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Name of Decedent: MARY E. TRAVI'I'7,
Date of Death: SEPTEMBER 28, 1996
will No. 1996-00811 Admin No. 2l96-08ll
Pursuant to Rule 6.l2 of the Supreme Court Orphans' Court
Rules, I report the following with respect to completion of the
administration of the above-captioned estate:
1. Stat.e whether administ.ration of the estate is complete:
Yes ~ No___
2. If the answer is No, state when the personal
representative reasonably believes that the
administration will be complete: _Jj11L-
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes NOL
b. The separate Orphans' Court No. (if any) for the
personal representative's account is: N/A
c. Did the personal representative state an account
informally to the parties in interest?
YesL No
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d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be
filed with the Clerk of the Orphans' Court and may
be attached to this report.
Respectfully submitted,
WIX, WENGER & WEIDNER
l3y:
D~~17~.J.t :z.t~.
Attorney ID No. 34838
508 North Second Street
P.O. Box 845
Harrisburg, PA l7l08-0845
(717) 234-4l82
Capacity: Counsel for personal
representative
Dated: June 23, 1998
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WIX, WENGER & WEIDNER
(lICIIARD H. WIX
'l1loMAS L. WllNOHR
DBAN A. WBlDNRR
S'lUVI!N C. WILDS
111BRUSA t~ SHADLI WIX .
l>AVID It OBTZ
snm-mN J. D7.UttAN1N
GIRARD E. RICKARDS
tn'HVRN It. Wll.LIAMS
KHVIN s. IIt.AN'toN
A I'IWFESSIONAL COlll'ORATION
ATl'OllNEYS AT LAW
~OR NORTII SECOND STREET
I'OST OFFICE BOX R4~
lIA1lRISBUIW.l'fiNNSYLVANIA 11108.0R45
(117)7.J.j.'1l82
'!lI.LHcortl\R (111) 2J4.~lH
4705 DUKB S'11U!ln
IIARR1SfJURO, l'A 17109.:1099 '
(117)'l~Olll .
PLllASB RRPL Y'fO
DUKEb"I'Rl!lrt'OflIIICK( )
. 1\1'0 MOlI\ber Mu~chulC,tlA nsr
DeOember 20, 1996
Ms. Mary C. Lewis
Register of Wills & Clerk of the Orphans' Court
Cumberland county Courthouse
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Mary E. Travitz
Estate No. 21-96-811
Dear Ms. Lewis:
the
the
We enclose a check
Register of Wills.
inheritance tax due
in the amount of $3,500 made payable to
This amount represents a prepayment of
on the above-captioned estate.
If you have any questions regarding the above, please do not
hesitate to contact me.
Sincerely,
WIX, ~NGER & W~JP~~
~A.Y/'." '/ ./j/1~(r;;/i;/I~(
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. --If- - .. _ - _...-r
~nise B. Williamson
Legal Assistant
DBW
Enclosure
cc: Ms. Anne T. Leedy, Exeoutr ix
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WI X, WENC1:R f\ WEIDNER
ATTORNEYS AT 1_'\\'<1
!'>08 NORTH SECOND ST~HRT
pOST OHICI: BOX 846
HARR1SIHlRC" PENNSYLVA~I.A, 11108.0845
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US MARY CLEWIS
REGISTER OF WILt.s/CLERK OF THE ORPHANS' COURT
CUMBERLAND COUNTY COURTHOUSE
ONE COUR'I'HOUSE SQUARE
CARLISLE PA 17013
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Re9:~,I"; (I' Wills
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,'0. o...rn 0' D....lH ...nn 11/31191 CHICK HIO
INHERITANCE TAX RETURN I:o~::r:~::.",,,u,.,, [
I RESIDENT DECEDENT mINUMII. ---NZ":"l996-00SJi - _-,
COMMONW'WHO'PENNmVAN'A (TO BE FILED IN DUPLICATE
OEPARTMfNT Of REveNUE PA No 2196-0811
H.,,,sfJib. ~~of!lll O~! .._ ....J '0' ~I.~H _'!.~~!~!~'!.9! W~L.LS) . COU':'lY CODE . -. YEAR
DfCfOfNl'S NAMe 11.4.5', III f. AND MIDDlf INl!lAlI M__ ----.-.-- -'-1-tC!OfNT" (OMPLEr! ADOllfSS
'l'RAVITZ, MARY E. 940 Walnut Bottom Road
SOCIAL 5!cultirffiiMii'r-- Fe, O!AfH -r;-roTiTli1H'-~-" Car 1 isle I PA
195-07-5606 . ___L.9.1~~L?i..o _J..9/l3/SJ~._._._ C~"!fAi cumberland
'" "'''~~'~,"'''''"O '00',"" ":"'''," "." '"' ."", '"''''ll rOClAL 1".v::::'~_~.i..oVNI "'c,,'"o 1m 'N,,"VCl'ONSI ____..
00 1. Original Return 0 2. Supplemental Return D J. Remainder R.turn
(fN dOl" of d.ath prior 1012.13.8
o 4, limited E'lalt (J .40. future Inl.rl.1 Compromise 0 5. Federal Ellat. Tal( Return R.quired
Ifor dolO, 01 d.a,h ollor 12.12.821
f.XI 6, Decedenl Died Tetlale 0 7. O.c.denl Malnlained a LIving Trull
(Alloch copy of Will) (Allach copy of Trulll
ALL CORRESPONDENCe AND CONFIDENTIAL T,u IN~ORMAll0N SHOULD II Dii~lSh ,.' :',
HAM! IOMPlET! MAllINO AOOUSS
ANNE rr. LEEDY / EXECUTRIX c/o DAVID R. GETZ / ESQUIRE
T!L""ONI NV.'" -.- WIX / WENGER & WEIDNER
717 234-4182 508 N. SECOND ST. / HARRISBURG/ PA 17101
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12 I -0-
(3 I -0-
14) -0-
(5) 74.011) fil)
20. If line lQ it great.r than line 18, enl.r Ihe difference on line 20. Thit itlh, OVERPAYMENT.
iii 0
21. If Une 18 it greater than line 19, enler the dHference on Une 21, Thil it Ih. T AX DUE.
A. Enler Ih~ inlerett on Ihe balance due on Line 21 A.
B. En"r the 10101 of line 21 and 21 A on Line 218, Thi5 il the BALANCe DUE,
Make Check Pavable tOl Rlgl't" of Willi, Agent
. _~ ~ B! SURE TO AN'SW'ER ALL-QUESTIONS ON REVERSE SIDE AND. TO RECHECK MATH ..(-(
Under penalUII of perjury, I derlare Ihal I hav.. 'komined thil return, including accompanying Ich.dul" and .llot.menll, and '0 Ihe be,t of my knowledge and belie
II II true. correcl and comple'e. I declare Ihal all real intol" hal been reported 01 Irue marke' value. Declaration of preparc" other Ihon the penonal rtpr"entative
bal on all informalion of which preporer hOI any knowledge,
~IO fUR! 0' '(1I50N IIJS'ONSI.\'€ToTfiliN'Gifft~-."~51,.312u~'.1Jrrrve-~------
. 1\ e ec~ (,.L' Boil ing Springs, PA 17007
510 ~I"! 0'- 'lIf,,~Ti' 9IHfffHAN.~tPII'l(Nf~-----' -. AOOl:f~*1Ii~-VJengei~&-Werane(-.-++-_.._-~----'-
Dal} id R":'~e{~'""f;~~lITt:e--~~~~~;5~~g ~!'i1n~1~f~~eL-_... --- .--.-----
llEV ISOO D. I' '141
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1. R.al ellat. (Sch.dul. A)
2. Stock. and Bond. (5ch.dul. BI
3. Clollly H.ld Slack/Partn."hlp InlO'OIt (Sch.dul. q
4. MorlgagOl and Note. R.c.lvobl. (Sch.dvl. 01
S, Cath, Bank Depotilt & Mlteellaneout Pertonal Property
(S,h.d,l. F.I
6. Jointly Own.d Praporty (Sch.dul. FI
7. Trandor. (Sch.dul. G) {5ch.dul. LI
8. Totol Groll All'" Ilatal lln.. 1.n
9. Funeral EKptnttl, Admlnhtratln COtll, Mltcellaneuut
e"p.n... (5,h.dul. HI
10. D.blt, Mortgage llabilitl... lien. (Sch.d"l. II
11. Tolal D.dvctio", (talal line. 9 & 10)
12. N" Valu. of ellate (line 8 I11lnv. lln. 111
13, Charitable and Governmental aequ'lls (Schfldute J)
14, N" Volve Subl"t '0 To. (L1n. 12 I11lnVl L1n. 13)
15. Spau.al T,and", (for dot.. of dea,h okor 6.30.94)
S.e Inuructlont for ^r.pllcable Percentage an Revert.
Sid.. (Include valu.t rom Schedul. K or Schedule M,)
16. Atncunt of Lin" 14 IOMabltt at 6% rate
(Include valuet from Schedule K or Sch.dule M.)
17. Amount of Lille 14 takable at 15% rolt!
(Indud. vatveI from Schedule K or Schedule M,)
18, PrlncipalloK due (Add lax from linin 15, 16 and 17,)
19. Credilt Spousal Poverly Credit Prior P~tmenl1
+ ,..].2.l!\J-,-OO
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___ 8. Tolal Number of Safe D.potlt BoKt,
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( 61 -0-.
171 -0-
( 8) 74,015.65
(9 I 7/358.34
110) 12.61
(11) 7/370.95
(121 66,644.70
(13) _ -0-
(14) ~.li44 70
(151
1161.66,644.70
(17)
)(,--
_" .06 D
3/998.68
." .15 .
(181
3,998.28-____
Oi1counl
+ 175.00
-~---
Interesl
3,E!75.QQ..__
(191
(20)
ChN~' t-i('t(> If yov 01(> I~que..t'" (l ,dune! 'of YOU"OVl"ptJyn1l'nl
323.68
(211 _
121AI
12181 .__......J23...68----.
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COMMCJNWUHH 0' P!NNSYLV,A,NIA
INHUITANC! TAX It!TUAN
_AUIO!NT DfCloeNT
mAlfOl!
MARY E. TRAVITZ
_~ SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
t PI.a.. Print or Typ.
PILE NUMBER
ITEM
NUMBER
A. Fun.rol bp.n.."
B.
4.
C.
1.
2,
3.
4.
5.
6.
7.
8.
DESCRIPTION
1.
West Shore Country Club
Funeral Luncheon'
Woodlawn Memorial Gardens
Cemetary Payment
Scrolls
Anne T. Leedy
Reimbursement of funeral expenses
. Admlnl.trClltlw Colt"
P.nonal R.p....ntati"" Comml..lon. I ~ '1 _ '-/~ _ ju t~(1-
Social Security Numb.. of P.nonal R.p....ntati"'"
V.or Comml..lon, paid ] 997
2.
3.
1.
2.
Attorney F..,
Wixl Wenger & Weidner
Family Ex.mption
Claimant
Addr... of Claimant at dec.d.nt', d.ath
Slre.1 Addr...
City
lip Cod.
3.
R.latlan.hlp
Slat.
Probate F...
Cumberland County Register of Wills
MIIC.llan.ou. Exp.n....
Smoker 1 Smith Associates (tax pr'ep)
Wix, Wenger & Weidner (reimbursement for
publication costs in The Sentinel)
Reserve
TOTAL IAl,o .nt.. on IIn. 9, R.capltulatlon)
.
(If more .pac. I. n..d.d, In..rt additional .hee.. of ,am. "...)
PA 2196-0811
AMOUNT
$ 443.34
685.00
210.00
228.50
3/000.00
1,775.00
148.50
308.00
60.00
500.00
$ 7/358.34
07-21-97
TRAVITZ
09-28-96
21 96-0811
CUMBERLAND
101
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. .... A~ount ~~_~l~j~'L~-.::=-
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BUREAU OF INOIVIDUAL TAXES
INHUUTANCf: TAl( DIVISION
Oll'T. 2110601
tiARFU58URG. "A 17178-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AlIO ASSESSMENT OF TAX
ANNE T LEEDY
C/O DAVID R GETZ ESQ
508 N 2ND ST
HBG PA 17101
DATE
ESTATE OF
DA TE OF DEATH
FILE NUMBER
COUNTY
ACM
(1/
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lJ4,lfll8-'
1[1.11_/11 I" IUlIl
MARY
E
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 ~
iifv: ii;4TEiC - AFii - i oi-: 97 Y -Hilt" feE - -6 F - i-NHEii f;: ANtE - "fAx - iiP" pilii f sEi.iEHT -; -A L i.-6WANt E - "(iff - - - - - - - - - - - - - - - - -
DISALLOWANCE OF DEDUCTIONS AND ASSESSMeNT OF TAX
ESTATE OF TRAVITZ MARY E FILE NO, 21 96-0811 ACN 101 DATE 07-21-97
TAX RETURN WAS: I X) ACCEPTED AS fHED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l es.t.t. (Schedule A) (11
2. Stocks and Bonds (Schedule 8) (2)
3, Clofi.ly Held stock/Partnership Interest (Schedule C) (3)
4. Mortg.ges/Notes Receiyable (Schedule D) (41
5. C.sh/Bank Deposits/Misc. Personal Property (Schedule E) (51
6. Jointly Owned Property ISchedu1e F) (61
7, Trilnsferw (Sohedul. G) (7)
8. Tot.l Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funar.l Expansas/Adm. Coats/Hiso. Expenses ISchedule H) (9)
10. Debh/Hor'tglge Lbbil1ths/Uens (Schedule X) nOI
11. Total Deduotions
12. Net Va1ua of T.x R.turn
13. Ch.rit.bl./Gov.rn~.nt.l Baquests ISchedule J)
14. Net V.lu. of Estat. Subj.ot to rex
CHANGED
.00
,00
.00
.00
74.015.65
.00
.00
18)
7,358,34
12,61
Ill)
(12)
115)
(14)
NOTE I To in,uI" proper
cr.dit to your eccount,
,submit the upper' porHon
of this form with YO~II'
tax plyment.
74,015.65
7....llJL.25...
66,644.70
.00
66,644.70..
NOTEI
14. 15 and/or 16, 17 and 18 will
returns assessed to date.
If an assessment was issued previously, linel
re.nect figures that include the total of ill
ASSESSMENT OF TAX:
1S.. Anount of Una 14
16. Anount of Line 14
17. Allount of Line 14
18. Principal rlx Due
at SpolJlal
taxable .t
taxable .t
rete
Lin.al/Cl... A rate
Coll,terll/CI... B rate
(15)
(16)
(17)
TAX CREDITS:
PAI'MENT
DATE
12-20-96
04-23-97
RECEIPT
NUMBER
AAI84987
AA211214
DISCOUNT (f)
INTEREST/PEN PAID (-)
184.2l
.00
,OOX,OO.
66/644.70 X .06.
.00X.15.
(18)
AMOUNT PAID
""3;"50"0:00--'
323.68
TOTAL TAX CREDIT
BALANCE OF TAX DUE
_..-....._-- ..-.------..
INTE~F.ST AND PEN.
--------..------ .-------
TOTAL DUE
,00
3,998,68
.00
3.998,68
4,007.89
9.21CI1
.00
9.21CI1
. IF PAID AFTER DATE 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~ IERI. YOU MAY ftI DIn
A REFUND. SEE REVERSE SIDE OF THIS FORM fOR INSTRUCTIONS. I
r'<
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RESER\lATtONI E.hlt.. of decedent. dying on or b.fure Deoll.ber 12, 1982 ~- if l'ln~ lutur. Inhr..t In the estate 11 trllnoferrad
In PO.....lon or _njoy..nt to CIa.. B (0411&t8ral) b.n.flcler!.. of the decedlnt aft.r the 8KPlratlon of an~ o.tate for
I1f. or for year., the Co..onwealth hereby 8Mprl..ly r...r~.. the right to appraJII and a..... tran.f.r Inheritance Taxe.
at the lawful Cia,. 8 (0011at,ral) rat, on any luoh future Inter..t.
PURPOSE OF
NOnCE I
PAYHENTI
REFUND (CR):
OBJECTIONS I
ADMIN
ISTRATIVE
CORRECTIONS:
DISCOUHTI
PENALTY:
INTEREST I
To fulfill the requlre.ent. of Seotion ~140 of tho Inheritance and Eltate Tax Act, Act 21 of 1995. <12 P.S.
Section 9140),
Cetaoh the top portion of thl. Notlca and .ub~it with your pay.ant to tha Register of Wills prlnt.d on tha raverse side.
~-Hake check or .oney ordar payable to: REGISTER OF MILLS, AGENT
A refund of a ta~ cr.dlt, which w~s not requa.tad on the Ta~ Return, I~y be requastad by cOlpleting ~n "Application
for Refund of PennSYlvania Inharltance and Estate r~M" (REV~1313). Applications are avaIlable ~t tha OffIc.
of the Regllter of WJ1h. any of the Z! Revenue District OHlcn. or by c~lllng the speellal 24-lIollr
answ.rlng sarvlce nu.b.rs for ForI' ordering: In Ponnsylvanla 1~600-36Z-20S0, outsIde Penn.ylvanla and
within loc~l t1arrlsburg arn (71]) 767~6094, TODII (717) 772-2252 WoarIng hlpalr-ad Only).
Any p.rty In intere.t not satisflad with the 8ppr~isa.ant, allowanoe or di.allowanc. of deduction., or a.......nt
of tax (Including dJ.count or Inter..t) as shown on thl. Hotlc. lust obj.ct within Ilxty (60) day. of receipt of
this Notice bYI
Hwritten prote.t to the PA Oopart.ent of Ravlilnua, Board of Appa81~. Dap\. 281021, HarriSburg, PI. 17128-1021, OR
--olaClUon to have the .atter det8r.lned at audit of the aocount of tha parsonal repras"nt~tlv", OR
--appeal to th. Orphans' Court.
faotual error. dhcoverod on thIs u...nant should ba addrauad In writing tOI p,t, DapartMant of Rev"nue,
Bureau of Individual Tax88, ATTHI po.t ASlUI.ant RIVllw Unltl Dept. 280601, Harrisburg, PA 17128-0601
Phon. (717) 781-6505. See page S of the booklet "In.tructions for Inhal'ltance TaM Return for a Residant
Dec.dlnt" (REY-ISO!) for an explanation of udlinhtratlveiy correctabla .rror..
If p''1~ tax due hpaid within three (3) calendar 1I0nths a'ter the dacedent'. daath, a flve Plllrc.nt (5:0 discount of
tha taM paid 1. allowed.
The 15;( tax a.nesty non-partloJpatlon penal ty h cOIIPuhd on the total of the tax and Int.ra.t au,uld, and not
paid b.for. January 18, 1996, the first day after the and of the tHM allne.ty period. Thl. non-partIcipation
p'nalt~ I, applllalable In the sa.. IIanner and In the the .a." tl.. per Iud al YOU would app.al the tax and Inter..t
that hI' ba.n a....I.d ~. Indicated on thl. notlc..
Intere.t 1. chargld beginning wJth fir.t day of dellnqueno~, or nln" (9) .onth. and on. (1) day fro. thl data of
death, to the date of pay."nt. Taxe. which beea.. dlllnquent b.for" January I, 1982 bear Intere.t at the rat. of
11x (6;() percent per annul calculated at a dailY rat, of .000164. All taxa. whloh b.ea.. d.llnqu.~t on and aft.r
January I; 1982 kill bear intera.t at a rat. which will vary froll calendar y.ar to cal~dar y.ar with that rat.
announoed by the PA Depart.ent of Rev.nue. Th. applicable Intere.t rate. for 1982 through 1997 arel
'!!!.!: Interest Rata Da.\1y Interut Factor Y'l!Ir Intera.t Rate !>.!1.!l. Int.rut Fac12!:
1982 20% .000548 1987 9% .000241
1983 16% .000438 1988-1991 11% .000301
1984 11% .000301 1992 .~ .000247
1985 13% .000356 1993~1994 n ,000192
1986 10;': ,000274 1995-1997 .~ .000241
--lnterllt 11 caloulahd .. fol1owlI
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
--An~ NotIce I..ued .fter the tax b.oo... delinquent wtll r.fllot an Intere.t oaloulat10n to f1ft."n (15) daYI
b.yond the data of thl a.......nt. If pav..nt I. IIade aft.r the Int.r..t oo.putatlon dati .hown on the
Notle., l!IekUtlonal Int.re.t .u.t bl calcuhted.
I' "'):j
c)' /?,) q.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DErT, 280601
IIARRISnURG, P", 17128-0601
COMMONWEALTH OF P~NNSYLVANrA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
/.
L/
,t
. ,'~
'~.' ..1~1'
'It't.*. ' t'1(*'
U~-1I01 [j I.' I~' 1/,
ANNE T LEEDV
c/o OAVID R GETZ ESQ
508 N 2ND ST
HBG PA 17101
DATE 08-18-97
ESTATE OF TRAVITZ MARV E
DATE OF DEATH 09-28-96
FILE NUMBER 21 96-0811
COUNTY CUMBERLAND
ACN 101
r'-- ,A.~~~j ~,~;;;jTt;'i'-~=J
MAKE CHECK PAVABLE AND REMIT PAVMEN'T TO I
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insurEll proper credit to YOl.lr acoount, submit the upper portion of this form wHh your t"x 11iI1Y/Illtnt,
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV; H,ll-i- EiCAFP-- fiij-;97Y--- ---Mil"M-- i NifER i YANCE--fiiX""si'i'iiEME-NT - OF -iic"coiiN-i"" "M-'; M -- -" -"" -""""""" - ,,- - -..
ESTATE OF TRAVITZ MARV E FILE NO. 21 96-0811 ACN 101 DATE 08-10-9'1
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN TilE NAMED ESTATE, StlOWN "[LOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS, niE CURRENT BALANCE. AND, IF APPLICAlILE,
A PROJECTEO INTEREST FIGURE,
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 07-14-97
PRINCIPAL TAX DUE, 3,998,68
PAVMENTS
<TAX CREDITS),
'--'~--
PAVMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (- )
12-20"96 AA184987 l84,21 3.500.00
04-23-97 AA211214 ,00 323.68
08-04-97 REFUND .00 9,21"
L
. _'~+_'.'h__~""-,-",~~_~~~~~,~,~,~~,-,
TOTAL TAX CREDIT
3.998.68
_ ____,._~_c_~.~__''""''n~~...~.~_~~_~__~__
BALANCE OF TAX DUE
.00
; ~ .1
INTEREST AND PEN.
.00
.
IF PAID AFTER TillS DATE. SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST,
IF TOTAL DUE IS I.ESS THAN $1,
NO PAYMENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY >>E DUE A REFUND, SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS, I
TOTAL DUE ,00
I
P",YHEHTI
Detach the top porUon of this NoUee end iu~m!t with your PlIYllentllladEl pOYlIblQ ~o the name nnd ,i!Iddrell
printaQ on the re~el'$e .ide.
If RESIDENl DECEDENT ftlekat:heek or mo""y order payab1Btol REG'1SYER OF WILLS, AGENT.
Ii' NOH-RESIO~Nr DECEDENT mekg check or mOnaY order poyable tOI COMHONWEAI.TH OF PENNSYLVANIA,
REfUND (CRll A refund of a ti!l~ credit, whIch was not request~d on the li!l~ Return, IlIay bEl requeltod by oo~pleting an
""pplJoatJon for Rgfund of PennsylvanIa InhQr1tence llnd'Esteto le)(" (REV-1313). AppllcatIonli fire available lit
the Off Joe of the Register of Wills, any of the 23 Revenue District Offices or fro~ the Department'li 24.hour
em.wering I8rvi(:1I nUlllbers for forllls ordGl'lngl In PennsylvanIa }-800"362-2050, ouhJcle PennsYlvania
and wIthin 10(:81 HarrIsburg eres (717) 787-8094, TOO" (717) 772.2252 (Heftrlng Impelred only),
REPlV TOl
QUQsUons regarding 01'1'01'5 cor'taJnod on thIs notloe should be addressed tOl P^ Oapartl1lClnt of Revumlej 8ureltu
Qf Indivldual h)(8S, ATTNJ P05't ASSGssment Review Unit, Oopt. 2806011 Herrlsburg, PA 17128"0601, phone
(7171 787M650~.
DISCOUNT:
If any telx due 11 paJd within throe (3) calendar months aftor tho decodont's death, a fJve peroent (B%r dhciOLirit
of the tax paJd is allowed.
PEN"lTV:
Thq 15% tax amnesty non.partlcipntlon pon81t~ 1s computed on the tots 1 of the ta)( and lnterest assessed, and not
paid blfor6 January 18, 1996, the first da~ after tho end of the tax amnost~ Plrlod.
INTERESTl
:nterost 1s charged beginning wJth fIrst day of delinquency, or nino (9) IlIonths and one (l) day frOM the dbte of
death, to the date of puyment, Takes which became delinquent before January I, 198~ bear Jnterest ot the rate of
sIx (ll%) poreent per Annu," calc:ulated at !I dllity Nth of ,OC0164, All t8~es whl<;h became delinquent on end after
january 1, 1982 will bosr Interest at 8 rato whioh 101111 vary fro~ oalendar yoar to clllendar Y~8r wIth that fate
announced by the PA Department of Revenue, The applir.able Interest rate8 for 1982 through 1997 arll
Voar
tnterost Rate Daily Interest Factor
Veal'
Intervst Rete
DailY Intorest factor
198~ 20% .000548 1987 9% ,000l41
19U 16% .000438 1988-1991 11% ,000301
1984 11% .000301 1992 9% ,000247
1985 13% ,000356 1993-1994 7% ,000192
1986 10% ,000214 1995"1991 9% ,000247
--Intorut 11 oalculatfld a. follows I
INTEREST . BALANCE or TAX UNPAID X NunBER or DAYS DELINQUENT X DAILY INTEREST rACTOR
~~An)' Notice issued after tho tal\; beQOlllU delinqullnt will rofhct lln lnterest Qi!llcuhtlon to flft..,., (IS') aayS
bOYClnd the datil ('If the aunuent. If paYlflent is _lid. altoI' the Internt cOllpuht ion d.te shown on the
Notlce, additional lnterlit Ilust bo calculated.
!'hl'.I', 11\\\lld, 111,11 dll Ild'>lIIl,iII,>f1 11111' 1'1\(111', ,jl'.'II\ '''I.ti
1,](.li I{(L:I',!I,II Till' IJll'\',I!LII \1"1":111(,1(( "illlw IL'I j"II" lill ;O"t;
"I-%-HII
If,q!',lli illj'II;llllildIiJllld,ll";tI!J,IIII\ IIh-d\\'III!111I .1',
f' d I\li"I ,I, (lllll t' I, 'I 1'1 :IILIIIl,'lli I illlll',
WARNING: Ills III~gnlto dllpllcilto this copy by photostat (1r photograph.
No,
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4,;r~((~W.Ot!f.t.;.,
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u'}N?.1 /'('/r;r4"'(;1.~'tt7L
Lqillll{{'glstlill' (J
I:('t:ful' this u;rtifjLll(~ $),00
3783838
o 2 1996
OCT
[Jatl'
,
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
y"
lIlATlI rilE I'IUIr,lN'/\
:''fem~~'5UR:Nlt\''1" .-5606 1P'8l\"t"';~~';"~IJi~~ _._
s~;;'~i~~: 1 09-:'~~r*:g~~I. :::6~!:::~~;~~:~~"'~1~~ =_[J---~;:::~-I-'
F'~llnY NAMIi QI f\Ql qtl1tLtM, ~v<I ,-"tI1I_rId numblJrl Wo\ft('fCEDt;Nl Of HI$p,I,l'IlOOOIGIN? fVl,:ll, .'.rt4flctn Im,n, IIItd', wn~," tit
Manor NSa.L"Ln liars N<l(Ft I'll. rJ lIy...N>t~jlycoo.n. ($i*'l(hl te
~xlC'n,P....rt.lF\k;.lIl,tlQ
MMEOf'OECEOf!t(i(F;'il,~\d(I&"l"l
,.Mary E. 'rravi tz
4Ci1i(lul~vl UNOEA1VEA1l
Iolornn. ClI.,..
.Pe~CENT':1USUAl.OCCUmlON
(oflWl~~IJt1%"'~I~~~'"1
housewife
"'c~~r'\\'~~~J't""li'8~t'dfu''l1ll. ~""""
Carlisle, Pa,
K1NOOfIlU81"'IlSSllNQ!!ft!flY ".. .
~SOECEDENTEVERIN
ilSM1ME't'FOflCES?
".0 ",[i!
MN~~t;'~::,~~;r
P'.....f("'(!lpec'l'j)
wldowea
lIurWlVINGIW(lUSf.
(II"/I*t lI'\1Ima~k><\IWI'\tI)
DfCEOENT'S
.....JTUAl
AIiSIDENCE
lS>Mf\I'lI<.o.;\'a!1I
ooDII-..ttl<kll
UI.Slllt.P..a..l-...
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Jl1.l.lIlbe.rland 1OW1lll!llfl' I1d.L1 ~i.=7\.rn"': Ill'
~0l1!f.R'8 NAME IfnI. Mod<~. Ma>Jon s.'m;,-;;;r----
~nD1e Ker~
IN~QRMANf.SMAILlNQ '&'oorE!IS!SUHLCIly(lqf.l~~"l'BCooII; I'''. 17007
1312 Aeper lr, uoH ng opringa, ~
PlACIlOFOISPOtHTlOtj.t-l.lT401C'_lrr,Cllmllll!y lOCATION. lly ,6111t,ZIfICM
"\f'~o~awn Memorial Gardens lIarrislJurg, Dauphin eo. Pa.
d.
N,~ME AND ADOAESS OF F'&'CIII,y l51l
sselmall Ii'unera.l Home Inc. J21l-Hummel Ave. LofnByne
UCENSIl NUmiEjj"" . lOAf!! 810NEO
"tfUA) OJ 5'87z, I< !":'.'''''~ 30 ,96
~8 CA6~ REFERRED TO MEDiCAL EKAMjNEfW~ONIlR1 tot'
...0 """'"
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