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HomeMy WebLinkAbout96-00830 -I' I ,-Ii of> t/) Q ..g V L l\; _.J UJ ()o :I: I ~ ..... 0" 0 a- d ! c-\. ). .~ . 0 f 0 ~ .. ,~ Z .,. ,:. It ~ :t PETI'I'ION Hm PHOIJATE lInd GI(ANT OF LETTERS ["/(1((' 1(1 1-If-lf::kJ C, Gf!o~;;:; No. ~,I - / qq~ --R~Dn alsoknoll'l/ (IS _ To: Regist,'r oi Wills 1'01' the , /!('<,('(I.I,'d, ('OlllltV 01'_________ in the Sodal S('('II'-;'" No. 172- - /J' ~/.:tc-s- ('oTlllliollWCall h or Pennsylvania The pel il ion or 1 he IIlldelsi~ned respect 1'1111, Il'pl'l'Sl'nts IIHlt: YOUI pi.,titiol\l'r{s), who Is/arc IX Yi.'HrS or age 01" oldi.'r Hlltlll.' l'.\l'Cllt('J.g.._ ___~_____..___.n__.,__~n_ named in Ihl' lasT Wi.11 or till' ab""e deel'dl'llI. dated :<.3 -.)-/)~?f' . .... . .. ..~__...._.., 19../..1..._. all~l,"ld&i~(~~~tedm.~ge.;s~. p !f'/') ..;]j),.,,~.i?) I()~p..~_~~:....==---=~-'-= hlatt' I'Ck\,\f\l ~'i!l'lIlmUlfll'l'\, l',g. H'Il\llldall(lll, death llr l'\~'l'IlI(H, (.'IC,) Dccendenl was domiciled at dealllin . C;YfnB.fJ.'..la/S.l!:l..... ('ounty, Pennsylvania, wiTh h.g,B.......... Ins 1 ramily 01' pl'inl'ipall'l'sidcnCeHI ._I1'1f'blD"w..LL1\i1N.c-,~C~",JEJ?...__._____..___._ -'tDLJiL'rJ!,Jf"J>I.e, . Rb) ...I!l~CHt'WLC:;~~l?CJHt,j Z.'?.L_nLlia[\)J'/>~!:'L~.\!'J') lli,[ \lll'l'l, 1I11ll\l1t'l-a!id t!l\lil1.'ipalilq DeeendeTlI, Ihen ~()_ l"eal's or age, died ._ C1CJ:~. 6('12,. ..'ii'......_~c_c__, 19 9&; , al i;\l:el~~:' f,i;(~\~;'''cd~~~iA lI~i\:l~~;"~~;S~~;;r~iJv;~r~'d 1111:1 did lIotCI\lj;:;;~I;ild G;;~;;"'~r nd~pted arl.er ewc'llIion or Ih" will oiTered ror probate; was 1I0t the vil'tim or a killing I1nd WI1S IIcvcr I1djudic~lcd incOl11pcten,l: ________________.u _______~~_____~..__..___.__~ DCl'('lldL'Il[' at death 0\\ l1('d properly with L'slillHllt~d values as rollows: (lrdonlieilcd ill Po,l All pcrsollol property (If not dOlllkilcd in Pa.) Personal pl'l,lperty III PennsylvHnia (111101 dOl1licik'd ill I'a.) I'l'rsollal properly ill Coullty VnhIL'nf' rcnll'slall' in Pl'llthyh'ania ShUHll,',d n.., rollows; $_'iiA:"fL~ $--.-. $--~._-"--~ $_--_. ...,~....._.m~~___._.._.___......., II'HERI'.H1RI'.. petitioner(,) respeetl\illy rcquc't(s) Ihe problllc or th. .last will llnd codicil(s) prc,el1lcd herewith alld tbl' grallt or lellers. n_')'J'1S.'N\MEN'j'I\~"-X______n~_.___ tllL'fOll, ((l'\!alll~'nUlt ~-: adlllini\lrnll(l1l l'.Ln,: udmlnlstrntiolid. h,n.r .t.Il,) " i! ~: :.J." :r:: ~ H ", .~ ~; :. /~ 1? ." /0 '(LC._.._tt!:....lt@:d-~1(t~__ R'e,lI*b/?oS'$ Okru'l,..:) .~L VI\l.J."'<VIi<IPj)g~ve. m(:,CIM/olJ<:-'}J\v~G} t'A.;N!i.r ;1. f-i OATH 01-' PERSONAL REPRESENTATIVE COMMONWEALTII OF I'ENNSnV ANIA I. "K ('OliNn' OF CUMDE:IH,ANIJ J Tlll'lWliliolll'r(l,) llhn\l"llilllil'd '\\l'tllhl III allinl1{sllhill !Ill' slatl'IlWnlS ill tll(' rorc~oing petition are- lru~' ;tlld '~'(\lTl'ct 1(1 till' lw''! llllh~' 1;llo\\ll'dgc alld Ill.'H\,'!' nl' pl,-'tiliulll'r(s) ulld lhut Us pt..'l'sonall'cprcscn. Ulli\'l'(\) (1j" tIll' ilhll\(' dl'l'l'liL'1I1 pt.'liiiol1l'r(s) will \\'ell Hlldt)"\lIY administel' Ihi."('stull.~ HlJf.:ording to lu,^', /!) /:J., SWnJ 11. hI or aITirlH.l'd iUlllSilh"l'l-ihl'd I '~-t::~td;e~/,;~4<C&~?!--<,~,~ ~ 1...'.."1(11" II.'." tlth 11 tt.l.... dr\~,t ~' OCTOBI::H _ _ __.1._ ..' .i: 19 ~':J__ _ J::l -liic.tll/X2U,UY pC \ [flU/tUlle".' () ~ ~_MNHY ~~. LEW J~) I Nt't'/\fl'r r{ ~ /3.5"'(1 " '- Ihl', I" III (('llih' 1\1,11 Ih( ild,)IIIIJII(111 hl'l, 1:1\"11 I', ",II' I!\ 1'1[']('! IlllIll ,Ii\ 'ill,!',II),d (('ltlll(,I((' lit <lc,lth dUly tiled wltlt lilt' ,1\ 1(11 "I 1,;t'p,I',lr.ll TIll (lIlgJlI,1! \'('1111 il ,11(' 'villlH It '11,\ ,Il'!t''! IL' rill ',I;llt VILd H!'\ (II ,1\ ()lIlu' Illl 1'('lllLIIH'11l tiling, WARNING: It Is IlIogal to dupllcllt(, Ihis copV by photostat (If photograph~ .' No, jiiiiNii"h'",,_ ~i,i" "II Of -'--" 'iii'~\.~'\.. :fEi;',. <11.:..."",- -' ..-Itf'" ~ :,,:,/.,'.. ,'.' ''\''.\ I"~.""'''''''~' '~'. j ,"." -. ,. ,~, I~I" .... . .' ,\~) [w. .,:\ ')i,; l,'" --,J", .<_"-:'/*~ &.\C; j'C, ,0 ,.' "'''''/ '~""_''-C:''_J''_:/~\\ '-9/i!TN'l-' ~~~\: """, ~'daii1IJ.l1!1)Y /J ,t"ll1lJ D. . ;:t&AM;:t,'YVI'fL. .... (, v ,W/;Jl.UV Lm-,d Rq.\i:-;trar h"(: 1111 ihLs n'nific,ltl', :h.J{l() ,\ 3871043 ~'1 J.-c J ( "(iLtIC>t"l. 8 {C[ljt.'_ y,;!t(' HII>>,14HI...1111 COMMONWEAl.TH OF PENNSYLVANIA' DEPAR1MitNl OF HEALTH' VITAl. RECORD9 CERTIFICATE OF DEATH TY'."''''H1 . HlUolAHINT "'''''''' NMl(Of ceOEN It.. "'oN.~/Ifl1 1. Helen ~o ll..-....... ... I. Foma le 11lQ'1""NlNltl\ SOCIAl. &liC\J/IlT'fNlJ...Ul\ " 1~tC'y- _1JI'Ol~CoI.nIr,1 ('..ol'ver,PA " 172 - 18 l'\.4Ct~Dl,(l"HICNIr.~t>Nf""'__""~""_tQo>l flO$P\1AL -ril'_O _. 1565 80 ",,0 ';;;/ COtIkT'Y01' C!fAl'll ClImbc rl and .. East Penn 'IWp ~INq.Q'~I!:!M.SIlNO\JHW .~.-.o...IIMc.'.WNlf,lII< """" t, Whit-e ~S/'OUst-_. (ll_, g.y,. "-___""""1 ()(ClOCN1'ausu_~OCCUPiltl'lOfl ~'fw!:~;.,%"::~:rr ill Homemaker ~wn DECeDtN1'SlotAll.'iQl>OOAlUlSo-...C~,su.,t.p~ 21 Valley View Dr 11echanicHbufg, PA 11055 .. r"'fIE'rBN.......E(r..t...""~lH:) II John Ross WIr('I\MANnNA6.lI1{l~""I t\I>I Richard .J, Coleman lolClHOOOl'OIsrosmoo eurt.Nilr_,,"oI\O~I,o.llSl...,D 0lI00Ir;p..;"r\ Ilome DECEDENT'a ACTUAL 1IE$!OEta ,...- ""_~l lT1.....~ ~ ~ ORPEIISt,ltjAGTI~"'8UCH 9 1996 lICEN&Ei'IV"'llEl\ .o11615-L ToIIwI"",oI,,,.,.~.~t1~OO;(UNl<lllll>fl_.IM"""'''fOf''''''' ISoo;NVtWId T...! "" - ..... 1" ~jl.1.unbl:tr1anL- ~~ nt.G;';;=::'::"L.11e.c.hRnic&b~~ ~lOltlEII'Ii~IAi,lE(1'....~.~s..._'-I l Jane Gre or 1Nf0lWNfT'SlMlLJN(IAOOflES8 - C~~,~COO6I 011 21 Val1e~w Dr Hechanicsbur I PA 17055 ~~0l'0l1rosnlON'N""'oI~"'!;C'__1Ory ~OO"'ION. '.llp~ 0I01J\t1"'- RD# 4 Somersct Co Hem Park I. SomHSet, PA 15501 '-i.wEAHCAOOAUSOI'MClI.fTY Hill er-Zei ler F11 494 W Main St SQrersctl FA 15501 UC NSf-NUM"EFI =:J:DRESk3NEO. p,tanI\OI/y,-. '" ~CASEIlUEnAEoroMEOICAl.UA"'INF.~R1 ......~ ~[J ""- -~ Tll.ltC#~ rJRl ~tOOl:AClI_.c.t\.u.t , '2 ,'20.. () bereft /990 U.HJ!1!, E,...,rht_..........-......""""""'.I"""..tw;h___\I>lrIIUlh c..r<lI'nl"lI'It'l'(..jut~Il.d\",*_..."opo,tl<l'y""..,lt.lctI"'/>IItI1l.""", l"'oNr_"""'''''fwt>'''' ,- -- 1=--= I , I , , , -+--~ I J '''I'fT"1 OINI~OOJdfIoN_"""""'''IM''~,tM 1'OI'"'......IIIII~_""""..PAAlI ~~~ OUfIOIOA~ A,COI'ISEOUfiiClOfl ~_~!f." II """'CONSfQl.Jflm~.uu _A ~--- .} E OIOOA.$"'Ccil.~tOlj~~~""" r~4.--.___ . Wflll;",u1"OPllY'lljrllN<lB ......NNEROfllCA/1! -.,[..t,lIlEI'II001"O COl.l1'lliTlCINClCAUSE ,..I>,orl'l tJl .."'".. 0 Of Ol'RH? """" 0 P""""VM~tlQl\ 0 ~O '" 0 .... D CooIl<I~~I/OII""'irol<l IJ tIA'EOF INJUF\Y 1"''"'''',CIty__. TI"'EOF IH.,IlII\Y lKj1jfl,y .tl1'oQ/1~1 [SClldM IiOWIt4N/lYOCCUIV\ED ,.,. 0 ttoD 101. l!!lii....-...-_~~_._..__~_ ,OO.tlIOl1d;~....~s..1 ... tlKlN,(l"URIAND'ITLlO('CtIlTlI'~ o '~~r"i51; t B ~~2p""-' ----.--- IJ ___ ~ _:!Jf_____,. NAMllAND.I.OOnESSOFPEA!IO'iWIlOOQl,lI"l[l(CCAiJIEOIOlo'lf1-\ (fll'll 11) Tl'Pt 01 I'1IIlI eiO Or Packman 1t 108 Lowther St Lcmuvnfl. Pt). 170/13 OAnfl\EOI"'O''',Dn,,,"il n... 1110 Cf~;';;",,"1 'C'l\ltfYiI'IQ'ItYIICI~H{I'J,l""""'<"I~e&\IW"__""""'fhyx""MlpI~"",,,lnlI~"'ftlm131 T.IIIII_I.r"'Yk""..lo<I..."""'I<<_d...If......~.!f...,"'.n"'I..."If4."....., ... ~R'_ I"lACE('llI.kJuf\Y.A1_".IIM",,"~l~~ ~,,"~1I'l ,~ ~ ~ ! .'o'mllOUflCII1Q~'lOCtPlTlfYl~I'11Y.IC\AH(f'\I,""...b'1lhtl'~.,..q{"~,,_O~..~"""'lIl_....1 To 1M _1.. "'v ~""Mt6Ot, H'~'''O\H'''' fIllI\f _. 'tlt..nd pll<t'. ,owl d",1O ,Ilt U''''l'l''''' "'"nn+tM ~.l"., 'MEOI(:;1;lUAIllINUlfCQflOM'lPl On ,~. bill! 01 t"ll'lln,Uon InlllOl !nvUlI,lllon.'n III, ~!~Ion, '"111 0Il01/".el t!!1II !Im., dll'. Ind pll<<,.rwI ell/'!O III, GlIIMltllM IIIIM"IIIII'..."....,......,......,.."..,.,..."............"....""..,..................,.,.,.........."... ,h 7ilt,l~lAA~ s !IGI1.WAt ~110NIJ~lItll ,~~l.tjall.,,~ 1lL~&J.<tl..k....,,_ [.5i.G,i.5llilJd " Oct AI1996 -,,'0 '" y- i9, . :,~ff F-J -f " .... ........ t;r .' L ( ~- ~~5 (.r~ (,,'1 , ,) ~;p_t;~ ..,1oi,,,",,, '-,!; ,U?f:J ,_ F ~ f f-< ~ ~ g j C/) C/) ~ 1/1 1/1 Z 0 ~!!: ;111 ~cll W w % ~ u a > .... . .. . , C- --- /' ' (, 1 ,) -~ .") _J . 1 I FOR DATES OF DEATH AFTER 12/31/91 CHECK HERF. IF A SPOUSAL , POVERTY CRF.DIT IS CLAIMED I I flU NUMBIR $IY L~UO fX + (/'1.1) ii.. ~:'rl' -''oI,)j ~ INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) '--' .J'> COMMONWEAL TH Of l'ENNSYl VANIA I DEPAIHMfNT OF REVENUE l Ofl'T 280601 H~~~U;.~Yl.9.:,f;~~ 17128 060_~_ DECEDENT'S NAME (LA::'T, FIRST, AN!) MIODlE l~iiTiAlT..--"....._".._..n. GReSS HELEfoJ C, 'CXIA~~~i~7t'/~UmuT~~,6;;""1?t. .. [~~~:~:i; 111t. "'-,""''''~':;;;~NO:ON''' '''M'''''' "'" """,,,,,,, '''''0 l'oClA' Sf(URII( '"(MBeR r~l. OrigInal Return I ] :::. Supplemental Return r-l 4. limited E~tole I ) 40, Futuro Inltlr01! Cornpromi;o (for doles of death after 12.12.132) [J 6, Decadent Died Testate I.J 7. DeGndon! Maintained t1 living Trust .....". B. Totol Number of Safe Doposit 80xes (Alloch copy of ~~~__._ _....__._..._.___.__.__~~~t_~~_~...:~!:t~.f_~.~~~.tL. ._.... .__.__.___"_. ..__u ... _.. ._..... .....___~_________.__. . ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO, Ih.... N"AMf--- _w__ -..-- -- .-. --- ----- --------.- . - - - -- --rO~iPLETE-;;\AiliNG'AOORfSS ll!~ RICI1AR.ll R. C:A.eMIIN ExE~uto~ .:t! VAtllii\-' VIEW bRll1e. "'z _ 88: "'''HONE NUM'" MECl-IAl-J1 CS 8o~l:: PA 17"S-S- __ -_L?!1 _ L.?t.t. -!:;L9f n.__J~~~~~==""_ ?~ YEAR J'.Jo NlIM8f.R .x( COUI,n CODE Tif('f'iiT;:'I~S-(:(JMPtTIfA-6D-RT5~---.-'-----~-- ,;1.1 VALLE\, VtE.w bftlve, \'l'IECHANICSeVR.'i, PII, noS'S' ("""" Cbro\ II E./UANI> I ;,,,oun' ",(f1Y1 II I',[f ,,,,iRllrTION51 >- ffi fil ... w c [ I 3. r I 5 Remainder Return (for date~ of death prior to 12.13.B2) Fodera! Estato Tox Return Required w )I;~(I) ...g:'" wc=g 5g:~ ~ (I) 121 131 I 4 I - ---------- (51___n_ ~}nQ.L_ I. Real E,'al. [Sch.dule AI 2. Slocks and Bonds (Schedule Bl 3. Closely H"ld Stock/Partnership Interest (Schedule q 4. Mortgages and Noles Receivable (Schedule 0) 5, Cash, Bank Deposih & Miscellaneous Personal Property ISchedule EI 6, Jointly Owned Properly (S~hedule F) 7, Tronsfe" ISch,dule GllSchedule l) a. Total Gross AHats (tolal lines 1.71 Q. Funeral Expenses, Adminhtrallve Cosh, Miscellaneous Expenses (Schedule H) 10, Debls, Mortgage lIabllilies, Liens (Schedule I) 11. Total Deductions (tolal Lines v & 10) 12. Net Value of Estate (Une a minus line 11) 13. Charitable and Governmenlal Bequesh (Schedule Jl 14. N&t Value Subject to Tox (line 1~ minus line 13) IS. SpclUsClI Transfers (for dates 01 death oher 6.30.941 See Instructions for Applicable Percentage on RevElue Side. (Include values from Schedule K or Schedule M.l 16. Amounl of line 14 toxable at 6% role (IncludB values from Schedule K or Schedule M.l 17. Amount alline 14 taxablo 0115% rola (Include values from Sched(lle K or Sch(lchlb M.) 18. Prindpaltax due (Add tox from Unes 15, 16 and P,) 1Q. Credits Spou\al Poverty Credit Prior Payments + z '" ;:: :5 ::> I::: ~ frl '" 161 -___________________ 171..----.-- -...+-...-.-.-----__.___+..__ 191____87FUL~ I 8 1 _____...1.~~l,oL [101 --.__. ._JU8.J~ 1111 1121 1131 1141 0.6 11. 0<><'."'<:':> .-"-P--t-..-- -.. 0,6 115) n____. ._______+__+x,_+~ 1161 1171 x ,06 = x .15 :II z '" !;; !; ~ IE c ... (lBI Discount Intorast 1191 1201 + 20. If line 19 is greater them linD 18, ente( Ihe difference on Lino 20. This \s tho OVERPAYMENT. mrl ~ >- Chnck ~crc -if-you tu'c,rc uesllng a refund 01 your overpayment. _ 21, If line 18 is greater rhan line 19, onter the difference on Lino 21, This is the TAX DUE, A, Enter tho inlorml on !he ualanro aue on Lino 21 A 121) [21AI 121B) B_ Entor the Iota I of Lino 21 ond 21A olllirw 21B_ Till, i. tho BALANCE DUE. Mako ~_h.cll Poyablo too: Ro_olltor of Wills, Agent ---------..--.--.-j; j;- BE SURE TO ANSWER All QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH U~.~U_____ Una~~'.-p.~'n~II.i~ s' of p~'ri~'~);;'i' d~d~-~-~..it;~;; '1- flCl ~e fl ;~~~in~ d-;'lli \ r~-l-~,:~,--i-!~-;--I~,-(~; ;;~; ~I ~-(-[~n~i~;;;;;~;~i-- ;~.I~~~J;I~~-~;;cl;t~;~-~~l~~~-d-t~.Hi'h;.b;~i._;;T~y-T;;~';"T;dg;-~~~~!i(}( it ii lruo, correct and Ci.1mplfJ!o, ! doclmo 11101 nil 1(lnl (\\1(110 hm boon repor!t!d (II lrUfl morket" ~(]Iue Declmotion of prOpdrllr olhor Ih(ln Iho porsontll 'oplobon!ntive i, based on 011 informat!on of which ptOpmfH hm tmy kno\lledgn "O~:;";;';;2"(;{":\);::JJ:)~;~( ,;;""~i~/;/I/ 1~ Il'il,-<t'IIt' 'l,rk/~~/M~21 1,/ 17~~- !'lc,t~A{iJP) W f'RII'ARIIl Cilllllll!!Allllll'lll ',1 111.\111'1 "I'llfl! '.\ ( .' / t ["";\1 ,,; -1,:1.--'17 [,,-,11 .. ~I \' ,\" I " i-', ~'ll I, ,:' y I'... .\!"")','(\ '1W'1.- COMMONW(AlTH Of PENNSYLVANIA !NHFRllANCE TAX RETURN Rr:,I[)ENT DECEDtNT I I SCHEDULE H I FUNERAL EXPENSES, 1.~~~~~~~~6~Js C~~T~~~~f. ESTATE OF~---' ~lEL EM Cd G.R.O~S I. .. .PleCl.ePrlnl or Type --'IFilE NUMBER ._._._-~ \''1'1(, - ?6 R~()._ ITEM NUMBER DESCRIPTION 1. A. Funerol Expen..., 14 AllGE.R. - ZE.IGl.ER. Fv...,Fl:i\L. 146mE'. B. 1, 2, 3, 4. C, 1. 2, 3, 4, 5. 6. 7, 0, Admlnl.tratlve Co.lt, Personal Represenlatlv. Commissions Social Security Numb.r of Personal Representollve, _____..:::___~__.__=__..___ V.or Commissions paid ___________. ..__.___ Allorney F.es Family Exemption Claimant __~II'\It__~. R ._.~(!~e~m~? Relotlonshlp___ So ,,~______.~_ Addr... of Claimanl 01 decedent's death Slre.t Add,e$$ ._?ol___\l~(J E'( _YIEl!,'>..j.>nJe._.______.___..___.___~__ Clly ITiS.,('HB~2-'-!',SflljlgC~_........_.___Slale__BCj,.__ Zip God....L1~S-S.. Probate F.es MI.cellaneau. hpen.." SC>N\E~~eT 0N''''~1\ MEI'lVIRIA-l PAR.k. - GRAve II1AR\!eR. PA1RI6r /-.)('I.OS- ESTATc. I'M"rICe. C6l>l<..T f'f'-f S rY\All\NJ G)(f.(-'''\Se. TOTAL (Also enle, on line 9, Recapitulation) (If more .pace I. needed, In.erl additional .heet. of .ame .118,1 AMOUNT 95'/ g, i0 3iJ'M,tJ(l {~;;.S-. M' '1 r-,.:2(" 1.1::1 ,(\6 7,73 s 'nS~,73 IS. /~<;; (/ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAl. TAXES INHUUlMlct IAl< lllVISION /lIPI. ,'1I0i10I IlA~RISBURa j PA I ~l i'd-OlIO 1 NOTICE OF INIIERIlANCE TAX APPRA.lSHIE~H. ALLOHANCE OR DISALLOWANCE Of DEDUCTIONS AND ASSESSMENT Of TAX RICHARD R COLEMAN 21 VALLEY VIEW DR MECHANICS BURG PA 17055 DATE ESTATE OF DATE OF DEATH FIl.E NUMBER COUNTY ACN 09"29-97 GROSS 10-08-96 21 96-0830 CUMBERLAND 101 ( .~. ~,.,~,,,~ ", ' >& ; . ,"... ~, , .. 'If. _ 'kI' 'H-a~1 III liP cll.tll HELEN C [~,~.~e~=::~~~~==!,~ - ~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 ~ lIfli: i slii - EX' -A F P - (0 j-: 9'7-'- - NoYi C E - -6 F - "iNH E if i;: AN-C E - fA ii - iiP' p RAY Ii EM E NT"; -A i.1 (j'WAN-6 E - ,ili - - - -.. - - - - - - -. - -.. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GROSS HELEN C FILE NO. 21 96-0830 ACN 101 DATE 09-29-97 TAX RETURN WAS: I X, ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Sohedule 81 (2) 3. Closely Held Stook/Partnership Interest (Schedule Cl (3) 4. Mortgages/Notes Reoeivable (Sohedule 0) (4) 5. Cash/Bank Deposits/Misc. Per sane 1 Property (Schedule E) (5) 6. Jointly Owned Property (Schedule f) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: q. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule HI (9) 10. Dehts/Hortgage Liabilities/Liens (Schedule I) (10) 11. Total Deduotions 12. Net Value of T.~ Return 13, Charitable/Government.l Bequests (Schedule J) 14. Net V~lu. of Est.t. Subject to Tax If an assessment was issued previously, lines reflect figures that include the total of ALL ASSESSMENT OF TAXI 15, Amount of Line 14 16. A~ount of Line 14 17. Am~unt of Line 14 18, Principal Ta~ Du. I CHANGED ,00 ,00 ,00 ,00 8,387,05 ,00 ,00 IB) 8,788,73 ,00 III ) 112) 113) 114) NOTEI To insure proper credit to your account, submit the upper portion of this form with your tax payment. 8,387,05 B.7AB 73 401,68- ,00 401,68- NOTE: 14, 15 and/or 1&, 17 and 18 will returns assessed to date. at Spoys.l t.xable .t taxable .t r.t. Lin..l/Class A rate Coll.t.ral/Class 8 rat. 115) 116) 117) TAX CREDITS I ~-PAVMENT _. PATE ------ L ,OOX,OO= ,00X,06= ,00X,I5= liB) RECEIPT NUMBER DISCDUNT It) T'~'--'------ INTEREST/PEN PA.lD 1-) AMOUNT PAID ,00 ,00 ,00 ,00 TOTAL TAX C.~~~! ___ 'O~ BALANCE OF TAX DUE ,00 -~--_.~.~--_.._..-... ----.----..------- INTEREST AND PEN. ,00 ______!OT~~_~UE._ ___________.:,00_ If TOTAL. DllE IS L.ESS THAN 11, NO PAYMENT IS REQUIRED, If TOTAL DUE IS REFL.ECTED AS A "CREDIT" ICR), YOU MAY BE DUE A REfUND, SEE REVERSE SIDE Of THIS fORM fOR INSTRUCTIONS,) . If PAID AfTER DATE INDICATED, SEE REVERSE fOR CALCULATION Of ADOITIONAl INTEREST, L-'-j" , ; r'~ I\.,j RESERYATIOHI Eltate, of decedent. dying on or before Oece~ber 12, 1982 -~ If any future lntere.t In the e.tat. I, tranlferred In pOlse..lon or .njoy~.nt to CIa" B (o~llat.ral) b.nlflolarlal of the deoadent after the Q~plr8tJon of ~ny ..tata for Ilf. or for yaar., the Co~.onwealth heraby axpre..ly ra..rvo. the right to appraI.e and HSSIS. tran.for Inherltanoa Taxas at the lawful Clas. 8 (collat,ral) rate on any suoh future Interest, PURPOSE Of NOTICE I To fulfUI thfl roqulrclIlIentl of SecUon 2140 of the Inhflrlhnce and Estate Tftx Aot, Aot 21 of 1995, (12 P.S. SeoUon 9140), PAYMENT: DetRch the top portion of this Notlelil and submit with your. PflYlllent to the Reglstur of Wills printed on the reverse side. ""Make cheok or mOlley ordor pl'lY~lble to: REGISTER OF HILLS, AGENT REFUND (CR) I A rofund of II tllX crodlt, \oIhloh wu not requflstGd on the hx Return, 1IIl1Y be requuted by oOlllpletlng an "ApplloatIon for Refund of Pennsyl...anJa Inhllrltanco and Estate hit" (Rf.Y-1313J. Applications fire 'I'allabh at the Offloe of the Ru;l.ter of Wills! any of the 23 Re...enue DistrIot Office., or by call In; the speolal 248hour answerJng urvlo. numbers for forml ordering: In Pennsyl....1n18 1-800-362-2050, outside fl.nnsyl"'lInlll !Snd within 100ftl HarrIsburg area (717) 787-8094, TOO_ (717) 772.2ZS2 (Hearin~ ImpaIred Only). OBJECTIOHS: Any party In Interest not $atlsfiod wIth the lIppralsemont, 6110wance or dlsollowence of doductlons, or as.esslll.nt of tax (Inch/ding (1iscount or Interut) liS shown on this Notice lIIust objlilct within siKh (60) days of receJpt of thh Not Ice bYl uwrlHen protost to the PA DepartMent of Rover'ue, AOllrd of Appuls, Dept. 281021, ttnrrlsburg, PA 17128"1021, OR nflleotlon to he...e thll lIIatter dotorllllned ot audit of the account of the perlional reprGlI8nttltlve, OR --app.al to thll Orphans' Court. ADHIN ISTRATIVE CORRECTIONSI factual errors dllcovorad on this 8Ssoll..nt should be address.d In writing to: PA DQpnrtMe~t of R.....nu., bur.au of IndivIdual hxos, ATTN: Post AII91flment Re...lew Unit, DGpt. 280601, HarrIsburg, PA 1717.8-0601 Phone (7171 787.6501;. See peg' 5 of the booklet "In.tructlon' for InherltanclI TI'lIt Roturn for a R.sldent Dnc.dent" (REV-150lJ for an explanetlon of ad.lnlstr/ltl...ely correctablll errors, DISCOUNT: If any talt due Is paid wJthln thr.. (3J calendllr lllonths lifter the dllcedent's d8flth, a flva percent f5%1 dl.count of the tax paid JIi llllow.d. PENALTY: The 15% talt aenesty non-partlclp!ltIon penalty Is OOllput.d on the total of tho tlllt rmd Intor..t au'llod, I!lnd not paid before January 18, 1996, the flrlt day after the end of the tflX amnesty periOd. Thl. non'partlcJpatlon penalty III IIppealable In thll UIlUI 1lI0nner P.lnd In the the 'I'IIIIR t111111 porlod al YOU lofould ""peal the talt end Intar.st that has b.en al'IIISld 81 Indicated on this notice. INTERESTl Int.rest 1$ oharged blglnnlng with first day of dellnquenoy, or nine (91 1lI0nths find one (1) day frOM the datil of dnth, to the date of payllltnt. Tflltllo' which beC~llle dellnquent b.fore Janutlry I, 198Z bear int.rut at the rat. of .JIt 16%) percent p.r annUlll clllculatod lit a d~llY rllh af .001)164. All tllltllS which becaM. d.llnqu.nt on and aft.r January I, 1982 will bllar Interest ~t a rate which will ...ery froe c~ltndllr ytar tu oalendar year w1th that rat. announcet! by the PA Dllp"rt.ent of Ravenue. Th. IlPpllcabh Interest rlltu for 1?82 thr'ough 1991 arel t!!r tnt.rut Rate Dally Int.r'lt factor rm Intllrlllt Rate Dall'j Intarut flotor 1982 20% ,000548 1961 9% ,000247 1983 16% ,000tj!8 1988-1991 11% .000!t01 1984 11% .000301 1992 9% ,000241 1985 13% .0003S6 19lJ3-1994 7% ,(100192 1986 10% .000274 199~-1997 9% .000241 uInt.rest it Clfllculated .. followSl INTEREST = BALANCE or TAX UNPAID X NU"BER or DAYS DELINQUENT X DAILY INTEREST rACTOR ~~Any NotIc. il.u.d aftllr th. tax beCOlll.' d.llnquent will reflect an Int.r..t caloulatlon to flft..n (lS) day, b.yond the date of the asu..",.nt. If paYlllllnt II lIIadll "Her the Interut cOlllputatlon datil showt' on the Notlce, add1tlonal Intere.t lIIu.t bl oalcu1at.d.