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COMMONWEAL HI Of' pI:NNSnVAHI^
DEPARTMENT OF HEAl.'rti vrr M m COfHl5
CERr. NO.3182884
~~----~~R41,~ol\h1&1~-'-'
Name of Decedent
'111'
SAlIAIL___..'liL__",,"L.U'rZ_..._____...__.l;;;r________.______._.__.....
Sex ----F,ema 1 e
.Soclal Secllrlty No.
207 ,_OJ_._.___'l..6.Q6...._....,.__Date of Death---I\.I.I.\WJl-t.....lh_L9.CJ.6.
Date of Blrtlt/w..r.clL..l2. ) qQ.9.._ Blrthplace____..__,__,n__nnlii9hsp-i.t:Q....._..1~lL__,_______,_."____
Place of Death . Chllrch of God.
F8CIHlyN.m.
Cumb~r~_-_--~ar\is1G. ~._____e..e..D.MYIYan!a
'011111\ CllV. {lltluilll 01 T....W(l~fl!P
Race--------YIhi tP. .Occupatlon PA"kp.r-OlmRtp.rl AFJ3.,___u__..Armed Forces? (Yes or No) _,....__~N.o__.___.________
Decedent's
Marital Status S i ng10.______ Mailing Address .ll.OJ....lI......JjanovAr ..S.tr:.eet.....Cllrl j Rle_,-_..J'A..._l.ll113_
Nl/rfIoor $ir&-Il' CllV (JI TO"'iI1 Slaw
Informant .....Mal:garel-ta L. Ch\lhh
Name and Address of
Funeral Establlshment.J1.L M .Knl gh.LF ,H.. 11
Funsral Director ..____6!",...J.l.UkELC.Uckov iCL..lL..l_.6..UP.t:.V_., __
(b)
Cancer of 1urHill>.. wi th
S eQ.Qnd..S..tr_ee.t..I-J] gh$pi re. J:1L..l.l.Q.3.4..___..___~_
: Interyal Between
: Onset and Death
,
,
,
~~----~-,_._-.-
,
,
,
,
,
,
,
-------~
,
,
,
J ~.._.._.........'~,.~__._
-------.
Port I; Immediate Cause
(a)_ Cardiac & respiratory failure
(c)_.. Metastas is...1.9, bone
Part II:
(d)__
Other Significant Conditions
Status J'.gst. Hy<\terectoj)lY
;----.---
-'-_-...
Manner of Death:
Nalural []Ix Homicide 0
Accident 0 Pending Investigation 0
Suicide 0 Could not be Determined 0
Describe how InjUry occurred:
Name and Title of Certifier __--II. R. Dav is. t1....!L,
Address,
MQ.l.ult Ha lly
(M.D., D.O., Coroner,-M.E:j
S p.tin.g.a.t..--ElL 1 7065 ._..__
This Is to certify that tile Information here given Is correctly cQpled from an original oertlflcate of
death duly flied with me as Local Registrar. The original certificate will be forwarded to the State
Vital Records Office for permanent filing.? ~_ ~.!. A /
{.l.u.,L-I..- (1, / ;:~L A_~ 22-02.&_..
1.~1"1'1 01" I'.. RlCo,ds Ollt',~, No
20 All911st 14%__ 120 Sprllce_St-,--,-_ltLc1dlc't_ovcD--,---l.'lL11057:::_1.1l5Jl
0:;11I. Fl-=-IV>Hl by Loctl R~IIt'" 8"Mt Adol. CUy, DOfOlllj". TOWI\'hifl
WI~LSllutz.WIL/DH
LAST WILL AND TESTAMENT
OF
SARAH B. LUTZ
I, SARAH H. LU~Z, of the Borough of Highspire, Dauphin County,
Pennsylvania, declare this to be my last will and revoke any will
previously made by me.
ITEM II
I give and bequeath any automobile which I may own at
the time of my death to my sister, MARGARETTA L. CHUBB, if she survives
me.
ITEM III 1 give and devise my house at lOB Second Street, Hi.gh-
spire, Dauphin County, Pennsylvania to my sister, MARION HALE, my
sister, MARGARETTA L. CHUBB, and my nephew, THOMAS CHUBB, in equal
,
shares. If I do not own lOB Second Street, Highspire, Pennsylvania at
the time of my death, this devise shall be adeemed. My sister, MARION
HALE, has no issue, and if she fails to survive me, her portion of this
devise shall be added to the shar.es of MARGARETTA L. CHUBB and THOMAS
CHUBB. If either of them fail to survive me, his or her share of this
devise shall palla to his or her issue, pel: stirpes.
ITEM 1111 All the rest, residue and remainder of my estate, of
every nature and wherever situate, I devise and bequeath to my nephew,
THOMAS CHUBB, now living at 2744 Hunter Heights, West Bloomfield,
Michigan. If THOMAS CHUBB fails to survive, I devise and bequeath all
of my residuary estate to his issue, per stirpes.
-1-
ITEM IV. I may have oertain aooounts in joint names with my
sister, MARGARETTA L. CHUBB, at the time of my death. I hereby deolare
that it is my intention that she be deemed the rightful owner of these
aooounts and that they not be included in my residuary estate.
ITEM V. I appoint my sister, MARGARETTA L. CHUBB, Executrix of
this will, If she fails to qualify or oeases to aot for any reason, I
appoint my nephew, THOMAS CHUBB, my Executor. If he fails to qualify
or oeases to act, I appoint MELLON BANK Exeoutor.
ITEM VII I appoint my Executrix and her successors guardian of
any property which passes, either under this will or otherwise, to a
minor and with respeot to whidh I am authorized to appoint a guardian
and have not otherwise specifioally done so, provided that this ap-
pointment of a guardian shall not supersede the right of any fiduoiary
in its disoretion to distribute a share where possible to the minor or
to another for the minor's benefit. Suoh guardian shall have the power
to use prinoipal as well as inoome from time to time for the minor's
support and eduoation (including oollege eduoation, both graduate and
undergraduate) without regard to his or her parent's ability to provide
for suoh support and education, or to make payment for these purposes,
without further responsibility, to the minor or to the minor's parent
or to any person taking oare of the minor.
ITEM VIII No fiduoiary acting hereunder shall be required to post
bond or enter seourity in any jurisdiotion.
-2~
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AlTonI'H~'(~ Ar hAW
,\\.lllHllJOI: t41fin:1
NI':W C\1t.11l1:1I1,,\N\I. 1''\ 1,,(71)
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PURPOSE OF
NOllCEI
PAVHEHT I
{11
,...~
!_"J,
,.
iii ~_.
CiO
To f\JUll1 tn, r.qu.lr...ntll of a.oUem 2140 of- the InheritlriOI "nd Eltlitt hI< Aot, Act U _of '1991,(72 P,S,
SloUon 9140).
!;lateen thl ,tClP potU;)n of this HoUClI end 'UbMIt with ~our pnYllont to t~1I Roghter of Wl1h printed on the
"1\Jlr.. .lde.
-- Heke ohlck or lIonlY Cltd., pal/obit tal REGI$TER OF WILLS, AGENT.
REFUND (CR)l . refund of a tax crldit, Iolhloh was not requIsted on the tal< ru'turn, 1IIt1'Y bl,l requ..hd by Clo.pllUne InftApplJoaUan
>for Rofund of Penn'lIlva'lla Inh.rUnnel and E.tatl Tax" (REV~1313J. Appllollltlons are Iwalhbl. lit the Offl(ll of
the Rlgl,tar of Willi, an!! of the 23 R......nU6 Ohtrlnt Offloos or by cHilling thll spechl 24~hour anlwlrlng "1"'\110'
nu.ber. for forlll orderlngl In PennlYlvanla 1-800-36Z-Z0S0, ouhide Pllnnty1vanla and within 10cII1
Hllrrhburg IIr88 (711) 787~8094, TDOIt (717) n~-22S2 (HtlIulng ImplIlrBd Onl~),
OBJECTIONS I Any pl!lrty In IntClrllSt not satisfied with thQ appralulllont, allowance or dl,li'lilowano. 0-' daduol1onl or .""11II8nt
of h~ (Including dlscDunt (lr intorutl 8S shown on this HotJ<:1I 1118'11 objlHlt wHhin sixty (60) day' of receipt of
thh IfctioQ bYI
--written prot..t to the P^ Oeparhllint of Revam'(J, Board of Appe"h, Dapt. 281021, ftarrl.burg, PA 17128-1021, OR
~~.leotinlJ to heve the 'IIatter deter",lned at the audit of the 8CHlount Qf thl personal repr8llentative, OR
--appeal to the Orphans' CQurt
ADMIN-
I$TRATIVE
CORRECTIONSl
DISCOUNT I
PENAL TV I
INTEREfiT 1
faotual IIrror. dlscover8d 1m this a8SClSslllont should ba addressed In writing tal PA Departlllent of Revanue,
&UI'''U of lndivldual Tn)ll!l, ATHII Post AsSASSRlent Rovillw Unit, DEPT. 2110MI, Harrisburg, PA 17128-0601
Phonlll (117) 7a1-6SUS, SOB pl.'llJe !i CIf th" bookl.t "Instructions for Inhel'lhmoe Ta)( !hlturn for a R..idant
O.c.c;.nt" (RE\,I~1So1) for nn 8l<plnnatton of adlll1nistratiy.1v correnteDle errcr,.
If any hI< dUll 111 paid within thruo (3) calandar lIlotlths lIfter the dllclldent's death, a flv. plIrcent (St.)
dhoount of the tnl< paid Is allowed,
The 1St. tax allne.ty non~p8rt1c:1pat1or' penalty II COMputed Oil the total IIf the t8)( and Inter.,t l.'I8uu.d, and not
paid b_for. JanUllry HI, 1996, tho flnlt da~ after the end of the tal< tlIItnlttv period. This non-part1clplltion
penllty It IIPpea1rlblll In the sallie manner and In the thll Il'l". time period III !lIOU would appu1 the tax IInd intere,t
that hell b..n 8U"Ut! !'II indlo!ltGd 0'1 this notic,).
Int.rut is charged beginning with flr,t dl'l'1' of d81inquII"c!lI, or nine \91l1lonthl lInd on. (11 day
fron tIlt datn of dllath, to tha dl'lt. of plIl!lllllllnL Till<.. whioh beOf\lIe dgllnqullnt before J811U8r" 1, 1982
b.ar intlr..t at thl ratl oi Sill< (6%) pIlIrc.nt por annuli cllllculated at lllhllv rat. of ,000i64.
All tall.. which beoallllil delinquent on or after January 1, 19&2 will bur lntlrOlt at 8 rllte which will v&r~ frail
Clllendllr yellr to oalendar ."aar with that ratll announced by the PA Dllpartlllllnt of l'<.v.nU8, Tho appl1cabll
int.rut ret.. for 1982 throllgh 1997 arll
~ Interest Rllhl OaJ1y Inhrut F8Ctor Vear Interust Rrtte (JeUy Inllrut Factor
1982 lOX .000S48 1981 9% .000247
19U 16% ,00043& 1988-1991 11% .000301
1984 11% ,000501 1992 9% .000247
1985 11% .Oo03S6 1993-1994 7% .000192
1986 10% .OD0274 1995-199' 9% .000241
--Inhrut 11 Cllllcuht.d .. folloliSl
INTEREST " BALANCE OF TAX UNPAID X NUNSER OF DAYS DELINQUENT X DAILY INTEREST PACTOR
--AnY NQtIoe 1..Ufld ftftar the taM blco..' delinquent will refleot an Interest calculation to fift.en (15) daYs
bayo"d the deh of the auullllenL If pay.,nt II .ade aftlllr the int.rnt cOllputation dl!lt. .hown on tn.
Hotlee, additional Interut IllUlt be calculat.d.
\
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT, 280801
HARRISBURG, PA 1712B-0801
/..$ 1/5 I
REV-..1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAl. l/6f. ONL '(
. '
~ R{/.1600 EX + (1-07)
FILE HUMBER
GOU~\Vr:OOE ~~2,7 ~gJ~,~
DECEDENT
DECEDENTS NAME (lJ\ST, FIRST, AND MIDDLE INI1"IAL)
lJ..1tz Sarah H,
SOCIAL SECURITY NUMBER
207-07-9606 08/17/96_
(I AP LleABLEI .URVIVINO ;POU."; NAME (LAOT, SOCIAL SECURITY NUMBER
FIfWT, AND MIDDLE INITIAL)
DATE OF BIRTH
03/12/1909
'OilS RETURH MUST BE FILED IH DUPLICATE
WITH THE REGISTER OF WILLS
3, Alm.tlntl.r Relurn"
1. Orlglnaj Return 2. Supplemental Return (dlllllll d..th prIor \0 12~13"82)
4, Umltod Estato 4ft. rdu"~::I~:~ihl.91~~~~~~~~~2) 5, Fodera! Eatate Tax Rtrn, RequIred
6, (~~~'Gdh'~~~~~1 ~1'lrl' 7. (~~i&'Qdh'~~W~11~:~:f)" LlvlrlO TruI' 8. Total No. of Stito Depoall Boxes
9 Lltl I. Pd R I d 10, 5pouUI(lov.rtyCrtdlr(d&llofd.lth bIIW.t". 1'1.' 11 EI":llon IO....Kund.rS.Q, Iill13(A)
. .9810nrOOO08..oo01/8 . .. 12~3-1.~d'~~ .. . ---1...L 'IAtll.ohSchOl .. .. .
1'Hlfl fl~I()N MUflT all C;OMPLltTIltl, ~fJ!!!:!.~~e?NO~!?f. ~CONFID~IAU~.lNl'Ol'IMAnON SHO\IU) 8l!DlftEOTIlll 'TO;
NAME ~(;OMPLHE MAIUNG ADDRESS
Charles H. Stone,_~ire _,_._.._____.._ 414 lk.idge Street ,
"RM NAME (II Ar,plicBbIB) H~ CunDerland, PA 17070
Stone IaFaver & Stone
TELEPHONE NUMBER
717-774-7435
CHECK
APPRO-
PRIATE
BLOCKS
CORRES-
PONDENT
1. Relll Estate (SchudulB A) (1)
2. Slacks and Bonds (SchBdule B) (2)
3. Closely Hold CorporBllon, PlII1nBrBhlp
or ScIB-ProprlBtorshlp (3)
4, Mortgages & NotB' RBCOlvablB (Schedule D) (4)
5. Cesh, Bank Depoalts & MlscellBneoua parsana!
Property (SchedulB E) (5)
B. Jolnlly Owned PropBrty (SchBduIB F) (B)
7, Inter-Vlvoa TrsnalB'" & Mlscellaneoua
RECAPIT- Non-Probate Proparty (SChedulB G or L) (7)
U~T10H
36,000.00
~
None
None
OFFICIAL. UBI! ONL V
None
837.36
None
B. Tolll Groaa _.. (tota! UnB.1-7)
g, Funera! Expensea & AdmlnlstrativB Coats (,,,,,,,, HI (9)
10. DBbts 01 DBCOdent, Mortg. Uablmles, & LIBna (a'h, II (10)
(B)
18,297.50
1,274.60
36,837.36
11. Tolll DeduoUona (101a! UnBa 9 & 10)
12. Hal Value of Eallla (Une B mlnua Una 11)
13. CharhablB Bnd GovernmentBl Bequ""lalSoo 9113 Tru.ts
for which an oloollon to t'll( h.. not been mBde (SchBduIB J)
(11)
(12)
19,572.10
17,265,26
(13)
Nune
14. Hol Valua Sub .0110 Ta. LlnB 12 mlnu. Une13
15, mount 0 inB 14
taxBblB et tho apouaBl
tax rate
See InBtruction. on pogo 2 lor appllcablB pB:centBgB
lB. Amount olllno 14
lax8b~ al 6"/0 rale
17. Amount 01 line 14
taxabIBat1~%ratB 17,265.26_. ,15 (17) 2,589.79
1B. ..... Duo PBI 2,51:19,79
'.. ... . la..ilICHllCKHERE1FVOOAREA!lOUESTINGAREFUH!!OFANOYeftPAVMEHT'- ....
\i\ '.." > ""Be SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND REOHECKMATH <<.,. ....... .... ..... ... .., ......
UndBr pena!ties 01 pBrJury, I doolRra that I hBvB B'Bmlned 1hla re1urn, Including accompBnylng schedulB' and iitatamBnts1and to the boa' 01 my knowlBdgB
and belief, h 10 trua, corroot an completB. Ooolara ~n rBparer othBr than thB pBlBOna! represenlativB I. based on all nlormation 01 which prBparOl h..
any know~
SICHlATURE OF PERSON A
'jA
14
17 265.26
'.:9_
(15)
TAX
COMpUTA-
TIClH
0.00 .
,06
(16)
0.00
ADDRESS
NTF lOaa~
Copyright r:ofml SOllWlf. Only, t897 NtlcCI, Inc.
AOORESS
414 Br.idge Street
New Cl.nrberland, PA
17070
D?~f'
/ ~E _
L, Jj~1 (J 5:..l_
See Schedule attached
". b' .._... .... ." 'Or-'
PA REV-11lOO EX (1-97)
Decedent', Complste Addr88S\.
STREET ADDRESS
Church of God Haoo
paga 2
CllY
Carlisle
Tax Payments and Credits:
1. Tax Du. (Page 1 Uno 18)
2. Cr.dlts/Paymenl.
A, Spousal Poverty Cr.dll
B. P,lor Pavmenla
C.Dl9COunt
STATE
PA
ZIP
17013
0) 2,589.79
Total Cr.dlls (A + B + C) (2)
0.00
3. Int",.sVP.nattv IllIppllc.bl.
D.lm.,..1
E. P9nllllV
TOlllllntor.sVP.n.lly (0 + E)
4. IllIn. 219 gr..I8I tlt.n IIn.1 + IIn. 3, .nl., the dll\.r.nc.. Thlslslho OVERPAVMENT.
Chock box on Plge 1 Un. 18 to requeat s r.tund
6. IllIn.1 + line 31s gr.al.r th.n IIn.~, .nt.r 1h. dll\orenco. Thlslslh. TAX DUE.
A. Ent., lho Int.,..t on tho lax du..
8. Em., Ih. lotal 01 Un. 6 + 5A. Thl. Is Ih. BALANCE DUE.
Mak. Check PSV.bl. to: REGISTeR OF WillS, AGENT
(3) 0.00
(4) 2,589.79
(8)
(M) 0.00
(58) 2,589.79
ANSWER THE FOllOWING
BV PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Old dOO8d.nt make . tr.nsl.r .nd: V..
a. r.taln tho u.. or Income oltll. proporty 1ranslorrod; . . . .. . . . . . . . , . . .. . . . , . . .. .. .. , , . . , , . . .. .
b, r.taln tho right to d..lgn.lo who shall u..,ho proponv tT.nslorrod or lIS Income;. , , , , , , , . . . . . . . . . .
o. r.taln ar.voralonluv Int.r..,; or. . . . . ...... . , . . . . '" . . . . . . , . . .. . . .. . . . ...... , . . . . . . . . ..,
d. rOO8lv.lh. proml..lor 1110 ololthor p.vmonls, bonoflls or caro? . . . . . . . . , . . , . , . . . . , . . . . . . . , . . .
2. II daath occurr.d on or boloro DOO8mbor 12, '982, did deceden. within two voare
prOO8dlng d..lh trans'.r prop.rty wlthoul recolving .d.qu.to consld.r.tlon? II do.th occurred
aher DOO8mbor 12, 1982, did der<ldent tr.nsl.r property within one voar 01 d..th wlthoUI
rllC<llvlng .d.qusl. coOlllcler.tion? . , . . . .. .. . , , , . . . . .. . . . . . . , . . . . . . . . . . . . . .. .. .. . . . . . . . . ... 0
3. Old dOO8denl own .n "In tru.1 for' or p.y.bl. upon d..lh b.nk .ccount or s..urlly
at his or hor d..lh? .. . . . . . .. . . .. . . . . . .. .. , . . . . . . .. .. . , . . . . . . . .. , . . . . . . . .. , .. . . . . . . . .. ..
4. Old dOO8d.nt own.n Indlvldulll r.tlromem.ccoum, .nnuily, or olh.r non-prob.l. prop.rty?, . . . . . . . . . , .
No
~ I
@
B I
IF THE ANSWER TO ANV OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN
72 P,S, 89118 (a) (1.1) (I) provld.d lor Ih. r.duction 01 th.lax la1.lmpo..d on Ih. n.1 valu. 01 Iransl.rs 10 or for the use olth. .urvlvlng .pouse from 6% 10
3% lor dat.. 01 d..lh on or after JulV 1, '994 .nd bolor. J.nusry 1, 1995,
72 P,S. 89116 (.) (1,1) (II) provld.d lor lho r.ducUon ollhe rat. Imposed on Ih. n.t valu. 01 tr.nsfe,.lo or for tho use of tho surviving spous.fram 3% 10 0%
lor dat.. of d..lh on or .h.r J.nuRry 1,1996. Th. st.tulo dO.' n010.ompl. tr.nsfor to. surviving spous.lrom tax, .nd tho sl.tulory r.qulr.mentslor
dlsclosur. of ....,. .nd filing. tax r.turn .re .UIi applic.ble .v.n 1I1he surviving spouse Is Ih. only bon.flciRry,
FOR DATES OF DEATH ON OR AFTER JANUARV 1, 1995 -- Ple.se .nsw.r lhe following qu..tian by pl.clng .n "x" In th.lIpproprl.,. space.
Old the dee_nt crelta . tru.t or .Imll.r .rrang.m.nt which I. ealaly lor the .urvlvlng lIpOu..'. benaftt lor hi. or her entire '".Um.?
V.. 0 NOf9c
11 you an.wer.d y.slo Iho .bove qu.sllon, tho lax on Ihe Irus1 or slmliar .rr.ngoment I. poslponed unUI the d..,h 01 tho seoond .pouse, .t which timo It will
bo fuliy laxabl. .1 tho rate(s) lIpplic.ble 10 lho rem.lndor bon.liclary(les), Enl.r tho v.lue ollhe trust on Schedul. J. Pan II, In ord.r to r.mov. It trom tho
c.'culation nf the tax duo In \hl. ..1.1., Vou muy wish to fiI. Sch.dule 0 In ordor 10 m.....lh. .Ioellon .vallabl. under Seellon 9113. 11th. al8c1Jon Is mad.,
lho tru.1 or .lmllOI arrangement Is1axed In lhe esl.l. ollh. Ii"l deced.nt spouse. Iho portion of tho 1ru" or similar arr.ngemont which b.neflt. the surviving
lIpouse'. taxed at the z.ro.ax ra1e, .nd tho remainder Is taxed at Iho rate(s) appllc.bl.,O Ihe remainder ben.f1clary(l8s). If you choose 10 make tho 8IeotIon,
you mu.t .1I.ch Schedul. 0 to .lImoly-fiI.d tax r.1urn, along wilh Schodulo(s) K .nd/ar M In order to ohow Ih. lIppOrtJollmont of lh. trust or almllar
arrang.ment botwoon Ihe .urvlvlng spouse .nd Iho romallld., ben.flclary(I..).
7 PAt&OO2 ~''10610
Copyright farm, Soft",.r. Only, 1991 Nelco, Inc,
REV-l00ll EX + (1-07)
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DEOEDENT
I!BTA TE ClF
Sarah H. IAltz
'"
SCHEDULE F I
JOINTL V~OWNED PROPERTY
._-_.----==:=.--~..--------
FlU! NUMBI!R
II an ....1 waa madalolnt wtthln ona vaal of tho d.oldanl'a data of daath, II mual be ,oporlad on 80hadula 0,
21-1997-~
SURVIVING JOINT TENANT(S) NAME
A Margaretta L. Chubb
JOINTLY-OWNED PROPERTY:
ADDRESS
W nut TI:/lCe ct.
Simpsonville, SC 29681
RELATIONSHIP TO DeCEDENT
B Iter
LETtER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR MADE Include name olllnanolallnetitullon and bank DATE OF DEATH DECO'S VALUE OF
JOINt lcocunt number or elmllar IdentltVlng number,
NO. ~:NANT JOINT Maoh deed for Jolntlv- held real Allale. VALUE OF ASSET INTEREST DECEDENTS INTEREST
-
1 A 08/03/71 Mellon Bank..checldng h;xrt.. 1,674.73 50% 837.36
*132-106-0:176
.
.
I
TOTAL (Alao enlor on line e, ReelDllulellon' $ 837.36
7 CPAII NTF '''08
Copy,tVnt Form. Softw.,. Only, 1997 NllcD, Ifill,
(II more spece Ie nooded, InSlln eddlllonalehoole ollhe eeme size)
, .
EstatE! of I Sarah H. wtz
SCHEIX1.Ul: H, PART B - l\dministrative Costs
Page 2
21-1997-0:163
Item
~. ~oorl~oo
J\mount
7 Settlement expenses on sale of property ($7,688.26 less rein'b.
on t~s and ~ $198.93)
8 CUrrberland IilW Journal-advertising grant of letters
9 The Patriot News Co.-advertising grant of letters
10 Register of W.ills-filing D.lscla.iners
11 PP&L-electric se.rV'ices at property
12 Bell Atlantic of PA..telephone service at property
13 Daniel H. Barninger."Appraiaal fee on property
14 Eshenaur's Fuel-fuel for property
15 oo1-ga.'3 seiI:"Vice at property
16 PP&L-electric service at property
17 AT&T-telephone ae.rvice at property
18 001 -gas at property
19 Bell Atlantic-telephone ae.rvice at property
20 United Water-water service at property
21 l'P&L-elect.ric service at property
22 Borough of Highapire-.aewer services at property
23 PP&Irelectric BE'..rvice at property
24 Eshenaur's Fuel, Inc.'-fuel for property
25 I'P&L-electrlc service at property
26 United Water-water senrice at property
27 Eshenaur' s Fuel Inc. --fuel for property
28 PP&L-electric service at property
29 N.F.J.R.-Nat1onal Flood IllBl1rance premium for p.tqlerty
'lUl'AL. (Can.y fOIWard to main schedule) . . . . . .
7,489.33
60.00
61.19
6.00
21.43
18.05
225.00
158.88
16.97
18.79
14.55
10.29
0.35
17.45
18.35
48.00
19.32
157.34
17.74
17.45
152.46
23.61
135.00
8,707.55
Estate of I Sarah Ii. wtz
SCHE:DUIE H, PARTB - Administrative Coati
Page 3
21-1997-0363
ItEm
No. ~scription J\Ilr.lunt
,-
30 John W. Hoch, tax collector-taxes for property 488.28
31 Borough of Highsp1.re-se\\'eI' at property 50.00
32 Eehenaur'e Fuel Inc.-fuel for property 171.30
33 PP&L-electric service at property 17.74
34 PP<-electric service at property 16.86
35 United Water-watar se.r.vice at property 17.45
36 .PP&L-electric service at ~y 18.53
37 Eshenaur's Fuel Inc.-fuel for property 149.35
38 Borough of Highspire-se.;er services at property 50.00
39 PP&L-elE1Ct:ric service at property 16.50
40 AT&T-telephone service at property 8.73
41 PP&L-electric service at property 16.68
42 United Water-watar se.r.vice at property 17.45
43 John W. Hoch, tax collector-taxes for property 441.58
44 PP&L-e1ectric service at property 20.16
45 Baralgh of Highspire-sewer services at ~ 50.00
46 PP&L-electric service at property 18.15
47 United Water-water se.r.vice at property 14.15
48 . PP&L-electric service at property 17.79
49 PF&L-electric service at property 17.44
50 Bort7.1gh of Highspire-sewe.r for property 50.00
51 Eshenaur's Fuel Inc.-fuel for property 125.26
52 PP&L-electric service at property 19.83
rorAL. (Cany fOIWard to I1lIlin BChedu1e) . . . , , . 1,813.23
II WILLS:lutz.W1L/DH
I
LAST WILL AND TESTAMENT
OF
SARAH B. LUTZ
I, SARAH B. LUTZ, of the Borough of Bighspire, Dauphin County,
pennsylvania, declare this to be my last will and revoke any will
previously made by me.
ITEM II I give and bequeath ~ny automobile which I may own at
the tilne of my death to my sister, MARGARETTA L. CHUBB, if she survives
me.
ITEM III I give and devise my house at 108 Second Streett High-
spire, Dauphin County, Pennsylvania to my sister, MARION BALE, my
sister, MARGARETTA L. CHUBB, and my nephew, THOMAS CHUBB, in equal
shares. If I do not own 108 Second Streett Highspire, Pennsylvania at
the time of my death, this devise shall be adeemad. My sister, MARION
BALE, has no issue, and if she fails to survive me, her portion of this
devise shall be added to the shares of MARGARETTA L. CHUBB and THOMAS
CHUBB. If either of them fail to survive me, his or her share of this
devise shall pass to his or her issue, per stirpes.
ITEM XXI: All the rest, residue and remainder of my estate, of
every nature and wherever situate, I devise and bequeath to my nephew,
THOMAS CHUBB, now living at 2744 Hunter Heights, Wast Bloomfield,
Michigan. If THOMAS CHUBB fails to survive, I devise and bequeath all
of my residuary estate to his issua, per stirpes.
-1-
I.
n'~o:l\LU1:Z .CAt
~
'rHIS IHDER'rURE made the 17tt. day o~in the year 199B,
between MARGARETTA L. CHUBB, iPdividUal~y and ~s Executrix of the Last
Will and Testament of SARAH H. LUTZ, late of the Borough of Highspire,
County of Dauphin, and Commonwealth of Pennsylvania and MARION HALE,
an unremarried widow, and THOMAS CHUBB and JUDITH CHUBB, his wife, all
of the first part, hereinafter called the Grantors,
- AND -
DONALD A. VELEZO and SHIRLEY M. VELEZO, husband and wife, of the
second part, hereinafter called the Grantees;
WHEREAS, the said SARAH H. LUTZ became in her lifetime seised, as
of fee, of and in to a certain tract of land, together with the
improvements thereon erected, situate in the Borough of Highspire,
County of Dauphin, and Commonwealth of Pennsylvania, and more
particularly described hereinafter; and being so thereof seised, died
on August 17, 1996, having first made her Last Will and Testament in
writing dated September 4, 1992, duly probated and registered in the
Offioe of the Register of Wills of Cumberland County on April 16,
1997/ wherein and whereby she appointed as Executrix, the said
MARC~ETTA L. CHUBB, to whom letters testamentary were duly issued by
said Register of Wills on April 16, 1997, and wherein and whereby said
premises hereinafter described were specifically devised to Marion
- 1 -
JAlj 16 '':'8 1::: 30
I
Hale, Margaretta L. Chubb and Thomas Chubb in tTEM II of the Will, all
as in and by said Will and the records of said Register of wills more
fully appears;
NOW THIS INDENTURE WITNESSETH, that the said Grantors/ for and in
consideration of the IllUlt of THIRTY-SIX 'l'HOUSAND AND NOIIOO
($36,000.00) Dollars, which has been paid to them by the said Grantees
at or before the sealing and delivery hereof, receipt whereof is
hereby acknowledged, have granted, bargained, sold, aliened, released
and confirmed, and by these presents do grant, bargain, sell, alien,
release and confirm unto the said Grantees:
ALL THAT CERTAIN tract or parcel of land situate with the improvements
thereon erected located in the Borough of Highspire, County of
Dauphin, and Commonwealth of Pennsylvania, more particularly bounded
and described as follows, to wit:
BEGINNING at a point in t.he northern line of Second Street. ~Ihich point
is in the western line of premises No. 110 Second Street. now or lately
owned by Paul E. Beard and Anna V. Beard, his wife; thence westwardly
along the northern line of Second Street twenty-seven (27) feet to a
point in the line of lands of David B. Detweiler and Edith K.
Detweiler, his wife; thence northwardly along said Detweiler property
one hundred four (104) feet nine (9) inches to a point; thence
eastwardly in a line parallel with Seoond Street twenty-seven (27)
feet to a point in the western line of premises No. 110 Second Street
- 2 -
717 77a 3869
PACi",03
aforesaid And thence southwardly along said property No. 110 Seoond
street one hundred six (1061 feet eight and seven-twelfth (8-7/12)
inches to a point the place of BEGINNING.
HAVING thereon erected and now being premises No. 108 Second Streett
Highspire, Pennsylvania.
BEING the same premises which George L. Lut~ and Mary J. Lutz, husband
and wife, by their deed dated November 4, 1965, and recorded November
8, 1965 in Dauphin County Deed Book F, Vol. 51/ Page 86, granted and
conveyed unto Sarah H. Lutz, the decedent.
TOGETHER with all and singular the buildings, improvements, ways,
streets, alleys, passages, waters, water-courses, rights, liberties,
privileges, hereditaments and appurtenances whatsoever, thereunto
belonging or in any wise appertaining and the reversions and
remai.nders, rents, issues and profits thereof, and all the estate,
right, title, interest, property, claim and demand whatsoever of her,
the said SARAH H. LUTZ, at and immediately before the time of her
decease, in law, equity, or otherwise howsoever, of, in, to or out of
the same.
TO HAVE AND TO HOLD the said lot or piece of ground above
described, with the buildings and improvements thereon erected,
hereditaments and premises hereby granted or mentioned, and intended
so to be, with the appurtenances unto the said Grantees, to and for
the only proper use and behoof of the said Grantees, forever.
- 3 -
, .
~ ,
'SJu+fJ C<<'AMntft...
COMMONWEALTH OF I __ .' IL~
COUNTY OF ~\...M.\/;:lie : s:
On this, the )10- day of Q-u/'Ilo.u./l.^f 1998, before me a Notary
PUblic, the undersigned officer, personally appear~d MARGARETTA L.
CHUBB, as Execlltrix of the Last Will and Testament of SARIUi H. LUTZ,
and individually in her own right, known to me or satisfactorily'
proven to be the person whose namp. is subsoribed to the within instru-
ment, and acknowledged that she executed the same for the pUrposes
therein contained.
IN WITNESS
WHEREOF, I have hereto set my hand and notarial seal.
.~~ )UA1~,"_ {j nL<.
.' Notary pu ic
COlOIONW'EALTH OF PENNSYLVANIA:
COUNT! OF ~
ss:
On this, the ~ 3<Yd day Of~ ' 1998, before me a Notary
PUblic, the undersigned officer, personally appeared MARrON liALE, an
person whose name is subscribed to the within instrument, and
unremarried widow, known to me or satisfactorily proven to be the
acknowledged that she executed the same for the purposes therein
contained.
IN WITNESS WHEREOF, I have hereto set my hand and notarial seal.
~_. - 'crEK~ -
Notary Public
- 5 -
NOTARIAL SEAL
CONSTANCE l. I<ARU, Notary Public
New CUmberland, PA Cumberland Co,
My Commission Expires April 13, 1999
PURPOSE OF
NOTICE I
PAVMENT I
REfUND (CR):
To fulftU tnlrequlrl..nu o(Slctlon 2140 of thl Inherltlnol .n,d Estatl Tal( Aot, Aat 21 of 11)95. <1t-P.S.
SlctJon 9140/, '
Dlt.oh thl' top portion of thll NOuCI and .ub.it with your pay.,nt to thl Rlohter of Will. prlnttd on thl
rlvern .Idl.
4~ H.~. chick or MonlV ordlr p.~.bll tOI REO%GTER,UF wtL~S, AQfHf.
A r.fund of . tl)( ,oredlt, whloh wllnot "qu..Ud on thl tllC return, "'V bl r.quut.d by co.pltting In _"Appllcatlon
for Rlfund of Plnn,Ylv.nl. InhlrUanca and Estatl fl>l" (RtY41313l. ApPllcatlon. are a\lalhbll at the Office of
the RIgI.t,r of Will., any of the 2! RIVlnUI DI.trlot Ofilce. or by callIng the 1P.cIal ~4'hour answ.rlng ..r\llc.
nUMblr. for for.s ordlrlngl In PlnnsYl\lanla 1.800']62~20S0, outside P.nnsYlvanl' and within local
Hlfrhburyat.. (117l 187-aO~4, TDD~ (717) 772.l2SZ (Hurlng I.palred Onlvl.
OBJECTIONS: Any party In Int.rllt not ..titf\ad with the .ppral....nt, allowanco or dlul1owMc, of d.ductlntll or atsutll.nt
of tl)( (Including dl.count or inter..t) It .hawn on thtv Hotlcl Illy obj.ct within sixty (60) days of rtet'."t of
thlt Notlc. b~1
-~wrltt.n prot..t to th. PA CIP"rt..nt of Pev.nuI, Bo.rd of App..ls, O.pt. 281021. Harrl.burg, PA 17128-1021, OR
-~.lIetJng to havI the ..tUr d.terllln.d .t the aud1t of the ICCOunt of the ".."onal rIPr.elntatllll, OR
uapp..l to thl Or'phan.' Court
ADHIN-
ISTRUIVE
CORRf.CTIOHSI
OISCOUNTl
OE~"'LTVI
INTEREST I
~actu.l .rrors alsoov.rld on thl. ......I.n\ .hould b. addross.d in writing tOI PA O.part~'nt 0' R,vlnue.
8ureau of Individual Tau., ATTNl Po.t A".....nt AI\lilw Unit, DEPT. 250601, Harrisburg, PA 1712&-0601
Phona (717) 7e7~c.SOS. S.. pagl 5 of the bookllllt "In.U'uctlons for Inherltlnc. TIll R.turn for a Ruldent
D.cad.nt" (REV-IS0ll for ,n IMPlln.tlon of ad.tnJ,tratlvllv corr.ctabla .rror..
If any tll( due It p.ld within thrlt (]) QII.nda,. lonth. .fUr thl dac.dtnt's d..th, I fl\ll perc.nt (5%)
dl.count of the tall Plld i. .llow.d.
fh- l~'l tlllY .~~.tv non.p.,.tlclp.tJon o.naltv Is Qo~utld on thl total of thl tux and Int.r..t .ss....d, .nd not
pIJd bill foro Janu.ry 18, 1996, tha flr.t d.v aft.,. thl .nd of the till l-n.sty pa,.lon. Thl. non-partlolpatlon
penllty I. app..l.bl.ln the .... ..nn.r and In the the .... tl.a p.riod al VOU would IPp.al thl tlM and Intlr.st
th.t h.. b.en ....._.d aa Indlo.t.d on this notlQI.
Int.r..t 1. ehargad btolnning wJth first dlY of dlllnqulncy, or nln. (9) Month. and on. (1) day
froll the dlt. of d..th, to tha date of pl!ly..nt. TllllI whlGh b.oa.. dellnqulnt b.fort Jan\lIrv 1. 1912
b..r Int.r..t at thl r.t. of ViM (6%) p.rc.nt p,r annu. cIIloul.tld It . dallv rftta of .000164.
All tllllt whloh bue... dlllnqu.nt on or aft.r Janullry I, 1912 will ba.r inter..t at a retl which will vary froll
r.llandar v.ar to elllndar v.arwilh that ,.at. announcld by thl PA Daparta.nt of R.vlnu.. Th. .ppllcable
Int.r..t r.t.. for 1982 th,.ough 1997 ar'l
!!!!: Inter..t R.t. OaUy Jnt.r..t Flctor V..,. Intar..t R.t. DillY Intarut Factor
1982 20% .000541 1917 .~ ,000247
1913 l6X .0DM14 l~a8~19'1 11% .000101
191< II:': .000101 19'12 " .000247
1985 1]i: .00nS6 1993-19'4 " .000192
1986 lOX .00OZ74 1995-1997 .~ .000247
nlnttrut 11 cllclulat.d .. follow'l
INTEREST . BALANCE or TAX UNPAID X NUNDER or DAYS DELINQUENT X DAILY INTEREST FACTDR
'-Any Notice I..u.d .ft,,. the tlX b.~o'" dtllnqulnt will r.fleet an Int.rlst calcul_tlon to flft.ln (15) dlYs
b.yond the da\a of thl ....u..nto If p.~..nt I. aad. aft.,. the Inter..t co.put.tlon da" shown on the
Hotle., addJ,lnn.1 Inttrut .u.t tI. calculated.
C:Of"ll1otlWF.Al,TlI I.ANIl TITU: tNSlJRAtWr. COMPMlY
. -1ttlfl lnauunca No,P19a702Cr
U,S, lJap.utment of UOUI.l.ng "nd OrbAn Onvfllopmftnt
OMU Ua. ~SO:l..O:iltiS
~t lamtl!l.L.~.tM2'!!U!L~.._
~LI2.UillJll
1.1 lFIli\ 2, (IFmHA ], 1 lConv, Un1n_, I G.Y!le Nllmb.r 17,Loln NUrnbftf IEI,Mort"gAge [n..HanOft CUc No.
LLIV~ s, I IC'lll4..l1i.L I I I
C,No,""1 Thl_ form 11 furnishad to givo you" Htltillmlint Qf Actual settlemant COlltl, Amount8,pa1d tt)'antJ by the .ottlement "Qent are
ahown. 1tftms mukad ~ Ip',Q,al" were pl1d outside th. 010"1ngl they aFe shown here for informational purpoRu and au not Includad in
the t;at"la. _
D,Name and Addreel at Borrowftr
Donald A. Velol!o and Sh1rhy M. .Velolo
IE,Nam.,.nd AddrUI of Selhr
I MugUfttta L, Chubb, indiViduAlly and AI
I Exeoutrix of thl!! Eltat" ot [lAtah If.
I Lutl, deae.eod
I
I
I
IP,N...
I CASH
I
I
I
I
I
and Addre.. of Lender
a.property Location
108 2nd Street
High.pire, PA 17034
Dauchin County. PA
J, DUMMAR't' OF BORROWERIS TRANSACTtON
100. GROSS AMOUNT DUE FROM bORROHERI
101.Contract .ale. price
102.Parsonal property
103.Setclement charges co borrower (line 14001
)6000,00
924,015
Ad1ustrlents for items paid by seller in ....dvance
106,City/town taxa. to
101,County taxes to
108 ,SCHOOL T1\X 01/23/98 to S6/3S/9S 195,04
109.S~WER 01/2J/9S to Sl/JI/9S 3,89
120, OROSS AMOUNT DUE
PROM BORROWER
200. AMOUNTS PAID BY OR IN' BElIALF. OF BORROWER
201,Depo.it of eatnest money
202,principal amourlt o( new lOt\f\(s)
20l,~xisting 10anlal
209.Sellor oontribution cloling cost~
31122.99
1000,00
1000,00
Ad1u.tmentfl for
;no City/tOWIl taxes
211.County taxes
items unpald ~y aeller
01/01/98 to 0\/23/98
to
220. TOTAL PAID BY/FOR
BO!tROWER
300. TOTAL AT SETTLEMENT FROM/TO BORROWER
301.0ross amount due from borrower {line 1201
302,Less amounts paid by/for borrower Iline ~201
303. CASU
(IXXI 'ROMI (I I TOI SORROWER
2030.03
37122,99
20]0,03
IS, 092.96
FORM 911 (4.B8l
30,03
H,S6ttlernent ^gon~
COMMONWEALTH LAND TITLE INSURANCE coMPANY
Plaoe ot Settlement
17 Salmi MARKiT SQ, SUtTE 2 -Ai
IlARRI SeURc, PA 171S1
LindaK. Trively LkT
k, Sut-ttAAY or SELLER I S 'I'RANSACT~ON
4 SO, CROSS !\MOUNT DUE TQ SEI,LER
401.Contraot sale. price
402. PetRana! property
403,
II,Setthullflllt Date
I
I J.nuary nl 1998
I
Ad1ustmentll for
I 406. City/cown taXDII
I 40?,County taxes
I 4CS,eCII00L T,'J(
I '409,SEWER
I
I
I
I
I
I
I
I
.1
I
I
I
I
I
I
I
I
I
I
I
I
lterns caid bv ~eller in advance
to
to
01/23/98 to 06/30/98
SI/23/99 to SI/31/99
120, GROSS f\MOUNT DUE
TO SELliER
SOO. REDUCTIONS IN AMOUNT DUE TO SELLER
SOl.Excess Deposit (see instruction~l
S02.Settlement ch~r9~8 to ueller (line 14001
S03,~x18tin9 10aO(8)
509.Seller contribution 010s1ng ~oacs
Adiustmflnts for
510,City/town taxe,
S11.County taxes
it~mR unpaid by seller
01/01/98 to 01/23/99
to
520. tOTAL REDUCTION AMOUNT
DUE SELLER
600. CASU AT S~TTLEMENT TO/PROM SELLER
601.0rofls dmount due to leller Iline 420)
602,t.esl reductionll 1n amount sl\l.!...!.fJ.l.!!I (line 520)
603. CJ\SH
IIXXI TOI (I
PROMI SELLER
HUn-l (3~861 RESPAf HB120S.2
JliOOO.OO
195,04
3.89
__.2!.~
13689.26
1000.00
)0.03
14118,29
36198.93
14719.~9
21.480.64
,__~__.-1!l?2101CP
I.. RE'M'L~MF.NT GHAROE:f1
_-1Jt~t, SAL~S/DROKtkfS COI1'lISJIION bued on puce
D1V.u..!$UL.2~b1on/ lint 1001 .. toll2lt.l.L.
2&20,OD to Prudential Thomp.on Wood Rial tltlte
to
P41d at Settlement
,lIOOO,OS ~-L!l.Q\
---
'101,$
702,.(1
103.CommluhlO
'104, $ to
'00, ITEMS (,"VAULt IN CO~mECTI0N WITH1,26tL-__.--.-
801.Lo_" origination rite , to
90;'. Loan Di.count , to
803. Apprailal Fu to
SO. ,Credit Report to
80S,Len~.r'. tnlpeation Fee
--2.Q.~~ITtMS ~M1Ll!X.J&IDJ.gJl TO at
90~,lnterelt trom tp
901,1 Interest from to
Y02,Mortgagft Inlunnofl flrernium for
90). Hunrd Insurance Prenl1um tor
PAID IN ADVANCE
.1
'1
mo. to
yrs, to
Iday
I~'y .
1000,RESERVES DEPOSITED WITH
1001, Huard insuranoe
1002.Mortglge inaurance
lOOl,City property taxeo
1004.County property taxeR
I,ENDER
me,CI$
,11'IO,11$
mo.lI$
me ,liS
per mo,
per mo,
per mo.
per mo,
1100. TITLE CHARGES
110l,Settlement or cl08ing tee
1102,AbatrAct or title soarch
1101.T1tlo examination
ll04.Title insurance binder
1106,Notary Fee
lincludes above items NO.l
1109, Tit 1e Insurance to COMMONNE1\.LTH'LAND TITLE
lincludes above items No,: 1101 ' 11041
ll09,Lender's ooverage
1110.Owner's coverage
1111.DISBURSEMENT CHARGE
to
to.
to
to
to .INOA K, TRIVELY
.1
I
I
36000,00
to COMMONWEALTH ~ TITLE
___H20, GOVERNMENT fti:COROINO AND TRANSFER CHAROES
1201, Recot-ding tees I Oefld $ :as. SO MortgAge S
120::.C!ty/county tax/8tampsi Deed $ 360.00 Mortgage $
1201,State tu/st.llmpa Deed $ 360,00 MortgAge $
Ralettllel $
1300. AODI1'IONAL SE;TI'LEMEtrr CHAROES
1)02, Peat. Inspection/Trellitment
130) ,Home Warranty
1104.Roof Escrow
1305. Home Inspection
1306. Transaction MAnagemeUlt Fee
130?Sower Nov,-Jan,
1308.Escrow for Inheritanoe Taxe.
IJ09.0IL DELIVERY 1~14~99
to Bowers Peat Connol
to NIS
to PRUDENTIAL THOMPSON WOOD REAL ESTATE
to flO\lsemlllter
to Prudential 'rhompaon W1)od Real Esta!;e,
to Hignapire Borough
to CLTIC
to r..henaura Fuels, Inc.
1400 'fOTAL SETTLEMENT CHAROE.S {entered on linea: 103. SECTION J AND SO~,Section KI
FORM 912 (4-89) See page 3 tor oertitication and signaturel
P.g, a Q~ Form ^~2Y.d OMB
I PAlO PROM
I nORROKE:R' 11
__I nmos AT
aa, OS --L-..uIrl&1:!Illi:t
I
I
I
I
I
tlo :-ii1QL.2}.i.!L
(lAID f'AOM
SEI.L.ER'E
fUNDS AT
SST'TLtMEN"I'
.3520.0(\
I
I
I
I
I
",00
1.......*........1..............
"~3,SO
I................I......~.......
1................1..............
I................,..............
I 35,00
_I
2S ,SO
360,00
360,00
657,010
360,00
:il240, 00
.2.25.00
125,00
!i0,00
7000.00
lll,S6 112,06
924,06 \3.688 ,'6
PAYMENT I
,
"
Dttloh tht top portlOf'i of thh HoUoI and .ubIIU wUh ~ou" p.y..nt .'M payablt to t.,. fiHf! and Iddrt,.
printed ont.,. r.vtr.. .Idt,
~- Hltc;e ohHjl. or llaMY ardtr Pbyabh tOl REGISTER OF WILL~, AGENT,
REFUND {CRll A ,'.fund of a t'l( or.dit, Which "'"' not rllqu..ted on thll Tax R.turn, IllY b41 reque.ltd by oOllpllUng en
wAppl1cBtlan for Rtfund of Plnn.ylv.nIQ Inherit.nct and E.tate Ta~" (REY-131!>. Application. ar. .vallable at
t.,. Offl~1l of the Rllgl.tllr cf Nlll.~ any cf the ~3 Rav.nue Dl.trlct Offlo.s or froll the nepert..nt', 24~hour
enswerl", .ervlcll fnr forls ordariOQI 1-800-36l~20S01 ..rvloll' for taxpayers with ,ploial he.rlng
en~ I or .peeklng n..dll l-aOO~441-!020 (TT only).
Re'PLY TOl
DISCOUNT I
PENAL TVI
INTEREST:
QuoltlOnI regarding .rrorD oontalned on this notlc~ .hould b. addr..sed tOl PA Depart..nt of Revenue, Boreau
of Individual Taxe., ATTHl POlt A.s....ant Rovlew unit, Dept. 280601, Harrl.burs, PA 17128-0601, Phone
(711) 781-6506.
If any tex w. ,Is pelrt within thr.e (3) oellndar Ilonth.~ft.r thll decedont'. death, a Uve parclnt (5,:> dhoount
of the tax paid I. alloMed.
The 15% t~ aInIsty non~partlcip.tlon p~nalty I. oOlputed on the total of the tax and Intere.t el.olftld, and not
paid before January 18, 1996, thl flr.t day afhr the end of the tal< 8llno,ty period.
Int.r..t 11 char..d beglnnlnll .,lith first day ()f dellnquenoy or nine (91 Ilonths and one (lJ day fro. the data of
..th to the datI of paYllnt. Ta)(e, which bee..e dllllnquent before January 1, 1982 bllftr Inhre.t at the rate of
,ix (6~) Pftro.nt per annuM calcul~ted at a dally rate of .000164. All taxes whloh beoa.e delinquent on ftnd .fter
January 1, 1981. will bea" lntlr.,t at e rate which wiU vary fr08 calendar year tu oahndar y..r with that rate
announced by thl PA Dopart.ent of Revenue. The appUoable Interest rates for 1982 through 2001 arll
'!!!r Int.rlll Rate DailY Int.ere.t Paotor :!!!r Interlst Rate DaUy Interett Factor
1"82 20Y. ,000548 1992 9% .000247
19&3 16:-; .000438 19~3-1~1"l4 7Y. .000192
1984 11% .000501 1995-1998 9X . OSOZ4 7
1'85 13;.( .000356 19"9 7Y. .0001'12
11186 lOX .000274 2UOO 8% .0002\9
1987 9% ,000247 2001 9i: .OOCl247
1988-199l 11i: .0OnOl
--Interut II caloulat.d as folloNSl
INTEREST " bALANCE OF TAX UNPAID X NUNBER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
-~Any Notloe Is~ued after the t6l< bacu.e. delinquent will refleot an Intor..t caloulatlon to flfte.n (15) day,
beyond the date of tho ftssou..nL If paYllent Is .ade lifter tho Interest oowputation datil llihown on the
Not108, addltlonsl Jnterest .u9l UQ ualculatod.
"
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
HI
Hllrgllrt\ttll I.. Chuhb
._--.~.. -- -- ---- --- ~_'.__~"._"__ _~.m,.~_..._.__,______~__,
being duly -.----fl_1!:!!Dl..._____ acco,dlng 10 law, depnus and says Ihat Ilh. ill the Executrix ,.__._ ...
___.._______.._.....__._____..____ 01 the EAtate 0' Sarnh fl. Lutz
Idle 01 -.--.. .Carlisl".llorough,_____. -.----..-_, , Cumberland County, Pa" dec....d and Ihal fhe
wi/hin is .n Inventory made by __. MHi\ar"tt. J ,~uhb.._ " the IIld--lll<ecutrix
01 the entire estate 0' laid decedent, consisting 0' alllhe personal p,oparty and r..1 estete, except roal eslata outside
the Commonwealfh 0' Pennsylvania, .nd that the ligures opposlle each Item 0' the Inventory ,apresent it's lair value
es 01 Iho dale 01 dacedenl's death,
~.
~~ -
//
19
.-Jj! tl."~ "jt-, J ;Jl, jj
HargarJtta" Ene.t""t' A4ntloIt.....r
Chubb r x
208 Walnut Trace Court
and subscribed ba'ore me,
/
./
--SimDsonville. SC 29681
Addroll
Date 01 Death
17
O'Y
08
Month
1996
V..r
INSTRUCTIONS
I, An Invontory must be filed wilhln th,ee monfhs .lIer appoinfment 0' personal rep,esentatlve,
7. A supplement Invenlory must be flied wllhln Ihlrty days 01 discovery 0' additIonal auets.
3. Addillonal sheets may be attached IS to parson ally or rtally
4, See Arllcle IV, FiduciarIes Acl 0' 1949.
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C'
COMMONNEALTH OF PI!NHSYLVANIA
DEPARTMENT OF REVENUE
1':/-/7,.1- /
BU~EAU OF INDIVIDlIAL TAKES
INtER I 'ANCE UIl llJVISI~
DEftT. 1"0601
UARAI5IURO, PA 1711.3-0601
L~
NOTICE OF INHERITANCE TAK
APPRAISENENT I ALLOWANCE OR DISAl.LOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAK
07..15'.1990
LUTZ
08-17-1996
21 97-0363
CllMBERI.AND
101
f..unAlioUiif iiHiHlid-.'----]
'='''''"==C'''''='~'''''''''_~,"""","-
~_.._..___. _L. .._______.._.__..._.,.____"M...___..~.
MAKE CHECK PAYABLE ANP REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE . RETAIN LONER PORTION FOR YOUR RECORDS ...
it 'E""\i': iS4"f" iic--.Uiji-iilFq'fi-NOT icr-op-ytiiii:it"i'i' AiicE - T AX- 'A-PPR'A"iiiiHENT ~ - -;. [UiwAiic E- iili ---.. ------- - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
SARAH HFILE NO. 21 97-0363 ACN 101
DATE
ESTATE OF
DATE OF' DEATH
FILE NUMBER
1l0UNTY
ACN
CHA~LES H STONE ESQ
414 BRIDOE ST
NEW CUMBERLAND
PA 17070
ESTATE OF
LUTZ
TAK RETuRN WAS I (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
I, RI.I E.tat. (Schedul. A)
2. Stocke and BOhds (Sohadul& B)
3. Clo..ly ~ld stook/Partnership Int.rast (Schedule C)
4. Hortyages/Not.. R.c.tvabl. (Sch8dul. D)
S. C..h/8~ napo.tts/Hi.a. Par.one! Property (Schedule E)
6. jointlY Owned Prop.rty (Sch.dule f)
7. Tr8nafer. (Sohedul. 0)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fun.rlll Expens.s/Aa. CC'sts/Hhc. Exp.n... (Soheduh H)
10. D.bts/Hortg_ge l.iabUiU.s/U.n. (Sohedull Xl
II. Total O.ductions
12. Net Value of Tax Return
13. Charibbl../Govern.."tal 8eque.ts; Hon-.l.cted 9113 Trust.
14. Hat Value of E.tate Subjeot to T.x
NOTE:
RECEIPT
_BER
AA270009
DISCDUNT (+)
INTEREST/PEN PAID 1-)
.00
) CHANGED
(1)
36 ,000, O..!L
,og
.00
,00
.00
837.36
,..U.J!..
(B)
(2)
(S)
(4)
(5)
(6)
(7)
'*
IIV.lh' ..." lit..,.
SARAH
It
DATE 07'"15-1998
HOTEl To in.ure prDplr
oredit to your .oco~nt,
.~it the up~r portion
of this for~ with y~ur
tlx pay...,t.
36 ,837. 3~
18.297.50
1.274.60,
(11) 19.57~ JjL
(12) _ 17.265.26
lIS) .00
(14) 17,265.26
(9)
110)
(Sch.dula J)
.00
,00
17,265,26
K ,00_
K ,06_
K .15.
(18)
If an assessmsnt was issued previously, lines 14, 15 and/or 16, 11 and 18 will
reflect figurel that include the total of ~ returns as.es~ed to date.
ASSESSMENT OF TAX:
15. AMount of Line 14 at Spau..l rat. (IS)
16. AMOUnt of line 14 taxable .t Lineal/Cla.s A rat. (16)
17. A~unt of Line 14 taxable at Collat.raI/Cl... 8 rat. (17)
18. PrincipII Tax Due
TAX CREDITS:
PAYNE NT
DATE
04-29=1998
AHOUHT PAID
2,589,79
BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-30-1998 TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
-------
TOTAL DUE
.00
.00
2,589.79
2,589.79
2,589.79
.00
221.97
221.97
~ IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
IF TOTAL DUE IS tESS THAH n, MO PAYNENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDI.T" (CR), Yau HAY BE UUE
A REFUND, SEE REVERSE SIDE OF THIS FO~ fOR INSTRUCTIONS.)
'.
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F.C f')
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RESERVATX()NI Elt,t.. of ~tI dyIng on or btforl o.a.llbtr 12, 19a2 ... If 8I1Y future Jntlr.,t In the ..t.t. h, tr..,.farrtd
In po.....Jon or *"jo~t to Cl,.,. (0011.t'''lll benefieiari.. of thl deold,nt .ft,,. the explrltlon of~y ..t.t. for
Ute 01' for ~""" the eo.oo..1th hereby l)Cpr,"ly "".,.11.. the rlllht tq IPPr..l.. IlOd a..... trln,f." l".,.dtlnOl hxu
It the lawful ct... ft (oo11.t~r.l) r.ta on any Iyoh future 1nt.r..t.
PllIll'OSE Of'
NOTICE I To fulfill the r.qulr..ent. of 800tloo 2140 of the InherItance end Eat,t, T.~ Aot, Aat 2l of 1995. C7l P.S.
s.otJon 9140).
PAVHENTI Det1tOh the top portion of thh Notice end tub, It wUh your Ply-.nt to the RIglllhr of Will, pdnted Of! the t/wI,... .ldeI.
--.... cMok or INMlfIY order p.y~l. tal REGISTER OF MILLS I AGENT
REFUND (CAl, A ,..fund of . tax credit, Whioh w.. not requa.t.d on the TaH Ret~rn, May be reque.tad by o~l.tl", en ~Applio.tlon
for R.fund of P~'Ylveni. InhlrltlnOe and E.t.t. T8~" (Rf.V~lSI3). Applloation. are avai!Qble at the OffIce
of the Regl.tar of Will., eny of the 23 R.w~,"~ DI.triot Offlo.., or by call1ng the .peolal 24~hour
,".w.ri~ .arvl~ nuMber. for for.. orderlngl In PennsylVatlia 1~800~S62-2050, outside Pann.ylvanla and
within 10011 Herrbburl ar.. (717) 787"8094, TODI (117) 772-22S2 (H..rlng Iapelred Only).
O&JECTION11 Any p.rty in Intar..t nQt .atl.flad with the appral.~nt, ellowanoe or dl.allowance of dedUction., or .......-ot
of tlX (Jnolvdlng dlleount or Interut) a. .hown on thh Hotloe IN,. objltOt wlttli" Ibty (60) chI)"1 of reoalpt of
thil Hotloe bYI
--wrlttto prot..t to the PA Depart.."t af Revenue, Board of ApPlels, o.pt. 281021, Harrl.burg, PA 17128-1021, OR
--.I.otlon to have t~ aatt.r d.ter.lned at ~udjt of the aeeount of the p.r.onal ra~r.leOtatlv., 01
~-eppa.1 to the Orphan,' Court.
ADMIN
ISTAATJYE
CORRECTIONSI
F~tu.1 .rrors dlleovar.d on thl. I....,..nt .hould b. .ddr....d In ~rlting tOI PA u.part..ot of Rlvenue,
Bur.au of Individual TaM.s, ATTNI ~OJt Ass.....nt R.vl.w Unit, Dept. 280601, Harri~bur8, PA 17128-0601
Phaoe (117) 78'1-6505. SIHl p81J8 1i of the booklet "InBtruotlon. for Inh4rltenel TaH Rlturn f('\r a H..ldtnt
Daoadent" (REV~1501) for an .xplar_tion of a~lnl.trativ.ly correctable .rror..
DISCOUNT t
If WIY tal( due it paid ~Hhjn thr.. (]) calander ..onth. a-ftur the decedent', d..th, a five percent (S;O dltcount of
the tax pllhl it nl1~d.
PENALTY I
ThI Is;( tax MM.ty non~p.I'UolpaUon p.na1t~ it otlllPut.d on the tot.l of the tf'H arKt Intlrelt .......d, Ifld not
paid before January 16, 19?6, the flr.t l.Iay aftar the and of the t.l( attnesty period. Thlt non-p~rt1olpaUoo
par.lty I. ~.alable in thn .... aannor and In th~ the .... tl.. period a. you would appeal the taH end int.r..t
that he. ~.n .......d 8' Indlclted on this notlc..
INTEREST 1
Interer.t II charged beginning with Ur.t day of daUnqu.ncy, or nIne (9) eonth. and one (1) d.y froll thf dlt. of
dHth, to the ct.tl of 'Iflyunt. Taxu ~hlch beeNs del1nquent b.for. January I, 1982 bear Intara,t at the rata of
,he (6;() perc.nt ptlr .nnlJlll oflloullltad at a daUy rate of .000164. All tanH whIch boe... dal1nquent on Md Iftar
January 1, 1982 will b..r Int.r.ut at I rat. whloh will ~ary frOM oalet)(jar Y.lr to oalendar y..r ..ith thet rete
announced by the PA Depart..nt of Rlyenu.. Thl epplloabJ. Int.r.,t rat.. for 1982 through 1996 ar'l
y..r In ter!.!.L!!.!! DaUy Int.r..t factor t.!!r Int.r.,t Rate PIUy Int.r..t Faotor
1982 20% .000548 1967 9% .000247
1981 16:< .000438 1988.1991 11% .000301
1984 11% ,000301 1992 9% ,000247
1915 U% ,000356 1993-1994 7% .000192
1986 10lC .000274 1995-1996 9% ,000247
--Int.r..t I. caloul.tad a. foUow'l
INTEREST . BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY I"T~EST FACTOR
--Any HoUc. luu.d aft.r the tal< beoOMe. d.Unquant ~1l1 r.fllot IM1 Intar..t oaleuhtlon to fiftHn (IS) d.n
bttyoncr the datu of the ...e....nt. If pay..nt it .Mlo aft.r the int.r..t oootputaUon dllt. .hown on the
NDUoe, IKktttJonl1 Il1t.r..t .u.t bl calculatld,
PAYtIEHT I
tlttMh tM top portion of thh tfotloe Ind .ubIIlt with your paYlHH1t aide paYMJb to the nIIlt end Hdr...
prlntH on thI r.wr.. ,Jde.
If Il!!SIDENT DEL'EOOHT ..... _ or oonoy or..r p.yobl. to. REGISTER OF WILLS, AGENT.
If HOll-l.EllIDEMT 1lE!1!1lElfT .... _ or IKIflOY order poYobl. to. CllHI10NIIEALTH OF PEHHSYLVAlfIA.
REFUND (CA)I A refund of I tex orttdJt, whlch wu J'l()t requested on the lex Return, ..Y be r~.ted by c0llP1eting en
"Applloetlon for AefUnd of Penn.ylv.,'1 tnherJtenca IInd Eltat. 'IX" (REY-UU). Applicltion. era avaUlble at
the OffiOl of the Regi.tar of Nlll., ~Y of the 23 Aayeou. oi.trlct Offlce. or frOl the o.plrt-.nt'. 24-hoUr
.,lWCtrlng urvlca OUIIber. for for.' Clrdlrlr\ll In Pann'Yh'lIni. l-aOO-362~20S0, oublckl Penn,vlvlnll
~ within 10cIl "-rr1lburg ar.a (717) 787-&094, TDUI (717) 772~2252(Ho~rlng IlPwlr.d only).
REPLV TOI QuI.Uoo. r.rdlng '1'1'01" contllntd on thh noUe. should be addr...1td tOI PA DeplrtMnt of A.venue, lur...
of Indllllduil1 '''M'', ATTHI Poat A.....unt RIIII.N Unit, lktpt. 280601, Harrisburg, 'PA 17128-0601, phone
0'11) 787-6505.
DISCOUNT J
If IInY t.x dUI 1, paid wlthln thr.. (3) cIl~lr aonths after' the dle.dont's d..th, I flye peroent (5X) dllcount
of the t.x pa1d is .Uowd.
PENAL TVI
The ISX tax ..,..ty non-plrUolvat1on ".,IUV 11 oNJ)uted on the tetll of the t.x r.nd Intlrllt .....".d, tnd not
pald bclfon Jlf'tUllr!.' 18, 1996, thQ fir.t d.y Iftar thl end of ttM tax Mnntv period.
INTEREST I
Inter..t II cMr8'td beginning with firlt d.~ of dll1nquency, or nine (9) .onthll and one (lJ day frOll 'thtl datil of
"'uth, tl) the date of PI\I..nt. Ta"I' whioh bee... dlUnquent blforo January I, 1982 b.,r in"r..t It thtl rat. 0'#
.ix (6X) "rcent per annua e.Iou~.ted at . dally rat. of .000164. All taxII whioh bee... dlJlnqutnt on end .ftar
Januarv 1, 1982 will bear lntere.t at a rlt. which ~111 v.r~ frOl ca1.ndar y.ar to oalendlr ye.r with thet rat.
IMOUnOM by the PA o.plrtunt of ROYenu8. The .ppllnble lntlr..t rate. for 1982 throuoh 1"8 11"1
V..r Intlr..t Ret. DailY lnt.relt Flotor V.lr Intlr..t Altl PaUlI Int.r..t Fletor
19aZ 20;: .00OM6 19&7 9% .000247
19a3 16% .OO04S8 1988-1991 Hi( .000501
1964 Iii' .000501 ''l9Z 9% .000247
1945 13:': .000356 1993~1994 n .000192
19a6 10le .000274 199&-1998 9% .000247
"'Int.ralt I. olloullt~ II fOl1CMi111
INTERBBT' BALANCE OF TAX UHPAID X HUNBER OF OAYS DELINqUENT X OAILY INTEREST FACTOR
~~An)' HoUcl 'uued Iftlr the tax beCOlKlI del1nquen1 wll1 rlfllct an inbtr..t ca1oulaUon to f1fteen US) dly.
beyond the data of the ........nt. If ply..r,t Is alld4t aftar the lnt.r..t OOlPutlUon dati .hewn on the
Hotiol, additlonal lnt.rllt IUlt b. ollcul.ttd.
..t\r.l\LUTZ8ARA,R&L
IN REI ESTATE OF SARA H. LUTZ
LATE OF THE BOROUGH OF
CARLISLE, CUMBERLAND
COUNTY, PENNSYLVANIA
IN THE COURT OF COMMON PLEAS OF
ORPHANS' COURT DIVISION OF
CUMBERLAND COUNTY,
NO. 21-97-0363
RECEIPT. RELEASE AND WAIVER OF ACCOUNTING
KNOW ALL MEN BY THESE PRESENTS, that I, THOMAS CHUBB, being the
sole beneficiary under the will of SARA H. LUTZ, the other beneficia-
ries having di.sclaimed their interests in my favor / do hereby acknowl-
edge that I have received all sums of money and property due me by
virtue of the death of SARA H. LUTZ/ in full satisfaction and settle-
ment of all of my rights and claims under her estate.
1 further declare, intending to be leyally bound, that r hereby
waive my right to require the filing of a First and Final Account and
Proposed Schedule of Distribution in any Court of Common Pleas having
jurisdiction over the same, and I acknowledge that I have had an
opportunity to examine copies of the books and records of the said
estate, and I agree to the final distribution of the estate without
further forJl1alities, and with the same force and effect all if a First
and Final Account and Proposed Distribution had been filed in a Court
of Common Pleas of Pennsylvania having jurisdiction over the same and
duly audited and confirmed.
AND THEREFORE, I, THOMAS CHUBB, do by these presents, remise,
release, quitclaim and forever discharge the Executor, his heirs,
succeSDors and assigns, from the acts of the Executor as aforesaid,
and of and from all actions, suits, payments, accounts, reckonings,
olaims, and demand!! whatsoever / for or by reason thereof / or any other
aot, matter, causa or thing whatsoever, and I do hereby consent to the
discharge of the said Executor.
.I IN WITNESS WHEREOF / I have hereunto set my hand and seal the
/ . day of 0,.:7""' r 1998.
/ } /
(./t.~ -Lj/
w-reas
(!.?
. /~'//-'-
~
~~~..~
THOMAS CHUBB
4')' //5 /
COMMONWEALTH OF PI!NNSYLVANIA
DEPARTMENT OF REVENUE
'*
Iu~eAU Of INOIVIDUAL TAKES
JHHf.I'A~ TAM DIVISION
(M:PT, !Mrfl
HARRISIIlIHIl, PA 111l1!l~0601
MARGARETT L CHURB
730 WALTON ST
LEMDVNE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD DR TRUST ASSETS
DATE
UTATE OF
DA TI! OF DEATH
FILE NUMBE~
COUNTY
SSN/DC
ACN
1I~.Uf4 U UP III-tn
PA 17043-2034
01-13-98
LUTZ
08-17-96
21 97-0363
CUMBERLAND
207-07-9606
97002921
E.----A.;Oun-rR.~lttOd--.J--
~===<- .~
----,---------~-
MAKE CHECK PAYABLE AND REMIT PAYMI!NT
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
SARAH
H
TOI
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
-~-_._-------~~--.---------~------------------------------_.._---------_._---------------_._---------~----------
REV-1604 EX AFP (03-97)
.. INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ..
DATE 01-13-98
ESTATE OF LUTZ
SARAH
H DATE OF DEATH 08-17-96
COUNTY
CUMBERLAND
FItE 110, 21 97"0363
ADJUSTMENT PASED ONI
S,S/D.C, NO. 207-07-9606
PROTEST BOARD DECISION
JOINT OR TRUST ASSET INFORMATION
ACN
97002921
FINANCIAL INSTITUTIONI MELLON BANK
ACCOUNT NO. 132-106-0376
TYPE OF ACCOUNT, () SAVINGS (X) CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 08-03-71
Account B.lance 1,674,73 NOTEI TO INSURE PROPER CREDIT TO YOUR
Percor,t T "xable X 0,500 ACCOUNT, SUBMIT THE UPPER PORTION
Amount Subject to Tex 837,37 DF THIS NOnCE WITH YOltR TAX
Debts and Deductions, ,00 PAYMENT oro THE REGISTER OF WILLS
Taxable Amount 837,37 AT THE ADDRESS SHOWN ABOVE.
Tax Rete X .15 MAKE CHECK OR MONEY ORDER PAYABLE
Tax Due 125.61 TOI "REGISTER OF WILLS. AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (t) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (- )
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN n, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTEO' AS A "CREDIT" ICR),
YOU HAY IE DUE A REFUND. GEE REVERSE SIDE OF TH!S FORH FO~ INSTRUCTIONS,)
INTEREST IS CHARGED THROUGH 01-28-98
AT THE RATES APPLICABLE AS OUTLINED ON
REVERSE SIDE OF THIS FORM
THE
133_~
,
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PA YIENT ,
Uttech thlt top portion ft' thh NoUce and .ubII1t with your paYHnt la<te plyebl, ..to i;ho nHI and Itdctr...
p~lnt.d on the r,Vlril 1101.
.... "Mti ohlck or IOnty order PIllYlblt tnl REGISTER OF WILLS, AGENT.
REFUND (CR)1 A r.fund of . tax credit. WhAch WI' not ~.qu..t.d on the TIH Rlturn, "V be r.que.ted by o~l.tl", en
"App1!o_Uon for R,fund of PMVllvlvbnla Inn.r1t1n01 IInd Elt.tt Ta)C" (AEV"l11S). Appl1olUonl .r. IV,Uable It
the Offl01 of the R_al,t.r of Willi, envof the 21 Rav,nue Dl.trlot Offlol, or ~r~ tht o.p.rt.ent', Z4-hour
anew.rlng ..rvlo. nuab.r. for for.. ordtrlngl In Plnn.vlvanl. l..aOO-562-2050, out.l~. Pennlvlvania
Md within locll Hlrr1.burg .r.. (117) 167-1094, TOO' (17) 772"ZZS2 CH..ring 1.llred only).
REPLV TOI Qu..Uont ,...rdlng .rror. e'onhlned on this notice thould be addr....d tOI P. Departltnt of Revenue, Bureau
of Individual TIX", "TTNI POlt A.......nt Ravllw Unit, Dlpt, 280601, Harrl.burg, PA 17128~0601, Phone
(7171 787"6505.
DISCOUNT! If InY ta. due I. paid within thr.. (5) callndar ~nth. aftar the o.O.o.,t.1 death, . flv. parcent (S~) dl.count
of the ta~ paid JI allow.d.
PENAL TVI
The 15~ tlX uo..ty non~part1elp"t1on penalty I. co.puted on the tohl of the ta)C Imd Int.r..t n.....d, 'l'1d not
paid b.for. JIIlI'lU.ry 18, 1996, the flr.t day aft.r the .nd of the ta)C 8IIMlty periOd.
INTEAF.8TI
Inten.t .. charltd beginning with flr.t d.y of d.Unqu.noy or I'll". (9) aooth. end one (1) day fro. tM det. of
death to the chlta of p.v......t, lex.. which b.e... delinquent nfor. Januer~ 1, 1982 b.ar Inter..t .t the rat. of
,IK (6~) ~rcent Plr ~ calculat.d at a dally tat. of .000164. All ta~e. which bee...6ellnquent on and after
JlN\IJIlrll 1, 1982 will b..r Interait !!It a ...ate which will vary froe calalldar lI.ar to celendar ya.r with that rat.
~Id bll the PA Depart.."t of R.v.nue. The applicable Int.relt rate. for 1912 through 1991 arel
Ye.r Int.r..t Rat. D.lly Inhr..t Faator Y.ar Int.r..t Rat. Dally Int.r..t Factor
1982 ZDX .00D"8 1987 'X .D00247
nls 16X ,00001 19lt"I991 llX .000SOI
19M Ul( .GOOSOl 1992 9X ,OOOZ47
1985 15:< .000556 1991-1994 7X .000192
I.M lOX . "0274 1995-199. 'X .000247
--tnt.r..t I, calcul.tad .. followl'
INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Anll Netic. IlIuld .ft.r the hK becOltl. dlllnquant wlU r.f1l1Ot ~ Inter..t calcull'lUDll to fifteen (5) deWI
bavond th4t det. of t~ ........nt. If ply.ent 11 .Itde Ift.l' the 1nterllt eOllPUtlUOfI d.ta .hewn on thli
Notle., addltlOfllll int.r..t'....t b. calcul.tad.