Loading...
HomeMy WebLinkAbout96-01075 III ~ - Z 0 l!) S 1-1 ~ .0 Z <t' .... 0 ~ '3 - CD ~ - 2: ... {2 . .2 ~ '..'0 Z ~ ',,;Z en W 0 '< . ~ OATH 0.' PERSONAL REPRESENTATIVE COMMONWEALTH 0..' PENNSYLVANIA COUNTY 0.' CLJMIlI';//I.MIl } 58 Thr prllllllnrr(l) above.namrd swrar(s) or affirm(s) that the Ilalemenuln the foregoing prlllion are Irue and correct to Ihe best of Ihe knowledge and belief of prtilioner(s) and Ihal B.l personal rrprrlrntallve(l) of Ihe above decedent petitioner(s) will well and trllly adminlsler the estale according to law. -4;,. ' '-_ /' . ;; . '" :". -/ ;11/o7HC, r!-) Sworn III or affirmed and subscnbed I ,,.,, r r",,- ?', before me Ihll_ 26th day of /" ' Il(o;Cl\l:!ljj;:// I 6 1J;:1.\~ ("NtJ.:UYIJCJ.Dn. 1 \ . . MAil,/, en L~~ ,. Re ISler l t.!!l f:f ., a:: I' N - CL ' ri ,\ i i ill \; .) ~'~:. a: a: \0 N l'..3 Q No. JI-/qqlJJ -010'75 'Il ,C ANDREW J. BOBONICK Es~te o~a , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW DECEMBER 31 J9...2L. In consideration of the petlllon on the rcvcrse sidc hercof, satisfactory proof having bccn prescnted beforc mc, IT IS DECREED that II/arc cnlltlcd to LCllers of Administration. and in accord with Such finding. LCllcrs of Administration arc hercby granted to LOUTSE F. BOBONTCK --.--. -----. --.---- In thc cSlalC of ANDIlEW J. BOBONTCK - 11 !ci-tli(' ,'i.LuLL~)p.J.l'.rJ{ ()W({L/\ kl- J , ~ 0 MAllY C. LEWIS Resl"" of Will1 FEES LCllers of Adminlstrallon ...., SIB. 00 Short CcrllfieatcsCl)......,... S J. 00 Rcnunelatlon .........,.,.,., S JCP S 5.00 TOTAL _ S 26.00 Flied .,., .DEG..,J.l...,.,. A.D, 19-9-6- A 170RNEY (Sup. Ct. 1.0. No.) ADDRESS PHONE I.E'J"I'EIlS AND OHDER MAT LED TO ADMINISTRATOR 11:1>" lil\ This is ltlll'flil\" Ih.ll Ihe 1IJI1Irlll,IIioll ht'fl' .l:IH'IlI... ~IITllllh 1III'a,!III"" .11l1l11.1~1l1,d ll'lIillt.lll' III dt'.lth dilly filed with me .IS 1.11t'.llltl'gl,lr.lr. 'Till' llrigill.1i H'nilll..Llt. will hl' lnl"...-.kd III lilt ~1.1!t \'11..1 Hl'Illl.l... (1IIIll' 1111 j1l'nn.lIll'lI[ fillllJ.:' WARNING: It Is Illegal to duplicate this copy by photostat or photograph. Fl.t. 101' thi... It'l(ili~,J((:. S!.OO i"l;i'.................;,,;~. .,,~~\1J!Of P(~ J,L'\~-;, ~',,'t. $ .\'\'?o ~."...,"'.I~ u, Ii: ~'.' ,.':-~. ~:-.. .,~,,~.:'/~~ 'f.fj;r--f'l-\~i [NT ~ "',' . . 3960320 No. &~ Pi. ~,,>>-,~~~ I..Ital Hl',l;i"uJr DEe, 1 7 1996 n,lle "'M,&)1l...2;I1 COMMONWEALTH OF PENNSYlVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH ,'.071'..t_1II s.oc'4,ua,t"'''''""",ulI ~Io!IO'or.u"'-.o..._1 "'" ,., "" IoAWI 0' Cf:U"'''' 1'''''''_''''' ... I, Hale L 194- ="0 Andrew John Bobonick, Sr. Io"OIilllQllt' D&I'IOf ""'TH .......1- ~o.._1 I, AOlA"~ "'IfDlIII'lN'l - .... ""f"'VCIlC*y_ ....,....,.'-"" ~06Dli.THQ<<.____~..__ ...."'- _0 72 .. ershc- town PA "........I"....~'7""......__, CGld iSIt. ~as COU".I"t'Ol'DtRM .;1.\ UotNl"'IAU l()OO __.:;:~;.s:::.::~:::: oo..oOlI\lSl""l$ It " DlCltlllfT'..U,H3.t.D01\lssr,.... ~ """'rll>~ 1833 Ritner IIlghv.y Shlppensburg, PA 17257 Olel ".," OCt"'.... iIIUIOIOICI -~ ~-- H....... PI Dol -- -.. ~ -....' .. 'RlClI'........I,......._U1Ol I Hichael Bobon1ck HQII.......,I'"'""I(l~ Louise Bobonick ...... ...,. O ......[] c.-D "--.........0 c..... 0-"-", . ..... .~, 14- 7225 . Dee, 13 1996 1"11I'.' l\ACI._...........-..tIC. --.. .. White -"""" 1I-""113skzicwicz .. u.uoo'\l.LllCrUS."_ .....11___ -- Harrle~ H..lII....__.. )J......~h flfDU""'" l'tO::-=~" . .,..,OA/II...,.' 1 UQTI1IJII,IO'''',J'.. "'_ w_..,._ AOOIIlU~~s.....G<rioI 1996 lIV<<OIClI$I'OIIlo.."'__ !1l;> "0-""" Cumberland Valley Memorial Cnrd I' OlAwtncl,l,tJOf\f,S,SOIfAClUTY Hoffman-Roth 219 Nor h lCI".KfoIIluetlll 010343 L ..N 1m, D"'I'IOOOtOI.I"oC(~Cf:.\O.__c.._1 u"c 13, ,q'l(" I: OUllOlQA'\sICOO<U.OVlOOC(ClI ""-lilt AU1OI'sY'oJollolfQ, .u.ukE~!O COWPlI'T1()foIQlCAUSf ()lItl(N1oor "'''''''>411I 01 O(&I'H ~&I'I01lftN'1' '_o....., ;l<Y o o . M'CAN IIIUIIlIlID rowtl~:.~S,U"""IM;OAONlM ~ ._0 1......-. :=-= , I ".IIT., c....~_........._.. ...............,......-......-~.."""I '....IOl"....'VIl' INJIIII'R'l'liClfMl' 1;ll1C;JllloK""",~D'X\.lNlID ..... ........- o !J o I"VCIOlNNl'......_.._._.........t"'If. II. -.....w~." 'h .-. -- .""o.,..~ ..... _ IN ClIIT""III,~._._~ .ctll''"'INQ~UlCl.".....__.I.'''Y''Qf....''.._.,..-...''''.'''.......pt..........I'l~... o.'oS,,"__n, ,....._....,.--..,........_.._.........Hl.'....._....u,.. . . C-'d....t.efp_ .. .'lfIOOoDUIIeIMGlloOt.IIIT."tIoG'"'\lCU...,n..........tw.....~.....""......o(I,~...,....."'''".., . ,....._..""...-...................."..._.,,,., _""'......_...........tt.l_...._...tt..... '1l'Ql(ALllAIl,...RttO"O".(II OII_............_.._............."'"_....""_.lltlIlIOCU.H....I..'................"H......lhI.I.....'.....I.I.... "'.............M. ,.. ...(0..,.... ~ '. "'" 0 ...0 o . 0 ".1..1.....DADClAIUD't.III~"-OCDf,l"'rTID~SlCl'OIttZH '_21l''"0I~_ vO'v\ r..eVt\c.J ",,, Ill' ,~, ~11l"'-rv Q 11 '.1 . 0....1''1.10,....,...'''._' '"3)<<.. \1) \'\0.'" .. .. O>.I-Iqq~ -/0 15 co ;;~ - ~ 0 J!1 N :j ~~ .~~ 0- J ci ") \0 - .. N - j; ".., t.] ,~ :;}:--. c ~ J .' ~.~) ..::1 0<1> \0 =E ma: P' Qlj a: 00 .. ... ,,:$., u"'" ....g X~.J U.." .. . z o >= ~~ ~::J .. :;; o o C' D10"linalRelum 0 2Suppk!mentalRelum 0 3 Rema,nderReluml",~"""~,,.",ll'~ o 4, Llm,ted Estale 0 4a, Fulure InlerestCompromlSel"'~""'" ","'~ 0 5, Federal Estale Ta, Retum Required o 6. Decedenl Ored Testate 1.l.l:M:I'l c~, of "".1 0 7. Oecedenl Maintained a living Trust (AllJeh tOCJ d fMt) _ 8 Total Number of Sale Oepos~ BOles o 9, UtJ9aiJOn Proceeds Rece.ed 0 10, SpousaIPovertyCred'II""~"""_ ",",II ",,,,,,," 011, Election to taxunderSe<> 9113IA)IAucI>Sd>O, THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: kAME COOPlETEJ.WlINGAOORESS 111..'''1,11,;''" 1.5 /51 - ,:< REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT J CO\4VOtM'[AlHi r PElmS'I'lVAWA Ol rAJUIJfPH or REV[tlU[ DEl'I i!l()j(Jl IiARHI RUR(; PA I lln ((lOT OlClOo-.T51iAJJr.(IA51.fIIlSl AII{)I,t.OO!.(llflllA.l1 ~"..~ bIldl'l~."1OIY1t\ I- Z W C W o W C flf ,f /' c /J OAlI()llllMtl J./I'j/I ? C(? L. L. .:; N.WE [lASt, fillS!. ANQUIO{)l[ INITiAl I M)ClAI. 5lCURHY MAlIllR /....Olt./ e- !Z .. Q Z f ., .. '" '" Q U fIRlJN,.I.J.'E(~""P~1 TELEPHONE NIA'BER 1, Real Estale {ScI1edule A) 2, Slocks and Bonds (Scheduk! B) 3 Close~ Held CorporaiJOn.Partnership or Sole,Propnelorship z o ~ ~ l- ii: c( u W 0: 4, Mortgages & Noles Receivable (Schedule 0) 5, Cash. Bank Deposrts & M","'laneous Personal Property ISchedule E) 6 Joinlly Owned Property ISchedule F) 7, Inler,Vivos Transfers & M,scellaneous Non,Probale Property (Schedule G orl) 8 ToUI Gron Anets {Iotal Unes 1,7) 9 Funeral E'penses & Administrawe Costs (Schedule H) 10, Debts of Decedent Mortgage Liabilities. & Liens ISchedulel) 11, Total Deductions (Iotal Unes 9 & 10) 12, Net Value of E.UleIline 8 minus Line 11) 13. Chantable and Govemmental BequeslSlSec 91 13 Trusts for which an election 10 ta, has nel been made (Schedu", J) 14, Net Value Subject 10 TaxlLine 12 minus Line 13) 15. Amount 01 line 14 taxable allhe spousal tax rate , , See instructions on reverse side lor applicable percentage 16. Amount of line 14 taxable aI 6% rate 17. Amounl of line 14 taxable at 15%",le x ,0 x ,06 x ,15 18 Tax Due 19, .l ,I'. III HUMBER ? If" / t,) 'I S ..-, dl rl'll,ejT,Ul(1( "'" OAl{()f ~H'1l / / THIS RETURN MUST BE FilED IN DUPLICATE WITH TilE ~ OJ ") -.> REGISTER OF WILLS (11) ../ ? ry. E.,' {J _?', 7-/- . U (12) 113) (14) Z) 115) 116) (17) (18) DATE I /1 ';/'if DATE DocEldont's C~I!!P!~!<<l_~ddros..!:___ :. III L l' A.1l{)I; I ~,'; em' I ~, , A I f Ill" Tax Paymonts and Crodlta: 1 T.1X Due (P.lge I Uno 16) 2 CredllS!PayrncnlS A. Spousal Povorly Crod,l 8 Pnor Palmonls C, D.sccunl 11) J, InleresVPenally " applicable D, Inloresl E,Penally Tolal Crod.ls ( A. 8. C) 121 TOlallnleresUPenalty (D. E) (3) 4, IIIine 2is grealellhan line 1 'line J, enlellhe difference, This is Ihe OVERPAYMENT. Check box on Pagel Line 19 to requelta refund (4) 5, II line 1 . line J is grealer Ihan line 2, onler Ihe difference, This is Ihe TAX DUE. (5) A, Enter Ihe interest on Ihe tax due, (SA) 8, Enler Ihe 101,11 of Une 5 . SA, This is Ihe BALANCE DUE, (58) Make Check parable 10: REGISTER OF WILLS, AG~NT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a, retain the use or income of the property transferred; ..........,....................,......................,...... 0 0 b. retain the right to designate who shall use the property Iransferred or its income: ................ 0 0 c, retain a reversionary interest; or..................,..............,................................,.......................... 0 0 d, receive the promise for life of either payments, benefits or care? ......................,..............,..,0 0 2, If death occurred on or before December 12, 1982, did decedent within two years preceding death Iransfer property without receiving adequate consideration? If death occurred after December 12. 1982, did decedent Iransfer property within one year of death without receiving adequate consideration? ..,"',....,..,............",.............""""....,.."....",....,..,....",...."..,..,0 0 3, Did decedenl own an "in trusl for" or payable upon dealh bank account or security ,11 his or her death? ............,..............,..,................,....,......,........,............,........................,......,.... 0 0 4, Did decedent own an individual retirement account, annuity, or other non-probate property?.... 0 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN "'~iN~W"~~.-f!l2UI1 !&AHlftrI_~~.JIll'FJI"~dib~""I1.Wi~- ~ 72 P.S, ~9116 (a) (1,1) (i) provided for the reduction of the tax rate imposed on the net value of transfers to or for the use of the surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995, 72 P.S, ~9116 (a) (1,1) (ii) provided for Ihe reduction oflhe rate imposed on the net value oflransfers 10 or for Ihe use of the surviving spouse from 3% to 0% for dates of dealh on or after January 1, 1995, The slalule does not exemot a Iransfer to a surviving spouse from tax, and Ihe statutory requiremenls for disclosure of assets and filing a tax relurn are slill applicable even if the surviving spouse is the only beneficiary, , ""~.>j:", i,J!i. ,";" FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995 - Please answer the following question by placing an "x' In the appropriate space, Old the decedent create a trust or similar arrangement which Is solely for the surviving spouse's benefit 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 poslponed until the death of the second spouse. at which lime it will be fully taxable at the rate(s) applicable to the remainder beneficiary(ies), Enter the value of the lrust on Schedule J, Part II, in order to remove it from the calculation of the lax due In this estate, You may wish to file Schedule 0 in order to make the election available under Section 9113, If the election is made, the trusl or similar arrangemenl is taxed in Ihe estate of the first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse is taxed at the zero lax rate, and the remainder is laxed at the rate(s) applicable 10 the remainder beneficiary(ies), If you choose to make Ihe election, you must attach Schec!ule 0 10 a timely-filed tax return. along with Schedule(s) K and/or M in order to show the apportionment of Ihe trust or similar arrangement between the surviving spouse and Ihe remainder beneficiary(ies), -.-.....- --.......--... orv....'..,'".. COMMONWEAlTH Of PfNNSVLVANIA INHERlTANCE TAX RETURN R I NT NT SCHEDULE E CASH, BANK DEPOSITS, & MISC, PERSONAL PROPERTY ESTATE OF FILE NUMBER Include I/Ie pmceed. 011rtJg.1ion and Ihe date Ihe pmceed. were receiv<ld by Ihe estate, All property jolnUy..."",ad with thl right of IUrvlvOllhlp mUlt be dlaclolad on Schadult F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH (J~t~{(3 ~/ Y;J. 7, II TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert addilional sheets of the same size) 1lIV"'lll'I"'" '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS CQI,lt,l()fffl[Alltl Of PENNSYlVIJlIA IN"ERlTANCE TAX RETURN R I "T NT FilE NUMBER E5T.NE?1j , ft(\/LJ'f I t;;""r,./ ~ r?~?;; G' IVr c..f.!.., Debl1 01 decedent mUlt be reported on Schedule I. ITEM NUMBER A, AMOUNT DESCRIPTION 1. FUNERAL EXPENSES r-:J H (.'.f rtf/itA! P)01 ~ fr,{,1f /1/ If'IT ;11 ~2~/7 f ft? B, ADMINISTRATIVE COSTS: 1- Pe"",,,,' Represenlali'll's CommisSIonS NarM of Pe""",' R.prosenlali'll (s) Social Security Numbe~s) I EIN Number of Pe"",,al RepresenlaliVe(s) StreelAddress City Slate Zip Y..~s) CommisSion Paid: 2, Attomel Fees 3, Fami~ Exemption: (II decedents address Is nol the..rM as claimants, allach ",planation) Clalmanl Street Add.... City SIa\e Zip Relationship 01 Clalmanl to Dece<I.nt 4, Proba\e Fees 5, Accounlants Fees 6, Tax Return Praparefs Fees 7, TOTAl(AlSOenleronline9,Recapilulation) $ y-' ~ '7 ;>b (lIl11Ole space is needed, insert additional sheets of the same size) /. ~ /.s/ ~.;{ IUREAU OF INDIVIDUAL TAXES ....RITAHC( 'U DIVISION DlPI. 180601 ItARAISllfi, PA 111U-otlll COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE * NOTICE OF INHERITANCE TAX APPRAISEMENT, AllOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX '''.1'''' II~' ltt.tlt LOUISE BOBONICK 1033 RITNER HWY SHIPPENSBURG DATE ESTATE OF DATE OF DEATH FILE NUKBER COUNTY ACN 01-18-1999 BOBONICK 12-13-1996 21 96-1075 CUHBERLAND 101 A.ounl R..III.d ANDREW J PA 17257-.U02 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~ iiEY:is4'rEX-AFji-iilij:m--ilil'ficniF"YNHEiiii'ANCn'-AX-iipiiiliiisEiiiil'r;-ALLOiiANCnii----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BOBONICK ANDREW J FILE NO. 21 96-1075 ACN 101 DATE 01-18-1999 TAX RETURN WAS, (X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Est.t. (Schedul. A) 2. Stocks end IIonds (Schedul. I) 3. Clos.ly Held Stock/P.rtnership Int.r.st (Sch.dul. CI 4. Hortgag..lHot.. Receivable (Schedule OJ 5. CashlBank DepolltsIHllc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedul. F) 7. Transfers (Schedule G) 8. Tot.l As..ts ( I CHANGED NOTE: To insure prope,. oradl t to your account, s...",1I the upper portion of this fo.. Mith your tax pa)'llent. ,00 .00 .00 .00 1.029.16 .00 .00 (8) (1) (2) 13) (4) (5) (6) (71 1,029.29 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral EXPen.../A~. Costs/Hilc. Expenses (Schedule H) 10. Debts/Mortgage liabiliti.s/li.ns (Sch.dul. II 11, Tot.l Deductions 12. Net Value of Tex R.turn 13. Charltabl./Goy.~.nt.l Bequests; Non-elected 9113 Trusts 14. N.t V.luo of Est.t. SUbj.ct to T.x 5,227.50 ,00 (11) (121 113) (14) (9) (101 J;,??7 J;O 4,198.21- .00 4,198.21- (Schedul. J) If an assessment was issued previously, lines 14, IS and/or 16, 17 and 18 will reflect figures that incl~de the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. Aeount of line 14 .t Spous.l r.l. 115) 16. Aeount of line 14 t.xebl. .t line.I/CI.ss A r.l. (161 17. Aeount of line 14 t.xobl. .t Coll.t.r.l/CI.ss I r.t. 117) 18. Principal Tax Due NOTE: .00 X .00: .00 X' 06: .00 X .15: (181 .00 .00 .00 .00 TAX CREDITS: PAYMENT DATE DISCDUNT (+1 INTEREST/PEN PAID (-I RECEIPT NUHIER AHOUIfT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS lESS THAN .1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE DF THIS FORH FDR INSTRUCTIONS.) RESERYATlOth PURPOSE OF NOTlCEz PAYltENTz REF\.ICD (CA): DIJECTIONS: ADHIN ISTRATIVE CORRECTIONS: DISCCUfT: PENAL TV: INTEREST: E.tat.. of decedent. dying on or bafor. o.c~r 12, 196Z -- If .ny future Int.r..t In t~ ..t.t. I. tr~.f.rred In po.....lon or .nJo~t to Cl... I Icoll.t.ral) beneflcl.rla. of t~ decadent aft.r t~ .xplr.tlon of .ny ..tata for 11f. or for y.ar., the eo-onwulth ~raby .xpr.sslY r...rv.. the right to eppralse and ...... tr.n.f.r Inharlt.-.ce Tax.. .t the l.wful Cl... I (coll.t.r.l) r.t. on any such future Int.r..t. To fulfill the requlreaant. of S.ctlon ZI~D of the I~rlt.nc. end E.t.t. Tax Act, Act 21 of 1995. 172 P.S. s.ctlon 9140). o.tllCh tha top portion of this Notlc. and .ubIIlt with your paV-Mlt to the Rqlst.r of "U" printed on the r.v.r.. .Ide. utWc.. check or RMY order payabl. tOI REGISTER OF MILLS, AGENT A refund of . tax credit, which wa. not requa.tad on t~ Tax R.turn, ..y ba r.que.ted by cOllPlaUng .n "Application for R.fund of penn.vlv.nl. Inherltanc. and E.tata tax" IREY-1515). Appllc.tlon. .r. avallabl. at t~ OffIce of the Reglatar of "Ill., any of the 2J R.venue DI.trlct Offlc.., or by callIng t~ specl.l Z~-hour en....r-Ing service ......r. for fotll. ord.rlng: In JJ.m.vlvanl. 1-8aa-36Z-2050, outsld. PennsYlvania and wIthin local Harrisburg ar.a (717) 787-8094, TOOl (717) 77Z-ZZS2 IH.arlng l~alrad Only). Any p.rty In Int.r..t not ..tl.fled with the appr.I....nt, .llowanc. or dl..llowanc. of deductions, or .....~t of t.x I Including dl.count or lnt.r..t) .. ahown on thl. Notlc. .u.t object within .Ixty (60) day. of recalpt of this NoUca by: --written prot..t to t~ PA Depart..nt or R.venue, Board of Appe.ls, Dept. 2810Z1, Harrisburg, PA --alactlon to hava the ..tt.r det.ndMd .t audit of the account of the personal rapra.entBtlva, --eppaal to the Orphan.' Court. OR 17128-IOZ1, OR FKtual .rrora dbcov.red on this .......ent .hould ba .ddr..sed In wrlUng tOI PA Dep.rblent of R.venue, Bur.au of Indlvldu81 T.x.., ATTNI Po.t A......ent R.vl... unit, o.pt. Z80601, Harrisburg, PA 171Z8-D601 Phone (717) 787-6505. Sea page 5 of the bookl.t ''In.tructlon. for Inheritance T.x R.turn for. R..ldant Decadent" IREV-lS01) for en axplanatlon of .o.lnl.tr.tlv.ly corractabl. error.. If any t.x due Is paid within thr.. (]) calandar aonth. .ft.r the d.cadant'. d.ath, a flv. percant (~) discount of the tax paid I. allowed. The l~ t.x ......ty non-participation penalty Is c~tad on the tot.l of the tax and Int.r..t ......ed, and not p.ld bafor. January 18, 1996, the flr.t day .ft.r the and of t~ t.x aana.ty parlod. thl. non-partlclp.tlon J*\8lty I. appealabl. In the .... ...-nar and In the the .... tla. p.riod .. you would appeal the tax and Intaraat that hat bun .....sad .. Indlcatad on this notlc.. Int.r..t 11 charged baalmh'tll with flr.t d.y of delinquency, or nine (9) aonth. and OM (1) day frOll the det. of death, to the date of paYHnt. Taxa. which bac... delln.,.nt bafora January 1, 198Z baar Inter..t at thct rata of .b 16%) parc..,t per IIMU8 calculated lit a d.lly rate of .OODIM. All tax.. which ~. de11nquent on and aftar Jenuarv 1, 1982 will ba.r Int.r..t .t II rat. which will vary frOll c.lendar y.ar to cal.ndar year with that r.t. announced by the PA Oapart-.nt of R.venue. The appllcabl. Inter..t rat.. for 198Z through 1999 .ra: !!!! Int.r..t Rata DlIlly Int.r..t FM:tor :!!!r Inter..t Rllta D.Uy Int.r..t Factor U8Z 20X .000S48 1988-1991 lIX .000501 1983 16% .00008 1992 'X .000Zft7 "84 llX .000501 1995-1994 7% .OOOUZ 1985 13% .000556 1995-1998 'X .000Z~7 ,... lOX .000Z7~ 1999 7% .OOO19Z 1987 'X .OOOZO --lntare.t 1a calculatad a. follow.: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notlca I..ued aft.r the tax bacoee. dallnquent will r.flect en Intare.t calcullltlon to flft-.n 115) day. bayonet the data of the .......ent. If paYMnt Is aada lifter the lnt.ra.t cDIIPUtaUon data shown on the Notlc., eddlUonal Int.r..t .u.t ba calculatact. STATUS REPORT UNDER RULE 6,12 Ihvir, !;' <- r: ~(' " j, 6) /1 r cj~ Nllme of Decedent: J / , Dllte of Death: / "2-/ ( s II ~ f " Will No. ,;(/ - ~(~/-J67~~ 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 wtether administration of the estate is complete: Yes V No 2, If the answer is No, state when the personal representative reasonably beiieves that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal repr~sentative file a final account with the Court? Yes No V. 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 ~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 attached to this report. '-' ,/ / . I - '..jU ., <J,/..../~7t-<.-t. ..::./ 5i nature / J-. (/- {(.: ., .Q. 8('..,1 (J/J I/{, .k. Name (Please type or print) /f-~C3 ;P1:N~-R/j", :'!.f ~1JX'<t'.? , <,,-,,,,, Ad ress " '--' " ',/" ,c ('7/ /) _J,,?'J....-;,;:? 76'.; Tel. No. Do<e' I {il f { c.: - . , .;, - .~ ~ ,~~ Capacity: Personal Representative Counsel for personal representative (MAH: rmfl AM3)