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HomeMy WebLinkAbout97-00447 I}ETlTlON FOR PROBATE and GRANT OF U:rrERS lis/ill(' ql A\t... r-. 5 IV ~ ( -t ii/SO kllOIl'1I liS ... No. To: 21-97-447 Register of Wills for Ihe ......... . ,/)('C('II.\('(/ Couul)' of ._g!lM.I!E..~LAND_ In the SOc!II/ SC'('urlty No. ...:L..~ :l,._ .. ..( I.. ...... '1 fOi.l'.J Comllllll1weulth of Pennsylvania The petiliou of Ihe lutdersigued respeelful!y represculS Ihllt: YOUI petiliolter(s), wl)(lls/lIll' J H yell" oj uge 1lI old.!')'alt IJle exeeUI ..f .~.~..~.___ named lit IIw la'l will ot Ihe lIhOlede",'den!. daled 't(lf/". 't___ ......._....__.__, 19__ and el\dlcil(s) dall'd.. _ _.. _. ......._____...__. ==-~. - '.' - -=-~..:.~--:,"~~1~___ - .. ~:~'..~" - -:::=:::.:'=-_=~___ ('lUll' rrll''':lnll'irl'Il11\,IIUll\'~, r,p, fi.'llund.uinn, dellth of l'\l'l.'lllot, ct(,) Deeeltdenl was domldled 1I1 dellth lit -.C.<..<........)L::. (i. ..I ..._ ~ounty, Pennsylvanin, with l+i~~~~flt~l~\; ,(~~~t'I'a~~e'i~"l"atS.=:3Z~~-~:b:; ~t_-== I.J r .-----=--=== (h~l \In'l'l. 1H111lb('r ,Hid f1HlIll:ip~IIIIY' I'kc'cltdenl, Ihelt.....,..L...~. yell" '~.lIgc. died .-........-l":1-tt...1r..--.-----, 19. <;:? , at i'~eci,t '''f,,'Y.;;;:;,~e~;(I~It;;ltJ ~'~;I;;II~f~.s-;;.O;~~;~I;j;i;IT~~;;.i;~~~ fa ~h~l~ ~orn or adopted after l',"c'utiolt of I Ill' will 01 fered for probate; WlIS not the victim of a killing and was never adjudicated illl'OI1IP"1Il'lli; .. ._.,-,-----~ ...' --_._-..-.,..._---_._..+-~---~._---_..._-_.. Deceltdenl al dl'ulh owned property with estil11l1led values as foi!ows: (If dOlnldkd in I'll.) AI! personal property (If not dOl11idll'd in I'll.) Personai property ill Pennsylvania (II nl\l dOltliciled in I'll.) Personlll property in County Vnlul' 01' rcall..'\laIC ill Pennsylvania ,iluatnl il\ followl.,: --..--------.------.---.------b..i17~~..:~~- ~. ~,pO,()J $ $ $--..-. L II IIERI:I'OIU;, pelilioner(,) re,peelful.I~.' re~est(s) Ihe probute of Ihe last will and codici!(s) prc\I.'lllcd IH.'l'cwilh and lht.' grunt or IL'ltl'l's.. .m_--1--I!:.Ll~_~ ' ....'f--,. - J , (tl'\!ill11l'llll\ty: I1dlllilli~lrali,fu c,l.ll.; Ildmlnlslrllliun d,h,n,C,I,a,) thL'l'{lI1. -7 ~ ~"; !.~ ::x::! ~E 3" L." .....en~)(,.. ...,<,frr<l--.eSf. .HI.s..I>.. J_.__ n' .. --tt="--G- . .. ..01 ../7L"!.j. n'__ <..71. }.J..j.l:i~",L 'n)_____n. ~~ ;i ", :" ..'__._T_.'_'__~._...... ."-_.,'_..,~..,.__. .---.----.- .----. ---.-.----.- . . ---- ... - .._..____._._._,._._.__..d__..'n..__._._.~_. _. ____. . .m.. ........ .___...._.__.__"._._______"_n _.~_ OATU (W PERSONAL REPRESENTATIVE {'OMMONWEAI:nl 0... I)ENNSnVANIA L'8 {,OliNH' OF (]~llf~ERL~ND_u_____n._ J ;,;, S\\()lll III (II i\rril'llll.'d i111d \Ull"Clihl'd hdnl\' Ill,' lhi\ 19th till \ nf .. .. MAY fl 9/ , .r V' (' '" I ,r 1- 1)/0..1.":1'<' ~(.i,.""-::l M~' . /1. ,.;' LLll.<'(~ (J ;.[Ltt't'f.. d.d '\I'l~I\/t',. TIll' I'l'lilinn:,:r(...) ilh(I\l'.I1a/lh:d'\\l~Hr(..) or arnl'lll(") lhal till' 'ilali.'rnCIlI!'l in thl' foregoing petition arc 1I'Ul' dlld l'Of"1\'rl In llll' 111'\101 (ill.' ~Il\l\\ IcLl!!l' <llld hL'lid of Pl'litiDllcr(s) and that liS personal rcprcscnR laHwl',) Ill' lhe lIho\'l' dt'l'l'delll P';'llttllllL'r(\) will \\'l'lI alld truly ndm;nistcl the cstntl' according to law. (c .<("rtP'~~~zi fSlf, m_.__~..~_ ~ ~ ~ ., '^ --.-- -----. ..... '?7 1 .. ....... . Thi"!,, II) ITnilr t11il1 lht' inltlllll,llioll 11i'11' gl\'I'll i" Illllcclll Illl;d ]{cgi'.1I;H, 'I'll\' tlrigllLd (cnllil,lll' will 11(' IUI\\:lId\'d (('j .;:z /- '/ 7J </'1 7 Ilqijnllllllll ,Ill l'll)',in,d, t'llifi, ,\IV Ilj' dv,n'h dlll\ lilld widl 1111' ,II, (he \L\I(' \'11.11 !{I'(llld.. (llllu' rill Il\'Hll.llH'1l1 lilin!',. WARNING: Ills II10galto duplicate this copy by photost!!t or photograph. No. _"iiiiiliTiJ;ii'jjj_. ,1~~~\~~Qffl,1:~\ li~...1 .......... \~..~~\ i ~/ .,':'Pr.' \r~ \ ~...!,. '.... . 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':II! .11:1 ='Ii i' , I'! : i " :I!!) I I' ii' ill!! i : ' ~, Iii i" :;.: i - !! ': ! : I' ': :: I 'II '!" ':, : ,- ii !' r :I! :: 'i ' ':1, , : I . , " , '" : : , : :',; I" " I j:,~ i ' :: " ' 'I' ' li:I' I" i,' 'j, , ~ ~i~ 1:~.J u.... ~ \; l'J z ~ ~ o u . /"'-~ I)' I "'J ,^ IlEVI~iJ('llil) . ..9-~l COMMONW~~VlVANIA DEPARTMENT Of REVENUE DEPU80001 HARRI 171 I uECeOHITS NAME (lAST, FIRST, AND MlDOl[ INIlIAL) uU .bI.... bb:;k kl "'P."If;)d, (1IIiU'IL'I-\illlr REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT flE NUMBER {J.,l q'l '-/'-1'7 t- Z W o W (,) W C S WEE 'I' SOCw. SECURITY Nl.tAUfn R 1 'I' A fl. OATEOfOEA1t1 DAfEOF 81Rftl II HII 99 SOCIAl SECURIT'( NW8fJl () 111 l III 9 2 6 THIS RETUNN MIIST RE FILED IN DUPLICATE WriH THE REGISTER OF WILLS 2 0 2" 1 6"4 () 6 5 0 5 (IF APPUCABlE) SURVlVlNQ Sf'OUSE'S NM4E (lAST, FIRS I, AND MIDDLE INrlIAq N/A 7 o 1. Or'9lnal Relum 0 2, SuppiomantalRelum 0 3. Remalndllr R.tum;""....""....,l.I>1l1 o 4. L1mlled Estale 0 4a. futur.lnlemst Compromls.I''''''do'''''''''12.ll-Il) 0 5. federal Eatal. Tax Ralum R.qulred [ill 6. Decedent Diod T.atalet""'" "" .....) 0 7. Deced.nt Maintained a L.'ng Tru~II""'" ",r" T""I _ 8. Total Number of Safe Deposit Sox.~ o 9. L1t1gallon Proceeds Received 010, Spousal Poverty Credltl.....dollh....... 12.Jl.i1 "'" 1.1-1'1 011. EIect;,n 10 la' under Soc. 911J(AIi_hS<hol THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFtDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NM~E COMPlETE ,l,WlINO ADDRESS L. R('x Bickley FIr'lMtW,lE (II AppIC6bIe) 121 South St. liar riablll'g, PA 17101 cr,',:,( '-'., 1. R.al E'tal. (Sch.dula A) (1) 2 3 I 7 o 2 6 0 2, Stocks and Bonds (SeIl.duio B) (2) 3, Ckl'.iy H.1d CorporQUcn,l>ertne"hlp or Sole.ProprlelOl1hlp (3) 4, Mortgage, & Noto, Rocelveb~ (Schaduio D) (4) 5. Ca,h, Bank Depo'ita & MIsceI~neou3 Personal Property (5) 5 I 0 6 5. 4 1 Z (SeIl.dula E) 0 6 JolnUy OWned Property (SeIleduio F) (6) 5 7. Inl.r.v.os Tmn,fe" & Miscellaneous Non.Probst. Property (7) ~ (SeIleduie G or LI I:: 8, Tolll Oroll AlIOtl (Iotal Lines 1.7) (8) 2 9 I 8 1 8 . 0 1 ~ (,) 9. fun.r.' Expense, & Admlnl'~aUve Costa (SeIl.duio H) (9) 1 8, 8 3 4 . 2 7 ~ 10. Dehls of D.cedent, Mortgage Llabllllltl" & Lion, (SeIleduio II (10) 1 3 5 6 8 9 7 I 11. Tolll Deduclla.I (total Lines 9 & 10) (11) 3. 2 I 4 o 3 2 II 12 Nil Vllue of EIllte (L1na 8 minu, L1n. 11) (12) (2 ,5 8 5 2 3) 13. Charitable and Gov.mmental Bequ.al8lSec 9113 Trusls lor wblch an e~cion 10 lex ha, not be.n (13) made (Sell.du~ JI - 14. Net Vllue Subjlctto ro, (Line 12 mlnu, Line 131 (14) 15. Amounl 01 line 14 taxabl. Z at Ule spousal tax rate I , X .0 (15) ~ S.. in,truction, on r.v.rse s~e far .ppllcab~ percentage 15. Amounl 01 line 14 ta'abl. ~g at6% rate X .06 (161 1"0.. 17. Amounl 011100 14 taxabl. :IE 0115% rale , .15 (171 0 0 18. Tax Due (16) 19 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Unclcr ponallJl35 01 roqury, I (leclare thaI i have e~amllll>d thiS iOlurn mcllldll19 OCConlp,ll1yillg schodules wid ~.1.11"Il\lnts, an.;! 10 ItIe oost III Illy knOYlIedge and boliel, it is lroo, COHeel IIIld complolo DoclaraliCJ(J 01 preparef OUIllI Ih&Il.!1l!l.QersonalrtlllrOsontalivOls~~!L!O!~lOll'fhlch..l!!9~~.!ill1.~~__..._____.__ SIGN~~~jONSIBLE FOR FlUNG RETURN AODRES12/ J. _I) .j"" _ _p~ {. !!': 1< _~1~ d(( 'J_ -IlL,I', L1L::~_____ SIGNATURE OF PRE~."R OTHER THAN REPRESENTATIVE . AODRESS OATE 1. /II( ~ ~__ DATE Decedent's Completl' Address: smEET ^DiJR(S~ - CITY F"" I liP Tax Payments and Credits: 1. Tax Due (Page 1 Line 18) 2. CredllslPayments A, Spousal Poverty Credit 9, Prior Peyments C, Discount (1) Total Credlls (A + B + C) (2) 3, InleresVPenally If applicable D,lntaresl E, Penalty ~ TolallnteresVPenally (D + E) (3) 4, II line 21s greater than line 1 + line 3, enlerthe dlflerence, This Is Ihe OVERPAYMENT, Check box on Page 1 Line 19 to requeat a refund (4) 5, If line 1 + IIna 31s grealer than line 2, enler Ihe difference, This I, Ihe TAX DUE, (5) A, Enler the Inturest on Ihe lax due, (5A) e, Enler the tolal 01 Line 5 + 5A, This Is Ille BALANCE DUE. (58) .~ ~ Make Check ~e to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE Af'PROPRIATE BLOCKS 1, Old decedent make a transfer and: Yes a, retain the use or Income of the property transferred; "",,,,,. """""""",,,,,,,,.. "," 0 b, relaln the rlghl to designale who shall use the property transferredpr Its Income; "'" " " " "'" 0 c, relaln a reversionary Inlaresl; or """",.,.."""",,,,,,,,...,,,,,..,,,..,.,,,,,,,,,,,,,,,,,,,...,,,,,,,,,,",,,,,.,,,,,,,0 d, receive the promise for life of either payments, benefits or care? """",,","""""'"'',,''''''''''' 0 2, If death occurred on or belore December 12, 1962, did decedent within two years preceding death Iransfer property wllhout receiving adequate consideration? If death occurred after Decembert2, 1982, did decedent transfer property within one year of death wllhout receiving edequate consideration? "",,,,,,,.,, """""" "" ",,"',," " " " '""'" """",...""",,,,,,,,,,,,,,,,,,,0 3, Old dacedenl own an 'In trust lor" or payable upon daath bank accounl or security at his or her death? """ ""."",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, '''" "" """'" 0 4, Old decedent own an individual retirement account, annully, or other non-probate property? "" 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN ~ No ~ !ZI ~ ~ ~ 72 P,S. ~9116 (a) (1.1) (i) provided for the redlJclion of the tax rate Imposed on Ihe nel value of Irensfors tn or for the use of the surviving spouse from 6% to 3% for dales of death on or after July 1, 1994 and before January 1, 1995 72 P,S, ~9116 (a) (1.1) (Ii) provided for the reduction orthe rale imposed on the net vallie of translers to offor the use of the surviving spouse from 3% 10 0% for dales of death on or aller January 1, 1995. The slalule 9-Q!1.'!.!101 pxempj a Iransfer to a surviving spouse from tax, and the slalulory requirements for disclosure of assets andlillng a tax relllm are still applicable even If the surviving spouse Is the only beneficiary, FOR DATES OF DEATH ON OR AFTER JANUARY 1,1995 - Please answer the following quesllon by placing an "x" In the appropriate space. Old tha decedent creato 0 trust or similar arrangement which Is solely for the surviVing spouse's bonellt for his or her ontlre lifetime'! Yes 0 No [J If you answered yes to the above quesllon, the tax on the trust or :;imllar arrangement is postponed until the death of the second spouse, at which lime It will be fully taxable al the rAle(t) applicable to the remalndar beneficiary(les). Enter the value of the trust on Schedule J, Part II, in order to remove II from the calculation of Ihe tax due In 1t,Is estate. You may wish to file Schedule 0 In order to make Ihe election available under Section 9113, If the election Is made, the trust or similar arrangement is taxed In the estate of the first decedent spouse, the portion of the trllst or similar arrangement which beneflls the surviving spouse Is taxed at the zero tax rale, andlhe remainder Is taxed allhe rate(s) applicabl~ 10 the remainder beneficlary(las), If you choose to make the election, you must aUach Schedule 0 10 a timely-flied tax retllln, along with Schedule(s) K and/or M In order to shew the apportionment of the trust or similar arrangement belween the surviving spouse and the remainder beneficiary(ies) tJ 1; IH:lJAH I Ml N r OIII{)(JBlf~U ^NO UllBAI~ IJlVU lJPMLN I OMII No ;!!IU~'U20~ lil' III FMFN I ~; I AI FMFNT "AY"? rL S~TTLE,!!EN..!_Cl!AnO:~_5--J_iIT9liu-------' _ -- --~~~:~;;-~--::~:,~!l- ~_ TOTAL~ALE.9IBROKER'9 COMMISSION ~~~O" prlco '_. H6000 , O.Q...~__ FUN09 AT FUNDS AT [Jivinlon of {;Olllllllfl!llnrl (11110 1(0) fill 1()Il()W!l 'rotal : . $S I 160.00 SETTLEMENT 7111.$ 2~;55,OO 10 '---,Tack Gaugllen Realfor 'hii,.:.L,''''Ihii''i)') 102, $ 2 60 5 -:-1fo to - ERA l\ude (son ;:~,;~4W::;.:;.::?t;;:,t=::.:;;;5,:~;:,:::-:.::::.'; 7in""(~7rlm\isolon puld nl Sottlnlllonl ~IIOIi\e Wan- _~Il!L..--_______. 000. ITF.MS PAYABLB IN CONNEOTION WITH LOAN 601. l.oan Origination Foo % 602 Lonn Discount 0/0 =-- S03 Approlsol FAola ao:;-Crodil n.porllo 805. Londars Inspectlon Feo ~Ma'I[J09o In,urance ApplicQlion Feo 10 607. AS9umplion Foo 000. Doc Prep REMR ~~tg Fee REMR S1306. 87 POC By PHH 010. UnderwrITe REMR Otl. Mail Fee REMR 000 ITEMS REQUIREC BY LENDER TO BE PAID IN ADVANCE 001 Inlerosllrom 11 / 0 3 /97 1011 /30/ 9 7 III $ 17 . 07 Iday 002 Mortgego InSlIIanco Promlum lor 1110.10 PIlII Mortgage Services 903. 1.laIard Insllranco Premium lor yrs, to 004. Flood Cert yrs.lo PHH \iDS: Tax Serv PHil 1000. RESERVES DEPOSITED WITH LENDER FDR 1001. HazarcllnsuTllnc& mo, C $ 1002 Mortgage Insuranc9 Ino, @ $ 1003. Cilyffown lax mo. III $ 1004. Counly lox 8 mo. C $ 1005. Assessments mo, @ $ ~9hoo1 tax 6 mo. C $ 1007 rno, C $ 1000. AoorAdi ust mo. III $ 1100. TITLE CHARGES 11101. Sottlomont or closing laa 10 11102. Abstract or Wie search 10 1103. Till. examination 10 ---=c- 1104 Till. Insuranc. binder 10 1105 Documanl proparation 10 1106, Notary laos to 11107. Allomay', f.., 10 I (include, abovoitoms No.:) 1100. Tilleln,wenco to Secured I,and 'rransfers I (Ircludas obovolloms No.:) End 100 /300 / 900 I 801 1109. londer', cov.rago $ 81 , 700 11 to. Own or', cov.rage $ B 6, 000 _ 1,111. Ma~l/DiSb/Tax Cprt. Secured Land Transfers 1112. Sewer 1 OLllL 1 ? Lower Allen Township IIt3. Refuse 10/11/12 Lower Allen Township 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201 Rocordlng 100': Deed $ 23 . 50 Morlgago $ 29 . 50 -MI,c. $ ~.!!Y/collnlY laX/,lamps: Dood $ 860 . 00 Morlgago $ 1203 Slola lax/,lonto' Oeod $ 860 . 00 Morlgago $ 1204. Rec Sat Secured Land_ Transfer,.!:!..____ 1205. Tax Cert Mary Ann prIor ~ODITIONAL SETTLEMtNT CHARGES 1301 SWyoy 10 1302. PU!-lIIIH;pocIICln 10 1303. Dues 9 /10 /11 1130,1 .. .) . ,:. ,:t .. .... . 5160.00 385,00 -.- ~250POC-BUyer 50POC-Buver -- 125.00 125,00 25,00 --'- 477,% 53,1.1 Mortqaqe Services Mortga~ervices 22.50 75.00 " 80.85 1100. Into. Imo. Imo. Imo. Imo. Imo. Imo. 216.88 27.1.1 485.10 -54.21 . POC-Seller Cash 5.60 5,00 ;@~::Wk!~n:~NWM~WW~f~~~q!Mtm:W(()! ;:j:::h:jt;::j:W(t)t~:: ~"_1 ..--- 48.00 26.40 46.20 53.00 860,00 -- 860.00 18.50 3.00 Yingst Exterminat~n~o. Vill'!ge Of Moreland 35.9.2- 211.38 r' -,' .....- " ;;..~ ~..... ~ -"'c_"" .' Jftdf~i(e allll ~ftfumenf 01 RITA M. 5\,EI.;'1' ,-.--.----.-.----.....---.---- of sound mind, do make, publloh /lnd declare this to be my Last wtlt and Test4l1\ent. hereby ), Rt'l'A H. SwgltT. of Hechanicsburg, Cumbarland CQunty, Pennsytvania. being revoking and mal~ing void any and all former Wi1l8 made by DIe at any time heretofora. \. 1 direct th8t the expenses of my burial and all my just debts be paid as 800n after my death as way be convenient to my Executor hereinafter named. L 1 hereby nominate, cono t i tute and appoint as Execu tor of thh, my Las t wU I and Testament. my attorney. L. Rex Bickley, \lsquire. 3. t hereby Rive ail of my real os tate located at: 5'.20 Oxford Drive, Mechnnicsburg, Cumberland County. Pennsylvauia. to my 80n. John Joseph Sweet. 4. 1 hereby give all of tho reet and rcmaindel: of DIY Estate. real, personal and mbed to ltIy son John Joseph Sweet. 5. To the extent that such requiteDlents can be legally waived. 1 direct that no Guardian. ~xecutor. Truatee or other fiduciary hereunder shall evsr be required to post any bond or give any 8ecudty in connection with hie or her duties, whether in the C01lllnonwea1th of Pennsylunnia or elsewhere. IN '.InNES!: WHEREOF. I. RITA M. SWBET. hereunto set DIY hand And seal thh day of J~ _' 1994. cJ.fY/"; , ~ th kwr-- M. SWl,ET / Signed, saaled, pubtlRhod and declared by thll above namcd RITA M. SWEET, to be her Last Wlll and Teatament in the presence of us, who at her request, in her preaence and in the presence of each other have hereunto subscribed aur names an witnessea. " ~~fd:-< C011nill ~~ of d ~ds bur:J fl of yr;Pd!cJ.J2U!4!Jf1(j J PAc , os" 25 - 98 SWEET 05-18-97 21 97-0447 CliMBER lAND 101 [~__~~~~~CR._"L~~=~~==j MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WIllS ClIMBERlAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LIN! ~ RETAIN LOWER PORTION FOR YOUR RECORDS ..... REV: isi,"j" E'lf "A FP" " f ii"9' :97T" NoYiar "oF" i NHiliif AileE" YAX ";iPPRA i SiHENr; -A [i"ow ANtE" iili - - - - - - - - - - - - -" -"- DISALLOWANCE OF DEDUCTIONS AND A~SESSMENT OF TAX RITA M FILE NO. 21 97-04(.7 ACN 101 If an assessment was issued previously, lines 14, 15 and/or 1&, 17 and 18 will reflect f:l.gures that includll the total of ALL returns assessed to dete. ASSESSMENT OF TAX: 15, Altlount of Un. 14 at Spau..l f,.t. (15) 16. A..ount of Un. 14 taxable .t Un...l/Ch.. A rat. (16) 17. Altlount of line 14 t.x~bl. .t Collat.ral/Cl..w a r.t. (17) 16. Principal T.~ Du. TAX CREDI"rS: ;5"/%1-;( COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE , BUREAU Of INOIVIDUAL TAXES INllf~1TANtE UK DIVISION OEPT'l'I Z80601 IjARIUSlURO, PA 1712&-0601 NOTICE OF INHERITANCE TA~ APPRAlSEHENT. All.OWANCE OR OISAt.LOWANCE OF DEDUCTIONS AND ASSESSHENT Of TAX l. REX BICKlEV 121 SOUTH ST HARRISBURG DATE ESTATE OF DATE OF ilEATH FILE NUMBER COUNTY ACN PA 17101 ESTATE OF SIIEEr TA~ RETURN WAS, ) ACCEPTED AS FILEO ( X] CItANGED RESERVATION CONCERNUlG FUTURE INTEREST " SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURtl 1. RRal Est.t. (S~h.dul. A) 2. Stoek. end Bonds (Schedule OJ 3. Closely HfIlld stuok/Partnel'ship Intflrest I Schedule CJ 4, Harig.gas/Not.. Raceiv.ble (Schedule DJ S, C..h/Bonk Oeposits/Misc. PerJonel Prop~rty (Sohedule EI 6. Jointly Owned PrDPerty (S~h.dul. f) 7. Tran,fera (Schedule G) 8. Total Auti. III 121_ (3) (4)_ (5) 16) (7) 23,702.60 ,no .00 .00 5.065.41 .00 .00 (81 APPROVED DEDUCTIONS AND EXEMPTIONS I 9, fUnerllll Expense./Adlfl. COfitl/tUBe. Expens.. (Schedule H) 10. Debts/Hortgage Lhblliti.s/L!.ns (SChlld~I.\. Il 11. Tohl Oeduct ion. 12. Net Valu. of rex Ret.urn 13. Cherlhbl.IGovernllental 8eque.ts; Non-.ll1ct.d 9113 Tru.tll (Scnodul. J) 14. Net Value of E,t.t. Subj.~t to rex (9) 110) 18,834.27 14,702.U. (11) ( 12.1 (13) (141 NOTE: ,00 X'OO. .OOx,06. ,00 X ,15. ~. (18)_ PAYHENT DATE RECEIPT NUH8ER DISCOUNT (') INTE~EST/PEN PAID (-) AHOUNT ~AID TOTAL TAX CREDIT --~---,- 8ALANCE OF TAX DUE INTEREST AND PEN. ------ TOTAL DUE . IF PAID AFTF.R DATE INDICATED. SEE REVERSE fOR CALCULATION OF ADDITIONAL INTEREST. * C' UY.IHI U U~ Ut-", RITA M SEE DATE 05-25-98 ATTACHED NOTICE NOTE I To inau,... prop_,.. cradtt to your .ceount, sub,d t th. upp." portion of this for. wA th your hx paYIIl.nt. 28,768.01 33.~37.24 4.769.23,- .00 4,769.23- ,00 .00 .00 ,00 'O~ .00 .00 ,00 If TDTAL DUE IS LESS THAt! U. NO PAYHENT IS REQUIRED. If TOTAL DUE IS REflECTED AS A "CREDIT" ICRl. YOU HAV eE DUE A REfUND. SEE REVERSE SIDE Of TItIS fORH fOR INSTRUCTIONS.)