HomeMy WebLinkAbout97-00266
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a/so known as .4.. H~'!fIf(A-,y . :!>7"/II~P(~~
PETITION FOR PRORATE and GRANT ()I<' LETTERS
~, -q')~~~~
No,
To:
..~.- -,.... K~gbler of Will, 1'01' the
'_..~.-.........-....., , D('c('(/s('d, COllnlY of,CUIll4m.!.i!&I~, in the
Socia/ S('<'lIrlty No, . ..J~,o'l..- ..oi.::-..,~e;i~., Conullonwelllth of I'enn'ylvanill
The petllion of Ih~ lInder"ign~d re'l'e~tflllly Icp,c,enl\ thlll:
Yon I I'etltion~rl)(), who b/......I H y~lll\ nf llg~ or older Iln I he e,XCClllQ"'. __............___..,.._ named
in lhe 11I~1 ,\ViII of th~ abol'cdel'l'dent, dilled ......,... ........................._.__.).t.MU.~_, 19j,"--,
and ~ud"II(:I) Haled, ..no ____0_ ..__....__h___...._.._____~...__~__~__~__
--....-..-...--- -.---.-..----.. __"'m..__ . ___ ... ____._._.. .__> ___..._.__....____....__. ._n._____~_~_._
(~llll~'rdi;'\'lll1ll'irf,,'UIll~HUWC~l l'.g. H'f1l1ncillllofl, death 01l'\l'CIHnr, Cle,)
De~endent \\'U, domiciled lit delllh in._C.JJ.m.Ii.s.e.I.A.N~._ ._.... County, I'ennsylvunia, with
hJL...._. 111'1 family 01' principlll r~si(\fl)l:V lit ._q.iQ----:-,s..!_Jr)..II-.~t<.1E..T ~T... SH/IeIF- .
_mMJ~7J;>wt,.}".P.~__..t:l,C1,". ...-AliA~.<>1Al(i.L<.&'-...k~.I....________,
(li~r ~fh'('1. 111llll~cr and llullh.:iplIlily!
Dccendenl, lhen......i''i,..__ yenrs of age, die(I....._.......,JJ1t1..r.k~It....!.!...___, 19.'l1_.,
ul.,_HP.J.Y. AeLl(i?: ..HMe(.r:."'I--""-..."......~".~._____.._,_.__....__..
!',Xi'el'l as follow" de\'cdellt did nOllllarry, wns 1101 c,livoreed und didnol hnve u child born or udopted
lifter e,xel'lltion of Ih,' will offered 1'111' probnl~; WIlS nOllhe vil'lim of a killing and WIlS never IIdjlldlcaled
IneOnll'Nent: '...-'..'...............'.....-.....,---....,----.--..... .._-~--.._-------
Del'endentlll delllh owned properly with e'limated vulues "' follow,: $, ""s: ~I)(). tlD
(If domiciled i1\ Pa,) All personal propel'll' !'[ ,v
(II' nOI domiciled in Pa,) Personal properly in Penn'ylvllniu $_............:...____.
(IfJlOt domiciled in Pa,) Personal properlY in Counly $__.____~
VUIUl' of rc.'ull.'~l\lIc ill Pennsylvania $__
sillllll,'d u, follow~: .9..!a....~m.A.S.JI,e.:r__~~1:I..1.&ti:m,q~,TQ(.Jl' ~II ' /7o..1l-
--'----...-~~-.~--------~.....-.--,.~~.__._._~_.___._h__~____.__ .. ~... ,~:.!!!...__
----. ..n _~ ._.____..,..._____ '_____.._.n__._.__m.h"._n_'._~________._"...__. ____._.~__.___.._~
WHEKEFOKE, p~ti.tioner(') respeclfully r7~pSll\) Ihe probute of Ihe IUSl 11'111 und eodiell(,)
pre,elued herewilh undlhe grunt of Ie II er'...... , .'.$7l1.t1J.G...~.._,..___,
I (1~'..lunH'rll{H~'j i1dlllinl'ilrl\lilllll;.I~n,; udl1llnlslrallon d,h,n,c,l,a,)
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OATH 0... I'ERSONAL REPRESENTATIVE
COMMONWEAI:III, (,)I"..'.,I,,:,N, NS,'\'LVANIA} ::l>l
COlINTY OF t;.v,~J!>(;~l-"/JP .,...,
Th~ peli,i(\n~I(\) HIHl\'I"I'"Il~d ,1Il'UIIs) 111 uffillllls)lh"l Ihc' ,'tlllemelll.,in lh~ foregoing petition arc
l!'lB.' ilml ".'or/'t.'l.:l 10 thl' Ill".! 01' 1 Ill' l--l1O\vkdgc and bl'lid or pctitiollcr(sl and thai us personal rcprcsen-
tUli\'~(-.) (If Ih\' ah,,,l' ,,,",'ed\'nl 1'\,llli(lnel(1I lIill IIcll "3d Indy udlllin!,le!' llfjape according to law,
SII,""I1, ,t(l, (II H,llillll)'d" Hlld ,"I,h\(rih,l'd ~',M,','"~:~~,,c:dl~;.......L___. ~
~m't' "l\~i~1r-.'l..J np '~n~JI. " .~.~-==-~~~== l
Ut~ ~IS' t,t'A\.<:':Sf!:' _ ,. "'H_~~='~~ !
15- \\Oq - 5
No. .. ? 1 - 97 - :>56
Estate of CARL HERMAN STANSFIELD a/k/a ,Deceased
C HEnMAN STANSFIELD
DECREE 01<' PROBATE AND GRANT 01<' LETTERS
and Letters
are hereby granted to
MARCH :>4, 97 "
AND NOW _~,__...._..__...____'_'__'h'__.. 19,:,,,,____, In consideration of the petition on
the reverse side hereof, sallsfaclory pro('f having heen presented before me,
IT IS DECREED thai the instrulI1cnt(s) dated".___~1I.!l.!!~~.Lh.J2.9..6
described therein be admitted 10 probale and flied of record as the last will of c,
CARL HERMAN STANSFIELD a/k/a C HERMAN STANSFIELD,
I ESIAffi:NIAKY ..-- ,
RICHARD C STANSFIELQ
FEES
Probate, Letters, Ete, ,,""", $ 200.00
Short Certifleates@ ) " , , , . , , " $_.hQ.Q
~~~~~gllon " " ." . " ".." $ .j. UU
, JCP ,-~- $ 5.00
TOTAL _ $ ?17 .00
Flied"" ,~~,~q~, ?~l, !.~~?," ""'" ,',
'71), ~AtrJiL~e:-{Jm&aL/
Regl'ter 01' III. . U "1
MARY ~
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ATTORNEY (SUp, Ct, t,D, No,) G38.$'lll)
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DDRESS
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Called attorney on 3-24-97,
This i~ Iii ~Tni(\' tllill tlll' illl~1I1l1iltiolllh'll' ~~i\'t'l1 1\ l"llIll'id)' \ (fIlled fflllll ,!II "'1)',11\,11 lnllfil..lll' nl de,lIh dHI~' lill'd widl Inl' ,I',
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WARNING: It Is Iltegalto dupltcate this copy by photostllt or photograph,
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COMMONWIiALlHOfl PINN8VLVANIA. DIPARTMfiNT Of HeALTH' VITAL AEOO~DII
CERTIFICATE OF DEATH
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!.-AST W,".1. AND TESTAMENT OF CARL HERMAN ST ANSFlflI.D
, ' ,
I. CARL HERMAN STANSFIELD, of the Borough of Shiremanstown, Cumberland
County, Pennsylvania. being of sound and disposing mind, memory and understanding. do make,
publish and declare this my Last Will and Testament, hereby revoking and making void any and all
piior Wllls by me at any time heretofore made,
1.
I dir~t the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done,
la,
I hereby give and bequeath the sum of Twenty Thousand and 00/100 ($20.000.00) Dollars
to Shiremanstown United Methodist Church, currently located on East Main Street i~ the Borough
of Shiremanstown. This money shall only be used for the building fund and/or maintenance and
improvement of any buildings.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate. I give, devise to RICHARD C, STANSFIELD, First Successor Trustee, or,
DAUPHIN DEPOSIT BANK AND TRUST COMPANY,Second Successor Trustee, as the case
may be. in trust, for the purposes outlined in that certain FUNDED REVOCABLE TRUST
AGREEMENT BY CARL HERMAN ST ANSFlELD WITH CARL HERMAN 81" ANSFIELD
FOR THE BENEFIT OF CARL HERMAN STANSFIELD, Said TRUST AGREEMENT was
execute-d upon the same date as this will but was executed and partially funded prior in time to the
execution of this will. Its provisions are fuily incorporated herein by reference, Should said
TRlJST AGREEMENT be altered or amended in any way. it is my specific direction that its
alterations or amendments be contI'Olllng despite having been made after the date of this will
because the TRUST as established provided for the making of alterations or amendments.
3.
I nominate, constitute and appoint my son, RICHARD C. STANSFIELD. to be the
Executor of this my Last Will and Testament. In the event that he should predecease me or for any
reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint
DAUPHIN DEPOSIT BANK AND TRUST COMPANY, to be Ex~utor in his place and stead. I
REV"1500 EX + (1-97)
,..
REV-1500
..
OFFICIAL USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN
HARRI~]~~~~i,?~I~~" 28-.(JOO!..,.'~_~=7 R E~ 1.1:>.~~,T.~E.':C.I:I?~.~~~=7c~.','c:'1~,fr~~~~~,_
~tl.E NUMBER
g'l
yri\l~
n26G
NlftJlUtf1
~--
DECEDENT
DECEOENT'S NAME (LAST, FII1~iT, AND MIODLE INITIAL)
Sla!lstlp;}Q.,-,.c::..c..J.I~'l1(Y'1tI a!k!a CC1!:.U.!..:-______,__
SOCIAL SECURllY NUMBER -lQArEOF DEATH
204-01'38~4 ~]1!9'1
(IF APl't.ICA(1LEI SUflVl'JING ~JlOtJ'H,'5 NAME /LAST, SOCIAL '.lECURlTY Nt IMBER
t:IRsr,ANoMIODLE INIT1Al.1 ,.. R
-~~--~---------
CORRES'
PONDENT
DA TE OF BIRTH
04112!1912
THIS RETURN MUST HE FILED IN DUPl.ICATE
WITH THE REGISTER OF WILLS
}1 0, I R I -3~;'ri7l;;Fiiii"ti'!ri--"---
ngma n urn 2, Supplomanlal Rolurn . (dale (If dlllltl prl\H to 11.'1:1.~2)
4u, Fulufe tnlllful Compromlu
4 Umllod Estato (dAII ot dll.tIl4'\III 1'2- !2.gZ) 5, F{lderul E~llalo Tax Rim. Ruqulrod
6 Dlculent Ollld Te511\1. 7. Olleedlnl Mlit1\/\ln,,(j A li~I!\O Yru~l 0 T I I N IS fall B
(Att.tCh r.Ofl'fof Will} lAtlboch copy of lrutll 8, oa (1.0 .au opOS OlHJS
9 LIII II' P d Rid 10, !Jpounj PnVtlty Crlld!t(dale of del\th h,,\wun 11, EI.ClllHl hl t.,. und.r fJlJe, 9\ lJ(Aj
_~~~.oCOO 9 oeova 1'1-" \~flll1nrll"l-q5 ~ Atl.tch~ch9L.-
THIS SECTION MUST BE COMPLETED. AlL CORRESl'ONO\!lNCf!.. CONFiDeNTiAl TAX INFORMATION SHOULD 81! OIRECTeD TO:
NAME COMPLET~ MAILING AODRESS
Charles E. Shields, IU" Esqu1re 6 Clouser Road
FIRM NAME (If Applicable) Mechan1csburg, PA 17055
CHECK
APPRO-
PRIA TE
BLOCKS
TELEPHONE NUMBER
717''166-0209
(7)
80,000,0
55,893.6t'
None
None I
l
c
44,735.51' i
None'fl
839,31.5.13
\CJJFFICIAL:xJi NL'l'
OJ <"
:'.0
- ,.,
1, Real E,lalu (Schedule A)
2, Slock' and Bonds (Schadule B)
3. Closely Held Corporation. PartnershIp
or Sole~PfOprletor9hlp
4, Mortgages & NotOH Receil/able (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal
PlOperty (Scheduto E)
6, Jointly Ownad Properly (Schedute F)
7. Inter.Vlvos Transfers & Miscellaneous
Non-ProbatA Property (Sehedulo G or L)
(1)
(2)
(3)
(4)
~
"<
I
O:l
I'.J
';\J
Ci
(,~)
(6)___
'"0
~
W
-J
-.,' -,'
;:::-: nJ
Vj- g"
8. Total Gross Assets (Iotal Ullea 1-7)
9. Funeral Expenses & Admlnlstratlve Costs (Schedule Hl (9)
10. Debts 01 Decedent, Mortg. LIabilities, & Llens (SCh.11 (10)
(B)
24,914.47
2,204.27
1,01.9,944.29
11, Total Oeduallon. (total Line, 9 & 10)
'12. Net Value 01 Estate (Uno 8 minus Line 11)
13. CIHullf\ble and Governmental Bequests/Sec 9113 Trusts
lor which an elecllon to tax has not been made (Schedule J)
(11)
(12)
27 ,118.74
992,825.55
(13)
20,000,00
TAX
COMPU1'A-
TION
14. Net Value Sub eet to TaM. (Une 12 minus Une 13)
15, Amount of line 14
taxuble at the npousal
tax rate
Seo Instructions on pogo :2 for applicable percentage
16. Amount of line 14
taxablo at 6% rate
17, Amount of line 14
taxabl" at 15% ralo 0,00 X ,15 (17)
18, Tu Due (18)
___ 19 ilful]~~~.IF VO..!!.M!..E REQlJESTING A REFUNtJ OF AN OVERPAVM!lliLI'
>. BE SURE TO ANSWJ:R ALL QUESTIONS ON PAGE 2 AND RECHECK MATH c< · .., '
Ondm penalties 01 perjury, I dedare thalll1ave OKarTlfnad this return, Includmy accompanying schodules and statements, and to the bust 01 my knowledge -
and belle', it Is true, correct and complete, Declnraflon of preparor other than Ihe personnll'OprOSfJlllatlvo Is based on alllntormation 01 whIch prepa.rer has
any knowledge.
SIGNAT AE OF PERSON RE')~ONSI8lE FOR FILlNU RETURN ADDRESS
. ,j'.~, " ;1 -.,l,,:L' See Schedule attached
SIONATURI:: OF PREPARE b ',fl R~~
~~"'-)/ j J IlL,-/
7 PA1S'DO NTF 10~69
Copyrlghl Fll ms ~OnWMe Onlv, \1197 Nltlc(i. Inc,
(14)
972,825.55
342,036,26 x ~
(Hi)
0.00
630,789.29 x
,08
(18)
37,847,36
0,00
37,847,36_
DATE
"'I/q/'i8'
ADDRESS
.3401 North Front Street
Harri,sburg, PA 17110 -0950
DATE
'0y'r:\'
..
A
P.ge 2
PA REV-1500 EX (1-07)
Dece!!!'nl'. Complete Addru.:
STREET ADDRESS
96 S. Market Stn~et
Sill r0J1limS L~Il~..E..0..-12Q1.L-.
CITY
I STATE
ZIP
TIX Plyment. end Credits:
1. T.x Duo (pago 1 Une 10)
2. Crodlla/P.ymenls
A. Spous.1 povony Crodll
B. Prior P.ymenlo
C. Dlscounl
(1)
37.847.36
15,000.00
750,00
Tot.1 Credits (A . B + C) (2)
15,750.00
3. InterosUPen.lly II .ppllcable
D.lnler.'1
E. Pen.11y
0.00
TOlellnteresliPenel1y (D. E)
4. IllIns 21. gre.ls, Ihan line 1 + line 3. onler tho dllloronce. This I. Iho OVERPAYMENT.
Check bOB on P.ge 1 Line 19 to ,eque.ta refund
5. If line 1 . line 31. grealer th.n line 2. enter the dlllorence. Thl.ls the TAX DUE.
A. Ente, Ihelntereet on the lax due.
B. Ents, the lot.' 01 Une 5,_ 5A. Thl.ls tho BALANCE DUE.
Meke Check Payable 10: RF.GISTER OF WillS, AGENT
(3) 0.00
(4)
(5) 22,097.36
(5A) 0.00
(5B) 22,097.36
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Old deoedenl make a transler and:
e. relaln the use or Income oltha property transferred;, . , , . , ' . , , . , , , . . . , , , , , , , . . , , , ,
b. retain the rtght to designate who shall us. the prop.rty translorr.d or lis Income; . . . . . . . . . . . . . . . . , .
o. (stain a reverslontlry IntereSI; or. . , , , , , , . . , . , , . . , . . . , , , . , , . . , , , . , . , , , . . , , . . , . , . , , , , , , , , ,
d. receive lhe promlsfllor IIle 01 either payments, benefits or care? , , . , , , , . , , , , , , , , , , . , . , . , , , , , , ,
2. If death occurred on or beloro Docember 12, 1962, did decedent within two years
precodlng death tranefer property wlthoUI roeolvlng adequale eonslderellon? II dooth oC9urr.d
aller Decembe, 12,1082, did decedent transler property within one yoor 01 death without
,ec.lvlng adequato eonslderallon? . . .. . . .. . . . . . .. . . . . . . . .. . . . . . . . . . . . .. . .. .. . . . .. li:l
3. Old decedent own an "In truBt for" or payable upon doath bank account or securIty
at his or h.r death? .. . . .. . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . .
4. Old decedent own an Individual retirement account, annuity, or othor nonwprobate property? . , . . . , , . , , ,
Ii
o
~ ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
72 P.S. 89110 (a) (1.1) (I) provided lor the reduellon 01 the tax ral.lmpo.ed on Iho nol voluo oltransl.r.lo or lor the us. 01 the surviving spous.lrom 8% 10
3% for dates of death on or after July 1, 1994 and before January 1, 1995.
72 P,S, 19116 (a) (1,1) (U) provided for the reductlon 01 tho ralo Imposed on tho not value oltronsloralo or lor the use 01 tho surviving apouse from 3% to 0%
for dates of death on or after January 1, 1995, The statute does not~ a translor to a surviving spouse frpm tw<, and the statutory requirements for
disclosure of assets and 1lI1ng a tax return are stili applicable evan lithe surviving SPOUSD Is the onlV benollclary,
FOR DATES OF DEATli ON OR AFTER JANUARY 1, 19D6 -- Pl.... answ.r 1110 lollowlng quesllon by placing an "x" In Ihe approprlato .paco.
Old tho decadent croat. a tNst or slmU.r ."angemant which Is aololy lor tha aurvlvlng apouee'e bon.m tor hi. or her onllra mellme?
1'.. IS No 0
If you answered yes to tho above quosllon, the tax on 1tle trust or similar arrangement Is p091pOllOd until the death ollhe second spouse, a1 whloh lIme It will
be hilly taxable st 1110 rOI.(s) appllcabl. to Ihe r.",slnd.r benollcl.rylle.). Enl.r Ih. valu. 01 the Irust on Soh.dule J, psn II, In order to remove It from ~he
calculallon 01 th.lax due In Ihl. oststo. You may wish 10 tile Sohodule 0 In ord.r to moko the .I.ellon available und.r Secllon 9113. II tho election Is made.
tM trust or !llmUar arrangement Is taxed In the oslate of the Ural decadont APOU9EJ, the portion of tho trust or similar arrangoment which bonellts the surviving
SPOUSft Is tll)(od stlho loro tOI< HUe, and the wmalndor IS18.l<od 8t the rale(s) applicable 10 the romalnder bOllollolary(les), If you ohoose to make the oloollon,
yo" must altach Schedulo 0 to 0 IImely-lIIod lax rolurn, along wllh Sch.dul.(s) K ond/or M In ord.r 10 show the spportlonmenl 01 the trust or similar
8rrangament ttotweon Iho surviving spouso and lhA remainder benoflclary(los).
7 PA1SOO2 NTF 10810
Copyright Forml SoftWAre Only, 1991 NeIClJ, Inl;,
.
.
.
U... O'IU~tlmHlI <<If Hou.ln.
.". Ur.." O...Io,mtHl1
A. S.W.m.nt SlOt.ment
aMi' No. "01-0'"
~. Iypo .01 I.oon
I. 0 FHA
2.0 FntiA 3.0 Con,. Unl", File H~r loon H_er-
H.noll.ld'PHI97
0.0 VA 5.0 Conv. Ino.
c.NOTE: Thll lom;l,iiimllhed 10 give you ilillemenl 01 10lUII llttlomln! 00111. .""'ountl plld 10 Ind by the le,Ulment Igent Ir. Ihowo.-
Itoml ml"'"d 'p,o.o." wlrl paid oUIII:lo 01 0101110: IhlV ere Ihown here 10' I1lormeUonll PWPOI.. Ind Ire not I10kJded " Ihl 10la1A.
0, NAME AND ADDIESS Of' BORROWER: SilVIO R. M.".llold -- -.
___";:2 Surrov Drive. MICh!ffilclbur.. pfI!l!llY.lvont. 17055
E. NAME AND ADDRESS OF SEl.lER: Eot.t. 01 C. H"man Stonoll.ld, O.c....d
--'.blltr TIN' l ~1tl.u..E, Shllld!. Ill. EIQ.. 6 Cloullr ROld. HIChonlclbura.. Plm.-tvlnl. 17055_
~tIIAMe AND ADDRESS Of' lENDEH: N/A
MortQIQe In.urlnce CIIII NI.JTtl
G. PROPERTY 2 w..t Gr,"n 'Iroot
_lOCAT~N: !!!.!.!:!!!-..!l!.!.'!'!'.....l'~ rn I ,
R,lll!i'fi]MENT AGENT: lI...tbokor, .r...-n & Spiro, P.C. Altarneys II tow
PLACE OF SETTl.l!MENT: 44 W..I Holn Ilr",l, Mechanlc.burg, PA '~5
[SETTlEMENT '5ii'fE:'-'- OClo..r 24 ;;;
J. . OF _ ;R'8 TRANSACTlflN ~ S{)MMARY OF SE.LL~R'S TRANSACtiON
100, GROSS AMOUNT DUE FROM BOAAOWER: . GR AMOUNT DUE TO SElLER:
101. Canlltel III.. pr!u BO, 000. 00 .O~. ODnlilCI III.. pile. ___ 80,000. (
lOt. p.ltonll prop,")' O~. P,"on'! IHop.rly
103. ..llItm4HII ChilD" 10 borrower: ..J.(Gross Proceeds-$BO,OOO.OO
(110m In. UOO) 2.073.50
104, 404.
-
108. ~.
-"ADJ-USTMENTS FOR ITEMS PAID BY SEllER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SEllER IN ADVANCE:
108. ClI.,ltClWn ~1Jl" ,. 401. OI,/tGwn lax.. ,.
101. Counly 111I.0 10/24/97101.2/31/97 3 5 :?-., 407. .CounlY In.. 10/24/97,.1.2/31/97 '--is;
101. A.....m.nll I. 4Oa. A.....m.nlt ,.
1O/:1.'/k7 ~'l.qrt :nO.52 School 11"''''/:0.'''''1 1l> 6/).:/9Y ..
lOt, School lox 400, 370. !
110. Sowlr 9111 10/24/97--12/31/97 16.00 410. Sewer Bill 10/24/9r--1Z/31/97 36. (
111. -411,
.
111. ..~
t2O. GROSS AMOUNT DUE FROM BORROWER: 82,51.5.24 420. GROSS AMOUNT DUE TO SEllER: 80,t\41.~
200. AMOUNTS PAID BY OR IN BEHAlF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SEll.ER:
~01. O.po.1l 0' .I,n,tt man., 5 000.00 101. bu.. d.pCl.lt I'" 1n.1f1J0tlon'l 5.000. (
~I. PrincIpII .mounl 01 n.w 10In(l) 10lP. 1I1II1,",nl eh",.. 10 11114' (lIn. 1400) 848.(
!03. Edltl"" 101"(1) Ilk.n lubJIllt 10 - o~ Ell. linG 10In(.) IIk.n IUbJ.ot to
"". 504. Pa'lIH 0111111 morIO'i1' loan
20&, SOl. P.yoft 01 IIcond mO'IOIIl' lOin
~O8, ....
. _.
207. $07.
---
loa. SOft.
20t, 501.
ADJUSTMENTS FOR ITEMS UNPAtD BY SEll.ER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
210. C!1.,/lown I.... ,. IiIO. CUyl1Clwn I.... ,.
-
lit, Oounly ,.... ,. Ill. County It... ,.
'". A....em.nll ,. all. A.....m.nu t.
-
.U, DU.
il.. 514.
111. 511.
Rlt. 511.
- -
m. 5t7.
211. 511.
atl. 5tt.
220. TOTAl PAID BYIFOR 5,000.00 520, TOTAl REDUCTIONS 5,848. (
BORROWER: I~l AMOUNT DUE SElUER:
300 CASH AT n FMENT FROMITO BORROWER: --
800. CASH AT SETn.EMENT TOIFROM SEllER:
301. Bross a...unl due from bwRlllLllln. I?nl 82.515.24 11:.01. Groll arrtOunt dul to teller (lIne 420' 80.441. .
302. I.... .....unl oold bv/for borr....r Ill.. 2Z01 5.000.00 602. I.... roducl'nl In .",1. duo ..11IrI11.. 5'0 5 84B.1
303. CASH I (ffROM) I 0 TO) BORROWER: 77,515.24 603. CASH ( gTOI ( o FROM) SEllER: 74,593.'
HUD-l (3-86) - RESPA, HB 4305.2
BUIIBTfTUTE FORM 10.. 8flt.ER STATEMf.NT: Th. ,"10""1110" conllln.d In Block. E. a, H. .nd I IlId on IIn. 401 (or "~. 0401 t. ..t"llhd. IInu 403 and 40') I.
Im"o,.,nt 'II kllormaUon Ind I. biting lu'nl.",d 10 th, trUlfnl1 A.lI.nu. lI,nle., II you ar. "quil.. 10 tII. . rClu,n, . n""g.M. p.nllly Qf Olh., unCUon will tit
Im,o... on 'OU Illhl. 111m II IIqulf.d 10 b, "pClft.d .net th. IRlJ .'t'/I'nl".. Ihll It "" nol bit,. ","'lid.
dI!UfA INIIlftJOTION8: II thl. ,..1 ..1110 "I' '01,1' "lnclpll,utitnOI, III. F-'!um '''I, 11111. Of eJl:C"lnl' 01 ip,lnol"al Atlli.nCt. lor Iny ,.In. wllh yo,,, ,"com. ,n
"Mn: lor other Iflnllollonl. CtlMpl.tlt th. .ppllo.bll parI !I' 01 FOfm 471', Fo,m nu .nd/o, le",.dul. 0 (Fo,m 1040t.
'Iou "' "qul,td by II" to pfnld. t... bo. HI wllh ,our cOff.ol ".,.,., Ict,nU"ulIon numb.f. II you do nOl p,ovid. I'" bOll HI wllh ,01,11 C'OIf.\l1 I.....'"
'dlnlUtoaUClII numb.f, 'lOll mlY b. .ubllCl 10 ol,~ n, ollmlul p.MllI.I tmpoud b, II"', .n; und.. ,..n.IlI," 01 ,...j.."" llltfllfy thll Ih. numbe, .hawn ~n Uti.
111I1.m.nt If! my llor,.1l1 IIllP'", Id.ntUlIl.'lon "um..,.
....,.. ",nltu,.
PAGE 1
RF.V-1&10 EX. (1-97)
~
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
__ RESIDENT .D~DEN2--__
ESTATE OF
.f.:... HermarL~/k/a Carl H. Stansfield
FilE NUMBER
Thla cohedule must be oOlT1pleled and lIIed" Ihe anowor 10 o"v 01 qUODllo"o 1 through 4 on Ihe rovoroe sid. 01 the, REV-t!lOO COVER SHEET It yes.
21-97 -0266
OESCRIPTION OF PROPERTY 'roOF EXCLUSION
ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S (IF TAXABLE VALUE
RELATIONSHIP TO DECO & DATE OF TRANSFER.
NO. AlTACH COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST APPLlCABlE\
.
1 Funded Revocable Lving Trust 333.763.32
Agrearent by Carl Herman Stansfield
w:i.t Carl Herman Stansfield for the
benefit of Carl Herman Stansfield.
Dated January 4, 1996 (See
jnv~ntory and Valuation attached)
2 Funded Revocable Living Trust 279,530.33
Agreerrent by Carl Herman Stansfield
with Carl Herman Stansfield for the
benefit of MaIy G. Stansfield dated
January 4. 1996. See Inventory and
Valuation attached.
3 1996 Buick LeSabre CUstcrn made 15,000,00 100% 3,000.00 12,000.00
within one (1) year of 000 to
decedent.' S daughter. connie Kautz
4 F&G Life Annuity No. D626438 13,t12.74
(payable to Richard Stansfield)
,
5 F&G Life Annuity No. 0465425 19,063. 10
(payable to Richard Stansfield)
6 North Arterican Security Life 176,821. 82
Insurance Annuity Contract No.
0000331087 (1/2 payable to Richard ,
Stansfield and 1/2 payable to .
Connie Kautz)
7 Prudential 64 Year Endcwrent 4,293.82
Annuity (payable to Richard ,
Stansfield)
, '
TOTAL IAlso enter on line 7, RecaDltulaUon\ . 839.315.13
7 CPAOl NT~ '0'10
CoPvrlght Form. SoHwar. 0"1)1, Hlil N.lco,lno,
(I' me'e spaoe I. needed, Insert additional sheets 01 the sa/11O size)
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COMMONWEALT" 0' PINNlnVAffIA. DIPARTMeNT 0' HBALTH. V!TALfUlCOAOI
CERTIFICATE OF DEATH
,'NIII
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l)(Ct Uf:,ulWM.ltfQ olOONUISoMl elo'....... II... IIIl,"]' '.,CfllUU', rCflflnhall1 \! LI
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....._..""......."'....,..........."...._._._r+oo..ooo4....II.......tI.,......._I.....M4
1~..#..9 ;.tM\I;o~b;;,,';,,7'fu-=
....'"'"... Or. WilHam Young
(I 3200 Market Str.et. Camp IIi 11. Pa 17011
"
-.- UU.'...II"'....",0., ....,
,...m.flfll~h. !~. 1,7 'LZ~u.. ___....__
.1ll'OiCUIUllll....IIC(\/IUI..1l
till I'" ....,. ,'."""""110" ."""., ~''''''I.I..... In..., ...,...~. .,..10 "'~'I" "II'........ 41....... ~".. .....otw. ,. N ......\tl..Ml
.., ""~"'"""""',..,..,. _ '..,... -".. -........,.. -..... _. -.."....,. -. _ _.. _. ., -., -,..".".",..,.........
-ji~ji;jfIJii'ii'cm:ii..-:O;;.~I-' 'lii"-------.-.----.~--
,,':t\"-4"YI!1'~.~.. L c),v,) ~ I \0<.. !ii .._.I~I~I~_/~:~I.
.. ..,~.
Form 4768 L Application lor Extension of Time To Fh" a Return
(Rev. October 1996) and/or pa~ U.S. Estate
P,::,~::'~;::;"t:;::~;:"" '__ (and G(~~~~.~~I~~:'~~I~~:~^,~~~~(~~~2 Taxes
Note: Usa Form 27~6 to roquOflt all oK!llflt\jUfl fm FOff1V1 f06...!}!1(D) and .'08~()tl( l}
L~ IdenllncB!!Q.'!--___~"... _.."....'...... _.__..... ......... ...~----..-
Decedimfs ftrslllM18 and rnlddlo Initial OlK:ud~Hlt'S la!lIIH11l\l.1
C. Herman a/k/a Carl II. I:l:wu; r I n lei
Name 01 e,ocUlo" '.'" ...._"~-:.._....--I-~i.,-,~,~-;lt,..,.-,,;illl"a;I";;m.lt(iI;;j110[ IlIo,n-'ho ex';;;;j;,,) ". '
Richard Stansfield ._._.._........__."l'.t!'r.. ~J~_"!,,,1~!1..Jisqllir6' . ,,'
Addr9S.1 of 81.ocutor (NUllIbtlf, llrool, Iml room or lIulln no,)
_ 7 Franklin Road. .........,,___....
CIIy, arlie, Ind ZIP codo
Land~.21~'O-I)'JU1...____
l1l!!:t!!I Ex\enslon..!.I' Tl.'!1o!()..Fllo J~ec. S(j8J)...
You rrtlst enach your wrlllon ,talufHnllllu o)lJIl."" III dullUI whV 11111 Ifl\JlllMlblo or ImpraotlcoJ 10 "Is
a roasonably oon'4)lalQ rnlurn 'Ntthln 0 mOllthB nflm 11m dBtfl (jlll\~ dO(llUlfllll's doath,
Iplrt ,m=Exte".'on or !!me}C?Pii'Y"(Se;::"ilili'i)'- m'''__''
You must .ttar:h your Wftllllll IItallMf\l.1Il1 to fllll'lI,lnlfl dllli\il whV II hllmpnn!llblo or ImprBCUcallo pay the
full ttmount of tho onlalu (or WH) tllJ( by tl\lllUhllll dill! dlllll II 11111 ImulU 0811110t bo dOlermlned because
tho silo of tho gfO:iff 99lalulJl U/llUICIWltlln/Jhlu, t:hlld lll/fII .. {.I iUld nnlOf "..0-" or other appropriale
lVTIO'Jnt on Par11V, Mno :J.;...'!.2!.lJ.~L~J!(~tl..~' ,'I(III~~.l!!J.!.L.-.__
IPBrIIV~enl_!()..~.9coI11rnny EMtonllIOJ1..!!eguest
1 Amount of osl"lo fUld, WH tft,",IM ",QtII,"'hH"t,lfI hf,l dll.,"..,.".,.,..,"",....,""',.".,...... rn1
2 Amount 01 cuh shortt_g.o ((~Hl~IIIl'f1 filiI I Ill) , , , , , , , , , , , . , , , , , , . , , , , , , . . , , . . . . , . . . . , . . . . . . . . . 2
3 Balan.. dul (lu'!."!a1..lIcn~.~.Ir~m_'.I~.11 (I?~v!'!itht!t~!fIf'"oallon.)"", ".,.,...,....,...... 3
Slgn.tur. and V.rffioallon
If "led by ufrautor .,.. Undor ptHllIlUmt 01 PUfllJfY, I clfKlllru Ihat I am an 8)(9CUlor of the astats of the abovo-named decedent and
that 10 the beat 01 my knowittdga Iml htllHlf, tho ItlllmlltJntft mado hBfoln and attllotlod are !rue and correct.
'1
1-......"" \
Dale 01 death
,03/11/97
Dec<Klonh ooclal .....rtty no.
204"01~3854 'I',
Estate tax return due dote
12-11-9}
~.xten.lon dalo requested
0.00
0.00
0.00
E>cocUlor's S4)naluta T1~e Dale
""led bV oom.."o oth... than tit. IMooutor -- Undor ponalllo. 01 perlury, I decl8le Ihal to the best 01 ITrf knowledge and belief,
the statements made horntn and aUAtlhud am lIuc and corroot, that I am authorizod by the executor to file this application, and
that I om (chack box(e.) Ihal applkl.l:
~ A n'olI/l1ber In good Blanding 01111., bar ollho hlgh.at court 01 (opaclly jurlsdlotlon) .... ~ Pennsylvania
A cer1lfled publlo lICCOuntl'" duly qUIUU..d to prlcUoeln ('Peoll~'1JitdloIlOn) ,." . , ., ~
A person enrollod 10 prl1clk:u bolnro thl' Inlornal RovmUHI SOrvl ~ \~^ "
.. ,\ f"'.v \
A dulV luthortzed Igllnt holding. pow", 01 aOOln"v, (The p~~C'~.qOlholY naod not be S~bml"ed unless requested,)
~llT"~' l{ .j ,.j. ( "_ ...__... '. 1~ 12/11/97
"\~' FlInf'" fllgru'III,",' (othur lIulfl tho Q)(O<lul Date
Pert V NoJlce to AppllcanL I~_b8 9.~.mp'8t~ B Internal Revenue Servlce-
1J Th appllcltlon lor ..xten.lon ollln..lo flI.. (PBlIIIJ I. 2,' ~".~;'lIon lor extension of lime 10 plV (pan III) Is:
f7 Approved ..OJ; ..proved
Not appruved hounuao _,_._____~..~_____ Not approved because
o Other
o Olhe,
Inlornal Revenue Service otflclaJ
Dato
ns on pigs 2 of thls1orm.
Form 47611 (Rev. 10-96)
'lun4 111~ I
Unltod Statliy Estato (and Generatlon..SklpplntJ .ransfer)
Tax Return
fllAle of . (Illite" Qr r..ttMnl of the United St..tOl1 (f1ce tlilp~rilte Instructlons), To be
O.ptflrn.nl (If lhl Iru'uly 'Ihlld for d_red..nt. dvlnu IIN.r ()()h)b., ., t8l0, For PAfJerwork Anduotlon Act Notice,
111'"1'.1 Rh'lI/llI' 'i,rvlc, _J.. ll.~' t of thll Me '!,tatt In81'~l(ltlona,
18 Il.t'lhnt'~ 111,1 ,l'rIlI "HI """ii). 'Hl\1.41141HII1l4"'_" t1!!1/1lt, II 411y) 1b ()n"n,flllll'"1,1!11 lid "'" 2 OeCledent's Sl::iN
$.c...J~J.lJl1iJII. _.i1f~jl~.G'r.I. ,I.'.e. _ ,p ....._. .cU;<.If.1[;U~:l_<:L_-li-- 204 - 0 1- 3854
aa ~r~i,~i!::~C!,~';~i:,I~I:tr'_I':\'}I~ll~IIIl!!lI!l1 flulh 1'.Il1m!)', .hll1, ,11101 3u ::~,~:~';:~:it' ]4 0"10111 tHrill 5 0.1. of du\h
Shl.mll>lfml.oWll, l'ot!!..l!JYlvmilil _ }')12 04/12/1.2 03/11/97
6s N.nll <<I.ur-ull" l.It'IUII_ t uIIlIIJlluttuulll)".j 6b r:~~!.UIIJ/'~ .rlclru~ (rlUmbdt MId ~lr.ltllnllluding.lp.srtm.nl or sulll 110, lH r',",~&,
~-t Rlcll()nt.nS!!}!Lr..;~~t~'_'~_ri~_""<__"""'__'._""""'_'_~~'_ rfHIII: !lIlY, tllwn, or pCllt pIlICI; .tat.."nd llPcudll1
6c [i'tlllur'j '1I1111l1 uturQyl1\f1Hhll (."il'V' Inl thllln.lfUnllnrl_i '/ Frankl.Ln Hoad
or ~___...____._____., __~enbet'g, PA 19350-9581
78 N.ml .nd hlLAtlfHI <II ClllHt 'Nil'" Will w" IHri1J4t,d 'If "14t' 4lhnllllQIIl'lcI
C\nnl29E~~1 1(1_ C9.!J!!1iL...ti!nnBv I.Vllnl1J _
J!..~~!~!~~!'.:.!-~I!.1!!.!.!!!!.:.!'~llf:!..J~!!,!.-' .. I X I .nd .1t411h . nlrl!li.d OllPY ullh. will,
10 II ~Iciulhil, "~!lh'lj, ~hllill ,'.!:,.!.;. < ~ I I
1 Tolal Qru"" 1I.lal" (trum P.rt n, Rlln.plllllatlon, p.go 3, II00n to), . , , . , , . . . . . . , . . , . , . . , , . , , , , , . .
2 TUIOI .lIow.blll dlldtlllllnrl. (I",rn Pari n, Roooplllllallon, p.ge 3, 110m 20), , . , . , . . , , . . . . , , , , . , . . . ,
3 TilMdblu (ftJlnlu (lIubtlaolllnn f! !rum 11/101) , , , , . , , , , , , , , , , , , , " , ,', , , , , , , , ' , , , . " . . , ,. . . . .
4 Adlll.l<ld lax.hl" gilt. (101.' tax.blG gltlo (within Ihe moaning 01 oecllon 2503) mode by Iho docedent
.1I0r 000 :11, 107U. other Ih.n gilt. IIlal aro Incllldlblo In docodenl" gro.o oolale (eeotlon 2001(b))) , , .
5 Add IInoo J .n. 4 ' ' , . . , . ., ....."".,.,..."."""."".."."'",..,.,,.
6 Ttllllaliyn laK 0111110 amounl Oil Uno f) lrom Tablo A on page 10 of the Instructions, , . , . " " ."""
71 IIllno 6 o",ond. $10,000,000, .IIler 11199"' olllno 6 or $21,040,000, II 1 I
1111061. $10,000,000 IIf 100', .klp IIno. 7a & 7b & onler -0- on line '10, 7a
b Hllbtr.cl$10,000,00U lrom line 7.."",.",.....,..,.."".... I 7b
o Entor 6% 1,05) ollllle 7b . , . , , , , , , . , , . , , , . , .. .. , . , , , , . . , .. , , .. .. , , , , . , . . .. .. , , , , . , . , . .
8 Totsltolllatlvo laB (.dd IInoo 0 .nd 7c) . , , . . , , .. , .. , , , . , . , , , , , .. , ..' ,.".,....,.",....,
9 Tolal gill ta. pay.blo Willi re8poollo gill. made by Iho docedent allar December 31, 1976, Include gill
1.'''8 pold by Iho dooodont 8 .pou.elor 8uoh .pou,o" .ham 01 'pili gills (.ecllon 2513) only lithe
dooodofU waR ltl0 ctonor 01 th080 gltt9 and they aro IncludIble In tho decedent's gross ostate (oe8 Inst.)
10 Ora," oatale lax (.ublraot line 0 Irom IIno 8) . . .. .. , . , . , , , . . , .. .. , .. .. . . . . . . , .. , . . , , , , . . . . ,
11 Maximum ulllllod medII agaln.1 o'lalo la..,."......,.".,....., 11 102,000,00
;. 12 Adlu.lmonl to unlllod orodll. (Thl' adJu8tmenl m.y not excood $e.ooo,
n Soo p.go' oltho In.fluotlon..), ,..,....'..,..'"""""',,.. 12 0.00 I>
13 Allow.blo Ul1ll1od orodll (.ublr8111I1no 121rom line 11). . , , . , , , , , , , '., , , . . . . , . , . . .., . . , , . . . . , , 13
14 Hublraot IIr1fl13 Irom 11110 to (bUl do not onl", 10'8 Ihan zoro) .",."." , , . . . , , , , , .,. ., . , . . . . , 14
15 Crodlt Inr otalo dliath 18)(on, 00 nol onter more than line 14, Figura the credit by using the amount on
Ill1e a '.8. $00,000. Soe Table B In the In'lrucllona and altaoh or.dllevldenoe (aoe Inslrucllon.), , . , ,
16 Hublraolllne 151rolr< line 14 , . . " , .. . , . , .." . , , . . . . , . , . . , , ,., , . . . . . . , . , .., . , , . , , . . . , , .
17 Crodlllor Fod. gift laxus on pro.10n giNs (Ull. 2012)(altllch compul.sllO'1l . 17 0.00
18 Crodlt for forolgo dualh taKoS (hom Sch.dull(lI) Pl. (Attach Fur",!,) 10e.CE,I, ' 18 0,00
19 Crodlllor lax on prior Iranolo," (Irom Schedule 0) . . . . , , , . . , , , . , , , 19 0 . 00
20 TUlal(add line. 17, 10, and 10)" , , , . . . , , ." , . . , , , , , , . . , . ", ., .. . . . , , . . . . . ,., . , . . . . , . . ,
21 Nel eotale tax (8ublrant IInll 20 Irom 11110 10) .. .. , , , . , . , . , , . , , .. , , . . . . . . . . , , .. . , .. , , , . , . , , .
22 Clllnarallon".klpplllg Iran.lor taxo. (Irani Schedule R, Part 2, IIno 10) . , , , , , , . , . , . , , , . . , . , , . , , , ,
23 H":lIon 4DOOA Inor08,ed e.tala tax (Irom Schedula S. pan I, IIno 17) ('lie page 20 of Ihelnslruollon.) .
24 TOlallrRnolor Iaxeo(odd IIno. 21, 22, and 23).,.,....,',...,..,., '.', I. '2.5..'''.... ....,....,
25 PII'" pay""'nto, Explain In .n an.chod slelomenl. . , , , . . . . , , , ' I 0.00
26 Unllod SIal08 Tro..wy bond. ,edoemod In payment oleslate tax . . " I 26 0.00
27 Tolal (add line. 25 ond 20) , , , , , , . . . , , , , , , , , , , . , , . , . , , , . , . , . . , . , . . . . . . , , . , . , , , . , . . . . . .
2B ~fllan~o duo (or oVOIpnvmwll) /subtraot line 27 Irom line 241 , , , , , , . . , . , ' , . , ' . , , . . , , ' , , , , , . , . ,
,'--.
FIlfIl1 706
(Rov April 1 Dol)
OMB No. 1545-0015
~m47881IlatlaClhld'ChICkh"',
17b cUlnu::..~
21 97 O,,~~
,,~I xl
1
2
3
4
~f-
6
70
8
9
10
I
15
16
,
20
21
22
23
24
,
27
28
1,021.677.25
379,253. )1
642.424.24
0.:0
642.424.24
208.496.?7
0.:0
208,496.?7
0.:0
208,496.?7
192.800.)0
15,6?6.?7
15,696,. ?7
: , ~o
0.00
C.OO
C.OO
:.00
:.00
:.00
:.00
\Ind.' ,,,nllll.. III JI''1IHY, Illlelm, Ih'-ll hi&~' I~~nllnld thlll return, me(udln; acoolllpanVlng schedules and !llItem.nt!, .nd to thl but 01 my ~nDwl.dOI and blllll, 11 '.I ~~J',
!lilt""!. '11(1 (;11I1111111ID. Olll,I",.liOIl nf fHIII"''' olh,' thAn lhl IUCUl0l15 bUld Dn IlIlnlo/J111110n ul which p'lplre, huallY ~nowlldg",
"~fU~;.1 ()11~,~~{,a',"~ICH;'~(20)U ',__
7k(tJ~f
Il j'"
~~I\ll1dl~-ij~I~":lllr IOI~llll i~rl~O(;UIOf
LAA 11051 ~jll ll!jj<,A
1". up "'-"Y III I It 111_ '~u 1,....011 II (lilly, I ~\l' N Ile<l, Irll~,
cro fj}Cl/';'" Sh/!k/f . Date
6 '/"HU'(' (i:(tf. Ifleeiw/i ~..t.f.,II/';:/'# / Mr
6 Clouser Road (/
Mecl1anlcsburg, PA 1'7055
AddroS9 (and ZIP codo)
<(.:J '7-9"
i'll/I'
o te
~,
.....
form 700 (Roll 4k07)
Part 4. -- GOl1oralflllolnut!lon (c:onUntlud)
Pleaae chook the "Vea" or "No~ bOil: for BIIOh qUlatlan. VOl No
6 0009 thu gross usl,Uu contain any aoctlon 2044 proporty (quallllod lorl11il1Bblo intoro!!l propCll1y (QTIP) lrom a plica gill Of
OS1810) (see pogo 6 01 the Instructions)? ' , , . . , . . . X
78 Havo Foderal gill 18)( relurns svor botlf1 Wod? . . . . . . , , X
__l! 'Y~s," please a"ach co los allha rolurns, If avaJlablo, and furnish the 'allowing Informallon:
7b Porlod(s) covorod 70 Inlern.1 Rovonue olllcel') whom IIIsd
If you answer "Vea" to any of quesUona 8-18, you must attach addltlon.lln.ormatlon 18 deaorlbed In the Inatruollona.
8a Was there any lnsuranco on the docedent's Ufa that IA nOllncluded on the return as part of the gross ~9Iale? , . , . , , , . . X
_,b Old the decedent own any Insurance on lho Iile 01 snother thaI Is n:>llncluded in lho gross ostato? , , . , , , , . . , , , , , , , . , X
9 Old Ihe decedent at tho time 01 de.lh own any property .s a joint tenant with rlghl 01 survivorship In which (a) ono or more
at Ihe olher lolnl tenanls was someone olher than the decedenl's spouse, and (b) less than Ihe lull value 01 the property Ie
Included on (he return as part 01 the gross ostale? II ''Yes,'' you musl complela and aUach Schedule E . , , . . . , . , , . , , . X
10 Old the decodent, at the time 01 dealh, own any inlerest In 8 partner9hlp or unincorporated business or any stock In an Inacllve
or closely held corporatIon? . , , , , , , , , . . , , , . , , , . , , , . , , , , . , , . , , , , , , . , , , , . . , . . . . . , , , , . , , , . . . . , , , . , , , , X
11 Old the decedent make Bny transler doscrlbed In section 2035, 2036, 2037, or 2036 (s9flthe Inslruollons lor SChedule 0
beginning on page 11 of the separate instructions)? 11 "Yes," you must complete Bnd anach Schodule G, , , , , . , , , , , . , , , , . X
12 Were there In existence allhe lime 01 Ihe decedent's de.tl1:
a Any Irusl. created by the docsdenl during his or her IIfellm.7 , , , . , , , , . , , , . " """",.""""...,..""... X
b Any IrUDls not created by the decedent under whloh the decedent possessed any power, benell~ial interest, or trusteeshi 7 " , X
13 Did the decldont I"er ponen, lIIerciu, or rolease ~ny,gltnll'lIl powerol ~PPolntmllnt111 "Yu,'you mllst compllll.and"ttach Schldull H , , , , , , , , , X
14 Was marilal deduction computed under transitional rule 01 Public Law 97-34, sec, 403 (e)(3) (Economic Recovlry Tu Act 0111l5l}7 . X
If "Y09," attach a separate computation ollhe marital deduction. e'lter the amou'nt on item 18 of the Recapitulation, and nota
on item 18 "computation attached,"
15 Was the docedent, Immedlatelv bolo," death, receiving an annuity described In Ihe "General" pa'agraph 01 the Inslrucllons
tor Schedule 17 II 'Yes," you musl complele and enach Schedule I . . . , , . , . . , , , , . , . . . . . . , , . , , . . , , , , , , . . , , , , . , , , . , . , X
16 Did the decedent have e total "excess reUrement .ccumulatlon" (es dellned In 'sellon 4000Ald)) In ~ualllled emplover plans
and Individual retl,ement plans? II "Yes." you musl complele and attach Schedule S, . , , . . , . , , . , , , , . , , . , . , . , , . , , . . . . . , , X
Part 5. -- Rocapllulatlon
lI.m
no.
Alternate value
Value at date 01 death
Oross Elstate
1
2
3
4
5
6
7
8
9
10
80,000.00
55,893.65
0,00
12,560.12
1, 172 . 84
44,735.51
613,~93.65
0.00
214,021. 48
Schedulo A -- Roal Estate. , .. . . . , . , . , . , .. , . . , , , , , , , . . , . . . , . , .. . .. , .. . . .
Schedule B .- Stocks and Bonds . , , , , . , , , . . . , , , . , , , , , , , . . . , , . . , , , , , , , , , ,
Schedule C -- Mortgages, Noles, and Cash. . , . , . , , , . . , . . . . . . . . , , . . .
Schedule 0 -- Insurance on Ihe Decedent's life (anach Form(s) 712). , , . . . , , . . . , .
Schedule E -- JolntlV Owned Property (anach Formls) 712 lor life Insurance) " ...,
Schedule F -- Other Mlscell.neous Property (anach cormls) 712 for life Insurance) , ,
Schedule (l -- Transters During Decedent's Llle (attoch Form(s) 71210' lIIe Insurance)
SchedUle H -- Powers 01 Appolntmenl , , , , , , , . . , . , , . , , . . , . . , , , . , . . . , . , . , .
SChedule I ..~ Annuities, , , , , , , , . . , , . . , , , , , , , . , , , , , , , , , , , , , ,
Total gross eslate (add Itoms 1 through D), Enter here end on line 1 ollhe Tax
Compulatlon, . . , , , , , , , , . . , , , , , , . , , , . , , , , , , , . , . . , , , , , , , .
Deductions
1. 021. 677 . 25
Item
no.
Amount
11
12
13
14
15
16
17
18
~
6,662,70
2,204.27
0.00
8,866,97
8,866.97
0.00
0.00
350,386.04
20,000.00
Schedule J -- Funeral Expens(;ls and Expenses Incurred In AdministerIng Property Subject to Claims. , , , , , , , ,
Schedule K -- DeblS o!the Decedenl , , . .. . . .. , , , , . , , , . . , . .. .. . . , . , , , , , . , ,
Schedule K -- Mortgages and liens . . . . , , , , . , ,. ."".,..".,.,."""."""..
Total olllOms 11 through 13. . , . . , , , . . , .. , , , , , .. . ,.. , . , , , . . , , , , . , , , .. , . , , , , , , , , , , , , , . , . . . . . , . .
Allowable amount of deductions from Item 14 (see the instructions lor Item 15 of tho Recapitulation) , , , , , . , ! ' ,
Schedule L ~ . Nf)t Losses During Administration. . . , , , , , , . , , , , , . . . . . . . . . , , .
S(:hedule L.- Expenses Incurred In Administering Proporty Not Subjecl to Claims, ' . . . . . . , ,
Schedule M -- Bequests, etc., to Surviving Spouse.
Schedulo 0 -- Charitable, Public, nnd Similar Glft~ and BeQuosts,
20 Total allowable daduclj()ns add Items 1S Ihrouqh 19). Entot hors and on II no ;! ollho Tax Com utatlon
Page 3
eM 77063 NrF 9593
C(lpyflght FnrrnsSultw.ue Only, 1997 ~lelr,(I, Inc,
379,253.01.
"""\
Hern~ alkla Carl H. stansfield
SCHEDULE B -- Stocks and Bonds
Descriptir.>n
Un.i.t
Value
Alternate
Val. Date
1 Keystone High Inccrne Bond Fund
(8-4) #46-83249004101 - 1.207.00
shares @ net asset value per share
of $4.28 = $5,165.96 (see
valuation letter attached)
2 prudential Mutual Fund Services,
Acct. # 3533332891-6
3 Dividends posted on daily basis
frcm Februazy 20 thru March 11,
1997 on item 2 (see valuation
letter attached)
4
I<errper Municipal Inccrne Trust
5 Vanguard Group. wellington Fund
6 prudential Securities polaris
Aircraft Incars Fund TV
7 Prudential Securities Polaris
Aircraft Inears Fund VI
8 Legg Mason Mum Bonds
9 Legg Mason M:lney Market
4.28
TOTAL; (Carryforward to main schedule) .'. . . . .
,-..
Altemate
Value
F:!l:;)e 2
204-01-3854
Value at
Date of Death
5.i65.96
12. 171. 59
62.63
6,250.00
4.085.33
1,733.04
1. 565.80
,20,748.60
4,110.70
55,893.65
........
~,
Form 106 (Roy, 4-07)
Eltlte 01: C. f!onl\f.l!l. a/k/a. Cal:..L.l~_ S\,~!..LLr~l!:!___._____.___ 2()~ -0 1- ]B~~.
SCHEDULE M -- Bequests, etc., to Surviving Spouse
Election To Deduot GUllllled Tlrmlnlble Int. real Properly Under $lOlIon 20fi5(b)(7), -- II n trll.llor 01l1or propmty) meal. Iho
roqulrol1lontu 01 qualllled lormlnablo InlOfUNI property undnr !IocliOIl 20~H(bl(7), and
.. Tho trusl or othor property Is Uolod on SGlludulo M, and
b. Tile valuft of the trusl (or Oll1or propmty)III flllloro!j In wholo or In purt us a duduaUofl on SClhodulo M,
Ihen unless lho (\)(oculor apoclllcallv Idontlllo9 H1R lrual (Eill or a lro<:Ilollul porllon or pnrconlago) or olllor pronorty to be
oKcludod Irom tho olecllon, lhn oxoculor lIt1aU bu dourood 10 lIovo mAc1n lln olm:tJon to hUllu RUGh lrual (or olhor propenYl lreated
I. quallllo:t termlnablolnloro.t proporly lIndor 'ecllon 2050(bll7).
lllnas Ihan tho onllro value 01 tho lrllsl (or olhor propOlty) thai tho O)(llOutor has Included Intl10 graaa olltato is entered U.9 a
deduotion on Schedule M, the meDel/tor shall bo consldured to havo mado an elocUon only as to 8 lrRclJon 01 the Irust (or olher
property). The numorator 01 thl. Iraollon Is oquallo 1110 amounl 01 tile Iru.1 lor olllor propllrlVl doduOllld on Sohedulo M, The
denominator ili equal 10 Ihe total value ollha trust (or othor property),
EllOllon To Daduot Quallfted Dom.sllo Trust Prop.rty Und.r S.ollDn 20S8A, ..1/ a Irust mools tho roqultemenls 01 a qualllled
dorne.llc tru,' unde' seollon 205aA(a) and 1111, relurn Is 1II0d no leler Ihan 1 vosr eltor the lime prescribed bV law (Including
oxtonslons) lor IIl1ng Iho return, and
.. The entlro va/ue 01 a trusl or trust property 18 listed on Schedule M, and
b. The enUre value of the trust or trusl property Is entemd as a daducUon on Schedulfl M,
Ihen unless lhe exoculor speolflcally Identilles the tTUstlo bo oxcluded lram Iho olocllon, Ihe exocutor shall be doemed to have
made an eloclion 10 have the onllra Irusllroated as uaUlled domosllc trusl ro (I .
1 Old any property pa.s to the eurvlvlng spouso as a result 01 a qu.lIl1.d disclaimer? . . . . . . , , . . . , . . , . , , . , , , . . . . , . , . . , , . . ,
II "Yes:' attach a copy 01 the written dlsclalrner required by ,ecllon 251 O(b),
2a In what country wa' the surviving 'pouse born? USA
b Whalls the .urvlvlng spouae'. date 01 birth? 04/14/20
c I. the surviving 'pouse a U.S. clllzen?, , , , . , , , , , .. , .. , , , , , , .. .. .. , , , , , . , . . .. .. , , . . , .. , , . , .. . , , .. , , . , , . , , , .. . ,
d 1/ tho surviving 'pouae Is . naturalized clllzon, wh.n did the surviving spouso acquire citizenship?
e 1/ tho .urvlvlng 'pou.e Is not aU,S. clllzen, 01 wl1al cOllnlry Is Ihe .urvlvlng spou.e e olllzon?
3 EleoUon Out 01 QTIP Tr.atment 01 Annultl.s, .. Do you elecl under ,eollon 2058(b)(7)(C)(li) not 10 treat .. qualllled
termlnablo Inte,e" property anv lolnt and .urvlvor annulllo. Ihat ..elncluded In the grose e.tato and WOUld olherwlae be
trealed a9 uallfled terminable Internsl ro fl under seellon 2056 b 7 C 1 see Instruallons . . , ,. ,.."".."",.,..,.,
110m
no.
Ye. No
X
X
X
Description of property :nlerests passing to survIVing spouse
Amount
See Schedule attached
Totallrom conllnuallon .ohedules or dddltlon.1 sheel' attaohed 10 Ihls sohedltlo . , , , , , . . , . , , , , , . , , . , " , , , , .
4 Total amount 01 prop~rty Inte,e.tsllst.d on Schedule M. . . . . , , , , , , . , , . . . , . . , . . . . , . , , , , , . . 4
Sa Federal e.tate taxes (Inoludlng .ecllon 4080A laxos) pavable oUI 01 proporty
Int.resto listed on Sohodule M , , , , , , . . , , , . , , , , , . , , . . , , . , . , , . . , , , ,
b Other death tllXe. pavable oul 01 property Interost. IIsled on Schedule M, . . . . , , ,
C Foderal and slate GST taxes pavable oul 01 property Inlore.,. l191ed on
Schedule M . .. .. . . , , . , . .. . .. , , , .. . , . , , , , .. " , , . , , , .. " , . , . , . . , . , .. 5c
d Add Itemu, b, and c , . , . . , , , " , " , , , , , , . . .. .. , , . , , , " " , .. , , , . . . , " , , , . . , , . . , . , .
6 Net .mount 01 proporty Intore9l.1I,led on Schedule M (subtract5d lrom 4). Also entor on Port 5,
Recapllulatlon. pace 3, at lIem 18 , , .. , , , , , . , , .. , , , , .. , . .. " , , . . . . . , . . .. " , . , . , , , . , . . , , , , .. . 6
(If more 'pace Is needod, attach the conllnuallon schedule Irom the end of Ihls peckago or .ddlllonal .heelS 01 the sa"", ,'ze,)
(8eo the InstrucUons on page 26.)
CAA 71'GSM1 NTF91114
350,386,04
]50.386.04
Sa
Sb
0.00
0.00
0.00
5d
0,00
350,386,04
Schedule M - PBge 27
C,Jpyrl~hl Form3 .!llJf!w4ro Only, 1!l97 Nolco, Inc.
\,
.-,
........--+------.....,-----~~
A, S~ltI_m.nt Slal_ment
lJ /I Dn"lm'~1 ~l t1G~"~~
1II'IU,.IIIOI,IH""'11I1
&. (Yilt
I.
1I1l04li
___~f1NG, ao,-o,"
o '''A
l,O Cony'. Ul\ln1,F'11.Nurrt,1'
M,n,'t,ld'PliS97
lO4f'l ~l/ll'C)C1r
1ot1lriQaQI 'j';'~C;;;-;;:;;;;'
~ANO ADDReSS OF SaLLER'
~n'l~';(s
" N AD, DO SS 0' LENDER:
1,0 ',jj'
4; 0 YA ILO Conv, lnl,
~: Thlt form- I, lumllhld 1(1 gNtI you. Illtem.,,1 at .Cllu,1 ,'lllftmlnlnoltl, Amounl' plld \0 tnd by (lIq ullltmtm 'QI"! .f. ,hQwn.
H.ms marked 'p.Q,O,' Wltfl Paid oul.lde of Clo.~O: th'V .t. ,hOwn hart 10' il11ofrnllllonlll PUrtlO'" 11M lire 1101 if1Qkfdld In l!llt 10111$
D,NAMH AND AOOA&8S OF BORROW6R: 1t''1111 _, ,II.ntfhld
12 turrlv Dril" Mtehanlclbura. Ptnru:d't.io.11 11055
Hltiltll of C, HtrtMn lun,~I.ld, Oltullud
~Io Chulu (, Shield.. flf. Ela.~.d. M.c:llnnltiburo.. Plnn'ylv.nl. 11055_
MIA
G. PFlOPemy a w..t Or.." Strut
~OCAt10N: 1I11rltll\4l"ltown, PA~.!3?ll-~,~__
Il, S!TlUMBNT AQENT: .netbllker, Ir.m~ i IpMIl, P.l:. AttorMYI lit LIIW
PlACE OF SS'TTleMCNT: 44 \lut ",In Strttt, "~k.nlo'burg, PA 110"
I. SETTll:MliNf DATE: -;-0--;;.,-;-;;-;;;;----
J. SU R RROWi;l=PS rnANGA<lltm:: . MMARV 'OF SELLER'S TRANSACTION
100, QROs..q AMOUNT DUf! FROM 80RROWER: ~, GROSS AMOUNT DUE TO 5EUER:
101. Ccl~t'Ul ,,'U "IU ~~O-L2.00. 00 40t. Cd~IIHt ,I'.. 'I'~I _ 80 000.00
lot. ~II'''~II D",1I1!L.-_ ot, PII"~~I aro,.."
10~. "IIII1M~t (1\110" t, Uttoor.n f003~ (Gross Pr.oceeds-$80 1000.00
!110m .~. '~QOJ
2 073.50
t04.
".
----------
10&,
ADJUSTMENTS POR ITEMS PAID flY SELLER IN ADVANCE:
~O',
- -
ADJUSTMENTS FOA ITEMS PAiD BY SEll.En iN ADVANCE:
101. ClI,It'''~ I'.... to
10r.ClI~ntylu" 10/24/97 to12/31./97
101, "..n.rn...." to
lot, Schoot Till ,oli.if17 "t" i;"l'Jjh1t;
.. 110. $eWQ,. IIlI 10124/91'''12/J1/97
111,
Ill.
401l. Clj,l\o.~ taUI
"
".>>.
10', Cou~I,!.Im lO,J.2.iL97 to121 J 1/97
_1Ji..ili
10, AIUtlm'~II
"
370.52
JL.Q.Q.
'"
...
Itl.
112.
School flJ( Il,/:j.<{/I'p ~~~ ~_
~.w.r IIHI 10/Z4/97'.12/31/97
) 7 0.52
'..no
.lJ2..2ROSS AMOUNT DUP. FROM BORROWER:
200 aUNTS PAID BY OR iN BEHALF OF E10P.AOWEA:
82,515.24
420. GROSS AMOUNT OUE TO seLLER'
500. REDUCTIONS IN AMOUNT Que TO SELLER:
80,441.74
101. aUOIlt ~I ..,...., mo~o,
",.!"tlMlo.1 ,mo"lIt ,,' ..." I,I~('I
10'- elll~U", '01"(.1 "un h~IIO' IQ
....
tOI.
,01,
101.
!!!.
'Of
ADJUSTMENTS FOA iTEMS UNPAID BY SELLEFl:
2.t...Q..Q.Q.,oo
501, f.,~"1 41'0.'t (101 '''II'u~I'o..'1
5,000.00
848.00
503, S.ltll.."..l c~"O" to ..ri" IW,," tlOOI
03. e.I.!,,,O IIIIMII tl'l~ lunllCt 10
SO,. PI,O!! of 1"'1 m~QIOIIOtn
\05, PAuli III ..con4 mllltO'O' IQ'~
".
'"
soa.
...
ADJUsnJlENTS FOR ITEMS UNPAID BY SELLER:
,10. ClI'/1O"..t.... "
Ill. OII~nl, t.... ..
IIf. "'..urnl..l. ..
IU.
11.. -
11'.
"O,Otyll<>""'....
"t, r...~"" IL...
iU AII,,"n'.!.~1
..
..
..
,II,
m.
211,
'~ll,
:UO, TOTAL PAlO OYfFOR
BOAAOWm
CAS AT seTIlEMEm FAOMfTO BORROWER:
30l Oron ~lIIOunt due frOTll borrow!! 11 M
jO~. lt~S 4.~~wr.~ ~lld b...I'~l' ~~:Ie:' !1\r,& ~~~.
303. CM1H (Gr.ROMl ( 0 TO) BORAnWr:R:
__f-_IlS
f---1.1~
f--!.\$
'"
$11.
'"
----
".
B2515.24
5 000.00
77,515.24
5,000.00 520. TOTAl. REDUCTIONS
IN AMOUNT DUE SELLER'
600, CA.SH AT Se:meMENT TOfFAOM SELLER:
2QL~"'ount r.lUt to 1IJllir....U..1n.L4,nl
IiO~. .ftn rNI\lct'," 11'1 t..tt r:lUft u!lor/linll SZO
603 ('ASH t B TO\ I 0 FROM) SEt.LeFI~
5,848.0C
eo 441.74
5 B4B.0"'
7.\ , 593.71.
HUD.l (3'B6) . RESPA, HB 4305.2
!IUIl9TfTUf!! rm.... IOU RF.tLEft t'IUll'IAENT, Th ''''0''''11'0" ~1I"I6'n'" ,,, e,.e., f 0, H. ,,," 1 '"" On ""I ~q' 10' ,t ""t ~q' " 10'''''_"4. ,,~.. 4a1 '"'' (041 II
l"'OOIU~t IU '''IOI"''IIO~ '~d I, ~tl.., fUt~"I\'" 10 tho I~"!"lt fl"'''uI 1'I''''c, "1.~ III "'IV"I~'O "'I I ""11", 6 ".Q"9,"e. ..",'t, ., ol~.. "OCI!O~ "Ht ~.
1",'01" 0" 10U il I~I. It".." t'.'IU~ I" ~I ,",01l.0 .,,4 I~' If"IlI """m'''" t~'I I! "II ~OI h." 'to~II'<I
tE\-UflIN&IAtJCTION" II !~I. It,1 "!.!<I .... ,,,." Pt'MlpII ,.'.d...;., "I, fo'''' lltl, ~'I' or f'C~'n;. 01 p""~'p'l R,,,dlne, '01 ,n, 0"", ..,,~ ,0YII"com. t~1
tfl~'": fOI OI~" '''....rotl'''I, c,m,'''' I~' ~DP~CUII "I" ~'I'a'''' 41", f.,,,, un ,,,4101 'lc~Uul, 0 fFo,m la401
tou '" '''~'IU to, 1,.. 10 ploo'4.(... ~<I' ~I\ .t1~ ,.u, c.lllet 16."'" ''''"II""tlon .uma" II "U ~o n,,1 .1"'''' I... n, Iii '"11. "UI COllfel "''',I!
'dlntll'e'IJ~" "umDII. IOU "'H U tUalHI 'Q ~,,'I ., ("""nl' 00"""" ''''DOH~ tl ".., I"" "n'" Qln''''.. ", ."'""" t ~..",. "II 'n. n.'m~1I .r..... <I" ,."
t111t",."t ,. '"f C","O! 1t.",0I '41"11II~It'<ln "~"'~..
________~_._______.,tU.'.II.nttu'" PAGE'
M~fI 'IQ 1\1I,~lU
It\JO.II....l."__
L.
100. TOf AL S.AlESIUROKllA'S COMMISSION
''''110 ON ""f:I!
SETTLEME T . A ".S
. ~.
PAlO F'ROM
flOMOWBR'S
FUNDS
AT
96in.llMENf
P"ID F'ROM
SELLER'S
FUNDS
AT
SETT'..l!MENT
-olVI510N of COMMISSION (liNe 100) AS FOLLOWS,
'011
PDJ I
101 Col~",lfI+'" Dlld II 1I!1I11111~1
,
10
10
Chuck Irldlr
Auc,Wnut
o
AY L
, W
N:
w....J.UD.J,i1WUaJlIU ~
1O'.LUft"..ounl ...
IJ.U.WIIUI II' 10'
101. bUd IIIOH I~
Idl LI~'I"I "'1D1r1,O~ !II
UI loiallUU ""WlInaUU'ICllla~ III to
10' hlu~,II611 In
101
II'
III
.1
Y N
.
10' loi'III1'I"'IU'UU .,.",fu", lor
HI Hili" InlullMI ,"mlwlIl far
1I1...!!lf'~ 'Mullnn oll",Iu",la,
.
I V WI
mOl I.
.,. 10
"I 10
L
mOM~1 ~ . ,"/l10ftlll
"'ont~1 'll . aft ~'Oftlll
m01\11I1 19 1 fir m01l11l
1IlIIlInl"" IIr mlnlll
mll\llI, U' "Imonlll
mOlllll' '" I III mO~tll
IIIlnllll" . III III~I\III
m01l11l1 ~. ""1<111111
W1..W.U" In'ullnd'
11001,l11lUII'"IUftMI
Idll4C'..ouIII.a,oGfIlVIIIII
tUt-hnllllllll..mlllll
IOU'IOadIHUIlMI
lall'
11111.HI.,UIIIOlelu",..,..IO
lief UII'I~III 11l!1 111101110
III! fill. ...",,,,Won f~
ill~..IIllL.!ll.lu'IIIU 11n'1110
4
450,001
J.I1LIoIIIII1lu.10
110'. ...nOIIl'" 1.11 t~ Sn,lbakllr, BrOMlllI'IIn & Spar.. P.C.
11MI\I'" nu.'II"" loIumbl!l~ Cortlflcate of Tln.l Tltl. Exam.
llU, TllI. In'ij''~O' t,
1~~Iu.U lib.. hi"" NllmU11
ltOO Lln.,,'1 e~u'I"
lUG 0.11,,'1 CO"I
till
lilt
t\l~,
.!NMN ATNA(AAG:
I:; =:::~:::::~ Jgg:rf' ~~::
_i. i; ;~AL SE;;;;;NT C;';;',
'I'lllillll
~I
=4
~g~
raOl IlIryn I~
tSO, 'UI ~"UIIOII ,/I
WJ. Sewer Bill (1.QL1L2.! to 12/J1/97>
4B.O(
t50&
1'01
1101
,too TOTAL SETTtE!Mf!NT CHAAoes 2 I 073 . 50 848 . 0 r:
'~t" u"'U~r ",'.,... 1111 HUO.l '1111''''1111 8!1I1""~1 '"1 II 1111 btU OI"'J '~O"".'I III~ h~lt. III1 . Uijl III' IUIt'"1 ''''I'''I~1 /I' I" 1101'011 1110 ",lij"''''.II', -If'
011 "'" IUIUIII or ~,mlrll 11111 UlnIlOItOIl. I lumll HII,I, 11111 111I.. IIUI'" I un or IlIlllun'l hllllm'"' llUII"'I~1
Elt.U of C. HorrrlGn Stansfield, OIlCIBSIl:l
0111.10/24/97 ::'~~rl."tZ....A// t: ~/~.Io ?IT,,~pm;10/24197
~~~t...r:l C. ~Untll'IJ, E~I;I'u(ol 1/
......,-...._.~~
~ r"'? /'v....t ~<....-,,~_~
,$Uy,n R, "In,fleld 'c...
10 If.'' II ~
8011'''.'
9'."0'
Olll_,""llll:
0111
,"I Hun' 1I111I'mllll .....mllll ..11I011 I ",.. '11""' II I trUI .", IUU'III .010111\1 01 I~I, 1,.~u~tIOIl
_MIIII,,'''I,.'''I''I
O.tl:
'tlIl1mllll _,llIt'
111101 (I,,"'~, ..~ tlulI ,II' 111"'1 II U ~IU\tlIU on ICU'H"~'
"-{'" ..' .-....
i . .////11
('~( ~"'_\i.(/ {/..,;f.--~,
SneINk.", '''~n .. SPirt
10/24/97
011.. _
WARNING: II II . c!lml I' '1I1I,,,",lf mnl 1.1.. 1111fm.1Il0 to 1101 UftI!,~ IltlU O~ 1~1t 01 U, ~1~1f .t"'~'1 I.,,,,. "on I"'" UllOII ~"lIyICIIIII elll "(lljll. . fin. In~ I"'",,,o~'
mlftl. ,,,r ~on;o nl' "110 It UI. Colli ltetlon lHI III. "CIIOll 1010
BLACK lETTDR lEGAL SOFTWARE, CORP. (617) 23101011
HUD.' (Rev. 3/86)
PAGE 2
.",-- ~. ~,- .~. ,.'- . "-" .
,.'"--0.
i Typo of polloV ---'--".
Pd Up
I awner'. n"".. I' tlecadenl I. n.II~. own.r,
pl.... ottocIl copy 01 OPI'lIcotlon.
Carl H. Slanslleld OS/23/61
iIV.IU. 01 t~. pulley .t tho tlm. 13 Amount of pl'.mlum
.1 o..lunm.nt (.... Inotl'llt1lon.)
$ S 00.00 Pd U
-
15 F... amount of poll.y ....... "....... ..........".."......".........'..... ..........,..............,.............,....,................
II Inllomnlly b.n.nta . ..,....,......, """""'''''''''''''''''''''' ......................,................. ........,............,...
17 Addllton.lln.."n.. ... ........,....,.. . .......,..........,......,...............,...........................................
'I Oth.r bon.tn. ..........,.."...,.....,...,.., ,............"...,...,.." ""'"'''''''''''''' '.. ,....."...,.......,..., .....'.... ,..
10 Prlnclplll or ony Indebtodn..o 10 tho compeny th.t I. doductlbl. In dolllrmlnlng n.1 p,ocudo..............
aD In.."ot on d.btadno.. (""m 19) .ceru.d to da.. 01 d.oth ........,.............."..........................................
al Amount of .ccumIIlatod dl.ld.nd. ....",.,...,.."",.".,....,....................,.........,....,..............."..................
22 Amount Of pO'I.mortem dlvldondo .....,...."..........,...............,........,..,..........................."..,.................,
21 Aanounl of re"'rn.d premium ",...".,..,..........,......,..,..."............,..,....,..,..........................................
a4 Amount ot proa.od. (If p.y.bl.ln.ne .um) ......................................................................................
as \loIu. 01 proceld. '" 01 dat. 01 do.th (If not pIIy.bl. I" one .um) ...........,....................".....................
21 ~ollcy prolrlolan. conc.mlng d,'arr.d p.yme"l. 0' Inrt.ollm.nt..
NlI.to: If o/h(l( Ihim lurnll-sum ..//I,mI'm/ is au/horlzed for 8 surviving spouse. please
ertach a copy or the I/1surance policy.
'OfIIM 712
(III.., -.. 1111) 1HoI'1lO.11M1001112
~~~~ LIFE INSU.~AN~ATEMENT _flllll," 1l~
D.c.~."I"ln'"r.d ITo I. Fllod WlIh Unllod Stot.. e.lal. Tu Rllurn, ~orm 7M)
D......nl.. FI'" Nom. & Mlddl. InHI.1 a O.c.donl'. Lut N.m. 3 D..od."r. So.',' S,ollrlty Humhr 'Doc. of Oullt
(If kno....'
Carl Stansfield 204-01-:1854
S N.m. .nd .ddr... 01 In.urln.. camp.ny Pllul Reverll lnourance Group
Indlvldu/lI Life Claims
P.O. 80M 180142
ChatJanooga, TN 370401
..- 7 ~ollc:y niiiniMt""-
01CMB8418
10 Aolldgnar'. n._. PI.... .ttae~
eOPY 01 _llnmonl.
03/11/97
8 D 1'1. II.u.d
11 D.", aulgj;;;j
T4 N.m. 01 banonelort..
Richard C, Sllln.fiold
10 (0).00
10 (0).00
------.--...------
27 ,,",ClIlnt 01 In.IIlI_nt. . ..,,'..,.....................,........................, ......'......................,............., ,................
ZC Polo of bIrth. MI Ind nonll ., I"y p....n 111. dUrallon 01 w~o.. II" may m...Ufllho numb.. of
p.ym.nll.
s
2. fn~:::.~p~:'.~T.";;j"n~~~~~ .~.~~,~~!..~.~...~n.!I....~.~~.~.I.~~. ~~~.~~...~tl~~,~~.~~~,~~...., ,~C=_.
30 1..1. (marl.1l1y t.bl. .nd rot. 01 Intofl.l) u..d by In."'ar In v.lulng !naltlllm.nt benon...
$
._~__..__~.______~_.._."u~............._........___.......~__,~...._____............_.....__.....
31 Willi It" Inlurod tho .n~ul..nt or b.n-"el.ry 01 .ny onnully eontr'.lluu.d by 11l. comfNIny1 ............. 0 Ve. [] No
32 N.n... a' comp.nl.. wllh whleh d...dont .."I.d olhar pOllel.. .nd .mount of .ueh pallcJ.. K thl. In'ormotlon I. dloe/o..d
by your roeord..
~-----
--.-..------.. ,---.--...._....._.._--~_._..-
Th. un.rol~
eOrroel Inlor-::r;"
lI.nature
Inllnlctlon.
IllllperWQrtc R.duetlon Act Nodn...We ask tor UH!I inr(lrmiUon on
thiS 'orm ID carry Dill the Infllrnal Revenue laws or the UnIt.,,,
51ltts. YOu are requlrea 10 QIUt! uS Inti ItHorm.'mn, We nftl!lCl II to
en.urfll lha( y"u .r6 complymg ",l(h InIlUt1 14llWS and to allOW us to
ftgure al'\d cOllect 1M rlgnt imount 01 .....
The Um~ netWtJd 10 C,t1mplf!lIB ilnt: 'II" ThIll. form Will vary depen<tlfl~
on InCft1,lIr.lu/it1 C1rl";umslanct'l~, The eslHNllea averaoe Umtll~:
Fa"" ~.oor"..pln~ pr.....1nt Ill. farm
712 1& hr$" 25 mill 18 lTur'l.
If you tll\le tommftnt!i COnCfJrnll'1Q Il1a .ccunr.y ot l:t1...e lIme
e;stlrNtU Dr sugge:ltlon9 ror '"1l11~ Inu rhll. rorm more .sImple). we
WQl.lld tie niPPY 10 /'leaf rrOm V'Jll Yau !;iHl WTI!r. to boln If'le I'1S
.'~ .b~ ~ '".unnel cotnp.ny h.reby c.rtIft.. <<h., U'll. ~.tamtlnt ..u ronh true Ind
:/,,;""""- ..?'''A~.. -_ THle IIltfdllf. UlI QIlUIa I'late of CIftlfl..Uon 12104197
.. .Jnd tho Offic:.a 0' MlnlgmTltJ'", 1M Bud'"'t .t the ladraSlMI lilted
In (fltl 1I'l!llruetions of ttle tl. raNrn wltn wnlr:tl U\II form II rtled. DO
NOT :lend tM tlIx fOrm to eIther 0' mese oMces. Inste..:J, rmrn It
to the exacuror or representative who rnquated It
Sui.'"..... Q' 1"...........- Ttll' f1ltemene muse bn mltd_, Dr! tJlfn"lr or
the In$Uflnce company mat Issued tt,e POlicy, by an OtnC8( Of (f'l'
company "''''"1;1 access !o the (ecords of rtUt companv, ~or
purposes 0' lhl' :it_lament, I 'ICSlmll$ Slanature may be USflQ II'
lieu or.. manual slgnall.lra Inti II usea, .'nAll De blncJmg as I mlnu.tl
:'Ilgrullurl't.
'~.t. Stattmlntt.-A SDpar..e .IIUlment must be filed tg, UCP1
pOln:)'.
Un, U...Reporl on lIn!'l 13 !I1n annui' premium, oot tnf'J t'.\Jmlllln\le
premium In dlle of dftllln, If de.tr1 QC(;lxrllld .nnr rnft ,"(I of the
pr$mlurn perlmJ, report me: IlIst .nnual premium,
DC.MS
Farm 7\2 IRey. 11-91)
'"""
1'"",
rOlm 712
'""",,, Auo~ 1'''1
Clftl4l1moMIO'I""TI~'l'
I'"MlII "~iRIt 6tf\Ilc.
Plrt I o.cotdol11.~llIurld lTu 8~ FII.d by th. E.ocutor With United Stlta. Eltata h. R.turn. Fo/m 7011 or Fo'm706~N"'.1
, Oloed.nt', IlnS! ntlme "nc1lflldrJl!-I Initial Z Oleld.nl', lair nlme , o.eeden1" 100i,I ..Ol,Jfltv nvmbtr ... 0'... of d..th
Carl H. Stan.f1.ld IIf knownl 204.01.3854 03/11/97
Life Insurance Statement
0"0 No '.'.'0011
II N.me end aUdrOIl 01 Inlurenel comp.MV
Oeplrtmal11 of V~tor.n. AU.I,., f',
. T'IP' 0/ polir,v --.
O,dlnlrY L1fa
0, Bo. 8079, Phllad.lphll PA 19101
8 Owner'. nlmll. If decedent i'5 not owner,
attach copy 0' .ppIiC81Ior1,
Cltl H. Stanlfl.ld
12 V.lot (If th.-;i;~r3 Amount of pr.mlum I." In.truetlanal
Un'tfI Of ''''gnm.nl
.2S,S5 .eml.lnlluelly
15 F.oe amount of policy
111 Indemnity benefit. ,
17 Addi.",,,,,/ In.urlno. ,
15 Other b,,,,,f1U
19 Principal of IllY Ind,bledn..s to the company that Is deductible In detlrmlnlng nat P/OC.edl
20 Inl",e.t on Indebtedna.. Ilooa 19) .cc,uld to dlle of d..th ,
21 Amount of "",cumulsl.d dlvld.nds
22 Amount of polt.mortem dividend.
::1:3 Amount of returned pr.mi~lm,
24 Amount of proceed. II paVlbl. In 01\1 .um
26 Value of proc.edl II of dot. of d..th (If not payable In on. IUM)
25 P(,lIcy plcvlelonl concerning deferred paymanta Q( lnetallm.nta,
Nato: II orhe, tha" lump.sum sa/tlamerrr I. .uthon'zed /of a surviving $l)OU'., etlllch . copy 01 th/l
insurance polley.
. Olt. I..uod
7 J>>ollcV number
V 270236
10 Alltuna,', nlme. Anflcll copy
of'lllgnmlnt,
1~' 1 O.t. ...ignld
12/27146
14 Nama of bon.fl"'."..
nIO;I.O C 'TINII't!LIl ILL
".,...................". "...,.". ,...,,,,,.,,,,,.....,,,,,...,.........,...,,,,,,,,..,,,,......,,,......,,,..,,,.......,,,,,..',
. UOO
.
.
.
.
.
.
. 42,53
. 4,38
. 2,546,91
$
..~
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.
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27 Amount of Inetallm.nt.
28 Oete 01 birth, .... and ".me 01 any parlon tho dU/ltlon of who.. life "'"I' mlalut. the number of
pavment... .,., ......, ,.,.., "......,,,,,,,,,,,,... ""'" .,1 ..", '" ",.......,....", "......', ,. "'" ''', ,..".
"",..,......,."...,...."."...",..... "".,................"........"""...............,.......,...".....,..",...,....,..,..
29 Amount .pplled by thl '''Gur.nce company .. . Ilngll pr.rnlum ra~e...ntlollthe flU/cha.. of
Installm.nt ben.IIU
30 Bula (mortality tabl. aNI r.t_ ol,nlllestl u.ed by Insure/lrt ,,"Iulng In.tallmen! beneflll,
I
""......"........".."."."""",.,..""",."""...".....,.,.....".............,.,,,..................,,,...,..,,,.,,,.,....,...,"""""'" .......",.,...,
31 Wo. the Inlurlld the .nnultant 0' beneficiary of .nv Innulty oCl11ract I..ued by 111. company? , 0 V" !XI No
32 Nlmo. 0' companl.~ wll~1 which d.clldont carried oth., policies and .mount of luch pollolaa If thil Information Ie
dlsc'oled by vour rtll:ordg ," ,..,.""..,..... .,....,,,,,,,,,,,,..",, '..., ......."..',., ",,' ,.,......,., ,', "..."", ".. ." ,',' ,., ,., "'"'''' ,.
,.,.".."'.""'.,.,.~.,."'.."""""...,.."'..""..."""..."..,..""",.""".,',.."..,.,",...,."..,.,....,.,.,.".."....".",...".,..""".."'"
Th. und',I/iII'I.d OUIt'lI' Qf ~. .bov. !1~:".d W\tl.l(ttnet (lomp"nv h.rMly OInrfll. lMt IN. .,,,,.m.nt It" fQoh lrue .nd COIr~C' ,nformlllon.
7'~ /'
Stgn.,ur, > ( jj:.(?(~;,~,'~:-.:... Tlllft > l08urenee SpeclaUI' Date 0' Cel1lt!oallon )0 4/3/98
Inltrucdono I /', II Budqe1 n thl ,ddt..... I"led in 1M lntffuollan. 0' 1M 111I te1lJm wtth .....,ct1
""'0" ....,otlon Acrt "ottc..,,~, ,'" fOl 1'" In'otmltlon on lhi. form to tnll form I, flied. DO NOT u"Clln. UIII lorm to tl1/'111 of It'I'' OWOII,
e.m' uut1"'. It'llltrlll Ae....nu. lawl! ol lh. l)MtO St'ffl', Yeu.,. 'lKllli'tcI !nuna. ,.,vm It to chi lu\,'ular OIl ,.""...nlllI''' ......no "QIIU,,1I11.
to oiv. "'11l'l' it't'Otm.tlnn, W. "I..d II III "nIlV" tkat you If. complYing 'o'tllrl 8Itlr1~ of IntUN"..Tl'III "'1",*,1 mUle b. micHl, on ~h.1I 01 ,,,.
Ih... l,wI ,nd 10 I!lOW UI III liQlIIC' .mrj 1,01111(;1 ,,... IIghllmour\t of I,", IIlIUf,nce {lompany trllllu\Hd the pohQY. by ." offiCI' 0111\1I camp,ny
T~ Iln,. n..dlld to camPI.,. Ino fll.. !Ill' 101m w,1l VII'V dlp.H'ldlnQ on "''''''01001'' 10 th. r.clWttl of 1M com".ny, 11I0.1 ou/~"I at th'l
!rtOlvldu.1 Clfcuml'lncn, Tl\, utll'fl.,.d ll.,.r1oe tlml i.: u".mIWu. II ft<lllfnll4l '~"fllll' mil" tJ. ulld In hlU at . mlnull 'lqntlUII
'Ofm ~GnA""'O "......ltn, thl tomt Ind If ~t..d. IIl11l be blt1(llng I' I tMfIuIoI I11l9nlltul'
7';Z 18 tlfI., 2!l m'(1, 18 min. ~'1f",.......,..'1I.. IIJlII.I.IIIQml 711.101' ..ch poolkly
If '(Qu hi"" cornmflllll cOrle.",lnu In" IH:CUI,r.y ()i ,,,..' Urn. IIumll" ur lJntI13...AilUIGft on Un. , J lilt .nnu.1 f,ltllNum, "lot 1M CUlT\I,illllv' Pf,",tl.ll'"
IUHullon, 'Of mllilt"Q 1"'" 1m"" mal.. ,,,not,,, ,,.,. would bfl hllI)CJy 10 h..r to dltl of rI.lf1h. If 11..,,, oct:uHld .ha' lh. ltI1(l of In' Jljemlum ~"gd,
horn you. 'tOu c.n HlllI '0 bOlf\ tl1l1 RS.M \ht OHiC. t>f M.,'IOlmenlll"rI rfpon th.lnt annUli D""lIUm,
e.L No, 101l0V
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I 'I} SECUR'I'rY' '(!'fl" 'iJiiSURANCE co.
"" ANNUITY b. . NICE OFrlCE
P.O. BOX 9230 BOSTON MA, 02205.9230
C";..,:F>...;..OWNER:":.,,.:,' ::'COnTRACT;'Ilt'1
.:~-----'" '
000712B29
~XW'#lN~ITA'NT'_=rOD==r.~PLA~I' ]
WIll:tDRAW'lype,IoII!MOCOOe . SO=CE ~J
qAA:1J~t.\ hi f<MqUt:lTA;11::l'lE~KNl)""BER
04(30/97
$8841M1
0000331087
. . .,,"" '.~.
"., .,..
Thll fundI hive been sent
at \".. Owner's Instruction.
. C?J\LCULATIOitOFNET:AMOUNT
Gross Amount $88,410.91
surrender chsrges $0.00
administration fee $0.00
fedBral withholding $0.00
state withholding $C.OO
munlolpal w/holdlng $0.00
Cheok Amount $88,410.91
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OOMMOHWIALTU 0' PINf.l8YI.VAIIIA' OllPAnTM6Uf OF H8ALHl . VITAL "IUlOng.
CERTIFICATe OF DEATH
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,~,Off'UII
f4A.lII'All'llUlVll
....,...~'OCCVM'lU
.t'.".,~....."II1_
[I
rl
LJ mtiOi."..,iirl;.'ii;.,.;;t'i;;~~iOiif;..,."""."
",.0 1.0
1101.....,.
":W"I"...t..~.""....-I
I'IIII'.Ull "'
lJ Hi.
\II;C"$t1itflifJlt III o.:liiii".olu..;. 0.. ..,
l:/II\ )tUO.~ L.l:.n L_..~_..__IIt..A-"IJ,.dLi1I(I'J1
,,'.., "J1tI'1 '('I"""ln~O""'.JOI."111 OCAII,15lbll-lll
.WID":All'.V...I!V~\>fllf"llII '....../!I!'9400"... Dr. William YOUlllJ
~~~::~::':':I':.:....:"."'~.n.~.:"..~~H~".'~",......,..""..n ~.,,~..,".,.~"",.,,"'. ~".,'"~.'.I.,.''..~...I.,I.......('I''''' {I 32UO r~ark.ct Strcot I Camp tllll, PlI 17U11
I'. ., ' ., 'I
~~7!Gji"iilr.w;i~"''':;'- /"~-~-I- -~~~-- ------ .---- ---'tAI t I...:]~~I~~I'."-- u~in"ilJ.....-f'IJ" .....
,_ ..)'>,IlI>vI!I....... '-',,~h,"I..J.:j\ \"" "\ _ ..___.___. ._.__ "-1UJ.i1:0~JL1..tr /.'i..'LL
'~"O"OVt<I"O .!tr.-~I~rl"...<l'll1tlC'A""",...-..."...... .,,".. '1"'"'' ",,""""'" ...", ,'. ,II
1.""'_..I""._....'..,...........,....I"".....u.. ......,......,...I.'~......"l.""..."n"..".'..
CHARLES E. SHIELDS, III
ATTORNEY.AT.LAW
6 CLOUSER ROAD
COI'Mr ofTrllld14 oIId C/o..., RO<Id..
MECHANICSBURG, PA 17~S
GEOROE M. HOUCK
(lm.l?91)
TELBPHONB (717) 766.0209
PAX (717) 79S.7473
August 26, 1998
Register of Wills
Altn: Cheryl Winters.
Cumberland County Courthouse
One Courthouse Square .
Carlisle. PA 17013
ReI Estate of Carl Stansfield 11.- ,';:t,., (;,
Dear Cheryl:
Enclosed is a Notice of Inheritance Tax from the Department of Revenue, and a check In
the amount of $750.53 for additional monies due regarding the above estate. I would appreciate
having a receipt.
"
Thank you.
Very truly yours, .~ .... . '
C!k&o~ W,-~~
Charles E, Shields, III
ej ,
enc~.
Qi ~ :n~
~ . (1)
l{;l',
.""....
, ~:" f" ' ~ ~l": t)
:l'i rr
.':.
, ~
.
;:.Y ~;i (i,
f...' 1'.\ fii g,
12 c Ui
-;;4 N
COMMONWEAL'I'H OF PENNSYLVANIA
DEPARTMENT OF REVENUE
,4REAU OF INDIVIDUAL TAMES
IHltERIUNCE TAlC DIYIS1QH
OEJ-T. ZII061H
"ARRISiUJRG, "" 17126~0601
NOTICE OF INHERITANCE TAM
APPRAISENENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSNENT or TAM
08-03-1998
STANSFIELD
0;1-11-1997
21 97-0266
CUMBERLAND
101
Eo ~~OMltted..~~
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 -411
rfili:i!j47'E"i"AFP"foF9;T"liioYiciniF"YNHEifii'iiiicE-TAiCA'PPRA'isE'i€N,.-;-,\i::rOwAN"cE-ifli------.---m-m
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
CARL H FILE NO. 21 97-0266 ACN 101
DATE
ESTATE OF
DATE OF DEATH
FIll!: NUMBER
COUNTY
ACN
CHARLES E SHIELDS
2 W MAIN ST
MECHANICSBURG
PA 17055
ESTATE OF
STANSFIEl.D
TAX RETURN WAS I (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
----
APPRAISED VALUE OF R!TURN BASED ON: ORIGINAL RETURN
1. Reel E.t.te ISohedule Al
2. Stock. ond Bond. ISohedule Bl
3. CloS81y ~ld stock/Partnership Int.r.st (Schedule C)
4. Horto-vea/Not.. Ree.lvabl. (Schedule D)
5. C..h/8~ Dopa.its/Hile. Pmrsonal Property ISchedul. El
6. jointly Owned Prop.rty CSch.dul. f)
7. T~~uf.r. (Sc~dul. 0)
ft. lot.l A.sets
( ) CHANGED
(1)
121
131
I~)
(fil-
l')
(7)
60,000.OQ
55.895.65
.00
.00
44,735.51
.00
839 ,315.13
(B)
'*
UV.IU7 II'" 11',"1
CARL
H
DATE 08- 03-1998
NOTE I To insure proper
cradit to your ~~ount,
subMit the upper portion
of thia for. with your
taK pay..nt:.
1,019,944.29
APPROVED DEDUCTIONS AND EXEMPTIONS I
24,914.47
9. Funeral EKp~..I/Ao.. Costs/Hile. EKpen... (Sohedule H) (9)
10. Debto/lIort""uo Uobllltiu/U.n. (Schedulo Xl (10) 2.204.27
11. Totol Deduction. (11)
12. Net Value of T.~ M.turn (12) _I
13. Cn.ritable/Oo"arnlNtnt.l Beque.te; Nonwehot.d 9113 Trusts (Sohedu1. J) (13)
I~. Hot Vel... of F..toto Subject to lex 1I~)
HOTEl If en essess.ent wes issued previously, lines 14. 15 end/Dr 1&. 17 and 18 will
reflect figures thet include the totel of ALL returns assessed to date.
ASSESSMENT OF TAX:
1&. AMount of Line 14 at Spou..l rat. (15)_
16. A.ount of Lint! 14 t.K.bl. at Unee1/Cl... A r.t. (6)
11. A~t of Line 14 t.xable .t Coll.teral/Cl.,. Brat. (17)
18. Prinoipal Tax nu.
TAX CREDITS I
PAYNENT
DATE
06-os-i997
05-05-1998
RECEIPT
HUMBER
AA211385
AA270047
DISCOUNT 1+ l
INTEREST/PEN PAID (-)
789,(,7
39.47-
---L
8ALANCE DF UNPAID INTEREST/PENALTY AS OF 05-06-1998
. IF PAID AFTF.R DATE INOICATF.D, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
342,036.26
630,789.29
.00
X .00_
X .06_
M .15.
liB)
?7.11A 74
992,825.55
20,000,00
972.825.55
.00
37,847.36
.00
37.847.36
37,847.36
.00
750.53
750.55 ~
( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED.
IF TOTAL DUF IS REFLECTED AS A "CREDIT" ICR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
ANOUMT PAID
15,000.00
22,097.36
TOTAL TAX CREDXT
BALANCE OF TAX DUE
INTEREST AND PEN.
-----
TOTAL DUE
____._.__.--.....L-
PIlRPOllEOF
NOTICE I
To fulfill the requJr..-ntl of s.otlon 2145 (b) of the InherltlnOt Ind eet"t. T.~ Aot, Act 21 of 1995.
(72 P.I. SeoUCM1 9145).
PAVHENTt
o.t.m ttM tOfl portion of thb NoUce n IUbIllt with your P8YMnt to the Rqht.r of NUb pdntu on thI
rayer.. flh...
-.. .... oheok or IIOntY ordlil' pey.t)la tOl RBOISTER OF MILLS, ,gENT.
REfUND (CAlf
A refund of . talC ortldlt NY be r~st.d b!Jf COItPleUna an "AppUcaUon for Refund of P"""ylvenl.
Jnhlrltanoe end Elt.t. 'ax" (REY~1313). A~llo.tlon. era available at the OfficI of the R.-llt.r of Willi,
tinY of the 23 Revenue 01ltrlot OffiCI' or frOll the DIPltrt..nt', 2"~hour answrlng ..rvl01 ~r. for for.. ordllrJOII
In Penn.ylvanla lweOO-56Z-20S0, outllde Pennlylvanla and within local HarrisbUrg ar.. (717) 787-1094,
TOO' (71)') nZ-2252 (Hearlno 1.pa."ltd Only),
OBJECTIONS I Any party In lnt.rlut not .aU,flad ..ith the 8s......nt of talC 8' ,hown on thh notio. "Y objeot wJthln
.111ty (60) days of receipt of thIs Hotlee bYI
--Nrltten protest to the PA DepartHflt of Revenue, Bo.rd of Aweah, Dept. 281021, Harrisburg, PA 17128~10Z1, OR
--aleaUna to haVA the ..tter deter.ined .t audit of the per.onal repr"ttntaUve, OR
~~appe.1 to the Orphan,' Court.
AIlIIIH-
ISTRATJVE
CQRRECTlOHSl
r.ottM1 error. dheov.red on thh ........nt .hould be tKtdr...ed in Nrit,tng tOI PA h1partHnt of Revllf1U8~
Bureau of Individual T.xe~~ ATTNl Po.t A.......nt Revi~ Unit, o.pt. Z80601, Harrl.burg, PA 17118-0601,
Phone (717) 787~650S. See page S of the book1.t ftIn.truotion. for I~ritlnC. Tax Return for. Re.ident
D~Ddentft (REV-ISOI) for an explan.tlon of aa.inl.trativelY correctable ~rror..
PEHAL1V1
Tho 15~ t.~ .-ne.ty non-p.rticipatlon penulty Is coaputod on th' tot.l of tho tax end int.r..t 'a....sed, end not
paid ~for. January 18, 1996, the flr.t d.y after the end of the tax .-neatv period. Thl. non~P8rtlolpatlon
penIIlty 11 ....al8bh In, the .... ..rmer &nd In th. tho .... tl,. period II' YOU MOUld appeal the, taM BOd lntere.t
that hat been .......d a. Indlcatld on thl. notlc..
INTEREST I
For dat.. of de.th on or after lO-3-~I, Penn.ylvanla Estat. TaM basad on the Fadera1 E.tate T'M
return tNacOM. delinquent at the aKplr.tlon of nine (O~) aonttll frOll the date of death,
ror dat.. of ~ath prior to 10-3-91, Penh,Ylvania r.tate T.~ baiRd on the F.doral Estat. Ta~ return
beCOM' delinquent at th. expiration of elghtMfl (18) ItOnth. froa the dbt. 0" death.
11M.. Nhich tMteue delinquent beforo January 1, 1982 bear Internt at the rote of sill (6;() ptlrc."t per IMla
ctlcu111tlld .t fl dally rate of .lJOOl64. All taMes Nhlch tKIcaIte dellnqu.nt on or after JMuliry 1, 198Z NUl bur
Intere.t at a rnte which will v.ry frOl calendar yair to calendar year with thet rate ennounoedbY the PA
n.partaant of Revenue. rhG appliCable Int.rest ratl' for 19a~ through 1998 arel
Ve.r Interest R.te Deily lnt.re.t raotor Viler Inllltll,t Rete Dally Inter..t Pector
1982 20X .000548 1987 9X .000147
1985 16;( .000438 1988-1991 ll~ .000301
'9M lU .000301 '992 9X ,000247
1985 13~ .00OS56 19f)~-l994 n .000192
'9" 1O~ .000274 1~9S-1998 9X .DD0247
~-Interlt.t ia calculated a. follONll
INTEREST . BALANCE OF TAX UNPAID X NU"BER OF DAYS DELIHQUENT X DAILY INTEREST FACTOR
....Any HoUoe h.ued aftlr the tlM beoOll8' cMIUnquent Nlll ..efleat an inter.lt calculation to flftHn US) lilY,
beYOnd U. dllte of the ........"t. If paYMnt II IIade after the lntera.t CC*pUtaUon dIIt. IhoNn on thI
Hotl~, ~itlonal lntnrl.t .u.' be calculated.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
IS~/(}i .S
BUkEAU OF INDIVIDlIAL TAMES
INtIERIlAHCE TAM IJlVISION
nml1.160601
ItAlmlfiBURQ, PA 11'11'1+0601
,,\
(/
NOTICE OF INHERITANCE TAM
APPRAISENENT. At LONANCE OR OlSALLOWANt:E
OF DEDUCTIONS AND ASSESSNENT or TAM
06-03-1998
STANSFIELD
03-11-1997
21 97-0266
CUMBERLAND
101
[===un~-~"lftDd ~
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiEV:i547'EinFjlufo'F9;T"liiiiT'icn;j1-YHHEifii'AN'CE"'fAX-A-fiiiiiifisii;.iEN'f;-AL.l."OWANCE-oR'---..----------m
DISALLOWAN~E OF DEDUCTIONS AND ASSESSMENT OF TAX
CARL H FILE NO. 21 97-0266 ACN 101
PATE
ESTATE OF
DATE OF IlEATH
FILE NUMBER
COUNTY
ACN
CHARLES E SHIELDS
2 W MAIN s'r
MECHANICSBURO
PA 17055
ESTATE OF STANSFIELD
TAM RETURN NASI I X) ACCEPTED AS FIl.EO
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONe ORIGINAL RETURN
1. R..I Est.t. (Schftdul. A)
2. stocks and bands (Schodul<l B)
~. Clolftly Held stook/PertnBrship Interest (Schedule C)
4. Hortgag.s/Hote. R8ce,vable (Schedule DJ
S, C.~h/D.nk Deposits/Hise, Personsl Property (Schedul. E)
6. ,Jointly Owned Property ISchedule F)
7. Transf*rs (Schedule G)
8. Total Assets
11 )
(2)
131
(~I
151
161
171
) CHANGED
80.000.00
55.893.65
.00
.00
44,735.51
...2.2..
839,315.13
(8)
*'
tIV-IH! ..", C".",
CARL
H
DATE 08"03-1998
NOTE: To insure proper
credit to yuur acoount,
SUbMit the upper portion
of thl~ forll with your
teK peYMnt.
1,019,944.29
APPROVED DEDUCTIONS AND EXEMPTIONS I
9. Funerel Expanses/Adll. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Nortgao- L1eblllUos/Llans ISchedule II 1101 2.204.27
11. Tobl Deduotions nl)
12. Net Value O'f Tax Raturn (12) _
13. CherUable/Gov&rnllenhl BequeshJ Non-elected 9113 Trusts (Schedule J) (13)
14. Net Value of Estat. Subject to Tex (14)
NOTE: If an assessment W8S issued previoUSlY, lines 14, 15 and/or 16, 17 end 18 will
reflect figures that include the total of Ab!.. returns assessed tc date.
ASSESSMENT OF TAXI
15. AltOuot of line 14 at Spousal rate (IS)
16. AIIOUl'lt of line 14 taxable .t lin.al/Class A rat. (161
17. Allount of line 14 taxeble .t CoU.t.raI/Clan 8 rat. (17)
18. Principal Tax DUI
TAX CREDITS I
PAYNE NT RECEIPT
DATE NUr,BE R
06-05-1997 ~A211385
05-05-19~ AA270047
BALANCE OF UNPAID INTEREST/PENALTV AS OF
DISCDUNT 1+)
INTEREST/PEN P~ID I-I
789.47
39.47-
24,914.47
342,036.26
630,789.29
.00
M .00.
M .06.
M .15.,
{l81
27.]]11 7!L
992,825.55
20,000,00
972,825,55
.00
37,847.36
.00
37.847.36
. -
05-06-1998 TOTAL TAX CREDIT 37'8~7'36,~
BALANCE OF TAX DUE .00
INTEREST AND PEN. 750.53
------.---- --------
TOTAL DUE 750.53
-~--------
IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED.
Ir TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, VOII NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I
. IF PAID AFTER DATE INDICATED, SEE REVE~SE
FOR CALCULATION OF ADDITIONAL INTEREST.
AHOUNT PAID
15,000.00
22,097.36
,....-,,'........,
~Q ~ ;p~
w
^'
t~ :': .,t- _'
" ~
-'
0
: ::sl '::'-_"1
"'0 l'~ 1-,) ~~r ()
I>' ~,
"" ~l \,Q
RESERVATION I est.t.s of dtOldtnt. dying on or before Deo..a.r 12. 19.2 4. if ~y futurl inter.st in thl ,It.t. i, tr~sf.rr.d
in pa'''ls1~1 or Injo~t to el... . (ooll.tlr.ll benefioilrils of the decedent .fter the .xplrltlon of any .It.t. for
11f. or for y.ar., the CNIOOWIIlth herebY ,xprsnly 1'...rYII ttw rllM to -wreSt. end ...... tr.,.f.r InherHlllo, TtX'I
at the llMlful Clalll ! (aoUlt.rli) rljt. tin any luoh future inter..t.
PURPOSE Of
NOTICE I To fulfill the r.qulr.-nb of SIOtlon 2140 of t1M1 Inherltlnoa Illd Estat, Tlx Aot, Aot 21 of 1995. (72 P.S,
9eoUon 91~0).
PAVtENTI DetlMlh ttMI top portion of this Notice and subltlt with your P'WIlnt to the Raghtlr of Willi printed on thl rlv.rs. _hM,
u",*. chick or aon.y order p.ypl. to I REGISTER OF MILLS, AGENT
REflJNl) (CRll A refund of a tax orfldlt, which Will not r.quolted on the fe)( Return. .ay be r.qoe.tlld by cOIlPleth'CI ., "Appl1olUon
for Rlfund of Penn,ylva"l. InhlrltltflCe and rltatl Tax" (Rl::Y-1313l. ApplJllIUonl .re avaUabl, It the OfficI
of the Ragltter of WIH., eny of the Z3 RlVlfllle Dhtrlot OUia.., 01' by oal11n" the Ip.oill' 2q.hour
.....wednG nrvlu ntMberll for fori' ordering I In Penn.ylv.nh 1~800-362~20S0, ouhlde P.nns~lv.nJ. end
wl'hin local Harrisburg ar.. (7111 787-8094, TDUI (717) 772~2252 (H..ting 1~.lred Only),
OBJECTiONSI AI1Y party In Intero.t not satisfied with tho appralte"'ent, "l1o""nco or disallow.nce of deduotlon., or ........ot
of tax (Including dltcooot or InternU as Ilhown on thh Notice .u.t obj.ct within shct~ (60) d.~. of reoelpt of
thlt HoUce b)'l
"~wrltten prot..t to the PA Oepllrhlent of Revnnue, Board of Appeals, Dept, 2'81021, Harrltburg, PA 171Z8~10.tl, OR
-"eleotlon to hllv. ttMI aattor deteralntd at Budlt of thtt IIOOOunt of the per.onal reprUtnteUv8, OR
-~eppeel to the Orphans' Court.
ADttIN
ISTRArIVE
CORRECllOHSl
FltOtual error, dltcoverld on thlt e18e".41nt should be raddr....d in wrlUng tnl PA Dtpartlllnt of Reveou.,
Bureau of Individual T.~41S, ATTNI Post ~'..'seant R.vlew Unit, Dept. 280601, Herrl.bUrg, PA 17128~060l
Phone (717) 787~650~. Soe peg. S of thR bookllt "Instruotlons for lnherit.no. T.)( Rlturn for I Re.ldeot
hcedlnt" (REV-ISO!) fal' an l)(p18nllUon of adlllnlttreUvlh corrlotable errorl.
DISCOUNT I
If any tll~ due I. paid within thr.e (3) callnd.r .onth. .fter the dlcedent's ~ath, . five percent (IX) dllcount of
the t~)( p.ld I. allowed.
PENAL TVI
T~ 15~ tl~ ~.ty non.plrticlpatlon penMlty II oo~uted on the total of the to)( 8nd lntera.t ......ed, and not
p.'d before January 18, 1996, the first d.y after thct Ind of the tnx unasty Plrlod. Thlt non~p.rUoipIUcn
pen.lho It app..labl" In the sa..e aanner It....., in the the .... ti.e p.rlod al you woulet apP.II, the tax and Inter..t
thet hes been a..et.ed IS Indla.ted on this notioe.
INTEREST 1
Inter..t It charged beginning with first day of delinquencY, or nino (9) ItOnth. and Dna (1) day frOll ttM at. of
death, to the d.te of p.y.ent. rl)(e, which b.o.lle deUnqUtlnt before Janu.r.v 1, 1982 baar Int.r..t .t the r.t. of
.I~ (6%) p.relnt per ennUI caloulated at . daJl~ rate of ,000164. All tO~.1 which bee... d.llnquent on Ind aftar
Janulry 1, 1982 NIll be.r Int.ra,t ot I rate Nhlch will yary frOll calend.r ye.r to oalendar ~..r with thtlt rat.
announced by the PA Dlp.rtunt of Jlltvenue. The IIPplIcabl. Interll-t ra".. for 198Z through 1998 aral
~ lnternt Rate DeilY Int.rut Factor ~ Inhlrut R.te Dally Interl1.t ~'eotor
1982 ZOiC .000548 1987 9% .000247
198:$ 16% .000438 1988-1991 111: .000301
1984 11% .000301 199Z 91: .000247
1985 l!X .000!l56 1993~1994 n .000192
1986 10% .000274 1995~1998 9% .000241
--Inter..t Ii c.loul.tyd .. fOUOWIl
INTEREST . BALANCE OF TAX UNPAID X NURBER OF DA~S DELINQUENT X DAILY INTEREST FACTDR
-~AnY Hotlee I,.ued after the ta)( beco... delJnqu.nt will refl.ct In inter."t o"lculatlon to fifteen (1S) d.Y,
btyontl the d.t. of the ........nt, If ply..ent 11 ...da .fter the Interut cOlIPutaUcndlt. 1MWI'! on the
Notice, oddltlonal Inter.ltau.t ba calaulated.
, -.. ,"., - ~ ,
COMMONWEALTH OF PENNSYLVANIA
(lEl'ARI M.NT OF ~.VENUe
aUReAU OF INDIVIDUAL TAMES
(lEPT,?SOOOl
HARRlS~UAG, PI. 17128'0801
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
.~'!J~'~
~
NO. AA 2 '70047 REV"" EX (""I
RECEIVED FADM:
I
AON
ASSESSMENT'
OONTROL
NUMBER
AMOUNT
SHIELDS CHARLES E III
6 CLOUSER ROAt>
1!lL
..~,~ I ()Q7 ;.}I-,
MECHANICSBURG, PA
17055
WHJHEllt
"
ESTATE INFORMATION:
FILE NUMBER
.,..El.::"H5':2:=O.E66__,aRN ~q4~.Ql~~l3q4
NAME OF DEqEDENT (LASTI (FIRST)" (MI)
m.SJ.ANSElan...nf\RI HF'RMAN
DATE or PAYMENT
FOlD HERE
".._...,5..LOh~a..
POSTMARK DATE
.. ,__...5.L05L 1 9q ~
COUNTY
TOTAL AMOUNT PAID
.,ea. 097 . 36
,._._-CLIMBEBUlNn
OATE OF DEATH
;:) 11 1 11 99'7
REMARKSRICHARD C STANsFIELD
cw
AEOEIVEO BY
/ t,..Y
I
MARY c. t.<wrs ;Ii~"":)(';~, _
,.... '. ...",...,,>',J./.I' '," 'f
REG!SHiR OF WILLS" .'!
, -i'
/i:
"
SEAt9HECt<*q30't
WILLS
---- -, ~ ~-,- --- -~-- -~ '." ". ~..,... ..........
,. ...,
'.. '....- . ,,"'.'
."...,.-.; ~.,~_~+- ,~~ ___. ,;rn.-i..'wrl..ri. ..........."-:''-,...-'"".,-_"' _"~.-~--'---~_.___ _.~,_
.
.
'c;. ,
"
'~;.~ -1':""----""'
,.. _............---
'__""~"- ~ _ Ii 'q. ~
I" / Ir i/ ,',
IUftEAU D' INDIVIDUAL TAKEB
IHHI:MIt~f. fAK UIYUJUH
nt'P" ~a1601
ftAMRllilUJRQ, PA l'UA~D601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
C'
'*
UHU1U A'P CII-'1>
CHARLES E SHIELDS
2 W MAUl ST
MECHANICS BURG PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-28-1998
STANSFIELD
03-11-1997
21 97"0266
CUMBERLAND
101
CARL
H
E~tR..ltt'd ==:J
MAKE CHECK PAVABL,E AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURl HOUSE
CARLISLE, PA 17015
HOTEl To insu.... pr~r o,...dit to your eocCtuntl lub.it the upp.r portion of this fot'lI with your tax p.Yllent.o
CUT ALONG THIS LINE .... RETAIN LOWER PORTION FOR YOUR RECORDS -411
iliWiiiiWiif-"Fj:i-foi':m-------.ii.--iNii€lii:i:i\iic'f-i'iiif's;'iiWifN"i'-cfF-ACciiijiiy--ii..------.--.--..m--n
ESTATE OF STANSFIELD CARL H FILE NO.21 97-0266 ACN 101 DATE 09-28-1998
THIS STATENENT IS PROVIDED Tn ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NANED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAM DUE, APPLICATION DF ALL PAYNENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
! PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 07-27'1998
PRINCIPAL TAX DUE"
3" ,847. ~6
PAVMENTS (TAX CREDITS),
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-05-1997 AA211385 789.47 15,000.00
05-05-1998 AA270047 39.47- 22,097.36
08-27-1998 AA296597 750.53- 750.53
. IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FDR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS lESS THAN .1,
NO PAY"ENT IS REquIRED.
IF TOTAL DUE IS REflECTED AS A "CREDIT" (CR),
YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. )
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
37,847.36
.00
.00
.00
if""
I
PA VItENlI
{'.J
I>,
o.tooh the top porttJ,J:~:':f thls Notlc. .nc:t .ubIIU wUh your PlJw.nt ..de payatU. to t~ neH tnd Iddr...
prlnt~ on the ".".r.. dele.
If RESIDENT DECEDEHT .1Ik. check or IIOMY order panbll tUI REGISTER OF WILLS, AGENT.
If NON-RESIDENT DECEDENT .ake chick or 10lllY order pllIyablll tOI COHHONWEALTH OF PENNSYLVANIA.
REFUND (QR)1 A rllfund of . ta~ credit, whlnh wal not r.que.t.d on the Ta~ Return, laY be requested by cc.pl.tlnt an
"AppUceUon for Mefund of P"nfl.ylvanla Inheritence and E.tat. Ta~" (REY-1513L Application. ar. available .t
~ Offlo' of the Regllt.r of Will., any of the 23 R.~8nu. District Offlc.. or fro. the Dtpart.-nt'l 24-hoUr
en...rlOl ..rvlo. nuablr. for for.. ordering I In Penn~Ylvanla 1-800-362-Z0S0, out.lde ,PennlYIVenla
end within local Harrisburg a~'8 (717) 787-8094, TOD' (717) 772~22S2 (H.arlng I.paired only),
REPLV TOl Quutlon. reuerdlng "rrora oontaln.d on this notice IIhould be addreued tOI PA Dapart..nt of RevMlU8, lur.eu
of Individual Tex.., ATTMI po.t A.......nt Revl.w Unit, DApt. 280601, Harrisburg, PA 17128-0601, phone
(717) 781M6505.
DJSCOUNTI
If any taw dol it paid within three (3) oalendar Ilcnths flUer tho doc.dent'. death, a flv8 peroent (5;() dlscOOl1t
of the tax paid it .llowed.
PEHALT\' I
The 15;( tax -.ne.ty non~parttelpatlon pen.lty I. c~utedon the totel of the t.~ and Intere.t .......d, and not
paid ~fore Janu.ry 18, 1996, tho first day aft9r the end of tht tax ..nesty periOd.
INTEREST I
Int.r..t h charged beginning .,lth first day of daUnQu8noy. cr nine (9) .onths and one (1) day froll ,he date of
death, to the date of p8~nt. Taxfts "hloh bee..e delinquent bafor' January 1, 1982 blar Int,re.t at the rat. of
Ilx (6;() peroent per """ua calcul.ted ot ft dally rate of .000164. All tawI' which blc... delinquent on and Ift.r
January 1, 198~ Nl1l baar Int~re.t at . rlt~ which will vary frOM oaland,r year to calendar yaar with tt~t rate
announced by tho PA Depart.-nt of Reve~. The applicable intere.t rate. for 1982 through 1998 .rl'
V.ar Int,re.t Rate Da~IY Int.r..t Faotor Ve.r Interllt Rat. Daily Inter..t Fector
1982 20X .000548 1987 9% .000247
1983 16Yo .000438 19a8~1991 11% ,OODSOI
19&4 11;( .000301 11192 9% ,00021\7
1985 13X .000356 1993-1994 n .000192
1906 10% .000214 1995-1998 9Yo .09021\7
~~tntor..t Is oaloulated a. follow.,
INTEREST . BALANCE DF TAX UNPAID K NUNBER OF DAYS DELINQUENT K DAILY INTEREST FACTOR
--Any Notico IlIued after the tex blCOIU dGUnquant will refleot an Interllt calculation tc f1fteen (11) dev.
beyond the d.te of the ....s.Mant. If pay.ent Is .ndo aft.r the lnter..t cOMPutation date .hown on the
Hoticlil, additional Interllt lIU.t be calcul.ted.
PAvtlENll
Detach the top porUon of thll NoUOI Ind iublllt with vourPIYltnt .ede p,Y~h to thtc n.t and Mdr...
pdntl8d on the rl~trH t1de.
If RESIDENT DeCEDENT IUkt OMok or loney ordtr pIYlbll tal REGISTER OF WILLS, AGBNT.
If MOH-RESIDI!Ifr Dl!CEPEHT .... chock cr .."". crdor p..llbl. tc' CDIlHONlIEALTH DF PENNSVlVANIA.
REFUNO (CAll ,Arlllfund of " talC orGdit, whioh w.. not requ..tMd on the TalC Rtturn, .ay b4I rlqtMlted by oOllpltUng In
"Appl1olUon for Rlflht ofPem,yh'llOia Inherl'tanol end Estat. lll(" (REY~1313)' APP1!Cltlortl Ir. Ivailabl. It'
the Offiol of the RIGi.tlr of Nilll, any of the 23 Rlvlnue Di.triot OfficI' or fr~ the Depart.lnt'. 14-hour
8nawerino ..rvla. ~r. for for., ordering, In p~,Yivania 1~800~362-205D, outlide Ptnnlylvlnl1
end within 10011 Hlrrl.burg .r.a (711) 787-8094, TDDI (117) 712~2252 (Haarlng IIP,irtd anlv).
REPLY lO, Questions regarding arror. gontalntd on th1l noUg. should bt .ddr....d tOI PA DtPlrt.."t of RlvtnUe, lur-*'
of Individual TalC", ATTNI Post A.......nt R.vi.w Unit, Dept, 280601, Harrl,burg, PA 17128-0601, ~
(717) 787.6505.
DISC(QCTI
]f InY tal( due I. p.ld within thr.. (3) oalandar aonths aft.r tht dto~.nt.. death, . flve perolnt (SX> discount
of ttMo tlX ptld 11 aUowed.
PEN.\lTVI
The lE~ tal( .-nI.ty non~partlolpatlon penalty I. a~uted on the total of the tax and intere.t "'~'Itd, and not
p.id before Jll'lUIry 18, 1996, the first day after the ond of the talC unllt~ periOd.
,INTEREST I
Interest Is ch"r.ed bt"lnning with first day of dllll.lnQulf1CY, tlr nlnl (9) ~nth. and Ont (1) day frol the date of
~th, to thl date Df payaant. TIICI. which bleaee delinqulnt before January 1, 1982 ba.r int.re.t at the rat. of
sJJC (6,'() pero.nt p.r annuli oaloulat.d It . dally r.t. o.f .000164. All tlIlCe. whieh bee... dellnqu.nt on IInd aftllr
Januery 1, 1982 will bt.r Intlrut at II "at. Whioh Mill vllry frOll eai,ndllr y.ar to oalMldar y..r with that rIte
lInflOUnO.d by the PA Depllrtunt of Rlv.nu.. The applicable inter.st rate.. for 1982 through 1998 IIr81
Vaar Int.r..t Rate Dally Inb.,...t Factor y.ar Intlr..t Rat. DaUy Intlrut Factor
--
1982 20~ .00054& 1987 9X .000247
1915 16X .000438 1988~1991 11;( .000301
1984 m .000501 1992 9X .000247
1915 IS:< .000:556 1993~1994 n .000192
1916 lOX .000214 1995~1998 9~ .000247
--Jntar..t 1. otlculettd a. follow.,
INTBRB8T . IALANCE OF TAX UNPAID X NUHIER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
....Any NoUce IlIuedafter the talC btoat. dtll1nqu.nt Mill rafltat In inter..t ollculaUon to fl,ftten US) da~.
tM)tond thl at. of the .........nt. If pay.ent h ..de "fter ttM interl.t oOltputaUon data IhotIn on the
NoUot, Mktltio""l Intlr..t w.t be oaloultt.d,
I'IJRI>OSE OF
tWTICEI
PAYMENT,
REFUND (eR) I
To fUlfill thl require..nt. of Section 2145 (b) of the l~ritanoe and Est,t_ rex Aot, Aot 21 of 1995. (72 P,St
Station 9145).
OetltOh the top portion of thh Notic. and II.Ddt .,lth your PIYHr1t b the 'RIghter of WUII printed on the
r,ver.. .1..
-., ,... aMok or IIOMY order payflble tOl Jt~ISTBR OF MILLS.. AGENT.
A refund of a tax credit "ey be rlqut.t,d by c~l.tJna en "Appllo8tJon fur Refund of P,"",ylvanl.
Inh8rlt8ftC1 ~ Eltat. Tlx" (REV-1313J, Applications ere Bv_Iieble ~t the OfficI of the Regl.te,. of Willi,
any of tht Z5 R,"~ Distriot Offic.. or frOll tht lJepnrt..nt', 2lt.hour an.Wetrlng ..,.vicI NMorl 10r for..orderlngl
In P~'Ylvanl. 1-800-362-2050, out.ide Pennsylvania and within lQCal "-rrlabur; .r.~ (717) 787-8094,
lPn. (717) 712-2252 (Hearlna I~.lr.d Only),
OIJECTIOH$l AnY party In Inter..t not .atltfled with the ........ot of tax 8. .hoWn on this notice MaY object within
.iKty (6a) day. of receipt of this Not~ce bYI
nwrltten prot..t 'to the PA Depart..nt of Rellenue, Board of APPflah, Dept. 281021, Harrhburg, PA 17128-10211 OR
h811KlUno to Mile the .atter d.t....lned at audit of the per.OOIIl r.vre..nteUve, OR
w-~l to the Orphan.' Court
AOItIH-
ISTRATlVE
CORRECTIONSl
PENALTVI
INTEREST I
rectual errors diacov.red on this ft..es.~nt should be addr....d In writing tal PA o.p.rt..nt of R.venue,
Bureau of Individual Tax.s, ATTHI Po.t A......ent RavleN unIt, Dept. 260601, Harrl.burg, PA 17128-0601,
Phone (717) 787-6505. So. page 5 of the booklet ftln.truotlon. for l~rltencs TaK Return for. R..ident
Dacedentft (REV-ISO)) for en explanation of a~lni.tr8tiv.ly eorrect.bl~ error..
The 15% tax ~ne.ty non-partIcipation penalty 11 coaputed on the total of the tax .nd Int.r..t ......od, and not
paId before January 16, 1996, the fir.t day after the end of the t.x ..na.ty periOd. lhls hQn4partiolpatlon
PMUlty h lIPptlulab18 In the .... .anner and In the the .... till. p.r lad a. YOU NOuld BPP'881 the tax and int.re.t
that ha. ~n .......d 8S indlcot.d on thin notice.
Additional Penn'Ylvanla E.tate Tax alsa..ed as ft re.ult of a change an the Federal Estat. Tax clo.lng
letter aCOMB dellnqoent at the e)(fllraUon af one III IIOnth frQII the date thA fInal noUce of the Ioor.a,.
In F5deral E.t.te Tax Is reeelvld.
h,MU which bee... dallnqu.nt before January I, 1982 bear lnter..t et tM rate of ilK (6:0 parc,"t per annul
cftlculated .t a daily rate af .000164. All t.xe. which beo... delinquent on or after Jwnuery 1, 19&2 Will bear
~nt.re.t at a rate Nhieh will var~ frOll c.l.ndar year to o~l.nd8r year with that rate ~.d by t~ PA
Depart.ent of R.venue. The applIcable lntere.t rats. for 1982 through 1999 .re:
!!!r Inter..t Rat, DaUy Inter..t Faotor :!!!! Inter..t Rate Daily Intere.t Faotor
1982 20t: .0OOS4~ 1988~1991 11:<' .000501
1983 16% .000438 1992 9X .000247
1984 11:< .000301 1993~1994 7X .000192
1'185 13% .000356 1995-1998 9X .000247
19M 10:< .00027', 1m 7X .000192
1967 9X .000247
~~Jnt.re.t il taloulatod a. follOM.:
INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
-~A".v HaUee l......d after the t.x ~COllU delinquent will r.fleet an Internt o.leul.Uon to flftHn US) dlty.
beyond the dnh of the asun..nt. If paYHnt is eade lIofter the Inh"..t oQtlPuhtJon d.te .Itotm an the
Notioe, tlddHlon.1 Intere.t .Olt tie nalculfttad.