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HomeMy WebLinkAbout97-00882 ',.. "'.. I eB.QQ.f..QE..Q.LA1M Maroh 04, 199B In the matter of the esteto of: RVAN BOBTICK Soolol SQourlty Number: 502.04.0116 Coss numbetl 21-1997.0882 Nature of olalm secured I unsecured Clelment: PNC Notlonel BanK In the amount ofl ~ $1,~9B,30 Acoount #1 410B127600600B33 AFFIDAVIT PNC National Bank on oath states thet the allegations In this claim are true, Signed and sworn to bafore me this .....Yth day of _March ' 193.t, 611alla A. I(uypqr: NotuIY Publlo .I,esldenl olTlppnc<uwo Counly, Indiana My Commlssloll Expires I~llbrumy :~7 1900 Signature of person algnlng for Claimant: Address of Clalmantl Attornay for Claimant: "CS.!a ~ 5~ "<t c'J ... <n t:,it 0.. ) 0 n ~5~ ) " f::J (:' f,j... li ~\:! (jl '1I n ~m! ~~l '1) \.,.0 ~ 8S PNC National Bal1k P.O, Box 460 Lafayette, IN 47902.0460 Jetnes A Gothard P,O. Box 469 Lafayette, IN 47902.0469 (3171 742-9066 Altorncyl.D.1231-79 ~. p.; ~,,;, .1 , ITV TIX Pllymlntl_n~ Credlt_, 1. Tax Duo (Pagsl "no 18) 2, Crlldl18/Poymont8 A. Spou891 PovSl1y Credit 8, Prior poymonl8 C.018count (1) o Tolal Credlll ( A + 8 + C ) (2) _ 3. 10lsrS8VPsnolly II sppllcabls 0.1"lorS81 . ~,psnolty Totallntors8VPsnalty ( 0 + F. ) (3) 4. If IIns 211 grsaler tllsn line 1 + IIns 3, enlsr Ihs dllleronce, This Illhs OVl!RPA YMl!NT.. Ohlck box on P.g11 Lln.1e to rsqueall refund (4) 6, If IInl1 + line 311 grsalsr IhM line 2, anler Ihe dlffersncs, T~I.118tItS TAX DUl!. (6) A. Entsr Ihslolsre81 00 Ihe IOJI dus. (6A) 8, Eolsr IholOIOI of Line 6 + SA, ThllII Ihe BALANOl! CUll, (6B) Make Check Pe abla to: REGISTER OP WILLS AGSNT P ASl! A SWBR THB FO 0 I CJ Q TIONS BY PLAOINCJ AN "X" IN THB APPROPRIATe BLOOKS 1, Old decedent make a Iranefer and: Yea a, ret,llln Ihe U$S or Income of the property tran$forredl""".""""",."."""""'"",,,,,,,,,,,,,,,,,,,,,,,,, ~ b, . retain Iherlght to dealgnate who shall use the propsrty trensferred pr Itllnooms; "."".,,,,,,,, o. retain a reversIonary IntI. reat: or "''''_;'''''' ,t "',,;,..iHi',,"" """"'"''1''' """""""""",,;,,,, i, Ij i ,t ""f' d, reoalve tho promlee forUfs of elthsr payments, benefits or oars? ",,"""""""'"'''''''''' " , """. 2. If dsath ooourred on or befors Deoembsr 12, 1982, did deosdsnt within two yeara prscedln9 death tranefer propsrty without reoelvlng adsquate oonslderatlon? If dealh ooourred after Deoembsr12, 1ge2, did dsoadenllrenafer propsrty wllhln one year of daath wlthoul receiving. adequate oonslderatlon?,'"''';''''''''' '" '''''''''''''''''''''lI''''''''';''''''''''''H '"'''''' "'"'''''' ,,', ""'" 0 3, Old deoedent own an 'In Irust for" or payeble upon death bank account or seourlty 4, ~tl~l~a~e~~~~~~~:~' I~di~id~'~'; ';~';I';~~;~'; '~'~~~~;;t:' ~~~~iiy :.~;' ~ih~~' ~~~~'~~~.;;~;; '~;~~~rty?:::: B o 1 o ~ IF THE ANSWER TO ANY OF THe ABOVE QUESTIONS IS YES, YOU MUST OOMPLI!TI! BCHl!DULE CJ AND FILl! IT AS PART OF THB RETURN 72 ,8, 91. e (e) (1.1) (I) provide for the reduotlon Of the tex rate mpoled on the net value Of tranefllrs to or for the ule 0 tha lurvlvlng SpbU88 from e% to 3% for 1I\11el of death,on or after Jyly 1, .1994 and before January 1, 19ge, 72 P,S, g911 e (a) (1,1) (II) provldlld for the rsduotlon of Ihe rate Impolad on the nst value of tranefllra to or for the uae of the surviving spOUla from 3% to 0% for datell of death on or aftsrJanuary 1,1996, The statuta d01l1 not e~emDI a,lransflr to a lurvlvlng spoule from tax, and ths etatutory rsqulremanta for dlsololurs of aesets and fillng,a tax rsturn are stili applloable evan If Ihe .urvlvlng epoule Is ths only benefiolary, FOR DATES OF D.I!ATH ON OR AFTER JANUARY 1,1888. Pleua answer the following qUeetlon by pleolng an 'K' In the appropriate apace, Old Ihs deolldsnt ore.te a Irust. .or11mJ.lat errangsment ~hloh III aolely for tha lurvlvlng .pouee'l bsneflt for hie or her enllre lifetime? Yea 0 No ~ If you answered yea to Ihe above question, the lllK on thet~uet or Ilmllar arrangsmentll poetponed until the daath of Ihe Illoond spouse. at which tlma It will bS fully taKllble at thll ralo(e) IlPplloabls to the remalndor bananclary(llls). enter tha value of Ihe trust on Schedule J, Part II, In ordsr to remova II from the Olllculatlon of the laK dua In thll 88tata, You may wish to fils Sohedule 0 In ordsr to maka the Illllollon avallabls undsr Seotlon 9113. If ths eleotlon II mede, tlie tru~.t or ,SI.mllar arrangement II taKed In the eet~te of,the firat deoedent spouae, tha portion of tha Irult or siMilar arrengemantwhloh bsnefits Ilia eurvlvlng epouse II taxed at Ihe zero tax rate, and the remalndar 18 ta~ed 8t the rate(a) applloablslo Ihe rem81ndsr bensnolary(lee). II you oho08e to make the eleotlon, You mUll attaoh Sohedule 0 to a tlmely.filed taK return, along with Sohsduls(l) K and/Or M In order to show the apportlonmant of the tru8.I or 81mllar arrangamont betwsan tha aurvlvlng spoule and the remainder bsnsficlary(lae), Dloceee of HEwTteburg fm Poet 0If1ce 80)( 3651 HwT1s1ug, Pemaylvanla 17100 . Offlc:e of Ccithdk: Cemeteries SAI..ES CONTRACT AND TEMPORARY BURIAL AOriEEMENT I. ..." , PArt! --/~/{:< ;~~~,:--'/ :.' I\L__...JrLlL Jf_-_.,; J _1". CUMUTlllW -' "., {....4 ,/j f -'.-) N ,_:/j _.__ 0, ___.~,,_......n___ SALUSMAN NO, _..n"'___'~ A/Nk PiN EASUMI!Nl NO, .u__.._._...___---:. AIR ' NAME~'(-{}~~:.i{. <-~-~:-'!.:~-~~~' ADDRESS...:L)'; 1/{.,5:/~'i,'(_' ,1__* _,,~.___n____ PIIONE ( ) (';"-:1/"";......-- _J ('''.1-1-1 ......... ~~ F '_' ,. 1._-,. !_rF._ .__ FAMILY PROTECTION / I '.- ....... lj / l{--'<j W CITY .-::.1"" r :k/,~i:i_:c.:h'i.;:.!:(_"___...__ ..._~_______aTATE__L:L___ZIP CODE IntormuntSllaCOI . . . . , '. @ . $--- 1. Prlco., . ,., . . . . . , , I , I . I . . , I , j , . I , . . I ,-) ,. ..f' $ I" (~I'U' rf" C:' -" t;,'-_'i(", ,('Y-- i I Ilron,o Momorlal~ . . . , . . @ SI,o $ ,1';';'3.,'0'-' ,"y:.l'~'/ 2,Oown Pnvmnnt , . , I , . . I . , , I I It' I fl' . I .,.,p)' 3, Unpnld Oolnncn (1.2) , t' , I , . , I . . . . , I , . . 4, Flnunco eha'ruo . I It. . . . . . . , , ; , , . . I I , , Found~lon'" I'" ,.", ,@ -$- 0, Dofurrod Poymont Amount (3+4) . , , , , , , . , . 6, Total Prlco (rf.4) , . , . , , " + , . . , . . , , , , , I IS?~i-:;: (~t') Burlnl Vaults . , , , , . , , . @ $ 7, AfllllllKlmnto Monthly Payment, , . . , , . . . , . 0, Numhor of Monthly Paymont. , . , , . . , . . . . . 0, Flllt Monthly pOYnlont Duo ""..,...... 10, Annual Poroontaoo RatQ . t' . , ,+,j . " I , , . . Crypt8pacot . ',' , , , , , . . @ $ Othor". III' I It' I t t. 1',,11" I" 'I $ 8001l0n ,,::~_J Lot c~);/j-" Grovols) ,(" Tormll COlh ':~'.- .~ .n ~)...';). ((J 90 DOYI Blook CrYI,t(l) Ooloollon mUlt bo mado within 30 dOYI or aomotory will moko oholoo, Inltollmant _ Tho flaymontls duo 011 tho doto Slotocl a\lovo <l11c1lllll'0l1l1llnlnll floym~JIlls on tho somu cloy of ollch SllCC(1I111111I1,nol1tll, _ Duyor may flropoy In <lclvanco tho 11I1I omOlll1t cillO Wltholll flol1<1llY <l11c1 will ho ol1titlod to a fllOfl(JI'tiol1olO rofund 01 tho unoorl1ocl flll0l100 charlJo, _ Upon dololllt In tho floymlll1t 01 OilY Il1sl<llll11lll1t clllO horlllll1dor for 0 p(JI'loclll1 oKCOSS 01 OlllJ hllndrlllltwonty (120) days, Soil or moy, ut Its opt 1011, void this OIlIIlOI1""lt oml IIlIIlII1 oil pllYl11llnts mlldll \Iy llllYll1 os IIquldotocl clal11ll{1os, _ Ouyor hllrohy oaknowllld(fus Illcollll of Ol1llKIIOt UKIlUlItud cOllY 01 this 1I111001110llt IIllhu tlmoof Il Kllcul 1011 hurnof. _ Ooloro ony \Iurlolls purmlltodll1 this lot, 0' ony 1110mull01 flloeod 011 thl, lot, tl10 pII"l of Ihll urbvo ol1dl11omorloll11ust ha flald In 11,11, _ Tho 'Purahosot(S)IIUIOO(S) to ahldo hy 1111 lulo, IIl1d rOllulatlola of tho C""lOl,,'y now ill 10'MIIS wolt <IS OilY rlllus al1d rooulatlol1s which fTlnY hOloaltur ho adoplllcl. Silld ,ulo, ol1lllunlllatlon.' I11IlY \Ill S("lIlUllOI11"qllo,t ot thn Sollllr's offlco. _ Upon 11IIIIIImol1t ul tho oOI1c1lllon, 01 thl, nOI,,"'"'"11 ,md ,o<,oipt ul <lllth""!>llvli "",,,d!>"" pnYl11ol1t" S"II111' OlJI'OIl' <111" hlmls 1t,,,1I to COl1wy to tho (]uyn,"/ hV its COlllUtlllV lHlS0I111llllj IO! intnlll\lltlt pmpO!iOS onlv. tho nhUVll mlllHhlll~Jd I1lJlllhllr llf sItos. .,. yOU, TilE PURCHASER, MAY CANCEl. THIS TIMNSM:TioN AT "'NY TIME 1'I110R TO MIDNIGHT OP THIi THIIlD QUSINESS DAY ArTEIl DATE OF THIS TRANSACTION, SEE THE ATTACHE I) NOTICE OP CANCELLATION FORM POR AN EXPLANATION OF THIS RIGHT. ._____..____,.~'" ..-___ _'_0" .._..._._....._.._~...u..._. -----~-..~.-.,.-. -~ ____~_,._ ...__ ..._.~___~.T_____________.-____.,,~_~'_.._... BY- .~ .. // ,~ / l 0'(" / CNI'r-_ ;;If<' .- /c-1' .. . (AUlhollz'lldRllflrn,ol1tatlvo) ':.!...:...- ".)J) .J1 / .'" ...." (flmehoIOl" SIIII1I1\111") NOTice: Soo othOI 91"0 ful' oddltlol\01111Io1I11utlol1, ----TC'!.plllchuIUI'S SllIl1atlllu) 1l1'lfl900 Diocese of HI:wTl~ ~ Poet Office I30x 0051 Harrteblxg, Pennsylvania 17105 Office of Cat110llc Cemeteries SALES CONTRACT AND TEMPORARY .BURIAL AGREEMENT DATa f~ i .j' / " 1\1::; .. ...~1 Z .tL ,. _~/ '1,'- , /,'_,': _'" ..-.. _ ._./ .:,.:! CUMernnv _(-'off .' ,.- (,..~-_.,_(~j_.~.~.~,,_____ NO. .:-:.-!....~.~~~-- SALUSMAN NO, un ~._~.n... llASEMllNl NO. ~..._w AIN L PIN ___ Am ----- ) . / I NAME ;t-C(Y:4/t"iLS:_~~.!- ,"--I~_!:-.;jl,'~>/'--/ i(",'.j f ~~'__-'. .m_________~_._.___ PHONe ( ) _Y''I'~:'!--:c('/if';~;;_J /' / /,'// JL..."..h . .....,. ,), ADDRESS / t'...- E -(.!..!...:.!.-:!......~.:_';;_-__!-.~~~-_,~_'_ //: (" 'I ' " ' '" CITV /f//,'_ ~.~~~{f~-".~..---'..".__~ ..._,__...___ FAMIL Y PHOTECTION ') ..... ...._.._____--STATE...c.:~ "'-"l .-_.",-~./ ZIP CODE ~~")" Intotm,ontSllaaos 1'1 (: I' (@ l-.-..';(J,(j~-} $ {:':~:;'()f()(i $ ({.-. ....~t() ( (}f~) 1. Prlco . , , . . t . . I , . , , . . I , , . , ; . . . , . I , I (;,~~/(<I, (/('1 2. Down PUYnlQnt , , ! , , , . . , , I , , , , , . . . I . . Orc)Ilzo Momorlall . , . . , , fii> $ SilO ____ 3, Unpllld 13nlancn (1.2) , . . . , ! . . , . , . . , . , I I .(;"';- 4, flnunCQ Chnruo . . . . , , . . . , . I . , . . . , .i . , Foundl'tlonl , , I . I I I . . . , , @ $ 0, Doforrod Poymont Amount (3+41 . . . . . , . , . , O. Totol Price (1+4) . . , , , . . . I . i , . . . . . , , . , ,:r;",\."{h,(\;' ourlol Vaulll . . , , . . , , , fii> $ 7. ApproKlmoto Monlhly Paymont , , , . , . , , . . , 0, Numhor of Monlhly Poymontl , . , , . , . . . . . . O. Firat Monthly Pnvmonl Duo ,."",...... 10, Annunl PorcontngaRnto . i . , . . . , . , . . . . , . Orypt SPOtoj . . . . . . , . ., @ $ Othor f I , . ~ I . If' It. I I I I , , , f . . . tIt. $ Sootlon C.,,~!,1 .f} ).-'" Lot ...."'-, Gravo(,) / I;.~ Tormll OOlh (";~,.:/{:'. ,rot) 90DoYI Olook Crypl(al 90100110n mUll ho modo within 30 daYI or oomolory will moko ohDloo, Inllollmonl _ Tho poymont Is duu on tho dot~ slul",1 ohovo unrllhu rUllloil1lnilpuymcnls on Iho somu rloy of uuoh ,uoouudlng monlh, Buyor moy pro pay In odvaneo tho lull amounl rluo without pnnolty and will ho nntillnd to a propolllonota rofund of Iho unoornod Hnancn choruo, ,. _ Upon daloull In Iho poymunt 01 any Instolhnol1t dllU hllrnundor lor 0 pnr!odln oKOOSS of one hllndl'od Iwonty (120) doys,801l0r moy, alllS option, vuhl Ihls oU,oomont ond Intoln ollpuVl11unts nlodo hy [luYl1r asllquldolud dnnlllllClS, _ Buyar horohy ocknoWloduas rocolpl of 011 UKuot uKooutod copy 01lhlsuUIUll111onl 01 tho tll110 of oKooution homol. _ I)ofo,'o uny hurlulll po,mlllodllllhls lot, '1I ony '1Inmorlol plueod on Ihl, 101, tho prleu of tho grovll on,1 I11omorlol mUlt ho pold In full. _ Tho Purchosor(sl ugrno(s) to ohldo 11Y ulllu"ls ond rouulation, of lho efJl110lillY nuw In lorno 0' woll oS O"Y ruins ond rcuulatiol1' which moy horo'aftnr ho ado!'to'\' Sold ",Ius and ,0uul.tiul1s I11ay ho 50011l/pnl1 "'qunSI .llho Sollor', offleo, _ Upun iulflllmol1t of Iho eOl1dllloi,S of Ihi, 011'''0"'''"1 ond ",,,,,IPlOI olllho "hovo "0"",11"''' p"Yll1on\', S"II"I' og,n"s 0",1 hll1ds 1I,,,1f to convoy to tho fluyot, hV.lts ClII1l0tulV 11l1SllnHll1t, fm IlltUlIllOllt pllr'pO!it!5 on IV I thu nhovll mtlnUol1lJd Ilumbol of situs, _ YOU, THE PUROHASEri, MAY CANCEL THIS TRANSACTION AT ANY TIME 1'11101l TO MIDNIGHT OF THE THII1D IlUSINESS DAY AFtER DATI: OF THIS TI1ANSACTION. SEE Till: ATTACHED NOTICE OF CANCELLATION FOIlM FOR AN EXPLANAtiON OF "HI8 HIGHT, .......:::;.:.:=-.::;=_..:'.;:;::--.::--=-.-:~._..,: ,.<.:.,~.,.~~~.:.,.,;:;~,~!:_~=;~.-.::.:::::-~~----;-.::.::~-:.:'.:--=::::::'-:.:::. .~.._---~.- . .._--~_.- JO-".-"'"-) ..1/ / ~. Py//(JiI/,(jll, (""~ (AUlhorl'od Roprosontatlvo) Xl . .;,".,.;.... '''." )',') ",,) ....{I,._/ ~ -.-. '-",.-.. (~U1eho''''', 8lunotll,,,1 NOTICE: 800 othor slelo for aelelltlontllln!qll11otlon. (OO'PUI ohosol"s Si0l1011lli,) IlI'IMIf)O pd 11-"I~?7 ~$>~s.t>1> /i'I'A'I'EMIlN'I' (WIlUNllltAl, C;OOI>S ANI> SllItVICIlS SI!l.lIO'l'UD C:llllfK~lllft' unl)' fur 11\",~lIc'III' Ihlll)'''11 ,,11"H'd III thllllll~ n'qlllrNl. Ir 11'1' IIn' It'qllll<'(1 h)' IIIII' III h)' !11'('l1Ielt'Q' "I erelll~l"q' W II" lilli' lIelll', II'~ 11'111 1'~plllllllllll'tIlIlIK Iwlllll'. If )'''11 ,dccled II IIlIIetilllhllllllll)' H'cllllle C'lIlll;1II11II1K, ,"l'll ", II rlllWIIII \l'lIh I'h'II'IIIK, )'I'" 11111)' IIiI\,(, III l'lli' rur elllhllll1llllK. ",,11,111 ""1 hm' III Pll)' r"l ~lIIhllll1llllK )'011 did 1I"11I111.\lIII.'t. Ir\'ml'...I.'h'~~. '~~I)I!I.~.'1j\~."..I..I.t."H" .' IW..h)ll)1 CII.tl't'1 YI.'.'J\\1I1 1,," '.'1 ..I.'\IIIlC'dl:lIl' hurl.,I.I.....II'. II.'C' dl."..IKI".I.. r".. .1..'IIII'.II....I\I.hIK, 11'1' 11'1\1 "~.~~9 ;;W.'I\\\I" l'llr tho Sml~e ;,lT~--;&~.t4~)--,L~(.{~-';7'--_......~-----..'7:.-_~-_n_~- '~II~e Ilf Ileath ...J..).' . ?- \;harKe tn, +:.I1.dL~ ~,A..iJ/IMA...:L'l<<~..j'{.J,,-...';',c~----'--7/.;;t..e.4\L,..J1~:J: [ l"L,,';'_~.:_..__"''':__~~-- IfI'lll .. ,\Ihln',\ . UI\' S.llIte A, CIIAIIliIII'UII SIIIIVI<:IIS SIII.l'.l:TIIIl, IlIlwI d"lhlllK __~c-...m....-"-- . I, i>1\OI'IiSSIUNM, SI!I\\'IClIS ..~,-.._,- ..,,'---..-----,~.-..- 1-_..- SI~II"III.~' ur 1'lIIlelllllllrc<H'IISliIf( . '.', '. 11.".'._.~.7.'.__ ('.-----1 -._-_.~.. .. 11--- Il1Ill1ll1l1lK . , . , . ,.- .. .. :11'111111 "" 1111I ' . . ,. --- Olhel PI~P!lIilllulI "r hmh' ,...._~. (lle"'llpll'''1I ..... ~---_.._._-- ~~~~._._-~..-.........------~...........-~-,......-- -..---..--------.......-------------.._-+_.._._----------.--~... 0'1'11111\ _..~__~_~.I~_ _" "n"" u__...,__..__~.....-----. ,__- .~...--.~---'-_...._- I.~ . ~ ':J(,'Gi_! . TOTAl. MllIlCIlANlllSII SII1.I1Cl'llll,... ,..""" 1I1~ C, SI'I!CIA1. cIlAII<ll!S,. !1mwllfdlng of rt'llljlll1l1 10 ..-..-.-------.____.1.- (l'uuellllll""11') IeI'n'll'luK "r lel1lilll1' ft'<>Il1 ---.-.----....----'..-~u__~.....___~...,_~_.___ ..""....". .,." ,....--... slIIJ.1'll1'AI, 01' l'II111'llsslllNAl. S111I1'1CIIS, , . , . . , ., A I L....._ 2. I'M:II.I'1'IIIS ANI> SI!I\I'IC:IIS 11.1' Or rllcllllil"illlll,"11'1l'l"111I ./ l'I~lI'lelK 11'1,lIilllol1/Wllkl'l. . . , . .. .. I.. (,,'--..- llIe of fllclllele> i1l1li "(1'11'1" fill Illl1cri1l crtl'l1ll>!\)' , , . ., . , , . . ., L.k~~. II" or rllclllll~' i1ml >I'll'ln" rill MI'l11urllll Sell'll'l' . . .. 1----. II'~ or el\ulpl1lelll lll1li "1I'1ee> /" (01 KIlIl'\'llde '1'1I'lee . , , , . . , , . .. . I ,.J.....~_ Ulller u'" Ilr IIICIlIlIe> v"'" ~-''''-'(j;ii,ielilIIlOl1lel IUllllelil:lle liullill ... , , , , . . , DlrN:t Crl'l1Iallnn"" 1_- .------.--- ~--... ........------- ..1.- I~_.- 1- SlIJ\ol'll1'^" IW SI'lIel^,. CllA\lllIlS " , , , , . , , , . , . . II, CASIl AllVANClIIJ Ilpl'l1ll1lCc;rlll'e... .,.,.".,....1_- CI'IIWII'()' 1\I\1l111l1leUI . . ' ., L ~I .,' ~ ""liI>!lilltl'CI.. ....".,.",..I~ Nl'Wsl1apl'f Nnllt'l's-l,lIl'lll """," ,..L1L:.:...., NI'II"P!!!,I'1 Nollec>-OU\.or'I"II'>!. .. . I.~., Tell'pll"'(' I'< Tt'II'KIIII1I' "... ."" 1-_- ,lIlrall' ."...,L~_ CII'IK)'IMII" Orll',I>!1C . , , , , . . . . , , . .. I.L'J.Ji..:~ Pallhl'i1Ict> , .. " 1- C:I't1l1leli c.o1*" ilr ,lie IlCll1h I . ,- ,:I.t1If1nlle.. ...",..., I~ 'I Pulll't llsl'llrt ,."", $---_ l'I"'I'ct> "...."......". 1LLl<- l'auIlSI'II'ln'c.1I1I1Ke" ,.,... ..", I~ t",:~,,\-'<J ~i...:-___________ ,~..... _...._~___~..__~ 1- ~.___~_. 1-- ---~--~___~_I- _.._..~~.-..__.--..._- ,_- _,_~,_'_-__'-- 1- ..CI~ ...---_---------.I.----------..~ , , "" "". " " " ." , ' , . , , ",', $------- S\IH.1'llTAl. OI'I'AClI.11'1IlS/I!QlIII'~1l1Nl' ' . . . . ,Il '----- ,I, AI,ITIlMOTII'I\ IIllilll'SlIiNT 1'1'1I1e1I'IOlti>ll'(I'tlel1laII\SIUI'I\I\I'r.IIIIIIlIIII',/ l.oCill",,,,,..,,,,.,...,,.,,....I~- Ilca,"\'IC:II,kl'l C';lIch) -' l.ocill.."",.."",..""'" .I~ 1.1111011.1111' I.neal. . , . , . . , , . . . .. I............... 1'1I11111)'w ""elll.""""" "." 1---- 1'1"11'1'1 elll III IInTi,llil'p"'1I101\ LUCIII"",;;,.""""."',, ",,$-~:": "\'ulimlelcrK), l'iII "oClII."..,,,'''''''' .."I.L C;II1 rnl pllllhl'al'," ""eill...""'...""'...,.,..,,,I-...._- 0111 III 11111'1\ 1rll11'PllllilllOl\ ""..". 1..---. ...,.1. - -,..~-_.....~=""..-' .' pet 11-.'f~c;7 ~..$?~>I>l) STA'I'IlMllNl' OF lIUNEftAl, GOOPS AND SIIRVICIIS SRU!e'I'I!p (:h"'MV' """ ulIl)' fur Ihmv IIvlI" Ih"1 )'u,,'vh'clid '" Ihlll IIIV Il"I"lled. If 11'1' I"" "'lIl1ll1'd hI 11I1I' III hI' 1'I'elllC'l",! ul' "n:llllllUl)' III 1111' '''II' 11"11\', we will "xplllln III WIIIIIIM 1lC'luw. II )',11I ."Ic'c",d II rllllelllllhllllllll)' n'(IIIIII' Cl1IhlllllllllH, ,"ch "' 1I f,,"ml wllh 1'11'11'11% )'111111111)' llil"" IU pll)' 101 1'l\lhllhllIIlM. \'1111 dllllul hilI'" IIIPll)' flit "lI\hlllll\llIH 1',U!' dld."il! IIPI~~II\'C' If )'UII '.l'Il'''!~I.I.lItllll!l\''"WII' "'e."I~)l' ;'!' dllec.' ~1.1;lIl1'IUII ur Illlnll'dhll~' hlllllll..lfll''' dHIIHccl fUI vn:hllhnh:H,"'" WIII/'.Pl;:~ wh)'! ~!II,II'. 1 ur Ihv S~rvl"" ,!(. ---~ Y.'<'f'~ -/LLJ:.!..L~7"-._-"cmm.-~-_.~t7-~-" ""Iv uf I)"alll __...,.~. '2- (;II~rMv 10' ~~lI"'~r .A;.~U;lt'liitl.\l'.IL'::'~~'~'-"'?"'f:\~."J.:..\&V.:~:Li:;c'''sii'I\; .... . Ie.-. A, (:IlAI\UlII'OIl HIIII\'ICIIH HIII,IICTIIII, 0,111'1 dOlhlnH n____.~.____._...~~_~ I. 1'lIoI'IIHHloNAI:Slrll\,(CUs __.~mn...~.__.~__.______ '_.m___ Hm'l"", of 1'II'lC'llllllln'I'IIl1ISI;II'f.... I 1.:,7' .._........~__L____.m___~_ ,_____ IIl1\hllhohlM ..., . . . . .. . . . . .. 1.--""--. CII'II""lulI urll . . . . . .. . . . . .. . .' . I.._'~m CHIll'I (II"P"tillltlll uf hllll)' ...~~. (I)c<'I'llplllllll m__~'__~m__._~~ ~~._--............-.--~-_.._...~--... ..................... ..:..I_~ HIIII.T01'AI. (lI'l'I\OFIIHHIONAI. SIIII\'ICIIH. . l. I'ACII,I'I'(IIS ANI> HIlIl\'lclrs II,,, or flldlllh', ;llId "'tl'lm rUI .. 1'1,'wIIIM (\'I'"11lluIlIIVllkl')......... I-"':::~ "'e:"r fll"lIl1lcs 111111 ,,,,,,I,,,, ..- fur rllllVIIII """11111I1)' ............ I~. II,,, offll"IIIII,," IIl1d '~II'h'I" fur Mt'IlUltlul Sl'r\'lcl' ,...."""",. j_~_ II" uf "l(UlpIl11'1I1111111 ,,,,,,1m /' fuIMrn"".ld","'\'kl.,............I~ Olh", III" Hf f:1C1I1I1", i/'" . .. ,II L.__.. "m OTlllil1 ___ L____ _._.m~____.____._~_ ,,,'_,_ --~----~__.I___- . . ._ TOTAl. MIiIlCIIANIlISII Slll.liCTI\I>. .. . . . . . . . . . . . . . .. II ,.{....i)) C, SI'IICIAI. CIIAlllillS, I'mwaldll1H uf "'l1ll,lu, I<> ----.{I'I1I1~lall(<>IIIl') 1I""I'II'II1H of Il'l1lalll' frolll ,~ ..........................1_- Sllll.TOTAI. 01' I'ACII.ITllIS/liQIIll'~llINT. ... . .. .. ,11'___ .1. AIITOMOTlVIi IiQIIII'MIiNT v"hkl" I<> 1r1l11.rC'1 1l'l1lnll1' I<> I'IUll'lalll<>lIlI'. I.u"al........."......'.."....,~ lIell'''' (Clllkl'1 Cual'll) . /" I.u"'il.......................'....,~_ I.hllulI,hl" I.Il"lIl.........................:,__ 1';l11l1l)' ('a, l.u""I................... l'luw", "", UI nornl dl'p'l.\lIlulI /. l.ilCal...........................,-t,.L I,,,"d ""I/e1I'IH}' cal I.uc;ll...,..:....................,~ C,'I fli, pllllh"nl"" (.ol'al......,....................,__ ()lIlufIUWIlIIllI1'pUrlllllolI.........,~ . 1- ,- Sllll.TOT.\1. 01' Alll'OMOTIVli I!QIJlPMliNl'........ .1.1 ,__ T01'AI. OF PROI'IISSIONAI, HIIII\'lCliS, FACll.ITlliS ANIl AIll'OMOTIVII liQlllPMIINl' ."...... ......................... .....1_- ,~ (I'II1l"rnlllul1ll') 11I1I1I"dllll'.IIII.II'I................,_ 1l11"cICIl'l1l1l1lou.................,_ ,- HlIlI.'I'OTAI. lIl' SI'liCIAI, CIIAI\OlIS . . . . . ., . . . . . . II, CASII A)1\'ANCI!ll Opl.IIII1HCiIiII'l...................$_. Cl'IlI"I"'}' Iil(Ulpllll'llI . . . . . . . . . . , . .. LmiL - I.olllnd n""d............ .... .... ,.~,,_ N,'wspa(lI'1 Nullm-(,ucal ......,.. '.L1!..~:". N"II"llI'I"'1 Nu'lm-OIlI.of.l<>wlI.... '..46..J... Telepllllll\' /\ T"kMIIIIII' ........... 1_._ ,"lfale.................... ,_ C11'IH}'/Ma" Offl'lllI>> . . . . . . . . . . I..L.JJL - 1';llIhl,,'rl'I,.................. ,_ C('IIIII"d copll" o',h" IlI'lllh .., C(',lIrknle ....... .............. L~ '/I'olh:l'1!5cnrt .,... """'" s_~_ J'llIwl.rs.......,.,.,........,..,s"'~ \'allll Herl'lc" ChalMe .. . ... . I~_ ~~A.,~J+! ' L_....L.l..:~""~. .~ ,- ----,-- ,-- I- ...C,___ SlIlI.l'Ol'AI. OF AIl\'ANCIIS. . . . . . .... I) ,!l2L -, IV" e111I1>>" }'uu fUI <>III ",,,'1,,,,., IlIllhlalllltlH' ('/lI'l'f!I' C(f.11i Ildl""[~"" 1I)~f 11'~.JIf(I/'kl'd'II") /{/(),4IiJ ~ '1.' "I'.... 'AI~ OU",,;~ullal cOI1!!lln", . . '(I}C''':llpllool~\;'/ ~. -...... ........)~\ I ._+". . ,~...t... ~"(..;;~ SIIMMARV 01' CIIAIIOliS A. Prof,,'.,'ullal Hl'II'kc'" l'aclIllII'I allll 1i'llIlpn\('1l1. al1d Alllol1wll,'" _'. " 1!l(lIllllllcl1l ..,................... , ,.I.y.. _ II. Merchandls". . .. . . . . . . . . . . . . .. ... I ~:. ~'J\- C. Sp"dnlChalHCS ..........:....... ,~_.. n. ClI,h M"'<>Im. . . . . ..., . . . .. . .... , .1:' I .. :';'S~ I ~ TOTAI,lIl'AI,1.sIiCTIONS............... ,...1_.. l'AIIl AT TIMlIlIl' Oil PRIOR TO ,j ARIlANmIMliNl'H.... ............ ..... ,_ lIAI,ANClllllJl!. . . . . . . . . . . ..... . . . . . . . . ""'" 1:C:.r.t..J.'- Il1!ASONJ'OIl IIMIIAU~j~ll. . /" .__;4-'>i,<;,>.. ,. ,;"/",'(-:,:.::~,,. ..-(.'''".~~ If all)' IIIII'. C"'ll"""~' mlllllllll)' ((''1I1II''lllelll' 11:11'(' le'lull"d IIIC' pUldlll'" IIf 1111)' Ill' Ih" It''Ill' lI.ted ahll"c' Ih" hill' !II tl''1Ullelll''1I111 "~(llnll1C'~ hdull'. j-~/;:;"~.t /"-"~"'-:Jr. .1"( ;' .-)/..... /~'~"i:.,,'/I_......-- ,/~(j-\lt~~ff,,~-,/:~J. ,riy _U/~;t; ~r.d-- II, CII~~~~ F(~~.~lIl~~IIA,NIlIS~.~~I.'I.ICT.II~I.;,..!I(_ (lk'''III'III)JlJ;> '~-", ) /" ." ..c //.;., ;".'.'-/'jI'1 Olh", Ile,'c'(lllld" '." .,... . . . . . . . ,___ ((Jmll(lllllll) A~kllll~INIH"m~1I1 tUld, " "". . .. . . . . '." ~i," _ "<Mill" hllllkl'! , . . . . . . . V;..;.;..:......... L . M"lllur)'fllldw..................I....:..._ 1"lI)'''I'.III!''...................... ,__u_ '1'''I11P'''"I)' >>1111'" """k,,, ...... . . . . . ,~_ lIulllllcllllhItIH...................,~_ (IH"'V Ih" I hlll'I' ""ll1ln,,~ th" lI"ml Ilf HUI"I, IIl1d \<1\'11'1'I ."Ie"','d IIhOl'I' IIl1d rlllllld 1111"11'" hI' 1'0,,,,,'1 ~lId II('('llldII1H III II\\' 1!II1IIIM"II\\'1ll11 hlll'e "'(111"""'1. IlIc'k'lllll''''dH'' lCl'I'I(lIUr II ""II)'ur Ihll SllIlImlC'''l"r l'llIlC"lIl Ollllds IIl1d iilln'k,'.' Hc'lc'CI('d.1 'I'(l.n""'.lI 111;11 I h",,' .lIlrnllc"1I rlllld, 1I1'lIl1l1hle fill P")'II1l'O'Ur IIIc' l'nlh (lllce .flll Ih" MllII'1I "'III.\CIl'lm" 1'""'d.llIl,,, aH"''' III lI'I'f)Ill),Ill""1 "f.' ."".'i"fi.t.L.:.::. ".'''"1.11_,-, '.' , , dlll's.IIIH!('I'IIII\\, 111111(1)' IIl1d "'I'm II)' ""hll' ,\'1I1t 111.')'11111' ,'he 11'11" IIHnl helll\\,. A hill' chlllMe IIf - (l'" lll!ulIh 1I111011111hlM (II _-I"" .' p'" )'1':" 11'11 hI' 1I(1(1111'd III Iltl' UII/"'Id hlllalH'e hl'HIIIIIII1H ~;L/......_ dll)" frum Ihl' dll'" IIf 11111 "HII'''I11''II1. I 11'11111 \II par III II\\' f'llIlC'hlll>III'l'lur 1111 rellcilflahk''''''I' (lllld h)' IIIC' ('''11","1 Olrc,..I", III l'1I I"el 1111I1111111' I OI\'C' Ulld", Ihll IIH"""\\,OI. Till>!" ""'1' mil)' 10"'lId" IIItIlIIl")"'''''"' CIIllll C'''''" anlllllhl'l CIIII,. All)' 1111111'1",,"1 Sl'fl'kCI or ",mhlllldlll' 1I111",,'d ..I II"I"C'lI'd Ilr"" Ihc' dill" ", Ihl. "HI"'",""1 will h" ,'lIolld""d pllll "f Iltll ~HI""I*llIlIl1d Ihl' ....1"II1'II'..r 11'111 h,' ,,,IIN'II'd 011,11,. fllllll hili 01 .\lnll"lll'lIl. ,'. .'" (St'af)__ .. _._____~_~~~~~__~j- ~~___.._~_u.~__.-;~_.___~':!~:~~;~~~.__~~~~__,._....___ 0- .':' . 'J..jl'lIr(hll\l'~) , J . r1)"I"L,. " / (S"lIll-X? \a Ll.f!!d......:;n~; ....-:,,-t,_~_ 'n...._~~n _.~~ .o,...?ii-.:..,.'1~:1:,-;;::(i1iii~~~lj~;;zr0, [Ij "fnll\)'I\'~ill~ I'lInnlllllllnlllf~ A\'lllWflltl \\'11111' l'unj'141 IlIrl'lllll HIt ('W l'ullHJIIII/frrur I""" ell'lulm'l .. rllrl11~' 6()O Ilc\'lscd il/'N CDHHDHWEA~ II' OF ~~HHmYAN'A II~PAR'NEHI OF R~YEHU~ BUR~AU OF JHO'YJOUA~ 'AN~I D~PT. 110601 IlAWRIIlURO, PI mll-0601 '*' ,~f-" .:/ {I,)' XNFORMATXON NOTXOB TAXPAVB~NRBSPON8B FILl ACN DATI ~/ m'''.IU''',,",,, NC,21 97-0882 98103830 02-09-98 NARVIA A 80STIOK 010 471 WOODOREsr OR MECHANIOS8URll PA 170511 :: TYPE OF AOOOUNT EST. OF RVAN A 80STIOK ~ SAVINGS S.S, NO. 802-04-0116 CHICKING DATE OF DEATH 10-22-97 TRUIT COUNTY CUM8ERLAND ceRm, RIHIT PAVMINT AND FORMS TOI REOISTER 8F WILLs . CUM8ERLAN 00 COURT HOUSE CARLISLE, PA 17013 DAUPHIN olPosn IK I TR CO h" prD.!<<," th, D,porlB,nl with \II' Inforo.lIDn llot," b.ID. whl'h h.. b..n v.." In ulOl.lhlltlng th.pot.nU.~ tllC dUll, Thli,. "lGord, lndialt. thlt It thl ""th of thl Dbl;lV' dlced.nt, VOlf WI'" I ~olt'lt own.r/tutnlflol.rv of thh IOGount. If yOU "'1 thll lnfor-lIIttlon h Inoorr.ot, pl.... obhli'l written ,Darr,aUan frol thl ,Inlnot.l It'l.Ut\4Uon, .thuh . OOPV to thh 'art Ind r.turn " to thl ,bov, .ddr,.., Thlt 'ODDU"t h ""cltH, In looordano. with thl Inh.rlhlnol h~ t..WI of the Co..om",.Uh of .,'""'V1Yllhl.( uuuHon. I'V I,. au.if.r.d by U1Un(l \/In 'I1.U~', OOMPL.TI FART 1 BILOW M M M liB RIVIRII'SIDI POR FILING AND PAVMBNT INITRUOTIONS A...~nt N.. 42-71109-6 Data 09-24-87 To In,vFO propor 0""11 10 ~Dvr ...Dvnl, 1.0 e.t.blhhld (2) OQPlu of thlt notloe IIUlt uoo.panv VOLlI" pav..nt to thl M.al.tlr Qf,Wl11i. HlklOh.ok Pllyabl1 tUI "Rluht.r 0' Mil", AUtnt". A...~nt lolan.. 949.98 por..nt TaMobla K 90 . 000 HOTEl If tIM('IIIlY..ntl '1'" ..d. within thrlt A~.~nt I~b~o.t t. TOM 274, 79 ell Bonth' of th. ~.o.d,nl" II." of "..th, TOH Rate . ~ . 06 ~ov B'V d.lIvol . &k "1"01/(l1 of tho 10, "v., , .rw Inhlrltlnce hlC dut wUI bUo., d.llnq\.llnt P.tentlol TaM O~I 16. 49 nln. m oonlh' 0/1Or Ih. doh 01 dooth. ~TI.~A~~,V~.itq ~"PONDW~Lk~I'QL~t::;~~qRJf~~:::~O~::A"I'.~.Nt 'A..~...q",1.' ~.."OnC. [ CHIlCK ] . ONE BLOCK ONLY Thl abovl Infor.atlon 'nd tiN dUI I. oorrlot. 1. Vou .'vohooll to rlllt pIYllnt to thl RI,htlr of HUh wUh two ooP"" 0' thlt notlcl toabtl'" . dhoount or .vold Intlre.t, or vau ...v oh.ok bON "'A" and riturn tM. noth. to the Rlgllte'" af Wllh and an offlollll Ul....."t wUl bl "'Uld bv the P~ l'1~.rtll.nt of Rlvenul. I. M Th. abovI ....t h.. bun or wUI bl rtporhd.nd taw Pflld with thl Plnnlvlvanl, It\huitano. TIM rlturn l.yJ tQ bt 'Hid bv thl 'dlOldent'l rlpr...nt,Uvl. ' C, 0 Thl abOVI lnfor..,Uon I~ncorr'ot 'nd/o~.bh 1Ilnd d,d\.loUOnl "fI'" p.ld b~ ~OY, Vou .u.t Go_pllt. PART ~J .nd/o,. 'PART L!J bilow, PART f Y.~ In I.. a a dUffrln OM ro I,.~louo e , a y.~r [!] rlhU.nehl~ t.' dl.ldlnt I . TAX RITURN . OOMPUTATXCN OF TAX ON JOINT/TRUOT AOCOUNTS LINE 1, Dot, e.t.bll.hed 1 2. A...~nt lol.n.o 2 S. Plr.ent T'MObll , M 4. A~.~nt S~bJ..t t. To. 4 I, Oeble IndO.d~.tlone I 6. A~.~nt TOMOblo 6 7, T'M Rata 7 M O. TOM O~I . A, OFFICIAL UaE QNLY AAF PA DEPARTMENT OF IlEVENUE ............ "..','....'....,.........,....,..... . ,. PART I!I DATE 8 UCIO I PAD 1 2 . ~ li;~ S 6 7 8 % I E' PAID PAYEE DESCRIPTION AMOUNT PAID ,..l ''''" " ""' . .f ,,, "",0" ..,,;, t Undlr ponoltl.. .f porJ~ry, I do.l,re thlt tho f~ot. I hOYI rlp.rtld ob.v. .rl true, ..rrl.t Ind ....,ploto to th' but .f ~y kn..lodgl and blUof. HOME (...'J....) "',....... -....7., ..,,7dfo-\.~;..,G...:ri~/..:2' WORK ( ~ ~ ):/.,;,~~';; ;~; ~l'I\VEll5TllRX1U1fE" TELEPHOllt' Nur'lffi OENERAL INFORMATION 1. PAILURI TO RIIPONO WILL RUULT IN AN OHICIAL TAX AlanlNUNT will, ,ppll.obl. In'"", b.lld .n In'''.oIlDn ,,,,,.1\1.. bv Ih. IIn.nolol In,1I1ulldn, r. Inhlrltlnal ,.,. b.Gu" dellnqu.nt nlnl lonth. .fter thl dleld'nt" dll. 0' delth, I. . Joint tOoDU"t t. ""clbl. IV,M thoUlh thl dlc.dlnt'. nil' If.. .ddtd II . .,tter 0' aonv,nltnoD. ft; ACDOWth C Inaludln. thatl hlld bit.,.." hu,b.nd .nd wlf,) wtdoh thl dlcld,n' put In joint n.... "Uhl" on. Vllrprlor to dllth .r. fully tlll.bll II tr.nlllrt, il hODunh ..tlblhhtd Jointly bitt..." hUlb.ru, and wlfl tar. thin on. Vllr prior to dl"'h I" not 'Iutlll. 6, AOOG""" htld bV. dlndlllt "In ,rult far" ,noth.r or othlr. ar. 'IMlblt 'ulh. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. '~OCK It . If the I"'or..tlon ."d oOIPuhUon In thl noUn Ir. oorr.ot end d.duotlon. Ir. fl9t btlng ohl..d/pl.ol In "M" In blook "A" of Plrt 1 of thl "TIMp.Vlr RIIPon.l" lIotlon, Ilun two aopl.. tnd ,ub"U th.. with vour ohlok for the IIClvnt Qf tlllil: to thl "1,lItlr of NUh of th. aounty IncUl1ltld. Thl PA OIPlrt..nt of RIVlnul will luuI an offlolll ........nt (Fpr'. AEY"lI~' EIO upon rlOllpt of thl return frna thl A'lIh"r of Will., 2" ILOCK . - 11 thl u..t IP'blUed on thlt tlotiol hit bltn or will bl r.portl~ and hM Plld ""th thl Plnnulvlnll lnhtrHI"OI TIM nlturn ftl,d bv thl dlOldlntl, rtpr..lnt_.UVI, pllol In "k" In bloak "I" of Plrt I of thl "lIMPIVIr AI.Mnll" 1I0tlon. Ilgn ani aopy Ind rlturn to thl PA OIPltt.lnt of RlvQnu" IU"lu of Indlvldu.l TlMII, DIPt 210601, tlerrhburg, PA 111""0601 In th. InVlloPI provIded. I, ILOCk C .. If thl tlotlo. Infor.IUon II Inoorreot Indlor dlduotJon. erl bllnl oltl",d, ohlok blook "C" tnd ulpl.t. Pit" 2 Ind I I"ordln. to thl hutrul1tlon. below. Glln two Gopl.. and lub.1t thu with vaur 'ilhoo~ for tho 1I11'lunt of tall p_vtbh to th, Righter of Willi of th. GOuntv Indlolt.d, Tht PA O,part'lnt uf Allvlnul will luu. In offlclll. """'I,nt CFor.. REV"It,., E~O upon rlaeJpt of thl r.turn frol the R.gllt" of Will., TAX RETURN - PART 2 - TAX COMPUTATION LINE I. Enttr thl dltl the loa aunt orlllnlllV WII Iltlblllhld or tltlld In thl .Innlr 1.lltlng .t dltl 0' dlath, HOTEl I'or I d.ctdlnt dvlno If.,. U/U/UI Accountt which the d.cldtnt put In joint nl.l, within onl (n Vllr of dllth Ir' tl.ibll 'It!Uy '" tranlflrl, tlowlvlr, thlr. It In IMolu.lo" not to IMUtcJ n,ooo per trlnlf.rll tlurdllt. of thl valul of thl .coount or thl nUlblr of locDunh h.ld. If. dO\lbl. ..t.rlsk CIlIl. IPPII,., blfo,.. your flret n"1 In the Iddr... portion of thlt 110tlOI, thl U,OOO"IMclu.lon Ilrlldv h.. blln dlductld fro. thl locount blllncl .. reported bv thl Onlnolel Inltltutlon. '-I. lint.r the tottl blllno' 0' tht taoount Including Inttr,.t laoru.d to thl dttl of d"th. J. Thl Plrolnt 0' thl Icoount thlt I. tlMllblt for eaoh lurvlvor It dltlr,ln.d II ,follo"," A, Thl,ptrOlnt ttMtbl1 for jOint 1..1" "'Ibll.",d .ore thin ani Vllr prior to tht dlo.dlnt', d"thl I DIVIDED IV TOTAL NUNIER OF DIVIDED BV IDTAL NUHIER OF X 100 . PERCENT UNABLE JOIN! DUNERI IURYIVINO JOINT OWNERe ENI.pl.1 A Jplnt 1IIIt rlollt'rld In thl, n... of the dloldlnt Ind two oth.r plrlon., I DIVIDED Ii I (JOINT OWNEAIl DIYIOED IV I (SURYIVORB) . ,167 X IDO . 16.7X C1AMABLE FOR EACII eURYIYDR) la, Thl plrolnt tl.abl. for IIlth crttt.d wlthlnonl Vllr of thl d,c'dlnt'l dlath or Icoollnh own.d bv the dlo.d.nt but hlld In trult for Inoth.,. lndlvldull(11 Ctrult blnIUohlrl,,)1 I DIYIDED IV TDTA\ NUHIER OF SURYIYINO JOINT' X 100 . PERCENT TAMABLE DNNERe OR TRUll BENEFICIARIES EM..pIIlJolnt 'Ooount reg!tter.d In tht n,.. of thl d.otdlnt and two nthlr plrlon. ftlid 'Itlbllth,d within onl Yllr of dllth bV thl dlOtdlnt, I DIYIDED IV' t (SURVIVORIl . .10 X 100 . 10M CTAxmE FOR EACII IURYIYOR) ~, Thl "Clunt .ub/"l to till Cllnl l't) It d.ter'lnld by lultlptvlnl thl loaou"'t blllncl Clln. U bv thl Pltclnt tlltlba. (lInl Sl, .. P.ote,. the tot" n t~. ,h,bh IIInd d.duotlol1l IlItld In Pitt I. . , 6. Th' ..ount-tAMlblt (lInl 6) It d.tlrllnld bv lubtrllotln, thl d.bt. Ind dlduotlon. ClInl I) frol thl I'ount lubjlCt to till Oln, 4), 1, Inter th. IP,proprlltl hM rat. (1Jnl 1) I. dtt".lnld b.low, A. For d.tu of dlath oDDurrlng Ift.r 6/10/94, the tlM ret.. for tran.fl,.. to IpaUII' Ire II followlI 1;' Pat" of d,.th Or'! or 1ft" 7/1/94 Ind blfor. 1/1/9& thl rat. It S:<. 2, Dltt. of dllth on or Ifter 111191 trlnlfltl to IPOU'" will b.tlMld It 01( hM retl. Notll Par d,t" of d..th prior to 1/1/94 tren.flrl to IPOUII. I'" tllCebll .t 6:<. e, Trlnlf"t to IIn,,1 duolndlnt' Inoludlng 'Ith,r, loth", lon, dluOhter, grandchildren, .an-In-Itw, dlulhteroln-llwtlt'PChlld and thllr IIIUI Irl tl"'blt It .IM perolnt (61lL C, Ttlnlferl tall othltl lnoludlng brath", shter, Unoll, lunt, nlPhl'" !'lnd nllol Ire tlublt It flftun Plrolnt (II>:). D. If yoU ahlngt th. '1M rltl, pl.... Ip'olf~ your rllltlonlhlp to thl dlCldlnt In thl Irll provldld. I. Th. '.ount of tlM dUI (llnl I) It dlttrtlnld bv JIIultlplvlno thl I.ount hubl. (IIn. U bv thl tlM tltl Olnl 7h CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allow'bll deb" end dlduatlonl Ire dlttr.lnld a. follllWII A, You 11,II11v Ir. rllPoMllbl. 'or p.v.tnt, ar thl ..tltl .ubUot to .delnlttrltlan bv I Plrlonll rlprtnntlUvl It Inluffloltnt to PI~ thl dldun Ubll tl... I, You lotulltv ,.lld thl dlbtl 1ft" dllth tH thl dlo.d.nt Ind oln fur"llh proof 0' PIY.lnt.. C, DlbU,bllng olll..d IUlt bl Ihlllld hIlly In P.rt S, If Iddltlonl' IplCI 11 ntldld, un pllln PIPit' 112" M 11", Proof of Ply..nt IIY bl rlquutld by thl PA O'Plttllnt of Rlvlnul, " . ... T~'PAYrnR ASSISTANCE IFY.OTUWEHD F.URTHER IIFOR AYlON OR ASSISTANCE, CONTACt' ANY . RI!Olq re . OP W. S, PA 'AI TMENT OF RI!VENUE DISTRICT OFFICe o ALL T B REA 0 NDI IDUAL TAXES. TAXPAYE I UXR N T IN HARRXS~U~O AT ( 17~ 7J\t~8~2~' lrbOI (717) 772-2252 (nEA~~NO tH~AIReD ONLY) ~. ') { P\IIIlI01IOI' h, MOIICII TO ,UI,1I1 1M rmlre....l. ., "oUoo 11_0 ., Ih. I,...rllan.. 11M 10\01. toM Aol, A.I II .0'.1''', 111 P,I, ".\lon '1m. PAY11IHTI De,..h 1M lOll por,IDn., Ihl. HolI.. and ......11 .llh vour p.V....1 I. Ih. P.ghl" 0' Wllh prlnl'" on lho rIYlr...llMt .. 1Itk. .h..k .r l\Ml.v, ..rlllr P'v""I,~ 1.1 "'''ITIR 01' WILL., *ttr, RI'URO (CRII A ro,~ ., . '1M .re~I', .hl.h .., n., roqu"I.U on I" I,M relurn, ..vb..r....'I... bv .....I.\lng .. "lI>Pllo'\lon 'or R.'untI.1 PtM,.vly..l. I""orll.... anU 1.\01. toM" (PIY-IIUl. Appll..llon,.re .y.lltbl. .1 lilt Offlo. ., II'. Raghl.r 0' Wlllt, any ., Ih. II P.y_ DI.I~W DIII....r bv ..1I1~ Ih. ....I.II4:hour an....rll\l "rYI.. .-ere for 'Dr.. .rU"lnll In PIM,vlyanl. I-SDD-16/'1010, ."t.IU. PIM'Vly..l. tnU .llhln 100.1 HerrltlMlr, .r.. (117) 181-UM, 100. (1111 111-UII (H..rlng 1I..lreU Onlvl, . O."OTlDltlI Anv party In Inler..t not ..,hll.U .lIh tilt oppr.I"..nt, .ll..ano. Dr UI..ll.."".. 0' UtcIUollon. .r .".._t ., II. (Inol\lll... UIlO....1 Dr Intornll .. ._ on Ihl. ""II.. ..v oblHt .lIhln .IMlv IUI U.v. 0' rH.lpt '0' thh ""II.. bVI ".rlt,,,, pro,." '0 tilt PA DlParl....t ., P.y....., ,ooru' 0' Aofta.I., IlIot, lllOlI, H.rrl""'", PA 1111I-1011. OR ...I..llng)o haY' tilt "I\ar IlItaraln.U .t tM IUIlII of 'h. ..._t ., tilt .."...1 roprn""II\1YIt OR '-_'1 10 ""Orph"".' court A~IH- llT.AnYl COIIRICTlDltlI ''''UlI orrore Uhooyor.U 011 Ihl. .........1 ,IlOUIU b, I<Icjra..... In .rlllnt 10' PA D..ort....1 ., ..y....., ,ura... ., lnUlYlllU.1 T'M", ATTH' Po.' A.........' ..yll. 1Jn1l, DIlPT. 180601, Hftrrhllur" P6 11In-OUI Phont (1111 161-6101. ... P," I ., Ih. _I., "lntlruolloo. '.r Inhtrll.... T.. '.,urn 'or. R..lcltal 000_," IPIY-IIDlI for an'Mpl".lIoo ., ....Inhlrelly.lv ..rr..IIIII' .rr.". II any toM duo I. p.IU Mllhln thr.. ql ..ltncI.r oonlh, .It.r' Ih. UHIOI..I'. H,lh, , IlY' ",rDant 1m ~I,.""".I ., 1M I.. p.IU I, ,IID..u, DIICOUHTI PlHALTVI IHTlP"T' Th' \1M I'M ....tv non-porll.lp.llon pan.llv I. ._Itel on tilt t.tll 0' lilt I.M .... 1"1...., ......ad, .... nol PIIU lIt'.r' JlnUorv I., .19H, ,Ilt flrll U.v .It.r tM Illll 0' tilt tlM _.tv HrIO<l. ThI. non-portlolp.lI.. _Itv II ",,"1"'" In tilt ._ ......r 11M In tilt \I,..... 11M HrlO<l .. you ....ld .....1 Ih. tiM IIl4Ilnt...., Ih., h.. _ ......tel .. Inclhlttel on thh noli... . IIlllr..t II .Ilt/.... ball,,"l.. .""lIrll U.V a'Hll_v, .r nino m IOO\lh. II\'! OM CIl UIV Ir.. "" U.t. .f dllth, to tilt UIIt 01 PIV_t, T'M" lI!Il.h ....... IlIlInqutnl IM,.r. J...orv I. UII IMar.lnl.rew.t tilt re'i ., .1. 1m Pir.ant Plr __ .IIoUIII" It . Ullh r.t. 01 .000l~, All la... lI!Il.h bo.... UIll_t on or .11.. J....rv I, 19'* .111 b..r Int.ro.1 .t . rll. lI!Ila" .111 ,.r'l Ir.. oll_r v....t. ..I.....r v..r Nllh IIltt roll """"""'tel bv lilt PA Dop.rl_t 01 ..y...... Tilt IPflllotbl. Inl.r..t rll.. '0' 1'.' Ihrough ,tI, .r'I v.., Inhrl.t RI" O.llv Int.r',l r..tor V..r Inl....t ..1. P,llv lntlr..t Flttor - - 1.11 m .0081<\' ..., .- .0001U .... 16M .OOOU' ".Ntll llH .000101 I'.. 1lH .0SOIOl 'tll 'M .000U1 .... lIH .000116 1"101''- 1- .0001" I... ,10M .ooom '"I-I'" OX ,0001_' --In,"r..t I' ..I.ull'" I. '011.." INTERII' . .ALANO. 0' TAH UN'AIO H NUH.ERO, DAV. DELINQUEN' H DAILY IH'ERII' 'ACTOR ""Anv ""110. It.Uld .11./ lilt I.M bOO.... HII_t Mill rlll..t an Inllr..1 ..Ioullllon 10 ,III... lIlI U.v. lItvand IhI IIltll .1 Ih. ....,..tn" "P.v...t It ..... IIt.r tho Inl.r..1 0_1111011 dll', ".,"" on lho Hotla., ldUl,lon.1 Inl.r.'t lU.t b. ,"l'UI.I.U,. HAKI CHIOK PAVA'~I AND RIHIT PAVHINT TOI R~OISTER OP..WILLS CUMB~RLANO co COURT HOUSE CARLISLE, PA 17013 OUT A~O~O THII ~INI .. jTA~~ ~OW.R PODTION POR YOUR RICORDI ~ ftW: IIl,,'f '.'lI' 'A~li" (~'If:.,nqllYfal' . ~'nl'R.liif A'IJ'd'tYAX'A'lI'~ftAl"lfiilt"..~t1.'d'QA'IJ'd'.''b'1f ........ m. - - --- DljA~~ow HCI ap DIDUCTIONI AND AII.sIHINT CP TAX IITATI OF BOSTICK RYAN A PILI NO. 21 97-0882 AON 101 DATI 03-16-98 TAK ,RRTURN WAIl e X I ACCIPTED Aa ~XLID e I CHANGED RIIIRVATIOH aOHalRNINO PUTURI INTIRIIT - III RaVIRI. APPRAI,ID VALUI OP RITURHIAIID ONI ORIOINAL RETURN 1, R..l lot.t. CSoh.aul. Al ., atook. end Bonde (loh.dlll. BI. I. Cloe.l~ H.ld atook/p.rtn.rehlp Int.r.ot eaoh.dlll. CI ~, Hortl'l.e/Not.o Roo,lvobl. Caoh.dlll. 01 a. C.eh/Bonk Dop..1 h/Hho, P'roonol Prop.rt~' eaoh.dlll. II 6, Jolntl~ OMn,d Prop.rt~ eaohodlll. ~I 7. Trlnoflro eaoh.dlll1 II I, Tot.l Ao..t. APPROVID DIDUCTIONI AND IXIHPTICNSI 9, ~1In.r.l IMp.no../Ad.. Co.to/HI.o. IMp.n... eaoh.dlll. HI C91 U. Olbh/Hortlll" Llobl1lU../Lllne e.aoh.dllll II 1101 17.268.00 U, TahlD.dlloUon. UlI 'A.UIl.nn 18, Nit Vlluo of TIM Rltllrn CUI 22 , S07 ,45- 11. ChlrU.blI/00v'rn..nt.l """.'hl Non-Il.ot.d 91U Trll.h ca.h.dlllo JI 111) ,00 1~. N.t Villi. of Hot.tl IlIbJtilt to TIM C1~1 22 ,1107.45- NOTII Xf..n .."..m.nt WI. 1"U.d prlv10u,lY, l1nl.14., 18 and/or 16, 17 Ind 11 will r.fllot figUraa thlt lnalud. the tatll of 6kk rl~urn. ......Id to dlt.. AIIIIIHINT OP TAXI 11. A.ollnt of Lin. 1~ .t 8polle.l rlt.' C1Il 16, A.ollnt of Lin. 1~ t.M.bl. It Lln..l/Cl.e. A r.t. 1161 17, Aftollnt of L'in. 14 hMlbl. It CoUlt'r.UC11.. B r.t. C171 11, . Prinolpll TIM 011. TAX CRIDnl. ~AVHINT DATI /j~.",:; II .~ ? BURIAU OF INDIVIDUAL TAKla IHtIERlTAHC~ TAN DIYIUO" Of I'! . 110601 IlARRIIIURD' PA 171/1"0601 COHHaNwIA~TH OP PENNSYLVANIA DIPARTMINT OP RIVINUB NOTICI OF INHERITANCE TAM APPRAISEHINT, ALLOWANCE OR DISALLOWANCI OF OIDUCTION' AND AISIISHINT OF TAM 'c/ RONALD SOSTIcK 471 WOODCREST DR MECH~NICSBURO DATI IITATI OP DATI OP DIATH PXLI NUHIIR OOUNTY ACN 03-16"98 BOSTICK 10-22-97 21 97-0882 CUMBERLAND 101 A.ount ~1_1t ,.d PA 170SS III (al Ul e~1 CII 161 171 .00 .00 "aD .00 11121.87 .00 .00 61961.00 ,00 K ,00. ,OOK ,06. ,00 K ,18. IUl RICU~T ,NUHBIR OllCOUNT C+ I INTIReBT/PEN PAID (-I AHOUNT PAID TOTA~ TAM ORIDZT IALANOI Op TAX DUI INTIRIST AND PIN. TOTAL DUI " If .~A1D APTIR DATI INDICATID, III RIVIRII FOR CALCULATION OP ADDITIONAL INTIRIIT, '* IU'IU1UJfPcu.m RVAN A " HOTel To In"lIr. prop.r orldit to ~ou~ IOOOllnt, ellb_At tho IIPP'~ portion of thi. for. with ~our tlM p,~p'nt, .111 l,721iS7 .00 ,00 ,00 .00 .00 . ,00 .00 ,00 e IF TOTAL DUE IS LESS THAN .1, NO PAYHENT IS REQUIRID. IF tOTAL OUI 11 RIFLECTED AS A "CREDIT" eCRl, YOU HAY IE OUI A RIFUNO. SIE REVERSE SIDI OF THIS FORH FOR INSTRUCTIONS.' RUERVATlDHI PUIlPDIE Of' HOmE I P~YHlHT I RlFUHD (DR)I D....OTIDH11 0' V.' , ,'j ':., \ , '.) (', E,I.I., .1 d...d~l. dvln. on or b.l.r. D..,Ob.r II, 1II1 -- If .nv fulur. Inl".,1 In th. .,1'1' I, Iron,l.rr.d In p...",lon or .nl,v..nl I' 01011 1 (..1111.,.11 _11",,,1.. ., Ih. d...d.nl .lIor Ih. ,"plrollon .f .nv ..1.1. f.r llf. or for v..rh-tht Co..onw..Uh h".bV ..wpr...l_ r_..rv.. the rllht 10 IPprflS.1 ilnd ...... tranJt,r InhlrUtnGl TlMI. .1 Ih. l..ful 010.. 1 (..U.I".llrol. on onv 'IIOh fulure Inl"..I. T. fulllll Ih. roqulr..'nll ,I ".Il.n II~O .f lho Innorllln.. .... hl.l. T.. A.I, A.I II ,f 1991. 171 P.', ...Uon 91\0). D.I..h Ih. I.p par\l.n .f Ihll H.Il.. .nd ,ub.ll Hllh VO\l' p.v..nl I' Ih. R'.IoI" 01 HIlIo p,lnl.don In. rov".. .Ido. ..H.k. 'ho.k 0' """.v ardor p...bl' I" RSOIlTSR OF MI~L', AOSNT , A rlfUnd flf . tiN C1ttdltl which w.. not rlqu..t.cnm 'hit TIM R'turn; ..V bl r.qulltld bv C1oaplaUn. In "APPllOlUon lar R.lund.1 P..",..l.", . Inhorllln,. ond E.t.l. ro." ClEY-111S), ~p.II'"IDn..ro .v.ll.bl. .1 In. 011I.. ,I Ih. ".111" ,I HIlIo, .nv 'I Ih. II "..nu. 0101,1.1 om..., ar bv ,.Illn. Ih. ....1.1 1\-hQUr ..,.....1"' m.I.. .-." lar I.,.. .,dorlnalln P..",.vl..nl. 1-800-161'1010. .ullldo .."",.IY..,I. end .llhln 1...1 Ho"lllMlra .ro. 17171 1t1-80'I. TOOl ml) 71l-UII CllII,I", 1",.lrod Onh), ~nV ..,IV In Inl.,..1 nol ..II.lled .llh Ih. ...r.I.....I. .110H"'" .r dl..ll...... .f d.dUallon., ., .,.....onl ,I I.. clnoludlne dl..aunl ., Inl.,.,I) ., .noon on Ihl. Holl" 00.1 .bl..1 .llhln .1.1. (60) do.. .1 ,...IPI 01 Ihlo Noll.. bVI ' ..wrIU.n prat..t to thl PA D'Plrt..nt of AIVlnut, , aolrd 0, f Appo.'., Olpt. nlOU, Illrrhbury; PA 17126.1011" ,-.I.ollon 10 h... Ih. ..II',d.I.,.ln.d,.1 .Udll .1 IhI ...Dunl .f Ih. ..,'Dn.1 r.p,.,.nl.1 Y" OR ..,pp.,l to th,Orphln" Court. OR 60ftlH IIIRAllYI! OORRtl~TlOftl' F"I~.1 mor. dlo'D.or.d on Ihl' ........nl .hauld b. .dd'....d In wrlllna 10, ,P~ Oo.orl..nl .1.R...n... luro,", 01 IndlylcltIol T...., Ant" Pel,l A.'.....nl RO.I.. Unit. D..I, "'601, H",lob",a. PA 17118-0601 Phont (7171 711"101, I.. p", 1 .1 Ih. b..kl.1 "In.lt.'II.n. I.r Inh.rllon.. T.. Rol.rn lor. Ro.ldonl 0.,00in1" (RIY'IIOI) f.r on ..plon.ll.n 01 ."'lnl.I,oll..IV .."o.l.bl. 'rr.'.. ollCDUHll l/..,vl..iIuo II .old ~lIhln Ihr.. (I) ..hnd" Ionlh. .111' Ih. d...lionl" d..lh, . II.. por..n'l (lXI dloDoun\ a' IhI I.. p." II .1I,..d, ' , . . PlHALTYI ThllIX I.. .....tv non'."II.I"II.n ..n'ltv It ._Ied an Ih. 10101 01 Ih. 11M end Inl",,1 .......d, and nol ..Id b.f.r. J~.r~ II, 1"6, Ih. Ilt'l d'V .11., 10. .nd 01 Ih. I.. .on"I. po,l.d. Thl' n.n'p.,IIOI.,llon , Plnlitv IIIPp..llbli In th. .... .1M.r Md In the ,the .... U.. ,..rlod.. VCJu would ,ppIIl thl tlk tnd lntll;'U Ihll h.. b..., .......d .. Indlo,"d'on Ihl. noli... Inl""1 II ,h""d b.al""lna Hllh llrel d.v .1 IIOlInqu.n.v, 0' nlh' ('I ..nlh, Ind .n. (ll d.v IrOI IhI d.l. ,I d..lh, I. Ih. dll. .1 ....onl. T.... ""lah '"'._ .IIOlIn..lnl b'W. Jon\I"~ I, 1"1 b.., InlO'''1 II lho ,01. " .1. (6XI ."..nl p" _..I'~I.I.d .1 . d.11v rol..1 ,000166.. All I..., whl.h b..... dolln""onl on Ind .11" JanUII'V 1, 19.. will bur Intlr..t It . ritl whloh NI11 YirvfrOi oallndar Vi'" to eil.nd,r v~.i"..Uh thit nt. ""'GUn..d bv Ih. P~ O.porl"nl .1 R...""o. Tho .....1I01b1. Ihlor..1 rol".I.. l'tI Ihrauilh 1"1 "" IHlrREII' 'lW tnt.r..t MltI D.l1~ t~nt.r'lt P'lotor 'lW tnt.r.U Rat. Dill" tnt.rut F.otDr 1"/ lOX .0001\1 1911 'X ,ooom I". 16X .OOOUI 1981'199' \IX .000101 1"6 !IX .ooom 1901 9X .ooom 19.. UX ,000116 1901'1996 1X .000101 1986 lOX .000116 1991'1991 OX .ooom' "lnl.roil 10 ..Iaul.l,d .. fall.." INTERBlT . 'ALANOS OP TAK UNPAID K NUHBSR OF DAYS DELINQUSNT K DAILY INTSREST F~aTOR "Allv HOII.. I"..d .1\" lho I.. b...... 11011_1 .UI rell'.1 In Inl""1 ..huhll.n I. IlIlton III) "'~. boVond lho "'I' 01 Ih. ......oonl, II.p.voenl I. .Ido .fl., IhI Inl.lo,1 .....I.llon d.l. ,hawn on lho NOlI.., Oddlllon.1 Inl.,..I..,1 be ..l.ul.ltd. ...... ..,.. ....! ,r,.' "'!~"I' J,....,.oo . ,,~~ ._ :i!: , .. ":,:) IH.~ IJ.J ..;'"..;JI ~ - 4, r., Ii:'--t c' ( I! " II ("'11",,'1 r 111"..'1 t.\lli.\:i 1-, ;,'1 '1" .' ~ " ~";" f . ~,'J b'.... '.. "\ "., ""t t ;;'/ iX~,,\,~,"..;,~<~, -'~":' I~,'Y., " ' (, (\;i'''',,~, e ""',), f~!;, ::' ..-; .... ( " '.1 J'l ~:;jl .,. "\i ~,"';# ,J. '1..,,__ r" =r L/1 ' ' =r ru .... r'I ru ru CI. d II !H ~ ~ rl-. ~ ) ...... ,6 id IS(./) It ~ -= - -= 1 . . :: , '1 ! 1 - ': - 1 - -. .. .....; .. :~ - - .- - ~ - ~ ~, I" S ~ ~ ffi