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HomeMy WebLinkAbout97-00873 I$" -~Jo - I tf' f CIATH AfTKA '" I CHICK HBAI q, AIV. 1I0oaa . (1.141 INHIRITANCI TAX RBTURN RISlOINT OICIOINT (TO BIII'I-IO IN OUPLIQATI n.97.0873 Counl Cumbodllnd (If APPLICA8LB) SUAVIVINc SPOUal'S HAMI (LAST,fIAST AHC MICDLI IHITI~LI SCCI~L &RCUAIIV HUMBIA COMMi~~HlJMC!J',PtMlWaV~HI~ HAAHIBI/8Ru,~1ii.o.ol DICIOINT'I N~MI IL~aT, fIRIT, ~NC MIDDLa INITI~LI Goooh A P8 BDOIAL BIOURITY NUMPBR 171.30.1315 I Hi lID: II CAlK Of 81RTH 09/10/1901. CAlK Of CIATH 10/26/1997 Orlglnll RII~rn Llmltld e.llll I I Q C U co CICICINT'q CCMPLITI ~CCRK&B Count~y MuudoW8 Mochun1cBbu~81 PA 17055 UM AMCUNT RICBIVIC IUI INSTRUCTICNB) 0.00 01. o I, - RIll'oIlndll Rlt~rn (for dstll 01 d..th prior 1012-13.82) Pld"ll ellall Tsa RII~rn Rlqulrld TOIII N~mblr of Slfl Dlpoan BoxlI o 9- one 4611,502.67 None None 31. 59 229,371.54 Nono 310 I, S~ppll""ntll Rlt~rn 4., P~t~lIlnllreat Compromlal (ford.11I of dlath Ihlr 12-12-82) Dloldlnl Dltd Tlatsll 0 7,' Dlcldlnl MBlnlllnld s Living Tr~lt Ahsoh co of wlln (Ah.oh. COpy 01 Tr~'I) ALL CORR SPONDINOI AND OONPIDINTIAL TAX I "ORMATION sHoU b BI DIAIOTID TOI HAMS COMPLIU M~L1NO AOORUS 101m. O. Sc ~/1C Win. O. Schrack, II I E8q\11~e TBLEPHCHB HUMBaR P.O. llOK 310 1 3. 3 11 8bu . RI. Itstl So . d~ A I. Stookl and Bonda (8chld~It B) (2) 3. Clollly HaW Slock/Pa~nl/.hlp Intllllt (SChedule C) (3) 4. Mortgsg.. and Notea Rlcllvebll (Schedule 0) (4) I. Caah, Bsnk Dlpoalla & M.lacell.~aoua PlI,onsl Property (Sch. E) (I) I. Jolnlly Ownad Ptopsrty (Schedula P) (I) 7. Trsn.fsra (Sohlduls G) (Schldull L) (7) S. Tolel Groll Alllta (totsl Lln" 1-7) , S. Punllll Expenlea, Admlnlatllllvl COltl, Mlacellaneoua Explnale(Schedull H) 10. Dlbla, Mortgsgl Llsblllll", Lllnl (Schedulen II. Tolsl Oeductlons,(lolal Lln.. 9 & 10) 11. Nil Vslul of EII"I (Line 8 mlnul Llna 11) 13, Chlln.blt snd Qovernrnenlll BlqU..tl (SChedule J) 14. Nit Valul Sub Icllo Taa Llnl 12 nua Llna 13) 11. SpoulIl Tlln.l"a (for del" of death ehlr 6.30-94) Se. lna"uctlonalor Appllcabll Pllc.rltagl on pege 2, (Include veluea from Schedull K or SchedUle 1.1,) II. Amount of LlnI 14taxsble et 6% r$le (InQlude vstuealrom Schedulet: ot SQhedule 1.1.).. 17. Amounl 01 Line 14 teuble $1 WI. r$le (lncludl V$lullfrom SchedUle K or Schedule 1.1,) 1s. Prlnclpel tex dUI (Add Is~ from Line 16, 16 $nd 17.) 1'. Credha/Sp POVlrty Prior P$yrnentl Olacount (l.00- 98.000.00 - 5.097.65 10. .II Line 191' vre",r th$n Llne.19, e.11'" the dlU"enQe Qn L.lne 20. Thl' lathe OVIAPAYMINT. [E] .3KI10hlOk ~t,.1f YOy"u'QuII\lng . r.l~ of youroyltPtymtnl.1 . 11. .II LlnI 161, gruter then Line 19. enl" the dlU"ence Qn Line 21, Thl' I'.thl TAX DUB, A. Ent" the Inl,,"1 on the bstsnce due on Llnl 21A. I. Enler thetQIsl 01 Line 21 and 21A Qn Line 21.. Thlall'he IALANCI DUI. t s 101 leofWls I " " IleURlI TO ANeWIR ALL QU1I8TIONS CN PA(l1 2 AND TO RICHICK MATH .. undtrptlntl,u.'UiPlfl\lty,'CttCl,aftlh' a,,1I1(1 ". 1ft urn, . "9 e:cC)mpanyng~ Ut" ...me _.1 0 _' . o.tTI'V now gu _ i . ut, COlftc( and compli\i. ~I._'.lhlt." ,..llIt,t, hi. bttn r.pon~ It trut """klt,VaIUl, O"I.'I,IDI'I of p"ptt.r otht, lhan the pfllOl\Il ,.pr...nlaU"t'l biNd on.lIlnfotmlllonot whICh p" " h.. toy knowltdO., BlOHM OfPlRBCNAU HIIGLlfQAFILINORKTURN Put~101a Wa1t~ , ~~. .~~h~t?y. .Q~~Y.l!............................ ...... 0111abu~ PA 17019 . 101m. D. Sohrack, III E9qul~e P. O. !loK 310 i:J"liisb"li;;'" 'pi-."'i '!iiic;j: 0.3111'..................... (I) (9) 11.446.46 (10) 2,770./13 (11) (12) (13) 14 (II) x : (11) X ,06: (17) 679.666.91 X .16: Inte,.al (lll_ (1') (10) (21) (21A)- ( 118) 693,905.60 14.218.89 679 .6116 .91 679 686.91 0.00 0.00 101,953.04 I! 101.953.04 103,097.65 1.144.61. 0.00 0.00 0.00 CAlK ~//Iltt' DATU ~ ~ -:r- Palm Atv, 7...) N !:;~ 15 R .,0;: ~!) ffJ co "J .. ) , .:t: '9 '.) '.:'=- !.,J i'-: ;i N c.'. \~ .... ;""1 -n , ~ Yl tll (1' :Ii o,P , J~' ~ ~8 RIV. lion" + 1....1 CCM.~.M11Y~NIA ICHIDULI . ^SOlla A. Cllooh S811 111.30.1315 10/26/l9!H 2 4,500 unita N\1vIIPn Mun1 VftIuo Fund 3 10 aharea lilt T~uat Ins 278A @278,87 4 10 sha~es lst T~ust Ina 94SA @70.86 5 10, 000 sha~ea/8tate of Texas/7. OO~ due 12/01/00 6 20 ahereN 1st T~ust Ins 17SA @209,34 7. 25,000 sha~ea/Fa1~faK Onty Va Watt Auth/5.8~ dup 01/01/16 8 5,000 aha~ea/Mary1and St OOA Oept HeS/7.375r. due 04/01/26 9 6 shares 1st T~uat Ina 38SA, @228,94 io 9 eha~ea let 'l'~ust Ina 29SA @250,l13 Aoo~ued inte~est/Nv TK Ex 'fr Spr 7!lSA Acc~ued intereat!Nv TK Ex T~ Ser 86SA AOCl~ued 1nte~est/Nv Tll Ex T~ Ser 90SA Accrued 1nterpat!Nv Ina Ntl T~ust 93SA Aoo~upd 1nte~eat/Nv Tx Ex Ins Ser 109SA Aoo~uocl inte~eat/Nv TK Ex Ins Bsr 118SA Aco~ue.d 1nu~est/Nv TK EK Ins Ser 122SA Acorued intereet/Nv TK Ex T~. Sor 125SA Aco~Ued intereat/Nv Lons Into~ Ins SII~ 7SA AOO~U8d inte~eat/NvTll F~ T~ Ins SP~ 333Q Aoorued 1ntereat/Nv Tll EK lna Ser 341Q Accrued intprost!Nvtll Ell lna Set 345Q Tot.al of Ooot!tluatlon Schpdule B TOTAL (AIIO Intlr on II", 2 l\eOI "ulltlon) (II more Iplce It ntlded, Insert eddnlonllshee" Qf same 11.1.) CopyrlOht (e) ,". f.rm ooflWIr' only CP8yllemo, Inc. 21-97.0873 10.22 45,990.00 2,788.70 708.60 10,100.00 4,186.80 26,907.50 5,050.00 :).,373.64 2,253.87 198.00 252.00 381. 00 204.00 203.00 456,00 711.00 411.00 342.00 625.00 670.00 258.00 349 299.80 . 464 502.67 Porm 1110O 8Chodult' (Atv, ..11) E~~.te ofl AgneR A. Qoooh B~ Beo 01 171-30.1315 . Patu of Death I 10/26/1997 Continuation of Sohpdule II (Stock8 and Bcnds) Item De8c~lption II Unit Vslue et Oatp Value of Opath Aocrued interest!NY TK EK Ins 8e~ 1748A 790,00 Aoc~ued inte~eRt!Nv TK EK Ine Se~,183SA 438.00 Aco~ued inte~est/Nv TK Ex Ins Se~ 1938A 678.00 Aoo~ued lnte~pst/Nv Tx EK Ut T~ Se~ 297Q 270.00 Acc~uad inte~est/Nv TK UtT~ Se~ 2628A 1,186.50 Aoo~ued inte~e.t/Nv TK EK Ut Tr Ser 3l2SA 238.00 Accrued int.~e.t/lst Tru8t Ins 178A 390.00 Aoc~upd lntp~pst/lBt T~UBt Ins 278A 73.40 Aoorued inte~e8t/18t Tru8t Ins 298A 73.08 Aoo~ued intP~est/18t T~ust Ins 94SA ].7.60 Aocrued into~pst/lBt Tru8t Ins 388A 70,72 11 100 units Nv Ins Nt! Trl,lst 93SA 44.8 4 ,.4eo . 00 12 :1.00 units Nv Ins Nt! TrU8t 1098A 24.95 2,495.00 13 200 unit8 Nv TxEK In8 8e~ 1188A 39.03 7,806.00 14 300 units NvTx EK Ins 8e~ 122SA 35.96 10,788.00 " 15 '100 unite Nv Tx Ex Tr 8e~ 1258A 81.45 81145.00 "" 16 200 \.lnite Nv Long Inter Ins Se~ 7SA 39.51 7,902.00 17 500 unit8 Ny Tx Fr Tt' Ins Set' 333Q 95.84 471920.00 18 500 units Nv .Tx EK In8 Se~ 341Q 100.33 50,165.00 19 200 unite Nv Tx EK In8 8ot' 345Q 98,44 19,688.00 20 200 units Nv Tx EK Ins Set' 174SA 89.68 17.936.00. 21 100 units Nv TKEx Ins 8e~ 183SA 103.27 10.327.00 Eatat' ofl ~8n'8 A. Oooch Boo ,Seo (II 171.30.1315 'Date otOpathl 10/26/1997 Oont!nuation cf Schodule II (Stocka ond, Bond.) . It,m O.ao~iption (I 22 150 Unit8 NvT~ EK Ina Se~ 1939A . 23 290 unita Nv T!I EK Ut Tt' 9a~ 297Q 24 350 unita Nv Tx Ut T~ Se~ 262SA 25 100 unita Nv T~ Ut T~ se~ 3129A 26 200 unita Nv Tx EK Tr Set' 75SA 27 200 unita NV'Tx EK Tr ge~ 869A 28 3'00 uni tsNv Tx EK Tr Se~ 90SA 29 U.S. T~ea8u~y Bill #9127944Q4 POPl'pnwimar " P/O/O to Oawl1 1; UnitValua at Date Value of Death 105.5 15,825.00 99.87 19,974,00 98.43 34,450.50 94,27 9,427.00 36.34 7,268.00 29.83 5 , 966 , 00 15.04 4,5~2.00 30 , 000 , 00 30,000.00 .....it............. 349,299.80 30 U.S. Tt'paau~y Bill #9127944T8 - P/O/O to Oewn Poppaliwime~ :' - EQUITIES umJU11i-~iliI"IZ'" ""'11' -',"li'il"'H"".,\L"',I""j;t"~""""I',"""",","',""""~"''''''''''!1',,'','',HR''W, 'll,"lr~1i ~'E'~'" ,. , , 'K. ,,,, ~'" ' , ~. 'd, '~1"'" ""'I co AR~a"" '", "'Ra O~J" ''''An II .,., ' , " ,-,;(,.-,~- 'r,'f ,~;~v..,-)t~\j~; -_ "'~;I+,i--;i-~, 'WPr}1'cMc_i ,f3!~ Ji'_l );- .Ull ...- _.1., _. ),';1i__d,rr_~_\",j""__",__,,,,,;,, ,.._._._".,.-..__,{:.\..._~_ _j""n'~,__,I.~., "__,,,__.. .aU..,,,.,, ',;li', ,v, GT GLOBAL TeLECOMM A 1,096 $19,68 $11,132,76 NON.TAXABI.E SECURITIES u~gj~.'l\!rm:~ ~w;,~~~"qg,:,ty,rt"J:,.If,~f.f".,.~j:Il't';'~"~~,!,:",~II!i",,~~r/s"H" 'A' 'R'~'Sli,:'I'(.,",'I!,'~'e;I'C"e',', :"!):\,;"A" C:~i~,.N'1P;;:'f,\ili:~. . ......... '" - -- - .. "lv.,,,_H,., "'-'- ",j" 'of',.1t.i.o(' "," _-_t:..r~,_.; lY" __...,IV,"."_ ",__,,., .,'J\",:nliIII.L ;'. ...... t- .1- "J,t'., _t:_~_ 1~~.. .. "",,. ik(!,,,,. ".;_ ,v-,___,,_,',III~h" ,,";' L'-'",,_,,: 4-". ,_, ,\ ,_, ;,,'''' J -j".._, , '" '-". '. '. ." .,' ...,' I, '-I, ,..,ll) .. " , . 1 ST TRUST INS 17SA 20 $209,34 $390,00 $4,576,80 1ST TRUST INS 27SA 10 $278,87 $73.40 $2,862,10 1 ST TRUST INS 29SA 9 $260.43 $73,08 $2,326,96 1 ST TRUST INS 94SA 10 $70,86 $17,60 $726,20 1 ST TRUST INS 38SA 6 $228,94 $70,72 $1.444,36 NUVEEN MUNI VALUe FUND 4,600 $10,22 $0,00 $46,990,00 NV TX EX TR SER 76SA 200 $36.34 $198,00 $7.466,00 , NV TX ex TR seR 86SA 200 $29,83 $252,00 $6,218,00 NV TX ex TR seR 90SA 300 $16,04 $381,00 $4,893.00 NV INS NTL TRUST 93SA 100 $44,80 $204.00 $4,684,00 NV TX ex INS SER 109SA 100 $24.96 $203,00 $2.698,00 NV TX ex INS seR 118SA 200 $39,03 $466.00 $8,262,00 NV TX ex INS seR 122SA 300 $35.96 $711,00 $11,499.00 FERRIS, BAKER WAlIS " '(01 .:] I 'i ".1, .".1.'.' ,"'.f" "'.. ,,"" r ,.- '; ,:t ',",', ',,( f {'~, .lfj Ufml1llBl&lRlflrmIO.lll . e "I 1..1;',': i . 'W.ll'Ir.'~I':: :.', Jt _ "-) ",Ihi Jf' -\' ,,1,,1 J,' NVTX ex TR SER 125SA 100 $81.46 $411,00 $8,556,00 NV LONG INTER INS seR 7SA 200 $39,51 $342,00 $8.244,00 NV TX FR TR INS seR3330 500 $95.84 .$625,00 $4a,545.00 NY TXEX INS SER 3410 600 $100,33 $670,00 $50,835,00 NV TX ex INS SER 3450 200 $98.44 $268,00 $19,946,00 . NV TX ex INS SER 174SA 200 $89,68 $790,00 $18,726;00 NY TX EX INS SER 183SA 100 $103.27 $43a,oO $10,765,00 " NVTX EX INS SER 1935A 150 $105,50 $67.8.00 $16,503.00 NV TX EX,UT TR SER 2970 200 $99,87 $270.00 $20,244.00 NV TX UT TR SER 262sA 360 $98.43 $1,186,60 $36,637.00 NY TX EX UT TR seR 312SA 100 $94.27 $238,00 $9,666,00 STATE OF TEXAS 10,000 $101,00 $10,100.00 7,00% .DUE 12/01/00 FAIRFAX CNTY VA WTR AUTH 26,000 $107.63 $26,907.60 5,8% DUE 01/01/16 MARYLAND ST CDA DEPT HSG 6,000 $101.00 $6,060.00 7.376% DUE 04/01/26 RESERve FUND BAl.ANCE $7,698,94 - I~ERRIS. BAKER WA1'rs In{'nrpmall!d REV, ,.oe IX + (II,M) CQM...MhY~NI~' 80HIDUI-III Aane8 A. Ollooh 8911 171-30-1315 3.Q/26/1997 JoIllllenanI<,)1 21-97.0873 A. NAMI Patricia loIaltlll ADDRIIS 26 Alhley Ddve Oil1lbu~g, PA 17019 o DIDIDINT I, C. JolnllV-ownsd proptllyl ITIM DAT' TOTAL Y ALII' DICD', DOLLAR YAWl OP MADI D180RIPTION 0" PROPIRTV NUM8IR Jell T 0" AIS'T .~ INT. IOIDINT INTIRIIT 09/30 9 .Oomme~oe llan~/Har~ilbu~g 1 .649.65 50,00% 9,32 .83 N.A. Chec~in8 Aocount 110512098369 2 A 09/30/94 Comme~oe Ban~ Savin81 132.026.85 50.00% 66,013.43 Aooount _ 1104101593~1 3 A 09/30/94 c~elta~ Ban~ Chac~in8 47,616,00 50,00% 23,808.00 Aoo'ount - 1100809" 6994 4 A 01/01/94 Oaup~in Oppolit llank ~ 43.173,40 50,00% 21,586.70 rust ce~tlfioste of , Oeposi t - 118140897019 5 A 01/01/94 Dauphin Oep08it Ban~ & 94,770.84 50.00% 47,385.42 ~U8t Co~tificatP of Deposi t - 118140896845 6 A 07/01/94 Fi~st Union National llan~ 4,535.51 50.00% 2,267,76 Cheo~ing Aocount - 111000050841726 7 A 01/01/91. Pennaylvania State llanK 117,970.79 50.00f. 58,985.40 Ados81 Savings Acoount 1122004808 TOTAL (Alao Inllr on II G,I\IC. nul.llen) (If moll aplc.la nt.ded, Inaert Iddnlenll aheeta cf ..me alII,) copyrlilht (0) 1814 101m IOlIwI.. OIlty CPBYlteml.lno, 229 371.54 'OIm 1110O sohod.18 " (AOY. lHa) .:.} r~ Deo~dent Confirnm.tlon .. Name Social Security No Date of Death - Agnes A. Goooh - 1'll-30~1315 - 10/26/97 Descri tlon Account Account' Account Account No. 8140896845 8140897019 .. Account Type Cllrtiflcatll of Certlfica te of De oalt Deposit Date Opened or Issued . 08/05/97 OS/05/97 Date Closed or Matured 03/05/98 (M) 03/05/9S (M) Date of Death Balance $93,~33.S4 $42,655.43 PLUS PLUS PLUS PLUS Date of Death Accrued Int. $1.137.00 $517.97 Joint Owners (if any) Patricia Waltz Patricia Waltz Date of Joltlt Ownership Special Comments: N/A (0 Date Prepared I November 1.1, 1997 Prepared bYI Amy L. Haivor (RIY &1'0/97) Page: 2 " . .' " LASW WXLL ANDWSSTAHSNT . OF ACJNIIlS A. CJOOClH X, ACJNIIlS A. GOOCH now of Chevy Chase, Maryland, deolare this to be my Last Will and 'J;'eliltament, hel;'eby revokinq any will preViously made by me. I ~ I direot the payment of all my just debts and fUneral expenses out of. my estate as soon as maybe praotioal after my death. II ~ I give and bequeath to my nieoe, Patl;'ioia Waltz, if living at the time of my death, all of my tangible non...inoome producing personal property, exolusive of qash, if my Ilieoe predeoeaees me, I qiVe the same to her hUBbanc;\, Donald Waltz, if living. If he, too, is deceased, the same ~hall be divid~d among my niece's ohi~dren then living and any SUrplus Sold.at pUblio qr private sale under BUohtermBand oonditionB as my personal representative deems appropriate, and the net prooeedS SA,m~!i.GUIPO shall. be added to my residuary estate. & MASLANP 2109 MarkO! SII"I Cem~ Hilii' PA "f , III ~ I deVise and bequ~ath a~l the rest,.~eBidue and remainder of my estate of whatever nature and wherever situate unto my nleoe, Patrioia Walta. ") .' /' I,.if. o~ h9'~ 1 HAKI CHICK PAYAII-I AND AIHIT PAYHINT TOI REGISTER OF WILLS CUMQERLAND co COURT HOUSE CARLISLE, PA 17015, CUT ALONO THIB LXNI .. RITAIN LONIR POATION POA YOUR AICOADI ~ ~W: IIW'a'l/"A~li"r&':m.'ilfIY'fB"'6i1-'iliililfffllrol-YA~'A'll'~ftA"fiiWilt~--At1."d'Q~WI~'b'K'--"-----"------- DXBALLOWANCI OP DltiUQTIONI AND AIIIISHINT OP TAlC ' , . IBTATI CP GOOCH AGNES A PILI NO.21 97-0875 ACN 101 DATI 08-2'1-1998 TAX MnUMN liAS I I X I ACCIPTlD AS FILID () CHANllID AISIAVATION C6NOIANINO PUTUAI INTIRIIT- IIIRIVIRBI APPRAZBID VALUIOP AITURN IASID aNI OPIGINAL RETURN 1, Mosl Istoto (SQhodulo Al . 2. stoqks ~ Sonde ISQhedul. BI 8. 'Cloeol~ Hold stook/Portner_hip xntorlOt '(SQhodUlo C I 4. Hortaoaos/Note~ Roosiveblo (Sohedule DI I. C"h/hnk Dopoe! h/HhQ. Por.onel "ropert~ 18Qhodulo I) 6. JQintl~ Owned Proport~ ISoh.dulo F) 7. Trsn*fer. IPQhedulo 01 8. tQt.l AII.to APPROYID DIDUCTION8 AND IXIHPT!ON81 9. Funorol .K~neoe/AdM. Coste/Hiso. I~poneoe (Sohedulo H) (9) , 10. Dsbto/Horta.as LiebUiUoe/Ltene lhhedulo II . (10) 2,770.45 11. Totolo.dUoU...,* Cll1 16.l'lA.AO 12. NstVelUBofTe~Aeturn (121 679,686.91 11. Cheriteble/oovsrneontel Bequeete, Non-eleoted 911S Trulte (Sohsduls JI (lSI .00 14.""t Ve1UB of ..tste SUb.:leQt to Te~ (14) 679,686.91, NOTII !1.n !.......nt.wh.. 1. aUld praviOUaly, l1n.. 14, 18 Ind/or ,1,,61 17'.nd 18 will r'11.0~ figur.. ~ .t inolud. th. tot.l of ~ r'~urn' .......d to d.t.. ASSISSHINT OP TAXI 11. AMount of Lino,14 ot SpoU.ol rete (11) 16, AMount of Linl 14 to~oble et LinoeUcle.. A rete 116) 17. AMount of Line 14 te.eb1e ot Colleterel/Clel1 B rete (17) la. Prinoipel T*~ Duo TAX CRIDIT81 PA VHBNT OATI If) -;2.1 () 111 BURIAU OF INDIVIDUAL TAXl8 IHllERIUHCe TAX IIVlelON IlfPl, 280601 ttORRIBBURO, PO I7UI-OOOI COHHONNIALTH OF PINN8YLVANIA , DIPARTHINT CF RIYINUI NDTICB Of INHBRITAHCB TAX APPRAIBBHINT, ALLOIfANCB OR DI8ALLOlfANCB OF OBDUCTIONB AND ABBEBBHINT OF TAX WH D SCHRACK PO BOX 510 DILLSBURO DATI 18TATI OP DATI OF DIATH PZl.1 NUHIIR COUNTY ACN 08-2'1-1998 OOOCH 10-26-1997 21 97-0875 CUMBERLAND 101 AMO t ""i~t'd III ESQ pr. 17019 I (1) (al (SI 141 (Ii 161 (71 .00 464.602.67 .00 .00 31.B9 229.371.84 .00 lal 11,448. '16 .00 X .00. .00X.06. 679.686.91 X.18. ual ftaCnPT HUlt8BM D18COUNT <<+) INTIRa8T/PaN PAID I-I ,0 AHOUNT PAID TOTAL TAXDRID!T IALANDI OP TAX DUI INTIRI8T AND PIN. TOTAL DUI M %F PAID AFTBM DATI INDICATID, IBB MaVIRII FOR CALCULATION OF ADDITIONAL %NTIRBST. '* UNU' II U~ m.t" AONES A NOTII To in.~re proplr oredit to ~our eOOQunt, ,Ubeit, tho ~er portipn of thie for. with ~our te~ pe~nt. 693,905.80 .00 .00 101,955.0~ 101,91ll1.04 103,097.6B l,1'14.61CR .00 I,144.61CR IF TOTAL DUE 18 LB8B THAN H. NC PAYHEllt ts RBllUlRED. IF TOTAL DUB 18 REFLECTEO AB A "CRIon" ICRI. VOU HAV 8B DUE A REFUND, BBE REVERBE SIDE OF THIS FOR" FCR INBTRUCTIONs.1 ~IOf "n"' . " ...... ,. .....-.... ~"."" '" .. .. -'- .. ..... ,. .., ..... .. ".. t1& P," '.ot~Dn 91lta), ._, .... .._ ..... .. ... .... .. ..." .... 0.' .-' .. ,. ~"'" ..."" .''''' · ... rlyerlll- .'da, _, ~"". oh'o~ or .onov crdOr Plv.bl' 10' ReOXSTeR OF "X~~S, ^OeNT. ..~ .... . .... . . ~ ..... .. . ....... . _,.... . ..."..... .., .'" . o~.'-" '-"'" .. .,.. ,,,. ,.,. """ ..' "..,.. .. ..""" .. '" ."". . ,. .."", . ., '" ..... U"- "...,. "".. ..,... -,-" ".... ...d. ..... -.... .... .."., ln p.....vlvonl. l_IOO_18I.20BO, 0.1.10' p.nn,vIV.nt. Ino ~t\hln 100.I'I\.rrhbUr. .r.. 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Icr 1911 InroU.n 1991 "" .. \ V..r tnt.r..t Ratl Olnv tnt.r..t Flotor v..r tnt.te.t R"i' O.UV tnter.,t rlotor - - - - - 1981 lOX .OOU~I 19a1 'IX ,0001.1 1911 16X .000~n 19a1'l991 UYo ' .000191 19&~ U~ ,000101 1991 9X ,00021\7 19&6 IJX .000lB6 199I'I99~ 7Y. .000191 1986 lOX ,00011' 1991'1991 'X ,000l~7 ..-lM:lr..t 'I olloulittd II fotlowS' _, . ....... OW ,~ ....". -- OW ~"..,"~... · ..." ,..- ,- ..... ..,. ,....,..... '",........ ."...' .", ,........ ,",.., .,,,,.,... - .,.". ".,.., bOvond thO ..t. of In. ........nl, If p.voonl I' .... Il\or Ih. Inl"..1 oo..utollon .,to .h.'" on 11\1 ' 1\0\1'" ,.IUllon.1 lnlar..1 .....1 bl ..IOUII\'" PRH~LIV' IIIlRIl2111 PAVlEHTI DotOOh IhI tOP p.rtl.n CI Ihl. H.II.. end .~II .llh vour pev.onl oed. p.vobl. I..Iho~'" ~ oddr... pr'nlOld ot\ tho royerH .loll. ._ If. R1lIlIlJllT DIlO~IICHT ..... oIlool< .or -v ~r"'r p.vobl. tol ftBGI,TBft Of WILLO, .AGBMT. __ If HOH-ltlleIIllHT O~OlIlJllT ..... chMk cr oonov or...r p.vobl. tel DotIHONWBALTH Of PBNNaVLVANIA. lItIfUHllICAlI ~'r.11Ild .1 . I.. .r,dll, IIhloh .11 nal "quIII.d on lho to. A.lurn, PlV b. r",ullted bV ......I.tl~ OIl -Af>pll..\l~ lOr. Atl\ll1C! Cl p"""ylyOlll. lflh8rlt..... end 'pt.t. TIo.- IAKY-II'I). ~1l..t1on..,'ro .y.lhlll. .1 lho Dfflc. '.1 lho A.ahl.r .1 NIlIO, .ny .f tho as AlY,",", DI.lrl.t Dfflc" .,. Iroo lhO Doper_I'. 14-\1oUr OIl....rl~ ..ryl" nuoI!er. f.,. f',p' orderl~j In p.nn.vlyonl. 1-100-101-1010, .11101... P...,.yIV..l. end .llhln 100.1 H.rrl.burl .r" (717) 7e7-e094, TDOI 17171 77'-11&1 lHo.rloa lopelr~ only). AIPLV TO. Queltlonl rl.arding .rror'oont~lnJd on thl, notle. Ihould bl Iddr....d tOI PA Dip.rtllnt of R.v.nu., aur.au .1 Indlylduol T...., ~TTHI P..t A.......nl A,YI," Unit. D.pl. la060l, Horrl.burl' p~ 17111-0001, phonO, (717) 787-0101. DlaOOUllT I If ..v I.. duo hp.ld .lthln Ihr.. Ul o.lender ..nlh. .lIer tho .....dent.. dIPtn, .lIy. ",r..nl (I~) dllOount 'f tho I.. p,ldl..IIOWOld. f'llHALTYI Tho IIX I.M .....ty non"p.rtl.lp.tl.n p.n.lly I. oClPulad on lho t.I.1 of Ih. t.. end Inl.re.1 .'.....d, end nol p.ld blfare 'JM'lu.r~ 11; 1996, thl flr.t d.~ ,UII" thl end of thl '1M MMltV ~rlod. IHTBItllIT I Inter..1 h oh....d bOillhnlnl Mllh 11,,1 d.y .1 dlllnau.n.y, or nlito (9) .onlh. end on. 111 d'V frop Ih. d.l. Cf doIIlh, t. thod.t. 01 p....nl, T.... .hloh b.C'" d,llnqu.nl ""f.rn Jonuory 1, 1911 "".r lnt.r..1 '1 thO r.l. 01 .1. IOXI p.~oont P.r """"" o.loul.t.d .1 . d.lly r.l. 01 .000104. ~ll t.... _hloh blO'" d.'1~nt on end .11.r Jenu.r~ 1; l'.t~111 b_.r lnter..t It . r.t."hl~h will varvfro. aellnd'" v..r to allendlr ~..r with thlt rlt. onnounood bY tho p~ beporl..nl 01 A.yonuo. Tho' ",pllcobl. Inloro.t "t.. I.r ,1981 l~rOU8h 1"1 er.. Vur Interllt Rltl P.l1y tnt.r..t ~Iotor V.I,. tnt.rut Rita D.lly Inl'r..1 fcOlor - 1911 IO~ .06O"e 1911 9X ,000147 1911 lOX .000411 'gel-1991 II~ .ooom 1914 m ,000101 1991 9X ,000147 19'- IIll .000181 1991-1994 7X .000191 1981 lOX ,000174 19~B"19ge 9X ,OQ0I47 ""lnt'rl.t I. o.loul.t.d .. ~.II"" IHTlM88T . aALAHCB OP TA~ U~rAXD K HUHBaR OF DAYS OBLIHQUBHT ~ OAILY IHTIMBlT FAatOR --~v Hollo. I.,uod .11.r lho t.. heo.... dollnqutnl MIll r'II..t.. Int.r'.1 ..Icul.llon to lllloonlll) do., boycnd tho dot. 01 Ihe ...........1, If p.y..nt II ..de .fter In. lnlor..1 cooput.Uon d.tlo ."""" on lhO HoII.., Oddltlbh.1 lnl.r"1 ...1 b. o.l.ul'l.d,