HomeMy WebLinkAbout97-00053
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INHERITANCE TAX RETURN ~OI1 D^TUl O~ OI'^TII ^FTER 12/31/91
CHECK HERE II' ^ SPOUSM. '
RESIDENT DECEDENT I'OVEf\TYC!1X~ITaISC:LAJ~!'DJL
W""ClNW"A<TI'or I"NW,V<VANIA (TO BE FILED IN DUPLICATE riLE NUMBER?/ 5,'11
(Jr"^RTMtNT or ni:VI:NUf. '" ~ 'J .;I
"AFlIII0~0~~i, ':~~~: ,,~~~' -==~=,~c.~!~~cR,,~~~~!!,~_~F~YI.L~St, ,.<;j)~.~l~ CO01=~~,,=c_YJ:~fl,=c=-__.~~lli)l.
In.V nOl1 [j(+ (1-11<4)
DECEDENT'S N^ME (LAST, ~IRST, ^ND MIDDLl' INITI^L) IJEC!Dl'Nrn COM!'!. ErE M)DI1ES~3
lOSH CA'[1lY cl. n'J WClfJl. GI'eell Street
~SECURI1Y NUMOER--]DAH_ -oi:' DEATII-l (,^lE-Of"f~~'TiI.~ .'Jhl n'ol'lllFJl:c.....ll, P1\ non
DECEDENT 193-36-3307__ _.l1.L?Q/9G _~ 03/.Q}/l, gr,(, _ (:O.!~II\'. C\nnly,rlanrl m__._____.,_.__..
~rn^;; kN1fM:61i'l~':~:~I~c1 SPOUS[" NAM' 1'"'01, [SOCIM SECURI1Y NUMllEf1 1 ^MOUNT RECEIVED (SEE INfnRUCTIONS)
lB7 Original Rohrrn ------0--2, supplomonlnl f~;;;~-.'. -- -..-----0:1 Romnlndor RotUfll --- ---
14, Not Valuo Subjocllo Tnx (Uno 12 mlnu~ Uno 13)
15, SI'lOllul T,anlhlll (10' d<'ltr'i of deo\th allo, 0-JO-94), See (15)
Inltructionllor Applic"bloPelClInt,lgnon Pagn 2,(lnclud/l
valuulrom Schedl.llll K Of Schedule M,)
16, Amount 01 L1no 14 'a<oblo al 6% ralo (10)
(Includa valuoo from Sch.dulo K or SCllOdulo M,)
17, Amounl 01 L1no 14 laxablo n115'10 ralo (17)_
(Includo valuoo from Schodulo K or Schodulo M,)
'fAX 16, Principal 18)( duo (Add la' I,om Uno, 1f<, 10 and 17,)
COMPUTA- 19, CrodllS SPOlllI1 P....vlHtyCralilt Prior Payment::
TION + +
---
CIiECK
APPRO-
PRI^TE
BLOCKS
CORRES-
PONDENT
RECAPIT.
ULATION
o 4, Umllod Fslnlo D4n, Fuluro 1111oro!!1 CClmprornl!!o
(lor clnW!! cl clonltl nllor 12-11!"U2)
Do. Docodonl Olo(J T09lalo 0 7, Docodant Mnlnlalflocj n Living TrwH
(Moch copy 01 Will) (Moch copy 01 Tr"'I)
ALL:'cofll\~seNDEfolC"'AHO CQNFIDEN'TIAl,TA~ iiiFOR~ATION SHOULD BE DlHE[OfEDTO:
N^ME COMPLETE M^ILlNO ^DDRESS
David}1. Radcliff, Esg, 3905 North Pronl: Street
TELEPHONE NUMBER Harrisburg" PA 17110
717-232-4701
1, Rool Eolalo (Schodulo A)
2, Slock, ond Bond, (Schodulo 0)
3, Cloooly Hold SlocklPortnOlshlp Inloro'l (Sch, C)
4, MO'lgogo, and Nolo' Roco!.voblu (Schodulo D)
5, Cooh, Bank Doposlls & Mlscollanoolls Porsonl'l
Proporty (Schodulo E)
0, Jointly Ownod Proporty (Schnell/lo F)
7, Tron,lar. (Schodulo 0) (Schodulo L)
0, Total Grosa Assots (lolalllno31-7)
0, Funaral E)(pansos, Admlnl91raUvo COSls,
Mlocollonoouo Expon,o, (Schodulo H)
10, Dobl', Mortgogo L1oblllllo" L10f" (Schodulo I)
, 1, TOlol Doducllon, (10101 L1no' 9 & 10)
12, Not Vnlllo 01 EntaIl) (Uno 0 mllllJ!) L1no 11)
13, Chollloblo ond Oovorl1lnonlol Boquo,l, (Schodulo J)
ADnfll!lS
l'clIlh'.. 01 de~nl fHI'H 10 11"11"82)
Of<
Fodornl Esl<llo Tax Rotum HoqulfOCI
o 8 Totnl Numbor 01 5alo DOpO~lll 80)(03
(1) 0.00
(2) 15,729.28
(3 )------NO'ne
(4) None
(5) 659.90
(0 )
(7)_
2,194,27
None
(0 )
18,583,45
(9 )
11.898.32
(10)
285,10
(11)
(12)
(13)
12,188,42
6,40,0~l
NOlle
(14)
6, 40(J .Q:L
, ,
6,400.0:3, ,00 .
:184.00
0.00 x ,15 '
0,00
(18)_
.JllA...illI
Inlorost
(19)
(20)
-lq~20
(21)_.
(2M)
(216)
:l64.80
0.00
___ ~M_
_-364~
"AT I ~/l- ? '/
--L_~_~_,__
DATE
__j-17-?Z__
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REV-1!109 EX + (12-88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CA'IlN J. W8H
Joint 'ononl(l):
NAME
A ,TOHN r..osH
Jointly-owned property:
SCHEDULE F 1
JOINTLY-OWNED PROPERTY
-=--.-----==--=-=--=-- I FILE NUMBER
..1996 -
ADDRESS
319 West Green Street
Shire11\IDsta,.nl, , PA 17011
RELATIONSHIP TO DECEDENT
Fat er -.--
LElTER DATE DOLLAR VALUE OF
ITEM FOR MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECO'S DECEDENT'S
NO. JOINT OF ASSET % INT.
lE NANT JOINT INTEREST
1 A 9/2/84 Dauphin Daposit Bank & Trust 4,388.55 50% 2,194.27
Account No. 61210439
.
,
"
- . L_ 2,194 ."'i'T
- -' TOTAL (Also onlor on IIno 8. Roolpllulall~
PA150tl
NTF 121eA
C'opytlOhl Forml Software Only, lIH14 Nllco, Int. NIll\F'AOlll
(II more 'pICO I. noedod, In.orladdlllonal.hll<ll. oleeme .1...)
5. The decedent was survived by her parenes, JOHN LaSH and
AVIS LaSH, with whom she was residing at the time of her death and
they have claimed the Family Exemption under 20 Pa. C.S. ~3132.
The decedent was also survived by her brother, BARRY J, LOSH.
6. The total value of decedent's personal estate is less than
$25,000 and consists of the following:
A.
Merrill Lynch Cash Management
Account No. 872-44201
$ 16,214.28
7. The following is a list of known creditors and the amount
of thei+ claims, said debts will be paid in full. petitioners have
advanced funds on behalf of the estate to pay the bills as
indicated. .
A. Neill Funeral Home, Inc.
(Paid)
D. Weis Pharmacy
(Paid)
$ 7,002.00
$ 500.00
$ 25.00
$ . 54.17
B. Cherewka & Radcliff, L.r"p.
C. Register of wills Filing Fee
(Paid)
. E.
Dauphin Deposit Bank & Trust
Credit Card (Paid)
$
166.71
F.
R.J. Romberger & Son
(Grave Marker) (Paid)
$
$
64.22
540.00
G.
QVC Shopping Channel
(Paid)
H.
Dinner for Family and Friends
(Paid)
$
331.32
II' 1'1\
'I'lIi... 1" lu ll'rlily lhill Illl' intlllJlLH,illlllll'H gi\('ll I', \il\!nrh 11'1l\1.! 11(1111 .1(1 (lll.!:II!,d ll'ndll',ltt III dc,HIt dlllv filed with 111(' ,I'"
L(\c.l1l{q;I',tr,II' 'J'h~' (ll'igill,d tl'!lill(,IlI' ",dllll' b.r\\'.I),lt.,\ (,I !ill' ',,'dl( VILli l{c((,rd... (ltliu' I\l( I'c flll.lll('l\( filing
WARNING: It Is Illegal to duplicate this copy by photostat or photograph,
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f'J(>-f-.W~L1.../i/1r IXi~u
!' Dale
.-;-..
Nil.
tlIO$l4)"-. lit,
COMMONWULTtl OF PINH&VLVANIA. OEPAATMBNT OF HEALTH ~ VITAL AICOROB
. CERTIFICATE OF DEATH
i
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
8UREAU of INDIVIDUAL TAXES
IN~If.RITAHCI:: fAll DIVISION
llfPT, 2806111
HARRISftURG/ PA 1717.8-060i
NOTICE OF INIIERITANCE T1.X
APPRAISEMENT, ALLOWANCE OR DISALl.DWANCE
OF DEOUCTIONS AND ASSESSMENT OF TAX
0{,-21-97
LOSH
11-20-96
21 97-0053
CUM8ERLMW
101
[.. ,. _...mA-";o-u~i ii~";1 ttOCl~-=:J
.~~.:';:<=._:~~~:~~=.~~:.~~~-~:'-'.'=:~~-~~
MAKE CHECK PAVABLE AND REMIT PAYMENT TO:
REGISTER DF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
It EV -- isi;7-Elf -;., Fi>- - f oj-: 97")" -NoW C E - -oF - YNHEif if ANtE-'flix - ;ip PRi\" ISEME NT -; -Al. i:owAtic II - OR - - - -- - - - - - - - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
CATHV J FILE NO. 21 97-0053 ACN 101
If an aRsessment was issued previously, lines 14, IS and/or 16, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. AMount 01 lin. 14 .t Spaus.l
16. AMount of line 14 taxable at
17. AMount of line 14 taxable at
18. Prln~ip.l Tax Due
TAX CREDITS:
PAYHENT I ---~---~---
DATE
01-21-97
DAVID H RADCLIFF
3905 N FRONT ST
fl8G
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
PA 17110
ESTATE O~
LOSH
TAX RETURN WAS, 1 X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..1 Est.t. (Schedul. Al (1)
2. Stocks ....d b"ndl (Sr.:tl.duh 8) (2)
3. Closaly Held Stock/Padnftr$hlp Intares't (Schadule C) (3)
4. HortgMg.~/Nota' Raceivable (Schedule 0) (4)
S, Cuh/BarU<. OepClsUs/Hlsc::, P.rsonel Proparty (SchedlJla E) (5)
6. Jointly Owned Property (Sc::hedule F) (6)
7. Tr.nders ISchedule G) (7)
8. Total Assah
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funaral Expense./Adm, Cosh/Mhe. Expense. (Schedule H) (9)
10. Debh/Hodgag. L1abU1t:l.u/L.lanl ISchadule I) (10)
11. Total Deductions
12. Net Value of iax R.turn
15. Charitabla/GovArnMental Bequast. (Schedula J)
l~. H.t Value of E$t.t. Subject to Tex
NOTEI
rat.
lin..I/CI.ss A reia
Coll.taral/CI.s, 8 rate
(U;)
116)
117)
RECEIPT
NUMBER
AA185090
DISCOUNT .. I
INTEREST/PEN PAID (-)
19.20
) CHANGED
.00
15.729,28
,00
.Jl!..
659,90
2.194,~7
.00
(8)
11.898.32
285. JJl..
(Ill
1121
115)
114)
,00 X' 0 O.
6,400,03 X ,06.
,00.X,15.
1181
AMoUNT PAID
364-:80-
TOTAL TAX CREDIT
BALANCE OF TAX DUE
---.
INTEREST AND PEN.
TOTAL DUE
. If PAID AfTER DATE INDICATED, SEE REVERSE
fOR CALCULATION Of ADDITIONAL INTEREST,
c..-
t[~.IHI (. IH Ill.'/!
CATfiV
J
DATE
04-21-97
NOTfl To insure propar
credit to your account,
subMit the upper portion
of this forn with your
tax paYlnent,
18,583.4.5
I? un 42
6,400,03
,00
6,400.03
,00
364,00
,00
384,00
384 'OO~'
,00
,00
,00
---
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 Of THIS fORM fOR INSTRUCTIONS.)
RUERYAtJOOI
PURPOSE Of
NOTICE I
PAVMENTI
REFUND (CR)l
O!Jf.CTlONSI
AOHIN
ISTRAT IVE
CQftRfCTIOHSI
DISCOUNT I
PENAl. TV I
INTEREST I
......
01(1
\D
'if)
r~,l
(,
":.~
i(l
N
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I):'
hht.u of ~"~. dyl"l on or b.for. Dlcl.lr 12, 1912 -- If eny fl,ftl,frl inter..t In 'hI""'. It tran.f.rrla
l"po"I..iorritr enjo~..nt '0 CI,.. . (0011It.ral) b'nlflolarla. of t~ decadent .ftlr thl Ixplr.'lon of anv ..tat. for
I1f'.or for v.er., the C~nw"lth hlrlby 'Kprl"I~ r...rv.. the rl.ht to appral.. and a~.'" tran.ftr Inhlrltlncl fa~..
.~,-tr:': laMful ~~~a.. tl Jroyatlral1 rata on any .uch future Intlratt.
u:.: . oU
To fuulll thl r.qulr...ntl of S8"tlon 21ltO of thl Inhlritancl end E.tatl Tall At!t, Act 21 of 19.5. <72 P.S.
Slctlon 91~O).
Olt.ch thl top pl)rtlon of thlt Notlol and .ubalt ~lth your ply."nt to the RIgllter of Willi printed on thl r.var.. .Id..
~."ltkCl ch,ck or IIOney ord.r payabll tOl REOIBTEM OF MILt,S, AGENT
. refund of . ta~ credit, wtdct. WI' not requlltad on thll TI~ Return, .1" b. ra~.ttd by cc*platlng ." "Application
for R.fund of P.nn'vlvanl. Inhlrltaoc. end E.tat. TaM~ (REV.lllS). Appllcatlonl arft ~v_llabl1 at thl Offlol
of thl R.glttlr of Will., any of thl 25 Rlvlnul Ol.trlct OffIQI', or by c.lllng the .p.clal 2~Mhour
.".w.rlng ..rvlcl nUllblr. for for., ord.rln"l In P.nnnlvanla l.eoO-S6ZM2GSO, out.lda P'nn'Vlvania .nd
within 10clt1 Harrllburu ar.a {711> 1a7.a09~, TOO' (111) l1Z.Z2S2 (!I..ring I.Plllrld Only).
Any party In Int.rl.t not .atllfled with thl appra!':l...r.t, allowano. Dr dlsallowanc. ()f d'dUctlon., or aullll....nt
of taM (Including discount or Intar"t) II .hown on thl. Notlell MUlt obj.ct l>llthln IIKh (frO) dUv. of r.n.lpt of
thlt NoUn bYl
-Mwrlttfln prottlt tCl thl f'A o.part.ant of Ray.nua, Board of Apptall, Dept. 2111021, Harrllburg, P. 11JZBMI021, OR
".llctlon ~o ha1o'l \hfl IIIIUllr d.terflllned at .udlt of thll Icoount of ths parlon.l r.p.....nt.Uv., OR
Happul to the Olphan.' Court.
FactuII .rror. dl.covarad on thll 11..I...nt Ihould ba sddro..~d In writing tOl PA D.part..nt cf RI1o'enu.,
aur..u of Individual leM", ATTNt POlt hu....nt Rlylaw Unit, Ulpt, 1.40601, Hllrrhburg, PA JllZBM0601
~. 11l1} 761-6S0S. S.. pag. So of tha bookllt "Inltructlons for InherJtanc. T'M R.turn for. A"ld.nt
o.\).d.nt" (REy.u.nll for an IMpla"",Uon of adtlnlltratlyah corractabll arrott.
If any to doa It PtJd within thrill (!) calandar aonth. aftar the dleadlnt'. duth. I filii percent (SX) discount of
thl t.1f paid It ellowad.
The ISX tal( ._.tv non-rldlclPltlon pen.lty 11 cOMPOtad on thl total of thl tl)l and Intarllt ......ed, M\d ItOt
paid bafo" J.nulr.Y 18, 1996, thl flr.t dll:;- aftar th. .nd of thl tall l.n"lty ptrlod. Thlt nCrn-p.rthlpltl~n
p.n.ltv I. app.allbl. In the .... .annar .nd In the tha .... tl.. plrlod a. you would app..l the ta.~ Int.rl.t
that ha. b..n .......d al Indlc.tad ~n tnt. notlcl.
Intar..t It cn.reln btglnnlnll wit., Utlt dai of dallnqu.ncy, nr nlns (9) aonthl and ani <l) dlr- frcI the d.tl of
dctlth, t() the data of ray..nt. TaK" which hao... d.lJnquant b.for. January 1, 1962 bllr Int.re.t at thft tIt. of
11M <'X) percent p.r annUl calculetad at a dIlly rlta of .000164. All t'K" whJch beca.. dlllnqulnt on and Ift.r
Jlmuarv I, lIJtl2 will blar Inter..t "t fI rat. llhloh will vary froll oallndllr vllr to cal.ndar Yllar Mlth that rata
announo.d by the PA Doparta.nt of Rlvonv.. 111. BPF-Ur..bla Inhr..t tit.. for 1912 through 1',j91 artl
t!.!.! Intar..t Rata 2!.!.!L.1nht'.. t factor !!!! !Jl!.!!:!!.S..l!!! .wu Inter..' ractor
Ilf82 20iC .OOOSU 1917 .~ .OOO2H
I'" 16X .00O~\a I9B1MII)91 11% .00OSOI
19t~ llil: .OOOJUI tnz .~ .00bZ47
19B5 15X .00035' 1993~199~ IX .000192
1986 lOX .000214 1995-1997 .~ .aOOZlt7
"Intar..t h oalculat.d .. followll
INTEREIT D IALANCE OF TAX UNPAID X NUNIER OF DAYI DELINQUE"T X DAILY I"TEREIT FACTOR
uAny Notice luu.d Ifter thl taM bl"O." dlUnqulnt wUI rafl.ct In Int.rut calculation to fHt...n (Iii) day.
b.vond the dlta of thl ........n\. If pav""t It .ad. Ifter thl Interllt cotlftUhtlon drota ahown on thl
Notlca, .ddltJ~nll Int.r..t .Ult b. ~11"ullttd,
~
~~~
~iffi
I
u
z
o
F;
~g
"'a..
lIE
o
o
/.'l I <\q)
"""^"'",,, j~t REV-1500
,(lMMO"~SVlV'N,^ INHERITANCE TAX RETURN
nf:PARTMrNl OF Rr.VENU~
f1A II ~F~l ~~\ \ RESIDENT DECEDENT
[lECWHff'S N,w[ {lA-liT, FmST, ANO lllO\1lf INIllAq U" ~ tM.n~ ~xk kl ~WMfl wl~d~
CA111Y J.
C /"
'LF. NUMBER
~f
II '7
, , r'~
O(I,.?/
~
W
o
W
U
W
o
1- 0 S H
SOCIAl,SrCUHIT'1'l1llMiitn
IJAl(or.OtAltl
OATFOffllRIH
03/0/1, q 5"4:-
[THill RETURN MUST BE mEO IN DUPLICATE WITH THE'
, REGISTER OF WILLS
[J I Original Relll" i:8 2 Suppl.manlill Rolum 0 3 Rem.lll'Jer Relum "...".. ,,,,,. 111l.811
o 4 "m~ed ESlale rJ 4. '"h". Inlerasl Compromise "...,,"'... "11611 0 ~ 'ede,,' ESlale Tax R.lum Roqulred
o 6. Doc:edenl Died Te5IDteIAJla:hcopvofW~) 0 ,/, Deoodenl MalntalnOd a l.lving Trust (AI1J(hcop~oITMt) __ 8. Total Number of Safe Deposit BOKes
o 9.1 ~~.hon Proceeds R""'ved 0 10, Spousal Povorly Crad~ I....""'......' 11.".9' Old ,-1-1" 011. EIoctIon 10 la, under Sac, 9113(A) 1,,",","01
THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAMe JL." Ii N -H' h eJ 5 H COl""137(lJlO"~ " (;.. R G: G N .s'T,
FIR""AME 1"",,1<''''' oDA (7~11
S I-f IR~ IVl/VJS TC?lL'I0, U'
I q'3'3~.33 (j'1
I/~~'I(I'"
[If ,l.PI'lIl;AfllEl sURVIVING Sf'WSE'S fW.tE (lA~T, FIRST, "-"le) MinGLE' INITI,l,L \
Sex:IAl srClIflllVNUMI\f:R
I Real E'lale(SchOOu~ AI II)
2 SleckS .nd Bonds ISchOOu~ B) (2)
3 Cklsely He~ Corporallon,p.rtnershlp or Soo,Propn.lorshlp (3)
4, Mortgages & Nol.s R"".able (Schedule 01 (4)
~, Cash. Bank D.posl~ & Miscellaneous P.rsonal Properly (5)
Z (Schedule E) ~~" R~T~)RN
0
~ 5 Jolnlly OwnOO Property (Schedule FJ (6)
7 Inler,V;vos T"nsl.rs & Mlscallaneous Non.ProMle Properly 171
:;) (Schedule G or II
I- 6 Total GrOll Ami' 1I01alllnes 1,7)
ii:
< 9, Fune,,1 E'pen"s & Admln~I"I.' Cos~ (Schedu~ H) (9)
U
W
0:: 19 D.b~ 01 Decadonl, Morlgoge L1abllllle.. & Liens ISchooulel) (10)
11 T 0101 DoducU.., (101a1 Lines 9 & 10)
. 'f !5 !J. D 0
(6)
.'t5!J.o(>
(11)
(12)
(13)
12 NllVllul 01 E'tato (L1n. 6 minus L1no III
13. Char;lable and Oovernmenlal BequeslSlSac 9113 Ttus~ lor which an election 10 ~, h.s nol been
mede (Sch.dul. J)
14. N*I Volul Subl'<lIo 'II' (Line 12 minus line 13)
1~ Amounl olllno 141a"ble ,.J ' r'
allhe spousal taK rale I I "( !j " .
See instructions on reV&r5e side for applJcable percentage
16 Amounl oll;no 141a"bO
flt6% fate
17, Amount of line 14 taKable
fll15%rate
-
(14)
, If .'5 5". " (>
1..'7.30
L~ ~)
x .0 ~
(15)
x .06
(16)
(17)
(161
:1. 1 .:'j ()
x 15
18, Tlx Due
19,
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
IIMfIl pe-;;'lllhes of POri~1 doclllfll IhIIll Mve llKllminod thl~ rfllurn, Inducting Ir..compllnying sc'oou~s 8lId slatenlOnls, 80010 the bes! of my kl\O'Nledge 611d belief, Ills lrue, COffeel WId compklle DecllV.\ion 01 preparnr o\tler
l!:!/!!L!~!jo r r Qiftill'flJUlSedonlll1lolorm I 11!ili~~.l'lL~._.__. ____
SIGNATUflEO ERSOl'RESPO~lEF9 lINGfETlIRN, . ,AODRESS, ".' (". ". {) , DATE
~1!:4:..,Li,:,_ _'p-il~,:-::____~l~_~~' c. 7l.'2f;'~~~~!({;U~~lA}JS'I('lt~/'A 171>'/ /1 - /9...:. '17
m_~~~~M ~~ ' ~
(1)
Tolal Crsdils (A + 8 . C I (2)
3. InteresVPen,lIy II applicable
D.lnlarest
E. Penally
..-
Tol,allnlere!UPenalty (D. E) (3) _
4. It line 21s graatar than line 1 . line 3, enler Ihe difference This i3the OVERPAYMENT.
Chock box on PIg. 1 Line 1910 raque'll rllund (4)
5. II line 1 + line 31s greater than line 2, enter tha difference This is Ihe TAX DUE, (5)
A Enl.r th.lnterest on Ihe lax due. (5AI
BEnter thetotel of Line 5 + 5A. This lathe BALANCE DUE, (58) /I J. ], j /)
Make Chtk Payabla to: REGISTER OF WILLS, AGENT
PL.EA9E ANSWER THe FOLLOWING QUF-STIONS
BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Old decedent make a transfer and: Yea No
a. retain the uae or Income of the proparty tran,lerred; ..... 0 0
b. retain the right to designete who shall u,e the property lran,lerred or Its Income; . [J 0
c. reteln a reyeralonal)' interesl: or....... ....................... . .........0 0
d, receive the promise for life of either paymenla, ben8fiteorcare? .............................. .0 0
2. If death occurred on or before December 12, 1 982, did decedent within two years
preceding death tranefer property without receiving adequate conaideratlon? If death occurred
after Dacember 12, 1982, did decedent transfar property within one year of death without
recelying adequete consideration?... ......................... ... ........... 0 0
3. Old decedent own an 'In Irual for" or peyable upon death bank account or security
at hla or her death?.. ..................0 0
4. Old decedent own en Individual retirement account, annuity, or olher 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
72 P .5. ~9116 (a) (1.1) (i) provided for the reduclion of the tax rale Imposed on Ihe net value of transfers to or for the use of the
surviving 'pouse from 6% to 3% for dates of dealh on or after July 1. 1994 arod before Janual)' 1, 1995.
72 P.S. ~9116 (a) (1.1) (Ii) providod for Ihe reduction oltho rate Imposed on Ihe not value of transfers to or for Ihe use ofthe aurviving
spouse from 3% to 0% for dates 01 dealh on or alter ..Isnuary 1. 1995. The statute does not exempt a tranafer 10 a surviving spouse
from tax, and the atatutol)' requirements for disclosure 01 assels and filing a tax return are stili applicable even If the surviving apouae
Is Ihe only beneficiel)'.
FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995. Please answer the following queallon by placing an "x" in the
appropriAte apace.
Old the dec.dllnl crelte I Irult or IlmllRr Irrlngemenl which Ie solely lor the surviving Ipoule'l benefit for his or her entire
IlIelimo? Yes 0 No []
If you anawered yes to tho above queatlon, the tax on the trust or similar arrangemant la poatponed until the death ofthe second
spouse, ot which time II will be fully taxable al the rats(s) applicable to the remainder beneficiel)'(les). Enter the value of the truat on
Schedule J, Pert II, In order to remove It from the calculallon of the tax due In this eslate. You may wish 10 file Schedule 0 In order 10
make the election available under Secllon 9113. If the election Is made, the truat or similar arrangament Is taxed In the estate of the
firat derAldent spouse, the portion of the trust or ,imllar arrangement which benefitathe surviving spouse la taxed at the zero lax rete,
and the remainder Is taxed at Ihe rale(s) applicable 10 Ihe remeinder beneficlel)'(lea). If you choose to make the election, you mual
atlach Schedule 0 to a tlmely,filed tax return, along wilh Schedule(s) K end/or M In order 10 ahow the apportionment of the trust or
slmilsr errangement between the ,urvlvlng spou,e arod the remolnder beneficial)'(le,).
Eo_~n~ RO.~::~_~J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO CDURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR IUCORDS ..
il 'EV: iS4-j . iTA i= i' - i oF97Y - NoTiCE: - -oF .YNHE:iii TAiic E - TAX - 'A-PPRXi sEifiNr; -A i. L oWANcE- iili - - -- - - - - - - - - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
CATHY J FILE NO. 21 97-005~ ACN 101
If an a.....~.nt w.. i..u.d pr.viou.ly, lin.. 14, 15 and/or 16, ~7 and lB will
r.fl.ct figur.. th.t includ. the total of Abk r.turn. a......d to d.t..
ASSESSMENT OF TAXI
15. AMount of line 14 at Spou..l
16. A.ount of line 14 taxable at
17. AMOunt of Line l~ tax.ola Rt
la. Pr,\nclp.l Tllx Due
/.1 j,)) -,:I
B~REAU OF INDIVIDUAL lANES
IHHfRtUHCf. TAlC DIYUIDN
DEPT, Z80601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPART~ENT OF REVENUE
NOTICE OF INHERITANCE TAN
APPRAISEHENT, ALLOWANCE OR DISAl.lOWANCE
OF DEDUCTIONS AND ASSESSHFNT OF TAN
JOHN H L OSH
319 W GREEN ST
SHIREMANSTOWN
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-02-98
LOSH
11-20-96
21 97-0053
CUMBERLAND
101
PA 17011
ESTATE OF LaSH
TAX RETUHN WAS: (X) ACCEPTED AS FILED
) CltlNGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN NO, 01
1. R.al Est.hl (Schedule I,) (1)
2. stock. and Bond. (Schedule 8) (2)___
S, Clo..ly Held stock/Partnarshlp Int.r..t (Schedule C) (5)
4. KDdeages/Notu. Raeeivable (Schedule D) (4)
S. Ca.h/Dank Oapoliih/Hlac. Per.onal Property (Schedule E) (!i)
b. Jolntl~ Ow~ed Property (Schodul. F) (6)
7. TrUl.f.r_ (Schadul_ G) C 7)
a. Total A...h
,00
,00
.00
.00
455.00
,00
,00
(BI
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral E)(pen,../Adll, co,t./Mile. E)(pan.e. (Schedule H) (9)
10, D.bh/Kortgag. UabllHl../Ll.n, ($oh6dula I) 110)
11. Total Deduction,
12. N.t Valu. of TD)( Return
13. Charitabla/GovarNlanb.l aaqu.,t.; Non-elected 911S Tru,h (Schedule J)
14. Net Val\MI of E,tato Subjact to Ta)(
,00
.~g.
(11)
(2)
US)
U~)
NOTE:
rata
Lineal/Cl... A rat.
Collateral/Cl.., I r.ta
U&)
1l6l
117)
,00 N ,00.
6,855,03 N ,06.
.00 N ,15.
UB)
TAX CREDITS:
PAYHENT
DATE
01-21-97
11-21-97
DISCOUNT (+ l
INTEREST/PEN PAID ("
19.20
.00
RECEIPT
NUHBER
7,A185090
AA242510
ANOUNT PAID
364,80
27,30
TOTAL TAX CREDIT
BALANCE OF TAX DUE
..~--_.~
INTEREST AND PEN.
-~-_._-_.._.
TOTAL DUE
*'
.'v-lHI U ,,, IIt.HI
CATHY
J
DATE
03-02-98
NOTE I To insura prOpar
orect! t to your aoCO\.I"lt,
tub.it the uppar portion
of thh forll with lI'04Jr
tll)( pay..."t.
455,01!.
00
455.00
.00
6,855.03
,00
411,~0
.00
411 ,30
- ---~
411.30
,00
----- -.-
----.-.- : :}
. IF PAID AfTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL 7NTEREST.
IF TOTAL DUE IS LESS THAN 'I, NO PAYHENT IS REQUIRED,
IF TOTAL DUE IS REflECTED AS A "CREDIT" ICR I, YDU HAY BE DUE
A REFUND, SEE REVERSE SIDE OF THIS FORH FDR INSTRUCTIDNS.I
lr\
\...~:
\,',j
c
N
I
r-~
""
;\.::
,_ "_J
(\ji(
u::.'-'"
'-[I
P\
6~
RESEAVATIONI E.t.t.. of deotdtntl dyJng on or befor. o.cllblr 12, t..2 .- If '"~ futurl Int_r..t in thl ..t.t. I. trln.f.rr.d
In po.....lon or InJo~t to Cll" I (oollat.ral) beneflolerle, of the ~.o.nt .ft.r thl e~,lr'tlon of eny ..t.te for
1111 or 'or Yllrl, thtl C08Onwee1th hlr.by ,)(pr..'h r..lrttll thl; right to epprlhl end ...... trln,flr InharUanel TlIIlCu
It thl lewful Cl.l. B (coll.t.rll1 rlt. on en)' IUCh futur. Int.rllt.
PURPOSE Of'
NOTIC[z To fulfill thl raquir'lIIflt. of SlCtlon Z140 of th41 lnhtrlttnc. end (.t,t, Tlx Act, Act 11 of 1995. (72 P.S.
$lOtlon 9140),
PAYHENTI DetlCh thl te>>p portion of tMrt HotlCI tnd ,utMllt loIlth ~our ply..nt to tht AI,ht.r of W11l1 prlntld on thllll rlvor.. lich.
--"11<. chick at RMY ordtr payabla tOI REGISTER Of' MILLS, ADENT
REFUND tCfUI .. rafund C'lf I tllC cradlt, which w.. not rlqu..ttd on the h~ A.-t\lrn, .IV bt rlqu.lttd bv co,phUng en "Appllaltlon
for Alfund of P....".Ylvanlll Inh.rltancl and fltltl TeIC" (!lEV.UU). ApflllcIUon, ara Ivallebh at thl Offlc.
of thl Alghtlr of Willi, Wlyof thl l3 RIlIlnut Dhtrlct OffiCI" or by celllng tIM .peele. ZO\.hour
,"~Irlng 'Irvlel nu.alr. for for" orderlno! In Plnn.ylv.nift 1.800.36Z.Z0S0, outlldl P~.ylYanl. ~
"lthin ,loc.l HlrrhbYr, .r.. (711) 717-1094, TDD. (711) nZ~lZ5Z OMlrlng IlIpl!llrld Only).
OBJECTIONS, My party In Intlr..t not ,atisfied with the opprllhlHnt, allowancl or dlsalloWancD of deductlon., or .....-.nt
of t.x (includlno dl.~ount or lntlrl.t) al ,hown on thl. Hotlcl .u.t objlct within Ilxty (60) day. 01 r.c.lpt uf
thlt NoUol bYI
--written protut to thl PA Dep.rt...,t of RIVtnUl, Bo.rd of Appaah, DIp," ZII0ZI, Harrltburl, PA 171Z'~IOZ1, OR
--Iltction to hl\l' the ..tter det.ralned at audit of the ICOO\lrlt of thti plrlon.l rl'tPr"lntttl\l6l, OR
ueppClal ta t~ Orphan,' Coyrt.
ADMIN
ISHtATIVE
CORRECTIONS I
FlCtual Irroro dltcoll.rld on thll .......tnt ."ould be fJddr....d In wrHlno tOI PA Dlpart'tnt of AI"'I""",,
BurlltV of Individual T.x.., AnNI po.t "......Mnt RIVllw Unit, Dlpt. Zl06U, Harrhburg, PA I11ZI-0601
Phon. 0'17) 717-11505. S.. pagl !i ot thl bookltt ")n.tructlOlU for Inh.rlt.nel TalC A,turn for I R'II~nt
o.ctdent" (REV~lSOl) for an "xplanatlon of "lni.tratlvGh aorrltltabll "ror..
DISCOI..WT:
If eny tlX due II p.ld within thr'l (1) calendar ~th. .ftlr tnl dleadlnt', d.ath, a filiI par(ltnt (5~) dJ.count af
thl tax paid 11 11lowld.
PENAL TV:
The IS:< tlX .....lIty non.PlrUc:1p.Uon ptnalty Is coaputld on thl total of thl t.1C end Intarllt IIlI,uld, and not
Plld tMfor'. Jtnulry la, 1996, thll flr.t dl'" Ift6lr thl end of thl hlC III1f\1'ty per'lod, Thh non-participation
ptn.lt.,. I, tppl.labll in th. .... Iftnnlr and In thl th. .11.. tl.. p.ried ft. YDU would app..1 the tlx .nd Intlr.et
tl'..t hat be,," a......d II Indicatld on this noUn.
INTE~ST :
Int.rllt h C1hllr..d b'lIlnnlng with flr.t dly of dellnquttnc;y, or nln. (9) lontha and on. (1) dllY frOll thl data of
death, to the dati of p.y..nt. T.x.. which bac... delinquent bafore JtnUlry 1, 1982 baar Intlr..t at the rltl of
.1M (6~) pare..,t plr ~ calcul.tld at . d.ll.,. rete of .000164. All hlC" which bl~'" dotllnqu."t on and Iftlr
Jtnuarv I, 1912 will balr Intarllt at a rate which ,,111 1I11ry froa Clll_fld.r year to cllltnd.r yaar with thlt ratl
announced by th, PA Deport..nt of R.v.nuI. The applictbll Int.r..t r.tl. for 19a1 through 1991 .r'l
'!!!! 1ntlrltt Aat. Oalh Int.r..t Factor !!.!r !.!l!.rltt R.tl !!!.!h Intllrut Factor
1982 lO;,( .000"1 1981 OX ,000l,..7
1985 16;,( .OOOU. 198'-1991 Ill( .000.501
IClJ., m .000301 1992 .~ .000Z"7
1985 m ,Oa01S6 1995-1994 7% .00019Z
1... 10l .O:tU7'" 199~MI991 .~ .OOOZO
--Int.r'flt l, ollcuhtld .. follow.1
INTEREST' BALANCE OF TAX UNPAID X NUNtER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlo. l..u.d Ift.r the tex hlcoe.. d.linqutnt will r,fleet "" Inter..t calculation to fift..n (IS) dftYI
b.yond thl dlta of thl ........-nt. If fllly..nt Ie ..de .Hlr thl Int.rut eOltPuhtjon d.t. 'hown on the
Hotlcl, Itddltlonftl Jntlrut .u.t be c.lcul.~ea.