill
A~L CORR""ONDINCI-AND CONPlDINYllLTA"K" iNPOlMATIONfHCfuL"P II DIREcteD TOI
~iA~;KY -~~I-~;'H( 11':~{- d(~~~I~iJ, ~\t!1 ~~~4~l~Hi~i-lcr:i;--LANE--'---
MI':C~lIfINICSBUHG P~H055
c: ........ , :u
_ 0' \0 JJ ro
,3.="~~-"j,=~"""_,=-,=,,,~=,,
, (1
....
ffi
III
U
"'
..
WELKEH milA
5()CTAC~i((JillY HUMR(k
I',,'"
'"
,!'Ii ~ II
'.
'.,
fOR OAIE> Of OIAHI AfTER 12131191 CHECK HERE
II ^ SI'OOSAl L
I'OVERIY CRWIII> CLAIMED I I
: ml tWMBlR
I ! I
({HIIHY COOl
l,j ! [" fj! '. r ',',\1'1111 "rilllif~-"--.
0795
96
yEAR
NUMBER
1'1 'If,
111,fA"'I'"
MANOH CAHI':
'1411 WAI,NUI' IHr'j\JM HOAD
('AllLISI,I': PA 17013 9177
209 12 9250
l!/ APP\'(Allfl ~u~vl'mj[. 1'(HI~1 \ tJA'" "All 1",1 "", ,."",
i.l,..,.
/I II (III
'''''''''[ <1IMI\I':RI,ANIl
I~"/'~'''' "["VII> ,',I{ IIIIlRUCHON".
.1 I',,! f 'I' i~'~1 w
I'I/A
I] J
RemaInder RehHn
(for dalel of death prior 10 12.13.82)
Fedoral E,Iale Tax Raturn Required
) IIUPldfH!!I,"I1(11 H..tll!n
I i.\.
III N/^
171 N/A
131 N/^
14) N/A
151 $120,575.0L
161 N/A_
17) N/A
'"
L-
:.>--,
~
c:
TflE~tlmU t~UMIf~
.1. 717 J 7(;(, 3(,(,1
fhlC11 blnl" l5rhedultl Al
Stock, unci f\ulld, l~dlfl(lulfI III
Clo,,,ly H.ld SImkll1ufllllHll11p lnt.,nt' ISrhndulft q
Mml{Jf\9"' Clncl NoI"1 f(fl(,f1IV(lbln lSch.dulfl Ul
Ccuh, BClnk D",1011" & MIH.elluIIIIOIH PeltonCll Propolly
15ch.dul. "I
Jointly Ownod Pf(Jporly (SdllHluln fl
Tro"lo" (Schlld..l. OIIS",,"ul. LI
T ot{ll Gron AU"'I (Iolalllnlll 111
funorol E.:pflnI4l1, AclmlnlUffl!lvfl COIh, Mh(ollClnfloul
f,po".. ISchodol. HI
Dobu, MorlgClge lIobUIiI.n, lIell' (Sehflel"lfJ II
Tolal Deduction, (lotHILlrilH 9 A 10)
Not VolulI of fuwn ILlna 8 minUI Lint! III
ChCHlIClble (lnd Gov.rnml'lnlul BOqUf"" (Sl'hndulo Jl
Ne! Vdluo SUhlfl(t 10 TUII(lIllft 12 mlnullIno 131
SpoulCIl TrclnlfClrt If or doh" !II dlloth Clfler 6,30.94)
Soe I,,"ruellon, lor ^f,pllwble l'or{t1lltCl{lO 011 Ro'o'ono
Side, (lndudn VQ!UfH rom SduHlulo K elf Sdlllduln M,l
Arn<HJnt of Uno 1 Ii lowblfl fit NY!) IUt{1
(Indudn 'o'(lluo, frolll Scllllflulll K lit Sduululo MI
Amount nlllrlll Iii 11Ill:uhlfl (II 111'1.\, r(lIlt
(Indt/eln vnlv*, /rum Sd1ltllIJln K (If ~dlftdulfl M I
f1Iltl(lflnltnll: dHA {Arlll hIll: 11('lIIllno\ 1'1. lit find 1/.1
(,nd,,, Spnuwl JlqV(lrl'{ (,Illlil Prill! l'flyIl1Utll.
-
Cl
.'0
t...J
.,,1,
(h. 0
-h
-n i
_....--':'t. ;:1
~
w
161 112Q.,.57,?,Q.L
I Q )$11 ,963.QO_~__
1I01N/A
$ 11,963.00
1111 ~-.._____~._~
108,612.00
112) ~._.,_~.nm_.
113) ....,3.,.0.0.0.....00
m____.____.__n___~~.~m..JJ?~~12~Q(L._".__
115) N/A
1161 N/A
- "... ...___...,_~. x.
.Ill ___._____,..._
...X .06 %I
1'7) $105,612.00
__x ,15 III
$1,?~_84f&Q
DiSCOlJllt
1161 $1~8A2.00
1191 ~/A
1201 N/A
Interesl
II Un.. 1'1 II (jI,wllll Ihnn 111I1t
iii I I
III "IIIt'1 !II" Ihflt'lflIII" 1111 IfllIl 20 This Is thn OVERPAYMENT,
rlWl ~ 'If" 'I If (JU (lUJ 'ht: u".tln 11 'lIfund of your ovo'J!nymont.
'J I II IIlln III II HlfH.ll.r '''.lfl 111101 I'I III I!'" llin dlll"l "II( n (If! 111111 'J 1 ThiS I~ Iho TAX DUE,
^ 1111.0 fir" intnlllll "" lf", l"dr,I"!' ,I,m "'1111'" /I^
1\ Ihlm thr; 1;,1(11 (,t II"" /1 III"; 11;\ "'1 I,,,;, /111 111i\ 1\ llfl1 8Al.ANCE DUE.
Mnlc. Chet!. ,lu"ul.11 IUI keqhl'lf n' Willi, Agent
(21) $15,842.00
121AI N/A
(2161 $15,842.00
~,. II lURE TO ANSWeR ALL QUESTiONS ON-REVERSESID!AND!~._'!IiCHE~_I5..MA~.~ 00( __~.m'__.n
Unclflr PlHltlltifl\ (,I PfHIWY, I du,lflllllh'fllll1l'd' U.'llllllllld 1\11\ (.dUfl" II111udirlq (f(lllml'c.nying \Chfldulos ond statemenh, Clnd 10 the basi of my knowledgo oncl balief,
II Illrllll, fflrrnfi nllt! flJtl!I'IIIW I df"I"I" dill! .ill ""11,'11(1111 h'll l'fl'1I1 ffllll,rlf!rI 01 Iruft nwrkol vnluo. Dfldorotion of preparor olher thon tho persoflol repr/)~f1nlolivo is
IHHMI nil rrlllllf'!'lllllthlll "I ,....1.111, l',lfl"H"1 lill; '"'y ~1If'wllld\l1l
~.I("I^HIIII (If 1'1 H~' III Iii ',I', HI"'"II r,;~ "1 "1" id I'J~'I "i'(I~1 '.',
\\""~'.LI\""I".\'I\'" _ I )'( ("I"""lu (.0,(.1/,,'
',11,' IA '1111[ if'PH! I'~IIIII r 11\1' II liI^~~11f ('1-1 .1 (,I" I, /1 -',1>111' i'"
I )I \:;, J"t , : (:1I(i, "J
''^'')
fJl oll,s/Ai / ?
O,,,!:
II'I/l
I
NON,f\l.NE W AlllE NON, 1I\ANSrEI\AI1EE";"""""" -""' -' --.. - \::
Ir:;"."'""''' ,,''''c_'';NONNE(]OlIAI~IIME DEPOSIT CERTiFICATE A~:~'~~~.lN(~MBER \\\
::1 MID PENN \:1
~:\' u
l~ H
::\ J \ I ,)11<;QiliQl'l~bc- \
::1 ..Clg,r;,l. x", !;;r-Jl,,:,"- __" _ _1:,;--,,--. ,,,"0',,,,,,, - m' Al""")'" ~,
\,1,\ . Oil""'"'''' ___[] .________,_______ L] __E,...YillQ.-j'~iDil,l,:!..D2:J.-- I~\
i,l ------ -i,e"oSl[O" ,--' ~lli fi~X ~J:.~ 2 Q-,-(j'Q.o'tbj'j \9 Q_ct ~~____ POLLllflS $.20.,00.0.00--- '\\
i~\ ____-------------.--------.------ AMOUNT lNTEI\l:ST ISSUED ~l
t~ r ~() % It/fEllEST PAlO l'jA'M'IIUlllY a- Q\IMIOlly [J] Typo (jOdi' ~\
I~ J-li' T'f''tt~,~;~i1lEU)~ INlCI\fSl~1tifPi:nANmlM- 8" Milll Cll'lel\ E3 n,win\ls "~ ~t
I':. Yonrly ~MonllllY )1
1 n(,r, "\ n v: rr. O(Mon f'jjf,!;lflJ[)~ GIII\' --- J(
H ..l::l.ar.c.h. "Y"} ~__ --rVH:rwIMfllunnv SPllll A"Ill/tllly WOlJIl.ly ~ ,I
l~ . MA'\Jf'TiTY~ll'. Gllllckfl!\! ^1~(;0l1l11 .----- --7)1)~;,I .1
\'~:: _, A(hl \lJllJI,IIKU L-L#~ __...!-_ (..=Gtdd-~ - \~:
.2o.o,...1?~?~()---_.- -;:',-,"nIlACl~olmiTWhi'iif,n - - IIU1IIUlIII.11l<JlllN"t2H r 1'1
7$Sfj'IINI~!i'l .... c" t/'A....,-7 ~i. ~~
~-(:~n-~ c~nr.:~~!ln..,
1~ .. . _ ____ ",;;:",,,.,,,.,",';j"''',;i''',,\?)({I~t.<1. 77),1,{I 5/(&luf(1l ~tt,JIl" ':t?t"/1U ":r1TIr.::.z.:;:::...H.:.1\HIJ:'i,r\!: ~ ..
Hfn l'fonnntih'"ffiDootnl:" ~ ~ t!.~:i:':. r,nD ..,.....: 0; '" .. -.... ~
;-.:;:; ~ hi;;:;;;': i::t:.;:; i: ;;.~ ~ 7:1_";:: 'Z:':;;j ~ ~_;::. ~';:: :::::: ','NON.NEGOTIABl.E
1 11II
j MID PENNtBANK
,
1
.
.
l
1
1
NOIH1ENEWABLE NON,TRANsrERABLE". 00"'::: 00'"'' 0'""' ',".0' 0',:"'"
I"
'"
1"
"
I~:
I::
I::
\11
oj
jn
,I,f
"
"
"
"
"'
"
"
"
"
It
,,'
.1
"
"
Iu
"
ill
. ?'D?{! 5/(/.)1'(/((1 Z1t/,J~" ;C(,(1J( ::r:t'lr,:::':'::;;~:,=:':~:i:l:.;:-::~n~~;i:i:~rl~H::tii':<-:.!t'!!:lt~~-l':!~!
TIME DEPOSIT CERTIFICATE
_2~'ZQilll__m.
ACCOUNT NUMBER
Cera K. ._~e}'l\_~r___ ___.J~ ______._____________.._LJ
DU'OSITOll
___..J::':'I ___~____._.____.____l.] }~lizabethvilleL.!'A_LIQ.2:L___.....
--~_..,_.- (}LJ'osiT.C)tl~'.- IJ!:POSITOIl AOD!1ESS
- MP) ~'F ~,I~J 't r-. 10\ f"Ir"I r\,,'I\, f"I 10 t"ot"
_________.______""'.iuuJJ0~~ ~~~_~_~ DOLLAl1S $10.000.00
AMOUNT
_ 94 C.~ll.!.er_!lt_'______
Al1Uflf.SS
DErO~lIr(JH
Sept. lQ,.J1~
!;;SULllA.1E
. lo.2L2.
I,JllHU,TflA.1Lf'f.llA/ltIUM
INTElltST PAID
l~n!;HtS,[ ISSUED
Sept.._~.2'L_
MIITlIRHYUA1[
10~'~.
f(IWI0MA.1Uf1l1'r'
~ 8
Mild Cllllck. SilVIIIIJ!l
-~ {l(JI{jI}UP,H')t,ook. 'Chill
Ct1l!dll1\1 AI:tOllnl
.._ Add 10 flillanen
[==l Al MallHily Quarlorll W1YPO C\~(!o
d':jj .M.. M<,,'hly
'2:~,- {}/C/J(~:I> "';:~"'__~___._
202,~12-5',g.~__
f,~.N In! flLJMllUI
--~~:;ilUll-Ar.i:oIJ;ilrii1Mr..t;i-
M I ~ PEN Nt ~::;n^";:~: "~:;:;I:o:::~I':::~~"";:'~~~~;::'"':""" '\,
I "
"
_CoraK_~'~~;~)~;~6'li_____uJ]___________m ____.___..f] _~~.~_O_~~~_B.:. St. ;1
UEI'()5ITuf-l "..nA~D[)'ri[:f,f,--~--~-'-'- :~
___.....___..__..____ ,m'_I, _. ['J !!:J.iZllbethvH1e, Pa. 17023 ..
"1f'''51Tafl !'::Ir,~~} :~~~TO-C;-6'Cr6ur~-cJObt S..---.-----Aoiir""'i.----- li
-.----...-.------------:.--"'-.--..~~---~_____ OOI.I.^flS $ 10,000.00 I::
AMOlJNT ~__~__~.._.".,'n. II
January 12, 198& H.50 % INltHlb1 PAlll INTEmr,TIS!~lJ[fJ; ::
---~fiJATI~~' -iNlr"liT;;;t,l.iii--N_'fl-'vm'iiM rl~ [--J It:
J 12 1 Ii Mill! Cllfll:k :lJIYinQs ::
~~uary I 990 _._~~~t's.~ .. Goldl1llf'ill,nl,(,pk -._."_ CI"lJ ,",,',
-~M~Tlml-tyli^-ll-"- Ilflf,ll~llIllfll ~- .
20..2.-12-92 50 -,~~ ClwckllllJ Ar.I:OlJfll :1
--. -'-I;~;~j"-ilil-;ili"~liinl-~---.'~" 1.1(1 1",,-1" ^i;{:-'-'\lt~-ili-(;;;-iilfil--o ---- Mc! t,. 1I<1I"fl';(1 ::
"
"
ND OPPENHEIMER HIGH YIELD FUND A
TATEMENT OF ACCOUNT AS OF 11/13/96
m OppenheimerFunds.
NUMBER 2 8 0 2 8 0 1 2 7 1 2 5 9
DEALER NUMBER 2359 3'1 020
REP, NAME SCOLA ROB ERT M
A E. NUMBER 9 1 3 2 8
DEALEfl
1."111,.,111",,1.1,,1,1,1.,,11,.,111..,,,11,,1,1,,1,1.,1,1,1
CORA WELKER
355 S SPORTING HILL RD STE 46
MECHANICSBURG PA 17066-7703
FINANCIAL NETWORK
INVESTMENT CORP
147 COLUMBIA TPKE STE 206
PO BOX 409
FLDRHAM PARK N,l 07932-0409
rTAAN~"AT1T I ON T'fPE OF TRANSACTION )?~LLA:l,~MO.~~~ f!1'l.o\RE fR~'\f~,M\'~~ " TeCJ.TAl l
TAA ACT! P lice ARE WNElD
i i
BALANCE FORWARD , I 4 4 514 8 3
01 31 96 ~ASH DIVIDEND 47117 , 445463
02 29 96 CASH DIVIDEND 47123 I I 4461463
I
03 29 96 CASH DIVIDEND 4 7 1 7 I 445463
04 30 96 CASH DIVIDEND 47115 1 4 4 514 6 3
05 31 96 CASH DIVIDEND 47119 ! , 445463
06 28 96 CASH DIVIDEND 4504 4461463
07 31 96 CASH DIVIDEND 44195 445463
08 3D 96 CASH DIVIDEND 44193 , 4451483
09 30 96 CASH DIVIDEND 45,04 ! 44 5,463
1 n 31 96 CASH DIVIDEND 4 4j9 5 4 4 514 6 3
11 13 96 CASH DIVIDEND 18185 i 4451483"
.
REDEMPTION 6191194 1 3i9 0 :000
i i I
. I
i i
i
1 i
,
i !
1 i
.
I i
I
,
i
, i
,
I i
I I
I 1
, i
I , I
,
I
,
DISTRIBUTION DIVIDENDSISHORT.TEAM CAPITAL GAINS L ONO-TERM CAPITAL OAtNSI CERTIFICATED SHARES I BOOK SHARES
OPT I DNS CASH REINVEST ,0'0 ,000
YEAR-TO-OATE DIVIDENDS ,I YEAR-TO-DATE SHORT'TERM ,I<EAR-TO'DATE LONa-TERM TOTAL yeAR-TO'OATE
CAPITAL GAINS CAPITAL GAINS DISTRIBUTIONS
$479,67 $0,00 $0,00 $479,67
PL.EASE RETAIN THI ST TEMENT AS A AEC AD OF Y UA TR:AN ACTIONS PLEASE 0 T U 8 au F T
S A ODS 0 NO SE THE A OVE F I RES OR AX PURPOSES.
BE SURE TO CALL 1-BOO-835-3104 TO HEAR MESSAGES FROM OPPENHEIMERFUNDS'
SENIOR MANAGEMENT ON HOW TODAY'S ECONOMIC ISSUES CAN AFFECT THE FINAN-
CIAL MARKETS AND YOUR INVESTMENTS,
I F YOU WOULD LIKE TO RECEIVE YOUR FUND ACCOUNT DIVIDEND STATEMENTS ON
A QUARTERLY, RATHER THAN MONTHLY BASIS, CALL US AT 1-800-647-1694.
~~A~~s11kl~~~g: YOU OWN .000 SHARES AND THE VALUE OF YOUR
SF.l fI[VERSr. SIOr: FOR ADDiTION At INfOIlMo\TlON.
Oppenheimer High Yield Fund A
TO MAKE AN ADDITIONAL PAYMENT:
PLEASE CeMPi.ETE THIS STUB AND RETURN IT WITH YOlJR CHECK MADE PAYABLE TO THE
FUND LlsnD ABOVE, MAil, STUB AND CHECK TO: P.O. BOX 173672, OEN\lEn,'CO 80217.3672.
o
CORA WE LKER
355 S SPORTING HILL RD STE 45
MECHANICSBURG PA 17055-7703
AMOUNT OF PAYMENT S
THANK YOU FOR YOUR ADDITIONAl INVESTMENT,
D FOH CHANGE OF ADDRESS, CHECK THIS
BOX AND FILL OUT AEVEASF. SIDE.
280 28012712591
m OppenheimerFunds.
FUND OPPENHEIMER HIGH YIELD FUND A
STATEMENT OF ACCOUNT AS Of. 11/13/96
DEALER NUMBER 2359 3 1 020
REP. NAME SCOLA ROBERT M
A, E, NUMBER 9 '1 328
DEALER
ACCOUNT NUMBER 280 280 1 244298
1",111",111""1,1"1,1",1,11"1,,,1,1,,,11,,1,11,,,111",1
BECKY 60MBERGER GUAR
FBO CORA WELKER
6327 CHESTERFIELD LN
MECHANICSBURG PA 17055-2621
FINANCIAL NETWORK
INVESTMENT CORP
147 COLUMBIA TPKE STE 205
PO BOX 40B
FLDRHAM PARK Nil D7932-040~
fFRA~SACTION - RPLTLf'^~ AMOUNT Stt^A,,~~ES THIS ."AJEq,T~\"N'n I
1'YPE OF TRANSACTION ~lJAR€
AT TA N' AC..llON -
BALANCE FORWARD I ; 5383183 S
01 31 96 CASH DIVIOENO 57 017 0 I 5383835
02 29 96 CASH DIVIDEND 570,71 538 31g 3 5
03 29 96 CASH DIVIDEND 3 Sb81b 8 I 5383 35
04 04 96 CK REDEMP ff 2008 1 3;5 9 22017 5 1 - 51631084
04 30 96 CASH DIVIDEND 55271 I I 5163084
05 31 96 CASH DIVIOEND 64721 I 51631084
06 28 96 CASH DIVIOEND S 21141 5163084
07 31 96 CASH DIVIOEND 5 21!4 6 , 5163,084
; I
08 30 96 CASH DIVIDENO 5 21!4 5 ! 5163'084
09 30 96 CASH DIVIDEND 521;41 516~1084
10 31 96 CASH DIVIOENO 521!43 i I i 51631084
11 13 96 CASH DIVIDEND 218,66 I
REDEMPTION 71 66!87 1 3!9 0 51631084- 1000
! ;
I
I I I
I
I 1 I I
, I
I
I 1
I I
I I
DISTRIBUTION DIVIDENDS/SHOAT'TEAM CAPITAL l;iAINS L DNO-TERM CAPITAL OAINSI ceRTIFtCATED SHARES I aOOK SHARES
OPT IONS CASH CASH .000 ,ana
YEAR, TO-DATE DIVIDENDS ,I iEAR.lO-DATE SHORT-TEAM YEAR'TO-OATE LONa-rERM TOTAL YEAR'TO'OATE
CAPITAL GAINS $ CAPITAL GAINS DISTRIBUTIONS
$5637.85 0,00 $0,00 $5 , 637. 85
PLEAse RETAIN THIS SfATEMENT AS A RECORD OF YOUR TRANSACTIONS. PLEASE DO NOT USE THE ABOVE FIGURES FOR TAX PUItPOSES.
BE SURE TO CALL 1-800-835-3104 TO HEAR MESSAGES FROM OPPENHEIMERFUNDS'
SENIOR MANAGEMENT ON HOW TODAY'S ECONOMIC ISSUES CAN AFFECT THE FINAN-
CIAL MARKETS ANO YOUR INVESTMENTS,
IF YOU WOULD LIKE TO REC.IVE YOUR FUND ACCOUNT DIVIDEND STATEMENTS ON
A QUARTERLY, RATHER THAN MONTHLY 8ASIS, CALL US AT 1-800-647-1894.
AS OF 11/13/96, YOU OWN ,000 SHARES AND THE VALUE OF YOUR
SHARES IS $.00.
SEI: REVERS!; SIDf. FOfl ADDITIO~^l !~fOf\MATION.
Oppenheimer High Yield Fund A
TO MAKE AN ADDITIONAL PAYMENT:
PLEASE COMPLETE THIS STUB AND RETURN IT WITH YOUR CHECK MADE PAYABLE TO THE
FUND LISTED ABOVE, MAIL STUR AND CHECK TO: P.O. BOX 173672, DENV(lR! co 80217-3672.
8ECKY BOMBERGER GUAR
FBO CORA WELKER
B327 CHESTERFIELD LN
MECHANICS8URG PA 17055-2821
AMOUNT OF PAVMENT $
THANK YOU FOR YOUR ADDITIONAL INVESTMENT,
O FOR CHANGE OF ADDRESS, CHECK THIS
BOX AND FILL OUT REVERSE SIDIi,
280 28012442983
o
II"VI',"I"I'n,n
ESTATE OF
WELKER
ITEM
NUMBER
nl> (;.~},9~.
"~ ~Wl:,;.
(OMMONWEALTH Of f'ft-JrW!'lVANiA
INI'tERITAN<:[ TAX RETURN
Re~IOENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES I..... ... Ple.a~oPrl~.~LIYP~n
-----...--.-...-- .n_..__.__. -"'>-'jlTLENUi,rilEii---
CORA
. 21-96-0795
___l... --....----..-.-l--..--
AMOUNT
DESCRIPTION
A. Funeral Expen.e"
L
$ 5,590.00
HOOVER FUNDERAL HOME
103 W MAIN STREET
ELIZABETHVILLE, PA 17023
B. Admlnl.tratlve CO''''
4, Pro bale F..s
C. MI.collaneou. Expon.e"
,. CUMBERLAND LAW JOURNAL
2, SENITAL NEWS
3, CERTIFIED MAIL
4, POSTAGE STAMPS
5,
6.
7,
a.
___.....w__._ ..~---~-._.._."_.~ -
L
Personal Represenlatlve Comml..lons BECKY BOMBERGER
Social Securlly Number oHersonal R.pr.sentatlve: ..~_l2.__=-_,"iQ__..~_Ql7~
Year Commissions paid ___.__1_~.~..?_ .______._
6,028.00
2.
I Allorney Feel N I A
Family Exemptlan N I A
Clalmanl _.~,_._._.____.____ Relationship
Addr... of Clalmanl al decedenl's dealh
Slreel Address _...____.______._.__,
City .,...__._._----,-.________._.___Slale __, Zip Code__.._~__
3.
229.00
ESTATE NOTICE
60.00
ESTATE NOTICE
47.00
3.00
6.00
TOTA~ IAlso enler an line 9, Recapitulation)
(II more .paco I. noodod, In.ort additional .h.... 01 .amo .1.., I
$11,963.00
Q<::
\-
\\"i'~' 'ii'
. "-.r' ~
\-' \\, (:
,C
"l~r;
. ,~~~,
\, ,-::
!.
i:
I
I
j ~.
i,l,
,..,
r-
..n
..n
ru
cr
o
..n
,..,
c..
.
.
.
Vd "00 pl.llll,laqwn;)
PM:"l c', n " "-*'10
;/,
(I: Ed 01 tM' L6.
lllllM jO K'llllf}tIl;I
10 bOll!; )PElP)~ij
i;
/ II / .;tJ / if
BUREAU Of INOIVIDUAL TAXES
INIlf.RITAHCF TAM 11loJISIOH
Of PI . 7.80601
ttAIHIISBtJlIG, PA 1/128 Q6Q1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
(,~
NOTICE Of INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR OISAUOWANCE
Of DEDUCTlONS ANO ASSESSMENT OF TAl(
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
0(,- It,-97
WELKER
09-14-96
21 96,,0795
CUMBERLAND
101
[....._:_-A~~un~3~m.~~~~=:_~J
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
R 'EV: iS47 - iiif -j. Fi'- - r Oi":97 Y -NoT i c i - -6 F - INH iii i;: ANC E - TAX - ,,"p pilii is i'ilE NT -,- -A r.1:6 W ANC E - b-R - - - - - - - -"" - - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
CORA K FILE NO. 21 96-0795 ACN 101
BECKY BOMBERGER
6327 CHESTERFIELD LN
MECHANICSBURG PA 17055
ESTATE OF
WELKER
TAX RETURN WAS, I X) ACCEPTED AS fILEO
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
I. R..I Est.te (Schndul. A)
2. Stocks and Bonds ISchedula 83
3, Clo..ly Held stock/Partnership Interest (Schedule C)
4, Hortgag../Notec Receivable (Schedule 0)
S, Cash/Bank Deposits/Misc. Pftrsonal Property (Schedule E)
6, Jointly Owned Property (Schedule Fl
7. T,..,,.1..,.1 (Schedule G)
8. Tot.l AUflh
APPROVED DEDUCTIONS AND EXEMPTIONSt
9, Fune,.el Expanses/Adm. Costs/Misc. Expense. (Schedula H)
10, Debts/HartGage Liabilities/Liens (Schedule I)
11, 1'ota1 Deductions
12, Het Value of Tax Return
13, Charitable/Government.l aequest; (5chedule JJ
14. H.t Value of Est.i. Subject to rax
If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
1S, Amount of Line 14 at Spousal
16, ^~ount of Line 14 taxable at
17, A~ount of Line 14 taxable at
lB. Principal rlx Dua
TAX CREDITS:
PAYMENT
DATE
01-09-97
NOTEI
rata
line.I/Cla.1 ^ rat.
Colleh.-al/Cla.. B rata
RECEIPT
NUMBER
-fiATils058-
DISCOUNT (.)
INTEREST/PEN PAID 1-)
---~----;-Oo"
I CHANGED
111
12)
13)
(4)
(5)
161
17)
.00
,00
,00
.00
120,575.00
,00
,00
(8)
,~..,~ 'fl .
i1tfJ~'
.(~, I~.I rl H' (U,tJl
CORA
K
191
110 I
11,963,00
,00
Cll)
(12)
(13)
(14)
DATE
04-14-97
NOTE I To insure proper
credit to your account,
submit the upper portion
of this form with your'
tax PIYllOnt,
120,575.00
11,963 DO
108,612,01!.
3,000.00
105,612,00
14. 15 and/or 1&, 17 and 18 will
returns assessed to date.
(15)
116 )
(17)
,00
.00
105,612.00
X ,00=
X .06=
X .15=
(18)
,00
.00
15,842.00
15,842,00
TOTA~ TAX CREDIT 15,842,00
-~---------
BALANCE OF TAX DUE .00
----_.._,-~----_.."--------- ..--.-------
INTEREST AND PEN. .00
__....___.n. __~". ______._. _.______~___,__...~_
TOTAL DUE ,00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CAI.CUlATION OF ADDITIONAL INTEREST.
AMDUN1" PAID
-------15,"'842-:00
IF TOTAL OUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAV BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS, 1
00
t'-.-: r;-'. \!.i_
i --
-..
~~
.--'1")
\-....) C'J
"
;"
\,J
0'>
RES~RVATIONl Eltet.. of doc.dlnt. dyJng on or bolero DQo8~bor 12j 198~ .~ 1f eny future Int.re~t In the estate t. transferred
In pouell1l1on or enjOYMent to Clau B (oolIQternll ben.Hehlr!" of the dltOodeht after the Ql(plr~tio" of any estate for
tHe or for ~OIlrll, theCo,"",onwoalth herebY IllI'pruuly rU8rvu the right to spprall8 and ftlS8U transfer InherJtanc8 Tax",
at the lawful ClalS 8 (collelhrnJ> rate on any such future Inter8llt.
PURPOSE OF
NOTlCEI
To fulfill the requirements of Section 2140 of the InherItance and Estate Toll' Act, Aot 21 of 1995. (72 P,S.
SlIcUon 91(,0)'
PAYMENT I
Detach the top portIon of this NotIce and sub~lt wIth your payment to the RegIster of Wll1$ prlntwd on the rever.. .Ide.
~.Hllk. olllok or money Ordflr 11Ily~blo tOI REOIS'l"ER OF HILLS, AGENT
REfUND (CR) I
A refund of a ta~ oredlt, which wes not requQ$ted on the Ta~ ~oturn, mey he requosted by oo.pletln; an "APPIJoatJon
for R.fund of PennsYlvonla InherJtenoA and Estate Tll~" (REIJ~1313). ApPUQtltion:l Drla BlfaUabll at the Offia.
of the Register of Wills, any of tho 23 Relfenue District OfficOl, or by clll1!ng the speoiai Z4.hour
Mlwerlng Ilerlfice numbors for forlllll ordering: In PennSYllfan!a 1'800-~6Z~~0!iO, outsJdQ PennsYllfllllla tlnd
wi thin looal fiarr 1 sburg area (717) 787-8094. TOD. (717) 772- U52 (Hear ing IIIIPa I red Onl Y 1 .
ODJECTIONS I
MIY party In Interen not satisfllld with the llppnllS8lllent, allowanoe or dlsallowanoe of doductlonll. \lr asseUllIent
of tax (inClUding discount or Interest) Oil llhololn on this Notice IIlllst Object within SJKty (60) dllYS of rGlceipt of
thls Hotlce bYl
ADMIN
ISTRATlVE
CORRECTIONS:
~~wrltten protut to the PA nep~rt"'ent of RQvlInue, Board of Applle1s, Dept, 2810211 Harl'1sburg, PA 17128-1021, OR
'~ll.ctJon to heve the IIIatter datorllllnCld lit audlt of tho llccount of the personal repr8l.ntnt!lfu, OR
--appeal to the Orphans' Court,
Factual errors dlscolfClred on thIs aBse~9ment shOuld be 8ddre~s~d In HrItlng tal PA Departmant of RevGlnu.,
Bureau of Individual TaXDS, ATTN! Post AuoSllment RflVIflw Unlt, DGlpt. 28061H, Harrhburg. PA 11l28~0601
Phone (7!7) 787-6505. See pago 5 of the booklet "Instructions for Inharltance T8x Return for 6 ResJdGlnt
Deced.nt" (REV-ISO}) for an explanatlon of adlldnistr8t1velycorrlictable arrors.
DISCOUNT l
If any tax dUGI Is Pllid HIthln throo (3) calendar ~onthD aftar the decedent', death, a fIv8 percunt (5%) dJscount of
the tax paid Is allowCld,
PENAL TVI
The 15% tax afllnilsty non~partlolpatlon penalty is coeputed on thQ tohl of the tal( and interest au....d, and no.t
paJd b.fore January 18, 1996/ tho first day after thCl .nd uf tho tal( aMn9sty period. This non~particlpation
p.nalty is sppliI!'Ilabla J" the sallle IIIanner SlId in the thfl sall"l tlllllia per lad 8S YOU would appeal the tax and Jnterut
thBt hal been as.essCld 81 Indloated on this notice.
INTEREST I
Interout i. Charged b.glnnln~ with first day of dellnquencYI or nine (9) months and one (1) day frOM the date of
dflath, to the det", of paYlllenL Ta~u whIch bOc8111e delinquent beforGl January 1, 1982 bear Interest at the rat. of
li)( <6%) percent pef' annUM calculAted at a delly ratGl of ,000164. All tSlfQIl which beQelll8 delinquent on end after
J~nuary I, 1982 will bur Int~rut at a rate whiCh will val'Y frOM Qalcmdal' YCler to calendar Y8ar with that rat.
annouOCled by the PA Dapftrhllmt of ReVlnull, The app!lQab1e Interui: "atos for 1982 throllgh t997 al'.l
~ 1ntore.t Rllte Dfllh Int5lrut Fllctor ~ Intllrut Rate ~l1y Interest Fector
1982 20% .000548 1987 9% ,000247
1983 16% .000438 1986.1991 11% .000~Ot
19&4 11% ,000301 1992 9% ,000247
1985 13% .000356 1993~1994 7% ,000192
1986 10% ,000274 1995.1997 9% .000247
~ - Interut 11 calculat.d .. follow"
INTEREST. BALANCE OF TAX UNPAID X NUKBER OF O&YS DELINQUENT X DAILY IN'fEREST FACTOR
-~Any Notic. inued IIft.r the tal( becoMe I d.lInquent wiU reftect 811 interest calculation to flftlen (IS) dflYI
beyond the datu of the RIS.'sftent. If pay~ent Is m8d8after the interest co~putlltlon det. shown on the
NotJc., additlon~1 Inter..t ~u.t be Qalculllted,
. SENDER:
~~ ltoms1 amVor 2 lo( additional &orvlco8.
" .Complelelleml 3, 48, aoo 4b.
~ .Ponl your nama and adelra.s Ofllho reverao of lhl'l form 80 lhlll wo car, folumlhll
~ ca,.d toyou.
> _Af1ach Ihllloml10 tho Ironl 011110 mallplOco, or on tho back illIpClco dOOli not
e pormll.
4) _Wrlte'Roturn RDCoipt Requo.,sd' on tho mallpleco bolow lho anlclo number.
_TIle Rulum Aocolpl Willllhow 10 whom tho ftltlclo WIlB eJOII"'OTOd "nd Iho dale
dollverod.
3. Mlclo Addrossod 10:
JEFF1\E:Y HOKE:
BOX 1318 RD 2
iUFFLINTOWN Pl\
17059
5, Rocolvod By: (Print Nama)
I also wish 10 recolvo tho
following sorvlcos (for an
oxtro fool:
1, 0 Addrosseo's Addross
2, 0 Restrlotod Dollvery
Consult poslmo6ter ICJr leo.
40. Article NumbeL
p 0'1 ~? c 'i: 3/~
4b. Servlco Type
o Reglslored
o Express Mall
o Relurn Recelpllor Marcl1ondl..
7. Dota of Dellv
Domestic Return Receipt
RELEASE
g' Co~lflod
o Insurod
o COD
i,..'. '//;<"..",," '.. """"H'\',,-'..'_."'Oll.llolll'
;,
2\~ j,;
M .11i
M
M IE
1i ri ........:, V',
] :::;,- ~ 01
....s ~.J <.:.1
c.r-- 5rJ
1i '" "
.~ l""- tA a
-~ In
0:, !0 ~l
E
~ .~ l1J
It
'" ~I ~ ()
,~ <a f!.. ~ ,,,", c-
, ~! 1/-1
" .~ <
- 0
0 ~ v!:2 n
~ -
"
~ 11I1"~1f; --,~
'"
c
~
r~ '" 'I .~
j, I. (. I~
o I
L ; (i
I,)
DC> WH Will rl;,i>I~\"I' ",q';lI~',N UEL[)W 1111" liNt'
. III ~;r:n~ (ffl' /.tl.'itf~;1.I\I.(llf,.-R)'lf!I~}N IJ:;l': . "
I ,,' :. a;/t/ ''',\':'"'/'';'I,.lnA (,'," /;
... ., ,ii1.~'" ..~1.:tli~:~~'\'..i..:~; .'"
I Jeffrey Hoke, after reviewing the accounting of Cora Welker's Estate and receiving my pol1ion
of the said, do release Becky Bombllrgcr, Excutrix of the said Ilstato, from any further liability or
obligation to me concerning Cora Welker's Estate.
.u~Q
Je~b Beneficiary -
flPRlC-
Date
ti
J
(C;~'7