HomeMy WebLinkAbout96-00918
WARNING: IT IS ILLEGAL TO ALTER THIS COpy OR
TO DUPLICATE BY PHOTOSTAT OR PllOTOGHAPH.
COMMONWEAlnt or rfNNsn VANIA
()[PAnTMUH OF Il[AUtl YIU,- fUr-onns
LOCAL REGISTRAR'S CERTIFICATION OF DEAHl
CERT. NO. 3210067
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ncLober 16, 1996
!)...:"i;i\.,;7:",-f'::;~;:-;~
Clm'l C5 H
Name of Decedent __n .,_______'.._____.,._.n' .., ."m -....
..,,, V 1'"
Male 201-18-2670
Sex -SepC.2!l-;T92~ocial Security NO-----Ru~Y.L~~~~.-r;A--.
Date of Birth ______ Birthplace...__________._________.__.___________.
Carlisle Hospital, Carl isle, CumlJerlanq County,
Place of Death --------.
. J.( ''"', t....... l ,;..~'.. t, 1I(}'''d~'' ')' tp..M.""1
CaucasIan Truck Driver
Race Occupation. ___.__._'__ Armed Forces? (Yes or N~
Marital ~~:;u~e~______ ~~~I~~;~~dress 1280~~I~~_~.ane_,.~e:ha~i C.sbur9, PA.
Melonay C. Oi lie,' ,,,..~, ....... c'"'' "00
Scolt O. Brenneman FO 012975 L
Informant Funeral Director -
Name and Address of
Funeral Establishment
___._____lJiJ.ler.....5r..---
\.u'
Date of Death
'0/15/1996
PennsyJvania
s'"..
Cock I in Funera 1 11111110, 30.1!,. Ch!!.stnut
SJ... ..Jlills bu I:g '-pjLjJ(ll!l
Inlerval Between
Onset and Death
Part I: Immediate Cause
Cnnges l. i ve lIea,'l Fa i lure
(a)
Hena I Fa 11 ure
---..---.-.--------
(b)
nCllte /lnlerior r'lyocardial Infarclil1n
---------------..- ----
,
.
-.-:..--l) i a be t e s
(c)
(d)
Part II: Other Significant Conditions
Manner of Death:
Natural t\
Accident 0
Suicide 0
Describe how injury occurred:
Homicide
Pending Investigation
Could not be Determined
o
o
o
11"1"11d J. KOl'acs, '.I.Il.
Name and Title of Certifier
Carlisle Hospital, Carlisle, PA 17013
(M.D.. D.O.. Coroner. M.E.)
Address
This is to certify that the information here given is correctly copied from an original certificate of
death duly filed with me as Local Registrar. The original certificate will be forwarded to the State
Vitel Records Office for permanent filing. II . _' /';,
,I} I . /~ /!. / / ./~:;>
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nclober 16, 1996
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21 - 96 - 918
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OF
CHARLES H. DILLER, SR.
BE IT REMEMBERED, that I. CIIARLES II. DILLER, SR., of 1280 Alma Lane,
Mechanicsburg, Monrue Township, Cumberhllld County. Pennsylvania. being of sound
mind, memory and understanding, do make. pnblish and declare this as and for my Last
Will and Testament, hereby revoking and making null and void any and all Wills and
Testaments and writings in the nature thereof by me at any time heretofore made.
ITEM I: 1 direct that my hereinafter named Executors pay all my just debts, my
funeral expenses. and the expenses of the administration of my estate. With this direction.
1 authorize and empower my Executors to expend for my funeral expenses and interment
such amounts as they may consider necessary and proper, without regard to any limit that
may be prescribed by a court of law.
ITEM 2: 1 direct my Executors to pay all inheritance, estate, succession, and legacy
taxes of whatsoever nature and kind, to which my estate. or the transfer of any property
passing hereunder or otherwise passing by reason of my demise, may be subject, and to
charge such taxes against my residuary estate, it being my intention that none of the
aforesaid taxes, either federal or state, on any property required to be included in my gross
estate, under the provisions of any state or federal law now in force or hereafter enacted,
shall be prorated among the persons interested in my estate to whom such property is or
may be transferred or to whom any benefit accrues.
The preceding instrument, consisting of this and two (2) other typewrillen pages, was
on the day and date thereof signed, scaled, published, and declared by the Testator herein
named, as and for his Last Will and Testament, ill the presence of us, who, at his request,
in his presence and in the presence of each other, have subscribed our names as witnesses
hereto'L~h
{,~~ h,.~
OF
Kl rPc6-. I ~
1/
OF
I tt.l.J'~7' f'~.
COMMONWEALll-l OF PENNSYLVANIA
COUNTY OF YORK : / / / .
r /We, CljARLEY'I1. DILLER, SR., din; c;4i(tItA~;; and
",,)(jU1tt JII. 01~ the Testator and the wltnesses, respectively, whose
names are signed to the allached or foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testator signed and executed the instrument
as his Last Will and Testament, and that he signed willingly, and that he executed it as his
free and voluntary act for the purposes therein expressed, and that each of the witnesses,
in the presence and hearing of the Testator signed the Will as witnesses, and that to the
best of their knowledge, the Testator was at the time eighteen (18) years of age or older,
of sound mind, and under no constraint or undue influence.
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SWORN TO AND SUBSCRIBED
BEFORE MKTHIS 1..:;..-01 DAY
(<?f .' ,,-.I~.ml'eu:1995.
, t, J;t
TARY PUBLIC
I
NOlanal Seal
Janel S. Gore. Nolary Public
D<llsbu'Q BOlO, York Counly
MV CommiSSIon Expires Oct 25. 1998
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STATUS REPORT UNDER RULE 6.12
Name of Decedent:
CIIARI.ES II I) II.I.EI(' SR.
Date of Death:
10/15/%
Will No.
2196-0918
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes xx No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
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 No xx
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes xx No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be :ttj1hed to this report.
Date: 08/2/97 / M
s~at:~re
1m Il SCIIRACK. III
Name (Please type or print)
P 0 \lOX ) I 0
D[I.I.SllURG PA [70[9
Address
.~-....J
( 717) 432-9733
Tel. No.
Capacity:
Personal Representative
(MAH: rmf/ AM3)
xx Counsel for personal
representative
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CAB
H P L
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C R C
K 0 K
P S
"ev. HiOO[X t{7.94)
1~--/..i(I-f
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS
coutHlCOn(
rOltnAlr~ or OtATIl Arlen lZ/ll/'l1 CIIECK utilE
I' A~iI'OU!iAl L.D
f'O....IIHYCll101l1~cl^"~ro
FILE NUMBER
COMPLETE MAllINGAOOIl[55
11m. D. Schrack, III Esqulro
124 II. Harrlsbure Streot
Dillsbur' PA 17019.0310
lU,lJlJU.UU
None
None
None
1.2/.2.50
None
Nono
10,888.03
35/, ./,7
(11) 11 ,2/,2.50
(12) 0.00
(13)
(14) 0.00
X : 0.00
X .06 : 0.00
X .15 : 0.00
(18) 0.00
Inlercst
Melonay G. Illller
1280 Alma Lana
M-;"';I;;l;;l~;;i,',;r .;: 'I;t," 'i'/Ci55.......................
11m. D. Schrack, III Esquire
~f!~. ~:.}!~lF.~! ~!>'~~('" .~~~.".<:~.......................
Dlllsburr" PA 17019-0310
co...~P~XI,~~~ '\ 9ft~fNfIl~l'""
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OCCCO[Nr'S NAME (LAST. fIRST. Mm MIOOl[ IWIIALI
Dillor Jr. Gharlon I!.
occrOENT'SCOMI'LCI( AOOR(55
1280 Alllla LallO
Meehan IC~ibl1rB I PA
20. If L1no 19 is greater than lino 18. enler the dillerenco on lino 20. This is the OVERPAYMENT.
~ 0 ICheck here" you are requesllng a relund 01 your overp.yment.!
21. lllino 18 is groalor th.m lino 19. ont!!r tho dlll!!Ience on tin!! 21. This is the TAX CUE.
A. Enter the interest on the balance due on Line 21A.
B. Enler Ihe tol.1 01 Line 21 and 21A on Une 210. This is the DALANCE DUE.
Make Check Pa .ble to: Re isler 01 Wills. A enl
.. .. BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ~ ~
Undo, pelNIIIClSol pelljury.l deel,lIo tholll hol~1I C.llmlncd thiS lelurn,lnc.tutJinlj olCCOnlpolln/lr'llJ SChCUlllc's "lid 5.lill<<-,"II-,"ls, 1100 to Iho besl 01 my knowledge olnd ballet,lt Is IIUO,
COUK' 100 compl'I',I dt'(lilllllhilllllloill 0,1.10 h.n beonlepoll~d olIllluo nlil,ktll villuo. Oecl"'ilUun 01 plt'piI't'f olhl't lholll1lhe pcnan.al U!Jullsont.tlvo Is boIsodon III Inlolm.allon 01
which Plop.ate, has Iny knO'o'loledgo.
OAlr Of UlIHIi
DATE OF DEAltl
10/15/1996
SOCIAL SECURITY HUMl1ER
201-18-2670
09/28/1925
CUlIIborlnnd
Cuunl,
:iOCIAL ~[Cunlt'( tlUl.4u[n
~F APPLlCAOLEj SURVIVING SPOUSE'S t4AME (LA51 ,f1n5T APlO MIOOLE ItllHALI
Dillor Mololln G.
X 1. Original Ralum
4. Llmiled Est.le
C P
o 0
R N
R 0
E E
S N
- T
2. Supple menial Relum
4a. Fulule Inllne~t Compromise
(lor dales 01 de'lh .Iler 12.12.021
[R] 6. Decedent Died Tosl.lle D 7. Decodent Milllll.,illed OJ UVlIlIJ Tlu!.t
(AlI.ch co 01 Will) (AlI.lOh " cop 01 Trust)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD DE DIRECTED TO:
05.
() o.
NAME
11m. D. Schrack II I ESI .
IELEPHONE HUMOER
717 /.32-9733
I. Real Est.te (Schedule AJ 1
2. Stocks and Bonds (Schedule BJ (2)
3. Closely Held Slock/Partnership Inleresl (Schedule CJ (3)
4. Mortg.ges and Noles Receiv.ble (Schedule 01 (4)
5. Cash. Bank Deposils & Miscell.neous Personal Properly (Sch EJ (5)
6. Joinlly Owned Property (Schedule Fl (6)
7. Transfers (Schedulo GJ (Schedule Ll (7)
8. Total Gross Assets hOlallines 1-7)
9. Funeral Expenses. Administrative Co!>ts. Miscellaneous
E'penses (Schedulo H)
10. Debts. Mortgage Liabilities. Liens (Schedule I)
II. Tol.1 Deductions (total Linos 9 & 10)
12. Net Volue 01 Esl.te (Line 8 minus Line 11)
13. Charitable and GovcrnmcntalBaquesls (Schedule J)
14. Net Value Sub'ectlo Ta, (Une 12 minus Line 13)
15. Spousal Transfers (lor datos 01 de'lh aller 6.30.94)
Sea Instructions for Applicablo Porconlago on page 2.
(Include values from Schedule K or Schedulo M,)
16. Amount of Line 14 lilll:ablo at G'I. rata
(lncludo values from Schedule K or Schedule M.)
17. Amount of Line 141axablo .1115". rale
(Include valuos from Schedulo K or Schedule M.)
18. Princip.lt.x due (Add lax from Line IS. 16 .nd 17.)
19.Credits/Sp Paveny Prior PaYn1C!nts Discounl
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SIGNATUnE OF PER50fl ntsPOt4SIDLE FOnflllNG REI URN
~)')
2196-0918
Y[An
HUJ.40[R
17055
A~OUN' "tCCIVCOlstt INstRUCTION:;)
0.00
Remaindor neluln
(lor dates 01 doalh prior to 12.13.82)
Fedoral Estalo Tall Rolurn Roquired
Tol.11 Nu,nbef 01 5.1'0' Doposit Do.e5
(8)
11 ,2/,2 . 50
(19)
(20)
0.00
0.00
(21)
( 2tA)
(21B)
0.00
0.00
0.00
DAlE
7/'L/r; )
DAtE
}~
Fo"'~ ~l9')
"- u.s. O(rAllJMCrH or IIOU51"0 an.1 UJIOAN ()(V(LOJ'U[uI QUO Uo. 2~1-0n5
SEllLEMENI :i1^1EM[N! 11111NtO
WM. D. SCHRACK, III l....,....
ATTORNEY AT LAW II. lYrE or LOAN
124 West Harrisburg Slreet 1.11"'" 1.'IIMIIA 3-llcom.uw":f,
P.O. Oox 310 q IVA '.IICOtN.I"~.
Dlllsburg, PA 17019 G,rtt.[NUl,IIIW I P.lOA""UUU[fl:
nn4
Phone (717) 432-9733 Fox (717) 432-1053 e. MOIIJ . III!;, CA~t flU:
C. NOTE: nllslolm Is turn/shad 10 Oiv.)'Ol.' a IlnlomOllI nlllclu"llolllomonl CO",. Nnounll pnkllo and by Iho solllomonl "oonllll. .llO'lm. lIoms mAlhd
O{p,o,C.)'WOfO p.,id outsido Iho cllninU: thoy A/Gshown 'U)/O for InfOlml1llon"t flurposos Md ntonollncludod In Iho lolllls.
O. HAM( NKJ AOUfl(fi!; Uf 1I0lUIOWlll [,,,.w( ^,lUAOOII[~50ru.U[1I r. flAM( NIOAOOfl[r.:;or U'lfXlI:
r,nrry E. Elicker J~Gli1t:o oC
Terri L. Elicker Churloo II. Diller, Sr.
O,rnOrtnIYlOC"IION: II. !.(lllCUWl AGCNI: I. SeTtLeMeNl OAI[:
Dillsburg, PA 17019
3 Ac/Whiskey Spring Rond Jane M. Alexnnder 05/05/97
Franklin TOWNSIIIP I'lACEOFficnlELlCNT:
YORK County 124 W. IIbg Streot Dillsburg PA 17019
J. SUMMARY OF DORRoweR', TRANSACTION: K. SUlruunv OF SCLLEn's TnAN!lACTION:
100 aROSS AYOUNT DUE FnDM DORnOWEn coo,anoss AYOUNT DUE TO seLLER
101. ConUllcllnlOI plieD >uuuu.uu cOl,ConlfacllAlos plica ~UUU(J.UU
lot, POfson.' pfOPOIly co1.l'Oft'Jnlllploporly
1113, Selllomonl chnrgos 10 b<",owof (IIno 1400) JJ.:J. '01
lOCo COt.
'" ....,
^dlUSlrnlJlIlS lor limns pAId by tolltlllfl ntJvnnco ^d/llSlmonls lor dum, paId by 10110' in ndvanco
1000ClryfTownl" I. t06 CU1flown 1.111 ..
IOP.Countyl" ,. cor.CounI, Iou ,.
101. Allo"menll I. toe,Anonrnonll ..
lot, Sthool ,. to'). Sthoat I.
". I. ". ..
Ill. "I.
Ill. tll.
110 anass AUOUNT DUE FRaU DonROwtn 10315.00 4I'o.aROS' AMOUNT DUE TO ULLtR 10000.00
* AYOUNn PAID 8V OR IN BEHALF OF BORROWER UIO.REOUCTlOHS IN AMOUNT DUE TO SELLEn
2'01. DopolIl Of oarnoll monoy >uuu. ull.e.lCOSS dOPOSIl (sco Instruclions)
2'Ol. P,lnclpal amounl 01 now Io:mh) IoIll,SolUomool ch:tlgCI 10 10UO' lllllo 1400) .~O
IOJ. blsli'lg IoM(I) IBkon lubjoellO tmE.liSlinQ Ionn(s) IBkon SubjocllO
.... foOt '101)'011 01 Finl MOllgago LOM
... !H.1'Olyoll 01 ~ocond MOII{J:t(JO Loan
... "",
lOr. !.Or. ..
... ....
lOt. ....
AdlUSlrnonls lor lIoms unpaid bV 101101 AdJllSlrnonlslof iloms unpaid by 101101
llo.C1tyfTownlu ,. S1o.CllyfTown... I.
1l1.County... I. '11.CountylJ. I.
'".AU.llmonll .. '".Allournonlt ..
,,1. Scllool .. .. 111 School ..
114. '14.
"' ...
"' ".
lU, IU',
"' ...
'" 50".
no. TOTAL PAID DYtfOn DORROWER 1000.00 (,10. TOTAL REDUCTION AYOUNT DUE SELLEn 162.50
:)00. CASH AT SETTLEMENT FAOU on TO DOnnOWtR GOO,C,UII AT SETTLEMENT TO on FnOY SELLEn
Jell, Groll DmOUnI duo !rom borrowoI (bno 1&'0) >UJ. ~. col.Gross MIOOf\I duo 10 sailor (1100 420) >UUUU.UU
)O',lllS amounl paid by/lor bouowor (hno ml .uuu. IOI.Loss 'lXIuclion M'lOUnI duo lollot (Iino 520) .~O
:101 CASIlIOCl FnOIl) II J TO) DonnOWEn 9315.00 t,olCASlIlOO TO) U I FROU) SELl[R 9037.50
0lIy0r Of DouCl'WOf" ~gnllur.
!:cDoI'.~gnal\lt.
11UO.11loY, UBI
.,
nEV. 1511 EX , (7'''1
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
COM~N\l\Y~4~moo~lhY.NI.
ESTATE OF
Pl.... Print or T .
FilE NUMBER
2196-0918
Charles H. Dlllor Jr. SS 201-18.2670 10 15 1996
ITEM DESCRIPTION
NUMBER
A. Funelal Expenl..:
1 Cocklin Funorol Home
B.
Admlnl.trallv. Co. Is:
Personal Representative Convnissions
Social Security Number of Porsonal Representative:
Vear Convnlsslons paid
1.
2.
Attorney Foes
11m. D. Schrack, III Esqulro
3.
Family Ex.mption
Clalmanl Me1onoy C. Dlllor
Addr.ss 01 Claimant al doeodenl's doath
Street Addr... 1280 Alma Lane
City Mechanlcsburp,
Stalo PA Zip Codo 17055
Relationship
Spouse
4.
Probale Fees
Register of \lills
C.
Mlseellan.ous Exponses:
Daisy S. Ohrum . appraisal of woodlot
1
2
Recorder of Deeds . filing Release
3
Register of lIi11s of Cumberland County . ancillary administratio
4
Register of lIi11s . filing fee
5
Register of lIi11s of York County . file ancillary administration
6
Reserve for future administrative expense
7
Transfer tax. sale of woodland (see HUD-1)
TOTAL (Also enler on line 9. Recapitulation)
(II mar. 'p'co Is neoded. Ins.rt.ddillon.1 .heels of sarno size.)
Copy,lght (c) 1994 form IOftwI'. ant'( CPSyslrms.lnc.
AMOUNT
6,500.00
1,120.00
2,607.53
47.00
175.00
14.00
39.50
15.00
20.00
250.00
100.00
$ 10 888.03
Form 1500 Sch""" H In... 7.")
. .
nEV. IIIJ EX , (1.171
SCHEDULE J
BENEFICIARIES
CO"~H'qfi!iL~~'WOO~r'l\"HI'
ESTATE OF
Charles
ITEM
NUMBER
ITEM
NUMBER
FilE NUMBER
219&.0918
H. Diller Jr.
55 201-18.2&70
10 15 199&
AMOUNT OR
SHARE OF ESTATE
NAME AND AODRESS OF BENEFICIARY
RELATIONSHIP
1
A. Taxable Baquests'
Charles Daniel Diller
532 Mountain Road
Boiling Sprlngs, PA 17007
1/& woodlot
proceeds
Son
2
Charles H. Diller, Jr.
52 Obsidian Drive
Chambersburg, PA 17201
Son
1/& woodlot
proceeds
3
Melonay C. Diller
1280 Alma Lane
Mechanicsburg, PA 17055
Spouse
residue of
estate
4
Russell Eugene Diller
2405 County Line Road
York Springs, PA 17372
Son
1/& woodlot
proceeds
5
Steve Ernest Diller
75 N. Union Street
Son
1/& woodlot
proceeds
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Govornmontat Boquosts:
s
TOTAL CHARITABLE ANO GOVERNMENTAL BEOUESTS (Also onlo' on Iino 13. Rocapitulation)
(II moro space is needed, insert additional sheets 01 sarm size.)
COp)'llgh1 (e) 199~ form sollw'J' ontt CPS~I'ms, Inc.
0.00
Form 1500 Schldul. J (n..d.l7)
1U"'a~t Jltnll cutO QIl\l,tanl~ttt
OF
CHARLES H. DILLER, SR.
BE IT REMEMBERED, that I, CIIARLES II. DILLER, SR., of 1280 Alma Lane,
Mech;lI1icslJllrg, Monroe Township, Cumberland County, Pennsylvania, being of sound
mind, memory and understanding, do make, publish and declare this as and for my Last
Will and Testament, hereby revoking and making null and void any and all Wills and
Testaments and writings in the nature thereof by me at any time heretofore made.
ITEM 1: I direct that my hereinafter named Executors pay all my just debts, my
funeral expenses, and the expenses of the administration of my estate. With this direction,
I authorize and empower my Executors to expend for my funeral expenses and interment
such amounts as they may consider necessary and proper, without regard to any limit that
may be prescribed by a court of law.
ITEM 2: I direct my Executors to pay all inheritance, estate, succession, and legacy
taxes of whatsoever nature and kind, to which my estate, or the transfer of any property
passing hereunder or otherwise passing by reason of my demise, may be subject, and to
charge such taxes against my residuary estate, it being my intention that none of the
aforesaid taxcs, either federal or state, on any property required to be included in my gross
estate, under the provisions of any state or federal law now in force or hereafter enacted,
shall be prorated among the persons interested in my estate to whom such property is or
may be transferred or to whom any benefit accmes.
I.'} / ;", ' . j)
. , ,
COHHONWEALTH OF PENNSVLVANIA
DEPARTHENT OF REVENUE
BUREAU Of INDIVIDUAL IAXES
IHULAI IANC[ UII DIVISIUN
DLPI. :1101101
IlANAISlUNC. PA 111;'11.0.01
NOIICE Df INItERJI ANCE lAX
APPRAISENENT, ALLDWANCE OR OISALLDWANCE
Df DEDUCTIONS AND ASSESSNENI Df lAX
WIllIAM D SCHRACK III ESQ
124 W HARRISBURG ST
DllLSBURG PA 17019
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
p.
10-21-97
DILLER
10-15-96
21 96-0918
CUMBERLAND
101
Anou"t Rallllt hd
c.
~.~
t1,.lhl III" 111.111
CIIARlES
II
MAKE CHECK PAVABLE AND REHIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiE"v:is'(jj-EiCiiFP--iili-:m--NOTicE--OF-YNHEiiiTAiicE-;:"AX-A-PPRA-isEH€N,.-,--iii.i:OWAiicE-ijR'm__m_m__m
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DILLER CHARLES H FILE NO. 21 96-0918 ACN 101 DATE 10-21-97
If an assessment was issued previoUSly, lines 14, 15 and/or 16, 17 and 18
reflect figures that include the total of abh returns assessed to date.
ASSESSMENT OF TAX:
IS. Amount of llna 14 at Spousal rat. (15)
16. A.aunt of llna 14 taxable .t Lin..l/Clall A rat. (16)
17. Amount of Lina 14 taxable at Call.taral/Clasl 8 rat. (17)
18. Principal Tax Due
TAX RETURN WAS. (X) ACCEPTED AS fILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rod E.toto (Schodulo A) ll)
2. stocks and Bonds (Schedul. BJ (2)
3. Closely Hald stock/Partnership lntara.t (Schedul. Cl (3)
4. Hortg.Del/Hota. Raceivable (Schedule DJ (4)
5. Cash/Bank Deposits/Hisc. Personal Property CSchedul. E) 15)
6. Jointly Ownad Property ISchadule F) 16)
7. Transfars ISchedule G) 17)
8. Tot.l Auets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expens.s/Adn. Costs/Hi.c. Expense. (Schedule HI 19)
10. Dobt./Noctgogo llobllltlo./llon. (Schodulo I) (10)
11. Tot.l Daduction.
12. Het Valu. of Tax Return
13. Charitab1e/Govarnaent.l aequests ISchedule J)
14. Het Value of Est.t. Subjact to Tax
NOTE:
TAX CREDITS:
PAYNENT
DATE
RECEIPT
NUNDER
DISCOUNT (t)
INTEREST/PEN PAID (-)
( ) CHANGED
10,000.00
.00
.00
.00
1,242.50
.00
.00
IB)
10,B88.03
354.47
(11)
ll2)
ll3)
ll4)
.00 X .00=
.00 X .06=
.00 X .15=
llB)
ANOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
NOTE: To insure proper
credit to your account,
subnit tha upp.r portion
of this forn with your
tax payn.nt.
11,242.50
11 ,?4? ~O
.00
.00
.00
will
.00
.00
.00
.00
.00
.00
.00
.00
. If PAID AfTER DATE INDICATED. SEE REVERSE
fOR CALCUlATIDN Of ADDITIDNAL INTEREST.
( If TOTAL DUE IS lESS THAN '1, NO PAYNENT IS REQUIRED.
If TDTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU NAY BE DUE
A REfUND. SEE REVERSE SIDE Of THIS fORN fOR INSTRUCTIONS.)
RESERVATION I E.t.t.. of dlcldlnt. dylna on or blfor. OICI.blr lZ, 198Z -- If any futura Int.r..t In thl I.t.tl I. tran.farrld
In pO..I..lon or enJoyaant to Cle.. a tcollet.ral) blnlflclarl.. of the d.cld.nt aft.r the .~plr.tlon of any ..tatl for
Ilf. or for YI.r., thl Coa.onwlelth hareby e~pre..ly rl,lrVI. the right to ,ppral'l and e"I" tran.fer Inherltancl Ta~"
at tha lawful Cle.. a (coll.t.ral) rat. on any .uch futura Int.ra.t.
PURPOSE OF
HOTtCEI
To fulfIll the raqulr..ant. of S.ctlon ZI~O of tha Inh.rltancl and E.tet. Tex Act, Act 21 of 1995. (lZ P.S.
Sactlon 91itOI.
PAY"EHT:
O.tach the top portion of thl. Notlcl and .ubalt with your paya.nt to the A.al.t.r of will. prlntld on the r,vlr.. .Idl.
--"ak. ch.ck or aonly ordlr payabll to: REGISTER OF MILLS, AGENT
REFUND (CRI, " rlfund of a ta. cradlt, which wa. not rlqu..tld on thl Ta. Rlturn, .ay b. requ..tld by co.plltlna an "Application
for R.fund of P.nn.ylvanla Inhlrltancl and E.tat. T.." (REY-Illl). ApplicatIon. arl av.llabl, at thlOfflcl
of the R.al.t.r of Will', any of thl Zl R.v.nua DI.trlct OffiCI', or by calling the splelsl Z4~hour
an,wlrlna slrvlcl ~blrs for for.. ordlrlnal In P.nnsylvanla l~aOO~l6Z-2050, outsld. PI""sylvanla and
within locsl Harrl.burg ar.a (117) 7al-809~, TOO' (117) 17Z-ZZ5Z (H.arlna I.pslr.d Only).
OaJECTIO~: Any p.tty In Int.r..t not ..tl.fl.d with the apprall...nt, sllow.nca or dll.llowanc. of d.ductlonl, or all.s...nt
of ta. (Including dl.count or Int.r.st) e. shown on this Notlcl au.t obj.ct within .Ixty (601 day. of rlcllpt of
thIs Notlcl bYI
--wrltt.n protl.t to thl PA nlparta.nt of R.v.nu., Bo.rd of App..l., O.pt. Z810ZI, Harrl.burg, PA 17Iza-IOZI, OR
--.l.ctlon to hav. the aatt.r d.t.raln.d at audit of th. eccount of tha plr.onel r.prl..ntatlv., OR
--app.al to the Orphan.' Court.
\
I
I
ADMIN
JSTRATlYE
CORRECTIONS: Fectuel .rror. dl.cov.r.d on thl. e"".aent .hould b. eddr....d In wrIting to: PA OIPart..nt of A.venul,
aur.au of Individual Ta~I', ATTN: po.t A..I....nt A.vl.w unit, O.pt. Z80601, Harrl.burg, PA 171Z8~0601
PhonI (717) 787-6505. SII pag. 5 of th. bookl.t "In.tructlon. for Inhlrltenc. Ta. R.turn for s A..ld.nt
Oacld.nt" (REY-1501) for an a.plan.tlon of edalnl.tr.tlv.ly corr.ctebl. .rror..
DISCOUNT l
l' eny te. dul I. peld within thr.. (l) cal.nder aonth. aft.r tha d.c.dlnt'. d..th, a 'Iv. p.rcant (5X) dl.count of
the ta. peld I. ellow.d.
PENALTY,
The 15X ta. aana.ty non'pertlclpetlon penalty 1. coaput.d on th. totel 0' tha te. and Inter..t a..a..ed, and not
p.ld be'or. Jenu.ry 18, 1'96, tha flr.t day aft.r thl .nd of the ta. aane.ty p.rlod. Thl. non~p.rtlclp.tlon
panelty I. 89P..labll In the .eaa .ann.r and In thl the .... tl.. p.rled a. you would app.al the ta. and Int.r..t
that he. been ...I...d e. Indlcat.d on thl_ notice.
INTEREST,
Int.re.t I. chargld b.glnnlng with flr.t day 0' dallnqu.ncy, or nIne (,) .onth. and one (II day fro. thl det. of
dleth, to the dati 0' pey.ent. Ta~.' which b.ca.. d.llnquant b.for. January I, I,az ba.r Inter..t at th. rata of
.1. (6~) plrclnt p.r annul calculatad at . dally rat. of .00016~. All tax.. which blca.a delInquent on and .ft.r
January 1, 1,8Z will b.er Int.r..t at a rat. which will vary fro. cel.ndar ylar to cal.nder Yler with that rat I
ennouncad by thl PA Dap.rt.ent of R.v.nUI. Th. appllcebla tnt.r..t rat.. for 198Z through 1997 .r.:
!!!! Int.rast Aat. Dally Intlr..t FActor ~ Intlr..t Aatl Dally Intlt..t FltCtor
1982 ZOX .OOO~48 ItJ87 .X .000Z47
19U lOX .0004S8 1'988~1991 lIX .oaOSGl
198tt lIX .00OSOI 199Z OX .DDOZ~7
1985 U~ .OOOSS6 1995~I"tt n .0001,Z
1986 lOX .000Z74 1995-1997 'X .00DZ47
"'Int.rast Is ulcul.t.d .. follow. I
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
..Any Notlc' I..ued .ftlr thl tax becDla. d.llnqu.nt Mltl r.fl.ct an Inter..t Cllcul.tlon to ,Iftl.n Cl51 d.y.
bayond th. date of tha 11.....ent. If pay.ant I. .ade aftlr th. Int.r..t cosputatlon dati .hown on th.
Notlc" .ddltlonal Int.r..t .u.t b. calculltad.