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1,Joan D, Johnson
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81)1 SOCiAL SECURIT'f NUIolIlf.R DATE of OfATH1J.lQllWl. 0011. _f
t, Female 1,197 - 40 - 6289 "January 13, 1997
OATI! Of IIIftTH "'H~(C"I.oo ~OID6Al'HIC/'lt(;lt~:!.- ",~""l"""on~ -
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COMMONWEALTH OF PENHSVLVANIA . OEPARTMEHT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
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IIUREAU OF fNnlVlnUAI fAl([S
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 91-0061
91101058
02-25-91
U~.Li.1 U ," f/.Hl
EST, OF JOAN D JOHNSON
5.5, NO, 191-40-6289
DATE OF DEATH 01-13-97
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[X] SAVINGS
o CHECKING
o TRUST
o Cr,RTlF,
CHERYL L BAIR
508 LEWISBERRY
NEW CUMBERLAND
RD
PA 11070
fiEMIT PAYMENT AHD FDRMS TD'
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, FA 17013
HEHBERS 1ST FEDER~l elf ha. pl'ollldld thl D.partM.nt with th. Infar"atJon II.ted below which ha. be.n "..d In clIlc1,.ll"tlng the
potentl,l tllC du., Their rlcord. Indicate thlt lit the dllllth of the abcvI dlo.dlnt, yoU Wlr' " joint owner/blnlficl.ry of thh Mccount,
If ~U1,.l f..l thll InforMation II incorr.ct, pll." abhln wrltt.n oorr.otlon fr'ol the flnlllnclel In.tJtution, attach a copy to thh for.
ltnd retui'n It to the above .ddr.... Thh IICcoullt 11 hlCllbl. in ftOcordlnc. with the lnh.rltnnc. T.eK tllW. of th. COMMonw..lth uf Plnn,villlnll,
wu...t ion. uv "1 IInlw.reo by l,JIIJ 1 WU l i J I! nit -6....,.
COMPLETE PART 1 BELOW
Account Ho, 100101-00
~ ~
~ SEE REVERSE SIDE FOR
D.h 02-05-88
E.t.blhh.d
FILING AND PA~MENT INSTRUCTIONS
I
I
1
,
"
Account Bohne. 503.70
P.rc.nt T...bh K 50,000
A.ount Subj.ct to To. 251.85
To. Rot. K ,06
Pohnlio! To< Du. 15, 11
PA~ TAXPAYER RESPONSE
m I FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNENT BASED ON THIS Noncel
.,
To Insur. proper crMdlt to your account, two
(2) CCpIM' of thl. notlcg IU.t aoeo.pany your
pay",.nt to HI' Reghhr of Willi, Hllk. th.ck
payable tOI "R,gilhr of Will., AII.nt",
NOTEI If talC IlftVlllnh ar. Jlad. ~lthjn thr..
(3) lIIonth, of the dlcedent'. d.te of d..th,
you .ay d~duct II 5% dl.count of thl taK dUll.
Any jnh.rltanc. hlC d.... 101111 b.eoM, d'll~qUlilnt
nln. (9) Month. afhl' the datil of duth.
[CHECK ]
ONE
BLOCK
ONLY
o Th. abolla InforMlltlon and tt\1C due II corract.
1. Vou IIIIIY choo.' to r.,lt payM.nt to the Roglstor of Will, with two capi.a of this notlc. to obtain
. d1lcount or !l\Iold Inter..t, or yoU IIIl1y chl",k bolC "A" and rlturn thl_ notlcl to the Raghhr of
Willi a~d an cfflcJal 1l.1...M.nt will b. l,.u.d by thl PA Oepart,.nt of Rev.nu.,
B. c=J The IIbcv. a...t ha. be.n or will b, reported and ta~ paid ~Ith the Plilnn.ylllllnill Inh.rltanc. TIIIC r.turn
. to bo flhd by the dlc.d.nt'. rtpr'..nt.tJlle,
t, c=J The IIbOll. inforllletlon l~;~nccrr.ct andlor dabt& IInd d.duction. w.r. Pllld by you,
You ~u.t ccftplet, PART L~ lind/or PART (~ b.lew,
If you indioat. I difflr.nt tax r.t.~ pl.... .t.t. your----
rll.tion,hip to d.cadlntl ~______~
PART
~
TA~
LINe
"~Tl!,!~ . ~!l"""JT,.T!N!
1, Det. E,t.bltahad
2. Account ael.no.
S, P.rc.nt Tlxable
4. AMount Subject to Tax
5. Debt, end Deduction.
6. AMount Tlxlble
7, r.)( Rat.
8. T.>< DUI
"r- T^.X ,,~! ...~~~T 'T~tl!"!, J',...~('IINT~
1
2
3
4
6
6
7
8
OFFICIAL USE ONL V 0 AAF
PA ~. RTHENT OF REVENUE
, . ....,;,~.. . .. :tl
"-'.., ,""'-'....~--, :"l'I'rlr'----
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PART
[!]
DATE
DEBTS AND DEDUCTIONS
1
2
3
4
5_
6
7
8
CLAIMED
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PAID
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PAYEE
DESCRIPTION
AMOUNT PAID
L
TOTAL (Enter on line S of
~
rlx Co,"pubtlon)
:'F
.
-
Und.r Pln.ltl.. of p.rjury, 1 dlclare that th. 1.ot. I hlv. report.d .bOVM .ra true, correct and
09.,l.t. to the b..t 01 MY knowl.dUI .nd bell.f.
HOME
WORK ( )
TELEPHONE 1lUFlBER
DATE
1. FAILURE TO RESPOND WILL RESULT IN AN OFflCIAL TAX ASSESSMENT .1". .,,"00'" Inl"." .n..' on I""",,\lon
.ubmlttad by thl flnllnclal lnlUtutlon.
?, Inh.rit.nt8 tll< blJlCOMU dlllllnqu.nt "1M lIIonthll aHar the dec.d"nt'fI dntlt 1;1' d4l/lth,
1. . joInt lI(Jcount It l,MKahl_ .van tho~'QI1 U,., fi.catipr\'" !llImlll WI!lI fuMed at " IIlBtter of conv.nlanc..
.. ...n.nll <1n.lu"'''. Iho" ,,," ......" ,,,....,,, .". .,/.1 .h'oh Ih, <,,,...,,1 ,"I I" ).1". ..... .1Ihl" on. ,..r ,rI.r I'
d.eth ar. hillY tll)((lbl. ltII HII",f.rll,
S, Accountt ..tnbll,l,ad jol"tlY b.t.....)n t1unhAnd find wlh IIIor' thl'm one yaelf I'rlor \('1 duth .r. not tall.f11I1I..
6. Accounttl h.ld llv II dllcldent "In tr'u.t for" f'lf\othllr or (Ithllr. IIr. tU:.ltlbl. fuit,;,
GENERAL INFORMATION
REPORTING INSTRUCTIONS . PART
1
TAXPAVER RESPONSE
1. >lOCK' ,/ .h. ,,,/.,,.\I.n .n" oo'pu \0 \I 0" In .h. 00\1" ." 00".0\ ond ".du.\I.". or' no' ..'n. 0,.1..., ph.. ." "X"
In ....k "0' 0/ p.rl 1 ./ ".. "'"PO''' ...pon.." ",\Ion, GI.n '.0 ,opl.. .n. ",b.lI Ih.. .1Ih ,our oh"k f.r Ih. ..oun' of
talC to thll Regl.tor of will. of the county Indlcat.d, Th. PA llllpartllant of ".v.nv. 1Il111 IIlu' an offlolDA .n.....nt
(forll REV-IS4" nn upon rllOlllpt of the return froll the Regilt.,. (If wIU..
Z. RlO~' B _ II Ih. ....I .."I/I.'.n Ihl. no\1" h" .un .r .111 .. ,"porl.d ond ,., ..'d .lth Ih. .,"".,I"nl. Inhorl"no.
,,, R.\urn fll.d "' Ih. d".dont'. roo"..n'o\I... ,I... on "X" In .'Dok "'" ., ,.d , ./ .h. "\..."" R..pon.." ..otlon. Slon on'
"" ond "''1," to .h. P' o.p"...nl ./ ,,,,,,'1', Bu,"'" 0/ Indl.'du,' la,.., 0... m601, Horrl.bur., PA 11I,B-0601 In Ih.
env.lop' provldlld,
S. BLOCX C _ If ,h. no\1.. In/o,..'lon 10 ""uI'r,,1 ondl.r d..uolloPl ... ..'n. ".I..d, ,h"'< b'.ok "C" .nd oo,plo" P.r" , .nd l
",...'1', " '"^ ,.....".".". k.I"" "C' .~" r..,'" ""^ ,,'hT" 'h.- ,,"k "..,,, .h"." '" 'h- ._"".., ,,/ ,., .....h" ... .h. ...,.,,,,
of Will' 0/ Ih. county Indl",.d, 'h. ,. OOp"I..n' 0/ R..onu' .111 1..'1' .n o/flo'" .......on. lFm REV-ISI.B EXl u,on "..1"
cf the r.turn fro. the Register of will..
TAX RETURN . PART
2
TAX COMPUTATION
LINE
1, Enter
NOTE I
thl.l dftt. the nc(;ount tlrlg11\1I11Y ~ft. ut~bllfhlld or tltllld In the mnnnllr eKI.tlng at dolltlll of duth.
for n dDcld.nt dying aft.r 12112182: Accounh which the decedent put In jnlnt naMU within onll (l) .....r of d.ath are
tn~abl. fully a. trftntfllr.. How~v.r, th_fe II nn exclusion not to excelld '3,000 per trnn.f.rll. r.~ardl.tt of the value of
the oIIccount or th. nu.ber of ftCcount. held,
Ii III doublo lutorlsk (lili) I!IpP,lIrll before your first I'\lIlIIe In tn. I'lddrllU portion of thll notlc_, tho U,OOO exclu,lon
eHeed... ht" boen deducted fro. thCl IIccount bl:'tlfmoIJ al report lid by the fln~ndal Instltut1on.
2. Enter the total balanr:e of thlil account Including Intrlrut accruad to thll dlltGl of dnth.
'S. Thll pero.nt uf th_ account th"t is tftKabl1Q for lIach .urlllvor is tJetorlldrled l'II follo\olSI
A. Thll pero.nt tlxabllll for jo.lnt luutll IIIItllt.lllhr.d 1lI0re thlln on. v.ltr prior to the decedent'. denthl
DIVIDE\') lW TOTAL HUH!f.R or
JOINT OflNERS
EKlIl'ilp!1l1 A joint fillet re"lsterlld
DIVIDED 8V TOal NUHRER of X 100 .. ~ERCEHT TAKABLE
SURVIVING JOINT OWNERS
In thlf nablll of thll decedent end two othllr perton..
16.7% (TAXABLE fuR EACH SURVIVOR)
B. 'h. ,m..' .....,. 'oe ...." or'o'" .lIhln ono ,.or 0/ Ih. d".don". d...h 0' ."o"n" o.nod.' th. d.o...n' bul h.ld
In tru.t for another Indlvlduul(lil (trust beneflclllrlu)l
lOll/IDEO BV 3 (JOINT OWNERS) DIVIDEO 8"1 2 (SURVIVORS) .. .167 )i 10n
l OIVIOf:O BY TOTAL NUHIIER Of SURVIVING JenNT
QWNf:RS tlR TRUST BENHICIARIES
)( 100
PERCENT TA){ABlE
EKa~pl'l Joint account rog!stllrad
th. decadent,
1 DIVIDED BY 2 (SURVIVORS) . ,SO
In the nl!lllll of thll dllcedlllnt and two other person' nnd IIt"blhhed within one veer of d..th bY
..
S.
o.
7.
The ..ount sUbJ.ct to tnx (line 4) Is d,tarlllined by ~ultlplYlnQ the account bal~nco (111'1. 2) by the p.rcent teKebl. (llno '$).
Enhr the tchl of the debts and denuctloflll 1 hhd In Part 3.
,n. ..ou"t ,,,dol. 'I'no"' " ..","In...' .u."""n. th. II.ut. "... ..11'1'"0''' "In. " !rO" ". ..ount .u.j.ct 10 I.. 'lIno",.
Ent.r the oppraprlate tnx rftte (lln~ 1) ~. d.tllrMlnod below,
1< )01)
50% <TA){AB\.E fOR r.AW SURVIVOR)
A, for datu of .1el'lth occurring after 6/10/94, thu till. r"t.. for trllnsfllrt to spOUIll. arll III fcl\oUll
1. Oa\e. of outh on or aftllr 7/1/94 "nd b.for" 111/95 th/f r&ta II 3%.
Z, Oate. of death on or after 1/1/95 trnn.f.rs to spou~'~ will be tl'l~.d at 0% tn~ rat..
Hoh: For date. of death pdaf to 7/1/94 trantfers to ,pou.... "ra taxllhlll at 6%,
Pi, Trtmlfarl t.o 11neal dllcandl!l!1h InclUdIng fath.I", lIIothef, son, dl!lllghtar, grnndchlldren, lon-lw1a...,
dltU"htlr-ln~lll1w, .tepctdId flnd their hflue "rll tlllxl!l1J1. I!lt .;ill pllrcent (6%),
c. Tranlhr. to all other' I.,cludlng hrother, Ililter, unclfl, I!llmt, nellhew l'Ind nleclI nra t8~able at flft.en
D. If you chani' the taK rat., plMasa specifY your relationship to thO decfld.nt In the I'lrea provld.d,
The naunt cf tllX due (line 6) III dlilt.rllllned PV multjphdnQ thll t1IllCHmt tl!lllrlble (llno 6) by the tu rftte (lln. 7),
\.0
.,.J
percent IDiO.
;J;jat
;;0
N
G.
CLAIMED DEDUCTIONS . PART
3
DEBTS AND DEDUCTIONS CLAIMED
5::
Allowable d_bt. and deduct Inn' afll dotQrlllned all follow5:
-:!-
.. '0'1 ....11' ". r..,...I". lor ,,,..n', 0' Ih. 0"'" .ubJ'" '0 ...'nl.".\lon ., . ,.""no' ,.P,......\I.. 1'''''"ffI,lon'
10'" th. d.duotlb" II.... (J1
IL 'Iou ftc:tl,lal1Y p~ld the dlilbts aft.r death of the deced.nt rmd can furnish proof of payunt.
C. D.." ...". o,.I..d ''1'' .. 1I..I..d fullY In Pnrt', 1/ ,""lonol .,... .. n..d.., 'I" ,I. In p.p" G 112" ,11". "'Dof 0/
pltYJlllent "'oily be reque.tad PV tilt. PA Departlll.nt of lI.evenue.
'fAXPAVER ASSISTANCE
IF VOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANV
REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAVER INQUIRV UNIT IN
HARRISBURG AT (117) 787-8327. TDDt (717) 772-2252 (HEARING IMPAIRED ONLVl
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MONTHLV DILLING STATEMENT
P,O, BOX 8832
WILMINGTON, DE 19899
PNClRANlI\
Account Number
New Balenoe
Payment Due Date
MInimum Pavmer,t DUB
IAmount Enolosed
4081 704'1 00103814
$1,828,91
02111/97
147.00
$ I
MaklcIlICIIIplyablelo:
PNC BANK
P,O, BOX 15397
WILMINGTON DE 19888.5397
JOAN 0 JOHNSON
PO BOX 266
NEW COM8ERLAND PA 17070.0265
Addrfl'B Change? D aheok 0011, Pr1nlllew .ddre.. Ind telepnone number on back olallllemenl.
4270032b06003S],],
0004700
0],6269],
RETURN UPPER PORTION WITH PAVMENT IN THE ENCtOSED ENVELOPE
Ar.COlJNT ACTIVITY
Statem.nt Closing Date
Previous Balanca
Payments
Credits
Purchas9s anC:: Advances
Other Charg.,
FINANCE CHARGES
Naw Balance
01117197
$'1,833,77
$47,00
$7,95
$7,95
$20,00
$22,14
$1,828.91
Account Numb.r
Total Craelt Limit
Available Credit Limit
Days In Billing Cyole
Billing Cyole Clo'lng Date
Past Due Amol!nt
Minimum Payment Due
paym.nt Due Oat.
4081 7041 00103614
$1,650,00
NONE
31
01/17/97
$0,00
$47,00
02111197
For 24-hour oU8tomer aervlee: 1-1100-782.2273 " card 18 loat or etolen 0811:1-1100-556-5878
Or writ.: CREDIT CARD DIVISION P,O, BOX 21660 TULSA, OK 74121.1660
lRANSA TIONS
Oat. of Oat. of Reference Oescrlptlon
Transaction Posting Number
12121 12/21 24a7OOJPNOIIQ8YBY1 JOPIHNIY tN. IOH2Ht23 t1lM-01117 TX
12121 12121 I'4U:lOOPNlCJ08,OOO2 AIt AOJUfiTMI!HT TO YOU" ACCOUNT
01/13 01l1~ 142:7(0)()OIHMFSKIX PAYMIHT. THANl( YOU
01/17 01/17 OVIAUMIT FEe
01117 01/17 'FINANCE!: CHARlltl. PUACHAII!B fn,1I CASH "DYANO. .....
Amount
THE BALANCE ON YOUR ACCOUNT EXCEEDS ITS CREDIT
LIMIT, PLEASE PAY THE AMOUNT OVERLIMIT OR CALL
US AT 1-(8001424.4976,
TRANSFER HIGHER RATE BALANCES TO YOUR LOW.RATE PRIME VALUE
CARD ACCOUNT, FOR MAXIMUM SAVINGS CALL 1.800.762.2273 ANO
ASK FOR A FREE SUPPLY OF TRANSFER CHECKS,
7,95
.7,95
~
~)
I
rC'Jerc:::.ecl
-{ees
An amount preceded bV a minus sign H Is 8 nradll or a cradlt balance.
FINANCE CHARGE
NOMINAL
ANNUAL
PERClNTAOF.
RAT!
ANNUAL
P!RCeNTAGe
RAT!
MOl1ltl~
Periodic
Rale
Balance
SUbject
To Finance
Charoe
1,316,74
507.44
fINANCE
CHARG!
PURCHASES
CASH ADVANCES
13,19
8,95
12.00% 12.00% 1.000%
21.15% 21.15% 1.763%
e per crate se oae on e ~ce 0 s sa emen may vary.
See your acoount agreement tor more precise details,
Please be auro to 6&8 the billing rights summitry and Important dlsclCisure InlormaUon on tha roverse side.
Sond Payment To:
P,O, BOX 15397
WILMINGTON OE 19886.5397
5953 AWO 1
17
E07
Page 1 01 1
4433 3260 PS07 0002 970117
fill lOCO) . /~ j') (, .5
"V 1\00 ", 17"'1 :) [).l 'OR OJ-TES Of DEATH J-nlR \1/31/91 CHICK HEAl
~. :i' ~.,'!\I' INHERITANCE TAX RETURN If J- SPOUSAL
. . POVIUY CRlOII1S ClAIMID I J
RESIDENT DECEDENT ,ii! NUMiiiii . .
wM'i~~X';;\W~,'~,'~WmJi^'''^ (TO BE FilED IN DUPLICATE ). I (; ./ (, '!
. ",,~=~,._ ~',~:~~,!.Jf~,l;~~'~N;'~I~:' ^i7;;fu5&li[iiii^lr~~I~~. ~cE.~ISTE ~OF.. \f.I.I~l~~ Jiii;, ji\<;?'~~f\t ;~;A(\~j1~-:LJ!6R ~~~,~;, ~I- N~I.\BE ~
t: _-=l_()..~N;:'Q..-:: } ()/\\."...........> 1""" '.II\' ,." ',' Il, ~l~' 1'.11 ')0 )('
m '~~;'~"':':z ':"M~; ~/{ O;'~ a; 0;''':; 7 "'" ,.. "",j ,. '. I" , C I." , .( <' .
~ '" i;;,;~i/'.';'~'c ;;;;,iI;; ;,;~. ,,,,; iii" '''" i"i"." ,,,I,,,,, .)""'" ~:Cl~'ii~ ~1I~:': f" (0"'0'[ ^M~i~;;.::My~6~'l; i;j,i?tiii'ii"\'.
fi I Orlglnnl Rfllurn
lJ ' lIml"" Eo'""
116.
II line lff h grtlolfll than \.i11f! lQ, nnt{\l lhn rlilhllfll\(!;! on linl'l 21 This i\ thfllAX DUE.
A, Enlflr Ihfl inletfnl nn !h~ holor1Cf' rill!' on tin!l 21.\
8 En!flr ,hI! lolnl ('Jf line ,1 ot\d 11^ on lil'ofl 211\ Thi\ i, Iho bALANCE O\JE.
,"__~~.k~_~h..~.~.r.f!'(~~!.!(}_i ~~~hl" 01 W~I~,. ~g~_nl
"u'.'-).-j;iiESlIRETOANSWER ALL oLii:iTioNs ON REVERsE sioEANDTO RF.CHECK'MATH-u"IC..c:'-~-"'--
(j~;j~, p;;,~iii;; ~T p~;j;,;y, i d,;d~;;;tj,~; i i,~,;.;"mi,,~d ,hi; """", i"i,,,ji,," ""no;p~"yi;rl ;,';;d"i.. ~~d ;i~;;;';;;i,,- ~;Jloih;b;1I ~f;';y k~';~i;Jg; nnJ ij;f!
" h '''''. ,""", nod ,"mpl." 'c1,"", ,ho' "II ,,,,1 ,,'n" "e> h.." "p""''! "".." ",,,,k,, ,01", D,dn<o'io,,"' p'.p"''' ",h" '''n" Ih.p"'OOO' "P'''''''"'''.
bCl~d 01'1 011 il\lonnolion of whkh prepmer hru orl)' knowllldgf'
~\:: ~::'~:~J2~'~'.':Li.';~~';" J~,. ~i::,~:'~08 i f~l~ At (2~ r
l<'vu.Jv'~---'~S ,Cl--/,i..<"'-'-"'" ...) 1.\ (V) t
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I \ 4n fuhne Inh'He~1 (ornproml~1)
(Int rlnlAI 01 rlflolh aflf\! 12.1?,A2)
Dft(od(l'll Dlfld rellC1lfl IIi OModflnl Molnlnlned a 1I1'lng trUll
(Atltlch ce.py nf Willi IAtloch copy of Trull) .
ALL CORRlSPONDi:NcEANDCONFiDENTiAilAX INFORMAllONSHOULoiiDiiiicTEiiTO, --~-~._~- --~. __n
N~~~'~.~"~~. .-~.:-~'l.\-':"'t ,.1 ",' u" . -.. ..'u. -. unl(~6M--m"'i :,\~'\:tR~ tl ^~~i,:,!l,: :-;~-1-'--''''-" ~.- - 1 i
mffiiO'NIt:iu'MiH -, - /l'l I- (l /1. I (I E j~ , 1\ ..,h P A , }(,l
_L'IJ..=L,.:!..l'I~~)'>c~-"c u.. .. n.'_ '-"==--'-'~-
If Line 19 il grftatflf IhM line 18, enler Ihe dllf(lrenul on lil\(l 20, Thh h the OVERPAYMENT.
m [,.-.1 UtJil1.illll'_I_'.I'l(_'"'.III,,\,r.rIhll\K!.I~m:r.n.'I'I'I.'1.'l"'I~.~i'IJI'1
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1. Reol E,tote (Schedultl A)
2. Slo(k, and 80ndl ISchtlduln 81
3. Cloully Held SlockfPnrlnerthlp InllHflll (Sche~ll~ Cl
4. Morl909fl' and Nolel Receivobltl (Schftd1.l1ft Dj
5. Co,h, Bonk Depositl & Mhc:olloneou, Ptlr,onol Pr('Jp"rly
ISch,d,,'. E)
6. Jolnlly OWl\fld Properly (Schfldule fl
7. Tron\lerl.(Sc:hedule 0) (Schoch.lle l\
8, 10101 Gron Aueh ltololl1ne, 1.7)
Q. funarol hper\le:$, Admlnillrolil/o eml" Mi1celloMo\H
Expenl8!o (Schedule HI .
10. Deb", Morlgnge llobllllifll, llftn, ISd,..dvht I)
'L Tolol Oeducllona Ilotolllnfl5 q 8. 101
12. Net Value of E$IClte (llne 8 mlnuI line 11)
13. Chorlloble ond Governmental Beqve,Ill ($chedule J)
_~~.__~~y'?_~u_e _~~,~l!~t"~o.--,!Ol( (lJ~~~.~.~~~~uI line 13)
15, Spousal Tranlle" lfot dote, of de('ltn after 6.30.QAJ
See IMlrucllon$ leu Applicable Pflrcen10ge on Revnrlfl
Side. (Include, l'olllS' horn Schedulfl K or Schedule M)
AmOllt\1 of line 14 lOll,oble 01 6% rale
(Include valUM from Srhedule K or Schndula M)
Amounl of Une 1.1 ItllI,ohht 01 \5% role
(Include vnlu8i from Sch~(hlln K or ScMduln M)
Prindpol lOK 0\18 (Add 101( horn line~ 15, 16 ond 17)
Credih Spousal Poverty CtfJdil Prior rtl)'mnnh
t
16.
17.
z
Cl
[i ,B.
I- lQ.
f
II
..
u
~ 20.
...
21.
("-
-.,..-
113.
[J 5.
Remal"der R.,Iurn
lfor dolflt (If deCJlh prior 1012,11.82
Federal hlnl" lOll Rfllt.lfn R.,qulr..d
~ 8, lolol NumhtH 01 501ft O"PO$lI BOli8S
(II
(21
13 )
I'}
( 51
I
(~~J ~'_}. ,~,
16}
(7) - .
181 ... ..~, .":.L1.-2u I
IQ) !>.J;>.;.,/!:,
(101
IJ"151'>(,.(.1
(111_~U'I?()') ,s7_
(12) LL~L,LU' Ie.)
(131 -.u
u...~_ _~n_J.1.~L~<...l.~c.:.)._~.~.c~'l:cc:-....
(15)
116)
~." .r.'-__"';. x,
.
x .06 J::I
1'7}
)( .\5 \;'
liB} - 0
Di"olJnI
Interetl
,
I'Q)
1201
121}
PIAl
!lIB1
I2DtV C
PII I 70 ;> c>
o^H
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~I V I~l! 'I, (I ~~l
.)(.L. SCHEDULE H
'11('" FUNERAL EXPENSES,
. (OMMOIJwtA"H Of '",fllrtVAlIIA ADMINISTRATIVE COSTS AND
\ \ ''''URIIANU lA' """" MISCELLANEOUS EXPENSES I
R(SID(I~1 o{cmfl'.ll ,P .0.. Print cr TVp.
~hAij~~':~~~O-~~=~~O~" _~:,~~~:_:.~,c .~c__'"'".''" - '" '" . .' =--~c-=rm Nlij~~;:;~ _~;~~~ I
I!EM
NUMBER
A.
\
B.
1.
DESCRIPTION AMOUNT
Fun.rol EICp,n...t ~ fb ^.) l '. _~, I.' It'. lZ ,Il , r-l..' A). t! ., (,
'10\\ ",I,~~\) ',1
Admlnlll...t1v. Co.,"
1,\<-)A--1t
.....' C
1'" "(PO
.2\1)1 J.()" \)'tAI,^ <.:tcr
(L\~.~
f:'lPi\.J't'H.!I
t"~tl..J(,.t.-n.'I'v (C.~,r(ft.r,; 6r.v,t1't.)'
VC,.i..,T
f<\'....( f( ,(\ L._ \' 1\ {"\<.,
Pe;':c~~i ~:~~~I:;t1~:I;~;o:m~~;::~~1 Rep,e.eMollv., .~~?.,:..~..=..~ (. . - 1.'~_
Vea, Comml"ion. pold .......u.......".............
2. ""'o,~ey F.e,
3, Family exemplion
Claimant ...'...m
4,
C.
1.
2,
3,
4,
5,
6,
7,
8,
Relallon.hlp .._~.__.._,.
Add,e" of Clolmant at decedenl" dealh
51,eet Add,e"
',<
City
Probale Fee.
Mllcelloneou. Expense.,
,1\ ~-( l' U IV '\ A IV ,.
(tCH.\....l "'tJ.
\,'\" f\\.,
.u
u.~ 'it '"
.... ..' .__. ..u__ Slole m_.__ Zip Code____
" , " '- ","-,,' "
'1(,1"" cr.... , \"]
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(.)'1 C., r./'i-
Q.1.(,'.t~1(1~,
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c. <?'(\ i/C!'1(:i
\.,i,,"_' 1: \'-\}~
ell" 11\ ~ ,.
.,-_._-~._----_.~-~-~--_...__._.,'_._~~-------,._--_.----_.,--.~------_.__._-
TOTAL (Also .n'e, 01\ Iln. 'I, Recapltu!atlon)
(II more .puce I. needed, In..rt additional .heet. 0' .ome .110, I
'-\~, (),O
~ S <'I'
(1(('("
tH 9 C.-COif!
\- ?~. "J tJ
f,Co!"'l ('If)
.......~...._....
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""'"""" OF
NOTICE I
To fulfill the r'qUlr...nt. of Slctlon 21~O of thl Inherltancl and E.tlt. flH Aot, Aot 21 of 1995, <1' P.'.
s"t1on 9140),
PAVtENf I
D.t~h the tQp portion of thl1 Hotlo. end .Ub.lt ~Jt~ your pay-.nt to the R'llltlr of NII1I printed on the
,'.vlr.. side.
_p H.I cheok or lIOMY order pc:tyeblt tOI REOIITtA CF WILLa, AGENT,
REfUND I CR) I
A rdund C)f I tlX credit, Mhlch wa' not requ..hd on thll tllK return, "'I be r......t~ by o0llP1IUne ." "App1JClt1on
for R.fund 0+ P,"".~llllnl. Inharltanol and Elt.t. TaH" (REV~15151. Applloltlonl arft Iv.llebl. It the OfficI of
the Ratht., of WU1., ItlY of the 25 Rlvenue District Offlc.. or by cIUlne the IPlOt.1 2ft-hour ."....rt"' ..rvll'Ol'
nuIlbar. for for.. ordlrln,1 In PlMlYlv.-.la 1-600-561-2050, cutllldl Pannlyllllllnle and wlthtn 10011
HlrrhbUrl area (7}7) 1'1-10'94, TIJDI (711) nZ-2152 (HearinG IllPalr.d OnhJ.
OBJECTIONS I Any plrty In Intlt..t not ~atl.(i.d with the appral..-.nt, Illowancl or dl'lllowano. of deduction. or ......-.nt
of tu (Including dheount or InhrllU II .hoMn on thh Notlc. Ilay object within .b:tv (60) dlY' of nuipt of
thh MoUe. bYI
*Mwrltt." prot.,t to the PA Departltnt of R.venu., Board of Appeal., D~t. 281021, Harrl.bUrg, PA 1712'-1021, OR
H.llotlng to have th. .attar dattrlllnad It thlll audit of thll acoount of thll pI,..onal rClpr.,antaUlla; OR
_Mitpp..1 to the Orphlfl.' Court
A""IH'
ISTRAnVF.
CQRRECflONSI
f'ltCItu.l IrrOrl dhcov.red on !ihh u....ltlnt .hould tM IMIdr.uad In IIIrltlnl tOl PA D.,lrtNnt of Rlvenuo,
.ur..... of Individual TftK", ATTNl Po.t A......ent Rllll.., Unit, DEPT. za0601, H.rr-htMlr" PA 1712'-0601
Phone (717) 7.7~6505. SM P'" 5 of the booklClt "In.trUClHon. for Inherltancl Tlx R.turn for. R..ldent
DlCledlnt" [RE\I-15011 for en .KpllMtlon of 8dtlnl.tr.tlv.h corrlCltabl. errore.
DISCOUNT,
If env tlK due II plld within thr.. (3) calandar aonth. aft.r the dlcadent'. death, . flv. p.rcont (SX)
dhcoun~ of the taK palel II .llo~,
PENAL TV I
The lSX tax ,,",sty non.plrtlolp.tlon p.nalty I. cDllPUtld on tht tot.l of t~ tlM end Int.r..t ......-d, and not
plld befor. J~ry II, 1996, the flr.t d.y aft.r the end of thl taK &IInI.ty parlod, Thl, non-p.rtlclpatlon
penalty II ..,.llablCl In the ,.... 'IOn.r and In thl the .... tI.. per led II you would "'11 the tllC and ll"lter..t
that h.. bMn ......ad I' Indlc.ted on thh notlo..
IHTERESTI
Intar..t Is chlrgad bttlnnlnlil with first day of delinquency, Dr IIlna (9) ItOnthl and on. (1) day
frOll the dttl of death, to the dati of pay..nt. Tlx" which blcUl dllInlfUant beiforll January I, 1982
blar Intlr..t .t the ratl of ~IK (6%1 perclnt p.r annul calculetld at . elaJly rate of .000164.
All tlK" Iohlch b.e... n.lInquant on or aft.r J8n!Alry 1, 1912 win baar lntera.t .t . rat. which wlll IIIrY frOll
calandar y..r to IUII.nda,. y..r with that rete announced by the PA Depart..lt of R,"InUe, Th. appllclllbl'
Intertat r.t.. for 1982 through 1997 artl'
1'12
Ins
19l~
1915
1916
~ ~ Int.r.,t
,,~
16~
111:
UiI:
l'~
II calculatad ..
,000541
,000451
.000501
.000156
,00021"
followtl
V..r Int"'lIt R.t. Dally Int.....t FlMltor
19&7 .~ ,OOO2'~7
19i1~1991 11:': ,000101
l"l .~ ,00021t7
JtJ95--I'I4M ]X ,000192
1995~ 1997 .~ .OODZ~7
V..r lnt.r"t Rlt. Dilly Intor..t ractor
INTEREST 0 BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINqUENT X DAILY INTEREST FACTDR
~_,,"y Notle. IIIIUM aft.r tha tlK hleo... dllUnquant will rlnlct an Intarllt calculation to Hftl." US) d.y.
beyond the dati of the ......lint. If P'YHnt II udI .ft.r the lnt.rllt cOl!Putltlon a.t. Ihown on the
Notlee, Mdl.tlonal tnt.rllt .....t ba o.lcullt~,
["--'-'A"ounTR'i;ljhd 'l
"" -==-~ft::L
------_...~~
MAKE CHECK PAVABLE AND REMIT PAVMENT TOI
REnISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS 0411I
R"E"V: isi,i" Elf - AFii" i 09":97"1 "Noli cE" -OF - i"NHiiii;: Aiic'E"'T'AX - APpiii\"i S ElfENr;- Ai.1.-oWANci- 'Or- --" - - - - -- - - - - --
DISALLOWANCP. OF DEDUCTIONS AND ASSESSMENT UF TAX
JOAN D FILE NO. 21 97-0067 ACN 101
APPROVED DEDUCTIONS AND EXEMPTIONS I
8,322.92
., f'unet'al Expen.../AdM, Coah/tille. Expan,.. (Schedule H) C,)
10, D.bts/Norto.o. U.blll tlu/U.n. IS.h.dul. II (10) 13 . 586 .67
11, Totol D.du.Uo", Ill)
12. N.t Vatu. of T.~ R.turn (l~)
15. Charitable/Govern..nt.l a.que,tIJ Non-ellctld ~11S Trult. (Schedule J) liS)
14. N.t Vdu. of E. tot. Subj.ot to To. 1141
NOTEI If an ......ment w.. i..u.d pr.viou.ly, line. 14, 15 .nd/or 16, 17 .nd 11
r.flDct figure. th.t includ. th. total of ~ return. .......d to dat..
ASSESSMENT OF TAXI
1&. AMount of L1na 14 .t Spou.II rat. (15)
16. AMount of line 14 taxable _t lin..l/CI... A rat. (16)
17. A.o~t of'LlnA 14 taxable at Collateral/CI... I rat. (17)
11. Principal Tax nu.
/.') h (., ,.,
lURE AU OF INDIVIDUAL TANES
INHERITANCE TAlC OlVJSiI~
DfPT, l106D 1
tlARAIU'JRO, f'A 1111'8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE Of INHERITANCE TAN
APPRAISENENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSNENT OF TAN
CHERYL L VAUGHN
317 MARKEl' 51
NEW CUMBERLAND
DAT!
ESTATE OF
DAT! OF DEATH
FILE NUMBER
COUNTY
ACN
01-19-98
JOHNSON
01-13'-97
21 97-0067
CUMBERLAND
101
PA 17010
ESIATE OF JOHNSON
TAN RETURN HAS I I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTERES'r - SEE REVF.RSF..
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. R..l E.t.t. (Sch.dule A)
2. Stock. and BondI (Schedule 8.
S. Clo..ly ~ld stock/Partner,hip Int.r'lt (Schedule C)
4, "ortoag../Not.. Racalvabl. (Sch.dule D)
S. C..h/8ank Oapalita/Hi.c. P'r~on.l Property (Schedule E)
6. Jointly Owned Property (Schedule F.
7. Trenlt.r. (Schedul. C)
8. Tot.l A...t.
1 CHANGED
(11
121
(5)
141
1&1
161
(7)
..ll.
.00
.00
.00
6.653,21
,00
.00
leI
.00
,00
.00
N .00.
N .06.
N .15.
Ilel
TAX CREDITS:
PAYNE NT
DATE
03-13-97
RECEIPT
NUNIER
AA185319
DISCOUNT (+)
INTERESTIPEN PAID I-I
.00
ANOUNT PAID
15.11
TOTAL TAX CREDIT
----
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
'*'
IIHH' 1M If' ~".fII
JOAN
D
DATE
01-19-98
NOTE I Ta lnlur. proper
oredit to your 1l0ClOunt ~
.ubld t the up,..,. POl" Uon
01 th11 for. with your
t.K payltent.
6,653.2!..
'1 .QnQ ,.q
15,2~6.36-
,00
15,256,36-
will
,00
.00
.00
,00
15,11 ~
.--.-
15.11CR
.00
___}~.1~R
. IF PAID AFTER DAlE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN Sl. NO PAYNENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU NAY IE DUE
A REFUND. SEE REVERSE SIDE OF THIS fORM fOR INSTRUCTIONS. I
RESERVATION, E.t.t.. of dec~tl dYlnt on or before o.o.~r 12, 1'12 ~- If any future Int.r..t In tn. ..tat. II tran.f.rrld
In po.....Jon or .nJOYMnt to Cia.. I (colht".U blneflot.rlll of the c:lIO","t .ft.r tM 'IePlr.Uon of any a"lt. for
11f. or for y..r., the Co.-onN..1th hlrlby 'Hpr...lv r..arv.. the rllht to appr.I.. and ...... tr,".f.r Inh.rltano. r.K"
at the lawful Cl... I (collat.r.l) rate on any .uoh future lnt.r..t.
PIMOf'OSEOf'
HOTICEI
PA't'HE~T ,
REFUND (CR)1
OIJECTIOHSI
ADMHl
ISTJI..nVE
CORREtTIONSI
OISCOUNT I
Pf:NALT't':
INTEREST 1
To fulfill the r.qulr8!"l't. of Section 2l~0 of thll Inh.rlt.no. and Elhta hH Act. Act 21 of 1995, (72 P.I,
S.otlon 9140),
U.t.oh the toP portion of thll Hotlel' and .ubIl1t with your PIYHflt to the Rllllltlr of Nlll1 prlnt.d on the rlll.r.1 llde.
--HI'" crn.ck or IOnlY or'~" Plllvebl. tOI RCOIDTER OF MILLS, AGENT
A refund of a t.K crltdlt, Ntllch w.. not requ..t.d on thfl rille R.turn, "IY bl rllqul.t.d by c0llp1eUnll an "Apj)1toatlon
for R.fund of P,"".Yly~t. Inherltancl and E.tlt. T.K~ (REV-lSI~). Appllo.tlon. .r. IIIallabl. .t the Offlo.
of thl Rlglster of Willi, an!.' of the 25 Rlv.nUl Dhtrlct Offloll, or by ClUing thl 'P4KI1II Z'o-huur
an.Wlrlno ..rvlo. ~er. for for.. ordering: In P.nn.y1vanta l-aOO-56Z-20S0, out.ido Pennlylvlnl. ~
within 10c.1 Harrl.burg .r.. (711) "1-1094, T~D' (717) 172.22S2 (H..rlng I~.lr.d Only).
Anv p.rty In Inter..t not uthfl.d with the IPprahl..nt, aUowlno. or clluUowanc. of dlduction., or ........,..t
of t.x (Inolucllnl dl.count cr Int.r..t) al .hONn on thl. Notlc. IU.t objlot within .IKty (60) clay. of rec.lpt of
this Notlc. bYI
--wrltt.n prot..t to the P.. Depart.ant of RIII.nUl, Soard of "pp..la, O~pt, 281021, H.rrl.bur" PA
--.Iectlotl to havlI the ..Un detlr.lned at Mldlt of thl ICcoont of the Plr'Of~1 repruent.Uv.,
~-app.el to the Orphana. Court.
17128-}O21,
OR
OR
Factu.l error. cllacovered on thla ........nt should bl &ddr....d In writing tOI P" Dlpart_ant of R.llenu.,
lurelU of Indlllldual TaKI', AnNI POIt .....II.llnt R.vlew Unit, D.p\. 280601, Herrltbura, PA 1712'-0601
Phone (117) 787-6S05. S'I pftOl S of th.. booklet "In.truotlon. for Inh.rHanc. Tall R.turn for. RtIi.ldent
Olc.clent" (REV~lSOl) for an Ixplanation of .o.lnlltratlvalv corr.ctable .rror..
11 lIMY hx due II ptlld within thr.. (5) calendar Ilonth. aftar the d.c.dlnt', death, e fllle parcMt (5iO dltoount of
the teK p.lcI I. allowecl.
Th. 15;( taK aMl.tv non-partlclplltlon p.nelty It cOllpuhlld on tha totlll of the till and Interest .u....d, IlncI not
paid b.for. JDrlul!fry 18. 1996, thCil flr.t dav .fhr the .nd of the taw a.nuty p.rlod, This non4partlolpatlon
p.nalty It IIIPP.Ilablu In the .... ..nnur and In the the 'H' tI.. perlocl II you would apPall I the taK and Intara.t
thet h.. ba.n a..aQ"~ a. Indlcat.d on thl. notlc..
Int.rllt Is chergld b.glnnlng with flr.t day of dellnquencv. or nln. (,) eonth. and 0f'I4II (1) day frOll the d.t. of
d..th, to the det, of p.VM.nt. TaK" which bee... delinquent b.fur~ Jenuary 1, 1912 b.ar Int.r..t at the rat. of
.lK C61D p.r~lnt par annutI calClulatld at . ddly reta of ,000164. All tIX" which bee... delinquent on &ncI after
January 1, 1912 wU1 bear Int.rut at " rete which wUI IIlry frOll calendar year t;1 clllendai" year with that rate
Innouno.d bV tha P" Dapart..nt of R.II.nu.. Thl appllcabl. Inta"..t "at" for 1962 throuuh 199. .r.:
't!!! Intarut Rita Deily Intare~~~ !!!! Inter..t R.t. CaUy Int.t..t FlKltor
1912 20;( .000S,.6 1981 .~ .0002U
I'as 16> .00008 1968-l991 11;( .000501
1914- 11;( .000501 1992 .~ .0002,.,
19'Ii 11;( .000556 1995-1~ 7~ .000192
191. 10;( ,000274 19'15-1998 .~ .000?~7
--Interest II oa)'cuhted .. follow'l
INTEREBT . BALANCE OF TAX UNPAID X NUNBER OF DAYB DELINqUENT X DAILY INTEREBT FACTOR
~-AnY Notlc. i..UId after the tftK bacOlla delinquent will r.fl.ct an lnt.r..t ~llculltlon to flfttln (15) day.
beyond the da" of the ......lIIMt. If PIYHMt II ... aft.r the Intar..t 1:l00000tlUon dIlt. .hcM<<t on the
Notice, IKkHtlOf..1 Int.r..t -.!.t be C1alcul.tlCl,
,
_c.-. _ ._<#" ", _'.._~_
'"
pTATUS REPORT UNDER RULE 6.q
Name o~ Decedent I :s- Og../\,,) b ')0 (..tvSO;V
Date of Deathl..J./-id!-n
Will No. /997 -OM, 7________ Admin. NO._/ 99"'" -oot. '7
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administr^tion of the above-captioned estatel
i
I
i
i
I
I
r
,
1. ~~:~~et~~~..:~:inist.rat.ion of the estate is complete:
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete I _________
3. If the answer t.o No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with t.he Court? Yes .1'---. No .___'
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 inten,st? Yesf- No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cark of the Orphans' Court and may be attached to this report.
7 . . I d--
(-.// /( '/ //2../~_
(ngn~~ ~
(iHl!f.Y / L t/A UC~f--I i/
Name (Please type or print)
Da te I '2 ~ f'.d... L/C/
. ,
-
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~.
c:.~
Iat
.$'Cl8
Address
L. F t..; 1 S' tJ f'tu?~ fJ
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.~o:
1_1
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",c)
") 7 '-I ~ 0 /78
( 7171
Te I. No.
Capacity: ~_personal Representative
__.Counsel for personal
representative
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