HomeMy WebLinkAbout97-00892
PltTITION FOR PRODA TE and GRANT OF LETTERS
Illa/, oJ J. NI,WELL VONCKX No. ~ - 9..'J - 8<1 ;;).J
II/Ia ki!oWh III uU11~ '1'l1!WEL1. VUN!:.!S.X TOI
_.._ _ Ih,IItor or WUlI for Ihe
, , " D'~fI!I~d, County or Cumberldnd In Ih.
Soclll/S,cur/IY/'/O" jQ/-1U-3go7 _', ,Commonwpllllb ofPonnlylvlnla
The petition ot lb. undmlanocl rQlpcctMy loprolonte Ihall
YO,ur pOlltlonel(I), Who,II/ar.IS yom of 'ae or older an Ihe oxeeu!., A l\~r~
In Ih.I," will otthubovo dOGodonl, dated _,." '" ,.lIl1r II ?!;. ' ' , IP
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(1111 111001. o~mbol .n6 mUMlpnllw)
~el\ ~: MeCly,arlOr...,dl.d ~,~~~ber 14 ',' " ,IP97" ,
,at." . llac .' liInicsbIH'IQ. PA l' .. II' . . . I
BKoepl II rollowl, dooedanl did 1101 marrYI wal nOI <!Ivoreed anddld nol havo a child born Or adopted
aner meutlon or.lha will orrerod tor Droba"l WII nOllhe vlollm ot . killin, and W.. nov.r aCl.Judloalld
Inoompellntl No n~ ,
Oeoendonl at dcalh ownod prope,lY wllh elUmMed v.lu.. AI tolloWII
. (It domlollod In PI.) All pe,lonal proportY ,
(lr nOI domlollod In Pa.) Po/lanai properly In !l.nnlylvanla
<H riOI domlolled In Pa.) Pmon,1 properlY In COllnlY
Valli' or real .IIlL1a In Panneylvanla ,.
IIIII.IOd II followl I
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WHla!lIfORS, pOlllloner(l) mpeol'ully. lIouelllll) the probato bt Iho ta'l wUl and oodloll(l)
prasontod herawllh and Ihe arant or lett"'_~S!!1l,t;.t1.,s't ra t I 0 n c. '. a .
h ' (Illtlmonl"~1 admlnlllta'lon 1,I,a,1 admlnlll"lIoo d,b.n.o,l.e,)
I oron,
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\:ier'~ld u, ~rllls~
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R.D. #1, Box 225
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OATH OF PERSONAL REPRESENTATIVE
COMMONWE,4.LTJ:I OF PE,NNS\'LV ANIA } sa
COUNty OF ' GUMBER~~ND
ThepOlI\loner(e) aboye.namad Iwear(l) 01 .ttlrm(l) Ihal Ihe Ilatemenllln lhe toro,oln, pelltlon aro
true .n~ OOlreollO thO bllt ot Ihe knowledae and bellet ot petlllonarll) and that.. pettonal repr..en.
tallve(I) of lhe above deeedenl pOllllon'r(l) wl1l wall and Irllly admlnlller Ih. ellalo aooordl", to law,
S\Yorn 10 or arflrl1l6d and lub 10 rlbed ~ " A ~<:-ft;/ . a~h-~., . I'
berore hll .6TH 'lor {:i-e1'8la u. 1!"rl~1 .
EM. 19
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" J. NEWELL VONCKX, a/k/a JOHN N. VONCKX, currentlY of Upper Allen
TownshIp, Cumberland County, Pennsylvania, declare this to be my last
WII' and hereby revoke any an~ all prior Wills and Codicils maqe by me.
I. 'direct that all my ,just debts and funeral expenses be paid
from ,the assets of my estate ass90n as practicable after my demise.
II. I direct that all estate and Inheritance taxes that may be
assesslld In consequence of my ,death, shall be paid out of the principal
of my general estate to the same effect as If said taxes were expenses
of administration and all property Includable In my taxable estate
whether or not passing under this Will shall be free and clear thereof.
II I. I wish to donate my body, unrestricted,. to the Humanity Gifts
Center of' the Pennsylvania Medical Society. 20 Erford Road, Lemoyne,
Pi;lnnsylvanla 17043. The recipient Institution Is the Hershey ~edlcal
Center, Training Division,' and it shall assume all expenses. The
Madi ea I Center prefers that the body not be amba 1 med.
IV. All, the rest of my property, of whatever nature and wherever
situate, I devise and bequeath as follows:
A. Forty percent (40%) unto my daughter, Sylvia M.
Eisenman, 809 Palo Alto Drive, Arcadia, CA 91006;
B. Forty percent (40%) unto my daughter,Dr. Carol M.
Kaske, 121 North Quarry Street, Ithaca, NY 14850; ,
C. TWenty percent (20%) unto Messiah Vill_ge,
Mechanlcsburg, PA 17055, to be used as It sees best.
D. In the event that either or both of my daughters'
predecease ,me, then said daughter(s) share(s) shall be given
In equal amounts to American Bible Society, 1665 Broadway,
NY 10023; and World Vision, lnc" Pasadena, CA 91131"
VI. I appoint the Administrator of Messiah Village, or his
~ ,,,,",,, of <hI. ., WI".;. h~ II d~
/ t)~ ~I 0.- L{
REV-1500
INHERITANCE TAX RETURN
RES I ENT DECEDENT
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j"..na'llJ!<i~Ol~'(
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COM~9VLVANIA
llIlPAATMllHT Of' IIMlHUe
om, 2tOOQ1
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o 0, Llllgellon PrOQtOdI Reoolved
T BOT 0 T,
'RALD J, (lRINSER, r:SQUIRE
AGNER & ZIMMERMAN
38-6348
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(1)
1, Real Pilato (Ochtldule ")
2, StOCke and Bondi (Schtldule 81
3, Clololy Held Corporallo~,Partno~hlp or Sole,proprloto~hlp
4, Mortgagoe & Notoe Recolveblo (Schodule 0)
5, Ceeh, penk Dopoeltl & Ml$oollenlOue pOllonel Property
(Schedule e)
B, Jolnt~ <>.vned Property (Schedule F)
7, Inter.Vlvoe Tranefora & Ml$oollanlOue Non.Probete Property
(Schedule G or L)
B, Tolal GrQII "...tl (tolal Llo08 1'1)
0, Funarel expeneee & "dmlnlell1lUvO COlla (Schedule H)
10, Deb~ of Decedont, Mortgege LleblllUoa, & Lleoe (Schedule I)
11, Totll Dtlductlone (tOlal LlnGl9 & 10)
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12, Net Vlluo of allale (Line a mloue Line 11)
13, Chenteble and Govornmontel aequoatllS~ 9113 Trueta for which en oloc1lon to tax hal oot been
made (8chtldule J)
14, N4I Vllue 8"bJtol to Tax (Llno 12 mlnue Llno 13)
15, "mount 0 line 14 \IIxob\e
atlhOlpoueal1ax rate , , ,I ,
Sce loewotlOoe on raveree e~o foreppllOable peroeotaoe" ,,' ''0 ^' ,.,,,,,
10, "mollnt olllno 14laxeble '1 6 9 4 7' 1 .. 6 . 4 x
atOllrato "'," ,I." '" "I. "" "', , ."" ' I. ,
17,"mountolllne14laxeble' .., ..," ,', ",,"" """",""'" ,",'
ftt 1611 rato x
10, Tax Due
(14)
(10)
X,Q
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(17)
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,00
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PA 17070
PA 17078
(lOX 323,
(lOX 323,
Decedent'. Oom
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,,'. Addrell'
ESS I
100'MT ALLEN DRIVE
MECHANICSOURG
E PA
TIl( Plymente Ind Oredltel
1, Tax Due (Page 1 Line 18)
2, OredlleIPeymentl
A, 8poulel Pove~y Oredlt
8, P~OI Peymentl '
C, Olloount
(1)
-0-
-6-
-0.
Totel Oredlll ( A + B + 0 ) (2)
'3, InleresVPenelty II eppll08ble
0, Interesl - D-
e, Penalty - u.
(3)
(4)
(5)
(5A)
4,
5,
P IIA8 R T II OI.LO I 13 Q E' TI N8
BY PL.AOINQ AN "X" IN THB APPROPRIATII BI.00K8
1, Old deoedent meke a tranafer and: Yea
a, retain the uae or Inoome of the property Iranaferred: ""'"'''''''''''''''''''''''''''''''''''''' " " ,,,,, " " '" ~
b, retain the right to dealgnate I'/ho ehall Ute the prope~y tranalerred or Ita Income: ,",,'"''''''''
0, retain a rever.,lonary Intereat; or,"II''''..II''.1I.'''"..."""".IO'..''''II''''''''''""...."...""".....""""....
d, receive the promlae lor IIle 01 allher paymenta, beneflla or cere? """"""'"'''''''''''''''''' '''''" ,
2, II dealh oocurred on or before December 12, 1982, did deoedent within two'yeare
preoeding death tranaler proparty wllhout receiving adequate oonaldaratlon? If death ooourrlld
aller December 12, 1982, did daoedent tranaler property within one year 01 cleath without
receiVing adequate consideration? ""''''','1;;'''''''''''''''''''''1'''''11''''''''''''''''''''''''''''''''''''''''''.""'1",,0
3, Old deoedent own an 'In truat lor' or payableupcn death bank account or eeourlty ,
4, ~tl~l:e~e~:~~~~~~'~'I~di~id~~i ;~';i;~;;;~'~'; '~~~~~~i:' ~~~~it;;:'~;' ~;h~;' ~~;;~~;~'i;~';~' ';;;~p~rt;;?:::: 8
170 5
10.160.30
-0-
-0-
-0-
10.160.30
-0-
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2 ,S. 91 6 (a , i) prov e lor t e reduot on 0 t e teH rate Impoled on t 0 net value 0 trane ere to or or the uee 0 the
eurvlvlng epouae Irom 6% to 3% Icr datee 01 death on or aller July t, 1904 end beloro January 1, 1996,'
72 P,S, 09116 (a) (1.1) (II) provided lor the reduotlon 01 the rata Impoled on the net value 01 Iranelere to or lor the uee 01 th" eurvlvlng
~pouee from 3% to 0% for dot.. of death on or afler January " 1996, The atatute doee not OHemot a tranafer to a eurvlvlng epouee
from taH, and the etatutory require mente for dlsclolura of aBBel1 and flllng a taH return ora etlll sppllcebla even II the eurvlvlng epousa
IB the only benefiolary,
Fon OATIS OF DBATH ON OR AFTeR JANUARY 1,1998. Please anlwer the following quaetlon by plaolng an 'H'In the
appropriate epaoe,
Old the decedent oreate . truat or similar arrangement whloh Ie solely lor tho surviving spouse'a bonoflt for 1111 or hlr entlra
IIfltlme? Yel 0 No ~
If you anewered yee to the abova queetlon, the taH on the trust or aim liar arrangement Ie postponed unlll the dealh 01 the second
epoule, et whloh time II will be fully taxable at tho rate(s) appllceble to the remainder beneflolary(les), !;nter the value of the truet on
Sohedule J, Part II, In order to remove It from the caloulatlon of the tsH due In thle eetate, You may wleh to flIe Schedule 0 In order to
ma~e the eleotlon available under Seollon 9113, II tha eleotlon Ie made, the truet or elmllar arrangemant Ie taHed In the eltate of Ihe
flrsl decedant spouee, the portion of the trult or almllar arrangament whloh beneflls the eurvlvlng epouee Ie taHed at the zero laH rate,
and the remainder Ie laHed at the rate(e) appllceble to the remainder beneflolary(lae), If you choo88 to make the eleotlon, you muel
allaoh SOhedule 0 to a timely-flied taH return, along with Sohedule(e) K end/or M In order to ehow the apportionment of the truet or
elmllar arrangement betwean the eulVivlng epouee and the remainder benenolery(lee), , . '
"
,lIv,tllltltll.1I1 'J
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imlk r~OM~~'~IJNi~:fSM~::~~~,. .., -
P J NEWELL VONCKX
. 5CHIDULI H
PUNIRAL IXPIlNSIS,
ADMINISTRATlVI COlTS AND .
MISCILLANIOUS IXPINSIS
PI.a.. Prlnl or T .
_....._._ ".w_... ___ ....~._~.u_.._~..--.. _.,.__ _~.
21-97-0092
--'--__________.~ _..____..,..__~______ __'~___'_'~__"__ _~"_'n ,,___,__, _._..~_.___~_~____ ____~ __.---...._
IT 1M
NUMBIR
DISCRIPTION
AMOUNT
_---'_-.-.-__k_____.________.______'_____..__......_...._..~..__~__._____~_ _.....___.
1.
PunllallMp.n.",
NEILL FUNERAL HOME -IMLANCE PUE
207,00
A,
1.
Admlnl.tratlv. COlli'
Perianal Repr8l8ntatlve Cammllllanl 23-2939695
Social Security Number of Perianal Reprelenlatlve. _..__~___-
Year Cammllllonl paid .--12~ 7 /1998
10,000,00
8,
fl,
Allarney Feel - BRINSER, WAGNER & ZIMMERMAN
5,000,00
3, Family EKemptlon
Clalmanl __ Relallanlhlp _
Addrell af Clalmanl al decodenl" dealh
Slreet Addrell _______________
City ___.___State _____ Zip Code
4. Probate FeeN - REGISTER OF WILLS , . 231.00
" ADDITIO AL COST OF LETTERS - REGISTER OF WILLS 70.00
C, MI.cellaneoul bpelllO"
1. CUMBERLAND LAW JOURNAL - LEGAL AD ' 60.00
2, THE SENTI NEL ~ LEGAL AD 70.86
3. REGISTER OF WILLS · SHORT CERTIFICATES 12.00
4, L.V.N,B. - SIGNATURE GUARANTEES 5.00
8,
6,
7,
0,
TOTAL lAlla enter on line 9, Rocapltulatlon) $ 15.735.86
(II mart Ipac. I, n..d.d, InlOrl addlllonal ,h..l, of .am. .In,)
m1.
.!ll.
1:.. ~E.WELL VONCKX
I, J. NEWELL VONCKX, a/k/a JOHN N. VONCK~, current Iy of Upper Allen
Township, Cumberland COlJn~y, Pennsylvania, declare this to be my last
Will and hereby revoke any and all prior Wills and Codicils made by me.
I. I direct that all my just debts and funeral eXPanses be paid
from the assets of my estate as soon as practicable after my demise.
II. I ~Irect that all estate and Inheritance taxes that may be ,
assessed In consequence of my death, shall bll paid out of the principal
of my genera I estate to the same effect as I f sa Id taxes were expenses
of administration and all property Includable In my taxable estate
whether or not passing under this Will shall be free and Clear thereof.
III. I wish to donate my body, unrestricted, to the Humanity Gifts
Center of the Pennsylvania Medical Society, 20 Erford Road, l.ernoyne,
Pennsylvania 17043. The raclplent Institution Is the Hershey M\ldlcal
Center, Training Division, and It shall assume all expenses. The
Medica I Center prefers that the body not be emba I med.
IV. All the rest of my property, of whatever nature and wherever
situate, I devise and bequeath as follows:
A. Forty percent (40%) unto my daughter, Sylvia M.
Eisenman, 809 Palo Alto Drive, Arcadia, CA 91006';
a. Forty percent (40%) unto my daughter, Dr. Carol M.
Kaske, 121 North ~uarry Street, Ithaca, NY 14850;
C . Twenty per C II n t (2 0 % ) un to Me s s I ah V I I I age,
Mechanlcsburg, PA 17055, to be. used as It sees best.
D. I n the event that either or both of my daughters.
predecease me, then said daughter(s) share(s) shall be,glven
In equa I amounts to Arner I can al b Ie Socl ety, 1865 Broadway,
NY 10023; and Worlq Vision, Inc., Pasadena, CA 91.131.
VI. I appOint the Administrator ofMasslahVlllage, or his
.~~ ",,",or of "I. my '"I'f h ~..v/.f V~
~IV'''''' r 11"11 .
OOM~9~i'I,~wn o~ p~t\l1~~~ANIA
RunlAU Cl!JUbl :r~~\t TAllie
ttAAA"Bolia,' ~'1!IIII'OIO'
DIOID8NT
INPORMATION
OORPORATION,
PINANOIA~
IN8TITUTION
OR
BROK8R
INPORMATION
AOOOUNT
INFORMATION
AnACIllNVINTOAV
0' IICUAITY
ACCOuNT LIIT'NO ALL
Allnl ANa DATI 0'
OeATIl VALU"
"'j 'I 'I y' ( .' ,.
','-, ~
RBQUSST FaA WAIVSR
OR
NOTIOD OF TRANSI'DR
SIlCU~rr~AA~1~~~~s'Wr~~I:~~~:~~11~vR POAM)
IP YOU ARB ABQUe8TING A WAIVBR
PLIlA8B OHIlCK THI811LOCK 0
VONCKX JOHN
rOO'(L SECURITf NUII1J OP PE~~eNT;
3 m[~} 1 8.[!J 2 [!]12J
ADDRESS OF DEOEDENT:
MESSIAH VILLAGE, P.O. BOX 2015
I
ZURICH KEMPER SERVICE COMPANY
~-----------_._-~~-_.
ADDRESS OF FIRM CITY STATe ZIP CODE
P.O. BOX 419567 KANSAS CITY MO 64141-6557
-.---.--
T,JilliPJ:!Q!;IllIY,MB,!ID., _ -fXTeNSION IIF ANY I
Lill LQJ LQJ'W II] m. [J 1 [I] [JJ m '.D
TY~~ ~~ A:Tc~.UN;iJND " CAPITl:jTOC~~.EGISTLr BONO A ~eclJLI:sET _~ECUUACCOUNT_
AOCOUNT BALANCE (INCLUDe ACCRUED INTEREST UNTIL DATE OF DEATH) IDENTIFYING NUMoEn OF ASAET
$11,236.36 [9J m II] Ii) L[J III [[]I]J []]
ACCOUNT TITLE AS IT APPEARS ON STOCK, BOND, SECUnlTY I seCUnlTY ACCOUIH--'o.nIGINAL PURCHASE DATE OF ASSET '
JOHN N. VONCKX lu!NiQl fQ]W)D 0 0 0
NEWELL
DATa F PaATH Or:.QECl!P.!lNT:J~~UlD'V.V.YYI
[JJ [9} [1] L1}[J..l [iJ IiI [LI
OITY ,-- ----oyATr:-..'--.zil' COlJl:"-----c6u~ify-.'- ,.
MECHANICSBURG PA 17055 CUMBERLAND
a II. '1'
SENEFIOIARY NAME (lOll)
INFORMATION
(FI1SI)
(Mlrldlo Inlllol)
OFFICIAL US8 ONL Y
N/A
---~-'._'_'______M_______R
AODnESS P8ROENT TAXAB~e
CITY STAff:'.------~-ili'CODF.-.-- - TAX RATB-'
RElATIONSlilP TO DECaOENT ------- BENEFICIARY'S SOOIAL SEOUnlTY NUMfJEn
ODD.O[}[]ODD
B8NEPI0IARy NAME (lasl)
INFORMATION
(PI,sl)
IMld(lIo Inilloll
OFFICIAL US8 ONL Y
'ADDRESS
PEROENT TAXABLE
CITY
'-----'--.STAff-'-------rlp'coi:i'jf----' . TAX RAT8
RELATIONSHIP TO DEOeDeNT
IlENr:PICIARY'S SOOIAL'SiiCURITY NUMBER
00 o.[] [}[l [J 0 [J
BENEFIOIARY NAME (LOll)
INFORMATION
(FI,BI)
IMI1Ic1lo InillAI)
OFFICIAL US8 ONLY
ADDRESS
__4..._._.__.__.__---'-____~_.______.__...._~._._~_........__
PEROENT TAXAB~B
CifY-
STAi'E
---'zii'CQi5ij--
TAX RATIl
RELATIONSHIP TO DE6iii'iiiNT-.----...
(717)838-6348
DAYTIME i'irCt'f'HONa NUMllij'/l'
In.truollnn. 'or IIlIng llill notlc. or. on th. r.verlO Ilcle,
HAKIOHICK PAVA.~I AND RIHIT PAVMINT TOI
REBISTER OF WI~~S
CUMBER~AND co COURT HOUSE
CAR~IS~E, PA 17013
OUT A~oNm THIB ~INI .. RI~AIN ~OWIR PORTION POR YOUR RIOORDB ~
""'W :lI'~"f.lj('.~~1I' .n~"':"')".N~W61.-r5 .WAlR"fflil'Di.Y~~.A'li~~A"f/limiil'...At1:6Q1WI.lllf~,.........- -.....
DlBALLOWA oi"o~ DIUUOTlONB AND AIIIIIHINT OP TA~~ ,
IITAn OP VONCKX 'J N PUI NO. 21 97.0892 AONlOl DATI 09-15-1998
TAX mURH \/AII I X I ACCBPTBD AI '%LBD I) CHAHB8D
IIIRV TlON CONOIR m TIRIT . I RI IRII
APPRAlllP VAL I OP RITQRN BAIID ONI ORIBINA~ RETURN
1. R..l B.t.t. Ilon-dul. A)
e. 8took. and lo~d. Iloh.dul. 8)
I. Clo..l~ H.ld Itook/P.rt~.r'hlp %~t'r..t Cloh.dul. CI
~. Hortg.g../Not"Rllio.lvabl. Iloh.dul. D)
I. C..h/8.~ D.po.lt./N1.o. P.~.o~.l Prop.rt~ Iloh.dul. B)
.. Jol~tl~ ~ned Prop'rt~ Iloh.dul. ,)
7. T~.~.f.r. Iloh.dul. 01
I. Tot.l A...t.
APPROVID DIDUOTloNI AND IXIHPTIONII
9. 'un.r.l BMP.~.../A~. Co.t./H1.o, BMP'~'" Iloh.dul. H) (9)
10. Dabta/Hortg.g. Ll.blllt1../Lh~. Iloh.dul. %1 (10) 2.977.71
11, Tot.l D.duot1o~. ' (11)
la, Hat U.lue of Tllii< Ratur~ I1BI
II, Ch.rlt.bl.(Gov.r",.~t.l I.qu..t.) Hoo-.l.ot.d 9111 TrU.t. Iloh.dul. J) C1II
l~. Hat U.lue Of 8at.tlli'lub~.ot'to T'M (14) 169,1\71.61\
NOTII If.. In ...., ..m.nt WI' 111Ugd pr.v1oU81Y, 1.1nee14 t 11 .nd/or 1ft, 17 gnd 18 1'113.1
r'Tllat figure. th.t 111alUdl tn_ tot.1 of AJ.J.. r_tur,n. .......d to d.t.,
A""'IMINT OP TAXI '
lB, Aaount of Llo, 14 .t Ipou..l r.t. (11)
16. A.ount of Line 14 taMllbh .t Ll~..lIC1... II I,.t. (16) "
17. A.ount of Line 14 t.M.bl. .tColl.t.r.l/Cl.,. I r.t. (17)
18. Prlholp.l 'T'M Du.
TAl< ORIDITII
PAVHIHT
OAT!
is ...2/,~ ' .'/
IURBAU OF %HD%UIDUAL TAXII
IHllEMIIAHCF. TAM DIYII10lt
DEPT, nom
ItAMRl8ll1flO, f1A 1111'-0101
OOMHONWIA~TH OF PINNIVbVANIA
DIPART"INT OP RIVIN I
HOT%CE OF %HHF.R%TAHCI TAX
APPRAIIBHBHT, ALLDWAHCB ,OR DI8ALLOWAHCE
DP DBDUCTIOHI AND AIIEII"BNT OP TAX
BENALD J BRINSER ESQ
22 N RAILROAD ST
PO BOX 323
PALMVRA PA 17078
DATI
IITATI OP
DATI OP DIATH
PI~I NUMIIIR
OOUNTV
AON
09,-18"1998
VONCKX
10-14-1997
21 97-0892
CUMBER~ANP
101
A.count :ft..Ht.d
(1)
, leI
III
(4)
ISI
(6)
171
.on
.00
.00
.00
230 I SS! .12
.00
100
lal
15,735,86
,.00 M ,OO~
169,4]1,61\ X ,06.
,00 M ,lIl.
t18)
RICUPT
HUH88R
DIICOUNT 1+1
IHT8R88T/PIH PAID 1-)
AHOUNT PAlO
TOTAL TAX ORIPIT
.A~ANOI OPTAl< 'bU.
INTIRIIT ANP P.N.
TOTA~ DUI
. IP PAID APTIM DATI %HDICATBD, 88B RBUBR81
FOR CALCULATIOH OP ADDITIONAL INT8RBIT.
,
j
.
UNW IX m UI.m
J
N
HOTBI Tco l~,ur' proP.r
or.dlt to ~our .oocount,
.ub'lt the Upp.r pDrtlo~
of thl. for. wlth~our
t.M P.~..~t,
2S0.SB3,12
"l.7'~A;7
2l,~ ,859 , BS
42,561'.91
,00
10 .168. SO
,00
10,168.50
10,168,50
,00,
.00
,00
I IF TOTAL DUB 18 LBII THAN .1, NO PAY"BNT II RBQUIRBD,
IP TOTAL OUI II REFLBCTBO AI A "CRBDIT" ICRI, YOU "AY II DUE
A RIFUNO, lIE RBUIR8R 8IOE OF THII FOR" FOR IN8TRUCTIONI.)
1'11,.
II
I,
'~il ;,IIJ 16 !"':I.'
GI",
OVllIi
1'(\
~.IIYATIOHI,E.I.I...f d..~nl. dvlng on., bof.,. Do.IOb., II, 1911 ,. II onv fulu" Inl.'..1 In Ih. ..1.1. I. I,on'f.'r.d
In po.....I.. or onj.v..n\ I. CI... I (..II.I.roll bon.f1.I.rl.. .f Ih. d...d.nl .lIor Ih. ..plroll.n.f onv ul.l. for
11f. or for v..rl; the C~nwt.lth h.r.b~ IMpr..,lv rl..ryo. thl rltht to IPprl... end ...... tren.flr Inh.rltlnG. tIM..
.1 tho I.Wful CI... I (..llolor.ll rol. .n OIlV .u.h fuluro Intorul. '
PURPOIf, Of
HOTlCEI
T. fulfill Ih. ro""lr_nto .f 1..II.n 11.0 .f Ih. Iooorll.n.. .nd 1.,.,. ro. A.I, A.I II .f 1"1. 171 P.I.
'..lIon 91001.
DoII.h lho I.p porll.n .f Ihl. H.II.. ond ......11 wllh v.u, p.v..nl I. Ih. H.,hlor .f Hlllo p,lnl.d on tho ro.or.. .Ide.
..HIIl. .ho.k or ....v .rde, p..llbh 101 RBOISTSR OP "1~L8, AOBHT
PAYItl!HT/
RI'UMD (CA)I A r.fund of I tlM arld!t, whloh w,. not rlque,tld on thl Tlk R.turn, "V b. rlqu,.t.d bv DOIPletlng en "Appl1altlon
f.r I.fund .f POM,vl.onl. Inhorllon.. OIld ..,.1. T.." IIIY'IIISI. Appll..llon. or. '.'11"'1. .1 Ih.Ofll..
.f Ih. 1.,1.1., .f Hili., on. .f Ih. IS I...hu. DI.lrl" Offl..., .r b. ..III~ Ih. .p..I.1 IO.hou'
en.NlrS", IIrvlo. nueben fur "ar,. ord.rlng! In PfM'Vlvanl. 1-600"16'.10", ouhld. P'MlVlvanh. end
wllhln 1...1 Horrloburl .rM 17111 717.109', TOO' (7171 711.UU lII..,ln~ Iop.lrod Onlvl.
OIJeCTIONII An>> Plrtv In Inttr..t not I,tl'fl.d with thl ftPprll....nt, 1110","01 or dl...lowlnG' of dtdUatlonl, or .......-nt
0' tlM Clnoludlnl dllDDunt or int.re.tl II ,howo Dn thll Hotlol .ult obJeot within .IMtw (60) ~IYI of rea.lpt of
Ihlo Hotl.. b.,
AlItIlH
IITRATlYE
CDRIlICTlOHI,
..wrStten prate.t to the PA DIPlrta.nt of Rlvlnul, Baird of App.al., D'Pt. '11b'l, Hlrrl.bur" PA 17Iea-IOII,
.....l.otlon to h.YI thl _.Ulr dltlr.IOId .t ,wit of thl .ooouot of thl p.rlon.l repr..tntltlvl, OR
....IPP.'I to thl Orphtn,t Court, ' , .. "
OR
IHTI~IT ,
Flatual .rrorl:dSlaOVlrld on thlt ',......ent Ihould b. Iddr...ad In writing ta, PA DIPlrt..nt of R.v~,
lur.,", of 11Id1.ldu.1 T...., ATTHI P..I h......n\ 10.1.. Unll, O.pl, 110601, 1I0rrlobu'R, PA 17UI.0601
_ 17171'117.6101. 1.0 pog. I .f tho b....I.1 "In.I,uoU.n. for Iooorllon.. TI. R.lurll fa, . I..ldenl
Dla.d~t" (RIlY-..Oll fDr III IMPlan,Uon,of IdtIlnhtraUvlh' oarr',atlbll _"ror.,
If OIlV t.. duo I. ..Id wllhln Iht.. lSI .ol.nd., ...Ih. .fl.r Ih. do'adonl'. de.lh. . fl.o p.,..nl IIH) dl...unl .f
tho 10. p.ld I. "low.d. '
Tho IIH t.. .....tv n.n.p.,II.lp.llan p..oll. I. .o..ulld .. Ih. 1.1.1 of Ih. I.. .nd Inl.,..1 .......d, ond nol
.old bofor. Jonu.,v II, 1996, tho 11..1 d.. 0"" Ih. .1Id .f Ih. to. _ulv porl.d. lhlo non.PII'U.lp.U..
~tnllt~ I. ."...ftbl. Intht.... .,nn.r and In t~. thl I'" tl.1 plrlod ,. vou would Ipp.e. thl tlM and Int.r..t
thol hi. b.on .......d .. Indl..I.d .n Ihl. n.II..,
Int'r..t I. .hlrlld bIIlnnlnl with flt.1 dov of dollnqu'no~, .r nino 191 Ofnlh. end ono (II d.V Iroo IhI d.le .f
d..th, to thl d,t. Df f;t1.nt,T'Mu which 'bea.., dtlinqulnt b.for. Janulrv 1, .1911 bl'" Intlrut It thl,..te of
01. (6HI p.,.on\ por ..... ..I.ul.l.d.l. d.llv r.l. .f,.DDDI6.. All I.... Whl.h b..... dellnquonl on end ,ft.r
JlftUlry 1,"" will' be.r Inter..t .t . rat. whioh will V'rv fral o.l.nd.r Vllr to a.llndtr Vllr wUh thlt rate
,","ounold bv thl PAc o.p.rtMnt of Rev.nu., The ttPPllotbl. Inter..t'rat" tor 19a2 throuth .991 Itll
OIICDtJHT I
PINAL TY,
UI.t Int.rut Rltl Dlllv tnt.r..t Plotor xur Intere.t Aete Dellv Inter..t reotor
1911 ID~ .OOOMI 1917 9~ .0001.7
1911 16H . DOOOsa 1911'1991 m .ODOSOI
19.. tH .ODOIOI 1991 9H .000107
19.1 ISH .00OSI6 I99S.I99. n .000191
1916 IDH .00017. 1991-1991 9H .000101
".lnt.,..st It a_lollllt.d I' fallowll
IHTRRBST . IALAHCB OP TA" UHPAID ~ HU""R OP DAYS DS~IHQUB"T " DAILY IHTSRBlT PACTOR
..AhV HoII,. 1..UId .fl., lho Ie. bo..... dollnquonl will r.fl..1 on lnl.,..1 o.louletl.. I. flfllOn 1llldov.
blW'ond thl dltl of ,iht ........"t, If PIW'Hf1t .. Itde 'fter thl lnter..t aowputlUan d.tl lhawn on thl
Hollo., oddltlan.1 Inl.,..t lU.t bo o.I.UI.lld.