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HomeMy WebLinkAbout97-00871 \ \ ] 1 \ ] I \ \ 'i I \ I I I \ ! , I I , ! COHHONNI'/llll Of IICNNlIlVANU IIM'/HIHI'N! Of HBVENUC I\IHI:/U Of INDIVIDUAL lIMCI OCIII, U0601 II/M~IUIIHO, 1'/ 11111"060\ /,~- _,:J../{I - Ie/{ ~ tNFORMAT~N NOTtO! ~ TAxPAvaQ RssPoNse m.lul U lff II.W PlI.1 NO. 21 "7" )'1/ AON 97143488 DATI 10-13-97 Tvpa OF ACCOUNT E8T, OP PEAR~E C TOTTY ~ IAVINOI 8,8, NO, 116-10-,87~0 CIIICKINO DATE OP DEATH 08-28-97 TRuaT COUNTY CUMBERLAND ' ,cum, RIHIT PAYHINT AND FORHI TOI REGISTER OF WILLS CUMBERtAND CD CDURT HOUSE CAR~IS Il, PA 11013 Ij',1, \ 0 q." \ , 1\':',\1' \ , , ' l's\ REITl! ,C A5PLEBV, 81 CRESC NT DR sH PPENSB RG PA 17287 DAUPHIN DIPDI1T aK I TR co h.. Movlooli Iho oo.orl.onl wllh Ih. Inf.,..lIon 1I0101i b.lo. .hloh h.. b..n Ulld In ..I.ulotlnllh. 1101.ntl.1 10. duo, Ihll, ,...rdo Inol,.I. Ih.1 .1 Iho d..,h 0' Ih',.I'ov. ....oonl, V.V lorO · jOlnl ,o.n.r/bonollol"1 01 1111. ...""t. I' vou f.OI Ihlo 1"lu,."lIo" I. 11100""01, pl.... uo"l" wrltll" o'ltr.oll.n (, u. ,h. fl,,,,,o',,1 In.lllu\I,", .\tooll 0 ..PV 10 Ihl. 10" ond rolurn 1\ 10 1110 .bOVO ood,.", 11110 ...ounl I. 1I..blo In ....'..n.. wltll Iho Inh"ll.n.. 'OM ,0.0 of 1110 n...on...II11 01 uonn.1Iv.nl., Quo.llon. .o~ bo on..o,.d bV o.lllnl 17171 717-1127, OOMPLaTe PART 1 alLOW. . . 81~ RavaRI181DI POR PILING AND PAVMINT IN8TRUOTION8 AOODunt Nu, 102661lS0 Doh 10-22-92 aohbllol1.d 10 lnlur. proper or.dl' to vaur IODount, two (U .OQp\",of thh notlel .u,t IICCla.plnv 'iour pl)illllnt\q. thl RIghtlrof \fUl,,',- Hlkl ohlck Plv1Ull/\al "Ruhtlr of "IUI, Aatnt", Auoount ..lon.. P.roont T.".1l1. 4Mount lullj.ot to T.M T.. Rat. Potontl.l T.M Du. . W HOTEl l,tlM plv..nt. .~. ..d, wlth'n thr" (I) .onthl of thl dlc.dlnt', dl'l of d.,th, Vo~ '.V deduot . ale dhoount of thi tlM dUI, Anvlnhnltanol t.K dYI ..lUblao.' dll1nqUlnt "Inl (9) .enth. .ftir thl dati of death, M /, 0 the aheW, '"for.aUan and tlM dUI hoorrlot. '1. YOln."V ohao.. to r'lIIlt fllVIlI.nt to thl Rlgl,tlr of HUll with two copl" of thlt noUol to obtain . dllcount ar Ivoid Inttrll\, or vou .IV ohlClk boM "~" and return 'hie I'!OtlCI to thl R"httr of W111' .nd an offl01al i.......nt will bt "'\.lld bV thl PA hlpartit"t of -R,vlnue. a, 0 Tho.bO,. ....,1 II.. bo.n, 0' .111 bl '1."lod .nd I.. p.ld wllh Ih. Ponn.~IVlnl. Inh"llln.o TI. ,.tu,n to bl ftlld bV thl dlc'd,n'" rtpr,.,ntalIY', . O. .zl Tho .b.Vo Inlor..II.n IU..o"o.1 .nd/.kllobl' .nd doduollon. ,,"I po'd bV ..U, You llIyt' ao,phtl PART W andlor PART L!J blhnf, P~T If ~ou Ind o. ~. I ,r.n ." r. ., Pl..... 0 · ,~our l.=J rOlotlun,l1lp to d.o.dont I AJ/}(,/ t.:j"" TAll RITURI1 oourUTATlON Dr 'rAX 011. JI)XI1TITRUIl'\' AOOOU'lTII LINB 1, Oot. Botobll.l1.d 1 a, Aooount 8a1ono. 2.5 ';1"1 ~ S, p.r..nt T...1l1. S ~ ~ ff. ~: ~::~~to~~b~::~o:~o~:. ~..~ ~~~~~ ., AMuunt T.MOlll. ,-,,' , () " T.M R.to 1 w .~ a, TOM bu. a ~ RJiT8 AND DIDUOTXON8 O~A,MaD [, C~~iK ] BLOCK ONLY ': " >'1"'" <, I ' I" , , ' '" I "I"'" 'I" \,"1"" I'," i 11\""", :', i 'i i;:!::"~'.i.:.'..'CH. i~I!(;,~:~i':r :':;,\':";:,:::","::,', , : : : : ! U : ~ . i ; :; : ' i ':::I:U::":,' 'I: PART l!l DAT 'DESCRIPTl N AMOUNT ,PAID / I, 1 o IIn or on In' 0 .M u~pu. on Und.r p'n.ltlo. of porjur~. I d.u10r. tl1.t tho f.ut. 1 h.v. r.uurt'd .bov. .r. tru', oorr.ot .n~ oo.pl.t. to tl1. 1l.lt of .~, kno\llodg. .nd b.lI,f, HOME ( 7 ''I) ..,?>' :. 7! _ '.. ';1. '[' ?, lj:.~ ~ 0..<.11 ~yctl"\ WORK ~ __+--_..---Ti>\il h 1 ~~ SIGNAhRE ," TELEPH~NE NUMBER DATE GENERAL INFORMATION 1, fAELUU TO R"'OHO If ELL "'ULT EN At! OffECEAL TAM AII.IIHINT .llh .ppllo.bl. Inl.rul blO.d on Inlor..\lon 'Ub.III,d bV 1111 f1nonol.lln,\llull.n; I, InIlorll.n.. ... ~lIl'" d.llnqu.nl nln. oonlh. .flor Ih. d".d.nl'. d.l. 01 ...Ih. 11 A Jolnt.ooount I. "Ktl:Jh tVln though'thl dlold,nt'. nl" WI' Iddtd II " ...tt.r (If Gony,nltnOlI \, Aoo,unl, i1noludln, tho" h.ld b.I...n 'h,,'b.nd .nd ~If.l ~hl.h Ih' d...d.nl pul In JoInt n.... .lIhln on. ~.., prior 10 d..lh ,r, fUlh ""bl... Iron,fIr.. I, A..oun" ....blllnld Jolnll~ bli...n hu.b.nd .nd ~lfo".orl I,,"n on. vOIr prior 10 d..\h lro nol I.~.bl', " AGoo,,"t. held b~ . dlo.dlnt ''In tru,t'or" I"oth.r or athlr. '1" tlM.blt fullV, REPORTING INSTRUCT~ONS . PART 1 . TAXPAVER RESPONSE I, ILOOK A. If ,Ih.lnlorll\l.n on. .0.pul.tI.n In Ih. n.llo. or. .orrool .nd dldu.ll.n. or. not'blln. ol.ll.d, .l...'~n "K" Sn "laOk"A" of Ptrt '- Of thl "UIlP'W'," A"ponll" iloUon. lIa" two C1QPlu Ind tUb,1t thl. Nlth~our ohlok for thl ..ount .01 I.. I. Ih. R..II\Ir,of NI11. of Ihl "unl~ Indl,"I.d, Th. PA OIP'rll.nl " R.v.nu. hili ll'u, .n olfl.l.l ........nl' lFor.RIV.U4lIMI vp.n r...lpl ., Ih. rolllrn 1101 th, R'Uhlor of hUh, I, ILOOK I. If the ....I.p.olfl.d on Ihh n.lloo hll b.,n or "Ill b. rop.rlod .nd I.. p.ld ~lIh Ih. P.nn,vlv.nl. Inhorlhn.. TiM Rtturn UlId bV thl dtGld,nt'. rIP""n,,UvI, ~lI,o' In "K" In blook "a" of Plli't 1 ~f thl "TuP.Vlr RIIPonll" ..oUon, Ugnon. ,ooPV .nd rolurntolh. PA O..,rI..nl .f R.v.nu., lu,,"u o'lndlvldu.1 To.'" D'ol 280601, II.rrhburt, PA 11111.0.01 In Ih' .nV.I.p' provided, J. _LoCK C ~(f tht.noUol l"'or..Uem 11 Inaarrlot and/or dtd\.loUO"1 "rlb,lng 01.1.ld, chlok blook "C" and do.pllt. Plrh t and I lIouordlncr to thl'tnttruotlon. hllow, 11""'"0 aap!.. and tub. it thl. wl1h'~our ot\lok tor thl ..ount o~ t.uc "'li'.bh \\1 thlll RI,ht" of Will, of lho .~IV Indl..I.d. Th' PA DIP.rll.nl 0/ R.v.nu'hlll I"v, .n of/lol.1 ......I.nl (Pori REV.II~1 101 upqn r"'lpl of Ih. rolurn frO'lh. "Ihler ., Will... TAX RETURN . PART ? . TAX COMPUTATION LINI 1. Entl,. thl dltl th. IOODU"t oI"J.ln.U~ w.. "'Iblhhtd ~r tltl,d In thl ..nn... 'MhUn~ It dati of d.ath, NOli' For. doo.d.nl ~vlnl .lIor 1I/11/1l, Aoo.unlo .hl.h Ih.'d...d.nl pul In Joint n.l.. hlthln on. I,ll ~,.r .f d"lh or. "Mlbll fuUv II. trln,fln, Howevlr, 'hare I. In 'MO_~u.lon not tC.'lCo,.d U,DOO pI,. trln,flt.. rllllrdhuo, the valu,.of th'IOODU"t or thl n\ilbar of looounh held, I[ ,doubt. ~.t'rl.k eM.) ,pp..r. blfar. vaur, +lr,t n... In thl adurl" portIon of thll,no,lo., thl ..,000 IMolullon . rlld)l hu ~.." dlduotedfi"O_ the ,ooaun, balll,ae 1'\1 ,'.partld b~ thl finanClIl InIU,tutlon. I, 'n,lor Ih. I,O\Dlbjl.nO,..f Ih. 10OOU,n\lnolUdln, Inln..1 ,ooru.d 10 Ih. dll. 0' d..lh, I, Thl PlrCltntof th, loaount thlt II ta)clbh far iaah lurvlyor 11 det.r_lll.d .. followlI A, Thl p.rCl.~t t'K~l. fOr. Jillnt ....ts ..hblhhld lor. thin anliIV"" prior to thl dlaldlnt'l d..tht I; I DIVIO,O IV TOTAL NUNIIR OF OIVIDID IV TOTAL NUNISR DF 0 10' . PIROBN! TAhAILE JOINT OhNlRI ' IURVIYIND JOIWT OhNIRI I."pll' A j'lnl....1 ..'......d In Ih. n..,. .f Ih. d..,d.nl .nd I.. othor por.on., I DIUIDIO IV I (JOINT D.NIRI) DIVIOID IV I llURYIVORl1 . .161 0 I" " 16i1H lTAKAILI paR UAOH IURVIVOR) I. lhl plra",' '"l1bU ,for ...Ih or..hd within ani Vier of 'hi dlCldlnt'l d.ith ar eooaunt.ownld by thl dlolaant b~t hald n Iru.\ fOr 1I\0\h~' IndlvldU.I('1 (\rU'1 b.n.fl.l.rllll, I DIVIOIO IV TOTA~ HuHaUR 'F IURVIUIN' JOINT 0 100 . PIRCBHT !AHAI~E bhNIRl'OR,TRUIT IINIFICIARIBI .)CIIP1" Jtlnt aaoount r,ghterld':ln th. nal' of thl dlQidln\ and two othlr plrtanl ,nd ..tabU.hld wUhln ani ~..r of d..'h bv I OIYIOIlO ~~ l'Ua=OlvDAIl . ,~O H 100 . DOH ltAKAILE FOR BAOH .URYIVDRI ' P p ",' ',! , ,-_I ; \, Th' ,".unl ,11II/"11. ,I.. (llno \) h, dllnl,ln'd,~v lulllphlno Ih. ...ounl b.l.n.. llln. I) ~~ Ih. p', 'OInl I'MAb,h IIlnoS,)' 't 1(1\11'\11. \u~. I \l1.."MiI,".t'oI \l.UUWUOI\t. U.h~ IId"..t I, .. ... . . .. . ,. The OODunt 1'.fIb, 'lllln. 61 II d'lor.ln.d by .Ublr","n1Ih. d.~" Ind d.du.llon. IIln. II frol \h' 010,,"1 ,"b)..1 10'1.. llln. 01, 1. Inlor Ih"lPorOll' 01. ". "I. 11 n. '1 II utor'ln.d b.I.., ',~;i A, fO,r d,II','jf d,,,lh ooourrlrti,"flor 6/10/,'4. Iho I,~ r,I" for Ir.n./O.. 10 'POU'II or. II f.lIo... Ld I' 0,11,. 0 dj.lh on or .lIor UI/'~ .nd bOfor. 1/1/91 Ih. ral. .. IH, ' 0'011" 00 ".Ih .n or.fl.r 1/1/'1 Ir.n,f.r. 10 ,p'U'" hili b' 1...d,.1 OH I'. r.I.. H91D1 For d,tlO 01 d.,th .rl.. I. UI/" lrantf,,, I. .pou... "" II..bl. .1 6K, ' I. T, ..n.f.ro to 11\0.1 d, ..OI~.n.. '1"nOlud1nl fllhor, ..Ihort IOn, d'"'h, In, I"ndohlld..n, ..n.ln.II"." ' , d.~.h"r.ln.I..1 .1.POhlld ond In.l~ h... ... I...bl. . ,.1. porllnl (6Hl, ' 0,. Tren",/,I"I to II .o,th.r. noludh\. brothlrt .lItlr, "'nQlI, aunt, nlPhilf Ind nl.CIa er,1 'IMlbla It flftlln p.rhnt (UH), O. If~'" .hInt. Ih' II. .1 " pi.... .p..lf~ vour r,lollon'hlp 10 Ih' d...d.nl In Ih. 'orll provld.d. ' , I. Tho ..ou~, Of II' clu.lIln. 61 I. d.lorlln.d b~ .ulllphln. Ih. ..ounll,".bl. l11n. 61 b~ Ih. ". rUt 111n' 11. CL,AIMED DEDUCTIONS . PART 3 DE~TS AND DEDUCTIONS CLAIMED , .llowibl. dobll Md d.dUO\lo~. .r. d.l,rlln.d "' folio." A, VOl! 1I,'.."lh .~,., rllPonllbl. lor pl~lIn\, or, Ih. ..1.10 'UbJI,.I, 'I. .d.lnlllrallon bV . porlOn.l r,p'lI.nl.tlv. II" In'vfflol.nt 10 PlV lho "dgtlbl' 10'1, , I. Vou,olu.lIv P' d ,Ihl d,bll oll.r d..lh oflh. dl.ld.nl .nd IIn furnhh pro.f ./ p'VI.nl. C, O.bl. b.lno 01' ..d 00" b' lI.ll..d lull. In Pori S, 11 .ddlllonll '''" It n..d.d, 'UII pl. In P.por I III" . 11". Pr.of of "V.'~I '" bj "qulll.d bV Ih. PA boporl..nl,ol R.v.nu.. ' lIll~.i'__ ":::,::""::,::",:::::"ft,~,~",J,i~,q",,,,, ",~m,:,:,tJ,,~.', 1":l"::,~].:,fl:",,,:J,~,, !",l:" ,:tJ,t".:":~,, ,,],: l~~~"",~,::"~~.,:""f",,~~:,,,,9~~~l:::'i'''':''''':'"e'::', PUIlPOIE Of' HOIlOE. To fulfill Ih. "qul,,".n" of I.. lion "UO of Iho II~IOrll...." ",.IIt.I.I. ,.. ,Aol, Aol EI 01 199U, eta P,I. 1..llon 9140 I, ' ~AVItENTt PoI..h lhe lop Porllon 01 Ihh Noll., ~,II Il~'oll w)lh .o'ir IIOV"", \0 Iho RoUhl.. of "lIh prlnl.d on Ih. rayer.. .1~, ' ,- N"" oheo~ or "ono~ ot.llt I....hl. 1.1 HEOmltH 01 utHI, AUENI. ilEl'llNO ICRll A "fund of, I.. _rodll, whloh ... nol tOulI..lolI on Iho I.. "IUtn, ... b. ,'.qllllloll b~ ..",hllnu"n "Applloollon for N.fund 01 Ponnl~lvonlo lnh..ll~l" lIIllI hID" II." INHY-IIUl, A~~1I001l001 oro "vollllth 01 Ih. Oil'" of lhe ...hlor 01 Nllh, onv 0' Ih. II Hov,",IO oh"I.1 01110" or b. .'lIlnu Ih. lpoolol 14-hollt on....lnu IItvloo tub.... fat for.. ordtringl In f1tn,"vtv""la 1."0"S"~uao, Qutlhli f1t1\lllvlVenhl and within 100,,1 H.rrllbllru or.. (117) ""1090, Too. 11111,1/1'UII Clllorlou III,"ro.Onl.1. Anv P"..tv In In,.r.lt not ..thfl,d Nlth th. ".lltlh...nt; ,UoH.nol or dhlllluwlnol of dlduotlon.or ........nt of 10. llh,lvdlOU 111......1 or Inl....1I ., IhPMfl ..., Ihl. Noll.. ..."'bj..1 "lIhln .I.W WI dOVI of r"olplof ' thll NoIIOlb~1 , ' --.rltton prol..!.to Ih. ~A 010011_1 .1 H'V"'IO, '.orll 01 Ap~..h,O.pl, 181011, ".r,.llburo. PA 171"8-1111, O~ .....110U,18 to."I"1 the '...tter dit*rlllll'.... ft. Itll "Udlt flf th. .00000' of thl fllt.onnt r.~r..."\ftt1Y't OR '-lPPIII 10 IhI orohon.' oOllrl OI...OIlDNII ADHIH- IITRA II VI! ODRRECTIDNI' OIICl/IlN" I!llHALTV I INtlRlIT. Flatual .rror. dl.ooy.r.d pn thh ........", It\lmlll h, "ddr....d 111 writing tOl PA bIP.,.u..nt of AlvlnUI; 8uruu 01 Indlvlduol r...., MINI 1'0" A...u..nl M.vll. Unll, UU~I, 'U601, lIorrhburo, PI 1711'-0601 Phlln.,17l'1l '''-001, III POU' 101 11I1 I..oklol "In'lr.ollon. lor Inllorllon.. TIM R.lurn lor I H..ld.nl D.tIldtnttt (REY-UOn for an IMplln.Up" n' .tt.lnlttrntlv,av aurt,at,IIlI .,.ror', , If '"~ ,hM dUf .It ".'d MIUlln thne tA) aAllndA" lonth. .ftlt th. d."ldlnt'. $.\h, .. fly, plralnt (1'0 dho""l 01 1110 I.. 0.111 I. oUo,,'II, Tho ISH I,._,b hon-porllo'~'lIll1l p""l1v h' OClllflU"d on Ih. 10"1 01 Ih. tl. ond Inl6rotl .......d, ""' ~ol p.ld boforo J_or~ II, 1996,lhl Ilrol ".. .fllr Iho...1 01 the I.. unll" porlod. .Thl. non-porllolpollon ptnlUv. " ,",PIIlltbl, In thi .... .ftfWlIr If1d.ln till Uti .... U.. p.rlod .. VOIl would apPle1 thl t"N end lntlrllt thlt hi' '..,nelll,"d tel ,,,dlaltld on thh nqUIlI, Inlorlll II oh""d bOUlnnlnu Wllh /1"11 ".. 01 "'lInqll"IO~, or nlnl (9) .onlhl ond on. Cll d'~ Ir.. 1110 d.l. 01 lloolh. 10 "10 d.I.,ol ~'VI.nl, I.... III1loh b..... ..Unqu.nl b01Or1 Jonuor~ I, lOa! bllr Intor..1 .1 II.. r.l. of .1. (6HI ~orOlnl nor ."""" ooloulol,d .1 . doll~ rol. of ,000164, All "KIl Mtlloh ~O... d,lIncttffn' on or.fUr J.n"flr~ I, 198Z "IU b..,. Int",."t .It .. "I\lt whJoh N111 very fro. aillnettr Wllr to ...Iltndlr Vilt With thlt.t rltt. .nnouoold b~ thl PA Dipart.,n' of Rlvlnu.. Thl IPpUoabll, lnlor..1 rolll for 1911 IhrouDh 1098' or" Y.W ,lnlll.1I Rot. Pith' lnhltiU hotor V..t lnt,,.,.t.. Aat. ba'tv tnt.tllt t:'lotor - 1011 toH ,008141 1987 9X ,00014' 1011 16H , ODO~18 19IHOOl m .000501 1914 IIH .00'M1 199. 9X tOOO2~7 19.. UK ,008111II 199~,i"4 'X, ,00019t 1914 IOH ,001114 199B-I098 9X .'0024' -'lnlotul II .11.,,1110. II lollowlI lNTBR8ST I .ALANOI or TAK UNPAlO K HU"BBROr OAYS,PBLINqUBNT K DAILY INTERIST rACTDR '-An~ No\lOl I..... 'flot, "10 I" 11.1.... d.ll~qu.nl "III ,,11..1 on InlOt..1 ..Ioul.llo" 10 f lII..n IISl d... blwood Uti diU. of' 'hi .UI.....,t, 1f "''il,nt "I.d, aU,,. th$l inter.it OMlPutlUon dati .haW" on thl NuU.., addlthH'll Int.r..t.",,~ be a.toul'l,d.