HomeMy WebLinkAbout97-00018
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COMMONWEALTH OF PENNSYLVANtA' OEPARTMENT OF HEALTH. VtTAL RECORDS
CERTIFICATE OF DEATH
NAME Of' oeCl~1.fl (f~. MoOlAt.l")
I,
AGE (l..lWhM'fl
1I..J:le.~ '
UNOEA , H.VI
....... "'-
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SIAl. ~'II""JilIlIIn
SOCIAL SECUAlty N IIlbUI
llllIEOP'Ol!.AHt,MonfIo.V,''''!
I fana1e " 165 - 18 - 5147
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N<>[P<i'II[]"l"&,~oIyCi.lblil l~1
Cunber1anll C""P Hill Pa ~425 Devon 1<1 ....'~'-_,., WhIte
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'I'M 0 NQiXX 10\2) 2114Cd'l Will .,~.,
Housew.\te 1 . 'L u, _,c_,____ 0""" ___
tl(('11iiiN1:SlMlLlN<l"OOf\fa.t(S/l"Cl\<fbwnsw.l'llC~1 DlCfOlHT"
425 !levon Road ""u" '''''.''-,,--"P&--__.__~..... 10.0..,_..._____________...
A€Slrll1~ _.
" ,~~ill, Pa 170~_ '::-:"~:;;::r' 1010 Coo, Cu1>ber1and :;:"-:.:,, IO.IllI~~".:::::'..
MlHEA'S N.wl: Ifni MoOlJe latll lMJT;-liifSNAiii;~~.M..,."Sut~1
Frank Miller L__A1~~a Werkheiser
I"'~T"HAW; I1Y/>1{f'''f1l) 'NfOlWANf'SIMIUffi -'O()flESSISlt"'Col-l~,_, l(JCOOIIl
Jean Johnson 425 Devon Hood lUll, Pa 17011
OI'DlSP081TION - O,qEOI'QlSPOSlTION PtAClOf0l5PO$l1QN.Nanlfolc.m..tfy,C",1IlI<'lV lOCAlION'CIfy"-'.Sltl.,~COOII
&..w;('J CflfMlblO "-ow.I"(O\\81~IJ 1~,o.Y'''''''J 1)I000000Pif,c.
-,""",,--------____LJ ()::tober 21,1996 Laurelwood Cemetery Strnudsburg,Pa
"".'" ..."" """",'"'''' ""UCH- '--~<"'6i'r&lJ'4-1, "'"''''''''''''''..'''-~- - 1903 Market StfeSt
_--1~ " ers-Hamer Funeral fone IlIc~1ilhJ'a ! 11
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WEfICi' A,uTOf>8Y FINDING! ~N(" 01' DE.lJH (l,IJE OF IN,JUAY fllilE Of'1"-!URV INJlIAY AI I'lOAl'It-[SCRlllf: t'QW INJUAY ~~CURN:O
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NAME OAOCl(\(liSOf/'tI1S0Nl'llfQCOMP\[TtOC^\lst. Ilt H
III"nl~/) fypolOf PUIII
89
. Octoberl6,1996
'"
Coon Hill
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21..97"18
ItENUNCIATION
In Re Estate of
Sa.J..'-j
A Newj,(J~'t:
To the Reglsler or Wills of
County, Pennsylvania,
deceased,
// / I
The undersigned (Oil,', dA..e~ or
lhe above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that
tellers
be Issued to
.~aYl
E. ~-f;;n SON
...<:. ,-?{.&:(
hand this ~ day or
61t~'f!-V
WITNESS
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Subscribed and sworn to before me
this ~(51 '" ~day of ~,
19" \.,
'C)l}~ ~'
, Nolllrl'ubll(
(
r-'-~ANN~~~~~~~fr; ;:JbIIC
lomoyne Borough Cumberland Co,
My Commission Expires Dec, 21, 1997
Ft'~n
35 of, /10
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J I fOR DATES Of DEATH AnER 12/31/91 CHECK HERE
~-,.rt:.!i INHERITANCE TAX RETURN l~o~~:~yug~DITISCLAIMED [,
~ RESIDENT DECEDENT Ifill-NUMBER' - ---
COM:::'~~~lfT;~6~~:~~!,^NIA (~~T~E :~~WT~~ ~~P~I~~~~ ICOUN~~~~DE _____~7~~~R___~~~8fiU~BJ_R
Of HlfNT'$ N.4.ME (l~ T, fiRST. AND MIDDlE INI'I~LI .--jOTCTfiENTTCOMPlNAbp-mr---------
NEWHART, SAI.LY 1I. 42') Devon Rood
$OCI~\ SfCURIIY NUM8ER -JDAlE On)E~lH ----~-TD~f( -6fBi~HT- - - ~ CaRl> IIi] 1, PA ] 70] ]
165-18-5147 1-]0/16/96 1l0/3]/06 CUMnERIAND
'" ..."",,,,,,,,,,,",, "0"," ",Mil"" "." ,," M:~'~'---I:~-' "e""I' NU:~~ _~ ~'~"t'_~:: ,fe",,, I~.~ 'N~:~~'-'=-__-==
001, Original Return 0 2. Supplumonlol Return [] 3. Remainder Return
(for dote, of death prior 10 12.13-82)
O~, limltfld E,tote [] 410, ~uture lnlerost Compromise LJ 5, Federal E,late To); Relurn Required
Ilor do'.. 01 dealh air" 12,12,82)
06, Decedenl Died Testate 0 7, Decedenl MaintaIned a livIng TrU$l
IAlla<h copy 01 Willi IAlloch copy of Trull)
A,ll CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO,
NIIMf Horace A Johnson Esq . COMPUH MAltiNG ADDRESS
. , ,. Johnoon, Duffie, Stewart & Weidner
'''''HON' NU"'" ---,,--~------------ 301 Market st., P. O. llox 109
-L2~_ 761-4540 _" wrovry.e" PA 17043-0109
I, Reol ellOlO ISchedule A) II)_____,______,_~_~
2, 510'" and Bondi ISchedule B) 12)
3, C1olOly lield Sto,kfPorin",hip lo",.,tIS<hedule C) 13 I
4. Mortgogel and Notes Receivable (Schedule D) ( ~ I ___
5, Cosh, Bon, Depolitl & Mi,colloMOUl Pn"onol P,operly 15) 162.611. 39
IS<hedule EI
6, Jololly Owned Properly ISchedule F) 161 _ 2,997.82
7, T.oOlI." ISchedule GIIS,hedule LI 17) 86,925.44
8, T 0101 Gran Anell (10101 lines '.71
9. Funeral Expenses, Adminl,'rotlve Costs, Mi,cellorlllous
E'p.n'" (Schedule H)
10. Debu, Morlgoge liabilities, liens (Schedule l)
11. TOlal Deductions (tolallinOl 9 & IOj
12. Net Value of E~lote (Line 8 minus Line 11)
13, Charltoble and Governmental Beque,lS (Schedule Jj
14. Net Value Sublecllo To); (line 12 minu, Line 13)
15, Spousal Transfers (for doles of dealh after 6.30.941
See 1I111ructlonlo for Applicable Percenlage on Rever,e
Side (Include "'~lluel Irom Schedule K or Schedule M,I
16. Amount of line 14 ta);oble at 6% role
(Include valuei from Schedule K or Schedule M.l
17, Amount of LIne 141 la);able 01 15% rote
(Include value, from Schedule K or Schedule M,)
18, PrindpallO); duo (Add 10); from litles 15, 16 and 17.1
19, Credih Spousal Poverty Cradil Prior Payments
._ 8, Tolal Number of Sole Depollt 60);e,
C;CJ
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....,
Z
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5
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18)
2~2,534.65
,
(9)----.15,253.85
110)
12.609.00
Cu
(111
(12)
(13)
(14)
27,862.85
224,671.80
-0-
224.671.80
(15)__
(161 ~24,67L80
-0-
X._D
x ,06 =
13,480.31
117)
x .15 c
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(18)
13,480.31
Interest
DllCount
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+ ------
+-~- -
(19)
1201
20. If line lq is greater Ihan Line 18, enter the diH~Hence M line 20. Thil h the OVERPAYMENT.
aD
Check here i you are ~cqucsting 0 refund of your O'verpoyment.
(21) ___]l!~!0.~____
(21AI __ ".~::.O.::._.._~__,,_
121B) ___11...4jHl...JL_~_
21. If line 181$ greater than line 19, entot the dlflerenco on lino 21. Thl~ ilthe TAX DUE,
A. Enler tho interell on rhe balance due on lino 21A
B. Enter the lotol of line 21 and 21 A on line 21 B. Thi$ II the 8ALANCE OUt
Mah ~h.!.k Paya~l. 00101. R'91.tl!.r._~_Wi1l~~~~~_ ._
..--___.. ~ ~ BE SURE TCl ANSWER -ALCiiU:ESTlONS- ON REVERSE SIDE AND TO RECHECK MATH -0( ~ ,
Under penolt\u of perl'Jry, I declare that I hove u.omined !hi$ return, Including accompanyIng "hodules and "atttmenl1, and 10 the be,t of my knowledgtl and bellel.
it Is true, correct and complete, I declare thot 011 reol e$tote hO$ bllen reported at true market value. Declaration al prcparer o,her Ihan the perianal reprel.Motlve h
~al8d 011 1~~ma'~?!2-af ~.~i:~~_'preporer hOl ony knawledge. _ .
~'GN.4. . (Of.HR~Qt"RfSPO '~X tOR-TIUNO-~f~-N) ",1-A'iO'RiIT'----4')'f) ~\/On HQid-'~.----'--~---~"-""-_.'------'-'._' PA-rr-:-'~ .__..~
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RtV.l~lW fJ( I 112,88)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE lAX RETURN
REsIDENT DECEDENT
SCHEDULE F
JOINTLY"OWNED PROPERTY
1
NEWHART, SALLY A,
FILE NUMBER
21-97-0018
ESTATE OF
Joint tlnantl.)'
NAME
A, Jean E. Johnson
.___,u__,,__ __,__.____~DDRESL......_._
425 Devon Road
Camp Hill, PA 17011
RELATIONSHIP TO DECEDENT
Daughter
B,
C.
---------.-.-----.----
Jolntly.ownld property:
~~~ L~g=R DATE TOTAL VAlUE DECO'S DOLLAR VALUE OF
NUMBER JOINT MADE DESCRIPTION OF PROPERTY
TENANT JOINT OF ASSET % INT, DECEDENT'S INTEREST
---
I. A 5/16/92 Members 1st Federal Cred:l t
Union " Share Savings
Account No. 126461-00
Date of death balance, plus
accrued interest. 1,144.27 50% 572 .14
2. A 5/16/92 Members 1st Federal Credit
Union - CheCking Account
No. 126461-11
Date of death balanCe, plus
accrued interest. 4,851.37 50% 2,425.68
.____J~~
TOTAL (AI.o enler on line 6, Recapltulationl
S 2,997.82
(If more spa!;.. is needfld insert additional ~heeh (If wmfl $;ze)
. !. '~" I', i' II
ESTATE OF
ITEM
NUMBER
A,
1.
2,
3,
4.
B.
1.
4.
C,
1.
2,
3,
4.
5,
6,
7.
e,
~ ,:1 V
,.~'ir~,~(\
...~j.....,..
COMMONW!AL1M m 'ENN~n""ANIA
INHERITANCE lAX Rl'TURN
RHIOINT OECfDENt
SCHEDULE Ii 11
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
___M,ISCELLANE~~SEX~E~SES ..,. ~I.a'. Print or Typ.
o - FILE NUMBIR
21-97-0018
~
NEWHART, SALLY A,
DESCRIPTION
AMOUNT
Funeral Expen.e..
Myers-Harner Funeral Home, Jnc. - funeral expenses
5,785.00
Laurelwood Cemetery C(xn~lny - Marker/Vase
Wcost Shore County Club - luncheon for famUy day of
funeral scorvices,
577.20
304.44
545.00
Iaurelwood Cemetery - grave opening & tent
Admlnl.tratlve CO.tsl
Persona! Reprelenlatl.e Commissions
Social Secvrlly Nvmber of Persona! Reprelenlati.e,
Veor Commi..lons paid
2,
Attorney Fees - Johnson, Duffie, Stewart & Weidner
4 rOOO.OO
3.
Family Exemption
Claimant Jean E. Johnson
Relationship Dauqhter
Addre.. of C!almant 01 decedenl's death
Slreet Add,e.. 425 Devon Road
Clly . Camp Hi 11
3,500.00
Stale _~ Zip Code 17011
Prabale Fee. - Register of wills - Cumberland County
263.00
Mlscellaneou. Expen...i
Cumberland Iaw .Journal - advertise letters
60.00
69.21
'rhe Patriot-News Co. - advertise letters
Hegister of Wills - file Inventory & Inheritance Tax Return
25.00
Donna Campbell, CPA - preparation of decedent's 1996 tax returns
50.00
Reserve for close-out costs
75.00
TOTAL (Also enter an line 9, Recapltulationl
(If mOrt 'po,e I. needed, In.ert additional 'h"ts of .ome .Ize.)
S 15,253.85
d Tolal number 0' exemptions claimed"
7 W.ges, saleries, tips, elc, AUach Form(s) W"2
80 Taxable Inlerest. Attach Schedule B If over $400
b Tax-exempt Interest. DO NOT Include on line Oa , ,
9 Dividend Income, Attach Schedule B If over $400 , " ,
10 Taxable refundsl credits, or offsets of state and locallrlcome taxes (see Instructions)
11 Alimony received
12 Business Income or (loss), Attach Schedule C or C-EZ
13 Capital ge.ln or (loss), If required, attach Schedule 0
14 OIher gelns or (losses), Attach Form 4797
150 TolallRA distributions l1~J ' , , ""I b Taxable amount (see Instr,)
180 Tolal pensions and annuities ~ ::::J b Taxable amounl (seelnstr.)
17 Rental real estate, royalties, partnerships, S corporalJons, trusts, ele, Atlach Schedule E
18 Farm Income or (loss), Att.ch Schedule F,
19 Unemployment compensation
20a Social security benefits, " , " "' li!1!J
21 OIher Income, Ust type & amount-seelnslr,
22 Add the amounts In the far rlght column for lines 7 Ihrou
230 Your IRA deducllon (see Instructions)
b Spouse's IRA deduction (see Instructions) ,
24 Moving expenses. Attach Form 3903 or 3903-F
Income 25 OM"half olselt-employment tax, Attach Schedule SE , "
If line 3t Is under 26 Selt-employed health Insurance deduction (se. Instr,)
$26,495 (under 27 Keogh S. selt-employed SEP plans, It SEP, check ~ 0','"
$9,500 If e ohlld 26 Penalty on .erly wllhdrewel 01 sevlngs , '
did nolllve with 29 Alimony peld, Recipient's SSN ~ ______,___'__
you), see the
Instnrctlons to, 30 Add lines 23e through 29 , ,
line 54, 31 Subtrectlfne 30 tram line 22. This Is your adJuslod g'o.. Income
For Privacy Act and Paperwork Reduction Aal Notice, .ee paga 7.
OM
Fo,rn 1040
Use the IRS
lebol.
Oth.rwlso,
pleas. prlnl
or type,
P,e.ldentl.1
Election C.mpalgn
~
1
Filing Status 2
3
It more than six
dependents,
seethe
lnstrtlctlons
lor line 50,
Att.ch
Copy -a of your
Forms W-2,
WM2G, and
1699-.R here,
It you did nol
gel a W-2,
seethe
Instructions
Icr IIn. 7,
Enclose, but do
not attach, any
payment. Also,
please 6nol056
Form 104Q-.V
(seelhe
Instructions
lor IIn. 62),
,-.-.-.
VfL~ 1
L
A
B
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Ooparlllllllll or tho T'flll~u(y.llIl(HMI fllI'IOtlllO ~orvlcn J ')
U.S, Individual Income Tax Return 1996 'RSl'''O'''Y'''''OO.'Wd';",'I'''t''.''.'"I.''lI...'~.... ':I,
For 11'10 caf Jail. 1- Dt'c. 3 1,1996,01 at/lor tax D4f Ilo Inning .19';10, onell'1 _ ... _~_.._.:_. Lt?I~_n_~!~. ~:'1rf-.[!~'-J!'
your IlrSl namo and !nlllal l.ut hamn Deceased Your soclnl s~C:llrlty numbor ..
,1JJI_~r"X_A,,-,______ ~EW!lART ._______"__,,.lQJLGj.2ii~16.5_=,18.::').1Ij?,.
Ir a lolnl relurn, spouse a '1'61 /lImo and Inlllll Lasl name Spouse's soolal socurlty numbor
~~id~~~~~~" '~Qk~1 ,,~u ..:;';';-;-;';'-... P.,~------'--=-I~.:' ~o_ ,----- -------- .
City, IOWflQI post "'tleo, aUto, and ZIPcodo. II you ha'lo a 'orolgnAddress, Sllb pago 11.
CM1P HILL PA 17011
Do you wanl $310 go to Ihl, fund?
It a oint raturn, does you~use want $3 t~o to 1I1ls "tnd?
X Slnglo
Menied filing lalnl retllrn (oven It only one hod Income)
Married flllng separate return, Enter spouse's socIal security no. above
and full name here, to
Head 01 household (with qualifying p'ersonj. (Sea 1t11lr.j It the qualllylng person Is Ichlld but ---. ____._.n~
f1C\! your depondont,enterthlschlld s namehefe. to ~__._._,_~_~...___~__
Q"all In widow or wllh de endont child aar, ouse dlod ~ 19 Soolnslructlons,)
Yourself. If YOllr parent (or someone else) oan claim you as a dependant on his or her tax
relurn, do not chock box ee ,
H
E
R
E
For holp Ilndlng line
Instructions, see pages
2 end 3 In the booklet.
~~~--N;' . Oii'-:Ch",,~i-
_U_ X -Vos'wlll not
-- --.. ctungo your tAA 01
. roduco yourroruM
4
5
80
} No. 0' boxos
checked on
In. Sa & 6b
No, 0' your
children on
(4) No, 01 IIna 6c who:
months -lived wtth
UIJed In
your home you
In Hl96 . dId not live
wnh you due
to divorce or
..pafallon
(seelns1r.)
De~endents
on 6c not
entered
abo'/e
Add numbers
entered on
1
1
b [1 Spouse
c Il<lpondents:
~
.~
(2) Dependent'S 500(al
security number, 11 born
In Doc. 1996,50" Ins!r,
(3) Dopenden!'s
relAtionShip 10
(1)Flr5tname
Lutnamo
ou
L!ii.L
7
Sa
5~l)"
, , . 5, 2651. b' Taxable amounl (soo Instr,)
9
16
11
12
13
14
15b
16b
17
18
19
20b
21
22
81,433
7.l.247.
4,475
h 21. This Is our total Income
230
23b
24
25
26
27
28
29
~
"....................~.,
~
30
31
81 433
ro,m 10401""1
''''''''''\''''U'1\l.!.Y ^. '.NEWIlJ\HT_-.--,--.-----..
).2 A~nl hum IltHJ 3' ("o!llStod gro~s Incomo) [ I
'.].a Ctulck It: ~ You WtHO fi!i or oldm, [ ] l\JInd; Spouso W,15 Gfi or olclor,
Add tho numbor of box~s ctlcdod abovo and unler thn lolal horo
b It yoll aro mnniod flllng sopnrnlnly ami your spouso Homlzus rJodllcllons or
you woro a dllnl-s!ahls nllon, 500 Im\r\JcUons and check. hflro ,
34 Enter i'"--' <<omlzed doductlons 110m Scho1julo A, IIno 26, OR
tho standard deduction shown bolow lor your Wing AUl\J~. But SilO lho
InS1fuctlons II you chocknd any bo)( online J3d or b or somoone
largur clInclalmyou as l dopondunl.
of . 5In"lo.$4,000 . Marrlod tiling lolnllyor Qualifying wldOwrfll)-$6,700
your: _' Held or housohOld-55,IlCO . Marrlod IIlIn\1 sopsratoly-U.3!)O
Subtracl IIno 34 from line 32 ,
If line 32 Is $60,475 or loss, mulllply $2,550 by the lotal number of exempllons claimed on
IIno 6d. If line 32 Is over $88,475, see Ihe worksheet In the Inslr, for Ihe amount 10 enler
Taxable Inceme. Subt.llne 36 from line 35, If In, 361s more than In. 36, enter "0"
Tax, See Insltuctions, Check If tolallncludes any lax from a 0 Form(s) 86'1'4
b ~m 4972
Credit for child end dependent cere expenses, Mach Form 2441
C,edll for the eldeny or Ihe disabled, Attach Schedule R ,
Foreign lax c,edlt. Mech Form 1118
Olher, Check if from a 8 Form3800b 0 Fo;"'8396
c 0 Form 6601 d Form (specify) _ 42
Add lines 39 through 42
Sublrect line 43 from line 38, If line 431s more than line 36, enler-D-
Self..employment tax, Altach Schedule SE
Allernative minimum tax, Attach Form 8251
Social security and Medicare lax on tip Inco,oo not ,eponed to employer, Attach Form 4137
Tax on quellned retlremenl plans, Including IRAs, If required, attach Form 5329 ,
Advence earned Income credit peyments from Form(s) W-2
Household employment laxes, Attach Schedule H
Add lines 44 - 50, This Is yaur 10101 lax .
Federellncome tax wllhheld from Form(,) W-2 und 1099
1998 estlmaled lax payments & amounl applied from 1995 relurn
Earned Income credit, Mach Sch, EIC II you have e quellfylng
child, Nontaxable earned Inc.: amt. "'L_ I
& type .. NO
Amount paid with Form 4868 (roq~IOSllor oxtenslon)
Excess soclsl security and RRTA lax withheld (see Inslr,)
Other payments, Check If from a 0 Form 2439 '
b 0 Farm 4136
58 Add lines 521hrough 57, These ere yourlotal p.!ymenls,
59 If line 58 Is more Ihan line 51, subtract line 51 from line 58, This Is Iho amount you OVERPAID,
60a Amounl of line 59 you want REFUNDED TO YOU.., ,.
. b Routing number [ .::::J c Type: 0 . Che~kl~~.[] .5avl;g;.
Tax
Compu -
lallon
It you want
Ihe IRS to
flgu~o your
tax, sos the
Instr\.lcllons
for line 37,
Credits
Other
Texes
Payments
Attach
Forms W-21
W-2G, and
1099-R an
the front.
Refund
Havo It sent
dlreclly 10
your benk
accountl See ..
Instr, end fill In
BOb, C, and d,
Amount
You Owe
Sign
tlere
Keep lCOPY
Ollhlsfnlurn
la/your
(acords.
Paid
[ IlIlInct,
.. 33a
. 33b []
:1
35
36
37
3B
39
40
41
42
39
40
41
1 G '.i' 18.::21~"0 2,
1''1--- .new
34
22,714
43
44
45
46
47
48
49
50
51
52
53
54
52
53
55
56
57
57
d
61
62
Account number L I
Amount of IIn. 59 you want APPLIED TO YOUR 1997 EST. TAX. W.
If line 51 Is more thail line 68, subtracl line 58 from line 61. This Is Ihe AMOUNT YOU OWE,
For delalls on how to pay and use Form 104()-V, sae Instrucllons
Esllmeled tax enol . Also Include an line 82
58,'719
2 J?2.Q
56,1E)9
.
12 609
63
63
.
43
44
45
46
47
48
49
50
51
12,609
W&/IA ;j ('Ml~ue.
t.. Donna B, Campbell ,
r 2536 Canby Street
Harrisburq
(lIte
12 609
.
.
.
.
Under penalties 01 perjury, I de claro thaI I have oxftmlned thl~ roturn and aceompanylnQ schodules and slaloments, and 10 1110 basI of my knowledgd and
~be~",', they oro true, co<<oo,; and comp"'e, o..,,,,,,;n ot prepare' tothor than ,,,p.yo<II' ba..d onolllnto'ma"on 0' which prepare' has any knowl,d.e,
~., ~~~)~I~re -t /.'.. .A./~j ~~/~Ct6. P'...t.I/ DAle/""} Yovr occupation
/. r T Ii G0-!.<i' 91 RETIRED
ll.e.a.fl- . *,,-- ~ -
SPOUSIl'S slQnlluro.11 Dalo Spouso'S occupation
3 29 97
algnaturll
Preparer's Firm's namf' ((If yours
Use Only II self-employod) and
OAA
t.ddross
CPA
PA
Propt.ror'saocIAI Ulcurllyno,
ZIP code
17103
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
'(
J
s.s:
:Jc'il11 l'~. \)ohnsot1
.~..__..._---_.~--_._._-~------_.
b.ing duly sworn _,,____ according to law, deposes .nd s.ys th.t she is Administratrix
-,----___ of the Est.te of Sally A, Newhart
I.te of __~ll9ro!d9l,-,of',,_0:1m8.l]i_~_,_________, Cumberland County, Pa., deceased and that the
within 11 an Inventory mad. by clean E. ,JC1hnson __ ____" the said Administratrix
of the entire estate of ,aid decedent, consisting of all the perlonal propdrty and real estate, except real estate outside
the Commonwe.lth of Pennsylv.nia, .nd that the figures opposite e.ch item of the Inventory represent It's f.ir value
os of the d.te of decedent's death,
Sworn to ___ .nd subscribed b.fore me,
.\ "'.....,\
'. ,
,
('
" -{', "-"?--:' \
, '>
I
~
' ,i'.1!,c-<....'
G~ ij~/L,vx- /(!tY~1
6iec:utar . Aclmlldlt,r4tor ,
,Jean E. Jtlhnson, Admlm.stratnx
425 Devon !load
19 97
1/
\;>,
,. "-'
/ ~
NO fAlllAL Still
DIANNE LENIG, Nolary Public
Lcmoyno BorolJgh CUlIlbOllanll Co,
My CommlssiDnl~plres Dee, 21,1007
---_._~- ~..
Camp Hill, PA 17011
Addr...
D.te of Death
16th
Day
October
Month
1996
'fur
INSTRUCTIONS
/, An inv.ntory must be filed within thr.e month, .fter .ppointment of personal representative,
2, A supplement Invontory must be fil.d within thirty days of discovery of additional a..ots,
3, Additional ,hoots may be attached as to personalty ot' r.alty
4, See Article IV, Fiduciaries Act of /949.
'"
0
'"'
0
I
M
<l'
0
r--
'"'
;:I .,j ~
>- 'ill .
t- W .
~ ~ t- o , ,
W ~ J . !l QJ
co ... u . rJ
'"' ~ 0 II) I . 0\ ~
0 W ~ w Q 0
0 J: ... ... '-
r-L t- ..J IJ. ~ . r.::
ell IJ. ..J 0( 0 a. 0 :t
~ UJ 0 <( w I ~ tIl 0( ,
> Z ~ ~ i1 '"
z 0 < . g 0
Q .
V1 Z 0 ,..j
0 ~ U
z I w <( ~I ... <i ~
... ."
.
0 ~
I - ;: ,
0 . ~ 0
.0 ." ....
. e 0 S ,
- . ..! 0 P-
Ii ~ u u: al
..J
Inventory of 1110 real and personal estate of
SM,LY II, NI':WIIIIJ('I'
deceased
L Capital Blue Cross - premium refund
2. Clerk of Courts of Cumberland County - final restitution check
3. Pennsylvania State Bank - Interest checking account No. 100-0105-5
Date of death balance, plus accrued interest.
4. Pennsylvania State Bank - Money Market Savings I\ccount No, 260-0074-5
Date of death balance, plus accrued interest.
5. Pennsylvania State Bank - Access Savings I\ccount No. 220-0297'.6
Date of death balance, plus accrued interest,
6. Promissory Note - William A, Newhart and Patricia L. Newhart
to Sally A. Newhart - Arrount: $40,000.00 @ 7% interest
dated September 11, 1992,
Date of death balance, plus accrued interest
'lUl'AL
00
~~ i~,',~
...,
f',,1
"(I
("t,
134 ]0
33 33
8,976 S5
1,159 08
112,185 61
40,122 72
162,61J _~~_,
Ie)
"'1
-,;
I~:. "'_ / ,).. ''') /-}
/' ) . ... - ,'} . /(-:'
COMMONWEALTH OF PENNSYLVANIA
DEPAHTMENT OF REVENU~
BUREAU or INDIVIDUAL TAXES
l"lIHRllANlI lA>< DIVISION
IlIPI. j'1I0hO!
IlMfR 1~l\lJl<'[j, flA I II ,'t1-DhOI
NDTICE Of IN"ERITANCE TAX
APPRAISEMENT I At.l.OWANCE OR DI~Al.(.OW^NCE
OF DEDUCTIONS AND ASSESSM~NT or TAX
C
,/
1.\.".
"",7 "'{>
,~"","'''f
,I" .."",\L'f-,
.(, H;~~\'" -~\"
1',,:!ll""'!",t \
.~:ft'O~'~~' Cd.
H..,:;" ill" Iii-Ill
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-11-91
NEWHART
10 -16 - 96
21 91-0018
CUMDERLAND
101
AlI10unt R~,~_~l,te~:.~,~~~~~~:1
,,_, ,,,-._....J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS UNE .. RETAIN LOWER PORTION FOR YOUR RECORDS ...
REV; i547- Elf" AFi;"f o~j: 97Y"NOYi CniF" Y NHEiiifANCE " YA'X"j\PPRA-i SEMEN:r-; -Ai. l"OWAN"CE "'OR - -."" - - --- -", ,.. -.
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
SALLY A FILE NO. 21 97-0018 ACN 101
HORACE A JOHNSON
301 MARKET ST
PO BOX 109
LEMOYNE
ESQ
PA 17043
ESTATE OF
NEWHART
TAX RETURN WAS, t X 1 ACCEPTED AS fiLED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1, Real Estate (Schedule Al
2, stocks and Bonds (Sohedule 8)
3. Closftly Held stock/Partnership Interest (Schedule C)
4. Hortgag~s/Not8s Receivable (Schedule OJ
5, Cash/Bank Deposits/Misc. Personal Property (Schedule E)
b, Jointly Owned Property (Schedule f)
7. Transfers {Schedule Gl
8, Tohl Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
q, Funeral Expenses/Adm. Costs/Mise, Expenses (Schedule Hl
10. Debts/Hortgage Llabilities/Liens {Schedulo Il
11. Total Deductions
12. Net VIlu. of Tax Return
13. Charitable/Government.l 8equ.st~ (Schedule J)
14. Net Value of Est.te Subject to Tax
If an assessment was issued previOUSly, lines
reflect figures that include the total of ~
ASSESSMENT OF TAX:
15. Amount of Line 14
16. Amount of Line 14
17, Amount of Line 14
18. Principal T8x Due
NOTE:
It Spousal
taxable at
taxable at
rete
Line.l/Class A r.t.
Coll.t.ral/Class 8 r.t.
,
I-~
(II
(21_
( 31
(41
(5 I,.
t61
(7)
I q)
110)
1 CHANGED
,00
,00
,DO
,00
162,611,3'1..
2,997,82
86,925,44
181
15.253,85
12.609,00
III )
1I2)
1I31
1I41
SALLY
A
,DO X ,DO,
224,671.80 X ,06,
,DO X ,15,
1I81
TAX CREDITS:
~-~----r-------'--~-~-- "~r'------'--'._'~-'-----'~-'''"'-'- ~_._..____..___.n__"__ .----..,-.--.
PAYMENT bRECEIPT DISCOUNT 1+1
DATE NUMBER INTEREST/PEN PAID 1.1 AMOUNT PAID
--05:-0'[=97 AA2112as--- ---------'~-oi)-- .'---f3~480~TC-'
L_______L____.,_,
DATE
08-11-97
----'--.--------rriTAL-TAXCREDi'r. r
-BALANCfoF-TATDUE i
- INTERESThANDPEN~T
'--~'.. ---- ;--
TOT AI. DUE ,
NOTE: To in sur. proper
credit to your account,
submit the upper portion
o'f this 'fornl with your
tax payment,
252,534,65
77 .A6? A~
224,671.80
.00
224,671,80
14, IS and/or 16, 17 and 18 will
returns assessed to date.
1151
1161
117 I
.00
13,480,31
.00
13,480,31
----.. ----I
13,480,31
_ _ ..__ ..~~.o.__
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
IF TOTAL DUE IS LESS TIIAN II, NO PAVMENT IS REQUIRED,
If TOTAL DUE IS REFLECTED AS A "CREDIT" (CR1, YOU HAY BE DUE
A REfUND, SEE REVERSE SIDE OF TillS fORM FOR INSTRUCTIONS,)
I';,
( )
(..;()
RES[RVATION: (statu of decedent! dYing on or bGfor'o DocQ~lb"r lZ, 1982 .. If tin\! future Intorut In tho utnh Is trl'll1sferred
In pOlleulon or qnjoymonl to Clnss 8 (00111lter1l11 beneflclarlos of tho decedent afhlr the ol<plrntlon of /lny oltate for
llfo or for yurs, t/-lll CQm",onl<l08lth hernby expreuh raserl/.' tho right to 'lIppralso llnd fllIOU trnnsfflr (rmorltMce Tnl<os
fit the lawful Clau 8 (collutllrnl I rClte on un\! slIch futuro Interest.
PURPOSE OF
NO.ICf.: ro fulfIll the requirements of SMIlon <'140 of the Inhorltanco nnd f.statll Tal( Act, Act 21 of 19%. (72 P,5,
Suction 9140),
PAVHf.NT: Detaoh tho top portion of thIn Notlc" ilnd ~uhll\lt with YOllr pnynlont to the Reglstnr of Wills printed on tho roverse side.
--Hske check or mono\! ordor Pll..,llhlo to: REClISTER OF WILLS} AGENT
REFUNn (CRII A rofund of a tox credIt, which WllS not roquostod on tho rilx Rflturn, ~lllY be roqun!otod tlY cOnlpletlng i1n "~ppllcotlon
for Refund of 11ennsylvtlnln Inherltanco and [stntn l11X" (REV" L!.l3J , Applications nre avallnbl11 iltthe OffiCII
of tho Register of WJlls, llny of the 23 ReV4lflue Olstrlot Offices, or oy clllllng tho special ?4"hour
.,nswerlng sorvlco nUl!lbers for forms ordering: In Penr)liylvanlll 1-600-362-2050. outside POflnsylvllnln and
within loonl Hnrrlllburg .1I'oa (117) 767'609(11 TOO" (7171 I7l-22S? lHoarlng I"lpldrod Onlyl.
OBJECllONSI Any party In lntorost not slItlsfled with thCl o'Ippr<llsnlllont, nllowanco or C!ISflllowlInco of doductlons, or lluossment
of tflX (Including dlsCOllnt or Intorost) ns sho...n on this Ntlllce must objoct wlthlr) sl)!;ty (6Gl days of roco!pt of
this Notice hYI
.'wrlttBn protost to lhe PA Dopnrtlllent of Rovenuo, Board of APPllllIs, Dopt. ~810l" ftilrr!shur9, PA 1112a.\0,I, OR
--ehctlon to hl!lve the :IIatter detnrllllned nt nudlt of the account of the personal represllntatlve, OR
. .appenl to tho Orphans' Cour t.
ADHIN
lSlRATIVE
CORRECTIONS:
fsctusl errors discovered on this OSSOSSlllent should he nrldrosserl In writing to: PA DeplIrtmont of Revenue,
Burll"u of Indlvldusl TaKes, ATTN: Post AfiSessmont Reviow Unit, Dept. 280601. ttftrrlsburg, PA 171Z8~0601
Phone (717) 787"6~0!i. So. pag_ 5 of lhe booklet "Instructions for InherltancQ hx Roturn fllr II Rnldont
neoldllnt" (RF:V'l!lOll for iIn explanation of admlnlstro!ltlvllly correctllhlJl errors.
DISCOUNl:
If ftlW tax due 1& paid ",{thin three (3) cftlendsr months aftllr the declHlent's death. " five percent (~%I dllcount of
the tal( paid I. "llowed,
PENALIV:
The IS% till( IlIIlnesty non'pllrtlcipatlon plInlllt\! II cOMputed on thll totlll of ~he tS)( snd lnt.rlllt SUlSllId, IInd not
IllIld be forI JllnullrY 18. 1I1l)6. tha first day aftor the find of the till( AM..ty period, This non'pftrtlc\Plltlon
l'lllnllltv Is appealllhle In the ~l'lmO ","nner <lnd in the the SlIlIIe tl",e pl5lrlod AS \l0~1 would IIppul the tax And Interost
thnt hall botn " Uel. SlIC! liS lnrllciltod on this notlco,
INTEREST I
In\ftrAst Is chftrCled beginning with flrstl!lI\! of delinquency, or nine OJ months lInd one (11 dllY frolll the dllte of
death. to the datil o-f paYlllent, lal<u Olhlcl) beClllI'lIi1 dellr,quent tlefore Janunry I, 1982 bear Internt tit the rate of
III< (6%) percent per "nmUll calmllilted lit a cllIlly rntn of ,00016(1, All tftKes which becllmo dellnquont on and after
January I, 1982 will boar Interest lit Il (lito which will VllrY from clllondar YOllr to clllendllr YOM with thllt rnll'
i1nno~mc8d by the PA nopllrtment of ReVllnue, ThQ flppl!Cllhlo Intllrost rattls f01" 1982 through 1997 lire:
~ Inter,,"t Rllte Olllly IntnrOlt f'lI<:tor ~ Interest illite OnllY Interest I'M.!!!!
1982 lOX ,000548 11)81 9% ,0002(t!
1'183 16% ,0004:\8 1'l88-}IJQl 11% ,000301
1904 11% ,000301 IIJ9? qi( ,00Ol47
1985 13% ,0003S6 191J.\ .11)1)(, Ii( ,OI)OIlJ?
1986 10% ,000214 19CJS '199/ IJ% ,000;'41
--Interut II cslculllhld " followtl
INTEREST: BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
HAny NoUr-e Issued aftDr the 1111\ hecomu r!elln{IUnnt wIll rnfhUlt un Interut ctllcullltlon to fifteen (IS) dllYI
btyond thll dlltll of thn lIu.ullIlInt. If 1111"''''lInl 15 mm1e I'Ifllll' thn lntnrost computntlon lInt~ shown un tho
Not I!1Cl, t1ddltloMI IfltUrRllt mllst h. cllltulnt'HI.