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21-97-177
RENUNCIATION
In Re Bstate of _~acob F. Dick
deceased.
To th~ Register of Wills of ___.
Cumberland
County, Pennsylvania.
The undersigned
children
of
the above decedent. hereby renouncc(s) the right to administer the estate and respectfully ask(s) that Letters
Df Administration
be Issued to Linda K. Caasell and David E. Dick
WITNESS
our
ht
hand thls.LL_ day of February ,19~.
U0\C, \i\,\\(\ (\:\OJ\J1L~
~ . .
Virginia (Slano,ure) Barrick
406 N. pitt Street
Carliale, PA' 17013
(Address)
0 tilt
15 N
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(Or)' \) AU" ,'L'LA
Karen Weekley (Slgnalure)
407 Bloaeraville Road
Newville, PA 17241
(Add,,,,.)
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(Slgnatu,e)
801 Sandbank Road
Mt. Holly Springs, PA 17065
(Add,",)
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FilED IN DUPLICATE
WITH REGISTER OF WillS)
rOMMot.jwrA-lTll or rrNt~SYLVAHI^
[l[r,U:1MtNT Of luVtNUf
orPl "O~OI
IlA-RR1$6tJRG,'^ 11 18.0601
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SOCIAl UCURIIY NUMUII
lOR llAIIS or D'ATH AfllR 12/J 1191 ClUCK HUt
IF A SPOUSAL
l'OVIAIT CR.DIT IS CIAIMlD I 1
fII' NUMn.R
II
COl)H1Y COPI
0171
'jb-Ai(-6ftiE^T,1 I"A"I'/)' ja;,/,,? I
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(It "'ll(.IlIl ~VlVI\'I"H HOLM '\ Ij"MI It.ll, '1~11 "NU ~nll{l11I~II1!"\) .~(j( IAl ~11 ( 1J~11Y 'WMlllI
.Il/LI.
XX 1. Original Retuul [" I 2. Svpplome"Iol ~nturn
IJ .4. limited EIla'e [J 40. future InhulH! Compromhe
(lor do,,,.I d.o,h oher 12.12.62)
[] 6. Decodenl Oled leilate [] 7. Decedent Moinlolned 0 living T"'111
. n _.__(~Io,h copy 01 Will)______ IA""h ,opy_~.'2rvl')_
ALL CORRESPONDENCE AND CONFIDENTIAL TA.X INFORMATION SHOULDBE,OIRECTED TOt
,t- tJAM[ --.- '"POM"'PiTIf"MAiWm--ADDiHr-- ..-'
t3ffi
l:'\i1 .]{2.\}_~~.d_..JL..}.glll:!r..<J_n..,-1~B.'1l1AI:".__.~.._~__ _ 78 W Pomfnet Slr,"'t
S~ lflfPlIONlNUMtU Carlisle, PA 17013
. -.. =::17-J::Z::.~l.=.~4:J.!'!!ill-2J_:~:o-:~:==:= -'-:-='==:::=:C~'___'_::';"- - -= .;,. =-==-.;.,.=-----'-----:;;;__=. .--;- -=:::..
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I. Rool EIIO" IS,h.dvl. A)
2. Slo,k. ond Bond. (S,hodvl. B)
3, ClcIOly Held Slock/Parlnerahlp Inlerest 15chedule q
4. Mortgog.. and Not.. Receivable (Sch.dule 01
5. Co.h, Bonk Depollh & MIscellaneoul Perlonal Property
(S,h.dvlo E)
6. Jointly Ownod Prop.rty (S,h.dvlo F)
7. Trani'''' IS,hodvl. 0) IS,h.dvlo l)
8. TOlol Gron Auell 110101 Lines ,.7)
9. Fun,rol Exp.nlts, Admlnhlrotive COlh, MIIC.Uaneoul
Expen,,, (Schedule HI
10. Debtl, Morlgagn liabilities, lien. (Schedule II
11. Tolol Deducllons 110101 Un.i Q t. 10)
12. Net Volue 01 Eltal. (Line 8 minul line 11 J
13, Choriloble and Govornmllnlol Bequells (Schedule J)
1.4..:. Net y~~~ Subject to! ox {Une 12 minus Line 13)
Spousal Tronsfors (for dotei of deolh ofter 6.30.Q4j
See Inllrucllonl for Applicable Percentage on Reverse (15l
Side. (Include value" from Schedule K or Schedule M.l,
Amount of line 1.4 taxable at 6% rote i 16l
(lndudo value" Irom Schedule K or Schodule M.)
Amounl of line 14 to Koble 0115% rote (17)
(Include valuf''' from Schedule (l.: or Schfldule M,l
Principollolt due (Add to>>; from linlH 15, 16 onelll.l
Cledill Spousal POyerly Credit Prior Paymel\ls
n
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"UMOU-
IS.
16.
17.
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~ 19
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11 E. ~;()lIth fil ruut
Carlinl",I'^ 17013
'"'0'[ CumIH',-1 {lml no' '_'_' ,_..
AMi""" """,,, 1\11''''''".'''0":
113.
I J s.
Remalndor Relurn
lfor dolO' of doolh prior 10 12.13.87;
federal (Ilole TOK Return Required
.0- 8. 10101 t~lJmber of Solo Depalil BOK(l1
I :~' .',
l"
II) . }:2,Q,OOJlL...
121. _....._~....__.._____n_
131 _
14). 1,770.00
151_.?5.?R7.as.
16) .
( 7 ) _..2.Q',l.5.iL.ll__~_
(9).._..7 ,006~56
18180;612.66
1101 __:.1..,.334 74
1Il)~J..4, 341. 28..__
(12166.471.38
(13) __________
114) 66.47_~,38
.X
a
66,64J,}8.__
x .06 a. _.J.l2.2~~~~.
'0 . X .15 =
(161
Discounl
InhHel!
f
(19)
120)
If line 19 il grfloler Ihon line 18, enter the differl'lnce on line ,0 lhis is lho OVERPAYMENT,
UI]
(heel< here if you ore requesting 0 refund of your ovorpDvmenl.
n}'2. 9(3,84
(21)
PIAl
(216)
3,9.98,84.
"{inn 18 h greater Ihan Llno 19, enlCf Ihl;' difference Cln l,nr. ,I This II !he TAX DUE.
A, Enlef Iho interel! on lhe balonce due nn line 21A
e fnter lhe 10101 01 lillo 21 ond ?lA (,n line 21!llhi\ i\ II". BALANCE QUE.
~~k~ ~h!ck Povahle 10: R.gilhH of Willi, Agent
.. uj.:' j; ... BE SURE rO ANSWER AliQUF.STIONS ON REVERSE siDe AND-rOile-CHECK MATH -(..(
Under pen;hl{,1 01 pertulY, I dcrl-;-~~~-if;"e';"1 i;~I"~ ~!~;minl.d Ihil r("t~lIr;: ;~'t1i!dOl\q Of(' mpnnyillq u.l;lldlJl~~ onj sIOI8m~nts,-~-~'~rtc;-;h~b~~I';;'r~yk~~w'ltldq!; m.d bl.l,
liS Irul', lOUN! and complelu. I doclcue tho! 011 [uol (011(111' hns IllIen reported ul II II!' miHk\!I' VOIUll Oodnrcl1ion [II prepCHOt olharlhofllho perlOnu! rCIHI'sr!lll[lj..,
'J"OI.C~_ on 0.1.1 l_ntormotiol1 (,1 which p:oporer hen OflY howll1ClrJc
SIC.'~"\lI~lo/rl~SOt~RISPCJt~'>I~llIORliUN('Rlh.)R"N "!lllvr)-,,/ '/H \, I' I I" t'
'JJHI ,l. ,1') - 1-..) <::; CO. \ (llll 1'1'_ ,drl'l"
~JfM~."i -fb~~'~Z"N.'i-'--:'-.'" ..(' '-'?~lll>llfS'>(7':8I1rWI.JI~~II'II. 1'/\ r,I~OI3 "
om l' t . t "t 1 t ~ t ' t
. .... .... Cadi.iv, I'A 11013
OA"~
. 'l'lZ '91
"A'bh0
~1'9"?1'
IJ,S Dllfl.\lltMr:Nf Of HOUSING MW UllllAN l)tVEt.OPMI:NT
SHTl.EMfNT STATEMENT
!'Am: 2
'?o.l~ETTLEMENT C
-"~-~- mE NO.': '10600'-'---' "AID FRo'M PAIOfROM-
:
~MISSIONbI.ed (In pr~. . 32,000,00@ . ~,~~ DORROWEII'S SELLeR'S
. J II loKow.: - FUNDS II r FUNDS AT
lel GUlghen h.e.ltor ..---- SETTLEMENT SETTLEMENT
,.--. -- 2.00~qg
tl...______ -- -----
~".ffi;ClI(l!! Wlfi' LOA-N' --
--'-~~~-' ---- -~-
.. -- --.- -----....-
--- . -- --- ----
--
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LENDER TO BE PAID IN ADVANCE
10 <ii>. .- .M!L-
!or ... 10 -.
, yr, to -
- . --
Willi LENDER FOR
'-'--;no:@~ -
Imo,
mo,fill Imo;
mo',,, Imo.
l'r'lO.@t /mo.
InO,e. Imo,
m.l,I.@t Imo. --
me.IM Imo. .
-- .- mo.@> Imo.
-
-
.-~- P,O.C, to Ron.l d Johnson
G~ry H. Gutshlll 2.00 UO
Orion Abstract. r~. I
. 355,05
!10111021l031104 -- I
..'
32,000.00 .... 3"55.05 - ifDO
OrIon "'b~~.ct, I",. ...
,~.__.
'OING-:ANO TRANSriffi"CliAlHlES -.-....- .-.
ft!2..!..___E~~ort~-i! . . ; Releases, 23,50
!.d.' 320.00 ; MortgaQ! 0 160.00 160.00
..d. 320,00 1 Mortoaa. I 160,00 160.00
--
-~----_.~-~~_._---" ...
ENTCHiiRGES ---.. .-
.
_. --
(lowers Pest Control 4~
~=1~d'j sle lloroUO~"."_. - 21.82
._,---~"~-- - . --
---~._._--------_. .-.---.- .---- _._-
IMRGES (enl91 on Wiles H)3 and 50?, Secllon; J llnd K) . 700.S5 Ul0.l!.2
,:llffiTIMENrcliARGES--
,00: TOTAl SAlfiSI8ROKEn'S-C~
:_ OMl~.!l.~ cO/hmlt.lon fl'fte,LOO
~lL-.__Y!O.OO 10.1
102,1 __~~
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6QJ.'ioln Ofla~lik;F;.~~.~
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l'~.e~!!!!I..!!!_~_~~
~~. fWpon 10
~g.!:..b!!l.d.!"..!...!!!.!R'cllon Fill 10
~~. Mlg. 1M. Applctllon Ftc 10
a07, AnU!!![l.,I,lonLH I~
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;". ITEMS nEoUii\Eo .BY
~)1. Inl.relll/om
))2, Mong!i~ lnlurlnel Prernlum_
~:]J. HUArd In,u/lnCl Promlum 10
i'~~.:.._
r)5,
)JO. RESERVES DEPOSlTEI?
:xlI. Hu.rd Inllluancl
m, M\M101;t In,,,,raoot
Q03. Ob PtOPwtv T.....
_004, Counly p~ "...,
;)05. Annual ,.,....."""'1.
006.
007.:
"".
100. TtTlE CHARGES
~Ol, Sett"",,,!l or c:lo."~ 10
~02. ~llrIcl Of Iltla lM<<';h 10
lOCI, nlla e..mlnclllon to
~O~, nle "'.wlnee bndef to
10S. Documltnl P~afaUon 10
~06, Nolftfy Fw, _ 10
\07, "'Iomly'al... 10
(helldn above lIaml_Na:
08, nleln,urllnol._ 10
~"'dG' aboVI ..ms No:.
C\9.l~o.f'SCOV~
10. Ownftl'" Cllvlr.!i!..!..-
\1. dl Sbl.lr'Mlefl!....t!.L__
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:~.
\0. GOVEfffiMENT !lECOA
)1, ~ordlng "!!!.:._ 0_
iih.Q!tllcoul!!l.~!IIfJ'()r.: D
:!..!!!.!!..!~'I'~J 0
J_,
;s:---.------~
" ADOIllONAL SHTLEM'
~ I. Su'!:!L_. _J2.
:~!L!n'plCllo.fl___----------lP.....
-], riral Wat!~~~_
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. t.......... ".I,,'d I~. HUG I a.nl.,...nl '1'1."'.~1 ., ,,, Ih. ...1 .f "'I ~ I d d II II ' " I
" tc..."l" ~r ,.,. It> IhI. ..lnoIPlj""....~lh' HI _ hi'" "c.l.. .":oW~: :tl~~ IfUO .~"~:~~.I~:l~~~~~'"I. /''''Ml ,I I~ rOC:I'll 'n~ ~..byl..ftlul' ,'utt.
,'l!:". ~.~_6'~-c:....-=_~u,. ('I)!^I(L'~I 'f'r?(!
~~ n 1)"'---------- ___ UOIr.f1Oilir"'iiWlr ).i(O~ltm- ~,I""
, ~~"'d:2':1!:.r'{JJf; { ;;);1.___~..~ (-,,>.,,1.. . CO<' ~;.C
\\" PVrll,UorrowOl -~--- - --riIi1
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RESPA, He 4305.2 -. REV. HUO., (3186)
_.;'~~:-,-"7:~',
."
PHONE
',/3' 7/;(:3
2_.uu/t. .
ZIP CODI
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.k/?Ld.(f~~n_.
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,.
I hetebv commlnlon you to leU Ole kerilS'P'tltd al:ovc & on tho at.
tlChed Ihoetl to the hlg~lt bidder' by public luctlon, I certlfv that
l..-n the OWnGl' of the Ihove b,teditems and have good tltllllnd t~ ..,.;;
right to seU \hem. I Ctlrtlly that'ttwltenil itted arl free Irom'all k'l.
'-,' , .,cumbrancos,'lllgroe to accept ",mportilblllty for providing good I
title Wld fOf delivery of thle tt) the ~ch.Pl', It II agroed thllt the l'
i..lt-lioonMonco Iloot rosponli~ tOfUlil ~pf Illy Item due 10 fire, thelt,.:"'",
'-':;:,:d.mege, atc; I UI'ldorstand ttt., ~~~...<<.,.l".:T.'" - ','" '*' commission' '.,~-;
wIN be deducted from the gross lIa~ of ,my Items" \ . 1-'
.i:",
,
Consignor Signature
CONSIC;IJOn's fHECKIN COi'Y
'""'''', (""1 j SCHEDULE I-t J
~:jb FUNERAL EXPENSES,
COMMONWfAUt< Of "l<l<mVAN,. ADMINISTRATIVE COSTS AND
II<'URlIAI<Cf lA' mU'1< MISCELLANEOUS EXPENSES
RHIOfNIOfClOfNI .__._._....... Plea.. Print 0' Ty!,.o _.
~F-'=- -- - ---...-.-. ---'~-"" . FILE NUMBER
__....!..~~ob ~..:.. nic~__~____~____...__.w._....__.._L_._~.7"0 177
InM
NUMBER
A.
1.
8,
1.
2.
3.
4.
C.
1.
2.
3.
4.
S.
6.
7.
8.
DESCRIPTION
FunOfol ExP'.IO"
prepaid
Admlnl.trotlv. Cost"
Peroonol Ropre.entollve Commlsslonl
Social Security Number of Personal Representative,
Year Cammlssluns paid ____
A<<orney Fee. to Andrews & Johnson, attys.
Family Exemption
Claimant ___.
Addre" of Claimant at decedent'. death
Street Add,e.. ___.
Relatla~lhlp
City __._..___._.
Stdte
Zip Code
Probate Feol
to Register of Will.
MI.celloneou. Expenses:
Frank Potteiger, Auctioneer - sppraisal
Montgomery Wards - income tax preparstion
Darlene L. Moyer, Tax Collector - ]997 County & Boroygb Roa!
Estate Taxes - 13 E South Street
Borough of Carlisle - wster & severbil!
T.V. Cable of Cadlsle - finsl bill
U.G.T. - gas .ervice
1'.1'. & L - electric service
United ofPA - t'.)"phone bill
AMOUNT
l,575.00
13'7,00
30.00
70,00
188.14
11,94
11.13
27.24
96.84
29.91
SUB TOTAL (Allo enter on IIn. 9, Recapitulotionl
~-----
S 2 . 1 77 . 20 (see attach
-
(II mar. .pac. II ne.d.d, Inllrt addition..! sheets olsamo ,'.e.)
L MORTG~~~~~~:~l!~~D~I~SJ. PI.... "".", ",.
.~. _~=~~-~~='~~~==rl~~ Nl:~~~:7~-0-17.7
'"'''''''''''''' *'
COMMONWIAlIIlI.1' PlNNIYW....NIA
INllUIIAN(t lAX ll'UU~
_UlOrNlllfCftllNI
fSTAfE Or----
.Jacob F. nick
-......--_._~~._-- . -,-~.----.."._~._-_._...-~.__._--~-- ~~--------~--
ITEM
NUMBER
-~._~ -~,--_..-.....--_.
......___._..._ ,,~,__,,______'__.~._m_""_"__' _..__~h
---._~~-_.._--
DESCRIPTION
AMOUNT
.._-.-_. -...----". .
1.
Ilendidal Consumer Disco\lnt Co., acconnt. no: 05686468
(see letter attached)
2,817.07
2,
Dauphin D~p08it Bank & Truat. Co. account no: 80370199001
(aee lett~r attached)
1,744,05
3.
Fulton Bank inatallmunt loan, ,account no: 217-1061917
(aee lett~r attached)
1,1,27.24
4.
Herman and Shenk - fuel oil bill
88.35
5.
United of Ph - tulephone bill
88,37
6,
Borough of Carliale - water & "ewer bill
23.64
7,
UGr - gas bi 11
54.44
29.65
8,
T.V. Cable of Carliale - bill
9.
R.W.C. Emergency Physicians - medical bill
Moffitt. Peas't! & Lim Assoc, - medical bill
Montgomery Wards - outstanding cr~dit card bill
Genevieve Yohn - loan repayment
12,7t;
10.
2.22
II.
846.95
12.
200.00
.___._n_~__.'____'_' __._.._~..__,__.__________ -,-~,--'-'''''''''''''--'-''--''-'--''-'-
.-..,--......-.. ,-..-----.- .--. ,. .-.----.-
TOTAL (Al.o entor on lintl 10, Recopihilolionl
$ 7,334 . 7 "....____
,.-... --_.__..._,--------_.,,------~-~--., .---
(If moro 'pace ;, noeded, imerl additional sheeh 0/ wmo SilO.)
'" J _rl-'"-....,/ /-:1 ,r-'
;II ;' /:1 --. /fL-1..? .. 0:-'
aUaEAU OF INDIVIOUAL TAKES
IHMIT~t UK DIVISION
DrPT _ ("11601
HAAAlSIUMO, PA 17121-0tOl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOnCE OF INHEalTAHtE TAK
ArraAISE"ENT. ALLOWANCE oa OISALLO~AHCE
OF DEDUCTIONS AND ASSESS"ENT OF TAK
12-15-97
DICK
01-23-9"1
21 97-0177
CUMBERLAND
101
["~-"-A.iiO..;;rR.Oirt.d-:J
--- . --=
_.__~~_._~.._~.,.~._.__u~_______.__
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG TMIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
illY: mriii{ -"FP"n,9= 9'1r NOY i tEnOF - "fNHEii if AN-C E - fAx -jiPPitA"i S EHEN'r-; - "L.i."oWANC E" jiFiU - - - - - n_.. - -.. - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
JACOB F FILE NO. 21 97-0177 AeN 101
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
RONALD E JOHNSON
78 W POMFRET ST
CARLISLE
ESQ
PA 17013
ESTATE OF DICK
TAK RErURN WAS I ( ) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. Rem1 Est.te eSchedule A)
2. Stocke ~d 8ond. eSchodul. B)
5. Cl~..ly Hold stock/Partner.hip Int.r..t eScheaul. C)
4. "ort,.g../N~t.. H~c.lyabl. (Sch.dul. D)
S. C..h/8~ n.pa.ita/Milc. P.~aonml Property (Schedul. E)
.. Jointly Ownod Property (Schedule f)
1. Tr.-nlfera (Soh.dull, 0)
S, Totlll Aa..t.
I X I CHANGED
SEE
(1) 32.000.00
(2) ~
(3)___..!L!!..
(4)_.__.1., UO. 00
(5) 26~li
(61 .00
e71 20,754.81.
eal
APPROVED DEDUCTIONS AND EXEMPTIONS:
.,. FUN",.1 Exp4m8e./Ad... Co.t./Mhe. b:pe.,a.1I (Scnedul. H)
10. Debta/I1o,'tpvlII liabiUU../U.na (Schodul. Il
11. Totol Deduction.
12. Not Volu. of To. ftoturn
1S. Ch.rl'tabl./Go....llrn...nt.1 aequ.at.; NDn-eleeted 911S Trust. (Sehedula J)
14. Net Value of E.t.to Subjoct to To.
If .n ......m.nt w.. i.sued previously, 1in.. 14, IS and?or 16, 17 and 18 will
reflect figur.. th.t include th. total of ALL returns assBss.d to date.
ASSESSMENT OF TAXI
1S. A.uunt of Lln. 14 .t Spou..l r.t. (lS)
16. A~t of Line 14 taxeble .t Llne.I/CI... A ret. (16)_
17. ~.nt of Line 14 to.oblo ot Collotorol/Clo.. Brat. (17)
18. Principal Tax Du.
TAX CREDITS I
PAY"ENT
OATE
09- 9-97
NOTE I
~ECEIPT
HU"BER
AA242253
DISCOUNT (.)
INTEREST/PEN PAID (-I
.00
. IF rAID AFTER DATE INDICATED, SEE REVERSE
FOa CAL.CULA nON OF ADDITIONAL INTEREST.
(,)-
llO)
7,006.56
l
'*
7.lli.ll.
Ill)
Cl21
Cl3) _-'
1141
.0eK.00.
66,471.3I!.K.06.
.00K.15.
Cl81__.
AHOUNT PAID
3,99B.84
~AL TAX CREDIT
l!^LA~CE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE .L=
.tv"lu; U ~I~ In.'1I
JACOB
F
DATE
ATTACHED
12-15-97
NOTICE
NOTE: To inl\lre proper
credit to ~our .ccount,
aubttlt the upper portion
of th1~ for.. with your
t.x pey"ent.
80,812.66
14.341 ?8
66,471.38
.00
66,471.38
I
(
~
)
"
.00
3.988.28
.00
3,988.28
3,998.84
."-._-
10.56CR
.00
10.56CR
IF TOTAL DUE IS LESS THAN .1, NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR I, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF TillS FOR" FOa INSnUCTlONS.)
,~
"
R[SER~ATIOHl E,tat,. of dlcld.nt. dyIng on or bafore D'c,~'r 12, 19&2 .- 1f I"Y fut~r' lnt.r..t In the ..tete I, tr~.f.rr~
1" po.u..lon ar ."jOl/llIillnt to Cl... a (coU"t.ral) b.nlflclt1'JI' of thl dlCldlnt ,fttr tilt Ixpiration of MY ..ut. for
11fl or for y..r., tha co..onw..lth IMrtby IMpr..,lv r..erve. thl rloht to apprat.. end al"" tran.',,, Inheritanol TIMI.
tt the lllwful Cl... I (cl;Il1etlrlll 1'lIt. on any such future Int.rut.
PURPOSE Of
oonCEI
To fulfill th. r~lr'Hnt. of $acHon 2140 of the Inhilr1t1nol and Eltat, TB>l ",ot, Act 21 of 1995. (72 P.S.
Slct Ion 9~40),
D,tlloh the top portion of this Hot1u and .ub.U .,lth lIour pay"nt to the RIghtlr of Wll1l1 printed on thl r'lIl"a .1d1.
'-l1ake ChKk or ItQnctY ardlr pIIY-lIbl, tal REGISTER. or MILLS} AGENT
PAVHENT I
OBJECTIONS I Any pertv In Int_r..t not '5tl.fied with the ppprBI....nt. allowancG or disallowance of dlilduQtlons, or ~.s..s.ent
ot t~K (Including discount or Intere.t) es .hown on this Not\cG IU.t object within si~t~ (60) dayS of receipt of
thh KaUca by:
A refund of tl taM. c:r~lt, which was not requested on the h~ rl.tur". eay be requut.d b~ co~letlng an "Appllctltlon
for bfund of Penn.~lvanla InherltltMe and E.tate Tax" (REV~13U). Appl1c:atlonl; are avnl1ltbl. at thll Office
of the Register of WillS, afW of the II Revenue Dhtrlct Officu, or by 08111nll the .~.c1al Zlj-hour
lM\.lot4trlnlJ ,.rvlca nulIbar. for for.' or'd.tio,,: In Penn.ylvanla I-S00<\6Z-l0S0, ouhide Penn.~lvanltl and
within local narrhbUrg lire. (7\7) "87-8094, rOOf (117) 771':-ll!i2 Wearing hlpair-ed Only).
REFUND (CR):
-.wdtten prot811t to the Pl nGpllrtlil~t of Rev.nu4l, Board of lpp.ah. nApt. 281021, Harrl.burg. Pl
--alactlon to have the ..ttar deter-.lned lit audit of the acc\)unt of the perIanal rap,UlIntatlve.
Happed tll the Orphanl' Court,
17126-1021,
OR
OR
ADMIN
ISTRABYE
CORRECTIONSl
fttotuei .rror. dl.coyer.d on thh fluen...lt .hould b. addr....d in writing tOl flA Oepflrte.nt of R,v.flUe,
Bureeu (If Indll.ddual hl<". lTTNl P(llt AII.....nt Revl.w Unit, Dept. 280601. Htlrrl.burg, PA 17128-0601
Phontl (717) 7&7.6505, S.. pitp ~ of the bookl.t "lnltrueUons for Inher-l'\;ltnce hI< Return for- 8 Fl..ldant
Dec~t" (kEV.1SDll for an .I<planatlon of adlllnhtr-at1vlll~ corrtlct:ablll errors.
If any tfU( dUll h pl.ld whhln thr.. (l) ulandar IIOnths after the dfJIcadent" deeth, I five perc.nt (5;() dlsoount of
the tall JUlld 11 "Howed.
The 15;( tall ..-MItty no-n-particlpaUoo pltl,al ty h eOllputed on thll total uf thli hll and Int.re.t ......H. Mtd not
p.id before January 18, 1996, tha flrlt dflY .fter the tlnd of thl till< allnnt)' period. lhll non~partlolp.tlon
penalty I. appe.1Abl' In the .ew. tlflnn.r and In the th_ Stl.G tl.. purlod a. yOY ~ould apPlilal the t8l( and Intere.t
that hu been ....".d III Indicated on thh notic..
Interest It charljttlG bill Inn In. with flr.t day of dIIllnqwtnt:y, or nine (9) lIonth. end one (U d.y fro. the date of
..th, tt:l the date of peYl*1t.. lIK" which bee'" d.llnquant b.fora JIInU.ry 1. 19U b.ar hlt.r..t at the r.t. of
,ill (6Xl p_rCl~t ptlr annu. clIltulflted at a daih tllte of .000164. UI tfll<U which b.c,.' dtlllnqullnt on ~nd .fUr
January I. 1982 will b.ar internt lit '" rflt. whlt:h wilt Yary fre. calendar y.ar to eal.ndl'll' year ~tth thnt rat.
lIl'lnOUr\Oed bv the PA D.part...nt of R.v.nu.. Th. .ppllcllbl. Intetut r8to. for 19&2 through 1'98 .r'l
DtSC~Tl
PENAl. TV I
INTEREST I
'!!!r lUternt Rate Oailv Int.rut F8eto; Y.!!! Intlre.t RllItll Dally Interelt F~
1961: 20X ,000548 1'87 9% ,0nOlll?
I '!If I!. 16:< .Q00418 19&1-19')1 11% ,000:\01
1'84 111: .000:\01 "'" ., ,OOOZlI7
1935 u:< ,OOO3S6 1993-1994 7Y. .00019l
1'66 lOX ,000274 1995-199' ..% .OOOZlI7
--tnt.rnt 1. ulculMt.d .. folloWll
INTEREST. BALANCE OF TAX UNPAIO X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
"-l"'.,. NotlcCl hlluld lifter the tu b.co... dlUnl1Ulnt w1l1 reflect an Jnhrut c~lc\j11IiDf'l tu flftun (IS) day'
beyond the d.h nf the ........nt, If pe')'...."t I. .ade aH.r tt\. lnterll.t COllputat hill date .~,own on thl
Notlo., additional Inter-.llt ....t b. cltlt:ullt.d.
PAVMENT I
Dtiteoh the top portion of thh Hotlo. Md .ubllit with your PIYI-nt .adl p.y.tIl. to thl nl.1 and Iddr..,
printed on thl rlv.r.. .Ide.
u If RESIDENT DECEDENT lak. cht<lk or ltOMy order p.ylbll tal REGISTER OF WILLS, AGENT.,
_.' If NOH-RESIDENT DECEDENT ..1<0 .hllOk or _.. ora, PIl.obl. t., COHHONWEALTH OF PENNSYLVANIA.
REFUND (CRll A r.fund of I tlM crtdtt, whloh WII not rlqu..tld on the TIM R.turn~ ..IY bl rlque'tlel bll' CloMPlltlnt In
"Appll..,IUon for Refund of PlnnlYlvenla InhlritW\Cl1 and Eltet. hM" (REVw!3lS>. ApplJC8t1on, Irl Inll_11 It
thl OfficI of the Rllhtlr of With, IIny of thl 23 R.v.~ Dlttrlet Offlc.. or fro. thlo.p.rt.."t', 24-hoYr
..,....rl", IIrvlel nuIIbIr. for fore. I)rdlrlnSIl In Pennlylv.,t. lwI00-36Z-2050, ouulct. Ptnnlylvanl.
.nd within loclt Hlrrhbur. ar.. (117) 711-1094, TDD' (7l7) 772-2252 Uk.rlne! IIlPCIIlnd onb),
REPLV TUI
Qu..tlon. rl..rulng .rror. contllnld on thh notlc. .hould be ,ddruled ~Ol PA DIp.rh~t of R.vll'lUl. au,..eu
of IndlvJdud TIMII, ATTNI POlt A.....unt R.vl.w Unit, Dlpt. 280601, fllrrhburll, PA 11121-0601, phone
(711) 187w6S0S.
DISC()IJNTI
If any tlM dull 11 olld within thr... (l) (lll.ndlr lIonthl Iftlr the (lelant" cMlth, I flv. plreent (SiO dlleount
of the tlX p.id 1. 111oWld.
PENALTVl
The ISi: tlX ~.ty non-partlcApIUon PINlft1t:y 11 oOllpUted on thl totll o~ the tex and tntarllt .......dl and not
Plld Mfor" JWtl!IrY la, 1996, ttlt flr.t day aft'r tM tnd of the t8M "nllty PI,.lod.
INTEREST I
Intlrllt 11 ehllr,," blglMlng with flr.t dl:l of dllInquenoy, or nl,... {'J IlOnth. end onl (I) dIIy frOll the tilt. of
dIIlth, to the dltl of P'YNnt, TikI. Nhleh *... dllln..,.nt blfo,.1 Jlf1ijlry I, 1912 belr Intlrllt .t the rate of
.IM (6iO plre...t per ~ cllcullted .t . dIllh retl of .OOOI61t~ All tI)CII Nhleh blClaH dlllnqutnt on .nd .ft.,.
JwMry 1, I'll ..111 bur ~"t.r.;.t It . r.tl which will ",wry frOll otlendlr y..,. to c.llndlr Yllr with th.t r.tl
ennouncMl bj thl PA o.pl,.tHnt of Rlvenue. TMeppllcabh Int.nlt: rlt.. fa,. 1912 th,.ough 1991 arll
VI.r Intlrllt Rlt. DIlly Int.rut P~tor V.lr Inti rut Rite D.lh Intlrut F~tor
--
1982 ZO~ ,0O~Ii41 19.' 9~ .000241
1'81 16:< ,oooua I9I'wl991 1I~ ,000301
19" IU .000101 1992 9~ .00OZ~1
1985 I!~ ,OO03Sft 199]wl994 r~ .000192
19116 1O:C: ,OO027it 1995.1991 n .000241
ulntlrut Is e.1cullttltl " follow'l
INTEREST . BALANCE OF fAX UNPAID X IMIIER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
_.Any Hotlel hi,*, ,ft.r the tflll ~OIII' cMlInqulnt ..111 r.f!Kt 10 Intlr..t ulcluhtlon to flU"," (IS) din
beyond thl dati of thl ......""t. If PIYHf\t II IIIdti .fhr thl Int.rut COIIpOtltlon dlt. lhown on thl
MoUe., addltlon.1 Intlrul MJ.t be uleul.tld.
Will No.
STATUS REPORT_UNDER RULEJLl2
I
Decedentl_0d c~b f!- ..{)~~
Deathl---#-t/tl--
____.~_~______ Admin. No. ..Lf'f 7 - tJC / )'7
Nllme of
Date of
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 above-captioned estate I
1 ,
State whether administration of the estate is complete:
Yes._~ 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 reBresentative file a final
account with the Court? Yes NO..z__.
b. The separate Orphans' Court No. (i f any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes ~ No
d. Copies of rece ipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to thi7 ~~t.
D.'" rt/PO 'tP/:7r
! -l~',i
l~ -j
I' .: I.?
Capacity: personal Representative
)(Counsel for personal
-rrepresentative
(MAH I rmf/ AM3)