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ITWIU. bRDaz hbrlllrv 12, 1991
J.A,ST WILL AND TESTAM!l:NT
Ql
STELLA TIMALONIS
I, Stella Timalonis, of Lower Allen Township,
Cumberland county, pennsylvania, being of sound and disposing
mind and memory, do make, publish and declare this to be my Last
Will and Testament, hereby revoking all Wills and Codicils by me
at any time made.
ITEM I: I direct that all inher.itance and estate
taxes becoming due by reason of my death, whether such taxes may
be payable by my Estate or by any recipient of any property,
shall be paid by my Executor out of the property passing under
this Will, which is not specifically devised or bequeathed as an
expense and cost of administration of my Estate. My Executor
shall have no duty or obligation to obtain reimbursement for any
euoh tax paid by my Executor even though on proceeds of
insurance or other property not passing under this Will.
ITEM II: I give, devise and bequeath all of my
household furniture and furnishings, books, pictures, jewelry,
ohina, linen, silverware, and all other like artioles of
household or personal use and adornment to my ohildren,
Rosemarie Malpass of Silver Spring Township, Cumberland county,
Pennsylvania and Ronald Timalonis of Indianapolis, Indiana, or
the survivor thereof, to be divided between them in as nearly
equal shares as practical.
~M III: I give, devise and bequeath all of the rest,
residue and remainder of my property not disposed of by the
proceeding portions of this Will to my children, in equal
shares, per stirpes.
ITEM IV: In the settlement of my Estate, my Exeoutor
shall possess, among others, the following powers to be exeouted
for the best interest of the benefioiaries:
page 1 of 4 pages
, ,
(a) To retain any investment I may have at my
death, 80 long as my Executor may de,em it advisable to
my Estate to do so.
(b) To vary invostmente, when deemed deslrable by
my Exeoutor, and to invest in such bonds, stocks,
notes, money markets, real estate mortgages or other
.eourities other than options or futures, and in suoh
other real or personal property as my Executor shall
deem wise, without being restricted to so-called "legal
investments."
(c) In order to effeot a division of the
principal of my Estate or for any other purpose,
including any final distribution or my Estate, my
Executor is authorized to make said divisions or
distributions of the personalty and realty, partlY or
whollY in kind. If such division or distribution is
made in kind, said assets are required to be divided or
distributed at their respective values on the date(s)
of their division or distribution.
(d) To sell, either at public or private sale, and
upon such terms and conditions as my Executor may deem
advantageouS to my Estate, any or all real or personal
estate or interest therein owned by my Estate,
severally or in conjunction with other persons, or
acquired after my death by my Executor, and to
consummate said sale(s) by sufficient deeds or other
instruments to the purchaser(s) conveying a fee simple
title, free and clear of all Trust, and without
obligation or liability of the purchaser(s) to see to
the application of the purchase money or to make
inquiry into the validity of said sale(s); also, to
mako, execute, acknowledge and de1i.ver any and all
deeds, assignments, options or other writings which may
be necessary or deeirable to effeot any of the bequests
or devises made in my Will or in oarrying out any of
page 2 of 4 Pages
,the powers oonferred upon my Exeoutor in this Item
IV(d) or el..where in my Will.
(e) To mortgage real estate and to make leases of
real estate.
(f) To borrow money from any party to pay
indebtedness of mine or of my Estate, expenses of
administration, or inheritance, legaoy, estate and
other taxes.
(g) To pay all oosts, taxes, expenses and
charges, except as herein noted, in connection with the
administratlon of my Estate. My Executor shall pay
expenses of my last illness and funeral expenses.
(h) To vote any shares of stock which form a part
of my Estate and otherwise to exercise all the powers
inoident to the ownership of such stock.
(i) To assi,gn to and hold in a Trust an undivided
portion of any asset.
(j) The right and discretion to elect the most
appropriate settlement options for any pension plans,
individual retirement acoounts or other em?loyee
benefit options payable to my Estate, assuming such
eleotion shall be in accordance with procedures
established by the plan's administrative oommittee or
administrator, as the case may bA.
(k) The right to engage accountants, attorneys I
appraisers and other agents, as deemed necessary by my
Executor, to render advice to and/or to represent my
Exeoutor, as my Executor may deem necessary or
appropriate to the administration and preservation of
my Estate.
ITEM V: Any person who shall have died at the same
time as Testatrix or in a common disaster with her, or under
suoh circumstances that it is difficult or impossible to
determine who died first, or who fails to survive her by ninety
(90) days, shall be deemed to have predeceased her.
Page 3 of 4 pages
ITEM VI: If at any time, any minor ohild or ~isabl.d
person .hall be entitled to reoeive any aseets hereunder, my
Exeoutor .hall aot a. Guardian of the a..et. payable to suoh
person. Said Guardlan may receive and administer all assets
authorized by law and shall have full authority to use suoh
assets, both principal and inoome, in any manner said Guardian
shall ~e8m advisable for the best interest of such person,
inoluding college, university, post-graduate or other eduoation,
without securing oourt order. Said Guardian shall have all the
rights and privileges as to the guardianship and the assets
thereof as are herein granted to my Executor as to my Estate and
the assets therein.
ITEM VII: I nominate, constitute and appoint my
daughter, Rosemarie Malpass, to be my Executrix (herein referred
to as "Executor"). In the event of the death" resignation,
refusal or inability of Rosemarie Malpass to serve as my
Executor, I nominate, constitute and appoint my son, Ronald
Timalonis to serve as Executor. My Executor and Guardian are
specifically relieved from the duty or obligation of filing any
bond or bonds.
IN WITNESS WHEREOF, AND INTENDING TO BE LEGALLY BOUND,
being unable to sign my name because of physical incapaoities
brought about by a stroke, I have had my name subsoribed for me
to this, my Last Will and Testament, consisting of this page,
the next page and the preceding three (3) pages, in my presenoe
by David R. Getz, Esquire and I have made my mark in the spaoe
between my name this !f~ I J, day of February, 1997.
signed, sealed and delivered
in the presence of: Her
JD. ,) 9
.. '6':/~ /F). /~!r(F
witness) ,I
CRJ
l..:) e Jc~
Mark
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Page 4 of 4 Pages
On the ~ ~ay of February, 1997, the above-named
Te.tatrix, stella Timalonis, in our presence deolared the
preoeeding inetrument to be her Will and, being unable to sign
her name hereto becauee of physioal inoapaoities brought about
by a stroke, direoted her name to be subscribed for her, whioh
ths undersigned David R. Getz, Esquire as directed in the
presenoe of the Testatrix and in the presenoe of the
undersigned, whereupon the Testatrix in our presence unassisted
made her mark or cross in the space provided between her name,
and we, in the presence of the Testatrix, and in the presenoe of
each other, at the request of the Testatrix, have subsoribed our
names as witnesses.
Cf\, A) ~
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lOItllOWLIDGKl1IT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.:
I, stella Timalonls, the Testatrix whose name has been
subsoribed for me to the attached or foregoing instrument, and
whose mark has been made on the foregoing instrument, having been'
duly qualified aooording to law, do hereby aoknowledge that I
made my mark and had my name subsoribed for me to the instrument
as my last Will; and that I made my mark and had my name signed
willingly and as my free and voluntary aot for the purposes
therein expressed.
sworn to or affirmed and acknowledged before me by
stella Timalonis, the Testatrix, this JRII- day of February,
1997.
Her
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'lItov( 10l1l "
Mark
ll'l'IDlVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss. :
we,J:.~)nvlcl j;,:: (~~r)L.. ,C\rr>~I;e At /-~;.'h' ,
and kJkli't"I\ A;--Tht IY, , the witnesses whose names are signed
to the attached or foregoing instrument, being duly qualified
acoording to law, do depose and say that we were present and saw
the Testatrix make her mark on the instrument as her Last Will,
that the Testatrix made her mark willingly and executed it as her
free and voluntary act for the purposes therein expressed; that
David R. Getz, Esquire, at her instruction, subscribed her name
to the instrument; that each sUbscribing witness, in the hearing
and sight of the Testatrix, signed the Will as a witness; and
that to the best of our knowledge, the Testatrix was at that time
16 or more years of age, of sound mind and under no constraint or
undue influence.
/J. rd sworn to 01' ~ffirmed
,,,,,rJ. ~ ' .
____, wlt esses, this ~,day
subscribed to ~U7.e me;, by,____
and .. . ~l',(( ( r J lA.1
February, 1997.
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ary public
commission EXpires:
(SEAL)
~ NO']n"I,\,al
\Judith A, c;~.':; L; !(i!.lry Public
Ennl p",,,,',IMOIYlI.', CU'I1I.",I<I",1 GounIV
MYC(1111rnl~)~;iull f.:1.plrus [Xl_ ~O, 1!J97
T.J0ii1iiii~FOiiii;YiW~Li AssoclaUo: I 01 maries
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2, Slack. and land. (Sch.dul. I)
3, Clollly H.ld Slock/Partn."hlp Inltrlll (Schodulo q
4, Mortgagll and Naill Roctl.ablo (Schodul. D)
5, Cash, lonk D.potlt. &. Mlle.llan.out P,nonal Prop.rty
(Sch.dulo E)
6, Jointly Owntd P'op"ty (tch.dul. F)
7, 1,an.fo" (Schodul. GI(Sch.dutol)
I, 10tal Grall ......11 (tolal Lin.. 1.7)
9. Fun.ral Exp.nt.11 Admlnl.tratl.... Co,tt. Mlsc.llan.ou.
Eoponll. (Sch.dulo HI
10, Oobll, Mortg09' Liablllllll, 1I.n. (Sch.dul. II
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12, Nol Valuo of Eltot. ILlnt 8 mlnu. lint 111 /
13, Cha,ltablo and GO.llnm.ntalloqulIlI(Sch.dufo J)
14, N.t Valu. Sub.et 10 10. (lIn. 12 mlnu.lIn. 1!L-
15, Spau.allran.f... (for dot.. of dooth ahor 6.30.941
St. 'n,tructlons for Applicabl. Perc.ntag. on nlVln.
Sid., (Includ. .alu..lrom Sch.dul. K'or Schodulo M,I
16. Amounl of L1n. U taKobl. at 6% ral,
(Includo .alu.. f,om Sch.dul. K or Sch.dulo M,I
17, "mown! of lIn. 14 IOllabl. at 15% ral.,
(Includo ,alu.. f,om Schodul. K or Sch.dulo M,)
18, Principal to. due ("'dd to. fraOl Lln.. 15, 16 and 17,)
19. Cr.dill Spousal Poverty Cr.dlt Prior Paym.nts Discount
+ n +.H._____ -
20, If Lln' 19 I. grtotorlhan L1n. 18, .ntll tho dlfforonct an Lln. 20, lhl.l. the OVU'AYMINT,
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A. Enltr th. Inl.rllt on th. balan('.. due on lint 21,4"
I, Entor tho tolol of L1no 21 and 21... on L1no 21&, 'rhl.l. tho'AL"'NCE DUE,
Mak. Ch..k Payabl. tOI hgl.ttr of Will., Agont
L..!!.!!!RI TO ANSWIR ALL QUISTIONS ON RIVIRSI SIDI AND TO ilCHlCK MATH .c.(
Undor ponaltill of porlury, I docla" Ihat I hayo ...mlnod Ihl. rolurn, Including accompanying "hodul.. and lIallm.nlt, and 10 tho Do.1 01 my knowl.dgo and boil.f,
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ial.d 0 alllnformallon of whic . or" hat any knowl.dg..
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, !~echanicabu['{jtJ)A-!70~2-_--
ADD'''' P.O. Box 845
_______,_",_"Jiarriaburg. _l'A 17l00-0045
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Tolal Numb.. of Sol. O.potll tout
oMm I MAIliNG A ,__ ~i. _
WlX, Werger: llwoldoo["
508 N. SccQIlid St., P.O. !lox
Ha["dsbu :, PA 17108-0845
( I) ____~__,__.,___
-0..: /
(21 ' ,---
(3)_ ..0- ---'
(4) ....:0-
( 5 ) 5..121..25.----
845
~
I
(6)
(7)
-0-
-0-
(8) _-50--12] 2" ---
(9)
2,489.32
11.::171 Q1
(101
(11) 19.817.23
(121 .-U4.095.98\
(131. -0-
(14) 114.095.98\
(151 _-------,M,---
(16)
____)C .06 .
(17) .
_M ,IS D
------
~
E
8
S
(ISI
-0-.
--
Int.r..'
(191
(20)_
(211 "
(21"'1._---
(218) _ -0-
, ~
- ~!"
"
,'] ,
\1/(.(;
LC
.,
[?:
l~
r<J
r;':-J'
Ptj -
U;,J
~rl
r' th'
ii'-S
au
,\I
RlV.II02IU (12,UI........ ~ J
~ SCHEDULE A
;".'I:,~21<<~~I~~m~l~AH~A . _~~L ESTAT~ _. ~~.__.
.. ur PILI NuMIIR .-'~-
S'l'BLl.A L. TI~JS __------.---------.-1~2-OOS231. 219'H>523._
",.,."" "'."tly..w..... with RI.hl,1 'u",Iv...hlp "'u., 100 ~."....~." Ich.~ul. 'I AII,..I..'." .h.ul~ Ito/lPO"'" ", fal, ",,,rk., v"lu.
which I. tIofl..... ". tho p,lc. ", which P/lPO"" "".ul~ 100 ...h"..... 100""".. . willi.. "uy.r ".~ " ""1111,,. ..II.r, ..I'h.r 100... .,,",poll...
..lolly .. toll, ItoIh ....,'... /I"......... ....w...... .1 th. ""u",,, ~ ----.---.--.--..- ------.-----..--
NUA~!R DUCRIPTION VA~etelftT!
--....-----,-
I.'
) /
'0' AL (AI.o ..I.r o!, IIn. 1. R...pltuIQllonl
III more .p.c. I. nood.d, In..'' addltlonQ,.h..', 0' .am. .,...)
$
I
~
-0-
IIV.1103.h 1',161 *
~O"''tS~1,^'>l~.Ol ,.tljj'~\l'.NI.
,Wlo'iNl O~OrN~ .
SCHEDULE B
STOCKS AND BONDS
1991-00523; 2197-0523
S'l'8L(J\ L. TlMAtDlIS
IAII p..,.rty 1.lnlly';;;... wHh 11th' .f S.IYluorlhlp ,".t' 10. .il.do.... on khe"ul. '.1
- -
ITEM
NUMIEI DESCRIPllON
-
--
VALUE Al DATE
OF DEAlH
,F'l
.'
S -0-
lOT AL ....110 .nt.r on lin. 2 Roco It"lotlon
(If mo" .po.. I. nood.d, In..'' odditlonol .hoo" 0/ '0"" "...)
UV.IIlllhl',111
S'l'Br.LA L. T1MAIDfIS
5CHIDULI H rl
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES Ploa.. P,lnt 0' TVpo
PILI AilM'11l
1991-.00523l 2191-0523
l.
2.
~tk
COMMONWIAITN 0' 'INNIYlYANIA
INNIlITANCI TAM IlTUIN
IIIIDINT DICIDINT
A,
C.
1.
2,
3,
A,
5.
6,
7,
8,
1,
2.
3.
AMOUNT
DESCRIPTION
Funo,al bponlol'
( Pt:e(lIIid)
eoo.oo
ITEM
NUMIIR
A.
Gravemar1cet (est imte)
.. Admlnllt,atlw Coat..
p.rlonol RoprolOnlOll.. Commllllonl
Social Socurlly Numbor 01 Portonal Rap,.lOnlal'..l 165
Vllar Commlnlonl paid 1998
700.00
42
63'41
Attorney foOl
Wix. wenger & weidner (estimated)
Fomlly exlmpllon
Claimant O' Rolollonlhlp
Addron 01 Clalmanl 01 dlcodlnt'. dooth
St,.lt Addro..
700.00
Zip Codo_
City
Stoto
P,obolo Foa' ,
C\JItlerland eounty Register of Wi Us
MIlCollanaeul bpon.."
15.00
C\JdJerland LaW Journal - legal advertising
60.00
19.32
25.00
.
'l't1e sentinel - general advertising
"ix, wenger & Weidner - out of pcket expenses incurred
50.00
Reserve
-
TOTAL (AI.o onlor on IIno 9, Rocopltulallon) S
Ilf mare Ipaco II noodod, '""" addltlollal Ihootl of lama 11,0,1
2,489.32
lIY.UI,... (I.en
ISTATI 0'
ITIM
NUM"I
1.
2.
lTlM
NUM"I
.
C~ONWIA4'" 011 ~NH"W"'HI'"
.......ANCI ,.. HNIN
--,
L
PILI NUM"I
1997-OO523; 2197~52,3
SCHEDULI J
BINlflCIARllS
STELLA L. TllWaIlS
NAM' AND ADDIISS 0' '.NIPlCIARY
llLATIONIHIP
SH~Tf~~~81T1
A. Taxablo loq.OItll
RoeeIIade MalpllS8
8 Southvatch Lane
Mechanicsburg, PA 17055
Ronald Ti_lonis
27'19 Shakespeare Dr:'ive
IrdilllllJPOlis, IN 46227
DalJ]hter:
50\
Son
50\
NAMI AND ADDIIIS 0' .INIPlCIAIV
AMOUNT O'
SHA.IO' I$TATI
a. Charltablo and OovOInmontalloq.OItll
1.
.
I,'
TOTAL CHAIITA.LE AND OOVeRNMENTAL BEQUESTS (AI,a 011101 on IIno 13, Rocaplt.latlon)
(If m,,. v,.., 10 _..., In""aUltlonal .h.... ,f ....., I""
s
-0-
....:-- "f
-
~-
~-"
ITwm, ,ORGU ,folbruarvlZ,'"1
LAST WILL AND TESTAMENT
Ql
~TELLA TIMALONIS
I, stella Timalonis, of f.ower Allen Township,
Cumberland county, pennsylvania, being of sound and disposinq
mind and memory, do make, publish and declare this to be my Last
Will and Testament, hereby revoking all Wills and codioils by me
at any time made.
ITEM-I: I direot that all inheritance and estate
taxes becoming~due by reason of my death, whether such taxes may
be payable by my Estate or by any reoipient of any property,
shall be paid by my Exeoutor out of the property passing under
this Will, which is not speoifioallY devised or bequeathed as an
expense and cost of administration of my Estate. My Executor
shall have no duty or obligation to obtain reimbursement for any
such tax paid by my Executor even thouqh on prooeeds of
insurance or other property not passing under this Will.
JTEM II: I give, devise and bequeath all of my
household furniture and furnishings/ books, pictures, jewelry,
ohina, linen, silverware, and all other like artioles of
household or personal use and adornment to my children,
Rosemarie Malpass of Silver spring Township, Cumberland County,
pennsylvania and Ronald Timalonis of Indianapolis, Indiana, or
the survivor thereof, to be divided between the. in as nearly
equal shares as practioal.
JTEM III: I qive, devise and bequeath all of the rest,
residue and remainder of my property not disposed of by the
prooeeding portions of this will to my children, in equal
shares, per stirpes.
ITEM IV: In the settlement of my Estate, my Exeoutor
shall possess, among others, the following powers to be executed
for the best interest of the beneficiaries:
Page 1 of 4 pages
,
4..
"
"'...-.....---- ~,,----,
"
(a) To retain any invest1\lent I 1\Iay have at ..y
deat~, 80 long as lilY Exeoutor may d.elll it adviaable to
my Estate to do so.
(b) TO vary inve.tlllents, when deellled desirable bY
lilY Exeoutor, and to inveat in suoh bonds, stooks,
note., lIIoney markets, real estate 1\Iortgages or other
securities other than options or future8, and in 8UOh
other real or personal property a8 lilY Executor shall
deelll wise, without being restricted to 80-called "legal
inve8tlllents."
(0) In order to effect a divi8ion of the
prinoipal of my Estate or for any other purpoae,
including any final distribution or lilY Estate, 1\IY
Exeoutor is authOrized to make said divisipns or
distributions of the personalty and realty, partlY or
WhollY in kind. If such division or distribution is
made in kind, said assets are required to be divided or
distributed at their respective values on the date(s)
of their division or distribution.
(d) TO sell, either at public or private sale,and
upon such terms and oonditions as lilY Exeoutor lIIay deelll
advantageoUS to lilY Estate, any or all real or personal
estate o~ interest therein owned by my Estate,
severallY or in conjunction with other persons, or
aoquired after lilY death by 1\IY Exeoutor, and to
consummate said sale(s) by 8ufficient deedS or other
in8truments to the purcha8er(s) conveying a fee silllple
title, free and clear of all Trust, and without
obligation or liability of the purchaser(8) to see to
the applioation of the purchase money or to lIIa~e
inquiry into the validity of said sale(8); alsO, to
1\Iake, execute, acknowledge and deliver any and all
deed8, a8signment8, option8 or other writings which may
be necessary or desirable to eff.ect any of the bequests
or devises made in lilY Will or in carrying out any of
paqe 2 of 4 pages
"
:
~,_.._..-
;.._-~,..
the powers conferred upon my Exeoutor in this Item
tV(d) or ele.where in my Will.
(e) To mortgage real estate and to make lease. of
real e.tate.
(f) To borrow moneY from any party to pay
indebtednes. of mine or of my Estate, expenses of
administration, or inheritance, legacy, estate and
other taxes.
(g) To pay all costs, taxes, expenses and
charges, exoept as herein noted, in connection with the
administration of my Estate. My Executor shall pay
expenses of my last illness and funeral expenses.
(h) To vote any shares of stock which form a part
of my Estate and otherwise to exorcise all, the powers
incident to the ownership of such stock.
(i) To assign to and hold in a Truet an undivided
portion of any asset.
(j) The right and discretion to elect the most
appropriate settlement options for any pension plans,
individual retirement accounts or other employee
benefit optiQns payable to my Estate, assuming such
eleotion shall be in accordanoe with procedures
establish.d by the plan's administrative oommittee or
administrator, as the case may be.
(k) The right to engage accountants, attorneys,
appraisers and other agents, as deemed necessary by my
Executor, to render advice to and/or to represent my
Executor, as my Executor may deem necessary or
appropriate to the administration and preservation of
my Estate.
ITEM V: Any person who shall have died at the same
time as Testatrix or in a oommon disaster with her, or under
suoh ciroumstanoes that it is diffioult or impossible to
determine who died first, or who fails to survive her by ninety
(90) days, shall be deemed to have predeceased her.
page 3 of 4 pages
"".
11
XTEM ~l If at any time, any minor child or disabled
person shall be entitled to reoeive any aeeets hereunder, my
Exeoutor ehall aot ae Guardian of the aseete payable to suoh
person. Said Guardian may reoeive and administer all aeeeta
authorized by law and shall have full authority to uee euoh
assets, both principal and income, in any manner said Guardian
shall deem advisable for the best interest of suoh person,
including 0011ege, university, post-graduate or other education,
without aeouring oourt order. said Guardian shall have all the
rights and privileges as to the guardianship and the assets
thereof as are herein granted to my Executor as to my Estate and
the assets therein.
JTEM VII: I nominate, constitute and appoint my
daughter, Rosemarie Malpass, to be my Executrix (herein referred
to as "Exeoutor"). In the event of the death, resignation,
refusal or inability of Rosemarie Malpass to serve as my
Executor, I nominate, constitute and appoint my son, Ronald
Timalonis to serve as Exeoutor. My Executor and Guardian are
specifioally relieved from the duty or obligation of filing any
bond or bonds.
IN WITNESS WHEREOF, AND INTENDING TO BE LEGALLY BOUND,
being unable to sign my name because of physioal inoapaoities
brought about by a stroke, I have had my name subscribed for me
to this, my Last Will and Testament, consisting of this page,
the next page and the preceding three (3) pages, in my presenoe
by David R. Getz, Esquire and I have made my mark in the space
'between my name this lf3J1- day of February, 1997 ~
Signed, aealed and delivered
in the presenoe of:
Her
{
(\ -r;~OlltS
~{,R~
.' witness)
Sfclh
Mark
Page 4 of 4 pages
;'
-j
INVENTORY OF THE REAL AND PERSONAL ESTATE OF
STELLA L, TIMALONIS, DECEASED
ESTATE NO, 2197.0523
Assets valued as of the date 01 death .. May 22, 1997:
Real Est~te
NONE
$-0.
Stocks/Q~
NONE
.0.
Cash/Blink Accounts/Miscellaneous Personal Property
PNC Bank Checking Account
5.121,25
TOTAL
.UJ.iL.U
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
SS
ROSEMARIE MALPASS, being duly sworn according to law, deposes and says that the Items
appearing In the loregolng Inventory Include all 01 the decedenfs real estate In the Oommonwealth 01
Pennsylvania and all 01 the decedent's personal assets wherever situate; that the valuation placed
opposite sach Item In said Inventory represents Its lair value as olths dale 01 decedent's death: and,
that decedent owned no real estate outside the O(j nweaith 01 Pennsylvanl , )
Of,>
e I,
.,
u:i
('-~'
,..,::0
!,,(),l
g
SWORN TO AND SUBSORIBED
BEFORE ME THIS :( r.i
DAY OF J:-<,\), l),'/\) ,
199~"J /'. /);Z/
l .PI \ / 1/ ~i ,
I ./.,.. .. ,.' I/,"f.. '. .. ''.,:,
Not P~~~ t, / t{J' 1/ VI'" )(:/ I.l -'
My Oommlsslon Expires:
~~~
Nolarlal S.a'
O.n118 S, Wllllamaon, Notary Publlo
Harrisburg, Dauphin County
Mv Oo",mloalon E~plr.. May " 2000
I
r~
'tJ
<-~-,\
, (j
~J
-"\
))! ,.0.1
15'~/f6-1
COMMONWIALTH OF PINNSYLVANIA
OIPARTMINT OF RIVINUI
(/
IUREAU UF IHUIVIUUAl TAXES
INHERllANCE 'AX Oll/lStDH
OfPl, l1060t
UARRISIUAO, PA 111ZI.Uf>Ol
NOTICE Of INHERITAHCE TAX
APPRAISEMENT, AlLOWAHCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
05-11-98
TIMALONIS
05-22-97
21 97-0523
CUMBERLAND
101
t- - ~:unt R..ltto~ . l
MAKE CHECK PAY AIL I AND REMIT PAYMINT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINI ~ RETAIN LOWER PORTION FOR YOUR RECORDS'"
iil"v: isi;j-iii' -AFP -r 09-: 9'ri - No"fi ar -oF-YNHiiiiT ANci. - "fAx - APPRA-iiEM!N:r; - ALt"owANci. - oli------ -- - -- - -- - --
DISALLOWANCE OF DEDUCTIONS AND ASSISSMENT OF TAX
STELLA FILl NO. 21 97-0523 ACN 101
DATE
ISTATI OF
DATE OF DlATH
FILl NUMIIR
COUNTY
ACN
DAVID R GETZ ESQ
508 .N SECOND S T
PO BOX 845
HARRISBURG
PA 17108
1ST AT I OF TIMALONIS
TAX RETURN WAS' I X I ACCEPTED AS FILEO
RISIRVATION CONCERNING FUTURE INTEREST . SEI REVERSE
APPRAISED VALUI OF RETURN BASED ON: ORIGINAL RETURN
1. R..1 Est.t. (Soh.du1. Al
2. stockl ~d londl ISchedule 8)
3. Clo..l~ Held stock/Partner.hip Int.r..t (Schedull C)
4. "otto.g.I/Not.. Receivabl. (Sehedull OJ
5. C'lk/lank Oapolita/Hlle, Plrlon,l Property (Schedull El
6. JointlY OWned Property (Schedull fl
7. Tran.flra ISchedull GJ
I. Toto1 ..uh
APPROVED DEDUCTIONS AND EXEMPTIONS I
( I CHANGED
UI
(2)
IS)
141
151_
161
(71
.00
.00
.00
,00
5.721;25
.00
.00
III
(91
UO)
2,489.32
17.327.n.
U11
U21
USI
(141
10.
11.
12.
15.
9, funarll E_pln.../AdM. Coatl/Hlle. Exp.n.e. (Schadula H)
D.bts/Mort..e- ll.bi11tl.s/Llons lSoh.du1. II
Total Deduction.
Net Value of Tax Return
Ch.rlt.ble/Govern~ent.l 'aqua.tiJ Non..lactad 9115 Tru.t. (Schedule J)
N.t V.1u. of Est.t. Subjoot to T..
If an ......m.nt wa. i..u.d pr.viou.1Y, lin.. 14, 15 .nd/or 1&, 17 and 18
r.fl.ct figur.. th.t includ. the total of ~ r.turn. .......d to d.t..
ASSISS"INT OF TAXI
1S. A~ount of Llna 14 .t Spou..t rata (lS)
16. A.ount of Lln. 14 t...b1. .t Lln..l/C1sss A rot. 1161
17. Allount of L'ln. 14 tax.bl. at CollatarallCla.. 8 r.te (1)
II. Prlnolp.l T.. Du.
TAX CRIDITSI
PAYMENT
DATE
14.
NOTlI
RECEIPT
HUHIER
DISCOUNT 1 + I
INTEREST/PEN PAID 1-)
.00 X .00.
.00 X .06.
.00.X.15.
UIl
AMOUNT PAlO
TOTAL TAX CREDIT
8ALANCE~AX DUE
INTEREST AND PEN.
TOTAL DUE
'*'
nY.l"'U ", UH"
STELLA
DATE
05-11-98
. IF PAID AFTER DATE INDICATED, SEE REYERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN .1, NO PAVMENT IS REQUIRED.
IF TOTAL DUE IS REflECTED AS A "CREDIT" lCRI. YDU MAY IE DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRM fOR INSTRUCTIONS.I
MOTEl To Inaure proper
credit to your acoount,
.ub.lt the upper portion
of this foro with your
tax p.y..."t.
5,721.25
lQ.A17 ,~
1(,,095.98-
.00
14,095.98-
will
.00
.00
.00
.00
.00
.00
.00
.00
,
i~ .~ ::0
~8
","",
~\~ ~ 'i :'~
,..! (1.1
~}.~ <!1
L ... c
N
("J '" ~'
o. a ~)
, , 0 iil
~~ .. So
VJ
0
REseRVATIONI e_tat.. q, d~~t. d~l",onor bafor. Dao..b.r 12; 1982 ~- l' anY future Int.r..t In the t.tate I, 'r,"'flrrea
In pOI....lon,or enjoYltn' to ct... . (col1_',ral) beneflclar... of the decadlnt .,t.r the ..plr.tlon of '"v ..teta for
11'. or for y..r"t.,. COIlIIonweI1th hereby .lCpr...lY r...rv.. the right to .,n1l1 4Ind ...... 'r.,,".r InhtrltltnCl TIM"
at the lawful Cl... . (collattraU r.t" on MY Iqch lutu'" 111t.,..t.
_Of
HOTlCEI To fulfill th4t r.qulr..enb of Section 2140 of the InherltMcI IlOd Ett_t. lllC Act, Act 21 of 1995. (72 P.S.
Slot Ion 9140).
PAVI1ENTl Detloh thei tOf! portion of thh Notle. and ,UbMlt with vour ply..nt to thl R"ht,r of WIUI prlntad on thl n....r.. std..
u..... oheick or tONY ordlr pIyabl_ tOI REGISTER OF M4LL8, AGENT
REfUt4b (CAll A r.'und of . teM credit, Mhloh w.. not r.qu..ted on the Tel( R.turn, .av be requ..tH by cOllPleUng an IOAppllcaUon
for Refund of Pann.yl"anla lnh4rlt~a and E.tat. T.M" (REY-I1IS). Appllc.tlon. are avallabl. .t the Offlca
of the Reghhr of N11l1, any 0-:'1 the 21 R.".nu. blttrlct Offlc.', or by _ooal1lng the .p.clal Z4~hour
an.werlng ..rylca nuaa.r. for 'or.' ordarlngl In Pann.ylvanla 1-100-]6Z-Z0tO, out. Ide Penneyl".nl. and
wl\hln loc.l Herrl.bur. are. (717) 7'7-1094. TOOl (717) 77Z-ZZSZ lHaarlng Iap.lred OnIV).
OIJECTlONSI Any pertv III Inter..t not .aUefl.d with the .pprsl....nt, .1loNane. or dltaUoNanc. of daducUon" or ......Mnt
of taM (Including dl.count or Inter.~tl .. .hoNn on thl. Notla. au.t object within .IMtv (60) day. 0' r,o'lpt of
thlt NoUce bYI
~~wrltt.n prot..t to the PA O.part-.nt 0' Ra"anue, loard of App..l., Dept. Z11021, "-rrl.bur., PA 17121-1021, OR
-~.l.oUon to hava the .athr deteralned .t .udlt of the account of the ~I'.onel rapr..entatlva, OR
-~appa.1 to the Orph.ns' Court.
AOftI"
ISTRATlYE
COMRECTIONSI
Flletual error. dlsco"ered on thh ........nt .hoUld b. .dd,....d In writing tOI PA Depert""t of Ra"anua,
lur.au 0' Indl"ldUal T'Me., ATTNI Po.t A.......nt Ra"law Unit, D.pt. Z10601, Harrl.burg, PA 171ZI-0601
Phone (717) 717-6505. S.. page 5 of the bookl.t "Instructlona for Inherlt.nca t.M R.turn for a Ra.ident
DHadent" (REY-ISOl) for an .Mpl."aUon of "lnlltraU".h correctable arrorl.
DISCOUNT I
If any taM due I. p.ld within thr.. (Sl c.landlr IOnth. a,tar the dGc.dent', de.th, a 'I'" p.raant (5~) dl.count 0'
thl taM paid 11 allowed.
PENAL TV I
The l!i:C tal( PM.ty nnn-pertlc1patlon pen.lty 11 COllPUtad on thl total of thl hM and Inter..t ......ad, Md not
Plld b.fora Jonuary II, 1996, the firJt day .fter thl .nd of the tax lIIM.ty p.rlod. Thla non.partlclpaUon
.-MltY I. app..labl. In the .... .llMIIr and In the the ... tin period.. you MOuld app..l the taM flnd 1ntl".t
that hat been .......d a. Indlcatad on thl. natlc..
INTERES",
Int.r..t 11 charpd b61Ilnn'nt with flrat day of dalln...-ncv, or nine (,) Hnth. Md one (1) day 'ru. thtl data of
daath, to the data of p.y""t. taM.' MhJch bee... delln.,."t bafore JllnUllry 1, 1'.2 b..r lntar..t at thl r.ta of
.IM ('X) peroent .-r ~ calculatad at a dilly r.ta of .OO~16~. All tax.. Nhlch bee... delinquent on and aft.r
January 1, 1.8Z will bu.r Int.r..t .t . rat. which will vary fru. c.l.ndar y.ar to c.lendar y.ar Nlth that r.t.
MnOUftC.d by the PA o.~rt..nt of R."MUtI. The ....lIcabla Intar..t nta. for 1982 through 1991 aral
U!I: Int"..t R.t, DailY Int.r..t Factor X!!r Intlr..t Rat. DailY Intar..t ~'actClr
1912 UX .000541 1'87 9X .OOOZU
19I~ 16:< .000oUI 1...-1991 It:< .OOnOl
1914 llX .00OSOI 1992 9X .000247
1'15 11:< ,OOOU6 1991-19'4 7" .000192
"
1916 10:< .000Z74 l"S~I99. .% .000247
.~Intar..t 1. c.lculeted a. fol1owll
INTERElT . IALANCE OF TAX UNPAID X NURIER OF OAYS OELINQUENT X OAILY INTEREST FACTOR
--AnJrt Notlca llIued aftat tha taM b.oOlM. Hllnquant Mill raUact an lntar..t oalculat1~ to flU.an (Ui) day.
"yoM the data of thl ........nt. If pay..nt II aad. aftar the Int.t..t cOllflut.Uon data .hoWn on thl
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INTHE COURT OF COMMON PLEAS
CLERK OF THE ORPHAN'S COURT
CUMBERLAND COUNTY
ESTATE OF: Stella Timalonis
NOTlq: OF Cl,AIM
ORPHANS COURT #: 21-97-523
Please enter the claim of Beverly Hcalth and Rehabilitation Scrviccs, Inc, at West Shore
Health and Rchabilitation Ccntcr (formcrly Bluc Ridgc Ilaven-Wcst) in the amount of
sixteen thousand and twcnty-thrcc dollars and four ccnts ($16,023,04), against the above
estate, on this date of .June 22, 1998,
Written notice of said claim was givcn to Rosemarie Malpass, Exccutor of thc Estate of
Stella Timalonis, at 8 Southwatch Lane, Mcchanicsburg, I' A 17055 on .Junc 23, 1998, via
first-Class U.S, mail.
CAPOZZI & ASSOCIATES, I',C,
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~achel H. Meaker, .squire
3109 N. Front Street
Harrisburg, PAl '/110
(717) 233-4101
Attorney for Claimant
Beverly Health and Rehabilitation
Services, Inc,
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SEP 1 4 '998~
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IN THE COURt OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
IN REI ESTATE OF STELLA TIMALONIS, :
DECEASED
ORPHANS COURT DIVISION
NO, 1997 - 00523
pECREE
AND NOW,
this ~~aY of
, 1998, after
havil1g considercld the within petiti n For Settlement of Small
Estate, it is hereby ORDERED AND DECREED that the estate of Stella
Timalonis be distributed to the persons entitled thereto as set
forth in the first and final account attached to the said Petition,
and upon completion of such distribution, Rosemarie Malpass is
discharged as Executrix of the Estate of Stella Timalonis.
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7. 'rhe entire distributable balance, as reflected in the
attached account, is not suf[!cient to pay all of the
administrative expenses of the dBcedent'fl estate and the
decedent's creditors; therefore, there will be no funds
available for payment to the decedent'S heirs.
B, All partieS in interest have received a copy of this
Petition as reflected on the CertHicate of Service
attached heretO.
9, The pennsylvania Inheritance Tax Return hafl been filed
with the Register of Wills and there wafl no ~ tax due on
the decedent'S estate. A copy of the statement of the
Department of Revenue showing no tax due is attached
hereto as Exhibit "D".
10. There are no unpaid claimants, other than those set forth
on the attached Certificate of service, of whom the
petitioner has notice or knowledge.
11. The decedent was not a fiduciary in any other estate and
was not a surety on the bond of a fiduciary.
WHEREFORE, petitioner. respectfully requests this Honorable
Court to direct distribution of the entire distributable balance of
the decedent'S personal estate to the persons entitled thereto as
set forth in the First and Final Account attached hereto as Exhibit
"C", and to discharge Rosemarie Malpass from the dudes of
appointment as ExecutriX on the Estate of stella Timalonis.
Respectfully submitted,
WIX, WENGER & WEIDNER
By:
. ... )
jjJrzt:;\ . ~ /, )kf--
David R. Getz, E~quire
Attorney ID No. 34838
508 Nor.th Second Street
P.O. BoX 845
Harrisburg, PA 17108-0845
(717) 234-4182
Datedl september ~, 199B
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Q'WI~~, ORQ22 ,.br~.rv 12, 1997
LAST WILL AND~
QE
STELLA TIMhLONIS
I, stella Timalonis, of Lower Allen Township,
Oumberland county, Pennsylvania, being of Bound and disposing
mind and memory, do make, publish and declare this to be my Last
Will and Testame~t, hereby revoking all wills and Codicils by me
at any time made.
ITEM I: I direct that all inheritance and estate
taxes becoming due by reason of my death, whether such taxes may
be payable by my Estate or by any recipient of any property,
shall be paid by my Executor out of the property passing under
this will, which is not specifically devised or bequeathed as an
expense and cost of administration of my Estate. My Executor
shall have no duty or obligation to obtain reimbursement for any
such tax paid by my Executor even though on proceeds of
insurance or other property not passing under this will.
llBM...I.l: I give, devise and bequeath all of my
household furniture and furnishings, books, pictures, jewelry,
china, linen, silverware, and all other like articles of
household or personal use and adornment to my children,
Rosemarie Malpass of Silver Spring Township, cumberland County,
Pennsylvania and Ronald Timalonis of Indianapolis, Indiana, or
the survivor thereof, to be divided between them in as nearly
equal shares as practical,
ITEM III: I give, devise and bequeath all of the rest,
residue and remainder of my property not disposed of by the
proceeding portions of this will to my children, in equal
shares, per stirpes,
ITEM.lY: In the settlement of my Estate, my Executor
shall possess, among others, the following powers to be executed
for the best interest of the beneficiaries:
Page 1 of 4 Pages
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I,
(a) To retain any investment I may have at my
death, so long as my Executor may deem it advisable to
my Estate to do so,
(b) To vary invostments, when deemed desirable by
my Exeoutor, und to invest in such bonds, stocks,
notes, monoy murkets, real estate mortgages or other
seour.itios other than options or futures, and in such
other real or personal property as my Executor shall
deem wise, without being restricted to so-called "legal
investments,"
(c) In order to effect a division of the
prinoipal of my Estate or for any other purpose,
inoluding any final distribution or my Estate, my
Executor is authorized to make said divisions or
diatributions of the personalty and realty, partly or
whOlly in kind, If such division or distribution is
made in kind, said assets are required to be divided or
distributed at their respective valu~s on the date(s)
of their division or distribution.
(d) To sell, either at public or private sale, and
upon such terms and conditions as my Executor may deem
advantageous to my Estate, any or all real or personal
estate or interest therein owned by my Estate,
severally or in conjunction with other persons, or
aoquired after my death by my Executor, and to
oonsummate said sale(s) by sufficient deeds or other
instruments to the purchaser(s) conveying a fee simple
title, free and clear of all Trust, and without
Obligation or liability of the purchaser(s) to see to
the application of the purchase money or to make
inquiry into the validity of said sale(s); also, to
make, execute, acknowledge and deliver any and all
deeds, assignments, options or other writings which may
be necessary or desirable to effect any of the bequests
or devises made in my Will or in carrying out any of
paqe 2 of 4 Pages
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.
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the powers conferred upon my Exeoutor in this Item
IV(d) or elsewhere in my Will,
(e) TO mortgage real estate and to make leases of
real estate,
(f) To borroW money from any party to pay
indebtedness of mine or of my Estate, expenses of
ad~inistl.ation, or inheritanCe, legacY, estate and
other taxes,
(g) TO pay all costs, taxes, expenses and
charges, except as herein noted, in connection with the
administration of my Estate. My Executor shall pay
expenses of my last illnesS and funeral expenses,
(h) To vote any shares of stock which form a part
of my Estate and otherwise to exercise all the powers
incident to the ownership of such stock.
(i) To assign to and hold in a Trust an undivided
portion of any asset,
(j) The right and discretlon to elect the most
appropriate settlement options tor any pension plans,
individual retirement accounts or other employee
benefit options payable to my Estate, assuming such
election shall be in accordance with procedures
established by the plan'S adminlstrative committee or
administrator, as the case may be,
(k) The right to engage accountants, attorneys,
appraisers and other agents, as der.med necessary by my
Executor, to render advice to and/or to represent my
Executor, as my Executor may deem necessary or
appropriate to the administration and preservation of
my Estate.
lTEM ~: Any person who shall have died at the same
time as Testatrix or in a common disaster with her, or under
suoh circumstances that it is difficult or impossible to
determine who died first, or whO fails to survive her bY ninety
(90) days, shall be deemed to have predeceased her.
page 3 of 4 Pages
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lTEM VI: If at any time, any minor child or disabled
p.rlon .hall be entitled to reoeive any assets hereunder, my
EKooutor shall act as Guardian of the assets payable to suoh
porIon. Said Guardian may receive and adminlster all assets
author 1 zed by law and aha II have full author i ty to use such
allllOt.lI, both prlncipal and income, in any manner said Guardian
IIhall deem advisable for the best interest of such person,
ifloluding oollege, unl.versity, post-.graduate or other eduoation,
without seouring court order, said Guardian shall have all the
rights and privl.legse as to the guardianship and the assets
thereof as are herein granted to my Executor as to my Estate IInd
the assets therein,
ITEM Vll: I nominate, constitute and appoint my
daughter, Rosemarie Malpass, to be my Executrix (herein referred
to as "Executor"). In the event of the death, resignation,
refusal or inability of Rosemarie MalpasS to serve as my
Executor, I nominate, constitute and appoint my son, Ronald
Timalonis to serve as Executor, My Exeoutor and Guardl.an are
BpecifloallY relieved from the duty or obligation of filing any
bond or bonds,
IN WITNESS WHEREOF, AND INTENDING TO BE LEGALLY BOUND,
being unable to sign my name beoause of physical i.ncapacities
brought about by a strolte, I have had my name subscribed for me
to this, my Last Will and Testament, consisting of this page,
the next page and the preceding three (3) pages, in my presenoe
by David R, Getz, Esquire and I have made my mark in the spaoe
between my name t.his lP;l1.. day of February, 1997.
signed, sealed and delivered
in the presence of: Her
('
'Ii'rt-ctkl":s
Jj f!s.) J ."
. O'~Ll' (< ?Jft.
witness) I
Sill 1'1.
Marl<.
page 4 of 4 pages
COMMONWEALTH OF PENN9VLVANIA
DEPARTMENT OF REVENUE
'*
IU"EAU ~F'INDI~IDUAL TAKES
lHIlUt1lAHCE lU lJlvtsl0H
DtPf. 11060 ~
HAR.lSIURO, PA 171ZI-0601
NDTICE DF INHE"ITANCE TAK
APP"AtSEHENT, AtLOWANCE OR OISALLOWANCE
OF DEDUCTIONS AND ASSESSHEHT OF TAK
tff.l'4' U'" II"HI
05-\1-Q8
T1MALOtlIS
05-27.-q?
21 Q7-0523
CUMBERLAND
101
DAVID R GETl ESQ
508 N SECOND ST
PO BOX 845
HARRISBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTV
ACN
STELLA
E:._~-~~===~ll~~~" --J
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 VOUR RECORDS ...
rEv: isioT EX -Ai'p-f oq:9ri "iicificr "oF" "iNHERit ;,HCE"TAX' -APPRAi sEMENr;" ALrowA'NcE - OR -.-...". - -. - -., -"
DISALI.OWAN(;I! OF OElJUC'(IONS AtlC ASSESSMENT O~ 'I AX
STELLA FlI.E NO,21 97-0523 ACN 101
PA 17108
DATE
05-\1"98
ESTATE OF
-'
tIMALON1S
) CfIANGfD
TAX RETURN HAS: I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED~UE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. stocks and Donds (Schedule B)
1. Closeh Held stocldPertnership Tnt.r.st (Schedule C)
~. Hortg.g.s/Note. Receivable (Schedule OJ
S. C.sh/Bank Deposits/Hilc. ~.rson.l Property (Schedule E)
&. JDlntl~ Owned Property (Schedule f)
7, Transfers IScherlula G)
a, Tohl A,ub
NOTEl To inlura propar
credit to your account,
lubllit the uppar portion
of this forM with your
hx p"Ylnant.
,00
,00
,00
,00
5,721.25
,00
,00
(8)
(11
12)
151
(4)
151
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(7)-
5,721.25
2,489,32
APPROVED DEDUCTIONS AND EXEMPTIONS:
,. Funeral Expanses/Ad,", COlhIHiIC, Expansel (Schedule tl1
10. Debts/Hortgage Liabiliti*I/Lians (Schadule I)
11. Tohl Oeductions
12, Nat Yalua of Tax Raturn
13, Chorlhblo/Govorn.onhl SOquOlts; Non-oloclod ~1l5 Truots (Schodulo J1
14. N.t Vdu. of Eshte subjeQt to Tax
I~)
110)
17.327.91
(11) _
112)
115)
114) _
lq .817 23
14,095,Q8-
,00
14,095,98-
If an a'les.ment was issued previouslY. lines 14. 15 and/or 1&. 17 and 18 will
reflect 1'igur6i tllat in"ludti thlil total of AI.L returnll llllli"BB"d to date,
ASSESSMENT OF TAXI
15, ","ount of Llna 14 at Spousal rata (1S)
16. ","ount of Una 1.4 taxable at Un..l/Cbs. ", rata (16)
11, "',"ount of Llna 14 taxabla .t Collateral/Cl..1 8 rata (17)
11, Principal Tax Oue
TAX CREDITS:
PAVHENT
OATE
NOTE:
,00 x' 00_
- "
,00 K ,06,
,00X,15,
I1S)_
,00
,00
,00
.00
RECEIPT
NUHSER
DISCOUNT I')
INTEREST/PEN PAID 1-)
AHOUNT PAID
TOTAl. TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN,
TOTAL DUE
,00
,00
,00
,00
-----
. IF PAID AFTE" DATE INDICATED, SEE REVERSE
FO" CALCULATION OF AODITIONAL INTEREST,
IF TDTAL OUE IS LESS THAN 11. NO PAVHENT IS REQUIRED.
IF T01AL DUE IS REFLECTED AS A "CREOIT" ICR). YOU "AV IE DUE
A REFUND, SEE REVERSE SIDE OF TNIS FO"" FOR INSTRUCTIONS,)
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