HomeMy WebLinkAbout97-00812
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COHHONWUl HI OF flf.NNSVl~ANIA
Ot:PARTHf.NT OF RtVJ:NUE
IUAUU Of INhlvlOUAl lAkES
DEPT. ll0601
HARAIS.UNO, P" 1112'.0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 ' 'Ii 'XI.;!
91138812
09-09-97
'l'VPE OF ACCOUNT
o SAVINOS
[XI CHECKING
[J TRUST
[J CERTU,
.1~.1I~1 U IH (/,911
~
EST, OF EDITH R DAVIS
S,S, NO, 171-30-6624
DATE OF DEATH 07-19-91
COUNTY CUMBERl.AND
PEARL E RUSSEL L
599 BALTIMORE RD
SHIPPENSBURG PA 17257
REHIT PAYHENT AND fORHS TU,
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSe
CARLISLE, PA 17013
ORRSTOWN BANk has pr('lvlded th. Dapath.ent with the InforMation Iht.d bllow which hI" b.." iliad In cfllculfttlng the
potenUll tillC due. Their rlcord. Indicate tnttt at the death of the above dloldent, you w.r. I'l Joint ownor/bln.flc1ary of thil aCC(llmt.
If you ,.,1 thl. Infarllltlon I. lncorr.ct, plea.. obhln wrltt." corr.cUo" frolll the flnllnclal Inltltutlan, attach II copy to thlJ for.
and r.turn it to U,. "bov. addr~"". Thl. IICClount II tallable In aC:f:ordllnoe tlith the Tr,~.,.H"n"''' '''''1 I..... nf ..,'" ('''....n.w~dH~ ~, rJ:-,...:~'l'..:;",':,
wu..tlone "IIY O' IIn.werld by olllllnl1 (717) 7e7-83i:1,
COMPLETE PART 1 BELOW. . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 000-600644 Ooto 12-01-82
EstabUshed
Acccunt ao1.nc. 1,&25.31
P.rc.nt T..able X 50.000
A.ount Sutlj.ct to T.. 912.66
T.. R.to M ,06
Pot.nthl T.. Ou. 54.76
PART TAXPAYER RESPONSE
m I FAILURE TO lIupaND WILL RIIUL T IN AN OFFICIAL TAX ASSISSNINT BASlD ON THIS Nonci'l
A. r-J Thl IIboVI Infor..tlcn and tall ckHl II cOI'rlct.
t&;J I. You flleY choo.. to rllllt pa""lnt to thl RIghtu of Will' with two copiu of thil notlcl to obtllin
a disoount or avu1d Interlst. or YOU lIa" chlok box "A" and return thl, notl08 to thl Reg),ter of
Willi and an official ....I....nt 101111 bl 1..uld by thl rA Dlpart".nt 01 Revlnu..
fD In,url prop.r oradit to your account, ~wo
(2) cop I., of thl, notice IIU,t aCCO"pII"y your
ply..lnt to the Reghtlr of WUlI. "akl check
plYllble tOl "RISlhtlr of Will', Agllnt",
~OTEI If ta~ pay"lnt, Ill" IIld. within thrae
(S) Month. of the dlcedent'. date of dllth,
you !'lay dlduct ft S% dhcount of the tall dUI,
Any Inheritanc. tall dUI will bleo". dllinquent
nlnl (9) lion the aftlr the date of d.ath.
[CHECK -,
ONE
BLOCK J
ONLY
a. rv Th. ahovI ....t hltl b..n or wltl b. r"ported Itnd tIll Jtald with the Plnn'ylvllnll Inherlhnc. Tall rlturn
~,,-\to bl filed by thl decedlnt', reprl,.ntatlvI.
C, 0 Thl abo\'1 Inforllatlon. I. In<:orr~t Md/o~lbh find deduction. were paid by you.
You .uet cu.pht. PAR r [D Indlor PART L!J b.lo~,
PART
~
If you indicat. a diffe,..ent teM rat.;- pl.... .t.t. your
,..latlonahlp to decedentl
OFFICIAL USE ONLY 0 AAF
PA DEPARTMENT OF REVENUE
..u
.nn
n:TUi\:: -........,-.---.. OF
""Wl'lrv,,, , ,""'I'
1. o.t. Eot.b11Ih.d 1
2, Account a.lance 2
5, Perolnt TallClbla 5
4. AlICunt Subjoct to To. 4
i. Dlbh and Dlduction. S
6. A.ount Te)(abla 6
7, T.. Rot. 7
a. Tax Du. ft.
il.;; uh ,,;vAi,i','ri\USi' ACCuUNi'S
PART
[!]
DATE PAID
.S'/, "< ~
DEBTS AND DEDUCTIONS
~1Ii1
1-
2~
3
4
S
6
1
8
CLAIMED
LINE
x
')'LI
n
M
AMOUNT
~ -L'
TOTAL IEnt.r an L1no S of T.. Co.put.tion) .
Unde,.. p.naltle. of ~e,..jur~, I dtc~re that the fact. I hive ,.eported abov. are tru., correct end
('v~lIPlato fl ~h~ b4'''~ of .Y kno"l.~Il*')"'d b.ll.f. HOME (IlL) ,S j:';-' r ,~I. 'I
Uj.,.;tZ / ",.U>:J ,Q l t.. WORK ( ) ~l.il
TAXPAYER SmNIIT E TELEPHONE NUMili/
PAYEE
,OESCRIPTION
PAID
iif/H!L L
A:qJ (1,( l
DATE
GENERAL INFORMATION
1. FAILUME TO RES~OND WILL MESUL T IN AN OFFICIAL TAM ASSESSHENT .tH, ..pll".I. Inl.,." ..... un Inlu,..ttun
'OOIllHtld by th. 'IInlnel.l Inltittltlon,
2. 1~.rltlMl' ~.)( blaD.'" a.Unqu.nt nlna lItO"tl\l aft.r the nlnd.nt', dlt. of d.,th.
I, A Joint ICOO,,,,,t h t,lllbi. Il,Ian though U,. ,IOClldl"t', OIl.' WItS add.lt tit I lIIatt.r 0' ClunYtnlanu.
4. Account. lInclucUnl tho.. hllld blhl"" h~l.b.nd Ind ",HI' which thl dtolldent put In Joint na... within on. 'JI..r prior to
dtlth .r. fully 'Ilitbl, '1 trln,'.r,.
!!it ACCDUnh Ifthlblhtled Jointly Utili.." hUlb..nd and .,if, lor. thin on' YI.r prior tl) duth .r. not tlllabll.
.. AClcoun~. h,td by . dlaldffllt "1n tru.t 'or" Inoth.t or oth.r. ar. 'I)llbl, fully.
REPORTING INSTRUCTIO~S - PART 1
- TAXPAVER RESPONSE
1. IlOCk' - If the tnfor..tton Ind oolltPuhtlon In th, notlcl ar. !lorr.et end d,duCltlon. II" not b.lng al.l.ed, phce an ")("
In blOClk "A" a' P.rt I of the "Y.llpeYlr R..pon.... .ectlon, SllIIn hlo copl.. IInd .ub,1t th.. wJth ~our chllck for the lNIOunt 0'
tlM to the nllllht.r of WUh of the county lndicet.cl. The PA n'1'8rt..nt of R."'.nu. NUl IlIu. IlO oHl01.1 ........nt
(For. MEY.U.... EMI upon r.c.lpt of thl return f,.o. thl R."htlr 0' Wll1.,
3,
Z. lLOCk. - 11 the ....t ,plclflld on thh notlc. h.. b.ln or wl1l bl r.porled and tall pll;d with thl Plnr"'wIYllnl. Inheritlno.
'II( R.turn fHld by thl dlc.d.nt'. r.p,....ntatlv., pllUlI un "M" In block "B" 0' Part 1 rf thl "Tlllpl"".r Rcupon.... section. Sll11n ani
COpy.nd rlturn to thl PA nlpl,t..nt of RII/'nu., f1ur..u of Indhddual hUI, nlpt 211061)1, Ill!lrrhburlll, PA 171211-0601 In thl
Invllop. Pl'ovldld.
..p
BLOCk C - 11 thl notlol InforllaUon Is Jnoo,.,.,at andlor dlductlon. IIII" b.lnG cl.llI.d, ch.ck block "C" 8nd oOll9llt. ~h 2 and !
locorclnll \0 thl Ihli".lI.Idu,,~ l,,,luM. :i~tl'! to.,) .:..~li.. ;J;"d ::r..lt~1t tt'.::! :;lth ~'!)'J" ...'?". 'to.. ..... .",""..t 'If tl'lY J"lllftbllQ. ~he R.aht.r
a. Willi of thl county Indlcltld, ',he PA Dlpartllllnt of R.v.nu. ..Ill I..u. IIn offlcl.la.."....nt (ForN REV-IS4a U~on ,..c.lpt
a. thlr.hwn froll the R.,iltlr of With.
TAX RETURN - PART
2
- TAX COMPUTATION
I
N
LINE
1. Ent.r
HOTEl
:po
thl dltl the accolH'1t orlgln.llY w.. l.tab1hh.d or tltlld In the ...nnar 'l(htlng.t dlltl of dlath. :J:
For. cluadlnt dylnv .fhr lUll/all Aceauntl which thl d.oed.nt put In jDint n81111\ within on, 01 Yllr of dI.~ra
t.lllbl. 'ully lit trlln.fere, HOlif.v.r, thlre 11 In Illclullon not to 'Nuad n,ooo plr trllneflrl. rlllardl... of .. Vl1ue of
the eecount or the nueb.r of accounts h.ld. cJ'\
If . doubll ..t.rl.k (MMI appa.rl b.for. your first na.. in thl add~a" portion of thl. natlce, thl '3,000 ,xcl~on
Ilrl,dy h.. b..n d.duct.d fro. the IIccount bahncI as r.partld by the flnancl.1 In.tltutlon.
2, Ent.r thl totlll balenol 0' tM .ccount Including tntlrl.t accrued to tha d.t. of d.lth.
]. The p.rolnt of the acoount thlt h ta:oc.bh for .ach lurvlvor II dahr.ln.d .1 followlI
A. TIM p.rcent hlllbl. 'or joint ....t, ..tab1hh.d 1101'1 thlln on. y..r pdor to the d.c.dlnt'. dlathl
1 DIYIDED IV TOTAL HOHlER OF
JOINT OHMS
EIl....I.1 A Jrdnt ....t rlghtlr.d
DIVIDED BV TOTAL NUHBER M )( 100 . PERCENT TAlCAILE
SURVIVING JOINT OWNERS
In the n... of the d.cld.nt Ind two othlr per.on..
I DIVIDED IV ] (JOINT OWNERS) DIYICfD.... 2 (SURYIYORS) . .161 M 1011 . 16.7:< <TAMABLE FOR EACH SURVIVOR)
I. Thl p.rcent tllllbl. for ae..ts cr..t.d liltthln ani yur 0' thl dlcldlnt'l de.th or Iccount. o~r.ld by thl dloldlfnt but hlld
1n trult for Inothlr Indlvldu.I(I) (truet bln,flclarl..);
I DiVIDED.... TOUL NUMIER OF SURVIVINQ JOINT
OWNERS OR TRUST IENEF ICIARIES
I( 100 . PERCENT TAXA.LE
EIl''''11I Joint account rlghtlrad lnthl na.a o' thl dlcldlnt end tlifo oth.r plnone and ..tablhhad within one Yllr of d.ath by
the d'Cldant.
1 DIVIDED IV 2 (SURVIVORS) . .50 M 100 . 50;( (fAUILEFOR EACH SURVIVOR)
4. The IIfOUnt lubJaot to taM (l1ne~) II dltlrllln.d by IlUlttptvlr.:g tha Iccautlt b.l.n(lo (I1nl r) by the plrc.nt tlllabl. (lInl 5),
S. (nt.r the tot.1 of the dlbtl and deduction. II.ted in Part ],
6. Th. nount teMebl. (II.,. 6) 11 ,dlter.ln.d by .ubtrlotlng thl debt. .Ild dlduotlonl Cllnl S) fro. thl ..ount .ubjlct to tel( lllnl It).
.,. Entltr the approprllt. tex r.t. Illna 1) .. dlt.r.lnld b.low.
A, For dlte. of d.lth oocurrlng .fter 6150194, the hll ret.. for trllf1.farl to Ipaue.. Ir. .. followlI
1. Dlt.. of d..th on or aftlr 7/1/94 ."d blforl 1/1/95 the r.t. 11 3;(.
2. D.t.. of d..th on or .ft.r 1/1195 t"n.f.,.. to .peue.. will bl t.ll.d at OJ( hI( ratl.
Not,l For d.te. of d..th prior to 7/1194 trenlfl,.. to .pou... .r. tlIClbl1 nt 6%.
8. Tr",,'"" to Ilna.1 delclnclenh Including fether, lother, son, dau,htllr, 'rlndchl1dr.n~ 10n~ln.hw,
dluthter-In-Iew, .tlPchUd Md their i..UI .ra tlubll .t IlM Plrc.nt (6;(J.
C. Tren,'ars to .11 other. inCluding brothlr, Ihter, unci., aunt, n"phlw end nl,ol arl tll(.bl. .t flfte.n plro.M (lSiO,
D. If you ohlnll tM tax ratl, pl.... IPlclfy your rlllttonlhlp to tha dao,d.nt In the ar.. prfivld.d.
I. The _!Unt of tal( duI (line a) 11 det.r.ln.d by .u1tlplYln, thl IIIOunt taMabl. (Un. 6) b~ the tIlM r.te Illnl 7),
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
A11owllbl. d.ble r.nd deduction. .ra deteralnld I' followll
A. You le..1ly arl r..pon.lbll for ply..nt, or thl ..tit. I~Jlct to IdIllnhtr.tlOl'l b~ , p.r.onll rtpr'''ntIUv. II In'ufflcllnt
to p.y the; dllkKlt Ibl. I tall.
I. You IICltuIUV plld thl dlat. .ft.r death of thl dlcedlnt and can furnllh proof 0' p'YII.nt.
C. Dabte bll,,- ohllled ItUlt ba It..lzad fully In Plrt 3. If additlon,1 'plca Is n..ded, u.e pllln plPII' . Ill" k 11", Proof of
p'YHnt ..y be rlquelted b~ thl PA Depart"nt of RIYlnu..
" . ,. ' TAXPAYER ASSISTAtICE
, ' IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANV
, , REGISTER OF WIUS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
' OR CALL THE BUREAU OF INDIVIDUAl. TAXES, TAXPAVER INQUIRV UNIT IN
HARR1SBURG AT (717) 181-8327. TOO' (717) ?72-221i2 (HEARING IMPAIR!!\) ONLY)
tOK"IlHWUl HI Of PI:HHSV\.VAHIA
IlI.PAR'Mf.H1 or RIOVt'NU[
IUNF.AO Of IHlHVIDlJAl UIU::S
O(Pr. 260601
IlARRI SlUflQ, PA 11121-0601
'*
/ 'J ,')0(,. -\ '
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO.
ACN
DATE
21 - 017- Y/~
97138873
09-09-97
UV'\td II '" 11"U
EST, Of EOITH R DAVIS
S,S, NO, 171-30-6624
DATE Of DEATH 07-19-97
COUNTY CUMBERLAND
TVPE OF ACCOUNT
IX) SAVINGS
o CHECKING
o TRUST
o CERTlF .
PEARL E RUSSELL
599 BALTIMORE RD
SHIPPENSBURG ~A 17257
REMIT PAVMENT AND FORMS TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
ORRSTOWN BANK tun provldld thl Departlllnt wtthth. infor.atlon lI,ted blloN which hu blln ulld In caleuht1ng thl
potenUll ta)( du.. Th.lr rico rd. indicat. th.t at thl dlath of the abOll1 dloed.nt, YOU were a Joint ownlr/b.neflclary of this ttccount.
U you f,ll thh Infor...tlon II incorr.ot, pllU' obtain written corrlotlon frolll thl fln.nclt,l II1!1tltutlon, ...thch. COpy to thlt for_
and r.turn It to the .bo.... lIddr.... Thl. accuunt L' taMftbl1 In acoordancl with the tnhlrtt..nC'l. T,IIIt 1..0.4" nf HlI' rl''''''''r''''.'!llt~ t.f PC'1!1t~'1"'t!:.,b.
Qu..Uonl I.y bM answer.d by Clll1ng (111) 187-8]21.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
A...unt N., 000-777706 D.to 12-07-92
E.toblhh.d
, ,
Account ..lanc.
P.rc.nt TIXllb.l1
A..unt Subj..t to
lex Rat.
P.tonU.l Tox Du.
To inlun proplr cr.dit to your acoount, two
(Zl copln of this notlc. IUlt acco.panv your
pay..nt to thl Righter of Willi. Hakl ch.ck
payable tell "Reghter of 1011., Ag.nt",
PART
m
31,246.51
50,000
15.623,26
.06
937,40
TAXPAYER RESPONSE
~AILU I TO RISPOND WILL RESULT IN AHOFFICIAL TAX ASSeSSH!NT BASID ON THIS HOTICI
x
NOTEI If tllM pay.lnt. are .ad. within thr'l
(.J) .onthl of thl dlc.d.nt', dati of dl.th,
yoU III1V d.duct II 5% dllltount of the taM dUI.
Any Inherltanu tax due w1l1 blco" dtllnqu.nt
nln. (9) _onUl. after the dati of dlllth,
T.x
x
A. lJiIl'Thl abolll InforMaUon and tex due 11 corrlCt.
lAIl. You .ay choo" to rl'U paY.lnt to the R.oht.r of Will. with two copl.. of thlt not lei to obt.ln
a discount or allold Inter..t, or you .ay ctt.ck bOM "A" and r.turn thit notlcl to thl R.ol.tlr of
Wills and an official I"......nt will bl hlu.d by thl PA D.pert.lnt of R.II.nu',
I. r;;, Thl ftbo.... a...t hat blln or will b. rlPort.d and ~ax paid with the Penn.yl...anla Il'Ihlrttanco TllX r.turn
'P( to b. filed by thl dlc.d.nt'l r.pr...nt.tI....,
C. 0 Thl abo.... lnfor..et Ion Is incorrect and/or debtl and dlducUonl w.rl pald by you,
VflU IUlt co.plltl PART 0 and/or PART 0 bllolif,
[ CmK J
BLOCK
. ONLY
PART
~
OFFICIAL US!; ONLY DMF
PA. DEPj\R.'rHENT . 01' .1l~I/EHUE
If ~ou indle*t. ..diff.r.nt tax rat., pl.... .t.t. your
r.l.tl~n.hlp to dle.dlntl____
Ti,^ Oi. J04:i,i, ii\l,;Si' ACCQUi,T& f'~u
I
.2
. 3
4
CJ.j1), 'tV 5
6
K 1
8
DEBTS AND DEDUCTIONS CLAIMED
._u
,,,...
....-.....~. _..~_.._.-_.... tit'
"","''''1 ,",WI'I"WI"""''''''''
1. D.t. E.toblhh.d 1
2. Account a.llne. 2
S. Plrcent TIXlbll 5
4. A..un! Subj..t t. T.x 4
5. D.bt. .nd D.duct 10n. 5
6. A"ount T.)(.bll 6
7. rax btl 7
a. l.)( Due a
LINE
PART
[!]
DATE PAID
S.
,~ '
PAYEE DESCRIPTION
.' :~ L.
AMOUNT PAID
'10
TOTAL (Entor .n L1n. S of Tox Co....ul.U.nl ·
Under pen.itt.. of plrjury, 1 decl.re th.t the flch I h....1 reported Ibovl .r. true, correct end
_)."'l.to(\~~t~ b.~.~.f .y kn.wl.dll"~"'l b.lI.f, HOME (/17 ) ,,'IJ-K.)(,';
TA'X1"A"'E1R"SI '~A' ..J'U/E""l-.:i 2. .~ l :' WORK ( ) {'l h
:I' if I TELEPHONE NUMB~
GENERAL INFORMATION
1. FAILURE TO RES~ONO WILL RESULT IN AN OFFICIAL TAM ASSESSMENT _Ith ...11...1. Inhr..t ....d.n Inloro.tI.n
IUblHtlci bv the On_nell,t In.lIlutlon,
2. Inh.rUllnc. tll( bleo... dellnqulnt nlnll llontt11 IIftl" thl dlclde"t" 'lat. of d."th,
S. A Jotnt IOCOunt I, h)l;lbl, .....n thoufh thl dIOlttlln\', n"....III "dd,d .. I ..tt.r of (lOnVIIlI,nlllt.
ft. Aooount. (Ina1udlne tha.. hlJd betw..n hUlband end lilUe' whleh thl d'Cld.~t put In Joint fllllll.. ..Uhl" onl It.., prior to
~..th ar. fully tllCabl, II trMIl'ln.
S. AOClounh utlblhhld _1olntly h.tw.." hll.band ftf'id ",If. lIor. th.m onl '1nr prior to d..th ar. not tluclbl..
6. ACloountl held bv II dllcadlnt "In tnat fur" .noth.r or oth"l .r. talCabl_ full'1.
REPORTING INSTRUCTIONS - PART
TAXPAVER RESPONSE
1. BLOCK A . If thll In'or..tloll and lJollpuhtlon III thl notlcl are corrlct and deduction. IIr. not hllnG cI61.ed, pllce all "M"
In blook ",.. of Pllrt I of thl '"TllipeYlr A..pon.." ..ctlon, Slon two copl.. Imd 'ublllt tI,... wJth your ch.ek for tha ucunt of
t.M to tha ".,hte,. of 10111 of th, (Jaunty Indleat.d, rh, PA lIapflrt..nt 0' Ravanu. will luuI an o,fic!al .".u...nt
(For. REV-ISttl EM) "pan rlulpt of tha raturn frolll tha RIghtllr 0' Wllh,
Z. BLOCK I ~ If thl ....\ .p,e1fl.d on thh notlo. ha. b..n or will b. r,purt,d and tflli p,ld "11th the Penn."lv"nl. Inharltanca
TIM Return fllted by tllIl dludant'. rlPrll.entetlvI, plaat In ")(" In block "B" of I'art la' thl "faMplIYlr R..pon.... ,.cth,", SllIn onll
Clopy and r.turn to th. P' IIIP.rt"lnt of R.....nu.. Bureau 0' Indl...ldual T/I,)I", D.pt 280601, HlIrrlsburg, P' 1/128,0601 In thl
.n....lop. provld.d.
5. IlOCt( C . If the "ot.lcl Infor..atlon III Incorrlct andlor d.duct lon, ar. bllng chl.ad, check bloClk "e" nnd ClOMpl,t. Plrt. 2 and S
.c.t;UrUlt11 (U lit" l.,.~, u..;U..".. 11..ill,t, ::lif", t...... ..;:;;.1;;.; ~,n:l J~t....lt ~~;::r. lil~h ','?'.'" <:101:"" ,,.... H'. ''''H",,,t 0' t..", nlllllllhll1 to th. R'OII,t.r
of Will. 0' the Clounh Indlcat.d. The PIl D.part"lnt of RIII.nu. wll1 l..uI 8n offloi.l ......."."t (for. REV-IStt! f.M) upon r'Clfllpt
of the r.turn f,.o. the RI"ht.,. 0' Will,.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter th. d.t. the eCClount originallY we, ..tabU,h.d or t!Ulld In the IlInn.r ')lisUng .t dllt. of duth, ~
NOTEI For I dec"d.nt dYing .f'-r IUIZ/aZI 'ccounh whleh the dlc.d.nt f1ut In joint na... within onl (1) ynr of d....,..'.
tl)(ab1. fullY III tran.hr., ttow.".r, th.r. hen 8)(clu.lon not to ttlH:..d H,OOO p.r t,.n,f.r.. r.gardl." of _....lUII of
thl .coount or thl nu.b.r of lecounts h.ld, M
~
If I doubl. ..t.rhk (..) IIpp..rt be for. your flr,t nail' In thl IIddrlll. porOon tlf thl, natlel, t:,. U,OOO I)lclu,hm
alrlldy h.. b..n d.duotld 'roil the eccount b.hnel a, r.port.d by thl flnlnclal Institution. N
2.
),
Enhr the total bel.ncl of U,. aooount lnoludlnt.t Int.r..t accl"u.d to the d.t. of duth,
Thl pltrunt of the aClco...nt that I. tIIIxabll for ..eh .urvlvor h d.t.r.ln.d .. 'ollow"
A. The p.rcant ta)labl. 'or joint ....h .,tablllhed .or. than ()n. ynr prior to the dICld,nt'. d..t~,
1 DIVIDED IY TOTAL NUMBER Of
JOINT OWNERS
blltJll.1 A :Joint ....t raght.r.d
DIVIDfD IV TOTAL NUHBER Of )( 100 . PERCENT TAKAlllE
SURVIYING JOINT OWNERS
In the nil.' of the d.c.dant and two othlr ,..,..on..
~
Ol)
..
UT
Q
1 DIVIDED IV S (JOINT OWNERS) DIVIDED !IV Z (SURVIYORS) ... .161 K 100 . 16,n: (!(AK'lItE FOR EACIlSURY:YOR)
I. Th. ".rcent tlx.bl. 'Dr ....t. cr.ated within one Yllr of the dlc.dlnt'. d..th or lIeeountt ownld by the d.cld.nt but h.ld
In tru.t for enoth.r Indlwldu.ll,) (tru.t b.nlflelarl..) I
1 DIYlDED IV TOTAt HUHIER Of SURVIYING JOINT
ONRS OR TRUST BENEFICIARIES
K 100 . PERCENT TAX....LE
EMHPIIl joint aooount raolltlr.d In t~a n3.. of the d.c.d.nt and two other par.on. and ..tabll.l'l.d wi thin on. YI.r of d..th by
the ~Cl.d'nt,
1 DIVIDED IV 2 (SURVIVORS) . .500 )( 100 . S()X n'K....LE FOR EACH SURVIVOR)
4. The ..unt .ubj.ot to t')I (line ~) It dlt.r.lin.d by Ilultlplylne the eceoUllt balllnoa Ulnl Z) hy the p.runt taMabl1 (lIM S)'
5. Enter thl tot.1 of the dflbh ."d d.dugUon' U.t.d In Plrt 5,
.. Th. Mount tl)lIbA. Uln. 6) II d.t.raln.d bY .ubtrocUng tn. d.btl and d,duCltion' (Un. iii fro. the allDUnt ,ubJ.ot tg tIl)l UIM itl.
7. Entlr thl app,.oprl.t. tlM r.ta <1ln. 7J II d.t.ralnad b.low.
A. For d.t.. of d..th Docy,.,.lng .ft.,. 6/S0/94, the te)l rlt.. for trln,f.r. to 'pou'" IIr. II '01 10(1f' I
1. o.t.. of d..th on or Ift.r 1/1/94 ."db.far. 1/1/'S thll ,..t_ 11 1%.
2. D.t., of de.th on or after 1/1/95 t,..n.f.r. to 'pou... 101111 b. tl)l.d at 0% taM r.t..
Hutel For d.~e. of dl.th prior to 7/1/94 t("anlf". tl) .pou... Ir. t,Mabl. It 6iC
I. Tran.f." tCl llne.1 d..c.nd.nt. Including hlth.r, 1I0th.r, Ion, d.ught.r, grlndchlldren, lon-In-hw,
d~t.r-I"-I..., ,t,pohlld and th.lr Iuu. Ir. ta)llbl. at .IM p.rCllnt (6io.
t. Tr""I'lr, to all othl" Incl...dln, brothar, .1Iter, unci., aunt, n.ph.w .nd nl.c. arl ta)labl. .t flftllln perc.nt <15l0.
D. If you Chengl thl tI.lC r.te, pl.... .p.clh vour r.htlon'hlp to the d.c.d.nt In the Irll proyldld.
I, ThI ..ount of tlM dUI (11M I) I. d.hr.I".d by .ultlplylng the l'Ount tll(lIbl. (lln. 6) by the taM rllta (1In. 1),
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowllbll debt, IInd deduction. Itr. d.t.r.ln.d II follo\ll"
A. You l"llh Irl ,...pantlbl. 'or p.y..nt, or tn. llteta .ubJact to ldelnlttr.tlon by I p.rlonal repr...n'-U.... II In,uflAol.nt
to PlY thll d.ductlbll It.... '
I. You .ctuelh p.ld thl d.bh .ft" dellth 0' the d.ced.nt end can furnhh proo' of ply..nt,
C. Debts b.lnl cl.l..d IlUIt ba It..lud 'ully In Pert S. If addltlon.l 'PICI It n..d'd, ..... phln pap.r 8 1/2" M 11". ProQ' of
plvnnt lIl.y be ,..qu..bd hy thl p" Dlpatt..nt of R'\I,nua.
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANV
REGISTER Of WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THEaUREAU OF INDIVIDUAL TAXES, TAXPAVER INQUIRV UNIT IN
IiARRl$1URG AT (7m 787-8327. TDDt (717)}72-2252 (IiEARINB IMPAIRED ONLY)
PUtlpo.eOf
NOTICe I
PAVItENT,
AEFllNO (CRl,
r'1'\
C'l
.,
,,-,
(!;l
Ii
,i ~-j
;:SCI
To fulftll the r,qulrllllenh of S.otlon 2140 of the InherltanQI end E,tet. TaM Act, 40' Z1 of 19911. <12P,S.
'Htlon 9140),
D.t,oh the top portion of thil Notlc. and lub.1t with Your pay""t to the RI,..httr of WHI, pl'lnttd on the
rlll'rll ,Jdt,
-- "aka chick or ~n.y urdt,. plY_bit tOI REQlSTER OF WillS, AGENT.
A rtfund of . tex oredit, whloh WI' not requ..ted on thl hI( raturn, lilY b, rlqul.tld by coapltUng an "ApPlloltJon
for R,fund of Pennlvlvant" InheritMce ftnd E.tat. JaIC" (REV~13UI. Applloatlons are IlIftUobh nt the Offiu of
the RIghtl,. of Willi, any of thl Z5 R''''nuI Dhtrlct Offlo.. or by mllllne thl spI(llal l4~holJr anlwlrlnl "'''10'10'
nUlllbtr. for 'orllli ordarlngl In Ptnntvlvlnlll! 1-8DO-:~6l-10~O, outside PennsYlvania l'lnd within locltl
tt.rrhburg araa (1171 787-8094, TDDt 0171 172-Z2!'l CHurlng hlP.lr.d Only).
OBJECTIONS, Any party In Intltrest not saU.fled with the appraheM.nt, allowflnce or dlsellowllncl of deductlcn. or I..au...nt
of hilt (Including dhcount or Interelt) II' ahown on thll Hotlu lIay Object within slll't\l (60J days of r.celPt of
thh NotlCle bYI
'''.wrltten prot..t to the PA Deparh.ent of Rlv.nua, Board of App.al., D.pt, 2110l1, Hardsbul'g, PA 171ZI-IOll, OR
--al.ctlng to have the Mathr det'r1dned lit the audJt of the account of the p.rsonai r.pre..ntatlv., OR
--app.al to the Orphan.' Court
AIMlIN.
ISTRAiTIVE
CORRECTIONS,
DISCOUNT 1
PENAL TV I
INTEREST I
Factual .rror. di,coverlU on thl. a"'I'I~nt .hould bl addr....d In writing tOI PA Depart..nt of R.vlnul.
lureau of Individual TaM", AfTNl POllt A"u'..nt Ravi.", Unit, OF.PT. la0601, tlarrhburll, PA 171la-0601
Phon" {117l 717-650!i. S.. pagl 5 of the booklet "Instructions for lnherltanc. TaM Return for a R..ldlnt
O.c.d....t'. (REV-ISOn for an nplanaUon of adlllnhtratlvaty l.lorrechble errors,
If any tllM due It paid within thr.e (~) calltndllr 116nth. afhr the olc.d.nt'. d..th, . fl". percant (5)0
dl,count of tha taM p.ld 1. allow.a.
Th. 151: tax ..,..ty non-p.rtlclp.tion penalty Is cOllput.d on the totel of tM taM and Inter'lIt .......d, lSnd not
p.id b.for. JltnUlry la. 1996, the first day aft.r the end of the tlM IIIII'lI.ty period. This non~partlolp.tlon
p'nalty 11 appe..labl. .In the ..111 .annlr Ind In thl the '''Ill till. p.r lod .. YOU would appe.l thfl tax and Inter.lt
that hi' bl." .......d ... indicated on thlt notic..
Intlrut 11 chargld blglnnlng with flrllt d,y of dlUnquancy, ar nine (9) IIOnth. and one (1) d4llY
frOll the data of dl.th, to the date of paY.lnt, TlMII which bac... d.llnqu.nt b.for. Janu.ry 1, 1912
beal' lnt.,..t at the r.te of .iIt (6iO p.rc.nt p.r annua calculated at. d.lly rata of .000164.
AU taMI. which b.aa.. d.lInquent on or aftlr January I, 1911 will bur Int.r..t at a rat. which will v.ry frol
cal'nder y..r to cllend.,. y.ar with thlt rate announced by thl PA Dep.rt.'nt of R.venue, Th. applicable
Int.rut ratu for 1981 through 199a aral
V..r Int.r,.t "ata Dally Int.r..t factor V'nr Int.rut Rat. 0.. 11 y Int.r.,t F'!Iotar
1912 20% ,000548 19a7 9:< .000l47
19U 16% ,0004~1 19ta-I991 111: .000101
19.4 WC ,QOOlt'll 1991 9X ,OOOl47
1915 131: .000lS6 1"!-1994 'X ,00019l
1916 11);( ,000214 199!H991 9% .000247
--Inter...t I. calcuht.d .. fOUON'1
INTEREST . BALANCE Of' TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
~~Any Notlca lI,uld aftlr the taM b.eo... d'llnqu."t will rlfllct an Int.r..t calculation to f1ftl." (15) dlYS
blYOnd thl data of thl ....II....t. If ply...nt 11 ..d. .ft.r the Int.r..t co.putaUon date .hown on thl
Notic.. additional Int.r..t ...,It b. calculatld,
0,
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PURPOSE Of
NOTtC'-l
To fulfill thl r.qulrlllllnh of seotion 2)40 of the Inherhanc. and f..hlt. Ttf)c Aot, .ot 21 of 19'5, (72 P,S,
slotlon 9140),
PAVHtNT I
O.tloh thtl top portlun of this Notlc. and IUblllt with your pay...nt to th. R.gilt.r of Wills prlnt.d an th.
rlvlr.e .Ide.
.. HIke Clheck or I<<m.y order plyable tOI REGISTER OF WILtS, AGENT,
AEFUND (CAll A r.fund of a t.1C credit, whloh wa. nbt rllqulltld on thl te>e rlturnl lIlay b. r.qu..ttrl by co..-lltino en "Appllc.tion
for R.fund of Plnn.ylvanla InhlrUancl and E.t.te l.x" (Rf,V*13UI. AppllClaUon. ar. avalhbl. at the Offlol of
thl Rlghtlr of Wll111 "ny of th. l3 Rlvlnul Dlltrh:t OfflClu or by Clall1nll the 'lplclal l4*hour .nlw.ring ..ryloe
nUMblr. for for". ordlrlnClI In r.nntylvanla 1-800-:\6l-20S0, ouhidl Plnn.ylvanla and within 100.1
Harrllburg 8t.. (711) 181*8094, TOO. 011> 1n.'i!2:5l (H.aring hlpalred Only),
OIJECTIONSI Any p.rty in Int.r..t not ..thfl.d with thl apptlllse..ntl allowance at dlsallowanoe of d.duotlorll at u....".nt
of hx (includinCl dhcount or Int.re.tl !It thown on thll Notice llIay objlot within siMt.,. (601 d.y. of reClIpt of
thll Notlc. bYI
*~wr1tt.n prot..t to the PA n.partll.nt of R.v.nUl, 30ard of Appult, O.pt. ~'10ZI, Harrisburg, PA 111za~lOZI, OR
~~.l'atlng to have the lIlatt.r d.tar.lmld at the audit of thll eccount of the lJarlon.l rapr...ntativ.. OR
uapp..l to the Orphan.' Court
A~IH*
lSlRATlYE
CORRECTIONS I
Flatu.. .rror. dl.cov.rad on thil e.......nt .hould b. .ddr....d In writing tOI PA n.p.rt..nt of Rlyenue,
lur'MJ of IndIvJriu.l Tax"l ATTNI po.t ........unt R.vl.w Unit, DEPf. 280601, H.rrhburg, PA 11128-0601
Phon. (7171 181-6S0S, S.. fl.'" 5 of the bookl.t "In.truction. for Inherltanc. hlC R.turn for II Ruld.nt
D.cld.nt" (REIJ~IS01) for en .)Cplen.tion of edIllnl.tratlv.lv oorr.ctabll .rror.,
DISCOUNT I
'If any tax due II paid withIn thra. (:\1 cal.ndar .onthl ofter the d.c.d.nt'. da.th, . flYI pltc.nt (SiC)
dl.count of tha tax paid 11 .llow.d.
PENAL TV I
Thl lS~ t.~ -.ne.ty non*partl~lp.tlon penalty I. co~t.d on tha total of the tax end Inter..t ......ed, and not
p.ld before Jlnulry 16, 1996, the flr.t d.y .ft.r the end of the tI~ 11In..ty Plrtod. Thll non*partla1petion
penllty II app..lable In the .... .1M1t and In thl thl .... th.. period as YOU liHMJld app..l tne tax ~ Int.r..t
that h.. b..n .......d .. Indlcat.d on thil notic.,
INTERt:STI
lnt.r..t h charlllld b.glnnlng with first d.y of d.lInquency, or nlM- (9) ..onth. &nd OM (1) dly
frail the date of death, to the date of pIYI.nt, Te)C.. which b.cI.. d.lInquant b.for. J....ry I, 1912
b..r Int.r..t at thl r.t. of .lx (6X) p.ro.nt ~ar ennui c.lcul.t.d .t II dally rlt. of ,000164.
All tIlt.. wh,lch bICI~1 dfllInqu.nt on or IIft.r Jftnulry 1, 1982 IilUl b.lr Int.r..t .t . rlt. whlah will very fro.
o.l.nder y..r to callnder y'lr Ioflth that rat. announced by thl PA naPlrt..nt of Rlv.nu.. ThtI IIPPI hlllbll
Int.r..t rat.. for 1982 through 199. .r.,
~ lnter..t Rat. D.IIY Intlre.t Faotor VI.r Int"..t Rat. O.Uy Inter..t feotol'
1912 20i( ,000548 1987 .~ ,000Z"7
1981 16i( .000431 1918-1991 11;( .000101
l'llt llX ,000501 1992: 9< ,0002,.7
l,eS 13;( ,000:\56 1993*1994 " .000192
1916 lOX OOOZ14 1995*1998 9i( ,OO02it1
ulntar..t I. a.loul.ted .. followlI
INTEREST = BALANCE 01' TAX UNPAID X NUHBER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
~.Any Notice IlIuad .fter the t.x b.co... dlllnqulnt will reflect an tn'.r..t c.lc.u~ation to flft.." (15) d.V'
b.yond the d.t. of the ........nt. If p.Ylllent 11 Ilad. .fhr the Inter..t oOMPut.UOfl det. IhOifll on the
HQtlc., add It lonel lnter..t lIt.l.t be o.loul.ted.
e~ ~
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PAVMENTI
Datloh the top portion Qf thh NoUo. and ,ub.it with ~our Ply..nt ",de plyablt to the nl.. and addr...
printed on thl rlv,r.. .id.,
It RE~IDENT DECEDENT !llka chIck or 1I0nlY order payable tOI REGISTER OF WILLS, AGENT,
If NOH-RESIDENT DECEDENT IIllllk, chIck or .onlY ord.,. _ paY'blt tOI COHMONWEAL TH OF PENNSYLVANIA.
REFUND (CR)1 A r.fund of . taM credit, which Will not r.qu..tld on thl 'aM Rlturn, lev bl r.quutld by cOlllplltlnl an
"AppllcaUon for R.fund of Pfmn.ylvlfnll!l Inherltanel and Est,t, TalC" (R€V.BUl. Appllcatlonl n,.. Ivallabl, .t
tht Offlol of thl Rlght.r of Wills, any of the U R."enutl Dhtdet OHicI' or 'rOIl the Dlp.rt..nt', 2tt~hou"
.n.waring ..rviu nUMbar. for for.. ordlrlngl In P'nnlylva"la 14aOO~36Z~Z050, outlld. Plnn'lIllllnla
and wUhln local Harrhbul'll ar.a (7111 l11M8094, TOOl (1l7l nZ-ZZ5Z (Hurina IMpalrld anlyJ.
RfPlV TOI QuuUon. rlgardlng Irr'orl contalnld on this notIo. ,"ould b. addrl".d tOI PA Dlpart..nt of Ru.nu., lurl.u'
of Individual Tflx.., AnNI Po.t A.......nt R.llllw Unit. D.pt. 280601, Harrhbur" PA 1712l!1-0601, phone
(1171 787-6505.
DISCOUNT I
If any \8x dUI h paid within th,... (3) callndar lonth. aftlr thl dlcld.nt'. dlath, . flvI Olrolnt (5iO dhcount
of the hx pGld Is allowld.
PENAL TV I
Thl 15% \81( a.,...ty nonMpartlclPIUon p.n.lty II COIIPutld on the total of the t.lC and Int.,...t .......d, ttnd 1'10\
plld b.fo,.1 January 16, IIJ96 , thl H,..t day aftlr tMi .nd of thl tlX ._n..tv pI,.lod.
INTEREST I
Int.,...t h oharald b.alnnlng with flr.t dall of dlUnqulnclY, or 1'111'1' (9) lonth. II'ld ani (l) d'lI frol thl d.t. of
duth, to the dati of pay..nt. Tax.. Io/hloh blc... dellnqulnt b.fo,.g January 1. 19112 b.ar Int.,..t at the rat. of
Ib (6%l p.rclnt p.r annUl calculatld at I dIlly rat. of .000164. All taXII whloh blc... dlllnqutlnt on and Iftlr
January 1. 1912 will baar Int.r..t at a ratl whh:h will lIary frol catlndar y..r to celinda,. y..r with that r.t.
announcld by thl PA Dapflrt"ant of Rlvlnu.. Tha Ipplloabll Intlrllt rat.. for 1982 through 1991 arll
V..,. Intl,...t Rotl Dalh Int.r..t Factor
Veer
Intlrut Rat.
Daily Intll'l.t Flctor
1912 20% ,000541 19l!11 'X .000247
1983 16% .000438 1'8&-199. 11% .000501
1984 11% .000:501 199? 'X .000247
1985 13% .000:556 1991 ~ 1994 ]X .0001'2
1966 10% .000214 1995M199l!1 'X .000241
ulnt.r.st Is calculatad I' followsl
I"TEREST . BALANCE OF TAX UNPAID X NUMBER OF DUS DELINQUENT X DAILY INTEREST FACTOR
~.An)' NoUn Iuuld .ft8r thl tax bICDII..dlllnquent wtll rlfllot an Int.tllt oalcul.tion to flftHn UUd.y.
blyond the dati of the a.......nt. 11 paY"nt II ..de eftlr thl Inter..t COllputltlon dat. .hown on tM
Katie.. addltlo"el tnt.rut .Ult bl ollculatld.
i~ ~
1:'1"
~1:. $
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"'"
PAyttENTI
D.tloh thl top portion 0' thls Notlcl and lubllt with 'lour ,U.'I"I"\ IIIlld, PItVlbh to the nalll Ind addr...
printed on thl ~'Vlr" .Id,.
If RESIDENT DECEPt:NT "ek, chick or lIIonl.., order pllIYltbt, tOI REGISTER OF WILLS, AGENT,
l' HOH-RESIDENT nfeEDEHf Make olllelk or ..onlY order PIYllIbl, tOI CO""ONWEAL TH Of PENNSYI.VANIA,
REFut4D (eA)1 A r.fund of a h)( flr,dlt, which loin not r.quut.d on thl TaM R.turn, IlIftY b, r.qu..ted by cO'pl,ttng an
"Application for R,fund of Plnn.vlvanlll Inll,rltancl Ind EI\at, Tal(" (Rf.Y.l11!), Ap'l.llcetlo"1 II" .vIII,bl, It
the OffiCi of thl Right.,. of Will., any of thl i'3 Nlv.m,. Oistrlot Of lie.. or 'rt'1lI the nlp'fh""t" t4-hour
'"'werlng .eryiae nUlIIb'''' for 'OrlU orderlngl In Plnrnylyanlll 1-800-,'62.20"0, o\lhlde'it."nllylyanla
and w1thln local liarr!thura ar'A (11i') 787-1101)4. 10DII (117) 77Z-2'lS'I. Ollllrlng I.palrld only),
REPlV'TOl
QuuUQn. relardlng .rrors contained on thl, 'lOtiO' should bl addr....d tOI PA D.pan"erlt of RAv.nu.. Bureau
of Indlyldual TalC", UTNl Po.t "....u.nt RIIVlllw Unit, Oapt. 280601, Ill'lrl'l.burg, PA 17128'0601, phone
(717) 717'6!iOS.
DISCOUHT I
If any telll due It paid within thr.. (5) oal.nder Month. after the dln.dent'. duth, a flvl p.rc'nt (S%) d1loount
of thl taK paid hallowed.
PENALTY I
The JS% talt altf'lllty llon-pert1clpatlol\ peOlllty 11 oo.put.d on the total of thl t."I and Int.rut aUI,lIId. and not
paid beforl Janulry II. 11)96, the Hrst day IIft.r the .nd of the tel( IIl1n..tv plrlod.
INTEREST I
lntlr..t It chargld h.glnnlng with first dllY of dellflQuenay, or nln. (91 Month. and one (I.) day froll thlt dati of
dllath, to thl datil of pIYIII"t, f"KIlI! which h.caM. delinquent blfor. January I, 1912 blar lnt.r..t at thl rate of
dx t6%1 perclnt per .nnu. cl'lloulatld at l'l daily rat. of .000164. 411 t/lll" which b'(l/lll. dlllnqulnt on Irld aft.r
Jlnuary I, 19"2 will bur lntlr..t at a rat. which w111 yarl/ fro. c:a1,"dar y.ar to cal.ndar 1/"" wHh that rat.
Innoune.d by thl PA n.parhulIlt of R.venuI. Th. applloabt. intere.t rllt.. for 1912 through 1998 ar'l
V.ar
Inter..t Rate Dilly Int.r.at Factor
V.ar
Int.r..t Aat.
Oal1\l Inter.1t raotor
19et 20% .000541 19.7 9% .000247
1981 16% .0004~1I 19811-I'J91 11% .000101
1984 11% .00O~01 1992 " .000247
1985 13% .000356 1993-1994 1X .000192
1986 10% .000274 199~"1'98 9% .000241
--lnter..t it calo11lat.d .. fo11tlw.:
INTER~8T . 8ALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREBT FACTOR
--Any f4otlol luued aftlr the taK been.e. dtllnquent will rlfteat an Int.,...t ealcuhtlon to flft,en <1S) day,
blyond the date of th. 1Il.....IIl.nt. If pal/lont II 'Ide Iftlr thl Int.r..t (lollputatlon d.tl .hown on tM
Natlet, IlIrldltlon.l tnt.r..t lIust b. (lahul.t.a.
IS~' ,;(O(,~ y
BUR~AU'OF INOIVIDUAL TAM~S
INtiERIUHCf TAM DIVISION
DI~Pf. 2i06O I
UARRISRURO, fI" 11lZI-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATE~ENT OF ACCOUNT
(>
~,
~
~n.I'01 u II' IU.tll
PEARL E RUSSELL
599 BALTIMORE RD
SHIPPENSBURG PA 17257
DATE 05-18-98
ISTATE OF DAVIS EDITH R
DATE OF DEATH 07-19-97
FILl NUMBER 21 97-0812
COUNTY CUMBERLAND
ACN 97138872
[-:==~~=Ii~~=,~_ ~- l
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Honl To In_ur. proper oredit to ~our aocount, lub..U the upper portion of thh forlll with your t.)( ply..nt.
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS --4
itl Ii: i/jjij. iie- Ai: p. iiiF 97i" .00 0 -. Iii;' ii 0 I NiiER i i'-ANi':"E". fAX - s flif EilENT - 'OF - Ac:coiJiif- - i.. Ii - - on _0.. - - _.000.....
ESTATE OF DAVIS EDITH R FILE NO.21 97-0812 ACN 97138872 DATE 05-18-98
THIS STAT~H~NT IS PROVID~D TO ADVIS~ OF TH~ CURR~NT STATUS OF TH~ STAT~D ACN IN TH~ NAH~D ~STAT~, SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAM DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT bALANC~, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 03-23-98
PRINCIPAL TAX DUE, 54,76
PAVMENTS <TAX CREIllTS It
PAVMENT
DATE
10-03-97
05-04-98
l,) ,:{:J
RECE I PT
NUMBER
AA242310
~ RE~lJ\l.P
~~ a.:
DISCOUNT (+)
INTEREST/PEN PAID (-)
2.74
.00
AMOUNT PAID ~
57,50
5.48-
...."~
<~
, .
CO
N
", >- ,1
".: ., ~
() ....',..! [,
() (LJ ~ ;!;'Jii
QlQ;:
a:: ad
. IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOT ~L DU~ IS LESS THAN n,
NO PAYH~NT IS REQUIRED.
TOTAL TAX CREDn
BALANCE OF TAX DUE
INTEREST AND PEN.
TOT AL DUE
54.76
.00
,00
,00
IF TOTAL DUE IS REFLECTED AS A "CREDIT" '(CR),
YOU HAY eE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS, I