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PETITION .'OR PRonATE und GRANT m' LETTEns
liJ'lale of _~OBER~,~_SII[I!l}L!II_.~_____ No, ._~~~,,).):.iJ.!L~:.Ji5
also known os ___.._,___~_.~_.___,.. To:
, _,.___._____. Register of Wills for the
. _,_._....~ Deceased, County of ..J;;UMBERLAN.D..._ in the
Social Security No, -lIL'l.::.26 - 5 5 2 7~_____~ Commonwelklth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitloner(s), whols/ar~ 18 years of age or older anthe execut r ix
In the last will of the above decedent, dated _~UN!L-'l.D,_
and eodlcll(s) dated N/a
named
,l~_
(5tate televant clrClll1utanccs, ('!,a. renunciatloll, death or execulor I etc,)
Decendcnt was domiciled lit death In CUMBERLAND_ _ CountYI.Pennsylvanla, with
~ is lastfall1ilyorprlncIJlalre~lden~eat ~99 BERNHEI.,SEL RIDGr; ~D
CAB.!,T~T.F., PA 1701:L "'hL(.Lt."tfJ -<1-'L~ Y;,.<,o,,,,,a.,!j.,'-,,,,--,
, f
(lI't .t,eet, number and munclpallty)
Dec<<:Jlde.nt,.Jhcn~ 63 \:.earsQfagcbdic.d JANUARY ~_.,.,. ,19~_,
at 09\1 J:lERNHEISEL RIDGE 1\ AD, CARLISLE, .-" __",/UU ,
Except as follows, decedent did not marry. was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a kllllujI Hnd was never adjudicated
incompetent: Decedent was married to DQ.NNA K. ~1.~.llAN
Decendent at death owned properly with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa,) Persoual property in Pennsylvania
(If not domiciled in Pa,) Personal property in County
Value of real estate In Pennsylvania
situated as follows:
$lliOOO.oo
$
$
$
WHEREFORE, petitloner(s) respectfully request(s) the probate of the last wlll and codlcll(s)
presented herewith and the grant of letters TESTAMENTARY
(tcstamcnlarYi admlnl.matlon (:.l.I1.; admlnlltratlon d.b.n.c.t.I.)
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DONNA K. SHM1AN
-
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OATH Olf PERSONAL REPRESEN'r.~,TIVE
COMMONWEALTH 010' PENNSYLVANIA } 8S
COUNTY 010' ...J:_~JMJJERL_A~D
The petltloner(s) above~nam~d swe~r(') or affirm(s) that the statements .1, the foregoing petition are
true and correct 10 the best of the knowidge and belief of petltloner(s) an<ll~at as personal represen.
tatlve(s) of the above decedent pClilioner($l will well and truly administer \ ',..' estate according to law,
() 1/ 4/J
swo.rn. to or affirmed and subscribed ~ --1./"// /<'-'1. ",. . IC{"e/~ Ii:!
before me this _~__._ d,y of DONNA K. SHAHAN }'
'M-: ~ \ . 19:' ~ .
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(G)
daughters, or their issue, including in said
division and distribution consideration being given
to the value of the two acre tract of unimproved
real estate being distributed to my da.ughter, ROBIN
I. CAMPBBl.L, pursuant to Item 5(C) above and the
value of the mobile home being distributed to my
daughter, TERESA K. REILLY, pursuant to Item 5(A)
above. Distribution to my daughter. ROBIN I.
CAMPBBLL, or her .issue, shall be made out right.
Distribution to my daughter, TERESA K. REILLY, or
her issue, shall be made under and subject to the
terms of the Trust set forth in Item 5(G) below.
I direct my Trustee to distribute all of my
remaining residuary estate not specifically set
forth above to and between my daughters in equal
shares, per stirpes, subject t.O the terms of the
Tt-ust set forth in Item 5 (G) below as to my
daughter, TERESA K. REILLY'S, share.
I direct my Trustee to hold any share of my estate
(excepting and excluding the mobile home set forth
in Item 5(A) above) to which my daughter, TERESA K.
REILLY t or her issue, may become entitled to by
virtue of the above stated terms of this Will,
intestacy laws or any other reason by virtue of my
death, IN SEPARATE TRUST for the benefit of my
daughter, TERESA K. REILLY, and her issue, under
and subject to the following terms and conditions:
(F)
(i) 'rrustee may accumulate the income from
that share or so much thereof from time to time as
it considers advisable; and Trustee may expend and
apply so much of the net income including
accumulated income and so much of the principal of
that share as Trustee may consider necessary for
the payment of real estate taxes, heating, fire
insurance, homeowner's insurance and other
necessary costs associated with the upkeep of the
mobile home and one acre of land set forth above or
the expenses for any other residence which my
daughter, TERESA K. RBILLY, may establish for
herself, and for the payment of expenses associated
with the college education, both graduate and
undergraduate, or post-secondary vocational or
technical training for my grandchildren, ADRIENNE
K. REILLY or ZACHARY S. REILLY, and for payment of
the expenses associated with the support and
maintenance of my said grandchildren in the event
my daughter dies before both of my grandchildren
reach age twenty-five (25) to be determined in
accordance with the talents, abilities and needs of
said beneficiaries. Trustee may pay all expenses
which she deems necessary and desirable in
connection with the foregoing provisions without
regard to equalizing distribution between
WITNESS:
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R ERT D. SHAHAN
(SEAL)
5
beneficiuies. The amount to be paid for the
benefit of said beneficiary shall be determined
from time to time based on said beneficiary's
needs. The said payments may be made directly to
any of the above beneficiaries if said
beneficiaries are, in the sole opinion of my
Trustee, of an age and ability to handle the funds
so paid, or may be made by my Trust3e directly to
the person having custody and oare of said
beneficiary, or may be made by my Trustee direotly
to any institution enti tl ed to such payment by
reason of services rendered or to be rendered to
said beneficiary.
(ii) The Trustee for the purposes of carrying
out my intentions stated above shall invest the
principal of the Trust and any undistributed and
accumulated income therefrom in an interest bearing
account, money market account, certificate of
deposit or other non-risk interest bearing
investment or any combination thereof.
Distribution from said investments shall be made
solely for the benefit of the beneficiary of the
Trust in accordance with my instructions set forth
in subparagraph (i), provided, however, that my
Trustee shall be entitled to pay for any taxes,
professional services or other fees arising out of
the administration of the Trust and shall be
entitled to periodic, reasonable compensation for
services rendered hereunder, which may be equitably
apportioned between principal and income.
(iii) Any and all payment or payments of any sum
or sums, whether in cash or in kind or whether for
princlpal or income, payable to said beneficiary,
shall be made upon the sole receipt of the
respective individual to whom the payment is made,
and free from anticipati.on, alienation, assignment,
attachment, and pledge, and free from control by
the creditors of any such beneficiary. All shares
of principal and income herein given shall be free
from anticipation, assignment, pledge, or
obligation of any benef iciary, and shall not be
subject to any execution or attachment.
(iv) This Trust shall continue until the later
occurrence of either the death of my daughter,
TERESA K. REILLY, or upon the last of my
grandchildren reaching age twenty-five (25). If my
daughter, TERESA It. REILLY, dies before my last
said grandchild reaches age twenty-five (25), this
Trust shall continue until my last grandchild
reaches age twenty-five (25), at which time any
balance remaining in the Trust shall be distributed
equally between my said grandchildren, or the
survivor of them. If my daughter, TERESA K.
WI'rNESS:
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COUN'l'Y nAIl
COD.
Ooc:pdent'o complete address
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Co-.onw..lth of ..nn.ylvan1a
n.partm.nt or Revonue
Harr:l1buro f Ph
INHIRITANCI TAX RlTURN
Rl8IDIN~ D~CID8NT
TO 81 II'ILID IN OUPLICATI
WITH REQIBTIR or WILLS
rILIIl KUMBIR
Oecedent's, Name (L~st, Firat and Middle InitiHl
filll\IV\N I fWBEH'l' [).
$0('.la1 seCUrily-:l Date of Death
184-26-!i527' '"'' I 1/9/97
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00g5
HUIGlIlI\
Datfl of Blrth
6/24/33
(,<)9 11E:RNIH~IS8L IlRIDG~ ROAD
CIIR!,IS[.E, PII 17013
2, Supplemental Return 3, Remaindar Return
(Prior to 12/13/821
4a, Future Interest Compromise 5, !'ederal Estate Tax
Return Required
7, Decedent Maintainod . [.iving (0) 8, 'llotal Number of Safe
Trust (attach copy of '{'rust) Deposit boxes
[X] 1. originol Return
4, Limited Estate
6. Decedent Died
Testate (at tach
co of \'11111
11 Corresponctence Bnd
NAM~
Confidential Tax Information Should Be Directeel to:
COMPLETE MAILING ADDRESS
3448 TRlNDLE ROAD
CAMP HILL, PA 17011
no
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OIANE G, RADCLIFF, ESQUIRE
elephone Number: (7171 737-0100
1. Real Estate (Scheelule AI (1)
2. Stock and Bonde (Schselule BI 121
3, Closely Held Stock/partnership
Interest (Schedule CI (3)
4. Mortgages and Notes Rncelvable
(Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous
Personal Property (Schedule E) (5) 911. 700.00
6, Jointly Owned Property (Scheelule F) (6)
7, Transfers (Schedule GI (Schedule L) (71
8. Total Gross Assets (total lines 1-71
9. Funeral Expenses, Administrat.ion Costs
Miscellaneous Expenses (Sch, H) 191 S 6.381,30
lO,Debts, Mortgage Liabilities, Liens
(Schedule II (101
11.Total Deductions (111)88 9 & 10)
12.Net Value of Estate (lines 8 minus 111
13,Charitab1e and Governmental Bequests ISch, J)
14,Net Value SUbject to Tax (line 12 minus 13)
""tH
)0 ;.;
( 8)
( 11)
(12)
(13)
(14 )
1S.Spousal Transfers (for date of death
After 6130/94)
16.Amount of Hne 14 taxable @ 6% rate
17.Amount of line 14 taxable @ 15% rate
18, Principal Tax Due (Add tsxfron, line
19.CrBdits Prior Payments
1151 $4,14B.70
1151
(161
15 and 16)
Discount
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$11.700,00
$ 6,381.30
$ 5,318.70
S !l.:nB.70
-
X ,01 ---'- 53.18
X ,06 ~
X ,15 ""
( 181
+
20,jf line 18 is great.er than 17 enter dlfferent on line 20 OVBRPAnar:NT
A, [ ) CHECK HERE IS YOU AR~ I\EQU~S'l'1NG A REFUND
21.If line 17 is greater than 18, enter difference on line 21 TAX DOl
A. Enter the interest on the balance due on line 21A.
B, Enter the total of line 21 and 21A on Hne 21B, BALAIICIi DUI
Make check pa~able to REGISTEI\ OF WILLS, Agent
Under penal,ties of perjury, I declare that I have examined this return, including accompanying
schedules and statements and to the best: of my knowledge and belief it is true, correct and
complete. I declare tnat all real estate has been reported at true market value. Declaration of
repine other than the personal representative is based on all information of which prepar€lr has any
r.' ledge, ..........~.. (;,Cjq ::~IIE:ISEL BRIDGE 1\0,
"~<J ~ 17013 Date b"3"c)-y/)"'
Interest
( 191
(201
(211
(21AI
(21BI
Address
3448 TIUN!lU~ ROAD
CAMP HILL. PA 1701 j
Addresg
o
$ 53.18
$ 53.18
Date
~-3cvO(~
Acl '48 of 1994 provld.. for Ih. r.duellon of Ih. lox rot.. Impo..d on Ih. n.' volu. of Iranal... 10 or far Ih. u.. .f
Ih. .pau.., Th. ral.. .. pr...rlb.d by Ih. .'alu'. will be:
. 3% (.03) will b. appllcabl. for ..101.. of d...d.nt. dying on or aft.r 7/1/94 and b.far. 1/1/96
. 2% (.02) will b. .pplleabl. fa, ..'0'.. of d.c.d.nto dying on or aft.r 1/1/96 and b.for. 1/1/97
. 1% (,01) will b. appllcabl. for ..Ial...f d.c.d.nll dying on 0' aft.r 1/1/97 and b.far. 111/98
. Spau.al tranal... occurring on or aft.r 1/1/98 will b. u.mpl from Inh.rllan.. lax.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK I '" )IN THE APPROPRIATE
BLOCKS IF THE PROPORTIONATE METHOD IS ELECTED OR IF PENNSYLVAN A REALTY OR TANGIBLE
PERSONAL PROPERTY LOCATED IN PENNSYLVANIA WAS TRANSFERRED WITHIN ONE YEAR OF THE
DEATH OF THE DECEDENT.
1, Old d...d.nt ..,ok. a tranll.r and:
YES NO
a, retain the UI. or Income 01 the prap.rty tranll.rrod, ".""".""""."",,,,,.,,,,,,,,,,,,,.,,.,,.,,.,,,,,,,,,,,,,,,,,,
b, r.taln tho right to dOllgnat. who .hall UfO th. pr~p.rty transferr.d or IlIlncom., ".""...."....,......,....,
)(
X
X
C, retain a r.vlrsionary intere.t; or ............."......................................"............................................
d. r.celv.th. pr"ml.. lor IIle 01 either payments. b.n.flts or care' ..............................................."....,
2, If death occurred on or b.lore Dec.mber 12, lQa2, did d.c.d.nt within two yea.. pr.cedlng d.ath transfor
prop.rty without receivli'g ad.q"ate consideration' If d.ath occurred aft.r Decemb.r 12, 1982, did decedent
tranller prop.rty within on. y.ar 01 d.ath without rocelving ad.quate conllderalion! ",,,.. ".....".. ".. ,"....
x
3. Did dec.d.nl awn an 'in trust for' bonk account 01 his or her d.athL......,,,.....,....,............,,.."'............
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FIL
IT AS PART OF THE RETURN.
PROPORTIONATE METHOD WORKSHEET
CALCULATION:
1, T ~:~~:~;nil~~~:~al:.p~ln~~\':artJa ~~~, ,~~,~~~~,I~. :.~,~~~~~~'" ".,'...".. ,,,., .......,.... ,.. "....", (1)
2 Total grass assets wherever sltuat.d (lin. a of Recapitulation)....",...."....,..........,...., (2)
3, PrClportion (Divld. L1n. 1 by line 2) ".....",..".."......""..."."..,........"""."....,......",."."..."....",....,.... (3)
4, Total debt. and d.ductions and omounll d.viled to charitable organizations
(Add line. 11 and 13 of R.capltulatlon) ....."................., "...."".."...... "" "".........
~, Taxable E.tot. a. If 0 P.nn.ylvania resident (Subtroct Lin. 4 Irom line 2}..."....,....",
6, Spousaltransfe.. (for dates of d.ath after 6.30.94)
Amount Taxable at __% )( Proportion (line 3) ,,,.,,..,,....
7, Amount Taxabl. 01 6% )( Proportion (L1n. 3) ,.....,......,,,"..,,..,..,,
a, Amount Taxable at 15% )( Proportion (Lin. 3),............""...."....,
(4)___
(5)
)(
m(6}_._
. (7)
m (a)
.)(
)(
The result of Lin.s 6, 7 and a or. to b. .nt.red on Iln., 15, 16 and 17 of Tax Computation resp.ctlv.ly,
All pl"())tHl olntl '.(Iwrwd wltll lil~t llf SurvlvOr-flhril Illll~ll 110 dl.'lclo:1f!d on !Jc:hl'Jdula "rl~-
ITJl:M DESCRIPTION VALUE AT DATE
II'JMBER or DItATR
NONE
,
"
,
,
TOTAL (Also enter on line 4, Recapitulation) $
[ c~';;~; ptNNlrLVl\HlA
INHIRITANC& TAX RlTUKN
RESID&NT DICIDINT
LSTATEOr--'
ROBERT D. SHAHAN
-J
SCHEDULE "0"
MORTGAGES AND NOTES
RECEIVABLE
rILE NUlCBItR
21-97-0095
(If more space is needed insert additional sheets of same size)
I
__J
SCH~,DlII,lc F:
CASII, BANK DEPOSITS AND
MISCELLANEOUS
P"RSONAl, PROPF.R1'Y
ItSTATI OF rILE NTn(BER
ROBERT D. SIWlAN 21-97-0095
All -.ro.I!.',l clint} '-(1wflfHI...r1th tIll:' HI<ht of slIrvlvorfll1-l) n\lwl be dlAolmHlo on schadulo n
COMMONW~:I\t.'rIl OF l'f,tl~~1,Yl.V^Nl^
INIa~IU'l'fl.NC]'; TAX HI';TIIHH
HI-::;lNarl' 1\1'):~:P~;N'\'
ITEM DESCRIPTION VALUE AT DATE
NUMBER or DItATR
1. 1986 ,'ORD PICKUP TRUCK $ 6,000.00
2, 1974 HOLIDAY MOSIloE HOME $ 5,700.00
TOTAL (Also enter on line 5, Recapitulation)
$11,700.00
]
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUM.ERLAND
P:
DQNNlI K. SHAHAN
boin9 duly,,, ws....Q[O, ,,_ occordln9 to I.w, depolll .nd "Y' th.t !h. ,_is the ~,,-------~--
"_._,,,.,, __._m_ of the Eltate of ____llnhArr. no !':h.h.YL-
I.t. of __Mid(ilesex Townlilhip, Car1isle,_____,~_, Cumb.rl.nd County, P.., cl.c....d end th.t the
within il an invontary mode by , ' .!'JQnmLK.__ShabllrL_, ____'_____, the Itld_ Executrix
of the entire eltote of,old decedent, con lilting of oil tho p."an.1 pro,..rty .nd r..1 ..toto, except r..1 ..tot. ouhld.
the Cornmanweolth of Pennlylv.nio, .nd th.t the figur., oppallt. uch It.m of the Inv.ntory r.prel.nt It', hlr v.lu.
o. of tho d.t. of docedent'l de.th .
19_~
~~~
~~)~';~d..~~::J1~~~t?i'~~
Executor. Aclmlnhtrator
.nd ,ub.cribed before me,
,,_______99~ Bernheisel Bridge Road
TARIAl SEAL
~ z:. CAMPBEll, Notary Public
/.fIllQ Hili Boro, Cumberland county
M ~Ion Ewplre. J Iy 3 1999
CarliSle, PA 17013
",44"..
o.t. of O..th ,____.....9.tlL_____
DIY
----->Ianuary
Month
1QQL
YII'
INSTRUCTIONS
I. An Inventory mUlt b. fII.d within three month, .fter .ppalntment of ptr.onol r.present.tlve.
2, A lupplelnent Inventory mUlt be filed within thirty dOYI of dllcovery of .ddltlon.1 ....h,
3. Addltlon.1 Ihe.h moy b. .ttoched II to pe"onolty or reolty
4. S.. Artlcl. IV, Flduci.rl.. Act of 1949.
If
.
~
III
....
r-I
B
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8 ~ I :a
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8 ~ 11\ I
..
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I
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a> W A j
I ~ o ~ =
.... ~
N ffi ~ ~
-
0 ....
Z A. ~ iJ 11
..
'l; "C
..ll ." ...
: e . 0
j 13 it :
Inventory of the real and personal estate of
______~--...-1lQBERT,J2'_.SI:llIllAN__________ deceased
1. ,1986 Ford PickUP Truck
6,000. 00
2.
1974 Holiday Mobile Home
5,700. 00
r-.. ~tf
'O'(/) :-;
N ?
((l~ LJ
! 1 j~:: P.- (_J d
. ,
-' :',j ~
" '" ~
m ..1
D -2;j , t(;
\,."....
C~ DJ d~
~! ~
$11700. 00
y::.
,;;.--
.
STATlIS REPORT UND.:R RULE 6.12
DATE OF DEATH:
WIL.L NO.: 21-1997-0095
ROBERT D. SHAHAN
JANUARY 9, 1997
NAME OF DECEDENT:
ADMIN, NO.
Pursuant to Rule 6..12 of the Supreme Court Orphans' Court Rules, I report the following with
respect to completion of the administration of the ahove.captioned estate:
1. State whether admini9lration of the estate is complete:
Yes X No
2, If the Answer is No, state when the personal representative reasonably believes that the
administration will be complete:
3. If the Answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the court?
Yes No x
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
interest? Yes x No
d, Copies of receipts, releases, joinders and approvals of formal 01' informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
<'
\<-
Date: Ju;Ly 24, 1998
0,:),
~~
I.D t::~
N "-1.:
~ ,
E: ~;
co
N
~
~ d~
:LIEF. ESQUIRE
Name (pleasp. type or print)
3448 Trlndle Road. Camp Hill. P A 170 II
Address
.-
o'f!.
(717) 737.0100
Telephone number
Capacit)': _ Personal Representative
-1L.. Counsel for personal representative
. I.' /. ,\'"1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
BUREAU OF INOIVIOUAL TAXES
INtIERITANCE TAX D1YISIOH
DEPT. 280601
HARRIS.URO~ PA 1712ft~0601
NOTICE OF INIlERITANCE TilX
APPRAISEHENT, AI.LQWANCE ~R DISALLOWANCE
OF OEOUCTIONS AND ASSESSHENT OF TAX
In.\u, u ~f' (....,1
09"07-1998
SHAHAN
01-09-1997
21 97-0095
CUMBERLAND
101
['.------AiiOunTii~;,Ttt.d--J
,..,.- --====-
~.__.__._._~~_._----
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
~EGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiE'v = iSi,-'nx-AFP - (0'9=9'fi - Nof iCE- -OF "ytiHEifii' ANCE - 'fA"x-"A"PPi!X i sEiiiNr ",-- ALi"OWANCE- orin - --- -..--" - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ROBERT 0 FILE NO. 21 97-0095 ACN 101
. .
DATE
ESTATE OF
DATE 01" DEATH
FILE NUMBER
COUNTY
ACN
ROBERT
o
DIANE G RADCLIFF
5448 TRINDLE RO
CAMp HILL
ESQ
PA HOll
ESTATF. OF SHAHAN
DATE 09-07-1998
ATTACHED NOTICE
( X) CHANGED
SEE
TAX RETURN WAS, (
) ACCEPTED AS FILED
iEiiRVATION CONCERNING FUTURE INTEREST " SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l E.t.t. (Sch.dul_ A)
2. Stocks and Bondi 15oh8dule 8)
3. Clos.ly Held Stock/P.~tner.hlp Ihto,..a.t (Sch.dul. C)
4. Kortg.g.s/Not.. Raoeiv.olA (Sc~dul. D)
5. C..h/BMk DepoII.t./Hi5C. ra,.,&onlll Prop."ty {Sch.dul. E}
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedul. G)
8. Total As..t.
.00
.00
.00
.00
11. 7 0 O..J!.!L
.00
.00
(e)
HOTE: To Insure proper
credit to your account,
eublllt tn. uppe;r portion
of this forw with your
tax pa)fMInt.
(11
(2)
(51.
(4)
(5)
(6)
(7)
II ,700.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9, Funer.l Expenses/AdM. CostR/Hisc. Expan..s (Schadula H)
10. Debts/Kortgau- Liabilitias/Lians (Schedula I)
11. To~.l Deduotions
12. Hat Value of Tax R"turn
13, Charitabl./Govarnsental 8uqua6ts; Non~el.ct.d 9115 Trust. (Sohadule J)
14. Hat Valu. of E,t.t~ Subj.ct ta Tax
6,381.30
.00
(11)-
(12)
I1S)
(14) _
(9)_
1101
6 .311I 30
5,318.70
.00
!!,,318.70
will
If en a.sessMent was i..uad previously, lines 14, 15 and/or 1&, 17 and 18
rafJ.ect figures that include the total of A.b.I.. returns allsna.nd to dete.
ASSESSMENT OF TAXI
IS. A.aunt of Line 14 .t Spousal r~t. (IS)
16. AMOunt of Lin. 14 taxabl. .t lin..I/CI..s A rat. (16)
17. A~unt of Line 14 taxable .t Coll.taraI/CI.., 8 rate (17)
18. Principel Tax Due
NOTE:
5,318.70
.00
.00
x .00.
K .06.
X .15.
lIe)
.00
.00
.00
.00
TAX CREDITS:
PA YHENT I
DATE
07-=02-'1998
DISCOUNT (+)
IHTEREST/PEN PAID (-)
.00
RECEIPT
lM1eER
"-AA296384'
AHOUNT PAID
53.18
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
53.18
._-
53.l8CR
.00
53.lSeR
. IF PAID AfTER DATE INDICATED, SEE REVERSE
FOR CALCULATION Of ADDITIONAL INTEREST,
( IF TOTAL DUE IS LESS THAN tl. NO PAYHENT IS REQUIRED.
If TOTAL OUE IS REFLECTED AS A "CREDIT" (eR I. YOU HAY BE OUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATIONI E.t.tal of ~t. dYint on or blfor. oao..b6r 12, 1982 .~ if any future intlre.t In _hi ..t.ta i. trlO.flrrld
In po.....lon or enjo~t to ClI.. I (oollet.r.l) bInIfiollrla. of the deoldtn_ after the expiratIon of any ..tate for
11f. or for y..r., ttM C~.lth htrlby .)Cpr...h raHrvII the right to IIPpr.i.. end ...... tr..,.flr 7nh1rltMOI h)CII
.t the l.wful CI... I (ooll,t.r,l) r.t. on any .uoh future tnt.r.st.
Nll'OllE OF
NOTICE I To fu.\flll the requlr...ntt of Section 2140 of thfl IllherJt1an01 and E.tatt T.x Aot, Aot Z1 of 1995. (n P.S.
Section 91itO).
PAYMENT I DatlMlh the top parHoM of thlt HoUell and tub. it with your ply.ant to ttM Rt9I.t.r of Willi printed on the r.v.r.. Ii..
---.... ohIe* or 1IOflI~ ordor p.~abl. tnl REGISTER or MILLB, AGENT
REFlIm (au: A r.fund of . tax oredlt, which WIS not nquasttd on the TalC Rlturn, .ay b,r.qutI.tact b~ cotlPlltlnt In "Appllo.tlon
for Re~ of Penn.ylvani. Inherltanc. and f.tat. Tax" (REY~131S). Appllclt!on. at. aVlll~le at the OfficI
of the R.,I.tlr of Will., eny of the 23 Rlv.nu. Diltrint OfficI', or by cIlllng the aplQlIl 24~hour
."..,.f'ing tervlo. mMb.r. for fot.. otderl",,1 In PannlyJvanil 1-800-362-2050, outl1cH1 Penn'Ylvanla and
\tlthln 1000al HfIrtltburll er.a (717) 707-8094, TOOt (717) 772-?;252 (....rina lap..rld Only).
OBJECTIONS: Any p.IIrb In int.r..t not ..t1dled with the apprals...nt, allowanoe or dlaaUOWItnC. of deduction., or .SHII...t
of tax (including dhcOUflt or Int.rllO I' shown on thh Notlc. ItUIt objllot within .bty (60l dlY' of reclipt of
thh Motle_ bYI
-.wrlttlN'l prat..t to the P^ o.pllrtMnt of Revenue, Board of APp..h, Dept. lalOn, Hertltburg, PA 17128-1021, OR
--elaotlon to ~ve the .att.r det.ralned at audit of the IOCount of the p.rsonal rapt...ntetlve, OR
WH~II to the Orphan.' Court.
ADtllN
ISTRA TlVE
CORRECTIONS I
Factual .rror. di.covlred on thl. ..a.....nt .hou1d ba addr....d In writing tOI PA Depltt..nt nf AI~enue,
lur.au of Indivldu.l T.~e., ATTHI Poat A.....-.nt Ravlew Unit, D.pt. 280601, Harrl.burg, PA 17128~0601
Phone (717) 787-6505. Su. pagt 5 of thv bookl.t "Instruotlon. for Inh.rltlno' T_~ R~turn for a R..ldlnt
a.cedant" H'EV~BOl} fot 00 .xplanetlon of adtlinl.trat1vlh oorr.ctabl. 'rrorlll.
PISCOUNT I
If M~ teIC due Is paid within thr.. (3) cnlander .onth. aftclr the dloedent', dG.ttl, . flv. p.r~t (SiO dhQOUnt of
the ta~ paid I, allowed.
PENALTY I
T~ 15% tax ~.t~ non-participntlon penalty i, ooaputad ~1 the total of the tlK and int.re.t ......fd, and not
peld blfor. Jartll.r~ 18, 1996, the fltst day eft.r the ~ of the tax ean~.ty p.riod. Thl. non-p.rtloipatlon
penalty 111 llPp.salabl_ In the' .... lII"nn,r and In the the .... U.. p.r iad II ~ou MOuld appeal the tax and Intar..t
that he. baIn ....III.d lIS lndloetld on this notie..
INTEREST I
Intar..t it oharn.d beglnnlnll with flr.t (I.y of deUnquenoy, or nine (9) aonth. and 0IlI (1) day frOll the ~.t. ~f
d..th, to the data of p.y.-ot. Tax.. which ble... dlllnquant blfor. Janu.ry 1, 1981 ba.t Jntlrl.t It the rate of
*Ix (6k) p.roent p.r an~ ~aJculat.d at . dally rat. of .000164. All t_x,. whloh bee... delinquent 00 and If tar
~ry 1, 1982 will be.r interllt lilt I "lilt. whloh wUI v.r~ froe o.land"r ~lIIIr to cIl.ndar y..r with that rate
~.d by the PA n.partllOnt of R.vonue. Tha IIlPP1Jalbh Intet..t r"t.. for 1981 thrOUGh 1998 Irll
't!!I Interllt Rate Oaih Interllt Flllator ~ Interllt Rlt, Dally lnter..t factor
a8l ..X .'00Sit8 1987 9X .000247
1985 16:< .0004;\& 1988-1991 11% .000501
19.. llX .000501 1992 91. .000147
1985 UX .000~56 199~-1994 n .000192
n86 10% .000174 1995~ 1998 9X .000247
~~Intlt..t I. o.lcul.ted .. follow'l
INTEREST Q BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
--Any HoUOI htu.d eftar the t.x blOOMS delinquent will refllof ftf". Jnttrl.t oaloulatlon to flft..... (liD day.
beyond the datu of thcl ......Hf'lt. If p.~....lt It .Itd. tlftat the Inter..t OQIIPUtlUon data Jhown on thei
MoUe., Mdltlon.1 Int.r..t lIU.t be ollou1.tld.