HomeMy WebLinkAbout97-00581
21-97-'ifll
This j,~ \0 u:.rtif)' that tht, lllhll"lllatiol\ hNl' gi\'t'll is (IIITt'ld)' (opkd 1"10111 ;111 Ollf~illili l'l'nll,c,lll' [II lk,uh ..lid" lill.d with 111l' (I~
Lou,1 H.t'gl~tral'. The lldglll:ll \'('uilk,lll' will he IOIW,lllkd to till' SLlll' \'ILlI l{nnld\ (lllkc fOl 11('IIlLlllCllt tilillf~'
WARNING: Ills II10gallo dupllcalo Ihls copy by photo$tol or photograph.
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4396159
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Nu,
COMMONWEALtN Of PENN8VlVANIA' DEPARTMENT Of HEALTH' VITAL RECOR08
CERTIFICATE OF DEATH
III I'__WllIcII,L_1
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$OCIA!, st:lJURlrt "111,l1l"
t, 192 - 14 - 7'557
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3/25/21 Mech, PO
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sllver spring
Nursery
OIH1"'MMINOHXlN"$"'~''''''''('.dI OIe'OINt..
7073 Carlisle pike ~~~
Carlisle, pa M~
a,..,._...,..... ".. G C R th
rover , 0
P-".
~herian Hockenbraugh
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-
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W01H111"NANlI'~Il""..,...""..ItlIs..'~'fl Marion Rlfe
lItdiimif........._..,~..~~_,'!l" '.C_
P.O. 'Box 141., lJoyavll1e t Po 17047
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o ,Tune 30, 1997 stane Church oemeterYJwEllveL' Spring Twp.. pa
-~/'IIUMII't H,f,'"ANOACOMIIOf' I'ACllITY
.J"., ".n,!!11897-T, sullivan ".11..51 N. Ti]n?ls Dr. Ponola PU
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1.01 DATIl O' DIATH Ami 1213' /91 CHICK Hili
INHERITANCE TAX RETURN ~O~:::n:~D" IJCLAIMID II
RESIDENT DECEDENT .liINUMllli" ,.,.,." ' , ,.".,.u
COMMONW!'L!HOf p!NNmV,N,A (TO BE FILED IN DUPLICATE 1 "97
OfP.RIMH" O. ReV!NUE 21,
HARRI!ltl:~, ~~o~~\"O',lI " "'," WITH REGISTER OF WILLS) , COUNTY C()OE, , .. ,. YEAR
I l~ftttj}~~;;:"O """'I:;';~;;;7~ ...I'~;;;';~ I~I~;f?;t~:;~.:;~ .i; :;)~
..__..._, ''':'_~'''.'' """''','' ""'''', '''''' '"'' "." "" "'"'''' "",,,,, I"'''''' "CUi"Y NoM'" AMe"",' "''''''' I'" 'N",",IIO"'I
~ Kll Original ReMn (.1 2. 5upplemflnlol Roturn fJ 3. Remainder Return
c (for dolet 01 death prior to 12.13-82)
~I-B LJ 4. lImUed Estale [ 140, Future Interf"l Compromise [) 5 Feder"1 Eslate TOIt Return Required
:z: :::i (for dolos of death ofter 17.12.82)
u ~ 0
K16, Decedent Died testata I--j 7. Decedent Maintcllned 0 living Trutl __.~. e Total Number of Safe Dopasi! 8oxo,
IAlIach copy of Will) (AlhlCh copy of Tnaf)
ALL CORRESPONDENCE-AND CONFIDENTIALTAX'INFOiiMATlONSHOUiOlifDtRECnO'T(),._.-.~.--_._--
NAM[-..--......--------.... --- --------" cOM-PiTTTIXAll\~iGA66ilgf ~------. ---.-------...--.
20. If line 19 is grealer than Une 18, onter the- difference on lino 20, This is the OVERPAYMENT,
II CJ...ft'III..III................-.'..I1IY-UWI...lllmmn.....u...lI...II.IJ.iI,..l11I1JI..
21. If line 18 is greater than Line 19, enler the dlfferflnce on line 21. This i~ the lAX DUE,
A. Enter the Interell on the balancf) due on line 21A,
B. Enter the tolal 01 Line 21 and 21 A on line 21 B. This ii the BALANCE DUE.
Mak.! Chick ~~Ia~11 t!l ~~.~~~!!!..!~~I.~!I!._~~.!~~__..__+_....________.__,. ,.__
~ ~ BE SURE TO ANSWER-ALL QUESTlONsON'REvERSfsIDE AND TO RECHECK MATH ~ ~
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based on 01 lnformatio which prepCHer hen any knowledge.
510 " P'~ p15NSi illiifciifl'u.'N-.' "AOD,f.T- .-_... ,--,-,," -,......, .'''.--' ,....--.-." oA"..............-.--...-
~ _m 300 West DClup_hin, f3.t..re.etL..r:~nola17025 P .:ml..~~-"1l..
--"bORf':.) . PA D~-lT
.. ..__ 717 North Second Street '11<II."E.~!;l~IlrCJLl'~_171Q.2 12-2.9.:~?..____..
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BATURIN & BATURIN
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717 234-2427
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1. Real Estate (Sthedulo A)
2, Stoch and Bonds IS~hedule 8)
3, Cloudy Held Stock/Partnership InlNful (Sched'Jle C)
4. Morlgagei and Nolei Receivable (Schedule D)
5. COih, Bank Depollh & Miscellclneous POrlonClI Properly
ISch.dulo E)
6. Jolnlly Owned Properly (Schedule F)
7, T,oOlf." ISch.dul. G) ISch.dul. l)
8. Tolal Gran Aneh (lotallinoi 1.7)
Q. funo(ol Expeniei, Adminislralive COSIi, Miscellaneous
hpensoi (Schedule HI
10, Debts, Mortgoge liabilities, lIenl (Schedule 1)
11. Tolol Deducllomllo1allines 9 & 10)
12. Net Valuo of Ellate (line e minui line 11)
13. Charitable and Governmental Beques" (Schedulo J)
14" Nel V<!.~!_~~l!~!-.!o To~_~t~~~.!,~~~~.~~_~!!!J~L_..
15. Spovial Tramferl (lor dales of d8~th after 6-30.94)
See ImtruclioOi for Applicable Percentage on Reverie
Side, llndude values from Schedule K or Schedule M.)
\16. Amount of line 14 ta)!,able 01 6% role
(Include valuei from Scher.lule K or Sdledule M.l
17, Amount of line 14 la,w;oble al 15% role
(Include value I from Schedule K or 5chfldule M.l
18. Prlndpolta,w; duelAdd la,w; from lillei 15, 16 and 17.)
19. Credih Spoulol Poverty Credit Prior Paymenh
-0- + -0-
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12 )
13\
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161
17)
581
. NUM~E,R
717 North Second Street
Harrisburg, PA 17102
. -. ,.-------_..._...._-_._.~-.---~._.,_.._-
. _ ________.... ___m.___~..,_,._.__.__.~~__...~_
..0-
--0-
":0:'
1,000.66
$20,-053.61
-0-
$
19)
$ 5,469.24
$
I B ).E!'uo.?~7.u
(10)
2,194.39
(II) ...L"06 6.:J..'.~3
(l2)..1.11,39Q-"_QJ
-0-
(13) ..__.HU_._" m._.'.....
,.,.."..__._.____.,___.J1.jl_"'-~:L~}9::.0::.,:g:~.-==::.:"",
(15) ,
(16)
(17)
-0-
o
.K. ____=
-0-
$
803.40
-0-
$13,}}Q..04
-0-
. .06 =
_K .15 =
liB)
$
803.40
t,
Discounl
--.0-:-,
InlerEllt
-0::....
119)
1201
......Q.-,
-0-
121)
12L~)
121B)
$
803.40
-0-
$..803,4,0
RIV.!5021K+ 112.ISI *'
__~~~~~.~~.,W~~~,~t~m~m'N" _
IITAffol'---" .___._um' '.
SCHEDULE A
REAL ESTATE
. piC. NUMB,.
0_____._,..___.... 'T________,~_,
._. ____. .,. ..__.. __________.u .
______JOI:I!-l P '. .RCIl'H ...._. _n 1<.ln-(lQ58L '
('..pefty I.l.tly..wn.ct with RI,ht .1 Su,vluo..hlp mU.I b. dl.cI...d .n S.h.dul. FI All ,.al..tat. .h.uld b. ,.p.,t.d .1 lal, ma,~.1 v"lu.
which I. d.fI.." a. II,. p,lce at which p,op.rty w.uld be ..,han,.d II.tw... a wlllln, buy., a.d a willi., ..11." ..lth., b.l., compell.d
~. buy ..!..!!II, ......t~_ ha"I",.!!,..!"_a~I!.I!...,,,I.d..ol I~._ ,.1._"...11.,.....---- .--..- --, ..
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
____ d" _______... ..____. .._______.._ _ _,__"..___,..__~___..>O____..
1.
~_..._._-- --.--------------------.--...--.-. ,
* NONE *
, ,- ~
I,
I' ~
.,
,
,-- '
-......<~~~------------.---~-.---....
s ...0-
TOYAL (AI.o .nl.r on IIn. 1, R..~Iulallo!lL-
III mora 'paco I. n..<led, In..'' addll/ona' .h..t. 01 .am. .,...)
~':;~~#Ji:1\1~,::1
mATI 0; ----,-.-~--~.. ..----- -.. .--
JOHN P ROI'H
SCHEDULE B J
STOCKS AND BONDS
""',.,~~,..., -..~o===".'==-'_.__.~'-ilLlNUMiill- ~~"~=.,===
1997-00581
.~+......-._----.-....-------'----_....__._.---~.._-...- --.. _...".._.._-----_.,,--._.~~~_.~-----~_..-
--_...............-_.._-~_.~.------.,.................-.-
(All proporty lolntly-ownod with Righi of Su,vlvorthlp mu" bo dltclo..d .n Schod.l. p,)
'--'~-.-,---~'-.'''--:-'---- ,~-_..._,._-----_...._--_..----_..._--_._---_._'
mM ..
NUMBER DESCRIPTION ,
VA\UE AT DATE
Of DEATH
1.
~.~...~-~,~ -~.._.;-,-._.~.-,.__._......,...._---~--_._..._-,~.~~'-""_---- ,..._-~..--.------------- -----'--------
* NONE *
.--,--.-lOTAL' (AI.o .nt.r on IIn. 2. Rocopll.lotlon)'
III mo(o 'POCl I. n.od.d, In..,' oddlllono/,h..I. 01 ,am. ./..,)
s
-0-
U'l'~O'U' fU7j \
~
COMMOI~Wf"'\1H Of PENNSVlVANIA
IHUIIII1AHCI TAK ..TUIIN
MISlOINT DICIDINT
ESTATE OF --.- --=,=~O
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELL.ANEOUS
PERSONAL PROPERTY
l~,... ..,. .-""
FILE f4UiABER '
. -.
.~-
____-ilQill:l...P.,..-B..<Zm..-----.---.-.-'..-.--..-----....-.'---.._.-...l9.fr.D.0.5.81..------
~II pf.p.f!!.lo~~IY......rt~d.."~-lh. .'lllht .!I~u!ul"o"hIP m~.t.~.dl..I...d!"..S~h.!~~'. '!-----.--'-- -..-.-----------.
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
~_.........------_"'_" .__~_..._..~.._~.. ..--,-_._~_.~....,.-~~..~".~----~-i--~---
$1,000.00
1.
1988 Chevy Corsica
(proceeds from sale)
.---
----.-
..--!~TAL (AI.o entor on IIn. 5, Rocapllulatlo~ ~.l.&9.Q-JHL_----
IAlIoc:h add,1I1onal eVl" x 11" ,h..t'U ",ore 'pace II ne.ded.) ,
...,qsoqll(+ll1l1l l
* SCHEDULE F
COMMONWIAltH Of IINNmVANIA JOINTLY -OWNED PROPERTY
INHUU1A.Ne! TAIt UlU"N
"fSloeNT DeceoeNT
~=.=--~-..:=..-..:.;-- .,.--_.~--
l
~ ~~-
(JOHN P. Rartl
..~_~_~.. _._~ ~_._____.u..~___.___~.__t_~_
PILI NUMBER
1997-00581
-~---------------
ISTATI O'
---~..---_.~._~._-_.-...._~-~_.-
J.I.t ,....'(.1'
NAME
._ADDRESS----.
RELATIONSHIP TO DECEDENT
-........------.-------------
A.
* NONE *
B.
C.
J.I.tly...;,..d p"p,"y'
--
ITEM LEnER DATI
'OR TOTAL VALUE DECO'S DOLLAR VALUE O'
NUMBE JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. J Camerce Bank, N.A.
Checking Acct, *032048548 $45, 161. 04 1/3 $ 15, 053. 6'7
Note: Account was held
with' Sherian, L. Hocke braugh
and Eugene R. Arnold, Sr.
2.
11
1984 Liberty Trailer $10,000.00
Title of trailer held
jointly with John I< Cheryl Ro h
1/2
$ 5,000.00
'TOTAL (Aho .n'" on IIn. 6, RICopllUlotlon)
'(1/ mOrt .poc. i. nood.d In.,,/ .dditlon.' .h..h 0/ ,.m. .i..)
$ 20,OS3.61
U\I.1Sl1lhl1.l'1
SCHEDULE H \_
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
_ ~ISCEL~~.N~.:'~S EXP~Nn~__ P.I.a.. Prlftl 01 TVI!~
_..__~.,__~._--- '_.,.'__.'.____.'_n~.'." .__~:_.~_J:' N~::;~00581
~:'~.~
'ilo(BII'_
COMMONWEAllH Of PENNSYLVANIA
INHE,.nANCE lAK RETURN
RUIDENl DECfDENT
n .-..' .... --.....--.---...
TATe OF ---
JOHN P. RO'l'H
ITEM
NUMBER
---.-----
A.
I.
2.
3.
;:;.r::::.:;;::::,~
DESCRIP1'ION
AMOUNT
~._............---.~~_".____~".'."_'-__' ,._.~m'_~~_'._'_~__________
Fun.ral Exp.n....
$ 3,465.00
$ 450.00
$ 78.00
Sullivan Funeral Home
Stone Church Cemetery
Gingrich Memorials
B. Adlnlnl'lrallv. Co.l.. ( Comnissions Waived)
2.
c.
I.
Fe..onal Repre..ntatlve CommllSion.
Social Security Number of Pe..onal Repre..ntatlve,
Vear Comml..lon. paid _._________
--t'"
Attorney Fe.. Batllrin & Batllrin
$ 1,052.68
3. Falnily exemption
, Claimant _.___..~___ Nelation.hip
Addre.. of Claimant at decedent'. death
Street Addre.. .
City _____.
Stata __ Zip Code_
4.
Probate F... Register of Wills - Cumberland' County
$
64.00
Mlte.llaneou. Expen....
Patriot Evening News (Advertising Expense)
Cumberland County Law Journal (1\dvertising Expense)
Register of Wills, Cumberland County (Short Certificates)
4. Register of Wills, Cumberland County (1\dditional Short
Cert.i.ficates)
5. Register of Wills, Cumberland County (Family Settlement
Agreement)
6, Register of Wills (Inheritance '['aK Return)
$ 233.56
$ 60.00
$ 15.00
$ 9;00
$ 17.00
$ 15.00
$ 10.00
I.
2.
3.
7. Register of Wills (file Inventory)
8,
--------------,_..-..~~-_.
TOTAL (AI.o enter on line 9, Recapitulation) $ 5,469.24
Ilf more .paee I. n..d.d, In..rt addlllonal ."..1. of .am. .1...1
IllV,lmnt{I-'ll)
*'
COMMQNWfALYH OP 'fNNsnVANIA
INHUlfANCf YAK IlftUIlN
IlUIOHIf O~CIOfNl
ESTATE OF
,lOHN P. RCfr\1
--;. ,,".,..... ..-- ._~..... ---------_.-._--,-"-
____.~_n___._._..~____>.. ..-.~-...-~.----~
'-~~~~E~T ..
DESC~IPTION
AMOUNT
..-..- ~_._._._-_.~-_....-~..-
1.
Pennsylvania p~r ~ Light Company (Electric)
$ 207.21
7. Leiby's Parkway (trailer lot rent)
8, Agway (Natural gas)
$ 264.23
$ 27.30
$ 71. 43
$ 29.01
$ 34.55
$1,052.00
$ 211. 34
$ 38.58
$ 65.00
$ 69.64
$ 12.80
$ 111. 30
2. Debra Basehore Wiest / Tax Co11e~tor, Si1verspring Twp.
(real estate taxes)
3. West shore Pathology
4. Bell Atlantic (telephone bill)
5. TV Cable of; Carlisle (cable service)
6. Conner" Rich - Kearney" Torchia Associates
9. Weber's (trailer repairs)
10. Eugene R. Arnold (car cleaning, dhurch ~ !'lastor) ,
11. Sheaffer's (carpet cleaning)
12. Post Master (stamps)
13. Masterr~lean (hydro spray)
_.,._..,....~._--------'..._~.__._..._._~___~_---------M..._~._-
....'n.-----------_.__
_________R
_____. TOT~~.~AI,o_~.n~'-""_~"_.~o~.~~'apllu~~~~.___ .!2,l2j....~---_.-
(If marft space Is needed, inser' additional sheoh 0' sames!le.)
~~ \
COMMONWlAllt1 Of pftm~'/IV...HI^
INHI."At~(llA. ..'UIN
~ ,^"_ .,~.1!~~.~~1 o..'~~O~~L;:,.:,"..~~;=;;':";':;~ri:;";--
ISTATI OF '
l..- ..
IlIV,UIHhlJ.tl\
SCHEDULE J
BENEFICIARIES
FILE NUMBI~
1997.-00581
JOHN P. ROTH
.--.,,-..---...---....-...-...-
....__._._u__._.___..__.
~.--~_.-~-
ReLATIONSHIP
____,,,__-.- _~____ _",,_~_..__n___"~ -----.-~~.-...---..------. .-.- .-----------~--..----.-
1/4
ITlM
NUMBI~
NAME AND ADD~ESS OF BENEFICIA~Y
-.---,--- -.----.--"--..--.--
\,
A. lOl<oble Reque.ls:
Eugene R. Arnold
161 5 On's Road
Enola, PA 17025
Son
son
2 .
John H. Roth
1517 OrrIs Road
En,ola, PA 17025
son-in-law
3.
Donald L. Page
632 Front street
Marysville, PA 17053
Daughter
4 .
Sherian L. Hockenbraugh
300 West Dauphin street
Enola, PA 17025
Daughter'
5.
Shawne L. Roth
121 Calvary Road
Carlisle, PA 17013
....------'----
~
--
NAME AND ADD~ESS OF BENlflCIARY
,.....---
ITIM '
NUMBIR
8. Charitobl.and GovernmenlaI8equ..ts:
1,
* NONE *
"'-~~
_.,_.-._-~._-~.--'~._----.._~
. AMOUNT OR
SHA~E O' ESTATE
1/4
$ 5,000.00
1/4
1/4
AMOUNT OR
sHARI O' 1ST A TI
~-~-----,-~~_........---~_...~_.__.._,_..~_.......-......----'~~...----~.__._-----
(limo,. .pac. I. n..d.d, In.ort addlUonol .h.." 01 .am' .,..\
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AI.o.onter on line 13, Recopllulollonl $
_=.0..."'----
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lnven\ory 01 Ihe real and personal e8tale of
. .i!Q!!!:L!:"" RO'rllL-
_---- deoeased
--
~~RSONAL PROPE~TY
15,053 61
Commerce Bank, N.A.
. Jointly held Checking Account No. 032048548
5,000 00
Proceeds from sale of 1984 Liberty Trailer
1,000 00
Proceeds from sale of 1988 Chevy corsica
WQEREAS, the parties hereto desire that the Co-Executors shall not be required to flIe a
fonnal accounting or Schedule of Distribution with the Court of Common Pleas of Cumberland
County, Orphans' Court Division, and that the net estate of the decedent shall be distributed
wlthoutthe necessity of filing a fonnal First & Filial Accounting,
lI/OW. THEREFORE, the parties hereto, intending to be legally bound, do hereby
mutually agree as follows:
I, The parties hereto, and each of them agree and acknowledge that they have fully and
carefully examined the Inheritance Tax Return and Inventory of Real and Personal Property with
the required original schedules attached thereto, and the Schedule of Distribution relating thereto,
and find them to be true and correct, and acceptable to the parties hereto and each of them, and
further, that each of them has received a copy of this Agreement and of the said Account and
Schedule of Distribution.
2. The parties do hereby release, remise and forever discharge the Estate of John P.
Roth, Deceased, and John H. Roth and Sheri an L. Hockenbraugh, as Co-Executors and ,
personally, ofand from all manner of acts, suits, claims, accounts, accountings, debts, dues and
demands whatsoever which they or any of their legal representatives or assigns may at any time
hereafter have, against the Co-Executors and/or their attorneys, the said estate or the assets
thereof, from, for, relating to or concerning any of the assets and property of the said estate
and/or any claim or interest thereto or therein, and the administration, management, collection,
sale or distribution of any of the said assets and for or on account of allY money, interest income,
-2-
assets or proceeds out of same, from the time of the death of the decedent to and including the
date ofthls Agreemcnt and Release.
,Furthennore, also by these presents, we remise, release and forever dischargc from
any further responsibility, liability, or claims, past, present, or future, Madelaine N. Baturin,
Esquire, and the Law Finn of Baturin & Baturin, and/or any of Its individual memben, attorneys
for said Estate, in connection with her/their representation of said Estate. Moreover, we are
entirely satisfied with the legal representation received in connection with the administration of
said Estate and the fee charged for services rendered in connection therewith.
3. John H. Roth lInd Sherian L. Hockenbraugh, Co-Executors of the Estate of John P.
Roth hereby waive the right to receive any fee, commission or compensation for acting as a Co-
Executor or in any fiduciary capacity whatsoever.
4. The Co-Executors and/or all beneficiaries, collectively and/or individually, named ill
, the will hereby waive, forego, forgive, and cancel any right or claim to which the estate may
otherwise have had for sums advanced, or loans made, by the, deceased to the individuals set
forth in paragraph 5 of the will.
5. It is understood and agreed that a sum in the amount of Two Thousand Two Hundred
Fifty ($2,250.00) Dollars shall be temporarily maintained by the attomey for said Estate to be
held In escrow as an Inheritance tax/fund reserve pending receipt of the final clearance letter
from the Pennsylvania Department of Revenue. In the event any amount shall be claimed and
proven to be due and owing to the Commonwealth or any credltol'(s) of the estate, in excess of
the aforementioned amount, the beneficiaries of said estate shan be solely responsible therefore
and satisfy same promptly, upon presentation and verification.
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MAKE CHECK PAYABLE AND REMIT PAYMENT TO!
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LXNE .. RETAIN LOWER PORTION FOR YOUR RECORDS -4
iiiV' = U;;1-ix -AFP-i 09 ="Y"Niifici - -oF-i"NHiiiifANCi- TAx. APjiiiA"i siiiiN:r; "ALUiwANCi-ii,r----- -." -- - - - -.-
DISALLOWANC! OF DEDUCTIONS AND ASSESSMENT OF TAX
JOHN P FILE NO. 21 97-0581 ACN 101
TAX RETURN WAS I I ) ACCEPTED AS FILED I X) CHANGED SEE
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COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
IUREAU OF INDIVIDUAL TAXES
tNHERITANCE TAX DIYISION
OE:PT. 210601
HARRISBURa, PA 17121-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT. ALLOWANCE DR DISALLOWANCE
OF DEDUCTlm4S AND ASSESShENT OF TAX
BATURIN 8 BATURIN
717 N 2ND ST
HBG pA 17102
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-23-98
ROTH
06-26-97
21 97-0581
CUMBERLAND
101
AMount R.Mlttod
l
ESTATE OF
ROTH
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. R..I E.t.t. (Soh.dul. A)
2. Stooke ond lond. (Soh.dul. I)
$. Clo..I~ H.ld Stock/p..tn.r.hIP Int....t ISoh.dul. C)
~, Kortg.l.a/Not.. R.c.lv.b1. <<Sch.dul. D)
5. C.ah/Bank Olpo.1t./Hiac, P.r.onel Prop.rty (Schedul. E)
i. Jointly Own.d P.op..t~ ISchedul. F)
7. Tr.n.fer. (Sch.dul. Q)
a. Totol A...'Io
11)
12)
(5)
14)
II)
Ii)
In
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.00
,00
.00
1.000.00
20.053.67_
.00
III
19)
110)
4,881.56
APPROVED DEDUCTIONS AND EXEMPTIONS I
.. funer'.l E><pen.../Adll. Coat./Hhc. Expen... (Schedule H)
10. Debt./Ho.t.... Ll.bllltl../Ll.n. ISch.dul. I)
11. Tot.! D.ductlon.
12. Net V.lu. of T.. R.tu.n
13. Ch.rltebl./GoYernM.n~el B.qu..t.) Non-elected 9113 Tru.t. (Schedu1. J)
14. N.t V.luo of Eot.to Subj.ct to T..
*
'I~.I'H U U, I...."
JOHN
P
1
DATE
ATTACHED
03-23-98
NOTICE
NOTE I To In.ure proper
credit to your account,
.ub_it the upper portion
of thl. forM with your
h)( pey..ent,
21,053,67
2.194.39
111)
U21
(151_
(4)
7.011; QIi
13,971.72
.00
13,977.72
If .n ........nt w.. i..u.d pr.viou.1Y. lin.. 14. 15 .nd/or 16. 17 .nd 11 will
refl.ct figur.. th.t includ. the tot.l Df abl r.turn. .......d tD d.t..
ASSESSMENT OF TA~I
11. A_t of Un. 1" .t Spounl ..t. US) . DO x. 00.
a. AMOunt of L1n. 1" to.obl..t Lln..lIClo.. A ..t. Uil_ 13.971.72 X .06.
17. AMOunt of L1n. 14 to..bl. .t Coll.t...I/CI... I ..t. U71, . DQ. X .15.
la. P,lnclp.1 Ta. Du. Ilal
TAX CREDITS I
I PAYHENT RECEIPT
DATE NUHIER
1:::::::::" ..,.,...
INTEREST IS CHARGED THROUGH 04-07-98
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
NOTE I
DISCOUNT 1+'
INTEREST/PEN PAID I-I
.00
AHOUNT PAID
803.40
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
,00
838.66
,00
83~
803.40
35.26
.10
35,36
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIOWAL INTEREST.
IF TOTAL DUE IS LESS THAN .1. NO PAYHENT IS REqUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICHI. YOU HAY IE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS,)
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CUT ALONG THIS LINE .. RETAIN '-OWER PORTION FOR YOUR RECORDS -4
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lURE AU OF INDIUIDUAL TAMES
tHHERJTANCE TA)! DIVISION, '
DEPT. 110601
HARRI'.URO, PA 17121-0601
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
, APPRAISEHENT. ALLOWANCE DR DISALLUWANCE
OF DEDUCTIONS AWD ASSESSHENT OF TAX
BATURIN 8
71 7 N 2ND
HBG
BATURI N
ST
DATE
ESTATE OF
DAn OF DEATH
FILE NUMBER
COUNTY
ACN
03-23-98
ROTH
06-26-97
21 97-0581
CUMBERLAND
101
PA 17102
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717 NOf'-TH 5PCOND STkUT
HA"...iOUl\.o. PBl>U>lSYLVANIA 11101
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MARY C. LEWIS
REOISTER OF WILLS
OFFICE OF THE REGISTER OF WILLS
CUMBERLAND COUNTY COURTHOUSE
ONE COURTHOUSE SQUARE
. CARLISLE, PA 17013
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IURIAU OF INDIVIDUAL TANI'
IH"UITAHC:E lAM DIVIIlIll<
DEP!. 2...0 I
HARMtIIURO, PA 1711'~D"1
"vnnv"'''''.....". _. . .'nw_._..........
DI'ARTMINT OF RIVINUI
J:NHERlTANCI! TAl<
STATEMENT OF ACCOUNT
"-.-.....
PAYMENTS <TAX CREDITS),
.
'''.1,'''''''11I''''
BATURIN 8
717 N 2ND
HBG
8ATURI N
ST
DATE 04-27-~8
UTATE 01' ROTH JOHN P
DATI OF DEATH 06-26-97
'ILl NUMIER 21 97-0581
COUNTY CUMBERLAND
ACN 101
F ~~t NH1H.d__]
MAKE CHICK PAVAILE AND REMIT PAYMINT TOI
PA 17102
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE I To 1/...... pl'OP.' orodlt to ~our .ocount. .....It the _.. po.tlon of thl. fo... wlih ~our t.. p.~"""t.
CUT ALONG THIS LINI .. RETAIN LOWER PORTION FOR YOUR RECORDS -4
itlV': lioiij"i.jf-AFP--C iii:m--. ----iiii..- "fNH!RiTANCI - TAje - STAfiiii-tiT- OF "A'ifciiiJii"f-- ..".Ii---."" -- - -" - -- - - - - ~ --
ESTATE OF ROTH JOHN P FILE NO. 21 97-0581 ACN 101 DATE 04-27-98
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN I~LDW
IS A SUllI1ARV OF THE PRINCIpAL TAX DUE, APPLICATION OF ALL PAVHENTS. THE CURRENT IALANCE. AND, IF APPLICABLE.
A pROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 03-16-98
i"RINCIPAL TAX DUE I 838.66
PAYMENT RECEIPT DI SCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
~
12-31-97 AA242608 .00 803.40
03-24-98 AA269885 .00 35.36
'Dill 0
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tJ t( I , 838.76
~, ..<'
J&' I,b
~ :',0 BALANCE OF TAX DUI .10CR
C~
ad INTEREST AND 'EN. .00
f--
II IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUI .UCR
L..
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN II,
NO PAVHENT IS REllUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREOIT" ICRI.
YOU HAV IE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I