HomeMy WebLinkAbout97-00577
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Huglslor of Willll of -Dauphin Counly, PannsylvillllU
PETITION FOR GHANT 01: LETTERS
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No,
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Social SecurllV No,
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tCOMPlETe "^" OR "U" IJELOWII
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WARNING: IT IS ILLEGAL TO Al rEA THIS COPY OR
TO DUPLICATE BY PIiOTOSlAT OA PliorOORAPH,
COMMONWEAlllt 01' l'trmsYl.VANIA
I)F:PMnMf~Nf 01' tU:AUU VitAl. "r(;CHUl~l
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO, 3518588
. J!!!!!I.3.Q.J9.2.t_~._. '.
C1~I. "IIUu. ~1T!1I.('~IIIHQ.Ill)"
Name of Decoqent
Sylvia
~. W__(~,_.jI""""'_
Hoffner
1...
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1.'11
Sexn..l'wlEl..n._...," Social Security No,
20i1:-!i(H 7.93
DElio 01 Deatl1...Ju!lJ!.M.~12.2L....n_..
Dato of Birli, . June 26,1913
Birlhr!aco .Jackson.Twp ...PA
Place of Deathu_Healthsouth Renova.Cent.er .CUllber la.nd
1,1'>li~H;",- c;.",,'.,
LQ"~r .^lbnT!m.~..l'.e.nnsY.ll/ilnia
('1,-. Ik,'.I';<il;;-,. f,......,.:I',1'
Race.u_WhitJL_..
Occupation HQIt~ker
Docudent's
Mailing Addross
. Arllled Forcos? (Yes or No) _.1IQ,....~,..._,_u.".
Marital Slatus ,.Widowed.
100 Mt.. Allen Drive. Mechanicsbura..l'A,,17.ll55_ ~.___
';,.".hH' ..,<.-"", . '.,'ye.,T,\...." Silk
Funorill Diroclol Bradley S.. Boyer..,_." nn'...__.u..._..__...._....
Inlormollt....1'... Leroy. Hoffner
Name and Address of
Funeral Eslabllshrnenl.._lIoover FuneraLHoae.
Part I:
.118.S. MarketSt..Millerllbur.a....PA...t706L..,__....__......,_.~_
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I Interval Between
: Onsel and Death
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Immediete Cause
(a) ._.P.ulaonarY.EdllllA
Part II:
(d) ....Sub......... .......____._~______
Othm Significant Conditions .
Mannor 01 Deall,
Describe how injury ocourred:
Natural [it] Homicido []
Accident [:J Pending Investigation []
Suicide L] Could not be Determined []
Name and Title of Cerllier ..lrA.J ..Packaan...Jt.D.
.---u.................-.---.(M,O. , -b-:-O:;-Coroner,-"M. ET
Address ...J08..Lowther_Sl....Lemylle...PA.17D43
This is 10 certify that tl18 information 110re giv€lI1 is correctly copied from an original certificate
01 death duly filed With me as local Ch)(1ISffar~11fl 1(1ln81 cOltlfleate will be forwarded to the
Stale Vital Recolcts Office for I,ormanont filing" . h _/\ . _
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LAE1.T.J{ILL AN~ TESTAMEN'T:.J?!' SYLVIA I...ll.91IFNEH
I, SYLVIA I. HOJ1}t'NE:R, n r,"I1:ldent DC UPP('~I' Paxton'l'owll~
ship, Dauph1.n Count.,V, ]\,r,llfiylvlin.!l\, btdn&! of' Hound IHld clisponj.ng
mine, memory and underot.anding, do hereby make, publish and
declare this inst.rument to be my last. Will n~TeBtam0nt, hereby
,revoking any and al] wUlfi .y nw at uny tinwhet'etofore nwde.
ITEM I: I d:Lrect my hero.lnafter named CoExecutor's to
pay all my just debt.s, funer'al expenses, adm:Ln:Lst.r'at:Lon expenses
and inheritance, estat.e, success:Lon or excise taxes, which I owe
or may become due on account. of my death, as soon as may be oon-
venientafter my decease.
ITEM II: I give, devise and bequeath all the ~est, ~esi-
due and remainder of my estate, be it real, personal or mixed, of
whatever nature and wheresoever sHuate which Irray own or have
the right to d:Lspose of at the time of my decease to be divide~
equally among t.he foLLowing:
1. 1/4 to my Bon, F. LeRoy Hoffner, of Mechanicsburg
R.D. #3, PennBylvanla.
2. 1/4 to my daughter, Sandra A. Hoffner, of 955
Margo lane, M1.1IerBburg, Pennsylvania.
3. IIi.! to my son~ Larry L. Hoffner ~ of Quarters
. 493-1, Ft. Rich:Le, Maryland.
4.. J/l~ to Barbara A . AstucdoJ of 5093 Maple Creek
Southeast, Kentwood, M:Lchigan.
ITEM III: I hcre1y nominate, constitute and appoint my
two sons, F. LcRoy Hoffner and Larry L. Hoffner,' CoE:xecutors of
this my Last W:L1I and 'rCfltament, wlth full power 1n the.ir discretion
to do any and all things necessary for the complete administration
. of my estate, w:Lth full power to sett. at pubJ:Lc or private sale
and without order of court any real or personal property belong:Lng
to my estate, and to compound, compromlse or otherwise to settle
"', ~/
(SF.J\L) .
"'-6f_ :~
or .~djU6t any and all cl.im8~ chargesj debts and demands whatsoever
againa!; or in favor of my eatat;eas runy, fill L eould if ;l:lvJ.n(\.
TN WLTNmss Wl-rn:mTIOI",
. ,
I huv,' }l(-!rnunto Bet. my hond Ilncl
. , .? -'
'1'e8 t;f.\m~n L th lU}1--;'"I"{ do,\". of,/-','/CO.,..,C"""
, (~ . ,
aeal to Hd.(1 m,\" Las t Will and
1978.
;/~~t1./t ~/,/ ,J, ,;1('(/> It )/ (milA r.)
S,\"l#:.1" I. Hot':t'ner! - .
Signed, sealed, publil1hed
and declared by the above-
named Sylvia I. Hoffner as
and for her last Will and
Testamen!;, in the presence
of us, who at her request,
in her presence and in the
presence of each other, we
believing her to be of sound'
and disposing mind, memory'
and understanding, have here-
unto subscribe~o\lr(names as
wi}:.l)1esse~ thisj"-'7'" .day rJf
,/~-'9ry?.(!~..... 197e.
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OIlRTlrIOATION or NOTIOE UNDER RULE 5.6(.)
Na" of Decade"t'
Date of Death.
Sylvia 1. Hoff"er
June 28, 1997
Will No.
Admin. No.
1997-00577
--
TO the Regiatar,
. 1 certify that notioa elf beneHoiel intareat required by Rula 5.6(a)'of the
orphana' Court Rule. wa. .erved on or mailad to the following benefioiaries'of.
the above-oaptioned e.tate on July 15, 1997.
IlIIIlll
addre..
r. Leroy Hoff"er
955 Margo La"e
Miller.burg, PA 17061
247 Mary street
HarriBburg, PA 17104
5 Yardly Oourt
Mt. Laurel, NJ 08054
7815 Abby Lane S.E.
Oaldonia Miohigan 49316
Sandra Hoffner
Larry Hoffner
Barbara Aatuooio
.DATBD.
July 15, 1997
Notioe has now been give" to all pereone
7.
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Ii h ffe
129 Market
Millereburg, PIi 17061
Phone. 717-692-2345
Oouneal for Pereonal Repreeentative
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INVENTORY
Ellal' ul
Nu. ~ l-q1 --$"'77
SYLVIA 1. HOFFNER
also knuwn a,
,
1)018 or Oa31h
6/28/97
206-50-1793
. Docoosoll
Suclal Socurllv Nu.
nl,...."M......'-"_/~...IW.o.nfl..UiIIlfI...Mn~IJIMu...IIU..UIMI...W'-
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F. Leroy Hoffner
.~
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ul I'u. ,,0Illul1l1l until. WIHIIOV., .llunlo 1111\1 1111 ullll" laDl IIlnlo IlIlhu CUlIIlI1onwoullh 01 P'"f1.yIYnl~' Itl ..Id UUG.d'lIl.thu1
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Ihnl Ouu.dulIl oWllud IIU lunl oolnlo out.ldo uf Iho CUIIUlltlllWOnllh ul "Olllllvlvonln 1.Il00II( 1111I1 wt~oh tlll,IOI.,.I" 1ll100l1UffUltlUfU
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IIUlho.lIlul,
No"'. ., Allen Shaffer
^"uII10Yl
. . 1.Il, NU,l 7116
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'l. M~II"l 129 )4.c:trhet Et.
Mi ller sburg, PA 17061
...
hlol.hollll 717 692-2345
QOI'"
9,'25/9Y'_
Oo'o.II.\I~1I
Vuluu
Real Estate:
None
Personal Property:
Cash
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/ ~- - 1'70
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"q., ,~', "~~ INHERITANCE TAX RETURN
~ RESIDENT DECEDENT
COMMONWeAlIHOP PINNIYIV"N,. (TO BE FILED IN DUPLICATE
DIP""MEN! Of REVINUE
H"RlllfJ.l1 ~~Otl12l060' __ ... WI!H R.~?~~.!.~R OF WILLS) COUNTY CQI?L
DeN '. N"ME IlAn. mil", A.~ltl Mi'bOLf INmA.lI - 36!CfDttW' COM'lllf'A65'iUS
HOFFNER, SYLVIA I, 100 Ml. Allen Dr.
IOCI'lIICU"," HUM'" D"" or OlAf" JO'I"IO""'"- Meehan I C8 bu r!\, PAl 7055
206-50-1"193 6/28/97 6/26/13 Co,,, Cumberlllnd
,,, "".''''''''''''''0 lIaull" """,''' '"" ,,,. ,10,"'''''''', rOW:'lifiJiiWNUMif' .-- :r~OUHI OI(IIVIO IlIIlHIlIUCtlOHI'
1, Rool! "0'0 (Schodulo "'1
2, Sloc" and Bond. (Schodulo 8)
3. Clo..ly HOld S'ocklPorlno"hlp In'''..' (Schodulo C)
~. Mor.gag.. and No... R"olvoblo ,Schodulo D)
5, . COlh, Bank D'pollll & Mllcellaneoul Personal Property
ISchodulo fl
6, )oln,ly Ownod Propor'y ISchodulo FI
7. I,onolo" (Schodulo GllSchodulo II
'S. To'al G'OIl ......" I'.'allln.. 1.71
9. Fun.ral ExPIA"', Admlnlltratlve COlli, Mlle.nan,ouI I Q I
Eopon.., (Schodulo HI
10. D.b", Mongogo lIablllll.., lion. ISch.dulo II
11. Tolol Dodu"Iono ('o'ollln.. 9 & 101
12, Nol Valuo of E,'alO (lIn. S mlnu, llno II)
13, Cho,i1oblo and GovOInm.ntal Boqu.." (Schodulo JI
14, Nil Voluo Sub,o" '0 To. (lIno 12 mlnu. L1no..!!!.....
15, Spoulol T,on,fOll (Ior~ol.. 01 doath aflO, 6.30.941
S.. Inltrucllons for Af,pUcobl. P.rc.nlag. on R.v.n. (15)
Sldo, Ilncludo yolu.. ,.m Schedulo K 0' Schodulo M.I
16. Amount of lIn. ,.. lall.abl. at 6% ral.
llnclud. value. from S,h.dultt K or 5,h.dul. M.l
17. Amount of Un. 14 tall:abl. 01 15% rale
llnclud. valu.s from Sch.dul. K or Sch.dul. M.l
, IS, P,'nclpoltax duol"'dd 'o.lrom lIn.. 15, 16 and 17,1
19. Cr.dl" Spaulal Pov.rty C...di' Prior Paym.nh
. + ~ 1 70 _ +
20, If lIno 19 h groa." .han lIno IS, on'o, ,ho dlfl"onco on lIno 20, Thl.I,.ho OVERPAYMENT,
mo
21. If lIn. IS I, groat" than lIno 19, onlO' ,ho dlfl"onco an lIno 21. Ihl.I, tho lAX DUE,
A. Enler th. Int.r'll on ,h. balane. du. on lIn. 21A.
S. En'" the 'o'alolllno 21 and 21... on lIno 218. Thi, II ,ho BALANCE DUE,
Mako Chock Poyablo tal Rogl.t".' Will" Agonl .
~ ~ BI SURE YO ANSWER ALL QUESTiONS ON .REVER-5E ~IDE AND YO RECHECK MATH -<(-<(
Und.r "l.naltl" of perjury, I d.dar. thai I hav. uamln.d this r.lurn, Including occompany'ing schedules and slat.menh, and 10 the bill of my ~l'lowled9o and bel,
It I, truI, corr.ct and compl.I.. I declare thai all real ISlate hal bltll'l reporled 01 true mar~.' valu.. DeclaraHon of pr.par.r other than th. perlonal r'pres.nlaliv.
balld on all Information (If which reportr has any ~nowledgt.
U 0 'U.SO A , S'IU'OR "UNO AfTUAN A.QQ"RHr----.. .~-_.- - DA.,1
Mlllersburg, PA 17061 9/25/97
~~E$~ DATE
1 9 Market St" Millersbur!\, PA 17061 9/25/97
I!!
II!
3
c
'OIIlAYII OflllAIH Ani. 12/3'''1 CHICIC HI
If A IPOUIAL
POVIUY CRlDIT II CLAIMID 0
,jUNUMII. -----------
~I
q7
.s 17
. NUMB
YE~~
I
o 3, Remainder R.turn
If., do... of doa,h p,lor '0 12.13.1
o 5, Fed.ral htat. Tal( R.lurn R.qulre(
-.18. Tolal Number of Safe D.pollt 801(4
II
lUll. O'lglnal ROIurn 0 2, Supplomontol ROlu,n
o ... L1mlled Eliot. I.. 0 40. Futur. Inl.r," Compromls.
Ifo, do'.. of doo,h all" 12.12.S2)
~ 6. Decad.nt Ol.d TellO" 0 7, Otlc.d.nt Malntaln.d CJ living Tru.t
(Allach copy of WillI . (Allach co~y of Iru,tl
ALL CORRESPONDENCE AND CONfiDENTIAL TAX INfORMATION' SHOULD BE DIRECTED TOI'
NA.Mf. __d COMmu MA.llINO ADOIUU
j .;' ,. .. '. ';' ~
Allpn Sh"ffpr I..qW OffiCE'
IIl'f"f'll1 HUM'"
692.2345
129 Ma r k e t S t ,
2Yr"~J.L 17961
-
~
~
i
(II..
121
(31
I ~ I.
151__---22.38
29,968,27
-0-
( 61
( 71
30,021,65
12,"18"1.62
( S)
(101
12,787.62
[7.234.03
-0-
17,234.03
(11)
(121
(13)
(1~1
)(._D
1161
17,234.03
1, 03LI .04
_)( ,06.
(171
)( ,15 II
;
.
B
S
(1SI
1,034.04
lnl.ttst
DIscounl
51.70
(19)
12DI __
(Ill'tlt hi II' If YOll 1l11' It'quP\ltllfJ (l fl,fund of yOUl OVI',puYIIlf'nl
(211_.
(21"'1
(2181
9 S 2-.-V~
982.34
E~'ISENTATlVl
IIYdtol'..I'."I
SCHEDULE "E" l .
. CASH, BANK DEPOSITS AND .
_:::~~i.'~~~~~~'~~~ ~~...._!.E:J~~~~~!V~T~...~..__ . PI.oI. Prln! or Typ.
nlAT~ u~YLVIA I. HOFFNER FILE NUMBER
--....----.--------.--~----.~-.-.-.....-~.,.-....---.--__.__.______.0'"... ._.. , __~_'"H"~___~
(All PfOpt,ty lolnlly.ow".d with the "'ghl of Survivorship muol b. d,.do..d on Schedul~'i ----
,_._--,-"-,~---,~,---"" -- ..-----.--___~__...'^...~mn__~.___.H___~_
"1M
NUMBI.
DESCRIPTION
VALUi AT
. DATI 01' DIATH
._.._.___...".________.,.c....__~__.__,
1.
Coin Sets/Cash found in safe deposit box
53.38
'!-
",
,-,
,---
; ; ~
P'
-;,
53.38
TOTAL (Allo enter on line 5, Reco
s
IAttach addlllonal 8Ya" N l' II Ihe.IS !' more 'pace Is ""ded.)
,/
IVV.ISOtIIl+llHII
~;iJ.
COMMONW'''llH Of f'NNIVlVANIA
INHIAIT~NCI T,4,l( AUUIN
"eSIDfNT DECIDfNT
SCHEDULE F
JOINTLY -OWNED PROPERTY
. '".-.......-.----" ".._-----_._----~._---,-
....._--------
.. --rLINUMIIR--
...,.. .'w..__~...-.__....___~_.
ISTAU o'
SYLVIA 1. HOFFNER
---_._-_..~---,.'---.~-_...- ,._~-_.~-"..~.--_.
Jolntton,nll'll
_______.-!l~I!'.L...__.....____..., ____..._._ ....._.~!I)~...SS..
.,.. mAI!~N5.HI~.!~ DICIDINT____.
A.
Sandra Hoffner
F. Leroy Hoffner
Harrisburg, PA
Millersburg, PA
daughter
son
I,
c.
--.-- -~-------,"-----' --------
Jolntly.ownod p,oporlYI
__, --
ITIM LEniR DATE
'OR YOYAL VALVE DECO'S DOLLAR VALUE OF
NUMBE JOINY MADE DESCRIPTION OF PROPERYY OF ASSET % INY. DECEDENY'S INTERESY
YlNANT JOINY
--~~.- ~------ . .-----.--"
1, 11/7/9 of Dep. 11-1260873
A Cert
Community Banks, N.A. $3,905.9 5010 1,952,99
2 . A. 1/7/90 Cert of Dep. 11-12608731
Community Banks, N.A. 6,546.1 50% 3,273.07
3. B. /30/72 Checking Acct 11-107161 6
community Banks, N.A. 7,235.9 50% 3,617.99
4. B. 116/92 Savings Acct 11-1071612
Community Banks, N.A, 36,983.5 50/0 18,t.91. 77
5. B. 116/92 Cert of Dep. 11-1071612
Community Bnaks, N.A. 5,000.0 50/0 2,500.00
6. A.. /4/76 Series E US Savings Bon
#K202681696E 264.9 50% 132.45
.__._~~~-----_.._.,--_.~--_.
TOTAL (AI.o Oil'" on IIno 6, Rocopllvlo"on)
$ 29,968.27
(II more space is needed inser' addi'ional shftefs of same sizeJ
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PAGE 2
ALLEN SHAFFER & ASSOCIATES
LAW OFFICES
129 Markel Street
P,O, Box 335
Mlllersburg, PA 17061
(717) 692-2345
(717) 896-3092
Tele~"': ~m)18tll-3554
Allen Sh.ffer, Es<\.
Berb.1I J, Pelton, Esq.
Perelegels:
JudY L. Peul
Cynthie Armour
Dorothee Buffington
community Banks, N.A,
Market Sq.
Millersburg, PA 17061
2941 N, FIOf1t 81Mtl
8u'lsl12
Herrllburg. PA 17110 .
(717)2"llllll
In r., E.tat.of sylvia 1. HOffn.r
aentlemen.
We r.pr....nt the above-captioned Estate. Sylvia 1. Hoffn.r died on J.une
28, 1997, r.siding in Dauphin County, pennsylvanill IInd whose Sooid s.ourity
Numb.r was 206-50-1793.
For inheritanoe talC appraisem.nt purpoe.s, kindly oomplete the bottom
portion of thie l.tt.r for all acoounts in which the Deo.dent had an int.rest in
your Finanoial Institution as of the date of death and have the same signed by
the proper officer or employ.e.
Your cooperation in this matter is greatly appreoiated.
S;~~y~~
~~rs.) J~dY paul
~9al Auistant
JPlaw
'Account Numb.r(s) 1112608730
Type of Aocount r;ert_ of Deposit
Date opened 11-7-90
principal Balance ~O.OO
Accrued 1 nterelllt -$0.00
Balance at Date of Death ~3.905.97
Maturity Date 11 7 ga
Aocount ownership Joint
Name of Joint OWner, if any Si~drl Hoff~~r
Date Joint ownership was
established 11-7-g0
If within 1 year of d.ath of Deoedent
could prior Account be traced into
a prior Joint Account in existence
over 1 year prior to death of
Decedent n/a
Names of owners of any safe-Depcsit
Box
Additional Information,
~~~
1112608731
r;ert. of Depos it
11-7-90
$0 00
$0.00
~6.546.14
11-7.pe
Joint
SI~drll "'off'1er
11-7..g0
n/a
"
- .., ,.-. ~ ~
',\
, "Ollf Fiwuly :icfll"'flY~lIf FIIII~/y :-;',
"",' ::tlJ)',~~.~)~JJfunCr~'~QI,ne~
~!., ".1., Ii,. '. '. ., I \
""," ,I)alu N, Iloovur'" I. llich~rll'lloo;'ur
, 118 S,Mal~ul ~I.', 103 W, Main Slruul
'.: ':',~il,l~p~L>urIj.J"\ 17U61. m...al.l'llhvlllu,I'A. 170.23
. .... b~~ nVK '. 3b2'K522 "
. -~.:- -~~ =--. '
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for lIoa funeral of: 5y' I
<.v.ta ,
HQ66nelr.
l);Ale: July 31
1991
;'l
. ,_u ..~..:::' :IJ
"
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400.00
" ,.635.00:,
;325:00.
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, ',250 . 00. '. "
.. '250,'00 .~.: I
J;',';j, '\'.--'j'J' "i'
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150.00
100.00
.50.00
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,"20.00
" 25. 0 O~,
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MINIMUM SIiIl.VICIiS 011 STAn' . IIAClUTlIiS
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2595.00
195,,00
,
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.... ,.
COMMONNIALTH OF 'INNIVLVANIA
DI'ARTMINT OF RIVINUI
IUREAU Of INOIVIDUAl TAMEI
IHHUITAHcE tAM DIYIIlll!l
lIE'!. ".."
HAMUIURO, Pi HUI-I"l
NOYICE Of INHERITANCE TAM
APPRAISEHENT. AllOWANCE OR OIIALlONANCE
0' OEDUCYIONS AND AISESSHENY 0' TAM
ALLEN SHAFFER lAW OFFICE
129 HARKET ST
MILLERSBURG PA 17061
DATI
IITATI OF
DATI OF DIATH
FILl, NUMUR
COUNTY
ACN
12-22-91
HOFFNER
06-28-91
21 91-0511
CUMBERLAND
101
A......t ROOIltted
I
(
'*
MAKI CHICK PAYAILI AND RIMIT PAYMINT TO,
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE. PA 11013
CUT ALONG THIS LlNI ~ RITAIN LONIR PORTION FOR YOUR RIICORDS ~
nV:lji.""iinjrp"n':;'iriliiYiciUcip"j"NHiiiifAiici-i"-A'X-APPR'A"iiiifiilr,--Ar.rciiiAi{ci-iiliun--n----m--
DIIALLOWANCI OF DIDUCTIONI AND ASSIIIMINT OF TAX
IITATI OF HOFFNER SVLVIA I FUI NO. 21 91-0511 ACN 101 DATI 12-22-91
APPROVID DIDUCTIONS AND IXIMPTIONI,
12.181.62
.. 'oner.1 E.pano.o/A~, Cooto/Hllo. E.peno.. ISohedul. HI 1.1
re. _to/Hort_ Li...Uitl../l.Iono CI._1. II (101 .00
11. Yot.l IIeduotlon. (11 I
12. Not V.l... of Y.. R.turn C 12 I
11. Charit"'10/Go..rnoont.1 loquoot./ Non-.loot.d .111 Truot. (Ioh.dul. JI (III
1_. Not V.lue of E.t.t. Subjoot to Y.. (141
NOTI, If.n ........nt w.. i..u.d pr.villu.ly, l1n.. 14, 15 .nd/Dr 16, 17 .nd 18 will
reflect figure. th.'t include the tllt.l IIf 6lJ.. return. .......d to dat..
ASSISIMINT OF TAX'
11. Aoount of Line 1_ .t Spouo.l r.t. (111
16, A80unt of lIne 14 t.....l. .t llne.1/Cl... A r.t. 1161
17, Aoount of LIne 14 t.....l. .t Coll.t.r.l/Cl.oo I r.l. 1171
II. Prlnolp.l T.. Du.
TAX CRIDITS'
PAVHENY
IIATE
011-25-9
YAM RETUIlN WAI, C X I ACCEPTED AS filED
RISIRVATION CONCIRNING FUTURI INTIRIIT - III RIVIRSI
APPRAISID VALUI OF RITURN IAIID ON, ORIGINAL RETURN
1. ROOIl Eot.to (Sohedul. Al
2, Stock. end lIondo (Soh.dul. II
I, cloo.1~ Hold Stook/P.rtner.hlp Int.r.ot CSoh.dul. CI
4, Hort_o/Hotoo ....Iv...l. (Sohodul. 0 I
I. C.oh/.onk Depoolt./Hloo. P.rlon.l Prop.rt~ ISoh.dul. EI
.. Jolntl~ Owned Proport~ ISchedulo FI
7. Tron.f.ro CSohedul. 01
a. Yot.l Aoo.to
( I CHANGED
nl
(21
(SI
(41
(II
(61
(7)
.00
,DO
.00
---&..ll.
53.38
29.968.27
,DO
III
,00 M .00.
17.234,03 M,06.
.00M.15.
nil
RECEIPT
_IER
AA242214
DISCDUNT (.)
INTERESY/PEN PAID 1-)
51.10
ANOUHY PAID
982,34
TOTAL TAX CRIDIT
IALANCI OF TAX DUI
INTIRIST AND PIN.
TOTAL DUI
. I' PAIIIAfYI. DAYI INDICAYED. SEE REVERSE
'lIa CALCUlATIIIN 0' ADDIYIONAl INYIMf.SY.
UW.lld U t~' nt."1
SYLVIA
l
HOTEl To in.ur. proper
or.dJt to your acoount,
oub.it the upper portion
of thi. for. with ~our
t.. p._t,
30,021,65
l'.7A7 la,
11.234.03
.00
11.234,03
,00
1,034,04
.00
1,034.04
1.034.04
.00
.00
.00
If YDTAL DUE IS LESI YHAN '1, NO PAVHENY IS .EquIRED.
I' YDYAL DUE II REfLECYED AS A "C.EDIY" CC.', YOU HAV II DUI
A RlfUNII, SEE RIVERSE II DE Of YHIS 'II~ '0. INlYRUCYI~.1
I
\'-
.,J
('j
RESERVATION I E,t.t.. of dec~tl dying ~ or be'a,. Dle....r.', 191e w_ If lAY future Inttr..t In th4 I.tlt. 't trln.f.rr_~
;1" po.....lon 0" tnjo~Hnt to Chu . (00111",.0 btlneflol,d". 0' the deG'" 'U.r thli IMPlr.Uon of MY ..'ete for
lIf. or far v..r., the COMOnNIII1th tMrebv IMprll.h ,...,,,.. th" rllht to .",.11. Md ...... t'lrIt'.r XnherltMCl,. hlitl.
., tM l",'ul Cl... . (oolltterM!) r.t. on any lUG" future Intlr....
...- OF
HOYlCEI To fulfill the requlr-.nb of Secltltln 2UO uf tM IntMrltllnClI Ind ht.t. 111( Aot, "ol .n of 1"'. (72 P.S,
Seotlon 91'0),
PAV.w:JilTI lNt~h thl tor rorUn" of thll NoUn and .ubIIJt tdth VOUi"' p'VMnt to ,thtl R.,ht., of ..1111 print" on th4t t.v.,.. .Ide.
u.... aMok or IIOMV Dr., PtlYlbla tOI REGI.TER OF MILLS, AGENT
RfFUNIJ (eA), II ,"unci of . t'l( orecUt, ~hJch "I' not r.qu..ttct on u.. Tall. R1liturn, .,y bt r,qu.Ued by oo.,llUnl .. "Application
for ..,und of P~'ylv~l. lnn-rAtlnCl and E.t.t. T.M" (REV~lJ1J). Appllc.'lon. ara ay.Slab1. a, ,he Offlo.
of thli R..tlt.r of "1118, any of thl U A.",-.nlJa Dhtrlet GfUe.., or bv o,UIRtI tht .pecl.l Z4~hour
an'Marl", laryle. ~r. for for.. ordarlngl In Pann.ylv~la 1.'OO~56Z~Z050, out.lda P~'Ylvanl. and
..ithin looal Hltrrllburl .r.. (717) 7a7~.O'4, TOot (711) nz.zuz (....rlnt llIpalred Dnh'.
a.ACTlONSI Any party In Intlr..t not .athUH Mlth the ...r.......,t, allowanc. or dh.llotlllnO. of deduotlone, or ........"t
of t'l( Orioludln. dl.coun' or Int.r.." a. .hown on this NoUcl ItUIt object Mlthin Ihcty (60) d'WI of reo.I,t of
thh MoUn bYI
--..ritt.n ,rot..t to the PA Gap.r,..."t of hVIlftu., 10llrd of Appaall, Dap'. Z11021, H.rrhbur., PA 11121.1021, OR
.-.IMtlon to ha"'l the ..ttlr dahraJnad at audit of tIM account of the p,uOMI raptl""t.Uy., OR
--.....1 to the OrphWt.. tour'. '
ADIU"
IITRAnVl
CCMtatTJDHlt
f.otual .rror. dl.oov.r.a ~ thl. ......-.nt .hould be addr...ai In Nrltlne tal PA a.p.rtaent of R.VInUI,
lur." of IndlvlMI hM", AnNI Po.t ......eent ~."'Ia.. Unit, Dept. 210601, tt.rrhburl, PA 11128.0601
Phone (7l" 717w'IDI. Saa ,... 5 of the book1at otln.truatlot"l. for InMrltanca hlC A.turn for. R..ldent
Decedent" (REv.l,01) for '" .~pl~tlon of ~lnl.tr.tlv.lw corr.ct__l. .rror..
DItcoUNl I
If eftV tile .. I, p.ld within thr.. (5' ClIIMdlr IICM"lth. Iftlr the dacltdtnt" doth, . flv. ,.reant (I~() dl'Gaunt of
the _ta. ,aid II .Howed.
ThI UX talC ......tv non.p.rUolp.Uon plftl!tty I. COIlPUtad on the tot.1 of thl t.I': and Int.r..t "......., and nIIt
paid IMfot. Janu.ry 11, 1"', t.,. flr,t d.y aftlr the and of thtl talC une.ty plrlod. Thlt non.partlcApltlon
PIlft.1h I. .....1.1. In thl .... .Inner and In thtl ttt. .... U.. padad at YOU Mould app.al the t.1C and Int.r..t
that hat bHn ......Id .. Indlc.t.d on thh noUo.,
PENAL TV I
INTEItIITI
Int.r..t I. charltld ..Inn'", ..lth flr.t day of .Unquanov, or nlM C') ""'h. Met OM tl) d.v frOll thl data of
..th, to thl d.t. of ,.pent. TalC" which b__ daiUnqu4mt bafor. Januarv I, 1912 belr Int.r..t .t tM rat. of
_hI (':'0 p.rcant pttr """" u10ulatld at I dala, rat. of .OOOU~. All tllC.' ..nIClh bee... rtellnct\tttnt on and I""r
Januarv 1, 1.ll .111 bear Int.r..t It . rata "thlch will vary 'rot c.lend.r YMl.r to calendar Y'" ..Uh that rlt.
announe.a bv tM p. o.partaont of A.venue. 'h. ."llc~l. Int.r..t r.t.. for 1912 throuth 1991 .r'l
Y!!! Int.r..t R.t. Dellv Int.rllt Flctor !!!r Intlr..t Aa'. D.lly Int.,..t Flotor
1..2 20X .0DOSlt. 1917 'X .0002tt7
I'll 1':C- .0000. 1"..1"1 1IX .000301
I". Iii( .00OSOI 1"2 'X ,0002lt7
1915 1J~ .OOOSS6 19n.199tt 7X ,000192
19.' lOX .00D:7lt ""!i-l'" 'X .000l1t7
N.lnt.,..t It OIlcul.t.d .. fOIlOlllI1
IMTE.UT . BALANCE OF TAX UNPAID X MUNIER OF IIAYB DELlMQUEMT X DAILY IMYERUY FACTOR
".MV MoUo. IliuM after th. t.1C bacOHi dllln.,ant will reflect an Int.'lIt oalcul.tlon to flft,," UU dlV'
bevond thl date of tM ......lIIftt. If paVHnt I. ... aft.r tM 'nt.r..t 1l00000tatlon data .hown on tM
Notlc., additional Int.r..t au.' be caloulatad,