HomeMy WebLinkAbout97-00885
IJE'fITION FOR PRonATE and GRANT Of' LI<JTTERS
21-97.:8&-:; __
li:\'/a/e of _c-MARillltfuJY.lUPll.IllL____
a/,\'o kilOI\'II (I,\' ____~_'m___._______
Nu.
To:
____..__.,___~ 'leglstcr of Wills for the
_ _~~.__, /)O('o[/,\'(!(I, Counly of .. Cumborllll1d...._ In lhe
80l'iol 80"lIrll)' No. .J..'l4~06~2113 Commonwelllth of l'ennsylvlInlll
The pelltlon of the'undmlgned I'espeelfully represents thlltl
YOUI' petltloner(s), who IS/lire 18 yellrs of lIye or older 1II111w exeellLr.lx ullmcd
In the IlIst will of the IIbove decedenl, dllted JanlUlr.Y...2ll.l-- ,19..'l.ll-
IInd codlcll(s) dilled --1\OI1e
--:/~-~10 JJ ~~,J ,,()~ '. 1f~.... "~r--Lh"7 (?' r ~:
(!ihllo rclcVlll\1 c1rClIlI1slruicclh c,y. rCllIllIcllltlOll1 den"l 'lr c~ol.'lIl(1r, rtc,'
Pcccndcnl WIIS domiciled lit dcnth In Cumberland il;;r:;- COUllIYJ,.Pem\syIVllnlll'AWllh
1~~lImIlY 01' prlnclplIl resldcncc III, " 4023~lIr_ll!lltROlIg, !,!lIrdners. p=--
(11'1 ,lre.l, !llIlI1b.r IIl1d II1ll1wlplllI\yl
f)(lCendcnllth~"n, ' 85 c!J~~~~:'IISC, died Ootober 23, ,19 97, ,
lit Fores~rlUie.alt4 ..oarJlsle, PIl. ' ,
Except liS fullows, decedent did 1I011111\rry, WIIS not divorced l\nd did not hllve II child born \II' IIdopled
liner execnllon of the will offerod fOl'problltei WIlS nolthe victim of 1\ klllhlS IInd Wl\S never IId)udlented
Incompetenll none
I)ecenclcnllll dellth oIVned properly with eSlll11l1tcd VlllUes liS follows I
(If domiciled In \111.) AlIllcrsolllll propcrlY
(If 1101 domlcllod In I'll,) 1'0l'sonl\Ipl'oPol'Iy In Pennsylvl\nlll
(If 1I0t domiciled In I'll,) l'el'soUl\1 pl'opel'ly In County
YlIluc of 1'0111 osll\lc In Pcnnsylvl\nlll
sltullted l\S followsl
$_..3,600.00
$
$
$
WHEHEFORE,pelltloner(s) respeclfully rcquesl(s) the prl'lbl\le of Ihe IlIst will ,lInd oodloll(s)
presemed herewith IInd the Sl'lInl of lellel'L ' , testamentarY
(\CSllIlI1clHllrYi'HIII1II1I"rlllloll .,1,110111111111111'1",11011 lI,b,lI,e,\,II,)
Iheron.
i~
il
~ ~'~~
, 'W'Mm~'\ ~
. er'
4038 Oarllsle Road
Gardners. PA 173M
"
OA TH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLV ANIA } S8
CO~NT\' 01<' CUMBERLAND
The petIl19nel'(s) above-numed sIVear(s) 01' nfflrn\(s) thl1lthe stnlel1\ents In the foresolns pellllon 111'0
true IIn(1 eprreot to the besi llf the kllowledge I1nd belief of pethloner(s) and thllt as llersolll\l represe1\-
tllllve(s) of the IIbove deeedelllpetltlonel'(s) \Y)!l-Wdl~nd truly administer the esll\te aceotdlnylo IIIIV.
Sworn to or IIffll'med IInd Sllbsorlb,ed ~~ ~. .,~ ~~.<::::.J<;;l ~hl'
before me t Is 30TH __ dllY of _
~R 6.\99h,. f5
J J87YJ(;;tt1, J '
IIry C, Lewis, ROllls/or, J -li
\S-.;zl\-I\
1I11" ;ill\ III \' 'lf~fI
This is t\l <,cnll)' Ih"l dlt' il1lilnllillloll h<'Il' 1\1Vl'I,lls ,'ol'll'<,d)' ""pkd n01l,11111 ollgll1i11 ",'r,lilir:1I1' ot' dl'illhlh\)l: fiied wilh 111<' 1\.\
LOlilllh'gislrnr. The olil\il1i11 lcllilh:illl' willi", 10lwilrded 10 IIIl' SIiIlC Yllilllll"o,ds (>lIlt." 101 1ll'1I\1i!!WIII Idllll\'
WARNIN(l; Ills II10gallo dupllollts ,Ihle oopy by pholosllll or photograph.
I'C<' I'll' Ihls n'lIilk,,"<, $.!.1I11
4601057
......-...:...--
No,
C\ (~
~l' " ~b (< \\\"\~..........-,-~~'iu
1.0r:,1 itqdslIlH ~ " . (
OCT, 2 (5 1997
_~.___..,.""....___a~_~~_'~"~_~__'~~
\11\1l'
tlICltlUI'tva",
OOMMONwaA~TH OP paNNav~vANIAo OaPAATMaNT OP HaA~TH' VITA~ AaOOAoa
oeRTIFIOATe OF DBATH
IIPI\INT
'.
IAN.NT
II\ItIK
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.,JUri 9/I<lll, ,P1'I
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4023 C.rll.lo Ro.d
. andn... l'A 17314
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w'l!ijQ I I ,1'1.., "t. .e;....1
36 car11ale Road, Oardn~rti
;~~tf :.' 11l1ON,~to'It~e."",.",elt""'tt\' . \00
.....
t"~fIIM tJ ..iIItl-III,,",, lltll CJ
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OlltCqlllotety
It/. HMHfltHII'''()f A lIfT
,bot H. nA1t.hnore
ICIH'1lOU
I GardnfJrl PI\ 1'7324"
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f.1M "."0' /Ilr ~1In1"", 'lIUIfI "tVllt'II~ 10111. u"..ttl Jnd IMM"" ,'fIU .
',".'OIJNC'!I(l'" o'l"""" ''''I.~H '''l'~'''............. ",~'M ""..... """.. "'~I
To tilt bll' tl /Ilr .iIrM..... ...III"illlllll., III' Imt, d,", 1M pUit, Ind 1M 10'110 CluUltlond """"".. ttmd
~..~~JA~~~.~:g~~OIlmt'II'.'I.,., I~ my .pllllon, "HIII,nun,d tllM If"", d.tl, I~d ,.IICO. ,nd,~ 101M ul.lttllllNl
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A\\W~srou. &1""''''t('Aal,IIRS1.lI<OWPlIlE 1N1nA1! . :OCIAl SE,CUfIilV NW_ SE. [--mIl R~TURN MUST D~ Fll~D IN OIIP1I/1ATU WITII TIlt
_ ' L RF.GI8TER OF WILL8
[J 2, SlIpp10m<lI>U11 Rolllnl [J 3. ROnlOll>dol ROII!m IO.'~"""~"'.111l111
IJ 4n, FIIII.,o 111101081 COnlplOnllso IS"'~""'''''' \1.\1111 0 5 Fodollll Eslnto T.. Rotum Roqullod
o 7, OQ(O(Jonl Mall>tall>od 0 lNlng T",sli"""'h'~r~l""1 J 8 TOI.I NUll1bor of S.lo OopoSltOo.os
010, SpousalPoval!y CrodIlISolo~"""l<,""n ll,ll,i1'n<l ''',Iii 0 11. Sloc!>on to t.x uM.r Soo. 9113IAlt""'h8<h01
OORRBSPONDBNOB ANDOONFIDllNTIAL TAX INPORMATION SHOULD BB DIRBOTBD TOI
COMl'ifitr: WUN MlORf:&S
6 South Hunovol' Strcot
,Cut'lIslo, PA 17013
COMMONW~ALTlI . P ,NN9YLVAN'A
11I'r'AIHM~N' or HlNVtHJU
1),1'1.180001
,
REV..1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
rill HUMOUR
21MU7M80ll
Illl IflIIAtllil..l~jrilAxl~Hop'U...udl
WElDNmt MAlwm B
e ,URI
OAT[ or OfAlft
(Wi-j)fnIilIH
II
174
tl
00 I Orilllll.' Rolllm
o 4. Llnlltod Estalo
[i) 6, DocodoOl Olod Tosl.lo 1"'."'~roIW"
o 9, Lit Alkm ProceodS Rooolvod.
T C S. 00 P BTBD, AL
~
" Roal Eslato (Schadul. AI
2, Slooksand Bonda ISchodlllo 0)
3, CI080ly Hold Corporallol>,Partnor1hlp 01 Solo'Plopnolor1hlp
4, Mortgsgos$ Nolos ROColvable (Schedlllo 01
'I;, Oaeh, Bal>k Oaposlts & Mlsoollanoolls PelSooal Proporty
(Schodulo 6) ,
6, Jolnlly OwMd proporty (Schodule F)
7, Inler,VNos Transfer1 & M18ooll.noolls Non,Prob.lo Proporty
(ScI1odulo G or L)
8, Total Oto.. A..ots (tolal L1noa 1,7)
9, FUI>OIII 6'po1>000 & Adnlll>lslreWo,Costs (ScnOdulO H) (9)
10, Oobts 01 Oocodonl, Mortgage Lleblllllaa, & Llona (Scnodule I) (10)
r::; itl'
"f ':',
(11
(I)
(3)
(41
(5)
(6)
(1)
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1
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1./ , i 4> 1 . & ~-
/ II? ". '7 . (,.!J-
, I .3 I ,1 f!J . f ,j-=
11, Total oaductJont (Iolal Lll>a. 9 & 101
12, Hal ValulOfBtlalo (Line 8 minus Lll>o 11)
13, Chartlablo and Govemmenlal Bequoots/S.o 9113 Trusts lor w11IcI1 an eloctJQn to la, has I>ot boon
mada (ScI1odulo J)
14, HttVtlUt SUbJtctl. Tax (Line 12 minus L11>013)
15, Amount 0' 111>0 14laxoble
at tho spou;oll."alo . I' X ,0
800 l.nslnJctIonl on IIvalle side for oppllcablo porcenlage
18, ~t":~:~f~"ne 141a,able t I ,J I , 1 'I ,$ . r J: X
11, Amounlof IIno 14laxablo
al 15% rate X
(11)
(12)
(13)
(14)
115)
,06 (18)
,15 (17)
(181
I of} /
19,
PA 17S!.!4
'7 0/.$ 9.5-
(I f 0 1/. d .:;
7, 9 () if. (, .:;
arllJilnoljlleflMtfothe,
DATE
'fAil ~ 1 , 1990
DATE
/)'(1/1 /{ f ' 1998
(I
Oe~.':ldl!..,n.t!l..g_~!1Elf).I~i\cfd,rolls,:,
BlIlI:rr Alllllll'Gn '112 'J (', II 1 I' I
I, , ~Ul' H 0 ,0111
.
- ,_.._,'~-... -'~"'., - ~._~~ _~n_"_"__,"",__
, '_.~-'~'_H.'"""_'__-,-,._'o.~.,
~....-r~_""-'-..-.-_'-'-_'_'~._~_~~T""'~" _ _______-,-'u.,~ ___
._n,.. 'n ,._ ......, _~,_.. _,_~".."'__~__
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(:ijy-- ~----a~I'(hl-~I~~-----L"-' - ---..,.... -----------..-..-j-,ifXil- . i; A- --/'./iF-'-./.7:ii;j---.-,..,'
--~~"~-~""'_-'-.,nn-"_..~~~~=_...u~-<'~___.__." ......, ., ___.,.....~..-,-~__ ..__"---h~..__~
TII~PayrnllntB and Crod/tll:
1. T ox OLIO {Pooo I Uno IIlI
2. Crodlla/PaYlllollla
A. Spollanl povorly Crodil
--'-..o;:'-~--~----"- -~-- ---,' "''''','n'___'
B, Prior Paymonla
C,Discoull1
(II _.._ .__~._.h004. 0.1..
---,-., .~~~~-~_~,._ "._"'n_._.'~_~.
J, IlllorosVPOllolly if oppiicnhlo
P,lnlorOSI .
e, POllally
Tolnl Cio(jil~ (^ , [I, C 1 I~) ,~"_~___.
rOlnllllloro~VPollnllY ( D . l'1 (JI
4. If Iino 21s oroolor Ihon Iino 1 t Iino J, onlor Iho difforonco, Thlslslho OVeRPA YMl!NT,
Oheck bOK on Pege 1 Line 19 to roquut. rofund (4)
5, II IIno 1 t Ilno 31s grealor Ihan IIna 2, onlor Iho dlflorol1co, Tills Is 1110 TAX DUI!, (5) 7,004,03'
A. Entor Iho Inlorost on Iho lax duo. (5A)
6, enter Iha 10lal of Line 5 + $A, Thlslstho BALANoe DUe, (56) 7,004.03
M$ke Check pa able to: REGISTER OF WILLS, AGENT
pL.ElAae ANllWElR THe FOLLOWING Q El TIONS
BY PLAOING AN "X" IN THe APPROPRIATe BLooKS
1, Did decodenl make a transfer and: , Yoa No
e, .retain ths use. or Income of the property transforrod; """'''''''''''''''''''''''''''''''''''''''!'''''''''''''' ~ ~
~: ;::::~ ~h~e~:~~lb~:~s:~~a~~ee~~~, ~~~~~ .~~,~, .t,h.~, ,~,~~,~,~:~~ ,~~~~~~,~~,~:~~ .~~, ~~~ ,I,~,C,~,~,~,:,:::::::::::::::: .
d, reoelve tha promlee for life of either paymonte, benefits or oare? """""'"''''''''''''''',,'''''''''''
2, If death ooourred on or before December,12, 1962, did decedent within Iwo yeere
preceding death transfer property Without rocelvlng adequate conelderatlon? If dealh occurred
efter Dacember 12, 1962, did decedent tranefer property within one year of death wlthollt
receiving edequele coneldorallon? ,,,,,,,,;,.,,..,,,,,,,.,,,,,,,.,,,,,,,,,,,,,,,,,,.,,,,,,,.,,,,,,,,,,,.,,,,,,....""..",.".. 0 Q!l
3, Old decedent own an 'In trlletfor" or payable lIpon death bank accollnt or eeol/llly .
4, ~tl:~a~e~:~~~~~:~. i~di~ld~'~'I' ;'~tll~'~;.~'~'; '~~~~~~i:' ~~~~i;~: .~;. ~Ii;~;' ~~~:~idb'~;'~' p';d~~;;~?':::: 8 ~
12 p,S, g9116 (a) (1,1) (I) provide or tho reduollon olthe tax rOle Impo.ed on Ihe nsl velue of transfers to or or tha use of the
surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and bofore JonUel)l1, 1996,
12 P,S, g9116 (a) (1 ,1) (II) provided for the reduollon of the rote Impoeed on the net valuo of tranefere to or for tho uee of the surviving
spouse from 3% to 0%. far dates of dsath on or after January 1, 1996, The statute does nol exemal a trenafer to a aurvlvlng epouee
from tex, and the etal\ltory requirements for dleclosure of eeeets and filing a tax return are sllll applloable even If the surviving spouso
Ie the only beneficiary, ..'
FOR DATeS OF PElA TH ON OR AFTER JANUARY 1, 1996 . P/oaseanawerthe following quesllon by placing an "x' In thil
appropriate spaoa, '
Old the deCadent oreats a truator aim liar arrangement which la aolely for tho aurylvlng apou80'a benefit for his or her entlro
Ilfellme? Yea 0 No l!l '
If you snsWered yae to Ihs above quesllon, the tsx On the trust or almllar arrangemantla poatponed lInlll the death of Ihe second
epouse. at whloh time II will be fully taxable at the rate(s) applicable to the remainder benonctary(lea), Enter the value of the Irual on
Schedule J, Part II, In order to remove II from the celculsllon of the lex due In this eatate. you may wish to file Sohedule 0 In order to
make the eleollon available under Seollon 91.13. If the eleollon Is mads, the trusl or similar arrangemsnt Is taxed In the estele of the
firsl decedent spouae, Ihe portion of the trust or almllar arrangementwhloll bon~fiIstlle surviving spouse Is taxed al the zero tax rata,
and the remainder 10 taxed al tile rale(S) appliCable to the remainder benefiolal)l(les). If you ohoose 10 make the eleollon, you muat
aUeoh Sohedule 0 to a IImely.fiIedtax return, along wllh Schedule(a) K and/or M In order 10 allow the epportlonment of the trust or
similar arrangement botween the surviving spouae and the remainder benefiolary(/ea),
Ilv 1~09 t.. lit III
~~
COMMOHWIAlIIl Of PlNNIYtvANIA
IHtlIRtlANt!"AK '!'UKH
A IHlINI urnu HI
mArI'o;.~-""-""- ==._~"~~"',..,~_~,'"_,"'__,~..__'".u,._..,"..___,_~._"~,,..~ tllLeNuMiiER ,,"-~.~-~=,,,~
, MAIWm Ii, WBlIlNWt 2H17-88n
SCHEDULE P
JOINTLY.OWNED PROPERTY
Jolnl I,non'hll
NAMI
_..~__.._.__. ..._._....~_~,.=____.h._
A, l)onnu IV, Mlllol'
,AllD,Il~U..
4036 CUI'lIalo Houd
(lm'dnol'a, I'A 17324
, _RIL^TIClNS.HIp'T()IlI.~I.!mtL,_
Iluughtol'
8,
C.
_.._..__... _~....____._u~ ..._____._.__..__ .. . --. ---...._---,,-,-_.. '- ..--..'''-..- ".._.~--..., ..__..~-_._,----.
JOlntly.own,d PIOP"'y'
--_. --.---...... ~_.__.._.._-... ....... __'n "._"__ .. ___... '_'n." "'" -..... .----_.~.._,._~.....~
N~~rlR LITTlR DA~EI r
b\m DISCRIPTION OF PROPIRTY TOTAL ~teLUE DICD'S DOLLM VALUE OP
T'N T ~~NT OP A S T 0/0 INT, DICID T'S INTI ReST
_~._._ '__'4m~..'_ .__"..._.~ on . 'n _. "_n~..___' _"'P' ..__ ..~ _.p ___,_. _ ___........,', nOn, -_....,..~--._.._--_.-
1. A 7/20/111 PNC CID #21001061667 10,1l00.0 611% n,ooo.OO
Aoorul.1d Intereat 10 10/23/117 4.3 nll% 2.17
2. A 8/6/111 PNC C/O #21001061669 211,2no.O 6096 10,12n.QO
Aoorued Interesl to 10/23/1l7 23.4 n096 11.72
3. A 1/11/94 ['NC C/D #21001061786 74,769.8 6096 37,384.93
Aool'ued Intol'oal to 10/23/97 138.1 nll96 69,08
4. A 1/30/1l2 ['NC cm #31900074474 16,000.0 n096 7,600.00
Aoor.uod Interest to 10/23/97 61.61 no% 25,80
5. A 1/30/94 PNC C/O # 31000073708 30,375,0 5096 16,187,60
Aoorued tnteresl to 111/23/117 104.5 GO% ' 52.20
O. A 8/17/90 Adams County Nnl, Bk. C.D
#13-4-87919 14,31l5,1 50% 7,197.69
Aoorued Interest to 10/23/97 130,4 50% 68.24
7. A 1/11186 U.S. Oov'l E. Bonda (seo nttaoho 115,705.2 60% 57,862,00
. _.._-- -.-...~._-- -..~-~,.~~._...._--...._._._~ ..n'~ .. .. ._....._....__.._r.__.. _., ......___._.._.. _.~__. _"~_"__.'h ~-'__,,_,.__~~
----..~.------_..--,.~-.--~---.--~,~--._~._._..~.__.~."~~_4________ __-'_
TOTAL (AlIa .nlor on IIn. 6, Rocopltuloilon)
$
140,476.81l
(II mar. .poco II n..dod /lIlorl add/l/onol '/1..11 0"0"'0 .I.o)
HAKI OHIOK PAYAILI AND RIHIT PAVHINT TOl
"REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
OARLISLE, PA 17015
OUT ALONG THI8 LINI .... RITAIN LOWIR PORTION pOR YOUR RIOORDS ~
TiW,: li'ii'f. i'lt.~~'Jl'.rll'9.:.,r.NbViBI.-OII-YtiAI'lfff7if(6'I.YIt'~.Ajill~AYii'M\l'Ilt"."~tt"o"~,Wi.b1f.."._.". -.... -..
DISALLOWANOI ell' DIDUcTIOHI AND ASIIS.HI~T OP TAX~
ISTATI 01' WEIDNER MARGIE SPILl Nel. 21 97-0886 AON 101 DATI 08-51-1998
TAX ReTURN WAa, (X) ACcepTeD Aa PILIP () CHANOED
lllsaRVATION OONOIRNINO pUTURI INTIRIST .SII RIVIRII
ApPRAISID VALUI 01' RITUIIN BASID ONI ORIGINAL RETURN
1. Raal e.t.t. (aohadUl' A)
2. stook. and 80nd. (Soh.dula 81
I. Clo"I~Hald 8took/Pa~tn.~.hip Xnt.~a.t (Soh.dul. C)
~, Ho~toao../Nota. R.o.iyabla (aoh.dul. D)
a. c..h/8ank Papo.it./Hi.o. P.~.on.l Propart~ (Soh.dul. E)
6. Jointl~OWnad Prop.rt~ (Soh.dula f)
7. Tran.far.( aohaduh 0)
B, Total A..at.
APPROVID DIDUOTIONS AND IXIHPTXONS,
" funaral Exp.n.a./A~. Co.t./Hi.o. Exp.n... (aoh.dUl. H) (,)
10. D.bta/Horto.o' LhbiUUa./Lhn. (Sohadul. I) (10) .00
11, Tot~l Daduotion.' (ill
12, Nat V.lue of TaK Raturn (12)
15, charUabla/OOy.rnuntal ,.qu..tol Non..laot.d 9118 Trult. (aoh.dull J) (111..
l~. Hat Value of Eot.ta a"bj.ot to TaK (1~) 151,745,96
NOTll If In ..!I..llI.ntwI. i.llu.d prlvi.C1u.1Y, Un" 14 I 18 Ind/ar 16. 17 Ind 18 wU.l
r.fl.at Tigur.. thlt i.nalud. th. tat.l of ~ r.~urn' .......d to dltt.
AIIISSHINT OF TAX'
II, AMOunt of Lina 1~ at Spou.al r.ta (11)
16, AMount of Linl l~ t.xabla at Linaal/Cl... A rat. (161
17, AMount of Lina l~ taK.bla at Collataral/Cl... a'rlt. (17)
lB. Prinoipal T.X DUI
TAX ORIDITI'
PAVHeNT
DATE
/'). ,)/1,11
aUREAU Of INDIVIDUAL TAXea
l'*IfRITAHC[ TAR PIYI810N
PlPT, 180601
IIAIItI1P81IHQ, PA 11118-0601
OOHHONWIALTH OF PINNSYLVANIA
PIPART"INT 01' RIVINUI
NOTICE Of INHERITANCe TAM
APPRAIaeHeNT, ALLOWANCE OR DISALLOWANce
Of DeDUCTIONa AND AaSellHENT OF TAM
c...
ROBERT H FREV ESQ
6 S HANOVER ST '
CARLISLE PA 17015
DATI
IITATI OF
DATI 01' DIATH
1'1101 NUHBIR
OOUNTV
AON
00-51-19911
WEIDNER
10-25-1997
21 97-0888
CUMBERLAND
101
AMount RIflWld
(1)
(2)
(I)
(4)
(II)
(6)
(7)
.00
.00
.00
;,.00
3,154.71
140.476.89
.00
(BI
11,867.66
.00 X .00.
11$1,743,96 X ,06.
" ,DO M .18.
(18)
RECUPT
NUHDER
DlacOUNT (+1
INTeREST/PDN PAID (.)
AHOUNT PAID
TOTAL T(lX ORIDIT
BALANOI 01' TAX DUI
INTIRI8T AND PIN,
TOTAL DUI
*
UVoIut U '" m.th
HARGIE
S
J
HOTel To in.ur. proPlr
orad it to ~our looount,
'UbMit tha upper portion
of thi. for. "ith ~our
tex PI~.lnt.
145,611 ,60
11".Ail.7 Ii"
151'1145,98
.00
.00
7.904.65
.00
7.904.63
7,904.65
.00
.00
.00
M I~ PAID AfTER DATe INOICATDD, see REVEReD
fOR CALcuLATION Df AODITIDNAL INTEREST.
( I~ TOTAL DUE IS LESS THAN .1, NO PAYHENT IS ReqUIReD.
If TOTAL DUE IS REflECTED AS A "CREDIT" CCR), VOU HAV SE DUE
A RefUND. SEE REVERSE SIDE Of THIS fORH fOR INSTRUCTIONS.)