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TOt!UPLICATIi BY PHOTOSTAT OR PHOTOGRAPH.
OOMMONWUAL HI or f1UNNBYI,VANIA
IJllflAI1TMf;NT or IIf;Al.TIl VI'IAI,III!00I11J8
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CF.:RT. NO. 3 65"78 5 8
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Nama Of Decodont _~~_~_ Robll;,t..
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,,_..Landia.____~n- ,.
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Sox ~..MJi;J,Jli__----'-'" Soolnl (;OQUlity No. ..J, U~:.a.1~Ji~lig,
Date 01 Birth ._..!l-:.lte.::o..1!lA2 ,. 8lrlhplnc)(i .c._Ur.i,e.C\ta 1,.,P A, '
()lIto 01 !Joath__~e.::JiL--...."..
.,. ~------------'-'---~-'.--"--'--'--"'---~'-~--_.
Placo of Deeth ..s_{!.r.tl,~ 1 \'1 .H.9~p ~,1H!, L_... ,.,...._..C vmb.~ri~l1tL.. .. -. ,C, ar.Uilli__._........J'_I)n1l!lylv.illJIf\.
fM.,t, tk,,~ ' Ghlt>l( i~;I(_ IL-""'\ih n r,,~,\,h-i'
~ace~_ Wh i.:!&...,,__..Ocoupallol1 _ _.." ,b.a.il9):'.!3.!'.......... ...m" ArrnocJ ForC()8? (Yo~ or No) "..JiQ....-...-.---.....-
Dooodol1l's
Marital Status .JU..'iJu.QJuL-.... tvlllllIl'Ig Address T..~,2Q.Be~r.
tb"I",1
Inlormant ..__Per.rY-JLL.bllng..ta.~.. ,....._....,__...I'ul'lornl Dlmolor
Name and Address of .
Funoral Establlshmel;t .........Q.l!Yj.c;! .MYIU'.lLJIH1Jlrll.l.I;lQlll.lt.,.
.ar.:I.c;!g fl..6tL ,. ....NIlI'L.r.u.m.b.er.J..llnd....E.IL12Q7 0
,,'.eo.-! elf'--! 1.,-,,1) fil~\q
.DaV ~ Q ..M.. .M.Y.a ~._.-------......---. ,......-
Part I;
ImmedlHto Causo
N~WI)O l' t._P.A..:l.Z"Q14 ----...--------.,..---.....-....'
I
I Interval Between
: Onset and Death
I
I
.._.~ _~, ~ 'U_V_'~ _ ._,.~_~~__J~_________~
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Other Slgnlfloanl CondltiOllf\' I
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'_"'~" ". ._._~_..L---_,.-..,"--u_-. ___...
(a) _,_,,___,,~.c~te_._ QlY.<J9 a.!:gJ_I;l_~_..;afa.r.Q.:ti. QO
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(b)~-...,...~-...".._.-........-n _..'Om '.'.n".__....._. ---'
(ol._u,.._._-".,..----.-.........-~-...--..-.--..,...,...--..,,"-.''''
Part II;
~._._........___~__,_._"_~_.______"~__u~.____'~~,u_p~~~___+~_.,~ n.__._r'_~_._..."..____. -.- ,.
Mannor of Doath
Natural lOt
Accident rJ
Sulolde Ll
1)08011\)0 how injulY l1co\Irrod'
HOInlcido
POndlng IIWl'r:t1gallon
Could 110t bo Dotllllnlnod
[]
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,__,,_~__.__._____._..__...__._--'_"_u.._~.___.........__".....~...____--~~_._--~
,,__.~____ _",'~__'''''__ ,_.___..... .H.~~~~..~_<_..---'__.__________-.......__~~--' . .
Nama al1d Tille 01 Cartflor ,,__...__...,__L..._____._ .}1J.gh.a~~JNQl'!:';\\
.~'-_ "'.______._. Co r 0 n e r ........___
(M,D" D,O" Coronol, M,E,)
Address uu,__""""" __. ~~..u .4.Q.5}.~tl'..W_ay_.Q .!:'J'{B ,_M'!()b..~.!1nlce b \), r.9LPA.J 7 OEJ?_~_.._.______
This IS to clHtlfy that IIw Infolln(\\lon h011l glvQn Is oonnolly oopled Irol11 an orlgll1al oolllflcate
of deatll duly fllorlwlthlllo as Loonl Registrar. Tho ollylnal oOlllllcl1to, will be forwarded to the
State Vital RaclHcls Oflloe for permanont fllln[1~ ~ c;) / ~
__ ..tk("Il tdu..,J,. 2, """~.__.. 50~455
r'~' ',1",1"1,1" II n,\tr!dtl(l
01 Barnett St,. New Bloomfield t PA 17068
"H~ 1 0....1' !)..c 7'1 ,,'_' on' , ".~U"U' ..~...,.,....-- ...-.. m_"_"_'~___~
\,JiTi."'nef",,~!n;rt<;(]tfrl,i' l' L!',",\ /,.-' ;f,,' C,\)' [I"II"l)!' r"M.~f'j[l
"" "''''''. ' ~~~~l~~", REV~1500 -'-'-~'5'-~';~i;i';"'_ S
r~' '11"')HM"t~'JlINavLVANlA INHE,. RITANCE TAX RETURN 1UllUfIWA-~''''''-''
Ilfl'A'lI/,'lIll or IInvntlun
1111'1 IRI)""I RESIDENT DECEDENT !)
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j I 1l;1'1I. tl'I,II; ~~li.Ti'R1TJJiij'J;lmm:llltll I ~,.. ~'lb;~ Nfl' '
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"._.__ ~._" ' T l".' ~'I ~ r.T 1 . RIIGI8TER OF WILLS
~ IXII,D,~illalRnlurll 0 l.6~ppltlmen\8IRltum o 3. Rlmeh1d1lRetumIOH.""".'"1111 UI
~ f~ 11 UllI,ilod fill"l. 0 ~I, FvtullIlnllmICompmml..II..ofjo....II.llln 0 0, FO<!.lIlftl\8\e TI' Retum R"'1ulrQ<j
ok,' U 1 R Doco".nl Dlod Tellel. iA\IIOMOl',~WlII 0 1"OlOldenIMlln\8lned I ~MI1'l TIUII\ffoohcon~'~ - 8. TD\8IHumbel of S.I, De""" 80111.
fl 1"1, n 1,II'oollon Plocondl i1eCQlvod [J 10 81'01J1I1 PDvelt1 Ol'll<lK II.. .",,,,_11.11,11 !OllHll DIU. to lax und" aoo 9\11 ^ll!"" IMI
i':,W.~lJiITlOH M.!l!! ~@ OOMI'LllTllb. ACL,OORnl8PONDIlNOII AND CO~~ID.~~t.~~.!:'l( INfORM~T'ON IHOULD BU DIRU 01
i\l1 (n 8\' . 22A ~hL1<ll, t Stroot
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~t, PA 17074
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a Rno IMllllc1lOnl on IlIver,uldo 100IppllOllblo plll<ln\eill, ,,, -.. "... .' . ". 'I
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n ChMIU,hlo end ooveOlmen\818IquO.lIIS,0 9\13 TnJI~ lor i<hk:l1 an eltlc\lOO to tal 1111 110\ ~~
100,10 ($chldlik1 J) .' , . .
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3 CI"lo~ Ilold COfllDrIIllon,pertn."lIlp or 801o.Ploprlelo"hlp
4. Mortg'lInl & Nolo. fllKJOlv,blo (Sot>.dvIeD)
5 CAlh, nnnk 0.1'011\8 & Mlteelloneoul Po"onol PropQr\y
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r, Jo'"II/ ()Nnod PlOpOf1y (8ot>edvle F)'
I IlIlof,Vlvol Trenlle" & MI.collaneovl HOn.Plobele Preper1Y
(8r,lIo<l1l10 0 Dr L)
8, Tol.1 OtOla Amla (10\81 Lln.1 h1)
II rUII",ol F..poIIIO. & ^~rnln~uallv. COlli (Scl1.dlll. Ii)
III DohL' oll)tlC<l1l01l1, Mo119ao. Llabllltiot, & Llenl (8c11lflvltll)
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Tllx PllVll1,nt. .UeI Credit.:
I. hK 0110 (POOl t 1.1110 16)
2; Crltdlla/raymonll
A, Spoulol povorty C,odll
B, PIlar Poymonll
C DI.coUnl .
3, 11I11I01i'Pa""lIy II oppllolblo
(l,llIln'a.1
e,I'llIally
..--------......-----.-.....-.,--.-<".
ISt1lh ~ {u,b70
(1)
Total Credll' (A + a + C) (2)
t
(3)
(~)
(~)
(OA)
-
6,
..."...''''.IT''ry.'.
.'.' ;
~"I1""," l J, .,
pLllASll A 8 R POI G TI
BV PI..ACING AN "X" IN THIl APPROPRIATB RLOOK8
I. 'lid dOlledollt moke a trallsfor And: ' VBI No
n. . rOI"ln thn usa 01'1"0011\0 of thn nroper1y treneferred: ""'"'''',"U.'''''''II""""""",i''''''lIll''''''''''' ~ ~
~~. ':~:~:~ ~\~a~~:~I~~\~~e:~:~~n~~~, ~~~~~~ ,:,~~, ~~:~, ,~;.:,~,~,~~; ,t,~~~~,~;,~~~~ ,~~, ~~~ .I,~,~~,'~~:,::: :,:::::::::::: "
d, 10,,"IV" the promlRo for IIfo or ollilA! pAymellle, benontB Dr oare? """"'"''''''''''''t'''''''''''''''''
? I, <lonlll O''''IIIIOd Oil or hnrOlo f),,('olllhor 12. 1082, did decedent wllllln two yearl
1',,,<:",\1110 oIOAl1i 1I0llRror prOpllltv wllhout recelvlllg adnqunte conelderallon? If deeth ooourred
:11101 (')coomhe/ I?, 1002, did rlu<:ndnnlUnr1lrer properly wllhln ol1e year or deell) wllhDut
, pr;nlvh IU nduqunln (:ollshlof ntlon? ,,,'" ~","" '"~III'''h''''' "."" "...." '1""" ",,,,,,,',.,... I, ,,"'" ";1'''''''''';'' (:J
n, I lid dllt:odonl own on "In lillOI fm" (lr pAvable upon deolh benk ftOcount or eeourlly
~ : 'JIIC\'I~::;n'd~;\~~~~:;;' i;;di~j;j;;~'1 ';~'il';~,~~';,'i ;~'~~~~;;i:' ~;;~~ii~: '~; '~I;;~;'h~h:P~'~'b'~'i~' '~;~~~rt~1:::: 8
[I'
B
If' Till! ^NSweR TO ANV 01' TH~ AROVI! QUB8TIONa 18 V1l8, "
VQU MUSTCOMI'LBTe BCIIIlOULI! . ANO PILIlIT All PART 0 THI!RllTURN '
,""mrl\1ro118f'nm;_'ftrt ' " ,,' " , '" ,......".-
7 J I' f,; ~1111 0 (a) (1 1) ,(I)provldacl for Ihe reduellor\' b the I~K rate ImpolBd on I e n,el velua or trnnlfete to or for the Ule uf Ihe
BIII"'lvl"g IIpOIlAn hom 0% 10 3% for dRlos 01 rJnnth 011 Dr nn,r July 1, 1904 ~nd barore,Jnnuary 1. 1090,
"
770 1',13 BOlIO (B) ,(1,1) (II) provided for 1I1P roduollon ollile r~te Impaled on thenel value of !tanlrere to Dr ror the uee orll\~ 'lItvlv"'~;
RpOllOO hom 3% to O%'lor detos or donlh on or nllot Januaty 1, 190o"Tha ItaMelLQU.llilUuJDIl.Ia tronsfer 10 a surviving ~pOUBe
hllll) III" l111d Iho ~Inlulo'y requlremenls fill' cII8cloilure of alletl Ind nllng alaK reMI1 are 11111 nppll08ble avel1 If the ,urvlvlI'g 'pOll~O
IA II," ,,"ly 11l111nnclo'y,
fOlltlATF.8 01' DeATH ON OR APTeR JANUARV 1, 18ea" Plaale'ilnswer IhB fdllDwlng que8Uonby plaolng In 'K".Inlhe
8PII/npllntonflnca,
Old Ihe dodildonl,or.al' alruat or .hnllllr nrrll1gBrnel1t whloh Is sole'y forth. .urvlYll1g .pou.... b,"e", for his or lIar .nlll.
IIfntllno? VelD 'No 0 " '
If YOllnMWOlOd YOI to the ebOVB queellr;m, tha leK DI1 Ih' trult or slmller errengement Ie poatpol1ed uhtll the deelh 01 Iho eoeood
ll""Hn, AI which time It will be fully tOKable ot tho r\lle(I)IPPIl~ble to the remainder benenolaty(l.I). Enter the VlluB of 11'0 IllItt ('11
SthOdulB J, Part II, In, order tD remove It from the oaloule\lon of Ihel.x dUe In Ihll ',8\at,. Vou may wish 10 flIe Sohedulll 0 10 o,dAl to
n\n~o Iho olecllon aVlllable under SlIo\loI19113.lf\hG ellollon Is mad', the trult,or.elmllllr afTllngemal1l II laKed In thB e.lsle of Iho
nl~' ,lnnndont Ipouen, tM porllonol \I)B 11\111 or ell\1l1er errangemenl whloh bel1l1fl11 thl Iurvlvlng apouee IsteKed et the relo tnx rnle,
nlHllhn romnlt1da,r II taKod al tha lale(s) apptlcAhle to the remelnder benenclaty(Ie8), If yo~ chaole 10 ri1\1ke Ihe elenlloo, yeu mURt
nl'n'h n'lhadule 0 to I tlmoly.flIed taK return, 810llg wllh Bohedule(s) K and/or M In order 10 Ihow tha epportlonment of the 'ruM or
,ll1IlInr orrnflyernenl batwaen the eurvlvlng epoil~eand the rBmalhdor bBnBnolety(III),
'" '," I" I I I, jJ~~1
~~~
5CH.DULI H
PUNIRALllXPllNUS,
APMINISTRATlVll COSTS AND
MISCILLANeOUS IXPINSlS
tOM,MlI1W(AIIIl or flfWUnYMH^
II UII ~I,^I iCf'^1( "ltuftll
Ml\1Il1111 prttO tll
H\'III ~'()jf~"" ""~"..._.,. '-~'='=~="i=.="'~"-'-
.-
i:O;; .-...
II, h '1'1: 1" 'tnlllfl
ITEM
NUMtlf.R
A.
1.
2.
B.
1.
2.
3.
4,
"C.
1.
2,
3,
4,
'5,
6,
7,
D.
.---' "' '." ,--~ -~~......-..,--
D8SCRIPTION
._ . ____..___.'_. __~__."~.. ,_~,__.......___~___~._._....._ _~_~_ ...._u ~___-_. ....,.
AMOUNT
Pvnoral bpon.."
~ljom Jhvrn1. J h1l1
'J1:l1ll'3tat:l
Admlnl.'rcltlvo Co.,"
Por.oMI Roprolonlallvo Coml11l11lonl
$oclal Socurlty Nvmbor 01 POrlonal ReprolonlDllvo. .
199B
Yoar Commllllonl paid ..-.-.......-,-'__--
201
Allorney Peol
Fomlly'f.xompllon
Clolmant _ Relallonlhlp
Addrell 0' Claimant at decodenl'l death
5treol AddrOlI
City ____.____5tolo
Probate Fool
MI.eonanoov. hpo"....
IJl3tote N:ltice w Qlli;mr:tml law JOJmU.
lll3tJ1te N:ltice - &:,lcim.J,
PhvU !1xll1t:e en! mf,oo:>.l.ll1lt.n~~
.'
1I11"fro1;\11'r.oc~r!n! or Tv.p."w__""'_'
,,21-9.7:<<179
5,TI'"I'()
1. ,(rom
- 60 - 2396
925.69
3,455.21
0.00
Zip Code
oo.ro
ro,ro
81. 65
2!XJ.ro
'...-.-."---.....m....-r ' , ,-.--, .-.----".
__ T~TAL(AIID entor oh line 9, Recapltulallonl $ 11 6
(II mal' .poco II noodod, In.ort' additional .h.o" o'lamo 11.0.)
"
AFFmA VI'l' OF IIJnIlSON,\ I. mCPIll~t, 1,:N'IWl'l \' I'.
a,,"nW nrl'.rry, "'
roO ..,..Jh~t;'!.rh..L.lJJll~...............-................_...u- _., ......._ ......'..... _......~_................. _."~, ,.............. .2.'.....;.~..... ...H........' ,-..
~1xu~\11 '
AJmlnlllrnl ar, ,or Ihe 1ll,lalt or" l~l!It, l~!!!!!J;I,__"_"__d_-""----"--'''-
,'''~'Qlld,lItlnl dulY .tMl111 _ agoDrdlnl 10 law, d'rOIl,al111 OilY Lhnllhu,lLulI\H nppunrllltlll1
Ihllll1vlnlo." and Appralllmllllllloludl all or Iho porlonn a..oll whu\'uyUl' 011111110 nl\lI 1111111' Iho 1'11111
o,lalt In I\l.e Cummonwl.\lh or I'tnnlylVPlIla or lalll d.oodlnlllhnllhu vlI\lInUolI p\l\~u oPP".Hu Illlch
110m or lald Inv.n\Qry rlpm.nll II,. flilr valli' .. nf Ih. d.l. of Ihe dOCOl\OIlI" IIOlllh\lIl\l\ Ihnlllocllllul\\
own.d \\0 rul ,,101' ollllldl Ihl OommDnWII\llh IIf l'.nnlylvnl\ln IlxellpL Ihnl whli!h npponl" III n
memorandum III Iho .nd nr Ihl hw.nwry. .
or _, A.n. 10_ -
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lOUU IU41 I~JlllU ,(1I11J1~Gd...1 'pINUlOOp t~m,'Wll1fiU'lltJ fo'i'N- 'ju "1"1
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lIPPtdeal forth. J!111tat:e of! Roberti I,tlndiB
Ttuok Col1eotion
10 Matdhnolj: Toy..
R C Moon
flheU Tanker
2 1\HF
Yellow
f>epBi
name Commissio.n
1\medgtlB
RI\I:
tlPA
2 Wal.-Mart
3 ~leifl
nig Peterbi1t:
Co rve He
Shur. F'ine
F're i th t: I,i ner
"DM
Navajo
Hall 'iii
Carolina Pup
J>l'lO IND.
Allied Fre,iq:'lt:
Pitt Ohio
Ootober (.3, ]qq7
O.o.n.
StateFarin Show
2 Hanover:'
camel liJl<preu
15 ,00
20,00
15,00
40,00
20.00
25.00
40.00
15.00
20.00
35.00
40.00
50.00
100.00
15.00
20.00
25.00
25.00
15.00
25.00
25.00
35.00
20,00
15.00
20.00
60,00
40.00
50'.00
~~ .' ',-'
/,:;..,)//-,5-
OOHHONWIALTH OF PINNSYLVANIA
DIPARTHINT OF RIVINUI
NOTICE OF INHERITANCE TAX
APPRAI8E"ENT, ALLOWANCE OR DI8ALLOWANCE
OF DEDUCTION8 AND A88ESS"ENT OF TAX
C~....
*'
BURBAU OF INDIVIDUAL TAMES
IHltERITA'lCE lAM PIVlall1lt
P1!Pl, ra060 I
1\"1II1BlURa, PA l7It6-060l
UY-IUPU'" c".trI
ALLEN E HENCH
224 MARKET liT
NEWPORT
DATI
ISTATI OF
DA'l'1 OF DIATH
FILl NUHIIR
OOUNTY
AON
09-2S-1998
LANDIS
10-18-1997
2197-0879
CUMBERLAND
101
AMallnt R_eMUt~d
RDBERT
L
PA 17074
MAKI OHIOK PAYAILI AND RIHIT PAYHINT Tal
REGISTER OF W~LLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA ..17013
OUT ALONG THIS LINI ~. RITAIN LOWIR PORTION FOR YOUR RIOORDS ~
RW:liW-ij(-~~p-r&':n,)"-RlilfienS~-'YN'Ai. JffUirlSi-Y'\X-Aif~R;i'fIiWilf,--~t'L'll'Q7iilcii-b1i~-----'-"""'--
DzsA~LOWANCI OF DIDUOTION8 AND ASSIssHINT OF TAX
ISTATI OP LANDIS ROBERT L PILI NO. 21 97-0879 AOM 101 DATI 09-28-1998
TAM RETURN liAs' ( ) ACCEPTED AS FUED << x) CHANOED SEI! AlTACHED NonlfE
RI81RVATION OONOIRNING PUTURI INTIRIST - 811 RIVIRsI '
APPRAISID VALUI OP'RItURN IABlD ONI ORIGINAL'RI!TURN
1. Reel Iotete (Sahedule A)
8. stooke end 8and. (8ohedule a)
8. Claeel~ Heldatoak/P.rtner.hip Interlet (sahedul. C)
4. "artSI.le/Natee R.aeiveble ISahldule P)
8. Ceeh/aenk Depallte/"iea. Pereanel Frapert~ ISohldul, E)
6. Jointl~ Owned Prapert~ 180hedule F)
7. Tren.fer. 180hedul. 0)
8. Totel A..lt.
11)
,tel
(8)
(4)
18)
(6)
l7)
.00
.00
.00
.00
18,541.18
lJOOO.OO
.00
(8)
NOTE, To In.ure proper
oredit to ~aur lacount,
.ubllit the upper portion
of thle for. with ~oUr
taM pe~Ment.
19,541.78
APPROVID DIDUOTIONS AND IXIMPTION81
9. Funerel EMpenee./AdM. Co.t.I"I.o. EMpln.I' (sohldul1 HI (91
10. Oebte/"ort.I.1 Ll,biUUu/Liene ISahedullll 110) 28.346.67
11. Totel DeduoUon. (11) !l.Q. RI P AI'
12. Net Vilu, of T'M R.turn (le) 19 ,971. 04-
18. Ch,rit.blI/GoV,rnM,ntel aeque.t., Non-ellotld 9118 Tru.t. (Sohedule J) (18) .00
14. . N't V'lue of Bltetl Subjlat to n'M (14) 19 ,'~71. 04-
NOTII If In .......m.nt WI' t..u.d pr.v10u.1Y, l1n.. 14, 18 .n..d/or 16, 17 end 18. w111
r.fl.ot f~gurl' thet inolude the totl1 of ~ rl~urn' .......d to dlt..
AS81SSMINT OP TAXI
18. AMount of Linl 14 et,Spou..l ret, (18)
16. AMount of Une 14 tIM,bl, ,t L ine'l/Cle.. A r.te 116)
17. AMount of ~ine 14 teMeble et Collltlrll/CI'ee ar,t, 117)
la. Prlno!p,l T'M,pue
TAX ORIDITSI
P~YHfiHT
DATB
11 ,167.lS
.00 ~ .00.
.00 M .06.
1,000.00 M .15.
1l8)
.00
.00
160.00
lSO.OO
RBcnPT
NU"8eR
DISCOUNT (+ I
INTBRBaT/PBN PAID (-)
A"OUNT PAID
INTeREST IS CHARGED THROUGH 10"13"1998
AT THE RATES APPLICABLe AS ,OUTLINED ON THE
REVERSE SIDE OF THIS FORM
TOTAL TAXORIDIT
IALANo1llDP TAX DUI
INTIRIST AND PIN.
TOTAL DUI
.00
150.00
3.22
183.22
. IF PAID AFTBR DATE INDICATED, SEE REveRse
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS Less THAN .1, NO PAYHENT IS REQUIReD.
IF TOTAL DUS 18 REFLECTED AS A "cRSOn" (CR) I yOU HAY ae DUE
A REFUND. SSS RSVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.)
R88ERVAnot41 E,t,t" of dlotdentl d~l"a on qr blfore D,cublr U, 1982 .... if any future lntlr-..t In tht ..tate 11 trMl.farr.d
In,~o.....lnn or tnJoVl.nt to Cl.'. . (0011at.rll1 bln'flolarl.. of thl dlc.dent 'ftlr the 'MPJrltloo of any ..ta, ~. for
llf. or for v..re, the CQtllomt,.Uh hlrtbV' IMPr...av r...ry.. t1M1 deht to .,.~r.J.. cmd ....u tnn,'lr lnhtrltlOQI TlNII
at thl, law,ul 018" D (oolhtlri') rat. on any .uch future lnterllt,
PIJR1l0SU ~F
HOTlC~1
PAYItEHT,
REFUHP (CR),
OlJl!CTlDH"
To fUlfill tht rlqulre.lnh of boUon 1!1~O of tht InherUlnnt and btah-l"lC Aot, Aot21 af 199&, (72 P...
"oUon 9IAO),
Dtboh thCt top parHan of tllb HoUo. and lubllllt ..lth !iOU!" pln,.."t to tht R..lIte,. 0' N11l1 printed on tht r.v.r....d.,
--H.k. cn.ck or .on.y ordlr p.,"bl" tOI RBOXSTER OF MILLS, AGENT '
A r.flMld of . hI( or.dlt, Mllloh WI' not r,qutlt.d em tht TftM R.turn, ..y ill re~..t.tf bv OOlPleUnll IIf1 "AppUuUon
for R.f~ of PeM.Yivanl_ lnherltanol end 8uat. TIM'" UUiy..nUl. AppUOdUcm. art Iv.Ualll. It the Offlol
of th. R'oht,r of Wl1lt, an~ of th. 25 Rev.nue Dhtrlot Dlfto.., or by o.Uln~ th.,plolal 14"hour.
an.w,rlnll .ervlo, nulb.r. for for.. ord.rinQ! In P.nn,vlv.nln 1"800"561-2050, out.ld. Plnn'vlvanl. .nd
within lce'l H.rrlob"ro lrol (717) 767"6094, TPPI (717) n2-U&E OIllrlno 1'~llrld OnlY).
~v plrtv In lnter..t not .,tlafl.d with the .ppral....nt"allowQno. or di..lloN'no. of dtduotlon" or ........"t
of tllM (Including dhQouht or Intert.U a. .hown on thlt HoUoe lIIu,t o!Jjeot within .hctv (60) daY' of r.oelpt of
Ihlo Holloo bY'
."wrltten prot..t to the PA DIPart.,nt of Rty.nUI, ~oard of App.al., D.pt, 251021, Harrl.burll, PA \1121"lnal,
.....l.otlon to hitVI thl ..ttlr deterat"ed at audit of thl aooount of the p.rlon.l repr~..nt.t1ve, OR
.....Pp..I to thl Orphanl' tourt.
DR
ADMIH
ISIRATlYE
CORRECTlONSI I'Iotua1 trror. ,tthClovored on thit ........nt IIhould bo .ddr....d In ..rltlng tOI PA DIPtlnt..nt of R,v.nu.,
lur..u Qf Indlvldltll hM.', AnNI po.t A.......nt R.VI..I Unit; n.pt. ea0601,llarrltburu, J'A 11128"0601
Phon.'(7l1) 7a1-6&01, SI. pilla B of the booklet "In.truotlont for Inhlrltano. Tax R,turn for a R..ldent
Dto.d.ht" (RKV"1501) for an o~p1inatlon of ad.lhl.tr.tlv.l~ Qorruotab11 Irr~rl.
If .nv tlM dUt .. paid within thr.. U) oalendar eonth. after thl dloed.nt"1 dr..th,1 fly. p.roent UUO dhoo""t of
1110 tl. plld to 'Uo.ld,
PIStOURII
I'tiHUTYI
lHT~RBSTI
Th. 1'~ tIM.-n..t~ non"partlolpltlon p.n.lt~ I, oo.put.d on thl total of the taM .nd lntere.t .......d,.nd not;
p.ld b.for. JitlU"r~ II, 1996. the flr.t dav aftlr' thl Ind 01 the tlM .en..tv plrlod.Thll non-parthd~.t1on
p'n.lt~ i. epp..libl. In thl .... .enn.r and In th. tltl "'.. U... period a,YOU woUld tlpplel thl ta~ and Intlrl.t
thlth.. bltn .......d e. Indloahd on thlt noUol.
tnt.rllt' I. ;ohtr...d blllinnlnll with f Ir.t ,day of dll inqu,nov, or nlnl (9) .emthl and on. C 1) day fro. thl dltl of
d.ath, tCl thl dati of pay...nt. ,TaMil whloh bloit.. d.lInqu.nt before Januarv 1, 1982 b.ar Intere,t It tht rete of
.IM (6X) p.rol"t plr InnuM oitloUl.tld at a ddllv rate pf .00016~. All ta~" whlo~ bloa.t d.linqulnt on end aft.r
Janu.r~,1. 1912 will bear Inter..t at a rate whloh wlll.var~ fro. o.llnder ~.ar to o.lendar YI.rwlth thit rlt.
II'1nounold by thl PA n.part..nt of R.v.nuI. Thl .pplloabl. Intir..t rat.. for 198t. throuOh U9a 'erl!
'tUI: Intl....t Ratt ballv Int.rl.t Faotor xur Int,re.t Rntl ballv Int.r.,t_~.otor
1982 fOX .0001l48 1967 9X .0001A7
ms 16X ,000418 1966-\901 llX .000101
19M UX ,000SOI 1992 9X ,000lA7
198a ISX ,0008a6 1'/98"1994 7X .000192
1960 lOX .000274 1995-1990 9~ .0002A7
~.tntir..t I. blloulettd a. f~lloW'1
~NTERB~T . BALANCE OF TAX VNPAIO M NUKBER OF DAYS DELINQUENT M DAI~Y XNTB"EST FADTOR
nAny Hotlct lllu.d aft.r thl tD~ bloo... dellnqu.nt will refleot en Interut CI.loulaUon tb Uftitn (15) diV'
blvond thi.dati of the ........nt, tf Ply..nt \, ..d. aft.r thl Inter..t co~ut.tton dati thOwn on thl
HoUcl; additional Int.r..t lIIult b. oelaulnttd.
PAV"JHI'
,.Ii
D,tloh the 'op PQrtl~n of thi, H~tlo. and lublSt wIth vour p~v..nt ..de p.v.bl.'t~ thi n.~' ,nd ,ddr.I'
printed on thl rIVlr.. 11d1i
.. H.k. oh.ok Dr 'Dn.v Drd.r p.v.bh tal RSOISTSR OF WILLS, A~SNT.
"SF~D (r~)1 A r.fund of a ,,"'or.d.t, ~hloh wa. not r.qu.tted on thl Tew R,turn, lav bl r.quI.ted bV cOIPilting ~n
"APplloltion for R,fund of Plnn,vivanla Inh,ritanol endeltet_ Taw" tREVM1S1a), ApPlloatlon. ar. .~.11.bl. It
the Offl01 of thlAIgllt,r of NUb, tnv of thl 13 RevenUt blatrhtt OfUc.. or frol thl DIPart.."t', IIl.hour
'1'1''''1'' Ing- ..rvlo. nu-b.t' for for.. .-ord.r lnal tn Plnn'viyanl. 1.800-'62"2060, out, Ide .plnn.vIV,"l,
IndwJthln 10011 H.rrhburg '1"" (717) 767"11094, TbPI (117) -772-2282 (HllrlnD taPllr,d only),
RJPLV
TO'
Pl~ellUHl'
PJRALTY'
lRTJRUT,
Queltlonl r'Qardln~ error. oontaln.don this not'08 .hauld bl addr....d tOI PA a.part..nt of Rlvlnuli,.ur.aU
of Individual TaHII, AnNI po.t A.......nt Rlviltw Unit, O,pt, 5!80601, Harrhbura, PA .,17128"0601, Phone
(717) 767-aaOJ,
If any taM du. I, paid, within thr.. (5) oai'nd~r .onthl afttr the deoedentl, dlath, . five ptrOlnt (8~) dllcount
of thl taM'paid 1. al10w,d.
Tht laX taM ..n.lt~ non-partioipation penalty II oo.putldon the total of the taM Ind lnt.r..t .......d, and not
paid b'forl Janulry ta, 1996, thl Brit dl~ afttr th.- end of the taM Dnuh' p,ripd. ;1 '
Int8t,.t i. charg.d bag Inning With flrlt dav of deUnqu',nov"cr "_In. (9) lIIonth..nd on. (1) day frOll tt,. date of
dilth; tCl the' dati of pay..."t. rlH..whloh blljla.e dtllnqu.nt beforit Janulty I, 1982 btlrlnt'rllt It tha rlta of
.I~ (6X) PlrOtnt per tnnUM ulloulattd at a dailY rat. of ,OOOI6~. All tiMe. whioh blo.",dll1nqUlnt on tnd tfttr
J"lU..r~ 1, 1981 .,111 btlr Jnt.re.t at a rlt. whJoh wUJvlryfrOM oalendlr ~..r to oihndlr"v..r with thd rate
tnOounotd bY thtl PA Olp."t.."t of R.Y,nu.. Th. Ipplloablt lnter..t rate. for 1982 through 1999 arll
V'lr Inl.r..t R.le ;, nalh lntlr..t hotor V.ar lnter..t Rite Oallv lntera.t faotor
- -
lOSE EO~ . ODOa~a 1961.1~0l 1I~ ,000501
19B5 16~ .OOO~~S 1992 9~ .000l~7
1~6~ m .000101 1995-I~~~ 7~ ,00019E
I~sa U~ ,0005ao 199a-I996 ~~ .0002~7
19S6 10~ .00027~ I~~~ 7~ ,000192
1917 O~ .GOOE~7 '
,R~lntlra.t I, a.lou,.tad It fOl\rWll NU"8BR OF DAYS DBLIHQUSH'
INTIRBST . 8ALA DB OF TAH HPAID M M 'DAILY INT8RBST FACTOR
..AnYHQtloa 1..Uldlftlr thl tlW baoo.a. d,1Inqu.nt will r'fleo\ an Int.rlit allout.tlch to flftean (15) diY'
beYond thl dllJ't of the ........nt. U plw.ent 11 ..de after thl Jntlr...t oD..,uhtlon data Ihown on th.
Hatlol, IIddlt10nll Jntlr..t _lilt ba aalouhttdi '
Proof Of Notice
''"1 c....,. ...1
~'~" ,I~h, ~1l1iF';l, . '" , , , , , , , , ,', , ,bolnrduly 'Wllr'l, ,ar.that hnerved noUotlotwhJoh Ihelorerolnr
"I1lKhlbll A" Ie a true ~~d ~orraot oopr lorether wllh a oopy 01 (ho aocoun( and alatemoM 01 propoa..d dlatrlbuUQn. ..tpllowlI
(A) By h.ndlngsueh notlen to the tollowlng ponons peuonally on the tollowlng datil retpeellvolYI
~:xmt: ....
(B) Bym.lllng such notlcea at the ~ PI" 1',0" to tho tollowlng penons at tho follow.
Ing addr...oa on tho fol\owlng datu rnpoellvely I
1, l\m:y E. llnlis. of I~. p, Ill, IhK 219A, MLl1.erat<M1, PA 17m2 .
2. RaMam G, Innis o~ R. P,' .//1,' IhK 3M, ltxx:nl.1tY, L PA 16695
3. loIldml R. J.m:Iie of \l.a,\t:a 1/1, lbx 79, J.ealll3SV:iJ..J.e, MLsaia9iwi.39451
4. ~ 1st FOJ of P,O.lbx IIJ-VIPJl, Mlclmicslug PA 17055-<Xm
5. carlisle A.L.S. of 503 NJr\:h 21st St.l:oot, <l1rp HUl, PA 170lH!204
I.!
Swo,n and sublCrl~d betore mo, this
I I I I I . ,day of I ,. . . . . , . . . . I I I I II t 9 I . I I'
"j i,.tll 'It'tl ,. ..lllll.j. 1111' ,..,
Clork of thO Orphana' Court,
i if
II a.
:f :r< ~ ' .
, r
!~ II
I i \1 f
,
, r
, Ii
~ ,
,
ji ,
,
[ ,
l