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IlInlu", .pnpllll '.prc; .~J8"'H uo 16DfU1;lJ'd IIQo'!IddV JOI ulolil/'lmUjlltS In'oc.q J'ijo ~IO'p 10 "IO~ 'oIlIJlI'II.lllo.nod~ h: l ,;ullMujw z 1 .u6f'M'o!- ;;'m;rq~.S-;~IQ^-~.'N' lr 'jt'lP'~)st '~..nb'e IOlu,wtjJ.^O~) pliO 'j'lol!JoYJ "C I i l! 191 (II fltll1l1IU!!.U UtJwl) "Irm~ 10 ",lj(J^ I'N 'll 10 I 'Ii 6 '"U! 1lo,lJll ~1I0!prlp/JO P/Q j I t II "lnp"psI tue!l 'tllWl!qCt!1 o606lJoW '11'1-0 '01 IH "lnpll~'I'1 '''lutdll':J 1noAuol!I)'IW ".'0) ."'1l0111!UlwlI'r ".'l,IlId"(~ IOJ.unj 6 fL-1 IIII!1IOI01) IlltHV "OJ!) 10'01 '9 (1 'Infl'~'lJI10 'lnp'~'li~ tJ','UOJl. 'i. I~ 'Inp'~'~1 ~".doJd p,u^'O ~IIUIOr '9 Il 'Inpo~'sl ,(JjodoJd IOUOUYd InUQlIo!lQ}t!W 'Ii' '1!,od.O ~uo8 '~II') 'SO 10 'Inp'~'s) 'lqO^!"'. ",oN p'o ,,609~oW , b AlnpA~)sll"JIIIU' d!~IJ,ujJod/V"'jS PI'H ,(,..01) (' 10 IJlni-"~'S' Ipuog put) 1~'I.1,S 'l. Iv 'jnplltpsl f11l)1':IIU&~ 'I ffl ~ .. n " ill ~ .t .. -, 6 z '\'1 ,--.. -~._~.._--- " ~ ~ ~ i ..jn En Ut>>~ ;;t i .... INri) + IU OIlil'I\JIII Act ,It. of 1991t provld.. far the r.duetloll of .h. '011 nl...lmptl.ed on tho n.t vldu. of .ran.f.,. to or for' tho u.. of .h. .pou... Th. rat.. a. pr..crlllld bv tho .t.tut. will bll I 3% (.031 wlllb. applleabll for ..t.t.. of dle.d.nt. dVlnl an or aft.r 7/1194 and b.'.r. 111/96 . 2% (.021 will b. appllcabl. for .,'atll' of dllc.d.nt, dyllla On or a".r 1/1/96 and bllfor. 111/97 . 1% (.01) will b. appllcabl. far 1II,'ot.. af d."d'nt. dVlng an or aft.r 1/1/91 and b.'or. 1/1/98 , Spou.al trall.fer. occurring on or aft.r 1/1/98 will bu ...mpt from Inharltanee tax. PI.EASE ANSWER THE FOLLOWING QUESTIONS .BY PLACING A CHECK MARK (...) IN THE APPROPRIATE BLOCKS. . l. DI"_"" .ok..",,,,,,,,,,", ["'! ..1 x I at retain tho use or inr.ome of the prop..rty tran5forred, ".................,,,......................,,....".., j.., ~-" . X i. h. m.nin the right to deslgnale who shall use Ihe property .rans'err,d or lIs Incomo, ............... ,.J_ x , t.. fAtnln Q reVfJfSlonnry lntftr8sti 0" ......".........................,.....,....."...........................,...,....., I -,-~;.. .0.._- !X d. rerolvll thll pmmim for lifo o'oithur pnyments. bene'ils or care........................................ f....-- ,.. 2. If death oCI:urfllll on or before December 12, 1982, did dlllcad.nt within two years preceding i X daath Iranllftr proparly without roc.ivinR ad.quate consld.ratlon' If death occurred after December 12, 1982. did dotedent Iransfer properly within one year of death without receiving I X adequote cOllslderotlonV. '0 ,,,....',..... " II ......", ...",., f Ilfl""""lIlfllll,,IUlHII11H II'H" II' ""tltu...n" \""-- ..-.- 3. Old decedenl own an 'in trull for' bank Der.nunl at his or h.r d.ath"'.........................".."..... I I.X_ . If THI: ANSWER TO ANY OF THE ABOVE QUESTIONS 15 YES, YOU MUST COMPUTE SCHEDULE G AND FILE IT AS PART OF THE RETURN. RIY.1I1. II. 11-1'1' I '*' I SCHEDULE G COMMONWeAl!" 01 "NNI,ILY'~I'. TRANSFERS . 'N":::l:'~IJtc~':Jr'N l J PIVASe PRINT OR TYPf _ _ . ~____________.._~..<__...._~____.~_~.____~__'._~'~~k_' ___..___ . ~,......_.. .ITAlI 0' ~IL' NUMI." . .. -. .....- ....n__ Julia Plpok - _u.,__"_ + ___n.__ THIIICHIDULI MUll II COM'LITIOAND P1L10 IP TIll ANIWEI TO ANY Of THE QUIITIONS ON THIIMIII SIDl O' THI COVlI IHIIT II VII. . ITeM-----'--"-~DE;C;I;;~O~ 0; PROP~':; .. .. .n_uu1 "'I'~OTAL VALue De~D - ~&~~g:~~__n. HUMIII l.d"C/O n......I Ih~ I~.~'..~., I,!lr ..Iofl.'"lolp 10 ."d..I, <I.,. oIl,.n,I". lXCLU$ ON or A$$n INT. ,. IJT,'iI.ULT_ ~ _._. I 3 Vanguard / Wellington Fund 5/31/94 U.S. Savings BondS ( Inventory Memo wtth dates of Issue attached) Members 1st Savings 153637-00 5/31/94 $ 32,116.55 $ 33.11610 $ 12,600.00 '00% ~ 32.116.55 $ 3~.1161O $ 12,60000 Vangurard / Wellesley Fund 5/31/94 o . '100% 100% 5 Members 1st Savings 153637-05 5/31/94 6 Members 1st CD 153637.47 5/31/94 7 Members 1st CD 153637-43 5/31/94 8 Members 1st CD 153637-52 5/31194 9 Members 1st CD 153637-53 5/31/94 10 Sovereign Savings 092-3013304 5/31/94 11 Sovereign CO 092-5014219 5/31/94 12 Summtt Checking 17353203 5/31/94 13 Summn savings 503024855 5/31/94 $ 9128 100% $ 91.2e' $ 4,457.77 100% $ 4,457.77 $ 6,270.59 100% $ 6,270.59 $17,92401 100% $ 17,924.01 $ 32:183.86 100% $ 32.78386 . $ 50,382.54 100% $ 50,38254 $ 5413 100% $ 54.13 $ 8,092.14 100% $ 8,097..14 $ 1,98663 100% $ 1,986.63 $ 5,717.48 100% $ 5,717.48 4 -..-...-- -~-_.. .----......- _._~. TOTAL (AI.. ..tor .n II.. 7, RlcOplI,l.tl..) $ (If marl 'PQc;. II ,..thrdt ;n$trf addItional '''Nfl o( laml flU.' 20~29.~ O~ . C~WI'UH Ol' P1NN,YlYANIA INHI~ITAI<CIIA. ~IIUIN ...'OIN' IlfCIOIN. "'.11 O. Julia Plpok __.~___...--.__........._,._._._..~...~._.._----_._--_J- H~UIl ... fI'" --" ITIM MUM"R A. 1. 2. 3 4. ~. 6 .. . \ 5eHIDULI H ,UNIIAL IXPINIIS, ADMINIITIATlVI com AND MIICILLANIOUS EX'INSIS Ploa" PrllII ., ~Y.e! . - .~ ,_..~' - ---------.--- AMOUNT DISCRIl'T.ON --.--------------------------- $ 2,880.00 $ ~a300 $ 14900 $ 2, 490.00 $ 8M 00 $ 90.00 'uMral 1M,......' Funeral Staff. Facll~les & Equipment Connell Funeral Home Belhlehe;n, PA Tran.portallon connell Funeral Home supplies & Funelal Merci1andlse Casket Vault Cemetary Lot 1. AIImllll.I,atlvo Co"" Perlonol Repre,en'atlve Commllllonl Social Security Numbe, 01 Perlonal ReprelontCltlve' Year Commiulonl paid 2. "'"orney Fe.. 3. Fomily Exemption Claimant _..... __ Relotlonlhlp ,6.ddre.. 01 Claimant at decedent', death SIreet "'ddro.. - IS-It/I'? lURE AU OF INOIVIOVAL TAXES INHERITANCE TAlC DIIJISIOH OEpr. l8li601 liARRISIIUIfG, flA 111l8"0601 COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE * ['-' NOTICE OF INHERITANCE TAM APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF Of.OUCTlONS ANO ASSESSHENT Of TAX "I-IH' Iii _"11,.t/1 12- 01- 97 PIPOK 05-21-97 21 91"0680 CUMBERLAND 101 f~~,,:~~O~~!-R~~n=~d~:"~~~] MAKE CHECK PAYABLE AND REMIT PAYMENT TOI REGISTER Of WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE .... RETAIN LOWER PORTION FOR VOUR RECORDS ... R"EV;' is;,-;' EX - AFP' i o'F 9'fi-ilii'f i ilE" -oF'"( NHEifi i ANC E - TAX - 'A'pjiRA i sEHEN:r; -A L rOWANCE - OR - - - - - - - -.- - - - -... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JULIA FILE NO. 21 97-0680 ACN 101 DONALD FAIR 1522 COLLINGDALE CIR MECHANICSBURG PA 17055 DATI ESTATE OF DATE OF DEATH FILE NUMBER COUNTV ACN JULI A ESTATE OF PIPOK DATE 12-01-97 TAX RETURN WAS I I X) ACCEPTEO AS FILEO RESERVATION CONCERNII<<lFUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN )., R..l est.tll <<Sch.dull Al 2. Stocks and Bondi ISchldul. 81 3. Cloa.ly Held stock/p.rtnlrlhip Inter. It (Schedule C) 4. "ort...../Not.. Receivable (Schedule OJ 5, C..h/lank a.pod tIt/HiIC, Perlonal Properb ISohedule E) .. Jointl~ Owned Property (Sch.dule Fl 7. Transflrs CSchedull OJ ., Total A...t. 1 CHANGED NOTE I To insure prop.r cradit to your ~ccount, subnit the upp.r portion of this forn with your h)( pay...nt. .00 .00 .00 .00 6.192.00 70.276.37 205.593.08 181 III 121 131 141 IS) 1&1 (11 282.061.45 APPROVED DEDUCTIONS AND EXEMPTIONS: .. Fun.r.l E)(p.n.../Adllt, Co.~./ttho, Exp.n... (Sch.dul. Hl 10. D.bt./Hortg.g. Llobllltl../Llon. (Sohodulo II 11. Totol Doduotlon. 12. N.t Value of TaK R.turn n, Charitable/Gov.rn..nt.l ,.qua.h; Non".lact.d .113 Trusts (Schedula J) 14. Not Volu. of E.tot. SubJ.ot to T.x 191 lIOl 8,815.96 .00 1111 lI2) (13) lI4) 8.8T~ 96 273.245.49 1,000.00 272.245.49 If .n ........nt w.. i..u.d pr.viou.ly, lin.. 14, 15 .nd/or 16, 17 .nd 11 will r.fl.ct figur.. th.t includ. the total of ill r.turn. .......d to d.te, ASSESSMENT OF TAX: 11. A~ount of line 1~ .t Spou..l rat. (1S) 16. Allount of Line 14 hJlab1. at Ur,..l/Cl... A rata (16) 17. A~ount of line l~ ta.abla .t Collat.ral/Cla..e rate (17) 18. 'rinclpal Ta)( Du. NOTE: .00 X .00. 272.245.07 X .06. .00 X .15. lI81 .00 16.334.73 .00 16.334.73 TAX CREDITS: PAVHENT DATE 08-13-97 OISCOUHT 1+) INTEREST IPEN PAID I") 816.74 AHOUNT PAID RECEIPT NUHIER AA211628 15,517.99 . - TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 16,334.73 .00 .00 .00 . IF PAID AFTER DATE INOICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN .1, NO PAVHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). VO.J HAV IE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RUERVATlONl Ettet.. of dlCldlntt dying (m at befnre Dec.Mber 12, 198Z -- if onY futu~e Inter..t In the ..tate I,"tren,ferred In po.....lon or enjoy".nt to Clan 8 ((lollfttera\l benlf1cdllrl.. of the dlCldlnt .fhr Hut I)(Ptratlon of arW e.tat. for life or for y.arl, thl COlll..onwulth hGareby expr...h' r...tv.. the rlUht to appr"h. "nd a..... transftr lnh.titanol '.11" at thl lawfUl Cia.. a (CoUatlrall rate on any ,L1oh futllrl lnt.r..t. PURPOSE or HOTlCE I To fulfill the r.qulr.lIllnh of Slotlon ZI40 of thl Inhedtancl' ann E.tate TlIllC Act, Aot 21 of 1995, (12 P.S, '.cUon 91"0), Oltloh thl tap portlon of this Nottce lmd .ubl~lt lollth your pay",.nt to th8 Rlglster of wHit prlnt.d on the rl\l.rs. .Id.. .'14akt ch.cl<. or lIIon8Y order paYlllble to: REGISTER Of' NILLS, AOENT PAVMENT I OIJ[CT10HS: Any p.rty In lnt.r..t not satl,fl.d wlth the appral"lIIent, allowano' or disallowance of dlductlon., or a.....III.nt of talC (Includlng dltoount or lnt.r..t) al .hown on thl, NoUo, IIIU.t obj.ct lollthln ,I)lty (60) dais of rlollpt of thlt MoHou by I ~.wrttt.n protl.t to thl PA D.part""nt of RII/.nue, Board of ApP'l'l1s, Oept. 281021, Harrisburg, PA 111Z8-l0Z1, OR ~-lllction t~ hl\ll the Matt.r dltlrRln.d at ludlt of the &ccount of thl personal repr.s.ntatlv" OR .-.pp.al to the Orphans' Court. Ar.fund of a talC or.dlt, whtch was not requIst.d on the TalC Roturn, ~ftY bl requlsted by cOMpl.tlng an "Application for Rlfund of p.nn.Yl\lanle InherttancA and Eshlte talC" (RF.IJ-U13L Application. Ilrll alll'l11able at the offtc. (tf the Rlgllt.r of wills, any of the 2:3 R.v.nuI Ohtr1ct Offtc.., or by calling thl sPlchl 24-hour antwlrln, ,Ir\llo. ~b.r' for for.' ordering: In Penn.ylvanla 1~800.!6Z-20S0. outsidl P.nn.ylvanla Rnd within 10011 Harr.ltburg ar.. (71ll 781-809". TOn. (717) 77Z-ZZSZ (H.llrlng IlIlpedred OnlY), REFUND (eRl I ANUN lSTRATlIJE CORRECTIONS: rlctual .,rort dhoo\lll'ed on this a.....r:l.nt .hould bl addr....d In writing to: PA nlPart..lnt of RIYlnu" lur..u of Indlvidual lII"es, A11N: po.t A.......nt Revl... Unit, D.pt. 2~0601, Harrisburg, PA 171Z1I~0601 Phonl 1717) 767-6505. S.. pa,1 5 of the bookl.t "In.tructlon, for Inherltano' TalC Rlturn for a R..ldlnt Dt.:.dlnt" (REY-1SOI) for an .xplanatlon of ad..lnl.tratl\l.ly correotabll .,ror.. If any tax due Is paid within threl (S) c.llndar 1II0nth' aftlr thl decedlnt'. dl.th, a fivI pareant (5:0 discount of the talC paid 11 allow.d. Thl lSX tllC .lIIn..ty nDn~partlclp.tion p.nalty I. oOIllPut.d on the total of thl talC and lnter..t .......d, and not pIld bafor. Jlnutry 111, 1996, the flr.t day aft.r the .nd of the t.lC allln..ty p.rlod. Thl. non-partlclpatlon p.n.lty It app..labll ln the .... .ann.r and In the the S'R' tl.. p.tlod a. you would app.al the talC and lnt.r..t that hat bl," .......d .. lndlcttld on thlt notlc.. Intor..t It charg.d blglnnlng with first day of dlllnqulncy, or nine (9) lIIonthl 8nd ani O) da'! frotl the date of d..th, to thl dtt. of p'YIll.nt. 1IIICII which b.et... dlllnqu.nt b.fore January I, 1982 b.ar Interl.t at the ra1l of SIM (6X) Plre.nt p.r annu. oalculat.d at a dall~ rate at .000164, All talC" whtch b.ealll.dellnqu.nt on and aft.r Jlnuary 1, 11)8Z will blar Int.rut at n rnt. which will Vlry frolll cal.ndar year to calendar year with that tI,tl announced by thl PA D.part.ant of Rlvlnu" Thl applloabl. lnt"..t rat.. for 1982 through 191)1 art: '!!!!: Int.r..t Rat. Oail'! Inter..t flllotor !!!! Interllt Rat. DailY Inter,.t Faotor 1lJ82 201: .000S411 1987 9;: .0002"7 un I6Yo .000438 1988-1991 111: .000101 11)8" 11% ,000101 1992 9% .000247 1lJ8S. U% .000n6 1995~199" 7% ,00019Z 11)116 10% .000n4 1995.~19'97 9% .000l"7 ..In1lr..t Jt oalculat.d .. follow'l onCOUNT I PENAL TV I IHTEAtSTI INTEREST' BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X D^ILY INTEREST. FACTOR '-Any Notlc. luu.d aftlr the talC b.eo... d.llnqu.nt will refllct an Intlrl.t calculation t.o flft..n (u.) daYI b.yond the d.t. of thl 1III.....III.nt. If "ay..nt 11 iliad. after thl lnt.relt (;o.putation flat. .hown on thl Hot'CI, additional 1nht..t IIlUlt bl o.leIJlatld,