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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
..
DlI~L ,U OF INDIVIDUAL TA~ES
IHHERITANCl: JA)( OllJlSION
tWflT. 2&0601
IlARRISftURO, PA 17128-0601
CHARLES E SHIELDS III
2 W MAIN ST
MECHANICSBURG PA 17055
NOTICE or NONRESIDENT INHERITANCE
TA~ APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE or DEDUCTIONS,
AND ASSESSMENT Dr TA~
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
.i~,~1I H Afp cu-",
12-30-96
SHERMAN LEWIS
02-05-92
99 96-0738 rt.,
NON-RESIDENT
101
D
E A.au!'! R..itlod ::::l
.___________.--J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
PA DEPARTMENT OF REVeNUE
DEPT. 280601
HARRISBURG, PA 17128, 0601
CUT AL.UNU .HiS ...11.. j;... n:TAI:: ~nWFn ~o!,.,'I"N F!lfl VOUP. m;CORllS ...
REV: si"i "EX-"AFP""C i F9& i" -tioiYc E "'(iF" Notili ES" I'ilENT" I 'N"HER'fi ANC"E - TAX - A iipliAfs EHli:ii ~ -. A L (,QWAt:ic" 'OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHERMAN LEWIS 0 FILE NO. 99 96-0738 ACN 101
TA~ CDHPUTATION METHOD ELECTED, (X ) fLAT RATE () PROPORTIONATE
TA~ RETURN HAS, ( X) ACCEPTED AS FILED I) CtlANGED
RESERVATION CONCERNING FUTURE INTEREST " SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1, R.el E_t.t. (Sohedule A)
2. Sto~k. and Bonds (Schedule B)
3. Clo..ly Held Stock/Partn.rr,hlp Inter.lt (Schedule CJ
4, Hortg.g.s/Not.. Raceivable ISchadul. D)
5, C.lh/Bank Oapo.lt./Hilo, P.rlonal Property (Schedule E)
~. Jointl~ Owned Prop.rt~ (Schedule F)
7, Trensfers (Schedule G)
8. Totel Ail.et.
DATE
12- 30-96
II)
(2)
15)
(4)
IS)
(6)
17)
.00
.00
.00
.00
500.00
,00
.00
NOTE I To inaure proper
credit, to your 8ccount,
SUbWlU the upper portion
of thiG forM with your
tax pay..ent.
(8)
500,00
APPROV~D DEDUCTIONS AND EXEMPTIONS:
9. Funar.l E~pen.e./Ad~. Costs/Hisc. Expanse. ISchedul. H) (9)
10. Debt./Hoduage Liabilities/Liena (Schedule I) (10)
11. Total Deductions
12. Net Value of rax Return
13. ChlldbbJ,a/Govarnlnantlll Bequ.st, (Schedul. J)
14. N.t Value of ElIt.t.. Subject to 'rax
.00
.00
Ill)
(2)
US)
1141
.00
500.00
,00
500,00
If a'1 LJSeSllment wa" issued previuusly, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
NOTE:
1'" Ui and/Clr 110, li ..r,1i u. "ill
returns assessed to date.
15. AMount of line 14 .t SpClu..l rat. 115) .00 ~ ,00= .00
16, Anount of Lina 14 taxabl,a .t Lin..l/Cla.. A rat. 1161 500.00 ~ .06= 30.00
17. AMount of Lin. 14 taxable at Coll.tar.l/Cl... Brat. 117) .00 ~ ,15= ,00
18. Principal Tax Du. (8) 30.00
TAX CREDITS:
--------- ~--_.~-- -----
PAYMENT RECEIPT DISCOUNT (') AMOUNT PAID
DATE NUMBER lNTEREST (-)
.-~-- ---- ---
10"01-96 AA162866 9,36- 39.37
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CAI.CULATIDN OF ADDITIONAL INTEREST.
B~::~E~T:_: -~:;D~~T E-.~ _= 30: ~I~~__
INTEREST AND PEN. ,00
_____-'!ll!.~~ DU~_ __ .,_.~~...._.___.&m...
IF TOTAL DUE IS LESS THAN fl, NO PAYMENT IS REQUIRED,
IF TOT~L DUE IS REFLECTED AS A "CREDIT" (CRl, YOU MA'f BE DUE
A REFUNO. SEE REVERSE SIDE OF TNIS FORM FOR INSTRUCTIONS,I
RESERVATION, Estatll of dlo~'nts dying on or before ORo..ber 12_ 198~ -- If any futurl Inter..t in the .Itlt~ II
trftn.ferr~ In POS'.I.lon or en1oy.ont to Clp1c 8 (Qol1~t8ral~ ben~~lolor j.m of the deued.nt ~t{er the explratton of any I.tate
for 11 fa or for yurl, the Co..onwealth hlrClby exprel1lly re..r"'.. the rIght to appral.. nnd II..... tran'for lnher !tance TI!I)(U
at the lawful ChIS 8 (collateral) rate on any luch future 1nterut,
PURPOSE OF
NOTICEl
O!JECnONS I
ADHIN-
ISTRATIVE
CORRECTIONSl
DISCOUNT I
REfUtm (CR):
PENAL TV:
INTEREST I
TO REMIT
P~VHENT I
To fulfill the req..drll",enh of SecUon 2140 of the Inh.r!tanq. l'Ind F.stl!lt. hl( Aot, Aut 22 of 1991. (72 P.S.
Section 2:140),
Any party In interut not satisfIed with tn. lIpprlll..llent, allowono$ or dhal10wancI of dlduQtlonl, or u......nt
of hx rlnclud1rIA dhoount or Interut) ft, shoMn on thh Notice IlUlt Object within dllty (60) daYI of rll<lllpt of
this ttoUc..
-Objecti~. lIay b. IInde by:
"-writtan protest to the PA Depnrbent of Revenue, Board of Appuls, Dllpt, 281021, Harrhburg, PA 11'128-102~, OR
uelacUnll to have the MaU.r detel'lIlnCld lit 8udJt of the personal repruentatlvl, OR
Uapp&al to tho OrphM\s' Court of OauphJn County, Court House, HarrIsburg, PA 17101.
FaotUlJl erro"l dbcollered on this ftlUSflllent should be addressed In writing tOI PA Dllpartllent of Rlvlnuel
Bureau of IndivIdual Tnl<U, ^TTNI Post Auus.ant Revlew Unit, Oapt, 280601, tlarrJsburll, PA 111ZBM0601
Phon. (717) 787"6505. See P8111 3 of thQ booklet "Inltructhms for InhlrJtnncl Tnx Rlturn for 1lI Notlrllident
OeQlldent" (REIJ-I716) for an BKPhmatlon elf l'IdlllnhtratJvllllY correctablo urrors.
If any tIIx due is pftld within thr.. (;\) .o.nthl aftllr the decldent', death, ft discount of filla plrcent (5)0 of
the tax paid II allowed.
A refund of a tax credit, whIch was not reque.ted on the Tax Return, 1l0Y ~e roqu~.ted by to~plltJn~ an "ApplicatIon
for Refund of Pennsylvanll1 Inh~rltence And Estatll T1\x" (REIJ-Bl:s), Aoplh:e.tlonl flr'lI rwnUablCl at th. Office
of the RlIglshr of Wilts,. any (If thl 23 RClVanul District O(flces or fro. the DIlP:trt..nt'. 24Mhour anlwerlng 'Irvlc.
nutllber. for for'MM ordlrlng: In Penn.ylvanJtt 1-800-?'6Z-20!i0, outsltle rennsylv8nia and ~dthin iocal Harrisburg "rea
(7171 787"AO?4, TDOI (717) 77?:"22S2 (HearJng hprl1red Only).
The IS% tax !llln.iIJty non-pelrtlolptltlon penalty Is co~pu\ed on the totft1 of the tal< and Interellt !lIl'lllued, and not
paId before January 18, 1996, the fir!llt dtly afhr thCl IIrld of the hax allna.ty period, Thh non-partlolp8tJon
plltnalty h appllf:lll!lblu In the I:8U _!:Inner ",nd In the the !il'IMCI th'lI periOd as YOU would Appeal thl h1x and Interest
that hu beln IlIUSUd 1"11 J,..(tlClltil~ C~ t~l::l t~"lt!Ol'.
Inter.st is chlilrged b.gJnnlrlg with first dny of dellmfuency or nine ('J) .onths and one (1) dflY fro. thCl dnt. of
d.llth tc. thl date of paYlllnt. Tnxo. .mlch twiN'.' delinquent beforu ,/anunry 1, 1982 be8r inhrast at the rllte of
six (6%) plrcDnt p<lr MnUlII cll'leuhhd flt II dally rnte of ,000164, All hxu which be,"e.. dCllinquent on and after
Janu8ry I, 1932 will bur Jnhrut 8t l'i rl'lHt which ~dll vary fro. cahmdar year to clllend!lr Vllar with th8t rate
ftnnouncld by thl PA Dllp8rtllont of R~IIC1nue. Thll ~ppJlcablQ Interest rates for 1982 throu~h 1997 llrCll
~ Interllt Rat. Dally In1er..t Factor Y.2r Interest Ratll D8ily Interest Factor
19~2 lOr. .000548 1987 9% .000Z47
1983 16:1. .000438 190ft~1991 11% .000301
1984 11% .000301 1992 9% ,0110247
1985 13% , OOO~56 1993-1994 7'1. .000192
1986 10% ,000Z74 1995-1997 9% ,OO02(t7
--Interast ,Is calculatCld "' follows I
INTEREST = BALANCE or TAX UNPAID X NUK8ER or DAYS DELINQUENT X DAILY INTEREST FACTOR
.-Any NoUce luued aftlr the t8X bleo... delInquent will rQf1ect IIn Interest ClllCltlatlon to fiftlln (IS) deYI
beyond the date of thl a...uunt. If paVlllnt Is 118de nfhr the lnhrut cOlllputnt,lofl date .hown on the
NotJoe, uddltlonal Inter.st ~~It be calculated,
G.tech the top portion "f thh Hotlce and sub_It with your paY.llnt to flA Oepartunt of Revenue, at thll addr...
shown on thl reverll sidl,
-Hak. ch.ck or IIOney ord~r fll'yabl1 tOI COnnDNHEALTH OF PENNSYLVANIA
All paYIl...,ts rllclJved Ihllll be applJld first to lIny ~ntlrut which M8Y b. dUI with any r....lnd.r apPUld to the t.lC.
.
(
", U...,I....Jl..11 13,'7j
c::.
*
COMMONWfAlIH m PfNNSnVANIA
oePARTMENT Of fHVENUE
INHfIIllANCE lAX UtURN
NONRUlO_ENT DlCEO.!~!
FilE NUMBER
Pl,ole Prln' or T yp~ alllnlormatlon
NONRESIDENT DECEDENT
SCHEDULE E
MISCELLANEOUS PERSONAL
PROPERTY
ESTATE OF
LEWiS ]), :W";;:iVl//fN
.. . , ' . - , I' I E I II ~ptmonol prope"y ore jewelry, furnilun
Parll muS! irlclude -olltongible ptHlonol properly hClvlng IH 1I1us Iri Penr,sy vanlU on y, Komp tl$ 0 OOgl e I 'd (All rt lointl
pointing$_ .,c, C'Hnpl.te Part 2 on ,.verae side ONLY when the proportionate mClthod of tOk comflutatlon II . itt.. prop. Y Y
owned with Right of Survlvonhlp must be disclosed on Sc:hetiule F.)
PART I. AlIlallglblo pe..nn.;i properly having It. .ltu. in Pennsvlvania.
ITEM
NUMBER
DESCRIPTION
1.
{Jowrr;AJ!.s OF 54FT: Dt:Pos,'I ~>< 1/-7 PIVe
'BliNK MECHIltf)/{!,S8wR& A-s fJEli? /J.)J/ErV"To.ey wl7i
CY<II-/G' (jv/lj)t:>/V. 4,' (""(.\,,, \,..\\ (r., f:\/
~N,a, 'r.,.. WAS et=L./4fJ/SJ By tEVER,h;>VG {HitT 7/T'E'
'Box WITS €:mm WNnt. 7Hr: I,uVE-Vn>,ey wA-S
/11;;. 7)(;,
k ME LIIO y's /If kM''+ T wH/1~ Pe/HU- GoLl> RlIlI &-
(,5c e CJ.ppro; ~a 16 alfac/'ed fr,r eAch ;lem)
E. , .::ilL VEl< Pe:;.RL
OA;/f LR-by s .:57~LIN(i. R./AJ&-
(1, ()Nf!' t./l-bY$ !57,4It1PED ,Hjh 71F:s T<if"D I Af .k41t1fr
GeLD EL(~/N PecKEr WI/TCI{
Po Ol)€ ,
L./fI>Y 5 ::>'TI/ 111 P eD ,HvD -r~srt:::J) /'1 KMH
G-ol../) BI/NCr UF 73IUCE"LE T
,
FE. ME t./N>Ys I't K/fIMT -r~ ?ONe G-c;LD tue1>,/)/N(,.
81/1ijJ>.
I
F. PtllE LIfoPY S S7/MII'EZ:> #>vI> ~srt!D /L{ K~-'lr )teLaw
Gt:>Li> DIArnol\!.D F(/N6-.
G-. ()1fJ/F S7/MlfJEb 1rNl> TESTED /'7f K/.rIM T Y€"LLOW
(ioL..D IN/11ft/... I</I'/G,
,
I-{. tJN€ I..""oy~ 18 K/f-RIIT tvHlr.: Gou> pJ~IN(; I3I/MJ.
X. (JrJE t.,4-Dys If I<I'MI/oT Yt:Uf)W (j.f;LD OPI?L .ftr])
I?tdJY If/Nv.
X '8 ftt.../}ttJC,6 of 17/H"r1:S ,?, &. Cos7LlMG .J!;lvt:'2Ry
,
(SOb' DO)
TOTAL (PART I)
TOTAL (PART 2) (Propo,"ono" Mo.hod Only from rovo", .idel S
GRAND TOTAL IAI.o on'or 011 line 5, Rocopi.ulo.lon) S
(If moro .paee I. nnoded, in.nrl addlliana: .heoh al .amo .izo,)
V ALUE AT
DATE OF DEATH
f/S/O.ot:>
;a 30 ,00
~/'?5.()O
,. 1..5- DO
"'~,.o
~1/51 00
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DC
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