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OOMMONweALTH OF PENNSYLVANIA' OElPARTMElNT OF HEALTH' YITAL RECORDS
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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FILE NUMBER
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COlJNI'ICO Y t4IJtl1ER
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(lfAii'iii'i'CAii1 [J SURviVING f,f'OlIS['f, NMlf (IMil_ flllST, ANn MIODlE l~jlrlAlj SOCIAL srCUJlrlv tUUWH
0'1129/1930
THIS RETURN MUSI De FILED IN OlIPLICA IE WITH THE.
REGISTER OF WILLS
MPI.T III lIel.h't:1 I.. 0 6 4 - B - 6 3 3 9
[~ '- Orlglf1MI Return [J 2, Supplomanlal Holum [J 3 Remainder Relurn(d~llOrdM!hpr\()(t(l12-1J-61)
[J 4,l.imited Estate [J 4a, Fuluro Interest Compromlso (lJdlSOldllath anar 11-12-82) [J 5, Fedcml E!llale Ts.. Retllm Rcqulred
o 6. Decedent Died Testate (AM,v,hwpyoIWlllj [J 7. Decedent Malntainod a living Trust (An,1r.h copy 01 'IUIII .. 8 Total Number of Stlf9 Oooo"3lt Boxes
[I 9 Litigalion Proceeds Recelvod 010. Spousal Poverty Credit (dilllloldQa!h~lW~n 12,.11.91 and 1.1,95) [J 11, Eleclion 10 tax undflr See 9113(A) (Atti\;~ S<;hOJ
THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL "AX INFORMATION SHOULD BE DIRECTED TO:
t~AME COMPLETr: MAILING ADORES,)
I\prbert. 1... M"..,i II 1800 Ilan.isburg Plk,'
~IRMNAMF IlfA{lpll<1aNel l\~t. 307 I Sup(lr 8 Mot-c']
Carlis'le, PI\ 17013
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1. Real E,lale (Schedule AI
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12)
(3)
14)
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161
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,. > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Under jlOnl!llies of pel jury, I dodme Ihitll havo examined Ihis return, including oc~ompanvin{l schooulflS and slalemflnls, llnd 10 Ihe OOSI 01 my knowledge nnd bollef.1I i, IIlJA. corr~lllnd comt"ilelo [)eclillallon of pref\iller o!her
than the oerso!lll.um!ti.Q.n~ based on alllnfOlllliltiQ!l of 'Hhich orooaror has IlOW koO'tlltodoll....--
X&IGNATlIRE OF PERSON. RESPONSIBLE FORF IlING RETURN AD. DRESS '" '(J"'''' II,Vr;i
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SI~NATlI,RE elF ,PR,~PARE~ OnfER THAN REPRESEN'TATIVE . ' ADDRESS I I . ,". , .' I' in i
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2 Slocl, and Bond' (Schedule 81
3 Closely Held Corporalion,Partnernhip or Sole.Propr.elomhlp
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4. Mortgages & Nole' Receivalile (Schedule D)
5. Ce,h, Bank Deposil' & Mi,cellaneou, Personal Property
ISchedule EI
6 Jointly Owned Property ISchedule FI
7. Inter. Vivos Transfers & Miscellaneous Non.Probate Property
(Schedule G or L) ,
6 TOIII GrOll Allell (Iolalllnes HI
16)
5 5, 6 8
9. Funeral E~pensfls & Administrative Costs (Schedule H)
10. Debts 01 Decedent, Mortgage Ualiililie" & liens ISchedule II
191
(10)
2 ,4
11 Tol.1 Deductlonollotal Lines 9 & 101
(111
(121
1131
12 Net V.lue el Eotete (Line 6 minus line 111
13, Charitable and Governmental Bequests/See 9113 T(\I$ls for which an election 10 lax has not been
madelSchedule JI
14, Net Value Subject to Tax ILinel2 minus Llno131
15. Amounlolllne141axable
at tho spousal lax rate , I
Sooloslructlons 00 reverse side for applicable percentago
16. Amount olline 141axablo
at6% rate
17. Amount ofline 14 la~able
al15%rale
1141
x ,0
(15)
X06
1161
117)
1161
-
x .15
16. Tax Due
19
DATE
ii-LL!rt ~
DATE ,
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Decedent's COITl.elet!.~~~re~s:.
SIRE[[ AIlIJ"IS'i 426 (Xy.JW()(XJ COLWt
CITY
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J liP 17013
Carl is\<'
Tax Payments and Credits:
1. T~x Due (Page I line (8)
2 Credlts/Paymenl'
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
Total Credits (A + 8 + C I (2)
3. InleresUPenalty If applicable
D.lnleresl
E. Penally
TotallnteresUPenalty (0 + E) (3)
4. If line 21s greater than line I + line 3, enler the difference. This Is Ihe OVERPAYMENT,
Check hox on Plgel Unel9 to requlet. refund (4)
5, II line 1 + line 31s greater than line 2, enter the dill.rence Till, is the TAX DUE, (5)
A, Enter the Interesl on the tax due, (5A)
8, Enter the lotal of line 5 + 5A. This Is the BALANCE DUE, (58)
_ Make Check Pal'able to, REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
I, Old decedent make a transfer and: Yes
a, rataln the use or Income of the property transferred; , ........"".. ...."."..""..". ......"" 0
b, retain the right to designate who shah use the property transferred pr Its Income; ". ..""".." 0
c, retain a reversionary Interest; or"",,,,, .."""....,..".. ..".""""..",.." ...,,,,,,,,,,,,,,,, ....""""",,,,, 0
d, receive the promise for life of either payments, benefits or care? """""""",....".."""...."..' 0
2, If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? If death occurred
after December 12, 1982, did decedent transfer property within one year of death without
receiving adequata consldaratlon? ",,""'" ....",,,.,,,,,,,,..' ,,,,,,,,,.,,,,,,,....,,,,,,,,,,,,,,..,,..,,,,.,,,,,,'''''' 0
3, Old decedent own an "In trust for" or payable upon death bank account or security
at his or her death?.,,,.. ,..'"""" ' ..,.."",.. , "..,,,,,,,,..,,,, ..,..",,,,0
4, Did decedent own an Individual retirement account, annuity, or other non-probate property?"" 0
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
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72 P,S, ~9116 (a) (1,1) (I) provided for the reduction of Ihe lax rate Imposod on the net value oflransfars to or for the use of the
aurvlvlng spouse from 6% fa 3% for dates of death on or after July 1, 1994 and before January 1, 1995,
72 P ,5, ~9116 (a) (1,1) (II) provided for the reduction of the rate Imposed on the net value oflransfers to or for the use of the surviving
spouse from 3% to 0% for dates of death on or after January 1, 1995, The stetute does not exempt a transfer to a surviving spouse
from tax, and the statutory requirements for disclosure of assets end filing e tax return are stili eppllcable even If the surviving spouse
Is the only beneficiary,
FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995. Please answer the following question by placing an "x" In the
appropriate space,
Did the decedent create a truat or similar arrangement which Is lolely for the surviving spouse's benefit for his or her entlr.
lifetime? Yea 0 No [XI
If you answered yes to the above question, the tex on the trust or similar errangement is postponed until the death of the second
spouse, al which time It will be fully taxable at the rate(s) applicable to the remainder beneficlery(les), Enter the value of the \lust on
Schedule J, Part II, In order to remove It from the calculation of the tax due In this estate You may wish to file Schedule 0 In order to
make the election evallable under Section 9113. If the election Is made, the trust or similar arrangement Is taxed In the estate of the
first decedent spouse, the portion of the trust or simller arrangement which benefits the surviving spouse Is taxed at the zero tax rate,
and the remainder Is taxed etthe rete(s) eppllcable to the remelnder beneficlary(les), If you choose to meke the election, you must
allach Schedule 0 to a timely-Wed tax return, along with Schedule(s) K end/or M In order to show the apportionment of the trust or
similar arrangement between the surviving spouse and the remainder beneficlary(les).
[-- - .AMOunt :~~itt~d .:J
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiEV:i!;.i-EiCA"ii-niF,'ri-iioficniF-i-NHEiiii'iiijcrTAX-jippii;iisEii€ii;-~--,Ul-ciwiiiicE-oR----------_.._---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
DOROTHY M FILE NO. 21 97-0957 ACN 101
TAX RETURN liAS. I I ACCEPTED AS fILED ( Xl CHANGED SEE
If an assess_ent was issued previously, lines 14, IS and/or 16, 17 and 18
reflect figures that include the total of Bib returns assessed to date.
ASSESSMENT OF TAX:
15. AMount of Lin. 14 at Spou..l rat. (lS)
16. A..ount of Un. 14 taxabl. at L In..l/Cbu A rat. (16)
17. A.aunt of Llna 14 te.abla at Collateral/Cia.. B rata (17)
18. PrlnolpoJ. Ta. D...
g;',}10 ~ IY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU Of INDIVIDUAL TAXES
UH!RITANCE TAX DIVISION
DEPT. za0601
HARRISBURO, PA 1712ft"0601
NOTICE Of INHERITANCE TAX
APPRAISEHENT, ALLOIIANCE OR OISALLOIIANCE
OF DEDUCTIONS AND ASSESSHENT Of TAX
HERBERT L MERRILL
APT 307 SUPER 8 MDTEL
1800 HARRISBURG PIKE
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-03-1~98
MERRILL
05-10-1997
21 97-0957
CUMBERLAND
101
ESTATE Of MERRILL
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. Raa1 E.tota ISohadulo A)
2. Stock. and Bonds CSchedule 8)
3. Clos.ly Held stoc~/P.rtn.r.hjp Iht.r.st CSchedulfll C)
4. "orio.g"/Not.. Reoeivable (Schedule DJ
S. C..h/Bank Deposits/HieD. Perlonal Property (Sohedule E)
6. Jointly OWned Property (Schedule F)
7. Transfer. (Schedule G)
8. Total A..et.
III
121
131
(41
151
16.'_
171
.0lL
.00
.00
.00
355.00_
1.563.07
_J!.!!.
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expen..s/Ad.. Costs/Hilc. Expens.s (Schedule H)
10. Dabt./Hortgoga Llabl11tl../Llon. (Sohodula II
11. Total Daduotlon.
12. Net Value of Tlx Return
13. Charitable/GovernMent.1 aequeets; Non~eleoted 9113 Trust.
14. Not V.lua of E.tato Subjaot to Ta.
191
1101
2,205,68
.00
Ill)
1121
1131
1141
ISohadula JI
NOTE I
.00 X .00=
.00 X .06=
.00 X .15=
1181
TAX CREDITS:
PAYHENT
DATE
RECEIPT
NUHBER
DISCOUNT I + )
INTEREST/PEN PAID (-I
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID 4FTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIDNAL INTEREST.
c>
'*
'.V-l'.' U "', (".m
DOROTHY
M
DATE 08-03-1998
ATTACHED NOTICE
NOTEt To in.ur. proper
oredi t to your ItOOowtt I
subllit the upper portion
of 'this fur.. with your
tax pey",ent.
1.918.07
'.,nJi ~A
287.61-
.00
287.61-
will
,00
.00
.00
.00
.00
,00
.00
.00
IF TOTAL DUE IS LESS THAN .1, NO PAYHENT IS REQUIRED.
If TOTAL DUE IS REflECTED AS A "CREDIT" (CRI, yOU HAY BE DUE
A REfUND. SEE REVERSE SIDE Of THIS FORH FOR INSTRUCTIONS. I
, Flou"
f'li'
,1\
'9(\
,HUG 10 T\? :M3
Ol~'n
nU\,(1b
1/\
RESERY4T1OHI
Eltate. of decadants dying on or b.for~ Deo..bar 12, 19ft2 -- If any future lnter..t In the ..tat. 1. trensferred
In poI..,llon or .njo~.'"t to Cia.. ! (collateral) benefiel.rl.. of the decedent after the 8kplratlon of InY ..tat. for
IUe or for year., the Co..onwllIalth hereby 8l<pressh raUI'lIeS the right to apprahe and ...... tran.hr Inherit.nce raMII
at tht lIIwful Class B (coUateral) rlllt. on anY luch future lnt.rut.
PtJRllOSE Of
MOlICEI
To fulfill the requll'..lInh of S~cUon 2140 of the Inheritance and Estate Tn)( Act, Act 21 of 1995. (72 P,S.
Section 9140),
PAYMENT,
Detach the top portlvn of thl$ Hotlce and sub.lt with your pay..nt to the Register of Wills printed on the revArt. oldl.
--Nake check or .oney order payable tOI REGISTER OF MILLS, AGENT
REFll'tD (CN)1
A refund of 8 taM oredlt, whlGh was not requ~5ted on the T~x Roturn, May be requested by oo.pletlng an ftApplloatlml
for R,fund of Pennsylvania Inheritanoe and Estate hxft (REY-UIlL Applications are a\lall.ble at tho Office
of the Register c..f WUh, any of the n Reyenue Dhtrict offjco~, or by calling the speclal 24"hour
an.wering ..rylce nlHlbers for for..s ordering 1 In Pennsylvania 1"aOO"3(,Z-20S0, outside Penn,Ylyanla and
within local Harrhburg area (711) 787"80lJIf, TDOII (717) 772-2252 Wearing Itl!pa.lred OnlY),
OBJECTIONS I Any party In interest not 5nt19ft.d with tho 8pprt~iso.ont, 8110w~nc. or disallowance of deductions, or fluess..nt
of tax (inoludlng dhoount or IntorDstl as .hown on this Notice MU.t object within sixty (60) daYII of receipt of
this Notice bYI
~-Nrltten protest to the PA DepartMent of Revenuo, Board of Appeals, Oept. 281021, Harrisburg, PA
ull'hotion to ha\le tll.. lIatter deter.lned at audit of tho account of tho personal repruentati\le,
-"appeal to the Orphan.' Court.
17128-1021,
OR
OR
ADIIIN
ISTRATlYE
CORRfCTIOHS:
Faotual atrots dllcov.ted on thh usess.80t IIhou1d be addressed In writing tOI PA Depart..nt of RIII/enue,
Bureau of Indi\lldual Taxes, ATTH: Post Assess..ont Rovlew Unit, Oept. 280601, HarrisbUrg, PA 17128~0601
Phone (717) 767-6S0!). See page S of the booklet "Instructions for Inherltance lax Return for a Resident
Decedent" (REV-lS01) for nn explanation of adMinistratively correctable urrors.
DISCOUNT I
H any tax due Is pedd within three (3) calendar Months aHar the d.cedent's death, 8 flv. porcent (5%) discount of
the tax paid is allo~8d.
PENALTY I
Tn. IS;: tax a.ne.ty nono.partlclplltlon penalty is co.putetl on the total of tho tftx and Int.rest .......d. and not
paid bill fora January 18, IlJ96, the firlt day aftftr the end of the tax allnesty period. This lIon'partlcIpatlon
penalty Is appealable in the sa.e ..anner and In the the 5a8e tiMe per iod 85 yau would appeal the tax find Inter.st
that hfl. heen a..es.ed as Indicated on this notic8.
INTEREST'
Int.rest 11 charged beginning with first day of delinquency, or nine (91 Months and one (I) daY fro. the dlllte of
death, to the date of pay.ent, Ta)(e5 whloh bemtlle dellnqUlmt before Januar!l 1, 1982 bear Jnterest .t th. tat. of
.Ix (6%) percent per flnoU' calculated flt fI daHy rate of .000164. All tIlXRS whioh heoa.e delinquent on and afhr
Jaoulry 1, 1982 will boar Interest at II rato which ...111 vary fro. calendar )/oar tCl Galondar year ..Ith that tate
announced by the PA Oepart.ent of Revenue. The apPlicablo interest rtltos for 11J82 through 1998 arel
~ lnt.refit Mat. OaJiY Interest factor :!!!!r Interest Rute Ilft\ly Inhtrlut fnctar
1982 lOX .000548 1987 9% .000241
19&3 \6% .00043~ 19t16~19C)1 11% .000301
19114 11% .000301 199? 9% .000241
19ftS 13% .000356 1993-1?94 7% .000192
19116 10% .000274 1995-1998 ,,% .000247
-~Int.r..t is eeleuhtted "' fol10wsI
INTEREST = BALANCE or TAX UNPAID X NUNBER or DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any HoUo' Inued Ifhr th4' tax beeNe. delinquent will reflect an Interest oa10u1,,1Ion to flftaen (1S) days
bayond the date of the IlIl1en..nt. 1f pay.ent 1s Mado aftol' tho Inter05t oo.putfttinn date 'hown on the
Notice, I!lddHlonul Interut .ust be calClulnted.
"
l'
,I
",
nQ
c; (1.\
~;
rT ~
.'tJ
~,J_i
,i~ ..-
,r
::0
. :n~
~ ~~- ~}
L -~,~
~ .':
L'
.:....
'0
''/ ,,-
,",
f<) ~: c'
b ....."
0:>
COMMONWIALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'.' 1U1I1:",'U O~. INDIVIDUAL TAKES
l_nAHCI: TAll DIVISION
U!PT ~ 2.1611
HAMI...." PA, 1712'-0'01
NOTICE OF INHERITANCE TAK
APPRAISE"ENT, ALLOWANCE OR OISALLOMANCE
OF OEDUCTIIINS AND A$IlESSltENT OF TAlC
I'
08-03-1998
MERRILL
05-10-199"
21 97-0957
CUMBERLAND
101
A_t R..uted
-
DAT~
ESTATIt OF
DATI. OF DIATH
FILE NUMBER
COUNTY
ACN
HERBERT L MERRILL
APT 307 SUPER 8 MOTEL
1800 HARRISBURG PIKE
CARLISLE PA 17013
Ill."" n '" e.....n
DOROTHY
M
J
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=iS'4'nx--iFjO-fo.j'.:97T"iiii'ffcE--cij:-YNHEiifi'iiN'cn"A'iC-XPPR'A-fsEiiiii:r,--iii."owiiticE-oli-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSES8MENT OF TAX
ESTATE OF MERRILL DOROTHV M FILE NO. 21 97-0957 ACN 101 DATI. 08-03-1998
TAK RETURN VAS, ( ) ACCEPTED AS FILED ( X) CHANllED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rael E.toto (Schadulo A)
Z. stock. and Bond. (_10 B)
3. Clo..ly Hold Stock/Portnorship Intoro.t (Schodulo C)
4. Kortgogo./Noto.. Roooivablo (Schodulo a)
s. Caah/Bank Depo.it./Hho. P..rsonal Pr-oper'ty (Schedule E)
6. Jointly 0_ Proporty (Schodulo F)
T. Tron.10r. ISctwodulo V)
8. Total A.oot.
APPROVED DEDUCTIONS AND EXEMPTIONS:
" FlM'taral I!xpens..IA,d.. Costs/Hisc. ,expense. (Schedule H')
10. Oobt./"ortgogo Liabiliti../Liono (Schodulo Il
11. Total Deduction.
lZ. Net Vol... of Tax Roturn
13. Ch.rltabl./Goy.~t.l Bequests; Non-eleoted 911~ Trust8
14. Net- Vol... 01- Eot.to Subjoot to To.
(1)
(Z)
13l
(4)
(5)
(6)
(7)
,DO
.00
,00
.00
355, 00
1.563,07
,00
(8)
NOTE 1 To insu,.. proper
cr.dit to ~our lCoountl
ouboit tho up,,"r port ion
of this 10'" with your
bx p.y....,t.
1.918,07
? .?n,;:; 6B,.
287,61-
.on
287.61-
If an a..e....nt w.. i.sued previou.ly, lines 14, 15 and/or 16, 17 and 18 will
reflect figur.s that include the total of ~ returns a.....ed to date.
ASSESSMENT OF TAX:
15. _t 01 Uno 14 ot Spou..l ""to 115 1
16. Aoount 01 Lino 14 t..ablo ot Lino.l/Clo.. A ""to (16)
IT. Aoount 01 Lino 14 t..ablo ot Collotorol/Clo.. B roto (IT)
18. Principol To. Duo
NOTE:
TAX CREDITS:
PAY"ENT
OATE
RECEIPT
NUHBER
OISCOUNT (+)
IHTEREST/PEH PAID (-)
. IF PAID AFTER DATE INDICATEO, SEE REVERSE
FOR CALCULATION OF AODITIOHAL INTERES'r.
191
(10)
2.205.68
,00
(l1l
llZ)
113)
(14)
,DO
,DO
.00
.00
,DO
.00
.00
,DO
( IF TOTAL OUE IS LESS THAN $1, HO PAYHEHT IS REqUIRED.
IF TOTAL OUE IS REFLECTED AS A "CREOIT" ICR), YOU "AY BE DUE
A REFUND. SEE REV~RSE SIDE OF THIS FOR" FOR INSTRUCTIONS.)
(Schodulo J)
,DO
.00
.00
K ' DO.
K .06.
K .15.
118)
A"OUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
~
w
o
w
u
w
o
._--~_.....-,--_.._-_..-'-_.-
,'-I.,.'," ,'I',;tll.'
REV-1500
INHERITANCE TAX. RETURN
RESIDENT DECEDENT
COIolMO.SYLV^NI^
Ilf.p~OFREV1lNUE
OIlPT,2IOlI01
H^ I 1
. ~&~.\lMT.'FIRli >_NJlJMlOOlEI,NfTW-l -~e6P,~!,~...,~.~,...."",~",. <,..,......"....
r~~;.t:~~:'7t";;:~'~;t::,..F-:~1
,! 2 1:,9. 7:\ 0 . 0 9 5 7
....,...' v~,,,,,,",,.,,., ,.,
. ,..-.....,"'..,.,,'
..-..._-~..... '1'--''''
Mer. r l.' I I D:~ 0 r ot L t1 Y M.
--~
SEcu.m'f NlJ,tlII:R oAltWF DE"TH OAT'!: U' IllRll\
l~~' ~ 24 _ 3410.':'~!;E 0'1.}: 9 9 '7 :0:' 'l;"~"ll 9 3 0
(If Al'P\.JC},8t.li) SURI/MNO SPOOst.'S N.AMl! (lAST. FIRST, AIK) lAoOlEirill.Ai.l SCOJ.I.. :;.EClJRnY ~~R~.OOs RelURN MUSl BE FtLED IN OOPUCATE wmt 1\41:.
Merr:iU Herber:t L. 0 6 4. I 8 .6 3 32.L REGISTER OF WILLS
-- --
Cia I. Onglnal R.wn' 0 1. Supel.",.nlal 'l.W," 0 1. R.malnde, Rewml...~_"",~\2.'''~
o 4. Limlled e.lal. [] 4.. Funl," Inla""t comprom"I'.~""'" 12.12.~ [J 5. Fod.,,1 E.1a1a Tax Reblm R.qulmd
[] O. Deced.nlOled Teslale\,,,,,,,,,."1 [] 7. Decedent Mainlalnod a Living Trus"""""'"ol '''"I - 6. TolAl NumlJe' 01 Safe DeiJO'rt Bo,es
[] 9. LItIg.lIon proceeds ReceNed [] 10. SpeJuseIPOVOrtyCre<!I\...."..-\2.l1." "",.1,", 0 11. E_n to laX untle' s.c. ~I'3(A)I_ScllOI
THIS SECTION MUST BE COMPLETEIl. AU..CORRESPONDENCE'AMD CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
fW,lE COMPLETE I.WLlNG ,lDOAESS
Herbert L. Mer:cill 1800 Harrisburg PIke
- --
FIRM_ I~""''''' hpt. 307/ super 8 Mot.el
_'__ Car Lisle, Ph 1701.3
2.119-7000
go "'j, 'fli:';
- "' ~ it'g
"j ~-
fT' lC1
'iI :JC ~".. ""'l
.:1 i4.Q.
~:; ==< nJ co
C.' N "9-
~ ,',ll')
,.. -v.
." . . .:; ~, ::..1
-0 <()
3 5 5 .0 ~ O~..; N ""m
I' Vf
, "ij ,~:: t-,,') !;l.
1. 5 6 3 ..0 ';ry'
.;.- ,-. '.D
,
-----~---_..__...--
(6) 1. , 9 1 8 . 0 7
2 " 4 5 5 . 6 8
1. Reel Eslal. (Schedule A)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
..
2. S\OCl<3 and Bonds (Selledule B)
3. Closely Hald CotfoOtellon,P.nn.r.lhip or Sole-ProprielOtshlp
z
o
~
::l
!::
~
u
W
It
4. Mortgogos & No,"" R0C8Nable (Selledule D)
5. Cash. Bank OeiJO'lls & MlsC9llanoous ~e"""" Property
(SclleduIeE)
6. Jointly ();jned Property (Schedule F)
7. Inlet.V.OS T"nsler.l & MlsoollanoouS Non-Probate Property
(Sclledule G or LI
6. Total G'OIl AII.ta (Iotal Lines 1.7)
9. Fune,,1 e,pen... & Admlnlslratlv. Costs (Schodule H)
10" Debts of Deced.nt Mortgag. LlabllilleS. & Lien. (Sd1edule II
"
(9)
(10)
,:
,.
2,455.68
(11)
(12)
(13)
11. Total Doductlon. (101a1 Unes 9 & 10)
-,537.61.
~
i=
~~
~~
o
12. Mot Valu. 01 Eltat. (Line 6 minus L1n. I')
13. Ch.ritable .nd Govemm.ntal BoqueslSlSec 9113 Trusts for which an election to tax nos not been
mad. (Schedule J)
14. Not Vllu. Subjoct \0 Tn (Line 12 minus une 13)
15. Amount olllne 14 tax.ble
at ll1O!peJusallaX "Ill ,. · .
8M inslJllctlo"" on ....... side 10' applicable peroentage
16. Amount of line 14 taxable . "
at6%rat8 " I
17. Amount of line 14 taxable .
a115% "te I
,
o
(14)
(15)
.
,.
x .0
X ,06
(16)
(1'1)
(16)
X .15
o
16. Tn Due
19,
>> BESURE-TO'ANSWERALL.QUESTlONS;ON,REVERseSIDE AND RECHECK MATH c:<
iJ""''''''....oII*1U~.I'''''...\ltl n........nod.,.,..,m, ir<iu<lI"l_II"ll<MdU,.....,_.. ...,,,.."''''I11'f__.......,.i1i'IlIJO. """"'...-. ~Ol_;--
tnll'IM MnOO1ll11lllrllllfl1ltl'l1 IS baled on 1II1lnfoo]P of wlIicll rvtllllW'I4' hM arw ItncMledoe
SIClN^TURe OF PERSON ReSPONSIBLE FOR FILING RETURN AODRESS SU_\:ll.J\ 'l; I'JIilfiI .
,\ .' 11~j.jCJ.!n"t)ur5 ~ ' ~ !?c.l Ccvll~li ~1
TATIVr. ADORESS I'),)! 1
)) ') ixd!-t>-rd 5-1, &1;/5U 1/I'kV3
D~I
2Lll.l.Cj ~
OATE d
5111~1