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STATE OF FLORIDA
BB:
COUNTY OF C I' A R L.UIt (.
on thilOl, the I~}h day of ~pi (!.m be (
1996, personally
appeared before me, TERRY L. GASTHOCK, known to me (Dr
sati.sractorily proven) t.o be t.he person whose name is signed to the
foregoing Renunciation and acknowledged that he executed it for the
purposes therein contained.
~AU,)J).1i~J
( . Notary public
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My C9mm. Expires:
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"'''1\"/'''''' ----.'JOANN ('(iii,:.; J
.",!,;, fr,.
r~' ~~'~~\MV COI/;,\\15~W)N ',I l'r': ,:1:', ill~
i.~!.' - _I:~j llXPIRES: SilPl(ifliLt;1 ~\I, 1\1.,.17
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"'a'P.nl\~:;'';'' Botilleillhni NotaiV r'u~'r~ UndllT'Nl116B
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HERSHEY, PENNSYLV ANI" 11(0).(ll>lll
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cumberland County Register of Wills
1 Courthouse Square
carlisle PA 17013-3387
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IOH DA! r:~; Of lllAl H ArlEn 12/j 1/9\ CHECK HEnE
If ^ ~;f'()U~;^1 f~
f'(IYf.;JH,'!'UiLIHJ I~j CL~Ltill.Jl.....---L-L"_________
FilE NUMBER
COMM~~.lMtI~'~ ~{nwt1f'\~ AN'^
HARR'sR5~~,'JlA \9\28,0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILI.S
NUMBER
F1f.J 1500EX.(7.94)
DECEDENT'S NAME (LAST, FIRST, AND MIOOl!:: INITIAU O[Cl()(:NT '~; COMPI, E l'E ADDR[~l~i
Bolland, Rosanna E. 9/,0 Walnllt Bottol1l Road
S.D. CIAL SECURITY NUMflErl ~DATE~F DEATH -]DAT~~;;m;;;---'- Ca r I I s Ie, PA 1 701 3
172-01-0~~3 08!0~/1996 0~/ll!190~
County CI.lmbor J Ulld
,IF APP' 'CABLE)SURVlV',:~~OUSE S NAME [LA"T-;~~::~-;;'ODC;; 'NIT~'~L '.ECUN"Y NUMBER
X 1, Orlglnal Relurn ~ Supplemonla! Rellnn
4, l.lmlted Estate D 4a. FUlUro Intorest Compromise
(lor dates of death aftor 12..12.82)
D 6. Decedent Dietl Testate 0 7, Docodent Maintained a Living Trust
(Allach co 01 Will) _ (Attach it copy of TrLlst)
C P All CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
2 ~ NAME COMPLETE MAILING ADDRESS
R D G.!!.EY...L, .Jamos Esq. .JwnoH, SmJLh & DurkJn
E E
S N TELEPHONE NUMBER ] 3/. Sipo Avonuo
T 71'1 533-3280 Bummelstowll PA 17036
1. Real Estale (Schedule A) 1 70 , 180,3,.
2, Slacks and Bonds (Schedule B) (2) Nono
3, Closely Held Slack/Partnership Inleresl (Schedule C) (3) Nono
4, Mortgages end Noles Receivable (Schedule D) (4) None
5, Cash, Bank DeposilS & Miscellaneous Personal Property (Sch E) (5) 117,061,61
6, Jo,nlly Owned Property (Schedule F) (6) None
7. Transfers (Schedule G) (Schedule LI (7) Nono
Q. Total Gross Assels (Iolal Lines 1,71
9. Funeral E)(penses, Administrative Costs, Miscellaneous
Expenses (Schedul, H)
10, Debts, Mortgage llabllilles, Liens (Schedule I)
11, Tolal Deducllons (tala I Lines 9 & 10)
12, Net Value 01 Estate (Line 8 minus Line 111
13, Charllable and Governmenlal Bequests (Scred"le J)
14, Net Value Subjecllo Tax (Line 12 minus Line 13)
15, Spousal Transfers (for dales of death afler 5,30-94)
See Instructions lor Applicable Percentage on page 2,
(Include values /rom Schedule K or Schedule M.)
16. Amount 01 Line 14 taxable at 6% rate
(Include values lrom Schedule K or Schedule M,)
17, Amount of Une 14 taxable at 15% rate
(Include values from Schedule K or Schedule M.)
18. Principal tax due (Add tal< from Line 15, 16 and 17,j
19, Credits/Sp Povorty Prior Payments Discount
+ 5,500,00 + _.289.117
20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is Ihe OVERPAYMENT,
[[] 0 [Check here If you ere requesting i relund of your overp~.nt.1
21. If line 18 is greater than Line 19, enter the differenco on Line 21, This is the TAX DUE,
A. Enter the interest on the balance due on Line 21A
B. Enter Ihelolal 01 Line 21 and 21A on Line 2tB ThIS is the BALANCE DUE.
M.ke Check Payable to: Reglste, of Will., Agent
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ~ ~
Under penllllles of perjury, I declare Ihlltl have eiMiilnlld this return, Including accompanying 'Schedules and stlltementll,llnd to the bOlll of my knowlodge and belief, Illstru8.
cortect and complete. I declaf81hal all '81118s11\1o has bNln reportfld III trlle mlHkol valua, DocllHlIlIon of pffJplHfH othor \hen th(l pfll!lOnllt represontallvo Is besed on alllnlormlltlon of
which prl'lpllrer hasllny knowledge
SIGNATURE O~ PERSON RESPONSIBLE FOR FlUNG RETURN Susan E. Lodoror j'.Bfl.
131. . S,I 1'0. Avonuo ,
...--Htt1111Tinl ~t()Wn, }'A 17036
. NTATIVE .JUl1'fih I Smith 6: Durkin
1 VI . Sll'o. AVCl1\H.'
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SIGNAllJAE OF PREPARER OTHER THAN RE
&0
/
CAB
H P l
E P 0
C R C
K 0 K
P S
1996-799
COUNTYGODE
YEAR
D
E
C
E
D
E
N
T
AMOUNT RECEIVED (~EE INSTRUCTIONS)
Il,OO
05,
8,
Remcllnder Return
(lor datos of death prior to 12 13.82)
Federal Estate Tax Helurn Required
Total Number of Sille Deposit Boxes
R
E
C
A
P
I
T
U
l
A
T
I
o
N
(8)
117 ,SIt!, 92
(9)
18,215,09
(10)
60,504,12
(11)
(12)
(13)
(14)
78,719,21
38,822,71
38,822,71
(15)
0,00 X
0,00
(16)
0.00 X ,06 '
0,00
T
A
X
C
o
M
P
U
T
A
'T
I
o
N
(17)
38,822.71 XIS'
5,823.111
(18)
5,823,111
Interest
(19)
(20)
5,789,1,7
0.00
(21)
( 21A)
( 21B)
33,911
0.00
33,911
DATE
<I;: . 'j I) I
DATt
-tic" 1'"
Form ist~~~)
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCEllANEOUS EXPENSES
REV - 1511 EX 1(7-68)
cO"'~N9~1~rX~~f'tYAN'A
ESTATE OF
Rosanna
ITEM
NUMBER
A.
B.
1.
2,
3.
4.
C,
Pl.... Print or T .
FILE NUMBER
1996-799
E, Holland
SSII 172.01,01,1,3
08 01, 1996
DESCRIPTION
1
Fun.r.1 Exp.n...,
Hoovar Funeral Home
Admlnl.tr.tlv. CO.tll
Personal RepresentatIve Commissions
Social S"curlty Number of Personal Represent.llve:
Year Commissions paid
Attorney Fees
James, Sl~i th /; Durkin
Faml~ Exempllon
Claimant
Addre" of Claimant at decedent's death
Street Addro"
City
Relationship
Stale
Zip Codo
Probate Foes
Register of Wills
1
MI.e.lI.n.ou. Exp.n.e"
Arnold Fuel Oil, Inc,
fuel delivery
2
Arnold Fuel Oil, lnc,
furnace repair
3 Barbara Sheetz - lawn mowing services
4 Compleat Restorations . mold abatement and restoration of real
estate after extensive water damage
5 Cumberland County Legal Journal - legal notice
6 Erie Insurance Group . insurance premium
7 Kerry Pae Auctioneers - expenses and commission from clean up an
sal~ of personalty
8 Pennsylvania Power /; Light - electric service
Total of Continuation Schedllle(s)
_ TOTAL (Also onter on line 9, Recapllulallcn)
ill more .p.cel. n..ded, In..1I .ddltlon.I she.t. 01 ..me .I.e,)
Copyright (1:) 199~ form soli ware only CPSYlllem9, Inc,
\
AMOUNT
191. 00
6,000,00
216.00
492,37
30,55
300,00
7,712,47
60,00
290,00
2,003,44
101,,03
815 , 23
$ 18,2)5,09
Form 1500schfldule H(RIY, 7-88)
>
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Register of Wills of
CUMBERLAND
County, Pennsylvania
INVENTORY
Estate 01 Rosanna E. Holland
No 1996-799
also known as
Date 01 Death 08/04/1996
,Decoased Social Socurity No 172-01-0443
~
Susan E, Lederer , ____,
Personal Representativa(s) of tho above Estate, decoased, verify thallhe items appearing in the following Inventory Include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent lhallhe valt/alian
placed oppo!iite each item of said Inventory represents its lair value as of the dale of the Decedent's death. and that Decedent owned
no real estate outside 01 the Commonwealth of Pennsylvania except thai which appears in a memorandum at the end of 1his
Inventory, I !\Ne verify that the statements made in Ihis Inventory are true and correct. I,We understand that falso statements heroin
are made subject to the penalUes of 18 Pa. C.S. Soction 4904 rolatlng to unsworn falsificatior, to authorities,
Personal Representative
Name 01 Gary L, James
Attorney:
I.D, No,: 27752
Address: 134 Sipe Avenue
Humrne1stown, PA 17036
Telephone: 717/533.3280
Slgnatur.: ~~"--- e. :1-~
Susan E, Lederer
Signature:
Addr...: 134 Sipe Avenue
Humme1stown, PA 17036
Tel.phone: 717/533-3280
Dated .f/2-",;}>7
Description Value
(See oontinuation page(s) attached)
(Attach addllion.1 sheets il n.cessary)
Total
117,541.92
NOTE: Thl' Memorandum 01 real estate outside the Commonwealth of Pennsylvania may. lit the election 01 the personal reprusentative,
include the value 01 each item, blJt such ligures should not be extended into the total of tt1B Inventory
PrepMftd by ltlt! Pennsylvanll Bar ,1,SSOCllllloll
Copyright (c) 199fi form lIoltwlHftonly CPSYlltflms, Inc,
Formt'AW-7(199Z)
, I) /1'1 ,)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
aUREAU OF INDIVIDUAL TAKES
INIII HITA!<jCL lAX OlV1SION
DIrT. ;'80601
llMmtsnUHO, PA 11126--0601
NOTICE OF INHERITANCE TAK
APPRAISEMENT, ALLOwANCE OR DISALLOWANCE
Of DEDUClIONS AND ASSESSMENT OF TAX
DATE
ESTATf. OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-'28-97
HOLLAND
08-04-96
21 96-0799
CUt~BER LAND
101
Amou~~~.:_-.:~-~~I'"tl~o"_
GARY L JAMES
JAMES ETAL
134 SIPE AVE
HUMMELSTOWN
ESQ
PA 17036
[
~,~t!.
'~IP"
l( ~. II-I [I If P 10J.91l
ROSANNA
E
MAKE CHECK PAYABLE AND REMIT PAYMENT rOt
REGISTER OF WILLS
CUMBERLAND CO COURT HOUS~
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .... ,
R if v: is';," E if" Ai: p"" f iij"':- 9 =; Y - NoYf c r "oF" "iNti E iff;: Atic E - TAX " ii-ii PR ii-is E i-f€ NT -; -A L'i'-OW ;.'f,ic E - i:ili-
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HOLLAND ROSANNA E FILE NO. 21 96-0799 ACN 101 DATE 07-28-97
If an assessment was i.ssued previously, lines 14, 15 and/or 1&, 17 and 18
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX;
IS. Anount of Line 14 .t Spousal
16. Al10llnt of Una 14 tfi)(able at
17. Amount of line 14 taxRble .t
18. Principal Tax Du.
HK RETURN WAS: (X I ACCEPTED ~,S FILED
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
u_______
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Re.l Est.te (Scheduln Al
2. Stocks end Bonds (Schedulo B)
3. Closely H~ld stock/Partnership Intorest ISchedule C)
4. Mortgsges/Not.u Roceivable jSchBd~ll" D)
5. Cash/Bank Oeposits/Misc. Personal Property (Schedule E)
6, Jointly Owned Property ($chedulo FI
7. Transfers {Schedule Gl
8. Tobl Assett s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. funeral Expansns/Adnl, Costs/Mise:, Expensos (Schedule H)
10. Dobh/Modgage Uabilit1os/Uen~ (Schedule Il
11, Tobl Deductions
12. N.t V.lu&l of Tax R.turn
13. Charl,tabh/Gov8rmnentlll 8aquesh (Se:hedule J)
14. N,d Valua of E,d.te Subjoct to Tax
NOTE:
rat.
line.l/Class A rat.
Coll.ter61/Clasl B rata
TAX CREDITS:
'''..---.-....-,....--...-.-- --------~----_.,
PAVMENT RECEIPT
DATE NUMBER
--rO-31--96-"---MI46898--- -,
04-25-97 AA211219
DISCOUNT (+)
INTEREST/PEN PAID (-)
--289:'47
.00
(11
(2 I
(3 I
{'.l
(51
(61
17)
19)
(l0 I
(15)
(161
( 171
l CHANGED
70,480,31
,00
,00
,00
47.061.61
.00
,00
(81
18,215.09
60,S04,u..
(lU
(l2)
(13)
(14 I
,00 X,OO,
,00 X ,06,
38,822.71. X .15,
(l81
AMOUNT PAID
-- --------s;soii~1l 0
33,94
NOTE: To insure proper
credit to your account}
submit the upper portion
of this form with your
tax payment.
117.541,92
78.11Q 71
38.822,71
.00
38,822.71
will
,00
,00
5,823.41
5,823,41
.. - ---'-l~
TOTAL TAX CREDIT 5,823,41
-~--_._----".- ._-
BALANCE OF TAX DUE ,00
--~~~~~"._._-- ~~,----
INTEREST AND PEN. .00
_...~.r "....._..___.-_________."... ---.-~---..--.-..
TOTAL DUE ,00
_..".,. ."n__.....'__..!....___.__, ________
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
IF TOTAL DUE IS LESS THAN .1, NO PAVMENT IS REQUIRED.
IF TOUL DUE IS REFLECTED AS A "CREOn" (CR I, YOU MAV BE DUE
A REFUNO, SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
, ~i
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RESERVATION I E.tet~. of dlced.nt. dying on or,b.fcrl Oeoe.b.r 12, 1982 -- if any futurl lnter..t In the I' tate 1. tren.flrrld
In po.....ion or .njO\fIll.nt to Cl".. R (collateral) blnlUoler 1.. of the dlcldent after thl IlCplratlon of Iny ..tat. for
11f. or for ~.ar., the Co..onwlalth hlrlby IlCpre..ly rl.erv.. the right to appral.M and I"'" trln.fer Inh'rltlncl TIIC.'
at thl lawful CIa.. 8 (collatlral) r.h on an", .uch future Inter..t.
PURPOSE OF
NOTICE I
To fulfill thl r.qulre'lnt. of Section ll40 of the Inherltanol and E.tat. TalC Aot, Act 21 of 1995. (7i P.S.
SecUon 9140).
PAVHENTl
Oetach the top portion of thl. Notlel and lubelt with your pay..nt to the RIgI.l.r of Will. printed on the r.v.r., .Idl.
~~Mak. chIck cr 10nllY order Pfl~l!lb1t \01 REGISTER OF' MILLS, AOENT
REFUND (CR) 1
A refund of II t8K crldlt, whloh Wfll not requested on the hI( RetUf'n, mllY be requested by oOIlPhtlng nn "Application
for Refund of Pennlylvflnla Inhllritance and Estete TalC" (REV-Illl). Applleatlonij are available at the Offlol
of the Regi.ter of Willi, any of th. 23 Revenue Olltrlct Offlo.., or h~ calling the ,plclal 24-hour
an.wedng IIlIrvloe nUMbers for for'l orderlngl In renn'Ylvenh 1-800-362-2050, outside f1enn.ylvanl. and
within 100al Harr'hburg .rea (717) 187-6094, rOOI (717) 772-2252 (Hcaarlng hpairlld Only!.
08JF.CTIONSI Any pllrty In Intttr..t not sathfllld with the appr'III1...nt, allowanoe or d1sallowanco of ded'Jotlonl, or a.....II.nt
of talC (Including discount or Int.re.t) al "hown on thlt Notlo. IIIU.t obj.ct within 51Kty (60) daVI of receipt of
thll Notice bYI
--wrlthn prot..t to the PA Oapflr. ,nt of Revenu., loard of Apput., nept, 281021, Harrilburg, PA 11128-1021, OR
--.I.atlan to have the Iltt.r d..'. dnad lit audit of the l'la(l<;)unt of the p.rsonal raprllentetlv., OR
-~.pp.al to the Orphan.' Caurt
ADHIN
ISTR"UVE
CORRECTIONSl
Fllctulli error. dhcover.d on {!Ill ........nt .hould be addr....d In writing to: PA D.partlllnt of Rev.flue,
Bureau of Individual TaKII, ATTNI POlt AtII.....nt Revll" Unit, nept, 2110601, Harrhburll, PA 171211-0601
Phung (717) 781-6505. S.. page ~ of the bookl.t "In.tructlon. for Inher\tano. Tax R.turn for II Relld.nt
D~c.d.nt" (Rf.V.1501) for .n IIlCplanatlon of ad.lnl.trntlvely oorreotllbl. error..
DISCOUNTl
If anv talC due 1. paid within thr.ft (3) olll.ndllr ftonth. aftlr the dloedent'. death, a flvlI p.rollnt (5%) dl.aount cf
the till( pllld J, allow.d.
PENAL TV I
Th. 15~ tlllC aan..ty non-plrtlolplltlnn p.nalty 1. o~ttd on the total of the tax IInd lntlrl.t 1I......d, and not
Pllld beforl Jllnuary 18, 1996, the flrlt dolo' aftllr the and of the tllX o.nll.tv periOd. Thl. non-pllrtlalpatlon
Pllnalty I. lIPP..labh In the 1811III IlMllr flnd In till the ..... tI.. p.rlDd &I YOU would apput the tal( and Inttr..t
that hat bllen a......d a. Indl~at.d on thl. notlo.,
INTERESTl
Int.r..t I. charglld b.ginnlng with flr.t day of d.lInquenc~, ar nlnll (9) lIanth. and ana (1) day fro. thll detl cf
d.ath, to the datil of plvwent. la~'1 which b.a~.. o.11nquent b.for. January I, 1982 bear tnt.re.t at the rltl of
.he (61:) p.rctnt pI,. anl'llM oalculated flt a dally rat II of .000164. All talC.. whloh bac... deUnquent on and ,Ullr
January 1, 1982 will bur Inter..t at a ratll which will \lar~ fro. c.lendflr Ylll'lf to a.l.ndar Ylar with that r.t.
announced by the PA Departllent of Rllvenue, Th. applloltb18 int.rut rat.. for 1982 through 1991 ar'l
'!!!!; Int.rut Rflte Oally Int,,".t fl'lOtor ~ Int.r..t Rllt'! Dally Inh"." factor
1932 20;': .00054. 19111 " .000247
1985 161: .000438 19aa-1991 Ill: .000301
19I~ ill: .000301 1992 9X .000247
1985 nx .0003S6 1993-1994 IX .000192
19.6 lOX ,000214 1995-1997 9% .000241
~-lnhr..t It calculated .. follow'l
INTEREST' BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlcl I..ued aftor thl talC beca... dlllJnqullnt will rlfl.ot nn Inter..t talculatlon to ftft..n (15) dllY'
blyond the date of the a.......nt. If pav.ent II ..d. .ft.r the Int.r..t co~utatlon det, .hown on the
Natlcl, eOdltlonal Intllr...t au.t b. olllo11ht.d,