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roR DAIIS OP DIAIH AmA 12131191 CHICK HII
,,~;in. INHERITANCE TAX RETURN ~o~::~yU~:~DITlSClAIMID [
_ RESIDENT DECEDENT flU NUMBIA
COM^l~Vm~\'I\'.(~,WVIWt^N'^ (TO BE FILED IN DUPLICATE 1/ '/ 7 .3 f/{,
"^"lSmiU~ntl'!\'8",O' WITH REGISTER OF WILLS) COU'"V COOl c, H_" ~E.^R NUM"
---'-D')<I~~mi'~~,~.~jvOf>i;:;t'1i"~-~h ~... . '1"~Z;tI:L~;PtJl=:'k' '- "
'Q(~i~i~~i;";i~-~~;tf I"^'s~;~'~ f~ 1''','; "';"~:" I /J / jj,fI:/1UIlj,. /..11. /tlec.ha.n i~sb4 (f I!f 1M!;
~~Ci"l'_'UO~/;.OUi' ill,"'''''''''''' """,,,,,,, "'"'''' '1"KIM '"tJ~;~M''' C""I'M~~i~~~I.~~r.":"1 '~. _,--..
C4 1. Original Relur" I 2. Supplemont,,1 R"'ItHn IJ 3. Remainder Relurn
- lfor doltt of dealh prior 10 I ~ .13.e
['" 4. Umll-bd E,lalll [ I 40. Futurfllnll,ro\I Comprumhfl LIs. federal Ellato TaK Return Required
lfar dale' of death "!!fn 12.12.821
C'-I 6. Dacedenl Died re,'alo 1..,1 7, Dllc&dftlll MClin/ulnad 0 living TrUll
IAllach copy 01 Willi I^/lo,h ,opy 0 1"../1
----.-...~.---_. AI,L"'CORRISPONDENCI AND" CONPIDINTIAL TAX INPORMATIONSHOULD BE OIRECTID TOI
'NAME ~._---_._.-...-_._--_.__._.-_..- --rOMPiEir-M~'Lij:iOiD6riSS
:~l1;~~i:~:~~e~=-~-_=.:~~~-.-'.-~~~~~~;::';~~~i, ~~ .. /~O.5~=.=,=.
I. R.al E,lol. ISd,.dul. AI 11 I () _
2. Slo,k, and 80ndIISch.dul. 81 121 __ 0 _.. _....._
3. Clo..ly H.ld Slo'klParln",hlp Inl..." ISch.dlll. q 131 ,__________._(;)______________.__
4. Marlgag.. ond Nol.. R",;,abl. (S,hodul. UI 14 I ~.._......___.J2__ __.n___'..,."_
5. Cash, Banlc Oepollh & Ml1cellanoClul Perlonal Proporly ! 5 I __~_____.1?_____.__
~~.~ ~
6. Jolnlly Own.d Prop..'Y ISch.dul. FI 16 I ___ ..~.",,_OffJ.--,- /3
{)
7. Iran,I... ISch.dul. GIIS,h.dul. l) 171 ,_u,~_..___.~_____
Q T utal Grnn AIIOh (10101 Lines 1.'11 l' '
9, funeral EXpenl\1~, Admlnhlro/lve COSIl, Mjscollonoo\l~ 191 ____y4--_~1..~~..'f1?_____ '
E.pen.., ISch.dol. iii
o .
10. D.bll, Morlgagl Llablllti.., LI.nlIS,h.dul.II 1101 ..__..___.-'-._~__
11. lolal O.dtJctialll Ilolal Lln.. q /I, 10)
12. N.I Valu. 01 E,lol. 11In. 8 mlnu, Lln. 111
13, Chor1table and Governmental 8equel" (Schedule Jl
___ ~. Ne/ Value. Suble" to I a. ILln'..!.3~""'-'-~In.'J.:1L_.___
15, Spousal Transfen lfor dales of death oller 6.30,Q41
See Inltruttlons for Ar,pUcoble Percenlage on Reveflt
Side, llncluel$' VU!UIlS rom Schedule K or Schedule M.I
16. Amount of Uno 14 100wblfJ 01 6% role
(Include valvllIlrorn Schedule K or Schedulo M,l
17, ^mounl of line 14 tUKoblo at 15% role
llnclude volues from Schedule K or Schedule M,)
18. Pdlldpal hlK due (Add lall from linfu 15, 16 und 17,)
IQ, Creclil, Spoulal Po~orly Credl1 Prior Potmenll
__......._0 + 0
REV 1 ~(,o r It". VQ~I
~
..:5\2
~I~
.,
I I,
!
..
_ 8, !otol Numb.r of Safe Depolit 80l(f
tiJi
h
~
I
. ,.
I 8 1 __.2;_9.$ 2. !_.!.~._
(III
(121
{131
(141
" ~,.~~.S,J'~___.
L.3 ".~.,J~L...
o
.--.-,,--- 3~~j~. u_
(151 _______._~.~__~._m ___________0
(l61__.__..._._..__.....J'.________~ .06 m
(171 _...u__..~?J_'I., ?~___~ .15 m
o
.__.,.__._~-, .--.-..-..
- 5$, DD
..----.----....----. .'--..
~ 55, or
z
"
r:
~
1Il
fl
g
(181
lnlount
OI$(;oulIl
o
o
P.
(191
1201 _..
o
+
20, If Une lQ II grlloler rhon lino 18, Mien Iho differenco on Une 20, Thh it tho OVERPAYMENT,
III]
Chock hbfo'lf au ",0 rl'quOiHt10 tI tofutlt of VCHJf oVNpclyml!t1t
" 5S,OD
21, II linG 18 II greolllr thCln line 19, flnler Iho djlfllrt~f1Ce on Lino 21 'jhh it tho TAX DUlL (21)
A, Enter Iho Intorell on Ihll ballltlCO cillO on lino 21A. (:lIAI - .-..__..-.~._f1...,......~'3,..o.a_..
8, htnr ihe 10101 01 line 21 Cllld 21A on Uno 21B, This Ii tho BALANCE OUE, (218) ____ _ .;;;J.
____...~~.~..~~!.~~._~.~.vabl. 10: Reg.lt'er of ~!!!t, Agln' . . .,_ ._ ..__..." n___........_____ ....._. _ ..
.____.._===_~ )>-8j SURE TOANSWEiI-AL(QUESTiONSON REiiERsiCsIDEA~iJ~T().iiJcli~~I('M~!H.__~
UndlH penalties of pefiury, I dtldnre Ihull hCl~e tHlOmlrlftd thil r(lturn, induding (le(ornpcmying Ictlfldulot Clnd Ilolomenll, and 10 the belt 01 mt k--;:;~-;Ie.dge a~db-~Ij
It II true, correel Clnd complelo, I d!ldCHe that nil rfHll fHtnlfl lien llnen roportod ell IrUfl rnClfkel ~oIU~J, Dodorolion of preporllr other than Ihe pef10nal represl!tnlatlvl
bC'lted on alllnformolioll of which prepare. hm (1ny knowlodyo
i'~:~~''''~O~jL~~~'i,,:Gi~';". '.. A"O;;;' }~1i~:~;:':{"'t~~ E'~~~~"~;~~'~~-:~~~;~5tE--'f' 7/~ 97
N '~""""N"'" 'I' ~i';']. W. "'A/A) ~r.-..~-"._-m__._--_._-- 0'" -21-7
. -. --I ..... ...(;5._tI1ifCHI9I11.ICS(j"fU'JIl_I1~~__._______.--.!!.____Z
'.
Acl 148 of 1994 provide. for Ihe reducllon of Ihe IGlC rClle.lmpo.ed on Ihe nel value of Irande,. 10 or for
Ihe u.e of Ihe .pou.e. The role. a. pre.crlbed by Ihe .Ialule will bel
. 3% (.03) will be applicable for e.lale. 0/ deeedenll dying on or a/I., 711/94 and beforll 1/1/96
, 20/0 (.02) will b, applicable for ..Iale. 0/ docedenll dying on or aft., 1/1/96 and before 111/97
. 1% (.01) will be applicable for e.lal,. 0/ decedenl. dying on or a/I., 1/1/97 and before 111/98
, Spou.al Iran.f.,. occurring on or a/I., 1/1/90 will be eKempl from Inh.,IIance laK.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (v-) IN THE APPROPRIATE BLOCKS.
.VlS NO
1. Old decedent make a tranlfer and:
x
a. retain the ule or Income of the property transferred, .................."...................................
b. retain the rlghlto designate who Ihall use the property transferred or itllncome, ...............
x
c. relaln a revenlonory Interelt; or ..,....."... ........"........ ..............."................................."
x
d. receive the promlle for life of either payments, benefits or care9 .........."....................."""
2. If death occurred on or before December 12, 1982, did decedent within two yean preceding
death transfer property without receiving adeCluate conslderation~ If death occurrnd after
December 12, 1982, did decedent transfer propl/lrty within one year of death without receiving
adequate cOllllderation9 .....,...",.....,..., ,., ,. ..,......,.,.....,.. ,. ,.. ...,.."",..,...."....."..,..........,......
)<.
,l<
~
3. Old decedent own on 'in trusl for' bank account at his or her deathL...".."...."..................."
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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4U,U'1 II '" 41,'\1
INFORMATION NOTI:JE FILE NO. 7.1
TAXPAYIJ~N~ESPONSfl ACN <J615l1258
DATE 08-15-96
--.-- --_...-.
lVI'!: OF
UlMHUHWIAIIHUI I'ltlNSVlVAHIA *
UlI'AlHHIHI UI IHVINU! ~'., y
IlU"!:AlI 01 INIIIVllllJAI IAKl:S .
1l11'I. ?1l01i1l1
IIAIUUliBtJHO. IIA 1I118-0hOI
EST, or NANCY M KISS
S,S, NO, 288-38-8414
DATE OF DEATH 05-13-96
COUNTY CUMBERLAND
ACCOUNT
Ixl ~AVINOS
[I CIIECKINO
[J TRUST
I] CERTIf ,
JOHN V SHOEMAKER
1 sHOEMAKER LN
MECHANICSBURG PA 11055
ReMIT r^YMENT ANO FORMS TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
OAurlUN DEPOSIT BANK I hili 11rn\llllnd tll. lIep8rt",.nt ..Ith lh. lnfnrllntllln II,t.d below whloh hn, bun ulllcI In cftloulotlng the
pottmthll talC due, Their rlcordll Indloah ttlnt lit the duth of th. nbov.dIOD<<."t, vou Wllrt 15 Joint oWller/hlnl,lolnry of thl. lllloount,
If vou fnl thl. Inforllfttlon t. Inoorrllot, rdulI'" obt,,111 wrlltln oorr.oUon fro'" the f1nllnolal In.tltutlon. attMh " oopY to thh fori
lInd r.turn It to the nbovI llddrlll. Tllil Moount I. hlllllbh In lIor.ordllnol with th. Inhtlrltl1no. Tnll law. or the COfllllanw..lth of rtlnn.vl\lnnlll.
QUI.tlon. MIIV he an.wared by onlllng (1111 181-8!?1,
COMPLETE PART 1 BELOW M M M SEE REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
Aooount No. 4600012847 Oat. 02-07-92
E.tabl hhad
AOClount I.i.nee 14 , 104 . 25
Paroant Taxablo K 50 . 000
AMount Subjaot to T.. 1.052,13
T.. Rate K .15
Polonllal Ta. Dua 1,057,82
pm TAXPAYER RESPONSE
COI FAILUR! TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT BAS!D ON THIS NOTIC! J
..
To In,urI prop.r oredl t to your ftecount, two
(21 copll' of thl. notlo. MU.t acoo~p'ny your
PIIVM.n\ to thl R."httlr of ~1\1l.. Hftkl OhtC1k
plyabh tOI "R.ylltlr of Willi, "glnt".
NOTE I If tftll pllIy..nt. r.r. ..de wi thin thr..
(3) Ilonth' of the dllud",t', dati tlf d.-th,
you .,.y cJlduot .. S% dltoount 0' thl tall d".,
AllY Inhllrltftnoo till( due wl11 beoo.. d.llnqu.nt
nlnl (91 IIonths after tho dale of dlftth,
I CHECK J
ONE
BL.OCK
L_ ONI.V
o lh, IIbO\l1 lnforutlnn ftlld taM due I. COI'rllot,
I. You ...y choolll to rult pRyunt to tt'A RIIgl.hr of "Ull~ with two copt.. of thh notlcI to obtnln
II dl.count or ftvold Inhrllt, or you .flY chick bOil "A" end roturn thl. /lotic. to HIll RlIgl.tlr of
Willi find IIn offichtl Il...uunt wilt Il. luulltl by thl PA Oepllrtl,.nt of Re\lllnUI,
0, 0 The Ilho\llt 1115..\ hll' been or 01111 he repnrlod "lid tAX pllid ..Itll the Pllnn,vlvnnh Inh.rlhnce Till( ntturn
to bl fl1.d by lh. dClC8dunt's repr..entlltl\lll.
c. IJ fh. "bo\l' infof","tlofl Is~ncorrQct and/or llgbt! IInll dllduotlOll1 w.r. paid bv you,
Vou lIust oOMpleh PART L~J nnd/(.1r PART [~] below.
PART
~J
TAX
LINE
If you indic.t. a different tOM rate} pl.lsl $t.t. your
rllationohip to dec.dent: ~-~------~-'-~-
ntTURN . OOMrUTATIO~
1. D.t. E.t.blt.had
2. ACDo~nt O.l.nol
!. P.roent raxabln
4, Amount 5ubjact to Tax
5. D~bt. end Deduction.
6, ^~ount rlxabll
1. rax Rlt.
a. Tlx OUI
OFFICIAL USE ON LV 0 AAF
PA DEI'ARTHENl' OF REVENUE
OF TAX ON JOINT/TRUGT AOCOUNTG
1
2
3J
4~
5
6_
7 K
8
PAD
I
2
3
4
5 Tl
6
7
8
DEBTS AND DEDUCTIONS CLAIMED
-
-
-
-
PART
[!]
DATE
PAID
PAYEE
DESCRIPTION
AMOUNT PAID
~
TOTAL (f.ntlr on linl 5 of Tal-( CUlllput.Uon)
I
.
--
Undlr peneltl.. of perjury, I ~ecler. thet the flct. I hlY. reported aboy. Ire true, corr.ct .nd
oo..pl.t. to thl be.t of MY knowledge and b.llaf.
tlLJI't~ ( _.1-__._.___
WORK ( )
THEPIWNE NUMBER
DATE
TAXPAYER SloRATUWE
GENERAL I NFORMA T I ON
1, fAIlURE TO RfiSPONn WIll RESULT IN AN OFfICI^L TAX ASSESSMENT wlth nprllt,l'Ihln Intarut UQud on lnfqrlllltton
IIthlftlthd hY the flnAncj", Ir!ltlll/tlnn,
1, lnher-Ihnal t"ll h.COI.IlI th".tll~\Jflnl nJrlll !IIonth. lilt",. 1t'1l dllctldont'! d,llu of douth,
~, A Joint IlcClount 16 tllllllhlli OVQn IhUlJ{J11 llIoa dOOotllll1t'!\ !l1II'll1 loin' ('tlldqt! III " "'"\tit/' 0' convonlonoCl.
It. ActlOllnt. tlr.cl\ldllll1 thtl'. hnld hntWllurl hUlh","1 flnel wllAI 101111011 tho n"llOlhmt l1il\ In Joll,t f\nIllClI wllh1" 6no V.flr prlur to
dOllth hrll fullv h'llllblll III lrnnllhrt,
!.. A(;(lotml;-, .,t..bll,"oll 1011111'1 "olwun hUlIllllnd ""Il ~lIffl lIIore Ill"" nrl~ ".n" ,,,'Iut to tJntll IIr. not tIUI8bl..
6. AO(lounh ",,111 lIy II line.lllmt "III 'rutt tor" tHlllttlor' or othtlrl tlr" tnll/lblq fully,
REPORTING INSTRUCTIONS
PART
1
TAXPAYER RESPONSE
1. BtOCt: A - If HIli Inforfllllllon IInd co",putnllofl In 111<<1 nntlCQ "ro !lorlAet "nd [hllluctlon. .rlll flut tt.lng oJallll.d, Pltl09 tin "K"
11\ block "A" of Part 1 of tlte "h~llavllr RUllonllo" 9oct!nn, Sign hm co,II.. wIn IUbllllt thctM Mt\h YOUr check for the .1II0!.tf't of
tai< to the Reghhlr of Will. of the county Indleftt.d, rhe PA lIQpllrhu,nl of fhwlIllU" loll!! "'u. an offlol01 ....in.nt
(f'orlll REV-IS...., DO upon roc::ulpl of tho rlltun\ frolll tho RIIII1tht of Will.,
2, BI.UCI': B ~ If the n..llt 'llIJolflod 01' thl, 110UCII tlln bun or will he rlported find t8M paid with tll. P.n".yll,lllnill Inherlt.nc.
hu Return fllod hy thlol tlllt,e(Jfmt', ropl'ltsontnUvlJ, plMfJ "n ")(" In blnel< "A" of finl't 1 Of the "Taxpayer R..pon.... ..utlon. Sign on.
copy ftttd I'lIturn to thlt IIA nopnrtmlHlt flf Rflvenue, Blll'BIlU of lndl"lduad IhllU, lhtpt 2"01101, Hftrrltburg, PA 171Z6~!l601 In the
e~v.lope provided,'
~. BI.OCK r. " If thGl not Ie. Infor",nUon ItlncorrfHlt flnd/ol. ("tdil~t1ol\' ftrQ hftl/l9 olftllltl(1, ohtUlk hlook "en ftnd callpllt, Perh 2' end 3
'H1Clnrdtn~ to thll In,tnwtlonll beltJll. Shill two cOIIIDl "fld s~,h",lt I.I1AM _11th your t;hnok (fir the nlllou\1t of hili plIvabh to the "egl.tu
of Wl1h of the countv lmllcl'lt"d. Thl PA OepMt",ent 0' flllvnnult 14111 Inu8 nn o"lcif.l M.elllll.nt (Forll REY~1548 EIO upon r.o.ipt
of th. r~turn frOM tht R.~l.t'r of Wlllt,
TAX RETURN . PART
2
. TAX COMPUTATION
lIHE
1. Enter
HOTEl
th. date the nooount orlglnlllllY ~r:l utltbl1shlld ur tAtted In thll lIlantlllr .lIlltlng nt dftt. of duth.
for e dlced.nt d~I/l\J afhr IUtZ/t121 Aeoount. which the (Iecedent put In joJnt nDMOI within one ell y",r of d..th .r.
te)(ebl. hilly 1111 trenllfon, IIOWe\l8", thttrll It all exclullon not to Cll<ceed t~,Ooo plr trllnlf.,... r4ltJlrdl... of the ....lu. of
the acoount or the nUMber of ftccounh h.ld,
If . doubla ...t.r1.k (MM) IIppear. b.fcrl 'lour first Oflll. In the ltdclrus portion of thit notlcI, thl U,OOO tllclu.lon
alr.edy hOI been d.ducted frail th. Meount bnllU1o. 'u reported by the flflflO<lhl Inltitution.
l, Enter thll tatll behnee of tho l'leClaunt Inc111dlnu Intlirut lI{wruad to the dato of do"t;"
3. Thl p.rcent of the acoount that It t811llbl. for neh .ur..,.Jvor I. dehtr.ln..d 8. foll{l~1I1
A. The pue.flt taMabh for jotnt nuh utftb)hhed 1I0r. thltn I'm. yur prior to the dlced.nt'lI deathl
DIVIDEO BV TOUI. NUHBER Of'
JOINT OWNERS
fiK.ap1e1 A Joint !llut rOifhtflred
UIVIU(l! BV TOTAl. NlJHrlER Of )( 100 .. PERCENT TAKABI.E
StntVIVINO JOINT OWNERS
In UUt IUU'" of the decudllnt and two oth.r per.on..
I D1YIOEO BY 5 (JOINT OWNERS) OIVlDED 8V 2 (SURVIVORS) '" .161 )( 100
16.1% (TA)(AalE FOR EACH SURYIVDR)
8, Thl p.runt tRubl_e for uIIlh crltfthd within ona vtlftr of the dUMdunt'l d'ttth or acCO\JOtto owned h~ the d~c.dlnt bUt held'
In tnllt for anathllr JmllvlthmHsl (trUtt ben..ncl8r1l1sI1
I DIVIDEO BV TOTAl HUHtlER OF SURVIVING JOINT
OWNERS U~ TRUST 8F.NFFICtA~I[S
X 100 . PERCENT TA)(AftLE
E~nlllplcH Joint flCCllllnt f{,glstorud In thn nomo (If Ihe dtlCudent n!HI two othM nOrlUnll l'lnd e.teblhh"d wlthtn onll y.er of d..th by
the dllcedont,
1 OIYIOEO BV 2 (SURVIVORS) .. ,SO X 100 Sll% (T^)(^Dll fOR EACIi SURVIVOR)
4. Th. ftIIount subj.ct to hll (llnl 4) I~ dutol'lIIlnod hy mllltlpl~lng tho ~()count IH.18MilI (llno 2) by the poro.nt ta)(abh (lin. $),
S, 1.:nhr tho total of thfl dobh find !Induet lottS Ilstod In fllIl't !.
6, Th. alllount t8)(shLe {tIn. III Is dlltorllllwd uy HlutrlletifllJ tno 11atltt .1ml (lo(1uction. Oill'" SJ fl'u. tile 8'!tlUnt ItUDj.<;\ to ~~~ 0411...."
7, Ent.r the 8pproprllltlt tftX rfttll (line 71 as doturllllnod lIelow,
A, For tlnhl! or (if/nth Ilct:url'lllU tlftlll' 6/~0/'J'I, tllll tll)( ,-ntIl5 fol' tl'Illlshll'9 to SptlUIOS llrCl 8'1 followSl
1. Ilntn of dllftth fir) or lIftell' '1/1/911 ~lI\d hoforll 1/1/9., \htl rllto Is 5%.
2. I1nt.. of duth all or Riter 1/1l'1rl tnmslllr~ tl'> ~pnu"Qs will ue tMQrJ ftt 0% ttlll rllt.,
Hot.l far d&t.. of dltllth ,'rlor to 111/1)(\ trlH15hH'l to SllOUSlU Aro IftllAble Ilt 6%.
8. Tran.ltu', to jll1.al de.centl,mts lncludl,," fllther, ,"l)thllr, Ojon, daughter, "rand~hlldren, .on-,In-ll'tw,
dtllughte,.~ln-hw, lltapchlld antl th.lr hlue 81"e l8118011 tit Iii< perelllnt (6%),
C. Tr.n.fe,.. to ell other. Including broth.,', Iltt.r. uncle, lIunt, nuphew "rid nleoe are tillable at flfte.n p.rOilnt (lS~).
n. If YOU chlltng. thl taM rite, r>lu.. Ipeetfy your rIIlatlonllhh' to the decadent .In tht tIIr.. prov.lded.
8. lh. olllount of till( du. Clln. 8) II d.tofllt1ned hy lIIultlplylng the IUI;)Unt talC.ble HIM 6) hy the hM rate (Un. 7),
CLAIMED DEDUCTIONS . PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowabl. debt. and deduotlon. lire dthrlllllad nl follow'l
A, \'Oll legallY ar. rlllPon.lble for ptlYII."t, .H thll utate .ub.jact to I!Idllnhtr.tJan b~ Ii fl.rtonel reprll..ntbtlvI Jt tn.ufflc:l.nt
to ptty tho d.duoUblfl lteu,
.. You aotuttlly paid Uti dlbh "Iter de"th of th. decld.nt ...nd clIn fllrnilh proof of paveent.
e, b,bh b.lnD ohi!lIl.d IIIUlt be Jt..iled fully In Purt 1. If ftddlUonal .pac. 11 needed, u.. ph in paper 8 Ill" H 11". Proof of
p'Ylllnt fl.? b. r8quuhd by thl PA Uepertlllll1t of R.v~nu.,
~ -:J
TAXPAYER ASSISTANCE .i
IF YOU NEED FURTfIER INFORMATION OR ASSISTAMCE, COtHACT ANY. .... ..............
REGISTER OF WlI.LS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE .. .... .. ..
OR CALL TftE bUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN
",,,,,auRG ^' m 7) '" "" TUAR m 7) ",. "" C ""'" 1M""" '" ,,'
~, I SCHEDULE .1
1~'S fUNERAL EXPENSES,
WMMONW'^,'" Of ,,"NWIV"'" I ADMINISTRAflVE COS1S AND
""I\~::~',lri'Il':c\M:::'" ... .. MISCELLANEOUS EXPENSES PI.a.. P,lnl 0' Tvp.
nTATEOF==~=~~-~~~-~~ m~__~~~m_ ~..' J pILE NUMlilr-
IV If'; ~y /11, I< I ss~-~_ -~~.~'___~ -- -~~,_=~-~~...u_u
Uvl\IIIK. vnl
ITEM
NUMBER
A.
1.
~.
3.
If.
B. S.
1.
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
DESCRIPTION
Funeral Expense.l
II1lftI'EZ;.( F/(,VEA2/H. HOlliE of I11Ii'C1YI/Alle.sI!1U~6-
(5ee leiteI'" alfachuiJ
Wo.ynt No <;s F/owf-r'V
5t. fJalr/cKs Church, (;raVll aliI G,.,ttve-of'tII,''!J
Cat-l,sle.. l!len1Pf/al .Jiervice, ~, -ll/thlpr;,,1
M'IIPrAl'ium ~ R-/l!;'t (.see -X- Wew)
Admlnl.lroliv. Co.h:
Personal Representativo Commissions
Social Socurily Numbor of Porsonol Ropre.entotlve: _.
Year Commisslonl paid ___.
2.
Attorn.y Fo.. Charles e. .:5IJ,'elrl.s :oJ:
3.
Family hempllon
ClalOlonl
Addre.. of Claimanl 01 de,.denl'. dealh
Slreo' Addrell _...m....' .
Cily __m..._'_'''_'__._~''''''''___'
Slale-'-___ ZlpCodo.
R.latl(m.hlp ~
Probal. Feo.
MI.eellan.ou. Expen.es:
P,l/~ -:J11her;fance '7.ZlG Reh4rn
* Ib fitY phCM I!Pnversah'e>l1 /,ui~ Tau I lJ;/r"ert, ~(JiM
cF "///.,5 MId pa.yll1el1tf. /Jfe alfunul herdt>. ~ mite(,
-Mtu. t'klfU WJ./'l filM wJrt /nPl1i6$ ,at'Qp/da/ by .J4,n
V. -Shuemaktr.
AMOUNT
"
"I, i,O/.~"
711
95'. 'If)
'/II
r ()t? (r(J
"
',1. 7'1. tnI
SlJ. H
.'jt
19, ()~
I . 1/s, Ot'J
TOTAL (AI.o .nler on IIn. 9, R.,apitulatlon) $ 6, "ed';' if ()
(II more 'poe. I. n..d.d, In..,1 additional .h.... of .am. .1...)
'j
,
,..,,;1:';'~:';1;""" '\
:.....
.
/" .', ,J,
\ .!
'II
,I
"II','
','-',
( 'I
WIAF.
, ,'biN, (J our
, '
I""
I ' .FtOAtBT
I ~,I
ADonase
.
,
",'"
, WAYNE NO~S FLowEtns
, 52$"Md"- tiIJ.''''::':~ ~ ,,';:1.1'
BO'L1NG>spfu~G9'h.A:~007 ';1
PhonfJ (717) 258-6438, '
'~'J ~\~':.:' '. '>:~,'::!_";'<:;;'" ",' ~:':i;;-:'i;('".:~",1
lJf'
, ",,'"
A$9QClAtKm
tODE-NO.
26564 ':'-
; ,I ; i" .~, '~!"" '
II,:, ~~~',)!, _ ",.,
. "'11e'
, " '.
,I ' ~.
,-
" (
\
, , ,
~-"....--""""
cAll fAt<EN BY. .. .
. , ,~'
PIlON!!
, ~oiARMN<llIM~' , ',:~ ,~li8PRAv"",
,1"~I'.:.t:.r'n"", '.',.,". c'- l./~J":' :_.
.,,'
~oeS~~rT1ON ,
:'
..
L
.
,
, ,
OCCASION
'...
CARD 10 REIID
oHAnOI TO
ApOAESS
,\
CITY/STATE
! \>.
, CHAROE QAAD T.,(P6
t - ".
,
,
j '.: -,
I', ,;;',
-,""',
'" .
.. '0'
1;11.,','
'!_,,- ',~r -',
: '. "-~"
~_\
"
" ' I'
I " '
.
---
ZIP
CIJ,.'.Aae CAAO NO.
a ~SH a CliARQE a COD
.1 -"'"
'\~f~:#:,'::THA~KY'OU.
!
I, ,,~
"';o~
::./'1,,_:..:'..,'1,1-
, ,
\:'"
" ~';~);.'/~;'''I.
rl
II"
,y
Carlisle Memorial Service, Inc.
DESIGNERS AND HlJlLDERS OF
OeM_I_tit MMf.fI.",~
41 South lledlord Street
Ca,II.I., I'A 17013
'I ~ ~ (),~./
I(~)
'. i If(}
Prlot '" /.f>. 1. ;.-: ~ /I>;L , 'i}vj.~_
. , .., I '," ~ ~cr. , , ",f;' r
i" I "',Ij" ,..,.,., ,.,t
, ) /f-;( ,1/
Totti PrllJf ,I, ';f t, < .., , . . , ,
Clrllsl. M.morl.1 Salvlet, Inc,
Celllsl., PA,
TeI.phon.243.6480
.1"'- ~3- f'6'
Pl.... dttlgn .nd build the loll owing m.mollll PA TI "."".....","
For ,,'1./)/I.I<!.. /1. ,,/((.:5,'~, . . . , . , , , , , , , , , 'I&.' , ';f , , , , , ,.", ,.', , , " , , . . r ' , , , ' , , , , . , , , , , ,. " ,
Add".. P:le.. ~(/, /tJ,tJ.,x".n ,~lf{, .If;,,, ,./1-" ,', ,~.r,+!.4-:J!. ,....,,,,,,,,,, ".'"''''''''
O""gnNo. ., /.II,~-:"..,
L' ,~ \"l() 0 (~r: r; fI.r' v'
nlJ, Mfil!!/J81 -, ,\~ ,~,~~"T-,.
Ole ?;~. 'j..//:i (!.Y: ,I. .-j
7. BY 1"'1. " 0-9)
81.. . ,c,- , . . .. ,.. r. . , . I-
In
oTfltR
Mark"'t ...........".,
(VlttJe-y (Y), f(1:~S
~:~ j:i >:t/~.'; :~;IPi ~r-vLt. 1/lJ t (J I; IIV(1, fYll5 /npR/
Deposit, , , , , . ," :',. ,'Ill, ,()[C2 if (f)! 5 I f'l (..
B.I.notOuo .....""", :yi./r.IJI 19 .;?- ~ II
Flmlly Nam. , , . , , , , , . . , ,
'nscrlptlon ",""""",
~'~I~'O~'~;,~r~':~&6:.:$:~ (I " -5- ~ .
Ijp-,llc;LE- /}/ICfr/A'I!ll I:p,v/ce :~vn\j...
Foundation to bel furnlsh.d by ..",. . , , , , , I, , , , , , . " . (~ ,'r, . f',f) "., h , ,..", '{J' " , '. . .. .. , ,
Mlterl.l \0 be b,n "Iteted monumln111 gUld. .nd to be fr.. trom lmPf,f.cHlant .nd flftt el... In every WlY. Work to be 'Inl,hld In . WOfl(mlnllk,
m.one, .
Thl. mtmnrl.II" bllr.CIOd In . , , , . , ' . . . s r. , ,f!. ( I.I.,:-k ~ , . , . . . . . . . . , . . . . . . . , , , , ' . , , . . . . . , ,e.m...",
In or neef , , , , , , , , . , , , . , , . , , , , " , , , , , , . , . , durinG the month 01 , , , , , , . , , , , . . , , , . , , , , , , . , , , , , , , , , , ,
unl", un''iOldtbly delaVld by labor traublel .nd other l:onllngencltl blyand our canHol.lId then I' loon.. p'oulblt. Addltlon.llllu,rlng 'l1d ath"
work on thlt mlmor'.lln thl fulU,.11 not Included In thl ContrlCt Prlct,
Tltl. and nght 0' poullllon .nd removal of tllld ,lonl, monUf1'Hltll flf 'PPllr1l1n'nct. .hllll rlmeln far .11 purro"l In Carllll. M.mm:.l Btfvltt
until wnrlc and ml"'l'" ord.r.d .r. hlllV plJld by purchlluH or purohe.erl, In coneld.rlllon 01 tht .cc.p1tnCt by Carll,l, Memorl,1 at"""Ice 01 thl.
ord.r, thl undlnloned (hlr.ln."., known II the pu(chlUlrl Igr'''llo p8V eMII.,. Mlrnafl,' 8erlllc" . . .. ,.,."., L1oll.r,
01'\ or before ,hI '6th day following 1M billIng 01 HlI' work or lob upon GomfJI'llon thoreol by Carllll. M.morll' Service Itld btlllnfj to be no11et: pI
compl.tlon theriot, ,hll order ,hili b,cotno a conlrlcl botwun ,he Illlrchltll'lr Ind CiI!llll. Mtmorl., Service upon ~r'pt'l\c, thN~of In thr 'PIn
below bV . dulV luthorlz.d rllp'Ittntallvll of laid C.rli.l. Momorllll Slrvlen; It being ufldlrl'oud 'h.t thl. lmtrume"t _,pan .uel; Kcapl'(l~(1 caven
,II of tnl I","m'"t bltwltn tht putch..., Ind Corllll. Momorl,l S'Hvlu .nd thlt no 'O.nt or r.pr",ntetlvlt of C.rll.l. M.ml/rl., 81r\/I-;1 h.. mlde
.ov It.t.menu Of IQrnmtoU. \/erbll or wrIH.n, modlfl.d or .ddlr19 to the IIrm. .nd oondlllanl h.r.ln "' forth,
"
It I_ furthlr und.,.tood th.t upon thl IIcclpllnell of thll ordllr 1111 conhect 10 mldll "ono' bo clncIlI.d, Illlr.d. 0' modifltd by tht pYrenlllH
or bV .nv .glnt of Car""1 Mlmorl.1 Service or In .nv m.onllr ucerl bv .",..ment In writing bltwten 1hl purch,..r Ilnd Ctrll"t Mttmorltl Slrvle.,
end It I' hlrlbv under.toad .nd ~rcttd bv ,II parUu Invol.....d 1h.t In CIIII of d.'.ull by purch,"n or purch...,., w..ntv,flVt ptr clnt of It,. tol.1
~rlglne' (lOU of th. work Or work .nd m(ltetllll ordl!rtd, .. the c.1t m.v be, ,hili be Iptclfied corr.ct .urn It IIqu;dftfd dlmAG" wf>lch purchlt.,.
1h.1I OM CI~Il.I. Memodll Strvltt, I." .ny J..vrn.nt em .ccount m~lI prior to .uch dlf.ull, Ihl. .ptclflc.tlon ()t dlmlQ" to be due (fl9erdll" of
flf'l'lov.1 .nd liking pOlla,.lon of stonlt, monum.nt or mllttrlll. frompurchl"r or purah...,. bV C.rIl11. Mlrnorl.1 Slrvlcl upor following .uoh
d.l."It,
,....,...,...................."",........"..""......"",,',.......,",.,...,'......,,,........,,, ....",,,...,,,,,....,,,,,,...,,.,,,,,,.......,. ,...",."",............"",'.......",.. "....IIEALI
,..6-:Ti,~..0:...../(d.4:L.. ................ .. '~)!II~i~ 19.9..0 ":Y'" ..., ~..........~ .'jj;;;:;x:;."........... ,..............,IIEALI
Carllll. Mom",I.1 5...1.. Approv.IBv ,-~'" ,. .~<rJl~. , . , ?1: . ,~t.-4<:'l. "..,'~.,....". ,ISEALI
~:' 'OfficI Cop V i Cln.,v: CUllom" Copy t Pink SlIlttm.n COllY,
{Jt.~1i1J {"t.Tt .2$'8-11-/'11.3' /019: IIfl'umtJJ flOAI ('AI<~'~'C'r,9 (}~.ltj.1;
1nIItIi.. . ~ I if I'M! r)/?I."irtf~tlrj 111/ (;t?Ii/;jlr::- ~ (A()~r)
08-11-97
KISS
05-]3-96
21 97-0386
CUMBERLAND
101
~=::o]_~~~:~~IHOci--1
l____h_______________-'
MAKE CHECK PAVABLE AND REMIT PAVMENT Tal
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE: ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
;(EV: is'4"j" EX";' "p"f 0'3"'-97"1" iiiifi c r "oF" YNHEii i i' A 'N"c E - "fAx - iippiiJii S Ei,f€ii:r-. - -;. L row ANtE - b-Ii' - - -- - - - - - -".. -" -.."
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
NANCV M FILE NO. 21 97-0386 ACN 101
/.r)l~' -It)
hURlAU or INDIVIDUAl. TAMeD
IHlfllll IAHU !AlI 1IIVI!iIOH
lillI', .'nol.ol
HMUII!iKIINU, I'A 1'1""'0,.01
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
NOTICE or INHERITANCE TAM
APPRAISEMENT. Al.l.OWANCe OR DISAll.OWANCE
or DEDUCTIONS AND ASSESSMENT Of TAM
CHARLES E SHIELPS III
2 W MAIN ST
MECHANICS BURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
C:OUNTV
ACN
PA 17055
ESTATE OF
KISS
TAX RETURN WAS I I X) ACCEPTED AS fIl.ED
RESERVATION CONCERNING FUTURE INTEREST " SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1, ~..l Estate ISchadule ^) (1)
2, stocks and Bonds I Schfldule B) (2)
:S, Closely Held stook/Partnershlp Intlrest (Schedule C) (3)
4, Hortg.g.s/Notes Rec.ivable (Schedule 0) (4)
S, Cash/Sank Oeposit3/Hiso, Perso~.l Prop~rty (Schedule E) (5)
6, Jointly Owned Proplrty (Schedull F) (6}
7. Tranl1erM (Schedule OJ (7)
8, Tobl AIII.ts
APPROVED DEDUCTIONS AND EXEMPTIONS:
9, funlral E~pon'.s/Adft. Costs/Hlsc. Explnsls (~chldul. HJ 19)
10, D~bts/Hortgag. Liabilities/Liens (Schedule IJ (10)
11. Tohl DoducUons
12, N.t VIlul of TI~ R..hlr-n
15. Charltebl./Oov.rnn.ntll BI~u.wt. (Sohedule J)
14. N.t V.lue of E.t~t. SYbjeot to Tax
If an assessment was issued previously. lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. AMount of llnl 14
1&. Anount of Line 14
17. AMount of line 14
18. Principal Tax Dua
TAX CREDITS:
---_...~.._-----~._._~~
PAVMENT RECEIPT
DATE NUMBER
04-25-97 AA211222
NOTE:
I CMANGED
.00
.00
.00
. OJ!..
.00
7.052.13
.00
(81
6,685.40
.00
Ill)
(12)
(13)
(14)
D
~, :l
~."M{~
l~JtjIfl~
'l~ll.' III IfP 11l.'n
NANCV
M
DATE
08-11--97
NOTEI To insure proper
credit to your account,
sub'"1t the lIj)p.r porHon
of this forn with your
1.x paymlnt,
7,052.13
_6.685.40
366 . 73
.00
366.73
14. 15 and/or 16. 17 and 11 wiU
returns assessed to date.
at Spousal
tsx.bll It
taxabla at
rite
Lin~.l/CI.ss A rate
Collataral/Cla.. 8 rat.
1151_
(16)
1171_
DISCOUNT 1+1
INTEREST/PEN PAID (-I
.00
.00
.00
366.73
X .00.
M .06.
M .15.
118)_
AMOUNT PAID
55.00
TOTAL TAX CREDIT
----
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
.00
55.00
55.00
55. O[tjo
.00
.96
.96
If TOTAl. DUE IS I.ESS THAN $1, NO PAYMENT IS REQUIRED.
IF TO'fAL DUE IS REfLECTED AS A "CREDIT" ICRI, YOU MAY BE DUE
A REfUND. SEE REVERSE SIDE Of THIS fORM FOR INSTRUCTIONS.)
0, .,t
\';' n"
" ((I
n.
-,
1""'.
C;'J
{,1,1
',I,
',i r':,
, !9
",it p, IV
1.1: (5(,j
MESERYATIONI E.tat" of d.oldtnh dyIng qn or b,forl 'Dlollllbtr 12, 1,982 ~~ if "ny future Int*rOlt In the ..t.t. II. 'trlln,f.rrld
In pa.....lon or .njo~..nt to Cl... a (collet.,.l) bin,flcJari.. of thl dlo.u.nt aft.r thl .~plratio" of any I.tlt, for
Ilflor for yur., th, COllllllonwlIl1th hllr.by IIMPI''''1v rllar".. th' rlqht to apPI'Il111 and a..l.. trfln.f,r Inhlrlt.ancl T1'KU
at the lrlwful Chi.. a (oollat.r.IJ rat. on any luoh future Inter..t,
PURPOSE OF
NOTiCEl
JlAVH€"lTI
REFUND (CR) I
OBJECTIONS I
ADMIN
lSlRAlIYE
CORRECTIONS I
DISCOUNT I
PENAL TVI
INTEREST I
To fulfill thl r.qu!r.~.nt. of Stctlon 2140 of the Inhlrltanc. and E.tata TaM Act, lot 21 of 1995. (12 P.S,
slcthm 91401.
Dal.ah thl top portion of thl. Nolle, and submit with your paYlIIlnt to the Register of Will. printed on the rlv.r.. .Id..
- -Haka ch.ck or 1Il0nlY order payable tal REGISTER OF HILLS, AGENT
II rlfund of a taM crldlt, which was not r.questlld on thll hI< Roturn, IIII1Y bft rlquft.tIId by oOlllpl.tlng IIn "ApP!1olltlon
fOI' R,fund of P.nn.~l1v'nl. Inh.rltanoll IInd F..tat. 1111<" (REY~U13). Appllcatlon. are avallablll fit th.OHlclI
of the R.glltllr of Will., any of tho l~ Revllnu. Olttrlct Off Ie.., or by calling the sp.cllll l4~hour
an,wlrlng ..rvlclI nUllbars for forlll' ordllrln~l In Pennlvlvanta 1~600-36l'?OSO, ouhlde Ponnlylvanlll and
wJthln local ttarrhbura area (7171 787-8094, TODlI (117) 172-22S?' (Hlarlng lmpelrctd Only).
Any party in Int.r..t not ..tl.flod with the appralSlllllllnt, allowano. or dllllllo~lInco of dllductlons, or 1I""'M.nt
of tax (Jnoludlng dl.oount or Int.r,.t) a. Ihown on thl. Hotto. ~u.t obj.ct within slllty (601 dayo of r.o.lpt of
this Hot Ie. bYI
--wrlttln prota.t to the PA Olpartlll.nt of R.vlnulI, Board of ApPlal.. Ollpt, 281021, Harrl.burg, PA 111za~1021, OR
~~.llIctlon to hay. the lIatt.r det.r.ln.d at lIudit of the acoount of thll p.r.onlll r.pr...ntatlvlI, OR '
--flpp.al to thll Orpllan,' Court.
Factu.1 .rror. dl.onv.rlld on thl. 1I......llnt .hould b. addr....d In writing tal PA Dlpart.llnt of R.vlnUII,
Bur..u of Indlvldu.l Tax.., ATTHI Po.t A.......nt RIVJIIW Unit. V.pt, ~80601, Hllrrl.burg, PA 17128~0601
Phon. (17) 7!7-6S0S. St. p.g. S of the bookllt ''In.truotJon. for lnhllrltanc, Tall Rllturn fnr a Ruld.nt
Dlo.d.nt" (REIJ.ISOI) -for an .IlPI.natJon of .cJ..lnhtratlv.ly .oorrllot.bll error.,
If toy tax due hp.ld within threll (1) oal.ndar Month. aH.r the d.o.dlnt'. d..th, . flv. p.ro.nt (5iO dhoount of
the tlX plld I. .11oNed.
Thl IS;: taM I.natty non~partlclp.tlon pen.lty II cOlllPut.d on the total of thl tlX and tnt.rl.t .tt....d. and not
paid be far. January la. 1996, the first day after the end of the tOll ."netty p.riod, Thl. non'parttcJp.tlon
p.nftlty I. appaal.bl. In the .... _ann.r and In the the .a.. tl.. pllrlod 8. you wouid app..l thlt t.x and Int.rllt
that h.' b..n .......d .. Indlo.t.d on thll notice,
Intlr~.t 1. ohargld b.gJnnJng wJlh ftrot day of delInquency, or nln. (9) ~onth. and on. (1) day frOM thl d.~. of
duth, to thlt d.h of pIy.ent, falle. which b.OIIllI de1tnqu.nt b.for. Janu.ry 1, 1982 b.ar Int.rllt at th.ret. of
.IM (6;:) p'rcent p.r annUM calculat.d at a d.lly rat. of .000164. All talll. whloh b.ol.. d.1Jnqu.nt on and aft.r
Janu.ry I, 1'82 will blar I~t.r..t ftt . rate which wJll vary fro. cQlllndar Vllar to callndar y.ar with that rete
announced by tho PA OePlrt~.nt of R'venu.. The appllcabl. Int.rl.t rate. for 1982 through 1997 ar.,
'!!!t tnt.rut Rat. OaJ1y lnterut Faotor ~ lnterut Rate DIllY lnt.r..t Faot(lr.
1982 20% .000S48 1987 9;: .0002<\7
1981 16% ,000438 1988.1991 11;': ,000301
1914 llX ,000301 199Z 9X ,000247
1985 13;: ,00OlS6 199~'1"4 7X .000192
1986 10il .000214 199!j-1997 9Y. .000247
HIntllrtlt I. o.lClolat.d .. folLow'l
INTEREST . BALANCE Of TAX UNPAID X NUHBER Of DAYB DELINqUENT X DAILY INTEREST fACTOR
-~AnY Notloe I..u.d after thl taK b.oc.... d.lln~J.nt 101111 r.fl.ct an Intlr..t calculation to flft.,n (15) day.
b.yond the d.t. of thl .......Int. If Ply..nt I. lIIadt aft.r the 1nt.r..t oOMputatlon date .hown on the
NotAoe, additional Int.r..t ~u.t b. oaloulated,