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WAflNINU, IT IS 1!.!.U1AI 10 Al.lUl TliI'; CUPY 011
TO DUPLICATE BY PHO\OSTAI 011 "IHJTDOIIAi'H,
eOMMOI'-/Wr^llll 01' IJI,W,~,'(l.V^fH",
lWPMlIMUIT or IILAt It! VIlA( Illcnllu~;
LOCAL. REGISTRAR'S CEnTIFlCATION OF DEATH
CERT,NO, 3569838
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Name 01 Decedonl
OOf',9thy . .8,,,:..
. . - ,.,. ...._.--.I(.,;}t'iI,c~-.....-.'_n
Sex ....Ee.md.l'l
Social Soeurity No. 272,.09,.5730
.. [Jalo of DoaU, ....._..-.....7.""6.~97..
Dato 01 Birth .4-18-1906
fJlrlhpl,100
Silver City, NM
Placl) of Df1all, . Mes.s:l.ah Village
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Race . Whi te Occupatio II H orne.ma k.e r
[)oGodOlII's
lvIaililluAddross 4?,4,cBlack Latc~ Lane
Cumber.land
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U All T ..__.F'()[1.nsv.l.va.nia
.. P P "1.1;\;"""",,, ,~J\,,;' .W p., ~.
Arlllod F"rCDS? (Y(-)8 01 No) --.----N.o.
Marital Status
Widow
... ;;,9,~!!ip-.HU1~,8; .17011
inlormantP llt ex 0 , .
Name and Address of
Funeral Establishment
Ki.rk
Funeral Director
David M.-- Myers.
(a)___'_c.nJllll}~l fdJ,ur.!ii.
Oavid Myers FuneraLHome,Newport, P.A 17074.
,
, Interval Between
: Onset and Death
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Part I:
Immediate CaLlso
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Part II:
(d) ..--..-...-...---_,..~....CT__".'---~~..,.______...:...._......__:.
Other 81(1nllloant Condillons
Manner of Death
Dosoribe Ir(IW injury ocollrred:
Natural brk Hcmlcide [I
Aooldent I, I f"ol1dln(l Invosllgallon LI
Suici(le [I Could not b" [)oterrrrinod [I
Namo and Tille 01 Cer.lfier
..__.........,LLli mmerma n
............--.----.....-........M...O.,... -- ..-.
(M.D" D,O" 00ro1101, M,E.)
Addrnss.
108 howt;he.r S:L.,..L.uQyn!l..PA17043
This is to certlly Ihallhu Illlorrnalionllere givoll i~l oOlloclly cupllllllrern an orlgHral oOltllicato
of doalh duly fitod with Ill" as LOCill Reqlsliar, The ori[Jlllal ClHllllcalo will bo forwarded !o th8
Stato Vital Reoords Ollieo lor pnrfll!llloflt filil1(~ ~~iLl {J, ~JZ~_.50::,~.;9i.~..--.
"'''TG",J'i;;'~;,-;~;~c;:,,, 101 Barn!ltt St.. New BloDm,~:,~e,~,d,t..PA 17068
21" 97 -,705:
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I devise and bequeath the msiduG of' my estate of every nature and wherever
situate, .in equal sha.res, t.o my chi.lclmn, Pi':'l'F.R D. KIRK (lnd HOBINE'l'l'l<; HOBBS.
In the event that my daughtor, ROBJNI~I'l'E HOBBS, shall pJ:(crl(~x'ase rm I dev1fle
and bequeath her share to her daughter, I,lNDSEY II. l.ElX) or her then-Hving
issue, per sthlJ8s. In the event tlmt my son, p~:l'rm D. KlHK, sha 11 predecease
n~, I devIse and bequeclth his share to his wHe, CI\ROl, O. KIHK, pmvidlou she 18
then living. In tho event that my son'R wHo, CI\ROl, O. KTHK, IR not then
living, then I dovise and l)(~ltleath my Ron's share, in equal shares, to hIR
children, IJAURI A. B1,CKER, WENDY L. KIHK ilnd BRADLEY P. KIRK, or theil-
then-living issue, per stirpes.
IV.
Should any of my issue enUtled to a sham of my estilt.o not have attained
the age of t~nty'flve (25) years at the tine of distribution t.o hIm or her, I
devl.se and bequeath the share of each Stich isslle to COMMJNWF'JlT IT'll Nl\'rTONI\I, Bl\NK,
of Hardsburg, Pennsylvania,' IN SEPARNl'E 'mus'!', to hold, manage, invest and
reinvest the shares so receIved and accumulation of Inca1'e thereon, and to use
and apply the incare and principal, or such milch thereof as, in 'l'rustee's sole
and absolute discretl.on, may be nm~essary or approprIato for such Issu(~'S
sUp[X)rt and education (includi ng t.rade school and college f,,:lucation, Loth
graduato and undergraduate) wlthoutmgard to his or her parent's abllit.y to
provide for such support or education, or to nnke payment. for these pUl1nses,
wIthout further respolls I.bi .Ilt.y, to slIch Issll" or to sllch Issue's parent.s or to
any person taking Cilro of such l.ssuo. I\ny prlncIpa I Or incOlIB not so applied
shall be distributed to such ISRue absolutedy when he or she at.talns the age of'
t~nty-five (25) years. If' he or she dies beforr~ attaining t.he age of
t~nty"'flve (25) years, the 1'mst shall tenn\nab~ ilnd sllch shares shall be
dl.stributed to his or her personal representilUve.
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1. R..I E1'a'. ISch.dul. ...,
2, S,ocIc. and lund. (Sch.dul. I)
3.' Cla..ly H.ld S'aclclPa"..,.hlp Inl..." (Schodul. q
~, Mallgag.. and Nal.. RK<Ilvobl. ISchodu'. 01
5, Ca.h, lank D.p..11t & MI...llan..u. P.nanal Prap.lly
(Sch.dul. EI
6, Jaln"y Owned Prap'u.y ISchedu'. f)
7. Tranofo"ISchodule GIISchodul. l)
I. Ta'al Grall A"et. (_I U... 1.7)
9. Fun.ral bpen..., "'d..lnl"""lvt Catll, Mlsc.llan..u. ( 9 I
bpen... ISchodule HI
10. D.blt, Mallgag. Uab"it'", u.... (Schodu.. 'I
11. Ta'al Dod...lon. 110101 U_ 9 & 10)
12. N., Yalu. al E'_IL"," I mI.u. line II)
13, Charltabl. .nd 00...._' "quoslt ISchoduI. JI
1~, N., Yal.. Sub 'a T.. U.. 12 ..In.. U.. 131
15, Sp.u.al Tran.f." (far daM of dtalh a~.. 6.31).9.'
S..ln.,...ctlon. f.r "'pplicabl. p.run.ag. an R...... (15)
Sid., Ilnctud. vol... "... Schedul. K a, ScIlodul. M,I $336 ,932 .93
16, ........n'.f U.. 1~ tooablt at 6~ rat. (161
(In,lud. .alu.. If... Schedu,. K ar Schodult M.I
17. ........n' af U.. 1~ ta.able at 15~ rate
Ilnclud. vat... ffatn Schedult K Of Schodule M.)
II, Prlnclp.1 ,.. du. (....... ta."'" line. 15, 16 and 17,)
19, C..dllt Spau..1 Poverty C..dlt + $ Na: ba~'3':" + $ 8 ~'r."T 1
20. II line 19 I. gr....r tflan U.. II, "'or III. dlll...n.. anll.. 20, Thl.,..he OWRPAYMINT.
aD
2L Illl.. 11 I. gr....r tflan U.. 19, ..,or ,h. dlffo..... an lI.. 21. ThI.I. ,h. TAX DUE.
..., En....... ,_ an.... ltala_ duo Oft Uno 21A.
I, En..' .... IOtal cllIno 21 and 21 A Oft Uno 21., Thl. I. .he IALANCI DUI.
M.~. ChMIl P Ie. R..'_ at WIll., A...'
II SURI TO ANSWIR ALL QUEmONS ON REVERSE SIDE AND TO RECHICK ATH ' ,~ ' ..
,d., p,naltl.. of p;1,lury, I dlclar. thot I hawI I.amined ,hi. ,,'u,", Including accompan}llng .chldul.. and 'tal,m,n'l, and 10 thl bill of my knowl.dg. and blli,f,
, 'dn..., corrlct and comp".'t. I declare that all ,,01 .,tat. hat bMn r.port.d af truI morbI valu.. p.c1aratlon of pr.par.r oth.r thon ,h. p.nonal r.pr'l.ntaUv. II
I' on Informallon 0 w"lch rt ar.' ~a. aft .nowl.d ..
iNA U 'I_SOM _ HSI . " UP:N ADD_UI om
5155 K lock Road. Mechanicsburg, PA
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
"ORDAnIO.DIATHAml '2'''''' CHICIl H.1I1
., A IPOUIAL 0
POYIRfY C.'OIY II CI.AIMIO
PlU NUMI.1I
21
97
785
i
;
COMMONWlAllN 0' "NNIYlV'NIA
(If,...'M'H' 2' IUVINUI
. N.~"sfJ:J' ~..mll_1
o 10 '10 NAM 1 AS" Ill, 0
KIRK. Dorothy R.
OClA' cv"," NUM"~ 10'7"/06' 0/'9' H?__
272-09-5730 ~
I" ""IJCAlU,'U.'IlYIt'lO lPOUU" PlNllllA". II'" _PlO auOOU IN.UAII S,
4/18/06
YEAR
~U~'ER
IA
COUNTV CODE
OfCfOfN' COM'1 f ADD
424 Blacklatch Lane
Camp Hill, PA 17011
c.,.. Cumberland
AMOUNT .fCUVID IU! IN5,TAUet'ONII
DATI Of Int H
II
o 3, R....lndor R.'urn
Ifar dalO. of d..'h prloor 'a 12.13.82,
o ~, lI..itod Elta.. 0 ~a, Futu.. In'..... Co",pro..l.. 0 5. f.doral E,'a.. Ta. Retur. R.qul..d
I'.r da'.. af d.a'h a~or 12.12.821
tJ 6, Doc.d.n' DI.d T.lta'. 0 7, D.cod.n' Molnjaln.d a lI.lng Tru,' -2.. B, Ta'al Nu..b...f Sal. o.p..I' ....,
("'ttach c.py of Will) (Attach c.py. Tru"1
ALL,CORRESPONDINCI'AND cONfIDENtl~l TAX INfOIlMAnON"SHOULb II DIRECTlD-TOI:7 "".~ ":'7":-'"''\i,,~';l'
AM M COM'U U MAI~INO ADOIIU!.
Michael' L. Bangs, Esquire 302 South 18th Street
Tl HONINUM Camp Hill, PA 17011
1, 0,181"01 R.turn
o 2. Suppltm.nlal R.lurn
717 I 7~Q-7nO
(I)
(2) $342.752.09_
(31__
I ~)
IS)
i
$9,022.30
(6)
(71
(8) $351.774.39
(>14,!l41.46
(10)
$14.841.46
111)
(12)
(13)
(1~)
$336.932.9~
M._-
. .06.
$20,215.98
(17)
. ,15.
I
s
(18)
520.215.96
In'.'.lt
$16.842.11
1191
(20)
Check heH' Ii you or~ '(lqoe...tm9 (J fefund 01 your o\llHpoymenf
(211 -9).373.87
(21A)
(211)
H
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302 South 18th Street. Camp Hill. PA
T. Rowe Price Services, Inc.
October 23, 1997
P,O, Bo. 8??oo
lla"mOrll. Mur,iend 21289.0260
1 ??oo Rod Run lloulovord
OWings Mils. Mo,yWi(1 7.1117
WWN.loowopfkJe,com
Michael L Bangs
302 S 18th St
Camp HlJI PA 17011"5521
Dear Mr. Bangs:
I am writing in response to your request that we provide balance Information on the
accounts of the late Dorothy R. Kirk. Below I have provided the share balance, closing price
per share, and account value for each of the accounts as of July. 6, 1997.
Fund Name/Account # # Shares Price Value
Growth Stock Fund
account #610082331-4 2,211.056 $30.95 $68,432.18
Tax-Free Short"lntennedlate Fund
account #610082327"5 1,561. 733 $5.33 $8,324.04
New America Growth Fund
account #610082335-6 597.086 $42.41 $25,322.42
If you require additional account Information. please call a representative of our
Shareholder Service Center at 1-800-225-5132.
Sincerely,
y~ ~O-H-nl O.f'-
Neal Patterson
Senior A~count Services Representative
,","', Wllh rmJ/ld'!'" ..
t~ltICe ...
'first C))ata Investor services group, Inc,
C))reyjus pamify ofPunds
P.O. Bolt 9671
providence, R\ 02940-9671
october 9, \ 997
^"n Mlchae\ Bangs
Attorney at LaW
302 South \ 11th Street
Camp \-\111 pi\ \70\1
RB: DreyfuS LIquid i\Ssets, Inc.
Account Number: 039_3339\22479
DreyfuS Growth opportunity fund, Inc.
AeCOunt Numbet': 01\\_3339122446
DreYfus Municipal Bond fund, Inc.
Aecount Number: 054_3339122495
Dorothy R Kirk
Dear Mr. Bangs:
_, ,ou r",OU< "",., ,,,,,.1" ",,,,,I., ,ho "r_" """". -"", ......
""" .1." lul, 6, 1"" .... ,,,,,,., .. ." ...,"1., 'OU .11b ,ho r.II""'"
Infofl1\atlon:
"" .r I." ;, 1991, ","'" ...."" '" ,.;;;9122'''.... I,"; .2611 ...". wllb · ..
"", ,.'" .r $I .00 p" ,1m'" "" ",,\d,"~ bolon<' .. th" dnI' ... ,1 ,"; .26. 'fh.
accrued Interest was $7,76.
"" .fl.l, ;, 1991, "".., ."""" 0 IS.;;; 912"" h'" 6,209. S06 ...". with · ..
..... "I.. .r $I 0.80 p" ,h"'" Tho tot. d,"~ ""- .. tbot d..... ..' ,062.66
The accrued Interest Is not applicable to this acCoun\.
M .r M, ;, 1991, ~,ou" .".."" 054.;;;9""" 1md ','55. \0; -, whh · ..
..... ,... .r $12." "" ""'... Tho "", doll~ bo'- .. ,bot d...'" ,t8_"''''
ihe accrued Interest was $76.39.
'""" ..1._ "''' "'..,." by ...ltl,,,'" tho t". ...."" .r.- by ,ho "I"
(net asset value) pet share.
...... not. .. "" ...bI' " I"'''' on, "ho< ""..." I. "" - .f "",,,., .. KIll<
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~ fEDmt^TEn~tVIcES1COMI'^NY
:.
Bolton DI,I.lon
October 7, 1997
MICHAEL L BANGS
ATTORNEY AT LAW
302 S 18TH ST
CAMP HILL PA 17011-5521
REFERENCE I 20242273
FEDERATED AMERICAN LEADERS FD INC A
ACCOUNT NUMBER 5860437316-9
DOROTHY R KIRK
Dear Mr. Bangs I
Ws have rsceived your correspondence regarding the referenced
account. In response to your inquiry, we are providing you with
the following information:
The balance of the FEDERATED AMERICAN LEADERS FD INC A account
on 7/6/97, was $63,156.78. This figure represents 2,651.418
shares at the net asset value of $23.82 on that day.
The balance of the FEDERATED PENNSYLVANIA HUNI INCOME A account
on 7/6/97, was $35,978.14. This figure represents 3,072.429
shares at the net asset value of $11.71 on that day.
The following items are required for a legal representative to
redeem or transfer shares from an account registered to a
deceased individual. If more than one legal representative is
named, the instructions must be modified to include all
appointees.
1) A LETTER OF INSTRUCTIONS, requesting the desired transaction.
The letter must reference the account number, and be signed by
the legal representative exactly as hiS/her name appears in the
Order of Appointment, indicating capacity.
If shares are to be redeemed, the letter should specify the
payee, as well as the address to which the check will be sent.
If the shares are to be transferred, the letter must include the
desired registration, address of record, social security number
and distribution options (cash or reinvest).
On the face of the letter, the legal representative's
signature(lI) must be guaranteed. A signature guarantee mar be
obtained from any "eligible" guarantor. Eligible institut ons.
Bo.lon Now York PllUburlh
I
'I
inolude oommeroi~l banks, trust companies, savings bankB, savingB
, loanaBsooiation., and oredit unionB as defined by the Federal
D.polit Inlurano. Aot. Also, a guarantee by a member firm of a
domeltio stook exohange il aooeptable. We oannot aooept
notarization by a notary publio.
It your request will be signed by more than one person, multiple
signature guarantees will be required.
2) A oopy of the Order of Appointment naming the legal
representative(l) of the deoedent's estate. The dooument must be
qertified by the oourt or olerk of oourt within 60 days of the
propoled transaotion. While a oopy of the dooument is
aoceptable, it must be certified in ink and bear the court's
stamp or raised oeal. We oannot accept a oopy of the
oertifioation.
3) A original Tax Waiver. covering the number of shares credited
to the decedent's account as of the date of death, if required by
the jurisdiction of the decedent. For more information about
this requirement, we recommend that you contact your State
Department of Revenue.
If transferring, the current accounts will be closed and all
shareB tranBferred to a new one(s) with the desired
regiBtration. A new account number will be aBsigned.
If redeeming, the ourrent accounts will be closed and the
prooeeds sent acoording to the letter of instruotions.
We hope this information has been helpful to you. If you have
any questions, or require further assistanoe in this matter,
please feel free to oontaot us. You may write to us at Federated
Services Company, PO Box 8606, Boston Ma., 02266-8606. Or, you
may call our Investor Services department toll-free at
1-800-245-4770. A Representative will be happy to assist you.
:ffi~
Brin FitzGerald
Correspondenoe Representative
""...,.. 111-101 .
COMMDHWIAUH O' 'IHHIVlYANIA
IHNUIIANCIIAlI UIUIN
RIlIOIHI OICIOIHI
SCHEDULE F
JOINTLY.OWNED PROPERTY
ISTATI 0'
Dorothy R. Kirk
PILI NUMIIR
21-97-785
J.lftl ....."11.1'
A.
NAMI
I"e\;or D. Kirk
AODRISS
5155 Kylock Road
Mechanicsburg, PA
-
RILATIONSHlr TO DICIDINT
Son
17055
I,
C. _
.-
.
.' ,',
...I..tty.ew..... .......rtyl
ITIM Lmn DATI
POR
NUMII JOINT MADI DISCRIPTlON 0' PROPIRfY
tlNANT JOINT
1. A 11/11 Mellon Bank Checking
1979 Account H112-542-0271
2. A 2/8/83 Mellon Bank Checking
Account H260-070-1367
TOTAL VALUI DICD'S DOLLAR VALUI 0'
0' ASSn 'HI INT. DECEOINT'S INflRIST
$11,646.46 50% $5,923.23
$6,196.14 50% $3,099.07
TOTAL IAloo .mlf on line 6. Recapl'ulotlonl
/If ...,. .,._ It ...ded 'n..1f aelelHID..a' ","h 0/ ...... II..,
$ 9,022.30
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SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
COMMONWIAIIH 0' P1NNIVIVANIA
INHUlllfANCt fAM ."UII:N
1IS101NI OICIOINI
1'1.... I'rlnt .r TV,.
HUMIEI -
21-97-765
Dorothy R. Kirk
ITEM
NUMBER
A. "unoral bp.n...'
I.
...
C.
1.
2.
2.
3.
...
5.
6.
7.
8.
DESCRII'TIOH
1.
David M. Myers Funeral Home
1.
Aclmlnlltratlw C..t"
"..onal ..p.....n'a"... Comml..lon.
Social S.curlty Numb.r 0/ "..onal ..p....nta'I...,
V.ar Comml..lon. paid
2.
Attorney .....
Michael L. Bangs, Esquiie
3. '. family Ex.mp,Ion
Claimant
Add..... of Clalmanl at deced.n". d.ath
5..... Add,...
City
..Ia"on.hip
5'0'.
Zip Cod.
Probate .....
Register of Wills of Cumberland County
9/26/97
MIIe.Il.no.u. ",.n"'1
Postmaster (overnight mail expense)/ 9/19/97
Cumberland Law Journal (advertising)
Postmaster (overnight mail expense)
Register of Wills (short certificates)
Frank Baker (stock valuat ion and liquidat ion)
Register of Wills (short certificates)
The sentinel (advertising)
See Continuation Sheet
TOTAL 1"". .nI.r on IIn. 9, Recopl'ulatlonl $
(If m... '1'.'. .. n......., In..rt .....Itl.n.l .h..h ., ..m. ,1...1
AMOUNT
$4,560.00
$5,000.00
$372.00
$10.75
$60.00
$10.75
$15.00
$150.00
$6.00
$85.03
III.
I devise IlIld bequeath the residue of my estate of every natul:e and whtlInMlIr
situate, in equal shares, to my children, PETER D. KIRK aM 'OHNl\"rI'E 1<<l1BS.
In the event that my daughter, ROBINETl'E OOBBS, BMll prndecooBe 1m 1 dlNllle
and bequeath her share to her daughter, LINOOEY H. LEOO or hat then~Uvlng
issue, per stirpes. In the event that my BOn, PETPJR D. KIRK, 1I1v111 proolllCMlIlI
lIB, I devise and bequeath his share to his wife, CAROl. O. KIM, provldAd Ill. !.II
then living. In the event that my BOn'B wHe, CARL O. IURI<, III nnl.. U19n
living, then I devise and bequeath my Bon's share, In oqulIl Ilhllmll, to hlll
children, LAURI A. BECKER, WENDY L. KIRK and BRJlDLE:Y P. KIIU<, or their
then-living iBsoo, per stirpeB.
IV.
Should III'1Y of my issue entitled to a share of my estllte oot. Mve at.tlIii'll'ld
the age of ~nty-five (25) years at the tine of distrU.__IUon to hlm 01.' her, I
devise and bequeath the sharE! of each such iBBue to Cl:JoHHolF.AI.Jl1{ Nl\TJCtollIt, MNJ(,
of Harrisburg, Pennsylvania, IN SEPlIAATE TRUST, to hold, IMMge, 11M'11ll and
reinvest the shares BO received and accunulation of incaoo thernon, and to UIl(I
and apply the incalla and principal, or such much thereof as, in 'rrulltoo'lI 11010
and abeolute discretion, Ill/I}' be neC8sBaI)' or appropriate for lIuch 11'l1luo'lI
sU(lX.lrt and education (including trade Bchool and college educat.lon, IxIth
graduate and undergrac:lutlte) without regard to hiB or her parent's ahUUy to
provide for such sU(lX.lrt or education, or to make paynent for these F"IJ.1lOll8ll,
wit.hout further responsibility, to such issue or to such 1B1l00'1I ~rnnt.1I or to
any perBon taking care of such issue. /\ny principal or ioccmJ rot BO /Ill)] led
Bhall be d1stributed to such issue absolutely when he or ahe IIttJIlllll the age of
twenty-five (25) years. If he or Bhe dies before attainIng the IIQQ of
twenty-five (25) yeare, the Trust !!hall terminate and Iluch shlll'u!, 1l11ll11 be
distributed to his or her personal representative.
- 2 -
I/J--.:<tJ </....9
BUREAU OF INDIVIDUAL TAMES
lHHEAIU,HCt Ul( DIIJISHIH
OEPI. /10601
IIARRISIURO,llA 11li'1l- 060l
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
(~-
NOTICE OF !NHERITAHCE TAM
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AHD ASSESSMENT OF TAM
UV.lh' um lot..,)
05-11-98
KIRK
07-06-97
21 97-0785
CUMBERLAND
101
1-- A~~::: _R.~I tt~d:=J
MAKE CHECK PAYABLE AND REMIT pAVMENT TOI
REGISTER OF WILLS
CUM8ERLAND CO COURT HOUSE.
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER po.nON FOR YOUR RECO.DS ....
iiiV': isii1 - EX. AFi; - ('09-: 97T -NOT" i c r OF - YNHEil if AireE - T"A'x - APPRAiSEMENT -; -A i. DjwAiie E - ,(ili ---- - -.. .-.. -....
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
DOROTHY R FILE NO. 21 97-0785 ACN 101
MICHAEL L BANGS ESQ
302 S 18TH ST
CAMP HILL
DATE
ESTATE OF
DATE OF DEATH
FII.E NUMBER
COUNTY
ACN
DOROTHV
PA 17011
ESTATE OF
KIRK
DATE
05-U-98
UK RETURH WAS, (X) ACCEPTED AS FILED
.ESERVATION CONCERNING FUTURE INTE.EST . SEE REVE.SE
APPRAISED VALUE OF RETU.N BASED ONI ORIGINAL RETURN
!. R..l E.lot. ISch.dul. A)
2. Stock. end Bonde (Schedull B)
5. Cloa.ly Held stock/P.rtn.rlhip Inter..t (Schedule C)
4. Mortgag../Not.. Receivable (Schedull DJ
5. t..h/Slnk Depolits/Hile. Parlon.l Property <<Sch.dull E)
6. Jointly Owned Property (Schedull F)
7. Transflr. (Sch.dule G)
4. Total A...t.
C ) CHANGED
NOTE I To insure proper
credit to your lecount,
lub_it the upper portion
of this for'. with your
tax pay...nt.
11)
(2)
IS)
(4)
(5)
(6)
(7)
.00
342,752.09
.00
.00
.00
9.022.30
.00
IB)
351,774.39
App.OVED DEDUCTIONS AND EXEMPTIONS I
14,841.46
.00
(11)
112)
liS)
114)
14.841 46
336,932.93
.00
336,932.93
CoJ
110)
9, Funeral Expens../Ad.. Costl/Hi.c. Expense. (Schedul& Hl
10. O.bts/M.rtg.g. LI.bllltl../L1.n. (Sch.dul. I)
11. T.t.l D.ductlcn.
12. Net Value of Tax Return
l~. Charitable/GovernMental aequ.lta) Non-elected '115 Trusts
14. N.t V.lu. .f E.t.t. Subj.ct t. T..
ISch.dul. J)
If .n ......m.nt w.. i..u.d pr.viou.ly, lin.. 14, IS .nd/or 16, 17 .nd 111 will
r.fl.ct figur.. th.t includ. the tot.l of ~ r.turn. .......d to d.t..
ASSESSMENT OF TAXI
1&. AMount of Lin. 14 .t Spousal rat. US)
16. AMount of Line 14 taxable at lineal/Cia.. A rate (1&)
17. AMount of line 1~ taxable at Collateral/Cla.s 8 rat. (17l
18. Principal Tax Due
NOTE I
.00 K .00,
336,932.93 K .06,
.00K.15,
(18)
.00
20.215.98
.00
20,215.98
TAX CREDITS;
PAVMENT
DATE
09-26-97
02-26-98
DISCOUNT (.)
INTERESTIPEN PAID (-)
--.----842.TI-.
.00
RECEIPT
NUMBER
AA242271
AA269797
AMOUNT PAID
16,000.00
3,373.87
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTE.EST "ND PEN.
TOT"L DUE
20,215.98
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REUERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN .1, NO PAVMENT IS REqUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU "AV BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.'
R
,
;
"
J
I
j
I
I
I
i
I
J
I
RESERIJ4 T I ON I
PURPOSE OF
HOTlCE I
PAYMENT,
REFUND (CRll
OIJECTlONS I
ADMIN
ISlRATlVE
CORRECTIONSl
DISCOUNT I
PENAL TV,
INTEREST I
i~
t;r'
t:i
~
::0
ID'~
(() 8
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.
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E,t,t.. of dleedlnh dying on or blfore Olclllb.r ll, 1982 -- if any future Inhrut in thl ..tat. h t"ri,flrred
In Po.....Jon or .njoy..nt to Cia.. a (collat.ral) bln,flcterl.. of thl dlced.nt .ftlr thG IMPlratlon of any ..t.t.
I1f. or for y.ar., thl Co..onw'llth hlr,by Ixprl..ly r...rv.. thl right to apprftl.. and ...... tran.flr Inherltanc.
Gt the lawful Clau B (collat.raU rat. on IIny luch futurl Intlr..t.
'or
hM"
To fulfill thl rlquJrllllnh III Seotlon 2140 of thl Inherltancl and Eetat. Till( Act, Act 21 of 1995. I1Z P.S,
Slction 9140),
Detach the top portion of this NotIce and llublllit with ...our pa",lIIent to the ~.ghter of Will, prlnt.d on the reli.rse lid..
--Hak. ch.ck or .on.... ord.r pa...able tOI REGISTER OF MILLS, AGENT
A r.fund of a tax cr.dlt, \Ihlch was not rllque,bd on thl Tax Return, lIa... be reqlll.t.d by co_pletlng an "AppllcaUon
for R.fund of Penn:tylvanh Inheritance and E.btl Tax" (REV~1!13), Applloation. are I\lallllble at the OffJcI
of the RIght.r of Willi, 8Iny of the 23 Rev.nlle Dlltr lct Offlcu, or by calling the .plclal 24-hour
an.wering ..rvlc. nu.b.," for forll, ord.rlng; In Pennsy!vonla J-800-]62-2050, outtld. P.nnsylvanla and
within local Harrisburg area (717) 787-8094, TOO. (717) n2~2252 (He.ring IIIPait'.d Ont'll.
Any party in Int.r..t not satisfi.d with the appr.tt...nt, allowanc. or dlsallowl!lnc. ofd.duction., or ........nt
of tax (inclUding discount or Int.rut! II .hown on thls NoUc. IIU.t obj.ct within .h,ty, (60) days of r.o.lpt of
thh NoUc. bYl
-~wrltt.n protut to the PA D.part..nt of Revenue, Board of Appuls, Dept. 281021, HarriSburg, PA 17l28~I021, OR
~~e1.cUon to ha.". the ..tt.r det.r.An.d at audit of the "cccunt of the p.rsonal repr".lltatlv., OR
_wappRlt1 to the Orphans- Court.
Fl!lotu.1 ~rrcr. dilcov.r.d on thl. 8....5111.nt .hould b. addr.'I.d In writing tal PA D.part..nt of R.v.nu.,
BUrll:lu of Individual Tax.., AllNl Post Anllto..nt R.vJ.w Unit, O.pt. 280601, tlarrllburll, PA 17128-0601
PhOn. (717) 187w650S. S.. p.g. S of the book1.t "Instru~tlons for Inh.ritanc. T.x R.turn for 81 R.sld.~t
O.ced.nt" (RE\I~ISOI) for l!ln .l(p1anat1cm of adlllnlstraUv.ty cOrl'.ctable .rrors.
If any tenc due it paid within thr.. (3) cahnd8lr Ilonth. aft.r thl dec.d.nt's d..th, . ,1\,. p.rcent (S~) discount of
thl tax paid h allow.d.
Thl lS~ hie alnuty nonwpartlclpation p.nalt.,. it co.puted on the total of the tal( and Int.rlst a......d, and not
P8lld before Januar... 18, 1996. the first day aft.r the .nd of the tllX 8I.n..ty ...rlnd. Thl. non-particJpl!ltlon
p.nalty ls app.alable in the .... .ann.r and In tha the .... tiN p.r tad at you would app.al the tllx .nd Int.r..t
tha~ hat b..n .......d IS Indlcat.d on this notlc..
Int.r..t it charg.d beginning with first d.y of d.lInqu.nc..., Dr nln. (9) .onths and Dill (1) day froa the date of
d..th, to the dlt. of paya.nt. rax.. whloh b.~a.e d.linqu.nt b.for. Januar... 1, 1942 bllr lnt.rut at the r.t. of
six (6iO p.rc.nt p.r annul v.loulat.d at a dally rat. of .000164. All t8lx.s which bIn.. d.Unquent on and aft.r
Janulry I, 1982 will b.ar Int.rut at a rat. which will vary frcI cal.nd8lr yur tc ll!lllndar .,.aar with thlt r8lt.
8Innounoad b... the P~ Deplrt.lnt of R.venu.. Th. .pplloabl. Int.r.st rat.. 'or 1982 through 1998 .r.l
!!at Int.ra.t.Rat. Ol!lll... Int.rut Factor :i!!! Int.rut Rat. Oftlh Int.r..t fRctor
1982 ZO~ .00054a 1987 9~ .000247
1913 16;': .000438 19aa~1991 II;': .0005Dl
1914 11~ .000501 1992 9;': .000247
1985 U;.: .000556 199J~1994 7f: ,000192
1986 lOX .000l14 1995"1998 9~ .000247
--Int.r..t is calculat.d DO fo110w'l
INTEREST' BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
wwAny Notic. Juu.d aft.r the tlX bacolllu d.1Inqu.nt will r.flact.an Int.rut clloulltlon to ,Jft..n (15) dl.,..
tt.YOnd the date of the ........nt. If pay..nt Is .ad. aftar the Int.r.st cOIIPutaHlln data shown on the
Notta., additional interut .ust b. o8lIcuJat.d.