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HomeMy WebLinkAbout97-00646 'ItETITION Io'()R ItROI.ATE unci GRANT ()It' LETTERS liS/IIII' Il,rr/ifJl:.lbJc_c./n..,COah.,.,_", No, ,.~I~.Cl7~.'.'1i__......;., 11/.111 kl/llll'l/ lI,f ._.__.c..."'cco.... .CO' ..'"'''_.''co._. To: .. ___._.........._...._.~,'_co__..' ".'CO.' '" ,..._" .' _...... ,Iteulslt1f of Wi1ls fur)he J, ._...._.,......,...........-..~'-t~"~...,......J 1!1'I'I'Il.\'fII/. COIIIIIY of.A::'~u.gli'r-{4\tl.Q"_ 111 the Sudll/ ,~I'I'l/r",I' Nil, ..L .S_'::,I.;.~.,r.e.,5.:.b.__.. . Cmnl11oll\Vclllthof I'cIIIIsylvlIlll1I The' pClltlollof thc IIl,dul'sIUII~d I'CSpcct flllly fUpl'CMClIls Ihllll YOllr 1lIlIItIml~l'(s). who Wnre IH YCIII'S of ""9 01' lilder IIl1lhc \lXCCIl"MI...,."'.~--._._.._.-----tlyed 111 Ih~'IIISI wlllollh~' III1\lI'C)IMI'dclIl. dilled coVU.f1'll.'f.~'''' .......,..,...,...____,._... ,II). llI11lcl\dlcll(s) dilled ~If....n..... .....'.'.......' ......_,.. ..........'.'______._____._ . ::J~A;; -.~:h);2t/iiirr::"-/._'€l.':~02i.iJJ--'.::..-==~:::.:~=:,~=.:"-===-"~- l'tllll~l t~II~\\'1I111 clH'IIIll'III1Wt''1. r.". rl'l1l1lll'lullnll. chmlh or ~'\1!1'1I1{l', VII:,) pCeCl\llell1 WI!S d0l11klludll1 dClllh 111. ..I"twl(Jt:.rk,.Jc..'r-.' n,r;CnllnlY, PennRylvllnlll, whh II,i.s"'CA,.,~~~}~;I~JP~IIt%~;~I~I~e _11.1:'.:::~~:~~~~=.:.~~::~=-n.. (Ihl. "III.'CI, IIl1ll1hur 11I1,11 tllllllL'll1nlh)'1 1I11l,~Ull:~~',~I!;~.=~::.:.::::.I~el~M,;~I~~~~:,~~~~~_"='!~~~t=:~~.r,~:::-,,:=~==:=---'__l 19 / 'l?"I : Ex~cl'lu, follows, d~~~dclII did 1I011l11l1TY, IVUS 1I0l \lIvOI'~cd IIml dill 1101 h~vu /I child borll or '/ldoflled :::'~~l~'~I~~~~~:iilll.~,f,~I.I~)r~,l'ur~ll:'~I~.~':~~..1~~~'~~l~~~I'~.~~u IIl1d \Vl~er IIdJlldICllt.~ llcc~'lIdcIII III delllh ownud prnl'crlY wllh csllllI/llcd YlllilUS liS follolVs: (ff dOIllIi:llclll/l I'll,) ^1I.pCI'Solll\lprnlletl~ S.J. , ,_,.;_ _c __..._ (11'1101 ilollllclled ill I'll,) I'mollul propel'ly III I'ellllsylvllnlu LoI$It'f't!I.' ere) ... (1Illlllllollllullud iu I'll,) 1'~'l'solllll propcl'lY ill COIIIII)', S_~, . Vllhl~' Ill' relll ~'lillll~' III 1'~'IIIlSI'IYIIIIIII " $___ '1Il1l1ll'd II' fl)lhnv,: ;"':.l,.~_....7t-r-'--"?i-'::::r7----------,,_,,':"'--;;e:: ~ tf') ~,' ,~. ,../>. t.J!.:ctFJjij:an;.,. .l!t::lI.l......l;;.Ift,_ffii,..,,;,,=(S'4a~"',-i" '-, __' ~ _ . \\'IIEltliI-<JIW. petlllurwl'(') I'C~11CcIfIlIlLrC(VICS\(S) 1)le pl'ohule of !he IlIsl will lIud codlcll(!) Pl'csulltcd hel'cwllh 1I11111hc "I'll II I ollellm.2!'!!I.DJ.lil!:/I.tlt.t.)!,..._____.,.____ ' I (l~"Il\llICl1lurY: ndrnl/ll\HIlIIUII C,I.il.llldlnlnllitrlllll1l1 d,h:n.l;,l,a,) IlwllllI, ~ H l;1i 7~ llf... ~ ~ J, , /'l /~, ..'-' /-" ~C4""'JHc:....'?\' ...'it;:(.1.b.t,. '~!~~-~i;_~~~~Zf:[:",'::"'=. ,~rllJ/.I:/.~.::,.:Il, ...':,:'::..::::: - ~..-.~._~--~._.~ ~.~-...........~_.... t_:~.~",.':1, _:~;""l_':;.c..-.:-,; .-._~~-'!.l;.~~::,7:;~'.-;:;!::..'<c:.::~".':::;:,;.;.~:=_;...~...::~_:tt~==';t::I!~::"~.::.==~r.~l-==::.l'~~;::~._"""-u.=. OAt... OF IJERSONAL REltRESENTATIVE ,COI\lMONWEAIJJI OIII'E~N'LVANIA Ltltl COliNTV, ()II ",~klill.a~".mtJ _,..,.:...,_ J , TIi~ l'ullilt'IIUr(')lIho\,lIoIlIIlIlUi( ,WCllr(S)l1Il1f1'lrlll(s) lIulI Ihc ,tIlICII\CIl" Illlhc flll'OllOill811elllloll nte, II'IIU 111111 com'ullolhu hu,1 of th~' klll1l\'lcd"u 111111 hullef 01' I'clllll1ncl'(') 1II1lIIhlllnsll"CrsonnlreptONcn. ,11I1I~'cls) 01 III<' IIhnl'l' dcuc\lulIl I'cllIl',II1CI(S) 11'111 wclIlIlIll Itllly udl1lllllslcnhc cslnlC IIccotdl118 to,IlIW, SI\'!'III 10 01 IIIThl1l~'b IInd '1I1l!'~'llhed~Lk'I.f-It~L:"~_"@~ I ~t 1I'l' 11\\' Ihl,.. dUlol . . . _ .. ~.._ ...__._....___.~__ ,,,'IJJ7I1 ,jul,y". ~'..J ,I~ 97 _.. .,.._..,_.._.~_.__..____,_ . '/.f..-vvr;4 G, . JUl.' (.cJ.~ t.!;~\l :, . :~L'~ _.. , ..... ...____ .._...._u_,__._ l.!r~/95..1 t1ry Cf:!l,ewja II~',I(/ ?I');;r.. _c"c~_.,_,._,__..___ t! PETITIONII'OR I'ROBATE und GRANT O~' Lln'n~RS , ' /;:1/11/(' 1\1' ~ Be~j;'pa, ti!.,..9..rf:,t~~-~ Nil. :,~.2 b2.7..:_~.!iL~-.--- l!/,\(/'kl/llll'll ll,\'_'-'~~~-_"~-""~"'---"'''~'''- Tlll ' __..",_,_.._,--,-,,,,..I~..-..-...",,---,,""-"'~ R~gIRI~r uf ~IIIK bor tll~' d _.._"'.:.....;..----.-.'-''>:1',,-''.-.1 INcc'c/,wr!. CCIIIIIIY llf '" urn er an In tl1~ 8od(ll8c'c'l/f/l,I' No, ~.".&.:C.:~.:..!!:!!1--_.. , Comll\onlvolIlllI of llol1l1Kylvnnl1l 1'I1IlIWlllllln Ill' 1110 IIl1d~I'KI~110dl'~KI1Q011'1I1IY rol11'oKonlK ihull YOIII' IWllllonor(K,l, wlill IK/uro-lK'~OIlI'K 01' U"O or Illd01'llglll0 OXQO\i1_-'U',_-~~-~ l1~d. 1Illl10,IlIKIII'III 111'1110 lI\mvo (Ioo('dolll, dnlod .___';!J,lnlit-..,/.-.--.-.._~-~ , ,19_ IInd \:lldloll(K) (hllod __,___._Nl.A-,--,-.~,...-.,..-.._.'.._..c.--;,~-_"_" ',----' ' ......--._~_.-_...,..;.-=~..---.,.............--.. ......,.,.........;......._,~~;;,.~~..:~...l~ ..J.Qhn._M..__o.l.:r.ili__.J1~,,~J..~7L-I~-,,-,-..---i---"-''''~ - ...__.....,......-______' _.. ~~ _. ___u ~..---___,..... ......_.......,..,..~ _~........._..~.~ ~-.............----.~- .-+. nT~---r----... (!illll~j'tcl\.!\'unl dtCllm\jiiU\c~~1 ~\", f\.!litI,twll1llnil, Mlllh I1r 1'\c;'l.1UHlt,.cllJi' pooondolll II'\IK dOlnlollod Ul\lollll1 In __...Q.JJri\lNIJ...~.n.9.-I.._.._.~,CUliIlIY, "oIlI1Kylvlln'illl wllh IIJL~" hl~lr"mll~' ol'J1(hloll'lIl 1'0Kldonoo III ~..'.J.l.!LM.adj.tLRQ~.._. '," " . J:JAl.:,\"J,ll.u..<~flL(,llQ.rou,gJ:\l-~..:-,.-'~~'_----- , (UIII 'lfl!ul,lIl1mhiH 1Il1\II1\\IIll.:lllllIllYJ 110001\dolll,llIon...___~L,I'0Ilr~ OI'II~O, dIOd.._'---_JU1~4-_...............-.--:; 19 97 111..,J!,Ii\1l)!il.-,,--'--,-..,,--..,........,.----'--_:----- ' I\SCOlillls rollow~. dooodolll dldnolmnrry; IVIIS nol (,1lvoroed IIl1d did 1101 hllvo II child born or IIdol'lOd IIrt~I' osoc\illolI or Iho will offul'od I'llI' I'I'0blllOi WIIH nOl, Iho vlellm or II kllllllg IIlld 11',118 novollldl\ldlolllod IlIoomlWlcl1Il __..Ji/..&...---, ,..-~_.~--' . [)ooclldonl III dtiluh ml'l,Wdl'nlPOrwwllh ,oSlln1luod vlIllIes ns l'oIlOIVS: (II' dnfniellod IlIl'n.) AlIl'orsonhl proporlY (\I' nol domlcllod 111 I'll,) ,'orsonllll'l'oI'OrlY 11I1'Olllls~lvllnlll (IIllol domlcllod In I'll,) POrHonll\ prol'ol'lY 11\ ,Connly Vllhle orrolll OSIl\IC III 1'0n1\~yll'l\nil\ slll\\IICd'(1~ ro\lo\\'~: --,--~--~.. $~~OO,oo $ " .. L ,$ - --_............,... .........------_...~......~ -- " .-,..-......' +-., .,~_.~--_._~------.............-_.. ----~.-~--- .......~.o<~L.m.__'_~__ \V11E1~EFORE, pOIItI\1llor(~) rospoOll'illly requoKI(R}'/ho probllloof Iho \IIKI will 11l1doodloll(s) I'rosenled horowl1l1 ulld 1\\0 ~l'lInl or ICl\crs:_'r~~M1entan' ' j - {lI)\;ll1nW1\llH)'l Ildmllll'ilrlltl\1n l:.l,l\.i IUllnlltllUrltllon d,tMi.c,t,n;} 11)010(1, ~ , L 'Ii ' ..i ';l:~ n .' 7 a:; :T'O' R -;. e. 1\ R," [//!j~,"~i" :;:t:;.,TJ"::,.),,::~)~'=;,,, ;1~:': 'J'J....,'lIJ, /rzs.,'1~-:.i;_,''.fI.!. J.J,c.....- ,('tt.,t; ,/r;;1"<1.t=~",..t)'..I)/..J... ~.&~J f cQ-1J?~ .__.-----_...~~.__r ........-----.....-"""-1-.-,---..,.....-- -,---_.--,_..;......~..... __~,_" ___,~ H~~__~_~___"'_-''''' .._-.... .~~......".--'--.._~~ _---.-._------.---~---- _ _ ~.__..~ .~_~ ..,_~_uu._.........__.......~~~u_____~_..__...~4' ~----.--- ;c,,::;...f,:.:_~-_::c~,.:-,=~~":':.'l=.~;<r=;':.:;;~~~=-,I~...;...................~~------~...:...-=~ -,~ ..... -- OATH OF I'I~HSONAL REPRES1~NTATIVE e()MM()Nw.~AL'l'I-I,O... 1)1';,NNsnv ANIA '} ss , eO\J N'\'\' ()II ,_g.\lWer 1.~W ' ,_........ Tho 1'~lilloIlOI'IKlllb()ve.llllllll'd ~wollr(') or Ilrnnn(K) I hili 11111 KIIIIOi1\Ollls III tho fotqgolnll 110111l0l1nrQ ')I'IIC Illld ,OllrrO'11 101110 hoM lll' 1110 kl\,o\\'lod~O 1111\1 holloi' ofl1olhlol\or(R}'lll\d 1 hili 11\ rQrK0l1l11 rOl'ro\Qn.' 11111\'01") lll' 11ll' IIhol'O ,looodoIIl110\1I101101IH} will wolllll\d,ll'lIly Ildl111111sl0r Iho ORllltO lIecordll1g 10 Inw, SW~1I11 III ,\01 nrnl'l\~o~I~~IIIlI KllhserlhO(I,~.jC~f.-_~; t, hol(11'1' In111" .__~.,,,.... It.ll ~. ..-- d~\"lll ' _.-,-,,--~---~~_..:....-, ri,.ilJ:!.lY..-A-~"--~-' )'Jr/, .diJ~'-"'--"----- 7t~l.,.;."i~i~1.fll1...A:~ r r'--'''- ......------.-. -- MarV,Lew e /k~I.II,'r, .. ......~__...-...,,- .:a. " ,'" ~~. (\. ~ c-'\ p.. <I \ i(5l, .~f.~~ ". , ,', \~. 1(' o _ ,~,;, .-...... " ,j)~ '01,;1 " !. ., \ " \ ,; " \ !i I /i ! ,,; i' i' .I " / ,'" / (10:" I t;.J. ..J" m,UOOI" 1M., *' INH::Jr~~EJ~~~EE~VRN ~~~~/iJ:I~A,~HC:;!:,~I~'llflC~ICKHIII COM'1,~V~ r,~&~~~ur'HI' (TO BE PILED IN DUPLICATE ~'J ,WI {,'Il, It R I ~~. ',01>01 . ""'" "YITH ~~'3.IS_T.E~ul:)~.~IL.L.~L. c:ql!r-l[y_c~q.~ . . _ ," ._~M~., _,. ".~,!:l,\!.l~~f.R ., IAII 11 A~l[lIlfU ~~rm\W ~1:...~aliil~~&-n"liiAlf6TiJmi'--u - ~IO I ,:~Ll ilp R.1";~II!l - ,~1> '. ,~ -:L.QJ.L ~_.__ -.~.~-l~.~3]1- IJl':IJ~l':-"-~, ,. '0- ~ov~lr~.~c.'-~-'I--.ctV 1'h~,a,V'_\.a,nd",._._.. III, ."lleAllfl MVIVII/O ,!Outt'",AMI (~"'I,lll" AI/lUlID{ItIIWII'll ,.oel I l.; Rnv tlUM' II AMOIiNf IIh. IVflJ1i rllr"~(re:mm" '.---- ---r--.----..---..---.~.-.- :--...-...-....--.....-- __,._u_._____~n_____.____._..u...,........ I [1/"1, Orlolnal Rllurn [J 2, Supplumlnlal Rllurn. IJ 3, Remalndor Rllurn ! . . .. . (10' dalll 01 dlolh p,lor 10 12,13.02) ~. CJ 4, lImllld ellal. . IJ 40. FUlu" Inll'T" Camplomlll [J 5, Fldorol ell~11 To. Rllu,n Required 15 . (la, d~11I 0 dloth oller 1201 2,82) LJ 6, Il.~.dlnl Dlld Ttll~l. . U 7. Ilu~'dlnl Malnjalnld a ll,lnO T,UII Q. 8, Talal Number 01 Sale DlpollI 80... . (Allo~h ~opy 01 Willi (Alla~h ~~py 0 Trulll -' D CO, D AT N' RMAT 0 ~ II I TIT I .." tt:letJ /:} '71]:11 t.t~, ). (I1A.f/JIi'I,,$!t~ , ----- el1-r/ti'/c..; t1~ 17(1'1.3 1. Rial eilOl1 IS~hldul. AI 2, Slo~kl and 80ndl IS~hldull B) '., 3, Clouly H.ld Slo~kIParln",hlp InlorllllS~hedull q 4, Mo'lgaOIl and NollI Roellyobl. .IS~hldull 01 . 5, COlh. Bonk Dlp011l1 & Mllcollanloul PI"anal P,oporly (S~hldull e) 6, Jointly Ownld Proporly IS~hldull FI 7. Tronlf", ,(S~hedul. OIIS~hldull L) 0, Tolal 0'011 AI.lllllotal llnel 1.71 9, Funorol e,penul, Admlnlll,atl" Calli, Mllllllanloul hp,,," Schldull HI 10, Dlbll, Marloag. Llabllltlllflllnl '(S~h.dull I) 11. Talal Deducllonlllolal Llnll 9 & 10) 12. Nil Volul 0' e,'all (Llnl 8 mlnu, Llnl 11) 13, C~a,lIabll clnd Oo,ornml,,'al BlqullIl IS~hldull JI 14, Nil Volul 8ubl.~t'lo Tax ILlnl 12 mlnul line 131 IS, Spoul~1 T,onlferl (for dale, 01 deolh allor 6.30,941 SI' Inll'u~lIonl la, Appll~obll Perconlogl on RovI... , Sid., (Includl ,olutl I,om Schldull K or S~hedul. M,I 16, Amounl of LIne 14 la.qbll 01 6% roll (Inc,ludl ,alulI from Schedul. K or Schedul. M,I 17, Amounl of LIne 14 lo'obllol 15% 'all (Includl YO lUll Irom &ch.dull K or Schedull 1.1.1 18, Prln~lpallax dUI IAdd lax from Llnll IS, 16 and 17,1 19, Credit, Spaulal Poyerly Credll P,lo, Poym.nll Dlllaunl Inlerl" + ----- +-~--- ... ----.-----... 20, If Llnl ''!.!!.9rooler Ihon Llnl 18, enler Ihl dllllrenco on Llnl 20, Thl'lllh. OVIRPAYMINT, II DIIIUIII.IJ(lf.I~III_IIII.."""I&.I"II~mmn_.~IIII_II.'.III''''''.'II'''" I 21. If LIne 1811 greall' Ihon Llnl 19, .nler Ih~ dlfforlncoon Llno 21. Thl'lllhl TAX DUB, A, enter Ihl Inlorlll on Ihl bolonco dv, on Line 21 A, 8, enler Ihl lOla' of line 21 and 21 A on Llnl 21 B, Thl, 1,Ihl BALANCI DUB, . . Mokl Chllk..!.ayiJbll t'l R.glller of Will., Ag.nt I' y. 'iTO NI IR ALQ II 0'0 RIV Uti DI AND TO Rle; Ie A Un er p.n~ 1111 0 perlu,y, I Idqre Ihal I hay, lXomlnl Ihll "Iu,n, In~ u Ing a~~ompa"y'lng ..hi ulll an 1I~lemlnll, on lolhl 1119 my knowlldg. and bill.,. III' truI, correcl and compl,te, I ~.cIQ" lhal all 'talk 11lloJ.hat been '.portla allru. mark'l valu.. Oeclaratlon of p"parer olh.r than thl perlDnal "pte.lnlal/vo I, baud on olllnlo,mallan 0 which p'.pare, ha. any now lidO I, , \IONA1UU 0' 'U~QN UIPONII,U ,o~ 'IUNO AItURN ADDRrn----- .. . _4_ PAl! _ - '~~'fl<<R~~lIi~~f1VI 1I..1l~Rf!(.I),~f~rl.--4_(1tAiL0. /at'I..L ~fL.d3k-_. --.J.-~.'o.-Q,,-~~~.c.;U_ltl. \ ~ I..\. '-'61... '- ::J:......c._Ch.\'-_\.u&.....j1_._\.LIH~_ -S>9.6Et7___._ I II I I a '; ....- 11 ) ..._...._._...". "'_."'.."...u..__. . (2) _u._.."._...___......._. (3) ...-....-c-..m....._.n__....._ 14 ) .............."..__.__.__._._.n_____... (5 1.--..----.....-.-...............-...... 16) __"_"_'_'''___'____m.n 17 ) ....__~.O.o.O._.OO_. 19) ._.."...(,("j?3...Q(L._ I 8 1._---3t-QQQ..~OO ..... 110) _________.._____. (111 (12) (13) (141 ..____<P_<.a.3.....Q..Q..__. -~~~-Q-=------,.. _.__~._a__=-_______. - 0 (151 __...._.._.......______.._.M,__ _._-'--___.__ 0 __._....... .------Q--.---... .....0.---.-.... (181 ...._..__...._..Q___.___..__.. 1191.._._..__.....Q___....... (20) _m._~._...cL....-_u (161 .____.m......._....___.._M .06 _ (171 ....__.........._....._.__._._...M ,15 _ (211 ____._..._______...."._... 121 AI _......_. _ ..____Q_.__......_ 121 S) _,___._.....0__--'-'" u"'.' , lr nv'1fl!IHI/"" .,~~ . COMIffl~, IV~~I~fc\alml~~NI~ SCHIDULI 11 . PUNIRAL IXPINSlS, ADMINISTRATIVI COSTS AND MISCELLANIOUS IXPINSES PI.a.. Print Dr T . _ Drvo\ fo.,<-,-~;W~ ,'ITlM NU.MIIR M" -e DISCRIPTION L AMOUNT 1. , PuntrallHp.n..". " :)\cl'('{l"""\'\'~ \C'~. \;.......'v~\ \~o;.tQ. (~l'l' I/i!>':') 'D~~~ S4rlAc:A ~t~) (ok \~ 112. ~) , . sC:tta,DO ")35'.60 A. l" "I. . Admlnl.traiiv.Coit'l 1, P"lonol R.pr...nfotlv. Commlu)onl Soclol 8,cul'IlY Number of PerloNal Repr..enlotlvel Veor Commlulonl pold 2, Attor~ey.Pe~. i'. 3. ,Family "Kelllptlon Clolmonl Relallonl~lp , Nfdreu of Clalmonl 01 decederil'l d,oth . ,Slreet Addr..;, Cliy' Slale Zip Code ;41 " Probole Fe.. ~~';.f I.V.OQ..A, ! ~ 1I.1/l) Mlle.llon,oui bp.n.." ~~'oo 1. 2, if 3. , 4, S. , 6. 7,' 8, TOTAL (AIICfenlelon line 9, Recapllulollonl S (P(.,S' .3.0 0 (II mar' .pac. lin"d.dr In'I" addltlonol .h.." of .am. III'.) rOR ll^bllFJ.' IllA'H AnaN Ulall91 CHICK HI" INHERITANCE TAX RETURN :9~~lnRt!!.ttll CI.A1MLR.lJ RESIDENT DECEDENT ml NUMUM cO"""b~i.~W'H,odJ~ I~Ul'HIA (~~T~B:JMfT~~ g~P~~tJ)E a I "1,1 I.1J-+1.1' ".____. !lL' ~ J~. 1!~ot9L ~. '"' ..." <_u C!?l!~lVSp!)!..__._,JIM. Nl!!!\ill I I. ,'N"A' It'Wi'iil' OiMfltl' A~iiiTI. t:') l"r'ltL N\,~ iL... II 0 N"I1!.d.1 i1 Roel. i ~tliWl'iifi'iijj R Ju.lfutmAII1-pl~HOni!Iii~- C \.t k P 170 I b i . 1" J,r~1 ;:."".~;J.~UL~,", HIlI'H'~~'i"l w ( ~cr1tu~/1 ~tf>i~ , :~I~-rU~';'j;"Vi09.t~J~J(i~~~l CJ I. Original R.lu," lii'. 2, SU/l/ll.m4nlul R.lu," '[l 2, Rlomolnd., R,.,.,n 1 . 110' dUI.. 0 d..lh p,lo, 10 12, 3-821 o 4. Lllllllld 1I11111 0 40, F.lulI 'nllm' C'lnwomll. 0 S, ,.dl,al IlIotl tn. RlIurn Rlq.llld , . II., do'" 01 dlOlloll'l 12-1l,021 o ~, r:,l:~~M~~I'~lff'I.. 01, r~lj~~~~W;I~I~~I~1 q 1I.lng Tryll Q.. 0, Tolul Numb., .1 Sol. P'/lolll e.", _._____J--*_..._._..,__..'--.__........._.,......;.~..,.._.....__.-..__...........,_. ALL ~ORRmONPeNCI ANll.fSW~T1AL TAX INFO..!!b1e!'9t1..~HO~~DII~IlI~ICUD TOI l ,- - l(OMr\if~AI"'lOAlIlllI'\r- r-",,-. UU,"0,1I NVMtU --. . ----:-- " ) ':, I , ,. , i - .~~~...- ..~_.' ~~=l'"'~~"'=~-;:::~~'" III. 121 '101-..._ 141_ (S I. 20, 1I1Inl 19 iI OfOQII, 'han \In. 18, '"'1' Ih. IlIlIo,on~..n IIno 20, thlll,lh. OVERPAYMeNT, , QCl~ih~li"'1ff"';:"~J flU IIJ~~MfimMr'1r.ill '~Ull'1"ILnii' . ~ 2\. II ~Inl Iii II gllollllhan Ilno 19, Inlol Ihl dlfl",,,el on II". ?I. ThilII Ih. 'AX DUe, Ill) A fill.' Ih.lni.,llI.n Ihlllolu"".duo On Iin. 21A, ,(21,1,1 Q 8' En'.' Iholohll 01 11"0 21 ond 21,1. ollll". 21b, Thil h IIIP UAIANce pue, 12101 _.__-,' ,P ~M'!h~h.I~F!\y!!bl.J!!.~!l!.I!lel .!.f.WU!IJ.~~,'II! _..__-l..,,_..~.__ _._. _'_ .,~~.___.._._,_ .' .... ~:':::::I":;:::;:'t.;' ffl~'~~I::~I~~Q~f:'~~~'~,I~f~~~~;~:~j~n~.~;~~~:~~~,,~~~~i1.~:f.~~~.:~~.~~~,~i~~-~~!~~:~~~~:~~.dO.Ond II:I~:~ II h I~w" wlttl,1 U/Ill rOnlP/1,..ltlI,lttr.lhol 011 ;.ull.HUIU ha. b.~n "po'II" al f(UII murk." Vtlhi" UuCIUHHlQnof prtpa'lf' ollliif Ihan Ih.,.;tiHonul ,..p,...nIGh,. It lJ,~Il_'n .onJ,H Inh~I~li'I_~n~~~h!!!1 I~ttlra'.! _1)!J_t!!!!.lM~.!tltllfq" I, '.. ~-_. {lwN4'fUf' a,7lIl\Oh ttIVONTI,n 'I"J_ Iflitnr"i h'"H "IJI)NU~ ... - PAil ' ~~?,~~ ~ /;4';.,A';' t1:'Nj' I') "":';:.1), rL ;'1. ," / ''7'1' .......n ,. 1ll"\':;;\:~a.:::......~y:r:;;IIii~I~I'f,t)irvl-'lt ..r,";"r" ',7-1.,14 T,'''l~(~.( i:L( / U,( SC''''' Jj.'(,.J_ ~;'-li~'- - \........-, -...-"" ~J ,[1"l' .c::.:___ltl '..L..JAI...I_L.S:L_.Q,~\'\,.JJ\... . _u'fl_11Clh.L.._ _._~1.al:S-7 ~,\.'l ' ....,'" 1M I 1""1 da i; it ,/ 4' I,. 1(/ ':", ~-) I' W -;/;'q" ! ~ " R..llttolO tAeh.d,11 Al a, SI.III qnda.nd, ISeh.dull el :\, CI.,.ly H.ld SI.,IIFQlInorlhlplnIIlOlIIS,h.d,l. C) 4, MotlgoQl1 Qnd N.IOI Rlul.,,\,I. laeh.dull PI 6, CQlh, lanl P'POI"I & MiI,.lIo"ooul P",o"ol P,.p.lIy (SI~.d,1t EI 6, Jolnlly Ownld Proplrly (Schodulo FI 1, T,anIIIIlISch.d.," GIISch.d.11 II e, TOI~IO'oll AI.~IItI'.lalllnlll,71 9, 'unO/a I Sop.nllli Adllllnhtroll.. COlli! Mhe.llan.... ( 91 . Soplnlll 15chldul. HI 10, Plblt, Mo,lgog. lIabllillll, II.nlISeh.dul.II 1101 ___. '_ , .. ~I~()SE (:>,.-, ,\, .~~clU,'loIll.II01.IUnIl9 & 101 "'1i(11k.l\nIl'~\""'C.''f1 OIIC\\Mt& ,?.ritu."L~~ , (111 --'-'--.~ 12, Nil VoI_..f e'lalollln. q IIIlnul II". 111 ..J /J; 3Ce e. (, c:.C' / (121 ..___..:=..0._... 13, Cho,,,able ond OOlo'nn\.n'ol60~""IISeh.d.l. II (131 - (\. ... 1~, Nol Vol.oS b oct 10 To.Lln. 12 IIIlnUl 11".131 (141 ,_'::'. .0 \$, S'l.u,al TlllOl'''' II.' dolll 01 <l.alh 01111 6'30,941 C) So.lnll.,uellontl91 Appll,obl. F..rconlll91 on R..."e (151 __..,_____K,_. Sldo, Ilncl_de .01... 11.11I S'hl~~lo K 0, Sehudul. M,I 16, Amounlo' Lln. 14 la,bbl. 01 6~\ 101" II~cl,d. ,0!PI,lrom Schldull K 0' S,hlll,l. M,I 11, Amo.nt 01 LI~1 14 to.obll 01 lS0/0 10'" Ilnd.do 001.'11'011I Sch.<iul. K .1 Sch.dull M,I 18, FlIn'lpol'o. dUIIAdd ,.~ /,.11I 11"'1 15, 16 and 11,1 ' 19, C,.dlll, Spo'lQI Pomty Clld" P,lo' PaYIII.nll PI"oun' + ~-+~~-- , , , \ tlj I 61 -'-. :' ..,..,-.....--- 11) .~_O iQ,Q..aCL I. 00 3rO(, Cl ( 81 ';- -..-.-.--..- - (161 1111'-- o o M ,06 .. K ,IS. m I a (18) {J InlU'lU o .0 (\91~_ 1201 ._r_'_ , 15-:/t!.!f.~1 BU~IAU O~ INDIVIDUA~ TAKII .....RmHCI laM PIVIIlIlM DlPT, flout ltMR1IIURO. PA 17111'0601 COHHONWIALTH Olf PINNIVLVANIA DIPARTHINT Olf RIVaNUI NOTICI ,O~ INHIKITAHCI TAK A~~~AIIIHINT. AL~OWAHCI OK DIIALLOWANCI 0' DIDUCTIDHI AND AIIIIIHINT 0' TAK Q...-. '* U"\HI" '" """1 CLARENCE ORRIS 918 II LOUTHER ST CARLISL~ OATIl UTATI Olf DATI Olf DIATH PXLINUHIIR COUNTY ACN 12-22-97 ORR'J S 07-24-97 21 97 - 0646 CUMBERLAND 101 AROU~\ ~a"l had BERTHA M PA 1701~ HAKI OHIOK PAVAILI AND RIHIT 'PAV"_NT TOI REGISTER OP WILLS CUMBERLAND CO COURT HaUSE CARLISLE, PA 17015 . OUT ~LONII .TJ:!XI LINI ... RITAIN LOlllR PORTION ~'OR YOUR RICORDI." . ftW =ltW".W "A~1I'. m':"r.N~Yf~ '''cS..YtfAlliif ~llcSi" YiR"A /lftAf'Il<<Nr;.At1."cSWA'Il'cii~'lili.""" ......""..."" ," DlIALLOWANOI O~ DIDUCuoNI A D All IIHINT Olf TA~ IITATI Olf ORRIS BERTHA M ifiLl NO. 21 97-0646 AON 101 DATI 12"22-97 TAX K&TURN WAil I IACCI~TU AI FILID I, XI CHAHtID SEE ATTACHED'NIlTICE RIIIRVATXO~ OONO_"~INII IfUTURI tNTIRIBT " III RIYIR81 APPRAUID YALUI OIf,RITURN IAllp ONI ORIG1NAL AND SUPPLE!olEN'TAL RETURN NO, 01 1. ~aal htata Ilohadul. A I '111" 0 0 NOTH I To 1~lura propar '1, Itotk. and land. elilh.lklla II e21 ,00" or.dlt \0 ~O\lr a.oount, I. Clolal~ Hald l\o.klPar\~ar.hlp I~tar..t 'el.h.dula ql III .00 luiHllt\ha uppar portlo~ ., Ho~t,'.a.lNota' Ra.alvabla elohadUla Dl e.1 ,00 o~ th~a ~or. with ~our ., C..hll""k Oap..lhlHh., Par.o~al ~ropart~ Ilohadu1R II III ,00 toMpa~Mllt, 6, JolnU~ ownad ~rop.r.\~ ll.halklla FI (61,00 7, Tr",,".a..a Ilohalklla 01 171 6,060.00 I, Total A..ah ell 6.060,00 APPROVID DIDUOTIONI ANDB~IHPTION81 .. 'unarall.p.~I.llAdo" 'CoatalHho. IRpanaaa(lohalklh HI 191 6,6n,oo 10, DaII\.IHortp.. ~llII1ll1t1..1~hnl II0hadUlall e1O) ,00 11;, Total DacluoHonl 1111 ~ ,~A!l nn 11, Hat Valua o~:Ta. Naturn IU) , 623.00. U. ,. C~.rltablaiO,var_\al laq\Hllt., .Hon-alaotad 'US Trulh Ilohalklla J) (1',1 ,00 1., ~t lIalua of htlta ..ubjaot to TIM 'U.) 625,00. NOTlI If'" .........n.1: W" t.,U.d prliv:l.ou,:l.Y, .:I.:I.n1l14, 11 lind/or 16,' 11 .nll 18 W:l.U r,n,01:,. fillUrll tnllt :I.n01ud. the totl1 of AIolo. return. .......d to d.t.. AIIIIIHINT OIfTAXI . . U. A.ilunt of 'LI~a 1~ at 'poulol rota Ul) ,00 X' 00. 16. AlIOunt of L,lnl, 1. ta~obla at ~i"aal/Clll." A r.'to 1161 ,00 X .06. 17. AIIO\i!lt o~ L11\R 1. tlMobla at Colll~arallCl,," I ra\a (7) ,00 K; U. II, 'rinolpol Ta. OUR' 1111 TAX CRIDn". ~AYHINT DATa ,00 ,00 ,00 ,00 ~.Clm HUHIIR DlICOUHT I + I . INTIRISTI'IN PAID 1-) AHbUNT PAID TOTAL TAX ORIDIT IALANCI OF TAX DUI ' INTIRIIT AND PIN. TOTAL DUI ,00 ,00 ,00 ,00 . IP PAID'AFTU DATI INOICATID. III KIVIRII 'OR CALCULATION 0' ADDITIONA~ INTERIST, IP TDTA~ DUI IS LIIS THAN .1. NO PAVHINT IS KEqUIKID, IP TOTAL DUI 11 RHLICTED AI A "CRIDn" ICRI, YOU HAY IE DUI A RIPUND, IBE RIVERS. S1DI OP TltlS ~ORN PDR INSTRUCTIONS, I , PUIlPOII Of IfllTlCal T. MIIlI I~' rooul,...nl' 0' ...Il.n 1140 ., Ih. 1",,"I\lnal and a.I.I. '1M ~ot, Aol II ., 1191, III .,1, "aU.. 9140), PAVICH" OIt..~ I~' t.. portiOn a' ttil. 'H.tI.. and .ub.lt wll~ v.ur ..v..nl to I~' R.,I.t.r ., WUI. prlnl.d .n tho "IYlr.' .td'. ._ H....'.~..~.r .on'V .,d.r .,Vobl. I.' RaOlllIR.OP HHU, AOIHT, RapUHO lCRll A ro,undo' . \lW .rodll, wtll.~ w.. ..t roou..I.d.o I~. I.. rolu'., ..v b' roqu..l.d bV ...pl.lln, ",r"~p.lI..Il." far R.,und ., p.nn.vl...I. In~orll.n.' .nd a.tol. ,.." tRav-um, AP.lIa1l1.n' ort ...llIbl.,1 I~' Of/I.. ., t~. R..I.tor a' WIU., onv a' I~' II R...nu' OI.lrl.1 o'fI....r bV ..1IIn. t~. ....1.1 14."..r "IOworln. m.I.. nuab.r. ,., f.,.. .rd.rln.. In p.nn'vly.nl' 1_100_361.1010, .ul.ld. p.nn,vI.."I. .nd HII~ln 1...1 Ilorrl'bu" or..' (711) 111.1094, '00' 11111 111-1111 lll.erln. 1...lrod Only), ~~IH- IIlMTlV1! CORRaCTlOH" P..lual orr." dl.oo..,od on t~1o ."......It .h.uld b. .ddrollld In H'ltln. to, .~ o.porto.nl ., R..''''', lurllU of Indl.ldu.1 T...., ATIH' Po.t A.......'" R..IIW Vnlt, oa.T. 110601, lIerrlobu", PA 11111-0601 p~.n' (1111 111-6101, II, p... I ., ,I~. b..~I.1 "1..tru.tI.nt 'or Inh.,II."". T" R.lu,n 'ar · R..ld.nl D.o.d.nt~ tfU!Y.UOl) for In IlCphnltlan of IdllnlttraUlJllV Gatt'tatabll error.. Anv portv In In,tor..1 nOI ..Il.'il.d wlt~ t~. ..p'.I....nt' .1l.H'".' or dh.U.H.n.' .f d.du.tI.n. .r ........"1 ., II' 11".IUdln. dlo..unl ., '1"I.i..tl .. .~.Hn .n Ihl. H.llo. ..v ..l..1 wlt~l" .IHtV (60) d'V' ., ,.o.l.t .f t~l. Hotl.' bVI ' .'Hlltt.",.,.11I1 10 I~',.A D'P"I.."t ., R...nu., 100rd ., ~.p..Io,O.pl, 111011, 11,.,I.bu,., .A 11I1i-IDII, -..,..tln. i. ~.y. t~. ..tt., d.t.,.,n.d .1 I~' .udlt ., I~. ....U"t ., 'Ih. p.r..n,I,.pr...nl.,I.., OR _"P.II' 10. Ih. O'p~~" c""rt, OR OBJICTlOHI. II ollCOUHT, If .nv tIK dIl. I. p,ld HII~I" W.. III OI'.ndor ,..th. ,fter t~. d...d.nl" dlll~, , fly. por...nt IIX) dl...ynt ., lho t.. p.ld I' .I,owtd, PIHAL TVI T~' In II" ...,..tv "....er,tl,.lp.!I." p",.1 IV I. ....ul.d .n Ih. ,lot., ., lho t.. end Inl....t .......d, ...dnal p.ld b~f.ro J...."V )1, 199~, lho flret d'V .ftor t~. .nd .f Ih' I" .....tv porlod, 1~1o"'.Portl.,IP.II." p.".ltV II .pp..l.bl. I" ,tho .... .lMor ond In lho Ih. .... II.. porl.d .. v.u w.uld 'PPIII tho ,t.. .nd IpI"lOt ,th.t h.' b.." .......d .. ,lndl..I.d .n thl. n.II.', . IHilRIITIo l"t....t I~o~or..d ..,Innln. Hllh ""I d'V.f d.lI"qu.n.v, .,"'n."I.."lh' ,nd'" (II d., fr.. the d.1O a' dlllh. I. Ih. d.l. a' p.v..nt, ,..... ~hl.h b.._ ~.llnqu."1 b.f.,' Jonuorv I, 1961 b'" ,I"torllt .1 Ih.""" a' .1' I'W, p...ent por """"" OII.ulll.d .1 · d.llV rot. .f ,OOOU~, All t.... Hhl.h b..... d.ll"""ent a" ., .It., Jonu.'v I, 1911 wl'l b..r lnl.r..t .1 · r.I' whl.~ will y.rv,r.' .ol.nd.. ,Vllr t. ..I.nd.. V," wllh thlt ro,. _.'d ,bY Ih. PA o.porl.."1 ,'R.y...... 'h. .ppIlOlbl' Inl.,..t rol.. 'A' I9Ilthr.uah 1991 or.. 1961 1911 1980 1911 1916 -'l"t~,..t lOX ,000&48 UX ,000611 IIX ,000101 lIX ,000116 lOX ;000114 I. ..I.UI.ted'.. f.IIOW" 1911 19"-19" 1991 19"'199~ 1,,'.199' 9X IIX 9X 1X 9X u.uv tnttr..t I'lOtor ,0001\1 ,000101 ,000161 ,000191 ,0001~! Vilr' Interll' Rlt, DillY lnt.rut flator v..r .....- ~ - lhtoroll R.I. lNTERS.T- IA~ANCS OF TA" UNPAID " NUHISR OF DAYI DeLINqueNT " DA1~Y lNTERelT FACTOR .-Anv H.Il.. lll.,.d .Ii.r thet.. ,b',_' d.Il_"t Hill ,,"..1 .. Inl....I..I."I.II.. 10 f.lIllI" IIIl d.V' beVond lho d"I.,.,.tho .,.......,t, If ..v...,1 I. .ode .fter the Inl.,..t .-,I.th," dot. "'"'"' an lhe ...11... oddlllan.1 'nt"..",,"1I b. ..I.ul.~td. " " PUIlpd.. Of' Homtl To MIIlI Ihe r..ul....nlo of '.ollun IUO of Ih. lnherllon.. ond E.I.I. 'I< hI, Aal II of 1'91, 171 P,I, ,..lion 91lOj, Del.ohlh. lop uorllon of Ihl. HolI.. .nd .ub.11 wllh y.ur p'YHnl 10 Ih. RIII'I.r a' HIlIo prlnl.d. on I'" rey'".. ltd.. -'HIk. uh..k or ....y ord.r P'YObI. 101 RIOI'TEA Of' HILL'. AOIHT, . PAVHlHTI RE~UltO' (CRJI A r~fund Of . "M or.dlt, which WI' not ,.qullted on thl "I( r.turn, ...v b, r.qulltad bv ao.,S.tln, en "Applh.UOf' for hfund uf P.nn.Ylvonl. Inherllon.. end EoIoI. TI<" IRIV.lJlJ), ApPII..II.n.... .v.llobl. 1\ Ih.Oll.o..' I'" R.,W.r 01 HIli., ony of Ih. II R'v,nu. O'.lrlul 011'0.. or by u.llln. Ih. .p.ol.1 14'h.ur on.werln. ..rvl.. . nulbtr. for for.. orderl"" In pennlvlvant. l-IOO.,6'-'OIO,'out.ldt P,nn,vlv,nJ. Ind ~Ithln 100,1 , Herrl.burg .... (117) 767-1094, 'DO. (717) 771-1111 IlIlIr'n. l.p.l..d OnlYl, otJlCT10NIl Anvpartv In tnt.r..t not. I.tl.fted with tht ,pprftl....nt, 1110N.no. or dl.llluM.no. of deduotlon. or ........nt of I.. (IneIUdln. dli.ounl .r 'nl.i..ll .. .~uwn .n Ihl. Hall.. ..y obJ.ol wll~ln .I.IY 1601 d.y. 01 r...lpl uf Ihle HolI.. bYI --wrltt'n prot,l' to thl PI. alplrt"n' of M,vlnul, IQlrd of ApP....,OIPt, 211011, Il,rrhburo, PA 17111-10,., OR ..,',oUn, 'D'h'V'. thl ..".r d.t.r.lnld It th. audit 0' thl looount of 'hi Plr.on.. rur'llfitlU"., OR ".pIII to thl Orphlnl' Court ADHIH- r, IITRATIYI , COARIlCTlOHII 'lotUII 'rrorl dlloa",r.d'on thh ....lIlI.nt Ihauld bl .ddr....d In wrlUn, tal' PA O,p,rtunt of Revlnu" luruu.' In,lIvldu.1 T.~.., ATTHI po.t A.......nl R.yl.w Unll, D.~P', 110601, Iterrlobur., PA 17111-0601 Phon. (7111 717-610', '00 Pot. . .f Ihl bookl.1 "In'lru.llon. for Inherltono. T.~ R.lurn for . R..ldonl DIGI"ent" (RSY-11G1) far an iMplln.tlon of Idllnlltrlttv,lv Gorrltttbl, trrort. DIICllUHll ,If ony I.. duo 10 Plld wllhln Ihru II) o.l.nder ..nth. .Iler lho d...d.nl'. d..lh, . f1v. p."onl (IX) dl...ynl ef tho I.. p.ld I. .11..... PlHAL TV, Th. II~ I.. __.IY non-perllo'pellon p.n.lIy 10 o.....tld on I~. laW 0' tho tl< end Inler..1 .......dr ~ nol p.ld b.lo" J....ery II, 1"..lh. llrel d.Y .Iler t~. .nd 0' Ihl low ."".IY period, Thlo non'porll.lp.llon p.nll\Y I. .PP.llobl. In lho, .... .onnlr end In lho Ih. .... II.. plrlod .. YOU would opp..1 lho I.. end Inl.r..1 Ihel h.. bun ...~,.Id'.' Indl..t.d .n thlo nollOl, IHTlRIIT" Inler..1 10 .har," bot'nn.n. with flrel d.y of dellnquenoy, or nino (91 ...Ih. ond OM III d.y !'.' tho d.llol dl.lh, 10 th. N.tl.1 p.y..nl, T"" whluh bet... dellnquonl blfqr. Jonuory I. 1911 , < boll lnlerlll II Ihe roll of .1. (4U poroonl per ....... e.luul.l.d .1 . d.lIy r.l. 01 .000164. All 1"6' Whloh beo... d.llnquenl on .r .'I.r Jonu.ry I, 1.11 wll. be.r Inllr..1 .1 . r'll Whl.h will ..ry froo oll.ndl,. V'I" to o.l.nd''',~iar with thlt rat. announo,d;b~ the PA DIP.rt.,"t 0' R.venue, ThI .pplloabl. Inter"l relll for 1911 Ihrouth 1"1 erll 2!r;. Inter..1 R.li D.llv Jnttr.lt f'IOtO,. 'fll" Int.r..t Altl D.llv Jnt.r..t FlOtor - .911 "X ,00"4. 1917 OX ,000147 1m 16. .000411 191'-1"1 III ,000101 .914 III .000101 1991 .~ ,000147 .911 IU ,00OS16 1"1-1994 71 ,000191 . 1916 \O~ ,000174 mI' 1991 ,~ ,000147 lul"t",,"t I. 0I1.1I1.1ee! .. f.llowlI INTBRBST . SALANCB OF TA" UNPAID " NUHSBR CF CAVS CELINqUBNT " DAILV INTBRBST FACTOR '-Any H.II.. I..u.d ~Iler lho II< .b"'H' d.Il.....'"t will "fl,ol on Inlerllt OI.oul.lI.. 10 flll.on (III d.U btvlnd thl dlt,'uf,thl ......-.nt, If P.v.ent II tide .ftlr thl Intlr..t ODlPUt.tlon dati shown on thl MYHil., 'delltlon,1 lnt.rllt IUlt 1M OIleullteel, PAY!4INTI IltIllth I". lop porUon 6. Ihl. N'U" ...~ ."b.1t wllh .our p..unl ..d. PI..~I. 10 I". n_ OIId .lIdr... prlnlod on Ih. r,.,'," .)dl' ,,"~ -. If RftIlOlMT DlhOlMT lok. oh... or IOn.V ord.. p.V.bll I.' RBDIiTBR 0' WILLI, ADINT, "If NOl/-RftIlDINTDICIDIMT .ok. Oh.o. or It".. ordor p.vul. t6, COHHONllBAL YH OP PBNIIIVLYANII" Rlp~ (OR), A ...und .. d I'. or.dll, Whl.. w..n.t,..quo.t'd' on I". I.. R.t"rn, "'. ~. r.qu..I.d b. .a.plltlno on , "Appll,"U.n' ..r R'.""d .. p"ln.vIVIII,i Inhtrlt.....OIId IlIil',,1I." IRly-m.', .ppll..II.n. orqv.UII>I' .t 1t1t,Dlfl.. o. Ih. Rllh'" o. Nllllr I/1V o. thl U R...nuI Dhldot o.Il....r .ra. Ih. O.porl..nt.. 1'-l1owr OII.....lno "'YI.'_~'" .01' fori.. .'rderln" In p.nn'Vlv.nt. 1-'00-161-1010, O"lIld' penn,.VI...t. .nd wllhln 1...1 Horrhbu., .... (117) 717-109', TDOI <7171171-..11 lH..rlno 1...I..d onl'~), RIPLV TOI ,Que.Uon.'ro,orolno orrorl..anhl"" an thll noUo. .h."ld b. odtjr....d I., PA O'P..\I'lIItO. R'.""", .""IY .. IndIVld".II...., AT1MI P..I ......""'\.~.vI.w 1h11t,.D'PI, 110601, Horrl.b\I.o, PA 17UI-D6D1,pno.. (717) 717-6101, 01l00Ut411 If 'n. I.. dIl' II p.ld within Ih... m ..I.nd.. ..nlh. .lIor Ih. dl..d.nl'. d.'Ih, . IlY. p....nl IIXI dI..o",,1 o. Ih. t.. p.ld I. '11.w.d, PIHALTY, T~.,ll~ tlM ..n..t~ non.p~rtlo'p.tlQn plnlttv 1. oOIPuttd on thl,atal;of th4 'aK .nd'lnt.r..'.......d, an~ nat paid b'f~r' J.nu.r~ 18, 199" thl flrif'd.~ aU.rthe .nd of thl tlM .."""tv ptrlodl IN11IRlI11 Intoro.t I"'h.r~.d ~..Innl"o with 'ilrll dl. a. ,d'lIn_o., or nlnl (f) ..nlh. .nd .n. <,II d.. iro. Ih. d.tl o. d..th, I. th. d.tl .. p....nl, , I....' whl.h b...... d.lIpqullll b..oro JOIIUorV' t, 1911 ~OI. Inter..I'" Ih' r.I... .Ik 16Xl p'r.onl, ....omu. .olouhl.d II . d.lI.v ,.h .1 ,ODOt6', All to," whloh b.....d.llnqullll .pend ,1I.r JOII"". I, .1911 will bo,r Intor..t .t . rolo whl.h will v.'.V fr..,o.hno.r vOIr to .Ilondor VOIr with Ihotrolo 1Il''''''''.'dbv th. PA D.p.rluo\t a. R~y.t\IlI' T~' IflPll..bl. Inlor..1 rllll .ar ,1"1 1hr0<lQt1 1991 ..., 19U 1911 1911 1911 "~6 ..lnl..1I1 lOX ,000$4' 16~ .000'.' llX ,000101 I.X ,000116 lOX ,DOOm II OIlo"l,t4l<l .. .011owlI V... Inl....t R... Dllh tnttrllt fI'Iotor - 1m IX "DOZ01 1911-1991 llX ,000$01 1991 9X .000147 1991-1994 7X ,000191 19...199. .X ,'DOI41 V..r Inl.r.it R.t. D.llv Inl.r'61 F.otor ~N'.."T . IALANOI'OP'AX UNPAID K NUHBER DF DAV'DILZNqUEN' K DAILV INTEREI' PADTDR .-AnV'MOlloo l"l'"d .m. th' t... ~'..I" d.lln~u.nl will r.flo.I .n Interoil Ulloul.lion t~'. Ifl..n lIlId.v. ~...o\d th. d.t. .f t,ho ........nt, If p....nl,l. ..d. "I.. Ih. In""1I .0...uI.tlon .dlll .ho... on Ih. HOII.., .ddlllonll lnl"'lt "'II bo ..I.ul'I.d, BENERA~ INFORMATION 1. PAILURE TO RIIPOND WILL RIIULT IN AN D~PXDIAL TAN A'~BI'HENT wllh .ppll..bl. Intor"l blOOd.n Inl.rooU.n .ullolll.d bv Ih."nonol.1 InUlluU.n, I. Inh.rllon.. I.w b.......d.llnqu.nl "In. ..n'h. .'Ier' 'h. d...denl'. d.le ., de.'h, I. It joint laoount .. "Mlbl, ,yen thouth thl dlo.d,n", 'n.., Wit added ,. . ..thr of oonYlnIlnOlI 4. At.aunh (In.IUdlnl Ih... held bilw..n hu.bond ond wll.1 whl." I". d...d.nl pul In jalnl n.... wllhln .n. y.or ~rlor I. d..lh .re 'ullv I.wobl. .. Iron.'er., I, A...unh ..lobU.h... J.lnUv b.lw.on hu.bllKl ond wll..." Ihon .n. y.or prior ,. d..lh ." nal ''''bl., e, A..aunl. h.ld bv . d.oodonl "In Iru.' I.r" onolher .r .Iher. .r. I..obl. lullv. REPO~1~NB INSTRUCTION~ . PART 1 - TAXPAVER RESPONSE 1. aLOCK A . If ,ht '"for..'I~" end oo,put.tlon In thl nallo. Ir. aorrtotlnd dlduotlonl Ir. not blln, ol,l.'d, plio, '" "M" In block ,"It" of Pert 1 of 'hi "TIMPIVlr Rt.pon,," 'lotion. t'ln two Gopl.. and ,ubllt th.. With your Ohlck 'or thl ..ount of I.. I. lhe R'llolor .f Willi ., Ih. ..unlv Indl..ted, lhe PA D.porloon' ., R.y.nu. wll'l hi.. "' 0"1.1.1 ........nl (P... RIY.UAI 101 ""an ....Ipl ., 'h. ..'urn Ir.. Ih. R'II.hr a' Will., . I, ILOCK I - If Ih. ...01 .p..III.d ." 'hi. naU.. h.. b..n.r will b. "part.d .nd ,.. p.ld wllh Ih. P.m.vly.nl. Inhorllll... TIM Rtturn fllld bv thl dloedent', r.pr...nt.tlv., pilot ~ "k" 'n blook "I" af Plrt 1 ., the "Tlwplv.r AI.pon.l" Ilollon, Ilan Onl ..pv ond"lurn I. the PA D.p.rl..n' 01 R.Y.....,.lur..u.' IndlYldu.1 I..... D.pl U060I,lIorrlob.r" PA 17.111'0601 In Iho." InVIlop. provIded, . I, ILOCK C - I' Ih. notl.. Inl.r..II.n I. Inearr..' 'nd/ar de~Ollon...r. b.lnl ol.I..d, .h..k bl.ek "CO ond e.opl.l. P.rl. lond I Hoard I,.., to thl In,truGUon. bilow, 'len two ooplll Ind lubltt thl. with vaur C1hlOk for thl NOlM1' Ot 11M, PIYlb.. to Uti ~'lIbhl!' ., Wlllo ., lhe .aunlv Indl..I.d, The PA D.por'..nl a' R.y.nu. will I.... .n ."1.1., ........", (P... R~Y.1I41 IWI up,", r...lpt ., IhI relurn fr.. lhe R'II.lor ., Wlllo, ' TAX RETURN . PART 2 - TAX COMPUTATIQN LIlli I, Inler Ih. d.lo Ih. lO.ounl.rllln'llV w.. ..1.bU.hld.r tlll.d In the "Mor .~lollnl.t d'l. .',,".I~, '.' HCTlI 'ar~ .......enl dvl.. ./I.r 1/11/111 A...unto w",." the d...d.nl put In j.lnl n.... w Ihln:.M (I! Vllr ..1 d..lh or: . '1M .. full~ II tr."I'.r'l Uow,vlr, there 11 In tlColudon not to IMO"" ..,oao plr trlO,l.r.. r...,dlltu of ttMJ Ii lut af the ooount or the nYlbtr q, IOOQUnt. h.ld, If _doUbt, .,t,r.lk eM"' IPP..r. bltar. your 'Ir" n... In thl Iddr... portion 0' thl. notlo., the .~,DOO IMolullon ,.r.tdy hili bl.,.. dtduot" frol the "oount blt,noe II r,part.d b~ thl flnano ,. In.Ututlon; I ,. 'lfn'.r thl tot,l b,l"'nl ot thl 101l0un\ In<lludJna Int.r..' looruld to thl dit. of d..th, .... I. lht ,..roent qf the 100000 t"lt h tIK." for tlGh lurYlvor 11 d'ttrllnld II folloWII 11 . The ~.rG'"t tlMlbl, for joint ....t. ..tlbla~h.d JQr' then one ~..r prior to the dlo.dlnt'. d.,th, I DIYIIlID IY TOTAL HUllIIR Of' DIVIIlID IY TDTAL NUliIIR Of' . K 100 . PERCENT TmaLl JOINT OIlHl!R' IURVIYINO JOINT 011111"' IM..,ll' A joint ....t r"a.t.rld In thin... of the dlc.d.nt ~ two oth.r p.r.on., I I DIVIIlID IV I (JOINT _RIl DIYIDIDIY I UURYIYORII . .117 K 100 . 16,7X (UKAlLI POR IACII .URYIYORI I" The p.ro..,ttIM,bl. for ....,. orll'ld Within ani ~'I'; 0' thl dlG.dlnt', dtlth or lacount. owned b~ thl dtotdlnt b~t hlld In Iru.1 I.r onolher .lndIYldu.U.1 Clru. "-f1alorlllll . I DIYIIlID IV TD7AL ItUttIIR Of' IURYIYIHC JOINI K 100 . PIRCINT UKAlU . _R' OR TRUll IENIPlCURIEI 1...,1.1 Jolnl ...ounl r~II.I.red In lilt n... 01 lho de.edonl ond two alh.. p.r.... ond ..Iobll.h.d wllhln .n. v..r ., de.lh bV , ,t". dtald",t. I DIYIIlID IY I UURVIYllflll . ,10 M 100 . 10~ 1TA0AILI POR IACII IURYIYDAI 4, The _t .....I.ot I. t.. 1I1.. Al '10 d~tor.ln.d bv IUlllplvlnl the ....unt b.lono. (II.. U bV Ih. por.enl to.obl. Ill.. II. II. In'., the 't'l of \~ debt. IOCt UlWf.lUUf.t l111h," h. Pill ~, 6, ThI_1 owobh Ill.. II lo "'lor.ln... bV .....1...11011 hi dibl. ond dldu.lI.n. (IIn. II 'r.. Ih. ...unt .ulIj..t to tow (IIn. 41, 7, Inl.r lho epproprl.t. I.. r'll (I n. 71 .. d.t.r.ln.d b.l.w, At Par dltl' of delth occurring ,ft'r 6/10/94, thl t.M r.t.. 'or tr'n.f.r. to Ip~II' Ir. ,. ,o110w.1 I. 0.1.' ., do.lh .. or "l.r 7/1/94 ond b.I.t. 1/1/9' lho r.'. I. I~, t, O. .. of d..lh .. .r ., .r 1/1/9' lron.,er. ,. Ip~"" will b. t,w.d .1 00 ,.w r.I., HoI., P.r d.t.. a' d..I"prl.r I. 7/1/9A ron.'.r. ,. .pau... .r. ,..obll .1 6~, I. Tron'l~" I. 11...1 .....ondonl. noludln, felher. IOlher, ..., dlUlhlorr ,r"".hlldl'.n, ....In.I.., doulh 6r.I".I~1 .llPOhlld ond th.lr I..u. Rr. I..obl. .1 .1. p.re.nt (.X , C. Troh.'.r. 1..1 olher. lneludl", br.lh.r, .I.t.r, unol.. tunl, ..ph.. ond nl... .r. I..obl. .1 Ilfle.n p.r.onl 111~1, O. 1f you ohenee thl 1M r.'., pl.... .p.ol'Y ~our r.letlon.hlp to thl d.a.dent In the Irl' provided, I, Tho ooounl ., I.. dUO CII.. II I. d.'.r.ln.d bV 1UIIlplvlnl lho lIOunl I..obl. (11..'61 bv lho I.. r'll (11..71, CLAIMED DEDUCTIONS . PART 5 DE~TS AND DEDUCTIONS CLAIMED ,1l...oIIle dobto ond _II... ore delor.lned .. 'all....' A. You 1...llv .r. r..p...lbl. lor p.voenl. .r tho "1." .ubj.., I. Idolnl.tr.ll.. bv . por....1 repr..ont.llye I. In,uI,lelonl t. pov lhe dodUOllbl. It..., I, You ..Iuollv P'ld lho dobl. jl,.r d..lh 0' the d...donl ond eon lurnl.h proof ., poVoonl. C, Dobt. bel", 01. lid lU.t be 101.1d ,ulIV n p.rt S, I' .ddlll...1 'P'" I. no.ded. u.. ploln poper . III" . 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MJU T~ II ..",,". .....",,,.,, "i,"i!"li'i!I,",';'~lmi,'iI'li'/!ii:i, .....T ,',0 u" ViL ..':':: "., il ""i~' ,"" 11..DU lC ..,ft., FF C .:'.I\'I,"I"i'))'li.;CII'\'('i ""lil:I'i'l(ii:,C")','OR CALL,TI R A . QF':'. DX o "i' l\TA A En x QUXRUNIT "XN""II"'.""!"""'!!::::""; ni,i,'!'HARRlSBURGAT ( 17) 87"8~1I(iT D.1 ")','i 711-aZ8Z( EA XNO HPA RKDONLVl'!iiil'il' ;.' - ~.:' '.:. :,:,',: -'.'': :.:. ,-, ,'- ,- ,.'. .... . ..... . " , . '. -. , '. -' . - . '. ':'.' ".', :.:.., - '" ,." .':' ',' .:.,':: " ",',,""'."'.'" - ;. .. ' :. '.. ., :' , .. ... , ,.', ':' . " '. . . :'.." - . ....: . -... -., ,:. . . '." '.'.',',:.' ........ - ..','