HomeMy WebLinkAbout97-00815
IJETlTION H)!t PIUlnATE lIUt! {mANT OF LETTEItS
~.'-_L9q.'1....~,BL5u..___
No. ,
'1'0:
Estate 0/ ___.Ildl.:.ll..klllY., r:l\JmN____
also known as
Ill' ( C I't'--'-'!', ,J
_ .. hi.... ._"" LI L:J.. I H l{egistN of Wills fot' Ihe
____~____..._. .. .... O""t'lIst'rI. <\lIll1ty of ...CI!I.I\.h,':rJQ,UIL..", III the
Sodal Security No. ,!:I/\".... Y'. .. 7 OBI COllllllOlIweolth of I'ellllsylyolllo
Thc Jletitioll of the ulIdersiglled l'csJleetflllly f'('pn'sclIts Ihal:
Your Jlctltlollcr(s), who Is/ore 18 yellrs 01' lIg" or oldet' RlIlhe e.xet'ut,t'tU
In thc last will of the above decedellt, dlltNIDI".' I'lIIh I' r. .. II.
and codlcll(,) dated ._,.Mlly",O:i. l~!n
D 'y--;"Ot:T,'/i; ,," ".. ".. i/,",""(' 'j"'" " t,. "-"""-(T~--'''-'-'-'----
___ L_.______.. LLn ....,,-, 1t:L' .. .. l\ttiL.\.)<\--..U!J...:j.._....._____
"...... ,_".____,,,"amcd
..-.----., I~
_ ____, __,'.k' .. .~,__..____~_"".u_n_.~~_~
....- ..--------.---.---.---.-.-.------'
(state relevant cirClllll~lll!lC(~~, r.~, renuIldlllion, <Ienth or t!1l;rClIIOl, etc.)
Decendcllt was dOlllkiled 01 deoth III ,.. .ClIlIl!,c'r I "!'" . ". . ...." CoulIly, Pennsylvania, with
h..CL-_llIst family or prillcipallesldence ai, 2 U,U:! B "~pr.tll~_.l\tlUJ.I.._lll.:.wv,H1<L,,J.'lL_
_.____.... (,licsLl' UlllIHllOI o. 'l'I'p..) "~_._,,. .. _" 'hM' ...--'-'-"
(I1~1 ~trec!, "UIH~K'r Mill nllIlH:ip"litYJ
Occendclll, then ._.M..... ... years of a~e, died. "S,'PlCiIIU,'l: 2/t, ...__..._....___, 19!1.L_,
at......sJ.r.allll.llcn1.Lh.CCliLel',.. 2.LU Jllg._BprJnJ!,Jl.ond" New.v i11e._..l'A~.17.241__..__.
ExceJlt os follows, decedenl did not n"lfry, \l'OS nol divolced and did nnt havc a child born or odoJlled
after cxecutloR of the will offcred I'm pmhale; \l'as 1101 the victim of a killing sl1d was l1ever adjudicated
Incompctenl: ___.....~_..."..-.._-...._-,. ..----.. ,~...----...,,-.-.-,,'
Oeceudent at dcath owned property wilh estimated values 0' follows:
(If domlcllcd in Pa.) All pcr,onal property
(If not domicil cd In Pa.) Personal propcrty In PenilSylvllnia
(if not domlcllcd in Pa.) PCTsonal pTopcrty in County
Value of real estale In Pennsylvania
sltuatcd as follow,: ...,,,_______a ........
$ .lli..900 . 00
$___
$
$-.---
.__...__~___ ... ..._,n_.. ,.,.__._._____n__...'. ....------ -~.~~
_,._._~____....__._._._______ a. __..~___....__._____M
WHEREFORE, pctltloner(s) re,pectfully reque,t(s) the probate of thc la,t wiil and codlcll(s)
pre,eRted hCTewith ond the granl 01' lellerL...". ".'J:s-~Ll.(!m.9lliJ)Ly._.._..._.._________
(11'~tlll1lC~lItary; I1dlllllliwlltlon c.I.a.; ndllllnlstillllOl1 d,h.n,C,I,a.)
theron,
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u' nO' _.___..._ ..,..._________,__.__.__.._.__
----_._"----_.~-_.,-_..---_....__..,...-.._.~--_.._--.---.-
---_.__.~----_..__...__._-~---_..._- .....,..-.----.- ----- . -- ..,....-. .',
-- _._..~--~-_.....__.-
.......,..-..-----.......- -- -.
-
OATH Oil PERSONAL IUWItESENTATIVE
COMMONWEALTH 01' I'ENNSYLV ANIA l >IS
COUNTY 01" _..cuJ1thcr:Lllld....,....._...h....-. J
The petllion"r(s) abo\'c'lIomed swearin or offll'mls) Ihat till' slatemelllS in thc foregoing petilion arc
true tinct l:OlTC(.:'( to llle lwst pI' lilt' kiwwledgc aud helief or pctltiol1('r(s) alld thnl ns persollal rcptescn.
tativc(,) of the above dt'ccrlellt I'c,i!iul1ells) will well alld II'llly admillisler the cst lite lI,coTdlng to law.
. O,,~~ .;J ~...--t("1 --.-- ~
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'~77 '/- /f'(..I;,L _..- ~ -. ~
/- . ~L. _/''-'",// q~,,(,t - .!:!
Sworn to. (.,r. affirmc'.'. 01.11'. Slll.'serihe.'.'.j
bcforc me this ......__L.......... ." .. dllY (If
~t~~I'(L"zti11JijJ1~.[/J'1~11Id.
{j :J R('~ISll'l'
L^~1~.l LLi\NIl..1J\flJ~.JI!l.!
I, HJ(LEN MAY GRggN, of 3153 Orrstown Road, ShIppensburg, IlrankHn County,
PennsylvanIa, declare thIs to be my Lllst WI 11 nnd TeHtament and revoko any wUI
or codldl prevIously made by me.
ITgN I: I dIrect that all my Just dobts Ilnd fURerll1 expenses, including
my gravemarker nnd all expenseH of my Inst 1.11ness, shall be paId from my
residuary estate as soon IlS prnetlenblc nftor my decease as n part of the
ndministratlon of my estate.
ITEN II: I gIve, devIso and bequeath to my step-grllndaughter, Joann Holtry,
the sum of $1,050.00. I further give and bequeath to JOllnn Holtry my green
pitcher and glnss set, and my blue butterfly pIn.
ITEN III: I gIve, devIse and bequeath to my st.ep-grandson, Robert Hamsher,
the sum'of $1,000.00.
ITEM IV: I givL', dcv:lsc aod bequoath all of the rest reaidue and remaIn de ,
of my estate of every nature and wheresoever situat.e, to my husband, Orville G.
Green, providIng that he shall survive me by thirty days.
ITEN VI Should my husballd, Orville G. Green, predecease me or die on or
before tho thirt.ieth day followIng my doat.h, I gIve, devlsc and bequenth all of
the rest. f<,sIdue and remaInder of my estllte of every nature nnd wheresoever
alt.uate to t.he ZIon Lutherlln Church, NowvIlle, Pennsylvanin.
ITEN VI: I direct that all taxes ('hat may bo qssoBsed in conaequence of
my death, of whntever nllture and by whatever jurIadiction Imposc"l, shall be
pnld from my reAidullry eAtote as port of the expenAeA of the ndmlniAtration
of my eAtnte.
ITEM VII: 1 HppoJnt my husbllnd, Orville G. Green, eXBcut.or of thIs my
LIlAt WIll Ilnd TeALlIment. Bhould he fall t.o qllnl ify or celiAC t.n Ilet liS execlItor,
CODICIL TO LAST WILL AND TESTAMENT
I, llEL.El"LMAYGRt:EN, u resident ofWestl'tmnsboro Township, Cllmberlund County,
Pcnnsylvuniu, being of sound mind and memory, do lIluKe, publish and declare this to he II Codicil
to my Lust Will and Testument hearing dllte of Decemhcr 17, 1985, in thc following mllnner, to
wit
\ ITEM I I do hcreby rcvokc ITEM VII of the slIid Last Willllnd Testament dllted
I December 17, 1985
i \ ITEM 2 I hereby nume, constitute, IInd IIppoint ,Ioann Holtry, Robert D. Hamsher, and
I \ John R. Holtry co-executors of this my LlIst Will"nd Testament.
\ ITEM 3 I do hereby ratify and conlinTlmy Last Will and Testament dated December 17,
I 1985, in all other respects.
\ I IN WITNESS WHEREOF, I hllve hcrcunto set my hllnd and seal thi~:~;t;day
\IOfMAY, 1997.
I
I
.JV(c.1:.~!..l,.\-' .\1..." ((~~(I.l...__(SEAL)
HELEN MAY GREEN
The preceding instrument, consisting of this and no other other typewritten page, each
identified hy the signature of the testatrix, Helen May Green, was on the date lIud date thereof
signed, published and declared by Helen May Green, the testatrix herein named, as and for her
Codicil to her Last Will and Testament, in the presence of us, who at her request, in her presence,
and in the presence of each other, have subscribed our names as witnesses hereto,
,
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residing at cJ\"~, 4"!!_J..(':c.I'~d' /::.X\
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SAtLV J. WINDER
AI/orne)' at Law
701 n. King Slreel
Shlrren.bnrg, PAI72l7
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COHtiONWfAI, tIt llt PI NN\lh~NIA h. e_.
OIl"O'HtNllIl "'"N''' '~",~,~,~D. INFORMATION NOTICE FILE NO. 21 97-0815
l\lJIUMJ 01 INlll\lllllJAt IAXt:S l'('~:"~~' ~~ I AND
1II11T ,'ROI,OI t j I~;' ~.1.. ACN 9711t9969
""01""00, PO 11,.',,,,,0( . .' . !..,..~ A>:PAYER RESPONSE I
DATE 12-09-97
'h \..1'1 lIP (/ HI
_~....-...... _~u~..~.,~ ._t.._~......_..........,-_"" _'...F....._....RO."'.-'-.-_'''"~__'''''''''''''O=-O..''"''''''-,..''~." ...,,,,~=
TVPE OF ACCOUNT
EST, OF rlELEN M GREEN
S,S, NO, 198'3(,-7081
D~TE OF DEATH 09'24-97
COUNTY CUMBERLAND
SAVINGS
CHECKING
TRUST
:xi CERTlF ,
JDANN V HOL TRV
ISSl5 CUMBERLAND
ORRSTOWN
HWY
PA 17244
REMIT PAYMENT ANO FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLI SlE, PA 17013
ORRs'rOWN BANk IIllS provlrlRtI tho UOllllrtPlOllt with tho Inf'lrnllltlun 115torl Ij8Lo\ol whlet, tHIS bR~n usod In
calculllllnlJ lhe potantl'll tilll duo. Their rocards IndiCA!" lhllt ,11 ttlll (tonth of tho dboVR ducudont. '1ml \oI11'Q il joint ownQr/DQnef,lclllf'l of
thl!! llucount. I' 'IOU Imll lhls Inform"tlon Is Int;orrllct, plcHlso obioln wrltton corrnetlon frolll thll Ilnanelill Institution, <litilCh" eo"V
to tills for!ll Ilnd return It to tho lIhOVD <lddross. 'lhlll ilCCOWlt l!l tm<itl1ln In iH:corrl"nco "lth t'IO Inh9rllflnr.a laji l'lWS 01 tho COflll"Om~Qllltll
of PonnsvlVllnla Ull9stJor\S IHIY hI) llnSl'IU'o(l 0'1 Llllllll\J \,..., (al 03':(.
Oah
Establisned
REVERSE SIDE FOR
12'01-92
FILING AND PAYMENT INSTRUCTIONS
COMPLETE PART 1 BELOW M
Aooount No, 001'0048017
M M SEE
x
2,033,37
50,000
1,016,69
,06
61.00
TAXPAYER RESPONSE
RESULT IN AN OFFICIAL TAX ASSESSMENT BASED ON THIS NOTICE
fa Insuro proper crodlt to your account, two
( "J cop IllS 0 f th \ 5 no t ICQ ~'us t ilCCOrnpilny your
ptIY~IO.,t to tho HO!Iistor of Wills. Hilk" chal:k
pal/able tOl "RaQlstor of \011115, Agent".
Aooount 8alanoe
Percent Taxable
Amount Subjact to
Tax Rat.
Potential Tax Due
x
NOTF.: If ta>: pllyments are Ill<ide within thrae
(~) fIlonths of the decodent.s date 01 doath,
'lOll may deduct II Ij% discount of thll tll>: duo.
Anv 1l1hor I tflneo ta>: cillO will boco<llo dellnqllont
fllno (lJ) montlls after the data of dealh.
To.
PART
[l] !fAILURE TO RESPOND
WILL
i'- CHECK
ONE
l BLOCK
- ON LV
A. Ihe lIboVfI Inlorlllll\lon and till< dUll Is ('.orrecL
1. You mllll choon to ,.8...lt fHIYlIlflnt to thll Register of Wills with two copies of thl, notlclI to obtllln
<1 dlsr.o\mt or Ilvold Interest. or Vall MIlV C/19(.1< OOK "A" and r9lurn Hils not Ica to th_ Roglster of
Wills ilnd <In afliciill :\Hllu",.nt will tIll 15~','ild 0'11 itHI PA lhlPartlllent of RQvemul.
II. V'Th. abovII It,s.t hi\~ been or wll\ be repmtlld and t,l'< Pllld with the Pennsvlvanla
~ to be tiled bv HIe docedent' 5 repl'e!lllntilt llle.
tnherltanr.e 11\>: r"Hlrn
C. Tho nboll9 Inforlll<1tlon i~..jl1correct llnd/o~_r.!9bt~ 'In<l tJoclllctlans wltre paid hy you.
Vou <TIust COlllJll.tll PART ? Ilml/or PARI ~ bolow.
PART
'2"'
~
If ~ou indicat. a differant tax r.tal pl..'. state your
relationship to decadent I -.----~------"._-_.,-.~.--~
OFFICIAL USE ONLY C AAF
PA DEPARTMENT OF REVENUE
LlNE
r.tTl.:::t: - COHrUTATIOt~
1. D.~a Established
2. Account Salanee
S. Percant Taxlble
4, Amount Subject to Tax
S. Debt, and Deductions
b. Amount Taxable
7. Tax Rat.
a. Tal< Dua
or- TI',X ("~ Jnn!T.'T:':'.!C"!' ^CC!"U~~"!"S P!,D
...".,
In"
PART
l!J
DATE PAID
DEBTS AND DEDUCTIONS
1
2
3
4
5
6
7
8
CLAIMED
1
2
3_~
4
S
6
1 X
6
PAYEE
DESCRIPTION
AMOUNT PAID
I
-+
,
TOTAL tEnter on line 5 of Tax Computationl
I
I
$
Under penaltias of perjury, I deolara that the hcts I have reported above aro trl.le, oorrect ond
cOlllplate to the bast of lilY knowledge and belief. HOME )
SIGNA~\1" '" 1.;1 11.. v.1x r WORK ( ) Q}tJq&
TAXPAVER TELEPHONE NUMBER
OIIHRAI I III IWMA IIIIN
I. FAILURE TO RESPOND WILL RESULT IN AN OfffClAt tAM ,\!.!H~;!iHI'Nl \dlll "!'PIll'ltill! IfI\II!I,~t tJ/ullll (Ill In'nl"l'111tlun
IUblllltt8d bv ttlll flllillle;lill lll~tl\qtlnn,
l, tnh8rltllncI tlll< hlllilll'1AIi 11111111.tllQllt "Iml rI(!Iltl,~ 1I1t.\! !hn (liltlldllljl'~ ditll' III ,14111\1\
1. II Joint nCCOllnt I' tllJ<IIIIIIlIlVII!l '11111'\111 thl! IhtUI'Illnt"i 'IilP'lI' .Iil~ .Illdlll! 'l~ q "liltllll "f (,II/WlI'lluhul.
4, Account. tlnclutlln\l Ill".... Ilull! It"tWllllfl 1I11',II,jl\l1 jII"j IlllAl \.jhid\ tllI\ rllllll/jlm\ pl,l 'II Jlljllll\;I~UU w\\l111I OIUt VII"" Itrlnr III
death nre /idly tllJ<uhlll IU Irllllliflll",
~. Accounts Cl'tnh\l~tllI0 lnll.I\'I 11I111/11Il!\ tlll~II'IIHI 'ltlll ,.'1"1111111 II\,H\ 11'\11/11'11 pt II,if 1(1 IjuHth 'Ill! !lot til~f1h\lI,
&, AcCollntg hlllllll'i II thH:1H1!ltll "Ill \111,;1 III!" iilHIIl\lIl 01 ,,\lUII'1 "Ill ""'lblll 11111'1
RU'ORIl NO I US I ~lJC II OIlS
PA~I
IAXPAYER RESPONSE
I. BLOCK A If tlllI IllfIlIM/IIlml 'UIl! ""'1IHIIIIIlul1 III 11111 !1I111411 'uo ,,(jft"fl 'Hlcl tllllhl<'tll1t\~ /Iro 11IIt holng c!I,IIIlOd, IIIoC8 (Ill "X"
In t'lo(1~ "A" nf.PiIIl I uf lhJII j'!,"IHiVIl! Illl~I""1fjll" ~tlLllo!l, ',1'111 l\llI tlll'lll~ mill r\lllmjl thum wlth vmlr 1)111101<, for HIlt IllllOllrlt of
tal( to Hill ~lllll!jhH nf \.1111', IIf IIIIt 1'1111111'1 Ilull"IIIIIL 11111 IIA 1I4t111l! Imull\ IIf Huvqnllll 01111 I!lsue IIn ufflcllll IlliUtSt;lIIont
(ror~' HlV 1'1'.1\ /)(1 !lllllll IIlII.I!,1 III IbM I ,till; II I! '11'1 11"1 lhHII~IIU n' "'III~,
(, alOCI( 1\ II HIli ;,~~", ~1'1I,llllIllllfl 1l11', 11I;llen II"~ IWIIII III 01111 hll 1'!!"Hlml 1Iml Illy. IlIIll1 with tho POl1fuvlvnnlil Inh.rllllhce
1",. Rotw'n fllml hv Il,lI rli!flltlfl!ll'~ '"ll1lr~1HII'lliojn, pl'ltU ,.1\ "l(" In Illoe~ "1I" of Pllrl I of \110 "l<\lipIIYIIl ~n~ponso" sl1ctlon, Sign one
COpy ilflll nltlHf1 In t!ill 1''' IIIII';I! I flit" I 01 IIllvl,IIUII. "'ifU<111 'If IlldivlfhJfl1 !'Ilill., /lul't ,'1101101, HIH"l'ls~l\lrY, IIA l'I~8.Q()OI In Ihe
on.... I 011. III uv Illtul ,
,\, IHOCI/_ C If III. 'HI\II'o 11l1'JIIIHttIOli IN 11l,,;,II'IH,t 'IrIll/tll IhllllH;tlllll!l urll hlllng (llnll'lod, chock lllack "e" anll conlplote flArt! ~ And'\
<lccnnjlng In ,!HI In"'II"I!"!!) lu,lllW, '.ill" III" lliHII'\ ;,,,01 '"dl" I I \tWill willi 'lour GhilC~ for tlHI 'lnwunl of t;I'( lIi1"ilhlfl In Ihp I1n'Jl<(tfl~
of WIII~ III Illlt l;lIlfll!'j lmllultllfl, 11111 p" Ihlll/I! I"I~III III Wtll,IlllJllJl oj!ll l,ftun ',n offlclal ilSSBssrlllnt (Form R(V-l~I'i6 EX) \lllon roculp\
01 tfl. I'IlhU'tl Iru"! 1I1111l"ul~llH "I wlll_.
TAX ~fIlJRU
PAR1
"
<,
TAX COMPUTATION
lIHl
I, [ntlll'
..orrl
tho (1111n UlIl 'IUll!Wi\ lIIl;lltl'lll~ 1/olS lI"I"IIII';IIII<II,1 IIIIIIl' in ttllll'lllllllor ulil~tlrlg ilt (I,lto of r1!Hltn,
fur II lhllallhllll flvllllJ ,dllu l"/I,'/~.'i Arl'fllll\\~ I-HIII,1I Ih" IhlHIl\llfIlllut In jOlnl names within an~ (I) vo.;tr of duth <lrlt
11l~f1hlll 11I11'l ,n \fllfl~ll"!;, IIml~lJllI, {JUIIIl I'. ,Ill IIHI\I~II"1 1101 t{\ 1I1<coml 5:\,000 por \f<tnsforo~ l'o!)<lrdlo5S of thll value of
Ih_ illil:lIll1lt II! Ibll !II/I'IIIII' II I ,llrOiHil ~ 1m I II,
1lllllU\lhlll '1!;lfI'\~I' j.Il' 'l'IIf\i\I~ lIululll v,nll 111',1 1\,IP\l1 In Uw ,1Itdfll!lS portion of this notlcD, \1111 $.\,000 ol(cluslon
IItrlt"ll~ Illn IIl1tHI [llIlhwlu;1 flU" \tIll ,jt1H\[I11 11'11'lIi<;" I'j lllpmtllll tl'i tho flnanel"l Instllution,
?. Enter thw 'utili hnlnllf'1I !Ii 11111 ,1111"11\1 InduIHI\l_1 11I11",""t ilccnJlld tll 1110 dflto of dUllth,
:\, lll. Ilol'fJlInt ul tlUt "n;rIIlUI Hltlt it; I ,,',llIhl fll' Ulltll ~llfvlvllr I. d.t.rmIIICHI liS follows:
", Th. II.rCllltlt Inl(llUll1 1111 )"llIt ;1~~III!; lI!;t,~IIIIIIIIM\1 nlIH" ttlllll tIn. YOllr prior to HlCt docodllnt's deathl
OIVIIlI () ''''' HHAl NlJl1l\I" III nlvllllll flV
mlH! OwNIIt',
r_lIfl1Jdlt: " Itdlil il~U1' IIllIl!;hlllll III \tu. I\llflIlt III
Will NlIl'iftl'R or l( 100 PERCENT ,",xABlE
',ll"VI...INO .JUINT OWNERS
tbll tlor.tulllflt IInd 1010 ot,her persons.
a. It\e 1'111 HilI I "I.,wllI III' '1~'itll~ 1.1110\11111 .,ttlllll 110M 'i1l;11 01 IhM lIQf.mlfHlt's rlAl\\ll or c'tcca~mt5 ownAd by 'he docod.nt hut held
In trlal fill 'lflUtlHIf 11\[1111111<11,1(11 111\l~1 IHl!ltlllLj'l! 1,,\1:
I 1I1YlliUl 11'1' _\' JOIN! OW"'I H'. 1 ()\~lUt 11 ftV " I 'aUlVI VOIf'lI . .Ihl
100
lb,n (!AXA8lE FOR ("ell SURVIVOR)
I UIYII1tI1IW lO!"l ItlJtillllf 01 ',IIItYI'IIN(l Iflllt!
OWNI ~S fill I IUJ'. 1 III Nil If IAIt \1 !i
X I Ill}
"H~ctNI tAX"IHI
r.lllllPll1l;ulfll ilUlI'H\1 I "wi "llIfflll III 11111 111I"'1t uf 11111 11c,(;Ilthlnt ,mil t~o oth.' IIArSon!; and estllbllshtd 'fllthln one V88r of dellth by
III. 11111.111111111,
\ lllVllltU 1\V " ('JlJIIVPIO~';i I ,1,11 lOI) 110% \ '''XUt!. rOil tActl SURVIVORl
Cj, The filllOI)nt 'illlhtl-t In 11\" (Il.l.. ,.1 I~ lllllftll'lltlflfl h'i 1IIlIItl"I'I11I1I IlllI Ilceounl hiil<1flC9 (11n9 II by the percent \axable (11n9 :\).
Ij, Enhr \t1. tutAI 0111111 i1nIJl';lll.llllIlhH.lillll'l llblll,j ili P"II ~,
D, I". ","ou.11 '1'1'_111"" (11ml t,l III IIMIlIlt'llfIlIlIIlV ~\llltl'I(,llll'l Itllt tltlllt, And tlA(luC110n~ \llnl!l~' Irom 1t18 A!IIOunt sllbJect 10 t8li (llnu 4),
7. Ent.r \11_ IlllllrUIHlllt. 11Ii< Illto 1111111 'I iJ~ ",,\III-I'1IIIIIIII1t1II1W.
&" rur dlltll~ pI Ihlitlllllll;lUllllll ,III,1t III\U/"", Ihll I;," IlltUIi Int Illlf1511lr'l to 511auses are f1S fo1100lS1
l. illite. III IhHl\h on!ll /lfllMl !l1/'1l1 '11111 ltlilllrl' 111/11'1 111ft r'lllI l~ \%,
'I, 11IIht III Illlltttl un III ,II Itu 1111'1'1 I I '111~ ftl! ~ In ~"mIUli w! II 1111 In~tHI (It 0% tllli fAte,
Not.l lur lI"h.. HI 'II/ftth 1'1 111I 141 fll/'h, II "n" hit \ III '1,'HIt~lt~ nt. tll~lIhlu III 6%,
a. II/lnl""<4 10 ll!llllll dll!;Ulflll.;HI, lruhlllllllj lalIHH, IIlIlU\Ill; rolll\, tlmlQhtitr, 'iH'iU!llchlldron, sOf).ln"l/tw,
1I~\llIht.r- III ltl~, lilll'll;1\1111 /11111 Ihlll' 1';~1I11 Mil li\"_,,1111I 'It ~I", f1AI'Cflnt 11>%1,
C, 11'''111/11'\ III ,Ill IIUI.I!; 1m 1111111111 1IIIIIIuI! , "Iijlttl, lHI"\II. ;Hilit. l\Illlh.lo4 IIml (lllteo M. I".able at flfhen perclInt (is%),
D. II VIlII/,Il/1111I1I 11\.. \Il~ [,,111; plllll~1I !;IIIIIII'I 'IIlHl ,..lltliHlIfltllfl III HIO llvcRdent In thllllr9<11110vidlld,
e, flit t1l11Qunt uf III" lit/ill 1 II nil IH lot 11111.r/llllllld ll'i mlllllolylntJ 11111 11ft\(IlHlI 111>lllt)11t (\11111 61 IIv thll till( rate tlln. 7),
ClAIMfO OfOUCIIOU5
PARI
5
DEBTS ANO DEDUCTIONS CLAIMED
AI 1111,11\11111 ll.ltt, tllulllllfhwlluo\ '1IIIIIItlolll\lll.tI ,U IlIllnw<t1
A, '1nll IIIVAII't Fl'. tll'llIlmlhlll !1I1 IlllY"'ItIl' , /It- thtllt,lllh ljl/hJJtGt 10 ilttmlnistrlltlor\ bv a personlll repr.a8nt8tlve II Insuf'ielent
tli IIII~ Ih" Ijlt,lw Illll. I 'l"H',
I, 'f'lIli f1tllll\ll'lI';fllt 1111I !hlhl~ ",till 1111'1111 of illflll.elldent ItlH1 r.iln hlrnlst1 proof of pllv",.nt,
f. Ihllrl_ 11.lolt 1l1!it>lIlj 1lI1!;1 hit ,'utlli"tlll ''lily III II/Irt .\, If Ilddllllln/tl SpilGlI I~ f'llodlld, USll pl<lln Illlpl!lr " I/Z" I( 11", Proof of
IHI'I'fIIMllt "111'1' 11>1 11I'llllIlil"ll hy IlIiI II" 1I1t1"" tl'l.111 nf Rllvt111\1/1.
c:-----
TAXPAYER ASSISTANCE
II YOU NEED rURTliER ItlFORMATlON OR ASSISTANCE. CONTACT AUY
RrOlS1ER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE
IIR CAl.l, IItl' BUREAU OF IUDIVIDUAl TAXES. TAXPAYER INQUIRY UNIT Itl
._,~IAR~.!.:~"~~n!~_~) 787-8327, TDDI 1711l 772-2252 (HEARING IMPAIRED OULY)
J,
I '
> /\
c...
MV1IOOf.'II"1 ~~l
Q,,~~)) COMMON\~IIY1VAIII;
, {}fJl"'H'~f;jl llfIII VfHll1
III 1'1 11100(\\
(I [' ('A I
f)t'(:ff)flj f1 '"IIAn fljlilll(jIjiIIJliliIlIAIII,"I'Id"~,,"~lwl\ll~.""(Jld'
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FIl.EHIIMIlER
2 1 <I 7
o 0
A I
5
C rt vr
ffi
~
~
n H I': I': N
l,O(I,4J ~ (lllfirt~ii.itU1r .
II I,: I, I': N M
-- --- --~~-"~""'--"fWf'llt tlI'AU('---
OAlfOf 61RHt
1 (j II -, 4 - 'I 0 II () 'J I ~ 4 11 'J ') 7
-iir,i.jlftli;AAi'(lmi\vivii~Yfl[\i~n j-lmnr,l;t;'rtligl~AJjn'r.i,l1rll f itflllAlI ~()CI.AlllEG\iRll '( NuMIlUI
05/24/190 8
L:HIS RETURN MUST BE fiLED IN DuPLICATE WOH THe
REGISTER OF WILLS
~~-~~.-- ,..~-----~--_.-
Ix1 1 onllill.1 H.h'fJI I, 11 RlIppl",,,,nlal R61ufJI [J 3 R.mal.der Relurn I......"".... '1,'U21
LI4 1I111i1.d"''''III [J 40 flllu,o Intllreol Comp,oOlI.. I'''.'''''''''' (2,(2"1 05Fed.ralist.18TaxR"llmRequl,.d
r-)lJ (I(I(Alilllf11 (Jiml Tllltfttil (M.th{(~lloIWIlj) I:-.J ,. Decodent Maintained a living Trust {Ab::IICopyoftMIl _ 8. TOlal Number 01 $ale DeposilBo1l8S
I] 1/ trti;j"""I'"",tIJ,j,nllCtiI"'" [J 11/ SpolI,"1 Pov.rty Crodll I'''''''''' ""'.., 11,".91 """'''1 [] 11. E~lon 10 lax UI/d., See 911)(A) 1_""01
.THiill[icfll)ln.li1iiTiiiicOM~LI!Ti1ifAiICOfiRE8PONDI!NCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
-~AAti----' ----. --~---~-~~-~ COI-.lPllr["-!,l,)!.INOAlJOflf:SS
nlllly d. \~ll\cI('J', 1':11'1. 701 F~lst K.i.n'.1 Street
"fil1i,rljij.-li""".~I'---~"--' ~-, -----.-,-----~._-'_. Sh.i.prxmsburg 1'>7\ 17257
II!
Ittt:fIi i--,".lMiiff'-~.--~~<"'----_.~___._r
'1H ~,17. - ')47(,
1 r~..1 hlS16 (f:oh'''"1Jt AI (II 0
1 liIockA 61111111111'" (Se".dlllJt III (1) 0
3. Cloaely H.~ COf""'ollon,PArtn.~hl,, or Sola,Proprlotol1hlp 13) 0
4 MIII1u/l\)e. & NIII.. RIl<OIV6blJt (Rchedule D) (4) 0
6. Ce.h, lid 06po'" & M,,,,,,I8O.oll' 1'.1101181 P,oporty 151
~ 1!l<I'odIlIeE) I 2 1 2 , 9 3 2 1 1
6. JOln"y 0;,110<1 P,o(lOrly (llc".dllla f) (6) 1 , 0 1 6 6 9
/ IlIte"VI,", 'ron,I'ffi & M"",II'"'OIl' NOII,PfOb,l. P,operty 17)
~ ISch.dllla G or l)
8 TolIl 0,... "",I.ltolSl 1.1".. 1-7) (8) ,2 1 3 . 9 4 8. . 8 0
,
1/ FII"",al e'po"18' & Admlnl.I'aU,. CoslS (ScI1.dll~ H) 19) 2 7, 7 9 4 4 0
~ 10 DeblS 01 Oeoodnol, MorIg.g.lIobllllios, & lloo. ISchodulo I) 110) 9 9 8 7 3
11. TOIaIDtducllon'llolalllll..9& 10) (II) 2 8 ,7 9 3 I 3
12 Net Valua 01 E.llt. (1I11. 6 mlnll' Line 1 I) (12) ,I 8 5 , I 5 5 6 7
13 Charllable .nd Oo,,,nmen"" lI.qll.'ISIS.c 9\1) T."ts 10' whlch.n .leo1IoR 10 la' has nol beon (13) ,I 8 3 I I 0 5 6 7
mado(ilcI>eduIeJ)
14, Net Valua Subjaelt. Tax (lIn.'2 minus lIn. 13) (14) 2, 0 5 0 0 0
15, Amounl 011111II 141Jt"ble
~ alth. 'pollsal tax "Ie I , X ,0 (15)
SOO ,n.jructlollS 0111".... .~.Io' oppllcabla pe'OORlJtg.
16. AmoulIl 011In.,4 ",..UIo
~I .16% 'al. 2 '0 5 o . 0 0 x .06 (16) , I 2 3' 0 0
17 Amount 011111. 14 ~..blo
0115%1816 x 15 (17)
18 Tu DUI (18)
19.
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Uflli,,_nllllMl, of pltfluri, I doclllfllIhllI hlYlllUlIInl!1IId thl6lutum, IM!udilll'J lIC(omlliO~lng ,chedul6s aod 'talements. and 10 U)tI oosl!)l my KI\OW!&:!Qo and ballel,l! i~ ln~, CO(ft'C1 and ~mOllllo Declil/allOfl 01 pl'ePdlor olfltll
IIMl - !Ji.,.UOUlM1 11M kl\O'llladae
SIGN I ~ - ADDRESS
A~SS .
/N 1::://(' !:'1 S I-
>ll"'j\61f! I',J}l ~.~.f~__
DATE
~.f(i;Y
DATE
I ;~(ll%'
.-......-- ..,-...--.--<.-.-.
Decedent'. ~omplete Address:
~._.
CITY ~:~~~:n T ~n~ r.rPAn
Ri,1q~ Vi11"QA
~/I
~
7241
Tax Payments and Credits:
1. Tax Due (Page 1 line 16)
2, Credlts/PaymeRts
A, Spousal Poverty Credit
B, Prtor Payments
C, Discount
(1)
Total Cre!llls (A + B + C) (2)
3, InteresVPenalty If applicable
D, Interest
E, PSRalty
TotallRteresVPenally (D + E) (3)
If liRe 21s greater than line 1 + liRe 3, 6Rterthe difference, This Is th6 OVERPAYMENT,
Check box on Plgll Line Ie to requlltl refund (4)
5, If line 1 + line 31s gl6aterthaR liRe 2, enter th6 differ6nce, This Is the TAX DUE. (5)
A. Enter the Interest Ofl the tax due, (5A)
B, Enter the total of Line 5 + 5A, This Is the BALANCE DUE. (5B)
Make Check Parable to: REG/~TER OF WILLS, AGENT .
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
I, Old decedent make a transfar and: Yes
a, retain the uee or Income of the properly transferred; ,,,,,,,"..",,, ",.... ,....,....,...." " ,,'.. "",,,,...... 0
b, retain the right to designate who ehall use the properly transferred pr Its Income; "'",........" 0
c, retain a reversionary Interest; or......,......",,,,,,....,,,,,....,..,..,,................,..,,..,,,,,,....,,,,,,,..,....,,.. 0
d, receive the promise for life of either payments, benefits or care? ....,..,......,,,,, " ",.., ,,'" "..,,, " 0
2, II death occurred on or before December 12, 1982, did decedent within two years
preceding death lransfer properly without receiving adequate consideration? If death occurred
aller December 12,1982, did decedent transfer properly wlthlR one yaar of death without
receiving adequate consideration? .."" ..,.. ",..,.., ,.."", ".." '''''' "" ",..'"",,,,...,,,.... "'" """""" "'" "" 0
3, Old decedent OWR an 'In trust for" or payabla upon death bank account or security
at his or her death? """......,..",,,,....',,,,..,..',,,,,,,,,..',,,,,,,....,......,..,,,,,,,,,,,,,,,..""",,,,,,,,,,,,,,,,,..,,....,0
4, Old decedent OWR an Individual retirement account, annuity, or other non.probate properly?".. 0
4,
-.
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
123.00 ","
123.00
;,
No
e9
[]
[]
[]
fXJ
~
.~ i'" ':'1),.'[ ,_" ," f, r':,.,J,I','Yi. t:..... ,l\!ld"'!\~'~ l' ~\ \",\\<,"'1 ] fj~,. '.: '1-1 ". ~.1' '"J " .
72 P,S, ~9116 (a) (1,1) (I) provided for the reductloR of the tax rate Imposed on the net velue of transfers to or for the use of tha
surviving spousa from 6% to 3% for datas of death on or aller July 1, 1994 end before Januery 1, 1995,
72 P,S, ~9116 (a) (1,1) (II) provided for the reduction of the rate Imposed on the net valua of transfers to or for the use of the eurvlvlng
spouee from 3% to 0% for dates of death on or allar January 1, 1995, The statute doas not exemot a tTansfer to a aurvlvlng spouse
from tax, and the statutory requirements for disclosure of assets and filing a tax return are stili applicable even If the surviving spouse
Is the only beneficiary,
FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995. Please answer the following question by placing an 'x' In the
appropriate space,
Old the decedent creat.. a truat or similar arrangement which Is lolely for the lurvlvlng Ipouse's benefit for hll or hor entire
lifetime? Yes 0 No !ill
II you answered yes to the above question, the tax on the trust or similar arrangement Is p06tponed unlllthe death of the second
spouse, at which time It will be fully taxable at the rate(s) applicable to the remainder beneficlary(ies), Enter the value of the trust on
Schedule J, Parlll, In order to remove It from the celculatlon of the tax due In this estate, You may wish to file Schedule 0 In order to
make the elecllon available under Section 9113, lithe elecllon Is made, the trust or similar arrangement Is taxed In the estate of the
first decadent spouse, the portion of the trust or similar arrangement which benefits the sUlVlvlng spouse Is laxed at the zero tax rate,
and the ramalndar Is taxed at tha rate(s) applicable to tha remainder bellaficlary(les), If you choose to make the election, you must
attach Schedule 0 to a tlmely.filed tax raturn, along with Schedule(s) K aRd/or M In order to show the apportionment of the trust or
similar arrangement belweeR the surviving spouse and the remainder beneficlary(ies),
DECEDENT CONFIRMA TION
NAME OF DECEDENT:
IIELEN M. GREEN
SOCIAL SECUR11Y NUMBER: 198 - 34 - 7081
DATE OF DEA T8 (000):
September Z4, 1997
Account No. 30010398 30010399 40010400
Type: l"l:u.t1 fil"Atil cer ti fica te certificate
Dlte Opened
or IlIued: 12/12/96 12/12/96 12/12/96
Dlte Closed
or Mltured:
Dlte of Deltb
Blllnce: 10,000.00 10,000.00 5.000.00
PLUS
Dlte or Deltb
. Accrued Interest: 143.44 143.44 72.44
Joint Ownen
(Ihny) Orville G. Green Drvi 11e G. Green Orville G. Green
Dlte Or Joint
Ownenhlp 112/12/96 12/12/96 12/12/96
Sped.1 Comments: All accounts were in the name of Orvi 11e G. Green or Helen M. Green
Dlte Preplred:
10/8/97
Prepared By: Carolyn H. KOllllh
Inltltullon Nlme: The Farmers National Bank of Newvii1e
Address: P. O. Box 156, Newville, PA 17241
-
PboneNumber: 717-776-5312
if\
Oecedent Confi nnation
Name
Social Security No
Date of Death
- lIelcn M. Green
- 19H-34-701l1
- (/9/24/97
Description Accou n t Account Account
Account No. 7H02243505
ACC<lIlnt Type Certificllte of
Deposit
Date Opened or Issued 01/04/93
Date Closed or Matured 01/04/01
Date of Death 8alance $20,000.00
PLUS PLUS PLUS PLUS
Date of Death Accrued Int. $224.66
Joint Owners (if any) Orville C. Green
Date of Joint Ownership 01/04/93
Special Comments: N/A
Illite Prepared: October 15,1997
Prepared by: Amy L. Halvol'
(Ro.8/26/91)
Page: 2
DECEDENT CONFlRMA TION
NAMI: OP DICIDINT:
BILEN M. GREEN
lIOCIAL 81CtJ1UTY NUMBER: 191. M. '7011
DATI OP DEATH (BOD):
Sept...ber U. 1997
AaH.' No. 001-0048017 001-0048019 001-0048034
'I'Jpe: CD CIl CD
BIte Op.....
or lII.elI: 12-01-92 12-09-92 01-14-93
Dale alii.
or Mlt"": N/A N/A N/A
BIte ., Del..
I.~~: 2 ,000.00 11,000.00 5,502.95
PLUS
BIte .,....
AccnIed Ia.....: 33.37 170.88 57.78
"'t o.-n
(II..,) Joson Holtry
BIt. .,......
0.......... 12-01-92
5..... C.....ta:
Diu Pnpand: 10-10-97
Prepared By: Wendy Bullock
........... N...: Orrs town Bank
AuId~: POBox 250 Shippensburg PA 17257
..... N..ber: 532-6114
DECEDENT -t:ONFlRMA TION
NAMI OP DECl:D&.NT;
BELEN M. GREEN
SOCIAL llCUlUTY NUMBEIll 191.34. '011
DATI: OP DEATH (BOD):
Sep....ber 14, I'"
A..... No. 001-0048210 001-0048240 001-0048242
TJpe: CD CD CD
-
DMe 0pMed
. ...ed: 04-15-93 07-06-93 07-09-93
...0111.
IN' ab.......: N/A N/A N/A
Dale ., 0...
'A~~ 6.000.00 7. 100.00 19.000.00
'LUS
Date 01 0...
Alca.... .........: _133.97 82.72 213.16
.
".... 0..__
(II..,)
Dale "'......
o.r..nwp
... C__ta:
o.te Prepand: 10-10-97
Prepared By: Wendy Bullock
........... N..: Orrstown Bank
Add....: POBox 250 Shippensburg PA 17257
.....N..bIn 532-6114
DECEDENT CONFlRMA TION
N.uo: or DECl:DINT:
HELEN M. GREIN
IOCIAL S&CUIUTY HUMBIIll 191- J4 . 7081
DATI: 0' DEATH (BOD):
Sep"Mber :U.1997
AccH.. No. 001-0048801 001-0048803 001-0048804
1)pe:, cn CD cn
Date Op.....
... ......: 10-02-93 10-14-93 10-25-93
... ~...d
... Ma'.red: N/A N/A N/A
Date .,.,...
.....~l 11.500.00 13.889.73 12.501.78
PLUS
Date 01.,...
04<<1.... ........: 277.26 312 . 04 106.18
..... 0I.r_.
(.....,)
BIde ., ......
Ow~.....
Sprrlll C__ta:
Date............: 10-10-97
'...p....d BYl Wendy Bullock
Orrstown Bank
POBox Shippensburg PA 17257
..... N_bIn
532-6114
DECEDENT CONF1RMA TION
NAMI 01' DEC'IDINTI
BELEN M. GREEN
IOCIAL RCUIUTY NUMBIIll 191- 34 - '701l
DAno. DUTH (900):
Sept..ber 14. 199'7
A.... No. 001-004880~ 001-00488/11 001-0050401
'l'Jpe1 CD CD CD
...0,.....
... .....1 10-23-93 01-09-94 10-11-94
Data tI.ud
II'Mat....: II/A II/A II/A
BIte "......
'.......,1 10.440.00 10.000.00 13.000.00
PLUS
... of Deatll
Accn........1 221.67 106.85 297.40
.....t Ch. .n
(1"111)
Date ".....t
0......,
8",,,,, ('......:
Dat.l'npand: 10-10-97
Prepllnd By: Wendy Bullock
........ N...I
OrrRtown Bank
Add..: POBox 250 Shippensburg PA 17257
..... N..ber:
532-611/1
DECEDENT CONFIRMATION
NAMI or DK'l:DINT:
HELEN M. GUEN
IIOCIAL 8ICU1UTY NVMBERJ 191- 34 . 7011
DAD or DIATH (DOD):
Sep.ember 24. 1997
AaH.t No. 001-0052599 001-0052600
'I)pe: CD CD
0... Op..'"
... ".Id: 12-0B-96 12-0B-95
0...0....
or M.......I N/A N/A
DIee ., Del..
I"~"",~ 4.000.00 B.OOO.OO
PLVS
DIet 010...
MQ_Jd ......: 59.73 136.1B
Jeblt 0wIMn
(11",)
DI.. " .....t
Ow..utp
&perlll Co......:
.hl'replred:
10-10-97
Prepared By: Wendy Bullock
........... N..e: Orrstown Bank
Add.-: POBox 250 Shippensburg PA 17257
.....N..ben 532-6114
RIV.IIOUI+ 17.131
UiA..;'!:~~~~"J~~~~~~~~~~t ';~PE: ".Ii'" o~_"""..~"~~"~
Helen M. GREEN __~~_:.9.1.._:-Qg1~__.~_-,_._-
______.~~..__~___,~~~.~.._________..,____.__c__.,_.._.__
J.lnt t...nt(.\.
.~------...~
___~--\ ~'~===::':::=_~~~~_isrn.
. 13 515 Cumberland Highway
Orrstown P A 17244
"". w___ ..,...______.__u_,._~_~.._._.~_,_._.__
,.._~,t~ltQ~.,.!!IU~tDICIDIML_.
NAMI
-~--~--_.
A.
Joann V. Holtry
Step-Orand
daughter
..
C.
...;-....-- --
J.lntly..w..." ........IIy. '
!TIM LmlR DATI
Jsr~T DISCRIPTION Of PROflRTV TOTAL VALUI DICD'S DOLLAR V ALUI Of
NUM.I MADI Of Asm % INT. DlelDINT'S INTlRIST
TENANT JOINT
l. A 12/01/92 Orrstown Bank, CD plus interest $ 2,033,37 50% $ 1,016,68
~
TOTAL lAI.o o",.r on IIn. 0, Rocopltulallon)
(1/ more .poc. I. n.oel.elln..rt oelelltlonol .hoof. 0' .omo .1..,
$
1,016.68
/5.:,j(j {;. /0
COMMONWlALTH OF PENNSYLVANIA
DlPARTMENT OF REVENUE
c....
*'
BUREAU OF INDIVIDUAL TAMES
INHERITANCE lA~ OIVISION
UEPT. Z80601 ,
t1ARRISIIURO, 114 11121-060l
NOTICE OF INHERITANCE TAM
APPRAISEMENT. ALLOWANCE OR DISALLOWANCF.
Of DEDUCTIONS AND ASSESSHENT OF TAM
H~'lhl {Ian In.'',
SALLV J WINDER
701 EKING ST
SHIPPENSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMIER
COUNTY
ACN
04"27-98
GREEN
09-24-97
21 97-0815
CUMBERLAND
101
HELEN
M
E=-'-A~oun~ ~o...~ttod_" J
MAKE CHECK PAYAILE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV: iS4?" E if -Ai: j'-. ('Oij': m- -NOT i ci""ciF - i"NHIR"if ANC i-T Ai - 'A-P'PRA"i S liii'ilr;- A L. "LciWAiic i - oli - - -- -- - _.. - _.. - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
HElEN M FILE NO. 21 97-0815 ACN 101
PA 17257
ESTATE OF GREEN
DAT! 04-27-98
TAX RETURN WAS, 1 X I ACCEPTED AS FILED
I CHANGED
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
--
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
l. Rool E.toto ISchodulc Al III .00 NOTE I To in.ur. proper
2. Stooks and Bondi ISchedull 81 121 .00 c,..dit to your aooount,
3. Cloa.ly Hald stock/Partnership Int.,...t I Schfldull C) 131 .00 subnit thl upp.r portion
4. "ortvag../Notl' R.~.iY.bl. (Sen.dull OJ 141 ,00 of this to,... wi tn your
S, C.~h/8.nk Dopollta/Hllc^ Parlanll Property ISchedul. E I 151 212,932.11 tax paYlllant.
6. Jointl~ Ownad Propart~ <<Sch.dule F) 161 1.016.69
7. Tt'.naf.r. C Sch.dula G) 17l ,00
I, Total A.s.ts 161 213.948.80
APPROVED DEDUCTIONS AND EXEMPTIONS I
9. Funaral Expen.es/Adm. Co.t./MiIC, E~pen.e. (Schedule HJ
10. Debts/Hortga"e l.iabili ti.,/lieh. (Schedule I)
11. Total Deduct ion.
12. Nat Value of Tax Raturn
15. Charitabl./Governmental eequ..tIJ Nonn.l.ctad 9113 Trust. (Schedul. J)
14. Hat Valu. of Estat. Subject to Tlue
Iql
110 I
27,794.40
998,73
III I
1121
IUI
1141
'A.1Q3. 1~
185,155.67
183.105.67
2,050.00
NOTE I
If .n ......m.nt w.. i..u.d pr.viously, lin.s 14. lS .nd/or 16, 17 .nd 18 will
rsfl.ct figur.. th.t includ. the tot.l of ~ r.turn. .......d to d.t..
ASSESSMENT OF TAXI
IS. AMount of Lin. 14 .t Spou..l rat.
16. AMount of Lina Ht tax.bl. at Lina.l/Cla.. A r.ta (16)
11. AMount of Lina 14 taxable .t Collat.ral/Cla.. 8 rat. (17)
18. Prinoipal Tax Dua
US)
.OOM'OO=
2,050.00 M .06=
. 00 M' 15=
IlII
,00
123.00
.00
123.00
TAX CREDITS I
PAY"ENT
DATE
01-29-98
RECEIPT
NUHBER
AA242698
DISCOUNT 1+1
INTEREST/PEN PAID I-I
~ .00
AMOUNT PAID
123.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
123.00
.00
.00
.00
. IF PAID AFTER PATE INDICATED, SEE REVERSE
fOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN tl, NO PAY"ENT IS REQUIRED.
If TOTAL DUE IS REFLECTED AS A "CREOn" ICRI. YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.'
Illi$ERYATlO!"
_EOF
NOTICE.
PAV"':"-' I
REFUND (eR) I
OIJfCTtOHSI
'OftI"
lSTRATIVE
CORRECTIONS I
DISCOUNT'
PENAL TY I
INTEREST I
p~
::1 ~,
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(,
~
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~J( " (0 b
htltuo, d.cld,,,t. dying on or blfor. OlcIllber 12. 191Z .. U any future Inter..t In t~'>"~ftt. IHran.f.rred....'
In PO.....lon or .njoy,.nt to CI... 8 (0011,t,r,ll bln,floA.rl,. of thl dlatdent .ft.r the IxplratlJKVof any ..t.t. for
11ft or for ""'" the COllltllonw..Uh h.r.bll ."pr'nty r...rv.. the right to appraise 'nd ...... tranl'.r 'Inh.rlhncI 'IIC..
at the llwful Cia.. . (ocll.t,r'll r.t. on Iny .uoh future inter..t.
To fulfill the r.qulr...nt. of S.otlon 2140 of t~ Inherltanc. and Est,t. raK Act, Act Zl of 1995, <12 P.5.
S.otion 9140),
D.tlch thl top portlon of thh "oUct and lubait with \four ply..nt to thl RIgIUlr of 14111. printed on thl r.vlr.. ,.ldl,
--Mall.. ohlelk or MonlY order Plyebl. tOI REOISTER OF MILLS. AOENT
A r.fund of II tII)( credit, wMch wu not r.qu..t" on the TI)( Rlturn, ..ey bl r.qu..t.d by ClollPl.t1ng an "ApplicaUon
for R.fund of P"nn.ylllanle Inh.rltllnae and Estllt. 'all" OiIEV.'1313), ApPlication, IIr. a\,lallabl. at the OffiCI
of the RIght.r of Wlltl, any of the 23 R.v.nu. Dhtrlct Offlcu, or by calling the IPlclel Z4.hour
an.w.rln. ..rvic. n~b.r. for fori' orderlngl In Plnn,ylv.nla l-aOO-36Z-cOSO, outllde Plnn.ylvlnlll and
within 10011 Hlrrllburg er.. (717) 111-1094, TDDI (1l7l 17l-llSZ (H..rlng r.plI1r.d Only).
Any plrty .In lnt.rl.t not .etl.fled with the appr.J....nt, 8110wano. or dilallowlno. of d.duction.. or a.....~lnt
of taK (Including dhcount or lnterllo al .hown on thh Hotlc. lIuSt obj.ct within shty (60) dlY' of recllpt of
this Hotlel' bYI
--written prot..t to the PA n.part..nt of R.v.nu.. Board of App.als, nept, 1110ZI. Harrhburg, PA 111Z8-1021, 0"
..'llIctlon to hay. th. ..atter detarMlned at audit of the lIcflount of the plr.onll rlpr,..ntltlYII, OR
--applll to thll Orph.n.' Court.
Flotuel Irroril dhc.ol.l.,.ed on thlt lU.u...nt Ihould be addrulld In wrItlrv.a to: PA Depart.ent of R.v.nu.,
lurleu of IndlyJduII Ta)(II, ATTNI Po.t hllss...nt R.vllw Unit, D.pt. ZI0601, Harrisburg, PA 171l'-OflOl
Phone (717) 7'7-6S0S, S,e page 5 of the book1.t "In.tructJonl for Illhlrltancl Te)( Rlturn for a RI.ldent
Dle'dent" (REV-1501) for an IKpllnatlon of adllnlltratlvllY corr.ctabl. Irror..
If any tax due il paid wi1hln thre. (1) callndar .onth. Ift.r the d.~.dlnt'l d.ath, . flYI p.rc.nt (5%) dl.count of
thl t.1( paid II l'lllow.d.
The a% hx I..nuty non-plrttCllpltJon penalty II coapuled on th. total of thl taK and lntlrllt u.....d, and not
Plld blfor. Janulry I'. t.96, thl fJr.t dbY .ftlr thl Ind of ~hl taK a.n..ty p.rlod, ThAI non.pertlclpatlon
p.nlity h apPlllable In the .... Illnner and In the thl .... ti..perIOd II YOU would applal the 1aK and In1.r..t
th.t hll been .......d .. Jndlc.t.d on thh notiCI.
!nt.,...1 h chargld blglnnlng with flr.t dly of delinquency. or nln. (91 lIonth. end one (1) dly frOll the dlte of
delth, to the d.tl of p.ya.nt, Te)(.. which bae... d.1 lnqu.nt b.for. January 1. 1911 b.ar Inter..t at tM rate of
,1M (6%) Plro.nt per ,nnua oelculat'd 111 I dalJy rat. of .000164. All tl)(" which blo..e delJn~nt on and .ftlr
Janu.ry 1, 1"2 will h.lr lnterllt It . rat. which wlll vlry froa calendlr Yllr to cII,nder Yler with thlt ret.
announoed by the PA Dlplrt..nt of R.....""'.. Thl IfIPlIclble Jnt.rllt rlt.. for 191Z through 199' IIr.1
'Wr Inter.,t Rat. D.lh Interut Factor !!!r Int.re.t Ret. O.ltv Interllt Fsotor
1912 U,% ,DODSltl 1917 9% .000Z47
191! 16:< .000438 1".-1991 11% .00OSOl
I"'" 11% ,00OSOl 199' 9% ,000247
I'U UX .00on6 1"3-1994 7% .000191
1916 lOX ,0001N 1995-19f11 9% .0001lt7
- ~ Intlr..t h c.leulat.d .. follow. I
INTEREST ft BALANCE OF TAX UNPAIO X NUNIER OF OAYS OELINQUENT X DAILY INTEREST FACTOR
.-Any Notlcel..ued aft'r the tlK b.eD.." d.1lnquent 101111 refl.et an Intlr..t ulculltJon 10 flftlen (IS) diY'
beyond the d.t. of the ........"., If pev"ent 11 lad. after thl interl.t flO.put.t1on d.t. Ihown on the
Nottel. addltion.1 Interllt MI.t b. <lllaut.tld,
6.
Farmers National Bank of Newville, Certif1cate ofDeposit 40010400,
in decedent's name, face value $5,00000 plus interest accumulated
to date of death ., '"."", .,"""..,'.,
$ 5,072,44
7,
Dauphin Deposit Bank and Tnlst Company, Certif1cate of Deposit No,
7802243505, in decedent's name, face value $20,00000 plus interest
accumulated to date of death , , , , , , , . . ,
$ 20,224.66
8, Orrstown Bank, checking acct, 000-303445, in decedent's name
plus interest to date of death . , " $ 2,632,20
9, Orrstown Bank, savings acct, 000-003034, in decedent's name
plus interest to date ofdealh, "'" """ "'" $ 7,792,09
10. Orrstown Bank, Certificate of Deposit No, 001-0048019, in
decedent's name, face value $11,000,00 plus interest accumulated to
date of death , , . , , , , , , , , , . , , , , , ' , , .. $ 11,170,88
II. Orrstown Bank, Certificate of Deposit No. 001-0048034, in
decedent's name, face value $5,502,95 plus interest accumulated to
date of death , , , , . , , " """'" $ 5,560,73
12, Orrstown Bank, Certificate of Deposit No. 001.0048210, in
decedent's name, face value $6,000,00 plus interest accumulated to
date of death , , . . , . , . , , . , , , , , , , , . $ 6,133.97
13. Orrstown Bank, Certificate of Deposit No, 00].0048240, in
decedent's name, face value $7, ]00,00 plus interest accumulated to
dateofdeath. , , , , , , , , , , , , , $ 7,182,72
14, Orrstown Bank, Certificate of Deposit No, 001-0048242, in
decedent's name, face value $19,000,00 plus interest accumulated to
dateofdeath. , , ., """,.".".".""" $19,2]3,16
. IS, Orrstown Bank, Certificate of Deposit No. 001-0048801, in
decedent's name, face value $1 ],500.00 plus interest accumulated to
date of death , , , . , . , , , , , , , , , , " "'" $ 11,777,26
16, Orrstown Bank, Certificate of Deposit No, 001.0048803, in
decedent's name, face value $13,889,73 plus inteiest accumulated to
date of death , , , , , . , , . . , , , . , , , , , , , , , , $ 14,201.17
17, Orrstown Bank, Certificate of Deposit No, 00]-0048804, in
decedent's name, face value $] 2, 50 1,78 plus interest accumulated to
dateofdeath."" "" '" """"""" $12,607,96
l'q,l