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PETITION HlR I)ROIIATE lmd GRANT (W LETTERS
')./. /991. /9 ~
(~ (', 1\ (I, \
No,
1'0:
I{rgl,II'rof WJII, for I I"'
. , /)l'CI'lW'd, Coullty of 1,.o,"f)"L(U,-,L" 111 the
Social Srl'lIril,l' No, ",,'.("f' ( ',~ -",. 1)03, C(lIl1l1Hlllwrlllth of I'cnnsylvllllhl
The pel II 1011 of Ihr ulldl'l,iglled rl"prl'l fully repr"\\'1I1s Ihlll:
Your prlillolwr(,), who ishu'e I H year, of age or older all Ihr r,~eeut,",U,._..,,,.._,,____~ IIllmed
IlIlhe la,t will of Ihl' ahove drecde,", dalrd... ')".f' 1 , ;,., ;..'''!X'L'_"..''_'____, 19_,__
IllId eodidl(s) dated ",. __"_,,, "__''''__,__""",_______
~---.,...~.-._.-..--,. --'-~..._--_._._-,--_.~---_._~
('lllll' rrk'\lIn\ ~'irnlfmIUr1l'C', l',g. '\'lHlIll'illljon, <k'alh (lrl'\Cl.'lllnr, ell',)
Dcer,lIdl'lIt lOll' domldlrd at dealh 111 '"''Q..'c,_~',j",!,~d~~-<l.,-,-(..,''' count, y, PellnsylvaniaA wllh
h..&C,_.. la" fal11il):-llI' prilldpal re,ldenee al )..,.Ll:~"'.('..~~~),,_:!,,\,~k['.1..L.~~[!D"I.', U\,
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1Il'1 \Ir('('l, 111ll11brr Hlld 1111Hl\.:ipnlilr)
1lI1)~~;~v'{!l~,~ra=e~~I~lf:I,~:~,,'~.:'::~::I~:..L _,~-~--' 19 ..:
Exerpl H' follow,. dreedrllt did nOlmarry, IVas 'HlI Qivo,eed alld did nol have a ehild born or adopted
aflcr e\el'lllion of Ihe will orrered for probale; wa, nol the victim or a killing and was never ~djudiealed
incolnpr.'tclll: __.".__~...__.~ ..._.___.__ ...".~___..__."._____._~_____._..
Deerlldrnl al dralh owned property wllh Collimated vlIlur, a, rollows:
(II' domiciled In Pa.) All pmollal properly $ l,o, lIOO C\ t)
(If nol domidled In Pa.) Personal property in Prnn'ylvHnla $
(If nol domldled In Pu.) Personal proprny In County $
Vallie of rcull'slU1C ill Pcnnsvlvania $___
situatcd Us l'olllH\'S; u_~.______~."~_._u__~.__._.__;--.--......-.-.....;....-.------.... '
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..----- ----- -_.-.-----.------...- --_._---..+.__._----.-------_._._~
WHEREFORE. prtllioller(,) rr~peelrullY reqyeSl(s) thr probalr of Ihe last will and codieil(s)
pre,\ented here\l'lIh and tlw grant of lellmu,_,,__,:(:.":,j~_\:\t'.i'21--..,___,
I IIC\lnllll'IHlIry; lldminl..\rmlon l'.l.n,; administration d,h.lI,c,l.a,)
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OATH 01, PERSONAL REPRESENTATIVE
C,OMM, ONWEAfjTH OF l't;NN~YI.V ANIA
('01' N'I'\' ()L' I . I h - ' {
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Thl' pl'lillOnCI'(S) ilh(lve"nillllC'd ~W(-,iH(S) or affirt1l('jlhHl the statements ill the foregoing petition are
InlL' and (,.'onl'l'l to llll' hl'~t llf the ~no\\'IL'dgl' and helief of P('llliolll'r(l.,) and thai as personal represen.
tali\I'I') ,,1'111,' ah()\1' d,wdellt pe';ti'''"'''I') will \\,'I,lj'llllruIY adminisler tllC,~'tale al'eordlng 10 law.
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h~~LW_U.~~_ANIl J:I~~i?:!:AMI';N.I
I, JOR1WIlTNII II. CLARK, or Bouth Mlddloton 'I'ownflhip, Cumlwrlund County,
Ponnsylvanjll, hetn~ of sound 1II1nd, memory und undt,rHtnndiny., do mnkt., publlHh
und qtJelnrc this flH and for lilY Lnnt \-1111 Ilnd Tl'Htlllllc'nl hl'1'l.hy ruvoldnjl, And mnkinjl,
voId 1111 fernier willB hI' Ill" lit. Ilny t.illle \1I'rot.ofore modI"~
!'lRST. 1 direct ull IIII' .1uHt dobtB Hnd funoral expenses tneludin!\ a)1
InhurJt:l1nee tuxeH he folly pn ld Hod Hill iHUed Ollt of IIII' ['Htlltu hy lilY per"onl1l
repreBentnt1.vc herelnl1fter Ol1l11ed nH soon ns ('(ll1VtHliently ITlIlY be done after lilY
decense.
SIICOND. My Bon Ronl1ld 1'. e11lrk having installed and puld for the furnll['e
in my home, I bequeath the BUill of One ThouHand Nine Hundred ($1.900.00) Dollars
to hilll or h1.s illslle. provided I have not previously reilllbursed him for this.
THIRD. I acknowledge that my children 'have hrought Hems to my home for
Btoruge and theBe items, therefore, belong to them.
FOURTH. larder und direct thut all the rest. residue and remainder of
my estate, real and personnl, be Bold at eltherpublic .or private sale and (.'on-
ve.rted :1.nto cllfth nnrl nf,"p.r my P9tntC:' haH heen conve-rted :Lntn cllsh" 1 g:lve and bequeath
the same as follows:
A. One-sixth (1/6) there!of to my son Ronn ld Clark or his issue.
B. One-sixth (1/6 ) thereo f to my son Roger Clark or hill issue.
C,. One-sixth (1/6 ) thereof to my daughter Barbara E. Leibrum or her iSBue.
D, One-six th (1/6 ) thereof to my son Theodore Clnrk. Jr. or his issue.
E. One-six th (1/6 ) thereof to my son .Jesse Clflrk or his taeue.
F. ,One-sixth 0/6) thereof to the children of my del'eu~ed daughter PatHY
Drsbenstadt or their i HBue.
LASTLY, I nOIll:lnaU', conHtitute Ilnd appoint my non, Ronald P. Clark. and
my dall~hter. Burharn II, l.eibrum. or the Aurvivor. Executors, executor or Executrix.
('of Lh:IH lilY LIlHt \-li.ll Ilnd TeHtamcnt.
TN WITNESS WHERlmF, ] h,we hereunto Bet ,my hond and seal this ,;;>'i'~ay of
)!!l~~....&^ , , 1989.
(lq~?J r.l. -1'" , f) . /jJOAJL (SEAL)
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COMMONW.ALT'" OF PENNSYLVANIA
COUNTY OF CUM'.RLAND
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belnll duly ":"",:5 !\j:.:= _ ,,_,.._ accGrdlnll to lew, dapoles and "YI thot ',he ~~._- /--" --,-.--,--
_,.,_.___L~,(.'_~~.w~-""--,,-- _,__, of the Elt.te of ,~'" ','_J'\)\' I, , I' I"': U Lit 1'.1::::...-.-_,_..
lote of __~:l,<."Ll\ "~I -'..-.i""'(\' \ ':.,... ., -,--,----., Cumberlend County, Po., ~~culed ond thot the
Ithl I I t d b k Ie- th Id ~ )0,'" _v...llA,,>-.
w n I an "v.n ory me e y ..__~._..__._. ~..__~..____~__~__._. ,___~,__'''M_'I ... - ,-
of the enllre eltato of uld decedent, conliltlnll of oil tho perlonal prop'.rty ond rul ~stoto, ucopt rul ..tote ouhlde
the Commonwulth of Ponnlylvania, and that the fl\lures oppollte uch Item of the Inventory reprelent lt'l f.lr volue
es of the d.1o of decedont'l death.
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__,.'>vt'-C'I... '-LL-_ and lublcribod before mo,
t ;~--~~_, " 2, 19 J1__
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tIIlilII.... t \ I 'IIId Coullly
14.2001
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IN.) JJILL..,_~). i (0.
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I. 7d v \'
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Month
11'17
Vu,
Dote of Oe.th __,
INSTRUCTIONS
I. An Inventory mUlt be flied withIn three monthl eflor appointment of personel r.pr..ent.tlv..
2. A luppl.m.nt Inventory must bo flied withIn thirty daYI of dllcovery of addltlonel .......
3. Addillonal Ih.... may b. attach.d II to perlonalty or roalty
4. Su Articl. IV, Flduclariol Act of 1949.
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'I' fOR DATlS Of DEATH Anu 12/31,/91 CHECK HERE
If A SPOUSAL
I POVERTY CREDIT 15" CLAIMED I I
flU NUMBER ,'_
I ",,2..1 "/1 . 0 I ""I ~
I:OUNTY cot>, !FAR NUMijER
i')[cflif~~Y's(oMJiITff '\"D(l~7~~u-~-,---
i ? '+- t--\.. 0 lJ (\ ,<I, I (\ I~~
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COC"r AM~;"~' ~r~iil~T.\':"~~::~~_~:=,,~.= ,_~~~==,
[J J. Remainder Relurn
Ilor do'., 01 demh prior 10 12.13,621
["-] 5. Federal Ellate Tax Return Required
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INHER!TANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
l2u e Total Numb~r of Sufe Dflposit 80xes
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{I )(,,"1. DOO 00
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COMMONWI:AITli Of PENNSYlVANIA
DfPAIHMfNl Of RfvHHH
DEn 100601
n_ ._l-!,A_~~I,S.~,l~_~~l,__P.~_ !/J ~n.o~~_I_ _
D~(EDENf;rNAMt llAST, fiRST, AN() MIDtHI: INlllAll .__~....~_,_._.__._.____._.___.nn_._.___
i 'O;~~~'::~~i~-:~<'V p ~I!'r~~f^'/~j'~~ Ir~~' ;~',";41 ~
n_ ~ _n, '"'~''''.''''':~.i~-,;~~.''.:'''I~''-'~\I ,;"",'"", "'"'''' I""'AI ",,'"'' 1<\"""
t)It Original Relurn [ ) 2 Supplomontcll Roturn
[] 4, lImlled fllClt& [ ) 4a, FUIUrft Inteffltl Compromise
(hH datos of death ahor 12.12,82)
[] 6. Decedent Dlod Teslate [OJ 7, O(lc6dent Maintained a U...ing TrUll
(Alloch copy of WUI) (Attach (Opy of Trusll
"~~~O~Rf.sP9NII.NC' "Nil cciNPjOENTIAd'AX 'NPO~M"TiOlriIlOIlLO 1l10IRICtil; TO;--'
NAY', _ /"-- ~ - _.._ f. COMPlm 1I:.IldllNO ADDRES!ih _
C')(2.af(c,,( f ,QOvtot-AS. W~&, 1-1 W,11\t S,
""PHONE"U"''''''--'----------' .,. (1",1' <, k , Pa, I ,Ot ~
Cl)lJ -~~'i:~?l",~l_J:tJ)c~, 'cC~C'C_'__' " "....ccc"c='c,=~=,==~~"",._=...
w
,-
:.c:!1I)
lrllE~
:cog
ut"'
.;,>-
wili
"",
[;!iz
,~~
z
'"
~
E
~
U
'"
'"
1. Real htale (Schedule A)
2. Stocks and Bonds (Schedule B)
3, Closely Held Slock/Partnenhlp Inleresl (Schedule C)
4, Morlgages tlnd Noles Receivable (Schedule D)
5. Cafh, 8ank Depo$11$ & Miscellaneous Per$Mctl Properly
ISchedule E)
6. Jointly Owned Properly (5chadule Fl
7, rICl..le" (Schedule GI (Schedul. II
8. Tolal Gron Altoh ItolalUMs 1.7)
9. Funeral Expenses~ Admlnhlrlllivo CO$IS, Mlscellaneout
Expenses 15chedll!e H)
10, Debts, Martgage llabllilles, llem (Schedule I)
11. T 0101 DeducH.", 1'0101 lIn.. 9 & 101
12, Net Value of Estate (llno 8 minus line 11)
13. Charitable and Governm(lntal Bequest! (Schedule JI
14. Net Value Subleclto Tax (Line_..1..3....mlnut l!ne 13)____..
15. Spousal Tral1sfer$ (for dotes of death after 6-30.94)
See Instructions for Ar,plicable Percflnlage on Reverse
Side. (Indude valuas rom Schedule K or Schedule M.l
16. Amount of line 14 laxable 01 6% role
(Include values from Schedule K or Schedule M.l
17. Amount of line 14 tOKoble 01 15% rate
(Indudl!l values from Schedule K or Schedule M.)
18. Principal lax due (Add lax. from Lines 15, 16 and 17,)
19, Cred!h Spousal Poverly Credit Prior Payments
(l01.
,- );!~ I
111) .%~'2L......i.l'..!i___,___
,iJ_ i '7'1'1: I '1
(l21 ,-'-..L'f----'- ' __, -".., ,
1131 ' ....._,_
(141 'fL-_LH li..!..J.J
z
'"
;::
;!:
'"
..
lE
'"
U
:l
>-
+
~
(lSI ,____,_._______X,_u
1161 ,!i~.....J._I.:I:.':f::.:...1_,j,,_~>< ,06 u
,:<5-0:- DO
~~___....L.......~~_~.._..
(l71 -'_ ,." ,,-'--_________....x ,IS.
'-'1:,:- (- . u
(l61 ---,",-,,,,,,"_;;1_.,...,,e
Dhcounl
tnteresl
+
(l9)
1201
20. If LiOQ 19ls greater than line 18, 6nter tho cliHeronce on line 20. This is the OVERPAYMENT,
me]
Chcck hr.l{' If you CIt(! rcql!e~tlng C1 refund of you, ovcrp(lymc,nl
21. If line 18is greottlr Ihun LJn& 19, onler lhe difference at! lina2L Thi$ i11he TAX DUE. (21)
A. Enter the inlerest on the balance dU6 on litl& 21A. (21A) .._._~<_.,.._.________
B. Efllar the lotol of line 21 and 21A on line 21 B, This is Ihe BALANCE DUE. (21 B) .__~~__~__~S.<-~_Q_. n. ,... ....___
-_____~~~~!~!.~'!'.~.~~.! .'~.:. .~,~~!~~.!__oL~!I~~_~_. ~~.~~!. __ _. ______un' n_ _ ___ ___ ________ __,,"__....___ _ __...__~ ,"_
'.. . '..=--~ > I.!:~URI TO ANSWER Ai:LQlf~STIONS ONR!VERSE SIDEANIHO' RICHICKhlATH ..c: -<, " "~
~~der pnnalliet of perjury, I dedare thcltl hove exominod this relurn, including accomponying ~chodules and stalements, and to the best 01 my knowledge and belief,
It II true, correct "nd complete, I declare lhol oil rflol ostot(l hen been reported llttrue market valuo. Dedarctllol\ of prcporor olher than the personal reprefenlalive il
bosed on 011 informalion of whic~ preporer hO$ ony knowledge,
SIGNAfliRf~ESP-6N!Pf-rCJii-F;rN.G)ltTU'R"N....'-.' ----A!)r.iRi'-5~ . OAU----;----n----.-...u-'
'iGN' 1~~iif';AiiiRDit:~JTi~ EPRES:~';;itr'::"': AI:~,l"'\:"<1 Dr ~\k\\~uu..lr~' e,. Oil,,:" DA[.V)"I'r,r.,...---
. "~1!.\ P(Ytw~>2~'llilll,! I,;) (. , - ..IS -ji.z.y 'i :1--"..
ClifiLlSLE, /'A 17013
,l!f\l,UllUi I1-UI
SCHEDULE H I
FUNERAL EXPENSES, I
~1~~~t~~R~:~r~~.~~!~:~~~SD.,L Plm. Print or Typ.
( ) ]PILI NuMOR -
'--,~(~L:.:-::._,P ~___.._.,.._,_ _~_'1/- D / 'j:;-
___n_____'__.__
DESCRIPTION
~jj.
COMMONWMltH ", ,rNNSYlVANIA
tNHfl:lTANce TAl( RfTURN
lIuwe~.~ oeceoeNT
dfAn OP
ITEM
NUMBER
A.
"J6YL8h'1'10 (2
1.
I Fun.:a,1 "E/"IP,.(n, "1.:~(~---_._---'-"-- --,,-,',--..---.
N_ , -\ v n ~:,..-Ji i '\';>')~
B. Admlnl.tratlv. co'"1
4.
C.
1.
2.
3.
4.
5,
6.
7.
a.
1.
Perlonol Repre.entatlve Commllllonl
So~ial Security Number of Pertonal RepreAentallvo: 188
Vear Comml..lons paid I l' q~
,
. - ':>.2.. - zll.')<'
2. Attotney Fe..
3.
Family e.emptlon ;-)
Claimant I< 0 (\ " \ J P. 0 q[~ela"Ohlhip SON
Add,," of Clolmant ot decedent's death
Street Add~, ~- ~ -+ lLlu u ^ -\tt, f'\ (l~
City Po d ,vi '\ 'S r ( , 1'\ '\-2--Stote PC\. .. Zip Co~e n 0 0.:1
Probote Feel
MI...llaneou. bpen.eSl
G...<I,\I<. I.h,,;,r' +-~
C4H,II O'Jr ad/ ..~.l~ ~ Z~v,~~.
C6-t1I>Ie. ~..p ...."T6Y\-e
I
<). ,,^,d~(-i.-{-ttr. '4'1"'r'^l' i ""y
. ~ .h r \ O<~,pn ,N'- ').....4.. iJ F tl JY\~
~~.,..:t pD' rn' V''^ ft.:>.uw. ':3<<l Ie (\~/JV\ h.d)1.ll ':.~
T 1'-~ 'S f't- f.<l..R.... ,oy-.. h """'€ '::>....t,......
'Do c... Pf2-e P ~~, <')..... h 0'\0"...( ~~-
/Vb;-<I \'
TOTAL IAllo enter on line 9. Recapltulotlon)
(If mart .pac. I. need.d. In..;t additional .h..t. of .am. "...)
AMOUNT
L; 172 .(Jtl
3'~S'"o. M
335o,C>D
~()OO.DO
/'13,00
~ 1.00
10&,00
'fro. 00
1 :,-; "0
4 () .2-. (). ~ ,l
'20.000, uO
L.."I,oo
'" .L~'. DO
2." ,;Ie)
$')"-"'" /
'" J ;, "} ,. 'f-
,
I '" '/~ ,j ",'-
,,).-/WY'L
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
, ,
,
aU~EAU OF INDIVIDUAL IAXES
INHUllAHCI: TAIl nlYJSIOH
MPt, ,.0601
HAItRl'IIURQ, PA 11121"0601
NOTICE OF INHERITANCE TAX
APP~AISE"ENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AWD ASSESSHENI OF TAX
IlATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-23-98
CLARK
02-02-97
21 97-0195
CUMBERLAND
101
GEORGE F DOUGLAS III ESQ
27 W HIGH ST
CARLISLE PA 11013
~ ~~~~tt.d
('"
*
U~.lhl n H~ cot."l
JOSEPHINE R
J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV: is;' 7' -Eif- Ai: ji - ((IF 97")" Niiff cE" -OF. "iNHER i;: AN"CE"YAx -APPRA is EjofEN'f; -A i. rciwANcE-iiri - - n_ - - - - - - - - - -.-
DISALLOWANCE OF DEDUC1'IONS AND ASSESSMENT OF TAX
ESTATE OF CLARK JOSEPHINE R FILl:: NO. 21 97-0195 ACN 101 DATE 03-23-98
,
,
"
TAX RETURN WAS, I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I ht.t. (Schedule A 1
2. Stock. and Rand. I Schedule B)
S. Closely Hald stock/p.,-tnarlhip Int.r.st (Schedule C)
4. Hortgeg../Nota. Receivabl. (Schedula D)
S. Ca.h/Bank Deposit./Hilt:. Par.unel Property (Schadul. E)
6. J~lntly Own.d Property (Schadule F)
1, T,..."starll (Soh.duh G)
e. Tobl A..ets
) CHANGED
(1)
(2)
(5)
(4)
15)
(6)
171
67.000.og
..Jl..Q..
.00
.......Q..t
283.60
.00
.00
(a)
APPROV~D DEDUCTIONS AND EXEMPTIONS:
9. Funer.l Expensas/AdM. Costs/Hi.c. Expense. (Schedule H)
10. Debt,/Hort".ge liabilitie./tien. ISchedul. I)
11. Tobl DeducHon.
12. Net Value of Tax Return
15. Ch.ritable/GovernMent.l Bequest,) Non-electad 9115 Tru.t. ISchedule J)
14. Nat Value of Est-t. Subjact to TIl<
(,)
110)_
25,539.41
NOtE t T", in.uf'e prape,.
crldit to ~OU,. ICCOunt,
lub_it the upper portion
of this for., with your
tal< pay...nt.
67.283.60.
~~.~~~9 41
41,744.19
.00
(,1,744.19
If an assessment was issued previOUSly, lines 14, 15 and/or 16, 17 Bnd 18 will
raflect figure8 that include the total of Ab1 returnl a.la.sed to date.
ASSESSMENT OF TAXI
15, AltOunt of Line 14 at Spou.II rate US)
16. A.aunt of line l(t hl<abl. at Lineal/Ch.. A r.t. Ub)
17. AMount of Line 14 texable at Coll.hral/Cl~.. 8 rat. (7)
11. Principal TI)( Du.
NOTE I
TAX CREDITS I
PAY"ENT
DATE
12-23-97
RECEIPT
NUMBER
AA242591
DISCUUNT (t I
INTEREST/PEN PAID 1-)
.0
.00
1111
112)
IU)
tl41
.00
(,1,744.19
.00
X .00.
X .06.
~ .15.
IIBI
A"OUNT PAID
2,505.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INlEREST AND PEN.
TOTAL DUE
BALANCE OF UNPAID INTEREST/PENALTY AS OF 12-24-97
. IF PAID AFTER DATE INDICA'fED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
2,505.00_
.00
2,505.00
2,505.00
.00
31.56
31. 56
( IF TOTAL DUE IS LESS THAN tl. NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR). YOU "AY BE DUE
A REFUND. SEE REVERSE SIDE Of' THIS FOR" FOR INSTPUCnONS. I
(:.:,',
".;;1
.,
Lei
t::J
j"l
.. - ~ :,.,
() C,i
RESERVATION I Eitatl' of dlo.dtnt, dylnt on or b,forl OIOllblr 11, 19a2 -- If any futurl Intlr..t In the I,tlt. 1. trenlf.rred
In poII..lllon or InJO)fl.nt to C.... 1 (ool1l1t'rll) ben,UoJ.rJu of thl dlCl,dlnt _fhr thl IMPJrQt10n of any ..tAtl for
11fl or for y,.r., thl tc..onw'llth hlrlby IMPrl..l~ r...rv., the right to IPprll.. end "'1" tr*Mlf.r Innerltancl T.~I'
,t th, lawful Cla.. B (oo11,-'ra1) I'It. on any IIUClh future Interut.
PURPOSE 01'
NOTICE I
To fulfill the requlr...nt. of Slctton 21~0 of thl Inh.rltancl and E.tet. Tex Aot, Act 21 of 1995. (72 P.S.
Slct Ion 9140).
PAVMENT I
nltaoh tht top port Jon of thil Netic, and ,ub,1t with YOU'- pey..nt to thl Rlght,r of Wllh pdntld on thl rlv"',, ,Idl.
--Hakl ch.ck or Mon,y erdr.:r plyabl, tell REGISTER OF MILLS, AGENT
REFUND (CR)I
A rlfund of I taM orldlt, which w'" not r.qultted on thl Tal( Rlturn, lay bl requutld by cOIplet1r'lf' an "Appllcltlon
for Rlfund of P'nnlYllJlI1\ie Inheritance Ind E,tIIt. Tax'" (REV-l5Ul. Applloatlen. ..re .v.ll.ble at the OfficI
af the Righter of W11l1, ,my of thll 23 RIlJlnUI Dlstrlot Offlou, or by Cl!I111ng thl Ip41clal 2it-hOur
an.wlrlng ..rvlol n~b'r' for for.. orderlngl In Ptnn.ylvRnll 1-800-362~2050, out.ldl Plnn,ylvanll ~
within loul HerrltbiJrp. area (711) 787~8094, TOO' (17) 172-Z~52 (Hearing IlIpalred Only),
OBJECTIONSl Any p.rty In Intare.t not ,.tl.fl.d with the .ppral.lllant, 0110w.noe Dr dlsallowancl of deduotlnn., or a.....II.nt
of taM <lnoluding disoount or Int.rllt) I' .hown an thlt NoUce IIU.t Object within ,1Mtv (60) dc:y. of recllpt of
this Notlll8 bYI
--written prot..t to the PA D.part.lInt of RlllJenUI, 80ard of Appult, Dapt. 281021, tilrrhburg, PA 1712S-1021, OR
-~,l.otlon to he". the ...tter cl.ttrtlr..d at audJt of the account of thl par.onal repr...ntetlv., OR
--appeel to thl Drph8nl' Court,
"OHIN
ISTRATIYf
CORRECTIONS I
FaCltual errors d!tcover.d on thlt a......."t should be addr....d !n wrltlna tOI PA Depart"."t of RIlJlnu.,
Bur..u of Ind1l.ddual TaKe., ATTNI Plllt A.......nt RelJllW Unit, Dep\. 260601, Horrhburv, PA 17126~0601
PhoM (711) 181-6505. 5". plica 5 of th41 booklet ''In.truetlonl for Inh.ritanc, Tal< Return for a R..ldtnt
O.eldlnt" (REV-ISOl) for .n el<planatlon of ftdalnlltratlvaly correct.ble arror..
DISCOUNT I
If ....y hI< dl.it it paid within three (3) calandar lIonth. aftar the decadant'. dl.th, a filJ' perCllnt (5:(1 dlsoount of
the till< peld J. allow.d.
PENAL TV:
The 1&1< tex I.,..ty non-participation pen.lty It cOllpUt$d on the total of the tlX and Illt.r..t n.....ed, and not
paid be for. J.nuary 18, 1996, the fIrst dall aftur th.. .nd of the talC alllnutv parlod, This non-partlolpatlon
pen.lty Is ep"aallllble In thl ..111 _anner and In the the .... tI.1 "artc.d at YOU would .PPIIII thl talC end Intar..,t
that ha. bllan ........d n. Indltllttd on this notlOI.
INTEREST I
Inter..t h ch.rald bllllnnlna with flr"t d.y of dt1!nquency, or nine (9) 1lI0nthl Ilnd on. (ll d.y frOll th. date of
de.th, to the data of pay.,nt. TaKe. which ble... d.llnquent before J.nuary 1, 1982 b.sr Int,rl.t .t the rat. of
.11< (6io peroent per .nnull colculattd at . dally rat_ of ,000164. All ta)(.. which blea.. dellnqu.nt on end .ftlr
JIf\IJlIry I, 1982 will bur lntQrut at a r.t" which will v.ry fro. cilllend.r yeal' to c.llndlr y.ltr with thlt rate
IInnoullcld b:J thll PA OIlPl!rtWlont of RIlJenue. Th. ftPPlIcablo Inter..t r8t.. for 1982 through 19'98 .rll
'!!!! Inter..t R.ta n.ih Inttrllt factor !!!r Tn'lIrelt Rate C.lly Interut Factor
1982 lO% .000548 1981 .X ,000241
1983 161: .000438 1988-1991 11% .OOO!OI
1984 11% ,000301 1"2 .X ,000247
1985 U;,: .0003S6 199J-I994 7% ,OOO19Z
1986 101: .000274 1995~I'98 91: .000241
--Interest It o.lculeteCl .. follo,,"
INTEREST. BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FAOTOR
~-Any Notloe I..uld afhr the tSK b.eo... I'JtIllnquant will I'IUeet an Inter..t ClIlculetlon to flU..n (IIi) dan
beyond the dat. of tkl e.~e'le.nt, If pay.ent I. lade aft.r the intere.t co~utlltlon dete .hown on thl
Notice, IddlUonol Intlr..t .u.t bl cllcuhhd.
IS,/~'1 J
BUREAU OF INDIVIDUAL TAMES
IHtIfRI lANCE lAIC UI\lUIOH
()[PI, 1111601
HAMhISMURO, PA l11Za-0601
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
.
U~'lH' U '" IIHII
GEORGE F DOUGLAS III ESQ
27 W HIGH ST
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
04" 2'1- 98
CLARK
07.-02-97
21 97-0195
CUMBERLAND
101
E , AlIOunt R~~tt.d=_-:J
MAKE CHECK PAYABLE AND REMIT PAYMENT
JOSEPHINE R
Tal
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
HOTEl To in.ur. prop.r oredit to your account, lubMit th. upp.r portion of th~. farM with your tax P.YM~t.
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV: H,ift -iif- ,,;:ji- (' o'3-:9'i"l" - - -" --...-- iNHiii i ;:ANCii -fA iesT ii f EHE-NT - ifF - Ai:"coUiff - - ii.. - - - --" - --- - - on - - - - --
ESTATE OF CLARK JOSEPHINE R FILE NO. 21 97-0195 ACN 101 DATE 04-27-98
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATeD ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUI1t1ARV OF THE PRINCIPAL TAM DUE, APPLICATION OF ALL PAVMENTS. THE CURRENT BALANCE. AND, IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 03-16-98
PRINCIPAL TAX DUE,
2,505.00
PAYMENTS (TAX CREDITS),
PAYMENT
DATE
17.-23-97,
04-01-98
RECEIPT
NUMBER
.-----
AA247.591
AA269909
DISCOUNT (+)
INTEREST/PEN PAID (-)
,00
31.56-
AMOUNT PAID
2,505.00
31. 56
0 3~
'l5 Po
:.,;~ N i)
a: /~
,.1 ~
~ 1
n 1./:
....,... "
~ ~l " ..()
~ ,- I':
a:: a: 08
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
2,505.00
.00
,00
. IF PAID AFTER THIS DATE. SEE REVERSE
SIDE FOR CALCULATION OF ADOITIONAL INTEREST.
C IF TOTAL DUE IS LESS THAN .1.
NO PAVMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREOn" ICRI,
YOU HAV dE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
.00
.AVHENT I
o.tlCh thll t'"' PCtrtiol' of this MoUo. ~ .ublU Mlth your pay,""t Ind<< Plv,bit to the l:Ialll and tddr...
prlnt~ ~ t~ 'Iv.r.' .1~.
If RESIDENT DECEDENT IIIlllkl chlok 01< IIOn'V ordar pllyabll tl)l REGISTER OF WILLS, AGIiNT.
If NOH-RESIDENT DECEDEHT .... ch.'" c, .",.y c,de' ...0111. to, COHI1ONWEAL TN OF PENNSYLVANIA,
REFUND 'CRl' A ,.fund .f . t.. c,..lt. which ,.. not ,.quo.t.. en tho T., R.turn, ..y b. r.qu..t.d by ,...l.tlng .n
"A..l1c.tlcn f., R.fund cf ..nn..l..nl. Inh"lton.. .nd E.t.t. T"" 'REV-mSl. A..,I..tI.n. or. ...l1011l..t
th. oW.. .f tho R.gl.t., .f Hili., on, .f th. " .mn.. OI.vlol Of/I." or f". tho O.."t.ont'. "-hoU'
lM'I.WIIr1nll 'Grvle. r\Uabe1' f(lr f~ru ordarl1'l1ll1 In pannsvlvania 1~8(l1)~36Z-Z0!iO, ouhld8 Plnnlvillanla
and within looal Harrlsburg .rllu {717) 787-8094, TDDt (7\71 712-2~!i2 (Hurlng I.paired only).
REPlV Tal
Qu..tlon. r,gerdinG .rrors tontalnld on thll noticl .hould ba addres.ed to: PA napart.ant of R'\I~nu" Bur'au
of tndhldulll Ta)(8II, ATTN: POlt ........nt RI\ll.w Unit, Dept. 28il601. HlIrrhburQ, PA 171?&-D601, phof\li
(717) 781"6505.
If .ny to. duo I. ..,d within th'.. m "l.nd.' .enth. .Il., .h. d.,...nt'o d..th, . "vo ..".n' 'Sl) dl.."",t
nf thti tRI/: paid is ~l1ol>l8d,
Th. ISl t.. .on..ty ncn-..,tl.l..tl.n p.n.1ty 10 .....t.d cn th. tct.1 .f th. ... ond In..,..t .......d. cod not
paid before JanuRry 18. 1996, th_ first dRY after thft tnd of the tal/: B.n..ty period.
DISCOUNT I
PENAL TV I
INTEREST:
Int.,..t I. .ho,..d b..'nnlng ,lth "rot dov of ..lIn...n.y, or nln. (9) ..nth' cod cn. (I) d.. f,.. tho d.t. .f
d..th. t. thO d.t. .f ..y..nt. T.... .hl,h b..... d,'ln.uont b.f." Jonu"y 1, I'.' b..r Int.,..t at .ho ,.t. of
.1. '6ll p.,cont .., OM'" ..loul.t.. at . d.11' "to .f ,000160. A11 t.... .hl.h b..... d.lIn."'''' .n cod .11.,
Jon."" I, I.at ,111 b.or lnt.,..t .t . rot. whloh ,lli yO,y frc. ..l.ndo, ymto c.,.ndor y.or ,lth th.t "t.
announced by tho PA Oepllrteent of RevlnulI. The DPfIlleabll lntlrlut rat.. for 1981 through }I)96 al'.'
Vaar lnter..t Rat~ Dally InterAlt factor
Vlar
Intlrut Rate
Dally Inlere.t Factor
1982 tuX .000S(t8 1987 " .000Z47
19&! 16;( .000438 19&8"IM1 111- .Ci00301
198ft 11X ,000:501 1"" 9% .000l4"
1985 1'5:< .000356 1993-1994 7l .00019Z
1986 lOX ,000Z7<1 1995-199& " .000241
--lnter.,t is oa1c.ulatltd .. fo 11 0IIl. I
INTEREST = BALANCE OF TAX UNPAI~ X NUHBER OF DAYS OELINQUENT X OAILY INTEREST FACTOR
--AnY H.lI.. I..uo' .Il., th' tox b.'_' dellnquont ,111 ,o".,t on lnto,..t oo",ul.tlcn to flll.on (m deyo
blYond thfl date of the a..uuant, If pDy...nt I. IMde "fte" thl Intllrut COllPutlIt1on d.tll .haWn on the
Motle., .ddit1onal Int.rlllt IIIU.t hi cllleulatld,