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4087665
No.
t!1UIURt,V'1
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HSALTH' VITAL RICORDS
CERTIFICATE OF DEATH
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of Houlid mind, memory and LlndllrHtl1l)d I,ng, do milk". l'uhU,sh and declare th:IH nH
I, ANNA M. SMITH, of MeChal1l.cshurg, CutnhedlUllI County, ,l'ennsYlvltnth, h"lng
wills by me at 1II1y tlllle heretofnro HlIlde.
IInd for my Lnst WU 1 Ilnd 1'., "t1ll1l011t . iwrehy revoking I1l1d nlllktng votd 1111 ,formor
I'IRSl'. 1 dlrect Ill] my .IUllt debtH nnd funerlll e\(pen8es tneludlng 1111
inheritnnce taxos that Inay bo IlSHeSRed Ilgainst my ostate bo fully p/lid nnd
sat1sf.fed out of Illy entat(1 hy lilY IwrsollllJ. rt~prOH(lnt[Jl.iv() hE:~reill(1fL€1r llnnwd
as Boon as conveniently may be done nfter my deceaso.
10l1a C. Hargrave, H living at the ttme of my death otherwise this bequest Shall
SECOND. 1 give Ilnd bequeath the sum of One ($1,00) doUllr to my daughter,
Il1pse. I do not intend for lona c. Hnrgrave or her hell'S to otherwise participate
in my estate.
THIRD. I give, deVise And bequeath all the rest, re"idue and remainder of
my estate, reAl and personal. whatsoever and wherever situnte, to my daughter,
E. Marlene Bosche, Or to her issue if she should predecense lIIe.
FOURTH. I diroet that my personal representative hereinafter named in
hor or his discretion may convert all or any part of my estate, real and personal.
whatsoever and wherever situato, i,nto cash at either pubUc or private sale or
J
his diseretion.
distribution in kind, in cash or partly in kind and pl1l'tly :In cash in her or
sales at the best price or prices obtainable in her or his discretion and mllke
Executrix, of this my Last Will and Testament, In the event my said daughter,
LASTLY, I nominate, constitute and appoJnt Illy daughter, E. Marlene Bosehe,
E. Marlene Bosche, should predecenBe tro, res.tgn, l"enOunl:e, refuse or be unable
Willillm Josoph Bosche, successor Exccutor, of this my Last Will and 'restatnent.
then in any of those events, I nOlllinllto, constitute and appotnt my grandson,
to serve for any reason or should die before my est!lte is fully administered,
I direct that my persona] representative shull serve in this or any, other jur.tscl:f.~tion
without giving ,'llY hond.
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IN WITNESS IvHERIWF, I hllve 11<;>1'<1unto aet my hllnd a,od ~eal thJs
r'd.
<"J day of
. A.P., 1989.
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWI.l1" Of ,,,,,"""vANIA I (TO BE FilED IN DUPLICATE
Ol"PARtMfNl Df ~fvHHH I I..".f " J
""RI\fJ:U,);,I~:'0"601 " " WITH REGISTER OF WillS) ~ol"Nn CODF
~.....:.c:c.;.'-"-:';":;;-- ll(c:tbtt,it.s NA-~[--llAflL ilkS!, ANI} M1IJmTiTjiliAli~-'--'---'-- - - - - --~111'~f(1I N\~;coMrll!f A1JOA.f~~"-
m 'O~L4,~U~;~~~~;~~~~~ jV\j"'I"t:~lr';'1 I"~',~)" ',,"/,,., c,':":~[' ~:C':~':;~::\'~Y'~d I::,
~ , '~~')~" ,""":0 "~~:' ''','''''' ,... ."" ,,,,,,,, '"''',,' l\n(l~~\'!~",1Y NUM'" AMOIINI '" "'"" IS~'~\i",:iI6~\I~~~______
~ (~1, Original Relurn LJ 2, Supplunlenlol Return t-.) 3. Rftmclnduf Rfllvrn
.III[VJ lfor dale' of death prior 1012.13.87)
b3f~ [J 4, limited euol. [] AeL fulvr. InleHul Comprorni" [) S. f,d.ral Ellal. To,.. Return Required
r,C1...l (for daten 01 death utter 12-12.82)
utaa [~r6, Oecedllnt Di.d Teslale [":1 7, Dec.d~nt Maintained 0 living Trust
II( (AlIach (Opy of Will) (Alloch copy of Trull}
---------. 'ALL coiiisPOND.NeE AND CONfIDINTiAL TAX IN.OItMATION !"DULD IE DII.CTIO TOI
NAME' COM~Lm 'MA'iTfN-C:' ,;.DDRUS
S. J~L2..~~~G. t'.}f",r\"~~__~~~~~~__~__~~m ',eJ\c;'C"> 'i",_,I""\:\~ r.q..:
~'~;:;\~1~1:'~,,4-~?_:::2~(1~'~7==~""=~=='~:=='~ \~O\ y ~~ \', I, Ci,"_'k.r.' \ i \ 2;\
<" Real Ellole (Schedule A} ( 1 I ..~\~:!,f...~...~..__._,~~~ . '., ~ ;'e;
,12, 5'och and Bond. (Schedule B) I 2 I ..t-)~.c:.'.':._...~.._,.~___~_, '"
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3, Clo.ely Held 51ocklPo,Inmhlp Inlo,e.1 (Schedule q 13 1 ..~ "c.,_ _. ~..
"4, MO'Igog" and tlole. Receivable 15chedule D) 14} J:.\~"\.:_.._____.~_~:._
Cash, Bonk Depollts & Mllcollaneoui Penonal Property I 5 1 ____l'-.tS;](J:::i
(5ch.dole EI
6, Jolnlly Owned P,ope,Iy (5ch.dule fl
7, Tronlfe" (5ch.dule O} (5chedu'e LI
t-8. Totol Groil Antll (tolC'lllinel '-7)
Q funeral hpenhu, Administrative Co,/I, MlscellafUloul
..... LJtpen," lSchedule HJ
0, Deb", Morlgoga lIobHltlel, Lianl (Schedule II
11. T 0101 D.ductlon\ (tolol Unes Q & 10)
2,:1 Net Value 01 estate lline 8 mlnul line III
].3/ Charitable and Governmental Bequllh (Schedule J)
__ \~~.~..Y~!~~Ject IO~_X (Un_II' 12 mlnulllne 13)
15. Spousal Tronlfers (lor dolll of death oller 6.30.941
See Instruction, for Applicable Percentago on Reverie
Side. (Include vtlloJII from Schedule K or Schedule M.)
.~ Amount of line 14 taxable 01 6% rate
llnclvde valu,,~ from Schedule K or Schedule M.l
,17. Amount of line 14 laKable at 15% rote
(Include volues from Schedule K or Schedule M.)
-18-'. Principal tox dlJe (Add tox from line, 15, 16 and 17,)
19. Credits Spouwl Poverty Cro!ldit Prior Payments
REy ! \000: + (1 '1,41
,,'tJ\t'Yl\
....$U;
tl~
"'''
"'''
Sf
'"
s:
S
::>
~
b:l
to
!
~
~
.
"
u
-~-_..^==..-----_.- +
,
"
'I 'OR DA!15 0' DIAfH AnlR 12/31/91 CHICK HIRI
" A SPOUSAL
i POVIRn CRlD" IS CLAIMID I I
'mE NUMBIR
\,11'
. \ ,
t-t,r'l;'
YfAR
NUMfHI
__ a. Tolol Number of Safe Deposit BO)(.e$
"'lJ
~
.:/
IJ
"
~-r->
:4
(6} ~.~,\".."., ._~
(71 _ \\0.\,
-J
~LI t.~
18)
-1~.1:_~(J~:,Cn
(II}
(12)
(131
, (141
:; ~4:'LJ1~
._.J~1..o &.hS,"__
~o 00
--'----~"---,..
,~LH1" '2'("'"
(151 N'l'il'~ _~'.,___.. ~ 00
116) "\ &y)tC;_~_.~~,_. ,06. _.~~_~g.::L'1.?
(17}10_""",~__~._,...~_..._~.~.'5 . ..~...~_.___ \..l_o,,,,g,
(181
(A '1 ~r
___~.______~___ ~l"'!'.~
4 qD
._........_.__..._-'.n_.._
'nrn~ r\,
+~, 1"L'-)-
Intere'l
-'
(191
(201
~
,.
20. If Uno 191s grealer Ihon line 16, fInltH the dlffflrenctl on lil\& 20, Thii 1$ the OVERPAYMENT.
IiID
thl'C~ hele If VOU QIl' It'qucs''n9 0 'Olund of ~OUI OV\!lfHlymc-nt
C/1. OC
~~~-.-~~T".I" '"
f"J ~...,
-'~~~'~'~=TI','~ -,
21 If Line 18 i. gteot~H tnon line 19, enter the diHtHOI1Ce on line 21 Thil is the TAX DUE, (21l
A, enter the intereu on the br.tlance due on Une 21 A. (21 A)
B. Enter the 10101 of line 21 and 21A on line 21B, Tlli& h thll BALANCE DUE, (216)
____~~~.~!!.e_~_.~~~~.b.~~_..~~~~.~...!~I~!.!~.~!.~~~U~,~ .~~._"_t_.________ _______._. "._... ",. ,..___ _. .~...~_.. ~_ n_ ~_._.____.___._~__._
_._.~. -~-)>. ~ I. !UIiE-ToANlw.!rA~~~!~!tc)NS~oN_REvmE5.IDi ANDTP..~~~HICK ",ATH _~__---'-_____
wr'lder penalli", 01 periury, I declorl'1lhat I hove examined thi, return, including accompanying !,hedule$ ond ltclements, and to ,ht'! bfll' 0' my knowledge ond belief
I 1\ true, correct C1nd complelf1, I de-clara thaI 011 real ella" hOl been r(lported at hUll mor~el value Declaration of preporer oth6!lt Ihon the penonal reprelontative i
bOled on Qlllnformation 01 which preporer hcn any knowledge.
;I';NA1TOi"'\ol~.fSj6N"'iln6;iw~G"',T'Nn~-'onR"'. ~ " ' ,-' '.~' ,~-- -; ,--~--~ '~.m Ii--r~ 5Ajf-I'-~-
n .~ '4/(ac.{(t~: _,!,';) ",tf'.,,/~gJ:t<' ,'.{'I<' f'1i~&((;,/.~:J{-',:---111fl'~ _":YL~,f/i /
~IGNAT lIE Of f>1l€PARfR01HfRltll\ Rfl'lIHfNTAflVE ADDRf~~ v l~ /7/'~)r DAlE
,,~J~9l\ SCHEDULE H
'. ~,... FUNERAL EXPENSES,
(llMM<>IIWIAlll' '" "NI"nv^,'" ADMINISTRATIVE COSTS AND
... ... . " '~\~:[~'~"'0"~~ ~:~:~N MISCEllANEOUS EXPENSES
nTAfE'~OF~--.~~~.~,_.~~~n'..~..
)~v:II^M,_':': (\:,,1\\
ITEM
NUM8ER
--_..._._.--~---
A.
tty 1~ll t;. (I ~~I
.'
1.
I PI. a.. Print or Tvpo
1 FILE NUMBEr -,. mnn '-~~"P'- _.~ ~
_ ..,._.. l' ,r1 (1' ('.
DESCRIPTION
_ __dn..'".___....~.~_
Funeral bp.n..., ( I \ I ,~\~~;~.'\.;~.~~ ~\;~ . ,~...\.. -:. .~;'~...-..\.....m.._.l....\- ..
,. ~ _ ,."',(..-\"';\01 11"\ -q., C\\'rr ,)
V,.A", "J: J,"/.l {I,,, 0" e 'r' I') \ v,,' .t.. '\. \ \J
. I' , I , \ .v.'< \ ., t., "'t ..0< '^"
C"I'nw"'l.~"''' .... c \ cev,;(-\..r,,, .. I
1,
8, Aclmlnl.tratlv. COlt..
2,
3,
4,
C.
1.
2,
3,
4,
5,
6,
7,
8,
P.rsonal R.p....ntatlv. Commlllluns
Social S.curlty Number of Personal Representative:
Year Commllllons paid
Attarney Fe.s
Family Exemption
Claimanl
Addre.. of Claimant at dec.d.nt's d.ath
Street Add,e..
R.latlon.hip
City ~
Stat.
Zip Cod.
Probate F...
Mlle.llon.ous bp.nl...
r,~J'~fvMr~1
,
~~dl.o("(e'(t1t'~ I'AMd S"ff"f'<:-
0" ~ II
,lv/;)(1 ,p 5
'7/1.tf1l1K -'101) (lD~e-; p~-"./." vtJ-;f,utc cJc..,
I I I I I' /1 I
CIJ.VVI~f12r'l (Pm (J~../- /~Icl/)j~'j .F1IY1~/ G.)(trls('~
5/-1!.-nl"V'fJ"t):'fc (:p~~ f-r, (uJ.-Y~I;mfM (,VII!
fYhle~([. (lit tl' j ()N')r./'~ r~/~1 ,/" dt~{tlJ .fr. h~II)&:..
,)...vt SM( (11)1'1'1 <J. Il h" I (..; 1 U II '.'),if I ,1, ,)?'#f'" :,::,,1-1 ,;.( t~ ,
I ,.I ".J I 1/' , ' , "
?t'()rvr,hf'lljC- v/'~r'';//,):wlf<./~1,1 tlY 'Y;},/5/'-rr,)
$3e (l111f~ @' ,3/ /Il,"k:, ,.. .
-----------..----------.-..---
TOTAL (AI.o .nler on line 9, Recapitulation)
(If more Ipa.. I. n..d.d, In..rl additional .h..1I of lame 1111,)
AMOUNT
sc..,1l4, ()("
to ~, ,
f./,."l (:-.-.
,J"'iI ~~
No ,', e
3&,.,00
50, ,...-
I'" r',
, --
2. 1_ , 2.'0
4-';', ()CJ
/,55
1&(,., 'IP
~~5(!1~, /4 v"
/1)> /. /3
&~Rp\U OF INDIVIDUAL TAKES
INH:"M'\ YANC[ UIC DIVISION
DtllT, l6D(.lOI
HAP,RISI8URQ, PA 11128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE Of INliERIT^NCE TAK
A~PRAlSEMENT, ALI.OWANCE OR DISALLOWANCE
Of DEDUCTIONS AND ASSESSMENT Of lAK
DATE
ESTATE OF
DA TE OF DEA TH
FILE NUMBER
COUNTY
ACN
06-16-97
SMXTH
01-18-97
21 97-0093
CUM8ERLAND
101
[~'~A.~unQ;~~.~~
MAKE CHECK PAYABLE AND REMIT PAYMENT TOt
REGISTER Of WILLS
CUM8ERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...
;iEV: iSI.-i - Elf -AF 'ji" i o:F 97"1" NoT" i CE "oF - "INtiE;i i;: AN-CE - T"Ax - A-pjiiiii i Ii i:;.iENT -, - - ii L. i'-OWAN"C E" a"1i - - - - - - - - - - - - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ANNA M FILE NO. 21 97-0093 AeN 101
E MARLENE BOSCHO
3900 BOLINGER 'RD
HBG
PA 17109
ESTATE OF SMITH
TAK RETURN WAS, I
) ACCEPTED AS fILED
RESERVATION CClNCERNING FU'rIJRE INTEREST " SEe: REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. R..l E.t.t. ISch.dul. A)
2. Stock. and Rond. (Sch.dule 81
5. Clo.ely H.ld stock/P.rtn.r~hip Inter..t (Sch.~ul. C)
4. Hortg.g../Notnl Raceivahl. (Sch.dul. 0)
S. C..h/Bank OeFoslt./M1Ic. Perlon.l Property (Schedule E)
b. Jointly Owned Pr6~.rty (Schedule FJ
7. Tr.n.f..". (Schedule G)
8. Tobl Au.t.
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fun.ral Expen.../Adn. Co.ts/Mime. Expen.es (Schedul. H)
10. D.bts/Hortu.gc L1abiliti../L1.n. (Sch.dul. X)
11. Tot.l Deduction.
12. Net Value of T.~ R.turn
15. Ch.rit.bl./Gov.rnnent.l a.qu..t. (Schedule J)
14, Hillt Value of E.t.te SUbject to Tax
I X) CHANGED
(1)
(2)
(5)
(41
(5)_
(6)
(71
,00
,00
,00
.00
7.61:.L..li.
,..!LQ..
,Oil.
(81
(.,
*'
(9)
(10)
5,943,14
, Oil..
Illl
U21
US)
eltt)
UW'lIH f~ ." CII-l1t
ANNA
M
SEE
DATE
ATTACHED
06-16-97
NOTICE
NOTE I To in.ur. proper
oredit to your .ecount,
.ub.1t the upper portion
of th1. for~ with your
t.x p'YII.nt,
7,625,70
Ii. 94~ 14
1,682,56
,00
1,682,56
If an ausensment was issued previously, lines 14, 15 and/or 16, 17 and 18 will
reflDct figures that include the total of ~ returns alses.ed to date.
ASSESSMENT OF TAX:
IS. "naunt of Une 14 at Spolf...l ".t. (1S)
16. AIIQunt of Un. 14 t.xabl. lit Un.al/Cla.. A rete (16)
17, Alltoul'lt of tine 14 t.x.bl. .t Colll1t.r.l/c.:l... 8 r.t. (17)
18, Prinoip.l T.~ Due
NOTEI
TAX CREDITS I
PAVMENT
DATE
03-19-97
RECEIPT
NUMBER
AAI85290
DISCOUNT It)
INTEREST/PEN PAID (-I
4.90
PAYMENT MUS. BE MADE BY 10-19-97W,
. If PAID AfTER DATE INDICATED, SEE REVERSE
FOR CALCULATION Of ADDITIDNAL INTEREST,
,00
1,682,56
,00
K ,00.
K ,06.
K ,IS.
(18)
,00
100,95
,00
100,95
97,95
;1,00
,00
3,00
If TOTAL DUE IS LESS THAN .~, NO PAVMENT IS REQUIRED,
If TOTAL DUE IS ReflECTED AS A "CREDIT" (CR), YOU MAV BE OUE
A REfUND, SEE REVERSE SIDE Of THIS fORM fOR INSTRUCTIONS.)
AMOUN; P~~~I D J
93, 05 I
TOTAL TAX CREDIT
BALANCE OF TAX DUE
-~-~-
INTEREST AND PEN.
-,,--_."---
TOTAL DUE
RESERVATION, E.t,t" of decedent. dving on or blforl D'o.~.r 12, 1912 -- If anv futurl !nt.r..t In the ..tate I. tran.f.rr.d
in po.....lon or Injov..nt to C1aft' B (oQll.~.r.l) ~.n.flol.rle. of the d,cldtnt ,ft.r thl 'Mplrltton of any .~t.t. for
llf. or for v..r" the COlMOnw..lth h.r.bv .MPr..llv ro..rVI. thl right to Ippral.. Ind """ tren.ftr InherltlnGl TIM.'
.t the IlIwful Cl... I (oollltlre1) rat. Qn 'n~ .uoh future int.r..t,
PURPOSE Of
NOTICEI
PAYMENT,
REFUND (CA) I
OBJECTIONS:
AD"IN
lSTRATlVE
CORRECTIONSt
DISCOUNT I
PfNALTYt
INTEREST I
To fulf1l1 the r,qulre..nh of Slctlon 2140 of thl Inh.ritanol IInd E.1at. TIM Aftt, Aot 21 of 1995. (12 P,S,
SlOtlon 91~a).
Dltaoh thl top portion of thll Notle. and .ub.it with your ply..nt tn the A.ght.r of Wlllt prlnt.d on thl ,'.yerll .Ide.
--Hlkl chlok or .on.~ ord.r Ply.bl. tOI REOISTER OF MILLS, AGENT
A r.fund of . t.M er.dlt, which WI' not r.qu..t.d on the T'M R.turn, .ay ba r.qUlltad by ooaplltlng .n "Applloatlon
for Refund o~ P.nnlylv.nia Inherit.nc. and E.tat. TaM" (REV-ISIS). Applloatlan, are .vIIlebl. It the Offlol
of the R.gl.t.r of Will., any of the 21 R.y.nu. Ol.trlot Offlol', or by ollllnl thl .p.olal 24-hoUr
an.w.rlng ..rviol nuwb.r. for for.. ord.rlngl In P.nn.ylvanl. 1-600-562-2050, outside P.nn'Ylyanl. end
wlthln 10011 Hlrrlsbura ara. (711) 767-6094, TDD. (717) 712~22SZ (H.erlng laptIr.d Only),
Anv p.rty In lntlr.,t not .atl.fl.d with the .ppraI....nt, .110Nlne. or dt~.llQwtncI of d.ductlon., or ........nt
of taM (Jncludlng dl.count or Intar..t) a. .hoNn on thl. Notlel au.t obj.ot within ~IMty (60) da~' of r.~.lpt of
thlt Notlc. bYl
--wrltt.n prot..t to the PA n.part..nt of Rtvenue, Board of App.tl., Dept, Z'l021, Harrl.burg, PA 17IZ6-10Z1, OR
.-'I.ctlon to have the .att.r deter.ln.d at .udlt (If tha Iceount of th_ parsonal rlprellntaUvl, OR
--applel to tho Urphan.' Court.
flCltual ..rrort dltcovlred on thlt ........nt should b. .ddr....d In wrltlnt tOI PA n.pert.In" of Rllllnut,
Bureau of Indlyldu.l TIMt., ATTNI po.t A.......nt R.vlew Unit. Dopt. 28C~01, Harrl.burg, PA 171Z8-0601
Phone (717) 787-650S. S.. pag. 5 of the booklet "In.tructlons for' Inh.rlt.nea TaM R.turn for' R..Jdant
Dco.oldlnt" (REII.ISOl) for an l>eplln.tlon of ad.lnlttrIUy.h /DOtl'totabl. .rrors.
If bny taM due I. pal~ within thr.. (J) c.l.n~ar lonth. aftar the d.cad.nt'. d..th, . flv. p.rcant (SX) dJ.count of
thl tlM paJd 1. allow.d.
!ha 15X tlM .anl.ty non.p.rtloJp.tlon p.n.lty I. co"u~ld on the totel of the t8M and Int.r..t .......d, snd not
paid b.for. Januery 11, 1996, thl 1I,.t da~ afhr the .nd of the taM ..,..ty parlod, Thlt non-pertlolPltlon
pen.lty J. spp..lftbl. In tho .a.. .~n.r and In the the .... tII' p.rlod a. you wnuld app.al thl taM and lntlr..t
that h.. b.ln a......d .. Indlcat.d on this notica.
Inter..t I. cherOld bllllnnlna with fIrtt day of d.Unqu.ncy, Dr nJne (9) lonth. and on. (1) dll~ froa the det. of
d.ath, to the data of p.y..nt. Tlk" which b.o,.. d.lInqu.nt b.for. J~.ry I, 1982 b..r Ant.r..t .t tnl rite of
.1M (6:() plrunt p.r flMUI calcullltod .t . d.lly rete of .000164. All taMe. which b.oe.. d.linquent on and after
J..,yer~ I, 1962 ~dl1 bltr lnt.r..t lit . rat. whloh wUI var~ froll cal.udar year to oallnG.r ya"r with th.t ret.
announeed by the PA D.part.~nt of Rev.nu.. Th. ~ppllc.bl. lnt.r..t r.t., for 1982 throuth 19'7 .r'l
\:!!t Inter..t Ret. D"lIY Int.rut Flctor :!!.!! !al!r" t Rat. Olllv lnt.r..t Fllctor
1912 20l! ,00054' 1967 9X .0002lt7
1915 16X .00041& 1988-1991 11)( .000501
1914 Ill! .000101 199ZO ,. .000247
198& 15)( ,00U~6 1995-19'4 n ,000192
1'8< 10% .OOM74 1995-1997 ,. .000247
--Inter..t .. oalClulflhd .. followlI
INTEREST ~ BALANCE OF TAX UNPAID X NUNSER OF DAYB DELINQUENT X DAILY INTEREBT FACTOR
M-Any NoUe. ...oad .ft." the taM b.oo... d.llnquent will reUea\ an Jnt.r..t c.lculatlon to flft.'n US) day.
bl~ond the date ~f th_ .......ant. If pay..nt il _ade aft.r the lnt.r..t cOMput.tlon dlt. .hawn on thl
NoUo., addlUon.1 Inter..t MI.t be celcul.t.d.
8lm~AU OF INDIVIDUAL TAKES
IHHEl'ti,rAWCf;' TA)( OIVISION
DEpT, J.'~0601
HARRISaURQ, PA 171ZS-0nOl
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
*'
NOTICE OF INHERITANLE TAK
APPRAISEHEN1, ALLOWANCE OR DISALLOWANCE
DF DEDUCTIDNS AND ASSESSHENT OF TAK
~[~'JU' U if' IGI."1
06-1.6-Q7
SMITH
01-18-97
21 97-0093
CUMBERLAND
t 01
E" A"ounCii."1 ttad"-
~ V :!:'t:: ~___
MAKE CHECK PAVABLE AND REMIT PAVMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
tUT ALONll lHU L1NE _ RETAXN LOWER i>ORTION .OR VOUFl RECORDS .....
REV: i547 -iic -"i:i;" (Oi"~'97T - No'fieE" 'OF -YN"HEifi i' ANtE - Yli'X -APPRA is EifiN'r; -iii.l"ciwiiNcE"ciri -- --- -- ---- - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ANNA M FILE NO. 21 97-0093 ACN 101
E MARLENE BOSCHO
3900 BOLINGEfll. RD
HBG '
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
ANNA
M
PA 17109
<5 (}
ESTATE OF SMITH
DATE
06-16-97
NOTICE
TAK RETURN WAS,
) ACCEPTED AS FILED
( X) CHANGE.D
SEE ATTACHED
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Red Eaht. (Schedule AJ
2" Stock. and Bondi (Schadule B)
3. C),o8aly Held stock/P'.,.tn.r.hip Int.,....i: (Sch_dul. C)
4. Mortgage./Not.. Receivable (Schedule D)
5. Cash/Bank O.pollt,/Hi.c. Parlonal Property (Schedul. El
6. Jointly Own.d Propllr{y ISchedule F)
7. Tran~fer' (SChedule Q)
8. Tot.l ASMatl
(ll
(2J
l~)
(4)
(5J
(6J
(7)
.00
.....9..9..
,00
,00
7,625,70
,00
,00
(0)
NOTE: To inaur. proper
credit 10 ~our .ccount~
.ubait the up~.r portion
of tn11 fora w1th your
t.)( p.YIl.nt.
7.625,7l!.
APPROVED DEDUCTIONS AND EXEMPTIONS: 5,943.14
9. Funeral Expens../Adn. COlta/Hho, Exp.ns.. ISchedule Hl ('l_
ID. D.bh/Hortg.g. LI.bllitl../L1ono (Schod\llo Il UOJ ,OQ
11. Total Deduction. (11)
12. Nat VlIlu. ot1 Tax R.turn (2)
13. Charit.ble/Governm.ntal Oequ..t. (Schedule J) (13)
14. Net Value of Esht. Subjllot to Tax (1~) 1, t82:J,i,
NOTE: If an assessmBnt was issued previously, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ill. ra'turns alslSsad to data.
ASSESSMENT OF TAX:
15. A.ount of Line 14 .t Spau,,_l rat" OS)
16. A.o~mt of line 14 bxable et Un..eI/CI.... A rat. (16)
17. A..ou~t of Line 14 taxable et CQII.t.ral/Cla.. e rat. (11)
la. Principal Tax Due
r; .;43 14
1.682. 56
,00
,00
1,682.56
,00
K ,00,
K ,06,
K ,15,_
(l8)
,00
100,"9S-
,00
100,95
TAX CREDITS:
PAVMENT
DATE
03-19-97
RECEIPT
WUHBER
AA185290
DISCDUNT H)'
INTEREST/PEN PAID (-)
4,90
AHOUNT PAID
93.05
PAVMENT MUST BE MADE
.-~--~
10-19-97~)
....... ;;;-"~...
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
97,95
3,00
,00
3.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION Of ADDITIONAL INTEREST,
( IF TOTAL DUE IS LESS THAN tl, NO PAVHENT IS REQUIRED.
IF TOTAL DUE IS REFLECIED AS A "CREDIT" (CRJ, YOU HAV 8E DUE
A REFUND, SEE REVERS~ SIDE OF THIS FORM FOR INSTRUCTIONS,)