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HomeMy WebLinkAbout97-00057 Will PETITION FOR PROBATE and GRANT OF LETTERS Will Estate. Jaroes.a, Wf\gQor"", """,.",,,.,,,,,,, also known as ,:~(.W""'f,., iJ..,>;. \::t~~"'"., ,. "" No. . . , ~/. :-.9'. ? . -: ,.$. 7. . . . , , . . , . . . , .,....,..,......"..0..'..... ......."..."....", To: Reglnter 01 Wills for the County of Commonwealth of Pennsylvania . , . . . . , , , , , , , , , , , , , , , , . , , , , , , , , , , . , , . , " , Deceased, Social Security No. ,52il:-12,214~", , , , , , , . , , , , , . . , , , The pelillon of the undersigned respectlully represents that: Your petUioner(s) is/are 18 years of age and the execut ,Qt; , , , , , " , , , , , , . . ". named in the last will of the above decedent, dated, . ,September, 30", , , , , , , 19, 9.6. . and codicil(s) dated NAne , , , , . , , , , , , , . . , , , , , , , , , ",. "",..., ...",......."" "'" ",.......,....", ,.".""". """"'" (State relevent circ:umllancell, e.g. Renunciation, death 01 executor, file,) Decedent w/lsdomlciled at dealh in Clunberland 'h Co(\ty, Pennsy~v nla..! with h, is, last famill' , (IIP~'" ~'^ . (D,'"":'; (. c""" C ~ or principal residence at "J>rl~n"""~~".,.,s,.'r::?~',,\',,, .~".~ ., , ",. <2..>-.,.... '" """ ""'" ,""'" ""," l:',~ ,N"", :,;::\,Lu,~.",",-"", """... "",...,."", "". (Il81.lr~umb4lr and muniCipality) Decedent, then .'Z?, , ,yeaIs of age, died, , November, 29, ' , , , , , . , , , , . , " " , , , , , " " , , , ' ." 19,96", at , , , , , ,Shippensburg, Heal th, Care ,Cenir-r,. ,Shippr-nllQlJl;'g,. i'.E\nn$ylYan~f\ . . , , ,. , , , , . . , , , . , . , ' , Except as follows, decedent did not mallY, WIIS not divorced /lnd did not have a child born or adopted after eXf'cullon of the will oUered for probate, was not the victim of a killing and was never adjudicated incom. petent "",""""""""""""""""""""""""""""""""""""""""""'" Decedent at death owned property with estimated va lUlls as follows: (If domiciled in Pa.) (If not domiciled in Pa,) (If not domiciled in Pa.) Value 01 real estate in Pennsylvania situated aslollows: ""." ' , , , , , , . . . , , All personal property Personal property in Pennsylvania Personal property In County b '(O() .c.{) $.........,. $..".." $..., ..,.,. .. $..."."... '" ",./.". .. ......"... ..,......""., .........,.....,'.....,..,........ ".,., """.' .."...",., ..0"""" .. .,.",. "".". ..". ".,..."" ..",.... ,.."""".", """.,., "".,.". ..",....." WHEREFORE, peUUoner(s) respectfully request the probate of the IlIsl will and codicil(s) presented here. with the grant ollotteIs . . , , , , .TesiatnE\ntIlI;'Y. , , . , , , , , . , , , , , ' , , , , . ' , , . , , , , , , , , . , . . , , , , , , , . , . , " thereen, (Teflllllnenlary, <'Idmlnislratlon c,t.t\., adminltllllllon d.bnc.I,lll \ Signatura(a) M.d Re'sldence(a) .~ e,j Pullhoner(s) """".4.",:, " " .,C'~~""',.,""',.,""',.,"',.,' ,"" """""" " ,,(S " ,~~',~ ~$;. ,~ ,,0.. """....,,,,,..,........,,.... """ ...." , , ". ,. '..'. :~~~~I~'~\ :~~~' :::: J:~c~:'~l') :::.::::::::,::,: ,..:::.: :.::::":: ::':.. OATH OF PERSONAL REPRESENTATij 0", (' ~ :0:0 "'~ (!:" 0 "l't) ,...,..... ". Li ~ t', ~~~~~MO~EA~Tu~~~r~~~~~YLVANIA f S8 ~b ~ ~~'~ The petllioner(s) above named, swear(s) or affirm(s) that the statements in the fore~irtq pelilion are true and correct to the best of the knowledge and belief of pelilioner(s) and that as personal representalive(s) of the above petitioner(s) will well and truly administer the estate according to law, "",Ji~~~""".....",.. - ~" , , , Sworn to or allirmea and sub- scribed before me this , ~ 7!:hay of .." "..F'.t1l!!\~L" , 19 n " t ' J..(..h-<-.~ r:~~*,,' '~;,~ ~~~ '~~;i~;~r "" ",,,,,. """" """ '" "..,."" .., ."."",.." ""." .""..., ..,."".. """.." "'."""., """"""'" '" "":'" ""\""" ." .""", ..,',.......".,......'.".,;.,., """"" No. ,2,:1,.:-9,7.":,5.7.,,, Estate 01 , , "Jarn6!$. H., Wagner, . , , , , , . . . , , , , . , , , , , , . , , , . . . Deceased DECREE OF PRODA TE AND GRANT OF LETTERS AND NOW, "". , . Jan\Jary. , , ) L , , , . , . " 19, ,97. , , in consideration 01 the petilion on the reverse side hereof, satislaclory proof having been presented before me, IT IS DECREED that the inslrument(s) dated " " , , ,September, 3.0" .1996" , , . . , , , , """ ., , , , , , , , , , . , ...", . , , , , , , . . . , "', , , , , , '.". , , , , "., , '" described therein be admitted to probate and hIed of record as the last will of . , James ,H., WagneJ;, , . '" , "" .".".....,. ". ",.". """.. .,., """""" "",', """".. '."", ,..,'.... ...."... .........' and letter. , , , , ' .'r~$t(l(T1f-n~I)1;'Y, . , , , . , ''', " , , , , , , " , , , . , , , , , , , , , , . " " , , , "" , , . . , , "" , , , , "" , "" are hereby granted to . . . , ,H. ,AnthP.ny. . Adams,. ' , , , , " , ,. , , , , , , , , , , . , , '" , , , , "., , , , , , ,,'" , . , "" " , " ) ",.., '."".. .,."".. '.",.", .,.".,',."..""."",..,.....,....., ,..",-.,. .,',-,........."". .. ........ ~~'","""~h~'..................... ~1~L~::"ci,f8~ ..... Oath of SubDcribing Witness(s) 0 Oath of Non-subscribing Witness(s) 0 Oath 0/ Witness(s) 10 mark 0 Renunciation(s) 0 Testamentary Sh. Cert. x-pages .JCP $40.00 6.00 6.00 5.00 --57:-60--' t1,., Al1~hQI,1Y. A.cl&n)$" j<:Sq4~r."".... . .""",. ATTORNEY (Sup, Ct, J. D, No,) 25502 ~~~, ,F,., ,~~!1g, ,~~.,$~~PP'~nsh!1:g, .~~, ,1?25.7. ADDRESS (7,m~~~~~}27Q . PHONE . .",."" ."".,. r>1~~.J t,it.'u t" at!.,. I -;J. \ ''1'1 LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, JAMES WAGNER, of 419 Meadow Drive, Shippensburg, pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last will and Testament, hereby revoking all prior willlJ and codicils by me at any time heretofore made. FIRST: I direct the payment of all my legal debts, funeral expenses including my grave marker and all expenses of my last illness, state, federal estate and inheritance taxes, administration costs, etc., shall be paid from my residuary estate and shall not be charged or apportioned to any other legatee, donee, beneficiary or joining tenant as soon as may be conveniently done following my decease leaving all specific bequests free of tax to the legatee. SECOND: I give and bequeath all my property, be it real, mixed or personal, to my wife, Bernice Wagner. THIRD: I give, devise and bequeath said Bernice Wagners share to H. Anthony l\dallls, as Trustee of my estate, to invest and reinvest the same with the following powers in addition to those currently gi"len under law: a. The power to \Ise the income from the said share for the beneficiaries support, health, maintenance of said beneficiary. b. The power to use the principal if the income should prove insufficient for the support, health, maintenance of said beneficiary. Roc ,,,('" J "frk" 01 ,.,), . ... R(,ji'l"lb~ I 'vI/Ills '97 JAN 17 P 3 :14 Oler"" 'p , . urt r\ ~ < .:-., ~" ;./! CUmbfiIlJI": 0...,,, PA \'-. 1...1 -a III >( ~ .~ ~ 2: ~ ''<) j i ~! ~ ~ . I ~ .( d .~ ~ g tl- ~ ta ~ ~~~~~ \n ~ o x ~ II " I' I II: ! III ...... el ~ .. ~ " z ~ ~ z ~ '" ~ 0(( l t6 :t m ~ " , STONE LAFAVEH & STONE ATTORNEYS AT LAW CHAAI.IEB H. STONE DAVID H. BrONa QERALD J, BHItKLIlTIKI ELlZA.ETH .. aTONI 414 BRIOOE BTFUtt:;T POIT all'FICE 10)( /it NKW CUMntml,M./Il, PA 11070 February 27, 1997 Register of wills Offioe Cumberland County Court House Carlisle, PA 17013 REI Estate of Mary C. Hernpt File No. 21-97-0157 JON p, !.'\PAVER of' COUNIEL TELIlPHONI 17171 774-7'" ~"O.IMILf. 17171774-3'00 Dear Registrarl Pleaee aooept this oheck in the amount of $14,250.00 as payment on account of the Inheritnace Tax due on the Estate of Mary C. Hempt. Please send the receipt to my office in the enolosed stamped addressed envelope. Thank you for your assistanoe in this matter. Very truly yours, STOHE LaFAVER & STOHE CArulp.II,c.~@ Charles H. Stone CHS/tmb . Enolosurel - '0 ':'": t!il: ~ :,\ 0:: N t. . 13: , , c;o ;. , , N " 'I' , , ~ l::i ..' ..-~ () ';"'.J .,~ !'V ~ a;; e!" '''''''''''',,, .t~t. ('lMMON~)IVMM llLl'fIIUM! Nf (II HIVI NUl 1l1.1'1;'IIIW,l)1 IIA!.!.!WilHUH; l'A \II,'1l [hl,:_ e / i",,\-ll',l','Ij[' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT .7<' 15'-/ SS I liE NUlmER 9 '1 0 0 0 5 '1 "'.I"'.H ,1M, 1."11, .--"- - ...-, Iller !lltjl"; fjAl.tl1i A!,I IIIi:,] {.JjiI 1,1I[HI\1 INI11^1111\~ ~ III,I"~ I."d In ',"1'.1<1111111',,111> ... Z W o W () W C WAGNER JAM [: S :,(JCIM :,u:UII11'rllllf.IlHII (1I,lIl1l{tlAlll 1,1,111-111'111" 5 2 4 ~1 2 -2 4 4 129/1996 1/28/192 pi M'f'(ICAfll() SUflvIVIN,l !iI'CH)Sf'S NAJ.ll 1\^~iT IlflS\. MJIl MilJIIl f IfJi!IAII SOCIAl <;rr:l!fllll' fllll,llIlH THIS RETURN MUST BE FILeD IN DUflLlCATt: WITH llU Wagner, Bernice 8 0 - 2 6 - 6 9 3 REGISTER OF WILLS IX! 1 Orlglnol Roturn 0 2 Supplmllol1lal Rolurn 0 3 Rmnrllnder Rfllurn Id,\I!: 0' 'J~"III foil,,, I', ',' 11 ' [] 4. Umiled Eslalo 0 48, Futufelnlero51 ComprornIS(ll~~lnolllaw)n"qll?-12 ell 0 5_ FfJdflffll Estate Ta~ Ro\llfrl RflqlllrlHI o 6 Decedent Died Testate (^"lIGhC(\pyorw,111 0 7. Decodf)nl Malntflinml i1l1ving Trust (A"~cllwr'j (\1 r!w,11 _ 8 T01<11 !\jumbnr 01 S(1fe Doposlt Br}~l'(. o ~_ Lihgation Proceeds ReClllved 0 10 SpOlisal Poverty Crodilld~leollMathb!ltwaer I} .l1l}1 Rill! 11951 (J 11 tln,'llon to tfli UIl(IBl ~;r:c 91 rllt,; THIS SEC ION MUST BE COMPLETED, ALL CO RESPONDENCE NO C FIDE AL TA INFORMATION SHOULD BE DIRECTED TO: IMME COMPLETE MAllItiG ADDRESS H, Anthony Adams FIRM flAME (II AppliCAble) 717.532.3270 TflEPIIONE NUMOER I!! " ~Vl :.l~g :to:.J ""Ill 1< ; ~ Vl ~ l!i u -- I. Roal eSIA" ISchedule AI (I) OFne/lll lI:iF ()I~I '( 2 Slocks lmd Bonds (Schedule 8) (21 3. Closely Held Corporallon, Partnership or Sole.Proprletorshlp 131 4 Mongages & Notes Receivable (Schedule Dj (41 5. Cash, Benk Deposits & Mlscell,neous Personel Prope"y (5) 7 I 5 8 .1 4 Z (Schedule EI 0 6 Jointly OWned Property (SChedule FI (6) ~ 7 IntOt.Vivos Transfers & Miscellaneous Non.Probete Property 171 ::I (ScheduleGor l) .... 8 Tot.1 Oro.. A..et. Itot'l lines 1.7) (81 7 ,5 1 8 .1 4 n: o.'l: 9, Funeral E~pens~'s & Administrative Costs (Schedule H) (9) 6 . 0 9 9 3 7 U W 0:: 10 Debts 01 Decedent, Mortg.ge ll.billties, & liens (Schedul.l) (10) -- 11 Tol.t D.ductlon. (tot.IUnes 9 & 10) (II) 5 ,9 4 9 3 7 - - 12. Net Vetu. of E.let. (Une 8 minus Uno III (\2) r5 6 8 7 7 13. Charitable and Govornmsnlal Bequests/See 9113 Trusts for which an elecllon to taK has nol been (131 made (Schedule J) 14 Nel V.lue Sub)acttc T,,(line 12 minus Une 131 (14) 15 Amount olllno 141Axable ,5 6 8 .7 7 X 00 z atthaspousallar, rate , (15) 0 See Instructions on reverse side lor applicable percenlaqe t= 16, Amount of line 14 taxable X ~g 1116% rate ,06 (18) ....Il. 17 Amount alline 14ti'lKablo X .15 (II) :E 81 Hi%Ia!(t 0 U 18 T" Due 118) 19 ,568.77 o .0 () o .0 0 << ;11'1,-(",1" ._ t_~ ~';IC;I~AlURE or PREPARER (l HEI~ THAN REPRESENTATIVE Ll) cl .,,, (~l~ P ~' ,,,\,)v,,, \), ')' DATE / (J!,U)ro rMll:',- 7' (1;;1 Decadent's COl1lpleto Address: ~;ffli_LIN~:;fll.'~"~ --- -- --~-~-~~ '~~__~~'_R___ ~ ,______4.19 Medal Dr~ve - - ---_::::~~~=- ~~. l'iiT~hippe~~b~;~'''-~--~---'-'-----------. _fSTAr, Pa ----r:~257_=_=- Tax Payments and Credits: \. Tax Due (Paga llina 18) 2, Credlls/Paymanls A. Spollsal POV&r1y Crodit B. Prior Paymenls C. Discounl (I) 0.00 3, Imeresl/Penally il applicable 0, Inleresl E,Penally Tolal Credits (A. 8 + C) (2) TOlallnlerosllPenally 1 D + E) (3) 4. II line 2 is grealer Ihan line 1 + line 3, enler Ihe difference, This Is the OVERPAYMENT. Check bOK on Page 1 Line 19 to request a refund 14) 5 II line 1 + line 31s grealer Ihan line 2, enler Ihe difference. This is Ihe TAX DUE, (5) A Enler Ihe inleresl on Ihe lax (Iua (5A( 8, Enler Ihe lolal of Line 5 + 5A. This IS Ihe BALANCE DUE, (58) Make Ch~k ~able to.' REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1, Did decedenlmake a transfer and: Yes No a, retain the use or income of the property transferred; . 0 IZJ b, retain the right to designate who shall use the property transferreel or its income; . '" 0 IZJ c, retain a reversionary interest: or ' 0 IZJ d, receive the promise for life of ellher payments, benefits or care? ""'''' "",""""""""'" 0 IZJ 2, If death occurred on or before December 12, '1982, did decedenl within two years preceding death transfer property without receiving Adequate consideration? If daath occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ",,"""" """""'''''''''''' ",,'"'''' " " , ""',""'''' """" ,,0 0 3, Did decedant own an "in trust for" or payable upon death bank account or securlly at his or her death? , 0 [R] 4, Old decedent own an individual retirement account. annuity, or olher non-prcbate properly? 0 IZJ 000 - 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,S. s9116 (a) (1,1) (i) provided for the reduction of the tax rale imposed on the nat value of trensfars to or for the use of the surviving spouse from 6% to 3% for dates of death on or efter July 1, 1994 and before January 1, 1995 72 P,S, s91l6 (a) (1.1) (ii) provided for the reduction of the rate Imposed on Ihe nel value of Imnsfers to or for the use of Ihe survlvlll(J spouse from 3% to 0% for dates of death on or after ,Ialluary 1, 1995, The stalule QQE!~Jlol,'LI@f]1Jl\ a transfer 10 a survlvln9 spouse from laK, and the statutory requiremenls for disclosure of assels anel filing a tax return are still applicable even if the survivin9 spouse is the only beneficiary, FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995 - Please answer the following question by placing an "x" In the appropriete space, Old the decedent create a trust or similar arrangement which Is soley for the surviving spouse's benefit for his or her entire lifetime? Yes 0 No IZJ If you Answereel yes to the above question, the tAK on Ihe trusl or similar arrangement Is poslponed until the death of the second spOllse, et which time it will be fully la,abla at the rate(s) applicable 10 the remainder beneficiary(ies) Enter the value of tile trust on Scheelule J, Pari II, In order 10 rarnove II from the calculation of the tax due in this estate, You may wish to fite Schedllle 0 in order to make Ihe election aVAilable under Seclion 9113, If the election is made, the trusl or similar arrangement Is texed In the estate of the first decedenl spouse, the portion of the IrUSI or similar arrangemenl which benefits Ihe surviVing spouse is taxed atllle zero taK rale, and the remainder Is taxed atlhe rate(s) applicable to the remainder beneficlary(las), If you ohoose to make Ihe election, you musl allach Schedule 0 to a timely,fited tax return, along willl Schedule(s) K and/or M In order 10 show the apportiollment of the trust or similar arrangement between Ihe surviving spouse and the remainder beneflclary(ies), "',.n",,":,.. COMMONWEAl HI or PE.NNSYLVANIA INHERllA.NCE TAX m. TURN RESIDENT DLCE(Jf:N1 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF ,WAGNER JAMES Include the proceed' ollitigalion And th. dalelh. proc~ed' we" received by Ih. "'ale, All property jolntiy.ownod with tho right of ourvlvorshlp mUlt be dllcloeed .n Schedule F, FILE NUMBER ITEM VALUE AT DATE NUMBER DESCRIPTIOL- OF DEATH I Orrslown Bank 166.77 Account # 000.656424 2, Orrstown Bank 6.77297 Accollnt # 000-559261 3. Refund from Shippensburg Storage Spaces 21.35 4, Refund from U,S, News 2,00 5, Refund from Shippensburg Health Care Center 555,05 TOTAL (Alsoenler on line 5, Recapilulalion) $ (If more space is needed, Inserl additional sheels 01 the same 51101 75~ /0 /,r~/.") \ aUR~AU OF INDIVIDUAl TAKES 1~'l:RnANC.: lAk DIVISION Df.PT. rlOtaOI HARRISBURG, rA 171'8-0~DI COMMONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INH~RITANCE TAK APPHAISEMENT, AllOWANCE DR DISAllOWANCE Of DEDUCTIONS AND ASSESSMENT OF TAH 03-03-2003 WAGNER 11-29-1996 21 97-0057 CUMBERLAND 101 [~:.',::.-.~~=~=~~I.~:~:=._j H^KE CHECK PAYABLE AND REMIT PAYMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ i'iifv: isijj"iinj:p. i i'li,~ii:rl.Noi" icr 'OF' i"NHEifif ANtE" TAx. ;iPPRA"iii EMENr,--AL:i.."owANti.- ,(ili m__ - - - -."" -.. -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JAMES H FILE NO. 21 97-0057 ACN 101 DATE 03-03-2003 TAK RETURN WAS, I I ACCEPTED AS FIlED I Xl CHANGED SEE ATTACHED NonCE DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN H ANTHONY ADAMS 128 EKING ST SHIPPENSBURG PA 17257 ESTATE OF WAGNER RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l F~t.t. lSchedul. A' 2. Stockl end Bondm (Schedul. B) 3. Clos.l~ Held stock/Partnership Interest (Schedul. C) 4. Hortgauas/Not.s R.~.lv.bl. (Soh.dul. D' 5. C..h/B.nk Oeposlts/Htsc. Parsonal Proparty (Schedule E) 6, Jointly Owned Property (Soh.dul_ f) 7. Tr~Nf.rs {Sch.dul. GJ e. Tot.l Ass.ts APPROVED DEDUCTIONS AND EXEHPTIONS: 9. Fun.ral b:pensas/Adll. Costs/HiSle. F,xpens.1I (Sch_dul" HJ l@, Debts/Horteaga Llabl1ltl.s/Llans (Schadul. I. 11. Total Deductions 12. N.t Value of Tax R.turn 15. Charlt.bla/Oovern.ant.l Bequests} Hon~.lactad 9115 Trust. 14. Het Value of Est.t. Subjoot to Tax I~ an ....ssmont was i..ued previously, lines re~lect figures that include the total of ~ ASSESSMENT OF TAX: 16. AMount of L Ina 14 .t Spausel rat. << 15) 16. A..ount of Lina 14 taxable et Linalll/Clan A rlata (16) 17. .MOunt of Line 14 .t Sil.-Ung rat. (7) 18. "Mount of Line 14 tDxab1a at Collatural/Class B rata (18) 19. Principal Tax Dua NOTE: DATE .. ::. -I,:':'=i:i.-;:, I . IF PAID AfTER DATE INDICATED, SEE REVERSE FOR CALCUlATION Of ADDITIONAl INTEREST. .....Jl.D.. (111 1121 1131 U41 14, 15 and/or 16, 17, 18 .nd returns a......d tD date. III (21 (31 141 ISI 161_ (71 ,00 .00 ,00 ,00 7,518,14 ,00 ,00 (B) . '* ~IV .114/ tM ", IIHII JAMES H 191 IlOI 6,099,37 NOTE I To insura proper credit to your avtJount, aub"!t the upper portion of thia for. with your taM paYliant. 7,518.14 6.099 37 1,<,18,77 ,00 1,418,77 19 will ,00 ,00 ,00 ,00 ,00 ,00 ,00 ---_._---~_._--- ,00 ________._._'~__H.. .00 ( IF TOTAl DUE IS lESS TMAN .1, NO PAVMENT IS REQUIRED, IF TOTAl DUE IS REflECTED AS A "CREon" ICRI, YOU HAV BE DUE A REFUND, SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS,) (Schedule J J 1,418.77 K 00 . .00 H 06 . .00 K 00 . ,00 K 15 . (19)< AI1DUHT PAID TOTAL TAX CREDIT ---._--- . BALANCE OF TAX DUE -------- INTEREST AND PEN. ------- TOTAL DUE RESERYATIDMI Elt.to. of decld.nt. dvlna on or blfor' DIO.~blr 12, 1982 .~ if ~n~ futurl lnt.te.t in th~ ..tat. 1. tr.n.f.r~.d in po~....lun IU' InJa!f.~nt to Cl... B (oollllltlr~ll bllnaflohlrlu of thl dlClldlnt aftlr Uti l'I(plr.Uonof anY ..tat. for lift or for ~..r', tht COllllonwulth hllrehy axpre..ty r.lflrv" th. ,.llIht to IlpprQhlllllid a..'" tr.nlfar I""',dtano. TaMI. at tl'll lawful Cle.. B (cml1etarllll r.t, on Dnl/ luoh future Int.rut. PURPOSE Of HaUtE 1 To fulfiU the requlr8llllnh of SecUon ZlftO of the Inhllrltllnc" and F.lhte hI( Aot, Aot 2! of 2000, (72 P.S. S.ction 9140 I, D.taoh the top portion of thh Notioa and subalt with your plll/lnmt to thll RllIgister of Willa printed on th_ rlVlr.e lid., uHMll oh'Clk or lIIon'\I order pnYlIblll tOI REOIDTER OF MU.LB, AOENT A refund of II tlUI erlldlt, which wall not rflqufllIhlld on the Tfllt Ruturn, llIay bll rllquested by cOllp,leUng IIn "Applioation for Rafund of Il.nn.ylvllnl, ttlhllrltllnoll and ElJtah Ta)l" (REVM131'5)' Appllantlon. arl5l aVIlUebl. at th.Offig. of th. A.gi.t~r of ~illl, mny of tha 21 R~v.nul Distriot Offlo&5, or by call1n; tha fipllolul 24-hour an.werin; ..rvitl for far.' ordllrlnlll I-BlIll~lf,?-lO~Oi 9tu'viou for t!JMPllylll'l with spaolel huring IInd I or .puking n..dlll I-ftQO-447-30ZlI lTT only), PAVMENT I RE'Futto (CR)1 OBJf,CTIONSI Anv parh in lnt.rut Ill)t IIBthfllld with ~hll flppr~hallllmt, allaweMOIf. or dhaUowence of tlllduotlcms, ar uus..ent of tal( (InolUdlng dhoount or Inhrutl III shown on this NoUcl lllllst objeot dthlll sb:ty (60) deys of rllc.ipt of thh HotltA bYI .-writhn prot.,t to thu PA Dllllert..nt of RflvllnulI, Board of App.nh, DIPt. ZBl(IZ1, Harrhburg, PA 1'11?1I~1021, OR --eleotlon to hlllv" the allttar dlltlrlllinad lit eudit of the lIIonount of the pllrsonlll reprlllgentaUve. OR --appaDl to th. Orphwns' Court, AnHtN~ ISTRATIYE CORRECTtONSI faotual lIrrors d'.ooverou on tll15 1I'1ge5SIIJ,ll1t IIhould be addro.ud In writing tOI PA Dapllrtllllnt of Revlnue, Bur..U of tndlvldufll TaMil!, AllNI po.t ^ullulIIlnt Review Unit, Dapt. 1.80601, Harrisburg, P^ 17128~06Dl PhoM (711) 787-6505. S.. psga 5 flf the booklet "trlstruot1onli for lnhllrltance Ta)l Roturll far II ~nhl.nt OaoDchmt" (HEII-ISlH) for IIn lI)1phmutlan of adainhtretl\lfllY oorrlilctabll IlrretS, If env tlll)l du. 11 p.ld \-lUh!n thrllllJ ('51 oalendar IIlcmths sfhr tha oeolldont'j; duth, El five p.rount (5:<l disoount of the tllM peitl 1. .llowed, The HiZ tlllM elllnllG!Y non-pnrtloipatlon pllflal tv Iii cOIIIPutlld on thll total of the tSM nnd intarnt IIUIlUlld. and Ilot p.id before JlMuBry 16, 199-b, thlll finiit oftl,! lIftllr tho end of thll talt a.nasty perlCld. This non-partloiplltlon penal tv is IIppulable 1n the nlll8 IlIftnner Dntl In lhe tho Stlli'lO thlll pllrlod ns ~ou would applllll the ta'll and Jnhrll.t that hIlS beDn nlOlIBliod BlI IndllJ~ted on this notioM. Intlr..t I" oh.ralld b81JlnninA with firlit day nf l!ellnquof'oy, or nlllo {91 "onths find flnB (1) d8'1' frolll the dote of de.th, to t.Me d.t. of Pllv..nt, TO)lIl'll wI, loll heOllllll' dl'l-llnquanl bufore J,mu8r~ l, 1'182 baar intenult at the ratll of Ill( (6;0 pllrollnt ptlr IlfltlUIll ottlculutod !It I!I cl!lil~ r!lh1 C1f ,000164. All taltU whioh bROII.1I delinquent on and eft.r J.nuarv 1, 1962 will be.'- Intllrltlt fit fl rBte Ilhioh will vl'lry fro. oahndar )fur to cahmdar yOllr with that r.te 8nnOl.lnoed b)l th, PA D~p.rt.ent of Revunua. The applloeble ktllrut rntali for 19112 throUllh 2003 arel Intlre.t Dedlv lntlnuiit llnlly lnterut 2:!!-. ~~ "liAr ~ ~~ ~J' ~ Oeilv ~ DISCOUNT I Pf.NAlTVI INl"ERESTI ~ 19112 ZOX .~00Sll8 19111 'Ii:: ,OIl0?47 1999 " .000192 1965 16X .0004511 1988"1991 111: ,000301 200li 8% ,ODDU\) 1984 11:< .OOOlOl 199~ 9:< ,000247 ZOOl .X .000241 1985 l!lX ,000556 1991.199(, 7'1. .0001n ZOOZ 6X .000164 19&6 lOX ,000214 199!i" 1998 91. ,000Z47 200:S sf: .0001'51 ~-Inter.st II aaloul.ted III fcllotllOl INTBUST . BALANCE OF TAX UNPAID X NUMB~R or DAYS OELINQUEHT X DULY INTEREST FACTOR .-Anlll NoUoe inutld IIftllr thtl tllUI heClOIlllI deUnquent will rllflaet bil l"t.rut oalculBtlan to fHteen OS) d"~1tl btlyond the dllte of the .....s..nt. It pltYlllllnt Is Mild_ after thll lntllrost oOlllputatlon dllte shown Oil the HOtl(Jll, lIiddltlOIl.l Intllr..t lIluut b. tllloulllted,