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PETITION FOR GRANT OF LETTERS 0'" ADMINISTRATION
1-..11111' IIf _~ld ~'. Moroth
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No.
To:
Soda/ Stc'urily Noo
/HMJJtd.
203-10-9040
Realster of Wllb for Ihe
County of CUHIIERLANIl in thc
Commonwealth of Pennsylvania
The pefilion of the undersigned respcclfully reprcsenl.llhat:
Y!,,:, JlCIitio~er(s). wh<?,is/are 180 years of ag ,orol~~r/ appl Y
C,-'-Ijl'/'~ r.:.....J '(:r/:',.. ) C ( 1
Cd.b.n.; rcndmll: lile; duranl!: abitntia; durante mlnortlltt)
the above decedent.
(>ecendent was domiciled at death in CUraJer1and County, Penll.\ylvania. with
h 18 last family or principal residence at 36 North Fourth ST
for leners of administration
on the estate of
(Iialilrtd, number and munlcipalily)
Decendent. then 79 years of age. died Auqust 8 , 1995
at 36 North Fourth ST, LenDvne ,PA 17043
,19
Oecendent at death owned propeny with estimated values as folllows:
(If domiciled in Pao) All personal propeny
(If nOL domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal propeny in County
Value of real cstate in Pennsylvania
siluated as follows: 36 North Fourt.h gr. I~p. PA
S 34,000.00
S
S
S 2t5 l1l8.M
17043
Petilioner _ arter a proper search ha..!L- asccrtained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
Eleanor J.
Robert J. r-tlnath
Me.;
h
THEREFORE, petitioncr(s) respcclfully request(s) the grant of lencrs of administration in lhc
81'prDpriate form to the undersigned.
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AUG O!I 1995
1).IIl'
COMMONWEAllH OF PENNSYlVANIA. DEPARTMENT OF HEALTH. VrlAL IIl:COhn~
CERTIFICATE OF DEATH
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REV-1548 EX AFP (12-951*
CO"HDHWEIolfH Of' PENNSYLVANIA . .
DEPAR'HEHf Of R(V[IM 1tr..
BUREAU OF INDIVIDUAL '''XES If; . ~"
DEPT. 1a0601
HARRISBURC, PI. 17111-0601
--
ESTATE OF MOf/ATH
FILE tlO.
.2...\-
RODEnT
36 N 4TH
LEMOVNE
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l"!IIT 61 nNr.l T~ITr. I " .w
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DONALD
q~ ~ b5d.
SoS/D.C.
J MONATH
ST
PA 17043
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150 - I.J!J .
NDTICE Dr INNERITANCE TAX
APPRAISEnENT, ALLDHANCE OR DISALLOHAN.E
or DEDUCTION"l AND ASSEssnENT Dr TAX DN
JOINTLY IELD OR TRUST ASSETS
DATE 09-10-96
F DATE OF DEATH 08-01-95
COUNTY
CUM8ERLAND
NO. 203-10-9040
ACN
95151211
REMIT PAVHENT TO:
REGISTER OF WILLS
CUM8ERLAND CO COURT HOUSE
CARLISLE, PA 11013
A"ount RellHt.d
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Rl;V-1548 EX AFP (12-95*
tUI"~lI"'WI Al III III l'IH...i't'l VANia ~
DIP&II'"I N' CII lit \lIHUI
eUII(Atl 01 INnlVIDUAl 'UI S
011'1. 1801,01
1I'1l11I UUIIG, I" 111/a.OUI ." , I
UOTlel: or UUII:NlTAtlCI: TAX
""I'WAI:iUU:tlT, ALI.OHAtfCI: ON DISALt.OHAIlCI:
or O[OUCTIOUS I Arm ASSf:sstttHT or TAX au
JOINTLY IItl.O OR TNusr AsseTS
DATE 09-10-96
COUUTV
CUMOERLAUD
ESTATE OF MOUAT II
DDtlAL 0
r DATE OF DEATlt 08'01'95
FILE NOo .U 'if. \'.,),
SoS/DoCo UOo 203-10-9040
ROBERT J MOUATII
36 N 4TII ST
LEHOVNE PA 11043
ACU
95151211
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
k-iv:is4-S-Ei(-AFii-ii1i:9Si------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLV HELD OR TRUST ASSETS
DATE 09-10-96
REMIT PAVMENT TO:
REGISTER OF WILLS
CUM8ERLAND CO COURT HOUSE
CARLISLE, PA 11013
Allount R."itt.d
ESTATE OF MONATH
DONALD
F DATE OF DEATH 08-07-95
COUNTY
CUMBERLAND
FILE NOo SoS/DoCo NOo 203-10-9040
TAX RETURN WAS: (X) ACCEPTED AS FILED ( )
JOINT OR TRUST ASSET
i
,
FINANCIAL INSTITUTION: DAUPHIN DEP 8ANK & TRUST CO
ACN
95151211
CIlANGED
INFORMATION
ACCOUNT NOo
4912101142
TVPE OF ACCOUNT: (lO SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISIlED 08-29-90
I
Account 8alance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rete X
Tax Due
112.119.35
0.166
18,696.93
.00
18,696.93
.06
1.121.82
TAX CREDITS:
PAVMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST (-)
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITIl YOUR TAX PAVMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR HONEV ORDER PAVA8LE TO:
"REGISTER OF WILLS, AGENTo"
AMOUNT PAID
INTEREST ulS CilARGED FROM--OS-08-96 TO o9=-i.B-q~-TOTAL TAX CR~DlT
AT TilE RAIES APPLICABLE AS OUTLINED OU TilE ~LANCE OF TAX DUE
REVERSE SIDE OF TillS FORM ~!~~ER,EST ~EN:.
! TOTAL DUE
. IF PAID AFTER HilS DATE, SEE REVERS[ rOR CAlCUlAflON or ADDlfi'ONAT "iHTERESf:-.-----
C If TOTAL DUE IS LESS mAN n, NO PAVNENT IS REQUIRED.
If TOUl DUE IS REFLECTED AS A "CREon" ( CRJ I YOU HAY BE our A REfUND.
SEE R[VIRS[ SlOt OF TIllS FORM fOR INSTRUCTIONS, I
000 1
: :: ~;t!t~j
:~)( :
PURPOSE Of'
NOTICE I
To lulllll the requlra..nts of Slctlon ZI~O 01 thl Inheritance and [stat, fa. Acl, Act 11 of 1991. (71 P.S.
Slctlon llftO).
PUKE"T I
attach the top portion 01 thl, Hotlel and subalt with your ply..nt to thl Alalltar 01 Will, printed on the
r.....r.. slda.
.. "aka chIck or .onay order payabl, to: RECISTER OF WILLS, ACENT.
All pay..nts raclivld shall IJr.t ba applied to any lnl.r..t which '.y bl dUI, with any r...lndar applied to thl III,
REfUND C CA 11
A r.fund of . t.. cradlt, which wI. not r.que.tad on t~ ta. r.turn. ..y b, raquI.tad by coaplltlng an ~Appl1c.tlon
for A,fund 01 P,nnsylvanl, Inheritance and [,tat, Ta.- (REV-ISIS). Applications ar. Ivai labia at thl OfficIo'
thl Rlgl.tar of Willi, any of thl ZS A.v.~ DIIlrlcl OffiCI' or by calling thl ,peclal Z4'hour answering .ervlce
~bars for for.s ordarlng: In P.nnsylvenla 1.IDD.36Z-ZDSD, out. Ida P.nnsylvanla and within local
H.rriSburg .ra. (717) 717-ID94, TOOl (717) 77Z-2252 CHa.rlng l.p.lr.d Only).
OBJECTIONS I Any p.rty In int.r.st not satl.fl.d with the apprals...nt, allowanc. or disallowanca of daductlons or ass.ssa.nt
of ta. Clncludlng discount or Int.rast) a. shown on this Hotlca ..y objact wllhln .I.ty C6D) days of rac.lpt of
this Holln by:
--wrlllan prolasl 10 the PA Dapart.ant of Aav.nu., Board of App..ls, Dapt. ZIIDZI. H.rrlsburg, PA 17Ill-IDZI, OR
"al~lIng to have tha ..tt.r dat.ralned at the audit 0' the accounl of Ih. parsonal rapresanlallv., OR
-'ap,aal to tha Orphans' Court
ADttIH'
JSTRATtYE
CORRECTtONSI
Factual .rrors dlscovarad on Ihl. .ssa.saent .hould be .ddr....d In wrlllng 10: pa Daparl..nt 0' Ravanue,
Bur.au of Indivldu.1 r...., arTH: Po.t A.....-.nt R.vlew unit, OEpr, ZID6DI. Harrl.burg, Pi 17IZI-D6DI
Phona (717) 717-65D5. S.a paga 3 0' Iha bookl.t "In.tructlon. 'or Inh.ritanc. ta. R.turn 'or a Ra.ldant
O.c.dant" (REV-ISDI) 'or an ..pl.n.tlon of edalnl.tr.tlv.ly corractabl. arror..
DISCOUHTl
I' any ta. due I. paid within Ihr.. (3) calandar aonth. a' tar tha dacad.nt'. daath. . flv. p.rcant (S~)
d(.count of the tax paid I. a110wad.
PENAL TYI
The ISX t.. .an..ty non'p.rtlclpatlon p.nalty I. coeputad on the lot.1 0' Ih. la. and Inlara.t .......d, and not
paid b.lor. January II, 1996, the flr.t d.y .'tar the and 0' the ta. ean..ty p.rlod. Thl. non-participation
panalty I. appaalabl. In the .... .annar and In the the .... tl.. p.rlod .. you would app.al the t.. and Int.r..t
thai has b..n ....s..d a. Indica tad on thl. notlc..
IHTERfS t I
Int.ra.t I. charg.d b.glnnlng with flr.t d.y 0' da1Inqu.ncy, or nln. (91 aonlhs and on. (II day
'roe the dal. 0' d.ath, 10 tha data 01 pay.ant. raxas which bac... d.llnqu.nl b.lora January I. 19aZ
b.ar Inlarast al Iha rat. 0' .i. (6Z) parcant par ~ calcul.tad al . dally rala 01 .ODOI64.
All la.as which baca.. d.llnquant on or a' tar January 1, 1911 will baar Int.ra.t at a rala which will vary 'roa
c.l.ndar y.ar to calandar yaar with Ihal rat. announcad by tha PA Oaparlaanl of Ravanua. Tha appllcabla
Inlara.1 rei.. for 19aZ through 1'96 aral
V.er Intare.t Ra'a Deity Inlar.sl reclor Vaer Inlar..t Rela Daily Inlara.t raclor
I'at tal .DDOStol 1987 9i! .DODttot
19U 16l .00D438 19"-1991 III .00D~01
I 'Jato Ill: .000101 199Z In .0DO('tol
I'JIS 11:': .oOOlS6 1"~'199to 1'1. .0DDJlU
1986 IU .DDDZ7to 1995.1"6 '7. .000ltol
'.lnler..1 i, calculated 0" follows:
INTEREST = BALANCE or TAX UNPAID X NunBER or DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Nollce is,uud afl.r Ihe Ie. beco..s dalinquent will reflacl an In1er..1 c~lcullllion 10 flflaen CIS) days
beyond Ihe dill. of Ihe 1I"es.eanl. If pay.enl i. .ade alter Ihe Inler.,1 co_pula,lon dale Shown on the
Notlca, addlllonAI Inter.st -us, be calculelad.
--.- '-..-.,
RECEIVED FROM:
146858 COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT or REVENUE
OFFICIAL RECEIPI' . PENNSYLVANIA INHERITANCE AND ESTATE TAX
ACN
ASSESSMENT r:t
CONTROL ...
NUMBER
.
D NO. AA
~IWllC''''1
I
AMOUNT
R08ERT J MONATH
951:51211
$1:'>8.95
36 NORTH 4TH STREET
LEMOVNE. PA 1'7043
ESTATE INFORMATION,
1:'1 FILE NUMBER
U 21-1996-0852
m NAME OF DECEDENT (lASTI
II DAlE OF PAYMENT
m POSTMARK
COUNTY
SSN 203-10-9040
(FIRST) (Mil
CUMBERLAND
DATE OF DEATH
REMARKS
m TOTAL AMOUNT PAID
$158.95
CW
R08ERT J MONATH
SEAL
CHECK" 756344
RECEIVED BY \
j
:, ' I , I I ,.' ,I. ~;; '- 1
alOHA'"'! . \
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
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146857 COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OP REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
.
DNa' AA
RECEIVED FROM:
fJ
ACN
ASSESSMENT r:'I
CONTROL ~
NUMBER
AMOUNT
ROBERT J MONATH
'f:Jl:Jlcll
.I,UVU.UV
36 NORTH 4TH STREET
LEMOYNE. PA 17043
ESTATE INFORMATION,
1:'1 FILE NUMBER
liII 21-1996-0852
1:'1 NAME OF DECEDENT (LAST)
~ MONATH OONALD F
II DATE OF PAYMENT
m POSTMARK DAlE
COUNTY
SSN 203-10-9040
(FfRST) (Mil
CUMBERLAND
DATE OF DEATH
ROBERT J MONATH
m TOTAL AMOUNT PAID
$1,000.00
CW
REMARKS
SEAL
CHECK II 756342
RECEIVED BY '\ \', '..
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SIGNATURE
,II':
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REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
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I~) / L '/ COMMONWEALTH OF PENNSVLVANIA C, *
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX
IJH:AIUHCE TAX DIVISION
DEPT. ZID6D 1 STATEMENT OF ACCDUNT
HARRISIURG, PA 171ZI-06Dl
m.uu II ." tll.t..
DATE 11-12-96
ESTATE OF MONATH DONALD F
DATE OF DEATH 08-07-95
FILE NUHBER 21 96-0852
COUNTV CUM8ERLAND
ROBERT J MONATH ACN 95151211
36 N 4TH ST AlIOunt Ro.ltt.d
LEMOVNE PA 17043
MAKE CHECK PAVABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
NOTE: To in.ur. proper credit to your .ccount, aub.it the upper portion of thll for_ with your tax peyaent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiE'y:i60"i"EX-AFP-ni3":9i.y------iiiiii-iilHEiiii"A'iic'E-i'AX-STAfEiiE'Ni'-i:iF-Accoliiif--iiliiiu-------------------
ESTATE OF MONATH DONALD F FILE NO. 21 96-0852 ACN 95151211 DATE 11-12-96
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS DF THE STATED ACN IN THE NAMED ESTATE. SHDWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE. APPLICATIDH DF ALL PAYMENTS. THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE. 0
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 09-03-96
PRINCIPAL TAX DUE, 1.121082
PAVMENTS (TAX CREDITS),
PAVMENT
DATE
10-19-96
10-19-96
RECEIPT
NUMBER
AA146857
AA146858
DISCOUNT (+)
INTEREST (-)
45.72-
.00
AMOUNT PAID
1.000.00
158.95
INTEREST IS CHARGED FROM 10-20-96 TO 11-27-96
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM.-
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
1.113.23
8.59
.08
8.67
. IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FDR CALCULATION OF ADDITIONAL INTEREST.
C IF TOTAL DUE IS LESS THAN fl.
HO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCRI.
YDU HAY BE DUE A REFUND. SEE REVERSE SIDE DF THIS FORll FOR INSTRUCTIONS.
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PA'nEHT I
DetKh the top portion of thl. Hotlctl ..a ~It with yeur ,..~t .... ,..nbl. to the naMI ..a .sdr...
printed on the r.v.r.. .Ide.
If RESIDOfT DECEDEHT ... chKk or .....y orct.r p'rml. tal REGISTER OF WILLS, AGENT.
If _'Rt:SIIlOfT D1C11lfJ1T .... cMck .. ...... ..... pa...1. t., C_EAL TH OF PEHNSYLVAHIA.
All p'YNnh ncelv.d .11 beepplled flnt to W1Y Int.r..t which _y be due with MY r_lnder -..lIed to the tax.
RU1.ICD (CAli A nhnt of . tllJl credit, which .... not reque.tM on the TIIJI Ratum, ..y be requelted b)' cOllPI.tlna ."
ooAppllctltlon for R.hnd of PIiMQ1VMI. JnherltMce Bnd EIt.t. Tu" (REV-1SIS). Appllcetlon. .r. ..,.11Bb18 .t
the OfficI of the R......r of WUle, InY of the Z3 R.venue Dletrlet Offlc.. or froe the Dep.rtaent", Z4"haur
.,....rlna Hrylctl ~r, far for.. ordllrlngr In P....,.ylvanl. l...aO-36Z"ZaSa, ouhlde P....,.yIVMI.
Bnd within local "-rr"burg .r.. (117) 717"1ID.., TOOl (117) nz..zzsz CHHrlna IlIP8lr.. only).
REPLY TOI Que.tlon. reprdlna .rron contaIned on th" notlc. should be addr..." tar PI DIp.r....t 0' R.v...., Iura.,
a' Indlvl~1 ',x'" A'THI Po.t A...lsaent R.vl~ Unit, Dept. Zla601, Harrisburg, PI 17121"0601, phone
(717) 7.7"6505.
DISCCUITI
If any tllJl due .. p.ld within thr.. (5) e.ltlndlr IlOf1th. .ft.r the decedent". death, . flv. perc....t CS~) d"cDU'tt
0' the t.x p.ld I. allowed.
POUt TVI
The 15% tllJl ....lty non-p.rtlclp.tJon PeMUy I. CoeputM on the tot.1 0' the ta. end Int.r..t ......Id, and not
paid before JWlUllry II, 1996, the flr.t de)' .ft.r the and 0' the tllJl .....ty period.
INJER[STI
Int.rut .. charged bealmlna with flr.t dly of delinquency, 0,. nine (,) IIOnth. and one (1) d.y 'rOIl the det. 0'
Math, to the dIIt. 0' PIYNnt. Ta... whIch bee.... delinquent before ~ry I, 19IZ bNr Int.rut .t the rete 0'
.Ile C6~) pere....t pe,. ......... c.lcul.tad .t . d11lly nt. 0' ,QOalM. All tax.. whIch bee... delinquent on and after
.....ry 1, 1911 will bur Int.rut at . rat. whIch will wry 'roe eel.....r y..r to cal__,. Y"" wIth that rete
announced by the PA Dep.rt-.nt a' R.venue. The eppllcBbI. Int.r..t ,..t.. 'or 191Z through 1996 er"
V... Int.nlt A.te D'lly Int.r..t Fectar y... Int.r'lt A.t. o.lh Inter..t Fectol"
1911 ZOX . Da a 541 1917 9X ,ODOlO
1913 16% .00043. 19aa-I991 1IX .DaalOI
1914 11X .DOOSOl 199Z 9X .aOOl47
1915 In .00DS56 1995-1994 n .000192
1916 lOX .ODDl14 1995-1996 9X .oan47
--Int.re.t 1. celcul.ted e. 'Ol1OWII
IIfTEIIE8T D BALAHCE OF TAX l'llPAID X HUKBER OF DAYS DELINQUENT X DAILY IIfTEIIE8T FACTOR
--Any Hotlctl Inuad _ft.,. .... tax baco.. delinquent will ranKt ~ Int.r..t calculation to '1ft.." CIS) dill"
beyond the dIIt. 0' the ....I......t. If P'v-1t Is .... .ft.r the Intarut COIlpUt.tlon dlt. shown on the
Notice, eddltlDnlI Snt.r..t .u.t be calcul.ted.
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BUREAU IlF INDIVIDUAL TAXES
IIOOITAHCE TAlC DIVmlll
DEPr. 210601
HARRISBURG, PA 17121~D6Dl
COHHONWEALT': OF PENNSVLVANIA
DEPARTHEIIT OF REVENUE
INHERJ:TANCE TAX
STATEMEN~ OF ACCDUNT
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ROBERT J HONATH
36 N 4TH ST
LEHOYNE PA 17043
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-12-96
HONATH
08-07-95
21 96-D852
CUHBERLANO
95151211
Aaaunt Reeltted
DONALD
F
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MAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CD COURT HOUSE
CARLISLE. PA 17D13
NOn:, To Inaur. proper credit ,to your KCOWlt. cubttl', th.. ItnD"r portion of thl. fOMl with your t.x pa,. ...t.
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o.tKh the top portion of thh HotlCtl Ind .-1t w1th YOU' "y8Mt ... payS1_ to the n.- Ind Mldre..
pr1nted on the rever.. I1de.
... If RESIDENT DECEDENT .._ chrKk or ....W order ,._1.
... If NOH.RESIDEK1' DF~_ ~~ ~,~,~ ,,'.'~h(
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REGISTER OF WILLS. AGENT.. ,
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UNO. AA 184909
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COMMONWEALTH OF PENNSYLVANIA
DlPARTMINT OF RIVINUI
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
RECEIVED FROM:
i
ACN
ASSESSMENT P:'I
CONTROL 1;,1
NUMBER
AMOUNT
ELEANOR J MONATH
"Jl::ll!!11
48.67
36 NORTH
LEMOYNE,
4TH STREEor
PA 170,,3
latDH'"
ESTATE INFORMATION:
!'I FILE NUMBER
li 21-1996-0852
1:1 NAME OF DECEDENT (LASTI
11I:,I MONATH DONALD F
II DATE OF PAYMENT
m POSTMARK DATE
COUNTY
SSN 20;:)-10-9040
(FIRST] (Mil
CUMBERLAND
DATE OF DEATH
08/07/95
REMARKS ELEANOR J MONATH
m TOTAL AMOUNT PAID
$8.67
CW
SEAL
CHECK" 4367
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RECEIVED BY I" . ,.0 . 0
GN
MARY c. LEWISJ /{fi,o/
REGISTER OF WILLS
REGISTER OF WILLS
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BUREAU DF INDIVIDUAL TAXES
ItetERJTAlIC[ fAX DIVISION
DEPr, ZIOU.
HARRISIURG, Pi 11IZ.-0'D1
COHHONWEALTH OF PENNSVLVANIA
DEPARTHENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
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.n-HUII 'u II.....
ROBERT
36 N 4TH
LEMOVNE
J MONATH
ST
DATE
ESTATE OF
DATE OF 1lEATH
FILE NUHBER
COUNTV
ACN
12-23-96
MONATH
08-07-95
21 96-0852
CUMBERLAND
95151211
DONALD
F
A.aunt R..itted
PA 17043
HAKE CHECK PAVABLE AND REMIT PAVHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTEs To inlur. proper credit to your account, lub.it the upper portion of thia far. with your teM p.yaent.
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
ifiv: iljiij"Ex-AFP-noF96Y------..ii-iiiHERIi"Aiici:--Y;.x-sTAfEilENY-OF-iiccouiifn.-i.---------------- ---"-
ESTATE OF MONATH DONALD F FILE NO.21 96-0852 ACN 95151211 DATE 12-23-96
THIS STATEHENT IS PROVIDED TO ADVISE DF THE CURRENT STATUS DF THE STATED ACN IN THE NAHED ESTATEo SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYHEKTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIQURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 09-03-96
PRINCIPAL TAX DUE, 1,121.82
PAVMENTS (TAX CREDITS),
PAVMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST (-)
10-19-96 AA146857 45.72- 1,000.00
10-19-96 AA146858 .00 158.95
12-02-96 AA184909 .09- 8067
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TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
1,121.81
.01
000
.01
.
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-,
1.1. J
t) '.1 r- . .M
We: c-. :3 -
IF PAIJCAFTER THis DATE~ REVERSE
SIDE FOR CALCULATION DF ADDITIDNAL INTEREST.
( IF TDTAL DUE IS LESS THAN tl,
NO PAYHEKT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI,
YDU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRH FDR INSTRUCTIONS. I
PAYMENT I
DetKh ttNI top portion 0' this Notice end lue.1t with your p.v.ent aecta p.yebl. to the "... and eddru.
printed on the r.v.r.. .Ide.
If RESIDENT DECEDENT .... ch.ck or IIOMY ord.r payDbl. tOI RECISTER OF WIllS, AGENT.
If NON-RESIDENT DECEDENT .... check or ~y order p.yltbl. tOI COH"ONWEALTH OF PENNSYLVANIA,
All paYMntl racalved .hall be applied flr.t to .,y Int.rut Which .ay be dull with any r...lnder applied to thll talC.
REF\ICD (CRh II refund of a tllX credit. which wa. not requa.ted on tt. Tax Aeturn, .ay be r~stlld by COllplatlng IlIn
-application 'or Aafund of Penn.ylvlllnla Inheritance end E'tete TalC- (REV-ISIS). Application. are .velllble at
the Office of the Aegl,ter of Will.. any of thl Zl Aevenue Dl.trlct Of,lca. or froe the Dep.rteent'. 24-hour
...."'rlng ,.rvlce "....r. for fore, orderlngl In Penn,ylv.,la 1-800-162-2050. out. Ide P.,..,.ylvenl.
end wIthin local Harrlaburg .r.. (717) 181-8094, TOO. (711) 772-2252 (Heerlng lapllred only).
REPLY Tal
Quutlonl reprdlng arran conhlned on thll notlc. should be add,...ed tal PA Depart...,t of Aav...,.. Bureau
of Indlvldu81 Taxe.. AllNI po.t A......-nt Aavl.w unit. Dept. 280601, Herrllburg, PA 11128-0601. phon.
(717) 187-65DS.
DISCOUNT I
If eny tax dull II p.ld within thrH (S) celender eonthl eft" the cMcedent'. dllth. a five percent (SX) dhcount
of the tax p11ld 11 allowed.
PENAL TVI
ThII In tu _Ity non-p.rtlclp.tlon penelty I. co.puted on the total of the tax end Intlrut ......ed, end not
paid before January 18, 1996. the flrat day ,'t.r the end of thl t.. 8Inelty period,
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INTEREST I
Int.r'lt I. charged beginning Nlth flr.t d.y 0' delinquency, or nine (,) eonth, and one (1) day froe the d.t. of
death, to the date of payttent, Talll, which bKMII delinquent before J...,.ry I. 1982 b..r Interut at thl! rete of
,Ill UX) percent per ........ calculated at a delly reta of .000164. All talCu which bee... delinquent on end after
January I. 1982 NIll baar Int.r..t at . rat~ which will v.ry 'roe calendar y.ar to c.l~'r y.,r Nlth that r.ta.
announced by the PA Dap.rteent of Ravenue. The appliCable Int.ra.t rat., for 1982 through 19'7 .r'l
Va.r Intar.,t Aata Oally Int.r..t Factor
V.ar
Intlr..t A.ta
DIllY Int.r.,t Factor
1912 20X .000S48 1.81 n .000Z41
1'15 16X .G00418 19as-I991 11;( .00OSOI
1'" IIX .00OSOI 1"2 'X .000247
1915 UX .000S56 199]-1"'" 7X .000192
1'" lOX .000214 1995-1991 'X ,000241
"-Int.rut I, calculated II followlI
INTEREST " BALANCE OF TAlC UIlPAID X ~BER DF DAYS DELINQUENt X DAILY INTEREST FACYDR
_."'y Notice hw.d .ft.r the talC becoM' delinquent "Ill r.flect en Int.r..t celcul.tlon to flft"" US) d.y.
bayond the date 0' ttM ........"t.. If paywent II .ecta Ift.r thl! Interut coaputltlon data shown on thl!
Hotlc., IIdCUtlONlI Int.rut .,.t be celcul.ted.
I>U1tAIlLE GENEItAL l'O\VEIt OF ATl'OltNE\'
21-99-848
NOTICE
THE PURPOSE OF THIS I'OWER OF ATTORNEY IS TO GIVE TIlE PERSON YOU
DESIGNATE (YOUR "AGENT") DROAD POWERS TO IIANDLE YOUR PROPERTY,
WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL OR
PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR API'ROV AI. DY YOUo
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THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO
EXERCISE GRANTED POWERS, OUT WHEN POWERS ARE EXERCISED, YOUR AGENT
MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS
POWER OF ATTORNEY.
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YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR
LIFETIME, EVEN AFTER YOU DECOME INCAPACITATED, UNLESS YOU EXPRESSLY
LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A
COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY,
!
.~-
YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S FUNDS,
A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR
AGENT IS NOT ACTING PROPERLY.
THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE
EXPLAINED MORE FULLY IN 20 P A, CoS, CHo 56,
.1
IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND,
YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN. IT TO YOUo
1
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I HA VB READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS
CONTENTSo . ,,"0
". .~....
rei':.. J~: oj loll. ~.;.,. :"
, , .I::J)~~~lirli!hl:l;i:~j.'M<!~:'lt\I;,'Jt~i
~<'M'''~!I!1J:!lJ!liIll.
KNOW ALL MEN BY THESE PRESENTS, that I, NANCY M. MONATII, of Outlook
Point, 129 Walnut Bottom Road, Sliipp~nsburg, Pcnnsylvania 17257, hcrcby rcvoke any gcncral.
powcr qf at. to,mcy th~t I h!l.YC? ~sr~lfifi,dr~~':",cn to, any pcrson and do hcrcby appoint my brotp~~, i..,',' ,
ROn.ERT J',MONATH; of,4Q~il'mfm~~Strcct, Dcnvcr, Lancastcr County, pcnnsYIV~io~f1?,S,,:17,
(hcrcmal\c,r "my Ag~nt'~), my tl1lC?,!\ll~a~~~ agent for mc and on my bchalfto pcrform a11l\':W~:r.:,':
acts as my Agcnt in his absolutc di~~rt1Wl\'omay dccm advisablc, as fully as I could do ifPer~~~~X'" "
prescnt. ., : .! 1'~,\i(!ft:I b:1 ,. ,'''r rt~i
., \ o'l,ot fJht,( '.lI~ .1~rr,h
MULTIPLE AGENTS . o),I:;i:~f}iJl ,:,: '
';t(I,rl-:., li.'I':!'
If morc than one person is n!lffi~,;l!o,Y!l ,as my Agcnt, cach person namcd may act al~noel!9.q !,o'rie
signature, without consultation wi~"l\ i~:rth,ers (although I strongly urge continuing contact. 'f!?rrg
them)o ' " p IU'" ..iI.' , , "
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1'!~m:";l~/',;'ilW~II~;l1'I~~bi",:J:'~~';I'~::;:"'I::'i"ii! ",' " '~I:"i:"';'~"'~l';";il'
. ~~t'!fH~~fP~I.:.., ~"!~',rll,ll~ ttMt fi'~~1t~lr. ~nol:li
..l _ t. ro..c,
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20 Stocks. Bonds, Sccuriti!:UIn!U!lVeslmentJ!.
(a) To scll, exchangc, plcdge, assign, transfer and delivcr to any pcrson, at my Agcnt's
discrction, all or part of any stocks, bonds, notcs, mortgages, intercsts in partncrships or
othcr sccuritics, and any and all pcrsonal propcrty standing in my name or bclonging 10 mc, or over
which I havc any powcr or control. To make, execute and deliver on my bchalf allncccssary
dccds, assignmcnts or transfcrs.
(b) To registcr any or all of my sccurilies in my Agenl's mIme as agent for meo
(c) To vote my sccurilics in pcrson or by proxy,
(d) To transaclall busincss in rclation to any stocks, bonds, sccuritics, or othcr property in the
nature thcreof; to dcposit thc samc undcr agrccmcnls of dcposit; to participate in any plan oflcasc,
mortgage, merger, consolidation, exchange, reorganization, recapitalization, liquidation,
rcceivcrship, or forcclosurc with respectthcreto; to excrcisc any rights to subscribc to ncw issucs
thcreof; and gencrally to cxcrcisc all rights of managcmcnt and ownership with respcct thcrclo;
(e) To invest in any form of property, all funds and sccurities hcld or receivcd for my account,
kecping such cash rcscrvcs as, in my Agcnt's discretion, arc ncccssary or dcsirable to mcet
conditions as they may exist from timc to time, Inthc cxcrcisc of this power, my Agent may invest
in any varicty ofrcal and personal propcrty as in my Agent's discrction appears to bc prudent
investmenls, and my Agenl shall not be liable lomc lur any error of judgmcnt in thc making or
continuing of any invcstment.
3, Real Estate
(a) To sell, exchange, plcdgc, assign, transfer and deliver to any pcrson, at my Agcnt's
discrction. all or any part of my rcal propertyo standing in my namc or belonging to me.
or over which I have any power or control
(b) To make, execute and deliver on my behalfall necessary deeds, assignments or lransfers
(c) To opcratc real property, separately or joil1lly with others.
(d) To Icasc for any term any real property and to vary the terms, including rent payable. of any
Icasc,
(e) To altcr, repair, improve, mortgage. divide, exchange, join inlhe partition ot: or give options
with respcct to, rcal property,
(I) To buy in at judicial salc any property on which I hold a mortgage,
(g) Gcncrally 10 transact all business and to exercise all rights of management and ownership
relaling to real propcrty.
-..--..-.---.---
--
,... j'
, "I),!~~II ,I ,
"TI
.. I 1111114 J J 1_-
. .. t ,~,...U I
4. (h1i!ll~.J,nw SVilll,..c91l)Il!QJlli~e.nmLMi5~.c!lnl1cml~.I'l)wers.
(a) To demand, sue Ill!. levy. collect, and give pmperreceipls thrall sums of money or pmpcrty
now or which may hereaner become due me from any source whalsoever. including all estates or
trusts, proceeds ofinsunlnce policies or othcr property of any kind whatsoever.
(b) To compmmise, relcase, settle or join with other Imrties in the compromise, release or
scttlement of any claims,
(c) To make, negotiatc, sign and pcrform any and all agreements and contracts now in coursc of
ncgotiation, cxecution and settlemcnt by me, or which may hereancr in the opinion of my
Agcnt bc to my intercst or advantage; to clrcct, procure and continue insurance of any and cvery
kind and dcscription; and with full powcr and authority to manage any real and personal propcrty
and conduct my anairs gencmlly,
(d) To cmploy attorneys at law and such othcr agents, employees or representatives as my
Agent may think propcr, and to pay any claims. fees, expcnses. wages, demands or obligations for
which I may now be or may hcreat1cr bccomc liable.
50 Tax Mattcrs.
To prcpare, execute and tile in my bchalf and in my name any and all income lax declarations
and rcturns, and any other tax returns and reports (includingo bul not limited to. protests. claims,
elcctions, conscnts. closing agreemcnts, waivers of statutes oflimilations and eXlensions), and to
reprcsent mc bcfore thc Internal Rcvenuc Scrvicc or Trcasury Department and any state or local
laxing authority with rcspcct to any claim or procccding having to do with my tax liabilitics,
fcdcral, statc or local, for any and all ycars.
(> 1\1\\~cLlQJ2eJega)c
To subslitutc one or more agent or agents under my I\genl. to carr\' oul any oflhe general or
specilic powers hereby granted
7. Sn.~l;.itic A!tJJ!Qrjt)'-HL!.'!I[gliL~_~'I~owe~lQJllI~
To purchase United Slates Treasury "llower" bonds on my behalf and to borrow money as
provided ahove for the purchase of such bonds
8. S 11.e.~iflC..Ei nnnci;! U)o\v.er~"J)sli IK<!JJY_ SJ a lu t e,
The following powers arc granted pursuant to Chapler 56 of the Pennsylvania Probille Estates
and Fiduciaries Code as lilrther delined lherein
(a) To make limited gills My Agenlmay make gins on my behalf 10 any donees and in such
amounls as my Agcnl may decidc subjecl 10 the Illllowing:
llf....rf...'~. 9,~9-
'cuw.)I"~~~';\l'A""
[,( PAlm"l Pl1 [\f I~f ','I MJI
",,,,,,,;.':;,\ o;':~lll'i"" RESIDENT DECEDENT
(/t el 1'1 III :,h.IJ.11 11,.:,1 l'Il,,1 mlll~OOlll",'wl "w.to.'!MIf. klW,'."'''.l''
/J7 ooN.tJ T/.I /) o/oJ /J clJ F
O,l!l(lt{AAItJ
0810711
REV-1500
INHERITANCE TAX RETURN
..,
,----
/ , , , '
I " i. I 1'/
FI.E NUMBER
., q (, ,~' ~- ')
,,<
Nll~T"tl'lO( .... .-.
~.~lAl. !J(\IH;T'I Io'"..r'll<
OATEO. H<RTlI
!Z
w
o
z
~
..
W
0:
0:
o
"
IOI/,/-I;?
'HifJ~;;;;;-1) """llllAO;;;I!"r '70,")I"~o 7 - "t If r:; lIllSRE'UR~~~;;~~'~~I;:~~~~lEwnH'HI
1.0rqlnillRelum 02 SUPlllementJlRclum 0 J RemainderRetuml~cu'''''ptl)l'''1l-1Hll
o 4 Llmlled E5~1" 0 4_ Fulure Inlerc'tCompromoo ,,,"d""'''''"l1li 0 5 Federal Estale Tal Retum Required
o 6 Decedent O~ Testate ll..l!.l::~cCf,oll'''l 0 7 Decedent Maintained aliVlflQ Trusll.&4ll:t\UlPftiTM11 _ 8 Total Number 01 Sale OepositBoxes
o 9 L.~.a""n Proceod' Rere"ed 0 to SpousalPovel1y Cre,liI ,""d""''''''''' 12 II "...,.,.,,, 0 11. EloctJontOtal undarSoc. 9113(A)_hS<hOl
THIS SE TION MUST BE COMPLETEDo ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
"'''' 06 e;1?., J C"~"E~;~"SN. ~-rll q-r
,,,OJ,,"" I"Hk....' J)vJlJd(J i1J /)':)17
2..{' I 0 6 0 . () 0
Real Estale (Schellule A)
(1)
05 - I O.
o If V
~
":!12
"1:"
woo
"O:-J
".."
..
.
2 SlocI.> and Bond' (Schellule B) (2)
3 Closely Held eorporatlOn,Partnership or Sole-Propnetorshlp (3)
4 Mong_ges & Notes ReceNable (Schellule D) (4)
5. Cash, Bank Deposits & MIscellaneous Personal Property (51
Z (Schedule E)
0 6 JOlnll1 Owned Properly (Schellule F) (6)
3
7. Inler.VlVos Transfers & MISCellaneous Non.Probale Property (7)
:J {Schellul. G or LI
!: B TolaIG,o.. Asset' (Iotal Line, '.7) (B)
n.
< 9_ Funeral eKpel\SCS & Administratrve Costs {Schedule HI (9) ~ II to .I..fb
0
w ,1/ I., .9S
0:: 10 DeblS of Decedent. Mongage Liabl"beS, & Liens (Schellule I) (to)
t 1. Total Deduclion. (Iotal line, 9 & 101 (11)
2.bIOOO.OO
z
o
I:;
~~
....::l
Il.
~
o
o
12 Net Value 01 Estate (Line 8 minus Line 11)
13 Cnantable and GO\lemmental Bequests/See 91 13 Trusts for which an election to ta~ has nol been
"",de (Schedule JI
t4 N.l Value Subject 10 Tax (Line 12 mlnu, Line 13)
15 Amount olltr.e 14 la.able
allhe spousal tax rate , I
See instructIOns on reverse side for applicable percenlage
16 Amount of hne 14 taJable
at 6% rale
17. Amounl of line 14 talable
at 15% rate
(t2)
(13)
7,'!:37.t.J)
I ~,'S~~.5'1
(t4)
x .0
('5)
x .15
(16)
(H)
(1B)
I I{ 5.7 ~
x 06
tB Tax Due
1,1' 3.7S
19
> I> BE SURE TO ANSWER ALL QUeSTIONS ON REVERSE SIDE AND REC ECK MATH < <
Undet ~be$off:efJ\lry.1 oocl,ye thai I tlave ellWT'llnedthtS retufn.lI'lCludlllg lICCClft'lI)<f')'1ng SChedules ;n:fstatements. and tl tI'\e bettor my k~...a baI.,r,.t1S true. correct and c:ompIele Oocl.Yaoon of ~efottlef
1tlil"llhe['l(>f'"..onaltPC'l~lal,we~b.lseo1(J'latl'l'llofm..lllOl'lof--nlChorf!03l'erhasanv.1'ICM\Mae
SIGNATUR~~E OR RE ADDRESS
SIGNATURE OF PREPARER OTHER AN REPRESENTATIVE
. r;TII sr:
Br
DA~ It:; /
DATE ~
Decedent's Complete Address:
~HHll "1'[11;1 ~;~, - -- .----
em
---.------.-- -'C';'~~_
----_.~'- -----.]
~T'-,c---j
It) /113 . 76
Tax Payments and Credits:
1. Tal Duo (pago fLmo IRI
2. Crodll~Paymonts
A Spousal Po,orty Crodll
B. Prior P.'y",~nls
C Discount
TOlal 01'<111S I A. 8 ..C) (2i
3 InteresuPenalty If applicablo
D.lnterest
E Penally
tj,IJ I /'J/
. ....' , ,,-, q; ,I..!, I, : ,,', ' \fl " " .. . ., ~ 1 .~.
Totallnleres~Ponally (D' E I (3)
4, If hne 2 is greater than line 1 . hne 3, entenhe d,fferen", ThiS IS Ihe OVERPAVMF.NTo
Check box on Page 1 Line 19 te requllt a rafund (4)
S. If line 1 .llOe 3 is grealerthan hne 2, entenhe difference This is Ihe TAX DUEo (51
A. Enter the interest on the tax due. (SA)
8, Entei the total of Line S . S",Thls i~ the BALANCE DUEo . (S81 / 5" , ~. ~
Make Check ~Ca~e 10: ';;~I,~!:~':!!:;!:!"~':~m~~W.lltt?
PLEASE ANSWER THE FOllOWING QUESTIONS
BV PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred: ....,............,....,.,..................................,.0
b, retain the right to designate who shall use the property transferred or its Income; ................ 0
c, retain a reversionary interest; or............,.............,....., ..........,..... ...,......,............,.............. ... 0
d, receive the promise for life of either payment~o benefits or caro? ,..,...................,...........,.'., 0
20 If death occurred on or before December 12, 19820 did decedent within two years
preceding dealh transfer property without receiving adequate consideration? If death occurred
after December 12, 1982, did decedent transfer property within one year of death without
recoiving adequate consideration? ...,...,...........,...,...........................,............,....,.........,.. . ........0
. 30 'Did decoden1 own an 'in trust for" or payable upon death bank account or security
at his or her death? .....,............".......,......0...............,.........,..,............,.,.,............,............... ..0
4, Did decedent own an individual retiremont account, annuity, or othor non,probate property? ...0
15'3.$'7
~
~
W
g'
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS VES,
VOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN
....._".O""..,1M"":3.c.J.,''''.w~.. ,.
."W-&~:Ja.W.!:.ttx~~i':"ti..;;." <.:...:~~~ ':'-t.:;~;~
72 p,oSo !j9116 (e) (1,1) (i) provided for the reduction olthe tax rate imposed on the net value oltransfors to or for th.. ,''. nf Ih..
surviving Bpouse from 6% to 3% for dates of dealh on or after July 1, 1994 and before January 1, 1 Q9S.
72 P,So !j9116 (e) (1,1) (ii) provided for the reduction of the rate imposed on the not value oltransforslo or for the use of the survivin9
spouse from 3% to 0% for dates of death on or after January 1, 1995, The statute does not exempt a transfer to a survivinq spouse
from taxo and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the survivinq snollse
15 tho only beneficiary,
. FOR DATES OF DEATH ON OR AFTER JANUARV 1, 1995" Please answer the following question by placing an "x" in the
appropriate spacllo
Did the decedent create a trust or similar arrangement which Is solely for the surviving spouse's benofil for his or her entire
lifetime? Yes 0 No 0
If you answered yes to the above question, the tax on the trust or similar arrangement is postponed until the death of the second
spouseo at which time it will be fully taxable at the rato(s) applicable to the remainder benefici~ry(ias). Enlar H;a va:~e cf the trust on
Schedule Jo Part II, in order to remove it from the calculation of Ihe tax due in this estate. You may wish 10 file Schedule 0 in nrner to
make the election availablo under Section 9113. If the election is madeo the trust or similar arrangement is taxed in the estate of the
first decedent spouse, the portion of the trust or similar arrangement which benefits Ihe surviving spouse is taxed at the zero tax rate,
and Ihe remainder is taxed at the rate(s) applicable to the remainder beneficiary(ies). If you choose to make the election, you must
allach Schedule 0 10 a timely, filed tax returno along with Schedule(s) K and/or M in order to show the ~pportionment of the trust or
similar arrangement between tile surviving spouse and the remainder beneficiary(ies). . , . 0 .
"', . : ,: ,:\J1. 't ~..1:Jt.y,;,';\t'1.tnli'r.l1tr~~H"i!ri~~i\~t ;':f,;',.;rh-"r~\'i>t 'rlJi.. t{ ~.SJ'1;,t ~i ~
-"":"''''.
COUI.lOlMEAl Hl or P11",SYlVAllIA
IMI[RIIAlICr fA); RUUHII
R.J:1 NT '( NT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE HUMBER
Debts Dr deced.nt mu.l b. r.porled on Schedula I.
ITEM
NUMBER
A,
DESCRIPTION
AMOUNT
1,
FUNERAL EXPENSES,
!eAV/GE:S", Q"", ~tt't VlJlJ!J;r pRAUIj)~p ~
frlllSft::UI'UIN FViJt:72JlL I-IOfV/J::' ItJt, 12.~ 1111M/)1(tAIItl,lJ.et1f
1dAAve rn~RKtRo 8RA<.,l:.mDllIlF rnCf\1otlAt.S, 2.H! I{t~"n'
I-\AAAI~bUR.~ ~
G.~Te 6f= Hl!'i\VlW ~'1\')E'TAl!.Y ,~'* Rb, ,.rh!(.H41oJ1t..S&i/(V I fA
G~A\Je.
liRAllt.. Opt!NII.J~
:S~7. 0-0
..5ob.~
.lf$'Sc./. rI b
bO().~
8, ADMINISTRATIVE COSTS:
1, Personal Represenlalive'. CommissIOn.
Name of Personal Represenlalive 1'1
Social Socun~ Numbe~'J , EIN Number of Personal RepresenlalNo(')
Street Address
City
Slale
Z~
2,
3,
Yea~'1 CommissIOn Paid.
AnomeyFee, (!or-JSl.ll,~TlooJS CJiJoe.~ S'11t1tlY A1TH. 'J)wvd, ~
Faml~ ExemplJon: (If decedent" address ~ noll/1e same a. claimant'., al1acl1e,pIanabonJ
Claimant
7 5. frlJ
Street Address
City Slalo Zip
Relalion>hip of Claimanl to Oecedent
4, Probale Fees
5, Accounlant'. Fees
6, Tax Relum Prepare(. Fees
7, i&14l f311(Te ~ppiUISt:i- ,,,
1~e Af'PA 'Sir(, fillt'lo-
,'I W fl1A III> ~T'
f'11~~t.1O ~ IoJ I 'P"J
Ft.,m. ,J L"rte~' of A~"""
~Ho~ e.e.l./ff'c.ATeS
1. 1. '5' . rl
1D.0-0
'l.~
TOTAL (Also enter on line9, Recapirulalion) S b"1 ~O , eft.:,
(If more space is needed, insert additional sheels of the same size)
--'-."- .......,.."c."...,_:'_._.,'
,
'1
I
,
,
i
j
I
I
i
/5 /,' J .' ~() a..u-
-,:):;-y. /(p-/(-
nURr:AU or UfIlIVIIlUM. IA~I" flJ7-1'!
IHIU"IIIHU lAM lllIJP,IllH
11I1'1. ;'t.O"lll
IIA~"I ~;I\lIlln. 1''' III,'" 01.111
COIU10UWEAL' II OF I'ErmSYLVA'UA
IlEIWlTIU;lH OF REVENUE
(/
o. ~00!1'
~" ,'/:'('<,.(./1
r;1~\Q?l~,\~
t5:~~"'~''t,~~
''''flCr: ur: IIU1UIlIMIr.I lAX
^1'1'll^I~)ll11fl', AlIUWAUCI: ON Ul:-.AltOWAUC[
or III nUll JUU5 f,un ^~~I:;~IH HI tlI lM(
U, IU' II a" II''''
0(,-30-;>001
MOIlAlll
06-06-1995
;>\ '}6-065;>
CUMOERloAll1l
101
I~: ~_-.=:~~~n~~U"~~IUd .'_~~j
MAKE CHECK PAVABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAIlD CO COURT 1l0USE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR VOUR RECORDS --
iiE'v=i.!;'4'j-Eif-Aj:i'--nFoi'-'--N07'icE--OF-YNHEifiiiiN'CE-TAi(A-PPRAiSEHEN,.-,--ALDlWANCE-ifFi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
DOrlALD F FILE NO. 21 96-0852 ACN 101
ROBERT J MOIlA TlI
(,04 II 6T11 ST
DEliVER
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTV
ACN
DOIlALD
F
PA 17517
ESTATE OF MOIlATll
DATE 04-30-2001
TAX RETURN WAS, (X I ACCEPTED AS FILED
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGWAL RETURN
1. Real Estate ISchedulo Al
2. Stocks and Bonds ISchodule 8)
3. Closely ttold stock/Padnorship tntorost (Schodulo C)
4. Mortgages/Hotos Receivable ISchedule OJ
5. Cash/Bank Deposits/Misc. Per~onal Proporty eSchodule EJ
&. Jointly Owned Proporty ISchedule FJ
7. Transfers ISchedule GJ
8. Total Assets
NOTE: To insuro proper
credit to your account,
SUbMit the upper portion
of this form with your
tax paYfllont.
(1)
12J
(3)
f4)
(51
(6)
(7)
26,000000
000
000
000
.00
000
000
(81
26,000.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adlll. Costs/Misc. Expensos eSchedule Iii
10. Debts/Mortgage Liabilities/Liens ISchodule II
11. Total Deductions
12. Not Value of Tax Return
13. Charitable/Govornnental Beque~ts; Non-olected 9113 Trusts (Schedule JJ
14. Net Value of Estate Subject to Tax
(91
(10)
6,720.46
716095
(11)
1121
(13)
(14)
7.437 41
18,562059
.00
18,562.59
I
\
,
i
i
If an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will
reflect figures that include the total of Abh returns assessed to date.
ASSESSMENT OF TAX:
15. A~ount of Lino 14 at Spousal rate elS)
1&. A~ount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Lino 14 at Sibling rote (17)
18. A~ount of Line 14 taxable at Collateral/Closs B rato (18)
19. Principal Tax Duo
T~~H~~P~' ilmTl"
DATE NUHBER
03-02-2001 AA478098
NOTE:
000
18,562.59
.00
.00
X 00 = .00
X 06 = 1.113.75
X 00 = .00
X 15 = .00
(19)= 1.113.75
CO H t
INTEREST/PEN PAID (-)
450.12-
AHOUNT PAID
1,563087
\
I
1
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
1,113.75
.00
.00
.00
--~
....,
IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATIDN OF ADDITIONAL INTEREST 0
R[S[RVATlOH: [Shltus of docndonh dylnu 011 or hoforo DUcl/lll1or 11, llJl\l -. If nllY futuro lntorost In tho uStllt.. Is tr"nsfurrod
In I'oulI5.lon or onJlIy_nnt to Clnn B h:ollatornl) IliIllollcll1rlo. of Ih.. tlncodont nUor Iho o.llplrnllnn of llny uslnt. for
life or fur ye"r., tho Con_nllwonlth horoby o",rossh rosorve. tho rhlht to "I'f,r-Ihe IInd IIS'oss trmn,fllr 'nhorflnnco Tn.ll.'
ftt tho lawful CllIss B Icollntorlll1 rilto on ilny slIl,.h luturo Inturnst.
PURPOSE OF
HOTlCE: To fl4lflll tho rU'lulrononh of 50ctlon l140 of tho Illhorltmleo .1I11.! [stnto T,llc Act, Act 15 of ;'000. IlZ ,1,5.
Suction ')140),
PAYH[Hh Detach the top purtlun 0' thl, Notice ilnd luhn1t with your 1,.,ynol1t to tho Roulst"r of Wills Ilrlntod on tho rover so slelo.
--Hako chock or "OllVY ordor p,wnble to: REGISTER or HILLS, AGENT
RHUHD (CRh A rolund 0' a tnlC crOltlt, which WitS nut rC>fJuntnd on tho tnlC Poturn, ",IY 110 rO'lllostod by cunl,letlng fin "Application
for Refund of POlln.ylvanl" Inhorltnllco 'Ind [st..to T"lC" OU:V-IlI3I. Appllclltlons nro i1vnllnhfo ftt tho OHlco
of tho Roahtor of Will., Any 01 tho 21 Rovelluo DIs.trlct Olllco., or by call1n!J tho sjJoclol 24-hour
lM15Wer1ng survleG lor fOrlll, ol"dorlngl l-eOO-16Z-20~01 snrvlcdS ror t.lllrilyurs wllh spuclnl hOdrln!) mid I or
Ipollkl~ nood.: 1.800-441.1010 (TI onlyl.
OBJ(CflONS: Any party in Interost 1I0t snllsllod with tho AI'rrllhonllllt, allQwilnclI, or dh..llowtllle.. 01 docluctlon., or oS50sSlllont
of tnlC (Includlnll discount or IntorQsU "s s.hown on Ihls Hotlco nust ullJoct within sixty (60) dily. of reeolpt of
this Hollco by:
nwrltton protost to Iho PA Dopltrtnltnt ul Rltvllnu.., 80tlrd of AI'pllah, 001'1. 181021, 1I.'Irrlsburg, PA 17128-IOll, OR
--olectlon to have tho n.,ttor dotAr.lnnd ilt "udlt 01 tho Ilccount of tho l>orsoll.'Il rltprosontatlvo, OR
--oppanl to Ih. Orphiln.' Court.
iDHtN.
[STRAflVE
CORREC' [ONS:
factual orrors dheovArod on this I1ssoss.ont should ho ,-..ddrouod In writing to: PI, Dnpartnont of Ravonuo,
Buroau of tndhddu,,1 T""0S, AnN: Post Assoss.ont Rovl.." Unit, Popt. 180601, lI.urlshurg, Pi 17128-0601
Phono (111) 781-6~OS. 500 r"ge 5 of tho booklet "Instructions lor Inhorlt.,neo Tluc Roturn lor II Rosldont
Docodfllnt" (REV-IS01) for nn o.llplnnatlon of I1dnlnlslr..tlvnly corrocl..blo ortors.
DISCDUHfl
If ony In. duo Is paid within throo (3) cnlenddr lIuntlls nltor tho docodo"l". dQath, 0 flva percent (5%) discount 0'
tho talC PRld is allowod.
PENALTY:
Tho 15;( tax anno.ty non-participation ponalty is conputed on Iho totnl of tho hllC dnd inter..t 8"...od, i\lId not
paid b,'oro January 18, 1996, the first day altor tho end of tho to1lC n..nosty porlod. fhll non-participation
ponal ty is npponlllbht In tho .u..o Mnuot nnd In tho tho sa..e tI.... period A' you would Rppoal tho tnlC bnd Intoro,t
that hft. heon assossod ns Indlcntod on this notlc..
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IHTERESTI
Int.ro.t 11 chargod bog Inning with first day of dollOlIUfmCy, or nino (')1 ..onth. and one II) day Ira.. tho date of
doath, to thlt data of pay...nt. TolC", ..hleh bocnll. dellnquont beloro JAnuary I, 1982 hOilr lntora.t at Ifll rata of
.Ix (11:0 porcont por nMU. calculated ot a dally rato of .000164. All lolCo. ..hlch bocnn, dollnquent on nod nltor
JN1uary 1, 1982 will boar Intor.,t at II rato which will vary Ira. cnlondM yonr to calonrl.lr yoar wlth that rat.
aMoune,d by tho PI, Deportnont of Rovonuo. 1ho npJlllcnblo lnterost tales lor 1982 through 2001 ar"l
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Year Intorest Rot.. Daih Intor..t Factor Voar Int.rest Rate Dftlly Intorost Foctor
1982 20:C .000548 11)?Z 9X .000247
1983 l6X ,000438 11)93.1')')4 7X .000192
1984 llX .000l01 1'J95-1,)98 9X .000247
1985 U:C .OOOl~6 11)99 7X .000192
11)86 10% .000274 2000 ax .000219
1987 9X .0002~7 ZOO 1 9X .000247
1988.1991 H:C .000l01
--Intorest Is enleulatod ns 101l0wII
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INTEREST = BALANCE DF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACl'DR
~.Any Hotlco luuod aft.r tho talC: boco..s d.lInquont will r..floct an Intor..st cnlculaUon to fifteen (15) days
boyond tho dato of tho au,....'nt. 11 pay.ont Is .1Ido oltor tho lnt.rest co.putatlon datil shown on tho
Hotlco, additional Inloro.t .u.t be calculatod.
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U.S. Postal Service
CERTIFIED MAIL RECEIPT'
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j' lIem 4 II ROSlricted Delivery Is desired,
1 · Print your name and address on the reverse
I 80 that we can return tho cord 10 you.
I · Attach this card to tho back 01 tho mailploce,
i or on the lront If spaco permils,
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D. Is delivery ass dlff8f8l'l1 from 110m 1?
If YES, enter defrvery address below:
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Cllnsured Mail
CJ Express Mall
CJ Return ROC:eipt for MerC:Mndise
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4. Res1ricted Delivery? (EMtm Fee) CJ Yes
20 Article Number
(Transfer from service label)
PS Form 38110 March 2001
10()1-;;-S.IO -0006 - 5"e-Ioc7l-:l '16'6
Domestic Return Receipt 102595.()1'''','.2.
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