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HomeMy WebLinkAbout96-01074 , , ~ -~ '0 CI) '5 1;; u.a '" , ~ ,0 Z'. " . '. -' /.:'.;- /,S-I - / :1.1-q (r / () 7'1- CO"""OHWUlltl 1lI P,HI4'iYI VANIA OlPA"IHEHI Of N(V(HU[ BUllE AU Of INDiViDUAL TAlliS DEPt. :aobol . tlAAIUSBURC, PA If..l 01101 ,~u r~~ INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO.21 ?6155273 11-21-96 ,", .~.I " ... " '\1 TVPE OF ACCOUNT PAUL E MAHON 7891 MOLLV PITCHER HWV SHIPPENS8URG PA 17257 REMIT PAYMENT AND FORMS REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 , SAVINGS CIIECKING ~-.~ ,." TRUST :x.; CERTlF . TO: EST. OF VERNA G MAHON 5.5. NO. 847-00-6696 DATE OF OEATH 10-08-96 COUNTY CUMBERLANO DAUPHIN DEPOSIT BANK & hIlS provided the Oepart...nt with the In'o,..,,\lol1 listed tlelov which hIlS hun used in calculating the potentlal hilt dUD. Thalr ,acordl lndlCl1ta lhot lit the dllath of the above Llacudqnt, you ",ar. ., Joint momar/benefidarY of this .ICCOUnt. If you '..1 thlt lnfnrlll'ltion II incornlct, 1110&18 oblnln written correction fll" the fln/lllel..l Inltltlltion. .,ttnch ,1 COpy to this for.. IInd 'Dturn It to ,t.. abO". <,ddr",ss. Jlds ",ccount Is tl1lti1hle In I'ICCOrl!i1,'f:lI wilh th. Inh"ritnnc. f,u l.IWS of the to....on....8Ith IIf PAnnsylyonla. WIjI.\lall. ...y u. <t:,.lOtI,..1J r,y .::./.lllg .111' Ini"e.H'. COMPLETE PART 1 BELOW Account No. 8100673365 M M M SEE REVERSE SIDE FOR Dolo 04-17-95 Established FILING AND PAYHENT INSTRUCTIONS Account aalanc. Perc.nt Texabl. Amount Subj.ct to Tax Rat. Pot.ntial Tax Du. 5,526.08 16.667 HOlE: If tax pay...nt. are "ade within 'hree 921.03 t!) I'anth. af th...4..ced.nt's d.t. af duth. .06 you aay d.duct .(3Jdlscaunt of the tax due. _ Any Inharltence tax due will beco.e delinquent 55.26 S J..:'J l...~nln. ICJJ .onth. aft.r the data of d..th. TAXPAYER RESPONSE FAILUR! TO R!SPOND WILL RISULT IN AM OFFICIAL TAX ASSESSMENT BAS!D ON THIS MOTIC! fo Insur. prop.r credit to your .lCcount, two 1;1 copieS of this notico nust .1Cco..pany your Pltv...nt to the ReQlstor of wills, "".... chack flavabla to: "RoQlst.r of Willi, Agant", K To. K PART [!] [CHECK ] ONE BLOCK ONLY A. 0 1h1i abo.... lnfornUon end tax w. Is corr.ct. 1. You ..y choo.. to re.lt pay.ent to the Regllt.r of will. with two coP I.. of thl. notlc. to obtain . dllcount or ayold Intera.t, or you .ay check box "'" and return this notlca to tha Ragl.tar of Will' and an official ........nt will b. II.ued by the P' Dop.rtaent of Reyenue. B. 0 The aboye auet hat baen or will ba report.d and tax paid with tM PlIfV11Y1"Bnle Inharlt.nc:. Tax return to be filed by tha dacadent's rapra.entatl...a. C. 0 The aboya InforaaUon 1,.~Jrcor,..ct and/or debt' and deductlon. wan paid by you. You wit coap1at. PART l!.J and/or PART (!] balow. OFFICIAL USE OMLY 0 AAF. PA DEPARTMENT OF REVENUE . PART ~ TAY lINE If you indic.ta a diff.r.nt tax rat., pl.... .t.te your rel.tion.hlp to decadent: DIl'TIIDN _ f"nWDII"'ATTnN 1. Ooto E.tobl1.hod 2. Account Balanc. 5. p.rc.nt Taxabl. 4. A.ount Subj.ct to T.x 5. Oebt. and D.ductlon. &. Amount Taxable 7. Tax Rate 8. Tax Dua T~'tl nM ,InTNTnal1otT Arr.nllMTot ?~!.' n" 1 2 3 X 4 5 6 7 K 8 DEBTS AND DEDUCTIONS 1 2 3 4 5 6 7 8 CLAIHED ~~ , ~ 'lJ; ........ ..... ;;.,~ o PART ~ DATE PAID ul o PAYEE OESCRIPTION )';;~ -0 N AM,OUNT PAID ..;~ C 0'1, I I TOTAL (Enter an Lin. 5 of Tax COMPutation) $ Under p.naltl.. of perjury, I d.clare that the fact. I conplat. to the b.,t of ny knowladg. and b.llef. f) ~'~', )}< ;,) / .. (l~( ..' ///('1 .(,....,_,....,~'O/~.. TAXPAVE 5 GNATU~E / ha"e reported abo". ar. true, correct HOME (1/ 7) ~),./ t; :1.-(/3 WORK ( ) TELEPHONE NUM8ER ond GENERAL [NFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OffICIAL fA)( ASSESSHEHT wllh .IIII,llubhll (nhrut 'Mud IIn Inlnrllllulnn tut".tU.d by the 'Inanclftl Instltutlun, :.. Inhll,-Itllnc. tnx b.Co.., 11111111'11111"1 nln. ""onlhl .llhr the ,IAf;ltlhm"" tlltl. III .1."lh. }, " joint ...ccount II I".nhl. ..v..n thnuqh the Ihu:Aclllll".. n"",. w.,' ,\tllle.1 .,. ,I ",.,ltll,. ,,' .:nm,."tum:tt. ... Accounts tlncludlnq thO.1I h.ld b.t",..n I""band .1ml Mlf.1 wllifh Ihll lIeclltllI"t pl.1 in JllllIl fl,II'"'1 wi'hln un. .,11,.1 Ilrlnr 10 tllIath orlf lulh '''.lIbl_ ,II I""fll'.r.. !J. Accounts .,tabl Ishad Jointly heh...n h".bllnd nnll wit. "or. HI.." 111111 't.'" Ildor III dlHllh 'If. not tn."bla. 6. Accounts held by 11 ,llIClldllnt "In trult Inr" Imother nr oth.r. tltll l".nbh. hillY. REPORTING INSTRUCTIONS - PARr 1 TAXPAYER RESPONSE I. IHOC. A _ It tl1. In'or,,"llon ,,"d co.pulllllon in Ihe notlc. Ma cunnct ,mlllladucllur" .Ir.. nol IJeln" clol..ed, 11111C. tin ")c" In hloc'" "A" of IllIrl I 0' tha "'tlllplly.r ~.,pun!i." uct lUll. Slqn two r.01l1... ,lnll ~ub.lt th... with your chac'" for the Ilaount 0' tall to the ~aghhr nf will. ot the county Indlcntlld. Iha III Ihl~"rI"ant lit ~av.nll" 04111 IUlla "n offlcllll .nless...nt tror.. ~[V-Iljltll UCI ullon rllcll1l11 0' Iha "lturn 'ro,. the Wllqlstllr fl' wllts.. :!. BlOCK B _ If Ihe lI"a' ~'lacllll1d IIn thl, 110tlca 11<1' 1I..n IIr 04111 lie fOllortlld iUlII I.'. 1IIIId with the Pnnnlylvllnln Inh.rttnnca "'II lI.turn fUed by Iha daclldllnl" reprelantottva. pt.'CII .)n "X" In IIloclo. "S" fI' I1l1rt I 0' Ih. ..tllllpayar Re,pon,." 'ulcl1on. Slan noe COpy o.nd return 10 Ihe PA Ollpllrt"enl uf ~avllnlle, 8urenu II' Indlll\lJuo1l 'nlllls, napt ;'lIObOl, llllrrl,burg, Pl 1111oS-0bOl In the envelope proyldad. S. BLOCK C . If Ihe notlclI Inforlullllon Is Incorrect .lIld/nr dllductll)ll!i .lrA lleinq c1atned. check block "C" and cOllpl"t_ Pllrts l "nd S O. Wills ot the county lndlcahd. Ihe PA Depllrt.ent of ~eyenue will Issue j,n ufflclal ilsnu.ent Iror. R[V-I~..8 [lC) upon recalpt ot the raturn fro. tho Raglstar of Wllls. :~:.:~~!-:o ': ...:: :~:~,- : ~: ;.-,: ,.~ ~;; ~ :;;:- ~..: ~ _..l:.. ~"":,,:" ',:~ t~': ;-:-...-'. ~, t~.. .,.:~.~:~~' '~ .,... II,:::!~.,,:. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enlar NOIE: tha data tha account origlnnllY was establlshed or 11tlod In tho ~annar o.lstlng nt date of daalh. For a decad.nt dyinQ a'tar 12112182: Accounts which tha d.cedent put In joint nll.as wllhln one III year of daath ftre tllllabla 'ully ftS trllns'ars. !lowovar, there Is IIn olleluslon not to 011 coed H,aaa por Irnnsforee reQardless of the vab. of the account or the nuabar of accounts held. If a double astarlsk (..) appaars betor. your first na.a In tha addr.ss portion of this notice. the IS,OOO Illclusion alraady has baen daductad fro. the account balanc. aa report.d by the financial institution. Z. Enl.r the lot.l balance of the ACCount InclUding Intereat eccrued to the d.t. of deeth, 3. The percent of thll account thet II tl.lIbl. 'or each survivor II detar.lned as 'ollowS! A. Th. parclllt t..eal. far joint asset. ..teallshed eor. then one year prior to the dac.dlllt's de.thl DIVIDED IY TOTAL NlRtBER OF JOINT OWNERS ExMPI.~ A joint en.t reghhrad DIVIDED BY TOTAL I<<JHBEA OF )( 100 . PERCENT TAXAllE SURVIVINC JOINT OWNERS In the n... of the decadent end two oth.r parsona. B. ThI parcent te.abl. 'or Isset. cr..tad within on. yaar a. tha decloant's death or accounts owned by the dacedent but hlld In trust far enothllr Indlylduall.J (trust beneficiaries) I I DIVIDED BY 5 IJOIHT OWNERS) DIVIDED BY Z (SURVIVORS) . .167 X loa . 16.7X (TAXABLE fOA EACH SURVIVOR) I DIVIDED BY tOTAL HUMBEA Of SURVIVING JOINT OWNERS OR TRUST BENEfICIARIES )( 100 . PERCENT TAXABLE [.laPl.l Joint account reglstarld In the naae of thl dlcadent end two other p.rsona end Istabllsh.d within anI y.ar of daath by the deCedent. I DIVIDED IY Z (SURVIVORS) . .50 X laa . ~OX (TAXABLE fOR EACH SURVIVOA) 4. The..aunt subject to t.. (line ~) I. dltar.inad by eultlplylna the &Ccount balencl Illna Z) by the Plrcent ta.abll (line ]). 5. Enter the total of thl dabt. and d~tlons IlIt.d In Plrt S. tt. ThII..ouRt taubll Illna bl la detlrlln.O bY sUtltractln" It.n 0.01. and OltOUCtlons 'line !I, trOl tM alOUrlt SUtlJKt 10 tIll (llna It,. 7, Enter thl approprllt. tIll rat. (1lna 7J as d.t.r.lnld balow. A. For datas of delth occurring aft.r 6/50/94, th. ta. rat.. for transfars 10 spoula' ar. as followl: I. Datas of daath on or att.r 7/1/94 and bafor. 1/1/95 the rat. ls SX. Z. Oata' o' d.ath on or aftar 1/1/95 trensf.rs to SpouSIS will be lallad at oX tall rat.. Not.l For data' of d.eth prior to 7/1/94 trenst.rs to .pou.as IIr' tllllabla at 6X. I, Trens'.rs to lineal da.candent. Including 'nther, .oth.r, son, daughter, grandchildren, lon-ln.l.w, daugtlter.in.law, stlPchlld and th.lr Issu. ar. taubla at sill perCllnt t6i!J. C. Trans'ers to all others Including broth.r, slstar, uncl., aunt. naphew and nlacl art tallabl. at flfta.n pareant (lSX1. D. If you changa the t.. rata, pl.asa sp.cl'y your relationship to Ih. dac.denl in Ih. ara. proyldad. I. The aaount of ta. dul Cllnl II Is det.nlned by .ultlplylna tha fI.nunt tlllllable Illne 61 by tha tu r.t. Illn. 71. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowabl. dabts and dldUctlons ara d.ter.ln.d as follows: A. You I.gally ar. rasponslbl. far pay.ant, or th. as tat. subj.ct to adllnlstr.tlon by a par,onal rapras.ntatlv. I, Insufflcllnt to p,y the daductlbl. It..s. B. You actually pald Ih. debts aftar dlath ot the dacadenl and clln furnish proof a. plly..nt. C. Dlbt' b.lng clal..d aust b. Ite.llad fully In Part S. If addltional spac. Is nead.d. USI plain paper a 1/2- . 11". Proo' 0' pay.ant .ay b. requested by 'h. PA O.part..nt 0' Aayanue. TAXPAYER ASSISTANCE IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY REGISTER OF WIllS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE OR CALL THE BUREAU OF INDIVIDUAL TAXES. TAXPAYER INQUIRY UNIT IN HARRISBURG AT (717) 787-8327, TOOl (717) 772-2252 (HEARING IMPAIRED ONLY) . - ... 0'. '....'. .-. ,..... \ 1\ f ~ ,~ I ), . Wi ,; , ' i i j i I " I , I f . I I , / I ~:"'..- , I 00) . '" f 1 0 X ~ + ~ M .1 'J -:l '" V r- 1 <l \J -( r 4. (l.. 'J v ~ I ~ oJ v i " I +- \, Jl , , ,~ 'J ,- j] - .... [ ... .., - : , J ~ oJ r- -..:I Isl ('( + r- 'l.. <t <.t ~ l\- V) .+ ; ~ <n t \, I 0 '"'1 ,~ ..t: .0 I ~ , :l ^ 1 ~ 1'0 c , " , l\- I J l!J n.. r-:' r- J: J1 ('oJ Q ('oJ ('oJ ro ('(J I ~I ... ISl ". ... " , ':\'" l'~ " , { ....' , ' t, , , . " ,r . ~ ~,' l" '. H t\ ,I , . r ~..,. . ~'. '" .~;. , . , " "i"! " i ~ \' - ,. .- -- -.,.-- -_---~~:JII. ~_ .,.:.-. r-'''- . ~ .. ,. - , " 00 . " . ) - " . ' .' I , . 1 \<( .. " ....... (OHHUNWlAllIl or III NHSYl VAH! A DUIARHUHI Of WlVINlJ[ BUill AU Ilf INOIVIOUAI tAlll S DEP', :Sllblll IlAIlRISBUIlG. II" 1I1..a.OhOI . INFORMATION NOTICE AND TAXPAYER RESPONSE 1".jhIIlIH .,.." EST. OF VERNA G MAHON S.S, NO. 647-00-6696 DATE OF DEATH 10-06-96 COUNTY CUMBERLAND :1.1- '1~- /67'-1 FILE NO. 21 ACN 96155274 DATE 11-21-96 TYPE OF ACCOUNT SAVINGS "_: CHECKING __ TRUST 'i: CERTIF . PAUL E MAHON 7B91 MOLLY PITCHER HWY SHIPPENSBURG PA 17257 REHIT PAVHENT AND FDRHS TO: REGISTER OF WILLS CUMGERLAND CO COURT HOUSE CARLISLE. PA 17013 DAUPHIN DEPOSIT BANK I hll' provided the nepart..ent with the Infor"lItion Ihtad helow which hIlS bun und In calculating tho pohntial tll. due. Their record' Indicate that lit tha de/tth of the ,lboVII doced.nt. ~ou war. ,1 joint ownnr/honeflclllrv of this olccount. If VOIl feel this Infornatlon I. Incorroct, III.aslI obtllln wrltt.n correction frma ttla fl""ncl"l institution, ",ttnch... COpy to ttlh for.. Itnd return It to ttle <lbove IIddr'ISI. This I'ccount Is It.."ble In n<:cornftnce ...llh thll Intlerltftnc. 1.1)1' l.lW'. (If the COllltfonwe.Uh of Pannsvlvanlll. Wa.tlon. .ay o. "n...erIlO IIV calling ..1/1 IIS/.":I(" COMPLETE PART 1 BELOW Account No. 6000443196 II II II SEE REVERSE SIDE FOR 04-03-91 FILING AND PAYMENT INSTRUCTIONS D.te Establish.d To insure pruper crealt to your account. two ez) copla. of thl. not Ie. ~ust acco.panv your paY.llnt to ttle Rllgistar of will.. Mak. check pavabla to: "Register of wills, Ag.nt", 2.690.56 16.667 448.44 .06 26.91 '),~;.S(, TAXPAYER RESPONSE FAILURE TO RESPOMD WILL RESULT, 1M AM OFFICIAL TAX ASSESSMEMT BASED OM THIS MOTICE Account eal.nce P.rc.nt Taxabl. Amount Subj.ct to T.x Rat. Pot.nti.l T.x Du. x x NOTE: If ta. paY.llnts Dra nllde within three (3) _onth. of the ~cedent's date of death, you .ay deduct a(gJdhcount of tho tu au.. Any lnheritanc. tax dUo will becoe. delinquent nine t9J .onth. after tho det. of death. Tax PART [!j A. 0 Th. above InforaaUon and ta. duo h correct. 1. You .ay chao.. to reelt pay.ent to the Regi.t.r of will. with two copies of this notic. to obtain . discount or avoid Inter..t, or YOU ..y check box "A~ end r.turn this notle. to the Ragistar of Will. and an official a......ant will be I..ued by the PA Depart.ont of Revenua. a. 0 The abov. a...t h.. b..,.. or will b. raport~ and tu paid with the Pomlylv.,l. Inheritanc. Tell raturn to b. fll.d by the dacadent's npr...,taUv.. C. 0 The above infor.aUan is Incorrect and/or debts and deductlonl wer. paid by you. You MI.t cooplata PART [!] and/or PART ~ bolow. [CHECK ] ONE BLOCK ONLY PART [!j T~.'C LINE If you indicat. . different t.x r.t., pl.... st.te your rel.tlon.hlp to dacedent: OFFICIAL USE ONLY 0 AAF PA DEPARTMENT OF REVENUE '='''" T6Y "N ...n.~T'TrU)~T Ar,..nIlNT~ p'~,!,I)~~ . rn~~:II.IT4T:rnN 1. Oat. Establish.d 2. Account S.lance 3. P.rc.nt Tax.bl. 4. ADount Subj.ct to T.x S. D.bt. and D.duction. 6. Anount Taxable 7. Tax Rate a. T.x Du. 1 2 3 X 4 5 6 7 X 8 !'~Jl 1 2 3 4 5 6 7 8 CLAIMED PART [!] DATE DEBTS AND DEDUCTIONS PAID PAYEE DESCRIPTION I I I I TOTAL (Enter on line 5 of Tax Coaputation) ~~ ~ Ct, " -Vi: )>;:' Under p.nalti.. of p.rjurYI 1 d.clare that the conpl.t. to the b.st of ~y knowledge .nd b.li.f. -1fx~'r.':(; ~iGt~~t~,; /z-- h.y. report.d aboye are HOME (/1 '/ ) f) oj " WORK ( ) TELEPHONE NUMBER fact. 1 - ... ,.,-..-... _.._--._- ~ 3'~ ;-.:. tJ 'ii ,-, C":l ." .I~ \..oJ '.' e -0 N u~. .' i.~ - U1 AMOUNT PAID I I I I t true, corr.ct and -c '/.1,'7' DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNENl ",lIh .IIIIIIIr.I1I1I11 lnhfl'" h",.d fill In'or",,\loo ,ub.lthd b.., the II",mcllll Instilutlon. L. Inh.rlll1nce tit. heeo..., delinquent nln. "1II11hS 'lfl.r the IleulIl.""", 1111111 III lllll,lh. 1. l joint nccount Is t"."blll lIyen thouqh tllll dilclllhmt', "".. w.'s .1l1l1Ad .1' .1 nlltt.t ,,' 1,1IIwlInl.I\r.... lit. Accountl I including tho,. held h.t.....n IUjlb"nd ilnd wile' .hleh thll Ih.cullenl Illlt in loin' 11I111II11' wllhlllllflll ",1I"t Ilrlor In dllllth .ire fully tn."blo .,. Irlm,f.r., S. Accounts 1I.lnblls"ed Jointly hatw..n hllsIJIlnd "nd ...tI. "',Ir. IhM on. 'lUlU Iltlut In cle/lttl;H1I 1101 t"."blt.. b. Accounts held lIy It declldent "In tr"I' for" ..nothe" or nll1.r. nr. IIIMllble 'tlll'I. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE I. BLOCK A . If thll In'Dr.lltlon .lnd cOIllPutlltlon in Ihe notlco dro correct .1nd deducli"n, .n. 110t h.lllf~ cllllllllld, Illoco .1n "X" In Illocl< "".. of P,.,rt I of Iho "lnllpa.,.r W.,pons." ..ecl1on. Slyn two copl., .1MlI .,,,Illlllt thelll wllh .,our eh.cll for thll .1.ounl of lall to Iho W.O!stor of wills of the county IndlcntAd. Iho PA O..p."tll..nt of IIA\lAnu. ...111 I,suo .1n offlcl<11 .1uo"...nt (forlll WlV'I!Jlta lXI upon roc.lpl of Ih. rolurn frolll Ih.. lIf1qlshr of Wills. BLOCK B . If tho .1sul ,pocl'lod on 'his nollco h,.,s tleen or ...111 Ilo rnportod and 1,'11 IIAld with tho Panns.,lv,.,nl., InhllrltMc. fall R.lurn fll.d b., thll decedent" repro,entlltlvlI, pl<1clI ,In "X" in block "B" of 11f1rt I of tho "'nllpn.,llr Ruponu" 'lOction. Sign on. copy and roturn to tho p" Ollpllrtllent of Rovenu.. BurfUtu of Individual IIIUS, CliP' .'SObOI. HllrrlsburlJ. 11" 1/1:,a-O&01 in thll envelop. providlld. 5. BLOCK C _ If the nollce Infor."Uon Is Incorrect ,1nd/or llllductions "rll hlllnq cllltlllld, chllck hlock "C" .1nd cOllpletll Pllrls ~ ,1nd J of wlils of the county Indicatlld. 1h. PA Deparlllent of Wllvenull will is,uo an official IISsllsslIAnt Cfor. REV-I!Jlta [X) upon receipt of Ihe r.turn froe the Regllter of Will.. ~:':Ar~~~: '.~ '.~: ~~:~r._:~!::",. ":::.:' ':'.:A . . :~:-!. ~ . ~--: ~ ...~- ,., ;"" 'r ~... :~' ':r ,..~ .... -:' ,. :_~~~!~ ': .~: n.:l:'~. TAX RETURN - PART 2 - TAX COMPUTATION LINE I. Ent.r the date Ihe account originally was estnbllshed or tltllld In the ""nner IIlIlstlng at date of dllath. NOtE: for II d.clld.nt dying ilftllr IUIZ/aZ: Accounts which thll dllcedent put in jDlnt nUlls within one III YOllr of duth are tlulablll fully,,. trnnshrs. !lowever, thllre Is .1M ..clu,ion not to ellceed $1,000 pAr tr"nsferoll rQoardlllss of the valu. of the account or the nulllber of account. held. If a double a.terl.k C..I appe.r. b.for. your first na.e In the addr.I' portion of thl. notice, the 15,000 e~clu.lon alr..dy has be." deduct.d fro. the account balanc. a. report~ by the financial in.tltutlon. Z. Enter the total b.lenca of the account Including inter.lt accrued to the date of de.th. 3. The percent of the account that I. taxabl. far .ach .urvlvar i. det.ralned .. follow.: A. The percent t..abl. for joint ....t. ..tablJshIId eore than one year prior to the decedent'. d..th: I DIVIDED BY TOtAl HUHBER Of' JOINT OWNERS Ex.-ple: A joint .11.t r.gllt.r.d DIVIDED IV tOtAL NUHIER OF X 100 . PERCENT tAXAILE SURVIVING JOINt OWNERS In the n.... of the decadent and two other personl. 1 DIVIDED BV 3 (JOINT OWNERS) DIVIDED BV Z CSURVIVORS) . .161 X 100 . 16.1X (TAXAILE'~OR EACH SURVIVOR) I. The percent taxable for ....tl creat.d Mlthln one y.ar of the decedent'. d..th or account. owned by the deced.nt but held In tru.t for another Incl1vldullU') Uruat beneflclarin!: 1 DIVIDED BV tOtAL NUKIER OF SURVIVING JOINT OWNERS OR tRUST BENEFICIARIES X 100 . PERCENT TAXAILE Exaaple: Joint account r.gllt.red In the na.. of the decedent and two oth.r persons snd ..tabllshed within on. y.ar of death by the dec:edent. 1 DIVIDED BV l CSURVIVORS) . .50 X 100 . soX (TAXABLE FOR EACH SURVIVOR) 4. The HO\I"It .ubject to talC Cline It) is d.teralned by lIUltlptylng the account bal8f1C. tllne l) by the percent t.lCable Ulne 3), S. Enter thll tot.l of the debt. and deduction. ll.ted In Part 1. 6. Thll aaaunt taxabla Illne 6! I. aet.~.lned by suolracttng tn. oebtl bna dllductlons Illn. ~J 'roe tn. aeount sUbj.ct to talC Illn. ~;. 7. Enter the .pproprlat. tax rat. elln. 1) al detaralned b.low. A. fo~ date. of death occurring aft.r 6/30/"', the tax ratel for tran.f.r. to ,pous.. .r. a. folloMI: 1. Dat.. of death on or aft.r 7/1/94 and b.fore 1/1/9~ the ra'e I. 1~_ Z. Oet.. of death on or after 1/1/95 trftn.f.r. to spou,.. will b. taxed at OX tax rate. Hote: for d.te. of d..th prlo~ to 7/1/9' tran.f.r. to spou... ar. taxable .t b~. a. Transfllrl to Iln..1 dalcendant. Including father, 1Il0ther. son. daughter, grandchlldr.n. son-In-law, dftUghter.lnrlaM, .tepchlld and their Issu. lira taxabl. at six p.rc.nt 16XJ. c. tranlf.r. to all other. inclUding brother. sl.t.r, uncle, aunt, nephew and nlac. are tllllabl. at flft.en percent 11SXJ. O. If you chang. the tax rata, plaas. spaclfY your r.latlonshlp 10 the decedent In the arll8 provided. a. the aaaunt of tax dua Illne aJ i. d.teralned by aultlplylng the aaaunt taxable Cline 61 by the tax rat. Cline 71. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowabl. debt. and deduction. are d.t.rained liS follows: A. You l.vally ar. r.IPonslble for pay..nt. or the lI.tftte subj.c' to adain1stratlon by a per.onal repr.'lIntatlve I. Insufficient to pay thll deductible i'..s. B. You actually paid the debl. IIft.r death of the dec.d.nt and can furnish proof of pay..nt. C. Debtl b.ing cl.la.d .ust b. Ite.lzed fully 1n Part~. If additional spec. 1s needed. use plain paper a I/Z" x 11". Proof of pa.,.ent .ay b. requ.sted by the PA Depart.ent of R.vllnu.. TAXPAYER ASSISTANCE IF YOU NEED FURTHER INFORMATION OR ASSISTANCE. CONTACT ANY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN HARRISBURG AT (717) 787-8327. TDD' (717) 772-2252 (HEARING IMPAIRED ONLY) " .. I I , 1 , f t I I I I I i ~~. '.~.") -, - , :'\ n. . I' t' A ~ ~_....~ , \ ! ! . l I i , , , , , r \j\ ('i .9 r .~ -<l: <r>- '. V1 .n ~ ,J ,0 Jl , " I'- cl ll- l .I:. j ',f) (l.. ... r ./J < .!: -:r I c1 ~ ; 1:: dl \ ., -., .- .J .,. - . 'J :r + (<) - ... 0 'J> j 'J r- J - '5 .J V L\, o -;l 1: oJ L 'lJ ,.f- "I 'l'1 l)) ~ ... II ..6 E J -.I :- 0, '" 0... ~ rl j'l , ~ " ~ ",\~ 'l; v , , 1 of" , " ;'.,; , " I,. ~ ,,j (, , " ',. <..~ ; ~ l' ,.. . ) .'. '" ., . r . . 71 4 .\ ~ ., \' ~. . . , , i ;" ..~~ ' ,- '.' . J \' ~' ,"". A .' --~ ..."..,:. __ G". ! -~--;-..-.o:'~ _._-~ -- r-'- FILE NO. 21 -'7(, 10'/'/ ACN 97101280 DATE 01-11-97 TYPE OF ACCOUNT o SAVIHCs o CHECKING o TRUST /Xl CERTIF, -. ,.... COftttOt.MAL rn Of PENGYlVAHIA DEPUTf€HT Of R[V[JU; IlREAU OF INDIYIDUAL TAX[S OCPT. 110601 HARAJSIURG, PA 11121-0601 l,s- ..../.5 / J INFORMATION NOTICE AND TAXPAYER RESPONSE '*' "'foIl4'O'" IJ.", (j ..., ....... q EST. OF VERNA G MAHON 5.5. NO, 192-14-6639 DATE OF DEATH 10-08-96 COUNTY CUMBERLAND :....or1"' 1". . .... a.. ., N PAUL,E MAHO~ 7891 MOLLY P.ITCHER HWY SHIPPENSBURa, PA 17257 REHIT PAYHENT AND FORNS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 .:,. ,j, .1>Q' 0::" ....... ~ 'W :;;t: _::I UU DAUPHIN DEPOSIT BANK & hu provld<<t the Depart.."t with the Inforll8t1on Iht~ billow which 11.. bMn used In calcu1etlna u.. potentia. tax due. TM... records Indlcat. that at U. d.ath of u.. above dKedent, YOU 11M,.. II Joint ownerlbeneflclary of thh ItCC~t. If you f..1 thl, Inforaatlon 1. Incorract, pl.... obt.ln written correction fro. the financial InstItution. attach II copy to thl, lor. Bnd r.turn It to the abo.... add,..... Thl. account h tIt.abl. In accordanc. with the IntMrltanca TalC LIhlI of the C~lth of P...,....lvanl.. Que,tlons "Y be In~red by callIng (717) lal-ISl7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No, 8100322295 Oato 07-27-94 EotabUahad Account a.lance Percent Taxabl. A.aunt Subject to Tax Tax Rat. Pot.ntla1 Tax Du. To Inaure pr~r cndlt to your ItCCOl.I'\t, two el) copl.. of thl. notle. .u.t acCOIlp.,y your pay-.nt to the Rlglltl,. of Will.. Make check payabl. tal ~egl.t.r of WIlli, Aa-nt". PART [!] 5.613.73 16.667 935.64 .06 56.14 TAXPAYER RESPONSE .FAILURI! .TO RI!SPOND. WILL RESULT IN AN OFFICIAL TAX ASSESSHEHTBASI!D OHTHISNOTICI! x x HOTEl If tax paYHnh ar. lade within thr.. (5) ~th. 0' the dee~t.. data of d.ath, YOU '.y deduct. S:C dhcount of the tax due. Any Inherltenc:. t.. dull "UI beeOlttl iHlInquent nine (,) lonth. .fta,. th. date of ~th. [CHECK ] ONE BLOCK ONLY A. 00 The above tnloraatSon and tax due 11 corrlct. 1. You '.y choo.. to ,...It pay..nt to the Rlglst.,. of Will. with two cople. of thl. notle. to obtain . dl.count or avoid Int.r..t, or you ..y check box ~'" and r.turn thl. notlc. to the Rlg..t.r of Will. and an official ......aent will be I.aued by the PA Dapartaent of R'venue. a. r:J ~ above .",t hat ba.n or will b. reported and tax paid with the P~.Ylvanla Inheritance Tax return to be flIed by the decedent'. repre.entatlve. C. 0 The above Infor.aUon h Incorr8Ct and/or debts end deduction. "wr. paid by you. You llU.t co.plete PART (!J and/or PART 0 below. PART ~ TAX LINE ~:l=~~~~:;a:: :a~~::~~~nt ta. rata, ph... stata your ....,'.'..'..'.'... OFFICIAL USE ONLY OAAFi 7"AX ~:: .:C:j~i,.inU~';" AC:OUilTS :;i~:!hJiiyef:~/p:~~~:!:~:~:~!:i::P~\y~~~~:y:~:~~~:!:'i\;jA l' .. .'....'.' ,.2 3 4 5 6 :7 8 DEBTS AND DEDUCTIONS CLAIMED Rt:TU:iN C:mr'UT:'T:CN ~- .., 1. Data Establhhad 1 2. Account aalanca 2 3. Parcent Taxabla 3 4. A.ount Subjact to Tax 4 S. Dabt. and Daduction. S 6. Allount Taxabla 6 7. Tax Rata 7 8. Tax Dua 8 ,', ,,'. ','~ ':'. x ...,.,....:. , ;:.;, -:: ,::;:':: ~;:: x PART [!J DATE PAID PAYEE DESCRIPTION AMOUNT PAID _:1-11 _ Y' , II e t ' I'( ,- .<(' L J. --rull /; .... ..' c- TOTAL (Entar on lina 5 of rax Co~ut.tion) . Undar penaltia. of parjury, I declare that tha fact. c~l.ta to tha ba.t of .y knowladga and baliaf. ....-rJ7a_t< 1/ E, ~YcIIi~-71-' d~l ~PAYER SIGNA~E j I hava rapor~ad abova ara trua, corract and HOME ('~':l ~j.L -~~ (j '13 WORK () ~ _ ~' _ " 7 TELEPHO UMB R A () \ ....::j : :-.::,~ ,~ '."j ,'.... GENERAL INFORMATION 1. FAILURE TO RESpOND WILL RESULT IN AN OFFICIAL TAlC ASSESSHENT olth _lIeoll'. Int.,... ........ In'.,oo"'" IYbIlltted by the flnMCll.l In.tltutlon. 2. Jrhlrlhnc:. tu becOMI dellr.quent "1M -.nths ,ft.r 'hi decedenP, d8t. of dulh. 3. A joint KCOU'lt II tauah Iven though the dec:ecs.nt', ,... .... ~ .. . ..Un of CDnYMlllnCtI. 4. AccCU\ta UnclucUng tho.. Mid bill....., huw.nd IInd "U,1 ""Ic:n tM dec:edwlt put In Joint MM' within 0fW y..r prior to dMth .t. fully tu.tJII '1 tten,f.r.. S. Accounh utllblllhed Jolnth bill","" hu,b8nd ~ ",If. Mr. th8n OM y..t prior to d..th .t. not taxiMJl.. 6. Account. held by . dececs.nt ~ln 'rull forw BnGther or other. .t. 'a.ebl, fully, REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLoat A . If the Info,..Uon and COIIPUtltlon In lhe notice at. correct IInd deduction. lit. not being chlMd, pl.ctl ." ""X"' In block ..,.. 0' Part 1 of ttM "la.paYlr R..pon.... .ectlon. Sign two copt.. and ,ubatt the. Mlth your CMck 'or the ~t of tax to the Regllter 0' Will, of the county lndlc.t~. The PA o.part-.nt of R.v~ Mill t..ue an offlcl.1 .....-..nt CFar. REV-l~a EX) upon receipt of the r.turn froe the Regl.t.r of Will.. z. IlOCX I - If the ....t apeclfled on thl. notlc. hat been or will b. reported and t~ paid with the Penn.ylvenl. Inheritance lex R.turn 'lied by the dec.dWlt'. rapr...ntatlv., plac. en "X"' In block ""Boo 0' Part I 0' the ""T.xpay.r R..pon.... .ectlon. Sian QtMI copy end r.turn to the PA DapLrteent 0' R.venue, aur.au of Individual Tax.., Dapt 280601, Harrl.burg, PA 11128-0601 In the env'lope provided. 5. .loa C - If the notlc. Infor.atlon 11 Incorrect and/or cMduc tJon. .... being c1alaed, cheek block ..t" end coeplet. Part. Z end 5 ........wI"" ~,;, t;,. :;..:......;.U.....tA ...:.... ::.. :'..01 ......:..... ...... .......t~ ~.... ..::.:. ,..,~~ ~....,;:. r..~ 'tJ.. __..;,;....~ ..: :..... ....:,t.:::a ~~ to..,: r:a.~.t".. of Will. of the county Indicated. The PA Dapartaent of Revenue will I..u. en official a.....eent (fore R[V-I54a EX) upon rec.lpt of the r.turn 'roe the R.gI.ter ,f Will.. TAX RETURN - PART 2 - TAX COMPUTATION 1I1E 1. Enter the dell the account originallY ..II ..tabllsMd or titled In thl! Iannlr ..htlng at dllte of death. NOTE: For a ~t dying aftlr IZlIU8Z: AccCK.rlt. which the decedent put In Joint nBll.' within QIMI (1) y.ar of death .r. taxable fully a. tren.f.r.. Howev.r, th.re 1. en .xclu.lon not to .xc.ed .5,000 per tren.fer.. r.gardl... of the value of the lICc:ount or the; ~r of account. h.ld. If . double a.terl.k (MM) app.ar. before your flr.t na.e In the addr... portion of thl. notlc., the .5,000 .xclu.lon alraady hi. bean deducted fro. tha .ccount b.lanc. a. reported by the financial In.tltutlon. Z. Ent.r the total balance of the account Including Int.r..t accrued to the data of d.ath. 5. The ~rc.,t of the account that 11 taxabla for .ach .urvlvor II dltaralned II follow. I A. Th. ~rcant taxable for Joint a..at. ..tabllshed acr. than QIMI y.ar prior to the dec.dent'. daathl I DIVIDED 1'1 TOTAL HUHIER Of JO I NT OWNERS Exa~le: A Joint ....t r.gl.tared DIVIDED BY TOTAL HUHBER OF X 100 . PERCENT TAXAILE SURYIVIHC JOINT OWNERS In the nae. of the decDdant and tva other Plr.on.. I DIVIDED 1'1 5 (JOINT OWNERS) DIYIDED BY Z (SURVIYORS) . .161 X 100 . 16.1~ (TAXABLE fOR EACH SURVIYOR) B. Th. pere.nt taxable for a..lt. cr.at.d within on. year of the decedent'. d.ath or account. ownad by the dec.dent but held In tru.t fo.. anoth.r Indlvldu.le.) (tru.t beneflclarl..)1 1 DIYIDED 1'1 TOTAL HUHBER OF SURVIYING JOINT OWNERS OR TRUST BENEFICIARIES X 100 .. PERCENT TAXABtE Exaapl.1 Joint account r.gl.t.red In the n... of the dec.dent and two other per.on. and ..tabll.hed within one y.ar of dlath by the dec.d.nt. I DIVIDED 1'1 Z (SURYIYORS) .. .50 X 100 .. SO~ (TAXABLE FOR Oat SURVIYOR) 4. The aeount subjlct to tax (line 4) 1. det.r.lnad by .ultlplylng the .ccount balanc. Cline Z) by the p.rcent taxable (line 3). S. Ent.r the tot.l of the d.bt. and doductlon. II.ted In P.rt 5. 6. ThI uount taxable Ulne 6) II d.tlr.ln.d by .ubtractlng the d.bt. IIInd deduction. Uln. 5) fro. the flItOunt .ubj.et to tax Uln. 41. 1. Ent.r the approprlat. tax r.t. (llnl 7) a. d.tar.lned bllow. A. For date. of dl.th occurring aft.r 6/50/94, the tax rat.. for tran.f.r. to .pau.e. are a. follaM': 1. Oat.. of death on or aft.r 1/1/94 and balore 1/1/95 the rat. II n. Z. Oat.. of d.ath on or aft.r 1/1/95 tran.f.r. to .pou... will be taxed at O~ tax rat.. Nat.1 For dati' of d.ath prior to 7/1/94 tran.f.r. to 'POU'.' are t.xabl. at 6Z. 8. Tran.f.r. to IIne.l d..c.ndants Including fath.... .ather, .on, daught.r, grandchlldr.n, .0n-ln.I..., daught.r-In-lDW, .tepchlld and th.lr IU\HI are taxable at .Ix p.reant C6:0. C. Tran.fer. to all other. Including broth.r, .I.ter, unci., aunt, nephew and nl.ee .r. taxable .t flft.en p.rcent (15Z). D. If you chang. the tax rllt., pl.... .paclfy your r.latlon.hlp to tha decedent In the ar.. provided. 8. ThI aeount of tax due Ulne 81 h d.t.r.lnad by .ultlplylng the aeount taxable Ulne 6) by the lex ratl Ulne 1). CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debt. and d.ductlon. ara dat.ralnad .. follow'l A. You legally are rl.pan.lbl. for payaent, or the e.tata subject to Bdelnl.tretlon by a ~r.onal repr..~tatlv. I. InlUfflclent to pay the deductlbll It.... 8. You ecWlllly paid the debt. aft.r dlath of the decedent and can furnish proof of pa.,.."t. c. Debts baing clalHd ......t b. It..lzttd fully In Part 5. If addltlon.1 .pacl II needed, u.. plain papar a 1IZ" x 11". Proof of payaant .ay be requa.t.d by the PA Daparteent of R.v~. ":'c',~~~,,> ,.. .,.'."",,:JAXPAYERASSISTANCE . . ,"'''', ',', 'c",c.c.<,<YIF'YOU, NEED FURTHER INFORHATIONORASSISTANCE, CONTACT ANY,,,, ., ',,' "':"':fi?\~<;:';\ REGISTER OF WILLS, PA DEPARTMENT> OF REVENUE DISTRICT OFFICE",,:". " ,;,,/A'<'~n< OR,' CALL THE BUREAU. OF .'. INDIVIDUAL'.T AXES , TAXPAYER INQUIRY, UNIT. IN ' :,C" "+" c,' \c\:'ltARRlSBURGAT (717)'' 787-8327; TOO' ..(717) .772-2252 (HEARING IHPAIREDONlY)':W:) -'... " ~-- -"-.-. - - . ... --'-"It'"-~ - '-.. RECEIVED FROM: 185015 COMMONWEALTH OF PENNSYLVANIA DEPAllJMeNT 01' REVeNue OFFICIAL RECEIPI' · PENNSYLVANIA INHERITANCE AND ESTATE TAX , ACN ~ ASSESSMENT '=' It CONTROL A;I NUMBER "-. - -- ._-~- '-., ---- -.- -- -- -- o NO. AA .NI"'lIf"'~ .. I I , ... . , AMOUNT PAUL E MAHON SR 7891 MOLL Y P nCHER HIoJY SHIPPENSBURG, PA 17257 '761:i:se73 ':;e.JO SSN 847-00-6696 (FIR5Tj IMI) SEAL m TOTAL AMOUNT PAID S52.50 SI< CHECI<# 3046 REGISTER OF WILLS I'i " . ,:,i RECEIVED BY /F:2;"r:- ijf/"V '!""r.- . SIGN .U~ MARy C. L"IoJIS4.,/Utt../~i7'./.2. REGISTER OF WILLS ~ '.-- '-"'-. -. "-'. --.. - - -- - -.,,- -.--.- --- - - - - '-. - - .~~ '. ___I -~ -- .,:. , ----.- - -..--:""'...... ... . . . i \ I I 1 ) ) ) \ ) ) .\\((\ ,.. ~'~'~,. f. " "" , - 'I , , , r-. ~"" ,.,-~ . : -: .~ C'1 ,... u. r ('J " --,,' " ,.. ...-4 "1, 0 "",1 , M M I , , 1 \ , . , \ ! . I . \ ~ .. ...., l;j :iI'l!~ ''&1 ~.._~ -.. ~ ~ r~. -' Rucu' R0\ '97 Jml 22 P 1 :07 .Fli.l - ::: ... "" C\t:L lZ Curroi-, ,.. ,url , PA - - - ,- ... 1\I ~ J ~ "l ~ ~ , , '-...l tl " rl I'l , rl .. o l" .. - ::: ... r-. ... ~ ~ ~ ~ ~"Y G ,~ ~ f> ~1~ ~" ~ ~ S \:J ~() \ IY) '- ~ ," ,z-\' , , (. , , , c,~ ~ ~ L" r '. " " l r ,j .',' -\ .'" ! , " I l;~ , .;.... 2' i i, If ~ . ) . . . J \f!" . .' ..... --'-_"-_.-:--~..:N" r -~1',' -,,'... - - .~ " .: , .' '. , '.. .. - -. ..-~.- I I I I I , ,I I 1 I , , , , , t LmcOH", t UNO. AA 185099 COMMONWEALTH OF PENNSYLVANIA DlI'AIlTM'NT 01' RIV'NU, INn" bl'~4 OPPICIAL RECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE TAX --.- -__h _..... __.'. . RECEIVED FROM: .. PAUL E MAHON SR ACN ASSESSMENT CONTROL NUMBER AMOUNT & m "/lVjC"EJO J7 E BURD STREET APT 6 SH I PPENSBURG. PA 1725'/ -wo. 14 ESTATE INFORMATION: m filE NUMBER U 21-J996-J074 !t NAME OF DECEDENT (LASt) i;I MAHON VERNA G II DArE OF PAYMENT S POSTMARK DATE COUNTY SSN B47-00-66'}6 fFIRST) (Mr) CUMBERLAND DATE OF DEATH /08/96 PAUL E MAHON SR REMARKS m TOTAL AMOUNT PAID '56.!4 PB SEAL CHECKtI 306S - ".-.. -- -,.- -.- -. - -.- -- - -----.. ."--. ------ ~~_. --- REGISTER OF WILLS ~ '--, ---'- --- ---~ -_. -.- _._-...~-- '- ------- . -...-...--... .- ' . -...-:,,~' 4.- . h/:>!',/ IU~EAU Of INDIVIIlUAL TAllES Ifr.DITAHCE TAX DIYISION D[JIT. lID6DI H'.IIIUSIlIIG, Pi l1UI-U01 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE * NOTICE or IHHEIIITAHCE TAll APPRAISEllEHT, ALLOMAHCE OR OISALLOMAHCE or DEDUCTION ,_AND A88E8SIIElfT or TAll ON JOIHTLT ~LD OR TRUST ASSETS "'.lMlIJ fl' IU.tu PAUL E MAHON JR 7891 MOLLY PITCHER HWV SHIPPENSBURG PA 17257 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN G 01-28-97 MAHON 10-08-96 21 96-1074 CUMBERLAND 192-14-6639 96155273 bount RMlttlHl VERNA MAKE CHECK PAYABLE AND REMIT PAYMENT Tal REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .... RE-Y:iS4-a-Ex--AFii-flz-:96i------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 01-28-97 ESTATE OF MAHON VERNA G DATE OF DEATH 10-08-96 COUNTY CUMBERLAND FILE NO, 21 96-1074 TAX RETURN WAS, S.S/D.C. NO. 192-14-6639 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: DAUPHIN DEPOSIT BANK 8 TR CO ACCOUNT NO. ACN 96155273 8100673365 TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (lO TIME CERTIFICATE DATE ESTABLISHED 04-17-95 Account Balanca Par cant Taxab1a X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 5,526.08 0.166 921. 03 .00 921.03 .06 55.26 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER DF WILLS AT THE ABOVE ADDRESS, MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT DATE 12-27-96 RECEIPT NUMBER AA185015 DISCOUNT (+) INTEREST (-) 2.76 AMOUNT PAID 52.50 . ' TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE · If PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( If TOTAL IlUE IS LESS THAN tl, NO PAYMENT IS REIlUIRED. If TOTAL IlUE IS REfLECTED AS A "CREDIT" << CRI, YOU HAY SE DUE A REFUND. SEE REVERSE SIDE Of THIS fORN fOR INSTRUCTIONS, I 55.26 .00 .00 .00 ()() cr;- -1 \d - :0 .",,, 'I (, L ~ l,.J Cl ~..... PlJlPOS[ Of NOTICE I ',I. }....- V'l I-N P.S. ,- To fulfill the requlr..."tt of Section 2140 of the Inhlirltl'lnC. end Estat. ffl. Act, Act ZZ of 1991. Section ZIU J. PAnEHTz DIIt8Ch tfMI top portlon af thh Notlc. 8M lubIIlt with your PI,..,.t to the Reglltl,. of Will. printed on the rlv."" llde. n .... check or MMV aNh,. PIYllbI. tal REGISTER OF WILLS, AC;EHT. '11 PIY'Mf1tl rKllvlld -"1111 flr.t be eppl1..t to eny Inlernt which ..., be dlMi, with any r_Ind.,. ~l1ed to the tax. REF1.ICD (CAli' nhrd of . t.. credit, which .... not requested on tM to nrurn, ..., be requested by cCMlPlaUng 8r'I "Application for R.fund of P~''Ilv.,l. Inhlirlt~. and E,tat. r.... (REV-ISIS). application. .r. avallabl. at the OfficIo' the Reall'.r of Willi, any of the 21 Revenue DI,trlct Offlc.. or by calling the ,pecla. Z4"hour an'~rlna ..rvlc. ~,.. for 'or.. orderlngl In P~.ylvanl. l-aOa-36l-Z0SD, out,lde Penn,ylvBnl. and within loeel "-rrltburg ar.. (117) 7.7-8094, fDD' (717) 17Z-ZtsZ (Hearing 1~.lr.d Only). OIJECTlONSI Any p.rty In Int.r..t not ..thfl.d with the flPPr.h..."t, allowanc. or dbaUowanu 0' deduction. or ........"t of tax (Including dl.count or Int.r..t' .. shown on thl. Notlc. ..y object within sl.ty (60) days of rec.lpt 0' thb Notlc. byI "written prot.st to the PA Depart.."t 0' A.v......,., Board of App..h. Dept. 2810l1, Uarrbburg. PA l1U8-10Z1, OR ".l.ctlng to have the ..tt.r d.t.,.ln.d at the audit of the account of the p.rsonal r.pr.s."t.tlv.. OR "~al to the Orphans. Court ADttIN- ISTlIATlVE CORRECTIONS I Factual .rro,.s dlacovlred on this ........"t mould btI addr....d In writing tOI PA Dep.rt-.nt of A.venue. Buraau of Individual T..... ATTNI Po.t A......."t A.vl... unit, DEPT. Z8a601, Harrisburg, PA l11Z8-0601 Phone (117) 187-6505. See P808 5 0' the bookl.t -In.tructlon. for I~rltenc. Ta. A.turn 'or a A..ldent Decedent- (REV-IS01) for Bft .xplanatlon 0' edelnl.tratlv.ly correctabl. .rror.. DISCOIMTI If Bfty t.. due I' P.ld within thr.. (]) cal....r IIOtlths aI..,. the decedllnt'. de.th, a 'Ive percent (5%) dltCOU1t of tM tax paid I, allowed. PENAL TV J n. 15% to ......ty non-p.rtlclpatlon pen.ltY Is COllpUt.d on the tot.l of the; t.1C and Int.n.t .....ted. end not paid before ....ry 18. 1996, the first day aft.r the end 0' the te. ...,..ty period, This non-p.rtlclp.tlon pw.alty It lIppe.labl. In the .... ......r end In tM the ._ tI.. period .. you would 1Ippe.1 t.... tlUC end Int.r..t that hili been .......d .. IncUcat.d on this notlc.. INTEREST I Internt I, charged bealmlng with first day of cS.lIrMIUMCY. or nine (9) ItOl"Ith. end one (1) dliy 'roe the ..t. 0' duth. to the date 0' paYMf'lt. Tun which bec_ delinquent Mfor. January 1, 19az bMr Intar..t at the rata of 11. C6:() percent per ....... calculated .t . dalh r.ta of .000164. All talCa. which ~ delinquent on or .'tar January 1. 198Z will bMr Intar..t at a r.t. which will vary froe calender y..r tD cal"r yNr with that rat. WI1OU'\CecI by the PA Depart.."t 0' Aavanue. TM flPPl1cabl. Int.r..t rat.. fDr 1981 through 1997 ar.1 .... Int.r..t Aat. Oally Int.r.st factor .... Inttr..t R.ta Oalty Int.r..t factor 1981 'OX .0ao~1 1987 .. .000247 191J I" .0auSl 1931-1991 IU .000101 I'" IU .0aDSOl 199. .. .000147 1915 In .000556 1995-1994 n .00019Z 1.66 10' .000174 1995-1"7 .. .000147 ~~Int.r..t I. calculat.d a. .01low'l IHTERElIT = BALANCE OF TAX IIllPAID X NUKBER OF DAYS DELINQUENT X DAILY IHTERElIT FACTOR ~-Any Notlca I..ued .'t.,. the t.. baco.e. delinquent will r.'lect an Int.r..t calcul.tlon to flft.." (IS) days beyond the ..ta of the .........,t. If pav-'lt Is MCM a'tar the Int.r..t cu.putetlon ct.t. shown on the Notlc., additional Int.rnt MIlt be calculated. 00 c -- , r "i o.-J :n -r),T' " t ~= v.1 o ..-, ;.:-~ P\.IlI'OSI:Of' NOTICE : PAvtENTl To fulfill the ,......,...."t. 0' section 21,.0 0' thli JnherltllnC. and E,t.t. TaM Act, Act ZZ ,of 1991. m P.S. Section ZlU). 'F. . U1 W the Ragl.t.t of Will. prlnt~ on ~ ro'" 1...) Detech the top portion of r.....r.. .Ide. __ .... cheCk or MlMV arM" papbl. tal REGISTER OF WILLS, A;EHT. All pay..-.tI received atMlll ,Int be applied to any Intar..t which ..., be duti, this HoUctI and sut.1t with your paYMf\t to wi th any r_lnder eppllMt to tM tax. RU\ICD (CA) I A r.,\RI 0' . tax credit, which "'.. not requested on the tlUt r.turn, ..y be requnted by capl.Ung an "'Application far R.fund of P.nnlylvanla Inherlt~. and E.tet, Tax" (REV-Ill]). application. .r. av.IIBbI. at the O.,lcI of the Real.tar of Will., any of the ZS R.v~ DistrIct Dfflc.. or by callIng the ,peclal Z4-hour an,werlng ..rvlce ~r. for 'ar.. orderlngl In Penn,ylvanla l-aOa-36Z-ZUsa, out,lda Pennsylvania and within local ~rrlsburl at.. (717) 787-ID94, TOOl (111) 112-215l t~rlnQ I~alr.d Only). OBJECTIONSl Any party In Intara.t not ..tl.fled with t~ appral.a.ent, allowance or dl.allowanc. of deduCtion. or a......ent of tax (Including dl.count or Int.ra.t) a. .hown on thl. Hotlce ..y ObJlCt within .Ixty (60) day. of rlCelpt of thl. Notice bYI --written prot..t to t~ PA O.partaant of Ravanu8, Board of Appeal., Dept. 2110l1, Harrisburg, PA 171l1-10ll, OR --.lactlng to have the .att.r det.r.lned at the audit of the account of the per.onal repr..entatlva, OR --eppaal to tha Orphan.' Court ADMIN'" ISTRATlVE CORRECTlONS1 FKtu81 .rror. dlscovared on this .....usnt should be addr...ed In writing tOl PI o.part.."t of Ravanua, Buraau of Individual Taxa., AllNI Po.t A......-nt Review unit, DEPT. 2106Dl, H.rrllburg, PI 111ll-D601 Phone (117) 11'-6505, S.. page 5 of th8 booklat Rln.tructlon. for Inheritance Ta. Raturn for a Ra.ldant DecadantR tREY-1501) for en .xplan.tlon of ~Inl.tratlvaly corrlCtable arror.. OISC0l..lfT1 If any tax due 11 paid within thr.. U) C8lander ~th, .ft.r t~ decedent', daath, . five parcent t5%) dlscOWlt of the tax paid II allowed. PENALTY I The 15% tax .....ty non-participation penalty Is capytad on the tot.l of the tax and Int.rnt .......d, and not paid before January 18, 1996, the flr.t day .ft.r the and of the tax .-na.ty period. Thl. non-p.rtlclpatlon paN 1 ty I. IIppMlabla In the __ ......r and In the the .... tI.. period .. you would appul the tax and Intar..t tn.t h.. bean .....nd .. IndlC8tad on this notlc.. INTEREST I Interast Is charged baglmlng with flr.t day of delinquency, or nine t9) .onth. and one (1) day frM the data of death, to thI dIIt. of p.~t, T.... which bee... delinquent bafor. J..-ry 1, 1981 bear Intar..t .t the rat. of .1. (6%) percent per ~ C8lcul.t.d at a dally reta of .000164. All t.... which ~ delinquent on or .ft.r January 1, 1911 will bear Inter..t at a rat. which will v.ry froe C111....r y..r to calendar yur with that rate arnounced by the PI DePart...,t of R.venue, The appliCable Intara.t rat.. for 1911 through 1991 arat V..r Int.r..t Rat. DailY tntara.t Feetor Vaar Intere.t Rat. Dally Intsrnt factor 19l1 Z'X ,000548 1981 'X .00;l41 1963 lOX .0001.38 1981-1991 \IX ,000101 I'" \IX .000101 I"Z 'X .00n41 1985 In .00GSS6 1991"199tt 7X .000192 \986 I'X ,00027" 1995-1997 .X .000lft7 ..tntera.t I. C11lculatad .. followlI INTEREST = BALANCE OF TAX UIlPAID X HUftBER OF DAYS DELINQUENT X DAILY IHTtJlEST FACTOR "'-Any Notice I..ued aft.r the ta. bacOM' d.lInquent will raflect an tntar..t calculatlon to ,1ft.." US) dayI beyond the date of the ........,t. If paYM"lt I. Ilade .ftar t~ Int.r..t co.-ut.Uon data &heMIn on the Notlc., additional tntlr..t .u.t be calcul.ted, PIIll'O'E Of' NOTlCEI PA'ntENT I REFUND (CR) I \ Ta fulfill the requlr..entl af SectIon ll~D of ~ Inherlt~. ~ E,tat. T.. Act, Act ZZ af 1991. (72 P.S. Section 2141). Detech the top portion of thl. Notice end subllt with your PI)'Hnt to the Alalll." of WillI printed on tt- rlVlr.. .leM. ..._ .... check 0,. MlMY order payetll. tal REelSTER OF WILLS, Acnn. All PIYM"tI nCllved IIMll first be epplled to WlY Inter..t lifhlch ..y be due, ..lth .,y r_Indlr IIPPlhtd to the tax. . nknl of . tax credit, which .... not reql.M,tect on the tax return, ..v be r.qutlltlld by capl,Una WI "Application for R,fund of Pennlvlvenla l~rlt8nC. end E,t.t. tax- (REV-Ill]). applicatIon. ara Ivallabl. at the O,flcl of the AIII.te,. of Willi, .,y of the Z3 A.v~ Dlttrlct O"lc.' or by callIng the apec18. Z.-hour answering ..rvlce ~r' 'or far.' orderlna1 In Pennsylvenl. t-aOO-]6Z-ZaSa, out.let. Pennsylvanl. end within locI I "-rrlsburl .r.. (717) "7"'1094, TOOl (117) 71Z-ZZSZ (Helrlng 1~.lred Only). OBJECTIONS. Any party In l"hr..t not ..t1lflMl with ttM appr........t' .1l0000a or dl..llonnca of deduCtion. or ..H......t of tax (lnclucU,. dhcount or Inhr..U a. ahoWl on th1l Notlc. .., object within ".b (60) MU of rec.lpt of thl. Matlce bJl --written prata.t to the p, o.p.rt.ent of A.venue, Ioard of Appe.l., Dept. 211021, Harrisburg, p, 11121-1021, OR --alectlng to t.va U. ..tt.r det.r.lned at the lIucUt of the ItCCCUlt of the perlONlI rllPralenhtlva, OR --8PPMI to the Orphen.. Court AllttIN- ISmTIYE CORRECTIONSI 01 SCOUrfT I PEKAl TV I INnRESTI hetuel .rror. dhcov.red on thl. ...........t should be IIddr...MI In wrltl,. tal P' DeplrtMnt of A.v..-.u., Bureau of Individual T...., ATTNI POlt AII'I~t A.vl.. unit, DEPT. 210601, Harrisburg, PA 17121-0601 Phone (717) 717-6S0S. See peve S of ttM booklat Wlnltructlon. for Inherltanca Ta. Aaturn far a A.lldent Decedent- (REV-1S01) for In ewpl~tlon of ad.lnl.tratlv.l' correctable error.. If In, tax due 11 paid within thr.. (5) callndar IlOnth. aft.r the decadent'l death, . flv. percent (5%) dhccutt of the tax paid h .Ilowed. The 15X tax __.b non-p.rtlclpatlon ~lb II c~tMl on the tot.l of the tax ..t Int.r..t .""Iad, Iftt not p.ld befora Januar, 11, 1996, the flr.t MY aftar the and of the tax ..-,sIb period. Thll non-p.rtlclpatlon panel b II .....labl. In the .... .......r and In the the I'" tI.. par loeS e. you would appa.l the tax and Int.r..t that he. bHn ...a..ad .. IncUcatad on \hit notlca. Int.r..t II charged baglmlna with flnt MY of dtIllnquancy, or nlM e') IlOnth. and one (I) dey frOll the dIIte of de.th, to the data of p.pant. Tan. ~Ich bK... dtIllnquM\t before ......r' 1, 1912 bear Intara.t at the rata of .1. (6X) parcent per ~ c.lcul.tad at a d.lly rata of .000164. All tax.. ....Ich ~ del1nql.*'lt on or .ftar January 1, 1912 will baar Int.r..t at .. rata ~Ich will VIIry ca ander ,aIr to CII!lnder ,ur with that reta Br'nQU1Cad b, the PA Depart...,t of A.v......... The applicable Int.ra.t rata. for 1'12 through 1997 ar.. ".. V.ar Int.r..t Rate OIIlh Int.r..t Fector V.ar Inhr..t Aate Oalh Int.r..t Factor 1912 20% .00054. 1917 'X .000247 1915 162 .oousa 1914-1991 lIX .000501 19" lIX .000501 1992 .X .0002"7 1915 132 .000156 199]-1990\ n .000192 1916 lOX .000l74 1995-1997 OX .000247 --Int.ra.t I. CIIlculatad a. faIlCN" INTEREST a BALANCE OF TAX UNPAID X HUKBER OF DAYS DELIHQUEHT X DAILY INTEREST FACTOR --An, Motlca IlIuad aftar the t.. bac~' delinquent will reflect WI Int.rut calculation to fIft"" US) day. beyond the data of the ..........t. If papant h IIade aft.r the Int.r..t CMPUt.tlon data ahoWl on the Notice, additional Int.r..t .....t be c.lculated.