HomeMy WebLinkAbout96-00805
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also known as n_~__'__'H__ n..'____________
PETITION FOn I)IWBATE llnd GUANT (H' LETTERS
,,' re)"
lcAl_, .'1 0L.c.--'_ .~':L__~
No,
To:
______,,_. . '. . neceasf'd.
Sodal Security No. ~.~~} -:-~~~:_~;(, lie)
"egister of Wills ffH, tllf 'I '
COli Il !'-' )f (,11H1 l(. I Itlll III
J ( .___.____._~..__
Commonwealth of I'ellnsylv:tnia
the
The petition of tlte undersigned respectfully represents that:
Your petltioner(s), who is/aX<kIR years of age or older an the exeeut-'-'~'
in the l:tst will of the above decedent, dated ....l1J.ly-2(, ,
:tnd codicil(s) dated ( =rs;:::;:~~~ 0;-'2.f
named
,19~
~p99'L
~
(Slate relevant drC'l1n1Slaf1CC~1 e,g, renunciation, death of executor, elc.)
Decendent was domiciled at demh in C:umll<-!r'lnnd County, Pennsylvania, with
h i~ last fmnily or principal residence at Manor Cal'o Hoa] th SQLY.i.c(J, Wn] n1.(1-
Bott2..!!l_lloa~J_Ctll',li" 1'-'2..L 1'^1 70'j'j--4-C<,rl';Qlp IlnrnlJ.gh)...__
(ltst street, number lInd muncipfllity)
8" ", ,+ 1 ')()
Decendent.then ~~ ,_vearsorage.di~d. ,)"p~om lor' ~
at "Manor~ eure "llC!lrTl:~~~LCO, LHl'.lls1o t P~)nns.Yl vania
Except as follows. decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate: was not the victim of a killing and was never adjudicated
incompetent: _____
,19 96
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property In Pennsylvania
(I I' not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
THE PRIMARY EXECUTRl~CIJAln.O'l'TI\ 10:. LARSli:N, DIED NOV. 4, 1992.
$ 1/,0,000.00
$
L
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the gr:tnt of letters ton t a In 8 n tar y
(testamentary; administration (,:,t.a.; admlnlslration d.b,n.c,t.a.)
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lfow Cumborland. PA 17070
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } ss
COUNTY OF ClJ~lIH:HT.ILNI) _
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The petitioner(s) above-named s\\'ear(s) or affirm(s) that the statements In the foregoing petition are
trll,e and correct to thc best of the \!lOwledge ?l1d beliel,' ,Of, peti~~n~r(,S) ar."hi thh;a;t:ts per, son~1 represen-
tatlve(s) of thc above decedent peOtloiier(s) Will well ~IY 'q:'~~, ::!h~:tateUccOrdlllg to law.
S\\'orn 10 or affirmed ancl ",h"cribed ,'.. I 1/ 'C ",;;;J /" ~ __ VI
before me this -....,..,.6._____ day of i ,I" 'I I" ,-I,'ll<'/1 V I' ,. ~'
," ~t obc'r I \! '1996 "
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CERTIFICATE OF DEATH
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OF DEAtH ~ACll"Y 'lAME' IW r\OC .",1\AJ(,iI ~>1l "'HI &lid f'Ullbell
1996
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2944 Yale Avenue, Ca Bill, PA 17011
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a\lOvu"named 1'untntor, 118 IInel I'llI' hIt! tlltl!' WIll 111111 'I','/ItlllnCllt I in tho. presence
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presence Of the II/del 'l'OHl'lIlol' 1111e1111 1'110 pl'eliUlWO of ellch othel'.
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J~NHERITANCE TAX RETURN ~F~~c?K'~~~~~FDH~MlIEn 12131/91
RESIDENT DECEDENT POVERTY_CREDIT IS CLAI~
COMMONWEALHI 0' PENNSYLVANIA (TO BE FILED IN DUPLICATE FILE NUMBER
DEPARTMENT OF 'IEVENUE 21 1996 0805
HA"AIS~~~~,~8~~:~26_"01 WITH R.EGIS_TER OF ~I_LLS) _~UNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS
LarBen, Herluf T. Manor Care Health Services
SOCIAL SECURITY NUMBER!liATE OF DEATH DATE" OF BIRTH Walnut Bottan Rd., Carlisle, PA 17013
DECEDENT 323-12-8656 _--LQ.~/29/96 01/15/1911 COlfnl Cumberland
fI' APPLlCA"L~ISUAVIVINa SPOUSf'S NAME (lA"T, SOCIAL SECURITY NUMBER AMOUNT REC-EII/ED (SEE INSTRUCTIONS)
rlHsT AND MIDDLE INITIAl.) w .
20, II Line 191s grealOf than Llno 18, onlo, Iho dilfOfenco on Line 20, Thi. is 1110 OVERPAYMENT,
~!C<<'Qk"W'i\i"yOi[ar-; i.qlJtllUngll,olund Cll your ovorPaYJ11oni. ' "', ""l
21. II Une 18 Is greater Ulan L1no 19, onlor 1110 dllloronco on Llno 21, TIlls Is Iho TAX DUE.
A. Enter lhelnlorost on lho balanco duo on LInD 21A.
8. Enler 1110 tolal 01 L1no 21 and 21A on Lino 2-18. Tills IH 1110 BALANCE DUE.
Mako Chock Payable t~, Register 01 W!lfo, Agent
L_<',::,_"",,_::::~~
Snd~;'~o';alll~s of P~'JurY'~OCI:I~~ ~I~a~~{~,~~~rl~~ ~~\~,~~,7C~\~~:~~~:'~~~Ir~gAS~~0~I~q~~E;~o~,~:, ':d 10~0 60"1 ~I mv knowlodgo
alld bollol, IIlstruo, carmet and cOlllplolo. I doc/ow that all runl oslalo has boon ropolfod at lfuEl markot valuo. Doclaralion 01 propnror olhar t!lan tho pOf9onal
rOprmlen1~tlv? 10 J~~ on alllnlo m 01 :~!..:~tllch pr(Jpmor Illl!! anV knowlodgo, . __ . .
SInNAT~. Of :11~al~-J ~ IN _,[ I!.INri f1fTlIflN ^flnf1I'~;~, OAlI
--I- -'.. / I,' / (I. See Schedule attached /. - / l - t-L.
SlnNA\USl f PfHY r I OTt1 I. 11 l!A ADllfH f,:i nAIl.
.....-'-- - (, 414 Bric!~~t:ree1: L:.l1- '1l
~"lSOO\ - "10;/0 - New CllIIOOrland, PA 17070
{;OPYrlghll'dtlMitrll"Wil.11l Only, 10114 NQILO, 111(;, N91\f'AoOl
Ilf. V \50u LX. (7~94)
CHECK
APPRO-
PRIATE
BLOCKS
CORRES-
PONDENT
RECAP IT-
ULA nON
TAX
COMPUTA-
TION
( ,
...-/
1, Original ROlurn
3, Remalndor Roturn
(lor dates of dIJalll prior to 12~ 13-62)
o 4, Llmlled ESlate
o 40, FlllulO Intorast Compromise
(lor dalos 01 dealh ahor 12-12-02)
g] 7, Decodent Malnlainod a Living Trusl
(Attach copy 01 T,uol)
. 'ClONFltleNTiA~'TAl(iINFOflMAtloNSIiOlJlPlla lllRltCt~Pt :' .1."
COMPLETE MAILING ADDRESS
414 Bridge Street
New Cumberland, PA ,17070
o 5. Fodoral Estato Tax RoturrI Roqulrod
IB 8, Decedent Died Teslale
(Allach copy 01 Will)
AW. RllllPQNtiii!Ne~AN
NAME
David H. Stone
TELEPHONE NUMBER
717-774-7435
1, Real Eslale (Schedule A)
2, Stocks and Bonds (Schedule B)
3, Closely Held Slock/Partnership Inle'esl (Sch, C)
4, Mortgages and Noles Roceivable (Schodule D)
6, Cash, Bank Deposits & Mlscellanoous Personal
Property (Sohedule E)
8, Jolnllv Owned P,operty (Sclledule F)
7, TranslefO (Schedule G) (Schedule L)
8, Tolal G,oss Assels (10101 Unes 1-7)
9. Funeral E)(penS9S, Admlnlstratlvo Costs,
Miscellaneous Expenseo (Schedule H)
10, Debls, Mortgage Liabilities, Liens (Schedule I)
11. Total Deducllons (Iotal Lines 9 & 10)
12, NOI Value 01 Eslale (Line B minus Line 11)
13, Charitable and Gove,nmenlal Boguests (Schedule J)
..Q. 0, Tolal NumbOf 01 Solo Deposit Boxos
',I,t::,'
i~
- 1
(1)__
(2 )
(3 )
(4 )
( 6)
None
None
None
None
6,382.00
(6 )._
(7 )
None
144,674.17
20,719.40
414.76
(8 )
151,056.17
(9 )
(10)
(11)
(12)
(13)
21,134.16
129,922.01
121,922.01
8,000.00
14,__Nel Value SubJecllo Tax (Line 12 minus Line 13)
15, SpClusal Trlln1l1ers llor dates 01 death altorB.30-94). au
Instruclionslor Applicable Percentago on PAge 2. (Include
valulls /rom Schedule K or Schedule M.l
16, Amount 01 Une 14 taxable at 8% ,ate
(Include valueslrom Schedule K or Schedule M,)
17, Amount 01 Line 14 taxable at 16% rale
(Include val'Jes from Schedule K or ScllOdule M,)
18, Principal lax due (Add lax from Lines 15, '18 and 17,)
19. Credits SpouS1lIPover\yCredll Prior Paymonts
(14)
(15)
x ,
,
0.00 x
.06 =
0.00
(18)__
B,OOO.Oq)( .15 =
1,200.00
1,200.00
0.00
(17)
(18)
Dlscounl
Intorost
+
(19)
(20)
,t
(21)
(21A)
(21B)
1,200.00
0.00
1,200.QQ..
Page 2
Estate of: Herluf '1'. Larsen
21-1996-0805
SCHEDULE J, Part A -- Taxable Bequests
Item
No.
Nama and J\ddress of I3enefioiary
Relationship
Atrount
1 Mat.thew Ellenberger
800 York Road, Lot 121
Dover, PA 17315
2 Andrew Ellenberger
3480 Grandview Drive
York Haven, PA 17370
1,000.00
1,000.00
3 Caryn Osberg
1109 Indiana Street
Glenwood, IL 60425
1,000.00
4 Adam Osberg
1109 Ir~ street
Glenwood, IL 60425
5 Ellen Ross
510 Lamp Post lane
Carrp Hill, PA 17011
6 Darren Ross
510 Lamp Post Lane
CanI' Hill, PA 17011
7 Sander Marrill
412 South Market Street
Mechanicsburg, PA 17055
8 Casey Marrill
412 South Market Street
Mechanicsburg, PA 17055
1,000.00
1,000.00
1,000.00
1,000.00
1,000.00
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,
SIGNED, SEALED, PUBLISHED and DECLARED by HERLUF T. LARSEN, the
"
;;above-named Testator, as and for his Last Will and Testament, in the presence
II
liof us who have hereunto subscribed our names as witnesses at his request, in
:the presence of the said Testator and in the preeence of each other.
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(1:) To lIold property in the n01me of Setllor or in its n01me without
designation of any fiduciary capacity, or in the name of a nominee or unregistered.
FIFTH: Trustee may apply the net income of this Trust for the support
of Settlor sllould he or she by re.1son of age, illness or any otller cause, in the opinion of the
Trustee, be incapable of disbursing it; and Trustee is further authorized to expend or apply
From tile principal of this Trust such sums as it, in its sole discretion, may, from time to time
tllink advisable for the support of Settlor to maint..\in him or her in the station of life to which
he or she is accustomed at the cre.1tion of this Trust, or during illness or emergency.
SIXTH: Subject to the approval of Tn IS tee, anyone may add property, real
or personal, to the principal of this Trust by deed, will or otherwise.
saVENTH: Trustee shall receive compensation for the performance of its
functions hereunder in accordance with its standard schedule of fees In effect from time to
time during ,the period over which its services are performed.
EIGHTH: Settlor reserves \0 himself or herself the right by an instrument
in writing intended to take effect during Settlor's lifetime signed by Settlor and delivered to
Trustee to revoke or amend this Agreement in whole or in part providr.d that the duties,
powers and liabilities of Trustee shall not be substantially changed without its written consent.
NINTH: The situs of this Trust for administration and accounting purposes
sllall be in the County of Cumberland and Commonwealth of Pennsylvania, and all questions
pertaining to the construction or validity of the provisions of this instrument shall be governed
3
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
$I:
Jon F'. Lo.li'avl:"!r
boing duly ---_....,SWDrlL _.,." according to law, doposes and says that he .....i.a the Executor
u__._....' _m_'.'m_m______d__m_m._ 01 tho Estato of Herluf T. l.arsen
Cllrlislo C bid
lato 01 ,.___..'.__m.._' um.r an County, Pa" decoued and that tho
'th" 't d b Jon P' l.aP'aver th 'd Executor
WI In IS dn Inven cry ma 0 y .".__,~.~____._~.__~_.~__~_ .______,1 e sal
of the entire esfate 01 said decedent, consisting 01 all the personal proporly and real estate, except real .state outside
the Commonwealth 01 Pennsylvania, and that the ligures opposite .ach item 01 the Inventory represent it's hir value
.s 01 tho dato of docodont's death, ...' ( ) ,f-
( . ) .'I-/y:f-.J!
. and subscribed boloro mo, / 't:J1Ji< (}h/f---
19 C Jon F. LaPave!><.cutor. "'oImi.;,t",t.>r-
---I
Addr...
Oato of Death
29
DAY
09
Month
96
ru,
INSTRUCTIONS
I. An inventory must b. IIled within thl'oe months alter appointment of personal representative.
2. A supplement inventory must be Iiled within thirty days 01 discovery of additional assets,
3. Additional sheets may b. attached as to pMsonalty or realty
4. See Articl. IV, Fiduciaries Act of 1949,
~ I:i -d
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Inventory of the real and personal estate of
lIerluf '1'. Larsen
Inventory
Estate of Herluf T. Larsen
From 09/29/96 Tb 6/6/97
Description
Checking 1\ccounts
POC Bank Checking .!\cat.
l-bney Market J\ccounts
POC Bank, N.A.-TIust .!\cat.
Refunds
Parth8ll'Ore FUneral Hare-VA benefit
l\CCrued Interest
l"l
, ,~."
il
C()
~
,.
':~i
.")
ji(I'
,le
1"'-""
0,
.,~.~~ ':j
()v
deceased
Value
(j
Tbtal
6,28 .00
I 144,67 .17
I
10 .00
------ ----
151,05 .17
I "j
I '
, /
/
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU or INDIVIDUAL TAKES
INIU~RtUNc[ TAX OIIJISION
Of-PY, 280601
tlAP.RISftURG, PA Illl8-060l
NOTICE OF INHERITANCE TAK
A~PRAISfMENT, ALLOWANCE OR OISALI,OWANCE
Of DEDUCTIONS AND ASSESSMENT Of TAK
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-06-97
LARSEN
09-29-96
21 96-0805
CUMBERLAND
101
[__~=}~~U;;r!~=t~d j
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: is/ii - Eif -A F ii -f oi-:m - - tioYi c r OF - YNHEii i;: AN-CE - "fAx .. iip P Ri; is Ei;E"ti'r; -A L D5wAN-C E - OR - - - - - - - - -.- - ,. - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
HERLUF T FILE NO. 21 96-0805 ACN 101
If an assessment was issued previously, lines 14, 15 and/or 1&, 17 and 18
reflect figures that include the total of abh returns assessed to date.
ASSESSMENT OF TAX:
IS. AMount of Line 14
16. Alloun.t of Line 14
17. A~ount of Line 14
18. Principal Tex Du.
DAVID H STONE
414 BRIDGE ST
NEW CUMBERLAND
PA 17070
ESTATE OF
LARSEN
TAK RETURN WAS, (X I ACCEPTED AS fll.ED
RESERVATION CONCE-RNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
I. Re.l Est.te (Sc~.dule A)
2. Stocks and Bond~ (Schadul. 8)
5. Clo.aly Hald stook/Partnarship Intarest (SchDdula C)
4. Hortgagas/Notas Racaiv~hla (Schadula OJ
5t Ca.h/Bank Daposlts/Hho. Personal PI'oparty (Soheduh EJ
6. Jointly Ownad Proparty (Schedula FJ
7. TranQfars (Schedula GJ
&. Total A.~at.
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funar.l Expanses/Adm. Cor,b/Hhc. Expanlla. ISchedule H)
10. O.bts/Hortgaga L18billtlas/Lian. (Sch.dula IJ
11. Total Deductions
12. Hat ValUM of rax Return
13. Charltabla/Governllllnhl 8equest. (Schadule J)
14. Nat Valu. of Eststa Subjact to Tlx
NOTE:
at Spouul
taxabh .t
taxabh at
rat.
Line.l/CIIII A r.ta
Collatarll/Cle.. Brita
TAX CREDITS:
--
PAYMENT
DATE
06-18-97
RECEIPT
NUMBER
AA211430
DISCOUNT (+)
INTEREST/PEN PAID 1-)
.00
CHANGED
ll)
(2)
(3)
(4)
IS)
(b)
(7)
.00
.00
.JUL
.00
6,382.00
.00
144,674.1;
IBl
( /
~~
(9)
llOI
20,719.40
414.76
(11)
(12)
1131
1141
U~.I~;1 fl If~ IOI-HI
HERLUF
T
1151_
lIb)
1171_
.00
.00
8,000.00
K .00=
K .06=
K .15=
(18)
DATE
10-06-97
AMOUNT PAID
1,200.00
NOTEI To 1n,ura prop.r
cradit to your eccount,
.ubllit tha uppar portion
of this for~ with your
tax plyment.
151,056.17
?1.134 16
129,922.01
121,922.01
8,000.00.
will
.00
.00
1,200,00
1,200.00
'. ~-- ~
TOTAL TAX CREDIT 1,200.00
_. ------
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
------.-----...-..- ---~_.._.--
TOTAL DUt ,00
-------._----- ......~--_.._._-_._~---
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION DF ADDITIONAL INTEREST.
IF TDTAL DUE IS LESS T1IAN n, NO PAVNENT IS REQUIRED.
If TOTAL DUE IS REflECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REfUND. SEE REVERSE SIDE or THIS fORM fOR INSTRUCTIONS.)
"
"
."
RESERVATIOHI BUtu of d.cedent. dY'lng' on or be forI O.ce.ber 12, ,1982 -- if any future Int.rut In thl utah 1& tran.f.rr.d
In po.....lon or .njoY.'nt to Clal. B (collateral) beneflolarle. of the deoldent after the expiration of any ..tbte fOI
lIfe or for year., thl COI~on~ealth hereby expre..ly re.lrve. thl right to appr~l'e and a..I.1 transfer Inherltanoe Taxe.
at the la~ful Cia.. 8 (collateral) rate on ony suoh future intere.t.
PURPOSE OF
HOTIC!::I
To fuUlll the requIrell,nt, of Slction 2140 of the Inh~r1tance and Eltate Tax ^ot~ Aot 21 of 1995, (72 P.S.
Sect Ion 9140),
PAVMENT I
Detach the top portion of this Hotlce and lub.lt with your payment to the Regl.ter of Will. printed on thl rever., sIde,
ul1ak. check or .onoy ord.r payable to: REGISTER Of' HILLS} AGENT
REfUHD (C~) I
A refund of . tax credIt, whIch wa. not r_quI.t.d on the Tax Return, lIey be requested by cOllpletlng en "Application
fOl' Rrafund of Penn,yIlJanla Inheritance and f.bt. Tllx" (REV~BI31. ApplIcation. ar. l!Ivalhble at the Offlol
of the Re;later of WJIls, any of the 21 Revenue DI.trlot Off(ce., or by oal1ln; the ,plcial 24~hour
an.wlring servIoe nUllber. for for.s orderlnAI In Penn.ylvanl~ 1-800-362-20S0, out. Ide P.nnsylvanla and
within local H~rrhburg ern (717) 787-8094, TDDlt (717) 772-2252 (thuring hpalred Only).
OBJECTIONS I Any party in Int.r..t not sati.fl.d with the ~ppralt..ent, ftllowance or dl.allowance of d.ductions, or a't.....nt
of tax (Including discount or Int,re.t) ftt fihown on thle Notlc. NUtt obj.ct wlthJn sixty (60) days of r.celpt of
thlt tfatloe by:
--written prot..t to the PA OApartll.nt of Rev.nue, 80~rd of Appeals, Dept. 281021, HarriSburg, PA 17128.1021, OR
~-el~otJun to hay. the .att.r d.t.rllln.d at audit of the acccunt of the pertonal repr.sentatlve, OR
M-app.al to the Orphan.' Court.
ADHIN
ISTRATlVE
CORRECTIONS I
Faotual error. dl.OOVlr.d on this a"".lIlnt .hould be addretted In writIng tOI PA O.part..nt of Rey.nuI,
Bureau of Individual Tax.., ATTN: Post A....'".nt R'vl.w Unit, nIp\' 280601, Harrhburg, PA 17128-0601
Phone (717) 787~6S0S, s.. pagfi 5 of the booklet "InstruotIon. for Inherltanol Tax Return for a Retld.nt
Olcedlnt" (REV-1501) for an explanation of ad.inl.tratlv.ly oorrectabl. error..
DISCOUNT I
If any tax du. 1. paid within three (1) ~al.ndftr eonth. aft.r the d.oed.nt', d.~th, a flvl plroent (SX) dl.count of
tho tax paid i. allo~od,
PENAL TVI
The lS~ tax a.ne.tv non-partiCipation penalty I. co.puted on thl total of thl 'tax and lnter..t a......d, and not
paid bltor. January 18, 1996, the fir.t day aftlr the .nd of the tax Illln"tlo' p.riod, Thlt non-pllrtlolpatlon
pvnalty i. applalabll in the 'a.~ .ann.r end In the the .a.. tl.. puriod .. you would app.al the tax and lnter..t
that hll been .......d II Indlcat.d on thh nuUe..
INTERESTI
Interut It charged blglnnln; with flr.t day of d.lInqu.ncy, or nln. (9) lonth. and on. (1) daY fro. the dati of
daath, to the date of paYllent. Tax.. which be~a.e dellnqu.nt beforl January 1, 1982 b.ar Intll'..t ,t the rate of
dx (6~) p.rcent per annul oalculated at ft dally rat. of .000164, All taxu whldl b'<.:alll dlllnqulnt on and aft.r
January I, 1982 will bur Jnt.rltt at a rat. which w111 val'y fro. oalendar year to oal.ndar Ylar with that rat.
.nnounc.d by the PA Dlpart.lnt of Rlvlnul, The applloabl. Interl.t rate. for 1982 through 1997 arl'
't.!!!! Interut Rate Dally Int.rut Factor !!!!! Int.rllt Aat. DeilY Intlr.llt Factor
19ft2 20~ .000548 1987 'X .000247
19n 16;( .0004J8 1988-1991 Il~ .OOOJOI
1984 11X .000301 1992 9X ,000241
1985 U~ ,OOOJS6 1993-1994 ]X ,000192
19ft6 10:< .000274 1995-1997 9X .000247
ulntlr..t 11 cllculat.d .. folJDwll
INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTDR
uAn~ NoUu luU4td Iftlr the tax bKOII. deUnqullnt will r.fllot an Inter..t calculltion to 'Uti." US) diY'
beyond the dlt_ of thl a.....aent. If p.~eent 1. eedI aftar the Int.r.,t COMpUtation datI ,~ on the
Notice, addltlOl\llI Inter..t MI.t bot ulculeted.
REJC1l1PI'S OF J:NCO.IE
Estate of Herluf T. Larsen
For Period 09/29/96 Through 10/20/97
Interest
POC Bank Estate checking 1\cct.
02/12/97 PIC Bank-Interest on Est.ate checking llCCt.
03/14/97 Pl~ Bank-Interest. on Estate checking soot.
04/14/97 m::: Bank-Interest on Estate checking acct.
05/14/97 PIC Bank-Interest on Estate checking soot.
06/13/97 m::: Bank-Interest on Estate checking soot.
07/16/97 PNC Bank-Interest on Estate checking soot.
08/14/97 PNC Bank-Interest on Estate checking soot.
09/11/97 PNC Bank-Interest on Estate checking soot.
POC Bank, N.A.-Tn1st J\cct.
01/11/97 PNC Bank-Interest on trust aoc::ount
05/09/97 IncClle on PNC Bank, N.A.-Her1uf T. Larsen
Trust
New York Life Insurance Co.
04/08/97 New York Life Insuraooe-interest on proceeds
of insurance
Total Interest
'.l'C1rAL RECEIPl'S OF m:n.m
$ 184.02
202.49
212.69
219.28
220.85
241.81
212.77
212.35
-----------
1,706.26
$ 3,851.05
1,230.38
5,081.43
$
211.38
Page 7
$ 6,999.07
$ 6,999.07
-
Ii
I:
:1 SIGNED, SEALED, PUBLISHED and DECLARED by HER!.UF T, LARSEN, the
"
Ii
~above-named Testator, as and for his Last Will and Testament, in the presence
IIOf us who have hereunto subscribed our names ae witnesses at his request, in
lithe presence of the said Testator and in the presence of each other.
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Page three of three Pages