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HomeMy WebLinkAbout97-00663 . PI~ITION ~OR 1~08ATI~ "nd GRANT 01<' LETn~RS A~\'((III' (\{ ____.-0/( (_\.L.~_u~~~.~'''~~ _~. Nil, ._:?L~'~11.u,::,4~-3,,--- III,\{) kllOll'l/ a.\'_.____u___~......_.+_..____u Till ____'u_+.. __.__u___u__________,,__..... I(cglslol' Ill' \~J1Kfg:; I?O / ____".._._,__-..-m_-n---y-'" 1~'l:J!a.\'('d, Clllfllly of ..nJ!t'h__I!.~/IIftl ~~ III tho Sodal S('('wlty No, _.Ji}_l(;::._.J~l:\l_' "1..,'-- CI1I11I11llnWOllllh Ill' I'onnsylvllnlll Thopcll1lon Ill' Ihc nl1\lmlgllod rusllCol fully rOl1l'0solilS ,I hilt: YolIl' pCIIlIIlIICI'(s),whll,ls/lII'ulK YCIII'S M !lgc'm'IlI.\lsl1' 1111 (hc cXOO\lLa!f_____...:,_~ llJl!Jlod In IIIC IlIslwllluf Iho IIhll\'o decl'dolll, dlllcd~__JfL~ll..~.I~)-.. ,_~_u_______.__, 19.J..L_ nlll~ cll~~I~I~(S)~~III:d~:~~=-'-,ylP'''u . :==~::~=~:.= :c""u-:~~~-' ~,::':'_:=_,"~_-c_",----- : " _-+-~,_.'.n'~_~'___~"'P_~_~......._,'n~_n.~;-.-,,;....~_..+-----<-<,...-...-....-.'_n~-._......__._,~_.o.._-_........,~,._-~_.t.:-~.....-.._---...,- .-.-.--,..., .._~m"'~~'_. _"'_"_~""_"" ..~"__..,-~_~-;~_,~~~_'___'~ --- ..__.~.----~..m.'_'___ ,,,~._~----+,,..-......~----"""--- , (slllll'r~lr\'nI1H..lrllHI1I~llIlI~'I'~! ~',".';~;lIllll\'lllllfll\'l dt'lllh fll ~"'-'\!\Ilotl IJIC,) , I)coonllcnl \\'IIS dUllllcllcd III IIclIlh 11I.,~Cli..~kW1~' Q".--_..'U...-JJ- (]7"ni'~~qllllAYlvnn\l\1 wll)i h_LL__ IIISI fllllllly \11' pl'lnclllllll'csldonoo III _H__c ~u(J.'11 J /O~~l.'(lLl -1t;(Ll./ (.,A/t "!let . 1701) __"~",---,,,,'_"__'_T~~.~+,-,_.~+~,__,,,~,,,-"'_"__'-'---'~'T~______________"'ri_'_~'T_~__'''''''''''___' " (11\1 \111.'1,111 11111111H!r IIl1cllllllnd\lalll~') I)CCOlldolli.lhClln.J!-.,...... YOIlI'I Uf.lIgC, dlod u~~Jv'inn'}'i_.~_u_n_-"--__' 19 q'? (\1.,;...,.___ .~_,._.~..~~___.,__..~._r~_+--,--,:"_"".__'_T'--'-----'_'__'~-.H~__"_~~." ________________....----..-----------.-.~ 1 Esocpl p' I'llllnll'~, dccollci\! did IIUI,IllIll'I'Y. WIIS 1\ll11,II\'l1Icod IIl1d <.lId 1101 hnvc II child born Ilr ndllflted oftol' csc~lIllllllllf illC will ulTcled 1'1lI11I'U\'lllcl II'IIS 1I01lhc 1'10111ll1l1' II killing IInd II'II~ ncvcr IIdjlldlonled Ilicollll'l'll'ol: u,.,.....,u,_.._"..,.,---,..__.__._,--~....:_.._-- 1l0CC,II,Ikni IIIIlc,,'lIlh oWllcul,\'rl1perIY \\'llh ,oslllllnlcd \'1I1110K 1I\.foIlIlWSI I I I $ Iii .... '" (if I,omll'lIod, 11,1"1\,)" ' All pCI'Slllll\ properly" __,,~vv (iI'IlIlld\l\Tllcllo\l.ln.l'n,) l'orsol1l1ll\l'Opel'IY In 1'0Ilus)'ly"1I11I $ (11ulll dlllnlcllfd IUI'II,) , 1'01'1011111 PI'ollcrly In CuuUIY '" $' . .,. Yuhl" ol:rcIII, eSllllc Iu I'clIlIsyl\'unlll It JIr 'Y lib fi, fY$~f...ff. .j) SII~~)ws: .-.===-___:~_-:~ _ ~_~:=~, /;/ =_~-!.A_~t1tL..-- . i . )(Oll/lj~/ 11li , ___..,..,.. ,_,,___,-"'n.,~~nu~~-"-".""--------_.'~'+---"--<--~'~-'.~--------''--''-'---'''-'-- , \\' Illii{HI'OIW, PVllIlllIICI'(S) l'elPocll'ull)' I'oqllcsth) 1110 pl'Ill11110 oflhc ills I, will nl1(\ elJ(lIcll(~) l\rOsclllcd hcrcwlth 1IIIIIIho "1'1111\ Ill' ICIICI'S._._ ~#rl11l!!!,i.fA~:t~.--~._--~ ' I tl~\UUllI.'I1IIU~'lIHI(lljlll~lrnlltll\ l;,I,II,IIUIIllIIlI'~H;i\llon.d,h,n,l.',t,R,) 11101'1111, j, ;~iLiti-- i:i ?]Ii~~7" ri~, ~~o~t;/iii.[C~P,RI.=';.' '7 ~ CCt r (-n~...l~- (_,:/12 (u'!J.~_~_ Un , tl .. _.___-+;~!..J_,..j..""'~L.:."_.T_~_~...~~.__':..--~---.,..~ _J ' >>,0 a .- <--"~..< -' ____~.,.~._,_.".u.~_-.---.--....;...-"+.__. $ ....___ ________u_.-r-r.~~._.~.. ~_.-------,----------+..---. ._~--.------.-.-...... ~U._~__'_T_.____~,-"n_,~------<_""'_ .....-...... _..------.._.__.-..--~_.~...... .~__________~.T+>---..-';.~T...-..---'......... ~;c~_~_.:.t"O-:::=)';;04,.,~;::;.~....;.....Tt1-.:;:;if~:;H:~:;O:::_=.:_;~:~.;;;.:,___,.;;:..C;~_=:,=~==,;~~_;r_i,.,..~__;_~~~"';:'~-m ".~. oAT'" OI<'I'lmSONAL IUWRI~SENTATIVE C.()~~~!~)NWlfAl"'lill (,>I>' I'I~~NS\'LV ~N\A } !:It! ' em N I,Y q. ..,""..,{',.l,l,m~jr...l,IUui......,,---:--- . H\\'1lI11 III pI' II 1'1'1 I'I110d IIl'1d hof,'I'I' IIIi' IIII- .,,_,Jit):l, _ Jq~ ~~'ef~L~~,th~~ Sill'SOrllll'd,j ,,_ dl~\ III' 19,,1.... N(',uis/('I' '~:~:.~::~u:::=-~~:~:::::==.=---- t '" ' ___._____.."_O'_T.___~_~ ~~~ ~__.D~.______ ~ Thi, h 10, <1'1111)' Ihal tilt' Il1lll1ll\illllll1 hUll' 1,11','11 I, l'IIIH'."k '" ,ie I r "I' ,,' ' ' \,II(,III\I'I'.i""II', 'l'1lt'."I'I\\ll1al t'l'IIIIll'iIlI' will 11("1,"will'dud I" tll! SI" ~'\]~'lli11111:"lgll1la (('III,IIiI~IIl' III <11"1111 dill)', 111.,<1 wlll1 I.\lt' a' . I (. ,tit III \l'ull\" (HI I'l' lo!' Pl'IIIIHltt-'1\1 filing, WARNINGlllla 1111Ig"1 10 duplloptll Il1la oopy by 1\110108111101' pl1o\ogrppl1, n...9?",663 , ,J_IOllllifllmIlJII,1i'"... :1""'~\'ttQf f(tI',t' , 'r,.,..i~'~,'i, ~~~ ~.~,~) \~"l., . ,ld/! , ~.?/,jrt~ln\~~'" JIJluihWY litH,'""""" 00/' f.1 ~ i ~ ;,.J.. i d:: , & 1 .' h'~ !i'l'lhhn'iJilk"I'''', nOli 1J~",j.~~ :'.,"..~'c.:~{;;..i"II~;;I'-lliI7...7~..-;-.,'J """ 4394118 '~,.:!...... "';'- ._ _ .~~_~L~:;:.~"!._.:j:.f~~_._~ 1),11(1 _.._..,~-.-""N;~.~m~..'m..'- OOMMOHWRA~TH 0' PBHH'Y~VAHI^' PB~A~TMBHT OP HBALTlI' VITAl AIOOAPI OBI\TIPIOATB OP DBATH .. .' 6'... ..., 7 o A /) , .-- IIJbIANr~ ~ M'A1 (ff'!' ... ' . .. \:tJr"::: O:t\" Ce.\ \ W. ~ ~ ....., '-" - 0 ...Cl ..0 - 0 ,.-- 0 ..0 ..... 0 CttMMlM~ CJ - .. ...'~ 1ltO~.!!!t.~tf'I\~.af\4~4*I..1i.....,,;..,.IfCit!I1~M4l\/I4Ii1l~IHtrlV<<!t......,WoIUl Mf(:r,;;;~,........~M..N'~.,tM~lflMf..., i"""""""""'";''''''''''''''''''''''''''''' '\:"'=r.: ......'",.."","""",M..... ......"'......................, ... ..,~,..."...W'".IH...,f4I4,tM~.,i~Mt!N.~.I~.......H"'...,','."..,. !"""""'" '~=~.P.!l'."!:=t:r." " , ' , ~R:J,'""" H ~~~~~~1~~1~:~,~,1.~,~:~!~~~~~~,t4 '11,~~:,..a,I~:~,~~:~,~~~:~~~~I~I,~ .' , ~I1'~I,;ral ',,-'..._", 'I .' , /., t:JC; ~ 1\1 ~lJO . ~...t ~ ~ !~~ ...t lJ...t \0 CIl \0 ,I ~ ~ . . lJ ~. ~ i'- i"l, ~ g . m \j-- ~ ~ ~e'N " ts ',...., -.... ~.. 'Qj ~ '5l :::l \'~. l' 1M ~ ~ I'" .~ ~ O~ ...t III Iol =f"lltl i.' ;, !i to j- . . f ...' !', qIliR'HFiCATIONOf'.NOTICElUNpERRULE 5,6/a) Na~. 9~ O.oe~entl P.t~iok J. Ahtoz~k Oat. of Oeothl July 28, 1~97, Will. No'", ,219'7-0663 _Adm!n, No, 1'0 the Regiat8l."1 , I cert~fy thot notioe o~ beneficial. Lntereat required by MUle 5,6(a) of the Orphans' Wourt RUlee Wlla eerved on or mailed to the !ollow~n\1 bl\lnef!ciarLee of the above~oapt.l.oned I\letllt:e on AUgue\: '15, 1997 I " , Name Address D'IWid, ~~t:ozak/ 32 Old GIt\:\:ysbu!:'g Rd./ M8ohanicebu~g, PI\ 17055 '., ' DaWn M. Hopple, 64 Scholfield D~., ,Elast Be~lin, I'I\ 173J:6 Deb~o, t.ee Pa~ke~, 5794 Clove~ Meadow tn., Il'a~m,tng,ton I ,N~ 14425 Ma~k, H. t.fbeok, 40 PhasM\: Hall Rd., da~1iah, PA 17013 , Not:"iclil,hlJs now been. given to all pereons entitled thereto under RuleS'; 6 (a) exqept 'NonA , ~ 'J;c t!om. 0;-: 0 j: , '31 T-- 'E~ , ;' '_iI U ';~ p' I.~ ilJ u: " 0,l 8 tt 1J '~ JtI( Si\1nat\lre Name Hersohel t.ook, Esqui~e Addre~s 3107 N. Il'~()nt: Street Ha~~isbu~~~ I'I\ 17110 Telephone (717J 238..66cll .' oat:~~AUgsut: 15, 1997 , Capacityt x Perllonal Reprl\lsentatlvQ Counsel for personal , rep~esentat1ve cPl-Q'7..,1 f..,(p;3 e: - RELEASE I<NOW ALL MEN, BY THESE PRESENTS, that I, MARl< LIBECI< of 40' Pleas!lnt Hill Road, Carlisle, PA do hereby aoknowledge as for divers and' 9ther good oauses and, valuable oonsiderations, have , remised, released, quitolaimed, and forever disoharged, and by these presents fo~ myself, my heirs, exeo~tors and administrators, do remise, release quitolaim, and forever disoharge the said Mark Libeok Exeoutor of the Estate of Patriok J. Antozak his heirs, exeoutors and administrators, of and from all, and all manner of aotion and aotions, Clause and causes of aotion and aotions, suits, debts, dues, duties,' sum and sums of money, aoooun~s, reokonings, bonds, bills, specialties, ooven/lnts, oontr~ots, agreements, promises, varianoes, damages, Judgments, extents, exeoutions, olaims and demands, whatsoever in law or equity, or otherwise howsoever, wh,l,oh equitYI or otherwise howsoever,whioh Aga.inflt the said Mark Libeok Exeoutor of the Estate of Patriok J. Antozak, I ever had, now have, or which I, my heirs, exeoutors,or administrators, hereafter, oan, shall, or may have, for, or by reason of any manner, oause or thing whatsoever," from th", beginnings of the world to the day of this date of these presents. IN WITNESS WHEnEOF, this nY\ I :~-, day of I have hereunto set my hand,and 'seal, ~~~.~ '7~ 7J~, " ,'j ! 1,-, IJ' " J ~': Antczak / Patrick J. 3g4 ~~~1~~~~~-~-~-r;fl7;:;~f;~~r~7;/R;~'-- Coo" ~j<J: Original Relurn -[J 2," SUPI'j;~onl~1 RlIur; o 4, Llmlled elloll IJ 4a,fululO 'Inleroll Compromlll Ifo' dalll af dealh (Ilior 12.1 2.02) 1,:.1 7, Peeedenl Malnlalned a Living Trull Allach' co ofTlul1 P1DINTIAL TAX INPO MAT,lOOULD81 DlIUCTID,TOI" ,',' ,-. 'ICOMPUTe MAlllNQ APotlU . ""'"'""""'",.","- _:~ ___ ~:_~;l:~;~~ '::~1i:~,f:~~ I.. Real e,,"" ISchedule A) I l)'_.n.._....9_Q_.J?.9_._n~_._ 2, Slack, and Band, (Schedule BI ( 21_, ........,..Q.QJ,.Q9~___u_,_. 00.00 . 3, Clolely Held SlocklPa,lne"hlp Inl.roll (Schedule CI (3) .._n~.~.'___m'_..__...m"__n 4, Morlgagll and Naill Rocolyablo'ISchedule PI ( 41 ~__._u_u_~9_:,O...~____n_". . ..n , ", '23/576.70 ,,,'>I 5, Call" Bank Pepo,11I & Mllcellaneaul PI"onol Properly I 5I,_'_c~___"'n___.____u__'non...." ' ($chldule e) 6, JolnllyOwnod Properly (Schedule f) ( 0) ,_..~~..~.L~.90 .0.9_'.____. , .' 00.00 7, Tron"e" (Schedule 01 (Schedule L) ( 71__.e....u ,...,-,---.........'-------... 0, Tolol.Oro" 8"el' (IOIOllln81 1.71 9, Funeral e"pen..', ,o.dmlnhlrallYO COlli, Mhcellaneou. ( 91 _.."!1..L.f_85".1.lL.__,... ...-- e"pen'" (Schedule HI " ' ' 10. Pebll. Morlgogo Llobllhlll. LleOlIS~hed~lel) (101 __.~,~,~~.~.i..!...~O_.-......._,~., "'51/248. '38 11. TOlalPbductlon' (lolallln81 9& 10) 1111, ___".._..____nU_._._ ,... , 12,'Nel Value ~fellote (line 0 mlnullI'ne 111 (121 ___,~,~,'..~.~.7.._'.2.~.,__, 13, Charllablo ood Ooyernl1lenlol OeoulIlIlSchedule J) lIal _,_.____,__l?..~.:.9._?_u__.. 14, NoiValue, SubluCIIO To" (line 12 mlnu. IIneEL__._____'_______ 11,11 ...o;:;.~_l__/!_io,_7_-,.,.,_~.. ~.'--.,,_'__ 15, Amoun!'of line 14 lo"oblo 01 6% 'ale 11$1 _~~__...,_.,_.._.___..._x :06.. -.. - .... u ~ . Ilnclude ,yafu.. fronl ScHedule K or Sch"dule M.I 16, Amoun!'of line 14 10Kable 01 15% role Ilnclude valulI from Schedule K or Schedule M,I 17, Pdnclpallox due!Md 10" from line 15 and from l'nel6,1 18, Credll. Prior Paymenll Pilcounl Inler8l1 _2..,.5..o.0..JlO_. ,~ ......,.._'...,,~~__. ~ --,....-----~-,~,... 19, If IIn,e 18 II grealer Ihon line 17, ~nler Iho dlff.renceon line IQ, THI.I' Iho OVIRPAYMINT, 110 20, If IIn~ 17 '.grealer Ihqn IIn. 10, enler Ihe dlff.r."ce On lint 20, Thil I. Ihe'TAX DUB, 120) _...~JJJ.i.~..!'~_~_.m_m A,lnt.. IhelnlerOlI on Ihe balance due On IInt20A. (20AI ..__......~,9..Q.!...Q.Q~~___m 8, Inter Ihe 10101 of line 20 and 20A on line 208, Thlt I' IHI BALANce PUI, 1208) ~.~,-~14 .1 '?,-,-~'-'" Make Check Payable tal RoUlller of Will.. Auent ... , '! . ..., '. ...aIlURI TO AH.WIRiALI/QUISTIONI ON RmUU1DI AND TOIlICHICK MATH....' .. ... - Under penolll.. of perlu,y. I decla,. Ihall aye ...mlned Ih'l return, Includ'ng occompany,ng ,chedulOl and,lIalemOnl,l. and to IHI bo,1 of my, knowledge and beli;r III' true. correel 'all (om ,'ei' .clare, at all ,enl <<"Iale hat bun roporlod ClI true ITll;ltkDI valuo, DedarallQn of prepar., 011,1' Inan !he pertollQ! '.p,..enlaH-/1t I~ bo,ed on oll'nf.. 110 whl e , hat an knowled e. " . (il!TIr" ----------- rnr--:---'~- t, rnrr.r.nTfffilfID.11'7l"'" 40."'~o\:r~;llnt Ii i 11 ROlldn~mCa.r: l!-sle, ~A _1 7~1~Ai;;ItIL9:1'" _._____.________________3_1 02 _~~ F r on:~ _~.t.:...~~ t.'._~1 a r ~~~_~~13115_~.DJ 0 n __ _. _..... "" . Rev.I.~'JO EX + 12.JJI I ~I! ~I ~ i I o ~ IG ( IV ft L- I 5 ,-/Cf Wi, - '-+ ~'J\t'9. ~J\.w COMMD~~mA~tIl OJ '1"!I'.1~nlANIA POll ~1~~,lo<J 831'1' IlARRIUURO PA 1110J,8ln_ INHBRITANCE TAX RETURN RBSIDBNT DECEDENT (TO BUILED IN DUPLICATE WITH REGISTER OP WILLSl [Ill "M IIR CQ. I .9fJIfI- 1 g '37 COUNTY CODE YCAR .. .u~ Patr10k J. Antczak 40 Pleasant Hill RQa~ Carlisle, PA 17013 Cumberland . -.........--,-.--------.--... CI 3, Remqlnder Relurn , Ifor dole. of dealhprlOrlo I~.\ 3,,~21 Cis, fedoral ellall Ta. Reluln Rloulred _ 0, TOlol Number of $qfe PopollI OOXOI 00663 NUMBER -_.-+......->~.~;.;,; 06, 'a3, 076.70 , I 01 .,,"-,-..-,.-,...------...---," t"J' (161~1}.L8_~,~L?..~_..~. ~ ,\5 . ;. ., (t,774.16 1171 4,774.16 (18) _..h~,g,g";.~g..nn. 1191 ,,,~__,__,,,'__...___u_,",,,,,, a " PAYIIIIHTI Del..h lho top I'CIrUun af Ihl. Holla, ""~ .llblolt with va~' ,p'v..nl ..d. p'V"'I. 10 lh. n_ I!nd 1Id<l.... prlnl.dun lho r,y.r.. .Ido, .. If RtII1D1~TDltlIDllHT .III!. ohook' or oono~ a'~.r pov...l. 101 "BllIST~" op WILLa/AGeNT, If l4OH~lI1Imm DllCKPl!HT olll!. ah..ka,' _.ford.. p.vabl'lol OOHItOWWB~LT" OP PBNNSVLVANIA, R'FIIMD lCA11 A,..f\tnd of . I..orodlt, Mhlah w.. nol........I.~ on Ih. 'j.. Rol~rp, ..v~, roq~..I.d ~v a"""I.llno", ~APPllo.llun far R.fund al ~onn'vIYonl. Inherllona. ond e.lal. rOW" IRaY-IJIJ), Appllo.llon, .r. .y.llobl. .1 tho Dfl'.. 01 In, Rlflol., of HUIo, ""v~f lho n R."onuo Dlolrlol Dltla., or 11'00, Ih. P.p.rl"nl', tN,o"r ""tNtrlno "rYI~. ......r',10r for.' ordl,lnol In P.nn,vIYonl.I-IOO-I't-tOIO. o~I,ldo Penn,vly""l. ~ wll~ln 100.1 H.rrlobUrO,.r.. (717) 717-IOO~, I.,ylo.. for I..p.v.r, wllh .p.ol"1 h..rlno ond 'polII!lno nood,l 1-100-4~7-IOtO (TT onIV), Ii RtlP~Y' TOI ll\l<!'lIou,,,.rdlno orro".onlolno~ un Ihh n.U.. 'ho~ld~. .ddr....dl.1 PI. D.p.,l..nl ~'f R.y.nue, 1~'oiMt of IncUvhtual' Tliell, ATTNI po.t A.......ntR.v.lt'N UnJtt b.pt. 2'0601,1 Ilarrhbura, PA 1711a.0601, phonI (717l' 717-6101. DISCOUNT I If WlVtl)( dUe h paid w!th!n thre, (S) C1.1'nchlr.C)nt~. IIt.r the d.a,d.ntt. cMath,. flv. peraent,CJ'CJ'dllaount of the tax paid l'.A1Qw.di PllH4LTY, ThllIX I.. _O\~ ""n-p.,Uolp.U.n pon.l\v I' .0onU\l~ .n Ih. 101.1 of Ih' 10. end,lnl,,"1 ,,,....d, end nol p.ld bolor. Jon_.rv 11/ 1900, lho fl,'I~,v .fl.r Ih,ond af Iho ,10' o","lvp.rlad, IHTaRlIT, Int"..1 'I' Oh."od boRloolno wlthtl"l dov 'Of d'lInq",noy, or nino 19I 'onlh. end on. (II d.v f'o. Ih. ""\I of d.ath, to the d"t,'of plva.nt. Tllf.. ..hhh buo.., d,Unqu.nt blforl J",uar~ 1, 1982 bur Int,rllt It the r-.t. Qf ,I. <6X, p"~.nl Ptr """",,,o.l.u"t~ .1 . dillv r.l. of ,OOOI~~, All IOK" whiQh,~lo'" d'II~'Mnl on end .ft.. Jonu.rv I, 104. will b.., Inl.,o,I.I " r.l. whlQh wl!1 YQ" froo o.londo, V'" 10 ool'nd., vo.r'wllh th.1 r.l. _o.d bv,lh. PI. Deport..nl of RIY.nuo, Th. '~Pllooobll Inl"ro.1 rotufor 1911 Ih'Olloh tOOD 0"1 VI.r Int"h.l R.I. D.llv Inl.,.,1 P.ol.r VI..r Jnt.r'-.t Rat, Oalh Intlr,.t r.ator - , IOU tOX .aDDI.a I9Ia-I991 U~ , ,ooom IOU UX ,000.>> IOU o~ ,DOOm 19M lIX .Don,1 I99J-190~ 7X ,DOOlOt IOU U~ ,DDnle ,1991-109a OX ,OOoe.7 " 1916 IO~ , aooe1~ 1999 7X ,000191 1087 oX ,000tA7 1000 I~ ,OOGal' ..lnttrtit II'O.lc~iat'd Ii fallow., XNTSRBlT- .ALANOS OF TAX UNPAID H HU"BSR OF DAYS lIBLINGUBNT X OAILY INTBRBlT FAll'rOM I ""'Anv ,Hotla1luUld .ftor thcl tlM ,"COlI" del1nqu,nt will r.fl.ct en Intlr..t allaul.tlo" to, fJft.." (Ui) din tMyond thl dati (If thl .........nt, If Plv.,nt h ..da> tlfter the Jnt.r..t oo",ut.Uun dati IhOW" Of' the Notlol, additional Inter..t .o.t b, a.loutetld. HAKI CHICK PAVA.~I AND RIMIT PAVHINT TOI REBISTEROF WILLS CUHBERLANO CO COURT ~OUSE CARLISLE, PA 17015 CUT ALONo 1.1:1IS 'LINIl ..... RITAIN LOIIIR PORTION rOR YOUR RICORDS ... 'ftW: li';,"f-i'lr-~~li'-fo'f:m--RoYfo""d'll-'i'NAiR{fAiloi-Y~x- A1S11ftA"filifiilt-""~t~-oliAilcl'i-'liIf""--"'----- - - no . DISA~LOIIANCI OP DIDUCTlcNilAND ASSlssHIIHT OP TAl( , ISTATI OP ANTCZAK PATRICK J PI~I NO. 21 97-0665 ADN 101 DATil 11-01-1999 TAK RerURN IIASI (X ) ACCIPTED AS FILID (I CHANGID RISIRVATION CDNCIRNINo PUTURI INTIRIST - SII RIYIIRSI APPRAISID YALUI OP RITURN BAS liD ONI ORIGINAL RE1URN , 1" Rftol htato (Sohadula A) 2. stook. 'and Bond. (Sohadul. B) 8, clo..1~ Hold stooklpartnar.hip Intar..t (Sohodul. C) ~. Hortoao..INot.. R.o.iyobl.'(Soh.dul. DI I, Co.hlBlIlIk lIepo.U.IHi.o, P.r.onal Prop.t.t~ (Soh.dul. E) 6. ,Join~l~ Olfnad Prop.rt~ (So~dulo F) 7, Tran.for. (Sohadula 01 S, ' 'Totll. A...to APPROYID DIDUCTIONS AND IXIHPTIDNSI 9, Funoral IKP.n...IAdIn. Co.t.IH100. 'IKP.n... (Soh.dulo H) (9) 10, Dlbt./Hortoao. LilbilHi../Lhn.(Sohldull I) (10) 33,963,70 11, Tot.1 lloduoHon_ Ul) 12, HIt Valuo of TaK Rlturn (12) 18. chlritobll/Goyor~lntll Blquo.t'l Non-Illotld 9118 Tr~.t. (Sohldull J) (18) 1~, Not Valu~ of eototo SubJlot to TIK U~) 51 .8:!1, 72 NCTII If iH ........nt w.. i..ued p~.viou.~Y, ~ine. 14, 18 .nd/ar 16, 17 .nd 18 Wi~~ r*f~.at figure. th.t i"olude the tat.l of ~ r.~urn' .......d ta d.t.. ASSISSHINT OP TAXI 11, Aoount of, Line l~ It Spou.ol ra~~ (11) 16. Aoount of Linl 1~ tOK...1. It Linoo1/Cll" A rot I U6I 17, Aoount of Line 1~ toMlb11 It Col1.tlroI/Clo" .,rltl (17) 18. Prinoipll TIK Duo TAX CRIDITSI PAYHINT DATE 0- 05-25-1999 /,'):,/90 --'I BUREAU Cf INDIVIDUAL TAKE8 IHtIERITAHCn TAK PlymPH DEPT, 100601 IIARRIBBllRO. PA 11118-060\ coHHONlIlALTH OP PINNBYLVANXA DIPARTHINT DP RIVINUI NOTIce OF INHERITANce TAM APPRAI8EHeNT, ALLOIlANCE OR OISALLOWANCE OF DeDUCTION8 AND A8SB88HENT Of TAM c.y " , 11-01-1999 ANTCZAK 07-28-1997 21 97-0665 CUMBERLAND 101 ,Allount Rlo~Hld DATI IIsTATI OP DATI DP DIATH PILI NUHIIR DOUNTY ACN HERSCHEL LoCK n07 N FRONT ST HBG PAli7110 \1,1 U).OO (21 ,00 (8) ,00 (~) ,00 III 2!,B76.10, (6)_ n9Jpoo.Oo (7) , ,00 17.285,28 ,00 K .00. .00 K ,06. ll1.827',72 K .15. (8) , RecIIPT HlJHI8R 2 AA311(1878 DISCOUHT (+) ,INTeRS8T/PIN PAID (-) ANGUIlT pAlO , 131.58" . , 2.27(1,16 8ALANCE OF UNPAID INTERES'tI;PENALTV AS OF 05-26"1999 TOTAL TAX ORIDIT BALANCI OP TAX DUI INTIRIST AND PIN. TOTAL DUll '* UV.IIUUUt'UHtI PATRICK J NDTSI To in~uro propor orldit to ~Dur IDoount, .ub~it tho uppor portion of thi. forll with ~our tl" p.~...M. (8) 85,076'.70 "1.?AR.QR 311827, 12 .00 ,00 .00 (1.77(1.16 4,77(1,16 (1,77(1,16 ,00 58,79 58.79 M IF pAID AFTeR DATB INDICATED. SSB REveR8e FOR CALCULATION OF ADDITIONAL INTEREST, ( IF TOTAL DUB 18 LES8 THAN .1, NO PAVHENT IS REQUIRED, IF TOTAL DUE IS REfLECTeD A8 A "CREon" (CRI, YOU HAV BE DUE A REFUND. 8Ee REVERSE 8IDE OF THI8 fORH FOR INSTRUCTIONs.)