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HomeMy WebLinkAbout97-00192 c( cr- '- 1:"'- cr- ..., '0\ I Ol~~ ~----'3' ,1 , - . o Z ',-, PETITION FOR PROBATE and (;RANT OF' I,ETTERS Estate of J ('nil' c. _ 2it:j,JJ(1 R- t:. _ No. _ ).. I - 9 7" I 9.;t a/so known as _________..___.__.___ To: (7"ln"~li<'. f.i..:':>ir'LvOIi't- _. Regisler of Wills for the u__ Deceased. County of _<;:lJMBERLANIJ Social Secur/IY No. :.tg~: I ~. <( I r. ~ .. Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who Islare 18 years of age or older an the e_xecu~_ in the last will of the above decedent, dated ---'.!1tJ.. rr IL q and codlcll(s) dated ____.______ In the named , 19..i:.L (stale relevant circumstances, e,g. remmchulon, death or executor, etc,) Decendent was domiciled at death in C 11mb" r- lCi. ,\ cI- County, Pennsylvania, with h."'" last family or principal residence at 'K..>I() Li",lll1rl\ k'NlI'I ;4f11. .'Fi:/(,J (l!lMPh:/1 f'A l'rOLL /;D/<~<>:'g, /}J/I'..J iwp. (lIst street. number and munclpalhy) Decemlent,then I/)~ y~age,died ,>I.-a,'" ,19..2..:l..-, at J.jIlJII S~,r' -/-; ()~P' . Except'as fo lows, 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 'Iictim of a killing and was never adjudicated inco;;)petent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Pers0\1al property In Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: .3 110(1 (!l! . $ $ $ $ WHEREFORE, petltioner(s) respectfully re~uest(s) the probate of the last will and codlcl1(s) pr.,ented herewith and the grant of letters -1<":;. Q 1>?~,rlCII2 V (testamentarYi aamlnlslrallon c,t.a.j admlnistraclon d.b.n.c.t.a.) theron. i 3 /}n~~ a, (J.d~'-<.., ] ~ ..llle..[{;!i}!.. (L R;:;-!:~ U ;,~ ~".:1.:1~U'lh,.r-^ J<DMI ~!J1LL-- ~ ~ " ,1./):1 I Ef! ('70/1 ~~. -- 1'0 a <i\ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } ss COUNTY OF .cl1MBERLANIJ The petitioner(s) above-namcd Iwear(s) or affirm(s) that the statements in the foregoing petition are true and correct. to the best of Ihe knowledge and belief of petitioner(s) and that as personal represen- tatlve(s) of the abovc decedcnt pelitioner(s) will well and truly administer the estate according to law, ~:&~~ ~~ th~: affiT~cfnd su.:s~~~~ { -211.,jJ'oH''i! {l. {l,dA..(!1.0 f '-n~~~: ~y,~;~:-'1~.. t.Cl. !1v;-I~ 1 Q "'~'" R"",,, :_ . . . 16-110<1- .:l u HlOO II' tl~V II-M I'll' 1('lI~ THill fltWtcAlf Ul'l'/i WAIlNING: It IS ILLEI1AL TO AU E:fl HilS COpy OR to DUPLICATE BY PHOTOSTAT OR PltDTOOnAPH, COMMONWfiAI Hi OII'H>IN!nIVANIA ()'flA""M~N1 or HI'AllH \Ill A\ HI<UlfHl!.i 21-97-192 LOCAL REGISTRAR'S Cf'fHlflCA liON 01' DEATH CERT. NO, 3401921 ,J ...z".. 7' 7' .-~~2-1nl~(j, (iTni.CI(iiffiiilOO~'-' Name of Decedent .__ afl~".,''r:'E~f![(~!L_~ .................~r:f..~__....__~H~_ _r77r~~~_.~._~_~._._. MiQdl~" - -LalI! Sex _.__~ ....m.___Soclal Security No._..:"?4L:.~.,2n=..)>/ c. i:'._.._._.... pate of Doath.._ ,;t..:...<2: J: 'r'..?_..__ Date of Bi rth........Z:(J._--,2._!...__.. BlrthPlace...._.jtft...!:~-f'.'~.I..k~~~;Ji..._____~.._.._____.__._._n....... Place of Death ~~J~;...d d.^l~p./ C;',,,,'6',l""',;4.!.:!c.C /_':-'/;:-..4/JIoMJ~;O, ~1D.mVg , ~11i'YN6m~t:..LS:!:j). Couflly Olly,t!qW<lgllnrToOitnslllpl Race ...~0~.E.z7..c_._ Occupation ._4>",-1'-i.~3",C:.Lf.:-____Armed Forces? (Yes orNo) _______.. , ' /. Decedent's . / / /' ,- 0' Marital Status j<k':-)2.v' ..._.._ Mailing Address JLf:) ,-__.&A'p<~,v' ;<-(.,~(..4f.,P$g ......t;!L(.,.?':~/1 NlImb.lt 5!tUQI ~Clly"T(lW" SlaM ..A: ' "/!:/, " . J''/ ' Informant ~r;ll0c7 h /"'rJ-I' o^!.j!~_..._ Funeral Director _._1.'{/i:~:1(!M;;.IJc" FI/J/C,.J;:r ...__ Name and Address of 'J" ... ,d ~/ c Funeral Establishment _Jl"1/t.J"-/1.~J' /7/1 ,;'<J0...~.-i'!..,tj- ;.gJr..t ,?7A'MIJ'?J,r/4A__.-'--____ r-- / I Interval Between Onset and Death Part I: Immediate Cause S') /I' A-.'..... (a) _ '-- {.<.,.IP"."C'-ff..J /W~,,-I;e: 47VC;ic:,.q...r..Jr.U",J-/i1-<<'!....'t;JAJ , . / (b) --.C.;)~1"1'l"f..<4 A#c..7Z"'-r . ,)..;S:CA..f.&::___.,-_ ( ( I /(cJtu.J ....-.----~.~ I J4/.;,<.f I (c)_. (d)_ Part II: Other Significant C9ndltlons ~_. ,/t:l,,,:-c,- l...l'1,(.:;'-:-1A/,1"';:;"./(1 j Manner of Death: j',i.:P.i."L;( ."f' "",.0.<<-1""" J'. r- , Describe how In/ury occurred: Natural l);1 Accident 0 Suicide 0 Homicide 0 Pending Investigation 0 Could not be Determined 0 Name and Title of Certifier ___ ,P<' 1/;'1_'<;[ Jc h-<,c'-:-Z-b'C""".. Address /,J' "',()Oa.::>c ,iY . A --C~:-/.<<) " L:"': ...E.__ /7(.1 ':/..1 / , . (M.l:?:. 0,0" Coroner, M.E.) This Is to certify that the Information here given Is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing, 4<'/.<:Jl..!--?~<<~~"L.(';:u../,'4'::'];;'d{-4 Jel""J!; taro.1 AIlOIl\f.roIVII.lflfICor." , blljIIGIN~ 3(, "," %'","J"\'.IJ'i-~ ,'V'<.Jt~<?"'h~"d Slr.l Mil'.. Clly, QI;)fCllJgl1, lOWf\tIllll )-jj-:"Y' ? ----ri~e(;i'w..TiiYlocal Atgliir.r--- ( I 'I I I I , :1 I " Ii ! i I I 21-9'1-192 me itementbrre:b 1ft " m~llt ~, of in the CQu,nty of and State o( Pennsylvania, beint of 1I0ltnd mind, momory alld, ltlldentumlint do "..a~ and publi,vh thiN my last Wilt and Testcurnmt, hereby rOlJokint a"lCl ,nakinl vol:d all former Wills by me at any time heretofore made. ""II ~inl.;J direot that my funeral be condu,cted in a mUllner correspondint with my estate and situ,ation in Ufe and fhat aU my ju,st debts and (uneral exptJ1f.- .8. be fully paid and Rati.8fie.d a..7 Roon as oonveniently may be a(ter my decease. t\nb to such estate as it has pleased Gnd to entrltst to me, I dispONe o( th.e same as fiollow., lJi:e,' , , ^ 1 ' {' )'.- - rr.?;' A. "I.-'" crt- A /7, ,7[i:A7'""'t:'. l'~...-r:~vv..-J< // ..-- - (. '(("F')L< '1/1 , ... ).r ~ o:S- ~ ct.<v'tr--bv ~ ~ 1~...A..Y .,4UrU I /?l17~<tl f p 17' .' ., f]" ~1 ~A~ ~lo-P-~ . aff~1171 ~~~r~' A '1JJ.--'''~,4 Ch-~'. : """r,{0#.ar (1'hJ. {'~p.)rl"" Signeq this 9th day of March, 1987./fj/d-<-rev<. f II:.? J,'vrtA"'/ ,~ A~ul 2~=:]at.t,,~ I / WI TNESS ;f , " _-'_)16[)/<, t (.:"1,;),- WI TNESS u' Stete of Pennsylvania County of Perry On t.his 9th day of March, 1987, peraonlllly ~ppeBred' Jenr,ie stewart, kr1o"'n to me to be thE' per~on whOoe signature appi;ars above, aa a Lrue Hnd'leg!l1 iliqnatLlrl'l\" . . ... il .' ''7 j'J roth ~a~;~rC~~;::'y Public . DOR01HY A, TAYLOR, NOTARY PUBLIC My Comrniuion g,p"e, May 26, 1988 Marysvill., PA porry COllnlv 1.1'\ .... co) .W mr.:,-; ,'1"--" "" " t~ <;( ')0. \) I ; ,~" () o r>: .~ ff1 u.. i"- ~ ,-. ..~ () (JJ ' .. t!!!u: 0 88 !,-nb I herebv nomin~te, OO/lstitu,te and ,!,ppolnt . .... E;uout of this my tWIt WUl and Testament. ;3Jn ~Iln... ~~ereof, ;lJ the Testat ,have to this, my Will written on one sheet of paper, set my hand and seal, this day of .,4, D. One Tho/l.sand Nine Hundred and """""""I...,.,.".,..""""",tt,,,,,,,,.,...,,,,.,,,"..,.,',."...".,',..,.,..,"~ Sitned, S~aled" Pl~bU.~hed and D~olared by the above named as and for last WiU and Testament, in. the pre"enoe olus, wJw haviI hereu,nto sub"oribed our names at. request as Witnesses theretn, in the presenoe of the said Te.,tat , and of each oth.er.. ..;...,..................,...,..........,.......................,..,.,.., ,...,. ....................,...,..... .... ....... ..~....... ... ..... r--t ~ i ~ ~' 1 ~~' I . ~ , -~ .1 - _. ~ - I , - - - .~ -o\::l ~ ~' \.o..tlll ~I)) ( $:l ))) ~ ~ IS t1'-~ i<1 - .. ~ J ~ - ......- - ~ m - ! ikJ ~ - -- , - ( i l / ' ~o ~ i. I l . \ \ I \ I I I qo 1itf. "lS N C> "0 gt ('\ :' ~, "0 ~, :..j':. .~ q , , '\ ;~ '\1 ~ fI; l.) _i~: , , b 0'-:)) ~~ on' p:; !a: " , 1-,' " " I O~ " 06-06-2000 STEWART 02-23-1997 21 97-0192 CUMBERLAND 101 [- ~ A~unf~~i~:~~ - 'l MAKE CHECK PAYABLE AND REMIT PAYMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS .... REV: isi,-j-iif-"FP-i iF99riiiificr-o,;- i:"NHEiiifliNcE-"fA"x-APP;liiisEHEiiY-;-"LrowliNcE-ori-------m- -- m_ DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JENNIE G FILE NO. 21 97.'0192 ACN 101 If an asses..ant was issued previously, lines 14, IS and/or 16, 17 and 18 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 1S. AMount of I.ine 14 at Spou\Jal r .t. (15) u., ".Qunt of Lin_ 14 tQ)(.bl. at Lin..l/ClMu A rat. (6) 17. Allount of I. Ana 14 tax.bl" .t (':oUah",allClass Q rat. (17) 18. P....incip.l Tax Due TAX CREDITS: -_. PAYHENT DATE /5--/G,<./- <1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUA~ TAXES iHt1UnlNtl Uk DII/ISHltl DtPT. nObO) ItARR I fiBURG , "A 111lfl-0601 NOTICE Of INHERITANCE TAX APPRAISEHfNT, A~lOWANCE OR DISAllOWANCE Of DEDUCTIONS ANO ASSESSHENT OF TAX II;' I d DATE ESTATE OF DATE OF DEATH FILE NUMBER OO~NTY ACN '[)O .JliN I? MELODY A ANTHONV RR 1 BOX 118C E WATERFDRD GJU PA 17021 CUII:I ESTATE OF STEWAR,. J ~: H j! 1: i TAX RElURN HAS: I X) ACCEPTED AS FilED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Er;bh (St,hedule A) ?. Stooks end Donds (Sohedule B) 3. Closely lIeld stock/Pllr,tnerlhip Interest (Schedule C) 4. Mortgege./Notes Receiv.ble (Schedule D) 5. Cash/8ank Oeposits/Hlsc, Personel P,'operty (Schedule E) b. Jointly Owned Property (Schedule F) 7. Transferlll (SoheckJ!e G) 8. Totel bsets U) (2) (5) (4) IS) (0) (7) .00. ......!l. .00 .00 2.837.89 ,00 .00 (8) ) CHANGED APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/AdItI. C06ts/Hiso. Expenses (Schedule H) 10. D.bts/~ortgeg. Liebilities/Li.nt (Sohedule IJ 11. To'tel Deduct Ions 12. N.t Velue of Tex Haturn 13. Cheritabl./Governllentel Dequesta:; Non-eleoted 9113 TI~usts (Sohedule J) 14. Net Value of Esbtte Subject to Tex 600.00 I I :1 1,'1 I I I i (9) UO) .00 Ul) U21 __ (15) U41 NOTE: .00 X .00. 2,237.89 X .06= .00 X .15= (18) RECEIPT NUHBER DISCOUNT it I INTEREST/PEN PAID I-I AHOUNT PAID INTERES,. IS CHARGED THROUGH 06-21-2000 AT THE RATES APPLICABLE AS OUTLINED ON ThE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT .---.-. BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE u * .fY.li~l (I n~ lIt."1 JENNIE G DATE 06-06-2000 NOTE~ To insure proper creeli t to your .Qco\.tnt, subMit the upper portl~l of this for. with your t.x PlYMnt. 2,837.89 600 00 2,237.89 .00 2,237.89 .00 134.27 .00 134.27 .00 134.27 27.86 162.13 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS lESS THA~ $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS RHlF.CTED AS A "CREDIT" ICRI, YOIl HAY BE VUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERYATlONI E.tlt.. of deoedtntl-c,lyl"" 0I't "r lMfou DeoHber 12, 19&2 ..~ if MY future Snt.rut in tha_ ..t.t. it- tren.f."rod 1n po....don or enjo)'Hnt to C1... 8 (collat.ral) benIIftctart.. of the /,Mo~t efter the expiration of ImY .stMt. for lHe or for yura, th-t COIIlIOnWeltl. hlirebY .xpr...b r...rv.. tht right to tlPprell. IHld ...... tr.,..f.r Inl'MlrlttnOl Te)(u .t t~ lawful CIa.. B (collateral) rete on an~ suoh future intere.t. _Of NOTICE: To fulfll1 the r.qulrannh of Seotlon ?l40 of the Inherltanu and E.tate Tax Aot, Act 21 of 1995. (72 P.S. SaQUon 9140). PAVttENT: O.tftCh the tpp pnrtlon f.If this Matico p,nd subltlt with your pay...nt to ttM Reahter of W111s printed on the r.yer.. deS.. --Kltk. check or "OOI'.ly order payebl" to; REGISTER OF' MILLS, AGENT REFUND (CR)I A refund of 8 tax \lretlJt, which WI." ntlt requested nn thQ Tax R.aturn, Ray be requested by cotIPlet1na en "Appl1caUon for Refund Of PYIlfllylllania InheritenfJ8 end F..toto Ta)('" (Rf-:V-1513l. Applications ere avallablll at the Offiee of the Reubt.r of Wills, flnll of thCl Z!t Revenua Dhtrlct Offleos, or by oaUlng the .peolel 24~hou" Mfl,...ting .er"I(;1I mMber's for forlls ordering: In Pennsylllftnht 1-800-!62~2050, ouhld411 PItflnSlylll&nla and within local Harrls~u~~ er.a (717) 787-6094, Services fn~ t.~pBYQrS with spacial heQrl~ and .~aklng h..d'l 1w600-44?~1020 (TT only). OBJECTlOHS, An)' party in inter'lt not .athflad 10Ilth the apprtil"eunt, aUowanca or dhal1a"ltOC8 01 dudllctlons, or 8......."t of tax (ir.cloo!ng dhcD\A'lt or Interestl a5 shown on thh Notice lIIust objlit(;t within sixty (6(1) doy~ of r4tCeipt of thil HaUee by, --written protut to the PI. lJapartunt of Revenue, Board of Appeals, Dept. 28102:1, Harrlsbul'g, PI. 17128~lDZl, OR --election to Mile the lII.tter datlwllllnud at audlt of the account of the perllonnl reprellentetlve, OR ~~appea1 to the Orphans' Court. ADMIN ISTRATIVE CORRECTIONS I Faotual errors dlscollerltd on thh atleultlmt should bu addressed in writing tal PA hepartHnt of RQVltnue, Illr.eu of Individual Taxu. AnNl Post bllenMGnt Review Unit, Dopt. 280601, HarriSburg. PA 17128~0601 Phone (711) 187-650&. Sfle page 5 of the booklet "Instructions for lnharitance Ta)( Return fl)r . Rei1ident DMoedunt" (REV-1501) for an 8)(planatlon of adeinlstrativelll correotnble errors. DJSCOUNTI 11' MY tax dull Is paid within three (3) calandar _onths flfter the decedent's dlloth, a five p.rcant (5):) dhcount of ttKl tax paid is aUowed. PENAL TV: The 15;( tax ..,..ty non-padlclpatlon penalty is cOlllputed on thll total of the tex and J,nterast tlsse.,od, and not paid bofore January 18, 1996, the first day IIfhr the end of the t<<l~ Nlnesh pl1lrlod. This nonRpartlolpaUon pflnalty is appealable In tha .""'" .anner- end In the the ue" tla& periOd as you would appeal the ta)( antI Intore.t thl!lt has twlan .......d ItS Indicated on thl& notlc(I. JNTfiRESlt Inbtrut is oharged lKi"lnnlng with first dRY of delinquency. or nlna t ~) _onths Itf1d OfMl (1) d.~ frOB the date of d.ath, to the datil of paYHnt, Taxea whIch bilolllHt dellllqt.Hmt before January I, 1932 bear Int.rest at th. rat. of six (6~) p.roent per Itnnua celeulated ftt B dally rate of .000164. All t8xes which bile... delinquent on end aft.r J8nuary I, 1982 will bear Int.rnt at fl rute wh-\ch will vttry fr()ll cnl_ndar year to cehtndttr ye"r with thttt rate announcad by the PA o.partu"t of Rell..nu.. The appLicable Jntllreut rates For 1982 th'"ough ZOOO arlf ~ lnterfil.t Rate D"l1y Inter"lISt Factor: :!.!!! Interest Rate DaBy Jnterest factor 1962 20>: ,000548 1988 '1991 H% .000301 19&5 16;( .000438 1992 9% .000247 1984 11;( .000~01 1993-1994 n .000192 1965 l'5y. .000356 1995.1993 9% .000247 1~" 10>: .0002'14 1999 n .000192 1981 9% .00024" 20ao 8% .000219 h~Jntere.t 1. c.lculated .s folloWSI INTEREST c BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR ~-AtlY Natloe luued IIIftar the tax beCotWlI dclllnquent wUl raftact an Intere.t caloulatlon to fifteen OS) dayS bII~ond thll datil of the 8ne..IHNlt. If p.y.ant Is eadll aUsl' tho Interest COIIputl!ltlon datil .hown on the Notic., additional Int.~.st lUst ~ cal~ulated. \ COMMONWI At HI ()[ 1'1 N~ISnv^NIA [JI,!'AII1MINl or I'IVI:NUE 1IU1IlAU or II~()IVIOUAL lAXU [In>' }BO(lO\ t(AIiIII~;lIUI\(l, f'A 111 'J!lotlO 1 RECEIVED FROM: MELODY ANTHONY R R # 1 BOX 9863 WATERFORD, PA 17021 ........lald PENNSYL VANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 193.12.9168 FILE NUMBER: 21-1997- 0192 DECEDENT NAME: STEWART JENNIE DATE OF PAYMENT: 11/06/2001 POSTMARK DATE: 11/05/2001 COUNTY: CUMBERLAND DATE OF DEATH: 02/23/1997 REMARKS: MELODY ANTHONY CHECK# 480 SEAL ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: INITIALS: SK RECEIVED BY: Rb:GlS'J'I;:1l OF WILLS IllY lH1;l LX! 1\ 1101 NO. CD 000485 MARY C. lEWIS REGISTER OF WilLS AMOUNT $178.25 $178.25 \. /~ /,<"'/ .,,;)/ BUREAU Of INOIVIDUAL TARES IHHUUTANCf: UN IIIVISION Dfl", '80601 tlARRIBlURG, PA 11lrl,.oUl COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX BTATEMENT OF ACCOUNT '* tH.Ut1 1M UP ClI-III ME L ODY A ANTHONY RR 1 BOX 118C E WATERFORD necor. ,i ,,j DATE 12-17-2001 R('I " I' , ESTATE OF STEWART '.1 \ DATE OF DEATH 02-23-1997 FILE NUMBER 21 97-0192 '01 ole 27 ~1D :()7 COUNTV CUMBERLAND ACN 101 JENNIE G PAUeOZl Climb" ",' .,( 1'/\ E_= ~~.unt .R..UIOd "'---J MAKE CHECK PAVABLE AND REMIT PAVMENT TOI REGISTER OF WilLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 HOTEl To in.ur. proper ored1t to your lecount, subMit the upp.r portion of thl. forM with your tMX Ply..ni. CUT ALONO THIS LINE ... RETAIN LOWER PORTION FOR VOUR RECORDS ~ REV: i 60rEif - AFP -nFii ii"i----- -liii.- -iNliER i "fANC'!- fiix -s 'j'iifEH"E-tif - OF - Ai:couiif --..-.. - - -- - m_ - - - - -- - - - - -- ESTATE OF STEWART JENNIE G FILE NO, 21 97-0192 ACN 101 DATE 12-17-2001 THIS STATENENT IS PROVIDEO TO ADVISE OF THE CURRENT STATUS OF THE STATEO ACN IN THE NAHED ESTATE. SHOWH BELON IS A SUHHARV OF THE PRINCIPAL TAR DUE, APPLICATION OF ALL PAYNENTS, THE CURRENT' BAl.ANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE, DATE OF lAST ASSESSMENT OR RECORD ADJUSTMENT, 06-06-2000 PRINCIPAL TAX DUE, 134.27 PAYMENTS (TAX CREDITS), PAYMENT DATE U-05'-2001 RECEIPT NUMBER CD000485 DISCOUNT (+) INTEREST/PEN PAID (-) 43.79- AMOUNT PAID 178.25 . IF PAID AFTER TillS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN .1, NO PAYHENT IS REQUIRED. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 134.46 . UCR ,00 .19CR IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YDU NAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRN FOR INSTRUCTIONS, I PAVHltNT, Detaoh the top portion (If thll Notloe and 'Ub,it lI1th your paY'.nt ud. ~.y.bh to the n... and .dar... printed on the reye,... Ilde, If REBIOEHT DECEDENT "ll(e chel:lk or .oney ol'der Plllotbl. tOI REGISTER 0,.. WILLS, AGENT. If HON~RF.$lDENT DECEDENT ..k. ohlck or lonly Ilrdlr payab1. tOI COHHONW2AL TH OF PENNSYLVANIA, REFOOD (CR) I A refund of . hI( crldlt, whloh Mil' not requllflhd on the TII)( R.turn, _lilY b. requ88tsd by oOlllpletlng an "ApplllileUan for "'fund Ilf Pennlyhlanhl Inhlritantl l!Ind Estat. TII,lC" (RF.V~1313l. ApPllc!.ltlonl Ire 8VIIU-.b1e .t the OfflcI of the Rlllhter of WUlI, an)l of the Z) Revenue DhtrJot Offjcu or frot tha OIlPllrt..I,tl. 24-hour ."....rlllil ..rvice for for.. orderinll' 1-800~36ZMZQSa, IIIrVlem8 for tB)(plIYlrli Iollth SPIChll hlllllrll'iG and I or .pa.kSng needs I 1-800-41\7-3020 or only). REPLY TOI Q~.t1vn. rlgarding arrorll contfllnecJ on this notlcl .hould b. addr....d tOI PA Dllp8dlenl of RavenuI, Bur..u of IndJvidull hl<lIS, ArTNI PCI.t Assailment Rlvlttl Unit, D8pt, 280601, Harrisburg, PA 1712'8-0601, Phone (717) 787~6505. DISCOUHTI If an" hI( dUll Ie Pl!lld within threo (3) (I.hndar lIIonth. afhr t.h. dllol!ldent's deflth, II flv. p.rclllnt (Sin dhcount of th. telC pllld is 1II1lowed. PEHALTVI Tha IS;': hI( IIM8lIIty non-pt'lrtlcJpIIUon PCinplty h cOIllPutllld on th. total of the hI( ..,d Internt .......d, ~d not pald b.fcr. January 111, 1996, the Ur.t d..... .ftlr thellnd of th. tax ellln.sty Plriod. INlEME~TI Inhrlll.t 11 chlllrlJ'Id beulnnlnu with first dlly ~f d.Unquency, or nln. ('I) .onths and onll (lJ dly frail th. tiat. of d8lth, to the d.t. of paYIII.nt. Te~1III which blltlllllllll dellnquunt bdorll January 1, 19&2 bear lntllrut at the rabl of III( (6::0 pllrcl!lnt par MFlUIII clllculat.d at III daily r'lte of .000164. All ta~.. which bec.IIIIl dlllnqullnt an end IIIft.r Jlnuary I, 1982 will bur Int.rut .t II rate whlnh will vlry frolll oal.ndar year to o.hndar y.ar with that ret. announo.d by the PA Oapart..nt of Rlllv.null. Thill app1icahlll Jnt"rost rlltu for 1982 through 2001: arllll Vnar Interut ~.t. Dnllv Intllrest f-'lIctor V.ar Inter.lt Rate Dally Int.rut Fllctar 1982 20X .000548 1992 OX .000247 1985 16;( ,000lf38 1993~ 1994 7% .000192 IOa4 11~ .000301 1995-1998 oX .000247 1985 B~ .000356 1999 n .000192 1986 10;( . DOOZ;'4 2000 aX ,OOOZ19 1987 OX .000241 2001 OX .00U247 19a8~1991 ).1;( .000:501 2002 6X .000164 --Inter..t i. clllcu1llt.d .. fo110wsl INTEREST. BALANCE Of' TAX UNPAIO X NU"BER UF OAYSDELINqUENT X DAILY INTEREST FACTOR "~Any NoUo. "tiLled aftar thfl hix btllcoIII.. delinquant will reflect IIn Interlllt ellcullltlon tu fUtDn US) days b.yond th. elllte of the alll"8111lIn\' If PIIYIII'int h Ilad. flU.r the lnhrut OClllputeUen dlltll Ihown Dn th8 Nottell, ftridltlon_. Jnhrflllt .Ult be a.leulated.