HomeMy WebLinkAbout97-00209
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PETITION FOn 1'1l0UATE null GllANT OF LE1TEHS
No. _-d..l:-1'1Q7 -~.
To:
Reglsler of Wills for Ihe
. Deceosed. Counly of C'nmb.,rl and In the
Social Secllrlty No. 195-07-7498 Commonwealth of Pennsylvania
The pe.lillon of Ihe undersigned respeelfully represenlslhat:
Your pctilioncr(s), whu iI/are 18 yenrs of age or older anlhe execul or
inlhe last will of lhe above decedenl, daled January 14.
and codicll(s) datcd
David.W. Basehore. the appointeQLCo-Executor. renounced
;1"\ f:nTnr nf 1\'Irl't'"m;;\n 1 B.a.c::ph/"':lrt::>. .1r D~\.,,1~y ~..,>~l,(.. V'rrtJf(..~j
N/~c((p-
Blalt oj NORMAN J . BASEHORE , SR.
also Anow" as
named
, IL2..L
(~lnlC rc:lcvnlll CllC:IIlIl.\It\IICCS. c..' IClluuclnl!ol1, cJClllh or CACtUla" tIC.)
Deeedenl Will domiciled nt dC~lh In Cumberland ' Coun~, Pennsylvania, wllh
II is, lasl family or principal residence at l:1;-3-9-i;crlulId.>=--Aveffil&.r!l. . ~ .
--1J)O /111 1'111<," .D..",- RnrCln\jl:l of ~ uf."." A\bv '''fO:'';:<::()
llislllLrceL, nUlllucr, 'l'wp. \lr Uora.'
Decedent, then 90 )'ears or Il~e, died February 2 "LL-_. 19.i~,
at Harri sbllr\l HClSpi tal .
Exeepl as rollows, decedent did nol nlarry, was not divorced and did not I,ave a child born or adopted
arter execution of lhe will orrcred for probate; WIlS 1Iot lhe victim of a killing and was never adjudicated
Incompelent:
Decedent at death oll'md properly with elllnloled values as follows:
(H domiciled in Pa.) All personal propcrly S 225.000 , 00
(H not domiciled In Pa.) Personal properly In Pennsyivanla S
(H not domiciled In Pa.) Personoi properly In County' S
Vniue of real eslale In Pennsyll'ania S None
sltualed as folloll's:
WHEREFORE, pelliloner(s) respeclfully req\tesl(s) lhe probate of the last will and eodicll(s)
presenled herewith and lhe grant of lelters Testamentary
theron. ~('e.\llm'nl:l; 71111s1"lIon c.~..: :::"lrOllon d.b.n.c.l...)
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OATIl Of PEHSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } s
COUNTY OF' CUMlIERI,AND ,
The pr,lltloner(s) nbove-nallled swenr(s) or affirll1(s) Iha lhe slalemcnls In the foregoing pelltlon are
Ilue and correello Ihe best of Ihe knowledge nud beflt'r petitloner(s) and thai a$ personal represen-
lallve(s) of the above deeedelll pelilloner(s) will w;l' an" trulY"admln er}I~-1:Slale Bccol'dlo 10 law,
Sworn 10 or argr~\led and subscribed' t!! /1/< {( i ..-- {~lt/1.u--1
. ~~~rcllne this _ . 1. i9 day of Nonnan J. re Jr.
-yy\IJ 1.11 ( 'J.t, ,( 1~)fLi~ I' YYYI}U\ii1r:"t
15-/liS- ~^HyJC. LEWIS JlrgiSlcr
Nu. lJ-lqq,,-O~
i"llle 01 _ HOIlMAN ~I. IlASEIIORE, SR.
, Deceased
DECREE OF PRODATE ANI> GRANT OF LEITERS
AND NOW MAlleI! -! 19,-!!... In conslderallon of Ihe pellllon on
Iha UVUU lid. hareof, ulllf'Clnry proof hlvln, been presenled before me,
IT IS DeCREED Ihltllie InllrUmerll(l) dated...- Januarv 14, 1991
dmrlb.d IIier.ln b. admllled 10 problla Ind filed of record as the lasl will o'f
Normon J, Basehore, Br.
Ind Leila,. Testllmontary
arehanbnr.nlad 10_ Norman.1. Basehore, ,Tr.
.
--,
--
MAllY C.
.. rYlJU.y C ~-U'.HJJ,^) ~(.LIIfl..JJftf
LEWIS R.,llI.r of Will. .
FEES
Proba.., Lelllrl, Ele. ......... $ 270.20
Sh~r! Carllneltll(7) .......... $ f ~: ~~
Jt\!ntiftYi'.~~n .,..... .,....... s_--=-
.Tep $ 5.00
TOTAL _ $_ 313.00
Richard W, Stewart (18039)
.1ohnson, Duffie, Stewart & Weidner
A1TORNEY (Sup. Cl, 1.0, No.)
301 Market St., P. O. Box 109
loAll\')yne. PA 17043-0109
ADDRESS
Filed . ""KARCli..4,..1~.~71'" I.'" ...
(717 \ 76] -4540
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LETTERS AND ORDER TO ATTORNEY
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RENUNCIATION
In Re Bltate of
NORMAN J. BASEHQRE, SR.
deceased.
To the RealsterofWllls of Cumberland
County, Pennsylvania.
The undersigned Son and appOinted Co-Executor
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
Testamentary
be issued to Norman J. Basehore, Jr.
WITNESS
my
hand this 3rd day of l-larch
97
,19__
SWorn to and Subscribed
before Ire this _l>"..S;l day of
'-c-- F II
...L-2c..:t (;U. -=::;'{o'-"'~'-uL
(5I,OIIU")
DAVID W. BASEHORE
24'1 () - +-'(.\ 'D\::'OCY. D1Z-\vc::
-S O-'\-M f<1"'\ fYl'Vl\../) C'1'\. (14 S B.s
(Add,.,,)
March, 1997.
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(5I,nIIU")
NOTARIAL SEAL
DIANNE LENIG. Notary Public
Lemoyne Borough Cumberland Co.
My Commission Expires Dec. 21. 1~97
(Add,.,,)
(5Ianllure)
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONW!AlT" 0' PfNN"'''NIA (TO BE FILED IN DUPLICATE
OfP...IltM[NT 0' R(VENUe 2.1
om. 210601 WITH REGISTER OF WILLS) COUNTY COD<
".."uu.G." 11120.0'01 ,
~ASF.lr~~~:T ,1ii~R:D :'Dlf8~;~'k~-'J~=-~=_c'--.-~--.- -1m;~3"'~:r:,~~~D~lil111~
1~;~~~u;~'7~;~' --=.G~~~~ - . J~/:/~~H--. co~~~I~?~bu , P^ 17055
I" ...;i(;,;"",..,~ii\",-, 1<''' ''''''"' .'PO" ",';;-;'i'-.--.l""".c.'Rfl' NUM,ii -- --t~f'VciibHI,--nn_- -..._- -- -- -
~J 1, Orlgl~~~----.--~~rJ~';-Su~plem:l~~R~~----- -. .-. -.---~-[~Ti:-R.mclnd.r RCtI~'~~----_.
Ifot do '" 01 d.oln prior 10 12.13.B21
o 4. limited estot. [J .40. Future Inl.rell Compromh. [J 5. Federal Ellal. TOI( Return Required
1'0' datil .1 d.otn 011" 12.12.821
II 6. D.ced.n! Died T.llal. [J 7. D.ced.n' Molnlolnfld 0 living Trull ~ 8. Total Number of Sofe Oepolll Box II
(Allocn ,opy of Will) IAlloch 'OPY of TrUll)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INPORMATION SHOULD BE DIRECTED TOl
NAoMI ==r10MPlfH MAILINQ AODRi$.$ ........-
Richard W. Stewart, Esquire ;lamson, Duttle, Stewart & W(,ldner
"'!PHON' NUM'" ---- 301 Market St., P. O. Box 109
&17 761-4540 l;)moyne, PA 17043~0109 -"
. -- ,--'
IIEv.1,500 fI(. (7 ~dl
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I. R.ol E,lo'. (Sch.dul. AI
2. Stock, and 80nd. IS,hedul. 8)
3, ClolOly H.ld S'o,k/Po,toltlhlp 10'''"' (Sch.dul. q
4, Mortgogel and Noles Rectll....able (Schedule D)
S. Calh, Bonk D.pos1t1 & Miscellaneous Personal Property
IS,h.dul. EI
6, Jolnlly Owned PtOP"'y ISchedul. F)
7, Tronol." ISchedul. G) (Sch.dul. LI
0, TOlol Grall Auels (tololllnes 1.71
9, funeral Expenses, Admlnlltratlve COlli, Mhcelloneous ! 9 I
Exp"'" (Sch.dule HI
10. Oeb... Mo,'gog. Liobllillll, LIOn! (Sch.dul. II
11. To'ol D.duclioo.(tolol L1nll 9 & 10)
12. Nel Vol" 01 Ella" ILlne 8 min" L1no II}
13. Charitable and Governmental 8equtsh (5chCldule JI
14. Not Vol" Sublecl'o To. ILlne 12 mln" L10. 13!
15. Spou.ol T,oool". Ifo, dolll 01 deo,h 011" 6.30.94)
Se. Instructions for Applicable Percentage (In ~.....erle 1151
Sid.. Ilnclud. volUOlhom S,hedule K Ot S,hedule M.I
16. Arnounl of LIne 14 ttJxable at 6(,0 role
(Include volulI from Schedule to: or Sth.dule M.I
17. Amounl of line 14 taKobl. 01 15% role
(Include valuel from 5chedulCl K or Schedl,lle M.l
18, Ptlnclpol'o. du'IAdd '0. ham llnll 15, 16 ond 17.1
19. Credlls Spol,nal Poverty Credll Prior Payments
_____ + l.2..500..JllL +
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. 'OR DATU 0' DIATH AmR 12131191 CHICK HIRI
I' A SPOUSAL ~
POVERTY CAlDIT 15 Ct,AIMID ( J
'Ile-NUMBiii- ,.. ..,.....
97
\'EA~
0209
NUMBER
.- ----.._-,,<. ..---- ---.
~--_.-
(11__
(2 )
(3)
(41
(S)
28,119.81
.-...
Ii
233,581.53
5,238.35
161
P}
(8 I 266,939.69
(101
12,636.36
2,018.83
(161
(111 14,655.19
1121 25i,281~____
1131 -G-
I1AI 252,284.50
)(._- -G-
252,284.50 )( .06 a 15,137.07
)( .15. -G-
1181 15,137.07
(171
Discount
6'i7_lJO
Inl.rlsl
1191 ____13,157.90
(201
20, If line 191s greater Ihon line 18, elller Ih, differen" un L1rle 20. ThllIs Ih. OVERPAYMENT.
DID
21. If L1na 18 II greoler Ihon line 19, enler the difference on Une 21. ThIs II Ihe TAX DUE.
A. Enter Ihe interesl on the balance due on line 21A,
8, Enl'r Ihelolol of line 21 and 21A on lint 218, This ISlhe BALANCE DUE.
Make Check Purabl. to: Reght" of Will., AUtn'
_ ~ ~' BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH o<(..c:..
Under penalties of perlury, I declare Ihol 1 hove examintld Ihll relurn, including accompanying Ichedulel and slalemenll, and to th, best of my knawl.dgl and bell.f,
II Is true orh)cl and complete. I declare Ihot all real "'01. hOI been reported atlrue markel ...alue. Oeclorotion of pr.pmer other Ihan the perlonal r.prellnlalive h
boseet olllnformotlo of ~h preparer hOI y knowledge,
'f __ U 0' "f~50N fiE 0 I. OR flU'jP IItTU.RN _.AO.D~.-7mT,' ""WjT1Cllnq WilY --.--.---------- 5.'l /~ 7 _ /
't.~ /I(,U 1 . ,) U (lUL~ l~K(( ('mnP..'.I~l~'A n1]O] 1____ C{L!.! (C/'l
\I ",,' ,~' "t'.ATf D''-'' 30,1 ~1ilrkd St., P. 0, Box l09 0"" / :;/17/7
r)~:1/ .~'.{,~....,I' , ._I<'Il.'0Vnt',.JYL_lJJ.L13.::0.ll!.2.._____. t:;'/~-----
al . ~ .f~WClrt., }',sq.
Ch{'(~ .H~I('" if you Of(! requc~tin9 a refund 01 yOU( over Dymcnl.
(211 1,979.17
121AI . -G-
12181 _..1,979.17
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...,WlJk.
COMMQNWlA,lTH Of ,fl"N5YLVANIA
INH""AHCIIAX RiTU~N
RIIIDINT DICIDINT
J
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCEllANEOUS I
PERSONAL PROPERTY J Plea'D Print ~.':2Y.e.!,._
FILE NUMBER .
21-97-0209
IIIV,ISO't".1?I11
F~TAYE <Sf
BASEHORE, SR" NORMAN J.
(All p,op.rtv lolntly-.wh.eI with the .Rlght of Survlvo'~~ MUll b.-ditc~o..d~o" Sch.~ul. .~. ._-
ITEM DESCRIPTION
NUMBER
VALUE AT
DATE OF DEATH
1 . Ladies Diamond Ring set with 1 old ~1ine
cut dialOClnd - 3.7nrn - .1B ct.- Appraised value.
2. Ladies Diamond Ring set with 7 single cut
diamonds measuring 1. 7mn - .14 ct. .. Appraised value.
3. Various Coins, Notes, Certificates and Dollars -
Appraised value
4. 1990 Oldsmobile Sedan - Sale Price
5. Ziegler's Auction - sale of household items retained
at Messiah Village
6. Electric Lift Chair - sale price
7. Electric Cart - appraised value
B. Cash in decedent's possession.
9. Internal Revenue Service - 1996 incane tax refund
10. PA Department of Revenue - 1996 incane tax refund
11. Blue Cross/Blue Shield - premium refund
12. Nationwide - automobile insurance refund
13. Nationwide - refund - nursing home contents insurance.
14. Fulton Bank - Certificate No. 222-0091520 .- date of
death balance, plus accrued interest,
15. Dauphin Deposit Bank & Trust Company - Checking Account
No. 2BB58557 - date of death balance, plus accDled interest.
16. Dauphin Deposit Bank & Trust Company - Certificate No.
B000186772 - date of death balance, plus accrued interest.
17. PNC Bank - Certificate of Deposit No. 31B00020268 - date
of death balance, plus accrued interest.
lB. York. Federal - Checking Account No, 090-844725 - date of
death balance, plus accrued interest.
19. York Federal - Certificate No. BOO-3185 - date of death
balance, plus accrued interest.
20. Harris Savings Bank - Certificate No. 04-66-25B9B7 - date
of death balance, plus accrued interest.
21. arris Savings Bank - Certificate No. 04-68-273755 - date
of death balance, plus ar,c.;,-ued interest.
SUb-Total fran additional SheEJt
250.00
175.00
59.23
6,200.00
1,504.50
500.00
750.00
50.00
835.00
21.00
200.30
113.30
95.00
20,076.67
17,474.28
40,207.95
50,1B1.79
6,98B.77
45,176.42
10,048,37
6,527.41
26,146.54
TOTAL lAlso enler on line 5, RecaE!!.ulalian) S
233,581. 53
(AI1C1en additional 8YJN )( 11" ,hteh If more 'pace II n..dfld.)
------
mAT"! OF
--=
SCHEDULEF I
JOINTLY.OWNED PROPER~
-- - I'PILi NUM'ER -
SR., NORMAN J. ~2l-97-0209
"VW)9lh 11~'''1
.!zl.9.
~
COMMONWEAUH 0' peNNSYlVANIA.
lNHUllI1"NCt '.1( RETU~N
~UIDENl DfCfD!NT
BASEHORE,
Joint tenont('l'
----,_._.~.._~_._...._-_._--_.~_.
NAME
ADDRUS
._---~....,.
RI~ATIONSHIP TO DECEDENT
A.
Norman J. Basehore, Jr.
240 Winding Way
Camp Hill, PA 17011
Son
B.
C.
Jointly-owned p,op.rty.
LEnn DATE
ITeM POR TOTAL VALU~ DECD'S DOLLAR VALUE OF
NUMBER JOINT MADE DESCRIPTION OP PROPERTY OP ASSET % INT. DlCEDENT'S INTEREST
TENANT JOINT
1. A 2/93 PNC Bank, N.A. - Checking
Account No. 51-4000-3169 10,476.69 50% $ 5,238.35
Date of death balance, plus
accl"ued interest.
.
.
.
,
, .
, .
TOTAL IAllo on'" on I1n. 6, Recopltulatlonl S 5,238.35
(I' mort spoC', Is needed inserl additional sh..,s a' sam. sin)
.tV.'3ll''''l'''':
BASEHORE, SH.,
SCHEDULE H L
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND "
MISCEllANEOUS I:XPENSES Ploa.. Print or Typo
- -., F E . MBER
NOHMAN'J. 21-97-0209
..,
,,~"~ll'>
~~......
COMMONWEAlTH (:If PENNLVLV",N1A
INHERIT~NCE ,....x f1tftuRN
U'I.ill!!'pf~NT
ESTATE OF
ITEM
NUMBER
-
DESCRIPTION
AMOUNT
A. Funeral Expon"lI
8.
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
1.
2.
3.
4.
Parthemore Funeral Home - funeral expenses
Holling Green Cemetery - grave opening charges
West Shore Country Club - funeral br.unch
R. J. Ranberg'i!r - marker lettering
8,354.'75
695.00
202.98
90.00
. .
Admlnlstratlv. Casto:
1.
Personal Ropre.entatlve C"mmi..lon.
Social Security Number of Personal Repr..ontatlvo. _
Voar Commi..lon. paid
2.
At1arney Fee. - JOhnson, DUffie, Stewart & Weidner
4,200.00
3.
Family Exemption
Claimant
Addre.. of Claimant 01 decodent'. death
Stroot Addre..
Relatlon,hlp
City
State
Zip Cod.
Prabat. Fee. - Register of Wills - Cumberland County
313.00
MI.cellan.au. Expen...;
Register of Wills - four (4) short certificates
12.00
65.20
60.00
5.00
28.00
35.00
10.00
15.00
550.43
S 12,636.36
The Patriot-News Co. - advertise letters
CtUTlberland Law Journal - advertise letters
PNC Bank - charge for Estate checks.
Register of WiHs - file Inventory & Inheritance Tax Return
Musselman's Jewelers - jewellY appraisal
Cam-ercial Coin Co. - coins, etc., appraisal
The' Patriot News Co. - advertising sale of automobile
futa1 fran Additional Sheet
"OTAl (AlIa .nt.r on line 9, Recapitulation)
(If more 'pace I. ne.dod, InlOl1 additional .hoe" of .am. .1".1
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CIIMBERLAND
}
ss:
_..-.tlorman J" ~.h.Qr..e.... Jr.
b.lng duly sworn ~ccordlng to lew, depolO' end ,eys that h. is Execut'?E..-___
. of th. Estate of Norman ,1. Basehore, SR.
I... of ~J2~-1I.n~..:rS?.!'!!1~!.l.!E.-___ I Cumberlend County, Pa.. d.o....d end th~t tho
d b Norman J. Ilasehore, Jr. h d Executor
within Is en Inventory me. y " _ _._._, t e sal _
of th. .nlir. ..tole of fOid d.c.d.nt. consisting of .11 tho p,"anel prop'irty end r..1 eshle, ncept r..1 elllt. outside
th. Commanw..lth of P.nnsylvlnl., Ind that th. flgurOl opposlt. ezCh It m of th. Inv.ntary r.present It'. fllr v~lu.
os of tho dot. of d.cedent's d.eth. '
Sworn to d b b d b f . / /' (/ ./
In .u scrl. . are me, / 1,7//(1. ./ttUllt""" /, l)..Li.
'-':'
\1,
19 97
,
Executor
\"...
..
, '
-::
DIANNE LENIG, Not lY hliu ,
LOIIIOYIIO Borough CUlIIDmlilllcl Cn, '
My Commlssloll EXpl1ll5 Doc, 21, In!)7
240 Winding way
Camp Hill, PA 17011
Add"..
Oet. of O..th
27th
February
M.nth
L997
DIY
Y..r
INSTRUCTIONS
I. An Inv.ntary mu.t b. flied within throe months efter appointment of porlon.1 representatlv.,
2. A suppl.ment Inv.ntary must be fiI.d withIn thirty deys of discovery of Idditionel OIs.h.
3. Addltlanel.h.eh mey b. etteohed II to persanelty or rutty
4, S.. Article IV, Flducierl.s Aot of 1949.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENr OF REVENUE
BUREAU O~ INOIVIDUAL TAKES
IHHERlfANCt lAK DiVISION
DEN, 280601
HARIHSBURO, fl... 1.,U6"OMl
NOTICE O~ INHERITANCE l~K
APPRAISEHENT, ALLOWAHCE OR OI~ALLOWANCE
OF OEOUCTIONS ANO ASSESSHENT OF TAK
RICHARD W STEWART ESQ
301 MARkET ST
PO BOX 109
LEMOYNE PA 17043
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
(~
09"29-97
BASEHORE
02-27-97
21 97-0209
CUMBERLAND
101
*
_I~.I~H U H~ UI.'"
NORMAN
J
[=_~~~~~~~i~,t=~:.=~~~ ~]
MAKE CHECK PAYABLE AND REMIT PAVMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTIDN FOR YOUR RECORIlS ..
if!"v: iS4"7 - EX' ^ FP - f '03:97 Y - Nfifi cE" .oF - '[ NHEifi T Ai-fcE - fA ii - iiPPRA" is EHENT -; -A L LowAi-fCE. ,ili' -. -... ... --. -...-
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BASEHORE NORMAN J FILE NO. 21 97-0209 ACN 101 DATE 09-29-97
If an assessment was issued p~eviously. lineD 14, 15 and/o~ 16, 17 and IB will
~efleet figu~es that inelude the total of ~ ~etu~ns assessed to date.
ASSESSMENT OF TAX:
15, A~ount of line 14
16. A..ount of l!"8 Iii
17. Alnoun-t of line 1'1
la. Prlno1p.l Tltx Due
TAX CREDITSl
PAVMENT
DATE
05- 23-97
06-13-97
TAX RETURN WAS, (X) ACCEPTEO AS FILED
RESERVATION CONCERNING FUTURE iNlrEREST --SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Est.t. (Schedulll A) (1)
2. Stock. end Bonds (Sc::hlldule 8) (2)
3. Clo..l~ Held stock/P.rtnership Int.rest (Sohedule C) (3)
4. Hor.tgllues/Note. Racaiv.bl. (Schedule D) (4)
S. Cash/Bank Deposits/Hisc. Personal Property ISch~dul. E) IS)
6. .Jointly OWnfld Property (Sch.dul. f) (6)
7. Transfers (Schedule G) (7)
8. Total Assats
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad... COlh/"U50. Expenses (Schedule H) (9)
10. D.bts/Hortgaue Liabilities/Liens (Schedule I) (10)
11. Total OadueUonJi
12. Net Value of Tax Return
13. Chal~it.ble/GoYern,".nt.1 Bequests (Schedule J)
14. Nat Value of Estata Subjeet to Tax
NOTE:
at Spounl r.t.
taxable at Linaal/CI... A rate
taxabl. at Coll.teraI/Cla.. B rate
115)
116)
117)
RECEIPT
NUMBER
AA211354
AA211418
OISCOUNT (+)
INTEREST/PEN PAID (-)
657.89
.00
CHANGEO
.00
28.119,81
,00
-,00
233.581.53
5 ,238...li.
.00
18)
12,636,36
2 . rUL.ft
I1Il
112)
(3)
114)
.OOK'OO=
252,284,5~ K .06=
.00 K ,15=_,
(8)
AMOUNT PAID
-----1'2 , 500-;00-
1,979,17
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
-~--
TOTAL DUE
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure prQpar
credit to yo~r account,
subllit the "pper portion
of thi~ form with your
tax pay...nt.
266,939,69
14.f.~~ 19
252.284,50
.00
252.284,50
.00
15.137.07
,00
15,137,O?_
15.137.06
.01
.00
.01
IF TOTAL DUE IS LESS TItAN U, NO PAVMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAV BE DUE
A REFUND, SEE REVERSE SlOE OF THIS FORM FOR INSTRUCTIONS.)
't.:;i'
'.
-J
CL
Li.J
1/1
RESERVAIIOH' E.t.t.. ., d...d.nt. d.lno .n or ..,.r. D......r II, 1961 .' It .n. 'ulvr' Int.r.lt In tho ..I.tl I. Iron.tlrrld
In ,...I..lon or ."jo...,,1 10 CI... . ,.011.I.rlll ..n.'I.I.rl.. .t tho d...dlnt .'I.r tho ..,Ir.tlon ot .n. ..1.11 '0'
II" or 'or ...r., Ih. t...o"...llh hlr'.' ..,r...I. r...r... Ih. rl.hl to .,nr.I.1 ond ...... I'M"'" Inh.,II.no, ,..,.
It the l.w,ul CIlln e (collet.rail ratll on any Iu(',h future IntGrut.
.'
,.
-.J
pUftPOSE OF
HOllCtl
'0 /vIUIl tho r.qulr...n" of s.ollon '140 01 tho Inhor".nt. ."d E...I. ,.. Aol, '01 Zl of 199'. '" "G.
seeUon 911\0),
O.t..h tho Ion norllo" of 'nl. Hnll.. .nd ."b.11 w"n youe n"..nl '0 In' ."I.tor of WUI. ,rlntod on Ih. ro..'" ."0,
...... oh'.' or .0nOY ordoc ....bl. 101 REGIStER OF ~ILLS, AGE,Nt
A rol"nd 01 . I.. or.dll. .nl.n ... ,,01 roqu"l.d .n Ih' ,oo R.M", n" b. roqv"t.d b. .o...."n. .n _..,."..lIon
'" R.fund of ..nn..lv.n'. Inn.rI""o, ond E.I... ,.... toEV'"'''' ,"."00"'"'''' ...Il.bl' .1 ".. DW"
.f tho RI.I.tor .f Will', .". .f Ih. ".ow.n'" Ol.trld Ofl..... or .y ..!lln. thl ,,001.1 ,Houe
.n...rln. ..rvl.. nu'.'" for fnr" ord"I".1 In ....".I"nl. 1..0H"'''''' ."t.ld. ..nnIYI"nl' .nd
w"hln 100.1 H.rrl.bur. ,1'" <7171 761."94, TOOO \117l 771-2'" (H..rl". 1...lrod Only"
Any ..rt. 'n In,.r.,1 no' ..II.,I.d .llh Ih. ...r.I....nl. .".w'''o' .r dl..I'o.,no. .f dldu..lon., or ........nl
.f ... <In.'udln. dllOount or Inl,,"" .. .n.WO .n u,l. Ho"" .... ollj.ot ."nln .1." (6OJ d... 01 roo.I.1 01
this Nollce by:
..wrlt\.n prol..t 10 'n. .. O..orl..nl 01 ..v.n"" .o"d 01 ."..1.. O..t. 2&1021, "orr,.b"", .. 17\26'1021, OR
.....oll.n '0 h." Ih. ..lI" d..".ln.d .. owd" of tho .o"unl of 'n' .".on.1 ro.r..I"""'" OR
__appeal to the Orph8nI' Court.
F..t".' .noro dllOo..rod 0" Ihl. ........nl .hould b. .ddr....d In wrltln. 101 .. O...rI..n' of R...n..,
."r.." 01 IndlvldV.1 ,...., ATH(, .,,1 ........nl .,,1.. Unit, o"t. 1.0601, ""rI.bUf., P' ""..0601
ph,n' (717) 7.7'6S0S, S.. p... S of Ih' boo"" "In.'r"o.lon. for Inh.rll.no. ". R.lurn for' ...ld.nl
Doc.d.n'" (REV'ISOIl for .n oopl.n."on of .d.lnl.,rollv.l. oorr.o,..I. "ror"
11 .n. 'OM du. I. p.ld ..lthln Ihro' '" "Iond" .."th. .ft" In. d.o.d."I', d..lh, . fl.. ."o.nl <ox> dl.ooonl 0'
tha taK paid 1. llI11owed,
'h' '" 10M ..n..IY non..""".."on ..nolt, I. oo.."tod on tho '0,.1 of In' 'OM .nd Intor.., .......d, ."d nol
..Id b.f.ro J."uor' 1., "96, ".. flro' d.. .ft" Ih. .nd of Ih. ,,, ..".... ."Iod. 'nl' n.n,..rtl.I.."on
..no1\y I. .....1..'. In In' .... ..n".r .nd In Ih' Ih. .... II.. ,,,Iod .. '0" .o"ld "..., 'he 10M and Inlor..t
thllt hal baen a~.u.v.d ., Indlc~ted on \hl~ notice.
Int.r..1 I. on.,..d b..lnn'n. .llh fir" d.. of d.'I"ou.n'Y' Dr nln. ('> .onlh' .nd on. (11 d'Y f'o' 'h' dol' of
d..ln, 10 Ih. d.l. of ..,..n\. '0... """h h'''.' d.II",UGnl ..foco J."u'" I, ,.., b'" Inl"..1 .1 Ih. roto ot
.1, (6Xl .ore.nl ." .nn" ..'o"",.d ., . d.lly rol' of ,000164, .11 I.... ,hlon b.c... dollnou.nl on .nd .ltor
J.nu,,' I, 19.' .111 .oor 1"1,,..1.1' "to ,hloh .111 .." ,,0' ",.nd" "or I. "I.ndor "or .lIh 'h' I "to
.n"."n..d b, tho P' D.,,,I.onl of ..v.n",, Tn' OpOlI"bl. Int,,,..1 ,,1" far ..., 'hrough ..97 or.'
'!!!! Inturelt Rat_ Oal1\1 inhrlillt factor '!.!!r tnt.rosl !!!i! !!!.IIY Inter.lt fllCtor
....---
19&2 ?DX ,QOaS{," 1?81 9% ,000241
198] 161. ,DOD4S8 1988-19.,1 ax ,DOOMl
19&4 11% ,OOO~Dl 1992 q" ,Q002.1\1
1985 131. ,0011356 1993-\9'14 7'!. ,OQOPJZ
1966 lOX ,Doon4 199!i-lCJ97 9% ,00024"1
.~lnterut l~ cah~ulatllrl .. follows:
INtERESt = BALANCE OF tAX UNPAID X NU"BER OF DAYS DELINQUENt X DAILY INtEREst FACtDR
...n. "olleo I..".d .ftor In' I.. ....... d.llnq".n' ,Ill rofl'O' ,n l"toro.1 ..Ioulollon 10 tlft..n II" d...
b..ond Ih. d.l. 01 'h' ........nl, If ..y..nl I. .od. .fl.r Ih. In,.r..1 oo..ul.llon d.l. .ho.n on 1\10
Hotlc;., additional IntarGtlt .ust ba crilllculated.
PAI/HENTI
~ErUHtI (eR) I
OeJECTIONGI
Atlt4tN
lSlRATlVE
CORRECTIONS\
Dl$COUHT I
PF.NALTVt
INTEREST I